Dr. Noor Al-Humaidhi is a general practitioner from New Hampshire who discovered a massive gap in midlife women's healthcare.

After experiencing perimenopausal symptoms herself and realizing how little she understood about the connection between hormones and chronic disease, she started Lifestyles by Dr. Noor a multidisciplinary practice focused on prevention, metabolic health, and helping women stop suffering through menopause.

We discuss why stress management isn't just "woo woo" but creates measurable biological changes in blood sugar and cardiovascular health, how continuous glucose monitors reveal the real-time impact of stress on your body, and why women in the Middle East face unique barriers to hormone therapy access.

Dr. Noor shares her approach to building a practice with dietitians, mind-body therapists, and weightlifting programs because hormones alone aren't the answer it's about addressing sleep, muscle, nutrition, and stress together.

The conversation covers why sleep is so under treated in perimenopausal women, the cultural differences in how menopause is experienced across the world, and why there's such a high tolerance for women's suffering. Dr. Noor explains why she refuses to give up on helping women access care, even when hormone therapy isn't available in their countries.

Highlights:

• Why stress creates measurable biological changes in blood sugar and blood pressure.
• How continuous glucose monitors show real-time impact of stress on your health.
• The importance of CBTI (cognitive behavioral therapy for insomnia) over sleeping pills.
• Why weightlifting with proper form matters more than endless cardio.
• Cultural differences in menopause experience between the Middle East and the US.
• Why suffering through menopause isn't noble you deserve to feel better.

You're part of a growing community of women who refuse to accept suffering as inevitable. If you found value in this conversation, subscribe and help us spread the message that midlife women deserve comprehensive, compassionate care.

Get in Touch with Dr. Noor:

Website

Instagram

LinkedIn

Get in Touch with Me:

Website

Instagram

Youtube

Substack

Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago Boutique concierge gynecology practice Led by Dr. Sameena Rahman, specialist in sexual medicine & menopause Unrushed appointments in a beautiful, private setting Personalized care for women's health, hormones, and pelvic floor issues Multiple membership options available Ready for personalized women's healthcare? Visit our Chicago office today.

GSM Collective

Hey y'all, it's me Dr. Smeena Rahman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. I'm Dr. Smeena Rahman. You guys heard in my intro who my very special guest is today, someone I love and admire so much. Another person that I've met on social media and befriended. Dr. Noor Al Hamidi. Dr. Noor Al Hamidi, welcome to my podcast. Thanks so much for showing up today.

Even though you showed up. I was just doing another podcast with the person that you guys probably heard last week and ignored chimed in a little bit early just to see what the landscape was happening. Get ready. So it's the same link. And so she's like in the middle of our longevity. Oh, this is an interesting story.

Thank you for having me. So fun.

you

Yeah.

So we briefly had three people. That's so funny. So I'm good, I'm good. How are you?

It was like, I was like, come on, ignore, join the fun. Anyway, how are you? How's everything? Good, good. So, you know, I love everything that you do and post. And, you know, I think we met in person just a few weeks ago when you were in town for a conference, which was very fun. And but I've been following you for a while as well. So I always ask people, you know, how what's the, you know,

since I'm dying overall, like a good backstory. So like, what was your backstory in entering sort of the midlife menopause space? Like, you what brought you to it and how you evolved into your own practice?

Yeah, so.

Yeah, so I am a general practitioner trained. I'm from Kuwait in the Middle East. I went to medical school in Dublin and then I had every intention of matching to a residency and coming to the States. then, know, age old, I met my husband and my husband was living in London. So I kind of abandoned that track and moved to London. And I started my general practice training there and I actually did also did a medical degree in medical law.

So I did my degree in medical law and then I started my general practice training in the UK and I started my career there. I had my kids there and started my career in a nationalized health service, which is very different than what we practice here. And general practice in the UK is very different than family medicine here. General practice in the UK is the only thing in the community. You don't have gynecology in the community. You don't have pediatrics in the community. Everything goes through GP, general practice. And so...

Yeah.

