Making Menopause and Sexual Health Mainstream with Hajira Yasmin MD, FACOG

Dr. Hajira Yasmin’s enthusiasm for her work is palpable. A board-certified OB-GYN, Dr. Yasmin (affectionately called “Dr. Yas” by her patients) is also a certified menopause specialist with expertise in sexual medicine. When you speak with her, it’s hard not to be moved by her passion for educating and empowering women to live their best, healthiest lives in midlife and beyond.


“Education is powerful, and we need to start the conversation about our sexual and reproductive health – especially in communities of color. Ask questions. Because there are OB-GYNs, who are devoting their life’s work to making aging and menopause better for women.” 


How you start is not how you’ll finish.


A global citizen, Dr. Yasmin began her journey as an OB-GYN about 25 years ago in the UK. Born and raised in India, she traveled to Birmingham, England, in her early twenties, where she trained to become a registered OB-GYN, working with the British Health Service. She says life then brought her to the United States, where she had to redo the entirety of her OB-GYN education and training. 


“I started my journey in Southeast Asia, trained as an OB-GYN in the United Kingdom, and here in the United States, I trained at Magee-Womens Hospital — the mecca of OB-GYN training at the University of Pittsburgh Medical Center,” she emphasizes. “It’s mind-blowing now to realize that I never heard about menopause training anywhere in these three countries or leading institutions across three continents.” 


That’s a compelling statement, given Dr. Yas’s extensive OB-GYN training. She was in her early 30’s when she began as a first-year OB-GYN resident in the US. Not surprisingly, she recalls the challenges of working an 80-hour-per-week residency program. What is surprising is that she does not remember receiving any medical education or practice on menopause throughout her residency. 


“I finished my four years of residency and, by this time, I was a very well-educated and practiced OB-GYN because I was already a trained OB-GYN when I came to the States in the late 90s.”  


After training at Magee-Womens Hospital, a renowned women’s teaching hospital in Pittsburgh, PA, Dr. Yas felt called to take her deep knowledge and skills to a smaller, more rural community where she could have a more tangible impact. She wound up in Wausau, Wisconsin, where she set up one of the country’s first da Vinci Surgical Systems, teaching and performing minimally invasive laparoscopic surgeries. 


“At that time, it was a completely new way of handling surgery in women…I was enthralled. How do you take out a woman’s uterus and have her go home later that day or the next and be back at work the following week?” 


A skilled surgeon who was also delivering babies, Dr. Yas thrived professionally while in Wisconsin and maintained a fulfilling yet rigorous work schedule for several years. It wasn’t until a decade or so later when she was in her early 40s, that she began to experience changes in her own body while noticing changes in the bodies of her aging patients.


“Working as an OB-GYN is pretty challenging work. You’re working 50 hours a week. And as a gynecologist, I never believed I had the option to slow down and say, ‘Hey, I’m going through perimenopause. I’m going to take a break’.”


Dr. Yas says that she noted things were changing with her body over time. She was particularly impacted by low energy and brain fog. She also began tracking that her patients in their early to mid-forties were experiencing similar challenges, as well as issues with poor sleep, mood swings, fatigue, low libido, vaginal dryness, and painful intercourse.


“It broke my heart because I had no answers. I was such a well-trained and skilled surgeon. I was an experienced obstetrician. I could deliver a baby with my eyes shut. But I had no answers to these women navigating menopause.”


That was in 2015. By then, she had become a prolific surgeon and in-demand obstetrician. But because of the damaging effects of the Women’s Health Initiative (WHI) study on the use of hormone therapy to treat menopausal symptoms, Dr. Yas says that at that time, there was not much literature in the medical community about how to treat women with disruptive perimenopause symptoms and sexual health challenges.  


“There was a hunger in me that came on and only grew stronger. Why are women’s vagina’s hurting? Why are my patients coming to me and saying their relationships are going downhill because they have no libido and sex is painful? I needed to know more about perimenopause and menopause so I could support these women and help myself.”


Coaching patients through menopause transition.


Although Dr. Yas continued delivering babies and taking on surgeries, increasingly, her focus shifted to wanting to better understand and support women through the unique health challenges and transitions they begin to face in midlife. So she did two things: she pursued and completed her professional menopause certification through the North American Menopause Society (NAMS), and she trained as a sexual medicine counselor through the University of Michigan. She later received her post-grad certification as a sexuality health educator through the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

Dr. Yas invested in this specialized education because, as an OB-GYN, she says she didn’t have the skills or the language to approach menopause management or sexual health challenges in a way that could help her patients. 


“Of course, I’d read about and studied women’s bodies – I know about the vulva and the vagina and the clitoris and all of that, but I didn’t know how to approach somebody dealing with those challenges in a very sensitive or respectful manner… In an inclusive manner.”


Today, Dr. Yas offers personalized treatment options for patients through her Raleigh, NC-based Alray Direct Gynecology and Intimate Health Center. Through her practice, she specializes in on-site and virtual perimenopause and menopause management, women’s sexual health, and gender-inclusive health, among other things. 


