Kerry: 0:28

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Alex Reyes. Welcome to the podcast.

Alexandria: 0:36

Thank you for having me.

Kerry: 0:38

I'm so excited to have you on today. You are, one of the, most popular menopause providers in the Tampa Bay area, so that's what I wanted to, pick your brain about today. So why don't you tell us a little about who you are and what you do?

Alexandria: 0:50

So I'm Dr. Alex Reyes, as she said, and I am originally board certified OBGYN. So I started my career that way. And then, about five years ago, I opened my own practice, gynecology only, and then basically from there, just menopause, perimenopause became more of a niche for me, if you will. I've always loved hormone care. I loved the fertility and fertility stuff back when I was in training. So this is just the opposite end of that spectrum. Just really enjoy getting people to feel better again. Over 35 to 40 we start having so many symptoms. So that's what I love to do now.

Kerry: 1:26

Yeah, absolutely. Yes we do. And like you said I think, it's a great niche and obviously I feel like this whole menopause space is blowing up and thank goodness for that Because, our historical I guess approach to women's medicine and women's health hasn't been very good in my opinion, so I was hoping that you might enlighten us on that and talk a little bit about why that is, historically, of why it's been a challenge for women to get good menopause care.

Alexandria: 1:53

I think a couple of things. I think historically in medical training we don't get a lot of that in medical schools, so that's the first thing. And then even surprisingly, to a lot of people in OB GYN residency, we get a very small amount of menopause training. And then if we think about perimenopause, those, say 10 years leading up to when your period stops, where a lot of symptoms start, that is probably even less talked about. And so I would say that is a big education gap. So we have that piece of it, which is a big part of it. I'm sure you didn't receive much menopause education every doctor in the United States did not. So it's a very small portion of what we learn. And so really to learn it, you need a good mentor. You need additional training, et cetera. So that's a big piece. And then also I think what has been known, about menopause was really clouded about has it been 23 years now ago? By the Women's Health Initiative in 2002 which was actually a really well designed, randomized controlled trial. But then the way the media portrayed the findings was problematic. You get a lot of, I would say still today, a lot of clinicians that are basing their opinion of hormone therapy or when it should be used or not used based on that study. And really more, not on the study itself, but on the breast cancer increased risk findings that the media the regular media portrayed as just high risk, which ultimately wasn't really true. And then all the good findings were also not really talked about, so it was just unfortunate the way it was. And it was a big study and and it was really publicized. The doctors that were practicing back then certainly could tell you more than I can even about, there was literally a day where people just stopped their hormones due to this headline, and, ultimately it does not increase breast cancer risk, especially with formulations we're using today. There's definitely some nuance to all of it, but that study actually had some really great findings. So yeah, that's been a thing for sure.

Kerry: 4:02

Definitely. You already mentioned it, but the study included, a different formulation of the hormones that we use today. And then it was based upon a certain population that they were studying at the time. And it is definitely the biggest study done on women ever. And like you said, I've heard it too from other providers that might have been practicing at the time, like all of a sudden they were treating menopause and like the very nice day after that headline came out, boom, nobody's treating it. No women was taking any of their hormones at all. Again, we certainly didn't get any benefit of learning any menopause education at school. And I don't know if it's,

