The World’s Leading Menopause Experts on Belly Fat, Brain Fog & Hormones
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Title: The World’s Leading Menopause Experts on Belly Fat, Brain Fog & Hormones
Author Name: Tamsen Fadal
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Menopause and perimenopause can leave you with questions about belly fat, brain fog, sleep problems and whether hormone therapy could help. Your jeans fit differently. You’re losing your train of thought. You’re exhausted, but you can’t sleep. Where do you start when so much feels unfamiliar?
For World Menopause Month, Tamsen brings eight leading doctors and researchers together in one episode to help you understand what’s changing and what deserves attention. These are the conversations she wishes she’d heard before she was struggling to read the teleprompter at work, leaving herself notes and wondering why she didn’t feel like herself.
You’ll hear from Dr. Sharon Malone, Dr. Lisa Mosconi, Dr. Shelby Harris, Dr. Rocio Salas-Whalen, Dr. Vonda Wright, Dr. Kelly Casperson, Dr. Avrum Bluming and Dr. Suzanne Gilberg-Lenz. Eight experts, different perspectives and answers you can come back to—all in one place.
Inside the episode:
Why you can still have periods and be in perimenopause—and why a single hormone blood test may be misleading
Whether menopause brain fog can improve, and why women’s experiences vary
Why more time in bed may not mean better sleep, and how cognitive behavioral therapy for insomnia (CBT-I) works
The difference between visible belly fat and visceral fat around your organs
Why bone health needs attention earlier than you might think
How menopause can affect sexual anatomy, arousal and orgasm
What to understand about hormone replacement therapy (HRT) and breast cancer risk
How to evaluate menopause supplements and “hormone balance” claims before spending your money
You don’t have to remember everything or make eight changes tomorrow. Start with the moment that makes you think, “Wait, that’s happening to me.” Write down your question and bring it to your next appointment.
If a woman in your life keeps telling you she doesn’t feel like herself, share this episode with her. And if these conversations have helped you, follow The Tamsen Show and leave a rating and review.
This episode provides general education. Speak with a qualified healthcare professional about your symptoms and treatment decisions.
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What We Talk About:
0:00 Intro
05:11 Perimenopause Symptoms Can Start While You’re Still Getting Your Period
09:51 Menopause Brain Fog: Can Your Memory and Focus Come Back?
15:24 How to Treat Menopause Insomnia and Finally Sleep Better
21:37 Belly Fat After 40: Visceral Fat vs. Subcutaneous Fat
25:59 Bone Health After 30: How to Prevent Osteoporosis in Midlife
30:30 How Menopause Changes Your Vaginal Anatomy and Sexual Pleasure
35:17 Does Hormone Therapy Increase Breast Cancer Risk?
41:19 How to Choose Safe Menopause Supplements
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Medical Disclaimer:
The information provided in this podcast is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional regarding any medical concerns or treatment options. The views expressed by guests are their own and do not necessarily reflect those of The Tamsen Show.
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#menopause #tamsenfadal #thetamsenshow
Transcript:
(00:00) Hi friends, this is the Tamson show and I'm Tamson Fidel. I have spent my career asking questions and this is where I ask the ones women need answered now. Every week I get to sit down with experts and people who have lived through the moments that change us. That's where today's conversation begins. If you're trying to figure out why you can't sleep, why your body feels different, or why you keep losing your train of thought, I want you to try to stay with me today.
(00:24) All year on the Tamson show, I have been sitting down with leading doctors and researchers asking the questions women send me every day about menopause. And for World Menopause Month, I'm bringing some of their most important answers together for one full episode. We're talking eight experts, the conversations that surprised me the most, and information I wish I'd had years ago before I was trying to figure it all out for myself.
(00:48) Because I know you don't necessarily have time to listen to eight different interviews, especially when you're tired, when your brain is foggy, and you're already getting a different piece of advice every time you open your phone. So I wanted to make this easy. I've pulled out the parts I most want you to hear, and we're going to go through them together one conversation at a time.