Yeah

It was different when I moved in that my skill set needed to be a little bit different or I lost some of my skills. felt like I wasn't able to use all of my skills that I had when I was working in the UK. So I started my career there and I worked for a general practice and did a lot of locum work. My kids were really little. And then about, it's coming up on nine years, which is crazy. My husband got offered a job in Boston, well, in Cambridge, just outside of Boston. And we kind of like just...

on a women of prayer, we moved our family across the Atlantic to the States and we settled in New Hampshire because that's where my mom is from. So I have roots here and family here and it's, know, commutable to Boston. And I sort had to redo all my US medical licensing exams and kind of start again. So I was able to do that. And then after a lot of roundabouts, I was able to get a medical license and then get boarded in family medicine here.

Yeah. Yeah. Yeah. Yeah.

Okay, so you can do that. Okay, yeah, that's right.

That was a long drawn out process. And I restarted my family, I restarted with family medicine, which is general practice in a kind of routine primary care setting. And a couple of years ago, I started to have what I now know to be perimenopausal symptoms. And as I kind of tried to figure out what was wrong with me, it sent me down this whole education.

and I learned things and I joined every WhatsApp group that would have me and I flew around the world to book launches and you know, to anybody that would talk to me because I realized that I knew about midlife. I cared for people with diabetes. I cared for people with heart disease my entire career. I can do that like the back of my hand, osteoporosis, know, fractures, UTIs, but I had failed to really understand the link between all of those things in women especially, but also men and hormones.

you.

And I just like this whole, can't, you know, as I learned more, felt like my entire medical knowledge really came into focus in a way that I'd never experienced before. And I thought, I need to bring this to people. Like people, people can't access this care. And so again, on a bit of a way, men of prayer, I started a practice, you know, as a side hustle on the side from my routine general primary care job. And

Yeah.

Yeah.

Yeah.

Yeah.

I and here we are and it's two years tomorrow that I started this practice, which is crazy that it's, crazy. We've really been, I've really been on a journey. started on my own answering my phone, you know, doing the faxes and you know, we've grown to be a team and it's amazing.

yeah.

I love it. I love it. Yeah, because there's such a need I think that is not being fulfilled. I think it's there's more people, right? Like they said even at the menopause society there was 12,000 we have 12,000 when I started the menopause society 2015 or something. I think we had like 500 members now there's 12,000. So like, you know, and that's actually like double from last year. I want to say it was like only six thousand last year.

That's crazy.

Yeah.

So I mean, obviously the interest in midlife women's health is booming. Some really good because other, it's not anything most of us learn, partly because I would say like, especially when it comes to things like in sex medicine, we didn't learn really how to treat sexual pain. But of course I graduated like over 15 years ago when most of this data didn't even exist, right? So it's stuff that's been evolving. And so you just have to keep up with it. But I think the need is definitely there.

you

what, 6,000 women going through menopause a day or something like that in the United States. As astronaut. Yes. Yes. Yes.

Yeah, all of us, all of us are gonna go through menopause if we live long enough and we need to be served, you know, and we need to not just be served from a hormone perspective, but we need to be robustly served from a metabolic health perspective and cardiovascular risk perspective and our bones and our muscles. you know, we're just not taught, it's just not how we're taught to practice medicine, right? It's much more.

Right.

It's prevention, but it's prevention 2.0. think historically prevention has been very focused on getting your colonoscopy and your pap smear and the lifestyle aspect, which is important. But I don't think there was ever this real conversation about, menopause is a huge shift and we need to be aware of the shift and figure out how we're gonna manage it. Whether that's with hormones or not, we still need our eyes on it. We need to know what's happening because if you don't know, you can't make changes.

Yeah.

Right.

And so, you know, I know your practice is called Lifestyles by Dr. Noor, right? Or my noor. And so what I think is fascinating is how so much of what's called this lifestyle medicine is not really honed in on or even, you know, I mean, obviously, I'll quit smoking, I'll do this and that, that's, part of your lifestyle modifications. But I mean, there's so much more we can do and how we can guide patients and really looking at, you know, sleep as a vital sign, for instance.

Bye, Noor.

you know, some of these other things. Can you talk to us about how you address that in your practice?

Yeah. So when I started my practice, one of the things that I wanted to be able to do was to bring a multidisciplinary approach. So I have a dietitian on staff, I have a mind-body therapist, we're working on new space and I want to plan to bring on more providers that way because I think it's not hormones by nor, right? It's lifestyle by nor. And anytime I talk to patients, I'm like, you know, doing hormones or whatever we're going to do or if it's a GLP or whatever we choose to do, it's one part of

Yeah.

this one cog, right, in this whole machine that we need to address. And one of the things that I think is so under addressed is stress management. And it's stress management around sleep and stress management around blood pressure. But when I talk to about stress management with clients, they sort of like roll their eyes at me when I say that I wanted to see my meditation specialist, they're like, here we go. And then and they don't quite understand.

