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Join Susan J. Baumgaertel, an internal medicine physician. In this conversation, we dive into her book, The Menopause Menu, as Susan sheds light on navigating the complex intersection of menopause and chronic diseases.

Susan J. Baumgaertel is an internal medicine physician.

She discusses her book, The Menopause Menu.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Susan Baumgaertel. She’s an internal medicine physician, and we’re going to talk about her book, The Menopause Menu. Susan, welcome to the show.

Susan J. Baumgaertel: Thank you so much for having me. I appreciate it.

Kevin Pho: We’ll get into your book in a little bit. First off, briefly share your story and journey.

Susan J. Baumgaertel: I’m from Seattle. I grew up in Ontario, Canada, came back, and actually got my degree in architecture and urban planning. Then I went right into med school and residency in internal medicine, stayed here in Seattle, and worked 25 years in a physician-owned company. About two years ago I pivoted and started my own business, My MD Advocate, and then, of course, published my book.

Kevin Pho: Excellent. Tell me about that transition from clinical medicine into your other ventures.

Susan J. Baumgaertel: Boy, it was really daring, as it is for many people who peel away from something they’ve done for so long, but it was time. Many things were going on. We can talk about burnout and moral injury, but truthfully, I wasn’t ready to retire, and I thought, “I can still give back.” So I found a way to serve patients in a different way.

Kevin Pho: How scary was it to make that transition? A lot of doctors like the security of clinical medicine, and when I talk to a lot of entrepreneurial physicians, that first step is often the scariest. Tell me how that was for you.

Susan J. Baumgaertel: It is. I think sometimes you reach almost a breaking point, and literally, I walked away. I walked away from a very incredible six-figure income to nothing, and that amazingly allowed me to become creative. I could peel back those layers of angst and frustration and find out what I wanted to do, so it was very therapeutic.

Kevin Pho: So your book is called The Menopause Menu. Tell us how this book came together.

Susan J. Baumgaertel: It’s an all-in-one gift book. It’s a medical guide, and it’s a recipe book for navigating menopause. It’s very experiential, so there’s a lot of color. There are pictures, photographs, haiku, poetry and art, and there’s a lot of medical advice, too. I drew inspiration from all the women I’ve been caring for for, gosh, 30 years now, and it was really clear that more information was needed about the entire menopause journey. That information needs to be evidence-based, yes, but also holistic, and I was really trying to put all that together.

I harkened back to a program I developed called Menu for Change. It ran from 2012 to 2019, and women came into it to lose weight, but it really morphed into a wellness program. It embraced a lot of different things like nutrition, movement, sleep and stress, so all those health-related categories were emphasized. It seemed like a natural extension to frame information about menopause and the midlife transition with a menu-based theme. So I launched my free website first, and then all this led to the foundation for my book.

Kevin Pho: What would you say are some of the biggest misconceptions about menopause today?

Susan J. Baumgaertel: I would say, crazy to start with this one, that it’s not just about women, right? I always say everyone knows someone going through menopause. It could be your mom, your aunt, your partner, your daughter, and so I think it affects everybody. Oh gosh, you can’t look at the Washington Post or the New York Times or any kind of tabloid without seeing a menopause article, right? It could be about menopause in the workplace. So one of the things I really like to impart is that my book is really for everyone. It’s not just for someone who’s 45 to 54 and trying to navigate that time. It definitely is for them, but it really extends to so many other people.

Kevin Pho: Now, in your KevinMD excerpt, you talk about various case studies involving some of the chronic diseases associated with menopause and some of the physiological changes that women go through. So let’s talk about that last one. What are some of the physiological changes that women go through during menopause?

Susan J. Baumgaertel: The list is so long; I think you can put almost anything you can think of on it. Joking aside, the top ones, of course, that everyone’s heard about are hot flashes, night sweats, sleep disruption, vaginal dryness, libido changes and all those things. But then you really start to look at the other layers. There’s mental stress, there’s angst, and there’s mental illness that may have been there and gets unmasked. There’s fatigue; what doesn’t cause fatigue? There’s so much there. You can think about skin changes or hair changes, or your GI system, or neurologic changes like brain fog. To me, it was almost a little daunting: How do you address all that? So I condensed it into 16 chapters, and each chapter addresses one symptom or one disease condition. That made it a little easier for me to navigate, at least.