(01:05) So when I started going through menopause, I didn't know that's what was even happening. I couldn't read the teleprompter at work. I would lose words. I would lose my train of thought. I couldn't remember names. Things I had done comfortably for decades suddenly started making me nervous. I started putting notes literally on my computer because I was afraid I would forget something.
(01:27) I wasn't sleeping the way I used to and my confidence was crap because I couldn't explain why I felt so different. I'd spent a career as a journalist asking questions for other people and now I needed to ask them for myself. Why couldn't I think clearly? What was happening to my body? And who was going to help me with all of this? The more answers I found, the more I wanted other women to have them too.
(01:49) That journey led me to write this book, How to Menopause. This is the book I wish I'd had when I was awake in the middle of the night wondering what was wrong with me. By the way, it's on sale now. I actually put a link in the description if you'd like a copy. Those questions are a big reason I keep bringing these doctors onto the Tamson show each week because writing a book about menopause doesn't mean I've stopped having things happen in my own body that I don't understand.
(02:13) Sometimes I'm sitting in this chair asking your questions. Sometimes I'm asking mine. And a lot of the time I'm stopping somewhere halfway through an answer saying, "Wait, explain that to me again cuz I just didn't know it." I love the fact I get to sit across from people who have spent decades studying this and asking them everything that we want to know and then help bring it back to you, especially when they explain something that helps make sense of what we're going through.
(02:37) So, first of all today, you're going to hear from OB/GYN Dr. Sharon Malone about why you can still be getting your period and already be in perimenopause. That's one misunderstanding that keeps so many women from even considering what could be happening. Then neuroscientist Dr. Lisa Mosconi is going to talk about our brains. She is brilliant.
(02:56) I told her I'd started feeling sharper again recently and some of my confidence and memory were coming back and then asked, "Is this real? Like could this really be happening?" If brain fog has scared you, I really want you to hear that conversation. Sleep psychologist Dr. Shelby Harris is going to explain why spending more time in bed might not be helping you sleep and I had questions about that one, believe me.
(03:18) We're also going to hear from endocrinologist Dr. Rocio Salas-Whalen. She's going to explain the difference between the belly fat that we see and then the fat around our organs. And then orthopedic surgeon Dr. Vonda Wright explains why our bones need attention much earlier than any of us even thought. Urologist Kelly Casper is going to take us through changes to our sexual anatomy that I certainly was not taught growing up.
(03:42) These are the things that women deserve to understand before they're experiencing them and wondering what's going on. Oncologist Dr. Avrum Bluming is a the of Estrogen Matters. He helps us look more closely at hormone therapy and breast cancer fears. Having lost my own mother to breast cancer, I brought my own fears into that conversation, and I know how personal those decisions are, so I don't take them lightly. And details really matter.
(04:08) An OB/GYN, Dr. Suzanne Gilberg-Lenz, who also practices integrative medicine. I love her. She helps make sense of the supplement aisle. When a bottle says hormone balance, what are we actually buying? What do you look for? And what are the questions that are worth asking before we spend so much money on supplements? These are some of the moments from The Tamson Show that made me think, "We need to make sure more women hear this.
(04:32) " So, that's what we're doing today. You don't have to remember every term or make eight changes starting tomorrow. I want you to understand more about your body, know what deserves attention, and have better questions to bring into your next appointment. And by the way, if you hear something you want to come back to, this whole episode is here for you.
(04:49) Before we start, if these conversations have helped you, make sure to subscribe to The Tamson Show podcast right here on YouTube. I want to keep bringing you the experts and answers you have been looking for. Let's start with Dr. Sharon Malone today because if you've been thinking, "I'm still getting my period, so this cannot be perimenopause," this first conversation is something you need to hear.
(05:08) >> [music] >> So, if someone says, "Okay, I'm starting to experience something. I don't know what it is. I'm early 40s. Most likely, without a blood test, is that right? You could tell somebody pretty certain you're probably starting in perimenopause. Can you define perimenopause, menopause? >> I think perimenopause is the most confusing of these stages because perimenopause just simply means around the menopause.
