“I saw an underserved population,” she says. “Women weren’t satisfied as patients, and I wasn’t satisfied as a practitioner. And while I loved obstetrics, I saw that older women fell through the cracks and were bouncing back and forth between their primary care doctors and their gynecologists. And I felt really unfulfilled when I would walk in and out of a room so quickly and realize that we would barely have scratched the surface of what women really struggle with.”
Charleston House is born
In 2019, Dr. Smith opened Charleston House. Light and airy, the waiting room looks like a stylish millennial’s living room, complete with a caramel leather chesterfield sofa and a huge painting of Dolly Parton. Off to one side is a conference room/co-working space, where in pre-pandemic times women sipped sparkling water and tapped on their laptops while they bridged the gap between carpool and their doctor’s appointments.
Dr. Smith says she set out to rethink the traditional model for women’s care and design a space where patients could feel comfortable. “It doesn’t have to be miserable when you come to the gynecologist’s office,” she says. “It wasn’t a difficult thing to conceive. I just had to think about what I would like to see when I walk into an office.”
Her vision was twofold: a welcoming clinical environment where she could care for her patients and a community of women who are interested in health and wellness outside of their child-bearing years. That community extends beyond her patients. In fact, any woman can become a member of the Charleston House community and participate in virtual events now and in-person events when they resume.
“I want a consistent place for education about evidence-based medicine and some things that are limited evidence but do no harm and are still safe for a woman. I want to be able to support those new and emerging technologies as well. And I want to create an open forum for women to talk about sexual dysfunction, arousal disorders, low libido — all of those things.”
She started with a lunch-and-learn series that drew more than two dozen women. COVID-19 forced her to put those gatherings on hold, but her dream of guiding women through the menopausal transition with careful attention continues to move forward.
Premenopausal women have common complaints
Dr. Smith is a certified menopause practitioner, a designation of The North American Menopause Society (NAMS), which offers resources for clinicians as well as women in midlife. Dr Smith reports that, “despite all the resources and best efforts by the experts, we continue to fall short in delivering women what they really need to improve their quality of life. Even something as simple as fatigue, one of the most common symptoms I see in my clinic, has little to no real recommendations.”
Sleep disruption. Irritability. Low sex drive. Dr. Smith says she hears this cluster of symptoms so often she’s tempted to call it a syndrome. “Patients always want you to check their hormones. But unfortunately, they appear very normal on paper when we check their hormones. “My goal is to help women thrive, not merely survive the menopausal transition.”
Lifestyle modifications are always the starting point. “I spend a lot of the time at the beginning [of a new-patient relationship] talking about external and internal environmental factors. What in the external environment is causing turmoil in the internal environment?” she says.
Then she addresses mental health and gut health issues. “That tends to really make them feel better before anything else,” she says.
Eventually those perimenopausal women become menopausal women, and though most symptoms fade away, one does not.
Vaginal problems are persistent
“Vaginal health is one of the bigger things we have to help women navigate after menopause. The vagina loves estrogen, as we all know,” Dr. Smith says with a laugh. “And low estrogen is low estrogen, which means vaginal problems are going to persist and vaginal atrophy is going to persist.”
Dr. Smith recalls a time when the solution for women suffering from vaginal dryness and atrophy was singular. “It used to be vaginal estrogen or nothing — that was not so long ago,” she says. Now the gynecologist is excited to have a closet full of alternatives to offer, including FemmePharma’s Satisfem™ and Satisfaite™, which are made with hyaluronic acid.
“I tell my patients with vaginal dryness symptoms to use Satisfaite once every day for the first 20 days and then use it on alternate days”. Untreated vaginal dryness “can set you up for a whole host of issues for a long time,” Dr. Smith says. Dry, thin vaginal walls can bleed, prompting physicians to order diagnostic testing to rule out other causes, and severe dryness means painful sex, which impacts desire. Studies that have looked at the VMI, or vaginal maturation index, and hyaluronic acid have shown that it unequivocally helps.
“I remember the first time I heard about hyaluronic acid for vaginal atrophy and thought, ‘Well, it’s about time!’” she says.
“FemmePharma’s products are fantastic,” Dr. Smith says. “I recommend Satisfem™ and Satisfaite™ to my patients because it is made without hormones. It clings to the vulvar and vaginal tissue, so there’s no leaking or dripping – the product stays put where it’s needed. I love that it has hyaluronic acid and vitamin E. Most skin care products use these pharmaceutical grade ingredients for hydration, why not for your intimate skin?”
The future is unfolding
The goal of Charleston House is to evolve with the modern woman. What does that look like?
“It’s an evolutionary process,” Dr. Smith says, just like a woman’s life. Charleston House will become the destination for women in Dallas who truly want to invest in themselves and in their health. “We are committed to comprehensive individualized care with regard to cardiovascular health, bone health, and brain health based on family history, cancer risk and prevention and also addressing the issues that women need such as sexual health and quality of life issues surrounding menopause — and then we bring in inflammatory markers and gut health and hormonal manipulation through that.”
Critics discouraged her from opening a gynecologist’s office with a designer aesthetic and the expectation that patients would actually want to spend time there. “Women need connection. They need a community. I wanted a clinic that brought good sound medicine to the table where women sit together and support one another. There is such a disparity in healthcare for women. Where do they fit when they no longer need their OB doctor and can’t seem to find the right PCP to discuss their dry vagina? My hope is that more women centered clinics will evolve but for now, these women belong at Charleston House.”
Learn more about Dr. Kamilia Smith and Charleston House at charlestonhousegyn.com.
Photo: Courtesy of Dr. Kamilia Smith