Podcast: What primary care looks like in midlife

Dr. Jean Marie McGowan urges women to keep up care after child-bearing years

Dr. Jean Marie McGowan, a Sanford Health internal medicine physician, poses in an exam room.

Episode Transcript

Courtney Collen (Host): Hello and welcome to Her Kind of Healthy, a brand new health podcast series brought to you by Sanford Women’s. I’m your host, Courtney Collen with Sanford Health News. We want to start brand new conversations about age-old topics from fertility and postpartum depression to managing stress, healthy living and so much more. Her Kind of Healthy is designed to bring you honest conversations about self-care, happiness and your overall wellbeing with our Sanford Health Experts. We are so excited to have you here.

Today, we are talking with Dr. Jean Marie McGowan on midlife care. Dr. McGowan, thank you so much for being with us.

Jean Marie McGowan, M.D. (Guest): It’s my pleasure. Thank you for having me.

Host: I want to begin by having you tell us about yourself and all about your role as an Internal Medicine physician in Fargo.

Dr. McGowan: I am originally from Brooklyn, New York. I moved out to Fargo, North Dakota, about seven years ago for my residency in Internal Medicine through the University of North Dakota. I served as chief resident and then I started working here at Sanford. I’m currently director of the Pelvic Floor Clinic and co-director of our Preconception Clinic. I am the only certified menopause practitioner in the state of North Dakota currently by the North American Menopause Society which is a medical organization that guides research or evidence-based medicine on hormone replacement therapy and other menopausal issues. And I’m also a primary care physician and I specifically see really only women and especially those who have many health issues.

Host: What do you most enjoy about being a part of women’s health?

Dr. McGowan: It’s such an honor to be a caretaker for caretakers. So, women are often so busy taking care of everyone else, their kids, their parents, their coworkers, their friends, whoever it might be that’s important to them, that they often don’t take care of themselves. So, I’m here to make sure that we spend that time doing that properly and safely and to the best that we can.

Host: Expand on that Pelvic Floor Clinic. What is that and what is your role as Director?

Dr. McGowan: So, the Pelvic Floor Clinic addresses many issues that affect the pelvic floor. And so that includes urinary leakage, or frequency, pelvic pain, pelvic organ prolapse, so like if you feel like your uterus is kind of coming down or just the pelvic floor itself, things are not as taut as they used to be and also bowel issues. So, some people have fecal incontinence as well so, they might have accidents and we address that as well. And we do that by providing both the exam, history and exam and then their first appointment with physical therapy, all in the same day. And we also give many educational materials that really help improve whatever array of symptoms that a woman can come with.

Host: So, did you start this clinic? And give us a little background on how long this has been around and how this was born.

Dr. McGowan: So, the Pelvic Floor Clinic has been up and running for about three years. but we started working on it about four years ago. I started with a urologist who was seeing a lot of patients who didn’t necessarily try the first and second line therapies before being referred right to the specialist. And these patients had not tried what we call behavioral changes. So, they didn’t change what they drank or how much they drank or distraction techniques and everything that’s not medication or not surgery. And this is not — by referring straight to the specialist, it’s not always a good use of time for both the patient or the specialist. So, we want to make sure that we bridge that gap between the physician who makes that referral and the specialist. So, we’re there to provide either these behavioral changes and the education on how to do that and make it as individualized as we can for each patient. We might start medications. We might stop medications. We might send for workup on other issues that could be contributing to pelvic floor issues and then of course, we can always refer to the specialist that we work alongside.

So, I work alongside the urology department, the gynecology department, the general surgery department, pelvic pain clinic and various other specialties that sometimes come into play.

Host: So, this episode is all about midlife. Dr. McGowan, first define midlife in a medical sense. And once we reach a certain age, what can women expect in that midlife stage?

Dr. McGowan: Current life expectancy in the US for women is 81.2 years, I believe now. When I looked it up last night, on the CDC’s website, so about 80 years old. So midlife would technically be around 40. In reproductive terms, we would probably say menopause is that big life changing point. So, when a woman goes from being able to reproduce and get pregnant to when she’s no longer able to do so. In the U.S., the average age of menopause is about 50, 52, give or take a few years. And some women, this might occur earlier if they have their ovaries removed or they are on certain medications or for other reasons. Menopause tends to be that important milestone in a woman’s life.

Host: Tell us what Sanford Women’s is doing in this midlife care space and — is this new?

Dr. McGowan: So, Sanford has always been caring for women and we’re just focusing now on midlife, we’re packaging it in a different way which is much more convenient and comprehensive for the 21st century woman. I now do menopause consults. I’ve only been certified the last few years but and our gynecologists have always been familiar with menopausal treatments. But now you have one more person and a group of people coming down the line who can address these symptoms as well.

