Ep 69: A Holistic Approach to Women’s Health with Dr. Anna Barbieri of TārāMD
Fertility Forward Episode 69:
So much of women’s health is based solely on conventional medicine, leaving little room for other evidence-based methods. Today we talk to Dr. Anna Barbieri who has a passion for truly personalized patient-centered care for women from preventative care to complex gynecologic issues. Dr. Barbieri is a board-certified gynecologist with additional training in integrative medicine. She completed a residency in OB-GYN at Mount Sinai Medical Center in New York City, where she is now an assistant clinical professor and a member of the Mount Sinai Center of Excellence for Menopause and Integrative Gynecology. Together with Dr. Suzanne Fenske, Dr. Barbieri is a co-founder and physician at TārāMD, an innovative gynecology practice in New York City. Dr. Barbieri believes that the patient is the most important member of their healthcare team and she partners with them to help them maintain or restore optimal gynecologic health. Today, she dispels some of the many misconceptions about integrative healthcare and lists some of the evidence-based methods that she uses in addition to conventional medicine, such as nutrition, behavioral and lifestyle changes, stress reduction techniques, and acupuncture. Tune in to find out the three things you should keep in mind at your next annual appointment and how integrative healthcare can help you take control of your health.
Rena: Hi everyone. We are Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital, New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Rena: I am so excited to welcome to Fertility Forward today, Dr. Anna Barbieri. She is a board certified gynecologist with additional training in integrative medicine. Her passion is truly personalized patient-centered care of women. From preventative care to complex gynecologic issues, Dr. Barbieri partners with our patients to help them maintain or restore optimal gynecologic health. Dr. Barbieri also has special expertise in helping navigate menopause where she focuses on each patient by customizing nutrition, lifestyle, and use of hormonal and non-hormonal treatments when appropriate. Dr. Barbieri completed her residency in OBGYN at Mount Sinai Medical Center in New York City, where she's now an assistant clinical professor and a member of the Mount Sinai Center of Excellence for Menopause and Integrative Gynecology. She is board certified in obstetrics and gynecology as well as integrative medicine and is a certified menopause practitioner by the North American Menopause Society. Together with her founder, Dr. Suzanne Fenske, Dr. Barbieri is the founder and physician at TaraMD and innovative gynecology practice in New York City. Aa busy girl, she is also the founding physician of Elektra Health, digital menopause education company. Wow. That is quite the bio. I am so honored to have you on giving us your time.
Dr. Anna Barbieri: Thank you, Rena. I'm so glad to be here and then talk about some, some of these topics that are so near and dear to our hearts.
Rena: Yes. So we initially connected because I saw some posts about TaraMD and it really spoke to me since I also very much believe in holistic integrative medicine and I'm also a health coach. So I was so thrilled to find that there was a practice out there that I, I, thought was really, really speaking to this comprehensive picture of what women's health needs.
Dr. Anna Barbieri: Thank you. Yes. So my partner, Dr. Fenske and I started Tara MD relatively recently, although our journey in medicine has been lasting quite a while. So I personally, I have been in practice for, I can't believe, but it's almost 20 years now. And for the last several years, I actually was really, really in love with this idea of trying to do things a little bit differently. And, you know, my background is really in conventional academic medicine, but I have always been interested in a more whole person approach, especially since as a general OBGYN, I've taken care of so many different women of different ages, different life stages, different issues, and have traversed with my patients through so many of sort of life's transitions. And I really started to think about how to integrate some of the principles of really more holistic treatment of women's health and started to implement some of these ideas into my practice. And I was just blown away by how changing nutrition or employing something simple, like stress reduction strategies would really change my patients’ health. So then I formalized my training through fellowship in integrative medicine, reconnected with a friend and colleague of mine, Dr. Fenske, and discovered that we both kind of had shared this dream. So we decided to put it together and that's how Tara MD was born. It's really something that we both were planning and dreaming about and it was really us connecting and reconnecting that made both of us be able to make it a reality.
Rena: I love that. I feel like that scent synchronicity right there too.
Dr. Anna Barbieri: And I think, you know, there's, there is a saying that goes something like you can go fast when you go alone, but you go farther when you go together. So I think just as a team, and by the way, you know, an idea like this, starting a new practice, leaving a previous kind of environment, putting us together, it sounds so inspirational and uplifting, but it takes so much work. Some of it is very logistical and practical and sort of nose to the ground type of work that I do want to stress that. And I think this is true in my life, in my personal life and my professional life, but also what I tell my patients to do is just do, if you have a dream, if there is something that you want to do, we can find a way to put it together. And often it takes a team and it takes a lot of work, but slowly but surely by being consistent going after it, we can do it. So I'm very excited about TaraMD. We're starting to see other patients in person very soon. So it's both a very exciting, somewhat stressful time because of how much work it's involving, but we were so looking forward to it.
