Dr. Laura Erdman on Hormones & Women's Health Through the Lifecycle. Ep 169
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In episode Sarah is going to be interviewing Dr Laura Erdman who is an obgyn on? WHO's GonNa be talking about various issues that I'm sure many of us are curious about both hormonal general reproductive-health all that good stuff I can't wait to listen to it myself. I'll be tuning in for the first time with all of you. So. Sarah, you are finally making all those annual appointments. Yes public service announcement was skipped everything in the beginning of the year and you have insurance benefits that give you X. visits in a calendar year. Now is the time to book them because everyone else is because I actually literally went to make a PCP appointment in their lake. Sorry you can come in January like no no. No. I can't come in January and I wanNA come this year. Yes Or especially, like eye appointments, you know that has to get done before the end of the year or your contact lens benefits circumstances. Yeah Luckily I did that so I bit. So that's another PSA like. I like to do them all at once because then I just remember to do them I don't have to think about it multiple times during the year and it does mean that that may be like, okay. Go to your ob in your eyes and dentist whatever all at the same time but wake. I find that I don't end up with some of them have different degrees of waiting. So the appointments ended up getting spread out by months. It's just that like the act of making them all. So some people I know like to do that in line with their birthday, which is sometimes what I do, but this year didn't happen because I was like pandemic peak. So yeah, don't forget. You still have time. You still have time make those appointments maybe I should do that too. I'm at least getting to the dentist. That's exciting. And I, specifically asked Laura. If she had any intel on a mammogram because I think you're supposed to get when you're forty which we both are. Awesome. Yeah I think the guidelines in this have have been shifting that it's not necessarily some places do recommend it universally some cases i. you know the broader guidelines that if you don't have a family history or anything that would be concerned than you can wait a little bit and not do it immediately when you're forty in any case I talked about it when I went in you know but I was I was pregnant for much of the time when I turned forty and then now I'm breastfeeding. So that's really not Going to be helpful in terms of screening either so. In my case. Put off for a while but actually that's a really good excuse. I have no familiarity with adult Yeah. You'd think I would have no idea what is recommended for any adult for anything so don't ask me. Let's. All the guidelines sort of change in. Unclear. So but yes, if you are in the market that you should read, this is October Breast Cancer Awareness Month Sarah make sure. That, that mammogram. Though neither Sarah Nor i? Will report back back. All right. It's not going to happen until twenty twenty one because that's when that's when your appointment is. So there you go. All right. Well, on that note, let's let's hear from Dr Urban Alright, I'm so excited to introduce Dr Laura Erdman she is an Obgyn with expertise in well lots of things but especially adult hormones and treatment of Peri Menopausal rate, related conditions including mood issues and everything. So would you like to introduce yourself? Dr Urban Highs Sarah it is my pleasure to speak with everybody today to be on this podcast I. Am an Obgyn physician I practice general obstetrics and gynecology at a community hospital in Maryland. So I see and treat women from their late teen years all the way through until they no longer need a gynecologist through their teenage years the onset of their periods, managing their periods, managing birth control through their childbearing years and today I. Think Specifically, we're going to talk about the challenges that arise when women hit the age of forty and forty going into fifth until they become postmenopausal been at my practice now for. Going on fifteen years at the same place in the same office. So I have patients whom I have known floor fifty years. So I met many of these women when they were in their early to mid twenties, I've seen them get. Help them not period on their honeymoon missing them have their children, and now they're coming to me when they're forty, two, forty, three, forty, four, and life is just changing. So hopefully, we can address some of the common things that happen at this stage and how to stay healthy. Yes Oh, I'm so excited I think this is great and by the way this was requested topic by some of our listeners I think spurred on by some of the discussion that we had about PM and hormones and all that kind of stuff. So. That's exciting and you are mother as well. Yes. I have four children. They are all older. Now I have a son who is a sophomore in college although he's home doing virtual school right now and Msn I'm a little bit happy to have him home again, my next son is a senior in high school with his own set of challenges trying to figure out where to go to college sight unseen, and then I have a set of twin girls who