Episode 96: Dr. Julie Thorne

Dr. Julie Thorne Answering All Our Women’s Health Q’s

This week Samantha chats with Dr. Julie Thorne, MD, MPH, FRCSC, OB/GYN. She is the lead for Family Planning at Women's College Hospital and Mount Sinai Hospital and Assistant Professor at the University of Toronto. She is an advocate for contraception, knowing our bodies, for taking care and really getting to the answers that we need.

In this episode Sam asks Dr.Thorne all your most wanted questions. How to feel comfortable about opening up and talking about your women's health issues, sexual health issues and reproductive issues. Diving into what contraception options are right for you and what works for your personal body and the difference between pelvic and cervical pain and what can be causing it.

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Podcast Script

Sam: [00:00:00] Monetize your passion for wellbeing like a job you love every single day. Find a happy life from a healthy lifestyle. What's up guys. This is Spin, Skin and Other Addictions, a podcast by me, Samantha E Cutler of The Fit Fatale. Each week I'm going to take you deeper into the world of wellness with entrepreneurs who are building brands designed to better your life.

[00:00:27] So you'll be hearing from fitness gurus, medical specialists, and influencers in the world of fitness, health, beauty, and nutrition. I hope you guys love it. Let's get down.

Dr.Thorne:[00:00:40] If you think you have a problem or you don't know if it's normal, then you have to ask. And I don't know if that means that you write it down or ask it out loud or ask somebody you trust first. But I know that I've done a good job. If someone can come to me and tell me that they are worried that their orgasms aren't good enough, like that's not something that everybody would necessarily go to their family doctor with. But if you're not [00:01:00] sure you have to know that those are questions you should feel comfortable to ask.

Sam: [00:01:04] You're listening to Spin, Skin and other addictions episode number 96, I made a promise to all of you last year that I would dive further into the conversation of women's health. And I'm doing that today with Dr. Julie Thorne who is an OBGYN here in Toronto. She is an advocate for contraception for knowing our bodies for taking care and really getting to the answers that we need.

[00:01:30] All of these things that stand for, and I personally have gone through this experience myself with winding up in places because I was in pain or wasn't really getting the right answers. And although this is a podcast, I hope that this can give you a little bit more insight into the medical specialist you should be looking to. Asking questions and the ways that you can do that, and just really feeling comfortable and opening up about talking about your women's health issues, sexual health issues, [00:02:00] reproductive issues, and diving into what contraception options are right for you and what works for your personal body.

[00:02:06] I hope this episode simply motivates you to get the answers that you need for your body and to really advocate for yourself. And I want to just start this by sharing. I know that can be difficult for so many. It can be uncomfortable to talk about our health as women. It can be uncomfortable to have those conversations, but it is necessary.

[00:02:30] We need to break the stigma and we need to really just continue this conversation. Through social media, with our friends, with our family, with our significant others and with our family doctors. So I hope that reminder just sets with you today and inspires you to take control of your own health here.

[00:02:50] And without further ado here is our guest today, Dr. Julie Thorne.

[00:02:53] Hello everyone and welcome to another episode of Spin, Skin and other addictions. [00:03:00] Today, I am joined by Dr. Julie Thorne, an OBGYN and in charge of family planning at Women's College hospital, Mount Sinai hospital, and also an assistant professor at the university of Toronto.

[00:03:13] I have been so excited to have this podcast with Dr. Thorne, because as I have my own personal women's health journey, but so many of you listeners have come to me with different questions and what we can tackle here on this podcast. So I have the best of the best here to do that with me today.

[00:03:29] I'm so excited. I'm a little bit of my own personal questions. And of course, some of your questions in this community of what we can answer around women's health and what is going on and getting to know our bodies more. So without further ado, Dr. Thorne, would you please give us an intro a little bit on your background and how your love and passion for helping women has really come to be.

Dr.Thorne: [00:03:52] Hi Sam. It's so nice to be here and to join you on this podcast. My name is Julie Thorne, I'm an obstetrician and gynecologist at a Women's College [00:04:00] hospital in Toronto, Mount Sinai hospital and the University of Toronto.  I have a particular focus and interest in contraception and family planning and I did some extra training in that are really founded a bit in my own interest in reproductive justice and it spilled over into my interest in global women's. I've spent the last couple of years doing some work here in Canada, but also in Kenya where I just moved back from on the heels of the pandemic.

[00:04:27]But I'm excited to be joining you today to get into some of these topics and and to talk about the roles that contraception can play.

Sam: [00:04:34] Yeah, I'm so excited and you have such incredible experience and knowledge, not just here in Toronto, but globally. So it's really interesting to bring that perspective as well to the conversation.

