WEBVTT
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I hear from women every day how difficult it is to navigate the healthcare system.
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Whether you're using an insurance model or a private practice or cash pay, whatever, it can take so long to find the right healthcare professional for you and to find someone who's truly listening.
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Our healthcare system has been, to be honest, not really based around women and not really based around wellcare.
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It's been about helping to reduce disease, reduce suffering, and kind of putting out fires.
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We're hoping to change that.
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We want to work on preventive care.
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We want to invest in women's health.
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We want to understand women, do better research on women, and provide better care for women.
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And so I thought it would be fitting to have a woman who has experienced it all through midlife come and talk on the show today.
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I feel like listening to women is what it's all about.
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And I think a lot of what she says is going to resonate with you.
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And hopefully we'll come up with some good ideas together.
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Julia Granacchi is a National Board certified health and wellness coach, comprehensive Pilates instructor, and founder of the Agecraft Practice, where she helps people navigate the physical, emotional, and identity shifts that come with midlife and beyond.
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Her approach brings together evidence-based behavior change, movement, nervous system regulation, and a healthy skepticism of the cultural messages that tell us that aging is something to fear, fight, or fix.
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She works primarily with women, queer, and gender-expansive people to build resilience, increase capacity, and create a relationship with their bodies rooted in curiosity and agency rather than control.
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Julia also works with Anna Barbieri Medical, bringing health coaching into the perimenopause and menopause experience as part of Dr.
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Barbieri's multidisciplinary care team.
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She trained at the Institute for Integrative Nutrition and Harvard Medical School's Sustainable Nutrition Program and completed her comprehensive Pilates certification through the Keynes School of Core Integration.
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At the heart of Julia's work is a simple idea.
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Midlife isn't a problem to solve.
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It's an opportunity to reconsider what's working, let go of what isn't, and craft the life you want.
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So, Julia Grunaki, I'm so excited to have you here.
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You know, I have been a big fan of yours since hearing your podcast Circling the Drain, which was like such a good concept and so relevant and also so shocking every time I listen to the beginning episode, hearing, you know, what people were saying to women in their midlives, like it is just shocking.
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So this is why I want to have you on.
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Thank you so much for being here.
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Of course, such a pleasure.
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So nice to be interviewed instead of interviewing because it's uh less crap and less pressure.
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So thank you for that.
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Yes, absolutely.
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You just get to show up and tell us about your experiences.
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So, you know, basically my idea was to talk to someone who has really been through it.
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And unfortunately, I think your story is not uncommon.
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I think it's going to resonate with a lot of people, but I'd love for you to just walk us through sort of what it's been like as you've been trying to find a healthcare provider, as you've been trying to find someone to address needs that you've experienced going through perimenopause and midlife.
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Sure.
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Yeah, happy to tell this story.
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I tell it often.
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Because I think, yeah, most people can relate to it.
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It's why I got into this work.
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It's why I had started that podcast, because I started my perimenopause, well, I should say I became aware of my perimenopausal journey during COVID, which was a terrible time to go through or start perimenopause, especially when we weren't sure what COVID was.
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And so I recall very specifically going to the grocery store in the middle of summer.
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I was masked up and gloved up, and I was waiting in the deli line to get some turkey meat.
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And I just started sweating.
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And it was this heat wave, and we've all, well, most of you have experienced this, that came up kind of like from my pelvic floor up through my body, through the top of my head.
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I turned bright red and just started to melt.
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And I thought I was dying.
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And I thought again I was wearing a mask.
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So everything is more complicated.
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You know, the hands are sweating in the gloves, the face is sweating behind the mask.
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And I thought this was an onset of like some crazy fever.
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I had gotten COVID.
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I I'm I'm dying.
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I'm dying.
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I wasn't dying.
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I was having a hot flash.
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And that was the beginning of my awareness of perimenopause.
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Yeah.
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Yeah.
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That's so common too, right?
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Because sometimes it's like that obvious sort of knock you off your feet symptom that lets people in on what's been happening.
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But do you feel like there were other symptoms that predated that that maybe you just so many.
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Where do we have how much time do you have?
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It's limited.
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I mean, let me get I mean, at that point, I think I gosh, how I think I was like 43, I want to say, or 44.
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You know, COVID just seems like so long ago, and yet it also feels like yesterday.
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So I think I was 43 or 44, and I was definitely one of these people who had a very athletic build most of my life.
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I am a comprehensively certified Pilates instructor.
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I have been a Pilates client starting in the year of 2006.
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So I have been in this practice doing it, teaching it later, but in, you know, practicing it for many, many years.
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So I've considered myself a person with a lot of strength.
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You're healthy, physically, yeah, very healthy, uh, very athletic build.
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And my body just sort of started to look weird, you know.
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And we've heard this before.
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And as a doctor, you hear this, right?
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It was like fat in strange places that I'd never had before.
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It was weight I couldn't shed, even though I was just, can I curse on this show?
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Yeah, absolutely.
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Okay.
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I was working my ass off.
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Like, and not only working my ass off at my crazy corporate real estate development job, but then going to Pilates afterward, I was getting up at like five in the morning to strength train like twice a week.
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I was doing so much and I was so burnt out and I was so tired and like nothing was changing, and I had so much anxiety and I wasn't sleeping, and I kept going to the doctor.
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And this is the story we've all heard.
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I kept going to the doctor, I kept being told I was fine.
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I'm having doctors prescribe, you know, sleeping pills and all of these other things.
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You know, I'm in this place where I like I don't want to get addicted to any kind of sleeping pill or colanopin or anything like that.
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Not that there's anything wrong with these pills, I want to clarify.
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Yeah, there's a time and a place.
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You know, and at a certain point I had just kind of given up, I think.
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And that all culminated in having that hot flash because that was very clear evidence of what was happening.
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There was no doubt.
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Yeah.
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And so, you know, I reached out to my my OBGYN at that time.
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And this is a story I think I'm sure that you hear, that I hear from patients all the time.
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Yeah.
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Is that I went to my current OBGYN who I knew longer than my husband.
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Okay.
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I mean, I had been going to her.
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I am a child-free person by choice, but this doctor had seen me through polyps and fibroids and surgeries and had been like in my corner for so many years.
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And I got into telehealth with her and was dismissed essentially for these symptoms.
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I was prescribed the birth control pill, which has never gone well for me.
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I tried it, it did not work.
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Again, birth control is fantastic.
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It is great for so many people, not for everyone, not for me.
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And that just, you know, from there went into a series of seeing different specialists, different doctors, finally seeing a, you know, a functional city, right?
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Like I, you were like, I should be able to throw a rock out my window and hit a specialist.
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Not true.
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So to make a very long story short, I ended up with a functional medicine doctor, like in a membership program, which was financially not sustainable and absolutely ridiculous.
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And the only positive about it was that I did start menopause hormone therapy.
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I became very educated.
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I went through Electra Health, which was also fantastic.
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So the kind of a series of different providers ended up at New York Langone once they opened their menopause care wing, which was like groundbreaking.
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I want to say this was four years ago or something.
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And to this day, like you can't even get in.
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I mean, I am so lucky that I got through the door basically the day they opened because you can't even get this is New York City.
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You cannot get an appointment there.
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And Mount Sinai is just, I think, now opening their kind of version of that.
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That is all to say, it's been a bumpy road.
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Yeah.
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But because of that experience, that's why I do what I do.
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You know, that's why I left this cushy six-figure job in real estate development and became a Pilates instructor and health coach specializing in this work because there is a gap that has to be filled.
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Exactly.
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There's a gap that has to be filled.
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You know, as you're describing this scenario, the thing that I think a lot of people basically have it wrong in medicine.
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And this is just my hypothesis from what I hear from my colleagues and from patients, is that even the research criteria for perimenopause is menstrual changes, like starting to have menstrual changes.
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And I think that could not be further from the truth of when perimenopause starts.
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And yet I sit on committees where we're reviewing grants, and I still hear people say, but they didn't include the menstrual changes.
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They're not using menstrual changes as the criteria.
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And I'm like, this criteria, I think, is what has to change.
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Because I'm imagining your doctor that you have a great relationship with on the other end and saying she's having all these things, but she's probably still having regular periods.
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So it's not perimenopause, right?
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And that is like, I think, where people just get it so wrong.
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There's such a disconnect there.
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I mean, I'm a great example.
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I just turned 50 in November.
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And up until the age of literally a 50, I want to say, let's see, I turned 50 in November.
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I skipped my period for two months after that.
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So I think December, January, I skipped my period and I thought, finally, the relief is coming.
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I've made it.
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Uh only to have it come back.
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And I actually just got it this morning.
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You're welcome.
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Um but up to that point, 28 days to the number, like every single time.
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So my menstrual cycle had never changed.
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It had been just completely normal for years and years and years.
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I was clearly in peri-menopausal.
