Nuances: Our Asian Stories

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GUEST BIO

Dr. Sophia Yen is a Co-Founder of Pandia Health, expert online women’s hormonal healthcare: from birth control to menopause and more. She graduated MIT, UCSF Medical School, and UC Berkeley with an MPH. With 20+ years in medicine, she’s also a Clinical Associate Professor at Stanford Medical School in Adolescent Medicine. Her passion is making women’s lives better She’s also the Mother of 2 future sheheroes and wife of a feminist. Taiwanese-American married to a Korean-American (feel free to cut the last 2 lines or edit as you will).

⁠Instagram⁠ | ⁠TikTok⁠ | ⁠Twitter⁠ | ⁠YouTube⁠ | ⁠Facebook⁠ | ⁠LinkedIn⁠ | ⁠Web⁠

MENTIONED

• ⁠Plan C Pills – Abortion Access⁠
• ⁠Inequality in Maternal Outcomes⁠
• ⁠Maternity leave in Mexico⁠
• ⁠Maternity leave in Canada⁠
• ⁠Maternity leave in the U.S.⁠
• ⁠Dr. Rebecca Gomperts from the Netherlands⁠
• ⁠Calculate your BMI⁠

TAKEAWAYS

1. Sex Ed is more than just “how to not get pregnant”. And. Ladies, you deserve satisfaction too.
2. Emergency contraception: Plan B only works well if your BMI is <=25. Ella works for BMI <= 35. Copper IUD works for all BMIs
3. Hormonal birth control doesn’t hurt your fertility. In fact it’s often used before fertility treatments to stabilize hormone levels.
4. Best to worst: the implant, vasectomy, hormonal IUD, tubal ligation, copper IUD, the shot, the ring, the patch, then the pills.
5. If you’re getting an IUD, you should be given pain management. DEMAND IT. (*paracervical block)
6. There are treatments to help you transition in perimenopause and menopause. You don’t have to suffer through hot flashes. Estrogen replacement also helps you avoid a lot of health complications from menopause.
7. Women used to have 100 periods in their lifetime (8 kids), now they have 350-400 and each time we risk developing ovarian, endometrial or colon cancer. But periods are optional!!!
8. The pill that works best for white women often doesn’t for Black/Asian women. Find the right one for you.
9. Disaggregating “Asian American” in medical research can help better identify genetic differences in our bodies’ response to treatments.

CONTACT

⁠Instagram⁠ | ⁠TikTok⁠ | ⁠Web⁠ | ⁠LinkedIn⁠ Host: ⁠Lazou⁠

Additional music links

Asian Diaspora Artists

Nuances Podcast – curated Spotify | Apple Music playlists with past guests, hosts & more Asian diaspora artists.

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Video

Transcript

INTRO

Welcome back to Nuances: Our Asian Stories, a podcast where guests from a wide range of Asian ethnic groups, careers, countries and communities join me to explore our often complicated relationships with our cultures and how they shape us. I’m your host LAZOU

If you have a uterus, or care about someone who does, you may want to stick around for this episode which will cover very important women’s health topics that aren’t talked about enough such as perimenopause and menopause care, why a different birth control might be better for you, and the fact that periods are optional! 

Today is Mother’s Day in North America. If for whatever reason, mother’s day is a difficult time for you,  maybe you recently lost your mother or lost a child, or have been trying to have a child, or have been estranged from your mother or child, I just wanted to acknowledge that. You are seen and I hope you stay far far away from insensitive comments and unwelcome wishes today 🙂 

To all the moms, moms-to-be, and grandmas, happy mother’s day! 

I also want to wish a special Happy Mother’s Day to the moms I’ve interviewed on the podcast:

• Career radio DJ Mimi Chen, who juggled between the world of rock and roll and mom duty. (S3 E1)
• The hilarious Ivy Le, mom of two, who discovered her love of podcasts while breastfeeding, and her knack for comedy writing while trying to re-enter the workforce. (S3 E12)
• Dr. Sachi Schmidt-Hori talked about the differences in American and Japanese parenting styles. (S4 E6)
• Samantha Ong, mom of two girls, who left wedding photography and creates culturally accurate Asian dolls. (S3 E13)
• AUSLIN, a single mom, carves out time at night to create her music while raising her two boys. (S1 E5)
• Tiffany Chou, who talked about becoming the primary caregiver for her brother Chris, who has autism, is now a mom too. Tiffany founded the company Depo Market, a jewelry store in Maui, which employs disabled employees. (S2E3)
• Cece !

And to all the people who are celebrating their moms today, let’s remember that it’s not enough just to celebrate moms once a year. We need to support moms during and after their pregnancy, and in their everyday lives. 

It is worth noting that while in Canada, mothers can have access to about a year of paid maternity leave, earning between 50-80% of their insurable salary, and in Mexico, mothers are entitled to 12 weeks of paid leave at 100% of their salary, in the U.S., the Family and Medical Leave Act only requires companies of at least 50 employees to give new moms UNPAID leave of 12 weeks. Some states have programs that do offer paid leave, and certainly many companies have their own policies for offering paid leave, but it is not mandatory according to federal law. 

Maternal mortality rate is still relatively high. 700 mothers die every year as a result of pregnancy or its complications. Maternal mortality is 2-3x more likely for Black, Alaskan Native and Native American mothers than for white and Asian mothers. It’s also worth noting that teen moms are at higher risk, which is why the stuff we’re gonna talk about is important information for your daughters to have access to. 

Once the baby is born, moms are still getting the short end of the stick. A 2022 Pew Research study shows that Moms are more likely to report taking on more of the childcare duties, while dads are more likely to report that they split it 50-50. The moms are probably right because a 2021 American Time Use survey shows that moms spend more time with their children than dads, especially when the kids are young. 

I am not a mother myself, and have no desire to be. If you’re a non-mom like me, I see you! This episode will have so much valuable info for you as well. Without further ado, let’s get into our convo with today’s guest. 

Dr. Sophia Yen is a Co-Founder of Pandia Health, expert online women’s hormonal healthcare: from birth control to menopause and more. She graduated MIT,  UCSF Medical School, and UC Berkeley with an MPH (Master of Public health). With 20+ years in medicine, she’s also a Clinical Associate Professor at Stanford Medical School in Adolescent Medicine. Her passion is making women’s lives better

She’s also the Mother of 2 future sheheroes and wife of a feminist.

She’s Taiwanese-American.

Growing up in the Bay Area

LAZOU: Thank you so much for being here, Dr. Sophia Yen. First I want to ask you, where did you grow up and what was that like as an Asian American?

Dr. Sophia Yen: So I was born in Chicago, shipped off to Taiwan for my aunt to raise me for a couple of years, and then my aunt told my mom "We love Sophia, why don’t you just let us keep her?" And my mom was like, No! So then she quickly picked me up. And then we went to Berkeley for my dad’s post doc, um, Milpitas for a bit, down to Orange County. Then back to Silicon Valley. And have been in Silicon Valley since about Fourth grade, but it was like in Milpitas for first and second grade, but have been in, in Silicon Valley since fourth grade. And then, went to MIT for college, went back to UCSF and wasn’t, have been in the Bay area ever since.

Um, growing up in the Bay area, there were a lot of Asian Americans. And so I hear a lot of stories from other friends that are from Virginia or Kansas or Texas or Ohio. we definitely had our group of Asian Americans, but, um, certainly amongst the Asian Americans, we would have like one Vietnamese, one Taiwanese, one Cantonese, you know, one Japanese, not more than three to five of each ethnic, subgroup.

LAZOU: Yeah. But, It didn’t feel like you were an outsider. You,

Dr. Sophia Yen: at all. Not at all. Yeah, the first time I felt as an outsider is when I was interviewing for residency. And back in the day, UC San Diego was very non Asian. And so when I got off at the airport for the residency interview, I was like, This is not what I’m used to and I was like, the way, you know, you’re not at a real Chinese restaurant because of course being, you know, of Chinese descent went immediately to the Chinese restaurant, P.