[00:04:44] So I want to get started with asking you what does a patient's journey look like? And I know that's a very broad question, but I'd love to hear from your perspective, how does that come into play with you as the doctor?

Dr.Thorne: [00:04:56] Yeah. It is a really broad question. Whe re do we start this [00:05:00] journey?

[00:05:00]I've done a bit of work with journey mapping before, and it's a little bit like, wait, you have to choose what your journey your starting point is. And then where do we go from there? And the journey is maybe recognizing a reproductive health need, and then trying to address that and navigate, discovering what your options are and how to access the healthcare system.

[00:05:16] And for some people it's trying to get in to see their family doctor or their nurse practitioner so that they can talk about what it is that they need. And that's not always an easy thing for them, either from a system standpoint or just not every patient feels comfortable talking about their reproductive health or their sex life or their menstruation with their doctor.

[00:05:35]And then sometimes people need to see a specialist and getting in to see a specialist can be pretty hard to find the solution that they're looking for and  so maybe that's a one patient journey anyways.

Sam: [00:05:48] Yeah, absolutely. And, I hear from a lot of people as well when I was sharing my personal story, just how difficult it is to find, like you said, either you're to get ahold of your family doctor necessarily to solve [00:06:00] any of those questions that you're having, or get to a specialist or the person who understands exactly what's going on with your body.

[00:06:06] And so finding the right fit, I'm sure, from both a doctor's perspective and a patient's perspective is so important. We've seen so many different trends happen, especially in regards to the pandemic over the past year and a half. What are some of the bigger trends that you are seeing in women's health and how has the pandemic affected that?

Dr.Thorne: [00:06:23] Yeah. So the pandemic has affected even that just really basic journey. Just in that initially everything's shut down, accessing her doctor was hard because a lot of people just closed their doors. Or people thought that they couldn't go to the doctor because they thought they would be closed because everything was shut down. Or they were afraid to leave their house or even if they could see them in some way, they couldn't see them in person or they would have a prescription, but they couldn't get it filled. And so there's, certainly a lot that changed or that was affected just from accessing care during the pandemic.

[00:06:52]And that includes things like birth control. For whatever reason you're using it and pharmacies are only dishing out maybe one month supply at a time, for example. [00:07:00] Or people who wanted an IUC or an Intrauterine Device couldn't get in place or couldn't find a place to go or couldn't get removed if they wanted it removed because they couldn't find a place to go.

[00:07:08]The trends, the virtual environment has changed so much. And in, in some ways we hope it'll make things more accessible. You can get on the phone and you don't necessarily need to disrupt or take your whole day off to, to talk to somebody. And maybe that can make your in-person visits more efficient. We can share resources, so if I'm on a virtual video call, I can pull up my screen and show them all sorts of things. We've can doing a lot more emessaging with my patients. And so just from providing care  that pace has accelerated and trying to think of different ways to communicate.

[00:07:37]And I don't know that the pandemic has necessarily impacted what women are doing. I think we've seen an uptick in intimate partner violence. That's not a nice trend, but it's a trend and that's problematic. We've seen a whole change in the dating scene.  For people who are single and what does that mean?

[00:07:52] And what does that look like? And that changes the landscape too, of thinking about things like sexual pleasure .  Those are some of the trends, or things that we talk about. [00:08:00] And then anxiety has played a really big role in how people are coping in the pandemic.

[00:08:04] And I think even in gynecology, we're seeing that in how people are managing what their pregnancies manifestations of menstrual abnormalities I think are like these physical, like real physical expressions of what's going on for them from a mental health standpoint.

Sam: [00:08:18]  Yeah, and I want to dive into some of more of those in deeper questions, but one of the things you touched on early in the trends that I think is pretty damn cool is the fact that things are more accessible to get ahold of your doctor.

[00:08:30] Like you said, you can echat, you can jump on a call and I think that a few years ago, That seemed impossible and unheard of and getting answers. The only options were Google, which we all know is like a deep, dark hole of despair when it comes to health. And so having professionals that you can actually access, especially if it's your own, that's treating you, I think is one of the bright lights that has come out of this and technology advances.

[00:08:55] For, maybe hospitals that weren't thinking of doing that because they were a little bit more old-school. So I love [00:09:00] to hear that trend from your perspective as a doctor, but from a patient side as well. I've had a few phone calls and it's been like, wow, why did I ever have to leave my house, find parking, like just become so much more simpler.

[00:09:12] And so in regards to stress and how that's been affecting women during the pandemic, I want to talk a little bit more about that and how have you seen that affect women's hormones, their cycles, the pain you mentioned quickly manifest. Strange periods or strange pains in our periods because of the stress that we were feeling and, many still are feeling we can say we're still in this, but we're like coming out of the darkness and hopefully get to stay in the light.

