Alyssa Dweck MD on Reviving and Keeping the Sexual Spark Alive with Linda Kreter
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Welcome to Wise Health for Women Radio with Linda Prater. Women are pressed daily to give more, learn more, and be more, often at the expense of mind, body, or spirit. Each week with intriguing guests and topics, we'll bring you fresh ways to view your limited time, encouraging a shift to new, healthier perspectives. Wise Health for Women Radio, helping women thrive. And now here's your host, Linda Prater.

Good morning and welcome to Wise Health for Women Radio. I'm here today with Dr. Alyssa Dweck, who is a practicing gynecologist and the chief medical officer of Bonafide, which is a company we'll be talking about because we're going to be discussing something that every woman goes through at some point or another, which is our gynecological health, menopause, perimenopause, comfort at every stage in our life, and staying healthy.

in touch with our intimate side, no matter where you are along the age spectrum. So I am really pleased to introduce Dr. Dweck. If you don't mind, I'll call you Alyssa. And Alyssa, welcome to our show today. Thank you so much. It's a pleasure to be here. Well, I think that we all, not all, but many of us who are post-50 experience

grew up in an era where we learned a great deal about what it was like to be a young woman and what will happen when you reach puberty. And then you will go on to have children if you choose to and all of those things. But then there was very little discussion about menopause and even less discussion about perimenopause or how early it could start or how

when you had a hysterectomy and were thrown into immediate menopause. And many women in our audience have faced a lot of these issues. And being a woman is complicated sometimes. It's not as easy as we sometimes think it is. But when we have answers and we know we have resources, I think it goes a long way toward giving us confidence. Do you agree with that?

Absolutely. I mean, you know, they always say knowledge is power. And I think that anticipation with knowledge in mind is going to make these transitions a little bit easier. And at least we can prepare and be proactive about some of the changes that are going to be inevitable.

Well, I also think that women are of the mind these days that, what do they say? 60 is the new 30. People are keeping in good shape these days. They expect to be the same as they were 20 years before. And regrettably, that doesn't always work that way. But the mind-body connection is very strong. And as you say, being knowledgeable goes a long way towards making you feel better.

And I do know that when, I mean, I was one of those that had really easy time throughout my entire female life until I hit perimenopause. And I have a hard time discerning what part of my life was through the strain of some life events that were going on and what was really menopause. But I will remember feeling like a glow stick.

under great stress and having flushes and hot flashes and really thinking, this is not fun. My poor aunt, she always looked like she'd just been in a shower. So some of us have a harder time than others, but there are ways to manage all of these things, especially if you know that

how to take care of yourself, what the changes may be, and to not fear them, but know them instead. Right. I couldn't agree more. So first, I always think it's important to put out some definitions and just some general statistics. So menopause is by definition

12 consecutive months without your menstrual period. So mother nature can trick you from time to time. And some women will go 10 or 11 months, think they're done. And then there you go with one last period and the clock starts ticking again. So that definition is important.

Number two, there's been so much confusion, even though this is probably just semantics, but the term perimenopause are those years leading up to menopause. And for some women, it's, you know, four to even 10 years. So it really can be long lasting with symptoms that are intermittent, bothersome or not. So I think that's an important just sort of baseline.

70% of women in menopause suffer from your glow stick phenomenon where they are having hot flashes and night sweats, which are what we call vasomotor symptoms of menopause. And the crazy thing is, is that a very good proportion of these women seek out absolutely no management options and just are suffering. So I think the good news is so many more people are speaking about this now and we can talk about different options.

so that people can manage this a little bit easier. I fully agree with you because I do know that it was, well, it wasn't among my mother, my aunt, no one talked about it at all.

