Colleen: Welcome back to How Flashes and Cool Topics. Today, we are going to be talking about perimenopause and all the fun things that come with it. With the CEO of Oova, Dr. Amy Divaraniya. Welcome to the show.

Dr. D:Thank you so much. It’s wonderful to speak with both of you and I’m happy to be here.

Colleen: Well, you know, we are interested in anything that can help women educate themselves and empower themselves when they walk into a doctor’s office because we have heard too many stories about women who get told it’s just menopause, it’s just perimenopause. Don’t worry about it. And that doesn’t help any of us So I know if we could start a little bit about how Oova health came to be. We think of it as being on a spectrum. You have fertility and then you go into perimenopause. It’s not two different It’s all on one spectrum.

Dr. D: Yes, well again, thank you so much for having me here today You’re absolutely right. It is a spectrum because women aren’t robots. We don’t go through very this shut a door and begin a new phase,
it’s very transitional, right? So the way that Oova came about was I’m actually a scientist by training and very tight day. So like my life was kind of planned for me for from like day one,
right? And when I was finishing up my PhD, my husband and I were like, all right, let’s try to have a baby, nine months until my dissertation or my defense, water should break that day,
don’t have to defend and we’re good to go. We get kind of two wins in one day. That was the plan I walked into that journey with and I realized very quickly that I just it was very difficult for me to get pregnant and I didn’t have any data.
The whole journey really opened up to or identified two huge problems for me. The first is that the healthcare system in the US is incredibly broken. And then the second is that women just aren’t getting data about their bodies to truly advocate for their health. And I realized quickly I could not solve the health care problem on my own, but I could solve the data problem. And I could figure out a way to give women information. So when they did walk into their doctor’s office,
they’re not walking in defeated and lost. They’re walking in with an armed resource saying, okay, great, I hear what you’re saying, but how does that relate to my hormone levels? And right there, you’re having a two -way conversation. So that was the foundation of the product or the company. We started off with trying to conceive, but very quickly realized that hormones are affecting every aspect of a woman’s life and now we’re starting to address every phase,
including perimenopause, which is our most recent one.

Bridgett: You know, when you said you walked in and didn’t have the data and you could do something about the data and you addressed also how women’s health care. There’s just not a lot of information out there on women’s bodies and what’s going on and what happens with women in perimenopause and it happened to me and it’s happened to so many of our listeners. They might tell you you’re depressed. They might tell you that you’ve got something else going on then you’re being treated for something that isn’t necessarily the root cause. So how did you come about figuring out what needs to be tested when a woman could be pairing menopausal?

Dr. D: Well, it’s not, okay, so this is really interesting, right? So when you think about science, there’s very few things that affect 100 % of our population. But if a woman is still solid to a certain age, 100 % of those will go through menopause.
And yet we don’t understand anything about the transition to get there. And I have a whole theory about it, which is like another soapbox that we could probably stand on. But the biggest thing is that what’s driving these transitions is a hormonal change. And when we’re experiencing these symptoms, it’s because by a hormonal imbalance, it’s your body’s way of saying something is off and I’m gonna have this reaction to it. So when you look at a woman’s body,
you know that progesterone estrogen are incredibly important. So when we came to our perimenoplasm product, we wanted to really understand how the estrogen trends are, how progesterone is related to that,
because that data doesn’t exist today. When you go to your doctor’s office, you’re going there once a year and you get a blood panel done. Great, you got blood work done. If you’re still cycling,
depends on what cycle day you’re on. If you’re not, well, what was the last period and you might just be a regular and you’re still on a cycle, just not necessarily bleeding as frequently as you were. So that snapshot measurement,
it’s really hard to draw a line from one data point. But when you have hormone trends, now you can start to see a pattern. And that was the beauty of the platform that we’ve built here,
to be able to provide that trend data. So you created a perimenopause kit, hormone kit. It’s actually called the perimenopause hormone kit. And one of the things that I thought was interesting is exactly what you’re saying.
We have spoken to many doctors who are like testing on one day is going to give you data for one day. But if I test that patient a week later, I’m going to have very different data.

Colleen: So you actually work over a period of 15 days. Am I correct?

Dr. D: 15 to 20 days. And a lot of our premenopause users are actually tracking for 30 days.