[00:09:37] But tell us a little bit more about how stress and anxiety does manifest within our hormones, in our periods and cycle.

Dr.Thorne: [00:09:44] I think that from like a physiology standpoint, that is an evolving area for trying to understand how it works. But we know that it's true immediately. We often lightly say that period is the fifth vital sign, if you will. If we think about like our blood [00:10:00] pressure and our heart rate and our oxygen status, your period is your fifth vital sign. And for some people they can start to develop bleeding,  irregularities, or even miss periods for periods of time. Any kind of stress can do that, whether it's mental stress or physical stress.

[00:10:15] Some people notice bigger fluctuations in their mood swings. PMS involves some pretty big chem, involves some pretty big changes in mood for people. And that has to do with our neural hormones as well as our reproductive hormones and the way they play off each other. And I definitely think that when someone's mental health is not as great as it is in times of anxiety and disruption  then we see bigger fluctuations in their mental status according to their cycle.

[00:10:40]And then we see it with pain and then, one of the overall trends I've noticed in women in general is that they're really keen to understand their bodies more. They're asking why, they want to know they're following and tracking what changes with their cycle and wanting to understand what's natural and normal.

[00:10:56]And that is neat for me because what we are seeing is that people are coming in with complaints [00:11:00] for pain and I want to say it's a little bit more. I've been practicing in Toronto only for the last year because I was away overseas . So I don't know if I can observe it as a trend because of the pandemic or if it was happening before that.

[00:11:11] But I think it was, and I've had a lot of women say, I had a bit of pain before and I'm really anxious and now my pain is worse. Do you think they could be related? And I think the answer is yes. And I think that could have both a physical reason for it, depending on the reason for the pain, as well as that just everything can be heightened, right?

[00:11:26] Just like your senses can be heightened than your experiences and physical sensations can be heightened when you're anxious.

Sam: [00:11:32] Yeah, a hundred percent. I personally have experienced that firsthand again, like a little bit before the pandemic, but anything that's gone on has only been heightened because of the pandemic.

[00:11:42] And I actually passed out and ended up in the hospital because of period pain myself. And so I think like it's something that I would never even of imagined and it all does tie back into the stress that we feel that we have felt during this pandemic, anxiety and also like worst PMS, [00:12:00] as you said and I've shared that. And I've heard from so many women in my community, just like the emotional roller coaster that everyone's facing and then throw in our monthly hormones, storm that we face, oftentimes, it's crazy. But pain has been a big one for me and for a lot of people in my community.

[00:12:16] And one of the questions that I did want to bring to you from them was, is there a difference between pelvic pain and cervical pain and what does that really mean? Or what can that be signs up?

Dr.Thorne: [00:12:26] Yeah, so pelvic pain is one of those areas that like is a big word that can have a few different etiologies.

[00:12:35] And  sometimes people have a sensitive surface. If anything touches it, they feel pain. And some people associate pain with their cervix, but it's more of like the deep location that they think it's in, but it's not their pain. It's not their cervix it's something else.  I don't want to get too much into the weeds, but pelvic pain can have a cyclical origin and it can relate to the way the uterus contracts or conditions like endometriosis or [00:13:00] adenomyosis like non-English words, but labels that we have for painful conditions related to our periods or they can have musculoskeletal origins and people forget how there are some major muscle groups and nerve groups that wrap around the bowl of the pelvis.

[00:13:13]That also attach it to our hips and thighs. And they are sometimes the source of the pain or it's the nervous system. That's in there, the nerves that can be related to the pain and then for some people, actually, their pain is more on the outside has actually has a little bit more to do with the way the nerves innervate the opening of the vagina.

[00:13:29]And for some people it's cyclical and for some people it's not. And then for others, it's related to their bowels or related to their bladder, and it's a little bit of a different condition and they all have overlapping their piece depending on what the etiology is, and that can be anything from anti-inflammatory diets to pelvic physiotherapy, to using some certain like freezing or neural agents to using like hormones perception to try to manage  the symptoms, as well as looking at like mindfulness and meditation and kind of more cognitive or [00:14:00] psychotherapies.

Sam: [00:14:01] And how does sex play into that as well? We were talking a lot about pain, that's going on, whether it's cervical or pelvic, and we're talking about our periods, but of course, how does sex play into that and painful sex? And when do you know to see your doctor or not?

Dr.Thorne: [00:14:17] Oh, good questions, right?

[00:14:20] Cause you're like when is this abnormal? The sexual response cycle is also a little bit complicated and they tried to talk about it as a cycle,  more we're actually trying to say no with the cycles and misnomer. A woman's sexual response is not cyclical. It's more varied and painful sex can be because of something organic. There's something going on in the pelvis that is getting triggered and causing pain that can happen with conditions like endometriosis that can happen with conditions related to pelvic floor dysfunction in the muscles that was preexisting.

