Dr. Sadia Malick has practiced medicine across four countries. She's delivered babies in the UK's best hospitals and in the mountains of Pakistan where women have nothing. She's founded a charity that's saved 8,000 mothers' lives. And she's spent her career caring for women who are told their suffering is just "the age of despair."

Dr. Malick has spent her life caring for women across the UK, Pakistan, UAE, and Saudi Arabia. She founded a charity that trains midwives on clean, sanitary practices and provides lifesaving interventions to pregnant women in rural Pakistan. We discuss why 50% of global maternal deaths happen in just four countries, and how evidence based measures can save lives.

We also talk about how menopause presents differently across cultures and populations, the cultural barriers women face when seeking care, and why conversations about hormones and aging remain deeply stigmatized in many regions.

While symptoms may vary, what's universal is how much work we still have to do whether it's PCOS and insulin resistance, young cancer survivors entering menopause without follow up care, or ensuring every woman understands why vaginal estrogen matters.

This conversation is about cultural humility, global health disparities, and why education about perimenopause needs to start in schools, not at age 40.

Highlights:

• Maternal mortality is concentrated in just four countries, but simple interventions like clean supplies and IV iron can save lives.
• Menopause symptoms present differently across populations South Asian women experience more joint pain and mood issues than hot flashes.
• Cultural expectations around fertility and aging create additional barriers for women seeking menopause care.
• Young cancer survivors are sent home at 23 in menopause with no follow-up care or education about long-term health risks.
• Vaginal estrogen reduces death risk by 70% and should be part of routine care for women over 40.
• The average age of suicide for women in the UK is 51, and 70% of divorces happen after menopause.

Get in Touch with Dr. Malick:

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Get in Touch with Me:

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Mentioned in this episode:

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So what time is it? You're in Riyadh, right?

Yes, actually, no. After we confirmed everything to you, my daughter is a teacher in Dubai. She's been working as a teacher in the British school for the last five years. So, of course, these girls, come up and my other daughter is a doctor in Manchester, but they're off. This is the December, January time. So they were off. So, of course, they planned something and involved me. And I was like, I have things to do. So anyway, I'm in Dubai now. I have a life.

life.

But now they are like my friends, you see, so it's lovely to kind of we go out like friends and everything. So now I'm in Dubai today and the first dinner that they planned I said no because you didn't ask me off you go and the house is really quiet. So I set them off and I'm here with you.

Yeah.

good.

very good.

wonderful. I'm so excited to talk to you. And I love everything that you're doing. So how old are your kids?

Okay.

Also my elder daughter just turned 30 and my younger one is 28.

wonderful. You must have started young.

No, I am old.

No, you're not. What was I going say? I love Dubai though. It's one of my favorite places to visit.

I lived here for almost 10 years. I was a chief of gynaecology in Cornish Hospital in Abu Dhabi for a very long time. And then COVID came and we are your frontline workers and I almost died. Really it was very, very difficult and we really worked hard and very proud of the work that we did. But then I got tired. I got really tired.

And I got this opportunity, know, proper burnout that we talk about. And I got this amazing opportunity to join Kingfessel Hospital in Riyadh. As you know, it's a wonderful hospital and lots of research to be done. So at my stage in life, I want to use all my experiences in, you know, publishing and talking about women's health and publishing about women's health and hormones.

Wonderful, Let's get started so that we can incorporate some of this into our podcast, but we'll just have a conversation, but I'll go ahead and get started. Hey, y'all, it's me, Dr. Smita Rahn, Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs, and Hormones, where we talk about the science, the silence, and the systems that shape women's health, especially when the systems fail us. Today's episode is truly a global conversation. We're talking about perimenopause, menopause, PCOS,

you

primary or very insufficiency, whatever else we can get to, but through an internationally and a cultural lens and really to ensure that those of us listening can really integrate cultural humility in not only taking care of patients, but seeking the help if you're a patient looking for someone. I'm very honored to be joined by Dr. Sadia Malik, who is a highly respected consultant obstetrician and gynecologist, a menopausal hormone specialist, and a global advocate for women's health.

She's a British trained OBGYN and a fellow of the Royal College of Obstetrics and Gynecology. And she brings over three decades of clinical experience caring for women across the UK, Pakistan, the UAE, and Saudi Arabia where she currently practices. Her work spans complex menopause care, PCOS, reproductive endocrinology, and women's health education, particularly in regions where the conversations about hormones, aging, and sexuality are still stigmatized and silenced.

What makes her voice so important is not only her clinical expertise, but her lived understanding of how culture, religion, family expectations, and healthcare access intersect with women's hormonal health. She spent her career caring for women who are often told their suffering is normal or inevitable and to simply endure it, which we know we don't want it to. This conversation is really about visibility, validation, and cultural humility. So thank you, Dr. Malik, for joining us all the way from the other side of the world.

Thank you so much. really honored and I really love these conversations. you know, as I keep mentioning that I am of a different generation and I was part of the doctors to start off with. They always tell my patients, don't use TikTok to give you information. You know, I will be very upset with my patient. I heard on TikTok, I would be so upset. But then, you know, if you can't...

Right on.

Well, it happens here all the time.

Yeah, then I said, okay, if you can't win them, join them. So that was my motivation of, to be honest, that was my motivation of increasing my internet presence in terms of I said, okay, if everybody is talking about it, I have a few degrees and vast experience to talk about it. I think I should be doing it. So very grudgingly, I have come to the fore of this new internet revolution.

That's right. To be out here.

Absolutely.

Let's.

Yeah!

I think it's great. And I love everything that you're doing. I met your, I came across your profile online and I was just so intrigued that I felt like I had to reach out. Plus, you know, we obviously have some similarities even though I'm in the US. My parents are from Pakistan and so, and you're also from Pakistan. And so I actually listened to one of, I think it was one of your podcasts in Urdu and I was trying to like stimulate my Urdu because of my Urdu is very bad.

Yes.

But my parents spoke to me mainly in Punjabi growing up. And so that's why I still see patients who...