Bridgett: So can you tell me what is involved with the kit and what it does measure?

Dr. D: All right, so the kit comes with 30 cartridges. So there’s 15 cartridges that measure both luteinizing hormone and progesterone, and then 15 then measure estrogen. It works alongside, I know we’re on a podcast, it’ll show it to you and I’ll describe it, if that’s okay. So this is what the kit looks like. It comes with a holder, a handle, and then 30 of these cartridges, right? So every cartridge has a QR code in this window that will show you one, two, or three lines depending on how much hormone is present. It works alongside a smartphone app. So when you download the app, you tell the app, okay, I’m perimenopause tracking, it will then start making recommendations on what days you need to test and which hormones to test with. So on a testing day, you would pick out the right hormone, the right hormone packet, provide a urine sample on it and scan it with your phone. It’s not taking a picture, you’re not having to align arrows or anything. This is really synonymous with doing a mobile deposit. When you think about how you do that, there’s a boundary box, you have to check the information to scan into your account. You’re not taking a picture of that check. That’s exactly what’s happening with Uber. You align the cartridge in the boundary box. We scan this window in the QR code and we put the data into your app. So you can get your hormone results within seconds. And then if you’re working with a provider, you will also share that data with them. But every 15 -measure luteinizing hormone and progesterone in the 15 -measure estrogen. – Looks like a pregnancy test just for, oh, I’m sorry, but I just want to say for people who can’t see it,
it kind of looks like a pregnancy test. Yeah. Yeah. Yeah. And we did that by design. So it’s really interesting when I started the company, I was like, I don’t know anything about starting a company or building a product.
So I went to my local CVS and I bought all the ovulation and pregnancy tests through them on a table, had a bunch of guides and girls around it. And I was like, go to town. And I just observed What they were doing and the funny thing was that the girls all grabbed the test and went to the bathroom to see how it worked Or like use it the guys sat down open the boxes and took out the ridiculous pamphlet and we’re reading it Well, like for guys that never read instructions. You’re really curious about how these tests What fun would that be? But I thought it was really interesting how intuitive a pregnancy test is for women. So we wanted to stay true to that design. Yeah, it’s familiar too, usually. I’ve had everybody’s probably taken one or another.

Bridgett: And you were saying– I just want to make sure our listeners understood the hormone. You said estrogen progesterone. and now I’m throwing a blanket, I’m looking at my notes.
– Lutonizing hormone, or at least– – Yes, did you explain that?

Dr. D: Sure, so luteinizing hormone is another hormone that we have in our panel. It’s really critical for determining if you’re cycling or not, because the luteinizing hormone is typically low or at a baseline level throughout your cycle, and it only starts to surge or peak when you’re about to release an egg, and that’s what actually signals also the ovary to release an egg. So when you’re in perimenopause, a question you’re often asked is when was your last period? That’s great information, but you may not have had a period and still been cycling. So you may not have ovulated. There’s a lot of factors that come into play. But by having that luteinizing hormone data as well, we can see if you’re still cycling. Well, that because because you know who held is with menopause and perimenopause, you could go five months, six months, then all of a sudden it comes back again and I know that is a really big question for a lot of our listeners that they’re wondering if they’re in it and you have to start again, you know, 11 months in 29 days and then hit those up again. So that that’s very important.

Colleen: What is the response? What has the response been from providers when patients come in with the information?

Dr. D: If you talk to many providers, they’ll tell you that hormone monitoring is not important or it’s not useful. But look at what kind of hormone monitoring has been available. A snapshot blood test. I completely agree with the doctor that that is not useful. But if you’re able to walk into your doctor’s office with 15, 30 days of daily hormone measurements, that’s like a different level of information That is incredibly useful for a clinician. So our clinicians have been loving it. They’ve to be quite honest We did launch with the trying to conceive product first though They were very familiar with seeing that trend data with Oova now adding in that perimenopause these case It’s just just as valuable You also I think I saw it on your website that it’s helpful when women First start HRT as well.

Bridgett: Can you talk about that?

