Dr. Zoe Rodriguez [00:00:00]:

Part of my recommendation is not to do research online because research online for the layperson tends to focus on other patients experience and that's a whole another topic because that's about like the culture of being a woman in this medical corporate led

Georgie Kovacs [00:00:28]:

Welcome to Fempower Health. This is Georgie. In today's pivotal episode, we're joined by Dr. Zoe Rodriguez, a distinguished expert from the Icahn School of Medicine at Mount Sinai will demystify the often confusing world of hysterectomies, including breaking down myths about surgical options and addressing common misconceptions about post surgical recovery. If you're wrestling with unanswered health questions or feel overwhelmed by the choices concerning your reproductive health, this conversation is especially for you. We're here to empower you with the critical insights you need to confidently advocate for your health, and don't miss out on this transformative discussion that will change the way you approach your well-being. Let's dive in. So Dr. Rodriguez, I'm so happy that, you are joining me on Fempower Health today. It was so fun getting to know you the first time right before you went on vacation.

Georgie Kovacs [00:01:27]:

So I I've been really wanting to talk about hysterectomies on Fempower Health because, you know, I I hear these stories of things like women will wake up from a surgery and they're like, hold on a second. I didn't know that a hysterectomy might be happening. There may be, you know, situations where women didn't know options of partial hysterectomy versus a full hysterectomy. The other thing I commonly hear is women will have their hysterectomy and were not given information about what will happen after, such as the massive hormone decline, and they're not prepared. So these are just some of the things that I've been hearing, and so I thought, why don't I find an expert where we can just talk about all this stuff? And you shared some really interesting cultural dynamics as well. So before we go into all of this, why don't you tell us about yourself and why you're also so interested in this topic?

Dr. Zoe Rodriguez [00:02:24]:

So, performing hysterectomy is a, you know, a significant part of my work week and my work life. You know, to to speak to the the, like, cultural gender differences, like, I I get to do hysterectomies on cis women and on trans men and it's it's pretty marvelous where it all intersects and where and where and where it doesn't. So I think that's what you were alluding to. So that's kind of like my, interesting take on things, I suppose. Hopefully, it's interesting. We'll see.

Georgie Kovacs [00:02:58]:

Yes. For sure. Well, also the Latina women and the culture around hysterectomy

Dr. Zoe Rodriguez [00:03:12]:

certain patient populations view their healthcare health care providers, and and how they view what what appropriate treatments are. And and I find that working in New York with such a heterogeneous community and also with a large Latina community because I am Latina as well. I'm a first generation American. It is very interesting how, Latin women view definitive management with hysterectomy versus, you know, non Latina women. So it's kind of fun to, you know, straddle straddle those 2 as well. It gives me an interesting perspective.

Georgie Kovacs [00:03:52]:

This is why I like to talk to clinicians because it's like you're seeing all the patients, not the one social media feeds you. And so I'm sure there are all sorts of stories, and I'm not at all diminishing the horrific experiences that that women may have. But I I this is why I wanted to talk to you. So maybe at a broad level, you can talk about, like, just some of these misconceptions that you're seeing people coming into your office with.

Dr. Zoe Rodriguez [00:04:18]:

Yeah. Yeah. Yeah. I can't I I can't speak to the misconceptions and the disinformation on social media because I don't engage. Although, I probably should. But I I think the biggest misconception I find and I kind of nip it in the bud very early on in our visit, but I do feel like there's this misconception that, you know, we western physicians are are out to operate on everyone. We're we're out to take away everybody's uterus. And and, you know, to some degree I understand it because I think we spoke last time about the long history of paternalism and misogyny in medicine.

Dr. Zoe Rodriguez [00:05:04]:

Still some misogyny in medicine. Luckily, the NIH is now gonna give out you know, you've heard that, you know, they're gonna, like, make a point of giving out money for studies that focus on women's health issues because historically, all it was only men that were being studied and all of these findings were extrapolated to us as if we share the same physiology and the same risk factors. So there is a history of misogyny not just in our field but across medicine. And there is a history of paternalism probably stemming from that misogyny. And I try to break that every day. I really do but I do feel that people come in with that misconception with this like historical, let's call it generational trauma, right? That like the the lack of trust. So I do I feel like that's the biggest misconception when people walk into my office. And then if we wanna go the cultural route from my Latina community, you know, their misconception is that doing the hysterectomy will cure everything.