Yeah.

that stress can bring about biological change. And one of the greatest ways I think we can demonstrate that is with a continuous glucose monitor. And always, I put a continuous glucose monitor on somebody, which I love to do, and they'll go away for two weeks and they'll come back and they'll be like, well, you know, I'm looking at their spikes. You we had a spike there, okay, and then I had a spike there. I had a bad meeting at work and my blood sugar spiked. And I wanna be like,

one.

No. No.

Yeah.

Yes.

your blood sugar actually, there was a biological change because of your stress. And the more blood pressure, blood sugar spikes you get, the worst that is for outcome for your brain and for your eyes and for your kidney function. And once you start to really help people really draw that connection between their stress and actual why their blood sugar is not good or why they're, you know, they start to really see the impact of stress and how, you know, doing the meditation and doing the yoga and the breath work.

response.

is actually going to have measurable impact on their health, which some people just can't get their head around that early on.

coming up.

Yeah, it's so true actually. did.

a podcast summarizing some of what I had learned from watching some of the videos because I didn't get to attend the Metapos Society meeting this year. And one of them was on like just microvascular damage to women in heart health and how so much of that is driven by stress and that what used to be just anxiety actually has a measurable effect on your heart. The microvascular changes as well as how your autonomic nervous system impacts

Yes. Yeah.

flow into your heart right like it was so profound that she was talking about the you know stress myocardial ischemia test and all these things that they're at these really specialized microvascular centers that you know makes so much sense that women are more stressed out than men because we're like the primary caretakers doing all the things all the time so I think it's really

Mm-hmm.

Yes.

but then we're the primary caretaker doing all the things and then we lose the hormones that support us to do all the things. It's kind of like a perfect storm. Not only do we have to do all the things, but then what we needed to do all the things, we've lost. It's like a double whammy, you know?

Yes.

We've lost. We don't have that shield anymore that we used to have.

We don't have the resilience that our hormones gave us. You know, we were able to just about cope, you know, and that's why tell people come and see me all the time. They're like, well, I think I'm just stressed because, know, I'm an empty nester. You know, I'm thinking, well, you know, what about when you had babies and went to college and did all these things and were holding down a job? You did that. You were able to do that. You had the stress resilience to be able to do that. And now you can't and you can't because of your hormones, you know? Yeah.

Yeah. Yeah.

Yeah. Yeah, absolutely. Absolutely. Yeah. And it's so profound, actually, because it's everything's happening at once for most people, right? And some are getting divorced and some people are doing this or that, changing careers, you know, all the things. So what do you do? Like, how do you how do you talk to your patients about it? And how do you kind of manage some of that? You said that you have them see.

Yeah. Yeah.

So I think it's really useful. do a big, we do a DEXA scan here in the office and we do a big, you know, lab panel and then they get to, they see my dietitian for an initial visit and they see my mind body therapist life coach for initial visit. And that usually sets them up and you know, because they're speaking to the, like, you know, my dietitian will kind of unpack their diet and really kind of hone in on their diet.

And then my life coach, she's really good at kind of like getting to the nub of it. What is your stress? Where are your stress points? How can we address that? And then I partner with a local weightlifting gym who are able to then get my patients in for like an initial assessment for like a stability core assessment to see where they are. And then there are one-on-one weightlifting gym and they offer for my patients a nice kind of perk to be able to join there to do some one-on-one weightlifting because a lot of

you know, women that I see have never lifted a weight or they say they've weight lifted and they've like, I don't know, they can curl like five pounds. I'm like, that's not what I'm talking about. You know, I'm talking about heavy, heavy things, but they're afraid, you know, they've been told I'm going to bulk up or I'm going to hurt myself. And so, you know, even just, tell people, even just an intro, you know, even if you just got a trainer, had a trainer in that setting one-on-one, just for a couple of visits, it's worth it because it's going to teach you that you can do it. Number one.

Yeah. Yeah. Yeah.

Yeah.