[00:14:49]But sometimes it's a mind issue. If you're not aroused, if you're not interested, then your vagina is shorter or you don't make lubrication, it's not enjoyable for you. You're not getting stimulated and that can also [00:15:00] precipitate pain. People who have a trauma history can have issues with pelvic pain and with intercourse and that can get a little bit complicated. And sometimes it's like physical things like the, if you're having intercourse with a man and  his penis is too big, like that can cause pain. And you're like what's that about? And then you have to make sure you're testing for STI.

[00:15:17] So it can be like a big spectrum of things that can be related to pain, but certainly having pelvic pain can impact your enjoyment of sex. And if it is then looking to at least talk it out with your healthcare provider and to start to open that door, I think is important.

Sam: [00:15:33] Yeah, absolutely and just knowing  your body, if something never hurt before, for anyone listening and then all of a sudden it hurts.

[00:15:39] Like I'm sure you would say that's the time when you got to start figuring out what's going on.

Dr.Thorne: [00:15:44] Yeah.

Sam: [00:15:46] So what about IUD's? And let's dive a little bit more into  this conversation. I know something you're so passionate about. You've done a lot of deep research into contraception options. I get so many questions around IUD's.

[00:15:59] So many [00:16:00] women are not sure about it. What are the steps? If they want to take it, if it's right for them, is it reversible? How does it impact their sex life, etc. So let's give a little bit of an overview on, how do we know if it's right for us and if it's a good option for contraception?

Dr.Thorne: [00:16:16] Yeah.  We should take a step back to talk about brief overview of contraception, there's a huge box of birth control options. And they can be used for preventing pregnancy and they can be used for managing other menstrual associated issues.

[00:16:30]And I still think we need to have more options at our disposal, but we have a pretty big spectrum of options so that people can try to pick and choose and try what works for them. And what works for me may not work for you, may not work for the next person, and that's okay. And that's normal. I like IUC's or intrauterine contraception or contraceptive devices as people often call them IUD's because they fit into the category of LARCs long acting, reversible contraception. [00:17:00] Which means that they work over a long period of time. They're not something you have to remember to take on a regular basis, like a birth control pill or a patch or a ring, those need more frequent replacements and they're very effective. If we're trying to prevent pregnancy, everything has a failure rate. Even surgical sterilization has a failure rate and using an IUD or an implant, which is now available in Canada, have failure rates that are the same as surgical sterilization. So they work very well. They're very reliable. It can last anywhere for five to 10 years if you were to use them for their whole lifespan. But they are completely reversible. So if you remove it, then if they were having an impact on your periods, they should go back to normal, if you are preventing pregnancy. And we have two different types, there's a hormonal type and a non-hormonal type. The non-hormonal type it doesn't have an impact on your cycles. You still cycle normally or you still bleed normally, but for some people you get a heavier period or more painful period. And again, that's not true for everybody but it does work that way for some people and it's [00:18:00] toxic to sperm.

[00:18:00] So it works by basically killing off the sperm or not letting them pass anything. The hormonal IUD works primarily by creating like a mucus barrier. So progesterone, if anybody's ever watching their discharge or their mucus that comes out on a cyclical basis, you'll notice that it changes according to your cycle.

[00:18:16] So the progesterone, and it helps thicken that mucus barrier at the cervix. Prevents sperm from coming in, changes the way that the sperm and the egg can float towards each other. And it thins the lining of the uterus. You tend to get lighter periods or we're know for, depending on which one you're using, no period at all.

[00:18:34] And  then for some people you'll get less.

Sam: [00:18:36] Yeah. I've heard that it does help a lot with pain as well. And just really like you said thinning the lining of your uterus, and sometimes that's often what's linked to, individual pains from my own experience and hearing about that as well.

[00:18:49] And so what were the, what would be the next steps if any of our listeners or anyone was interested in trying out that mode of contraception?

Dr.Thorne: [00:18:56] Yeah, so you need someone to put it in for you. So it does involve [00:19:00] a doctor's visit or a visit to somebody who's trained. So there are nurse practitioners and even increasingly midwives now who are putting these in.

[00:19:06]And you need to find a place to go, to get them placed, and maybe you'll want to learn more about them from learning more, getting more information, or you recommend websites like sexandu.ca, which is put out by the society for OBGYN of Canada. You within the letter, u not y-o-u or birthcontrolforme.ca or this last one's American, but I do like the way they put their information out, if you don't follow brands and healthcare systems too much. And just the information they're giving that's bedsider.org B E D S I D E R. Because they have some nice like patient facing or kind of patient experience related FAQ's and things like that.