And then when you, and then my mother died in my 20s, so I didn't have someone to talk to me about, you know, what to expect, you know, even from a familial standpoint. And it wasn't the sort of thing we all talked about. It just simply happened.

was something you, as you put it, suffered through or conquered or just kept going. But I think once symptoms really start to bother you, you do start to seek answers because we are a generation that wants answers. And so we start to look for, okay, are there any symptoms

ameliorating things that I can do. Can I try nutrition to make a difference in my symptoms? Can I try different exercise? There's a lot of things you can do. Mindful thinking. I do know that stress added to symptoms and people are not always aware of that. You're so right. I think the hardest part of perimenopause is that these symptoms are

that you're speaking of, whether it's hot flashes, night sweats, whether it's a change in weight or the way weight distribution is noted, a change in sexual habits or drive or dryness, and even mood changes, especially irritability. These things often take women by surprise during the perimenopausal time. And there's kind of a disconnect between

I can't tell you how many women come into my office in there. Let's just say in their early to mid forties, Dr. Dweck, I think I'm going crazy. Some days I don't even recognize myself. My moods are out of control. I have no patience or tolerance for things that usually didn't bother me.

And then when we talk about maybe some irregular bleeding habits or a couple of hot flashes here and there, the connection is made and we can realize that there's a physiologic cause for this, which is the drop in estrogen due to irregular or absent ovulation.

Then you throw on top of that all the life circumstances that we all face and they, let's face it, they tend to get more complex with age and time. And, you know, these things can be bothersome. But I love that you brought up one of the first measures to help manage symptoms of all types, which is diet, because this is something that really can be addressed and done in a proactive way well before symptoms get out of control. Right.

So for example, there are many triggers that bring on hot flashes and night sweats that are in our diets. Caffeine is a common one. Alcohol is common. Artificial sweeteners for some people, large meals, spicy foods, processed foods. These are a couple of very common triggers for hot flashes. So something to keep in mind.

When it comes to weight management, which so many people are really concerned about, rightfully so, because we want to try to maintain our weights and be as healthy as we can from a cardiovascular standpoint. The Mediterranean style diet, which is not a crash diet to try to lose weight, but it's a lifestyle, is definitely linked with longevity. It's linked with excellent cardiovascular health. It has...

ties and associations to better immunity. Also, we don't see the, um, you know, peaks and valleys in sugars, um, so that, you know, those types of, uh, symptoms of, you know, the racing heart or palpitations or, or anxiousness due to high sugar or high caffeine, uh,

may not be an issue if this diet style is followed. So I think that's an important point to bring up. It's a really important one. And I think it also helps to regulate your mood, your self-perception. I think a lot of symptoms can be managed too by a little more self-awareness of, all right, I feel my anxiety rising that sometimes will trigger more anxiety

uncomfortable symptoms. So I'm going to be mindful about what I can do to manage the peaks and the valleys, because I think that's the difficult part. If you can minimize the peaks and the valleys and make it more steady, it goes a long way. And I am one of those who never had any PMS, et cetera. And then when I got toward perimenopause and into menopause,

I wanted to kill people. I mean, I thought it was like PMDD. I was like, okay, this is really not good. Now I understand what my fellow sisters went through in terms of the mood changes. So that was a surprise to me. But once I became aware that that, thank goodness, was short-lived because I learned to manage it. I think one of the other things that

was very bothersome that does affect quite a few women is the brain fog.

And we've all had vicarious trauma through the last couple of years with the virus, with the isolation, with the uncertainty, with the anxiety, with just things not being normal. I personally believe normal is a setting on a dryer, and that's all it is. But brain fog is distracting.

And we don't feel as sharp as we did. And that is a very discomforting thing.

Yeah, well, it's also frustrating. And let's face it, a lot of women worry when they have brain fog that they really have something organically wrong. And that's frightening. And of course, that always should be looked into, especially if the fog is notable. But keep in mind, sleep is so important in maintaining acuity, mental and emotional acuity during the day.

And that's not only the quality of sleep, but also the quantity of sleep.

I noticed that a lot of women have no trouble falling asleep during the perimenopausal or menopausal times, but they have trouble staying asleep. And that interrupted type of sleep can be really jarring to the mental acuity in the morning. I find that most people complain that they wake up because they're, let's say having a hot flash and it's physically uncomfortable. They need to change out their sleep clothes or whatnot, or they maybe need to go to the bathroom and

But then when they try to fall back asleep, the busy mind takes over and, you know, those racing thoughts come about and it's really very difficult to fall back to sleep in a restful way. Your mindfulness exercises can actually play a really big role here to help people sort of quiet down that busy mind.