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I'm clearly in the menopausal stage or getting into it and regular periods most of the time.
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Yeah.
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Yeah, exactly.
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I I had a patient earlier this week who's 52 and she's like, When are these periods gonna stop?
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Like, why can't they stop?
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And you know, aging.
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Like you can you can tell the rest of her body is aging and she's still having regular periods.
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You just could never say that she's not in perimenopause.
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But if you talk to her and you base everything on her menstrual period, she wouldn't be by the straw criteria.
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Correct.
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Yeah, and to your point, you know, I would add also, I am still in shock.
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You know, I work with a clinical practice.
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Yeah.
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We specialize in menopause care, that is what we do.
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And I am still shocked every day when I meet patients who tell me when I say, what brings you here today?
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And they say the same story that I had.
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I have seen my OB.
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She has delivered all four of my children.
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I went to her with these issues.
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She drew labs.
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I'm getting my period regularly and told me I was fine.
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And I am shocked every single time.
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I'm still amazed because there is an organization called the Menopause Society that exists that can tell you that this is not the criteria.
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Yeah.
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I mean, you literally can look it up on the internet.
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I know right there.
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It's just, yeah, gobsmacked every single time.
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And so there's definitely a gap in education for healthcare professionals.
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Absolutely.
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And I feel like it starts in medical school, you know, where the emphasis is not really put on what is normal.
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We are really taught about like look for the pathologies, look for what's abnormal, look for the disease states.
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And even when, you know, in residency for OBGYN, I kind of came into it from a really holistic perspective.
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I was really into like natural childbirth and I had trained as a doula before I was a resident.
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So I kind of came in with some skepticism.
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I realized, like, yes, we do pathologize everything, but to provide care for the vast numbers of women who are going through, you know, I don't want to pathologize menopause, but there really is suffering associated with it.
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So why are we not learning how to relieve that kind of suffering?
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Yeah, I want to acknowledge, I think, I think it's really important not to vilify doctors and the medical system because this is me as such a coach, like this is not your fault.
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This is not your fault, right?
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One in five US OBGYNs report formal menopause training.
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That's not a lot.
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80% of OBGYN residents report little or no formal training and menopause management.
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So it starts in education.
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And then you know this if you want more, you have to seek that out on your own.
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And my God, you're busy.
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You already have to get continuing education and other things.
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This may not be the thing.
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So that is all to say that it starts in the education system.
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And I would even add it starts even earlier with educating kids in their health classes.
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We learn about birth, we learn about puberty.
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Why aren't we discussing menopause?
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Why didn't I learn about menopause when I was 14?
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Yeah.
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Sometimes I don't know if anybody's listening.
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Is anybody out there?
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But then I hear that people are enjoying the podcast episodes I'm putting together.
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If you are one of those people, please like and subscribe.
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So I know that there are people out there listening.
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That keeps me continuing on.
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And then you'll get notifications when there's a new episode.
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Also, if you know someone who could use the information that I'm putting out there, please feel free to share and forward.
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I love your support.
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Thank you.
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Yeah, I agree.
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No, I I love that I try to teach my kids about menopause.
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And it's funny because even this morning my daughter was asking some questions and I started going straight to the hot flash thing.
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And then I had to tell myself, okay, but it's not just hot flashes, you know.
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So I'm like, I feel like there's a constant education that we all are are needing to do.
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And I I follow that with there has to be incentivization in the healthcare system too.
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Because I love what Melinda Gates is doing by trying to bring more education, but like we are lifelong learners in medicine.
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We're expected to learn more information as like new research comes out all of the time.
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But if people are not incentivized to actually provide that care or held accountable for providing that care, like the needle's not gonna move.
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And you know, I feel like one of the things I've heard you guys talk about on circling the drain was, you know, finding someone who would take insurance.
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And then again, like hearing about the program at NYU, like getting in, right?
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Like, right, how are we serving the millions of women that are going through menopause all around the country if we don't have people who will take insurance and many of them who will provide this care?
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Yeah, I mean, that's such a great point.
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And I think naming that is really important because again, it's not the doctor's fault.
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You know, here in this particular case, when it comes to talking about insurance, look, I work for a membership-based practice because the people that I work for want to provide a very specific kind of care.
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And we cannot do that within the insurance system.
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And I'm sure you know this better than anybody.
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And you you've talked about this previously on your show.
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First of all, insurance companies don't reimburse for seeing lady parts the way that they do for seeing dude parts.
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So there's a discrepancy in reimbursement.
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But then also, if you want to spend more than 15 minutes with someone, you are not gonna get paid for that.
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So it starts with the insurance companies first.
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Reimbursement has to be better, it has to be easier.
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Yeah.
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Otherwise, back to incentivizing, they're not incentivized to take insurance.
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Yeah.
00:17:11.210 --> 00:17:16.170
I mean, this is a bigger, a bigger conversation politically, but it starts with government oversight.
00:17:16.170 --> 00:17:16.970
I mean, right?
00:17:16.970 --> 00:17:20.329
Insurance companies, my God, it's uh to quote Dr.
00:17:20.329 --> 00:17:23.529
Rachel Rubin, it is a dumpster fire of brokenness.
00:17:23.769 --> 00:17:24.569
It is, it is.
00:17:24.649 --> 00:17:25.210
Yeah, I know.
00:17:25.369 --> 00:17:30.730
So, how do we help the women not like navigate around and out of the dumpster fire?
00:17:30.730 --> 00:17:33.369
Because this is what I know, like you and I both really want to do.
00:17:33.609 --> 00:17:35.769
Yeah, I mean, my God, it's so difficult.
00:17:35.769 --> 00:17:51.289
Okay, from a more systemic point of view, it is calling, it's calling your congressperson, it's getting in touch with organizations where we can actually start with the government oversight, calling your insurance company, asking them why they're not covering certain things.
00:17:51.289 --> 00:17:52.889
So this is this bigger picture.
00:17:52.889 --> 00:18:07.690
And if you, if you can, if you are capable contributing financially to groups that can help with that, from a patient standpoint, unfortunately, the whole responsibility falls on your shoulders for advocacy, finding the right provider who can meet that criteria.
00:18:07.690 --> 00:18:15.450
So with a place like Newark Lingo, and again, just as an example, it might be getting on a waiting list and just coming to terms with the fact that you're gonna have to wait quite a while.
00:18:15.450 --> 00:18:17.930
But when you get seen, you're really gonna get taken care of.
00:18:17.930 --> 00:18:20.250
And then it's like menopause.org.
00:18:20.250 --> 00:18:23.689
Again, educating women so they know that these resources exist.
00:18:23.689 --> 00:18:26.250
Every single patient I see, they've already come to us.
00:18:26.250 --> 00:18:26.969
We've already won.
00:18:26.969 --> 00:18:28.889
We've got the patient, they're doing the thing.
00:18:28.889 --> 00:18:35.209
I always tell them to go to menopause.org just to be aware that it exists, so that it's there as a resource.
00:18:35.209 --> 00:18:42.649
So knowing that you can go there and find your provider, likely, hopefully, a provider that takes your insurance who is listed on menopause.org.
00:18:42.649 --> 00:18:46.809
And, you know, these telehealth companies, there's the good and the bad, right?
00:18:46.809 --> 00:18:55.209
But they they really are very helpful in the way that there's more access for people in these sort of dry zones of America where they don't have access to this kind of care.
00:18:55.209 --> 00:18:59.849
They can barely even see a gynecologist or a general practitioner because of the area that they're located.
00:18:59.849 --> 00:19:02.329
So these telehealth companies are making a huge difference.
00:19:02.329 --> 00:19:05.289
We've got some, you know, that do take insurance, some that don't.
00:19:05.289 --> 00:19:06.250
There's some good ones.
00:19:06.250 --> 00:19:08.730
There's good actors, bad actors.
00:19:08.730 --> 00:19:22.649
We all know some of them are not so uh savory, but I think in general, the telehealth approach is not bad because most back to your point, most of what is going on with women doesn't require a physical examination.
00:19:23.449 --> 00:19:23.849
Exactly.
00:19:23.849 --> 00:19:33.449
And I see a lot of women who tell me unfortunately they had to wait like three to four months to get in with me, but then they found a teleprovider who was able to get them started.
00:19:33.449 --> 00:19:34.649
And that's awesome.
00:19:34.649 --> 00:19:36.409
That saves me a step, right?
00:19:36.409 --> 00:19:42.009
And helps me to kind of get them moving, to really sort of personalize or customize or tweak.
00:19:42.009 --> 00:19:43.929
I think that's a really nice combination.
00:19:43.929 --> 00:19:47.289
So many more resources are out there than there used to be.
00:19:47.289 --> 00:19:51.049
I wonder what you think about like what needs to change.
00:19:51.049 --> 00:19:56.889
Like, what would be the single most impactful way to change the healthcare system right now?