[00:19:41]And then you need to go talk to your healthcare provider. Hopefully you have a family doctor or a nurse practitioner that you can see and tell them you're interested in an IUD, or you want to talk about your options and if they don't place it themselves, then they need to refer. And that's often to a gynecologist.

[00:19:57] It depends on where you are in Toronto. We actually have a lot of [00:20:00] options and even some walk-in options. So I work really closely with the baby center for birth control at women's, they'll take self-referrals for IUD placement. So that's that's a nice thing. Some of these more contraception oriented places like planned parenthood would be somewhere where you could self-refer.

[00:20:15]There's a website called raice, raice.ca. That allows you to try to find a provider near you. So if there's other listeners from other places in Canada, they may be able to see which providers are in their area, that they know would be able to put in an IUD for.

Sam: [00:20:32] Amazing. I just love that this is wealth of information and that you're also able to provide the accurate sites to go, to, to find that information, because we know that can be challenging as we had said.

[00:20:41] So something that came up in the conversation, when, I had the pleasure of listening to you and your fellow OBGYN's at the women's health panel few weeks ago, was the conversation around contraception for women post childbirth and post children when they're looking for contraception options.

[00:20:59] And [00:21:00] I found that very interesting. I, myself don't have any children yet. And so I'm thinking of it in a preventative way, but there are so many cases where it's okay, I'm still childbearing age and I need to return back, to what are these options? And I know so many of our listeners are impacted by that as well.

[00:21:15] How does that affect women? Post children are their options different? Can they still have IUD's is after they've had a child or what does that look like?

Dr.Thorne: [00:21:24] The options are the same. So for the longest time, nobody would put IUD's in people who had not had children, because it was thought to be contra-indicated you can't get anything inside the uterus cause they've never had kids.

[00:21:35]But it was totally a misnomer and that was true. Even for me, when I was first looking at birth control. I'm not that old, it wasn't that long ago. Where initially it was a no-no because, oh, we don't do that for people who hadn't had kids.  And then I moved to Toronto and they were like, I've never heard of that.

[00:21:48]And then now we're saying it's actually available for everyone. And so if you've had kids then it's becomes a lot more of am I using it because I never want kids again? Or am I trying to space my children. So the purpose a [00:22:00] little bit may shift because they're just trying to create a nice child spacing.

[00:22:03] There's actually international guidelines on what the ideal timeframe is between your kids to allow for appropriate neurodevelopment. Women want to heal, they want to recover a little bit sometimes after having kids. It can facilitate that but the options are all the same immediately after you give birth.

[00:22:20]There's a little bit of concern in using estrogen because in the immediate timeframe after birth, Women are at, and people are at higher risk of making blood clots in their legs and lungs different from the COVID related blood clots that are getting so much attention right now. But and there's a slightly higher risk of that happening with estrogen containing birth control pills or patches or rings also.

[00:22:41] And so we tend to say that you got to wait at least six to eight weeks before you initiate any estrogen containing birth control. Things like IUD's, we certainly put in and sometimes even we'll put in immediately after birth, they have their epidural, the placenta comes out. We can slip an IUD in right after, and it can be really convenient way to say, okay, we know you don't want to have kids [00:23:00] right away.

[00:23:00]You're here. Let's provide it for you at the same time and there's been an increased awareness of that as an option in the pandemic when people are having a hard time getting to clinics.

Sam: [00:23:09] You actually just made me think of something. I know that I've heard, women who get migraines as well, have a hard time finding the right contraception options. Because they try to stay away from estrogen and so  IUD's fit under that as well because it's mostly progesterone as you said, right?

Dr.Thorne: [00:23:24] Yeah, exactly. So almost every progesterone containing birth control is safe. For most people who have a contra-indication are not supposed to use anything with estrogen and that can include people with migraines. The migraine world is getting a little more nuanced and increasingly we are sometimes using estrogen and people with migraines. We're learning also that migraines can be cyclical and that estrogen containing birth control stops ovulation. So if you stop ovulation, you could stop the migraines.

[00:23:48] So it's been getting a little more nuanced than it used to be but the nice thing about IUC's is that they are local acting. And they really focus their attention inside the pelvis, inside the uterus and then should not have so much [00:24:00] of an effect. I say that with a caveat, because certainly someone's going to come back and say, oh no, but it affected me this way.

[00:24:04] And I always have to, say everybody's experiences unique and related to their own body, but among what we have available, it's the most local acting and the least likely to affect the whole body.

Sam: [00:24:15] Yeah, that's so interesting. I We're all just so different and we all struggle with our own, Issues, like I said, from migraines to cervical pain.

[00:24:23] And so it is so unique and so important to just find what works for your body, best. And even as you're explaining this, we tend to think of our own issues, but there's just so many others that come into play. One of them that I hear so much for my community as well is, and  we see it everywhere on social media right now is PCOS.