F. Chang’s and they had a piano player. The rice came by the bowl. The tea came by the cup. They sold wine. There was a fork at every table. I was just made a list of like 10 ways. You know, you’re not at a real Chinese restaurant.

LAZOU: That’s funny. I’ve never been to a PF Chang, but I remember I went to a Panda Express one time in Nashville and I was like, this isn’t Chinese food.

Dr. Sophia Yen: Well, Panda Express was, you know, founded in LA by people that are Chinese. So it’s legit. But PF Chang’s, if you don’t know the story, it’s Paul Fleming, white dude who did steakhouse and just threw the thing Chang at the end. And so it is in no way legit.

LAZOU: Wow. Yeah. I, I didn’t know that.

Asian American umbrella – good or bad?

LAZOU: you know, as you said, you’ve been part of a lot of different groups of people in the Bay Area and the term Asian American, people have very strong feelings about it.

Some people love it. Some people hate it. I think you have, some thoughts to share about that.

So. Let’s get

into it.

Dr. Sophia Yen: lots of opinions. It’s a love hate. I would say the love is all of us coming together to seek greater power. Like, I’m always like, well, black people and people of Latina descent and Caucasians have this power. Let’s achieve the same power. People of Jewish descent. But as being a person of Asian descent, you know that amongst the different Asian subsectors, there are battles and conflicts.

And even Taiwanese vs. Chinese, Mainlander vs. Nationalist vs. Democratic Party in Taiwan. Like, if you haven’t seen, what is that movie, The Grinch! How the Grinch Stays Alive. Christmas. there’s like a battle scene featuring the Taiwanese government beating each other up.

So even amongst Taiwanese, there’s like battle. And then there’s the people who are expats. There are people who are here. There are people in Taiwan, but as a, you know, born in the USA, but parents are very strongly vested in Taiwan. I’m like, It’s Taiwan. Let their people decide.

Who are we to be U. S. Americans interfering with what they’re doing? But, I get it. You were born there. It’s your country. You have a lot invested in it. But I’m also American, and I hate it when people are like, Where are you from? And I’m like, California? No, where are you really from? I was born in Chicago.

No, where are you really from? My parents are from Taiwan. Is that what you’re looking for? Because, you know, and I think for purposes of research we need to separate the Asian because we’re seeing health-wise is different consequences and the example I give is HDL. That’s the good cholesterol. You want as high as number as possible.

And those of Japanese descent have a crazy high HDL. So I would love for my children to marry somebody of Japanese descent. Or in the future, just splice in some CRISPR, just so we can get that HDL. And then if you’re of South Asian descent, you have low HDL. You have a greater risk of heart attacks. And if you put all of us together in one glob, then the high may balance out the low, and then it may average, you know, different.

And then also our food. Asian food and AAPI food is even a greater difference, right? There’s the deep fried lumpia, and then there is, you know, spring rolls and deep fried rolls, and then there’s naan, and then there’s curry, but then there’s Japanese curry, or South Asian curries, which is like, on your food, because I’m also an obesity expert, that’s gonna affect your risk of heart attack, That’s going to affect your risk of obesity.

So, for power and politics, let’s come together, but for research, let’s separate out. And probably the future is genetics because, I like to make fun of my brother Kelvin cause he has little brown hairs in his chin. I’m like, haha, that’s the Portuguese in you because the Portuguese took over Taiwan at some point.

So, you know, bottom line, it comes down to your genetics but it’s obvious that different Asian subgroups have different genetics that respond differently to drugs.

LAZOU: Yeah. That’s so interesting. I didn’t know that Japanese had the high HDL. that’s pretty cool to

have. So

Dr. Sophia Yen: Yes. No, I have a Taiwanese friend and she has high HDL and she has some Japanese relatives in her lineage. And I’m like, Oh, I would love to have a baseline HDL of 60 to 80. Like that would be awesome. Cause the only way to get it up there is to exercise like crazy. And I am a couch potato.

Why choose medicine

LAZOU: I. what made you decide to become a doctor?

Dr. Sophia Yen: As you know, all Asian Americans, your options are doctor, programmer, and maybe entrepreneur now or maybe lawyer, you know, only jobs that make money and that are very dependable. No artists, no music. No acting, though we have seen great success with Crazy Rich Asians, yay, But, you know, that is the one in a million versus the 80 percent will do fine if you choose that profession. But I chose medicine. Because I love science and I love people and my brother chose the PhD route because he loves science But I guess he didn’t like people as much or that he could contribute better to the world doing research Whereas I really love people.

each person has their own story to tell. And I love the idea of making a difference in someone’s life by giving them information to improve their health. and my mom was a nurse and she said, don’t be a nurse, be a doctor because the nurses do all the scut work and the doctors get all the credit.

And I was like, Oh yeah, yeah, I’m into that. I want the credit. So, that’s why I became a physician.

Why reproductive medicine?

LAZOU: And how did you decide on women’s health and reproductive health?

Dr. Sophia Yen: Yeah, so as a pre med in high school, I was sexually active and I was like, I cannot get pregnant during high school, college, medical school, residency, fellowship. And as a as an underage person, I’m like, I, I deserve the right to comprehensive sex ed, confidential reproductive health care. If anything happens, I better get to decide what happens to my body.

And I don’t, if I’m old enough to have sex and I’m old enough to decide what happens to my body, if I’m old enough to be a parent, I’m old enough to decide what happens to my body. And so that really got me into reproductive rights, reproductive health. Also as a pre med, it worked really well. I would go around and give contraceptive roadshows at any organization that MIT wanted me to speak at.

So a dormitory, a fraternity, a sorority, a club, a pre med group, anybody that wants to learn about birth control, I would go in front of and it was great for my resume. And then, as I went through medical school, I was like, well, do I want to do OB GYN or do I want to do something else? And OB GYN seemed obvious given my passion, but I wasn’t so great at anatomy, not so great at surgery.

And then I found adolescent medicine where I could do outpatient gynecology without having to do the surgery, without having to deliver the babies. And I was like, yes, I can talk about birth control. I can catch young people as they start to have sex, give them the good habits. You can have sex, just don’t get pregnant and don’t get any diseases, you know?

So, that’s how I chose where I went.

Cultural discrepancies in education about women’s health

LAZOU: that’s awesome. in your experience, I’m wondering if you see any discrepancies that seem cultural when it comes to education about reproductive health and women’s health in general.

Dr. Sophia Yen: Yes. One thing that came up to me as a feminist is tampon use. So race and ethnic disparities in tampon use in my team clinic. When you ask you use tampons or pads, how many, how often, oftentimes I would say, um, Less than 1 percent of Asians, Blacks, and Latinas use tampons. And like 60 to 80 percent of Caucasians use tampons.

And they’d be like, oh, that’s a racial, ethnic thing. Don’t touch that. Don’t mess with their culture. And I was like, there’s nothing in the book of Asian, Black, or Latino that says you cannot use a tampon. It’s simply education, that my mom had pads, my grandma had pads, I was given pads, pads work fine, why would I try anything different?

But when I talk to the young people in my clinic, or any woman that has not tried tampons, I’m like, have you tried tampons? It’s like night and day! But I also pull on the immigrant thing, which is like, we came to America to be on par with the Caucasians. And if 80 percent of Caucasians are using tampons, then 80 percent of us should be using tampons.

Like, pads is a old, old technology. Tampons is new. And I don’t know if this is still the case, but last time I googled it, there’s only one manufacturer of tampons in all of China. And back, you know, about 5 10 years ago, if you wanted tampons, you had to import them. Or you had to go to the expat store. You couldn’t just go down to the corner store and get some tampons.