Dr. D: Yeah, so when you’re going through HRT, you’re basically getting like small doses of A -horma, right? And we don’t know if that dosage is working. Is it suitable for you? Is it too much, too little? We don’t know. The whole point of getting that HRT is to try to get the hormones back to be in balance or in sync again. Now, if your doctor is monitoring you quarterly, if you’re lucky monthly, if you’re even more lucky or annually, you won’t know for quite a while whether it’s working or not. With Oova, if the treatment is working, you will see that the hormone trends are working in the predictable or anticipated pattern, right? That’s really how we’re utilizing it. You know, that is so important too. I am on hormone replacement and at one point they switched it up.

Bridgett: I was on the or oral prem run and I started bleeding again and I hadn’t bled in like three years and that and I did call and and it seemed as if they immediately lowered the dosage and I wasn’t bleeding anymore but that’s really important I mean you know if you still have your uterus is that correct that that if you’re you know getting that lining is building up again, that can be very dangerous.

Dr. D: Correct. Exactly. So you really want to understand what’s going on, but do you see like what you just said, like we’re starting to become self -proclaimed experts on hormones and what’s going on with our bodies because the information isn’t out there, right? A lot of women would not even know how to address that, that symptom you just said, like if I sell my uterus is my lining still growing ’cause that could cause problems. That’s a critical thing for us to know as women.

Bridgett: Right. And the only reason I know is because we did this podcast. You know, I probably wouldn’t have known had I not been already, you know, Colleen and I were talking about it on the podcast five years before I wouldn’t have known about it. Right. And that’s unfortunately the truth of a lot of women today. Right.

Colleen: Some women have concerns about using monitoring systems for sharing with their doctor information that other people can get access. Now you’re HIPAA compliant. Can you talk about the safeguards for using?

Dr. D: Yeah, sure. Yeah, absolutely. So there’s a lot to this, right? So I started this company after I finished a PhD at Mount Sinai and a lot of my work at Mount Sinai was looking at electronic health records and the company actually spun out from the hospitals. So when we set up our database, There was no other way for me to think about setting up a database than to make it HIPAA compliant. Like there’s no option. And then in order for us to work with clinicians,
we need to maintain a certain level of security to even be able to partner with some of these doctors that we’re working with. So HIPAA compliance is often used as a loose term, but I can kind of go into it a bit more. We don’t store any sort of patient identifying information in our, in our massive database. So We don’t know the patient’s name. We don’t know their email address, and we don’t know their phone number. I don’t think we capture phone number outside of like ordering, but in our database, we don’t save name or email address. What we do save for research purposes is date of birth and zip code. Those are really not identifying. And so when you do a data download, we have the name and email address under lock and key that we cannot access. The clinicians can, but it’s all within our hip -hop compliance system. Via email or doing a data dump or anything like that, we cannot access that information. And yeah, that’s very important.

Bridgett: Like Colleen said, at this time, especially with everything going on in the world of female reproduction, it is really a scary time and I understand how they are. People are very concerned about it. What is the availability and how would someone get this?

Dr. D: There’s several ways you can get it. We are available in all 50 states. We’re only in the US at the moment. You can order directly from our website if you want to, so you don’t need to have a prescription to buy this. You could be working with the provider who could recommend it to you or sell it to you directly from their office. A lot of our clinicians keep kits in -house. And then also for the fertility use case, we’re actually stocked with several specialty pharmacies. So if you’re going through IVF or any HRT, you can’t go to CVS or Walgreens to pick up your medications. You have to order from a specialty pharmacy and we’re stocked there. So oftentimes I’ll just include an uva kit with their medications as well.

Colleen: And I think it’s interesting because what you’re saying is over the pattern of time, you know, some of us may get hormonal migraines, some of us may feel more depressed at certain times,
and you’re able by doing it longer for 15 or 20 or 30 days to kind of track when your depression hits and what’s your hormone level when that hits or when your brain fog is bad. Can you talk a little bit about those patterns and how they’re tracked?