Rena: Well, so tell us more about the practice and really the concept of TaraMD, you know, and how it's this comprehensive approach, how it's different than just going to, you know, an OB cause I know it is very different.
Dr. Anna Barbieri: Sure. So again, I come out of a background of conventional medicine and spent my career taking care of patients in a more usual practice. So I would see 30 to 40 patients a day. I delivered lots of babies in my day, about 2,500. So it's quite, quite a lot. It's like a small town. So, but, but two years ago, really my interest in this sort of a different approach to women's health took over and I realized I really needed to spend more time on that. And I decided it was time for me to transition out of obstetrics and into gynecology and into kind of developing this different style of a practice. So TaraMD is different in that we focus on gynecology beyond fertility which means that we really focus on all aspects of gynecology. In a typical OBGYN office there is a lot of focus on fertility and pregnancy whereas for us, we really take care of women across the range of our lifespan, well, reproductive lifespan. So from teenagers to women who are much older and really have a lot of patients who are sort of in midlife and beyond, because we do want to stress that our health as women does not begin and end with fertility. And we focus really on delivering the best of evidence-based conventional medicine. We do testing, we use medications, we use surgery, but we also employ other methods that are rooted in evidence, everything from nutrition to behavioral and lifestyle change, stress reduction, techniques, acupuncture for some conditions and we also employ supplements as depending on what's happening, the evidence behind them, the safety margin and the conditions that we're looking at. And we also deliver this care as a team. So it's certainly not just myself and my partner. We also work with a nutritionist, a health coach, and we're going to start acupuncture services soon. And I think the other big difference is that we're really interested and not just treating women one-on-one, but really want to put forward just greater knowledge about how our bodies work, how we can keep them healthy and functioning and how to really access the best care that women can get. So it's both, yes, it's a medical practice in that we take care of patients one-on-one, but we really very much interested in education and pushing forward this notion of how we can do women's health differently.
Rena: I love that. I think, you know, it speaks to sort of all the things I certainly believe in. You know, I think one of the most wonderful things about being in this space as I find my patients are all, they're so smart and know it's no longer this culture of just sort of like, taking whatever your doctor says and believing in it. And that's it, you know, people they want to understand, they want to know they're asking questions and they want better care. And I think, you know, that's exactly what you're delivering and sort of this comprehensive approach to realize that it's a team. You know, that's how I work with all of my patients too. What I do is great. Mental health is great, but it's one piece. And I find my patients really have the most success when they're integrating, you know, a team of people and we can all work together collaboratively to put a comprehensive treatment plan in place for somebody.
Dr. Anna Barbieri: Yeah. And I, I really agree with that. And I think, you know, our patients are an essential part of that team and the care, not just, you know, what we're trying to get away from the idea that medical care is administered to somebody. Medical care or healthcare really should put the patient at the center and really have the patient be an integral and the most important part of that team. So I do see, you know, I do have, I take such joy in taking care of patients that recognize that and recognize the power in that, recognize their own power in what they know about their health and their bodies, and are really, I'm hoping that my place is really to help empower them to take better care of their health whether they do it with things they can do on their own or with my help or the help of the team.
Rena: Right. You know, I think so many patients are still afraid to ask questions and patient advocacy is something I work with a lot of people on and I say, but we love your questions because we don't know unless you ask, you know, and that, you know, having a dialogue and open line of communication between, you know, a practitioner and patient I think is so important. And the true joy that I find in working with people is this communication.
Dr. Anna Barbieri: Yeah. And, you know, I think that is such a valuable piece of advice. And that would be like such an essential tip that I want to give to all women out there that we should not be afraid to ask questions. We should not be afraid to Google things before a visit. I actually kind of love it when somebody comes in and they've done their research and then I can help them sift through the sources of that information, help them interpret how that applies to them and answer any questions about it. I see time and time again, especially in the space of integrative medicine, we can get into the definitions, but integrative medicine is not really alternative medicine. Some people are afraid to really disclose even their treatment preferences or what they have tried, their doubts, their questions. And I think that can be counterproductive to good healthcare and to good medical care. We do need to be aware of these things. There's a statistic that actually over 50% of women use some sort of a complementary type of help other than what's considered truly conventional medical care. So let's say medications and surgery, that complementary help can be everything from massage to acupuncture, to supplements, to vitamins, even prayer is considered instead of a complementary method. And many, many, many women don't ever talk about it with their physicians because they assume that the doctor either doesn't know enough about it, or is going to be very judgemental about it, or is going to make fun of it, for example. And I really believe that there is tremendous value in being open and honest about health information because that's how we move forward. So I'm certainly always very appreciative of what my patients share with me, including what they've learned, what they've Googled, where their sources were from. And the other thing is that I think we need to be honest and say that as physicians, we really don't know everything. So I'm very happy to kind of delve into what my patients have researched and have found because then I can kind of check it against what I know and use the time and use my energy to really look into something that I may not know much about. So definitely.