I was so glad. Sorry, I was so glad for that conversation. see, this lady, she's born and brought up in Canada. I she's been in Canada for a long time, but she insists on calling herself the Urdu mom and she does podcasts in Urdu. And I'm very proud of my Urdu. You know, I used to win all competitions in poetry and things like that. So I was like, bring it on. Oh my God, I will use my medical concepts in Urdu. So I was very pleased about that. It went really well.

huh. It's so good.

Oh my God, you do a lot of what is it, society? The poetry?

Yes, I love Iqbal, I love, you know, our and of course, I know all the songs and my mom is very upset that as to why I know the lyrics of songs like Noor Jahan and things like that. So when were you listening to it? You were supposed to be studying to be a doctor. But I still know all the lyrics.

Oh my God, that's so funny. know, speaking of family and everything, you know, obviously I have my gyno, I'm a gyno girl on inner internet. And so I like a good backstory. So tell us your backstory. What brought you into this women's health arena specifically when we talk about OB-GYN, sexual health, menopause, all these, you know, taboo topics that are still pretty taboo, I think, in other countries.

Yes. So I always talk about starting from my mother. We are six sisters and growing up in Pakistan in a household of six sisters, you can imagine the amount of problems that girls have and everything psychological, physical, all of that. I was a second in the lot. And I saw my mum in dealing with all of us in her own best way possible. And most importantly, to really help

to educate us. And I remember in all the problems her standard line was, your job is to study, don't worry about the problems and about the stresses and the stigmas and abuse, I would use the word, you know, it can get very, very, you know, not nice these conversations, but that's what you face, psychological and physical abuse. so I, so, so

Yeah.

I know women looking at my mom and then looking at the stories of my sisters. grew up and supporting them and then my patients. So I always consider my patients as an autobiography. have to listen to them and because I really connect with their problems, I always believe that what a woman's story is, you have to know a story and then we talk about PCOS and menopause. If you don't know their story and how you connect with them and share with them. So I think I was kind of

tuned into doing this as a very young girl, grew up into it, and then I said, this is what I have to do. And for me, every woman is a mother and she is my mother. see that, especially in my obstetrics when I'm delivering a woman, I know that if my mom would have died delivering me, I would never have achieved what I have achieved. So.

So unfortunately, every every two minutes a woman dies giving birth to a baby still. And so that's it was such a motivation for me. I still I am I'm an advisor to four international charities. I have founded my own charity in Pakistan. And when we have time, we will talk about that. I and we have, you know, reached more than eight thousand women and and hopefully save their lives. But this is my main motivation for women's health is that.

no woman should die, no mother should die and every mother should have a lot of support when her children are now in university and her husband is behaving like a kid also. These women need a lot of support and if I can be one of them, I am here.

Yeah.

Yeah.

Yeah, absolutely.

wonderful. wait, tell us about your charity because I didn't know about this part.

Yes, so thank you very much. So as I said, I've seen the pain of mothers dying. Unfortunately, I practice in Pakistan and as a junior doctor, I moved to UK, but I never forgot the country that made me what I am. So even since a junior doctor for last 20 years, I have been returning to the mountains of Pakistan in the KPK province, taking my young girls to the most unknown places, do not mention to my husband. And we went there.

We went there to train midwives because I love midwives passionately and I believe midwives save lives especially in the areas where you only have midwives. Even if you tell me, Dr. Sadia, why don't you work there? I won't be working there. So we only have midwives. So I spent the last 20 years going to the mountains to train midwives.

Take me next time.

And then I've been a huge supporter of this all my life. I've advised a service organization, APPS, so many organizations, but finally I said, I've got to do it myself. So in 2022, I co-founded Sakina Health Foundation in Pakistan, and where we use evidence-informed measures to go to the unreachable mothers, because the statistics are just stacking up. imagine if you use...

if I give you 100 % maternal mortality in the world, 100%, divided into 50-50, and 50 % of this maternal mortality is burdened by only India, Nigeria, and Republic of Congo and Pakistan. So we have four countries shouldering the burden of 50 % of the deaths. And the reason, at least in Pakistan, is that the 70 % of these deaths do not happen in hospitals. They happen in

Wow.

Wow.

that happened.

homes and low resource settings. And you have to come up with an idea to reach this 70 % of the group in order to make a dent in these horrible statistics. So according to international guidelines, and I am an advisor to WHO, I'm a stakeholder in the prevention of postpartum hemorrhage for the World Health Organization. And I have developed these clean birthing kits, which include

Yeah.

6 items, 3 for the mother and 3 for the baby. For the mother we have a clean sheet which protects her from infection. Then we have myosoprostol tablets which you give to the mother after she has a baby so it contracts the uterus. And the third thing is clean surgical gloves. Because you know when you deliver in the mountains of Pakistan the midwife will come, she'll take a bag of onions, throw the onions out, rotate that bag on her hand.

and do a general examination with that. I think that causes infection definitely. Yeah, you just go up smacked at this, isn't it? So that's...

Wow, okay. I mean, it's so amazing that the resources are so limited.

Exactly. And this is a very common practice. And that's why when I talked to WHO, you know, meeting, I said to them that the problem is that you do not understand the meaning of nothing. You know, when we start from nothing, nothing means no toilet, no room, no running water, no heating, no clothes, nothing. No clothes for the baby. You know, the midwives have to remove a layer of their body to actually cover the baby.

All

Right.

Yeah, did not know that.

So the nothing is not understood by the world to then help the nothing. So that's three for the mother and for the baby, we have a surgical knife, we have cord clamps, clean surgical clamp and a chlorhexidine cream. Because if the midwife will not have it, shall I put you through the quiz because I do this mean thing of asking this question.

that if I, Samina, invite you to the mountains of Pakistan and then you're having a great time, both of us, and we get lost and now you are alone because I currently left you alone. And now somebody tells Dr. Samina, I'm really happy that you're in the mountain and this baby has delivered. So what are you going to do? How will you help that baby? So the baby has delivered. Now take me through what will happen next.

I mean, I guess you have clean the baby off, right? You have to wipe the baby off. Yeah, yeah. The placenta is already out probably, I'm sure. Yeah.

Okay, you've done it. Okay.

with the baby so now you have a baby and this center attached to it so what are you going to do

No, no, you have to collect the court. Obviously the babies outright you clamp the court already.

How are you going to get the God?