They had some seriously high tech pads that, like, smelled like peppermint and made your vagina swoosh. But, like, they did not have any tampons. And so, um, anybody who’s anti tampon, I, I propose to you, if your young person was bleeding blood out of their nose like crazy you wouldn’t be like, Oh, you can’t put a tampon in there. You’re going to violate the sanctity of her nair. No. And that’s the same thing with, with tampons is you’re not going to violate the sanctity of her hymen. The hymen is not a cribiform plate. The hymen is just around and you can slip it in. It should be fine. But there are also other things that can break the hymen, such as, you know, riding on a horse or a bicycle or doing the splits or doing some karate kick. Who knows and who cares? Right? Like, for me, I pitch it, again, as equality, as well as better life, and I also, I pitch it as cleanliness. Is it better to stop the blood where it originates, or let it ooze out and smear here, smear there, and my pet peeve is, you know, underpants, clothing, bed, sheets, like, all sorts of horror, and just like, just horror, blood, everywhere, everywhere.

LAZOU: I agree. Yeah. I would even say since a couple of years ago, I’ve switched from tampons to cups and that’s even, that’s even better

Dr. Sophia Yen: the environment and next level, absolutely. I’m, just trying to get people to tampons and once we get the tampons then we go to cups or we can go straight to cups just not pads because to me pads is like again messy and chaffage, you know.

LAZOU: it’s uncomfortable.

It’s

Dr. Sophia Yen: tried the other, you don’t go

Birth control myths

LAZOU: I agree. so other than the pads and tampons thing, like, Are there any misconceptions that you’re seeing often in patients terms of reproductive health or any anything related to what you’re doing?

Dr. Sophia Yen: No, I would say let’s go over the top myths in birth control. So the number one myth is that if you use hormonal birth control or even the copper IUD that it will make you sterile. And my joke is It’s going to make you infertile while you’re on it. That’s why you’re taking it, right?

But the question is, I think, when you come off of it, does it affect your long term fertility? And the research shows that once you come off of these medications, the pill, the patch, the ring, the implant, the pill, any of the IUDs, the shots, all of those except for the shot are out of your body by two weeks.

And the way you know this is I’m going to show a little thing here that has a birth control pill pack. There’s three weeks of active pills, one week of sugar pills. And when you get to the second or third day of your sugar pill, you bleed. And that’s because the hormone has washed out of your body. So a week and if you want to be really anal thrown an extra week by two weeks, it is out of your body. So it has no long term effect on your body.

Same thing goes for the implant. Same thing goes for the IUD , all of that is out of your body in two weeks and so it has no effect on your long term fertility. The shot, I made an exception because it is shot and it sits in your muscle and so sometimes it takes eight months for it to wash out completely from your body.

But on average, 80 percent of people will get pregnant in a year in attempting to get pregnant. But with the shot, it may take you an extra eight months to completely wash that out and get pregnant. And the reason for this perception is if you take a hundred women on the pill, patch, ring, IUD, implant, and you have a hundred women not on a birth control method, wait 20 years, right?

Because they’re holding off on having babies during that time. And then take everybody off and say, "Hey, you all get pregnant". 10 percent of each group will develop polycystic ovarian syndrome and women with PCOS, polycystic ovarian syndrome, have a hard time getting pregnant because they don’t pop out an egg every single month.

And if you don’t pop an egg, you can’t get pregnant. And so 10 percent of those women who had never been on birth control will have a hard time getting pregnant. And 10 percent of the women that were on the pill patch, ring, IUD implant will have a hard time getting pregnant. And people are like, "Oh, it was the birth control".

But no, it’s the same in both groups. It’s the polycystic ovarian syndrome. And then one more thing to hammer that in. I was giving a talk to a bunch of infertility specialists and I’m like, why am I giving a talk about birth control pills to infertility specialists? And they’re like, we use the birth control pill to normalize the hormones in people with polycystic ovarian syndrome.

And then when they come off, BANG! That’s the best time for them to get pregnant. That’s the most normal that their hormones are going to be. Because when PCOS people are not on birth control, their hormones get weird and weirder and weirder and weirder and weirder. And then it’s harder to get pregnant.

But by putting them on birth control pills, it flattens things, normalizes things. And when they come off, , they bleed because the hormones drop, and they bleed, and then they build back up and Two weeks out, ready to go. That is the most fertile that PCOS person is going to be. So again, birth control does not make you infertile once you come off of it.

It makes you infertile while you’re on it, and that’s why you’re using it. And birth control pills, patch, ring, are actually used by infertility specialists to prep your body to become fertile.

Birth control use in the Asian American diaspora

LAZOU: Yeah. I’m wondering, , if you have any stats for the Asian American patients group, for example, percentage wise, how many of the women in the fertile group are on some sort of birth control

or not?

Dr. Sophia Yen: so about, I think, 92 to 95 percent of sexually active people will use some form of birth control in their lives. And this includes Catholics, just so you know. I think it also depends where, I mean, if you’re in the Philippines where it’s illegal and it’s harder to get your hands on it, but if you’re an Asian American.

The 92 to 95 percent will be on some form of birth control in your life. so it’s highly prevalent, highly likely, and then I also want to emphasize the non contraceptive benefits of the birth control pill patch ring. And for me, Hashtag periods optional. You don’t have to bleed every month. You could bleed every three months, every six months, or never.

Also, acne. I used to get one giant zit once a month. I called it the North Star. The commercial that made it totally hit home as a teenager when I saw that. I was like, yes! Me! North Star! Once a month! And I forget if it was before my period, after my period, whatever. But once I went on the pill, that decreases your circulating testosterone and decreases it.

And once I stopped that up and down, up and down, up and down every month without hormones, and going on hormones, it was smooth. I did not get the zits. And then if you have polycystic ovarian syndrome, endometriosis, bad evil periods, as I like to say, heavy periods, painful periods, anemia, the number one cause of anemia in a menstruating woman.

So these are all the benefits of being on the pill patch ring that have nothing to do with preventing pregnancy and everything to do with just quality of life. Laughter

#PeriodsOptional !!!

LAZOU: had a TEDx talk about making periods optional. Why am I only hearing about this now? And are there any risks or side

Dr. Sophia Yen: Thank you so much for saying what I just want to shout out from the rooftops to everyone. My gift to this world upon my deathbed is I shared with as many people as I could with a uterus that you do not need to bleed every single month. If you ask your uterine bearing doctor if they’re bleeding every month, the likelihood is very low. Did they share this with you? Not so much because doctors are afraid. They want to have enough data They don’t want to get sued in the United States and stuff like that. But are they personally doing it? Yes They are and it’s become more acceptable recently because more people are using the IUD and with the hormonal IUD 30 percent of people have no bleeds whatsoever And then 70 percent is lighter. So the hormonal IUD is actually used as a treatment for heavy, painful periods. Same thing with the implant. And then with the shot, after three shots, about 75 percent of people have no periods again. Yay. And then the other 25 percent will have lighter or irregular periods.

And then we’re realizing as we learn more history that the maker of the pill , only have this one week off to bleed because he was like, "Oh, I don’t think women can handle it if we took away their periods". And I was like, how about you ask, ask, you know, like, I would like to not have my period. I would like to have it every three months, six months or never.

And in fact, I haven’t had it for the past 14 years because I realized as a doctor, the only reason those of us with a uterus bleed every month is we build that lining. We’re like, Embryo, uh, no embryo, bleed, and then we build it up again. Embryo, oh, no embryo, bleed. And if we’re not trying to catch an embryo from age 12 to 26 on average in the United States, or for those of us who had to get through more education in 34, and then pop out two kids, and then no babies until 50, why are we going up and down, up and down, up and down, up and down, every single month?

