Bonus Episode: "That's What She Said!" What EVERYONE Should Know About Menstruation with Dr. Diana Wang, OB/GYN

In this segment, Dr. Mistry and Donna Lee are joined by OB/GYN and fertility specialist, Dr. Diana Wang of Austin Area Obstetrics, Gynecology, and Fertility. Today, Dr. Wang describes the process of menstruation, its impact on fertility, and how partners can offer support. If you’ve ever wondered what actually causes the ups and downs of the menstrual cycle, Dr. Wang explains how dynamic hormone surges change the bodies and brains of women throughout a typical 28 day cycle. She answers questions like, Do I need a period? Is my menstrual cramping normal? And, Why are my periods irregular? Dr. Wang also discusses both male and female fertility, including some warning signs of infertility to watch out for. To learn more, call 512-652-7001 or online at https://www.aaobgyn.com/.  

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 1: 0:15

Hello

Speaker 3: 0:16

And welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, men's health expert, board certified urologist. And , uh, really the, the anchor of this show joined by my ball and chain , <laugh>

Speaker 4: 0:30

<laugh> . I thought I was the anchor of this

Speaker 3: 0:31

Show. Well, there, you're, I'm the chain. Okay . You're the ball and chain . Donna Lee , thank you so much everybody for joining us today Ball and

Speaker 4: 0:37

Chain . Thank you for joining us, Dr. Misery

Speaker 3: 0:39

<laugh> <laugh> , uh, this is a Men's Health show. Uh, this show is brought to you by N a u Urology Specialist, the urology group that I started in 2007. Donna, tell people about our practice. You

Speaker 4: 0:50

Can reach out to us at 5 1 2 2 3 8 0 7 6 2, our website, armor men's health.com, where you can see Dr. Mystery's smiling face there. You can submit your questions through the inquiry button there and we will answer them anonymously on the show. That's armor men's health.com. We're in Round Rock, north Austin, south Austin and Dripping Springs, Texas, where they still love dripping and dripping springs.

Speaker 3: 1:10

They love dripping and dripping. We're

Speaker 4: 1:11

Trying to fix that though. We

Speaker 3: 1:12

Are trying to fix that. All right . Stop

Speaker 4: 1:13

Dripping.

Speaker 3: 1:14

So when I have a patient that comes into my office mm-hmm . <affirmative> , and they're like a man who has some kind of diagnosis mm-hmm . <affirmative> , their wife is like all into it. Yeah . They have notepads and like asking questions and stuff like that. I bet. And when I have a woman that comes with a problem, that guy's sitting in the corner quiet on his phone, on his phone. Mm-hmm . <affirmative> . And so , uh, I think that's because a lot of times men don't know what the hell's going on with women when it comes to their health daycare . And that's why we have brought to you once again, a wonderful segment. What do we call it?

Speaker 4: 1:41

That's what she said.

Speaker 3: 1:43

And she here , and we have, that's what she said. This is with , uh, Dr. Diana Wang. Diana, thank you so much for joining us today. Hi.

Speaker 5: 1:49

Yay. I'm so excited to be here.

Speaker 3: 1:52

Dr. Wang, you've been on our show before. You are so important to us , uh, and our family. You, you , you deliver two of my grandkids.

Speaker 5: 1:59

I know. I feel very honored. Aw , that's right. <laugh> . Aw .

Speaker 4: 2:03

Look , you so excited.

Speaker 3: 2:04

Yeah . So you're somebody that we , uh, think of , uh, you know , uh, quite fondly when it comes to , um, uh, women's health type issues. And , uh, really the purpose of what we want to do , uh, in , in , in this , in this next few minutes, is to talk about common health conditions that women suffer from, that men should know a little bit more about. And I thought maybe what we would talk about are maybe some of the hormonal changes that go around with menstrual cycles. Mm . And , uh,

Speaker 4: 2:31

Fun

Speaker 3: 2:31

And what we can expect, you know, women to experience and maybe why their moods change. Why

Speaker 4: 2:37

We're.