and get back to sleep. But brain fog in part is due to poor sleep, whether it's quality or quantity. Again, a couple of helpful tips when it comes to sleep hygiene, making the sleep chamber a ambient, comfortable temperature. Even if you have to freeze out a partner to make yourself comfortable, they can

They can wear something a little warmer. Give them another blanket. Absolutely. If you have a partner that snores, I hear this all the time, that keeps you awake or wakes you up, then mitigate that, whether it's with earplugs or some sort of treatment for the partner who's snoring, and that may really be helpful. And then shut down those screens a good hour before sleep because

although I can't really explain the ins and outs of this from a physiologic standpoint, apparently the lights in our screens really do interfere with brain waves and interrupt our sleep, and that's problematic. So sleep is the first thing to help combat the mental fog.

Second would be to treat things that are physically uncomfortable, like hot flashes and night sweats. And whether that comes in the form of, you know, an herbal supplement or a hormone therapy or something in between that's pharmacologic. This is very helpful to keep people comfortable so that they can focus and feel like they're sharp.

Well, if you've ever had young children, you remember what it felt like to have interrupted sleep for months on end. And I remember describing it like being pecked to death by a chicken.

because you were exhausted in the morning. You weren't yourself. And it was reminiscent of that because falling back asleep was very hard. It's often a very busy time of life during this period, both with young children and then later on in life after you're launching them in many ways. But it's also super important to keep your sleep comfortable and consistent because

Because it's not just for your mental acuity, but it's also for your restorative part of your brain. No question. The connection between Alzheimer's and poor sleep is proving out very,

pretty conclusively. So it's very important that we don't just shrug off. I can get by on four hours of sleep. You really do need more than that, correct? Yes, absolutely. So, you know, the standard seven to eight hours is usually recommended. Again, everybody's going to have their comfort zone as to their duration of sleep. Sleeping even too much can make people foggy. Some people will complain of headaches or fogginess.

The other thing is diet related. Again, what do we do when we haven't had enough sleep? Well, we get sleepy. So we start eating high sugary or high caffeinated foods in order to stay awake, which not only is not that kind to our waistlines, but also leads to the crash afterwards, which is even more disconcerting. So I think we can 100% agree how important sleep is on so many levels.

The mental fog also comes about because of hormone changes. You know, we do have hormones receptors in our brains and with drops of estrogen, we will see changes that go on with our neurotransmitters. And so that's going to have something to do with it as well. I often recommend puzzles or reading or music or taking up another language, something to sort of exercise the mind to keep things as sharp as possible.

Well, I think that's good advice anyway, because I think that we can get caught in a rut. I'm a lifelong learner. So I'm always, always learning something because I'm intrigued by it.

And I find it gives me new topics to talk to people about too, which helps as we're really trying to form back social connections that may have been a bit stifled or have gotten stale. And so it is important to constantly be, well, for me, it's important to constantly learn. And I agree with you. I think it's fun to learn new things anyway.

And then let's talk about the fact that not only do you have some brain fog, it may feel like you're managing your stress better. You're working on your sleep. The mood changes. Frankly, your hair and your skin change too. And that can be very abrupt. You go from this oily skin with a lot of acne growing up and then suddenly you

It's an about face. Yeah. So this is typically in part, at least hormonal as well, because what happens is the ratios of three, you know, hormones, estrogen, progesterone, and also testosterone become altered during perimenopause and menopause. And so higher androgen or higher testosterone ratios are

can often lead to a resurgence of acne, which is seems so horribly unfair, but it can happen. So that is something to keep in mind. Most of the time we'll recommend, you know, topicals or maybe even a visit to the dermatologist to get something a little bit stronger to manage that. And some women even notice, you know, coarse hairs that may grow on the chin or in the

Luckily, that's pretty much short-lived. The main concerns that I see in my practice are some of the changes in skin, like fine lines and wrinkles, you know, due to diminished collagen and diminished hyaluronic acid, which naturally are in our skins, but diminish significantly with age.