[00:24:43] And how PCOS is affecting women right now, affecting weight gain, how it's affecting their periods, et cetera, if they're getting them. And  what can you share about that? Do you have any tips and where to specialists come in and who are the right specialists for PCOS?

Dr.Thorne: [00:24:57] Ooh, so many good questions. We're seeing a lot [00:25:00] of PCOS too. Being in medicine is an ongoing learning experience. Like you never really finished school, which is great. And  PCOS is certainly one of those evolving environments. For those who don't know PCOS stands for polycystic ovarian syndrome.

[00:25:14] It's a bit of a misnomer because you, the name says you have cysts on your ovaries, but you don't have to have cysts on your ovaries to have PCOS. But what that is getting at is that, often women who have PCs are not ovulating regularly. So they're not releasing an egg, which means they're not having a menstruation every single month.

[00:25:31] And they'll go for months at a time without a period among other things. They tend to gain weight really easily and have a really hard time taking it off predisposed to diabetes and hypertension in a way that others aren't and can have what we call like some, we call it hirsutism some male pattern features, and that might be like excess hair growth outside of normal or expected for their ethnicity, extra acne that just persists. We're really careful to give this diagnosis out to teens. I think we [00:26:00] caught some trouble with that sometimes because teens are more likely to get acne, more likely to have system their ovaries or skip periods just because they're going through puberty and their bodies are adjusting to the new hormones.

[00:26:10] And so I like to save that diagnosis for adults, but  that's a nutshell of what PCOS is. PCOS can be manifested less if you lose your weight. People hate hearing a lot that they need to go lose weight because they try and it's really hard, but if they are successful, then their cycles can come back to normal and some other symptoms can get better.

[00:26:26]But one of the ways that we manage the lack of periods is by giving contraception. And the reason we do that is because even though they're not bleeding , the lining of the uterus is growing and  that can cause problems. It can cause bleeding problems, some people with PCOS start to get really crazy bleeding but it also can predispose you to cancer of the uterus.  So we try to protect you as can do that by giving progesterone especially and so that feeds back into it. The classic treatment would be the birth control pill, but actually an IUC of hormonal IUC is a great option to help protect the uterus for someone who has [00:27:00] PCOS and can provide them contraception.

[00:27:01] So the other thing I hear a lot is that people with PCOS been told they can never have kids, and that's also not framed quite right. People who have PCOS who are not bleeding every month are not ovulating every month, which means they're not always going to be at risk for pregnancy, but sometimes they will ovulate without realizing it and it's not timed. You can't track it the same way. And then they get pregnant and they realize it really late because somebody told them they couldn't get pregnant.

Sam: [00:27:25] Wow.

Dr.Thorne: [00:27:25] So those are some things that we see, or are talking about.

Sam: [00:27:30] Yeah and if you do, is it hard to diagnose someone  with PCOS? Is that a tough process? Cause I've heard for endometriosis it's very tough.

Dr.Thorne: [00:27:38] Yeah. The answer is you need to do a little bit of blood work and a physical exam, ideally, a physical exam. Lately we've been making the call on a really good history. But it's nice when you can actually see someone and see some of the complaints that they have and we work with endocrinologist a lot. So you did ask what specialists and this is really an area where endocrinologists, which are doctors who focus on the hormones of the body. And that [00:28:00] goes well beyond reproductive hormones and gynecologists work together. And so I have some patients that I work really closely with endocrinologists.

[00:28:07]I think this is a great area to work with holistic nutritionist and sometimes Naturopaths also. Just because there's such like a health and wellbeing aspect to trying to manage PCOS.

Sam: [00:28:17] Yeah and so we spent a lot of time talking about some of the issues, some of the pain, how we can solve that. Let's just talk about regular day to day or month to month taking care of your health as a woman.

[00:28:29] What are some of the appointments and checkups that we need to have on the calendar that are just regular, that we should be having?

Dr.Thorne: [00:28:35] Yeah, it depends on your age a little bit whether or not you're still menstruating. So  in reproductive health we talk about age related, we mean, are you pre-menopausal or post-menopausal and are  have you started having your periods? Are you past puberty and then whether or not you're sexually active and mostly in that sexually active, no matter the gender or anatomy of the person that you're with. So if you are sexually active and not [00:29:00] necessarily with only one person, and you've never had STI testing, then having STI testing on your radar is important.

[00:29:06]Testing for things like chlamydia and gonorrhea trichomonas, but also things like HIV and syphilis and anybody who had sex is at risk for that. You're also right for HPV and as soon as you have sex, you are at risk for HPV. They think that most women get exposed to HPV with their first sexual encounter and HPV causes cervical cancer and cervical cancer is preventable so you need your pap tests.