Speaker 3: 2:37

Yes. Oh . Oh, this is gonna be a tough one, isn't it? This , this is,

Speaker 5: 2:41

This is dangerous territory. This

Speaker 3: 2:42

Is gonna be a good one. I love it, <laugh> . I love it. I love it. I love it. Well, well , why don't we first just start talking about why do women have cycles? Like, what's, what's happening? Like, what is the whole

Speaker 5: 2:52

Purpose? The menstrual cycle? Okay. Well, if God created us perfectly, we wouldn't have them them until we desired pregnancy. Right. So, for example, when we have a menstrual cycle, the whole purpose of that is to procreate. Okay. Because otherwise it's detrimental to our health. It's makes us feel so horrible and we bleed. I mean, who just bleeds? What human, I mean just us women .

Speaker 3: 3:22

What other medical condition

Speaker 5: 3:24

Causes this? Yeah . What do you just randomly bleed? And that's my favorite and it's okay. My

Speaker 4: 3:27

Favorite Chris

Speaker 5: 3:28

Rock . Joe . Yeah .

Speaker 4: 3:29

Well , I don't trust women 'cause I don't trust nothing that bleeds for a week and doesn't die.

Speaker 5: 3:32

I mean, any, like, if a man bleeds <laugh> Yes . He's be like's , I'm bleeding, I'm bleeding, I gotta go to the er. Right? What , help me. Right? A woman could hemorrhage secretly every month and nobody knows about it and suffer that. And then it's like, it's normal. And then she goes about her daily life, like nothing happened . So

Speaker 3: 3:51

If things were perfect, a a woman would just say, you know what? I think it's time to get pregnant. Yeah. And then only,

Speaker 5: 3:56

Only have the cycle then. And only because the whole reason for the menstrual cycle is, we're just gonna go more technical here, is to build a lining in the uterus that is preparing for an embryo to implant. Right. So when our body is basically saying, Hey, look, every month this human, this woman could potentially want to get pregnant. So let's just get ready and build this really, really nice nourishing lining. And at the peak of that cycle, which is, you know, basically halfway through a woman's cycle, usually, you know, perfect cycle is around 28 days, let's say. So in the middle of that cycle, 12 to 14 days, the hormones in a woman's body will trigger a surge, which makes her ovary ovulate. And those hormones have been also preparing while this lining is building to create this dominant follicle, which is like the one, you know, it's like the one, it's the one, the one that's gonna become somebody's mother . It's the , what's that movie? It was like, there can be only one Highlander. Highlander. There you go . So that one is the one, and at that moment, that one will drop the egg, and then if the sperm comes during that perfect time, it will fertilize. Um, well the egg drops and the fallopian tube will grab that egg and carry it through this big fallopian tube and the sperm will find it and fertilize. And then that's the moment that we conceive . So every month this is potentially gonna happen. It doesn't even matter if we want to get pregnant or not. <laugh> . So we struggle. Seems

Speaker 3: 5:37

A little unfair.

Speaker 5: 5:38

Well, you know, most women struggle their whole lives trying so hard not to get pregnant. Right. <laugh> . Because every month there's this risk and it's so scary for them. And then there's a moment where they do wanna get pregnant. And then, you know, statistically it's just that one moment. So then it's so hard when they don't get pregnant. So we go through life wanting this, not wanting this, and it's all focused really around this menstrual cycle. Mm-hmm .

Speaker 3: 6:04

<affirmative> . And these signals are not sent to our body through electrical signals or telegrams, right? Mm-hmm . <affirmative> , the , the , the way that mm-hmm . <affirmative> , uh, bodies communicate with distant organs is through hormones. Exactly. The hormones released by the brain and has an effect on other organs in men. We know that it's released, released by the hypothalamus and pituitary mm-hmm . <affirmative> and affects our testicles. In a woman. It's the same thing.

Speaker 5: 6:24

It's the same thing. Yep .

Speaker 3: 6:25

And so those hormones don't just affect just the, just the target organ. It affects the whole body. Yeah .