Alexandria: 4:36

and then they only taught the WHI. In my experience, the WHI was what was taught, but then I don't think the nuance was discussed. So the average age of the patient was 63. They were not necessarily healthy at that age already. So many of the patients had diabetes or heart disease already. And so that's not your average 45-year-old that's starting to have hot flashes. So we have to look at that first. And then also the formulation, like you said, it's different than what we really have learned in the 25 years since that study. More and more has been accumulated. We still need, honestly, better data, but what we do have, we really, got away from synthetic estrogen, progestin prescribing and more body identical formulations of estradiol and progesterone. So just like what your ovaries make, so that is a huge difference too. So the population wasn't really representative of an average midlife woman. And so that was, that's a huge problem. And the formulation being different also as an issue. But we did learn some really good things from that study'cause it was very well designed. For people who don't really know medical studies and how they're designed, we want a randomized controlled trial. Ideally we want numbers, statistical power and all of that for certain endpoints. And so we did learn that, that's actually one of the best data that we have on bone density. So estrogen therapy, increasing bone density in regards to that breast cancer situation that really caused everyone to stop their hormones. The actual data showed that the estrogen only arm decreased breast cancer risk. And that was, a relative risk reduction of 30%. We have to realize that wasn't talked about. And then the people who were taking both estrogen and progestin, there was a slight increased risk of breast cancer and their absolute risk. So that's like a better way to talk about risk is like our individual risk as a woman or as a person. If I take this medication, is it gonna increase my risk? And there was a slight increased risk. But honestly it was really not anything profound. And I like to liken it to if we drink alcohol, if we have an overweight body mass index, if we don't exercise, those things actually also increase our risk very similarly to even that old formulation. So if we even say that's the worst formulation out there, that might increase risk, which when they really looked at the data again later, it probably didn't. But. Long story short, even in a worst case scenario, it was with longer term use with synthetic formulations, with progestin, not estrogen. So that's a big confusion is people think it's estrogen causing breast cancer. And it's probably honestly, truth be told, not menopausal hormone therapy causing. Or your own hormones even causing breast cancer. I think people get pretty confused on that too. Yeah. And then the data sense then, yeah, the data sense then has been, more shifting towards body identical prescribing for a number of reasons for heart health for bone density and then also just for breast health, we know like the body identical progesterone is more neutral to the breast tissue than a synthetic is. So if there's been any signal in any data that increased breast cancer risks, it's the synthetic progestins, but that the magnitude of that is really not very high and it's really not going to be to an individual a huge increased risk, if any. And it's more with longer term use is gonna be a little bit more likely, but again, really not something to write home about. And I think that we don't think enough about the lifestyle stuff of, hey, what's my breast? And then what's my breast density, my family history? Am I exercising that reduces breast cancer risk? Am I eating a plant forward, Mediterranean diet, am I, what are we doing in our daily life? Alcohol even so I think that has to be looked at more. And then people get very lost on the, most breast cancer tumors are hormone receptor positive, which does not mean your hormones caused it, whether they're your own hormones that your ovaries are making, or with your menstrual cycle or if you're taking them. And I think that confusion needs to stop too, because that makes people think their bodies have turned against them here, or their hormone therapy caused a breast cancer. That's very common. So that's not the case. It's just, it's normal for a breast cancer to have a hormone receptor on it, just like your uterus, just like any other hormonally sensitive organ. And so we actually- as like hormone receptor, negative tumors are more aggressive'cause they don't resemble regular breast tissue, whereas hormone receptor positive are actually easier for the breast surgeons on oncologists to treat. So it's something that we have to realize is a causal necessarily, but it's a common, clinicians they still say it all the time to my patients and they say, you should never take that or they exclude them for a number of reasons that aren't real contraindications. So that's difficult too. And that I think it does stem from that study. I think it comes from that, and it comes from then no one really prioritizing looking at women's health and menopause after that, or even before that.

Kerry: 9:42

So much you said right there. Like I think it was, the breast cancer findings were really not that much more than the general population, right? Like you said, the other risk factors are very, important and

Alexandria: 9:54

They're equivalent if you think about the increase in it. So even if there was an increase in using that formulation, it was like akin to using to not exercising, to smoking, to alcohol, drinking a glass of wine every night. So it's something we have to be a little more careful with how we talk about it,

Kerry: 10:10

you mentioned something else basically the long length of use of it And I think we hear a lot of myths about, oh, I have to stop it now, or, things like

Alexandria: 10:19

Yeah.

Kerry: 10:20

can you dispel some of those myths?