And we actually have 350 to 400 periods in our lives, which is three times normal. Normal would be a hundred periods in our lives, because back in the day, we would have eight babies. How many periods do you have when you’re pregnant with eight babies? Zero. How many periods do you have when you’re breastfeeding exclusively every two to three hours? Zero. And so that’s why back in the day, we only had a hundred periods and now we’re having three hundred and fifty to four hundred. I don’t want to bleed enough for three other women. That’s not okay. And so we can achieve that with the pill, the patch, the ring, the IUD, the implant. And every time you build up that lining, it can mutate and turn into endometrial cancer.

Every time you pop out an egg, and we don’t know if it’s the popping, the healing, or the tubes, we think it has something to do with the tubes, um, you risk ovarian cancer. If you ask any educated physician, how do I decrease my risk of ovarian cancer? There’s only two ways. One, take out the ovaries, which we do not recommend unless you’re post menopause and there’s no purpose and you might as well just take them out.

Or, going on the birth control pill, patch, or ring for five years will decrease your risk of ovarian cancer by 50 percent because it stops that ovulation for five years and decreases your risk of ovarian cancer. And it also decreases your risk of colorectal cancer. And that allows me to bring up that your colon is around your uterus and your uterus is like up and down, up and down, up and down every month and your colon and rectum is like, Oh, I’m sad for you. I’m going to run faster and then you get diarrhea. I’m going to run slower and you get constipation and 30 percent of those of us who bleed every month have one of those.

And so not only do you have blood coming out. Now you got poo. It’s like insult to injury. And then a zit. I’m like, this is just horrifying. If you’re not trying to make a baby, why are we suffering? This indignity, this blood loss. And if you’re cold, tired, pale, make sure you get checked for anemia and iron deficiency.

LAZOU: Yeah. when you said if you go on the pill for five years, that decreases your chance by 50%. Is that taking the pill, without the sugar pills at all, like just skipping the period altogether or doesn’t

Dr. Sophia Yen: It doesn’t matter because the pill in general, the main way it works is blocking ovulation. But if you skip the bleed, that will decrease your risk of the lining cancer. Because again, every time you slough that lining and you build it, you increase your risk of cancer because it can mutate. The more times you turn it over, the worse it is.

And I think that also affects colon cancer too, because the colon is only affected by the hormones going up and down, but also the When it goes down, then that’s a drastic kind of change. And actually, uh, you know, an extra caveat is this last seven days of pills was fine. When the birth control pill was at 110 micrograms of estrogen, and now it’s at 30 or 20.

And so they’re actually seeing escape ovulation on day five, six, seven. And so you’ll see the new pills only have five. Four days of sugar pill. So in general I would recommend cutting your sugar pills down to four and I would recommend none at all because why risk a bleed at all?

LAZOU: one thing I wanted to ask was, um, I know some people who have had that side effect with birth control pills, where they have, or Blood clots.

Risks of blood clot

LAZOU: so how prevalent is that? And is that something that we should be worried about if we’re going to take the pill indefinitely so we don’t

bleed?

Dr. Sophia Yen: So the risk of blood clots goes up with age. And so if you’re a 35 and a smoker, then we do not recommend an estrogen containing birth control pill. The risk of blood clots on a progesterone only method, such as the shot, the IUD, the implant, all of those, the risk is very, very low. And with the copper IUD, there’s no hormones at all.

But I’m not a fan of the copper IUD because more blood, more cramps. But if you’re the kind of woman who’s like, Oh, is that blood running down my leg? You, you’re a great candidate for the copper IUD. But if you’re like me, I feel every blood coming down my vagina, and like coming out.

No, no, you are not a candidate for IUD. But, back to the blood clots. If there is a family history of blood clot, if you have a blood clotting disorder, anecdotally, my Taiwanese family, we’re the opposite. We actually bleed like stink. And so we don’t have a known blood disorder, but we notice when we get a cut, it like takes a while for it to stop.

East Asian blood disorder?

Dr. Sophia Yen: And when my dad had his quintuple bypass, the doctor was like, he was a little bit oozy. And I was like, Oh yeah, that runs in our family. And he’s like, why didn’t you tell me? And I was like, why didn’t you test for it? But I did get a test for it. And the test that they have for it is really barbaric. It’s called the bleeding time, and all they do is take a razor, slice your arm, and time how long it takes for you to stop bleeding.

I was like, that’s not cool! And now I have a little slice scar on my arm. So like, not worth it. So I do think that’s a brilliant question, and I definitely don’t know. But I’d be curious if anyone has done that research that do bleeding disorders vary by race and I think absolutely because we hear certain, races and because of our genetics have different diseases such as again, Asian Americans have Thalassemia, which prevents malaria, but causes small blood cells.

My entire life growing up, I was traumatized by my physician because they were like, you have anemia, you need to take iron. I was like, okay, I’m taking my iron. I’m taking it every day and I’m taking it with orange juice and I’m taking it with beef jerky to increase the absorption. They’re like, you’re not taking it.

I’m like, I swear, I’m taking it. And then I go to medical school and we learn about thalassemia and I was like, wait. I think I have thalassemia! And I looked it up, and I have thalassemia! So no matter how much iron I took, I was not gonna get my blood cells up. Boo. So it’s really important to know the difference by race, by genetics, in prevalence of disease.

Asian BMI

Dr. Sophia Yen: And also just a random fact, the BMI cutoff is different for Asians than it is for Caucasians. you know, in general, we’re a more petite society. And so the BMI cut off of 25 for being overweight and 30 for obese is too high. And they actually see cardiac badness at lower BMI, which makes me sad because I love my desserts.

LAZOU: Oh, I didn’t know that. So what would be the cutoff

Dr. Sophia Yen: Yeah, I believe it’s two points lower.

LAZOU: Oh,

Dr. Sophia Yen: So 23 and 28 would be our cutoffs.

LAZOU: Damn.

Yeah. you know, it’s funny you mentioned about your dad having the bypass cause my dad also had a triple bypass and he also

bled a lot. And the surgeon said he noticed that the, my dad is in Mauritius. So he said the Chinese Mauritians that he operates on tend to bleed more.

Dr. Sophia Yen: So, see, I think we have a bleeding disorder that they have not yet figured out. It’s not like hemophilia, which we all know happens when inbred Caucasians in the UK, the kings, that’s why they got it, right? Because they were all incestuous and whatnot because they had to breed the royalty or whatever. And we know hemophilia is a Caucasian thing.

But, I’m pretty sure, there’s this ooziness. Yeah, and, and how come this, because he’s a surgeon, he’s not a blood doctor, but if he were a blood doctor, he could study this, or if we get Asian blood doctors to study this, or Asian Americans to study this, versus Caucasians, you know, the problem in doing the research is you have to get enough data.

of the numbers. So whenever I do research, I like to break the Asians down by all the subcategories and like Taiwanese and then Vietnamese and then Tongan. And then are you half Taiwanese, half Korean, you know, like all this stuff. But then in the end, when I’m trying to do the analysis, I don’t have enough numbers in each of the groups that have to glob them all together.

And I was like, but they’re different.

LAZOU: Yeah, I think because in Mauritius, the majority of the population is from India, it’s an Indian or African descent, and Chinese people are about 2%. But it’s a small island, and that’s all the people you have, there’s barely any white people there. So he was able to notice that trend.

So whereas in the US, I think you would see, you know, once in a while, you would see an East Asian person.

So it makes sense that you wouldn’t see it. so we have several birth control methods available and you mentioned some that I had never really looked into before.

Best to worst method of birth control

LAZOU: So I’m wondering if you want to go through, like, best to worst

Dr. Sophia Yen: Great question. I call this Dr. Yens, what you need to know now that Roe is gone in the United States. So we’re blessed to be in a crazy, awesome, liberal state of California, who has declared themselves a sanctuary for the rest of the country. But if you are not blessed to be in one of these liberal sanctuaries, New York and California, if you don’t know, Arizona just went back to 1864.