And number two, it's gonna teach you how to do it safely and then you're gonna feel better about it. like weightlifting is something I harp on about all day and all night.

So, so important. Yeah, I think, mean, because you you can hurt yourself if you have never done it and then all of a sudden you're out there trying to do a deadlift, like your lumbar spine is not gonna talk right. I can attest to it because I did that after my second job. I was totally in the CrossFit and I had one bad, it's like one bad deadlift. That's all it takes. And so, you know, that, yeah.

Yeah.

Yeah. One movement, one twist that was wrong.

Don't you have like the midlife woman who was like, all I did was move the wrong direction. Like, it was just getting, like, yeah, where you get out of, you're like, barely got out of bed and that's.

I know. I mean, I've done that. I did that.

I have a terrible back, like I had a back injury, but then I'll tell you how I got it. My daughter was little, she was like a toddler, and we had gone to pick up my son at school. This was, still lived in the UK. And I helped, like she was still just toddling and I had her by the hand. And we were walking into the school and there was this other mom that had this new puppy, was a spaniel. And the puppy sort of like, I don't want to say lunged at Ava, like kind of moved towards Ava. And I just like in the moment, like thought,

Yeah.

Yeah.

you know, just so my reflex was to grab her. So I like sort of half grabbed her. She was tiny. She weighed like 20 pounds. And I hurt my back so badly. I was like in the ER, like they thought I had caught a quina. It was a disaster. And I've spent my entire life trying to mitigate that damage, but it was the stupidest little movement.

Yeah.

Yeah.

moment.

No, I agree and it's like anytime I get like

within a five pound, you know, if I've gained five pounds, that's it. I get that numbness and tingling down my legs. It's bad. You know, you have to really stabilize your core. But so interesting how, you know, you can never really, once you have a radiculopathy from your disc herniation, it's never going to be back to where, you know, like you can get under control, but one bad movement again, or a little bit of weight around the midsection again, that's And that's what happens.

Yeah. It's back.

Yeah. Yeah.

No. Yeah.

Yeah. And it's a great measure, I have to say. If I get super stressed, my back will hurt. If I, you know, if I'm not exercising, my back will hurt. So it's a great measure. It's like, your body's telling me something. You gotta like do the things, rein it in. Yeah.

Yep.

Yes, me too.

Yeah, it's time to go back to it. Yeah, it's true. Oh my god. So stress, we agree. Muscle, we agree. Diet, we agree. Where else are you looking at lifestyle modifications? I mean, right here. Big one. Right? I know. It's such an under...

Sleep, sleep, we talk about sleep all day and all night.

I mean, it's amazing though. I mean, I think I was one of them. sort of was like, I remember telling my mom, oh, well, it's because I have little kids and I'm listening for them. I can't sleep. Cause I just was not sleeping. I would sleep in like snippets, 45 minutes. And then I was up any noise I would wake up. And I thought this was just being a mom. I really did. I really thought, okay, I'm just a mom. And moms sleep like this because they're listening for their kids, even though my kids weren't that little.

Yeah.

So the number of women that are out there that just don't sleep, they're awake at three in the morning, unloading the dishwasher, doing laundry is, and back to what we just said, it's such a biological marker. If you don't sleep, your body is going to show it. It's gonna show in your blood sugar parameters. It's gonna show when your blood pressure, you start to develop microvascular change. We know that, and it's just so under...

Mm-hmm.

Yeah.

It's undertreated. mean, I don't say undertreated because the approach is generally to give people things like Ambien. they're, you know, I can't tell you the number of women that get to me and they're on Ativan and Clonopin and Ambien. you know, not that that's, you know, they were desperate and I get it, but, you know, none of that's doing them any good either. And nobody really like talked to them about it. One thing I would love to add into our, which is hopefully when we're into our new space is some CBTI.

Yeah.

Yes, absolutely. Yeah.

I want cognitive behavioral therapy for insomnia. I really want to have some sort of program that my patients can access because time and time again, it's been shown to be so effective at helping people sleep.

for sure.

Yeah, it's just so hard for people to buy, you know, because it's not a, it's not a quick fix. It's not a quick fix at all. So.

You have to work.