Dr. Zoe Rodriguez [00:06:11]:

You know, I have people coming in all the time like, just remove it. I don't need it anymore. Like literally saying things like that. And I don't think that's exactly what they mean. I just think that that's how they're expressing themselves, but I spend a fair amount of time really educating people on what that means and trying to refocus them on their symptoms and ways to treat it. So it's kind of like I have the Latinas walking in with a more paternalistic view and I'm trying to debunk and then I have other women coming in, you know, assuming we we have a paternalistic view and I have to debunk that. So it's kind of kind of fun.

Georgie Kovacs [00:06:46]:

Interesting. Yeah. So so back to the, you know, surgeons wanna do surgery. A question there. I had, I did an interview. I think it's now 2 years ago, talking about uterine fibroids, and I had understood that ACOG, had put out, I guess it's not a mandate. I can't think of the word at the moment.

Dr. Zoe Rodriguez [00:07:09]:

A practice bulletin with bulletin. Thank you. Evidence based recommendations. Correct.

Georgie Kovacs [00:07:13]:

And it was really about, you know, let's not automatically do a hysterectomy. Let's figure out what else to do first. So can you talk about that dynamic? Because I know what when we spoke last time, you had mentioned that with minimally invasive surgery now becoming more prominent, it's the hysterectomies aren't as, like, let's do this first type of thing. So can you talk about where we are with that? Because I would also presume different parts of the US are very different in how they they view it. So can you just give us, like, the rationale of why that was in place, and why it needed to be in place just to give people some perspective?

Dr. Zoe Rodriguez [00:07:58]:

I think governing bodies, putting out evidence based recommendations is just part of, you know, helping guide physicians make informed decisions with their patients, helping provide the evidence behind it, and taking that evidence, and making it relevant to our practices. So I don't think that it was put out because like, oh wow we have to really speak to this elevated, you know, hysterectomy rate. You know, we really got to tell the doctors the way it is. You know, they put out practice bulletins on all sorts of recommendations. So, for obstetrics and gynecology alike. But the nice thing about having them, you know, publish this is that it does give doctors guidelines and it does provide the evidence. And and it really nicely, Barry went through like these are these are the things you should consider, which many of us already know. Right? So you wanna first try with, you know, you talk about fibroids specifically.

Dr. Zoe Rodriguez [00:09:03]:

You know, fibroids can really respond to medical treatment. So historically, it was always the birth control pill. We have other non hormonal means of treating fibroids that help reduce the amount of bleeding. Even taking Motrin in an intentional kind of, you know, way can help reduce bleeding. And we have another medication called tranexamic acid that's incredibly effective and is great for people who have contraindications to hormonal management of bleeding. And what has happened is that so we have this advance in medication that we can offer, but we also have advances in devices we can offer like depending upon where the fibroids are and how big they are and you know you can offer management with hormonal IUD which is very effective at significantly reducing bleeding and sometimes even leading to no bleeding at all which is great. So you want to exhaust all the medical ways to treat the fibroids. Then we have other minimally invasive ways to treat it because, you know, what's interesting with fibroids is that every uterus is different and you know, some of the treatments that you may offer your patients may depend upon where the fibroids are located.

Dr. Zoe Rodriguez [00:10:22]:

Is it within the muscle of the uterus? Is it inside the cavity? Is it on the outside? And, to just go back a step, what's very important is to make sure that patients are getting the appropriate imaging studies that their doctors need to help patients make an informed decision on what treatment is best for them because it could vary depending upon where the fibroid is. For instance, fibroids that are inside the cavity, what we refer to as submucosal fibroids. Right? Those are less, more difficult to control medically and certainly you can't place an IUD inside a cavity when there's a big fibroid in there. So, those you might just need to resect but guess what? When I was a very young physician, they didn't have the ability to remove fibroids by putting a camera through your cervix, through the vagina into the cervix and remove the fibroid without even making an incision on your belly. So there were women who had a fibrin inside their cavity who were having hysterectomies and were no longer doing that, right? So I think that, you know, making sure your doctor's doing the correct imaging and sometimes it may require something like an MRI which is a bigger deal because you gotta be in that thing and the loud noise, I get it, but it's very good at really characterizing exactly where your fibroids are. So now we have hysteroscopic myomectomies, that's what it's called. The hysteroscopy is when you put the little camera through the vagina into your cervix and that's been a game changer. I mean there were people, you can remove polyps that way too, I know we're not talking about polyps, but it used to be that people 30, 40 years ago were getting hysterectomies for a little polyp that we now remove in our offices.