are sophomores in high school. Oh my gosh. So you are not in the empty nest fades yet. That's still like a lot Oh. Yes. Yep. Yep. Yep. It's a very full house at the moment with you know big kids have a different set of challenges. It's nice that they can all get their own breakfast and lunch and I don't have to worry about that and they can certainly do their virtual school by themselves or should be able to but but it's it's a full house and lots of other things to consider plan for and not everybody's driving but then the ones who are driving are really worrisome to. It never stops. You're like, do I want you to drive or do I want you to wait This is a conundrum. It is a big conundrum, but it's overall quite liberating. I will say it's been nice to have an extra driver or two in the family. So cool. Well. Why don't you talk to us I about some of the common complaints and things that you see as women come to you either in their late thirties or early forties? And some of the things you often suggest to help them with it. So one of the main things what one of the things that I tried to to to model my practice around is I've been lucky to have a great pediatricians for my kids over the years and one of the things that I loved about them is that at their annual visit I sort of have gotten over the years. An anticipation of what's to come in their development. So when they were four and I was reminded not to be surprised about nightmares when they were six, make sure everybody knew how to swim and as I've sort of modeled my practice around that so Different Ages. I talked to women about what to expect what's coming, and so pretty much what I'd like to cover when women turn forty is. First of all period irregularities. So periods go wacky at the age of forty for many many many women sometimes they get closer together. Sometimes, they get heavier sometimes stay longer in it's really important to know what is normal versus what is just what is abnormal and could be a sign of something being wrong. So I tried to explain what's going on in the background because that helps a lot of women understand and a lot of. Women whom I see just want to know that everything is okay. They see some changes they don't necessarily they're not bothered by them. They don't necessarily want to treat them are going any medicine. They just want to know that everything is okay. But when you see a change in your period when you've always had a perfectly regular monthly period now all of a sudden is coming every three weeks that might see have normal where actually. Isn't. So it's important to remember that in the background are ovaries are getting better, and so they have a limited life span, which is around forty five to fifty years about the age of fifty or fifty one most famous start the transition into menopause Tomase, your ovaries just stop responding to the input from the rain they start making their Hormuz they stop ovulating but before that they get a little bit lazy and they don't really. Respond they don't really let the brain know too well that they're still doing their job. So your brain starts driving them a little bit harder. The brain doesn't age the brain would like our to keep working for forever. So that signal from the brain gets really really really strong but sometimes array say okay, fine I got it. I'll do my thing and so you get pretty much higher highs and lower lows of your normal hormones. And the cycle links between your periods gets a little bit shorter 'cause ovaries almost working a little bit too well in response to does signal from the brain. So that's why if you've had a period that has always been every twenty eight days and now all of a sudden, it is twenty four days that seems like as almost a week too early, but it's not that's totally fine. That's just the brain responding to that increased influence from the or the ovaries responding to the increased signal from the brain. But also since your hormones are hitting your ovarian hormone estrogen progesterone are hitting higher highs and lows. Things like PMS can become a little bit more exacerbated if you have a much higher progesterone level in that second half of your cycle, some people actually start to feel. The beginning of hot flashes right before their period as your estrogen is hitting alot than it ever has before the period can get a little bit heavier because the lining grows a little bit thicker if that estrogen is high in the beginning of the cycle higher than it has been. So all these things have a reason why they're happening, but they can be really really really bothersome. So these are like higher amplitude screens which were already doing but now they're actually kind of going wider in either direction and potentially at a higher frequency, which is what all of us want right now I'm scared. So. It's really really annoying. Now again, none of this is is is there's nothing wrong. Then this there's note illness there's disease there's nothing wrong but as just really really bothersome and it comes at a time in life where for many women their children are getting older there might be other life changes, just normal body aging into it's more difficult to lose weight the joint start aching a little bit more perhaps there's more