I guess you're right. You have to have the instruments. You have to have something to compress the bleeding and then cut. So there's no scissors? No scissors, yeah. Nothing, huh? There's not anything to compress it. Well, what about like a tie? Can you tie it off?

Yeah. No.

Nothing.

Okay, tie it then, tie it with something. What do you have?

I mean, I'll just take, I'll take a Nala and tie it. Right? Can you do that? No.

good yeah very good yeah yeah yeah so so to take a thread out of the Nala yeah great how clean is it isn't it that thread is so clean anyway you've got the tie great now cut it

Any title? I know, yeah, it might not be...

Yeah, I guess I don't know. Is there a knife available to cut it?

You are not allowed to use the knife because the mother-in-law, the knife is clean, park, and the baby is balit. So you cannot use this knife on the baby.

huh. huh.

so you can't use any knives? What about any scissors? Can you use any scissors? I guess I tried to rip it with my hands. Is there nothing to cut it with? Or is it an eraser? Eraser? Yeah. Yeah.

no you cannot because they are used for if they don't have scissors

Think something the man uses? Yeah? Yes. So where is the razor? So you lost the children or you lost the mother. What does your husband use as a razor? Where is it?

Try them.

Yeah, what did I tell you? In the bathroom,

Where is it? There is no bathroom. They don't have toilets. So where is it?

wow. Okay. Probably in his bedroom.

There's no bedroom. This is the room where they all live, eat, sleep. There's only one room. It's a shack. So he keeps it outside. Where does he shave? Where does he shave? Outside. Yeah. Where he has the animals. So he puts it on the top, the tree so the kids can't get to it. Right.

Okay.

Mmm.

Okay.

Probably outside then, huh? okay. so.

you

Yeah.

So then when you say, I have a razor, the kids will run, run, and they will say, we can help you. It's on the top of the tree. And what is at the bottom of the tree? The animals. So you got your razor. You asked for a razor. You got it. Now what have you given to the baby? Tetanus. You have just introduced Tetanus' baby. That is why Pakistan is now.

wow, so yeah.

Yeah.

But you probably can't, because you said there's no running water, right? So you can't clean the razor. Amazing. Wow.

There's no running water. So now Pakistan is in the top three countries in the world with the highest rates of newborn deaths behind only India, Nigeria, and then Pakistan. Top three countries in the world. Imagine how many countries there are in this world. Because of these practices, and see, Pakistan is a rural country, isn't it? And we are talking about the 70 % of the deaths over there.

Yeah.

Because of these practices we have now more than 90 centers in Pakistan. We are working in every single province. And I can tell you that we work with the midwives, we know their practices and this is the practice. They have not seen, this group of midwives has not seen a cord clamp. And our biggest challenge has been to teach them how to use a cord clamp.

I

Yeah, wow, okay.

It's amazing. You just never think about. Yeah, you just don't think about it.

So together with a clean birthing kit and a midwifery training because you need to train the midwives. You need to tell them to please stop using this practice because they didn't even know they just gave the baby tetanus until you treat them. the other third most important intervention that we are doing, which I'm so proud of, is that we are the only charity who is giving IV iron to pregnant women.

Yeah. Yeah.

Wow, okay.

because now we know the research that we got it wrong that the reason of postpartum hemorrhage is actually lack of iron. Your anemic uterus is not going to contract. So PPH is because of anemia and not because of lack of uterotonics. So if we have to give, if we have the, have the, her iron to be normal and not to be anemic, she'll, uterus will not, will contract, number one.

to smart.

Yeah, yeah.

Yeah, interesting.

Pakistan is in the top countries of the world with the biggest stunted growth. Stunted growth is due to lack of development of white matter in an anemic baby. When the mother is anemic, the baby does not receive iron and you need iron for the development of white matter. And this is the biggest cause of putting Pakistan's babies in the top of the world for stunted growth.

Wow, it's amazing the concept.

So we are the only organization who is giving IV iron to pregnant women and not tell them to take those cheap anemia tablets, iron tablets, which only give them tummy pain and they don't eat it. will not eat it. Have you tried eating a cheap tablet? Nobody will eat it. Exactly. She already has enough problems than you adding to her problem and she has nothing to eat. Remember that she has nothing to eat.

Yeah, they won't take it. Yeah, they're just, they're awful. And they constipate you and all the things, right?

Three, one.

Yeah.

You know when you tell them to it after you eat food? The first meal that she will have in her house, she is going to give it to her children and her husband. Whatever is left, she will eat it. And that's it. They eat only once. They don't have three times a day meal. So when is she going to eat those tablets?

Yeah.

Wow.

The poverty is really, huh? That's astounding. That's astounding, you know? That's, yeah, a hand-la-la that you're doing a lot. That's great.

So, so, Alhamdulillah, we are, yeah.

These are real women, real mothers. the babies, the deaths in the babies is much, much less than the deaths that they will see in Pakistan. So we are very proud of our work and inshallah you will see it published soon. I'm trying my best to publish it, inshallah. And we want people like you to help us to raise awareness. That's all we want you to do is to talk about.

Amazing.

That was amazing. Wow.

It's very good.

Well, you know, during Ramadan, should put a launch. You know, the launch good launch. What is it launch good for? Yeah. I'll put it on my website and stuff too when it comes out.

We are doing that and we are doing that and this time we have Thank you so much. We want you to be our ambassador So we are collecting our ambassadors and if you would kindly agree to it, we will add you to our whatsapp group So all these resources that you need to be an ambassador in terms of what I'm saying my videos explanations Whatever you have we just request you to forward it to your friends who trust you that you are forwarding something good

100.

Yes.

So if you can do that for us this Ramadan, we will be very good.

Done, done. Well, that's amazing, Sadi. I mean, really, it's just astounding that you're doing that. And I'm happy to help in any capacity because I think it's such a mean. Let's talk about some of your other work and really about our understanding of how, you know, I've obviously have been practicing in the US for over 20 years, but I've done a lot of international travel and talks abroad. But

Thank you so much.