00:19:56.889 --> 00:20:08.889
If you think back to yourself at that time where you are experiencing that hot flash and like looking for help, like I guess what would have made it so much better is if your healthcare provider was like, oh yeah, you're not too young.
00:20:08.889 --> 00:20:10.809
You don't you didn't do well on birth control pills.
00:20:10.809 --> 00:20:11.849
Here's some other options.
00:20:11.849 --> 00:20:14.409
Like, is that where the crux lies?
00:20:14.649 --> 00:20:15.529
Or I don't know.
00:20:15.529 --> 00:20:16.569
That's a good question.
00:20:16.569 --> 00:20:18.569
I think, I think it's really resources.
00:20:18.569 --> 00:20:22.329
You know, if we're gonna ask that specifically, what would have helped me in that moment?
00:20:22.329 --> 00:20:29.769
And what I do think is improving, if I'm being honest, is the amount of resources we have out there for people going through this transition.
00:20:29.769 --> 00:20:40.809
Because at that time, I was taking the deepest dive into PubMed and was like, oh, look, there is one singular paper about how micronized progesterone can help with sleep.
00:20:40.809 --> 00:20:42.169
I want some of that.
00:20:42.169 --> 00:20:44.490
And I would ask people and they'd be like, What?
00:20:44.490 --> 00:20:45.529
Like progesterone?
00:20:45.529 --> 00:20:46.569
And I'm like, you're a doctor.
00:20:46.569 --> 00:20:48.250
Like, why am I, why is this news to you?
00:20:48.250 --> 00:20:52.730
And I would print out the paper and bring it with me and be like, it's cited.
00:20:52.730 --> 00:20:54.490
So we're we're way past that.
00:20:54.490 --> 00:20:56.169
I mean, there's so many resources.
00:20:56.169 --> 00:20:59.929
But again, I still get patients through the door who this is new to them.
00:20:59.929 --> 00:21:01.369
They've never heard of it.
00:21:01.369 --> 00:21:04.490
And it's like there's a desert out there, even though there is not.
00:21:04.490 --> 00:21:07.049
We know that there's a lot going on in what I call the metaverse.
00:21:07.049 --> 00:21:09.209
So, you know, there are a lot of resources.
00:21:09.209 --> 00:21:15.689
So I think continuing to build resources, shine a light, you know, we've got a lot of celebrities talking about it.
00:21:15.689 --> 00:21:18.730
You've got Halle Berry and, you know, a number of other people.
00:21:18.730 --> 00:21:21.129
So all of that is helpful.
00:21:21.129 --> 00:21:39.049
But I just want to say that one of the problems we run into with more exposure is this idea of people preying upon this community and a very vulnerable population with supplements and, you know, doodads and all these other things.
00:21:39.049 --> 00:21:48.329
So while that information is very helpful, I feel like we're more in a spot where it's difficult to be discerning of what is to be trusted and what should not be trusted.
00:21:48.329 --> 00:21:50.889
So now there's a whole other layer of complication.
00:21:51.289 --> 00:21:51.609
You're right.
00:21:51.609 --> 00:22:00.009
It just gives me heart sync because I saw a patient last week who was telling me, you know, I got into this beautiful private practice.
00:22:00.009 --> 00:22:03.289
It was like very, you know, beautifully decorated.
00:22:03.289 --> 00:22:04.969
It was curated for women.
00:22:04.969 --> 00:22:07.289
It was just so appealing in so many ways.
00:22:07.289 --> 00:22:09.689
They listened to me, which is huge, right?
00:22:09.689 --> 00:22:14.730
And they started her on compounding hormone therapy, which was fine for her.
00:22:14.730 --> 00:22:19.369
There were some tweaks that we decided to make sure that her uterus was getting properly protected.
00:22:19.369 --> 00:22:22.889
But she's like, I just had this feeling that I was being upsold.
00:22:22.889 --> 00:22:26.169
She's like, I was so grateful for what they were starting me on.
00:22:26.169 --> 00:22:32.809
And then, you know, they wanted me to do this thing for that, or they started talking to me about aesthetic treatments for this.
00:22:32.809 --> 00:22:35.049
And I just felt like I was being upsold.
00:22:35.049 --> 00:22:42.250
And she just kind of like, we talked about how it was like her spidey sense of like, okay, take what you feel like is right and then leave the rest of it.
00:22:42.250 --> 00:22:58.409
But I was appreciative that she shared the experience with me because you're right, like there are people who are trying to make money off of this situation of there not being enough people out there to help and the desperacy of how I'm sorry to say shitty perimetopods and menopause women feel.
00:22:58.409 --> 00:22:59.929
And say it, it's shitty.
00:22:59.929 --> 00:23:01.609
It's pretty, it's so shitty.
00:23:01.609 --> 00:23:05.849
And it's uh it's even more shitty to take advantage of someone in that situation.
00:23:05.849 --> 00:23:06.889
It just bothers me.
00:23:07.129 --> 00:23:10.089
And to your point, I think patients they start to feel it.
00:23:10.089 --> 00:23:18.889
They know when they're being sold to, and they may not know it initially, but even for me, like I said, I To this functional medicine doctor I was working with in this membership.
00:23:18.889 --> 00:23:22.969
And like you said, it got me started on this journey, and I'm grateful for that.
00:23:22.969 --> 00:23:29.049
But it came to a point where I was like, I don't really need this amount of like blood work and I don't need a Dutch test.
00:23:29.049 --> 00:23:30.649
I don't need any of this stuff.
00:23:30.649 --> 00:23:33.769
I think I will change course in this moment.
00:23:34.009 --> 00:23:39.529
But you were so PubMed and you were so proactive in like learning this yourself.
00:23:39.529 --> 00:23:45.529
You know, I I don't know how you help the woman who, you know, doesn't do that or doesn't know how to get started.
00:23:45.529 --> 00:23:49.369
And I hate that people have to learn medicine in order to get help for themselves.
00:23:49.529 --> 00:23:50.490
Like, you know.
00:23:50.490 --> 00:23:51.849
So true.
00:23:51.849 --> 00:23:55.689
I mean, as a coach, for example, you know, I work with a clinical practice.
00:23:55.689 --> 00:23:57.769
I also have a practice of my own.
00:23:57.769 --> 00:23:58.089
Yeah.
00:23:58.089 --> 00:24:05.129
And I have a particular thing that you can book, which is essentially you get 30 minutes with me to ask me anything that you want.
00:24:05.129 --> 00:24:12.329
And to tell you the truth, a lot of people spend 30 minutes asking me everything about perimenopause and menopause.
00:24:12.329 --> 00:24:17.369
And then eventually the last thing we usually cover is how to find a doctor, where to go.
00:24:17.369 --> 00:24:20.329
Just to clarify, you know, I am board certified.
00:24:20.329 --> 00:24:23.689
There are ethical guardrails to what I do.
00:24:23.689 --> 00:24:25.689
I do not prescribe, I do not diagnose.
00:24:25.689 --> 00:24:29.529
So I simply spend 30 minutes giving verified information to people.
00:24:29.529 --> 00:24:32.169
So I myself am a resource in that moment.
00:24:32.169 --> 00:24:34.569
But most of the time that's exactly what we do.
00:24:34.569 --> 00:24:37.609
It's I spend a lot of time validating people's symptoms.
00:24:37.609 --> 00:24:40.329
I would say it's validate, educate, advocate.
00:24:40.329 --> 00:24:42.649
So I spend time validating their symptoms.
00:24:42.649 --> 00:24:44.889
Everything that's happening to is real, it's not made up.
00:24:44.889 --> 00:24:46.089
I'm sorry you've been gaslit.
00:24:46.089 --> 00:24:46.809
I'm glad you're here.
00:24:46.809 --> 00:24:51.929
I spend some time educating, which is just basic information that you can find on the Mounta Society website.
00:24:51.929 --> 00:25:02.169
And then advocating, I am handing the reins over and reminding the patient that they have agency and that there are resources available to them to see a specialist.
00:25:02.409 --> 00:25:02.649
Yeah.
00:25:02.649 --> 00:25:04.169
And that's what's needed, right?
00:25:04.169 --> 00:25:05.689
Like you are a midlife doula.
00:25:05.689 --> 00:25:18.009
You know, speaking of doula, this was like, this is what we needed in the childbirth community to help women advocate for themselves and not like be passive individuals in their birthing and pregnancy experiences.
00:25:18.009 --> 00:25:22.490
And this is exactly what we need for validating and advocating for women in midlife.
00:25:22.649 --> 00:25:24.490
Yeah, I think that agency is so important.
00:25:24.490 --> 00:25:36.169
I think that often women come to, I mean, even in with this clinical practice, them seeing us is the first step in this journey of agency and self-advocacy.
00:25:36.169 --> 00:25:38.569
And it's the first step they may have taken in their entire life.