Dr. Zoe Rodriguez [00:12:02]:

Now we remove them and I just removed 1 20 minutes ago. So so it's it's really great and so it's good to just to speak back to, you know, the practice bulletin. It's good to put all of that in one document as a reference point. Now when you're when you're talking to patients about treatment of fibroids since we're on the subject, so you have the medical thing the medical treatment, excuse me. You have medical management with the hormonal IUD. You can do minimally invasive procedures like putting the camera in and removing any fibers that are in there. We also have other more advanced minimally invasive procedures that use radio frequency ablation. So you put a camera through the cervix and there's someone doing a sonogram while you're doing that and you can actually ablate fibers that are in the muscles.

Dr. Zoe Rodriguez [00:12:49]:

So you can't really access them from below, but using this device and ultrasound from above, you can access these small fibroids that are in the muscle of the uterus. And again no incision on the belly, no overnight stays in the hospital. So so things are really looking up as far as offering other minimally invasive treatments for for fibroid bleeding or pain Right. Which is great.

Georgie Kovacs [00:13:16]:

What are some other common reasons why people need to get a hysterectomy?

Dr. Zoe Rodriguez [00:13:22]:

So, obviously, fibrosis is probably the most common reason. Other indications obviously include endometriosis, obviously a variety of malignancies. Like I mentioned earlier, it can be part of gender affirmation. Not every, transgender or non binary patient chooses that that route, but but it is an indication for hysterectomy. And then there's like pelvic organ prolapse, right? So sometimes in order to treat someone's prolapse, you need to remove the uterus so that you can suspend the vagina or the bladder or that, you know, whatever is is prolapsing.

Georgie Kovacs [00:14:02]:

You know, I think about this I mean, I've talked to so many experts and so many women. And I I think to put it into perspective, we, as women, don't know all the things we need to know, and many things are normalized. And we're busy, and we take care of everyone else. So we don't always track given that entire dynamic. We don't track or we don't know what to track. Then we have the clinicians who see tons of patients. They see you for 10 minutes. If you're lucky, you get an hour appointment, but they still only know 10 minutes or an hour of your life.

Georgie Kovacs [00:14:37]:

So Mhmm. If the the perfect little nuance that would completely change your treatment pathway happens to not be covered because the physician is busy and forgot to ask, or wouldn't have even thought to ask or the woman didn't bring it up, that could affect the future. Right? And so I feel like we we can't do this whole, like, the doctors are terrible or, gosh, these patients are annoying. It's like this it's a dynamic. And then there's reimbursement pressures, you know, cost pressures. So I I just I say that and and, so I feel like I do the Fempower Health podcast with the AIM main focus of women. Hear what the doctors here's what the doctors are saying. Like, you gotta do this stuff.

Georgie Kovacs [00:15:25]:

Do your homework. And then for the clinicians who listen, it's like, oh, that's such an interesting perspective. So that's it's I hope I'm serving both parties effectively. But going back, partial, full, informed consent, like, how does that dynamic happen?

Dr. Zoe Rodriguez [00:15:40]:

So first I think it's super important to define what the difference is between a total hysterectomy and and a supracervical hysterectomy.

Georgie Kovacs [00:15:51]:

Okay.

Dr. Zoe Rodriguez [00:15:52]:

Because partial is not the medical term although I know it's become lay and and widely used. I wanted to find it because people get confused because they think partial hysterectomy means you don't remove the ovaries and removing the ovaries is a whole separate procedure in and of itself. So if you're going to have a total hysterectomy and removal of the of the ovaries, it's called a total hysterectomy and removal of the ovaries.

Georgie Kovacs [00:16:18]:

No way. I thought total hysterectomy was uterus and ovaries.