Speaker 5: 6:30

And so when these hormones change in a woman, they will feel emotionally different. And it's very variable. And so before, when they're triggering this ovulation time, the hormones are at its highest surge. So they, you're supposed to have more desire. So you'll notice more emotion, you know, more emotionality, more desire to horny. Is that what you're trying to say? Say yes. Thank you, Donna. You're , I mean, this

Speaker 3: 6:54

Is really important because Thank you. 'cause a lot of guys, I mean, you know, honestly, even though I'm in the medical profession, sometimes I'm wondering if I'm imagining Yeah . My wife being like, particularly amorous. Oh

Speaker 5: 7:05

Yeah. Oh my lord . But also, like, particularly irritable too, right. At times. So, and then once the lining sheds, if nothing happens, no fertilization occurs, they just feel so much better. 'cause it's over that whole change in their mood and their mind, their body. So for us, it's a miracle we survive every day . Right . You know, like <laugh> , for us to go through these changes constantly, there's nothing worse

Speaker 3: 7:31

Than Yeah . So, so there's a lot of apps out there for women to track their menstrual cycle.

Speaker 5: 7:35

Yes. There's a , a bunch of apps , but

Speaker 3: 7:36

I really feel like there's a real market for men to track their partner's menstrual cycle. Mm-hmm. <affirmative> <laugh> . So if I was gonna create one, oh Lord, at what point during the days, would I expect somebody to act or feel a certain way so I could, I could provide the most emotional support to them?

Speaker 5: 7:52

Oh, I think like, it's so difficult to say something like that. Yes. I think you should be supplying them . Just

Speaker 3: 7:58

Buy them roses

Speaker 5: 7:58

Every day . It's actually every day old

Speaker 3: 8:00

Man , you guys have an

Speaker 5: 8:01

Agenda. That's the problem. It's every day because that surge time, there's some stuff going on there. And then when the egg releases, that's, you know, a huge time. And then when it comes down, I mean, we're, we're feeling things the whole time. So

Speaker 3: 8:14

You can't get away with every day . Oh,

Speaker 5: 8:15

Every day . Yeah . Every day

Speaker 3: 8:17

Must be

Speaker 5: 8:17

Everyday now all of a sudden. Because then when you bleed, guess what? You feel better, but you're bleeding. That's , and you should get more support. I mean, you're like bleeding things out of your body, you know?

Speaker 3: 8:27

That's true . Even though you're an OBGYN that's been doing this for a number of years, uhhuh you , you still seem kind of amazed by this process. I love that

Speaker 5: 8:34

About you . I'm amazed that we have to go through it. <laugh> It's a miracle because, you know, there are some women out there who don't wanna have children ever, and they go through their whole lives

Speaker 3: 8:42

Bleeding, having to do that. Yeah .

Speaker 5: 8:43

So I didn't think about that . And so there are things we can do to help people not bleed, you know, with birth control pills or other hormonal methods to bypass this whole cycle.

Speaker 3: 8:52

So when they do those kinds of things mm-hmm . <affirmative> , they avoid the bleeding part, but do the other kind of emotional and hormonal components get affected as well?

Speaker 5: 8:59

Right. So it , it does , um, for some women, they actually feel a lot better because instead of having these dynamic hormone surges, they're getting a constant surge of medication daily, a hormone dose that's the same every day .

Speaker 3: 9:15

So there's not a lot of variability from moment

Speaker 5: 9:17

To moment . There's , yeah . There's not as much variability. So when people talk about premenstrual syndrome, which is, you know, right before their menses, they, people get very emotional. Some people get depressed, anxious, those types of , um, feelings can sometimes be alleviated by , um, having a constant hormone dosing. So

Speaker 3: 9:38

Especially people that, where it affects their lifestyle, whether it affects their personal relationships, whether it's they're having trouble at work.

Speaker 5: 9:44

Exactly. And

Speaker 3: 9:45

Then those people need to seek some treatment, not just everyone. Right . Who might just

Speaker 5: 9:48

Feel a little sad. Unfortunately, sometimes it can get very dark and it's, it's called premenstrual dysphoria where they actually are depressed to point that they are maybe at risk to themselves.

Speaker 3: 9:59

So this is not normal. This is not normal, and these people need to seek some type of care. And an OBGYN is an appropriate person to see for that.