responsibility in a job, and so it just hits all together at the very wrong time. I feel like I wonder what the evolutionary purpose of this is although maybe the real answer is well women at that age are kind of. No longer part of natural selection anywhere. It doesn't matter I know how interesting Seem like very, very bad timing. Can you talk more about? Well, actually I have one question and this comes from a little bit of a professional knowledge standpoint that I don't understand maybe you'll know the answer. There will I hear you on progesterone my personal mood issues I know were like my entire second half of a cycle into period and it was it would correlate with like normally like post ovulation was like than the rest of my month was ruined like two three weeks of it. Yeah. Why is that progesterone so bad but then OCP's that can sorry oral contraceptive pills that contain progesterone. Why do those not make us feel? That I have been personally wondering about. So I think that it's the variation, the the progesterone starting to be released when you oscillate peaking and then dropping. And it's not necessarily the steady state of the progesterone like the one that it's in the birth control pills. But rather those wild swings just like some people think that in early pregnancy, the nausea and vomiting doesn't necessarily come from the level of H. CG which is the pregnancy hormone being high because everybody's pregnancy hormone is sky high. It's that rapid increase that swing that goes up and down and there's some evidence for this. I'm probably GONNA get it wrong but in men who I know nothing about medically. But some men with certain prostate artistic. Your cancers also have these wild hormonal fluctuations and they also have a syndrome that's very similar to nausea vomiting of pregnancy, and it's probably the shift, not necessarily the level. So the beauty of birth control pills is that your hormones are steady every single day you say the exact same level of Hormuz? There is no up and down no fluctuation no adjusting to anything. But some people do notice from the progesterone in birth control pills that does make them moodier and that it does trigger acne. So those that progesterone in the pill can still have its progesterone like effects in the body, but it doesn't do that to everybody. Okay we're GONNA take a very quick break and then more into the different treatment options and have lots more questions for you. 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All right we are back and we were just talking about progesterone and I know from my own expertise that there are just that are more or less Andrew Genyk in their effects. So I would think that that might make some impact on whether you might see things like acne can you talk about? Well, two things number one if a woman for some reason doesn't want to go on hormonal treatments but experiencing these wild swings, are there other things that they can do or quote unquote natural methods is something that people ask me about a lot And Yeah I guess just go through and what are the hormonal options. So kind of the non-hormonal things and then the hormonal things that you might do potentially alter some of these swings if they are bothering you in that way. one of the most effective non-hormonal options is the anticipation. So if you have a humongous proponent in almost require my patients to track the periods, and if you know that you every week before you're going to get your period are going to be cranky and tired and hungry for food that is not good for you will maybe that is the week that you don't plan to go to the new restaurant or you don't plan to go to. Stan movie where you're GONNA eat too much popcorn. Maybe that's the way that you don't schedule your big meeting that you could probably do the week after as so that anticipation can go a very, very, very long way if there's a difficult conversation that you wanted to have with your boss or with your children or with your with your spouse again, push it a week. Later you know you're coming up on your bad week. So that is extremely helpful. There is not much in the way of natural supplements or herbals that has been shown to help people try all kinds of things and they feel better which is great. If that's what helps for you I honestly think that it comes back to the trucking in the knowing when it's coming and that's when they take their supplements and they feel better. But I think it's the anticipation of knowing what's coming. In terms of non-hormonal treatment, we have mostly relied on antidepressant medications the whole category of selective Serotonin reuptake inhibitors, which are like your flu Ocsta- Tina, search elaine, which are very, very common for the treatment of depression and anxiety and many women are on there already. So a reminder that are helping with their symptoms already is really useful for women who don't have depression or anxiety who don't normally take these medicines. It's really cool that this can be taken two weeks. Only for the two weeks before the period. So again, here's a period. Trucking comes an extraordinarily helpful because you need to know when to start it. So you stop taking your pillow when you get your period and then you need