Dr. Zoe Rodriguez [00:16:21]:

It's not. It's very confusing for the people. So it's, and and it's super important. So total hysterectomy means that we remove the uterus and the cervix.

Georgie Kovacs [00:16:32]:

Okay.

Dr. Zoe Rodriguez [00:16:33]:

Because that's the uterus and hysterectomy is removal of uterus. So it's the uterus and the cervix. And and then removal of the ovaries is a separate thing. It's called an oophorectomy. So a total hysterectomy, you remove the cervix. A partial hysterectomy you leave the cervix. So do you want to hear about the supracervical hysterectomies, or do you want to hear about like do we remove the ovaries or not?

Georgie Kovacs [00:16:58]:

I mean, now I have no idea how to ask this question because

Dr. Zoe Rodriguez [00:17:04]:

so, you're the expert. You can talk about the ovaries.

Georgie Kovacs [00:17:07]:

Whoops. I think what let's think about it from the patient. Like, what matters to the patient of the difference between removing just the uterus or the cervix and uterus and then now add to that the ovaries? Like, what happens? Because I have a feeling when they leave the surgery, different things happen to their body, which means different things need to be told to them. And if someone doesn't, they probably need to know from you.

Dr. Zoe Rodriguez [00:17:34]:

When when I'm sitting with a patient and we decide, okay, I'm I'm gonna have a hysterectomy for whatever reason, All of them except cancer because I don't I don't work in that field. Then I explained to them what parts we're gonna remove. So I said okay, so the uterus and the cervix. And then I, you know, depending on their age, we talk about any indication. We talk about whether or not we're gonna remove the ovaries. So when they're like, what do you mean the cervix and the uterus? What does that even mean? How do I make a decision? And then I let them know, look, the fact of the matter is is that as the people who who leave the cervix behind, the surgeons who leave the cervix behind, you know, they have a different take on what that can do for sexual function. The evidence doesn't support that wholeheartedly. You know, there's some conflicting evidence, but for the most part, we do recommend removal of the cervix.

Dr. Zoe Rodriguez [00:18:37]:

Now, if I have a patient who is like, I wanna keep my cervix for whatever reason. I don't even ask. Meaning, I'm not going to stand in judgment on whether they want to keep a body part that's not causing any problems for whatever reason. Right? But obviously, they need to have had a history of normal paps all along. Right? Because you don't want to leave a cervix behind where someone has had a history of dysplasia and then, you know, the risk of cervical cancer. And I also remind them that they'll need to continue to have cervical cancer screenings, you know, the PEP that would be done at whatever cadence is indicated for that patient. So, we have that and it's a pretty brief discussion that we have, about that and most patients in my practice choose to have their cervix removed after kind of talking to me. Then the issue of removing the ovaries or not is kind of age and indication based.

Dr. Zoe Rodriguez [00:19:37]:

Okay. And we can do a whole podcast on this as well. But generally, if you're younger, the number used to be actually like 65. Like if you had normal ovaries and you were having a hysterectomy for benign indications and you're under 65, we should leave your ovaries because even though the production of estrogen is significantly reduced, there's still some activity, a small amount of testosterone that's produced. So so it was kind of like this no net harm would be caused but potential benefit to leave the ovaries. And recently, actually, it's in one of the papers that we had to do for a maintenance certification. There's this big study done. I think it was in Canada.

Dr. Zoe Rodriguez [00:20:24]:

I don't think that matters, but they they it turns out that in looking at all the data, the risk of death was slightly higher if you remove the ovaries prior to the age of 50, and slightly lower if removed after the age of 55. So whether or not people have put them into practice yet, you know, I don't know if it has been widely accepted, but that's kind of, you know, and you always have to like, you know, new data comes out, new analyses come out, and oftentimes in medicine there's that big pendulum. You know, when I was a very young doctor everybody was using menopause hormone therapy and then like, I know, we got caught up at the knees and now everybody's re embracing it again.

Georgie Kovacs [00:21:07]:

That's right.

Dr. Zoe Rodriguez [00:21:07]:

And by the way, if we remove the ovaries, obviously we can, we can reduce those risks a little bit presumably by providing patients with menopause hormone therapy. Right?