Speaker 5: 10:05

Yes. I think , um, most OBGYNs know how to, you know, help alleviate these problems and have some options like we talked about with hormonal therapy and sometimes with antidepressants, conjoining with hormonal therapy to help these, these moments. But , um, this can really, you know, hinder someone's life. So that's why if God was a woman <laugh>,

Speaker 4: 10:26

I thought she was, it

Speaker 3: 10:27

Would be, you know , we would just have

Speaker 5: 10:29

A message. Well, I don't think she, she is. 'cause he would not have done this <laugh>

Speaker 3: 10:35

Definitive proof of the gen indenture of God. Oh boy . Yeah . Thank you all very much too . Diana, thank you so much for joining us. We're gonna be back and talk a little bit about fertility. So , uh, thank you so much, Donna. How do people get a ahold of us?

Speaker 4: 10:46

You can call us at (512) 238-0762 and listen to our podcast wherever you listen to free podcasts. Hello

Speaker 3: 10:52

And welcome back to the Armor Men's Health Show. This is Dr . Mystery , your host. Thank you all to our listeners. All the question askers , even the critics of the show. You really help us keep going. I'm Don , I'm joined by Donna Lee who really suffers most of the complaints of this show. I think I

Speaker 4: 11:09

I get those every now and again. We had a lovely lady who really, she said we were an embarrassment to the community,

Speaker 3: 11:14

An embarrassment to the community. Well, thank you very much, <laugh> . After 12 years of, of training 15 years of practice and helping tens of thousands of patients and saving their lives. That's right. I guess I've let my parents down. I

Speaker 4: 11:28

Love your, your quote when I told you that and you said she had to have listened to the entire show to get the phone number to call us to tell us that. So

Speaker 3: 11:35

I'm very impressed with Thank you lady , your perseverance. Lady <laugh> , thank you so much. I've really appreciate it. It happens. We are joined again by one of my favorite people on this earth, Dr. Diana Wang. Diana, thank you so much for joining us Please . Sweet us .

Speaker 5: 11:47

Thank you. I'm so excited.

Speaker 3: 11:49

<laugh> , this is the second part of our, that's what she said . Segment. This is our very feeble attempts to help our male listeners understand something about their spouses, daughters and wives and mistresses. Oh, and mistresses. So , um, you know , uh, Diana, we see a lot of people for male fertility evaluations and invariably what the men say is, my wife told me to come because it was cheaper and easier for me to be evaluated. But in truth, their wives have also gone through some type of evaluation for fertility besides not getting pregnant. What are some other signs that a woman might have that she might have fertility problems?

Speaker 5: 12:29

Well, before we , um, talk about this, I just want you to know that when those men come to you, Sonny , the women have already been evaluated so much <laugh>,

Speaker 3: 12:38

Right? I mean it's not like it's not fair . It's it's not like it was , it was an afterthought.

Speaker 5: 12:41

Right. Was it was like a begging please go see. Because what has happened is her ob , G Y n , has probably already checked everything and that was the only thing left, which is male factor in fertility.

Speaker 3: 12:54

And that's really important because

Speaker 5: 12:55

It's super important.

Speaker 3: 12:56

It's just parts of their regular evaluations gonna check their fertility. The women often come in with some kind of notion that something's wrong. Yes. And so they really have been evaluated. Yes .

Speaker 5: 13:05

And it's a very simple test. 'cause you, you can just, as you know, check a sperm count and already figure out if this is male infertility. And a lot of times what the men don't understand is it's a combination. You know, if a woman has some issues that is causing her to be having difficulty becoming pregnant for my practice I've seen, you know, I would say 20% of those, the men also have something in conjunction. So I I think it's great that they go, I'm always happy when they finally go see you. 'cause we figure out so many extra things.

Speaker 3: 13:39

Absolutely. And if , and and , and in fact the numbers are that 40% of couples infertility issues are a, a combined thing combined. And especially as couples get older and older, you know, men kind of know that women have fertility problems as they get older, but they may not really know that their fertility problems also get worse as they get older.

