Tips for Top Mental Health for Fertility Patients with guest Dr. Anna Glezer
Today’s conversation with reproductive psychiatrist Dr. Anna Glezer is one that I feel is so important for all of us, especially while on your fertility journey.
Dr. Glezer began her training at Harvard and then transitioned to UCSF where she has been a practicing physician, teacher, mentor, and an associate professor.
She is board certified in adult and forensic psychiatry, a member of the American Psychiatric Association and a past president of The Northern California Psychiatric Society.
Dr. Glezer founded Women’s Wellness Psychiatry to help women access reproductive mental health services and is really passionate about helping as many patients as possible. She’s also the host of the Women’s Wellness Psychiatry Podcast.
I’m so excited to have her on today to talk about reproductive health and women’s mental health. She has such a clear passion for her field and her patients, and she brought it with her to share with all of us in this conversation.
Dr. Aimee: I am so delighted to have my dear friend Dr. Anna Glezer on today’s show. Hi, Anna.
Dr. Anna Glezer: I’m excited to be here. Thank you for having me.
Dr. Aimee: I’ve wanted to have a psychiatrist nearby me for a long time for patients, so it’s just wonderful that you had the time today to come on and talk to us.
Dr. Anna Glezer: Absolutely. I’m glad to be here. It’s such an important topic.
Dr. Aimee: It really is. I feel like mental health is so important to our full physical wellbeing. You’re the best person to talk to us about tips for top mental health, especially as a fertility patient.
I’d love to learn about what brought you to the specialized field of psychiatry. Tell us more about that.
Dr. Anna Glezer: The field of reproductive psychiatry is one that has definitely been growing over the last few years and decades. When I joined the field, well over a decade ago now, it was very much in the early stages, and it was really exciting to be at the forefront of this kind of research.
Patients that I work with are so invested in their treatment, and the treatments that we have actually work. It’s so rewarding to see patients feel better. Some of my favorite parts, I occasionally have patients who have gone through a very challenging fertility journey, pregnancy, post-partum, and then at the end, when they’re feeling better, I get these pictures of their kiddos, and it’s just so rewarding to get that. I imagine you do as well.
Dr. Aimee: I do. They’re the best part of my day. The best part of my inbox is clicking on those messages. I really cherish those. I actually keep them in a separate folder so that anytime I want to, if maybe I’m feeling a little down, which sometimes can happen with what I do, I just pull them up and take a look at them, so I totally agree.
Before we dive in, there’s a different field called psychology, and then we have psychiatry. Can you share with us what’s the difference between a psychologist and a psychiatrist?
Dr. Anna Glezer: That’s a great question. I think that a lot of folks do get those two confused because they sound so similar. The most simple answer I can give is that psychiatrists are medical doctors, so we’ve gone to medical school, we have an understanding of the biological aspects of the body, and we can prescribe medication because we have that background. A lot of psychiatrists also do psychotherapy, which is primarily what psychologists tend to do, they do the psychotherapy work that is so important for mental health. Psychiatrists are trained both in biological prescribing, as well as in psychotherapy.
Dr. Aimee: And what is integrative psychiatry?
Dr. Anna Glezer: Integrative psychiatry is a field that is even newer than reproductive psychiatry. It’s more of an approach. It’s really looking at the person from the entire whole person perspective, where you’re not just looking at the biology and prescribing a medication, you’re looking at so many different components. You’re looking at the individual’s background, at their psychological makeup, at their spirituality, at their lifestyle factors, as well as their biology. The treatment plans from an integrative perspective take all of that into account.
Sometimes I prescribe medication, sometimes I recommend botanicals and supplements, sometimes I give a prescription for yoga or physical activity, or we talk about nutrition and nutritional psychiatry. All of those integrated components where you’re taking some complementary treatment options and so many of these things and putting them together with some of the more traditional Western medicine, that’s integrative psychiatry.
Dr. Aimee: How is this different from perinatal psychiatry?
Dr. Anna Glezer: Perinatal psychiatry specifically refers to women who are in the process of building their families, so it includes women who are in the preconception process or going through child gene fertility journeys, those who are pregnant, and those who are postpartum. It’s important to look at perinatal psychiatry, which is a little bit more contained, a little bit of smaller number of patients compared to reproductive psychiatry, because reproductive psychiatry really looks at women across the entire reproductive life cycle, so it might include women who are struggling with mental health symptoms premenstrual or during perimenopause. Both perinatal and more generally speaking the umbrella term of reproductive psychiatry really looks at the influence of hormones in a woman’s mental health and emotional experience.
