An Interview With Dr. Anna Barbieri

Anna Barbieri, MD, is a board-certified gynecologist, integrative medicine physician, and specialist in menopause. In her New York City practice located on the Upper East Side of Manhattan, she strives to offer truly personalized, modern holistic care. From preventive care to complex gynecologic issues such as PCOS or fibroids, Dr. Barbieri partners with her patients to help them maintain or restore optimal gynecologic and hormonal health.

What drew you to pursue OBGYN as a specialty and what drove you to ultimately specialize in integrative gynecology?

Being in OB GYN affords you a unique opportunity to get to know someone over a very long period of time. Looking back, I've had some of the same patients for 20 years so I've seen them go through things like hormonal struggles, fertility struggles, pregnancies, deliveries all the way through to their menopause years. OB GYN is a great combination of different fields of medicine. It incorporates a bit of endocrinology, oncology, and mental health. Also, I think as a woman in medicine and a working mother, the ability to integrate my personal life with my professional life is something that I find very valuable in this field.

The practice of Western medicine entails a lot of prescriptions of pharmacologic therapies and surgeries, both of which are extremely valuable. But we have not paid much attention to other aspects that go into maintaining health, preventing illness, or healing. We have to acknowledge the power of relationships, sleep, nutrition and movement. I know this on a very personal level through my own health issues that I was unprepared to handle from a Western medical perspective, but have improved through my use of integrative approaches. I now employ that same philosophy in my own practice.

In what way do you apply integrative approaches to otherwise Western practices? 

There are five pillars of health that we need to acknowledge: 

• Nutrition: What we eat is essential to how we fuel our cells, repair damage, and prevent disease. The reverse is also true, in that what we eat can cause severe damage to our organs and systems.
• Movement: We're meant to move our bodies - whether we are 80 and have had two hip replacements or a 25 year old marathon runner, we all need to move our bodies every day.
• Sleep and rest: Pay attention to the time that both our bodies and minds need to relax and recover. 
•  Relationships: How we interact with our environment, how we interact with people around us, families and friends, how we do that with intention,  how we grow those relationships and not grow the ones that do not serve us. 
• Passion: What's our purpose? Where are we going?  What do we want out of life? What gives us meaning? 

So, whether one pursues medication, hormone therapy, botanicals, surgery, acupuncture, hypnosis, these are all modalities that can be woven together, but ultimately one's lifestyle and intention are essential to improving outcomes.

Have you found one specific use case where integrative medicine has improved outcomes more than any other specific use case, potentially fertility?

There are so many underlying factors that lead to fertility challenges. For example, I’ve seen someone with a diagnosis of metabolic syndrome and PCOS treated through nutrition and perhaps supplementation to the point that her ovulation returns to normal and she is able to get pregnant on her own. I’ve also seen a 43 year old with low ovarian reserve who really wants a baby, employ integrative practices of relaxation, foundational nutrition movement and then seeks modern methods of donor egg in vitro fertilization. So with all of my patients I recognize that there are many tools available in the box and we need to use the right tools for the right scenario.

The prevalence of PCOS has increased by nearly 65% over the past decade. What factors do you think have contributed to this significant rise?

There’s more awareness and more recognition of this condition. For example, the awareness that having irregular periods may be a sign that something is not quite right is common now. Whereas before, if your period came every four to seven weeks, women were told not to worry about it. "If you're not trying to get pregnant, it's fine." We are also seeing rising rates of obesity and insulin resistance, and we know that PCOS is closely tied to metabolic dysfunction, both in people who may be overweight or obese, but also in people who are thin. So, there is certainly correlation. And then finally, food quality and food production methods as well as the presence of endocrine disruptors in our environment are impacting our hormonal health. Everything from heightened awareness, better diagnosis, as well as rising rates of metabolic dysfunction, potentially influenced by both genetic factors and environmental factors.

Specifically for the population that seems to have a normal BMI,  what's your first step in helping them address the symptoms of PCOS? If you know what they're eating isn't the issue, what would be your process to support these patients? 

Supporting a patient starts with an initial assessment. For patients with PCOS, it’s important to start with a metabolic assessment. This includes looking at a patient’s hemoglobin A1C, fasting glucose, fasting insulin, lipid profiles, and more. As for movement, a combination of weight training and HIIT is important. As perfect as we can get our diet and movement to be, there are cases where loose intervention can not solve the problem. Sometimes you need external help such as medications, IVF, and supplements. So I do discuss all the interventions for my patients should they be open to it.

What advancements in the field of gynecology are you currently most excited about?

Genetics is a field that will revolutionize the field of OB GYN. I am excited to see the explosion of genetics in the cancer prevention and screening process.

I think we are also seeing an increased awareness and dialogue around hormone health, fertility and menopause, specifically as it relates to testing and intervention as well as hormone therapy. 

We value hospitality as a key factor in optimizing health outcomes. In what way do you apply hospitality to your approach to care? 

I really try to understand and take care of my patients. Healing happens when you form a continuous relationship built on trust. I consider the atmosphere and do what I can to make my patients feel welcome and taken care of in my practice.