Rena: And I think, you know, even beyond, of course, it's important to know, you know, what a patient has done, but I think too, it speaks to som sort of, you know, mental health perspective. If you find out they've been pursuing all these alternative treatments. And I think, you know, that is a really important part of someone's presentation, right? And just speaks to kind of where they're at mentally. And certainly I want to say too, look if you present information to a doctor and they judge you or make fun of you, maybe it's time to find a new physician because that should not be happening either. You know, no one should judge you for your choices. That's not, you know, a safe space. So I don't want anyone to think that they need to put up with that either. You know, this should be a respectful relationship.
Dr. Anna Barbieri: I really agree. And I think that openness is essential to the issue of trust between a healthcare provider or healthcare team and their patients. And I think it's time for us to really build that. So I think it's, I really welcome the information that my patients bring me. And I'm also on the other hand, very honest with them about my own interpretation or the evidence behind some of the methods they may be trying. I think there is just like in conventional medicine, we should be talking about the risks and benefits of different approaches. There are risks and benefits of complementary treatments also and I, I think we really need to approach them almost the same way because some of them may be harmful, some of them may not be effective. Some of them may be expensive for not providing much, but some of them may be very useful and healthy. So I think it's it really, that openness and communication and trust is just so essential in medicine.
Rena: I think that's a really good point too. You know, a lot of times, you know, I hate when people are kind of taken advantage of, right. And in healthcare, you know, if we were told, you know, there's something wrong with us, you know, a lot of times that can lead us to be desperate, right, to want to fix it. And so then we want to believe, because we want to believe there's some cure. And so then, you know, we might spend money on something that is not proven. And I think that is very important for your healthcare provider to talk to you about as well. You know, unfortunately there are a lot of people out there who will take advantage, you know, ofpeople, and that's not good either,
Dr. Anna Barbieri: You know, when we talk about these worlds of conventional medicine and integrative medicine, people sometimes divide these worlds into two different extremes. The conventional medicine where everything that's not part of our pharmacologic choices or more traditional medical interventions is considered dangerous or unproven. And then the other side where everything within conventional medicine is somehow considered to be driven by profit margins and not oriented towards improvement of health and where integrative medicine comes in and this is really what we try to portray with the whole idea behind TaraMD is that there is a more central way of doing it. You know, we practice evidence-based medicine. We practice what I think is just good medicine. We use different strategies according to what a patient needs. We certainly use medications and vaccinations and surgeries, but we also use some of these other therapies that really work for people. And certainly, you know, especially with the sort of rising rates of chronic disease that we see, the increase in the number of medications people take, I really think the power of integrative medicine and this middle way is the knowledge that we can live healthier lives by knowing how our bodies work and accessing appropriate solutions at appropriate times.
Rena: Can you maybe talk more about how to use sort of this school of thought with hormones. You know, I have, of course, a lot of patients with PCOS, talk a lot about hormones and how maybe your approach can help someone struggling with PCOS and the effects of that.
Dr. Anna Barbieri: Sure. So PCOS is one of the most common hormonal conditions that we see in women. It's typically marked by irregular periods and irregular ovulation as well as often signs of elevated androgen levels, including testosterone. So many women with PCOS will complain of acne, unusual hair growth and so on. The irregular ovulation piece is tied into fertility concerns, of course, because we needed to ovulate to get pregnant. And when we don't or we ovulate irregularly, often conception is really delayed or needs to be enhanced. And then finally PCOS, and this is where my sort of philosophy of integrative medicine really comes in, I often see the metabolic or the total body effect of PCOS. Some was dismissed or not addressed and that is the tie in of PCOS with things like insulin resistance, increased risk of diabetes and so on. And I think our philosophy at TaraMD and of integrative medicine is that of sort of a whole body approach. So we don't look at PCOS as just a fertility related condition. We look at it as a general body condition and we try to really approach it from all these different angles. Metabolically speaking, there are certainly nutritional interventions, including things like increased fiber, heavier plant use, less saturated fat, cleaner sources of meat, for example, less high glycemic index foods and less starchy foods, less added sugars. That's sort of the preferred diet for PCOS. Intermittent fasting can be helpful, especially in women that really want or need to lose weight. There's also some supplements that have been looked at in PCOS and including in fertility patients with PCOS. So we have a conversation about that. And then we also talk about medical approaches, whether it's approaches with insulin related medications like Metformin, whether it is fertility treatments that may be required, or if someone does not want to get pregnant, really regulation of their hormones with other hormones, if that is needed. And there are things that we can do in terms of using progesterone or progestins, birth control pills, things like that. So it's a whole sort of range of things, but it requires a really careful assessment of that individual because PCOS exists on a spectrum. It requires an understanding of where that individual wants to be. You know, is it someone who wants to be pregnant in two months, or is it someone who is trying to just being a little more of a balance? So we use, you know, we really use a combination of approaches, typically starting with lifestyle and moving on up through the sort of levels of things that are more invasive and expensive.