You have to work. so, you know, in our day and age when you can Amazon anything or, know, door dash to your door, it's really a hard sell for people. always like, well, this app has CBTI, this person's CBTI, and it's a real, real hard sell. They're just like, well, can you just give me? And I'm like, well, if the progesterone doesn't work, you know, because for some people it does. I would say if they're in my patients do really well with, you micronutrients, progesterone. Yeah, the CBTI is a hard sell for a lot of people.

Yeah, it is hard.

Yeah. Yeah. Yeah.

something. Yeah.

Yeah.

Yeah, it's a hard sell, but if people would do it, mean, and I think, you know, access is a thing. think if it's like right there in front of them, as opposed to having to go out and look for it, I think it makes a big difference. So, you know, if I have it in the office and it's there and it's in their town and, you know, it's somewhere that they're comfortable going, I think I'm more likely to get buy-in.

Good.

Yeah.

Dr. Sameena Rahman (18:04.707)

Yeah, yeah, yeah, that's true. Because also just, know, because some of the apps have it now, so ways that you can, but that's also, then you're back on your phone.

Mm-hmm. Mm-hmm. Yeah. And I've been using Insight Timer. So I went to Kuwait recently and get to give a talk. I, I don't know, my A, as I've gotten older, I cannot do jet lag. I'm just like terrible at jet lag. It's, I used to be able to fly all over, fly to Kuwait, two days, come back, just be totally fine. Well, those days are gone. And so I was struggling and I was texting with one of my best friends and she was like, download this app. It was Insight Timer. Have you heard of it?

So, that's all.

Yeah.

Uh-uh.

was really good. was sort of, it's all meditation, mindfulness, know, it's, know, CVT, I sleep. It was excellent. So you just like listen to, you know, there's different kinds of things. It's like meditations and mantras, and then there's like visualization techniques and all sorts of things. So insight time where there's a plug. It's really good.

Yeah.

Yeah, I mean, I think that, yeah, that's the hard part. then you're right, as we age, we just don't have the capacity to overcome some of that anymore. yeah, me too. Me too. I try along with them all the time and be like me and my. Yeah. And it's like now it's just like, I mean, now they're older, it's easier.

I And I used to fly with kids and, you know, little kids and like all over the place. All the time!

What if I had to do that again? I'm like, I couldn't do it. There's no way. It's crazy. Yeah.

I know. It's really old.

I mean, speaking of koi, I love talking about like how different women experience, you know, menopause, perimenopause based on their cultural understanding of it or, you know, what's accepted within their culture. You know, for some people, it's kind of like this rite of passage that you just kind of like have to endure. Other people, it's like, hey, you know what? I don't have to miss prayer or I can go on pilgrimage whenever I want and not worry about it because my men's use is gone. For some people, very liberating. For other people, it's the age of despair.

It's the phrase, right? I think they're trying to rebrand it though, my understanding. Yes, and then yes.

Yeah, so it's, yeah, they call it senelias, which is age of despair. And you know, I've been talking to a lot of women about this. So I've talked to a lot of women in Kuwait.

That's the phrase from menopause

Yes, and yes, yeah, which is the age of despair. Women have talked to me and I see a lot of women from Kuwait and they're very much of the mindset that hormone therapy causes breast cancer. They're still very much there and their mothers and their grandmothers would say the same thing. So there's a lot of myth busting there. But I would say there's a lot of deference to matriarchs in...

Yeah, for sure. Well, I think any culture outside of the US or the European culture, I find like there's so much deference to like you actually get.

in the Arab culture, you know, and they're very, you know, yeah, yeah.

hugely, you know, respectful and, you know, and I do think that, you know, many women in, you know, view it as, as actually liberating. Number one, you know, being able to, they don't have, they can, they can fast, they can, you know, go to Umrah or Hajj, they can, you know, they can pray, they don't have to do, stop doing any of those things because they have a period. And equally, they now kind of are seen as a little bit of a matriarch and somebody with wisdom. So I do think there's, there, there,

Yeah.

wisdom.

this sennelietse doesn't really fit with the actual lived experience, I think, of menopausal women in the Middle East. So I find it funny that they even call it that. And I often kind of wonder where that even came from. But equally, there isn't, no. But equally, there isn't, it's definitely like a grin and bear it. You gotta get through it. There's nothing we can offer you.

I agree. Yeah.

Right, right.

Yeah, not to limit going through it.

Yeah. Yeah.