And I also see a lot of women complaining about their hair. The first sign of hair loss, often that they're, let's say they have a part in their hair that it sort of widens a little bit and they can see their scalp or that when they're showering, they're noticing clumps of hair or more than the usual amount of hair coming out. And this can be so disconcerting because it's outwardly apparent and women definitely want to do something about this. So, uh, certainly we want to make sure we're not missing any, uh,

dietary supplements like vitamins, vitamin D, and there are surely products, in fact, Bonafide just launched a newer product called Silvessa, which is like a combination system just to address these symptoms of fine lines and wrinkles in the skin and also hair thinning that occurs due to hormonal change of menopause. So that's important to know. Well, and I think what you're creating and

at Bonafide is very interesting because with hormone replacement therapy, there were first studies that said, no, this is problematic. And then those outcomes were reversed and they said, no, no, it's not problematic. And so a lot of people have been using bioidentical hormone replacement therapy, but there are others who would really rather use natural safe alternatives.

And that's what you're offering in all of your products. Am I correct? Yeah, absolutely. So I think that in practice, I usually really see a pretty good distinction between, you know, those who just want to be on hormone therapy because they want to, and they feel that the benefits outweigh the risks. And of course we go through that on an individual basis. And

And there's definitely a big camp of women, particularly in my neck of the woods where I practice in New York, who would prefer either a natural herbal supplement or just at least something non-hormonal. So yes, and thank you for bringing up the Bonafide products. I guess the real...

flagship product that I was originally introduced to and really stand behind is called Relazen, which is made from a Swedish flower. So it is not hormonal in any way. And unlike some of the other over-the-counter phytoestrogens or plants like substances that are estrogen like,

This has no estrogen component. So it's been extremely helpful to manage hot flashes and night sweats of menopause in women who can't take hormones or who don't want to take hormones or, you know, have fears because of their family histories or their individual circumstances. So this has been quite helpful. And I think the most important thing is that there is science and clinical research that really support the safety and efficacy of these products.

So that is something that is very important to me as a clinician. - Well, I think it's critical that we have choices because until recently, and I would say, I don't know the exact time, but it's around a decade or so,

Functional medicine, getting to the root of problems as opposed to symptomatic relief only is new. And so when we start to look at solutions that really are helpful to people and give them choices,

I think it offers a freedom that we didn't often have. So as an example, men are given Viagra, so there's no end in sight to their sexual libido if they don't want it. But women often don't feel the same way or have symptoms that make it uncomfortable or dry, or they're just done. I mean, I've talked

I've talked to so many women who have such varying ideas on this that, you know, 60 is now the we're done stage as opposed to 60 is the new 30. Whereas I think there are other people who feel like, okay, this is great. I no longer have my period. I can be as spontaneous as I wish.

Some of your products really do help with the fact that libido can go down, response can be diminished, but there are alternatives to this that can be addressed, but you have to be brave enough to ask your doctor about them.

Right. Or your doctor or health care provider needs to be, you know, bold enough to bring it up. They're not. I mean, I will tell you from personal experience that, you know, in many, many instances, you know, I have asked questions of doctors I were going to and

They had been trained many, many years before. And they didn't really want to talk about these uncomfortable things. Whereas today, I think everybody realizes you are able to stay in shape, keep going a lot longer than you maybe did before.

And I think that we want to know that we could be sexual beings as long as we wish to at a comfortable level. But there are variances among us all. And that's a personal choice for people. But isn't it nice?

that you have created these products that will actually help people be exactly where they want to be at whatever stage of life they are. Yeah. Look, I set realistic expectations and I'm one of those doctors who's specially trained in female sexual health. So I'm the one who asks patients about their sexual health and wellness. And they look at me like I've got three heads if they're not interested in talking about it, but

I'm glad you brought up that many providers don't because that's changing, but you are absolutely right. We're not taught this in medical school. It's an uncomfortable subject matter. The other thing is that there are, there were, and still sort of are instances where many practitioners don't know how they're going to handle these complaints. So they'd rather not ask because they don't have a solution that they feel comfortable with.

I think first and foremost are the vaginal changes that occurred during menopause really take women by surprise. These are changes like dryness, like inelasticity, like, you know, burning women will say, my vagina feels like sandpaper. I razor blades. I'm, I don't want to engage. It's so uncomfortable. And this is something that we do have.

management for. So for example, we talked about hyaluronic acid, which is a super duper moisturizer. And so many of our face moisturizers and body creams and whatnot, it is a natural substance that we've always made a lot of, and it diminishes with age. We now have hyaluronic acid in the form of a little insert that you can place in the vagina, maybe two to three times a week to maintain wonderful moisture.

