40+ and Not Feeling Like Yourself? 7 New Rules for Women’s Health. Dr. Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center at Hackensack Meridian Health, explains how hormone changes in midlife affect your muscle, bones, sleep, and heart.
Jeffrey Snyder, Broadcast Retirement Network
Well, Dr. Chadha, it’s so great to see you. Thanks for popping by the program this morning.
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Thank you very much for having me here, Jeff.
Jeffrey Snyder, Broadcast Retirement Network
Well, look, we always enjoy having conversations with practitioners like yourself, and look, the world’s evolving and it’s always great to tap into the latest research. That being said, area that we’re going to talk about this morning is healthy aging, but in particular for women. Let me start off with a basic question.
I would assume that based on all the research you and your colleagues in the medical field are doing, what is defined as healthy aging and what is construed as the best actions for healthy aging have evolved over the past several decades?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Most definitely. I think we have a lot of new information regarding women’s health, and there’s been a lot of attention to midlife women’s health ever since the black box warning was removed in February of this year. So I think that’s brought a lot of attention as well as curiosity, but it’s also encouraged the healthcare community to want to learn, to want to help and advocate for our patients.
So I think there’s a lot of, there’s a huge learning curve for us as healthcare professionals, but there is a lot of options that are now available for females in their midlife that wasn’t present, for example, for my mother’s generation.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, and my mom’s, although, you know, my mom, I know, exercises every day. I think she’s adopted some of these things we’re going to talk about, and I bet your loved ones have as well. So let’s kind of get into that because it used to be, you know, when you think about retirement and aging, people thought about the rocking chair, having the grandkids on your knee and hugging them and kissing them or whatever, watching television.
But really, it seems that a more active lifestyle is really lends itself to healthier aging as we get hit midlife. Is that correct?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Agreed. I think one of the biggest risk factors that we can have and one that we have control over is to not have a sedentary lifestyle. I think there’s a lot of research evidence out there that says that even 30 minutes of strength training, any resistance training is helpful.
And the worst thing that we can do is have a sedentary lifestyle because that will not only contribute to high cardiovascular diseases, such as, you know, heart attacks, such as diabetes, such as metabolic syndrome, but it will also not help with our bone health.
Jeffrey Snyder, Broadcast Retirement Network
So let’s start with the exercise part. Then we’ll get into, I want to get into bone health in a second. Let’s talk about muscles because people think that if you lift weights, and in particular, I think this is like a misconception that you’re going to get big and bulky, but you do need muscles because muscles have a very important physiological function other than being able to lift heavy things.
Do they not?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Right. I mean, as we’re growing older, because there is a drop in estrogen, we’re also losing our muscle mass. And so we need to make an actual conscious effort to actually do resistance training at least two to three times a week, 30 minute sessions, even if it’s just lifting some amount of light weights, doing some resistance bands, all of those movements are very meaningful at this stage of our lives.
Jeffrey Snyder, Broadcast Retirement Network
And you brought up bone health. I know that one of the concerns, I think, is as we get older, there’s osteopenia and osteoporosis. If you fall, especially at an advanced age, that could lead to a very quick demise.
So how do you get that? First is bone density and bone health. Is that an important thing that people should be looking at?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
It should definitely, because I mean, right now, the screening for bone health as an ADEXA scan is approved for age 65 and more, but oftentimes by then it’s too late to do anything about it. And so we need to realize that the estrogen that we had, it protects our bones. And so as there is a drop in the estrogen, bone loss actually speeds up.
And so we need to make a conscious effort to do weight bearing exercises, resistance exercises, and getting enough calcium and vitamin D in our diet primarily. And if there’s any gap between what we’re consuming in terms of our food, then we need to supplement with vitamin D and calcium supplements. But we have to realize that even simple things like participating in maybe like a Tai Chi class, those things all contribute to having the most optimal bone health that we can put ourselves in.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, I think recently my mom participated in a Dolly Parton exercise class. I think everything was to like Dolly Parton hits. So I think what you’re talking about certainly is resonating.
We’ll get back to that in a second. You mentioned calcium and maybe eating better for better bone health, better muscle density. How does building your, what they call building your plate, how has nutrition evolved?
What should women, I was gonna say we, but I’m not a woman, what should women be thinking about as they start to age and how should they look at their food intake, maybe a little bit different or improving it?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
I think as we’re growing older and we’re in our forties and fifties, our body’s really not processing the cholesterol and the carbohydrates that we’re consuming in the way that it was in the prior few decades. And so we really need to prioritize the amount of protein we’re putting on our plate, the amount of fiber we’re getting from our vegetables and fruits and making an effort to maybe consume a little lesser carbohydrates, but not significantly. We don’t wanna be deficient in any other minerals and vitamins, but I think we need to recognize that we all are born with an X amount of genetic risk factors as well.