Alexandria: 10:23

Yeah, so due to that same study because those women were 62, 63 and they stopped the study due to not just that breast cancer, but there was heart, like there was blood clot, increased risk and heart disease, right? So the age of the patient in that study was part of the Menopause Society guidelines for a while, like we should probably try to get these patients off of it by 62, 63. That has, now that we know that the body identical formulations and notably like the through the skin or transdermal estradiol, like patches or gels or they even sprays those are. They really don't have any risk of blood clot stroke. They don't go through the liver, which is how that's avoided. And then the micronized natural progesterone, like what your body makes, that's also very cardiovascularly neutral. So as things have shifted that direction and then of course more data's accumulated and looked at, they have changed the stance on that at the menopause society. So there's not a hard cutoff to when you should stop hormone therapy. So we really individualize it. And there are like. Probably 15% of women, I think it is, it's a small but meaningful percentage of people who do have pretty persistent like hot flashes and night sweats, even into their sixties well over 10 years after their final period. And they really can't stop their hormones. They're pretty miserable if they do. And there's really no reason in general to, to push people to come off. And if someone's I really want to come off and see if I even need this, certainly we can guide that. And if there's a real contraindication that comes up with health, we have to stop it. Let's say if someone has an active breast cancer diagnosis, but it's something that we just totally individualize it and we say, what are the risks? What are the benefits for you individually? And it's a very safe medication overall. We prescribe much riskier things and there's no there was no black box warning on those things or, there's just been a lot of. And unfortunate things about hormone therapy that were discussed through the years that really have not proven to be true, especially with modern prescribing, but it is what it is. We're unlearning all that hopefully now.

Kerry: 12:26

The good word for this.

Alexandria: 12:27

yeah. Or learning the new way. Yeah.

Kerry: 12:29

you mentioned the black box warning. So why don't you tell us what it was and now what recently happened with that?

Alexandria: 12:36

So that same study. There's like the same, right? That same study basically resulted in the black box warning. And the same cautions breast cancer, overstating risks on, blood clot, heart disease, stroke and it even said dementia was higher, which again, I'm not saying it decreases dementia for an average menopausal patient, that's another conversation, but it was again that study population and those flaws and that study and that kinda just outdated information at this point. So that was on the label of all estrogen containing products for the last 23 years or something like that, 20 plus years. It was on everything including any formulation that was not just the synthetic formulation studied in that study didn't talk to you about this maybe not, doesn't apply to you if you're X, y, z. It just put this statement on there. It's a very serious warning that the FDA puts on some drugs when we believe it can cause a serious adverse effect. That was recently removed just within the last couple months. And, it was basically due to some doctors that in the menopause, world that advocated for that to change. So it was recently removed, so we did see some, uptick in, prescribing. We have an estrogen patch shortage now the last three weeks. But I think it didn't change anything for me personally.'cause I just, told my patients, Hey, this doesn't apply to you. But it did scare a lot of people. And truth be told, even if I counsel you and tell you, Hey, it says this in there, don't worry. It's not the same thing. And it was even on vaginal estrogen, which is local vaginal doesn't even go into the bloodstream. Made no sense that one really needed it removed because that's prevention of UTIs, prevention of vaginal dryness, sexual pain. The genital urinary syndrome of menopause needs vaginal estrogen. And that one just totally was not applicable. So it was really hurting women, I think, more than helping anyone because it was putting that blanket statement on products that it didn't need to be on. And so interestingly though, we have this patch shortage around the same time that this happened, and I don't know. I don't know if I, for me, I didn't change my prescribing, but like this is what I do. But I wonder if we had just an uptick in people asking for the estrogen products or clinicians comfortable doing it after that was removed. It is what it is for me it's a good thing. I think it's a great thing for women. Theres Concern on both sides, but I do not think that we have an over-prescribing epidemic of hormone therapy. So I think it's a good thing and it was not an accurate statement to an average midlife person. So it doesn't,

Kerry: 15:19

I would say, I spend all this time counseling and saying

Alexandria: 15:22

Yeah.

Kerry: 15:22

okay, especially just for vaginal estrogen, right? And then all of a sudden they get home and they read the thing and they're like, oh my God, I'm not taking this right. And you spend all that time like going over it. And then they're just afraid, like it's fear