Thank you so much. Thank you very much.

symptoms are minimized and normalized for women here. know, it says we're talking about perimenopause, menopause. Do you think women are delaying even more because of cultural expectations and family expectations in the regions that you practice? I mean, I would think that would just make sense in my head, but like when it comes to like, is it that women aren't coming to see me? You're a midlife woman. You're carrying the world on your shoulder. You know, you're trying to...

you know, take care of kids, maybe high school kids, maybe college kids, maybe parents that are elderly. You know, there's so much that a midlife woman has that we just endure the suffering. But I also think there's this element also in Pakistani culture and Muslim culture and in different cultures where the woman becomes like the matriarch of the family too, right? Like they have a lot of, which I think is wonderful in terms of the way that women age.

Yes.

Absolutely.

abroad in that respect because there's a lot more respect given to them. But don't you think the delay is there because of all these other cultural expectations?

my God, where to start with, you know, you are absolutely right. And it's more in Pakistan, more in UAE, Saudi Arabia, this matriarchal shift that you are talking about when it happens. The woman becomes the pillar of the household, the, you know, the all wisdom, all wise lady, and also the gatekeeper of the tradition.

you know she's all of this and everybody puts her in that high pedestal okay but she has I would swap that I said okay you are all these three things I would swap that with strong bones healthy heart and clear mind because these are the three things you don't have you know and 50 % of you are going to break a bone

I need a book. Yeah, absolutely.

and your whole family who reveres you so much is going to keep on carrying you in wheelchairs and in beds and give you three maids and helpers to take you to the toilet and bring you back because you've got a hip fracture and then you broke your other hip.

Yeah.

Yeah, yeah. Instead of you going out there and getting stronger and right. Yeah.

Exactly. So something has to change. This is what I tell them that and then the other thing that we have talked about especially in in Saudi Arabia or Middle East is that you know this word the vocabulary let's start from vocabulary, you know It is so bad that talking about these things is first of all we don't have vocabulary to talk about at least the West has found a huge list of vocabulary to define your symptoms

Yes, let's start with vocabulary.

Right?

While over here we are struggling to define menopause? Sinulias? Sinulias? You start from there? How do you give a diagnosis? Your FSH is 120 and you have got Sinulias? Age of despair, exactly. And then I will tell you something that so much so, you know, your worth has been linked to your fidelity.

Yeah.

Yeah, which is age of despair, right? Age of despair is okay. Yeah.

Yes.

for ages and ages and ages how fertile you are that says you're worth. So there is something which I call I love that word internalized ageism. So I'm trying to talk about I am trying to talk about oh come on we're going to give you HRT we're going to break a bone or make your bones and there is this severe sense of depression inside her and her heart has just sunk and she says she's

Mm-hmm. Yes.

49 and she says so I can't have a baby doctor So I'm talking about tender and

And you're like, yes, I can have a baby. This is amazing.

And this is so sad that you know literally that is what comes up. So you are sure I can't have a baby? And the sadness that overtakes her that now she's going to go home and tell her husband who's by the way planning another lot. So it is culturally acceptable now for him to marry again and have her babies from a younger wife for him to move on.

And to be honest, in their culture it is accepted and the men give lot of respect and everything to all their wives and she will always be the first wife. And in lot of cases they do love them as their children's mother and everything. But he has to move on because he feels that he has to have more children and everything. And yes, she's accepting of it as a cultural reason. But do think she's happy about it? I will never use the word happy about it.

No. Look, be happy about it.

So these are the additional things that I have to deal with in these cultures, which I understand and I always, the different thing that I do is I bring in the men to have a discussion. Number one, I always try my best to, which is very shocking for them as to why does doctora want me in the room? I no, no, I want you in the room.

You

Yeah. Yeah. Yeah.

And that's where I discovered the love that they have for them, which is a lovely thing to see also because, you know, once she told me, he may marry again. So I'm like, I want to meet them. Exactly. But they turn out to be such lovely men who just want, know, so you see that also very much, but it is, it is very important that we address exactly what is going on in our head. I can't give her babies. So I have to give that bad news.

Yeah. Yeah.

Let that new settle, which is like an accepted and given for many cultures. But over here, you know, it's it's very like much like that.

Yeah.

mean, many kids do you think average people are having in Saudi these days?

So that is decreasing. So I would have said 20, know, maybe 10 years ago. Yes, they have huge families, but I will give you my own experience for the last three years. Only in three years, 2023, I joined Riyadh, 23. 24, 25, and now 26, I will be completing my three years. I've been running Homo replacement therapy clinic since 10 years in the UAE and 20 years since UK.

Yeah.

Mm-hmm.

So in three years ago, I would say, I think you will benefit from hormone replacement therapy and the shock of it that you are giving me something that will give me cancer and you are confidently advising me to do that. So from that shift within a matter of, I would say, two and a half, three years has changed drastically. So now they are very open to discussions for hormone replacement therapy. And at the same time, to answer your question, the children per head, per women,

Yeah.

Good. Good.

It has also declined a lot because women are doing more work and they are deciding to not have as many children as before.

that's good. think, yeah, I feel like the shift obviously has been happening here for the last few years too, the association isn't as severe as it used to be from the WHO, which I'm glad to hear that it's kind of transferred over in your arenas as well.

Do you think when we talk about perimenopause and how it presents, are people chalking it up to it's just stress or it's just aging or like what kind of symptoms are differently presenting from you that we would see different?

Yes, so absolutely we have research to prove there's a very good paper also that they did about it. I talk about it in my my talks. The Asian woman does not present with hot flushes and night sweats and sleep disturbances. Asian woman top complications, top presentation in Asian woman is body aches, joint pains and mood and low mood. I promise you sadness. That's why they call it sinilias.

Right now.

I'm scared.

that it's just a feeling, a horrible feeling. I think in the West women have other things to do to cheer them up. So they may be having a bad night with hot flushes and night sweats and whatever, but their mates are there in the morning and they're going to go for a run or a walk or a jog or dance in the evening or something like that. I think that's my interpretation. But physiologically, women do not get as many hot flushes and night sweats.

as the western women get, but the joint pain, every single part of the body hurts, it's very more common, and there's a paper also about it.

is

Do you think, mean, so, cause like there's this general feeling of temperature dysregulation too. Like some people are just feel hotter than normal, but if your temperature, like, you know, climate wise too, it's like much warmer there. And so that, you know.