00:25:38.730 --> 00:25:38.889
Yeah.
00:25:39.129 --> 00:25:40.409
When it comes to their own healthcare.
00:25:40.649 --> 00:25:41.289
That's huge.
00:25:41.289 --> 00:25:42.649
That's life changing.
00:25:42.649 --> 00:25:44.569
So how can people find you?
00:25:45.369 --> 00:25:49.289
You can find me very easily at juliagwellness.com.
00:25:49.289 --> 00:25:51.609
That is juliagwellness.com.
00:25:51.609 --> 00:25:57.849
And then honestly, if you just punch my name into Google, Julia Granacki, I will come up in many different places.
00:25:57.849 --> 00:26:02.009
You'll find all my uh handles for all the social links and all of the things.
00:26:02.009 --> 00:26:02.329
Yeah.
00:26:02.809 --> 00:26:03.449
That's awesome.
00:26:03.449 --> 00:26:05.449
And you have your new podcast now.
00:26:05.449 --> 00:26:07.129
Can you tell us a little bit about that?
00:26:07.449 --> 00:26:07.769
Sure.
00:26:07.769 --> 00:26:15.209
I have a new podcast called Agecraft After Dark, where we talk about the things essentially that keep us up at night.
00:26:15.209 --> 00:26:21.449
So I would say there's a little bit of residual vibe from circling the drain that has carried over.
00:26:21.449 --> 00:26:25.929
So there's definitely things about health care and that health and wellness approach.
00:26:25.929 --> 00:26:28.889
But then we cover some things that are not related to that.
00:26:28.889 --> 00:26:32.250
And, you know, my first guest was my tattoo artist.
00:26:32.250 --> 00:26:34.730
So it varies across the board.
00:26:34.730 --> 00:26:38.250
It's a little bit witchy because I am there is a woo-woo aspect.
00:26:38.250 --> 00:26:42.009
I'm very grounded in science, but there is a woo-woo aspect to what I do.
00:26:42.009 --> 00:26:42.409
Yeah.
00:26:42.409 --> 00:26:45.289
And so, and there's also some storytelling that occurs on that too.
00:26:45.289 --> 00:26:49.609
Every guest is uh tasked with telling us a spooky story at the end.
00:26:49.609 --> 00:26:54.250
So I think it's a fun time, it's a good hang, and also you might learn something.
00:26:54.250 --> 00:26:55.849
So yeah, H craft after dark.
00:26:56.089 --> 00:26:56.250
Great.
00:26:56.250 --> 00:26:58.250
Well, I've got a great story to tell you.
00:26:58.250 --> 00:27:01.609
I'm gonna pin it down to remember to tell you.
00:27:01.609 --> 00:27:02.089
Yeah.
00:27:02.089 --> 00:27:04.329
It is a little, a little witchy and a little woo-woo.
00:27:04.329 --> 00:27:06.009
So I think it'll end.
00:27:06.009 --> 00:27:07.849
But thank you so much for your time.
00:27:07.849 --> 00:27:20.169
I hate that you had such a hard time, but I love that you turned this into helping other women and helping other women find themselves, find their voice, and get help that they deserve.
00:27:20.169 --> 00:27:25.769
So thanks for everything that you do, and thanks for all of the work that you're doing, you know, outside of just your one on one work.
00:27:26.169 --> 00:27:26.809
I appreciate that.
00:27:26.809 --> 00:27:29.449
I'm also glad that it brought me here and I love what I do.
00:27:29.449 --> 00:27:31.769
For the first time in my life, I absolutely love what I do.
00:27:31.769 --> 00:27:33.369
So yeah, it was a good thing.
00:27:33.689 --> 00:27:34.569
Awesome.
00:01:15.929 --> 00:01:21.129
I hear from women every day how difficult it is to navigate the healthcare system.
00:01:21.129 --> 00:01:33.609
Whether you're using an insurance model or a private practice or cash pay, whatever, it can take so long to find the right healthcare professional for you and to find someone who's truly listening.
00:01:33.609 --> 00:01:40.889
Our healthcare system has been, to be honest, not really based around women and not really based around wellcare.
00:01:40.889 --> 00:01:48.169
It's been about helping to reduce disease, reduce suffering, and kind of putting out fires.
00:01:48.169 --> 00:01:49.849
We're hoping to change that.
00:01:49.849 --> 00:01:52.090
We want to work on preventive care.
00:01:52.090 --> 00:01:55.370
We want to invest in women's health.
00:01:55.370 --> 00:02:00.329
We want to understand women, do better research on women, and provide better care for women.
00:02:00.329 --> 00:02:08.169
And so I thought it would be fitting to have a woman who has experienced it all through midlife come and talk on the show today.
00:02:08.169 --> 00:02:11.689
I feel like listening to women is what it's all about.
00:02:11.689 --> 00:02:14.969
And I think a lot of what she says is going to resonate with you.
00:02:14.969 --> 00:02:17.449
And hopefully we'll come up with some good ideas together.
00:02:17.449 --> 00:02:30.810
Julia Granacchi is a National Board certified health and wellness coach, comprehensive Pilates instructor, and founder of the Agecraft Practice, where she helps people navigate the physical, emotional, and identity shifts that come with midlife and beyond.
00:02:30.810 --> 00:02:41.930
Her approach brings together evidence-based behavior change, movement, nervous system regulation, and a healthy skepticism of the cultural messages that tell us that aging is something to fear, fight, or fix.
00:02:41.930 --> 00:02:52.649
She works primarily with women, queer, and gender-expansive people to build resilience, increase capacity, and create a relationship with their bodies rooted in curiosity and agency rather than control.
00:02:52.649 --> 00:02:59.689
Julia also works with Anna Barbieri Medical, bringing health coaching into the perimenopause and menopause experience as part of Dr.
00:02:59.689 --> 00:03:01.930
Barbieri's multidisciplinary care team.
00:03:01.930 --> 00:03:12.409
She trained at the Institute for Integrative Nutrition and Harvard Medical School's Sustainable Nutrition Program and completed her comprehensive Pilates certification through the Keynes School of Core Integration.
00:03:12.409 --> 00:03:14.969
At the heart of Julia's work is a simple idea.
00:03:14.969 --> 00:03:17.129
Midlife isn't a problem to solve.
00:03:17.129 --> 00:03:23.050
It's an opportunity to reconsider what's working, let go of what isn't, and craft the life you want.
00:03:23.050 --> 00:03:26.569
So, Julia Grunaki, I'm so excited to have you here.
00:03:26.569 --> 00:03:44.329
You know, I have been a big fan of yours since hearing your podcast Circling the Drain, which was like such a good concept and so relevant and also so shocking every time I listen to the beginning episode, hearing, you know, what people were saying to women in their midlives, like it is just shocking.
00:03:44.329 --> 00:03:45.609
So this is why I want to have you on.
00:03:45.609 --> 00:03:47.289
Thank you so much for being here.
00:03:47.609 --> 00:03:48.569
Of course, such a pleasure.
00:03:48.569 --> 00:03:53.129
So nice to be interviewed instead of interviewing because it's uh less crap and less pressure.
00:03:53.129 --> 00:03:54.009
So thank you for that.
00:03:54.250 --> 00:03:55.210
Yes, absolutely.
00:03:55.210 --> 00:03:59.769
You just get to show up and tell us about your experiences.
00:03:59.769 --> 00:04:05.449
So, you know, basically my idea was to talk to someone who has really been through it.
00:04:05.449 --> 00:04:09.370
And unfortunately, I think your story is not uncommon.
00:04:09.370 --> 00:04:23.769
I think it's going to resonate with a lot of people, but I'd love for you to just walk us through sort of what it's been like as you've been trying to find a healthcare provider, as you've been trying to find someone to address needs that you've experienced going through perimenopause and midlife.
00:04:23.769 --> 00:04:24.409
Sure.
00:04:24.569 --> 00:04:26.090
Yeah, happy to tell this story.
00:04:26.090 --> 00:04:27.529
I tell it often.
00:04:27.529 --> 00:04:31.210
Because I think, yeah, most people can relate to it.
00:04:31.210 --> 00:04:33.049
It's why I got into this work.
00:04:33.049 --> 00:04:49.289
It's why I had started that podcast, because I started my perimenopause, well, I should say I became aware of my perimenopausal journey during COVID, which was a terrible time to go through or start perimenopause, especially when we weren't sure what COVID was.
00:04:49.289 --> 00:04:56.490
And so I recall very specifically going to the grocery store in the middle of summer.
00:04:56.490 --> 00:05:03.610
I was masked up and gloved up, and I was waiting in the deli line to get some turkey meat.
00:05:03.610 --> 00:05:07.370
And I just started sweating.
00:05:07.370 --> 00:05:19.370
And it was this heat wave, and we've all, well, most of you have experienced this, that came up kind of like from my pelvic floor up through my body, through the top of my head.