And the problem in Kuwait is that, or in the Middle East in general, is that we have such a high risk of metabolic syndrome. Such a high risk. know, so many people have type 2 diabetes and cardiovascular disease. It's, it's women and men are at very high risk. And when you throw in menopause, we really have kind of like a ticking time bomb. Also, and I, and I don't know if this is the same where you're from, but we have a much higher risk of osteoporotic fracture as well.

Yeah. Yeah. Yeah.

and was doing kind of a deep dive on that as well. And the question around that, that's probably a genetic factor and there's probably nutritional factors and vitamin D deficiency. I think there's a lot of vitamin D deficiency, partly because of women cover up and generally don't go outside. Yeah, it's like sunny and 120 degrees, but nobody's outside in the 120 degrees. Yeah, yeah, yeah, yeah.

Yeah.

Nobody's getting exposed to it. Yeah, exactly. Everything's underground, whatever.

No, it's so true. I mean, I think similarly, you know, Pakistan is like number one in diabetes. South Asians, you know, have like the world's largest burden of heart disease. So I think, you know, it's a big issue. And so when I, that's why whenever I have a patient from those areas, I'm always like honing in on their cardiovascular risk. Cause I'm like, this is going to kill you way before your breast cancer, you know, like, so I think it is a lot of educating that you have to do a lot.

Mm-hmm.

you

Yeah.

Yeah, yeah, yeah. And there's this feeling that it's not natural. There's also that, which is conversations that we have here about, this is natural and this is normal. Not that it isn't, but there's a lot of, you have to converse around that as well.

So, yeah.

Yeah.

Yeah.

I mean, and I think some of the symptoms, sorry about the symptomatology is a little bit different. Maybe there's hot flashes, but there's more fatigue and joint pain, think, in some of the, versus other areas that have different stuff. But I think it might even be more of what you're asking the patient and whether or not they're telling you what you're, because I mean, if you give them a list, like these are all potential peri-menopausal symptoms, who knows what they'll check off. But this is just what they're coming forward with.

I would agree. Yeah.

This is what they're telling you.

People are not asking either right like the clinicians are not out there like let's get to the bottom

Yeah. And there's not a lot of conversation. know, women here will come into the office and be like, I have vaginal dryness. You need to fix this so I can have, you know, intercourse. Whereas there, they won't tell you unless you really like start to kind of dig, you know, I'm like, so are you having, you, you know, and then they will tell you. And that's just kind of a cultural thing around, you know, sex and, and yeah.

Right?

Yeah.

Yeah.

I'm going to start with

It's funny because I see so much of sexual dysfunction in my office, it becomes one of these things where people tell the front office that they're there for just pelvic pain or menstrual concerns when they have neither. It's obviously just what they have to, you know, and then once you get in there, they're like, oh, you know you treat this all the time, can you tell us? And then we get in the store and say, oh, you don't really have pelvic pains. You have GSM.

Yeah.

Yeah.

Yeah, yeah, you have GSM. A little bit of bad monstrodial is gonna sort you right out.

Yeah, exactly. It's so funny. And I think equally so is whether or not when they're partnered with their husband of who knows how many years, where it lies for them to feel obligatory to have sex with them or not. I think that's always.

Yeah, and I think that's definitely a thing. And, you know, in our culture, yeah, that's definitely a thing, that it's your duty. Yeah, yeah.

Yeah, I mean, I think as a whole women don't value pleasure like across the world, but definitely in those areas of the world. It's not one of the things that they're looking for. They're just like, let's get it done.

I know, so I posted a couple of weeks ago, I posted, so I have a lot of followers from the Middle East and Kuwait and I posted what's in my bag. I don't know if you saw it. Anyways, I had like, I happened to have a vibrator in a box, a new one, because one of my patients that had been in was gonna grab one and then didn't and I was gonna drop it out for her. So I happened to have like a box of, I had all sorts of things. I have a giant bag.

Yeah.

Yeah.

And I was like, everybody, whoever was filming was laughing. was like, and I have a vibrator in my bag. And you know, they were laughing. And then I got all these messages from people in Kuwait, like, why do you have a vibrator? Why would you have a vibrator in your bag? And I'm like, first of all, I was bringing it to somebody. And second of all, it's not a big deal to have a vibrator and you all should have one.

