An interview with Dr. Leslie Saltzman

Dr. Leslie Saltzman is Ovia Health’s Chief Medical Officer in addition to her role as a practicing, board-certified physician specializing in internal medicine. Today, she sat down to talk with us a bit about her menopause experience, both from a personal perspective and as a provider. Dr. Saltzman is a member of the North American Menopause Society. She lives in New York City with her husband and daughters and sees patients in her hometown, Philadelphia.

Can you tell me a little bit about your menopause experience?

I experienced menopause as a result of a hysterectomy BSO, or having my uterus, tubes and ovaries removed. I was only 36 years old when I had the surgery. 

Going through menopause so early was really hard for me to deal with. In a way, I had to mourn the fact that my life didn’t turn out the way that I thought it would. There was a part of me that wanted to have more children, and I was really sad about that chapter of my life coming to an end. I felt that my decision about whether or not I would have more children was made for me. 

I also think I had internalized some of the messages that post-menopausal women have less value in our society. I was worried that I’d suddenly feel much older and that I wouldn’t be the same. I was also breastfeeding at the time and was concerned it might impact my milk supply.

Now looking back I feel very comfortable with my decision, but it’s important to acknowledge that there can be a real profound feeling of loss associated with menopause. 

Did you feel like going through menopause at an earlier age than most people do impacted the conversations you were able to have with your community?

Most definitely. It made me so much more comfortable talking about menopause and the experience of loss that we all have throughout our lives in different ways. 

Can you tell me a bit about the symptoms you experienced? Did you feel prepared going into menopause? 

Because I’m a doctor I knew a lot about menopause — particularly the symptoms and the treatments — and still I didn’t feel prepared. The hot flashes were really intense. Even in the winter, if just the smallest sliver of sun shone on my arm, I would break out into a hot flash. Or if I drank a hot beverage or had soup. I couldn’t eat anything that was hot. I couldn’t tolerate it. 

My resting heart rate was higher and that was terrible. It made me feel very anxious and jumpy  all the time. I remember telling my doctor this and being dismissed because my vital signs were in the normal range.

I had vaginal symptoms, and while I expected the vaginal dryness, I also noticed that my labia were thinner. When the tissues of the labia don’t feel as cushioned and comfortable, sex becomes uncomfortable (HRT helped with this).

I asked my doctor about hormone replacement and breastfeeding and no one had answers. They had never talked about this with their patients and they didn’t know. It was discouraging. 

Let’s talk about HRT – how did you weigh the pros and cons?

First, not everyone can go on HRT. It depends on your personal health and risk factors. It’s also different if you don’t have a uterus (like me) because we don’t need to take progesterone, so I just use an estrogen patch. Those with uteruses will need to take progesterone too. 

I was also under 45, and for this age range we know that estrogen helps to maintain bone density, protect against early progression of cardiovascular disease and dementia, and minimize symptoms.

I wonder if going through this process and doing HRT made you feel more connected to  your body and its signs and symptoms? 

Yes, one of the benefits of getting older is that you understand more about your body when it comes to noticing symptoms, sexual satisfaction, etc, but I also just love not having a menstrual period. I really don’t miss that. And for me, it’s a relief to not have to worry about getting unintentionally pregnant. There is liberation in that knowledge.

What do you wish more people knew about menopause?

I wish people understood how the symptoms can be so full body and I hope that people feel comfortable asking for treatment. 

But also, so much of what we internalize makes us think that really bad things are going to happen during menopause or somehow overnight everything is going to change. And that’s not necessarily true. I’ve been in the best shape I’ve ever been in my life — I’m running at the fastest that I’ve ever run in my mid forties!

As a doctor, what do you think is the biggest misconception about menopause?

A lot of people are still uncomfortable with hormone replacement treatment as a result of the WHI study and the warnings that were applied to HRT. It’s really important to look at more recent studies.

Anything else you’d like to share?

This impacts 50% of the population. We need to talk about menopause to normalize this part of life, starting early. 

I think about my daughter’s school — they approached puberty in a very inclusive way. All students received information about menstruation, not just the students who were going to be menstruating. And when she got her first menstrual period, my daughter felt totally comfortable sending her father to the pharmacy to buy sanitary products. This is so different from when I was her age. It gives me hope that people can become more comfortable talking about menopause transition and menopause and thinking about how we educate people to get rid of the shame and stigma.

We don’t have a class for middle aged people to understand what their peers are going through and maybe that’s what we need. We need to teach everyone about what menopause means, what it looks like, how it effects our community. It’s a community health issue. 

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