So, we have more providers who are educated on proper hormone replacement therapy and other treatments that are — we have newer guidelines for. So, we’re just getting better and better.

Host: Yeah, what a fantastic way to care for women and like you said, kind of make it a — package it all up for convenience and comfort so that women know that they’re getting the best possible care and everything they need is basically within one place, right?

Dr. McGowan: Right. I might not be able to be everywhere, but I definitely see women from Bismarck and now that telemedicine is much more available, and insurance is more likely to cover, these will make these consult appointments easier as well across the enterprise. I know Sanford in Sioux Falls does have a women’s center and they do have providers who are up to date on menopausal management.

Host:  Yeah, what kind of impact is telehealth having on the care that you provide to women?

Dr. McGowan: I think it’s made it convenient for kind of everyone over the enterprise. I mean we’re out here in the Midwest. It’s definitely more rural than say my home city of Brooklyn. So, to be able to video chat your doctor, or from the convenience of your own home when it might be a few hours to drive or many miles and rides don’t work out; I think this has improved our access and improved our care. So, we’re able to now see many more patients in that regard.

Host: What does it mean to have an integrated health system in midlife care and tell us why that is so unique.

Dr. McGowan: We need integrated care because unfortunately, I cannot know everything, and neither can each of the physicians. We all have our little like sub-specialties which we really love to focus on and when we love those sub-focus, that sub-specialty, we know a lot about it. but I’ll be honest, my dermatology is not the best. So, I really need my dermatology colleagues to come in and help me and recommend the best anti-aging treatments or acne medications beyond my basic knowledge. And Sanford has every specialty that we could ever need. It’s very rare that we would need to refer out of network for any kind of care. And there’s just so many hours in the day to read and keep up with the very fast changing advice and evidence based medicine. So, we really need to have people who are most up to date on the current guidelines on screening, on medications, on vaccines, everything. Who is on top of the newest surgical techniques or procedures. And like I said, we have every single specialty here in Sanford that we could ever need. So, if I can’t do something, I can always call one of my colleagues and I think one of the reasons why I stayed out here in Fargo, North Dakota, so long is because everybody is so nice to work with. I’ve never encountered another physician or provider whose been too busy to chat with me about a patient or go that extra mile for them. Which is awesome.

Host: Do you tend to see a drop off in regular care among women who are entering that midlife phase of their lives?

Dr. McGowan: I’ll be honest, I think my viewpoint is biased because my days are full with primarily middle aged or older women. Women are seeking me out. But women, I find like some are very motivated to get as healthy as possible. They want to reduce as many medications as they can. They want to be as healthy as they can. And some are — there’s some anxiety with health care and that’s to be expected too. So, I see a variety of women with a variety outlook on medicine or doctoring.

Host: Obviously, medical care does not stop after those childbearing years. When do you transition or encourage transitioning from OB-Gynecologists to someone like you, internal medicine, primary care physician? What’s next?

Dr. McGowan: Well first of all, pregnancy is the ultimate stress test. So, if something went wrong during pregnancy like high blood pressure or diabetes, these things are unfortunately more likely to come show up later in life. Whether that’s because of genetic reasons or because of the diet and lifestyle that people may follow. So, that’s one thing. The second is that as we get older, the more things will tend to go wrong. So, blood pressures tend to increase as we get older. Bone density tends to decrease. Our sugars may increase a bit. We might have mood or sleep changes, and these can really affect other organ systems. So, really, the older we get, the more likely things are to go wrong. So we really need somebody who’s kind of overlooking everything from your head down to your toes, inside and outside and emotionally and physically. So, that’s the job of a primary care physician is to really take care of all of that.

And there’s Family Medicine physicians who are great. They take care of kids all the way up to as old as people get. And they’re great for like one or two fairly uncomplicated medical problems. But if a person starts having high blood pressure, diabetes, they’ve had cancer in the past or are prone to cancers; they have prostate problems, vascular issues, history of stroke; then you should really see the Internal Medicine who’s specialized for adults.

Host: How important is it that women continue that care after having babies, having children for several years?

Dr. McGowan: Well it’s very important. The older we get, the more likely things are to go wrong, right. So, it really matters. Those decades that we might have between having children and going into menopause, I mean that’s setting us up for like twenty, thirty years down the road. So, we need to — it’s so important to develop healthy habits and healthy living and we might not be aware of how our blood pressure is running if we’re not going to the provider on a regular basis. Or sleep issues, will definitely catch up with you after so many years of getting poor sleep or working nights for a long period of time. So, we need to have somebody again, looking out for you to make sure that we’re getting ahead of things and we’re not treating after the fact.

Host: What are like the top two or three most important things that you tell women we can do at home to really maintain a healthy lifestyle?