Kevin Pho: So in the exam room, and we’re both internal medicine primary care physicians, what are some things that I should look out for when I talk to women about menopause?

Susan J. Baumgaertel: This is almost so simplistic, but it’s so powerful: listening. Many women, as patients, and I’m a patient too, find that the visits are fast-paced. Your hand is on the doorknob, you’re running late, there’s too much going on. It’s, “Oh, I’m tired.” “Oh my gosh.” So the tendency is just, “Oh, let’s do a bunch of labs.” And when the bunch of labs are normal, it’s, “Well, I don’t know. Go exercise.” Well, duh, they probably know about exercise and nutrition. So it’s really about listening to what’s going on and allowing a little space. It’s hard, but allow time for that dialogue, and make sure women don’t feel like they’re crazy or being histrionic.

There are some pretty interesting things that happen before you’re in menopause. Let’s say you’re only 42: “Why am I having hot flashes?” Well, maybe as a physician it’s important to make sure they don’t have lymphoma or pheochromocytoma or some other zebra diagnosis, but maybe it’s perimenopause, early menopausal symptoms. So allowing the space for them to talk about it, I think, is key.

Kevin Pho: So you mentioned hot flashes, of course, as one of the more common symptoms. How does your book approach that topic?

Susan J. Baumgaertel: It’s hard to describe, but each chapter is laid out like a restaurant menu. There’s an introduction, there’s an appetizer, and the entree is the meat of the matter, the information about hot flashes in that case. Then there’s a palate cleanser and a dessert. For instance, the palate cleanser is a recipe, so you get 16 recipes, and the recipe for that chapter happens to be miso soup with tofu, green onions and seaweed. When you think about nutritional support, miso is soy-based, and you think about tofu. There’s a lot of discussion, and you can look up articles and really get evidence on this, but think about phytoestrogens and how they might be able to support someone with hot flashes. Does it mean you eat tofu and miso all day? No, but that might help ratchet it down a little bit. So that’s one example of how I blend those things together.

Kevin Pho: So how did you learn about that holistic approach? Because some doctors would say, “Try this medication. Try estrogen.” But you take a more holistic approach with this dietary example. How did you learn about that?

Susan J. Baumgaertel: That really just morphed from my program, Menu for Change, where I had a lot of different practitioners: a naturopathic doctor, a nutritionist, an acupuncturist, an exercise physiologist, a psychologist, just the whole gamut. I paid all their salaries, and they worked in my program. Women came in and would see me, and we’d do labs and talk about the medical side of things, Western medicine, and then they would work on stress management techniques, body movement and nutritional support. It all came together in a nice little bow, and to me that was just the perfect way to take care of anyone, but certainly women going through menopause.

Kevin Pho: Now, let’s talk about some chronic diseases, and of course the chronic disease most associated with menopause would be heart disease. Tell us about that connection.

Susan J. Baumgaertel: I don’t profess to be an expert on heart disease. I would bow to some of my cardiology colleagues for that. But I would say there are amazing bodies of research going on right now looking at estrogen, for instance, and the risk of heart disease. I think it’s one of those double-edged swords. Estrogen can help improve your lipid profile, and if you improve your lipid profile, that of course may reduce your risk of cardiovascular disease. Well, if you’ve had a stent or heart bypass, is estrogen safe? Maybe not. So again, you have to step back and look at those layers. I’m very much schooled in the view that nothing’s all or none. It’s not that hormones are good or hormones are bad. There are a lot of nuances there, and I think there’s a lot of nuance when it comes to cardiovascular disease, and a lot that we’re still learning.

Kevin Pho: Tell us about some other common chronic diseases that may be associated with menopause.