That’s just so messed up. Anybody with a uterus is now being treated as if you were 1864. even before Arizona was a state. So, for those in Arizona, Texas, Florida, Kansas, Alabama, all those states where your rights have been stripped away, very important for you to hashtag get your birth control under control.

So um, one way to quiz your doctor to see if they’re on the cutting edge of birth control is to ask them, what is the most effective birth control method? And this blows my mind. The implant. It’s this little rod the size of a toothpick, the thickness of a toothpick, and it goes in your arm about. Uh, 8 centimeters from your oligchronon process.

My daughter’s now 14, but when she was 10, I was like, a 10 year old could learn how to put this in. So if you were to go to a third world country and you want to do some service and just throw down a whole bunch of these implants and people, this is the most effective form of birth control. And it beats Vasectomy.

Vasectomy is a permanent birth control and is the gold standard, but this hormonal thing that goes in your arm that lasts for three years and actually has the good hormone, , that I’ll tell you about later, , beats vasectomy. So first the implant, then vasectomy, then comes the hormonal IUD. And for those of you who can watch the video, I just want to show how small this is.

Look how small, smaller than my thumb. This is a real IUD size shape. It’s just not a real id ’cause it doesn’t bend and it’s purple to tell you. Do not stick this in anyone. But, um, the normal one is white and bendy and goes in and, this beats tubal ligation. The fact that people can get pregnant on tubal ligation shows you how fertile the human body is.

Tubal ligation is not just snip the tubes on each side of the uterus. As you can see my necklace here, but. For those of you who can’t, the, the tubes, they take out an inch, they burn it and people still get pregnant, but this IUD with hormone beats tubal ligation. Then comes tubal ligation. Then comes the copper IUD.

Then comes the shot, which is every, , 12 weeks. The negative of the shot is it gives people munchies. And then if you’re on the skinny side, it gives you bad bone density. But anything is better than pregnant because pregnancy will give you the munchies and it will take away your bone density. And then comes the ring.

what’s cool is there’s now a one year ring. You can just stick it up there and leave it for the entire year. Or you could take it out every three weeks, have a bleed for a week. I don’t know why you would do that, but if it brings you joy to bleed, then yeah, go for it. And then, there’s the patch. And now that I’m on the estrogen replacement patch, I’m like, why is this patch so big?

My estrogen replacement patch is like this small. This is huge. Why can’t they make it smaller? But anyway, better the patch than nothing. And then the Ring, the patch, oh, and then the pills.

The (40 different types of) pill

Dr. Sophia Yen: The key thing to know about the birth control pill is that there are 40 different birth control pills. 8 different progesterones.

If you don’t like a particular pill, please note, this is a progesterone and I don’t like it because it gives me zits, it gives me munchies, it gives me irregular periods, blah, blah, blah. And then I realized, as a woman of color and a physician, what I was being taught at the academic institutions were great.

If you’re a caucasian female that wants to bleed every month. What we are teaching everyone to prescribe in all of the medical schools is great. If you’re a caucasian female that wants to bleed every month. But if you’re of asian or black descent or you don’t want to bleed every month, I talk to my fellow asian and black doctors and like, Oh yeah, that drug that we’re teaching everyone to write?

Does not work for our people. And I tested it because I was like, oh yeah, I had to go through three different birth control pills until I found one that didn’t have side effects. And so at Pandia Health, we have an algorithm that our doctor asks, what race are you as a proxy for genetics? What’s your BMI? What’s your bleeding preference? Do you want to bleed every month, every three months, every six months? How old are you to make sure we give you enough Estrogen for your bone density. And with that, we’re able to make 82% of people happy at a year on their first birth control pill ever, versus the standard of 30 to 50%.

And our a hundred percent doctor team has been trained on this. And I took all 40 birth control pills because I’m academic, went to M-I-T-U-C-S-F. Stanford couldn’t just sit there and write birth control and watch people have side effects. I had to study it and took all the birth control pills, ranked it from most likely make you bleed.

Least likely make you bleed. Most likely give you zits. Least likely give you zits. Most likely give you munchies. Least likely give you munchies. Took what we were telling everyone to prescribe, everybody across the nation, fixed it for the side effects we were seeing in people of Asian and Black descent.

And so much better treatment and putting it in the minds of physicians that, and they know, we now know, it’s called pharmacogenetics, that people with different liver enzymes metabolize drugs differently. And so if you chew through the drug faster, you’re going to have more breakthrough bleeding. If the drug stays around longer, you’re going to have more breakthrough bleeding.

You’re going to have more side effects if you have different response to androgen or you have more androgen, which is testosterone, the manly hormone that gives you zits and hairiness and munchies, then it’s gonna be different. So, , that’s how I’ve improved experience for people by coming up with this proprietary algorithm that only my company has.

Pandia Health. We’re the only women founded, women led. Doctor founded, doctor led, Taiwanese American founded and led, company in this space.

Why you should still use condoms

LAZOU: That’s awesome. Yeah, I didn’t know that there were that many different brands and that they all had different types of side effects. That’s, that’s great to know. what are some things that you think people should consider when trying to decide what kind of birth control to go with?

Dr. Sophia Yen: you know, A new paradigm was when we talk to patients, offer them the best and work our way down. Because in the old days, we’d start with condoms and we’d work our way up. And by the time I got to IUD or implant, you’d be like, Uh, not paying attention, you know.

And certainly, I recommend a hormonal method or the copper IUD, if you’re that kind of person that can tolerate it. Plus condoms and I do that as a feminist. So I actually have a condom bag and for those of you who are watching this Condom bag and people are like you’re married. Why do you have a condom bag?

Are you like cheating on your husband? And I’m like, no As a feminist, , I don’t like to have my vaginal flora messed up by semen every single time I have sex. I also don’t like to leak secretions for 24 hours. And if you had to leak secretions for 24 hours, you would sure as heck make sure that I took my secretions with me.

And so I like condoms for prevention of pregnancy doubling up with a hormonal method and prevention of, sexually transmitted infections.

IUDs, demanding pain management, and tips to make your experience less painful

LAZOU: I’d like to touch on IUDs briefly. I’ve never had one, but I have some friends who have. Um, The pain sounds nightmarish. should they have been offered pain management or is this the norm? Is that just how it works?

Dr. Sophia Yen: Pain management for IUDs is going to be like pain management for circumcision. And because not everyone’s a pediatrician, I bet you didn’t know that for the longest time they did not put any anesthesia for circumcision because they’re like, ah, it just takes a second slice and the baby just cries, wah, and then it’s over.

And so I was like, that’s kind of like gross and barbaric. And certainly I’m not criticizing the Jewish culture, blah, blah, blah, blah, blah. They give the kid a little alcohol or whatever. But in the hospital with a doctor, we now numb it up before we slice it up. And so when I learned about IUD insertion and there were like, Oh, well, we don’t have the data.

We don’t know if numbing it up helps. And I was like, as a woman, I’d err on the side of numbing it up. Whether or not you know, cause like, err on the side of numbing it up, you know what I mean? There’s no addiction to lidocaine in my cervix, you know? And some people are like, well, you know, the effort of sticking a needle in there, that’s more painful than the thing itself.

And I was like, No, I don’t think so. I think you should numb it up. research has been done showing that it does help. And then some people like, well, I can’t get my hand on it. It takes too much time. And I was like, so you’re just gonna like cut someone open because you don’t have, you can’t get your hands on it, or you don’t have that much time.