Dr. Aimee: As I take my patients through treatment, I make a lot of jokes, and some of them are about the medications that they take. For example, I say Clomid is Clomonster, and DepoLupron is DevilLupron. I have a bunch of other names, too, but I might not be able to say them out loud. You probably see this as well, as far as the hormonal changes that can impact a patient’s mental state. How does that affect how they’re able to process things?
Dr. Anna Glezer: Absolutely. Our mental states are very much influenced by the hormones, whether they’re internal or exogenous hormones that they receive in the context of whatever medical treatment they’re going through. It affects all of our wellbeing in a couple of different ways. It affects us directly in the sense that certain kinds of hormonal changes can impact our mood, can impact our cognition, can impact the way that we function.
Then also a little bit indirectly, because when we’re impacted physically, our physical state will of course then impact our emotional state. If you’re feeling unwell because you’re having pain or you’re having bloating or you’re having some kind of physical discomfort, that is going to impact your mood as well.
The other really important contributor to all of this is sleep. We know that hormones impact our sleep. If you go back to basic medical school biology and you look at those complicated graphs with the way that all of the hormones interact with each other, there are just so many connections and so many interactions in all of the different hormones, whether we’re talking about stress hormones like cortisol or the gonadal hormones like estrogen and progesterone, and they all interface in very complex ways. I think it’s just important to notice how those kinds of interactions absolutely are going to impact our mental health, including the way that we feel physically, how we’re sleeping, our mood, anxiety, all of those kinds of things.
Dr. Aimee: I basically tell patients just blame me for how you’re feeling, just give yourself a little bit of grace.
What is your advice for someone who is facing loss or a setback during treatment? How best should they be working through that, in your opinion?
Dr. Anna Glezer: Really developing a sense of self-compassion and how we talk to ourselves is really important. Giving yourself grace. I think that a sense of self-worth is really related to self-compassion, so really making sure that we love ourselves.
I think sometimes there’s a little bit of a misconception that self-compassion means that I go get a massage every couple of weeks. Sure, absolutely, go get that massage, I agree that can be really helpful, but I think that self-compassion and working on self-esteem and self-worth is something that’s done on a daily basis, if not an hourly or minute-by-minute basis based on how we just have conversations with ourselves and notice the way that we talk to ourselves.
I think one of the challenges with fertility journeys, especially more prolonged fertility journeys, is that a lot of times women aren’t sharing that they’re going through something like this. That can really lead to a sense of isolation and not being able to get the support that you need. I think there are many different reasons for that.
I’ve had a number of patients where they might go through a loss, they might go through a miscarriage, and then they happen to mention it to someone, and then that person goes, “I went through a very similar experience,” and there’s that kind of connection which never would have happened before if the person hadn’t been a little bit vulnerable and shared that they’re going through this experience, and then they get to have that kind of connection.
I think sharing, getting support, and also working on that piece of self-compassion. A lot of times, especially with really challenging fertility journeys, there’s a lot of self-blame, “What did I do wrong? Maybe I ate the wrong thing. I shouldn’t have gone on that bike ride. I did something wrong.” A lot of women develop a really negative relationship with their bodies, “My body is failing me,” or even, “I’m a failure,” and those kinds of negative thoughts really make an impact on our emotional wellbeing and our ability to move through this journey, which is just such a roller coaster. It’s so full of optimism and disappointment, and you just go up and down on this roller coaster. It’s really important to have that foundation of self-compassion as you’re going through it.
Dr. Aimee: I couldn’t agree more. At what point should someone get off that roller coaster and see you?
Dr. Anna Glezer: There’s no wrong time to begin to seek treatment, certainly in the form of working with either an integrative mental health clinician or a psychotherapist. One of the things that a psychotherapist can do is really help develop that self-talk in a way that’s healing.
