Midlife Matters: Navigating Perimenopause and Beyond

[00:00:00] Joy Rios: Hello there and welcome to the HIT Like a Girl podcast. My name is Joy Rios and this is a show where we talk about how complicated the world of health care is, complex, and each one of our guests gets to share a piece of essentially their puzzle. Like how do they make it better? And I would like to give you a moment today's guest an opportunity to introduce yourself.  

[00:00:30] Joanna Strober: I am Joanna Strober, and I am the founder of a company called Midi Health, and we are a midlife care provider for women, really between 35 and 65, for all the things they go through during that time of life. 

[00:00:41] Joy Rios: Okay. Can you tell me a little bit more about your journey and how MidiHealth came to be?

[00:00:49] Joanna Strober: Yeah. So we started Midi about two and a half years ago, but it really stemmed from an experience I had with experiencing perimenopause. And the reason I stress the word peri is that we all know what menopause is, which is that period of time after you've stopped having your period, but the symptoms of perimenopause, which is the decreasing in estrogen that starts in women's bodies around 35 actually causes a lot of the problems that women experience in their bodies.

The decrease in estrogen is related to joint pain and sleep issues and anxiety and depression and vertigo and hot sweats and all of these other things that are all related to really the estrogen decline. It actually turns out, for example, that your hair loss and bases that start to look old also related to estrogen decline.

So because you're not in menopause, very few women understand that these things are related to being a female and require expert female oriented care. So we started MIDI to basically provide that level of expertise for women's bodies and women's health. really during this time of women's lives.

[00:01:58] Joy Rios: Okay. So I am, I think right in the middle of that, I'm 44 years old and I've been, started collecting like resources and tools just for me and everybody that I know who is essentially unsure of where we are on this stage, right?

It's not like you have a map and you're like, this is exactly where I am. Like, it's mysterious. And from what I understand, there's hundreds of different symptoms that a person can feel all related to the same thing, but nobody is exactly the same and their experience is unique, right? But it's all just supposed to be like that's just part of it. So handle it.

Can we talk just about that and where you are coming into sort of, it sounds making make it a little bit better, especially if it's female focused care.  

[00:02:47] Joanna Strober: We just did a study of over 100 doctors and to understand how they view this. And they basically believe that 80 percent of women will go through these things, but they're not really a big deal.

And so yes, but this is male and female doctors because the things that are a big deal are life threatening deals, right? And the things that are all the things that I was just talking to you about, whether it's joint pain or lack of sleep or increased anxiety or heart palpitations, all those things are seen as they're not, they don't require surgery and they're not going to kill you. So you should just deal with them.

And I think finally women are saying, actually, I don't need to deal with them. And I would care for them. And really the good news is there is very good treatments available for them. And I want to stress that. I believe a lot of us and you said you're talking to your friends about it.

You're, “Oh, what's going on?” Part of it is that we don't know that there are good treatments. So therefore we don't know to go to a doctor for them. And then one thing is that a lot of snake oil gets marketed to us, right? So there's so many like movie stars talking about supplements on Instagram saying they're going to cure one of these things or another, none of which are actually medically proven to work.

But we get sold a lot of snake oil. And so what I have realized and through the research that I've done with our team is that this is a medical issue and there are medical solutions to it. And women need to know that there are doctors who are experts in this and providers who are experts in this and they can go and get care for all these things.

You do not need to suffer through them. But because there are not enough providers who are trained to do this, and there are not enough, there's not enough information out there about how you can get treated on this, then that's really what's going on. I do want to pretty quickly bring up painful sex as a really good example, right?

Because on every single podcast or every single TV show, people are talking about erectile dysfunction meds, right? Everyplace erectile dysfunction meds are marketed, everyplace. So erectile dysfunction meds are marketed everyplace because people make money on those medications. That's why they are marketed.

Women have painful sex that is actually a huge issue for them that starts around 35 or 40. Because of the decrease in estrogen, our vaginal walls get thin, which makes sex less enjoyable and can often make it painful, so women then lose interest in sex because it hurts. Because that medication is not widely marketed, because no one makes money on that medication, no one is telling women, raising their hand like they're erectile dysfunction.

Sex doesn't have to hurt. No one's doing that. Our doctors all know exactly what to give you in terms of prescription medications that are very inexpensive and generic that can make sex feel good in a week or two. It's magic! But women don't know about that.

[00:05:41] Joy Rios: Wait, what are they called? Because we know what Viagra is called.

What's that one called that should be at the tip of our tongue?