(05:38) And it is also called the menopausal transition where you go from your peak fertility years to no fertility, and it's that gap in between. And for most women, that can last anywhere from 4 to 10 years. If you're African-American woman, your symptoms and that period last more closer to 10 years than 4. Um it is characterized by a lot of things, but the one thing that it is not characterized by is a lack of periods.
(06:07) And we think of menopause as being, "Okay, that's when my period stops, right?" Well, in perimenopause, you may be getting your period regularly. It may be different. It may be heavier. It may be lighter. They may be closer together, further apart. That's sort of the first signal that there's really something going on is there changes in irregularity.
(06:28) And if you don't understand that the presence or absence of bleeding is not a defining feature of perimenopause, then you'll think, "Oh, it's not it doesn't have anything to do with menopause." But all of those symptoms that we talk about, that we associate with menopause, can start during perimenopause. And the reason why it's not helpful to get blood work during perimenopause is because your hormones during perimenopause are fluctuating.
(06:58) They may be too high one day, too low the next, and it is that sort of erratic hormone production that really produces a lot of the symptoms that women have, particularly the brain fog, the irritability. Imagine, it's like having PMS every day. Um that is sort of what perimenopause is like. And for a woman to come in with all those any combination of the symptoms that we talked about, but you're still getting regular periods, and you go see your doctor, and you're like, "What is wrong with me?" And your doctor says, "Well, when was your last
(07:28) period?" If that's your first question, and you say, "2 weeks ago." And they've immediately taken anything to do with menopause off the table. That is not correct. And I think that's where there has to be some adjustment with doctors. So, they understand that perimenopause and menopause are different things, and they occur at different times.
(07:51) And it's not a blood test, you don't need a sonogram, you don't need a soothsayer, you don't need anyone to tell you You know who decides >> things are now available, it seems, out there in menopause world. >> need a pee on a stick, you don't need to do any of that stuff to tell you if you're perimenopausal. Perimenopause is defined when you say it is, when you are having symptoms.
(08:12) And you are between the ages of 35 and 45. That's sort of typically when perimenopause starts. But because it There's no bright line that signals the beginning of it, that's where I think the confusion is. And I think that there is uh also this misperception that you can't start hormone therapy until you've gone a whole year without a period.
(08:35) Why? >> Why would that be? Because your the hormones are fluctuating. So, can you You can start hormone therapy in perimenopause. >> You can start hormone therapy in menopause. Or and I say or, we get back to you can use low-dose birth control pills, cuz remember I told you birth control pills and hormone therapy are just two, you know, they're sort of different you know, same but different.
(09:01) Um because sometimes you need a low-dose birth control pills because birth control pill because when you are perimenopausal, if you're 42 and having symptoms, the one thing that you are not yet is infertile. So, unless you are actually actively trying for a baby and you need birth control, then a birth control pill will kill two birds with one stone.
(09:23) It'll give you birth control, it'll control symptoms. If your periods are too heavy or too long or too erratic, then a birth control pill may be more appropriate at that particular time. But as you progress through this transition, then yeah, as you get closer to menopause, then sometimes if you if you don't have those other things, then yes, you can use menopausal hormone therapy.
(09:44) >> That's why I wanted to start with Sharon. I was still getting my period. So, menopause, it wasn't even a word on my radar. Meanwhile, though, I was struggling to find words and wondering what was happening in my brain. Dr. Lisa Mosconi is a neuroscientist who studies exactly that. When we sat down, she showed me brain scans from before, during, and then after the menopause transition. It's fascinating.
(10:08) But I also had something I wanted to ask her. I'd started feeling sharper again after starting hormone therapy. I wasn't reaching for my notes as much. Could my brain fog actually be getting better? Here's a piece of the conversation with Dr. Lisa Mosconi. >> [music] >> And so we really see, you know, for people who are listening, we see the pre-menopause scan with a lot of red, a lot of brain energy.