Rena: I'm so happy that, you know, you said all that, I think, you know, as you said, of course PCOS impacts fertility, but it also impacts people as a whole. I think a lot of times people don't find out they have PCOS until maybe they're trying to conceive. And then I see for a lot of patients, you know, myself included, I speak on the podcast a lot. I also have PCOS. And I think for a lot of people, it kind of clicks for them. And then they start to realize, oh yeah, that makes a lot of sense. You know, and maybe people have struggled with depression or anxiety for years, and it was misdiagnosed and it has nothing to do with, you know, more of a, like a chemical imbalance, but it has to do with hormones. And so they haven't been managing it in the best way, or, you know, they think my quality of life is sort of just lower. And I have to kind of deal with this up and down of feelings and you don't, you know, and as you said, it can be managed with sort of this comprehensive approach, you know, supplements, medication. And so I think it's so important for people to know they don't have to suffer like that
Dr. Anna Barbieri: For sure. And, you know, I see a lot of women for whom this diagnosis has taken many years because they were, for example, just, just had irregular periods when they were 18 years old and somebody just gave them birth control pills, and they were on them for 12 years. And no one even looked into the cause of irregular periods. And now this is coming out when maybe they are 38 and trying to get pregnant. I see a lot of women who have a lot of feelings of guilt and shame over it because they think that something is wrong with them. When in reality, this is a common condition that we think one of the reasons for it is actually a certain expression of certain genes. So this is not, you know, this is not something that you caught or you gave to yourself, this is the mechanics of your body. But on the other hand, I also don't want women to believe that, oh, it's because it's genetic, that's it. This is what I have. I'm now destined to suffer like this and have these problems because our genes, although we cannot change them, they can be expressed, meaning they show up in life in different ways and we can actually affect their expression. So for example, women who are overweight with PCOS, just weight loss, just change in nutrition can make a tremendous difference, mind-blowing difference, to their symptoms.
Rena: Hmm. Well, I hope that people with PCOS are listening and that this is giving them hope and they know that they don't have to settle.
Dr. Anna Barbieri: And the other thing, since we're on the topic of PCOS, you know, we do so much work in sort of midlife women's health also, you know, PCOS is really a lifelong condition. So it doesn't stop with us getting pregnant. PCOS affects our risk for diabetes. PCOS can affect through that, the risk of cardiovascular disease and so on. So this is something that if we're living with it, we need to be conscious of it and to know how to make our own individual health decisions, according to what's best for us. So certainly in our forties, fifties, even beyond PCOS is something that we should keep in mind as we make those nutritional decisions. As we go through our physical activity routines, as we go through our sort of preventive tests and screenings and all of that. So it's a perfect example of our hormonal health travels with us. So PCOS is not over with a pregnancy, but we can really be empowered to do something about it.
Rena: Sure. And even before pregnancy, too.
Dr. Anna Barbieri: Sure.
Rena: You know, when you start to menstruate and maybe have, you know, regular periods, you know, and just have that awareness, you know, before, you know, as it's so commonly done, just being on the birth control pill for 10 years, until you, you know, started to try and get pregnant, if that's your path and you know, is it to have this sort of understanding of your body from a younger age, I think is so important.
Dr. Anna Barbieri: I think in medicine, in general, we don't do enough of it. And I would, I'm like on this mission. And I think that's the mission of the practice is exactly that, you know, we can only do so much by treating women and helping women one-on-one. Where we really hope to make a big difference is putting forward this education that people can take with them, use it on their own, or maybe even use it with their doctors and their providers and all these fields and live healthier and live better.