Susan J. Baumgaertel: I would say it goes both ways. Women who have chronic disease and enter perimenopause or postmenopause may have added burden. I can use myself as an example: I have rheumatoid arthritis, and I’ve had it for 23 years. Was my RA worse because of menopause? Yeah, probably. Was my menopause worse because of RA? Yeah, probably. So it goes both ways.

God forbid we talk about weight, that’s my favorite topic, but weight gain can certainly impact a lot of things in the chronic illness arena. The first thing you think of is diabetes, and that could be something that rears its head or becomes more of an issue in perimenopause if weight gain is a problem. But honestly, when I think about what’s happening in menopause, it’s midlife, and what things are happening in midlife? You’re screening for cancer, certainly. You could be developing osteoarthritis or other things that lend themselves to chronic illness. You’re worrying about osteoporosis or bone loss. All of those become important to focus on and think about during the menopausal journey.

Kevin Pho: One of the things you touched upon in your KevinMD article was genetic predisposition, when it comes to family history and how menopause affects one’s health. Talk more about that.

Susan J. Baumgaertel: I think the best example of that would be cancer screening. When we think about genetic testing, many people have heard about BRCA and the risk of other cancers, but certainly breast cancer. So that’s one important thing. In fact, it might be part of the package when you think about whether hormones are safe for you: Do you need to screen for that kind of cancer? So that would be one marker to pay attention to.

Kevin Pho: Tell us some of the other major themes that you want readers to come away with from your book.

Susan J. Baumgaertel: Wow. I like the fact that it’s very experiential. When you read this book, you don’t have to read it cover to cover. I designed it like a coffee table book. You pick it up, maybe turn to chapter eight, read for five minutes and then you’re done. I’d like people to feel like they can hunt and search for something that’s meaningful to them at that moment. Or maybe they have a friend with some urinary trouble: “Oh, chapter seven, that’s where I’m going to look.” So it’s a resource in that sense.

But I also feel like, if you know me, everything’s a story. There are a lot of art, flowers and plants around me, and I like that experience. So it’s not like a medical text. It’s not full of jargon where you have to look up every third word on Google to figure out what it means. At the same time, it’s not, dare I say, snake oil and the woo-woo stuff that is unfortunately very misleading. It’s a combination of things. I want people to feel like this is literally a book they can keep on their coffee table, look at and feel validated: “Oh my gosh, I’m not going crazy. Brain fog is real. I’m not having a stroke or dementia. I can do this.”

Kevin Pho: What kind of advice do you have for women who turn on the television or go on the internet and see a lot of drugs from the pharmaceutical industry that medicalize many of the symptoms menopausal women experience? What’s your take on that?

Susan J. Baumgaertel: Oh boy, I have so many responses. First of all, I think direct-to-consumer marketing is just ridiculous. How can anyone understand what a drug is, what it’s for and what it’s meant for, when they just have these cute little scenes? I feel like not everything requires a medication, and sometimes medications are really helpful. So you have to really understand that this is not just a decision for the woman to make alone. She should be working with her physician and her team, getting good guidance and understanding. Don’t go to Dr. Google. You may love your cousin or your sister or your best friend, but everyone is going to have a different experience. So I think it really validates getting honest-to-goodness good medical care.

Kevin Pho: We’re talking to Susan Baumgaertel. She’s an internal medicine physician, and we’re talking about her book, The Menopause Menu. My final question, Susan: Tell us some of the take-home messages that you want to leave with the KevinMD audience.

Susan J. Baumgaertel: Well, again, it’s been a pleasure to be here. I think everyone needs an open mind when it comes to menopause. There are so many commonalities and so many similar stories, and at the same time, every woman’s journey is unique. So as a woman, as a patient, make sure you ask questions of your physician and allow the time, hopefully, to be heard. As a physician, make sure you understand that you can’t just throw the book at someone or think hormones are the solution for all. It’s good to have a dialogue, and it’s good to be open-minded.

Kevin Pho: The book is called The Menopause Menu. Susan, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Susan J. Baumgaertel: Thank you so much.