Like, No, no, and no. So yes, um, absolutely demand a paracervical block. If they have any questions, there’s a research paper out by, I think, It’s a group in San Diego. I was at a conference and we actually had the authors of the group come in. And it was really interesting because I had just been in a group in the morning and they’re like, Oh yeah, I never offer it. If they ask for it, I’ll give it to them. And I said, isn’t that a very privileged position? Cause they have to have read the New York times or had a friend that suffered through it in order to know, to ask you like, you know, For equity, you should offer it to everyone. And then if they say no, then that’s fine.

But to only give it to those who know to ask, that is totally a privileged thing to do. and they’re like, I can’t get my hands on it. It’s like, well, go get some, you know, like, certainly if there’s none to be had, like right now there’s a Wagovi shortage, or when there were no COVID vaccines, then you could prioritize.

But like. That’s not an excuse, go get some. And so there is a hurricane spray that you can spray, and then do the injection, but I would ask for the paracervical block. My other tip to you is, 30 minutes ahead of time, take 600 to 800 milligrams of ibuprofen. Assuming you don’t have an allergy, assuming that your kidneys are fine, take it with food so you don’t get an ulcer and scream at me later about it.

But 800 milligrams of ibuprofen is equivalent to a milligram of morphine. So, good for pain relief. And then, , the other tip, I know it’s hard to do, and it’s not necessary, but if it were me, my daughter, my friend, I’d try. , try to schedule it on the last days of your period, because the hole is already open, and stuff is coming out.

You don’t want the first day, because then if you put it in, it might come back out. But if you do the last days of your period as it’s drying up, The hole’s open and you go through. If you don’t do it on your period, then the hole is closed with some cervical mucus and they just have to push through it.

So it’s not a big deal. It actually is not making a new hole in your body. The implant is making a new hole. Just a little hole in your body. But the IUD does not make a new hole. It just has to push through the mucus plug. But it might be easier if it’s already open to begin with.

And certainly somebody who’s had a baby before, it’s going to be a lot easier to go through.

LAZOU: that’s great to know because when they told me about it, I’m like, that sounds awful.

Dr. Sophia Yen: No, do not suck it up. Totally advocate for yourself. Invoke Dr. Sophia Yen Stanford Adolescent Medicine and say, I want the cervical block. There’s a paper on it. It works. Don’t do this to me, and then if you want to freak them out, because if pediatricians, they’ll be like this is gonna be the circumcision of your time that you did not offer me pain relief for my IUD placement, I’m like, they’ll back off, or argue that, would you do circumcision without anesthesia?

LAZOU: That’s a good point. And I had no idea that they did that without anesthesia. That’s

Dr. Sophia Yen: Yeah, it was during my time, I guess after 1997, they started testing sugar, and they noticed if you give the kid a ton of sugar, he cried less, and then they’re like, how about we numb it up?

LAZOU: Like, duh.

Dr. Sophia Yen: I’m gonna chop off your foreskin with no anesthesia!

BMI > 30? No Plan B for you!

LAZOU: going back to BMI for a second, you mentioned in one of your posts that BMI affects how effective birth control is. Do you want to talk about

Dr. Sophia Yen: Yes. So really important for people to know, I’m all about preventing unplanned pregnancy and I’m not paid by this company. I’m looking for my package right now, somewhere here. is the Ella emergency contraceptive. So it’s, there are two pill emergency contraceptions. Aha. One is over the counter and it’s plan B and it’s generics.

And then the other is prescription only. And the prescription only is Ella. I’m not paid by Ella. I’m just trying to prevent unplanned pregnancy. Ella works up to a body mass index of 35. Once your BMI is 35 or greater, Your only option is the IUDs. But know that if I were sexually assaulted or my daughter was sexually assaulted, I wanted the lowest chance of being impregnated by my rapist, I would use the copper IUD.

The copper IUD is 99. 99999999 percent effective in preventing the egg and sperm from hooking up and a baby from happening from that. if you get it within five days of contraceptive failure or sexual assault. Um, this one works up to a BMI of 35, but plan B is generic so that over the counter a woman may be taking it and like, I’m preventing unplanned pregnancy But, if your BMI is 26, and 66 percent of the U.

S. population is a BMI of 26 or greater, BMI 26 or greater doesn’t work so well. BMI of 30 or greater does not work at all. So there’s a whole bunch of campuses that are putting these in vending machines, and I’m like, you need to put a sticker that says, check your BMI. If your BMI is 26 Doesn’t work so well if your BMI is 30.

Does not work at all. Don’t even waste your money or time on this. You know, and then know that you can get this ahead of time. So at Pandia Health, when we write you for a birth control pill patch ring, we’re like, you want some emergency contraception with that, in case you forget taking your pill, in case you run out or whatever, in case your friend needs it or whatever, and we write on there, please give the patient the one with the farthest expiration date, because usually you can get one that expires two years from now.

18 months from now. And thanks to the Affordable Care Act, if you have insurance, no copay, no deductible. Free! You just gotta get your doctor to write it and fill it.

LAZOU: That’s awesome.

So for people who want to work with PANDIA, are you able to prescribe anywhere in the

Dr. Sophia Yen: So we are licensed to prescribe in 16 states and we can deliver to all 50 states. So I started the company so that no one runs out of birth control on our watch. I actually coined the term, pill anxiety. That if you get to that last week of pills, and if you don’t have pills, you start freaking out.

And then, why should women have to suffer every month from age 15 to 50, I gotta get to the pharmacy, I gotta get to the pharmacy, if I don’t get to the pharmacy, I’m gonna end up pregnant, or bleeding, or can’t have sex when I wanna have sex, like, Forget that. We’ll just ship it to you and keep shipping it to you.

So we can deliver to all 50 states. If you have insurance and a prescription, you pay us nothing because thanks to the Affordable Care Act, no copay, no deductible. If you need to use one of our expert doctors who’s been trained on this algorithm that I came up with and taught all of these physicians, um, then it’s just 30.

Once a year to use our expert doctors. I made it with unlimited follow up questions for a year about birth control, nothing else. Cause you only paid 30 and so 16 States, we purposely chose the biggest States because it costs the same amount of money to start up in Alaska as it does in California, Florida, Texas.

So we did California, Florida, Texas, Nevada, Arizona, , we did some swing states, Pennsylvania, Georgia, Ohio, Illinois, New York. The example I give is we’re not in Connecticut or New Jersey because of licensing stuff, but we are in New York. So if you can get to one of these states and be like, I’m at SFO, I’m at LAX, I’m in Vegas for funsies, I’m in New York, JFK, on my way to Europe, or whatever.

And you fill it out and like, I’m here right now, then legally our New York doctor can write that prescription. Our Arizona and Nevada doctor can write that prescription and then we can ship it to all 50 states. And you just got to get back to one of those states in the next, you know, year to renew it.

Because legally we have to rewrite the prescription every year.

LAZOU: That’s great to know. Now, one more thing I want to talk about you know, growing up in Mauritius, I’d never heard much about menopause. I knew it happened and that it was hell, but didn’t think there was anything much we could do about that.

so do you want to talk a bit about perimenopause and menopause and what’s

available?

Dr. Sophia Yen: Same thing in medicine. In 1997 when I graduated medical school, what we were taught is you put your hand on the woman’s shoulder and you’re like, menopause, suck it up. Sorry. this will pass. It is what it is. Now we know that on average hot flashes on average last seven years.

Would you ask a dude to suck up anything for seven years? No, I think the maximum, you know, in my ADHD world, that I’ll tolerate something is a week, maybe three weeks, maybe a month, maybe three months, but seven years? Hell no, but women are just like, okay. Oh well, we’re strong. We’ll suck it up. It is what it is.

No, no, and no. And somebody said something the other day that was brilliant. You will not get a medal for sucking it up for five years to see how long I could like hang out until I need the medication. The research has actually shown the sooner you start it, the better. For your heart, for your bones, and for your brain.