The other thing to keep in mind is when does it begin to impact your functioning? That’s really a red flag for me that we need to intervene in a particular case. When it’s keeping you up at night and you’re not able to get the sleep that you need to be getting, or when you begin to feel like this is impacting you to the point where you’re not engaging with others the way that you would like to, maybe you’re turning down social activities or maybe you’re withdrawing from family or friends, or maybe it’s really hard to focus at work because you’re ruminating. When there’s a functional impact, I think it’s a really important time to take a step back and reach out for help.
Dr. Aimee: I think so many patients are just afraid that they’re going to then be given a medication that is harmful in pregnancy. I reassure them that your mental wellbeing is actually going to be really good for your pregnancy. How do you answer that question when a patient says: do these medications, for example an SSRI, impact a baby’s health?
Dr. Anna Glezer: The foundational principle that I work with is what is good for mom is good for baby. The only way we’re going to have a healthy baby is if we have a healthy mom.
I think one of the things that is often missed when we’re having these conversations about medication is that people think what are the risks of the medication, and we miss the conversation about what are the risks of untreated symptoms, because those have risks as well on the fertility, on the outcome of the pregnancy, on obstetrical outcomes, and later neurodevelopment of the baby. We have to really focus on that comprehensive risk-benefit conversation.
Also, keeping in mind that SSRIs and medications are just one treatment option. That’s why I really like integrative psychiatry is that it’s more than just me writing a prescription for a particular medication. It’s really approaching that person from a very holistic whole body perspective, because there are so many things and other treatment options to consider.
Dr. Aimee: I also love how you talked about nutrition as medicine. What impact or role does lifestyle, nutrition, and fitness play as far as mental health during fertility treatment?
Dr. Anna Glezer: There’s an entire body of literature and growing research on how our nutrition and how we feed ourselves impacts our mental health and wellbeing. You may have noticed this yourself. If, for example, you have a weekend where there’s a lot of candy and there’s a lot of processed sugar, you sort of notice yourself going on an up and down roller coaster and you might feel a little bit irritable. That’s true in general, and certainly more specifically during the fertility journey.
That’s the case for other kinds of lifestyle factors as well. Like physical activity. There’s definitely research on the role of exercise, specific types of exercise, aerobic exercise with a particular increase in heart rate, that can impact our mental health and help decrease symptoms of mild depression or anxiety and things like that. So, there’s a lot of different lifestyle factors that can make a big difference.
Dr. Aimee: If you could wave a wand over a fertility patient and say ‘these are the things that you need to do to feel mentally well during your treatment,’ as someone who is the expert in this, what would those tools be?
Dr. Anna Glezer: I think it’s definitely those lifestyle factors that we just mentioned, including nutrition and physical activity. I want to go back to that piece about support. I would love it if women going through fertility journeys would be able to access more support for themselves, to be able to sort of build their village in advance, so to speak, and have that support from many different directions.
Then I would also consider the role of therapy, whether it’s psychotherapy with a psychologist or maybe doing work with a coach or maybe it’s doing a workbook on your own, to really help navigate some of the negative thoughts that sometimes come up with a prolonged or challenging fertility journey.
Sleep is so paramount to mental health. I think that making sure you’re getting good sleep and having a good sleep hygiene routine is going to make a big difference, too.
Dr. Aimee: I can tell when a patient emails me her Google search terms that she’s gathered at 2:00 or 3:00 AM that I need to remind her about sleep. What are you doing up at 3:00 AM sending me questions, links, and articles? I will answer them anytime, it doesn’t bother me when patients email me, but it just makes me worry that they’re obviously ruminating and wondering and thinking.
Dr. Anna Glezer: Exactly. It’s a sign.
Dr. Aimee: It’s definitely a sign. What are the top three most frequently asked questions you get from people as they start working with you and some of the answers you share with them?
Dr. Anna Glezer: I think some of those are questions that we’ve already gone over. For example, “Do I have to take medication?” One of the reasons I think patients seek me out is because of that integrative approach, which is more than just medication. The answer is no, you don’t have to take medication. It can certainly be helpful. The way that I often think about it is it can be a floor or a foundation for you to be able to feel a little bit better so that you can engage in all of the other long term treatment options like psychotherapy or physical activity.