00:05:19.370 --> 00:05:21.930
I turned bright red and just started to melt.
00:05:21.930 --> 00:05:23.210
And I thought I was dying.
00:05:23.210 --> 00:05:25.529
And I thought again I was wearing a mask.
00:05:25.529 --> 00:05:26.810
So everything is more complicated.
00:05:26.810 --> 00:05:30.169
You know, the hands are sweating in the gloves, the face is sweating behind the mask.
00:05:30.169 --> 00:05:33.450
And I thought this was an onset of like some crazy fever.
00:05:33.450 --> 00:05:34.809
I had gotten COVID.
00:05:34.809 --> 00:05:36.169
I I'm I'm dying.
00:05:36.169 --> 00:05:36.970
I'm dying.
00:05:36.970 --> 00:05:38.009
I wasn't dying.
00:05:38.009 --> 00:05:39.529
I was having a hot flash.
00:05:39.529 --> 00:05:42.250
And that was the beginning of my awareness of perimenopause.
00:05:42.250 --> 00:05:42.490
Yeah.
00:05:42.570 --> 00:05:42.730
Yeah.
00:05:42.730 --> 00:05:44.330
That's so common too, right?
00:05:44.330 --> 00:05:52.490
Because sometimes it's like that obvious sort of knock you off your feet symptom that lets people in on what's been happening.
00:05:52.490 --> 00:05:57.129
But do you feel like there were other symptoms that predated that that maybe you just so many.
00:05:57.289 --> 00:05:59.289
Where do we have how much time do you have?
00:05:59.289 --> 00:06:00.250
It's limited.
00:06:00.250 --> 00:06:09.049
I mean, let me get I mean, at that point, I think I gosh, how I think I was like 43, I want to say, or 44.
00:06:09.049 --> 00:06:13.450
You know, COVID just seems like so long ago, and yet it also feels like yesterday.
00:06:13.450 --> 00:06:21.929
So I think I was 43 or 44, and I was definitely one of these people who had a very athletic build most of my life.
00:06:21.929 --> 00:06:24.970
I am a comprehensively certified Pilates instructor.
00:06:24.970 --> 00:06:28.490
I have been a Pilates client starting in the year of 2006.
00:06:28.490 --> 00:06:33.610
So I have been in this practice doing it, teaching it later, but in, you know, practicing it for many, many years.
00:06:33.610 --> 00:06:37.929
So I've considered myself a person with a lot of strength.
00:06:37.929 --> 00:06:42.169
You're healthy, physically, yeah, very healthy, uh, very athletic build.
00:06:42.169 --> 00:06:45.929
And my body just sort of started to look weird, you know.
00:06:45.929 --> 00:06:47.850
And we've heard this before.
00:06:47.850 --> 00:06:49.450
And as a doctor, you hear this, right?
00:06:49.450 --> 00:06:52.809
It was like fat in strange places that I'd never had before.
00:06:52.809 --> 00:06:56.730
It was weight I couldn't shed, even though I was just, can I curse on this show?
00:06:56.889 --> 00:06:57.529
Yeah, absolutely.
00:06:57.850 --> 00:06:58.009
Okay.
00:06:58.009 --> 00:06:59.450
I was working my ass off.
00:06:59.450 --> 00:07:11.289
Like, and not only working my ass off at my crazy corporate real estate development job, but then going to Pilates afterward, I was getting up at like five in the morning to strength train like twice a week.
00:07:11.289 --> 00:07:20.090
I was doing so much and I was so burnt out and I was so tired and like nothing was changing, and I had so much anxiety and I wasn't sleeping, and I kept going to the doctor.
00:07:20.090 --> 00:07:21.769
And this is the story we've all heard.
00:07:21.769 --> 00:07:24.090
I kept going to the doctor, I kept being told I was fine.
00:07:24.090 --> 00:07:29.450
I'm having doctors prescribe, you know, sleeping pills and all of these other things.
00:07:29.450 --> 00:07:36.730
You know, I'm in this place where I like I don't want to get addicted to any kind of sleeping pill or colanopin or anything like that.
00:07:36.730 --> 00:07:39.289
Not that there's anything wrong with these pills, I want to clarify.
00:07:39.289 --> 00:07:40.809
Yeah, there's a time and a place.
00:07:40.809 --> 00:07:45.210
You know, and at a certain point I had just kind of given up, I think.
00:07:45.210 --> 00:07:53.049
And that all culminated in having that hot flash because that was very clear evidence of what was happening.
00:07:53.049 --> 00:07:54.009
There was no doubt.
00:07:54.009 --> 00:07:54.490
Yeah.
00:07:54.490 --> 00:07:58.330
And so, you know, I reached out to my my OBGYN at that time.
00:07:58.330 --> 00:08:03.289
And this is a story I think I'm sure that you hear, that I hear from patients all the time.
00:08:03.289 --> 00:08:03.529
Yeah.
00:08:03.529 --> 00:08:07.850
Is that I went to my current OBGYN who I knew longer than my husband.
00:08:07.850 --> 00:08:08.250
Okay.
00:08:08.250 --> 00:08:09.850
I mean, I had been going to her.
00:08:09.850 --> 00:08:20.970
I am a child-free person by choice, but this doctor had seen me through polyps and fibroids and surgeries and had been like in my corner for so many years.
00:08:20.970 --> 00:08:27.689
And I got into telehealth with her and was dismissed essentially for these symptoms.
00:08:27.689 --> 00:08:31.129
I was prescribed the birth control pill, which has never gone well for me.
00:08:31.129 --> 00:08:32.809
I tried it, it did not work.
00:08:32.809 --> 00:08:34.970
Again, birth control is fantastic.
00:08:34.970 --> 00:08:38.330
It is great for so many people, not for everyone, not for me.
00:08:38.330 --> 00:08:47.049
And that just, you know, from there went into a series of seeing different specialists, different doctors, finally seeing a, you know, a functional city, right?
00:08:47.049 --> 00:08:52.250
Like I, you were like, I should be able to throw a rock out my window and hit a specialist.
00:08:52.250 --> 00:08:53.450
Not true.
00:08:53.450 --> 00:09:02.889
So to make a very long story short, I ended up with a functional medicine doctor, like in a membership program, which was financially not sustainable and absolutely ridiculous.
00:09:02.889 --> 00:09:07.769
And the only positive about it was that I did start menopause hormone therapy.
00:09:07.769 --> 00:09:10.330
I became very educated.
00:09:10.330 --> 00:09:13.529
I went through Electra Health, which was also fantastic.
00:09:13.529 --> 00:09:23.129
So the kind of a series of different providers ended up at New York Langone once they opened their menopause care wing, which was like groundbreaking.
00:09:23.129 --> 00:09:25.850
I want to say this was four years ago or something.
00:09:25.850 --> 00:09:28.009
And to this day, like you can't even get in.
00:09:28.009 --> 00:09:34.250
I mean, I am so lucky that I got through the door basically the day they opened because you can't even get this is New York City.
00:09:34.250 --> 00:09:35.769
You cannot get an appointment there.
00:09:35.769 --> 00:09:40.330
And Mount Sinai is just, I think, now opening their kind of version of that.
00:09:40.330 --> 00:09:42.649
That is all to say, it's been a bumpy road.
00:09:42.649 --> 00:09:42.889
Yeah.
00:09:42.889 --> 00:09:46.970
But because of that experience, that's why I do what I do.
00:09:46.970 --> 00:09:58.570
You know, that's why I left this cushy six-figure job in real estate development and became a Pilates instructor and health coach specializing in this work because there is a gap that has to be filled.
00:09:58.570 --> 00:09:59.210
Exactly.
00:09:59.370 --> 00:10:00.889
There's a gap that has to be filled.
00:10:00.889 --> 00:10:09.930
You know, as you're describing this scenario, the thing that I think a lot of people basically have it wrong in medicine.
00:10:09.930 --> 00:10:24.649
And this is just my hypothesis from what I hear from my colleagues and from patients, is that even the research criteria for perimenopause is menstrual changes, like starting to have menstrual changes.
00:10:24.649 --> 00:10:29.610
And I think that could not be further from the truth of when perimenopause starts.
00:10:29.610 --> 00:10:37.129
And yet I sit on committees where we're reviewing grants, and I still hear people say, but they didn't include the menstrual changes.
00:10:37.129 --> 00:10:39.450
They're not using menstrual changes as the criteria.
00:10:39.450 --> 00:10:42.970
And I'm like, this criteria, I think, is what has to change.
00:10:42.970 --> 00:10:51.050
Because I'm imagining your doctor that you have a great relationship with on the other end and saying she's having all these things, but she's probably still having regular periods.
00:10:51.050 --> 00:10:53.370
So it's not perimenopause, right?