Alexandria: 15:34

And then you see them the next time and they're like, oh, I didn't use that because I read that. And I'm like, oh, yeah. Yeah. And I totally, I've had that same situation many times where you're like, man, I even gave her the heads up. But it's, the language was very scary and I can see why, nobody wants to take something that says basically you're going down a stroke, heart attack, or, get breast cancer from it, which is, it was totally inaccurate and that's what's really unfortunate about it being there for so long. And I think in, I don't know what the current numbers are, we'd have to look at new studies and take a survey, but I know for the last 20 years they say that only 4% of eligible perimenopause menopausal women were taking menopausal hormone therapy that could have been. So we've had a very small percentage taking it. And, nearly all of us, I'd say 80 plus percent, but nearly all will have symptoms at some point. and then it was pushing a lot of prescribing too towards non hormonals because it was, oh, it was like hormone therapy is a last resort, and that's not really true either. It should be first line.'cause that's the reason that, we are having the symptoms as a hormonal source, so giving an antidepressant or giving something that can work for some hot flashes may not be the best choice for every patient. But that was what we'd seen is. That study, that black box warning, it resulted in all of this like prescribing of other types of medications, sleep aids, Benadryl use, which has its own risk. Tons of things that like we don't really need to be taking that have far more risk honestly than hormones do. And they're the same hormones we've been making our whole life. And I think that needs to be thought of too. And it's like we shouldn't suddenly be afraid of them because, it was the wrong formulation talked about, I don't know

Kerry: 17:19

You mentioned you didn't mention but the bone health too I feel like all the women who missed out on being able to take their hormones like, or, to treat for whatever symptoms they had before are now all suffering with osteoporosis. And I wonder, like you said with the sleep thing that maybe the drugs for osteoporosis weren't as much, needed that we use now. Granted estrogen is FDA approved for osteoporosis.

Alexandria: 17:43

Yeah.

Kerry: 17:44

interesting about the sleep pills that are now used because we don't have enough progesterone and everything to help us. You also mentioned, estrogen receptors on, breast cancer things, but they're also right throughout the entire body. So you mentioned hot flashes. I think some people that's like all they think of, right? So what other things could be going on that is someone doesn't even know really?

Alexandria: 18:10

So many things. I think there's like now, I don't know, 40 plus symptoms that you could write down that may might be associated, but the way I would say I'll, that it starts is usually early perimenopause symptoms can start in the mid to late thirties, early forties. Everyone's different, but you usually start to get some sort of cyclic association of symptoms. And because estrogen receptors are everywhere, I'd say the top ones, yes, people get night sweats and hot flashes. And that's due to the estrogen decline affecting your temperature zone, your thermostat if you will, in your brain. And then, mental health changes are very common in that early phase. So anxiety, depression, irritability, maybe worse or new onset premenstrual symptoms of mood that, Hey, I've never had this before. Now I'm just really irrational in these days or this couple of weeks. And then, so I'd say mental health sleep. So sleep with or without night sweats is actually associated with hormone changes of perimenopause, menopause you mentioned how much night sweat, vaginal dryness, urinary frequency, urgency, vaginal dryness, that's all that genital urinary syndrome menopause, which those if it's isolated to just, that can be treated with vaginal estrogen. We even see joint pains, so we'll see maybe even some autoimmune conditions where, they are having more flares in perimenopause or, they're just having joint pains that are just, osteoarthritis or maybe they're not. And you can usually tell because they get better with hormones or not. What else we have? Sometimes people get anxiety palpitations. Certainly that's a really common one. So I have a cardiologist I talk to often or, evaluate with because patients wanna make sure nothing else is going on first. But a lot of times it's just hormone changes. People talk a lot about brain fog, so mental clarity, word finding. I even see dry eye, dry mouth. Gosh, just basically everything, like every body system is affected. I would say. Not feeling like yourself too is a common thing. I hear some people have a hard time putting to words. They're like, I don't know that I'm necessarily depressed. I just feel, I don't feel like myself. And I think that is a, is almost needs to be an identified symptom, if you will. I like write it down all the time as a symptom, but it's a basically every body system, even some GI things like constipation or, I'm not having worsened acid reflux. It's all very. Yeah, lots of things worsen or are new and you'll see some, maybe you're not saying all those things will get better with hormones, but they need other treatment and evaluation, but they also, there's sometimes more of a factor than people realize. So I do see patients a lot who've come have, who've been evaluated by multiple specialists. They've seen a cardiologist, they've seen a rheumatologist for their joint pain and their palpitations with the cardiologist, and they've done endocrine and they've done these and my thyroid's fine et cetera. Or I'm gaining weight, that's a super common one too. And everyone else just tells me everything's normal. And I'm like it's just, it's probably perimenopause. So it's I think needs to be considered earlier by primary care. By all I would. I love all doctors to at least be able to identify it so they can refer, because I think that would really, I think it's not even on the radar a lot of times still for many doctors, but it's changing, right? So more people are learning, which is helpful. But it's very common for me to have a patient who's seen. A couple of OBGYNs, their primary maybe even specialists depending on how their severe their symptoms are. And it's more common if it's not just classic hot flashes. But you'd be surprised even with that, you see a missed diagnosis. Like she's not having periods and she's having night sweats. This is menopause. So you would think, but it's just I think it's just one of those things that wasn't taught to us well in our medical education and I'm like hoping it's changing. I think it

Kerry: 22:13

I was wondering.