Yeah.

sometimes you would expect people to maybe feel even hotter than they usually do. I mean, I would say that here, of course, people come for vasomotor symptoms, but one of the biggest symptoms I think women are coming for now is mood disruption. Really, mood is huge, right? Or just not feeling like myself. I think that's like a big issue that we see as well. You know, most people associate, you know, menopause and perimenopause with vasomotor symptoms. But I think when we start telling them that their nuance at anxiety and depression and all of these

things are related to have more mobile flux, then it's not only empowering, but it makes them want to come, you know, get some therapy. So I do think, do you think that that has a factor at all as well?

Yes, definitely. I mean, they're in AC all the time. So everybody talks about hot countries and I will say, I talk about my jackets. I've never worn so many jackets in UAE and Saudi Arabia as I've worn them in UK. So they're always in a lot of AC all the time. I think that's one of the things that, you know, the ones that are truly a tribal, the nomads that are there, you know, but they are strong women.

Yeah.

Yeah, this is true.

they are blessed and nobody even reaches to them to say how you are feeling and unfortunately then that is expressed as psychological symptoms of anger, rage, crying, emotion and manipulation because you don't understand what is going on with you and nobody is explaining to you so you're going to take it out on your family, isn't it? So unfortunately the mother-in-law culture

Yes.

you

Yes, yeah.

As I said, every complaint about mother-in-laws that I get is just a crying out loud for having an HRT, an indication for HRT. That's what I look at.

Very good.

Yeah, that's totally true. And that's sort of the stigmas around, even having a mother-in-law live with you and all the things is that, she's going to be demanding and yell at you. you know, but I think you're totally right that they're just being undertreated. I always joke and say, you know, we have like this joke that like the Karens of the United States, it's what we call them. And so for the people that are always like trying to call the police on black people in the parks and stuff like that.

Yeah.

Yes

that we always joke like maybe they're just all sure they're underlying racist potentially, but maybe they're just all undertreated because most of them are midlife women, you know, but I think that that's probably the case a lot for so many of the mothers and mothers in laws in that society.

Absolutely, nobody is talking to them and you know the Asian women we now know that their menopause is much much earlier. So we are talking about 40-45 already your FSH is in the hundreds and estrogen zero and now you are 52 so you have 10 years of no estrogen by the time you reach 50-52. So where would your mood have gone by now?

early.

That's so true. That's so true. Yeah. Do you think how like between religion and family opinions and even like social media is big everywhere. Like how does that play into the fears around hormones or the fears around aging?

Unfortunately, religion is taken as, like if you're talking about libido or sex or anything like that, then you're a bad woman. I don't know where, and I think again, I'm on camera saying these things, I really think that mother-in-laws, when they don't have this at all, so then you hide behind being extremely religious.

Yes.

So this persona of being extremely religious would mean that we don't do these kinds of things. So anybody who does these kinds of things would be in that non-religious thing to be looked down upon. While basically the reason is that you don't have any estrogen to do those kinds of things. So now you hide behind that saying that anybody who has estrogen and wants to dress up and put some lipstick on.

Yes, yeah. Yeah, yeah.

Yeah. that's not true. Yeah, that's true, actually. I can see how that plays out. Do you think the partners are like the husbands? They seem to be more supportive now in terms of getting women treated and getting on board with some of these therapies?

is non-religious.

Yeah, but...

Yes, absolutely. I mean, this is the power of social media, you know, as I said, again, being a proponent of being upset about social media to totally turning to social media, the first big thank you. Yes, yes, we have to thank the Mary Claire Havers of this world, Dr. Wanda Wright of this world, Dr. Samina of this world. We have to thank you for bringing it to you. But in the end, we have to thank the social media. You know, this...

Wow.

Yeah.

how small our world became. I'm talking to you and you're in Saudi Arabia, you know, and I'm in Chicago.

Yes, FDA, Mr. FDA with all the misters in charge of FDA, for 20 years, they put a blind eye to it with all the evidence screaming in their face, but they were on the high pedestals until in 2025, it was not the evidence that changed them. And I'm coming on camera and saying that it was the hue and cry of millions and millions of women. The pressure was unbelievable.

that now they're turning Mr. Nice Guy and say thank you very much we've changed the rules no hello no

No, exactly, it is. I always say that too. mean, what was striking to me even was how the CDC came out with a statement about use of pain relievers for IUDs. Where in our training, we were just told, just shove it in there and there's no nerve endings, women can deal with it. But literally women were videoing themselves on TikTok, getting IUD insertions. And that virality is what caused that change.

Yeah.

Exactly. so that's why I just think we thank the social media and these things where it is good in the sense that that is a main movement that happened for us. And finally, know, FDA changed their mind about things and so many other good things are happening. And men now, sorry, your question was about the men. Absolutely. Now that the men are getting involved and they're listening that they don't have a mental wife.

Absolutely.

Yeah.

but she's actually got a diagnosis which is perimenopause or menopause and there's actually things that are supposed to be done about it and that's why this is also the shift is happening.

I love it. I love that.

And we see this across the board with hormonal shifts. We know also, we were gonna talk also a little bit about PCOS and how we know that South Asians tend to have more PCOS, like I think one in four, we have more heart disease, have Pakistan's number one in diabetes in the world. So we know we have this cardio metabolic dysfunction that we sort of inherit genetically. Tell me about how PCOS kind of,

Yes.

and the presentations that you see, know, Pakistan versus Middle East, you know, compared to what we might see here.

So after practicing for so many years in the UK, I came here in 2014 in Abu Dhabi first, and I was like, everyone had PCOS, everyone. And so I always questioned, again, as I said, we're all very much into our evidence and things like that. So I've always stuck to my escherie, sign symptoms investigation two out of three. This is what is my thing about PCOS.

Yeah.

So I would want to diagnose it according to the ASHRAE criteria. I would always say that to my patients. So in that, when I would do, I would say, yes, it was very high, but 50 % would not meet the criteria. And my diagnosis for them was obesity. That you are obese, you know? So let's tackle obesity. So we can talk about cause and effect and cause and effect.

Sure.

Right.

Yeah, yeah, Right.