00:10:53.370 --> 00:10:57.290
And that is like, I think, where people just get it so wrong.
00:10:57.529 --> 00:10:58.889
There's such a disconnect there.
00:10:58.889 --> 00:11:00.250
I mean, I'm a great example.
00:11:00.250 --> 00:11:02.490
I just turned 50 in November.
00:11:02.490 --> 00:11:09.129
And up until the age of literally a 50, I want to say, let's see, I turned 50 in November.
00:11:09.129 --> 00:11:12.490
I skipped my period for two months after that.
00:11:12.490 --> 00:11:17.529
So I think December, January, I skipped my period and I thought, finally, the relief is coming.
00:11:17.529 --> 00:11:18.889
I've made it.
00:11:18.889 --> 00:11:20.810
Uh only to have it come back.
00:11:20.810 --> 00:11:22.250
And I actually just got it this morning.
00:11:22.250 --> 00:11:22.810
You're welcome.
00:11:22.810 --> 00:11:30.649
Um but up to that point, 28 days to the number, like every single time.
00:11:30.649 --> 00:11:33.370
So my menstrual cycle had never changed.
00:11:33.370 --> 00:11:37.129
It had been just completely normal for years and years and years.
00:11:37.129 --> 00:11:38.730
I was clearly in peri-menopausal.
00:11:38.730 --> 00:11:42.649
I'm clearly in the menopausal stage or getting into it and regular periods most of the time.
00:11:42.649 --> 00:11:42.889
Yeah.
00:11:43.129 --> 00:11:43.769
Yeah, exactly.
00:11:43.769 --> 00:11:49.529
I I had a patient earlier this week who's 52 and she's like, When are these periods gonna stop?
00:11:49.529 --> 00:11:50.970
Like, why can't they stop?
00:11:50.970 --> 00:11:52.730
And you know, aging.
00:11:52.730 --> 00:11:57.290
Like you can you can tell the rest of her body is aging and she's still having regular periods.
00:11:57.290 --> 00:12:00.409
You just could never say that she's not in perimenopause.
00:12:00.409 --> 00:12:06.330
But if you talk to her and you base everything on her menstrual period, she wouldn't be by the straw criteria.
00:12:06.970 --> 00:12:07.210
Correct.
00:12:07.210 --> 00:12:12.009
Yeah, and to your point, you know, I would add also, I am still in shock.
00:12:12.009 --> 00:12:14.730
You know, I work with a clinical practice.
00:12:14.730 --> 00:12:15.050
Yeah.
00:12:15.050 --> 00:12:17.769
We specialize in menopause care, that is what we do.
00:12:17.769 --> 00:12:24.570
And I am still shocked every day when I meet patients who tell me when I say, what brings you here today?
00:12:24.570 --> 00:12:26.730
And they say the same story that I had.
00:12:26.730 --> 00:12:28.330
I have seen my OB.
00:12:28.330 --> 00:12:31.050
She has delivered all four of my children.
00:12:31.050 --> 00:12:33.210
I went to her with these issues.
00:12:33.210 --> 00:12:35.210
She drew labs.
00:12:35.210 --> 00:12:38.649
I'm getting my period regularly and told me I was fine.
00:12:38.649 --> 00:12:40.649
And I am shocked every single time.
00:12:40.649 --> 00:12:48.250
I'm still amazed because there is an organization called the Menopause Society that exists that can tell you that this is not the criteria.
00:12:48.250 --> 00:12:48.490
Yeah.
00:12:48.490 --> 00:12:50.570
I mean, you literally can look it up on the internet.
00:12:50.889 --> 00:12:51.930
I know right there.
00:12:52.170 --> 00:12:55.129
It's just, yeah, gobsmacked every single time.
00:12:55.370 --> 00:12:59.210
And so there's definitely a gap in education for healthcare professionals.
00:12:59.210 --> 00:13:00.009
Absolutely.
00:13:00.009 --> 00:13:06.730
And I feel like it starts in medical school, you know, where the emphasis is not really put on what is normal.
00:13:06.730 --> 00:13:12.009
We are really taught about like look for the pathologies, look for what's abnormal, look for the disease states.
00:13:12.009 --> 00:13:18.170
And even when, you know, in residency for OBGYN, I kind of came into it from a really holistic perspective.
00:13:18.170 --> 00:13:23.529
I was really into like natural childbirth and I had trained as a doula before I was a resident.
00:13:23.529 --> 00:13:25.769
So I kind of came in with some skepticism.
00:13:25.769 --> 00:13:39.610
I realized, like, yes, we do pathologize everything, but to provide care for the vast numbers of women who are going through, you know, I don't want to pathologize menopause, but there really is suffering associated with it.
00:13:39.610 --> 00:13:43.129
So why are we not learning how to relieve that kind of suffering?
00:13:43.370 --> 00:13:55.930
Yeah, I want to acknowledge, I think, I think it's really important not to vilify doctors and the medical system because this is me as such a coach, like this is not your fault.
00:13:55.930 --> 00:13:57.450
This is not your fault, right?
00:13:57.450 --> 00:14:01.050
One in five US OBGYNs report formal menopause training.
00:14:01.050 --> 00:14:01.529
That's not a lot.
00:14:01.529 --> 00:14:06.330
80% of OBGYN residents report little or no formal training and menopause management.
00:14:06.330 --> 00:14:08.009
So it starts in education.
00:14:08.009 --> 00:14:11.850
And then you know this if you want more, you have to seek that out on your own.
00:14:11.850 --> 00:14:13.850
And my God, you're busy.
00:14:13.850 --> 00:14:16.730
You already have to get continuing education and other things.
00:14:16.730 --> 00:14:17.930
This may not be the thing.
00:14:17.930 --> 00:14:21.930
So that is all to say that it starts in the education system.
00:14:21.930 --> 00:14:28.170
And I would even add it starts even earlier with educating kids in their health classes.
00:14:28.170 --> 00:14:31.050
We learn about birth, we learn about puberty.
00:14:31.050 --> 00:14:33.930
Why aren't we discussing menopause?
00:14:33.930 --> 00:14:36.170
Why didn't I learn about menopause when I was 14?
00:14:36.170 --> 00:14:37.050
Yeah.
00:14:37.769 --> 00:14:40.250
Sometimes I don't know if anybody's listening.
00:14:40.250 --> 00:14:41.769
Is anybody out there?
00:14:41.769 --> 00:14:46.330
But then I hear that people are enjoying the podcast episodes I'm putting together.
00:14:46.330 --> 00:14:49.529
If you are one of those people, please like and subscribe.
00:14:49.529 --> 00:14:52.250
So I know that there are people out there listening.
00:14:52.250 --> 00:14:54.409
That keeps me continuing on.
00:14:54.409 --> 00:14:57.529
And then you'll get notifications when there's a new episode.
00:14:57.529 --> 00:15:04.409
Also, if you know someone who could use the information that I'm putting out there, please feel free to share and forward.
00:15:04.409 --> 00:15:05.370
I love your support.
00:15:05.370 --> 00:15:06.250
Thank you.
00:15:06.250 --> 00:15:07.769
Yeah, I agree.
00:15:07.769 --> 00:15:12.330
No, I I love that I try to teach my kids about menopause.
00:15:12.330 --> 00:15:17.850
And it's funny because even this morning my daughter was asking some questions and I started going straight to the hot flash thing.
00:15:17.850 --> 00:15:21.370
And then I had to tell myself, okay, but it's not just hot flashes, you know.
00:15:21.370 --> 00:15:27.769
So I'm like, I feel like there's a constant education that we all are are needing to do.
00:15:27.769 --> 00:15:32.810
And I I follow that with there has to be incentivization in the healthcare system too.
00:15:32.810 --> 00:15:39.690
Because I love what Melinda Gates is doing by trying to bring more education, but like we are lifelong learners in medicine.
00:15:39.690 --> 00:15:44.170
We're expected to learn more information as like new research comes out all of the time.
00:15:44.170 --> 00:15:51.930
But if people are not incentivized to actually provide that care or held accountable for providing that care, like the needle's not gonna move.
00:15:51.930 --> 00:16:00.570
And you know, I feel like one of the things I've heard you guys talk about on circling the drain was, you know, finding someone who would take insurance.
00:16:00.570 --> 00:16:05.370
And then again, like hearing about the program at NYU, like getting in, right?
00:16:05.370 --> 00:16:18.250
Like, right, how are we serving the millions of women that are going through menopause all around the country if we don't have people who will take insurance and many of them who will provide this care?
00:16:18.490 --> 00:16:20.730
Yeah, I mean, that's such a great point.
00:16:20.730 --> 00:16:26.970
And I think naming that is really important because again, it's not the doctor's fault.
00:16:26.970 --> 00:16:39.529
You know, here in this particular case, when it comes to talking about insurance, look, I work for a membership-based practice because the people that I work for want to provide a very specific kind of care.