Speaker 5: 13:57

Right. And I know I'm not, you know, saying anything against men, but there is this kind of pride men carry around that they are always ri ri and fertile. And I'm so manly <laugh> and there's no way my sprm count could be low. And it's also kind of sad when they do find out. 'cause they get ,

Speaker 3: 14:16

They get , they get so defeated. They get

Speaker 5: 14:18

Defeated . They're very defeated. And we've seen couples in the office when I get reports from you that, oh, you know, your sperm count is low and it's just such a sad, sad moment. And it shouldn't be. It should be, Hey, guess what? We figured it out. Solve a problem. It's very interesting. Right .

Speaker 3: 14:35

Because I think in our society, the female partner carries a lot of the guilt of a , a couple not being able to have children.

Speaker 5: 14:41

It's not, it's not fair. And it's ,

Speaker 3: 14:43

It's unfair.

Speaker 5: 14:43

It's not , it's unfair.

Speaker 3: 14:44

And I think if you were to tell most men, and this is what I do, I say, listen, if you found out your wife had problems, you wouldn't think less of her. You would just kind of come up with a solution and move along. That's great. There's no reason to think that she's gonna think less of you.

Speaker 5: 14:56

Exactly. So I think that's a great message to put out there right now. That you are not less of a man and that is not the judgment of your, your , you know, how vir you are is not the judgment of who you are. And it's, it's good to get checked by someone like you. You,

Speaker 3: 15:11

It's the size of your penis. Right . <laugh> always <laugh> and your hands . Right . And your hands. That's right . Which luckily I have huge hands.

Speaker 5: 15:17

Right . So don't worry about that.

Speaker 3: 15:18

Don't worry. Don't worry . Yes . It hass nothing to do with the size of your, but you have small feet. It's very confusing. Hey , it's very confusing. <laugh> . Yeah . So when somebody's coming in for like a , like even a basic fertility evaluation that who's a woman, what are some tests that she can expect and what can the man expect the woman to go through?

Speaker 5: 15:34

So, you know, something very simple that the man can observe just at home is how regular her periods are. So a woman who has regular periods, most likely is having ovulation. So we are hoping that, you know, the first step is if a woman is ovulating appropriately and on a normal time in their cycle, they are releasing an egg each month. So there's a chance for conception. So if he notices that his wife hasn't had period in like two months, or even some people three months, that's a big zinger that hey, this, this woman may not be ovulating. And there's certain things out there that can cause women to not ovulate. One which is very prevalent in our society right now is , um, polycystic ovarian syndrome. Some women will just, you know, have their lining build up like we talked about before, during the menstrual cycle. And it just stays there. And the menses never release because she never ovulates. And if that occurs, then there are things we can do to help a woman ovulate. There are medications we can give, we can help her release her period. Um, building up a lining that long is not healthy for a woman. It , she can build up endometrial hyperplasia, which can be a precursor of endometrial cancer. So I think number one, regularity of her menstrual cycle.

Speaker 3: 16:54

So it's not a gift that she's not menstruating except every three months because something can go wrong. Right.

Speaker 5: 16:59

Unless she has a reason like,

Speaker 3: 17:01

Like, like she's taking medications ,

Speaker 5: 17:02

Like she's taking birth control continuously or, you know, and there's other things that can cause aary like thyroid disorders or

Speaker 3: 17:10

Excessive exercise or

Speaker 5: 17:12

Yeah. Excessive exercise to the point where her body fat is so low. But that's, that's one thing to look for . The second thing would be, I would say painful periods. So women who suffer from extreme pain and cramping during their periods, every woman suffers that. However, there are some women where they are in so much pain, they can't go to work, they have to stay at home. They have to, you know , have a heating pack . Some women are almost nauseous to a point where they vomit 'cause they're having so much pain. And some have even passed out. You know, like when they experience so much pain. And there's something out there called endometriosis, which a lot of women , um, know about, kind of. But it's actually more prevalent in our society than I had thought. You know, graduating from residency. I, in private practice, I've seen it so much more. And that's when, you know, the menstrual lining can release outside of the uterus and implant in different parts of your pelvic areas . It's

Speaker 3: 18:07

Like having an alien that's not in the right home. And then when it grows grows mm-hmm . <affirmative> and it , it , it , it caught and bleeds. It's bleeding, not in the uterus. So you're having that pain inside your abdomen

Speaker 5: 18:16

As well. So you're bleeding from the uterus, you know, the cramps and then you're bleeding. You know, you're feeling the inflammation inside your pelvis. So when that occurs, those areas of implants can cause scarring inside the pelvis and it can cause infertility.