But just prove me wrong because at the moment that your signs, symptoms and investigations are not coming up to be according to Eshri for me to diagnose you as PCOS. So let me manage your obesity. So that's one thing. Second thing, of course, out of the four types of PCOS, 70 % are insulin dependent, are the insulin resistant PCOS. And the diagnosis for that is to say my parents are Arab or Pakistanis.

Mm-hmm.

Then the diagnosis is made. I'm really sorry, but you've got these genes and you it appears you have got PCOS So that's your 70 % that you have been given with these insulin resistance your insulin resistance to your PCOS and then the very small amount then comes as as to the one which is adrenal PCOS is and your poster post-pill PCOS, which people don't tend to remember, you know, so that so the presentations in this group

Yeah.

If you're insulin resistant and you like your carbs, that's bad news, know, because you cannot, you can, I'm sorry, other people can have that cake and enjoy it also. You can't have your cake. You can't. And I can tell you so many stories, you know, because I, my best friends are all fertility doctors. Now, again, we follow guidelines. I'm a gynecologist of 30 years. I know, mashallah, lot.

Yes. Yeah.

of things about fertility, but I always raise my hand up to my patients and say, I'm not a fertility doctor. I'm not a, I don't have a piece of paper to say I'm a fertility specialist, you know, but my friends always when they have a difficult patient for fertility, they say go to Sadia. So in terms of fertility, I have without any medications, I have convinced women to just increase your muscle mass, stop your carbs.

Bye.

you

decrease your visceral fat, check your husband's sperms and got them pregnant.

Yeah, absolutely. Yeah, no, it's true. And I mean, I treat a lot of vaginismus in our community too, so I'm not sure if it's pelvic floor dysfunction and actually the physical act of not being able to have sex. Right. So I always joke, I'm not a fertility doctor, but because I'm a sex med doctor that I can get help women become pregnant by helping them cure their pelvic floor issues. Right. And I'm sure you see plenty of that as well.

Just, yeah.

Yeah. Vaginismus is very common in Saudi Arabia. Much, much more common than I saw in UAE. I don't know. I really am not the expert to tell you why, but I can definitely have my reasons behind it. It's just wrong ways of, you know, not talking, sexual education in a correct way and so many things. But when the time comes, oh my God.

These girls are really stressed out and the, and the, God, the pressure of the family trying to, for you to produce the baby at 30 days after marriage, you know, it's just like a very, very, very strong and doesn't have these, these people. But we really, yeah, vaginismus is very high here.

Yes.

Yeah.

I attended the World Sexual Medicine Conference when I was in Dubai and that was probably the biggest topic was how to overcome the vaginismus treatment, which there's not a lot of pelvic floor PT in the Middle East, which I think is one problem and I think the other issue is just the lack of education, the lack of talking about it and sort of like de-stigmatizing some other. But it does seem to be a significant issue. it comes back to the, when I was, forgot to ask you about the menopause stuff in terms of how much

urinary syndrome menopause you're seeing and and you know how many people are actually getting treated for it.

So that's the topic, you know, my friend runs a huge conference over here in Riyadh and she said, what do you want to talk about? Last year I talked about menopause and she said, and hormone replacement therapy particularly and risk and benefits. So I said, she said, I said, I'm only going to talk about general urinary syndrome and menopause. And she was like, you're gonna use half an hour to talk about GSM. I said, I need 24 hours to talk about GSM.

Yeah.

Absolutely.

It is so close to my heart and especially after bless them whoever these guys are the American Urology Association Like I am so embarrassed as yeah I'm embarrassed as a gynecologist that the Royal College the American College Nobody woke up to it and the urologist just ran and they made this guideline Which is the best guideline possible and it and they took the research of 11 million women 11 million women divided into half

Yes, the Bible.

Yeah.

Yes.

those who use vaginal estrogens will have a 70 % reduction in death people. mean, who would have said before 2025, I would have said everything except the fact that madam, this tube is going to decrease your risk of death by 70%. And blessed the neurologist that they have given me this even that our mamas, they go to urgent care emergency centers with a bit of a confusion. The AIME guy says,

Thank you.

Yes.

mama's got sepsis, I don't know from where and mama dies. know, how many deaths are because the vagina is supposed to be acidic, it is now alkaline, you don't have estrogen, every single bug is welcome, you have a small urethra, up, up and up, all the bugs go, live in your urinary system. Hello, you've got old burning urinary tract infection, it'll take 10 years but it will kill you.

Mm-hmm. Absolutely.

Yeah.

It's so true. And we used to always say that this was life, you know, this is a life saving measure, but it was, was so happy when the AUA came out with those guidelines. And in fact, really changing the nomenclature in 2014 from just Volvo vaginal. Are you okay?

Yep, I just bluh, I do.

Okay. And even changing the nomenclature in 2014 when we

we withdrew the term atrophy, robo vaginal atrophy. it was, they were initially, actually it was interesting because they were initially gonna just call it Degenerative Syndrome of menopause. And it was a urologist, Dr. Erwin Goldstein, who's like the godfather of female sexual medicine. He's one of my mentors. He's the one who was like, you know, we gotta put in urinary too because it's the urethra, it's the bladder, it's the cystitis, it's the infection risk. And so that was, I think, a big moment, you know, that changed really directly.

of women's health in so many ways, you know?

I am a big pro, you know, in my desk when you inshallah, I hope you come and see me in my clinic. so I've got the I've got the the famous thing with Dr. Always uses Dr. Nighat Arif. She always has got that uterus in her hand and I love her so much. She's an Asian Pakistani woman in United Kingdom. You know, I love her so much. So big. Yeah, big love to her all the time.

Yes, I would love to.

Yes, I know. absolutely. We've been in community. Yeah.

Yeah, she's got that uterus in the hand and I have the same uterus in my clinic. So I've got that and I've got the applicator, you know. So I sit there, believe me, with every perimenopausal woman. I started after 40. Any woman after 40, I educate them on this. I said, it's like your face, you know. Why do you put cream on your face? Nothing really happens, you know. You use so many creams and nothing really happens.

that's good. That's awesome.

Yeah.

Yes.

It's for mentions.

But you do keep using them, isn't it? Because if you will not use them, I keep on saying what will happen to you if you will not use them. That's exactly what is happening down there. and now we know there's no risk associated to it. And I can tell you like so many stories that how women have come back and said, you know, this was the best thing that has happened to me. So please, everyone, everyone after 40 start using it.

hundred percent.