Yeah, yeah. Yeah, just have one in your bag. That's so funny. You never know. mean, there was that SNL stick in a box like buy a brand new bag. it's fine. my God. Yeah. That's so funny. Do you get any like different sort of

You never know when you're gonna need it.

I mean, I'm all for it, to be honest.

Questioning when you do your Q &A's from like is there or do find like across the board most women are kind asking the same questions?

So when I've done podcasts with people in the Middle East, it's more around the basics. It's very much, know, what is it, what's happening? Let's talk about HRT. Is it safe? There's a lot of that. We're still kind of working through a lot of myth busting on the topic. And there really isn't, you know, like for example, in Kuwait, there

like to ask me.

Yeah,

you know, on the formulary of the drugs that are available in the country. There's no HRT. None. None. So it was, it had been, and then after 2002, it was removed from the formulary. so you can't actually, even if you like somebody wanted to write you a prescription in Kuwait, you couldn't get it. So, you know, I've worked with, I work with a compounding pharmacy in Dubai that will work with me. There's one in Egypt that will work with me. And we're sort of trying to kind of like,

No?

I'm going it.

Yeah.

but find a way to get people access to care.

Yeah, it's true. I have some patients from Pakistan and Dubai and what they tend to do is because they have family here, I'll prescribe it to them and then their family picks it up and mails it to them, right?

Yeah.

And I do that in the UK. I have a couple of pharmacies that will work with me in the UK and I send them the prescription because people in the Middle East often travel to Europe and London and they will pick up like a year's supply while they're there. that's, yeah. But I mean, we find a way. We want to get access to care. have, I tried...

Yeah.

Yeah, yeah, yeah, that's. Well, I mean, of course, we're seeing the patients that are probably the richest of the rich over there, too, right? Like, it's like, you know, the average woman in those areas is not even not even part of their questions. Like, they're not even. It's it's such a privilege to be able to even offer that to them, because most women are just like living life, trying to survive or whatever, you So let's see.

Exactly.

It's not gonna. Yeah. Yeah.

Yeah. And I did, when I was there in Kuwait recently, I had, you know, a couple of women, like my age, maybe a little bit older that brought their moms. And, you know, so we're talking about women in their late seventies, eighties, and they came up to me after and said, Dr. Nour, I've been on HNT for 40 years. So they were traveling, you know, they would go to Switzerland or, wherever they would go.

Okay.

Yeah.

Yeah, they weren't them. Yeah.

France, you know, and see their doctors there and they've been on HRT and never stopped it. And they were like, don't tell anybody, but I've been on HRT all this time. But yeah, you're talking about, we're talking about people with financial privilege. Yeah.

Yeah, for sure. Because it's very interesting because, know, they're

We need to talk about how people are still stuck in the the W.H.I. era there, but we equally have that here. Although I think it's changing, right? It's changing a lot here. Just even saying that there's, you know, 12,000 people at the that are now menopause society members means that clinicians are trying to get forward. But yeah.

we are as well.

Yeah.

Yeah. Yeah.

learn. Yeah, but still, and I'm sure the same for you, is that when you post something, you know, sometimes it reaches new followers and inevitably get somebody being like, but doesn't HRT cause breast cancer? You know, so, you know, we're still, there's a lot, vast swathes of the population that have never heard this before.

Yeah. Yeah.

Yeah. Yeah. It's kind of this weird balance because, then you have people in the ivory towers who are like, well, you guys are saying that HRT cures everything, which is not what we're saying either, but we're trying to de-stigmatize a lot. But I think that's what ends up happening is, you know, they're trying, maybe they're saying the pendulum is starting to swing the other way, which I mean, I'm where I don't see it.

But I don't think so because so few women have access.

Yes, yes. And then even the study that came out Mayo yesterday, like 80 % of women don't even seek care for their menopausal. Yeah. And you know, who knows?

I don't even see.

Well, and a lot of women don't say that, don't even realize that their symptoms are menopausal symptoms. don't know, menopause is my personality. So people now stop me in the street out in like my, where we live. And, you know, and they'll be like, no, I sailed through menopause. And I often like, I'm pretty sure you didn't. I just think you didn't have pop flashes. And that's what you think is a symptom of menopause. know, once you get, even when people make it all the way in here and I start to talk about menopause, they start to realize, you mean my, you know, my joint pain?

Yeah, right.