And so particularly, people of Asian descent, we suck at our calcium. Right? A lot of us are lactose intolerant. None of us had milk built into our diet anywhere. Certainly Asian American maybe had more milk somewhere along the line. But I was not one of those people. And so we are at risk of osteopenia.

There are four indications. Legally for, , hormone replacement therapy. And one of them is risk of osteopenia. So basically being Asian, or being Latino, or being black and lactose intolerant. Scores you that, which is awesome for once, that we get something just for that. Um, the other ones are not so great, because if you don’t have hot flashes, if you don’t have night sweats, if you don’t have genital urinary symptoms, but I think you will notice, because the way I kind of knew I hit menopause is what I call sandpaper V.

It was like sandpaper down there, not pleasant. And then, I had a family member, they had recurrent urinary tract infections at age 70. And I was like, what’s that about? Like, you know, um, usually it’s like 20 years old, you don’t know to pee after sex, that’s when you get that. And I was like, is that 70 year old having like wild crazy sex?

Or, it turns out Then in menopause, if you don’t have enough estrogen and it affects your vagina or urethra that way, it goes and it gets all dried up. And if your vagina dries up, then your urethra dries up. It’s right above it. And then you can have recurrent urinary tract infections. So yet another reason to go on hormone replacement therapy or hormone therapy.

So, there are a bunch of different companies that are, you know, treating menopause. My company is one of them, pandiahealth. com forward slash menopause. We’re charging 130 for the first visit because it’s with a physician, it’s asynchronous, but you ask a whole bunch of questions and we have to review all the questions and then make sure it’s safe to write you the drug.

And then 60 per follow up afterwards. But if you’re doing great, you don’t have to do the follow up. And then the medications are covered by insurance, but the insurance are requiring a copay. So I’m working on an advocacy component. I’m hoping that Biden Harris will consider making menopause no copay.

Just like they did with birth control, and I’m calling that V2. So V1 was birth control, V2 should be menopause, and if you don’t cover it, then you’re sexist and ageist. So, um, don’t be afraid to talk about it. Talk about it with your parents, particularly Asian Americans, because we’re at risk of osteopenia.

Um, it also helps with dementia my mom, unfortunate, my family has it in our family and, I’m afraid of it. So definitely, and again, you want to get on it within 10 years of menopause, but the sooner the better. And I’m going to give you Dr. Yen’s take on it. Which is, I believe that age 52 ish, your body takes away your estrogen and is like, thank you for your service, go die.

And I’m like, well, they took away the estrogen, put it back! You know? Because when they take away the estrogen, your bones Go to badness when they take away your estrogen, our arteries turn into what I call man arteries. They become hard, they get filled with clots. And so that’s why you don’t want them to become hard and filled with cloths and then throw estrogen on them.

You want them to take away the estrogen and put it back, quickly put it back. And then the same thing for the brain. They’ve shown that estrogen is really important for the brain. So there’s just so many benefits, but there’s currently only four indications right now. So you have to have hot flashes, night sweats, genital urinary symptoms, or a risk for osteopenia.

And then perimenopause just means before menopause, it can start 10 years before. The way I like to think of that is your estrogens runs out like gas in a car and it can either go put, put, put, put, put, put, put, or it could just go. So what people are talking about is flooding. I’ve talked to these women.

Have you heard about flooding? So, menopausal women, all of a sudden, flooding blood, like four to five pads, afraid to go in public, because they might stain their friend’s couch. I was like, dang! And I was like, is this a one time thing? And they’re like, oh no, it happened like four or five times! And I was like, this is unacceptable!

So, like, I suggest making hashtag periods optional. When you’re going into menopause and then every six months we take you off and we’re like, are you there yet? Are you there yet? Or when you hit 52, then you just switch over to the menopausal treatment rather than suffer the indignity and the risk of this flooding or this random bleeding.

So if your periods are getting heavy, they start getting weird. That is like indication potential of menopause. If you have any of these symptoms of menopause, there’s actually like 34 or maybe 42 different symptoms of menopause, then you might want to consider going on the pill and just making your hormones flat, or patch, or ring, or hormonal IUD, or implant, versus up and down, up and down, or just random.

LAZOU: Yeah. So you said perimenopause is about 10 years before, so it starts in the

40s. Typically. What advice do you have people who have a uterus and who currently live in a state that is not one of those liberal states, they don’t have safe access to abortion Some states are even trying to get, take away birth

control apparently.

Dr. Sophia Yen: I think hopefully we can argue from the scientific point of view that you cannot take away quote birth control. It’s estrogen progesterone treatment. 70 percent of people on the birth control pill patch ring hormonal treatment are on it for non birth control reasons as well. PCOS, endometriosis, anemia, acne, other things like that. And so hopefully we can prevent them from making birth control illegal for those sakes. Because what am I going to treat PCOS with? I need that, I need that medication to treat it with as a physician. But in those states, make sure everyone knows about the website PlanCPills.Org So my friend came up with it She’s brilliant plan a is your regular birth control plan B that we don’t like plan B We like Ella instead but cute plan B is emergency contraception and then plan C is Oh My goodness, I am pregnant. I do not want to be pregnant. So Plan C is a nonprofit website, you punch in your state and for every state in the United States no matter which state it tells you how you can obtain medication abortion and there’s actually a doctor. Dr. Gompertz in the Netherlands, I believe. She used to take women out on a boat to international waters, perform the abortion because there’s no law in international waters, and then take them back. But then medication abortion came and she’s like, why am I taking women out on boats when I can just mail you pills in the mail?

And so she will write the prescription from the Netherlands. They will ship the drugs from India or some of these sanctuary states, California, New York, to whatever state you are. So that no one goes to jail and you can get your medication. And there is a legal warm line and a medical warm line.

It’s warm line because it’s not a hotline because it’s not 24 7, but it’s a warm line that can guide you through this. And if I were traveling to such a state or considering attending college or doing an internship for a couple months, I might get it in my liberal state. Bring it with me in my suitcase in case of emergency in case anything happened and actually what’s crazy Thank you for reminding me.

The Supreme Court is looking at a case that may make Mifepristone You can’t mail it or you can’t get it by telemedicine You have to see a doctor in person or that totally illegal. And even liberal states like California and New York will no longer have access to 50%. There’s two drugs you have to use together for the best medication abortion.

You could use one of them alone, but it works not as well and it has horrible side effects. So all you’re gonna do is torture women. Which is mean. Why make us suffer? Bleed. Have cramps. We should just get our business done. Get what’s my body, my choice, your body, your choice. So we need to all protest the Supreme Court.

Do not let them make it illegal to ship it. Do not make them require an in person visit. Do not make them make this drug illegal. Five million women in the United States have used mifepristone and misoprostol together with no problems whatsoever. It is safer than Viagra. It is safer than Tylenol. To make it illegal is insulting to those of us with uteruses and those of us that care about uteruses.

What I love about my feminist dad is,, he remarked about my necklace that we all came from the womb. No one escapes the womb. Respect the womb. And so respect the womb!

LAZOU: I think if they’re going to be banning our medication, we should ban Viagra because then they’ll be like, Oh no, we should not do

that.

Dr. Sophia Yen: Yes, No, that always irritates me that Viagra is covered in some places and not birth control, not menopause. So you want the 70 year old dude to get it up, but his wife can’t have sex with him. Or you want the 72 year old dude to be able to impregnate, but you won’t give the 20 year old the ability to prevent that.

LAZOU: Yeah.

Dr. Sophia Yen: absolutely sexist and shows you who holds power in this country, and therefore we need more people with uteruses. To run for office. Run for office. And then, please support female founded, female led, women founded, women led companies. All things being equal. And please support your fellow Asian American entrepreneurs.

LAZOU: All right. Well, before I let you go, I usually end the interview with rapid fire questions. These are one word or one phrase answers. You do not have to explain, but you can if you want to. The what’s an Asian food that you should like, but don’t.