[00:05:49] Joanna Strober: It's vaginal estrogen. It's just a generic medication and it is magic. And literally we have women who come to us who have not had sex for three to five years and two weeks later they are enjoying sex again.

[00:06:00] Joy Rios: Is it topical? Is it a pill that they, it's a topical ointment or cream?

[00:06:00] Joanna Strober:  Exactly. It goes in the vagina and it thickens the walls of the vagina and brings moisture back to the vagina and makes it so that sex Is enjoyable. Again, that is so important and because people don't make money on selling the product, no one talks about it. And so to me, this is a really good example of what's going on in women's health.

So we have care providers who were trained to talk to you about these things. There's also other things you can do for your vagina. You can put DHEA on the vagina, which actually increases testosterone, which also makes sex more enjoyable.

[00:06:35] Joy Rios: What is that? What if, I don't know what DHEA is?

[00:06:37] Joanna Strober: It's a essentially a medication that turns into testosterone. It's a precursor to testosterone, but it is just something that you can put on the outside of your vagina that actually increases the pleasure of sex. There's also actually an arousal cream that we can prescribe you that increases the power of orgasms.

[00:06:55] Joy Rios: Tell me more, right? It's incredible.

[00:06:58] Joanna Strober: Yes, but all of these things, they're not manufactured by someone who's marketing them, so no one talks about them. This is just one example of women's health though, right? This is a really important one, but it's just one example of a very undertreated area.

[00:07:11] Joy Rios: So certain things that I've heard of, literally, friends that have told me that they're experiencing itchy ears, right? Okay, where did that come from? Or literally itching, bright nipple. And I'm experiencing night sweats. And I'm, okay, this is not my favorite.

Yeah, it's all related. And is there something that can be done for each one of these symptoms? Is it symptom based that we should be thinking about how to take care of ourselves? Or is it holistic? Maybe it's both.

[00:07:42] Joanna Strober: For about 90 to 95 percent of women, estrogen will take care of all of those symptoms. If you have a uterus, then it would be a combination of estrogen and progesterone. If you don't have a uterus, then it would only be estrogen. But most of these symptoms, including itchy ears, and itchy other places, and certainly including night sweats, can be treated by a combination of estrogen and progesterone.

If you don't want to take estrogen and progesterone, or if you have breast cancer so that you cannot take estrogen or progesterone, then there are non hormonal medications that absolutely work for these things or supplements that work. So there are on all of these things very good options for you. None of these things have to be experienced. You can, you could take care of all of them.

[00:08:32] Joy Rios: And is it the kind of thing that I would need? Can I go to a pharmacy and sort of self medicate? Or do I need to go to a doctor and have them direct me? And then also do I need to be specific about the doctor that I go to? To your point if not all providers are well versed in this stuff, I need, do I, is it a primary care thing or do I need to go see a specialist?

[00:08:57] Joanna Strober:  This is why we started MidiHealth. Essentially, there are very few specialists. So the challenge is that there are not enough trained providers in this care that understand hormones and understand the right medications or non prescriptions that people should be taking for this care at time. MIDI, we've actually started something called MIDI University, and it's a training program that we put all of our providers through to explain to them all the different symptoms of menopause and all of the ways that we can cure menopause.

And perimenopause, I want to stress the perimenopause, that starting around 35 or 40, we have experts for all of these different types of challenges, and we have care protocols that have been written by experts in each of these areas that we use to guide our providers toward giving them good care. And we've had to develop this because there are not enough trained experts out there.

[00:09:51] Joy Rios: So how many folks have gone through that training and also how many need to still go through that training? Because I imagine that would be extremely valuable for provider population.

[00:10:01] Joanna Strober: We have about 100 providers right now and we're increasing rapidly, but we have, so we have a combination of physicians and nurse practitioners who are all trained.

now to provide this type of care.

[00:10:12] Joy Rios: Okay. And I just think as a patient, what questions should a patient be asking if they go see their provider and are looking for this type of care?

[00:10:20] Joanna Strober: Yeah, you need to make sure that your provider is extremely up to date in all of the research on hormones, on who should be taking hormones and what the doses are of hormones, what your different hormonal options are.

There's a lot of different options. There's patches and pills and gels and creams, and you need to know which is the most appropriate one for you based on your health profile. So when you talk to a provider, make sure that they're up to date on all of the most recent research.

[00:10:49] Joy Rios: Okay. Now, is this the kind of thing that is available for all types of insurance? What's the model? Is it an employee benefit? Is it just included in my insurance? How am I accessing it?  

[00:10:59] Joanna Strober: So at MIDI, we are getting in network with as many insurance companies as we can. We currently have care in 14 states. We don't go into a state until we have about 50 percent of the PPO population.