Well, also want to speaking of 40, like I think that you've talked a lot about the primary ovarian insufficiency and some of the issues. Do you see it more commonly where you are in terms of like this premature menopause, primary ovarian insufficiency, which is less than age 40 where you have entered into the state?

Absolutely.

absolutely it's a topic which is very very close to my heart and I always say like 10 years ago if my junior would come and say to me this girl has irregular periods and I did an FSH for her and I would be thinking why were you doing FSH you know what were you thinking I said POI why should she have POI know it's one of the 10 years ago but now it's a must for me for every young girl as young as she would be I would just check her FSH

And so that was my practice. So when I came here, the first research project that I suggested to King Faisal was POI. And they said, we don't have POI. I said, OK. So I looked at the numbers in three centers, Jeddah, Riyadh, and Medina. And I looked at last 20 years. And I found more than 1,000 women who were less than 40 with the raised FSH.

And when I did the number crunching, I found out that because we are huge tertiary hospitals, 60 % of these were actually patients who were post chemotherapy. So we get these 18 year olds, 20 year olds, we give them chemotherapy, they're cancer free, but now they've got menopause at 23. And we discharge... Sorry.

What kind of cancers are they having at that age?

because we are referral centers so we get all kinds of cancers so majority of them were bone cancers, blood cancers and so and then transplant patients because when they have transplanted to give them suppression and they ended up being menopausal and then these patients were sent home to family medicine doctors. Do you think family medicine doctors are going to continue?

Well, I

And the 30%, only 30 % of these patients were started on HRT and they were told you can take this HRT but you will get cancer with it. Already she has come out of one kind of cancer and she's going to take this medicine. So this whole, and then I compared these results to the tertiary hospitals in Canada and in America. And guess what the evidence is telling us? That there is fragmented care even in the best hospitals in the world.

There is fragmented care for women who once they come out of. And I'm so happy to say that. Yeah, so this this was my first research and it got accepted in one of the best journals in the world. Q1 journal Menopause is an American journal. I'm sure you know about it. So it will be available online soon and I'll send you the link. It just got accepted.

wonderful. Awesome. I love it. Okay. That's great. Well, can't wait to see it. Yep.

Yeah, so that's yeah, it's not yet available online. So as soon as I will get it, I will send you the link. Very happy about it. Really pleased about it because I want to shout out about this and I got a good, you know, platform to shout out. But the next thing is now to talk about the POI quality of life questionnaires, because, know, the POI call questionnaire that you have across the board, it

I'll just wonder.

Yes.

Yes.

has got no information around cardiovascular health and bone health.

yes, agreed. Yeah.

This is not highlighted in these women. they only talk about babies. you can't have a baby? What are going to do about it? Okay, that is important, but you're going to...

I know. What about your risk of death from your heart disease that you're going to have? Exactly.

It's that you're going to die earlier according to the new entry guidelines. Unfortunately, you have a high risk of dying earlier due to cardiovascular death and bone disease. You know, have 4 % of my women in my research, 4 % already at osteoporosis. So we have to help these women. But the other question that you are saying that is this more? Absolutely. I tell you.

Thank

With my work in POI, I can confidently tell you that it is underreported. It is much more than the current prevalence that we are talking about. And the reason behind it is first of all, your endocrine-deceptive factors in your makeup. That's the first thing I always shout out about. Your vaping and smoking, which the girls taking out their stresses by actually vaping and smoking is killing you and killing your ovaries. They never connect this together.

a lot.

and the horrible, horrible advertisement of cold smoke? my god, how did they get away with it? I caused this cold smoke, only today I saw this. Sorry?

Yeah.

What do mean by cold smoke?

Yeah, they call it Icos, you know, these vaping things. It's cold. So cold doesn't harm.

Sameena Rahman (52:16.619)

Oh, is that right? Okay.

Yeah, every single teenager tries to teach me when I'm teaching her. They say, but it's cold smoke. said, so TikTok taught you it's cold smoke. It's okay to to vape until you don't have any lungs. Vaping associated lung injury valley is now a thing that you know that your lungs are totally destroyed by all kind of cold smokes. But what about your ovary, darling? You know,

to do it. Yeah.

Yeah, that's great. Yeah. Yes.

You have no eggs left. Do the AMH. I had a very important person, very, very high up figure in the, she's an actress in the Middle East. And she said to me, you can't tell me to stop, baby. I said, you're Mahzoon. They call it Mahzoon, AMH in Arabic. I said, you're Mahzoon. We'll finish. She said, I'll buy it.

my god, that's crazy.

I said where do I start now? Where do I start this conversation? How did you get to buy Maqsoon madam? know? Just speechless. But I made her sit down and cry and I did tell her everything.

How do you get to do that? I know.

my god, speechless.

or cry okay

didn't make her cry so that came out wrong but she ended up once she let me explain to her that yeah then she understood that then she was like literally crying she said nobody ever told me that nobody you know

Thank

Then she understood it. Yeah.

See, but then you the time and you need the patience to talk to people, which is something you have. Yeah.

to do that exactly so this is what is bringing on POI endocrine deceptive factors are bringing on POI your cheap fashion is bringing POI if you just google polyester okay this I've learned from my daughters you know they read about these things you go and you just the most expensive clothing if you go inside and see what is inside it says 100 % polyester and it's 200 pounds

just because it's from a fashion brand and it's a fashionable thing to wear. It is stating that clearly on that piece of clothes, it's 100 % polyester. So that means you're wearing a plastic, you know, and that absorbs from your skin and that affects your ovaries. So we have to send out this message for young girls that...

When we talk about perimenopause, people ask me, so Dr. Sadia, when do we talk about perimenopause? When does it start? 30, 35? I said, please push it to school. Push it to the schoolgirls. Let's talk about perimenopause to the schoolgirls. So we tell them that, darling, you are born with the finite number of eggs. OK? So now you're going out into this world, and you will have several life choices. And yes, you can say it's my life.

Yeah.

as long as you understand that some of the life choices will affect your health in the future. So already you are bringing the POI forward and forward in the same way you are going to bring the perimenopause at 40 or whatever because of these life choices and educating yourself about your health is what I'm saying.