[00:29:27] We start screening at 21 years old right now. That's actually different than how BC does it. They do it at 25. Like hot off the press, I think we're going to be switching  our start date for screening to be age 25 and sexually active. So people are 28 and have never had sex before they're not really at risk for cervical cancer, but that's when we start. And  then you need it every three years and it's, not everybody's favorite exam to go for a pap test, but it's important and way better than having cervical cancer. And so those are the major things, and then there's looking for abnormality.

[00:29:56] So if you're having a period every month and you're healthy, you don't really [00:30:00] need a lot more than that. From a reproductive health standpoint, anyways, if you're starting to get problematic menstruation things that are cycling,  that are probably troublesome for you or your periods are irregular, you're having pain, that's impacting your function.

[00:30:12]Those are things that require attention and that would be outside of normal screening. If you are sexually active and at risk for pregnancy and not wanting pregnancy, trying to do something to reliably prevent pregnancy becomes important. If you are pregnant, then there's a whole set of visits that you have to do to help the baby's health during pregnancy.

[00:30:29]And then as you get older and it depends a little bit on your family history, but as you get older and start to hit menopause and usually by the age of 50 or so then we start to think about breast health and other cancer screenings. So we use breast and colon cancer screening, and that becomes really important.

[00:30:44] Your bone, health and monitor, getting more regular family doctor visits to make sure that your bone health is strong and using calcium and vitamin D that some other kind of easy preventative health stuff that people can do. Everybody should be doing a mix of aerobic and weight [00:31:00] bearing exercises to maintain their  bone and their heart health now and for the future.

Sam: [00:31:04] A lot of those tests that you spoke about for premenopausal women, are those done with an OB GYN or would you suggest going to your family doctor first?

Dr.Thorne: [00:31:14] In Canada, they're done with your family doctor. We see, especially in Toronto, we see people from a lot of different places and it's a lot more common for gynecologists to do what is called primary care. But our like structure here for the most part is for things like pap tests and STI screening to happen either at designated centers. So there's places where you can go specifically for those tests, like hassle-free in Toronto, for example. But otherwise it's with your family doctor and then occasionally for religious reasons, or for reasons where the exam is difficult or there's a problem identified,  then they get referred to a gynecologist.

Sam: [00:31:47] And what would you suggest to someone that doesn't have a family doctor?

Dr.Thorne: [00:31:50] It's such a good question. It's a huge problem that we have. We have a dire need for more family doctors. There's a couple of different options. Again, there are some walk-in [00:32:00] places, depending on how rural you are, that would be like a public health unit that you could go to for those tests.

[00:32:05]Or some of these designated centers that are more like a planned parenthood or an STI screening center, or a lot of the freestanding abortion clinics also will do STI testing or pap tests. And if you have none of those options it really becomes a little bit tough to try to advocate for yourself.

[00:32:20]And that could involve things like trying to go to a walk-in clinic and saying that you need a gynecologist and getting a referral. In Toronto, actually, there's a walk in gynecology clinic, you do need a referral, but  really fast access for easy problems. It's not for long standing issues, but that's called access. And so they're great  for quick things that you've just quick attention. So we're trying to devise solutions, but it's a bit of a problem, but starting with a place like public health or trying to use a walk-in clinic as as a gateway to access  specialists can be helpful them.

Sam: [00:32:50] Yeah and I know there's a lot of women I heard, and this was my experience as well is, winding up in like an ER somewhere because you have this pain and you [00:33:00] don't know where to go and you don't know what's going on. I think, especially during the pandemic, a lot of the answers where you have to go to the ER, because a lot of clinics weren't open and there weren't other options and people weren't seeing as you mentioned, but from there, obviously an ER,  job is to make sure you're alive. Like their job is to check your vital signs and make sure you're alive. And if you're okay and you're, maybe get some pain meds, etc. But from there, what would the next steps be like? Go immediately book something with your family doctor, because that's a question I've gotten from a lot of our community is just I wound up in an ER because of my pain or because I was excessively bleeding or whatever. And now I don't know what I'm doing. What are, what do I do from here? Kind of thing. Cause they made sure I'm alive.

Dr.Thorne: [00:33:40] Sometimes the emergency doctors will do a direct referral and that's true for a lot of places. So if someone's come in with a problem and in getting an ultrasound and they see something or they don't have a family doctor, then they have a bit of a duty to refer.

[00:33:53] There can be waitlists, specialists, also there's not enough of us and there's long wait lists sometimes but then I don't know how well that's always [00:34:00] communicated. Then there should be an office that's calling you with an appointment. If that's not true, or they say, oh, no, follow up with your family doctor, then  book an appointment and say, "Hey, I was in the emergency department with this problem, I need a solution I don't want that to happen again". And sometimes they will have the answer and sometimes they may not and always maintaining that like trust that you can advocate for yourself. And if you feel like the solution is not helping you then ask for a referral.