So we are, we're working on getting as many lives covered as we can. And we're doing that rapidly. I think we'll be in 50 states next year.

[00:11:18] Joy Rios: And you said you guys have only been around for a couple of years. Is that correct? Okay. So I would love to learn about just the trajectory of your business, the business side of things.

How do you go from not existing to working in 14 states and hopefully 50 relatively soon, that must be a rollercoaster ride in and of itself.

[00:11:35] Joanna Strober: So we spent the first year building care protocols. Our company is fundamentally based on expert care protocols. So we spent the first year developing these protocols and making sure that, and creating MIDI University so that we would be able to offer really high quality care.

And at the same time, we were working on getting insurance contracts. We didn't launch until we had insurance contracts and we had these care protocols built. But since then, the growth has been really strong. We have a lot of patients who are growing much faster than our. Then our business plan would have expected and so we are the number one complaint we see from people is why are you not in my state?

So we or why do you not take my insurance? Those are the two right? Why are you not in my state and why do you not take my insurance? So we know that expanding states and expanding insurances is the key to serving a lot of patients and really democratizing access to as many people as possible to get access to this care.

So that's really what we're working on.

[00:12:34] Joy Rios: Are there any specific challenges? Because I imagine this populate, the conversation is around women's health, which tends to be controversial, but not in the reproductive side, right? This is the other, side of that spectrum. Do you run into any kinds of challenges based on it being specifically women's health and having to do with the retirement of our reproductive organs?

[00:12:59] Joanna Strober: It's interesting that you say controversial. I don't think it's controversial. I just don't think people have been known to look for it. I think that once you explain to women that their bodies do function differently, as we age, estrogen goes down. That results in a lot of changes to our bodies. You need to go to a provider that is an expert in that.

Once you explain that to people, it doesn't It's not really controversial at all. I think it's actually common sense.

[00:13:23] Joy Rios: That's not the controversial part. The part is that it just hasn't been focused on. This has been happening to women's bodies for, since women's bodies have existed. It just seems that now there are more resources available to them and because of studies, right?

Oh, we're including this in the information that we study about the human body, that women's bodies are not just smaller versions of men's bodies.

[00:13:49] Joanna Strober: I think that's it. Partially, and I think it's also that younger women are demanding it. I actually think some of this is women are saying, you know what? I shouldn't actually have to just deal with these symptoms. There needs to be research. Now there's more money available because women are directing research dollars and women are directing investment dollars.

And so they're saying, look, this is a massive opportunity to help women and to create big businesses because women are a big part of the population, actually and have deserved better care than they've been getting.

So I actually think some of it is the demand from younger women who are saying, I don't need to suffer. And why are you not putting more money into helping me?  

[00:14:29] Joy Rios: Can we talk about the research aspect? What research is now being done specifically.

And also if somebody wanted to participate in research, do you know how they might get to do that and say I want to be part of the solution?

[00:14:41] Joanna Strober: That I'm not sure how to participate. So there was a study done in 2002, the women's health initiative and that study has been widely seen as one of the worst things that ever happened to women.

It was misinterpreted. It was seen to have told women that they shouldn't take estrogen and that estrogen gave you breast cancer. That has been 100 percent debunked. I want to be really clear, 100 percent debunked. That said, that study did a lot of damage because for about 25 years, all research on women's bodies and estrogen stopped.

Now, people are going back and looking at the data and saying, actually, no, not only does it not cause breast cancer, but it looks, studies appear to be showing that it reduces heart attacks, that it may be reducing the risk of Alzheimer's in women, that it is clearly preventive of diabetes. There's a lot of benefits from taking estrogen.

For 20 years, that research stopped. Now people are going back and re evaluate and doing the research again and saying actually there's a, we should be paying much more attention to this work. And so there's a lot more research getting funded now on that, that had stopped for a long time.

I'll tell you a fun story. Actually, in the fifties, women used to put estrogen, a form of estrogen on their face. And all of this, if you go look at ads in the fifties, they say, this is the best thing you should put on your face. The research actually shows that's the case. That in the same way that I explained to you that the vaginal walls thicken through putting estrogen in the vagina, it actually does the same thing for your face.

A version of it thickens the epidermis, bringing more moisture to your face. In the 70s, I believe, the FDA said estrogen is gonna be regulated by and require a prescription. What happens? All estrogen comes out of face creams. Period. Because you can't make money on it. It's the same problem as we keep on getting to.