to start it down the road when it's going to be two weeks before your period. So you're period the to have of your period. The first half is leading up to ovulation. The second half is after you've obviated, the second has much much. Much more consistent than the first half. So once you obviate the second half pretty much lasts two weeks for everybody is the first half that's really variable. So when you track your period, if you have a twenty eight day cycle, you start this medication on day fourteen, two weeks before you're gonNA get your period. But if you have a twenty four day cycle, you're GONNA have to start it on day ten after you've got your period if you're getting period every thirty. Five days, you can start it a little bit later the wonderful thing about taking this medication this way is that it avoids a lot of the side effects like a decrease in your sex drive and the weight gain that comes with them. Why they work nobody really knows because you're supposed to be on him for like six weeks before his impact on but they do work really really really well, and also had a very low does it's difficult to remember to take them. But they do help. It's interesting that there is one that we use for postmenopausal women in a super low dose for the treatment of hot flashes also. And that is on paroxetine will do that and it comes even marketed that way. So they're doing something at the level of the brain. We just don't understand it perfectly well, but that is a nice alternative for a lot of women. I remember when I learned that I was like well, that goes against everything I learned days And there are studies and I think certainly is like the first line because. Shorter acting, but you're right it like shouldn't work but it apparently, but it does but it does and there's so much data confirming it because nobody believed it. So whoever thought of it I don't know but his brilliant. Not and then birth control pills. So it's a shame that they're called birth control pills because really they are Hermano medications that have. So many beneficial side of so many beneficial effects. They're not even side effects. I would even consider the contraception aside effect of all the goodness that they do they come with their risk they're not for everybody. This is something to be discussed with your own doctor. If you're at high risk of heart disease, if you have a family history of heart disease, if you're overweight if you're a smoker if you have high blood pressure than probably not the best choice for somebody. For. A woman who is at a healthy way exercises who has no other medical problems it they can just be life changing they shut down the over completely. So you're void these wild swings of Herman's going up and dash they give you predictability give a steady state. There are certain pills that have certain ingredients and the are the same. They'll have estrogen and progesterone in them. They just differ by the type of progesterone. So when you search around from pill to pills, just trying to find a gesture that agrees with you the best and some professors are really really good and have been shown to trait pms really well to be really good for acne. One long-term benefit of being on birth control pill for five years or more is that your risk of ovarian cancer in the future will go down there really good for your Bowen was most of us are starting to have a little bit of decline and our bone density after the twenty. Really. So having adequate estrogen that was in exercising to keep our from deteriorating up too much before we get into menopause, but it just makes life predictable you. Also really don't ever need to have a period and so if you wanted to skip over the sugar pills and just never have a period, you might have some random bleeding here or there, but it's going to be really light. There's absolutely no purpose in having a period when you're on a birth control pill that makes life really manageable. A lot of women in their forties again have a period heaviness and cramping as the pill can help manage that. And another question that I, hear is women who come to me who other upside or their husband has had of a sesame. They don't need birth control and they think they can't be on birth control pill and again that is such a misconception. So call them hormone pills. I also call them while. So for for me, it's very different angle. It's usually that I'm trying to treat a fourteen year old with us or something, and if I tell the parents that were going to go on a birth control, they will flip over and die. So I say, yes, these are marketed as birth control, but we're just using it as a hormone replacement supplement. Never ever calling them birth control pills. Now I have to say I have a couple of comments but we said and I love everything you said first of all, I feel very vindicated my choice to take one again because I didn't realize people benefit was so strong and I do have ovarian cancer as well as osteoporosis in my family. So Gay Times too, and then the other thing I will say is about the skipping I will I'll just say personally I have tried that and I cannot make it terribly long without having a lot of spotting. So I guess your mileage may vary on that one. It probably just depends