Alexandria: 22:14

Yeah. I think it is. I don't know about

Kerry: 22:16

into the curriculum now,

Alexandria: 22:17

I know residency stuff is better, but I don't know about I don't know about medical school, but that's really where it needs to start.

Kerry: 22:23

Definitely. I think they're not gonna know about anything unless you're going out and seeking the education. And I feel fortunate that I'm a nerd and wanna do these things, so I tend

Alexandria: 22:33

Yeah. Yeah.

Kerry: 22:34

possibly can because like all the things you said, like they've been to all these different doctors, right? So you really gotta be listening to the person, right? And sometimes it's like a great mimicker, like it could be fibromyalgia, it could be lupus it could be, anything. And yeah, it really, just dialing in on what they're saying

Alexandria: 22:51

A lot of the thyroid symptoms, high or low also overlaps. And obviously like periods change, that's a common one, but irregularity of timing or flow lighter or heavier. And actually one of the more classic things with the earliest years is you'll see like a shorter cycle interval. So say I was 28 days, now I'm like having my period every 24 days or even shorter. And so that's actually a pretty common sign of decreased egg count, ovarian reserve, those early perimenopause years. So there's many signs. So we could probably make a list. But yeah,

Kerry: 23:30

How do you think we build back that trust that for all these people or patients even that, maybe they're going outside traditional medicine because they weren't getting the care that they needed. Like, how do we build back that trust? Does this black box removing help that, or what would

Alexandria: 23:45

I hope so. I think there, hopefully it'll at least open more conversations around it, but the doctors and clinicians have to have the practical prescribing experience, so there are like courses for that out there too. But I think I don't know. It's gonna be a long road, I think too.

Kerry: 24:06

Yeah.

Alexandria: 24:07

Correct that. I do think the more that we educate clinicians, the more the patients keep asking, the more we should fix the problem. But I think the doctors and clinicians have to know what to do for it, because if they get that classic answer of. Oh, I don't know. I've never heard that. Or I don't know. Or they don't refer you. They just say, I don't know and I can't help you. Those patients definitely are at med spas getting hormone pellets. Really honestly, I'm not saying, every provider in those places are, not good or something. But I do think that traditional medicine has a lot more to offer that's safer and more evidence-based, and I

Kerry: 24:46

and affordable.

Alexandria: 24:48

And affordable and yeah. And I think definitely just more clinicians being trained, I think, and addressing it and identifying it, because a lot of times also they're just, they're truly just told I don't know what's wrong with you, or, I think you're fine. Your labs are normal. And they're like I don't feel fine. So what's going on? And so they end up feeling like what's wrong with me then? And so that's, I think the more the identification is there with the clinicians and the validation. The better. And then they, because that's really why they seek care outside of the system or outside of traditional doctors, is because they're not getting the answers they're looking for, which does require listening. It does require a little bit of time that a lot of doctors may not have. It's a complex conversation. My new patient appointments are an hour, so I it's because it's takes a while. And so to tease it all out and they are trying to figure out what's what. So I'm hoping with education it helps and validation by doctors and people like you that care about it. And it's just, it's not common though, is the thing I, every time I think, am I just repeating myself? Do we need to keep saying this stuff and then I'm like no, we do because it's like there are millions of women and people every day still that I see that have never heard of any of this stuff that you and I probably see online or from our patients, and so I'm like, yeah, we keep going.

Kerry: 26:14

Yeah, so provider education, obviously patient education and meeting them where they are and listening and things

Alexandria: 26:20

Yes. That will help tons.