And studies show that in nine short days, women will notice improvement and then improvement gets better over time. And studies show that these improvements are occurring on a cellular level. So if you look at vaginal tissue under the microscope,

after there's no estrogen exposure whatsoever, like a menopausal vagina, and then look at the same slide or tissue that's been exposed to hyaluronic acid regularly, we will see changes that mimic those of women who are well estrogenized. So that gives us a lot of hope and optimism in terms of this type of product, really managing some of those uncomfortable effects of menopause. So that's important.

Moisturizers need to be used regularly. So unlike hot flashes or night sweats, which sort of run their course, and yes, they may last many years, but they will eventually end, vaginal dryness and those changes tend to be chronic and progressive. So they need to be managed continuously.

And then lubricants go such a long way, whether you appreciate like a regular water-based lubricant from over the counter or a silicone variety, or even something simple like coconut oil, which lots of women love. Those are used on demand to help during intimacy to facilitate and diminish friction a little bit. So moisturizers and lubricants are also often a first step.

And there's so much more we can do to manage discomfort of intimacy, but it does depend an awful lot on motivation. It really does. I think one of these things that is striking me is that if you

want to have these kinds of discussions, you do have to find a receptive practitioner to have it because Dr. Google will give you 6,543,000 answers to things that are not necessarily correct. But it really is, the body is an amazing thing and we can adapt over time.

But again, you mentioned it earlier, knowledge is power. So knowing that there are answers, knowing that the vagina has elasticity, that you can moisturize, that it can be comfortable, that you don't have to have pain during intercourse, it really does make a difference for people. And I also think there are a lot of people who are dating for the first time in middle age.

after a very long period of time. And so the world has changed and you may not have kept up with it, or it may feel just very uncomfortable in terms of re-entering into a dating scenario or just feeling sexy again.

And I think that that's a really big part of a woman's self-confidence is feeling that they're attractive, that they are just as fun and sexy and vibrant as they ever were. They're just wiser. Yeah, that's a really good point.

I will say to your point about being new in the dating world, my gynecology perspective has to come out here and recommend condoms for protection, just in case you're with a new partner. Right. Because it's not only teenagers who get exposed to infections. So I'm just making a little plug for that. And the second plug I need to make is that

the women in the perimenopausal timeframe are still susceptible to pregnancy. So that's something to keep in mind. If that would be a problem, one needs to take precaution for that. So just two little pearls that I always want to bring up. No, no, those are very smart pearls because...

I think, was it a couple of years ago, they were talking about in retirement homes that there were a lot of sexually transmitted diseases. Yes. And it was because it was, there was sex going on. Some of it known, some of it not known because they were in memory units or things like that. So it's amazing how the...

Parts of our life don't ever go away many times. So I'm glad that you mentioned condoms and STDs and pregnancies and things, because those can really change the trajectory of that aspect of your life, can't they? For sure. I also wanted to bring up another population that I see so frequently, and that's the breast cancer population. Yes, absolutely.

Because many, many, many of these women are just so much younger than what we would might typically think and really go through a sudden change into menopause. Surgical menopause, right? Well, surgical or just chemical menopause due to treatment parameters. So that's something that we're always thinking about, especially with the vaginal changes because

Many of these women had very active sexual lives that were not being interfered with by lower libido yet or by, you know, sexual pain or dryness. And so these are people who really do benefit from, you know, preventative vaginal moisturizers and lubricants. So I just wanted to bring that up as well.

You're absolutely right. The breast cancer population is a growing one, regrettably, but the good news is many more people are finding that they have solutions to some of these problems that they perhaps didn't have before. And that's what you offer with Bonafide, yes?

Yes. So again, these are non-hormonal nutritional solutions to so many of the common menopausal and perimenopausal complaints. So we really are focused on safety efficacy through science and then also the non-hormonal vehicles.

Which is super important. And I think that the alternatives are so important. You are also the co-author of three books. And I really think, well, first of all, I think people who write books are amazing. I'm an editor of books, but I am not an author. So talk about some of your books and what was the impetus for writing them?