(10:34) Perimenopause >> And in between. >> In between, post-menopause, we see a lot more green and blue, but not as much red, which is a brain energy. Now, does that come back after we are in post-menopause, after we've hit menopause and post-menopause? Because I have to say, when you and I first met, which was a few years ago now, I had really debilitating brain fog to a point that I'd be very nervous.
(10:59) I didn't feel my confidence like it used to be because I didn't have the memorization skills that I used to have. >> Mhm. >> Over [clears throat] the course of the past maybe 6 to 8 months, I felt those coming back. And I And I have really felt them. And I I was like, am I imagining it? Am I just wanting to feel them? But I definitely feel them.
(11:16) I definitely feel that I don't hesitate, right? I don't hesitate when I'm speaking. I don't feel like I need cards. I mean, I I was to a point where I would put notes on the top of my computer because I would be nervous that I would forget something. And so, that's very nice, but is that what happens? Is there a a bounce back after you've been in menopause for a little while? >> You may not be surprised to hear that there isn't a lot of research done on >> Dr.
(11:43) Lisa Mosconi, I'm shocked by this breaking news. >> Yes. So, we are now following our patients over time and the results are not published yet, but what we do find, and this is until peer review allows publication, um we do find at least descriptively that it depends. So, after menopause, there can be different outcomes. For some women, cognition rebounds.
(12:08) In other studies, clinical studies have shown that that after the final menstrual period, there's still the early postmenopausal phase where the brain is kind of settling down, it's trying to adjust. And then for quite a few women, actually, cognition bounces back. That's usually between two and four and maybe six years after the final menstrual period.
(12:30) >> It starts to bounce back to where you were before you went into menopause? >> Sometimes. >> You don't have your 26-year-old brain again, most likely. >> Well, [laughter] at that point, you're also older, right? So, it would be a lot to ask, I think, over and over again. But I think just getting to where you were before you started having the brain [clears throat] fog, more or less, I think it's a good it's a good thing.
(12:52) For many women, it just stabilizes. Doesn't get any worse, but it kind of remains a little bit lower than it used to be. >> Does every woman go through these changes? >> No. No, not necessarily. So, about 62% Between 34 and 62% of women that we have surveyed, not me personally, but the field, uh report cognitive changes, which other scientists have shown, and we have shown too, that they are actually measurable.
(13:20) That you can see that if if we have we have this test, it's called the MoCA, like coffee. >> [laughter] >> Oh, MoCA, I'll remember that. >> Yeah, with a C. Moca is the Montreal Cognitive Assessment, where the scores range from 0 to 30. Most women around age 40 are between 28 and 4 and 30.
(13:41) But also women in their 50s, more or less between 27 and 30. So, if you're a 30, when you're going through menopause, you may end up being a 29 or a 28. And you may then bounce back up to 29. >> Okay. So, >> 30, you know. But the variability is small. However, the two-point drop is the difference between needing notes and not needing them.
(14:03) For most women, cognition may either bounce back or stabilize, but for some women it does not. And that's when we start really talking about Alzheimer's prevention and what we should do to try and either really reduce the risk of Alzheimer's or try to prevent or delay onset and progression. So, there are different strategies depending on each woman.
(14:28) So, there is no specific answer >> Okay. >> after menopause. There's a lot of different factors that come into play and they do need to be assessed thoroughly. And then an individualized plan can be made for all women. But on average, on average, things do tend to get better. >> If you've been wondering whether you're going to ever start feeling sharp again, I hope hearing Dr.
(14:48) Lisa Mosconi explain that cognition can improve or stabilize stays with you. I really needed to hear that as well. The truth is though, it's so hard to even think about any of these things or feel like yourself when you're not sleeping. Sleep can be one of the first things to change and then it touches everything else.
(15:06) I spent years sleeping on my couch because I was flipping over in my bed back and forth and couldn't get to sleep. So, I'd just go out on my couch and lay there. So, when sleep psychologist Dr. Shelby Harris told me that spending more time in bed could actually make it harder to sleep, I needed her to explain. Here's Here's of our conversation.