on the person and their uterus and God knows. Very much. So so there are pills birth control pills that are marketed. Where you only get period four times a year. That's not by accident. So when we put somebody on those birth control pills, we tell them give it six months. So give it until the second package to make sure that you're not spotting all the time. The first time that you try to skip over your period by the time we get to about I think it's at seven weeks or so about fifty percent of women will start spotty. So few just take a four day break and seven days of sugar pills is a little bit too long for days is ideal. So you just take a four day break. Let Yourself. Have a little period then and then go back on it again, the next time by it's about nine to twelve weeks that fifty percent of women started spotting, take a little break and then it's really hard to make it past sixteen weeks for two to sixteen weeks. It's very difficult to make a past that point without having some spotty. That's why those pills are marketed. That way they could have picked a period twice a year that could have picked period three a year but people would hate it because at the very end of each pack, almost more than half of people would have been spotting. So that's why they picked a twelve week break and that is so interesting to know that the longer you're on I guess because you're lining. Thins the more more lucky may have with stretching it out. So okay, that's very, very useful information. Now, one thing I know our listeners are going to be curious about is, what's the Max Age that you can take birth control pills? Is there a expiration? Is it like your brain will explode second? You take a pill in your forty five or like you know what's When do you have to stop in and then what could you potentially switch to I was hoping for that question. So one of the other goals of being on a low dose birth control pill in your forties to completely avoid the craziness of the transition into menopause let that happen the background. So menopause is is the transition that happens when you're over a stop working and it is the exact same thing as puberty, but in reverse. But culturally, we have no patience for Peri menopausal women. So I. Have Daughters who are fifteen years old and so from the age of like eleven until now boy are we patient with them and they can screaming Al and they can bang doors and a week later they're perfectly normal beautiful human beings again, and we don't think anything of it. We call them teenagers we call it puberty were kind to them. We give them a lot of leeway but I am about to turn fifty years old and if I lose my temper I'm a bad mother I had a difficult day at work I need more sleep and this shouldn't happen and so that is really Something that culturally we need to get better at but. When you are on a low dose birth control pill. Again, you're Hamas are steady state your over in the background are still going through their aging process and getting ready not to work. So for somebody again, who's healthy with no risk factors for heart disease while I do in my practice is when the women just to be fifty years old, I'll ask her to go off of her pill and I'll send her to the lab to check the hormone that the brain makes that drives the ovaries. If the ovaries aren't working in sending a signal back, that's going to be sky high. That's called an H. level so you've gotta be. Off Your pills for a little while like three six weeks. Go check enough as h level. If it sky high in through the roof that means you've completed the transition into menopause, you have no clue that it happened and you're done no period irregularities you probably didn't feel any hot flashes. You probably had no surprises with your period and these mood variations. If you have this h level isn't in that range yet, you can go right back on your pill and we'll check again in a year. So I took it fifty, one, fifty, two, by fifty, three, fifty, four I get a little bit nervous keeping people on the birth control pill. But. Usually by then most people have transitioned into menopause or they just don't want to be on it anymore. So then. And if you're not feeling too well and then all of menopause heads and you can't sleep and you're having hot flashes and you have joint deafness and you can't get out of bed in the morning. Then we can talk about going on hormone replacement therapy. So that is not for everybody but Health Initiative study from twenty years ago has really been teased out. So people women in their fifties can't go on hormone replacement therapy very safely. Right at the transition into menopause for short course like two to five years. So eventually, you do have to come off it without increasing their risk of breast cancer. Those heart disease risks are always there because that's what these Harman's do but you don't. have to worry about a risk, an increase in the risk of breast cancer in the only difference between a birth control pill and hormone replacement therapy is the dose level. They are the exact same medicine, but a birth control pill is about eight to ten times higher dose than what you need. So if you did well birth control pill, now you're in menopause you can just think of it as a dose adjustment