Georgie Kovacs [00:21:19]:

Well, my understanding is when the ovaries are and this is, by the way, this is so interesting. I'm now trying to figure out how this whole thing caught on where I view I always thought total hysterectomy meant ovaries and uterus. And I because I I think women have to be clear. Like, let's let's be like, I think we should always triple check with our doctor on what's happening. I think the the clinicians know, but I think we women have to triple check. And I say this because my understanding is if the hormone therapy is not given when the ovaries are removed, they can have a major crash because you're now in the surgical menopause, like, right when that happens. What are the things that women should be told about and prepared for, and what are the options? Because it was interesting. I would have assumed you said you must go on menopause hormone therapy because it's gonna be a really hard time right after that, and you're not saying that.

Georgie Kovacs [00:22:12]:

So now I'm curious medically, like, what women should be told as far as, like, here are signs that you should look for. So it's not an automatic, oh, you just had a hysterectomy. Here you go.

Dr. Zoe Rodriguez [00:22:24]:

I had a patient recently. She's 46, 47, late forties. Regular periods, not in menopause. She we tried everything for her fibroid heavy bleeding. She had to get transfusion, she had anemia. I was like, that's it. We're done. She's or maybe she told me, usually patients tell me that they're done.

Dr. Zoe Rodriguez [00:22:43]:

I don't tell them I'm done. So, she's like, I I just want the surgery. I said, okay. Great. So and then I go through the organ inventory, like, we're gonna remove the uterus, the cervix, and the fallopian tubes, and we'll leave your ovaries behind because of your age and blah blah blah. She said, great. And I obviously I say, if I see anything wrong with your ovaries at the time of surgery, we're we're gonna have to remove it. So now she's 46, 47, and she had a hysterectomy, and we left the ovaries behind.

Dr. Zoe Rodriguez [00:23:10]:

Let's just look at the people after 40 for now, not the people before 40. The people after 40 who who have a who don't have their ovaries removed, they're still at risk for earlier menopause. Right? But I get to have that discussion with them. I say, look, this is gonna protect you from going to menopause right after the surgery. I don't know what's gonna happen. You don't know when you're gonna go through menopause because you're not gonna be bleeding anymore. That's the purpose

Georgie Kovacs [00:23:37]:

of the surgery. Okay.

Dr. Zoe Rodriguez [00:23:39]:

So I need you to really pay attention to your symptoms because that's the only way I'm gonna know. And if you pay attention to your symptoms and you are having symptoms, then I can just provide you with these beautiful menopausal hormone therapies that I think are perfectly indicated for you because you don't have this that and the other. You know, we go through the whole thing. So there is a discussion of what to expect. Now whether or not she'll remember that, I don't know, But we mention it at each visit. Okay. How are you doing? Are you having menopausal symptoms? Are you not having menopausal symptoms? Not everybody has menopausal symptoms. So we have to kind of prompt the patients to say you got to tell me what's going on so I can provide you with this menopausal hormone therapy.

Georgie Kovacs [00:24:18]:

Right.

Dr. Zoe Rodriguez [00:24:18]:

Okay? Because there is a risk that you know the average age is 51, it may be sooner, I don't know. Even though I preserved your ovaries, there's still a disruption. The theory of course is, I don't know they'll ever know, but the theory is a disruption of the blood supply to the ovary because everything is all connected. I wish we had like a little picture of the uterus and ovaries, but there's tissue that connects the uterus and the ovaries. It's very fine tissue that has all these blood supplies coming in. That tissue gets disrupted when we're performing the hysterectomy and removing the tubes and leaving the ovaries. So that's probably why we may see increased risk of, you know, going through menopause a little bit earlier for women over 40 even with ovarian preservation.

Georgie Kovacs [00:25:06]:

So if the ovaries are removed, what do patients need to be warned about?

Dr. Zoe Rodriguez [00:25:11]:

What we tell people about menopausal symptoms, if the plan is to remove the ovaries, It really depends on their age. Really? Like I many years ago I had like a 36 year old who had such bad endo. She's like, I'm done and I want you to take my ovaries. And it was like a big deal. Like I had to fight with the insurance company because they didn't even want to pay for her hysterectomy. She was like in her mid thirties, they wouldn't, they're like no, she's too young, this is what they're selling me, this is like 10, 15 years ago. And I really struggled with that. So, you know, she's like, I will take the estrogen.