So if you know that you have family history of metabolic syndrome, like hypertension, diabetes, or your family suffers from hypothyroidism, then you need to make a conscious effort of recognizing that these are risk factors that you were born with and that you need to modify things that you have control over, like your diet and lifestyle to basically put you in the most optimal health in the future.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, probably wanna stay away from processed foods, although they do taste really good, those potato chips and fried foods, like I had the other day. Those probably don’t stack up when it comes to either being nutritionally dense or really helpful in terms of the building blocks that you were talking about earlier.
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Right, and we also need to recognize that there’s a lot of changes in the things that are actually causing us to have mortality and morbidity at this point. With the increase in processed foods, there’s also probably a strong link to why we’re seeing an increase in colon cancer. And so we need to realize that maybe decreasing processed foods, maybe consuming less bacon, sausage, like those kinds of things are very highly linked to colon cancer.
And so that is why we’ve also dropped the screening age cutoff for colon cancer from 50 to 45 in the last few years. And so I think we need to all make sure that our physicians are guiding us to get the screenings at the appropriate time, because there has been a lot of significant changes recently.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, that would be, I think by screenings, you’re referring to like a colonoscopy or they now have, for people that are like ColoGuard or things like that- Right, and knowing that with each type of different screening method, there is a guideline as to how often you’re supposed to do them.
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
So like a colonoscopy is ideally done every 10 years, a ColoGuard would be much more frequently. And knowing that the standard for colon cancer screening is actually still a colonoscopy and nothing replaces the sensitivity and specificity of that test.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, I just went, as an aside, I just went through my colonoscopy last year. It was, suffice to say, it was a pretty pleasant experience You say it’s the best sleep. It is probably the best sleep I’ve had.
And that’s a perfect segue to the importance of sleep. And I’m not advocating that people just go to get a colonoscopy- I wouldn’t recommend that. Just for the sake of getting sleep.
But how important is, because I’ve read that in the past, as you get older, you actually tend to sleep less, but do you really need six, eight, nine, 10 hours if you can get it?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Yeah, I mean, when we are having sleep disturbances or insomnia, we are actually having an increase in our cortisol levels. And that can actually add to the weight gain that we’re suffering from. So we need to make sure that we’re adopting proper sleep discipline, making sure that we’re going to bed at a regular time, making sure that we’re not opting for a screen time, whether it be on our phones or on our television, at least an hour or two before.
We need to have a consistent sleep and wake schedule, going to bed at ideally 9, 10 p.m., waking up at ideally 6, 7 a.m., and making sure that we’re not eating two or three hours before bed, not engaging in workouts that are late at night, because all of those things do contribute to having sleep disturbance. And if suppose, if you’re doing all of that and you’re still finding it to be a struggle to have good quality sleep, then you can invest in certain supplements like magnesium glycinate is really helpful. So that is something worth looking into.
And then another thing that often gets underdiagnosed in midlife women’s health is obstructive sleep apnea. A lot of us think that we have to be morbidly obese or we have to be snoring in order to have sleep apnea, but there are plenty of patients out there who will test positive for obstructive sleep apnea after they do an official sleep study and find that, hey, even though I’m not overweight or obese, or even though I don’t snore, but I do suffer from obstructive sleep apnea. And so it is very helpful to invest in a sleep machine as per the guidance of your physician.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, let me go back to, we were talking earlier about estrogen. I think the thinking has evolved on hormone replacement therapy. And that means, I guess, getting either estrogen or testosterone.
How has that thinking evolved for practitioners like yourself when you think about longevity and aging correctly? Is that something that people should at least take back to their PCP, their primary care physician, to discuss?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
I mean, so initially it used to be called hormone replacement therapy as an HRT, which has now been renamed to menopause hormone therapy as an MHT.
Jeffrey Snyder, Broadcast Retirement Network
Okay, my bad, my bad.
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
No, it’s just a recent change. But there are only certain situations where MHT as in menopause hormone therapy has really been FDA approved for. So there are three reasons.
Either if you suffer from vasomotor symptoms like hot flashes and night sweats, or if you’re preventing bone loss, as in you have osteopenia. Because if you’ve already reached the point where you have osteoporosis, then you actually need treatment. And hormone therapy only prevents bone loss.