00:16:39.529 --> 00:16:42.250
And we cannot do that within the insurance system.
00:16:42.250 --> 00:16:44.090
And I'm sure you know this better than anybody.
00:16:44.090 --> 00:16:46.330
And you you've talked about this previously on your show.
00:16:46.330 --> 00:16:52.570
First of all, insurance companies don't reimburse for seeing lady parts the way that they do for seeing dude parts.
00:16:52.570 --> 00:16:54.649
So there's a discrepancy in reimbursement.
00:16:54.649 --> 00:16:59.129
But then also, if you want to spend more than 15 minutes with someone, you are not gonna get paid for that.
00:16:59.129 --> 00:17:01.930
So it starts with the insurance companies first.
00:17:01.930 --> 00:17:05.849
Reimbursement has to be better, it has to be easier.
00:17:05.849 --> 00:17:06.329
Yeah.
00:17:06.329 --> 00:17:10.809
Otherwise, back to incentivizing, they're not incentivized to take insurance.
00:17:10.809 --> 00:17:11.210
Yeah.
00:17:11.210 --> 00:17:16.170
I mean, this is a bigger, a bigger conversation politically, but it starts with government oversight.
00:17:16.170 --> 00:17:16.970
I mean, right?
00:17:16.970 --> 00:17:20.329
Insurance companies, my God, it's uh to quote Dr.
00:17:20.329 --> 00:17:23.529
Rachel Rubin, it is a dumpster fire of brokenness.
00:17:23.769 --> 00:17:24.569
It is, it is.
00:17:24.649 --> 00:17:25.210
Yeah, I know.
00:17:25.369 --> 00:17:30.730
So, how do we help the women not like navigate around and out of the dumpster fire?
00:17:30.730 --> 00:17:33.369
Because this is what I know, like you and I both really want to do.
00:17:33.609 --> 00:17:35.769
Yeah, I mean, my God, it's so difficult.
00:17:35.769 --> 00:17:51.289
Okay, from a more systemic point of view, it is calling, it's calling your congressperson, it's getting in touch with organizations where we can actually start with the government oversight, calling your insurance company, asking them why they're not covering certain things.
00:17:51.289 --> 00:17:52.889
So this is this bigger picture.
00:17:52.889 --> 00:18:07.690
And if you, if you can, if you are capable contributing financially to groups that can help with that, from a patient standpoint, unfortunately, the whole responsibility falls on your shoulders for advocacy, finding the right provider who can meet that criteria.
00:18:07.690 --> 00:18:15.450
So with a place like Newark Lingo, and again, just as an example, it might be getting on a waiting list and just coming to terms with the fact that you're gonna have to wait quite a while.
00:18:15.450 --> 00:18:17.930
But when you get seen, you're really gonna get taken care of.
00:18:17.930 --> 00:18:20.250
And then it's like menopause.org.
00:18:20.250 --> 00:18:23.689
Again, educating women so they know that these resources exist.
00:18:23.689 --> 00:18:26.250
Every single patient I see, they've already come to us.
00:18:26.250 --> 00:18:26.969
We've already won.
00:18:26.969 --> 00:18:28.889
We've got the patient, they're doing the thing.
00:18:28.889 --> 00:18:35.209
I always tell them to go to menopause.org just to be aware that it exists, so that it's there as a resource.
00:18:35.209 --> 00:18:42.649
So knowing that you can go there and find your provider, likely, hopefully, a provider that takes your insurance who is listed on menopause.org.
00:18:42.649 --> 00:18:46.809
And, you know, these telehealth companies, there's the good and the bad, right?
00:18:46.809 --> 00:18:55.209
But they they really are very helpful in the way that there's more access for people in these sort of dry zones of America where they don't have access to this kind of care.
00:18:55.209 --> 00:18:59.849
They can barely even see a gynecologist or a general practitioner because of the area that they're located.
00:18:59.849 --> 00:19:02.329
So these telehealth companies are making a huge difference.
00:19:02.329 --> 00:19:05.289
We've got some, you know, that do take insurance, some that don't.
00:19:05.289 --> 00:19:06.250
There's some good ones.
00:19:06.250 --> 00:19:08.730
There's good actors, bad actors.
00:19:08.730 --> 00:19:22.649
We all know some of them are not so uh savory, but I think in general, the telehealth approach is not bad because most back to your point, most of what is going on with women doesn't require a physical examination.
00:19:23.449 --> 00:19:23.849
Exactly.
00:19:23.849 --> 00:19:33.449
And I see a lot of women who tell me unfortunately they had to wait like three to four months to get in with me, but then they found a teleprovider who was able to get them started.
00:19:33.449 --> 00:19:34.649
And that's awesome.
00:19:34.649 --> 00:19:36.409
That saves me a step, right?
00:19:36.409 --> 00:19:42.009
And helps me to kind of get them moving, to really sort of personalize or customize or tweak.
00:19:42.009 --> 00:19:43.929
I think that's a really nice combination.
00:19:43.929 --> 00:19:47.289
So many more resources are out there than there used to be.
00:19:47.289 --> 00:19:51.049
I wonder what you think about like what needs to change.
00:19:51.049 --> 00:19:56.889
Like, what would be the single most impactful way to change the healthcare system right now?
00:19:56.889 --> 00:20:08.889
If you think back to yourself at that time where you are experiencing that hot flash and like looking for help, like I guess what would have made it so much better is if your healthcare provider was like, oh yeah, you're not too young.
00:20:08.889 --> 00:20:10.809
You don't you didn't do well on birth control pills.
00:20:10.809 --> 00:20:11.849
Here's some other options.
00:20:11.849 --> 00:20:14.409
Like, is that where the crux lies?
00:20:14.649 --> 00:20:15.529
Or I don't know.
00:20:15.529 --> 00:20:16.569
That's a good question.
00:20:16.569 --> 00:20:18.569
I think, I think it's really resources.
00:20:18.569 --> 00:20:22.329
You know, if we're gonna ask that specifically, what would have helped me in that moment?
00:20:22.329 --> 00:20:29.769
And what I do think is improving, if I'm being honest, is the amount of resources we have out there for people going through this transition.
00:20:29.769 --> 00:20:40.809
Because at that time, I was taking the deepest dive into PubMed and was like, oh, look, there is one singular paper about how micronized progesterone can help with sleep.
00:20:40.809 --> 00:20:42.169
I want some of that.
00:20:42.169 --> 00:20:44.490
And I would ask people and they'd be like, What?
00:20:44.490 --> 00:20:45.529
Like progesterone?
00:20:45.529 --> 00:20:46.569
And I'm like, you're a doctor.
00:20:46.569 --> 00:20:48.250
Like, why am I, why is this news to you?
00:20:48.250 --> 00:20:52.730
And I would print out the paper and bring it with me and be like, it's cited.
00:20:52.730 --> 00:20:54.490
So we're we're way past that.
00:20:54.490 --> 00:20:56.169
I mean, there's so many resources.
00:20:56.169 --> 00:20:59.929
But again, I still get patients through the door who this is new to them.
00:20:59.929 --> 00:21:01.369
They've never heard of it.
00:21:01.369 --> 00:21:04.490
And it's like there's a desert out there, even though there is not.
00:21:04.490 --> 00:21:07.049
We know that there's a lot going on in what I call the metaverse.
00:21:07.049 --> 00:21:09.209
So, you know, there are a lot of resources.
00:21:09.209 --> 00:21:15.689
So I think continuing to build resources, shine a light, you know, we've got a lot of celebrities talking about it.
00:21:15.689 --> 00:21:18.730
You've got Halle Berry and, you know, a number of other people.
00:21:18.730 --> 00:21:21.129
So all of that is helpful.
00:21:21.129 --> 00:21:39.049
But I just want to say that one of the problems we run into with more exposure is this idea of people preying upon this community and a very vulnerable population with supplements and, you know, doodads and all these other things.
00:21:39.049 --> 00:21:48.329
So while that information is very helpful, I feel like we're more in a spot where it's difficult to be discerning of what is to be trusted and what should not be trusted.
00:21:48.329 --> 00:21:50.889
So now there's a whole other layer of complication.
00:21:51.289 --> 00:21:51.609
You're right.
00:21:51.609 --> 00:22:00.009
It just gives me heart sync because I saw a patient last week who was telling me, you know, I got into this beautiful private practice.
00:22:00.009 --> 00:22:03.289
It was like very, you know, beautifully decorated.
00:22:03.289 --> 00:22:04.969
It was curated for women.
00:22:04.969 --> 00:22:07.289
It was just so appealing in so many ways.
00:22:07.289 --> 00:22:09.689
They listened to me, which is huge, right?
00:22:09.689 --> 00:22:14.730
And they started her on compounding hormone therapy, which was fine for her.
00:22:14.730 --> 00:22:19.369
There were some tweaks that we decided to make sure that her uterus was getting properly protected.