Kerry: 26:22

I mentioned the affordable thing because I know that, the bioidentical market, using that term is Yeah is not always needed. There are some cases where it be needed, but I know there's a shortage of the patch, but it's also probably the cheapest, most covered one,

Alexandria: 26:36

right. That's why most people are on patches, I would say'cause they are the most accessible. We have the most options. For it, earlier in my career, they only had, people didn't like the generic patches. They were too big and they only wanted their vial dot, and it was like always a problem. But now we have so many good options for the small estradiol patches. And then actually the gels too, like the divi gels gone generic. There's other ones that are brand still only that, are a little bit more expensive. But there's even ways like Mark Cuban's pharmacy Cost Plus has good products like vaginal estrogens, like$12. That's the cheapest I've seen it. And then I think yeah, estrogen and Eva, miss some of those you can get like on HRT Club, which is like a, online pharmacy that'll do like a membership, but their prices are lower. So there's like ways to do it. You just have to navigate. Unfortunately in the US we don't have, a really easy to maneuver healthcare system. But there are ways, but yeah.

Kerry: 27:32

I'll speak to the Mark Cuban thing. I actually went on there recently. I don't I was just getting like migraine medicine and it was just a fantastic place for the amount. I was

Alexandria: 27:40

It is. Yeah,

Kerry: 27:42

Yeah, realizing that you are getting generic and I'm fine with that. So

Alexandria: 27:46

Yeah. Which for the hormone therapy products that we use, I think a lot of people are surprised that, like when you hear the term bioidentical, I would say most people are referring to compounding. And while that is an option for things and, can be great, there's also the FDA approved estradiol and progesterone, which has just made it a manufacturer for a commercial pharmacy. And the quality control of what you're getting every time is a little bit more sound? We think so. Especially for estrogen. I don't prefer compounding, but that's just, my preference and my clinical experience with it. But we do have to compound. We, I've done testosterone that way and I've done it all of'em that way, but it's, certainly cheaper and safer and FDA approved quality control to get the body identical. I think that's the better way to honestly term it, because I think bioidentical just gets, like marketing term thrown around. I think when most people say it, they are referring to compounding, like measuring blood levels for you to create this product for you. And it's not really done like that. I wish that, it somewhat can be in a menopausal woman, but perimenopausal is a whole different animal. You're still making your own estrogen levels. There's not, it's not quite that easy, but we have absolutely safe, great estradiol, progesterone and testosterone gel. I use the FDA approved male version for that. There's ways to do it with, and it's actually, it does end up being quite a bit cheaper overall as well. And they're very safe and honestly better in my opinion.

Kerry: 29:12

I noticed you said body identical earlier, so I

Alexandria: 29:15

yeah.

Kerry: 29:15

that term. That's a good way to

Alexandria: 29:17

It's better. Yeah.'cause it's understandable too. And it's more descriptive. So it's the hormones your body makes. So ovaries make estradiol, that type of estrogen, progesterone, and testosterone as well.

Kerry: 29:30

Yeah. Makes

Alexandria: 29:31

yeah. Yeah.

Kerry: 29:31

Well, What's one thing that you really don't you want a patient to know about, menopause or you or your practice that we shouldn't overlook?

Alexandria: 29:40

I think the thing I always say, I've been asked this before, I really just think if you don't feel like you're getting the answers that you like, something is wrong, you don't feel like yourself. You've had an evaluation, basic labs, you've seen your doctor and you're not getting. A treatment plan that starts to improve your quality of life.'cause a lot of this is quality of life. And I think that's also why sometimes menopause, perimenopause, and then I do like sexual medicine too with like painful sex and orgasm disorders and low libido and things like that. So I think those things get pushed into this it's not a heart attack, so you'll be fine. It is but it's quality of life. It's relationships. It's what keeps people vibrant and healthy and feeling good about their life. And as you age, you wanna age vibrantly, right? You wanna age in a way that you feel you have some vi vitality. And so I think that is why it's ignored. But I do think if they don't feel like something's right, something probably isn't. And always for, at least for menstruating people and women, I think we have to think, we have a hormone system that is literally working on a monthly cycle. And when you don't feel okay, you don't feel right, there's probably a hormonal issue going on and you need to see another opinion or go to your ob GYN and if they don't give you answers,'cause that's not a foolproof place either to get care for perimenopause, unfortunately. Then, seek another opinion. And and obviously in Florida I can see anybody, but but it's just, seek answers. You don't feel like yourself, you're probably right. Something is wrong.