If you can make money on it, it can go in a store and it can be sold in the department store. Then it gets a lot of attention. When it has to be a prescription, then it's not. So now we are actually prescribing women the estriol face cream that has been 100 percent proven in studies to have a 60 percent efficacy rate in increasing the epidermal of your face.

[00:16:54] Joy Rios: And I imagine that might reduce the appearance of wrinkles too.

[00:16:58] Joanna Strober: Yes. And you know how old ladies, sometimes their faces look very thin, right? So that reduces that because it thickens the wall of your face. So it does, it reduces wrinkles, but it makes the skin healthier and look healthier in the same way that the vaginal skin does with you when you put the cream that I mentioned earlier into your vagina.

[00:17:15] Joy Rios: Is it the kind of thing that has to be regulated? I don't know that you know the answer to this. This is just my thought process. Why? Viagra is available over the counter, right? Somebody can go… 

[00:17:25] Joanna Strober: Viagra is not available. No, it's prescription.

[00:17:27] Joy Rios: I live in Mexico. It's available over the counter here.

But is it the kind of thing that, I don't know, that in places here, where I am, is it is something like that available over the counter in pharmacies ? Would anybody ever be trusted to use an estrogen cream on their face and just decide that they wanted, that's what they wanted to do, or it has to come through prescription? I imagine it has to come through prescription.

[00:17:52] Joanna Strober: The vaginal estrogen that we talked about earlier, you can absolutely get that in Mexico at a pharmacy. So you don't need a prescription in Mexico for it. The research level of estriol in the face cream is not something that most pharmacies would stock.

So you'd have to go to a compounding pharmacy. But in Mexico, they, my guess is it would also be available over the counter. You would just have to go to a compounding pharmacy to create it. I haven’t gone to Mexico to those pharmacies that have a lot of different things that are available to you.

It is the case that vaginal estrogen is 5 dollars or something like that in Mexico and it's easily available.

[00:18:28] Joy Rios: I think I can report back to listeners. I'll put this on my to do list as research. So where do you see y'all going from here? I guess that's my, you guys have had a really quick trajectory to date and it sounds like where you're going is all over the U.S. Will you guys also be expanding beyond the U.S.?  

[00:18:49] Joanna Strober: The U. S. Market is a big market, so we're really going to be focused here. My goal is honestly for all women to know that they don't need to suffer, that the symptoms they were experiencing can be treated. And I want them to know that they should have access to great care.

That is our mission and that we want to make sure that women have access to providers who are trained. In women's health to give access to great care. And one thing I want to quickly say is a lot of the problem with this is that we have OBGYNs and we have primary care doctors and they view the world very differently.

So one thing we're trying to do is bring that the two together that we are a women's health specialist, including both the primary care and the primary care specialty care in one place. And with your podcast, you talk about this a lot, the fragmentation of the medical system, right? So we're trying to fix that fragmentation by offering everything in one place so that you can go to a women's health expert, not necessarily talk about delivering babies, but to talk about the other issues that are happening in a woman's body.

[00:19:46] Joy Rios: I love, love, love what you are doing. And I'm very excited to see you grow and Midi grow over the next decade, really. If people want to follow you if they would like to get access or either to you or to your organization Where would you direct them?  

[00:20:01] Joanna Strober: Yes www.joinmidi.com. You can get care there

 [00:20:05] Joy Rios: And is that for patients like me? As an individual I can go?

 [00:20:09] Joanna Strober: Yes, and if you need to drive over the border to California and we have lots of California providers who can help you. Please do not do the call while driving. We absolutely ask our patients not to do the call while driving because we're having a lot of people who want to do that. So we're asking to pull over on the side of the road.

Women are really busy, right? And so this is actually the perfect way they can get care. We find that they leave work and they go sit in their car in the parking lot or they find a closet at home. But it's great that they don't have to go in person to the provider and that they can get it virtual.

This is also the perfect mode for that because honestly when you're talking about painful sex or you're talking about these other issues, you don't really want to be sitting in a doctor's office. It's much better to just be sitting private and having these conversations.

[00:20:55] Joy Rios: I will definitely be checking out joinmidi.com and sending our listeners there as well. And I will report back on what I can find in a Mexican pharmacy. Thank you for your time today, Joanna.

Thanks for listening. You can learn more about us or this guest by going to our website or visiting us on any of the socials with the handle HIT Like a Girl pod. Thanks again. See you soon.

Again, thank you so much for listening to the HIT Like a Girl podcast. I am truly grateful for you, and I'm wondering if you could do me a quick favor. Would you be willing to follow or subscribe to this podcast or maybe leave us a rating or review? Or if you're feeling extra generous, would you share this episode on your Instagram stories or with a friend?

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