Rena: I love that. Do you have, you know, sort of any, even in the field for so long, you have such amazing experience, any of words of wisdom just for, you know, women might be listening to this that haven't really thought about any of this, that maybe they were just kind of, you know, yearly, you know, OB appointments or a GYN appointments, you know, any kind of words of wisdom for women?
Dr. Anna Barbieri: Yes. So I have, I have kind of a set of three ideas that I think when we go to our next GYN, our next annual, we should keep in mind. And before I get to know even number one, the initial thought is that the annual exam is really not about the pap smear. I think for decades now we've been thinking about that's why we go, but the pap smear, which is a screening test for cervical cancer and precancerous changes on our cervix, should it be a small part of that visit? It's an important part, but it's not the main goal. The main goal is to really make sure that our gynecologic and to meet our hormonal health is okay. And to really know how to move forward for the next year. So my three pieces of advice would be one, know your history, look back. What have your periods done? You know, our periods are such a great weather vane of our hormonal health. Are you tracking them? Has there been any change, go back even before. Know your history by knowing your family history. There's a lot of hormonal and women's health related, including certain types of cancer related conditions that are linked to our genetics. Go back through it. Are there any red flags? Are there multiple people that had the same thing and bring it up during your annual visit. We're very fortunate to have certain tests, both screening tests, and also genetic tests at our disposal that can really make a difference in terms of health going forward. So that's know your history. The second thing would be to know your body. Are there any differences this year compared to last what's going on? If you think everything is okay, great. But are you feeling more tired? Is your hair falling out? Is your period changing? Is there anything else? It's time to bring those things up. Do you have any questions about how your body works? Let's say someone is 42. I do a lot of work in the sort of field of menopause also. A big transition is coming up for women in their forties, early fifties. A transition, just as significant as that of puberty or pregnancy. Let's see what questions you may have. And let's talk about that. So know your body, ask any questions you want about it. And then finally is when you go for that annual visit, if something is off and you're not feeling well, know what your goal is in feeling better. You know, I always like kind of figure out what my patient's wants, what my patient wants. Is it having more energy to spend with your family? Is it being able to get over their anxiety of finding another job maybe. Are they worried about menopause because they are 43 and they were considering getting pregnant. For example, I want to know what's driving that concern or what's driving those questions.SoI know your history, know your body, and know what you want.
Rena: It made me start thinking about all the things I need to ask at my next appointment too. That was so awesome. Thank you so much.
Dr. Anna Barbieri: Sure.
Rena: Well I think it was so lovely to have you on, I think, you know, hopefully listeners learned a lot and this was wonderful. I'm so excited for you guys to open your doors and to have this amazing resource for people to go and, you know, a team who really cares so much about women's health, like I do.
Dr. Anna Barbieri: Thank you so much, Rena. It was lovely to talk to you and you also do such great work and help so many, so many women along this journey. And I think it's wonderful to be talking to also just people that whose goal is to improve health care delivered in a different way and sort of partner with each other because our goals are really, really the same. And again, we're very, Dr. Fenske and I are super, super excited - and a little scared because it's something very new to put this project forward - and we're hoping we can, we can make a difference.
Rena: Well I love that. And that's such a great way to wrap. I like to wrap each episode with sharing a gratitude to end it on positivity. So on that note, is there something else you just shared so many, but something else that you are grateful for?
Dr. Anna Barbieri: I am really grateful for the discovery and the awareness that so many people share really positive goals and want to make a difference. It really makes me, especially after this last year and a half, when we see so much suffering and so much heartache and so much division, meeting people along this process has made me realize that we humans tend to be really good and that we want to do good, and I think we can. So I'm grateful for that lesson.
Rena: Oh, I love that. That was so beautiful. And I guess I'll sort of piggyback off what you said before and that, you know, I'm really grateful to meet other like-minded people in this space. You know, I've said on here before, I didn't really start my career until I was 30 and my whole life, I always knew I wanted a career. And you know, to me, a career is something like you eat, sleep, breathe, live it, it's not, you don't clock in clock out. You just, you're, you're kind of doing it all the time because you love it. And, you know, especially this past year, one of the, I think beautiful things has been the opportunity to really work harder to connect with people, to try and keep that going. And, you know, it's how I connected with you and Dr. Fenske and so I'm so grateful to meet other women who really genuinely want to change the space, want to change healthcare. You know, we want to make this better. So I'm so grateful to you both for receiving my ask to connect and to come on and share. So thank you so much.
Barbieri: Thank you so much, Rena. This is so fun. Hopefully we can do it again.
Rena: Yes, of course.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself. And remember you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us www. Rmany.com and tune in next week for more Fertility Forward.