00:22:19.369 --> 00:22:22.889
But she's like, I just had this feeling that I was being upsold.
00:22:22.889 --> 00:22:26.169
She's like, I was so grateful for what they were starting me on.
00:22:26.169 --> 00:22:32.809
And then, you know, they wanted me to do this thing for that, or they started talking to me about aesthetic treatments for this.
00:22:32.809 --> 00:22:35.049
And I just felt like I was being upsold.
00:22:35.049 --> 00:22:42.250
And she just kind of like, we talked about how it was like her spidey sense of like, okay, take what you feel like is right and then leave the rest of it.
00:22:42.250 --> 00:22:58.409
But I was appreciative that she shared the experience with me because you're right, like there are people who are trying to make money off of this situation of there not being enough people out there to help and the desperacy of how I'm sorry to say shitty perimetopods and menopause women feel.
00:22:58.409 --> 00:22:59.929
And say it, it's shitty.
00:22:59.929 --> 00:23:01.609
It's pretty, it's so shitty.
00:23:01.609 --> 00:23:05.849
And it's uh it's even more shitty to take advantage of someone in that situation.
00:23:05.849 --> 00:23:06.889
It just bothers me.
00:23:07.129 --> 00:23:10.089
And to your point, I think patients they start to feel it.
00:23:10.089 --> 00:23:18.889
They know when they're being sold to, and they may not know it initially, but even for me, like I said, I To this functional medicine doctor I was working with in this membership.
00:23:18.889 --> 00:23:22.969
And like you said, it got me started on this journey, and I'm grateful for that.
00:23:22.969 --> 00:23:29.049
But it came to a point where I was like, I don't really need this amount of like blood work and I don't need a Dutch test.
00:23:29.049 --> 00:23:30.649
I don't need any of this stuff.
00:23:30.649 --> 00:23:33.769
I think I will change course in this moment.
00:23:34.009 --> 00:23:39.529
But you were so PubMed and you were so proactive in like learning this yourself.
00:23:39.529 --> 00:23:45.529
You know, I I don't know how you help the woman who, you know, doesn't do that or doesn't know how to get started.
00:23:45.529 --> 00:23:49.369
And I hate that people have to learn medicine in order to get help for themselves.
00:23:49.529 --> 00:23:50.490
Like, you know.
00:23:50.490 --> 00:23:51.849
So true.
00:23:51.849 --> 00:23:55.689
I mean, as a coach, for example, you know, I work with a clinical practice.
00:23:55.689 --> 00:23:57.769
I also have a practice of my own.
00:23:57.769 --> 00:23:58.089
Yeah.
00:23:58.089 --> 00:24:05.129
And I have a particular thing that you can book, which is essentially you get 30 minutes with me to ask me anything that you want.
00:24:05.129 --> 00:24:12.329
And to tell you the truth, a lot of people spend 30 minutes asking me everything about perimenopause and menopause.
00:24:12.329 --> 00:24:17.369
And then eventually the last thing we usually cover is how to find a doctor, where to go.
00:24:17.369 --> 00:24:20.329
Just to clarify, you know, I am board certified.
00:24:20.329 --> 00:24:23.689
There are ethical guardrails to what I do.
00:24:23.689 --> 00:24:25.689
I do not prescribe, I do not diagnose.
00:24:25.689 --> 00:24:29.529
So I simply spend 30 minutes giving verified information to people.
00:24:29.529 --> 00:24:32.169
So I myself am a resource in that moment.
00:24:32.169 --> 00:24:34.569
But most of the time that's exactly what we do.
00:24:34.569 --> 00:24:37.609
It's I spend a lot of time validating people's symptoms.
00:24:37.609 --> 00:24:40.329
I would say it's validate, educate, advocate.
00:24:40.329 --> 00:24:42.649
So I spend time validating their symptoms.
00:24:42.649 --> 00:24:44.889
Everything that's happening to is real, it's not made up.
00:24:44.889 --> 00:24:46.089
I'm sorry you've been gaslit.
00:24:46.089 --> 00:24:46.809
I'm glad you're here.
00:24:46.809 --> 00:24:51.929
I spend some time educating, which is just basic information that you can find on the Mounta Society website.
00:24:51.929 --> 00:25:02.169
And then advocating, I am handing the reins over and reminding the patient that they have agency and that there are resources available to them to see a specialist.
00:25:02.409 --> 00:25:02.649
Yeah.
00:25:02.649 --> 00:25:04.169
And that's what's needed, right?
00:25:04.169 --> 00:25:05.689
Like you are a midlife doula.
00:25:05.689 --> 00:25:18.009
You know, speaking of doula, this was like, this is what we needed in the childbirth community to help women advocate for themselves and not like be passive individuals in their birthing and pregnancy experiences.
00:25:18.009 --> 00:25:22.490
And this is exactly what we need for validating and advocating for women in midlife.
00:25:22.649 --> 00:25:24.490
Yeah, I think that agency is so important.
00:25:24.490 --> 00:25:36.169
I think that often women come to, I mean, even in with this clinical practice, them seeing us is the first step in this journey of agency and self-advocacy.
00:25:36.169 --> 00:25:38.569
And it's the first step they may have taken in their entire life.
00:25:38.730 --> 00:25:38.889
Yeah.
00:25:39.129 --> 00:25:40.409
When it comes to their own healthcare.
00:25:40.649 --> 00:25:41.289
That's huge.
00:25:41.289 --> 00:25:42.649
That's life changing.
00:25:42.649 --> 00:25:44.569
So how can people find you?
00:25:45.369 --> 00:25:49.289
You can find me very easily at juliagwellness.com.
00:25:49.289 --> 00:25:51.609
That is juliagwellness.com.
00:25:51.609 --> 00:25:57.849
And then honestly, if you just punch my name into Google, Julia Granacki, I will come up in many different places.
00:25:57.849 --> 00:26:02.009
You'll find all my uh handles for all the social links and all of the things.
00:26:02.009 --> 00:26:02.329
Yeah.
00:26:02.809 --> 00:26:03.449
That's awesome.
00:26:03.449 --> 00:26:05.449
And you have your new podcast now.
00:26:05.449 --> 00:26:07.129
Can you tell us a little bit about that?
00:26:07.449 --> 00:26:07.769
Sure.
00:26:07.769 --> 00:26:15.209
I have a new podcast called Agecraft After Dark, where we talk about the things essentially that keep us up at night.
00:26:15.209 --> 00:26:21.449
So I would say there's a little bit of residual vibe from circling the drain that has carried over.
00:26:21.449 --> 00:26:25.929
So there's definitely things about health care and that health and wellness approach.
00:26:25.929 --> 00:26:28.889
But then we cover some things that are not related to that.
00:26:28.889 --> 00:26:32.250
And, you know, my first guest was my tattoo artist.
00:26:32.250 --> 00:26:34.730
So it varies across the board.
00:26:34.730 --> 00:26:38.250
It's a little bit witchy because I am there is a woo-woo aspect.
00:26:38.250 --> 00:26:42.009
I'm very grounded in science, but there is a woo-woo aspect to what I do.
00:26:42.009 --> 00:26:42.409
Yeah.
00:26:42.409 --> 00:26:45.289
And so, and there's also some storytelling that occurs on that too.
00:26:45.289 --> 00:26:49.609
Every guest is uh tasked with telling us a spooky story at the end.
00:26:49.609 --> 00:26:54.250
So I think it's a fun time, it's a good hang, and also you might learn something.
00:26:54.250 --> 00:26:55.849
So yeah, H craft after dark.
00:26:56.089 --> 00:26:56.250
Great.
00:26:56.250 --> 00:26:58.250
Well, I've got a great story to tell you.
00:26:58.250 --> 00:27:01.609
I'm gonna pin it down to remember to tell you.
00:27:01.609 --> 00:27:02.089
Yeah.
00:27:02.089 --> 00:27:04.329
It is a little, a little witchy and a little woo-woo.
00:27:04.329 --> 00:27:06.009
So I think it'll end.
00:27:06.009 --> 00:27:07.849
But thank you so much for your time.
00:27:07.849 --> 00:27:20.169
I hate that you had such a hard time, but I love that you turned this into helping other women and helping other women find themselves, find their voice, and get help that they deserve.
00:27:20.169 --> 00:27:25.769
So thanks for everything that you do, and thanks for all of the work that you're doing, you know, outside of just your one on one work.
00:27:26.169 --> 00:27:26.809
I appreciate that.
00:27:26.809 --> 00:27:29.449
I'm also glad that it brought me here and I love what I do.
00:27:29.449 --> 00:27:31.769
For the first time in my life, I absolutely love what I do.
00:27:31.769 --> 00:27:33.369
So yeah, it was a good thing.
00:27:33.689 --> 00:27:34.569
Awesome.