but I don't WanNa give you ten times as much medicine as you need. No that totally makes sense and then you could be gradually come to us the over the next decade or. Whenever safe to do snow depending on risk factors. So once you have been on it for a few years, especially as are approaching sixty I'll tell them you've got to stop, and usually all we win it off over the course of six months because if you stopped them abruptly, you'll have this hot flash says you feel too good but there are a lot of different ways of cutting back little by little in a way that takes. Six months, and again, if we think about that theory of the drastic changes, if we don't do it drastically, we do it little by little. Your body slowly gets adjusted to slightly little bit lower level of estrogen as time goes on and then I mean eighty year old women don't have hot flashes anymore because their bodies used to they're very low estrogen level. So you just want to do it slowly as your body adjusts to that new. That makes sense. Well, that was super super helpful. I think that people are going to. Feel Very. Educated after this episode as to some of the underlying physiology of why we feel certain ways as well as some of the available modalities for treatment. So I thought that was really really helpful. What do you? What do you have? I know that one very common complaint in Peri Menopause in is something that you mentioned, which is issues with weight and body changes. What do you tell your patients about that or you know what advice do you typically give them I think that one is the toughest one because all the birth control pills or hormone replacement therapy in the world. Is Not going to help with weight especially with the redistribution of your weight over to across your Middle Amazon women were used to couple pounds over our ideal way. It's all in our is in our hips and it's really easy to in two weeks eat really well exercise a little bit more and we get right back into our address. Now, all of a sudden, it comes into the middle and I think that is a huge challenge that has to do with the pathway that our body now uses to metabolize our food. A really beneficial PAPPA is up regulated by estrogen his. Estrogen levels start dropping another. The replacement in the world isn't going to help it. It goes down a different path, which is more similar to men, and so we end up with like the analogous of a beer belly, which is really annoying. It's the time to really be. Conscious about what we`re I think especially for women who are lucky enough to never have to worry about their weight. They've always been able to eat whatever they want head and that's not necessarily a healthy way of eating. So paying attention having a majority of vegetables, limiting your carbs to a quarter of your total meal intake staying well hydrated and most importantly staying active and it doesn't have to be anything fancy walking for thirty minutes. Five Times a week is going to be. Probably Enough Morris better. You've gotta work on your strength. You've got to work on your balance you've got to work on your flexability. Those are all things to keep you healthy as well, but it's just a matter of. Watching, your food intake making really healthy choices. Now, if you never had to before and also some of it, you can't do anything about and just accepting that this is how it's going to be. It doesn't have to be bad. You can manage it but you're never going to have the body that you did what you were thirty. I think you know we have to at some point acknowledged that our bodies are only going to age in one direction they are. Will ask me. Well, if I take hormone replacement therapy, will my wrinkles go away? No, that's another one that's not going to change either. But again, sunscreen moisturizer getting enough sleep drinking enough water you can do a lot to make them not horrible. Botox. Sorry. Anyway. So well, okay. This has been fantastic. Is there anything else you would add to as advice where listeners or anything that we didn't cover with respect to hormones or getting older or peri menopause or or anything Matt only other little plug that I love for women who don't want to be on hormones whose main problem is just period bleeding as to remember to consider an IUD, they're super save they can last for six years. Now, the really good ones that make your period very light or non existent and I don't know if it's urban legend or not. But. If, you go to obgyn conference says most of us who are in attendance are women and informal polls of the audience have showed that about eighty to ninety percent of those in attendance at one of these protests and containing IUD's just because it makes your period really light or non-existent makes really easy to live with. So I'm a big proponent of those to do suppress. In women too. So you may not fight right some some proportion it's not it's not super predictable but for women who are afraid who don't any hormones that all the the such low dose and it stays just within the uterus only really the amount of progesterone circulating in the rest of your body is almost none. So this stomach side effects are very, very low. I did have copper for some years and let me tell you I'm glad. I, don't have it