(15:22) >> [music] >> Okay, so you talk about um CBT-I therapy. Can you explain that that's a specialty and something that you focus on with with people that come to you? >> Yeah, so CBT-I, cognitive behavioral therapy for insomnia, is really it's the gold standard treatment. It's the first-line treatment for insomnia ahead of medication, believe it or not.
(15:47) And that even is important for women in perimenopause and menopause. So, we might sometimes use hormone replacement. We might also use CBT-I. It really does work really well, even for women who are having hot flashes. We don't fully know why it works, but it does help with hot flashes in in a number of women.
(16:03) So, what it is um is it's people often think it's sleep hygiene, it's not. Sleep hygiene is just a tiny piece. So, you start with the sleep hygiene, but then we limit the time in bed. So, a lot of times people are in bed 8-9 hours a night, but they're only sleeping 6 hours. So, I might actually limit that at first.
(16:21) It goes against common sense to help really make them sleepier and increase their sleep drive so that they sleep throughout the night. They might have a quick awakening and go back to sleep. I might have them go to bed later because that might actually help them fall asleep faster, and then we move it earlier once they're falling asleep faster so that they can get more sleep.
(16:37) We also work on what people are doing in the middle of the night. So, are you getting up? Are you laying in bed trying to force sleep to happen? All those sorts of things. Then we work on like the thoughts about sleep, like if I don't sleep I can't function tomorrow. We'll challenge some of that stuff. >> Yeah, let's talk about I would like to go into it.
(16:52) So, if somebody comes and says like listen, I need uh CBT-I and I want I have insomnia or I'm just not able to sleep. Is it possible you can do it for a number of different things? Would you recommend that if you're a woman in perimenopause and just can't sleep? You've tried everything, nothing else is working. >> It's very effective for people who have insomnia.
(17:08) >> Yeah. So, you come in and you adjust you adjust sleep schedule. That's the first thing. >> Yep. Then I will also talk about what they're doing in bed. So, a lot of times people never thought about sleep before, and now it's preoccupied. Like they're preoccupied with it. So, when the night comes, I often hear people say, "I dread the night as it gets closer.
(17:24) " >> Yeah. >> It's so true. >> I I understand that feeling, though. >> so true. So, they might be tired but wired at night. So, they were like, "I'm so exhausted. I just want to get in bed." But they're not sleepy cuz they're not falling asleep. So, I might adjust what they're doing before bed and have them go to bed later so they're not putting as much effort into it.
(17:42) >> So, what would they do instead of panic? >> I don't care. It really doesn't matter. There's no magic thing. It's They can They can watch TV, even, believe it or not. They can do I have a People will say like I'll have them go to bed a few hours later and they're like, "I don't know what to do. I'm so bored.
(17:56) " Is there a drawer you can clean out? >> Wow. Okay. >> Right? It doesn't matter. Just stay up later and maybe unwind a little bit before but not hours before. And so, I'll have them change that. Getting up at the same time every single morning and not compensating for a bad night of sleep is super important.
(18:13) So, we're going to pick a wake time. We're going to pick a way that they can use an alarm clock, not their phone because a lot of people just if use their phone as the alarm clock, they're looking at that in the middle of the night. No. So, we're going to use an alarm clock, maybe. And then, we'll also talk about maybe if they're up in the middle of the night, what are they doing.
(18:29) So, getting out of bed. It really there's no magic answer. It's Some people read. I honestly, if I have a rough night, I get out of bed, if it's really bad, and I go through I collect cookbooks. I go through my cookbook collection. >> You do? What do you do with them? >> I literally just look through them and I earmark things that pretty pictures and things that I want to make in the coming few weeks, months, whatever.
(18:48) It's >> That's your >> Yeah. People laugh at me, but it works for me. >> And then you go back to bed cuz >> I go back to bed, right? >> I think I feel like I could have had my whole house decluttered by now with the amount of sleep that I don't get, but I just lay I lay there and panic. >> Right.
(19:01) But what happens is the less time that you spend in bed and if you restrict that time a little bit with the guidance of someone who or an app or someone who can help you, you fall asleep faster and you stay asleep more in the middle of the night so you don't have to get out of bed as much in the middle of the night. Your brain is just not as active because you're spending less time in bed.