It doesn’t treat bone loss once you’ve already had it. The third indication is genitourinary syndrome of menopause, which is either vaginal dryness, recurrent urinary tract infections, or painful intercourse. And so those are the three things it has been approved for.
But they are removing the black box warning for a couple of other indications, as in most recently in the last week, there is consideration for removing it for cardiovascular disease, dementia, and other reasons. But that’s still in the works. And the good thing is that a lot of people come into my office and they say, you know, I think I need hormone therapy because I’m suffering from hot flashes, but I have history of maybe like breast cancer, or I have history of a clot or a stroke.
That doesn’t mean that we don’t have other treatment options for them. The good news is that we actually have non-hormonal options now for patients who may have contraindications to taking hormone therapy. And so there are drugs out there like neurokinin receptor antagonists, or certain SSRIs or SNRIs, oxybutynin, cognitive behavioral therapy, weight loss.
These are all proven treatments for vasomotor symptoms.
Jeffrey Snyder, Broadcast Retirement Network
So it sounds like obviously things have really progressed over the past several decades in terms of the research. There’s a lot of information out there. And to your earlier point, when we first started our conversation, there’s a lot of education going on with practitioners like yourself to get up to speed on the latest thinking.
How does someone find, you know, if they’re just curious, maybe you don’t think you’re deficient, but you wanna begin the process, how do you find the right provider? You’re obviously based in New Jersey at Hackensack Meridian Health. So not everyone, though you’re certainly a great doctor, not everyone can come to you.
So how do you find someone in your local area that really is aligned with some of the things that you have articulated this morning?
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
One of the great resources we have is the Menopause Society, which you can just Google the website, has a provider list of every practitioner in the country who has an MSCP certification, which is Menopause Society Practitioner Certification. These are healthcare providers, whether they are APNs, PAs, or physicians, and they have actually made the effort to study the material, the material that is up to date. They have read the position statements from the Menopause Society, and they’ve actually taken an exam, a two-hour exam, to prove that they are up to date and they’re equipped to help patients with their midlife women’s health.
And so you can easily go on that website, put in your zip code or whatever state you’re looking for, and you can find a list of providers. And I highly encourage that everyone uses a provider that has the certification, or at least has the years of experience managing midlife women’s health, because there’s a lot of danger if you’re actually taking medications that are either compounded, which are not been tested by the FDA for safety and purity. There is a lot of misinformation out there.
You don’t wanna be in a situation where you have a certain contraindication taking hormone therapy, and then you end up taking it and unfortunately suffer with a bigger problem like a stroke or other issues. And sometimes I do find that patients are coming into my office and they’re taking compounded medication like testosterone pellets, and they unfortunately will suffer from irreversible changes, like changes in their voice, enlargement of their clitoris, hair loss. These are not reversible changes.
And so these remain permanent. And it’s unfortunate that the patient was misguided by somebody.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, there’s so much. It’s really difficult. Maybe we end here.
I think you bring up a really interesting point is that with the power of social media, anybody and their mother or father can put something up and claim something. And none of that is really validated by anybody on the platform. I mean, there’s a lot of stuff out there for people.
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
And the thing is, there’s a lot of social media influencers who do advocate for a lot of products, but there has to be research behind it. I have patients who come into the office with bottles and bottles of supplements that have not been FDA approved or have not shown any kind of evidence that they make any impact on your brain fog or your hot flashes or your bone loss. And patients are investing all this insane amount of time and money into these supplements and they’re electrolyzed and everything are all off.
And it’s unfortunate, but there’s a lot of misguidance out there. So I encourage people to look out for centers like the one we have at Hackensack Meridian Health in Pramas, New Jersey. We have a multidisciplinary center.
We have a primary care physician. We have social workers. We have a DEXA machine.
We have a mammogram machine. All under one roof. You have a hormonal specialist like myself, who’s an OBGYN.
We have mid-level providers. We have the support. We have the lab available to draw your blood tests all under one roof.
And with this comprehensive care, what happens is that everyone’s not just sitting in their silos and managing one little portion of your body. We’re all looking at you as a whole and trying to get you to where you need to be and optimize your future.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, well said. And I do think that going back to the social media aspect of this, I think that creates a lot of challenges for people. And I think if we get people to go to accurate sources and get accurate sources of information, they’d be a lot better off, have greater longevity, and also a better lifespan.
Dr. Chadat, we’re gonna have to leave it there. Thanks so much for popping by the program. Really enjoyed it.
And look forward to having you back again very soon.
Kanchi Chadha, MD, FACOG, Director of the Midlife Women’s Health and Longevity Center, Hackensack Meridian Health
Thank you very much, Jeff. It was a pleasure.