Dr. Zoe Rodriguez [00:25:50]:

I just, I can't risk that I will need multiple surgeries. That's how done she was. And we got there and, you know, she just, you know, she started taking her hormones and it's great. So, it really all depends on their age. If it's somebody who's already gone through menopause, you're gonna say, I expect little to no change to your symptoms. Right? Because I don't wanna say a 100% that the ovary is completely inert. Right? Because we do know that there is some sort of hormonal production. But I wouldn't put the fear of that in a patient's mind.

Dr. Zoe Rodriguez [00:26:27]:

And I'll say, look, if we do remove your ovaries in your past menopause and you're having symptoms we can have a discussion and try if a little bit of estrogen works, you know, and there's always room for that discussion as long as hormonal treatment is not contraindicated of course. Always that caveat.

Georgie Kovacs [00:26:41]:

So for the uverectomy because I I gotta practice this now. So for the uverectomy so you don't always need the menopause hormone therapy. Like, the next day, you don't have to walk out. It's just it's going to be dependent on a lot of factors, and the patient should just be aware. If you're, like, having x y z symptoms, you gotta call me.

Dr. Zoe Rodriguez [00:26:58]:

Right. Yeah. I mean and it's also age dependent. Like, if you're doing it if you're removing the ovaries on a young patient, you know, for whatever reason, benign indications. I don't wanna talk about the cancers because that's like another 6 part podcast. I, you know, I I may say and your pain meds and your hormones will be waiting for you at the pharmacy. You know what I mean? Right. So it all depends on your age and and you know, all of it is, it's a risk benefit discussion and it's using an individualized plan, using evidence based medicine from a large population.

Dr. Zoe Rodriguez [00:27:33]:

Right? So that means you have to take your patient's needs and concerns into consideration, their age, their special circumstances and and, you can come up with a plan together. And look, what I will say is, you know, because we started talking about, like, pre op stuff, like, there are times where I have maybe 2 pre operative visits for my patients, right? So you know we may sit here and decide okay we're gonna have surgery and I'll go through the whole spiel but then I always have them come back in like 1 to 3 weeks before their surgery because a lot of people don't remember what you say which is very common and you want to also provide patients an opportunity to ask questions, clarify things, go through the logistics of like what do I do to get ready for hysterectomy, what do I do afterwards, which I think is part of the stuff you wanted to cover and it gives them an opportunity to be like, you know what, the ovary thing, am I keeping them, am I removing them because people forget, people have their own busy lives and to your point, we have like 15, 20 minutes with them and I'm using that 15 to 20 minutes like no fluff, no fluff because we have a lot to get through. But the brain cannot process Right. 20 minutes of information with no fluff. So, I I try to take that into consideration. It's difficult when you're so busy, but I do try to take into consideration that look. I tell the I'll give you a perfect example. Talking to a patient and say, Okay.

Dr. Zoe Rodriguez [00:29:06]:

It's time for the exam. I say the same thing every time. I say, So, I'm going to step out, just remove everything and just put the gown with the opening to the front and sit on the bed. That was 12 seconds of the instructions I give every time. 15% of the time I walk in, the gown's all like, they're they're wearing like a toe guard. I don't know what they're doing. I'm like, do you not pay attention to what I say? And then I'm like, of course they don't, which is why you have to repeat things over and over and that's you have to have multiple visits and patients hate that part because depending on their insurance they have out of pocket, expenses for multiple visits, but it really really is the best way to get all the information.

Georgie Kovacs [00:29:45]:

What makes a good patient through this process? Like, what should we do to serve ourselves and to help you?

Dr. Zoe Rodriguez [00:29:50]:

I really think it's about asking the right questions and that's so horrible to say because, like, if you think about it, if your doctor's giving you all the information, you shouldn't have to really ask all the right questions because all the information is being provided to you. But the exchange of ideas and information, it varies from person to person and between 2 different people. So I do think it's important to come with all the right questions. For instance, other than hysterectomy, is there another way to treat my condition that you would recommend? Like, and and that question doesn't require you to know all the alternatives, but at least you're asking. Okay. Another thing is to make sure that, like, do not be afraid to say, I know you gotta go. We're pressed for time. I get it.