(19:17) >> I got to be honest, I could have used that advice on so many nights. So, if you have been laying there night after night trying to force yourself to sleep, I hope Shelby gave you something new to bring up to your doctor. I love hearing there's actual treatments that can help you through that part of life.
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(20:58) Let's talk about getting dressed. You reach for a pair of jeans you've always worn and suddenly they don't fit anymore. And now you're going through your closet in a panic thinking, "Oh my gosh, what's changed? I'm eating the same. I'm still working out." I've had that conversation with myself more times than I can count.
(21:16) When I sat down with endocrinologist Dr. Rocio Salas-Whalen, she explained that the fat that we can see, and then the fat around our organs, they're totally different. And that really matters when we're talking about our health. Her explanation of what liposuction does and doesn't change really stayed with me as well.
(21:33) Here's a part of that conversation. >> [music] >> I want to go back to fat and inflammation and some of the other dangerous kinds of fat. Um I know you mentioned visceral already. When we talk about fat and we talk about inflammation, can we talk about the difference between those two and how they show up in the body? >> So, we have subcutaneous fat that is basically what's under our skin.
(21:56) Uh so, if somebody has liposuction, what they're going to remove is subcutaneous fat, right? That is not a bad fat. That is not a pro-inflammatory type of fat. Then we have intra-abdominal fat, which is inside of the men that attaches to your internal organs, to your liver, to your gut, to your pancreas.
(22:14) That's what we call the bad fat. >> And what was that one called again? That's >> Visceral fat. >> Visceral fat. Right, right, right, right. Okay. >> this can cause And visceral fat is a pro-inflammatory tissue. So, in that fat tissue, in the adipose tissue, there's cytokines, which are inflammatory cells, right? So, they promote inflammation in your body.
(22:36) This is the fat that can promote different types of cancer because of the constant state of inflammation that the visceral fat is on. Now, if it surrounds your organs, it can lead to in your liver, fatty liver, right? In your gut, in your pancreas, can cause insulin resistance. So, that's the fat that we want to target whenever we're talking about weight loss, we're really targeting visceral fat.
(23:02) That's why somebody, let's say with that overweight and they have high subcutaneous and high visceral fat, if they go with plastic surgery and they have liposuction, it's not going to touch the visceral fat. So, they're still at risk of disease. >> So, they'll have the vanity part might be somewhat happy. >> external part, but the metabolic part is not touched.
(23:20) >> So, how do you target both of those things? Cuz I know there are a couple different ways, I know there's some new ways, and there's a lot to to discuss with it. But, what are some of the ways to start targeting that if you're a woman that whether you're on hormone therapy, I guess or not. >> Yeah, so two easy changes that don't require any medication if we want to talk about and that first is going to be strength training, right? Building muscle.
(23:44) The more muscle you have, the more fat you burn for energy. >> Anywhere in your body, whether you're doing your arms, your legs, anywhere. >> you need to build muscle. Resistance training and then strength training, right? That's one. And the second is your diet. So, increasing protein in your diet is a must and this is for any age, but especially in midlife where we tend to lose more muscle mass, we need to up our protein intake in midlife, right? Also, and I'm talking about lean animal protein or whey protein.
(24:17) Why these two? Because they're complete protein, meaning it has all the amino acids for muscle protein synthesis. >> You give me the whey protein, I put it in my coffee like my creamer now. I mean, that's where I that's literally where I start my day because of you. >> it in. >> And and fiber.
(24:31) I think of you every morning. Every morning with my I'm having coffee [laughter] with you. >> Well, cheers. >> If you've been looking at your body and blaming yourself, I really hope this conversation gives you better questions to ask because you deserve to understand what is changing and what you can do about it. Also, I want to remind you my book How to Menopause is there for you if you want to spend more time with this information cuz I know we're covering a lot today.