Dr. D: Yeah. So I feel weird saying this now because now it’s become such a hot topic, but I promise you that since we started the company, we’ve had AI embedded in our platform.That was in 2017. So it’s always kind of been there. But what we are building out is I learned very quickly the data sets to model an algorithm on are non -existent. The data that we are capturing just hasn’t been curated before. So now we have over 10 ,000 cycles of data that we’ve been able to train our algorithm on. But based off of certain hormone patterns we are able to predict when certain symptoms are going to arrive and it’s a little bit more well -defined for fertility than it is for perimenopause because we’re still actively collecting the data for perimenopause but we canapply we can basically apply the same logic here right when there’s a certain hormone pattern we can determine okay you’re about to experience migraines typically happens when the progesterone drop happens at the end of your cycle which is what like PMS is typically associated with. So it all makes sense when you start looking at the data. But for what you just said, Colleen, you’re absolutely right. Being able to track your data over time and then also tracking your symptoms alongside that and overlaying those on top of each other, it’s an incredibly powerful data set. And the ultimate goal is to give the control back to the woman so she understands, she’s not going crazy. There’s actually something physiological happening here, and I know what that is now as a woman Yeah, and you know just So many doctors aren’t educated in the in the area of menopause, but having this information there is tracking information

Bridgett: How does how do you do that? You said, you know, you use your phone to scan. How do you get information to your clinician?

Dr. D: So we have a HIPAA compliant clinician dashboard and basically when a woman registers in our app or is using our app she’s able to select who her provider is. So we have a list of all the doctors that we work with and when she selects them the patient controls everything. So under HIPAA the patient has to have the right to share not share data with whoever they want. They select the provider and then once they do the provider can view the data in their HIPAA compliant for it. If the patient is no longer working with a doctor, she can always remove them from the app and all their data is removed.

Colleen: if your doctor is not on the provider list, can you add them?

Dr. D: Absolutely. Yeah, so that’s oftentimes how we get a lot of inbound commissions coming through. So either the patient will talk to their provider about it, about the platform, and then they’ll reach out to us, or they’ll just connect us. And there’s so many different ways. And what I love is that when you’re talking about people in this community, many of them, I’m talking about the providers, are really in it to support their patient. So if their patient is asking for something, they’re not resistant to giving it a try. And we make the onboarding so easy that they don’t mind it.

Colleen: What has the response been from the physicians that you’re working with as far as the perimenopause kit?

Dr. D: It’s been very positive. They love the value of the data, you’re seeing trend data. I mean, it’s helping to, I think a frustration that all clinicians have is that the only answer they can provide to the end user or the patient is,
looks like you’re going through perimenopause. And there’s really no actionable step to provide to them outside of, yeah, this is expected. We’re providing a layer of data that just wasn’t except like they couldn’t get it before outside of a patient coming into the clinic every day for blood work. And then when you layer the symptoms on top of it, I mean, the beauty of Oova’s platform is we’re providing you with data that clinicians are used to seeing. Right. So now you show them the trend data, they’ll know what that means. It’s the reception that’s been really positive. That’s great. And you have both one time kits and like a subscription base, right? For some women will want to do this over an extended period of time,
like you said, to kind of overlap and see, oh, this is when my depression starts to get worse, or this is when the rage comes, or, you know, this is when I’m starving more often than not.

Colleen: And we actually, you guys were generous enough to give us a promo code called uva hot flash 10, or 10 % off if you go on the oova.com?

Dr. D:  It’s oova .life.

Colleen: Oova: which is O -O -V -A. So thank you for allowing our listeners to get a little break on trying it. And we appreciate your time. Thank you so much for joining us. – Of course, thank you. I hope that we can just like remove some of the frustration that women go through because life’s hard enough. We don’t need to let biology frustrate us even more. – Well, as Bridget and I always say, it’s gonna be women that correct and figure everything out because it’s when we actually start experiencing this stuff and we don’t see answers that we’re like, forget it, we’ll just figure it out and we’ll get the answers ourselves. – Thank you for doing this ’cause so many women need in both areas, fertility and perimenopause and menopause.

Dr. D: I’m looking at our data 46 % of our users are above the age of 35 and they’re trying in sieve space, guess what the mean age is for our party menopause users right now?

Bridgett: Probably 41, but that’s exactly it. – That’s what I was gonna say, 41.

Dr. D: That’s exactly it, so like our hypothesis is true, like people are having these conversations earlier, they want to be more informed and I just love that you guys are having these real conversations with women because they need to be informed that they’re not going crazy.   Thank you, I appreciate it.