Speaker 3: 18:30

And you want to get rid of that sooner. Sooner because you can. Right. And so if you have pain that's causing you to have limitations in your activities of daily living, not allowing you to move along or that has worsened from previous periods, these are kind of hallmarks of maybe Right . Seeking an evaluation.

Speaker 5: 18:46

Exactly. I think those things, you know, as a husband or a partner, they can observe this and realize, oh man, she called in from work, you know, she called in sick again from work 'cause she's feeling so sick. This is not, this is

Speaker 3: 18:58

Not normal. Normal.

Speaker 5: 18:59

Mm-hmm. <affirmative> .

Speaker 3: 19:00

And as women are aging, you know, kind of people have this expectation that their , their fertility's gonna drop mm-hmm . <affirmative> . But what I've noticed is women aren't as, and this may be unfair to say that I'm not sure they know when they're actually aging mm-hmm . <affirmative> , I mean , you know what I mean? I mean , uh, you know, oftentimes we'll meet 37, 38 year old women who are saying, yeah, we're thinking about getting pregnant <laugh> and this big, you know, target goes off in my head thinking about getting pregnant. Don't you have any idea how difficult it is to get pregnant after the age of 30 or 35? Well, what do you, what do you teach people when it comes to kind of advanced maternal age and when people should really kind of hasten their fertility evaluation? Mm-hmm . <affirmative> .

Speaker 5: 19:38

Well that's always a difficult topic because for us as women, having that time clock has been an extreme burden to us for many, many years. And I think most women are aware of this. Uh , you know, in society, we've talked about it over 35 aged women pregnant are called elderly pregnancy now. So <laugh> . So it's really actually love that this huge burden we carry. And for me as their physician, it's difficult to talk about because I don't want her to feel pressured either, you know? But we're fighting against this biological clock, which is very unfair, you know, that we have this , um, where men actually don't really carry that as much. 'cause when do you think for men, Sonny , like they're able to , um,

Speaker 3: 20:26

Over the age of 45 and 50 is when we are starting to have some difficulty , but can father chil children even

Speaker 5: 20:32

Seventies and age ? Right. Which is unfair. And so when we talk about this, we have to evaluate what her desires are. You know, I talk about this with some women and they secretly don't wanna get pregnant, but they're feeling pressured by their family, their spouse. They're like, I am not ready to have children. And yet they have to because they're 35. And for me, I just have to give them the data that, hey, you can still get pregnant after 35 safely and have very healthy pregnancies, but as you move forward onto your age, there may be more, you know, challenges , challenges, more risks , more risks. Like , um, his charact

Speaker 3: 21:10

Skin. It reminds of the joke of the , of that I tell, you know how I know that a man doesn't really want a vasectomy reversal because he had a vasectomy, <laugh> . You know, I mean , sometimes people don't really wanna have more children. And , and having that honest conversation that , that's the biggest piece of advice that I have for men out there is that if you, if your spouse or partner really wants to have children and they're approaching or getting over the age of 35, we all just need to be realistic about making sure that we're getting the appropriate evaluation. Right.

Speaker 5: 21:38

And just being very communicative with your partner. It's great to have a good plan going into seeing a doctor because you know, a lot of times the spouses are not on the same page page. That's right. And for us as physicians, you know, we can't coordinate that discrepancy in the office, but we can help if they're on the same page and have the similar goal. And that struggle between them can be very difficult on their relationship. So I think, you know, communicating well with their spouse, Hey, I'm ready to have children, or I am not ready, and being ready to make a plan. And if, if they can't, that's okay too. But it's one of those things that it's, it's been very difficult. We are, it is unfair once again <laugh> that we have that, you know, time clock on us.

Speaker 3: 22:25

Well, thank you so much, Dana , for joining us today. You are awesome. We can't wait to have you on the show again.

Speaker 5: 22:30

Thank you.

Speaker 2: 22:31

The Armor Men's Health Show is brought to you by N A U urology specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.