Right. So my favorite book is my latest book, which is called The Complete A to Z for Your V. And I think you can all probably understand what V stands for because this is my language. But, you know, I really am approached all the time from patients, from friends, from family members.

about what is normal when it comes to gynecologic issues. And that's the big question. Am I normal? Is my bleeding normal? Are these hot flashes normal? Do I have sex the normal amount of time? People just want to know what's normal. So I thought that it would be really interesting to put together with a co-writer of mine, a co-author, a book

about the A to Z for this so that we really cover every topic that has presented itself to my office and to my practice. So that's really the brainchild behind that. And, you know, it's fun and it's the type of book that doesn't have to be read cover to cover, but rather interesting subjects for each individual can be looked into. Well, and I think everybody has different questions. And so I know that I,

I've spoken with a sexologist on the radio before. And so people are really eager for information on an intimate level so that they have answers to their questions and they don't feel like they're in the dark. You are not kidding. And the funniest thing of all, I'm sorry to interrupt. No, please. You know, so many people buy books of this nature and who's really sneak peeking a look at all of these chapters?

It might be the men in their lives. Which actually would be very helpful because some people need a map. They need, what is it called? Waze is the GPS system. Exactly. So we have to be kind because just as we weren't fully informed, I don't know that the men in our lives are always fully informed. And a lot of that is because there needs to be two-way communication.

And so the more confident and comfortable someone feels about talking about these things, and your book, I'm sure, is very helpful for that, it really does make a difference because two-way communication and engagement and not feeling inadequate, because I think that confidence can be shot in just a phrase or two. And so, but on both sides,

So I think that really does help to have people have discussions. But I also want to make sure we have where people go to find out more about your solutions. And obviously, your books would be under your name. And I'm sure they're wherever books are available on Amazon, Barnes & Noble, et cetera. And I'll put those names in the show notes.

And then the website, correct me if I'm wrong, but it's hellobonafide.com.

And you have just a plethora of products that are for wellness, that are for menopause, perimenopause, intimacy. There are just options that I don't know that people actually even know exist. So you go everywhere from physical arousal to hormonal variation to itching and discharge and painful sex and make it all far more pleasurable because there's

we're sexual beings and it would be nice to be comfortable and confident at every phase in our lives, yes? - Absolutely, and thank you for that shout out. I also wanna make note that there's some incredible content

educational content about all of the subjects and then some that we've been speaking about, much of which is edited by me and or even written by me. But, you know, these are sourced from experts in the field. So I think that's really important because, of course, you know, women want to know.

We do want to know. Inquiring minds want to know. And I was enjoying reading some of your blogs prior to the show, because I think sometimes a blog seems like a very friendly way to get information and it is a shorter commitment time. But again, it brings up things that you can talk with your

your friends, you can just learn yourself, but it also brings it into the common vernacular so that people are talking. Because I think that in many ways, after a couple of years of isolation and concern, as we talked about at the very beginning of the program, we want to go back to what feels more routine.

or start new routines and become our best selves again, because it's not easy to reenter after a period of time where things were just not routine.

in any way, shape or form. And so I think that what you're sharing here today is super helpful because there are answers. So when you want more information, go to hellobonafide.com. That's hellobonafide, B-O-N-A-F-I-D-E.com.

And I urge you to do it because, again, knowledge is power. Having communication skills to talk about some of these things, I think you'll find it's actually fun to talk about these things with your partner because it certainly is a change of pace from talking about what's for dinner.

Very true. Thank you so much. You're so very welcome, but I don't want to get off the show before mentioning that you have a wonderful English bulldog called Pearl, who I know just has your heart. And frankly, I think our pets are just as important as our family members, if not the most important family members are.

because of the unconditional love they give us. So thank you for sharing. I will say she shared a picture of Pearl with me. It was an English bulldog who was white in color with a few spots and very sweet. And I think that these are things that keep us human and happy. And we are so much better for having learned from you today. Thank you for sharing your wisdom.

It's my pleasure. Thanks so much for having me, Linda. It was my pleasure. And again, thank you for your time today. You bet. Make it a great week. Thank you for tuning in today. You can find more shows at wisehealthforwomenradio.com.