Dr. Sophia Yen: Kimchi.

LAZOU: What’s an Asian food you’ll never get tired of?

Dr. Sophia Yen: Xiaolongbao.

LAZOU: What is a pet peeve you have as a physician?

Dr. Sophia Yen: When they Google it and they try to sell it to you and it’s like, did you go to medical school? Did you take boards? Do you know microbiology, virology? You think Google knows more than me and sometimes Google can diagnose stuff But like was it a safe source or a tick tock tick tock so worth? I saw it in tick tock and the chiropractor or the personal trainer said or the person who’s pushing supplements said Again, did you go to medical school?

Have you done the research? Has it been tested in people?

LAZOU: And what’s a pet peeve you have about, the medical industry?

Dr. Sophia Yen: I would say Insurance companies are evil. Pharmacy benefits managers are evil. We really need to go to universal health care. I absolutely agree with Dr. Paul Song and anyone else who supports universal health care that there’s middlemen here and they all need to go and we need to act in the public’s interest, the public health interest, and that doesn’t happen when you have an insurance company in the middle trying to make money.

LAZOU: for sure. And lastly, what’s on your bucket list?

Dr. Sophia Yen: My bucket list. I would love for Pandya Health. We chose the Greek goddess of healing, light, full moon. I made up the definition so people can remember how to pronounce it and spell it. Pan is every and Dia is day. We want to be with you every day. from your first period to your last breath, because we’re doing birth control, acne, and menopause.

I would love to ring that NASDAQ bell. That would be so cool. And then my second one would be to be the first surgeon general to say masturbation without being asked to resign, which is what Bill Clinton did to Jocelyn Elders, the first African American Surgeon General. And it wasn’t like she was pushing it, they were just like, how do you prevent sexually transmitted infections?

And she’s like, condoms, abstinence, and masturbation. And because the other side flipped out, somebody had to go under the bus, and she had to resign. I was like, Clinton, of all people, couldn’t use more masturbation. Of all people.

LAZOU: Wow. Yeah. Yeah.

Dr. Sophia Yen: And so if I were Surgeon General, I would be about comprehensive sex ed. I would be about hashtag periods optional. I would be about menopause and equal treatment, equal research dollars used on those of us with uteri. Because if you don’t know, not until I believe 1993 or 97 were they required to have women in research.

And even then, I would push for as many dollars as you, Spent on not women, we need to spend on women so we can get up to the same level of research.

LAZOU: yeah, that’s something we didn’t talk about at all, but sex education, you wanted to share thoughts quickly because I feel like you have a lot you want to talk about there that we didn’t get to talk about.

Dr. Sophia Yen: know that our government has spent a billion dollars on abstinence only sex ed. And I believe in abstinence plus sex ed, born again abstinence, but abstinence only sex ed. Allows you only to talk about birth control with respect to its failures, and that is not in the best interest of our young people, but birth control plus abstinence, and so I’m my born again abstinence talk is if you didn’t enjoy it.

Then you don’t need to do it and know that in 30 percent of heterosexual encounters, the person with the uterus does not get off. And if you don’t get off, why are you risking pregnancy and sexually transmitted infections? So make sure you get yours ladies and improve that communication and know that that guy wants you to get off too.

That’s kind of a good person, a good human. You each get yours, right? and then there’s a great, sex ed curriculum, health connected in California. They’re actually the ones that gave me this condom bag. And the example of how cool their curriculum is, is their homework assignment is go ask your parent.

What was their first sex? What was that like? And what do they want your first sex to be? And I, and so there’s this book called Not Under My Roof. And so if your young person were to come home and say, Ah, my significant other wants to spend the night, the American would be like, Not under my roof. The person from, I forget if it’s Netherlands or Sweden, who did that original research, they are like, Okay.

And it’s not like the person just shows up and spends the night. It’s like, you expect them to come to dinner, we know them, we get you both on birth control, we get tested for STIs, and this is a loving relationship, and yeah, you spend the night. And when I think about it, I was like, yeah, better under my roof than in front of my house in the car, or in the park, or under the bleachers, or at prom.

Like, no! You know, you want it in a safe environment where no one else can see, where I won’t be publicly humiliated. That at the very least should motivate Asian parents to be like yes in my house not on the street where the neighbors can see right? Or for any parent. So, um, I’m looking to see if there’s anybody with connections in universities. I know that they have a alcohol. edu that they’re requiring all undergrads to take, which is a four hour thing. And I’m proposing let’s do sex. edu for two to three hours. One hour of Dr. Yen telling you all your birth control options and open Q& A. One hour of consent and making sure everybody gets off and gets theirs.

And then. Another hour of whatever curriculum. So if anybody wants to collaborate on that, please reach out.

LAZOU: All right, well, thank you so much for taking the time to chat with me today. It was really great

Dr. Sophia Yen: Thank you so much for having me here and for your amazing podcasts, making lives better for Asian Americans.

LAZOU: Thank you so much.

OUTRO

Here are my takeaways for today’s episode:

1. If your BMI is over 25, but under 30, plan B is not as effective. If your BMI is over 30, it does not work at all. Ella, works for BMIs up to 35. Beyond that, and the safest bet, is the copper IUD if you had an oopsie want to prevent the sperm and the egg from hanging out. 
2. Contrary to popular belief, birth control doesn’t affect long term fertility. In fact, fertility clinics often will put women on the pill to stabilize the hormone levels before starting fertility treatment. 
3. From best to worst, the most effective birth control methods are: the implant, vasectomy, hormonal IUD, tubal ligation, copper IUD, the shot, the ring, the patch, then the pills. So depending on how definitely you don’t want to get pregnant, you might want to consider upgrading to a more effective method if you’re on the pill. 
4. If you’re getting an IUD, you deserve pain management. Ask for a cervical block. If your doctor won’t give it to you, tell them that’s like performing a circumcision without pain management and they’ll probably let you win. 
5. If you’re in your 40s or 50s, and you have a uterus, you want to watch out for signs of perimenopause and menopause. Getting on estrogen replacement can help you avoid a lot of complications relating to bone density, cardiovascular health, and more. You do not have to suffer through seven years of hot flashes!
6. Historically, women had about 8 children on average, which meant they had about 100 periods in their lifetime. Today, the average woman has 350-400 periods. And every time we run the risk of developing ovarian, endometrial and colon cancer. So making periods optional sounds like a solid plan to me.
7. There are about 40 different birth control pills and the one that most doctors are taught to prescribe works better for white women than for Black and Asian women, who tend to have more undesirable side effects from them. So if your body is not super happy with your pill, talk to your doctor! Or you can try Pandia Health and Dr. Yen’s proprietary matching technology to increase your chances of finding something that works better for you. 
8. Umbrella terms like Asian American can be great to build solidarity when it comes to getting our voices heard but when it comes to research and medicine, disaggregation can really help us identify genetic differences in how our bodies respond. 
9. Sex education should include more than just “how to not get pregnant” and ladies, you deserve to have fun too. 

All right everyone, this one is a bit of a long one but I hope you enjoyed it and found it super helpful. If you did, please please please send it to all the people in your life who have a uterus who could benefit from this. If you would like to learn more about Dr. Yen’s company, or watch her TEDx talk, I will link that in the show notes, which will be up by Tuesday on nuancespod.com

Thank you again so much for continuing to tune in every week and for sending me lovely messages about how much this podcast means to you. If you have a minute, it would really mean a lot if you could go on Apple Podcast and leave a rating and review there. This would be my gift for this AANHPI heritage month, how about that. 

Quick reminder that In a few weeks, I’ll be premiering the new limited series that will explore “queerness” in premodern Asia, which I’m super excited about. So stay tuned for that. 

Alright thats it for today. Once again my name is LAZOU and I hope you’ll join me next time for another nuanced conversation.