anymore. Yeah. Yeah. Those are they're they're great at preventing a pregnancy, but they're not so good for your period. Do its did his job very nicely to prevent pregnancy. So I'm great I'm grateful for that, and let's remind our forty year old and forty one and forty two et cetera listeners that you can get pregnant and dot exempt from needing birth control or if you do not want to continue to extend your family. So to remember to talk your Obgyn and not just assume that once you were at a certain point that is not going to. Surprise babies happened all the time. Yes and sometimes that's welcoming. Wonderful. But just make sure that you've thought about that. Okay. So one thing we do before we sign off as we always share our love of the week I will go first to give you a chance to make sure you have yours and mine you already do. But anyway mine is. So you guys know I talked about the baby sitters club and my love for the Netflix series as well as the book series when I was kid and the Comic Book Series Still Exists Now and my daughter likes those to. The author of a series called the startup squad reached out to me. The startup squad he called is like the baby sitters club of the modern age, and it's a series book with a group of four girls that are are getting startups and he was right. My daughter was super super into them. They said, she loved how the girls had all different backgrounds and. All different kinds of ideas and so if you have kind of like an eight year old ten year old maybe even like eleven who is into series books and want some inspirational reading that's still really fun. You should check out startup squad and the authors names are Brian WICE Feld and Nicole here that's my love of the week this week Oh. That sounds awesome. Very, very cool and so modern to. Yes while I thought long and hard about this and my my love of the weakest kind of my love of my career and it's an APP for your phone. That's a period tracker that's called clue. There are a bazillion different apps out there, but I will give a shout out to this one. It was developed by a bunch of physicians over in Europe. There's some big health award that's given in Europe to like the most innovative physician or development and of several years ago this APP won that award. So it's very well maintained the information that you can get from it as super reliable it's free and you can track absolutely everything. Often people think of using a period tracker to see when they're gonNA ovulate when they want to get pregnant but you can use. It as the opposite. So as a natural family planning if you want to, but it has almost every single pms symptom listed and you can list your own and so it's really helpful I. Think it's really helpful to to women in general from me for their physicians. Extremely helpful. So and somebody causes my period is irregular. I asked them to pull out their APP and read it off to me, and then I can tell them it is right. Isn't. So it's it's a good habit to get into an can help avoid a lot of worry and a lot of. As time goes on and it's free so it's nice to have. That is awesome. I will admit I tell my patients to track but I don't give them a specific wreck but now I will and I'm going to check it out my child so good about clue. Well. Thank you so much for being on the show. This was fantastic. So informative I, think that a lot of people are GONNA get a lot out of it. Where can they find you if you have social media if they have any other things to ask her accolades to give I do my practice is a small practice in suburban Maryland, it's called It used to be called Charles Street Obgyn, and so our website is W. W. W. Dot C. S. obgyn dot com. I will admit that it's my younger partner who maintains our facebook page and I believe that we do have linked to it from our website. So awesome facebook. See US Obgyn, Charles Street Obgyn. and. So yet when suburban Baltimore? So if you're in the area, it would be lovely. Yes, you're going to get. Very. Cool Oh that's wonderful. All right. We'll. We'll have to look for you. There I'll maybe I'll convince you to start an instagram handle by the time this airs and we can link to you there as well. Thank you so much for being on and have a wonderful day. Thank you. It was my pleasure in hopefully a little bit useful for for women as they navigate their forties and stay healthy. It will be. All Right? Yes. So that was great. Thank you, Sarah So this question comes from a listener who says that she has been listening to off the clock tidying up in the kitchen. So Gold Star for listening to my books while multitasking while her husband was putting the kids to bed and she was contemplating opportunities to linger, and soon after she was cooking her fiercely independent two and a half year old son to go to the potty fundraising teddy climb into bed during this frustrating process was acutely aware of how many times she was saying quickly. She's always been conscious of how she speaks to her kids but the note signed seeing that the more impatient she wants to get into bed the would resist. She's keen to get on top of her quickly habit. The obvious solution is to start bedtime early. So there's less need to rush, but she says in a practical sense, there will always be