That's good,

Yes, absolutely. Absolutely. Well, I love this conversation, Dr. Sadi, I want to be cognizant of your time. What else? I have this thing, my husband jokes at the people that listen to my podcast are vagilantes. So I have this end thing that I do at the end, vagilante verdict, which is your hot take. Like, what's your one piece of advice you would give to the listeners about any of what we're talking about so that they can take home something, what's your take home message?

Education, educate yourself please. Please educate yourself. Please don't let anybody else wait for you to have harm. As a menopausal woman, you are looking at one in eight risk of developing breast cancer. About one in four chance of developing heart disease. One in three in having a stroke and 50 % of you will break a bone. So together we need to...

do those choices in life where we change these figures. That's all that I'm trying to do. I don't like these statistics for myself. I don't like them for any menopausal woman. But we will not be able to change these figures on waking up at 40 and saying, my god, no. Exactly. So now when this movement has started, we want this conversation. So my take home message is to have this conversation with the teenage girls.

Yeah, what should I do now? Yeah.

Everybody should have this conversation with the teenage girls. So the education would start from the schools and by the time you're 40 is not that moment like many women sadly are now waking up.

No, it's so true. my house, I have two girls and a boy. My youngest is six and my oldest is 14, 15, sorry. But my little one is six. Whenever I get a little bit irritated, she's like, mama, is this scary Perry? Like scary Perry Menopaule. I'm like, yes, scary Perry is coming for you.

I like that, I'm going to use that definitely. But see now, what an amazing thing that these girls, this generation is going to go into this, know, that they don't want to be, yeah, so that's just great. But unfortunately, working in the mountains of Pakistan, where your problem is daily food, do you think those women don't go through menopause? Do you think they don't cry? Do you think they don't feel sad? And they have...

Yeah.

Yeah.

Yeah.

So I always say that pain is the language of There is no language of pain. Pain is the same across the border, across socioeconomic status. It is the same. A woman is the same across the whole world and across the social. So imagine when you are mourning about your problems. There is this woman who is going through the worst kind of menopause.

Yeah.

So true.

and she hasn't even got food on the table and we haven't even talked about mental health that that takes you to suicide and this strange deaths that happened in the night people don't record suicides from where I work you know women take down that in the United Kingdom the number one cause of death in the United Kingdom the average age of death is 51

Suicide sorry the average age of suicide for women is 51 in United Kingdom Does that not ring a bell? So women are left alone to sort their problems out So we should all join hands together to as I said make how armor placement therapy available All across the world, you know to whoever needs it as I said mental health is huge for me for me the number one reason of prescribing I Go over and beyond to the risks and benefits

Thanks.

Yes.

Discussion if I feel mental health is involved and I give hormone replacement therapy to improve mental health So which I think is the core in menopause and perimenopause Your divorce rates. Yeah, your suicide 70 % of divorces happen after menopause 70 % That's just not right so, you know, so that's huge for me

Yes.

Mm.

It is so taboo,

Yeah, this is down.

I'm glad you're doing that as well. I I think that's one of, like I said, one of the biggest things we see in the office is people don't feel like themselves. They're getting anxiety attacks. They're panicking. Their mental health is declining. So I agree.

and then the relationship. Relationship total breakdown with your own children. You know, I had this lady and she had three children and she came to me when she was 45 and I looked at her results for last 10 years. She was menopausal. She had premature awareness insufficiency since 32 and she met me at 45 and then I diagnosed her that you've been suffering from menopause for 15 years and I started on hormonal basis.

Yes.

She came back, she cried when she first met me, when she took the hormone replacement therapy. She came back and she was crying again and said, I'm crying now with happiness because she said that she had a divorce and her three children stopped talking to her because they said, you're not a mom anymore. But after the hormone replacement therapy, she got back with all her children. So she was so happy that she is, and they say, mama, you're back, you know.

That's great.

But she cried, said, Dowsadi, can't get my husband back.

Yeah, that's that.

You know, so there are so many stories that that we can actually change if we listen to the patients and the only question she asked me you met me for the first time and you talked about FSH why didn't for 15 years I am seeing doctor, you know, so yeah, so what we do is really very important. We save lives and we save marriages and we save, you know, children's mothers and that's what we

Right.

I know. know. We hear the same thing here.

Relationships, yeah. Well, this is great Dr. Sadi, I love everything you're doing. I look forward to collaborating with you again and I'm serious about this ambassadorship. I'd love to be involved.

Thank you so much. That's really from the bottom of my heart. Thank you so much for agreeing to that. We wouldn't bother you much. It will just be on a WhatsApp. So whenever you have the time just to forward it to people and maybe have some Aftar parties and things like that. So we've got lots of ideas and things.

I'm just, Shane, I'm just finishing. I'm just going to do another podcast. So great to meet you, Dr. Sadea. Okay. This is Dr. Shannon Chavez. She's my next, she's a sex therapist.

I'm good.

hello! Ooh!

Pleasure to meet you.

She's doctor from the UK and Saudi Arabia, actually. She's amazing, actually. She's done so much work internationally on menopause and sexual wellness for Pakistanis in the UK and Pakistan and Saudi and reality and everything. But anyway, so glad that I was able to do this with you, Sadia. I will be in touch with you after.

I have so many questions and things I would love to chat with you about as well.

you

for it.

Thank you very much. Once again, thank you very much for this opportunity. And I feel as if I found a new friend over the point. My whole family is in America, by the way. All my sisters are there, my brother, my whole family. I'm the only one who was in UK. We've got in both sides, New York, New Jersey, Florida, Washington.

Okay.

Where are we now?

nice. Well, let me know next time you're here. I'd love to meet you in person.

I will, July is a big family gathering together, we're going to Colorado, my sister just got a job there, so I will get in touch definitely. Take care, nice to see you Dr. Nath. Yes, thank you, same here, same here, bye bye.

Okay. Wonderful. Okay, wonderful. All right. Thank you. I'll be in touch with her. Okay. All right. Take care. Bye. Oh, can you make sure it loads 100 % of I'm going to hold on. I'm going to stop this recording and make

Nice to meet you. Take care.