Oh, you mean, you know, or they get treated and they come back and they're like, well, I've now realized that this and now, you know, I've got had burning mouse syndrome and tinnitus and it was gone and that was a menopausal symptom.

Yeah.

Yeah, totally, totally. And they don't even realize, or they're like, man, if I had known back then, I would have, you know, so there's a lot of like that lamenting kind of feeling. But yeah, that's so true.

and

Yeah, yeah. But my mom was one of those people who had been on HRT and stopped it in 2002. And she subsequently had, you know, broken every bone in her body practically. She was just, you know, shouldn't be that way.

Yeah.

Yeah, yeah, no, it's unfortunate. No, it shouldn't, unfortunately. We have the boomers who are kind of the unfortunate group there.

Yeah.

Well, I love everything that you're doing. have this segment that my husband kind of jokes that the people that listen to my podcast are probably vagilantes. So I do this thing called vagi... because you know, I'm kind of a girl vagin. So I do this thing called a vagilante verdict, which is your hot take, like whatever your hot take is on that you want people to remember. So what's your vagilante verdict?

Yeah.

My vigilante is that you deserve to feel better. There is no prize for suffering through. You're not gonna do yourself any service in somehow white-knuckling this. If you feel terrible and you're struggling, you deserve help.

get some help exactly. I agree 100%. What is the saying like menopause is inevitable? I think Dr. Malone said that.

you

Suffering is not. And it's so interesting, I always say, the first time I went to the Metapod Society, I don't know what year that was, Sue Dominus was there. That's 2002 maybe? 2001, I don't remember. 22. And she said out loud that quote that's in her article about there's a high cultural tolerance for the suffering of women. And I always say that, anytime I speak anywhere,

Oh yeah, yeah. uh, that Philly? 22. Yeah.

Yeah.

Anytime I, you know, I always say, you know, I always say that quote and people are like, they really kind of like, there's a sharp intake of breath. you, it's really like kids who write in the middle and people realize, you know, not just about menopause, but about birth, you know, oh, you know, I, you know, had no pain relief. Yeah. I had, and I want to be like, why, why are you suffering?

Yeah.

Yeah, that's so true. It is, it is. Yeah. When you say that, Yeah, I actually do that.

The lathes. Yeah. I didn't have enough girls. Yeah.

Why'd you do that? You're so dumb. Why'd you do that? I slept through labor. I was joking.

We think that somehow, you know, if we suffer, makes us more noble or we're better people and we're programmed and conditioned to believe that suffering somehow is good. And so we live with this inbuilt in us that we, you know, we deserve to suffer and suffering is somehow some, you know, a direct work, you know, probably something even cultural, right? And from a biblical perspective that, you know, suffering.

Right.

Yeah.

Yeah, and we need to kind of like rid our shelves of that shackle.

Yeah, which is exactly why, you know, there's this huge orgasm gap, right? We don't deserve pleasure either. So we can suffer, but we don't deserve pleasure. You know, at what other point would you like grin and bear something just to get to the end of it? You know, like if you got a bad meal, you'd probably say something to the person giving it to you if you're at a restaurant. You take it back, maybe, or you'd ask for like, you know, a better service. Most people, you know, like very few people, they're just going to, okay, I'll just eat this crap. You know, but no.

Yeah.

Yes.

Yeah, and you wouldn't need it. Yeah. Yeah. Yeah.

Yeah, yeah, it's No.

Not for, you know, not for the pleasurable things or whatever. so yes, agreed. Don't suffer. Absolutely. No point. Yeah.

Don't suffer. There's no point. And tell your friends. That's what I always tell people. Often at the end of my reels, like, and tell your friends, tell your friends.

Tell your friends, they don't have to suffer either. They deserve it. They deserve something better. All right, well, thank you so much, Nora, for being on our podcast today. This was fun. We will hopefully see you at some point. I think we're gonna see each other at some point in the next month or two. Right, ready?

Yeah.

Exactly.

I think I'm going to say aren't you going to be at Ishwish next week? I will see you there.

wonderful. Yes, I'll see you in a couple weeks. Yeah, awesome. So thanks everyone for listening. My name is Dr. Smeena Raman, Gyno Girl. Thanks for listening to Gyno Girl Presents Sex, Drugs, and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me next week and please like and subscribe to my channel. Thanks.