Another question which is really foundational is, “Have you worked with someone like me? Am I going to get better?” I think that once people reach out, there is sometimes a place of having gone through a number of hurdles and maybe a little bit of pessimism and maybe a little bit of disappointment, so they’re looking to me to help provide and instill some of that hope so that we can go back up on that roller coaster in the right direction. I provide that, I am very optimistic because based on my clinical experience these treatment options work and so many of my patients feel better. That’s another seemingly simple initial question that a lot of patients come with, but it really means so much when it’s asked.
Those are probably the two most common questions that I get.
Dr. Aimee: I think I get the same ones. “Do I have to take medications? Have you ever seen anyone like me and have the treatment you’re recommending work?” So, I think we definitely work well together with our patients.
What’s great about you, and one of the things that I love and the reason why I refer my patients to you when they need help in this way, is that you talk to me. We have this great relationship where, of course with the patient’s permission, we’ll talk about a patient and what their needs are. I imagine you also work with other OBGYNs and fertility doctors as well. Can you talk to us a little bit about that?
Dr. Anna Glezer: Yes. I work in partnership with a number of different OBGYNs, I work with a number of primary care doctors, I collaborate with a lot of different therapists. Even my clinic has a number of therapists within the umbrella of Women’s Wellness Psychiatry. A number of patients come to me who already have a therapist that they have a good relationship with, so I partner with that person to make sure that the patient’s treatment plan and mental health goals are moving forward in the right direction. I really do think that kind of conversation and collaboration is so important. We’re not working and treating patients in vacuums.
Dr. Aimee: Absolutely. Every single woman is going to go through menopause at some point in their life. It’s going to happen to every single one of us. For some of us, mentally it hits us harder than others. Can you speak to the care that you provide if a woman is struggling during their menopausal transition?
Dr. Anna Glezer: I think a lot of times what happens is whether it’s the perimenopausal transition or sometimes it’s similar to when women have significant premenstrual symptoms, a lot of people have just this stereotype that you’re just supposed to go through this, including all of the negative challenges, that it’s just a part of being a woman. It doesn’t have to be, not to the point where it’s leading to functional impairment.
For example, I work with women who are going through the perimenopausal transition, and their work might be suffering and their personal life might be suffering. That’s not something that you just have to grin and bear. There are definitely a lot of interventions that can be really helpful.
That’s one of the most important things that I like to emphasize is if you’re struggling with this, reach out because there are so many different treatment options, both prescription and nonprescription. Psychotherapy, there is actually some really good research on specifically the role of cognitive behavioral therapy in treating perimenopausal symptoms. Not just the psychological symptoms, but the motor symptoms like hot flashes and sleep disturbances, cognitive behavioral therapy has been shown to be helpful with that. So, there are a lot of different treatment options.
Dr. Aimee: Yes. I don’t think people realize that you have to see someone to get the right training for cognitive behavioral therapy. It’s basically a form of self-talk and you need someone to teach you how to do that. I think it’s hard to watch a video or read a book. I think having someone that is trained like you or a psychologist teach you how to do that is really helpful.
If someone wants to work with you or learn more about the work that you do, where can they find you?
Dr. Anna Glezer: There’s a few different places where they can find me. My primary clinical website for my practice Women’s Wellness Psychiatry is just my name, so it’s at AnnaGlezerMD.com.
I have an informational website for patients, which is MindBodyPregnancy.com. That’s more of a blog that has a lot of information. I have a podcast, The Women’s Wellness Psychiatry Podcast.
For anyone who is a clinician who is listening, I even developed a fellowship program to just increase the amount of education on reproductive integrative psychiatry, and that’s PsychiatryFellowship.com.
Dr. Aimee: I love all of those resources. We’ll make sure to include all the links that you mentioned in the show notes for anyone who is interested in learning more. Thank you, Anna, for joining me today. I really appreciate it. Is there anything else you want to add before we wrap up?
Dr. Anna Glezer: I just want to emphasize for anyone listening who might be having a little bit of a hard time with their emotional and psychological health that you’re not alone, this is really common, and to absolutely reach out to get the help that you need.
Dr. Aimee: Thank you for that. I couldn’t agree more. Thank you again, Anna. Thank you for your time today and thank you for all you’re doing to keep my patients as mentally healthy and well as possible as they go through fertility treatment. We need you more than ever now. Thank you again.
Dr. Anna Glezer: Thank you so much for having me. I appreciate it.
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