Dr. McGowan: So, I firmly believe that we are what we eat, how we sleep and what we do. So, the food that we eat is so important. So, we really need to get a well-balanced diet with lots of fruits and vegetables, whole grains, like very little processed food and sugars, little to no red meat and that includes pork. And I know this is North Dakota where red meat is very popular, and a way of life and that’s fine. I’m not telling you to get rid of it completely. As long as you are eating healthy about 80% of the time, you should be OK.

Like I said, sleep is important. So, on average, adults need six to eight hours of sleep and that’s good quality sleep. So, you are not snoring. If you get up more than twice to go to the bathroom, then that’s a problem and you should talk to a provider about it. And then you want to make sure that you’re doing things. So you’re not — if you work at a place where you’re sitting most of the time, then make sure you schedule some activities during your week where you’re getting your heart pumping and you’re building a sweat if you can. Make sure that you’re doing some weight training if you are able because it’s good for your bones. And bone density peaks when you are 30. So, we have to work really hard in your 20s and 30s to prevent osteoporosis in your 60s, 70s and 80s. So, I think, like I said, eating, sleeping and what we do is so important and without that, you will probably need medications by the time you’re 65.

Host: Such simple things and all fantastic advice. One of the things I wanted to ask was about sexual health in the midlife stage. Do you have frequent conversations with your patients? And what are some of the common questions that they have for you?

Dr. McGowan: Yes. So, first and foremost, for sexual health, for women of any age is to make sure that we’ve done the cervical cancer screening in the appropriate timeline. So, that’s first thing. So cervical cancer is caused by the human papillomavirus which is sexually transmitted. New guidelines are coming down the line I believe now the American Cancer Society is recommending screenings starting at 25 instead of 21 years old. And primary HPV screening every five years. But again, that depends on the tests we have available. So, that should be changing soon but it’s at least every three to five years that a pelvic exam with a Pap smear may be necessary. There are other factors to consider and that’s what you definitely want to talk about with your physician if you need them more frequent.

The other thing for sexual health is that of course, you want to prevent sexually transmitted infections if that’s a concern, if you are having multiple partners. If you want to become pregnant or not. That’s if your reproductive age, that’s important. And then as we get older, sometimes women can experience vaginal dryness which makes sex uncomfortable. And if sex is uncomfortable, you’re not going to want to have sex, right? So, sometimes that contributes to decreased desire as women get older is just because it’s uncomfortable. So, we want to make sure that we treat that appropriately and help with that. So, that’s not a part of your relationship that needs to suffer unnecessarily.

So, other things to consider for sexual health for women are certain medications or medical conditions that they have like Sjogren’s syndrome where all the mucosal surfaces are dryer can affect desire as well. So, and antidepressants are the biggest offenders of affecting sexual libido and the ability to achieve orgasm. The other thing too is unfortunately, women are — the amount of sexual assaults or trauma is greatly underreported. And it’s too common. So, if that has affected anyone at some point in their life, that should be addressed because once we address it, some of the other things, other health problems tend to get better as well. So, it’s really important to bring that up with a provider that you trust so that they can get you the help that you need.

Host: I’m learning so much, just from this conversation, I’m learning so much from you. What are other things women should know to keep living their best life in this stage of their lives?

Dr. McGowan: Specifically in midlife, if — about 60% of women midlife or older will have issues with pelvic floor. So, that urinary leakage, or overactive bladder, that vaginal dryness, about 60%. So, that’s a large chunk of women out there who have some degree of this issue. So, that’s a big part of my practice especially with the Pelvic Floor Clinic. And then you have about 75% of women with menopause might have hot flashes. And that could be anywhere from one hot flash in their entire life to one every 30 minutes. And so, we can — I talk about various options for that whether it’s hormonal or not hormonal. And then osteoporosis is huge. So, bone mass will greatly decrease once women stop menstruating or have that estrogen. So, it’s really important that we get women moving and doing weight bearing exercises and if they need treatment for osteoporosis; that we treat that. And the other thing too is the biggest thing is heart health. So, at 65 and older, it’s heart disease that is the number one killer of women, not breast cancer. So, I’m not saying don’t like stop breast cancer screening, that’s not what I’m saying. I’m saying we need to still focus on the heart in addition to getting a yearly mammogram.

So, eating a heart healthy diet, and getting regular exercise. If we need to do heart screens or get medications started, we talk about all of those different options.

Host: Awesome. Dr. Jean Marie McGowan, thank you so much for your time. This was really fun wasn’t it?

Dr. McGowan: Yeah, thank you so much for having me.

Host: Yeah, we really appreciate your time and your insight on midlife care. Gosh, women in the Fargo area are super lucky to have you and we are too for this episode of Her Kind of Healthy. Thank you so much again for your time and be on the lookout for our next episode of Her Kind of Healthy coming your way soon. Stay well and have a great day.

Posted In Midlife, Specialty Care, Women's

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