times in life when I do need to keep things moving for various reasons and I hope the kids can learn to respect that. So I started thinking about how I talk about time in general and she is curious about how we talk to our kids about time thinking about how they spend it the responsibility to others in terms of punctuality respecting other people's time choices I'm. So what do we do to talk to our kids about time? A mostly GONNA leave this one to you. I don't feel like I have mastered at all. I will say there's certainly a countdown timer leaving for school cameron we have to leave in six minutes camera we have to leave in. Et CETERA. But. No I don't have grants I will say I I enjoy Annabel and I. Some has will sit down with our planners and I think using planner is a great way to get a little bit of a grasp on you know what time you have available on how you might like to use that but alleged do planning I'm curious what is she putting in her planner? Then you'll plan her entire day she'll be like check boxes. Check. Box Eat. Breakfast Tech. I'm like, Oh, I learned from. Mommy. Really, cute yeah. Plans for next year coach has her own So we've talked about like, what are you gonNA. Put in there. I need to help her with the weekly spreads dessert. Sure, we could all use her help with our weekly spreads exciting for animal that she has. Professional consultation options in in her own home and so young. Yeah I think talking to children about time is. Just an interesting concept, a little kids have very limited concept of time in general. They are very much in the present and that's fine That's what they are. That's obviously challenging when you need to move them from the present to something that is happening in the future and I know that one of the things during this pandemic that has been sort of. You know. Easier in many ways from a people's, there's less of that rushing to get to some time specific thing. That you know if baseball canceled gymnastics is canceled schools. There's no rushing to get in the car for anything and in some ways that makes life a lot more relaxing even if it introduces for different challenges as well. So you know always being like the countdown, the NSA we've decided that we wanted to go do this and you know you're going to have fun doing this and so in. I'm giving you a five minute warning and so then they can. They're not yanked out of whatever fun thing they were absorbed in quite. So immediately talking with little kids obviously. Setting routines like I. We do this than we do this, you know I, we eat breakfast, and then we brush our teeth and then we put our shoes on and then we get in the car or at night first week try the bathroom than we wash our face in whatever like just do they understand how one thing happens after another I think. As kids get a little bit older, you can start introducing the idea more of thinking about the future and sort of planning your process toward that. You know certainly of kids start getting weekly assignments. That's a really good opportunity like, Oh, well, your teacher wants you to have it on Friday when would you like to do it and let them consider The various options in if they want to do it, Friday morning I mean you can let them try why not? Right like let them figure it out that there are than rushing coming in late bedraggled I mean this is a learning experience that then helps them as they get two grades where it actually matters more that you can map out your time. For things that happen in the future you know against smaller children talking about how many sleeps there are. Until we leave for that trip on, they wanNA know what they can expect in the future actually for my eldest for Jasper we've had a lot of conversations about not wishing time away like sometimes he's very much like I can't wait till this or I. Only eight more days until we're GONNA, do this as well. Yes. That's true and we are looking forward to this and in eight days but there could be fun stuff in this upcoming eight days and we don't want to necessarily lose sight of that in our rush to get to this thing. So that's that's one of the things have been been trying to. Talk about. You. Know I think time management something everyone has to learn for themselves. I mean you can offer guidance and help kids learn to think about how they sink through their time and how much time stuff is probably gonNA. Take taken when they probably can get to it. But until you are in charge of your own time, fully it's it's sort of hard to absorb many of these lessons and many adults are not good at them. No, that's our. Not Saying that adults learn them either. So there you go but. I I agree that yeah. We spend a lot of time often yelling at kids to hurry it up and it might be good to think about that as as we did. All right. Well, this has been best of both worlds. Sarah has interviewed a doctor, Laura Erdman and Obgyn, and we will be back next week with more on making work in life together. Thanks for listening. You can find me Sarah at the shoebox dot com or at the underscores shoebox on instagram. And you can find me Laura at Laura Vander Kim Dot Com. This has been the best of both worlds podcast. Please join US next time for more on making work in life work together.