Kerry: 31:08

So where tell us about your practice. And you mentioned you can see anybody in Florida,

Alexandria: 31:12

Yeah, so I'm in South Tampa. Yeah, so I'm in South Tampa, like our physical office location. And at this point I'm really not doing like new patients for general gynecology anymore. We have Dr. Morehead who does that. She joined me last year, which has been really helpful. But I solely do hormone care, perimenopause, menopause, and hormonal issues. I see PMDD also PCOS some. Certainly, but I'd say most of my patients are like 35 to 60, maybe a little older. But I do purely that and so I can see anyone in the state of Florida virtually. I do a lot of my,'cause it's a discussion kinda like this and basically for just to get a good history. Really, it's a clinical diagnosis, so just, I don't really need a physical exam to tell you your perimenopausal or menopausal. So at the first visit, I usually do a full hour to talk about that, but I do a lot of telemedicine that way so that I can access, people, have more access because surprisingly. Maybe not surprisingly there's really not enough of people like me who do solely menopause care. And like you said, they go to other maybe unqualified places. And so that's why I really expanded the telemedicine side because I wanted more people to be able to see a menopause specialist truly. Because it's very common that there are local primary or ob, GYN wasn't able to help them. And so that's the way that I do things. Mostly, but I do spacious in the office as well in the South Tampa office. But yeah, I have quite a few from other areas of Florida, Miami, Jacksonville, all, all over so far. So that's been really nice to see because, they're trying to get help locally and haven't been able to. I'm one person, but I try to be there for who I can. But yeah, that's what I do is mostly just peri meow has menopause and hormone care and that's been lovely for me. I love it. I think it's very gratifying for people to feel better. That's my favorite part of it, is figuring it out and helping them to especially in perimenopause because it's actually a little harder to manage in perimenopause. There's so many ups and downs but yeah, anybody can see me throughout the state of Florida that way.

Kerry: 33:20

Nice. Yeah, I'm sure you get a lot of gratitude and just, honestly, at the end of the day when someone comes back, I'm sure you feel great.'cause I know they're gonna be feeling better. It's really a nice, rewarding job

Alexandria: 33:31

Yeah, it is. It truly is. Yeah. And thankfully that is the case most of the time, so That's great. Yeah, there's very few people who don't tolerate hormone therapy. If you're not tolerating it, it's usually a dose or a formulation issue. Something just needs to be changed. It's definitely not one size fits all. And I think most of that, quite honestly comes with the clinical experience of it. How do I dose somebody? What do I use? Should I cycle her progesterone? Should I do continuous? There's all these like little decisions that, you know, and then it's okay, if she has side effect, a what do we do? So it's a, it's definitely an art and a science, but it's a big art, I would say it's fun. I find it helpful and people really feel better, like you said.

Kerry: 34:12

Yeah, definitely a personalized approach like you had said earlier, for sure.

Alexandria: 34:15

For

Kerry: 34:16

So where where can people find you? Are you on social media? Where can they find you if they wanna work with you?

Alexandria: 34:21

So I am on social media. If you just go to Dr. Dot Alexandria dot Reyes that's my Instagram handle. That's probably where I'm the most active. And I do post education content there for perimenopause, menopause. And then I have some links in bio there that people can access even to schedule through their or you can reach out to my office. Actually probably the easiest way is to just email my assistant it's Maggie, M-A-G-G-I at. And it's dr alex reyes.com. So yeah, so that's us. Yeah. Yeah. And then of course our website and everything you can do magnolia gynecology.com. And then I have my personal website too, which is just all menopause, dr alex reyes.com. But yeah and then Maggie's email, she's the best to reach out to. We have a textable number too, which is really helpful if you want that. She usually answers that,

Kerry: 35:13

awesome. Thank you so much for your time today. This was a great discussion and, very educational, obviously, I like to, find out why things are changing in, the media or any medical space. So the menopause space is definitely hot right

Alexandria: 35:27

it is. It is. Which is good. It brings awareness, so that's good. Good to see you, Kerry.

Kerry: 35:34

Yes. All right, everybody. Stay tuned for next week's episode. Get Healthy Tampa Bay.