She believes in an integrative approach to reproductive health and menopause management. She prioritizes addressing the root causes of her patient’s symptoms vs. medicalizing them. She draws on a range of treatment options – including hormone therapy – depending on a patient’s needs and medical history.


“I work with my patients systematically, and I try to meet them where they are,” she says. “I want to understand what, if anything, they’ve tried on their own and what is their lifestyle. Are they using any supplements? Are there any situational stressors? Are they facing grief or loss? Are they facing something new with their children, husband, parents, or friends?” she continues. 


“Do I need to collaborate with a physical therapist? Do I need to collaborate with a psychotherapist for them? I’m assessing all of these things before we can even begin treating their menopausal symptoms.”


Dr. Yas emphasizes that stress is a massive player in how menopause shows up in her patients’ lives – especially among immigrant women and women of color — who disproportionately experience social and economic hardships. 


While the biological process is the same in those who experience natural menopause, on average, Black, Latina, and some Asian women living in the United States experience menopause two years earlier than white women, and their symptoms tend to last longer and be more severe. 


“If I see a woman who is so stressed with her job or living in an economically challenging situation, they often have no space to look after themselves. These women experience menopause in a much harsher way.”


Dr. Yas says that this is because when we are stressed, our cortisol is high, and we experience insulin resistance causing our adrenaline to spike. 


“High levels of adrenaline and cortisol are the disruptors for a good life because they deplete your hormones — your estrogen, your progesterone, your testosterone.”


 Some stress management techniques Dr. Yas uses with patients are rooted in mindfulness and positive intelligence, which focuses on tuning into your senses and disrupting ruminating thoughts. She encourages self-care among her patients by making time to do something they like – like dance or taking a walk or listening to their favorite music – something that will stimulate their dopamine.


“It’s amazing how your body responds in the absence of stress. Of course, we cannot tell women, don’t be stressed, okay? Because the world is full of stress. But I tell them that we can manage how we respond to stress.”


Observing her patients navigate the aging process and advising and supporting them through menopause transition has been personally empowering for Dr. Yas. It allows her to give to the world differently. 


“For me and my practice, it’s been a natural shift. I’ve seen my patients from 18 years of age up to 95 navigate life and health transitions. I’ve observed what happens to a woman’s body over a period of decades, so I’ve had to evolve and progress because I see the raw reality of human life. But my patients don’t see that. That’s where I have to step in to educate them.”


Sexual health is women’s health.


Dr. Yas believes that if we want to change the paradigm for women’s quality of life, sexual health and menopause management must be part of mainstream discussions on health and wellness.  


“Being a woman of color, I was raised with my own sexual script and menopause script; everything was around shame and guilt. My mother never spoke about menopause. My grandmother never spoke about menopause or sexual health. Vaginal pain or dryness or low libido — these things were never spoken in a women of color community.” 


Informed by what wasn’t, and still isn’t, being discussed among her community of women elders, Dr. Yas wants to reach every nook and corner of those communities with information and education. She says that while many of her patients may suffer from vaginal pain and dryness or a low sex drive, they’re often too ashamed or embarrassed to raise this during their visit.


“Patients will never ask. Patients are afraid. That’s the cultural – the societal barrier. Women will come into the office, and they will do a mammogram. They will do a pap smear. But they will not bring up problems related to their sexual health.”


Dr. Yas attributes her training in sexual medicine with being able to respectfully, but effectively, engage a patient in an informative discussion to determine the source of their problem. She notes that oftentimes a woman doesn’t raise concerns about her sexual health because the doctor or health provider is not initiating conversation – most likely because they haven’t been trained to do so. 


“When a woman comes to me, as a trained menopause and sexual medicine expert, it’s important that I create a safe and trusting environment in which I seek permission to ask intimate details that may be impacting their health. It’s critical for me to be sex-positive and leave my own sexual script outside the exam room.”


Dr. Yas’s training to become a sex educator was rooted in a biopsychosocial approach that considers both the biological and psychological reasons an individual may be experiencing sexual problems. For example, perimenopausal women may experience vaginal problems due to depleting hormones; vaginal dryness and thinning (which can cause painful intercourse) are biological issues. However, unresolved trauma or severe stress may also impact how a woman experiences sexual pleasure. 


“To experience sexual pleasure, a woman has to have that confidence and security in her body. My job is to give them that confidence because I’m the doctor who is trained to tell you what’s to be expected. I assure them that what I’m seeing is normal and they can feel better,” she continues, “so they can have safe, pleasurable relationships throughout their lives.”


Dr. Yas says her job is to empower women and inspire them to embrace this phase of life. At this stage in her career, she sees herself doing this work until she retires (which she adds is several years off).


“I want menopause and sexual health conversations to reach every woman in this world. I want every woman to be confident talking about the menopausal symptoms and the sexual health challenges they are having. I want conversations to begin. I want women to seek help. I want them to be empowered with education.” 


To work with Dr. Yas or learn more about her services, visit her website. You can follow her on Instagram @dryas.alraymd.

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