Dr. Zoe Rodriguez [00:30:42]:

Can we please make another appointment? Because I do have a few more things I'd like to discuss and I need clarity because I'm not clear on it. And you know, so don't be afraid to ask your doctor for more time. They won't be able to give it to you in the moment, but if you're open to coming back in a week or 2 or even a video visit, I I think that that's critical because when patients say that to me, they're telling me, I'm hearing you, but I I'm not getting it. I need more time, and I'm happy to come back another time, you know, because our you know, in the back of our minds is like, okay, I see my schedule, 5 people have shown up, but I'm still sitting, you know, here at 2 o'clock with my 1:15, you know, or something like that. Right. Or my 1:15 at 2 o'clock. So to say that just, you know, hit pause, you know, makes the doctor like stop and reconsider and then you come back for another appointment. Notice how part my part of my recommendation is not to do research online because research online for the lay person tends to focus on other patients' experience, and that's a whole another topic because that's about, like, the culture of being a woman in this medical corporate led infrastructure.

Georgie Kovacs [00:32:04]:

Yep.

Dr. Zoe Rodriguez [00:32:04]:

But it's very hard to I'm telling you 90% of my patients are getting wrong information. 10% are going to like the websites of our governing bodies like ACOG, the Menopause Society, and various other ones like the ASRM for reproductive medicine. So if you if you go to those websites, they do have great patient information. So you don't know you can't validate what someone is saying. They may just be saying something, and I don't wanna invalidate it either. But I think it's it's difficult to generalize people's experience. I always tell my patients who are prescribing birth control pills to. I said, it is very well tolerated.

Dr. Zoe Rodriguez [00:32:46]:

The majority of patients tolerate it very, very well.

Georgie Kovacs [00:32:49]:

A question then. I just wanna address one of the things I brought up in the very beginning is stories I hear where women wake up from surgery and they're like, I can't believe I woke up and I don't have my uterus.

Georgie Kovacs [00:32:59]:

Can you just address that, please?

Dr. Zoe Rodriguez [00:33:01]:

I think the number one issue or one of the main issues is that women don't even have an idea of what their organs look like inside. You know, for men, I'm just gonna use men and women as a binary, but for men, like, everything is like, it's there. Like, it's all Yep. It's there and they have a great understanding of it. And for women it's on the outside and even though we have charts and graphs and figures it's like, but I don't know what it looks like. You know, people show like hearts on TV, like, nobody's out there be, like, this is a universe in Europe. You know, I think that that's, like, a thing, like, we and and then, you know, we have to, like, find a way to like show them like this is what's inside and this is how it's all connected and this is how close it is to your bladder, to your rectum and, you know, they don't even understand how close everybody thinks the ovaries are up here and like no they kind of just fall down with gravity you know and so they don't even, it's so hard. It is hard.

Dr. Zoe Rodriguez [00:33:54]:

So I think that like really explaining the anatomy is important and also like finding and I don't know how to address this, but really fighting against the misogyny and the belief that it's this inner organ. That if it's removed, whoop dee doo, you're done making babies, so who cares? But it's not whoop dee doo, you're done making babies and who cares? We already know that even if you preserve your ovaries, you can go through menopause a little bit earlier that can increase your risk for certain factors, for certain cardiovascular disease, and and for cardiovascular disease. So we we know these things. We know that it's not let's just take out this inner organ. I think more and more people are really understanding that.

Georgie Kovacs [00:34:33]:

So, this conversation, like, I I knew it would be a good one, from the first time we met, but this was, like, absolutely fascinating. Oh, that's interesting. I mean, I I love that you shared, like, from your perspective because, you know, sometimes I even wonder, am I swayed by all the things I'm seeing on social media, which is why I love talking to the doctors and being like, here's what I'm hearing. Like, is it true or not? And just hearing a balanced perspective, and so I really appreciate it. And I know this is gonna be helpful for so many people. I guess, you know, on the last note, on a positive note, like, what's your greatest desire for a change in health care?

Dr. Zoe Rodriguez [00:35:09]:

I would love it if everyone, irrespective of their immigration or citizenship status had access to high quality health care in this country.

Georgie Kovacs [00:35:19]:

This was so much fun. I really, really appreciate your time. Wishing you the best.