Sam: [00:34:27] So what's one thing and one way women now can educate themselves and really take charge of their own sexual and reproductive health. What is one thing you would say do today? Start today?

Dr.Thorne: [00:34:38] I think, starting the conversation like this is really important tuning in to people who are raising awareness like yourself is really important.

[00:34:46]When it can also come with links to  really reliable evidence-based information and so that idea of  self-empowerment educating yourself with quality resources so that then, what you're looking for is really important. And then [00:35:00] maintaining an open mind to have that conversation, because I do still think you might walk in saying, I think I have this and I want this and it's also okay for maybe the picture to be uncovered to be a little bit different. Going to websites like sexandu.ca which has actually a bit of a broader reach for different reproductive health issues that you can read about or birthcontrolforme.ca can be great places to try to gain more information, especially about things like IUC's or other contraceptive options and some basics of sexual health.

[00:35:29]I really like to talk about more evidence-based tracking apps like Clue because they are really focused on trying to bust myths on trying to empower people to understand their bodies better. They've got a pretty great blog. And those are, some resources that I endorsed as places to empower and then feel free to ask questions and remember that as healthcare providers, we hold a lot of expertise but we don't necessarily have all the answers all the time. We usually know where to go looking for them and people like your family doctor, or nurse [00:36:00] practitioner deal with everybody's problems. That's a really big box of problems and so if they don't know the answer or haven't dived into it, it's because they're trying to juggle so much at once. And so playing that role of a self-advocate becomes really important.

Sam: [00:36:12] Yeah and just like asking your doctors, and I think a lot of people do have a  fear intimidation, and they don't know how to approach the conversation with their doctors around sexual reproductive, health or contraception.

[00:36:24]What would you say to those women that are listening that are just so uncertain? What to say, and maybe like for one reason or another ashamed or scared.

Dr.Thorne: [00:36:33] I feel like this is society's fault like it's just been millennia of saying that women can't talk about their sexual health and so it becomes really uncomfortable to talk about it out loud.

[00:36:42]But if you think you have a problem or you don't know if it's normal, then you have to ask. And I don't know if that means that you write it down or ask it out loud or ask somebody you trust first. But I know that I've done a good job if someone can come to me and tell me that they are worried that their orgasms aren't good enough, like that's not something that  everybody would [00:37:00] necessarily go to their family doctor with. But if you're not sure, and you want to know if it's normal or if there is something you can do to make it better or you want to know if you need a workup or a treatment. You have to know that those are questions you should feel comfortable to ask.

Sam: [00:37:13] Yeah.

Dr.Thorne: [00:37:13] And we're here to lift up each other, I think. So that's where I'm hoping that these conversations will just normalize. How we talk about our own reproductive health.

Sam: [00:37:20] Yeah, absolutely. And I hope, even episodes like this and conversations like this can help normalize that. And, we're all a little intimidated to have that conversation, but we have to, we're the only ones living in our bodies and we have to advocate for it, but I can definitely resonate with how intimidating that conversation can be and just getting that out there.

[00:37:40] Dr. Thorne, you were awesome today. You answered all of these questions so incredibly. Is there anything else you'd like to leave our audience with?  Any more advice, last tidbit for our listeners too?

Dr.Thorne: [00:37:52] No, I really think we've covered it all. As the contraception expert, I have to leave with a little contraceptive message and just say, whether it's for [00:38:00] managing or controlling your periods, which you can do cause there's a problem or cause you just don't want them anymore or you're trying to manage your fertility.

[00:38:07] And when you want to have a child there are a lot of contraceptive options. Think about them, ask about them and don't be afraid to be open-minded to try more than one. If the first one doesn't work for you, it doesn't mean that all of them won't and you can get more information from the websites that we've mentioned, like sexandu.ca, or birthcontrolforme.ca

Sam: [00:38:24] Absolutely. And I will link it all here. If anyone is looking to follow your story a little bit more, can you share where they can find that as well?

Dr.Thorne: [00:38:32] Oh, I know I should be more active on social media than I am, it's always been the plan. So I work at College hospital and at Mount Sinai and University, I worked pretty closely with the Bates center for birth control.

[00:38:43]And so those are some places that you can find me. My Twitter handle is @juliegthorne, I go in and out of activity, and so those are some other places you can find me.

Sam: [00:38:52] Amazing. Thank you so much Dr. Thorne, and this was such a pleasure, and I know there's tons of information, insight for all of our listeners [00:39:00] today, and hopefully they just feel a little less alone and heard in this conversation.

Dr.Thorne: [00:39:04] Great. Thank you so much.