(24:54) And here's why I wrote that book because I I sometimes you have got to sit with something, you have to read it again, maybe underline a sentence, and then even bring it into your next appointment to make sure that you're able to talk to your doctor about what's going on. Because I remember trying to explain how I felt myself when I didn't understand it.
(25:12) And it is so hard to ask for help when you don't even know what the hell to ask for. That's the woman that I was thinking about when I wrote this book, How to Menopause. And if that's where you are right now, I want you to have the information I wish I had had. It is on sale now, and the link is in the description to help you out.
(25:27) So, this next part is something I wish I'd understood sooner. How much we need to pay attention to our bones, which is something I never thought about. I just thought like, "Uh, maybe I should be careful not to break my bones." But, we notice when our jeans fit differently, bone loss is much easier to miss. Orthopedic surgeon Dr.
(25:44) Vonda Wright explains what our mothers and our grandmothers' experiences can tell us about our own risk when it comes to bone health, and why we should not wait until we break something to have that conversation. >> [music] >> If we have a woman who's in her 30s right now listening, is she in an incredible place to be >> god.
(26:06) >> building >> Ideally. So, it is estimated that we reach peak bone mass, the most bone we're going to build, between uh 15 and 25. Extends up to 30. So, I personally think that we should all be getting some kind of bone measurement, whether it's a DEXA scan or an ultrasound, REM scan for bone quality as a baseline then.
(26:28) Because I kid you not, every woman coming into my orthopedic office, no matter what her age, gets a DEXA scan. And I have 20-year-olds and 24-year-olds and 30-year-olds who come in with poor bone density, and they don't even know it. And they've never built enough bone as a young woman. If you carry that, you just assume you're fine, you're young.
(26:49) But, if you come in with low bone density, and we and it levels off, declines about 1% a year like a man, until you reach perimenopause. Within this 5 to 7 years of perimenopause, you're going to lose 15 to 20% of your bone density because of the mismatch that comes when we don't have estrogen. OMG. >> So, what do we do? What do we Where do we >> We help.
(27:12) >> Help. [laughter] >> When we're Let's say we're Let's talk to the young millennials right now. You want to do that? >> because I feel like Yes, I need you to talk to them. I need you to talk to them because they're important because you have four daughters who are millennials, but you hit your peak bone mass by the age of 30.
(27:32) >> 30. >> Yes. It doesn't mean it's too late, though, right? >> mean it's too late. There's never an age when we cannot build bone density, but you want to start from the highest level so that as we have the natural decline, we're not declining from osteopenia, we're declining from amazing bone density, right? So, what do I want 30-year-olds to do? I want you to look at your mother or your grandmother.
(27:57) Are they shrinking? >> What does that mean? >> That means that they have enough osteoporosis that their vertebrae are collapsing. So, if your mama used to be 5'6" and now she's 5'3", she's lost 3 in of bone height, probably due to osteoporosis because part of bone health is genetic. >> Mhm. >> So, the first thing a young woman can do is look at her female relatives.
(28:22) What happened to them? Do you have a grandmother who broke her hip? If you're 30, but you had a fracture, you fell off the the curb, or you fell and broke your wrist, fracture after 20 pre- predicts future fracture. >> It does No matter how it happened? >> Oh, yeah. Unless you wrap your car around a tree. Hi. But, lower impact, like falling from a standing position, falling off the curb, your dog pulls you down, break a bone.
(28:49) After 20, that's a predictor. >> Why is that a predictor? Because you have a low bone density? >> Yeah, because even low energy situations are enough um force to break your bone. >> Wow. >> Yeah. >> So, if you see that your mother or your aunt or your grandmother is shrinking or somebody broke um a bone, what does that tell you? That tells you that genetically you need to be paying attention.
(29:10) >> There can be a pre- a genetic predisposition because sometimes bone density has a component in that. So, we can't ignore that shrinking going on. >> Yes. >> It's one of the risk factors. >> to shrink. I'm 5'3" and 1/2. I don't know what I'm going to do. I don't know. I'm going to need a booster seat for this table.
(29:25) >> So, it's one of the risk factors that your doctor can use to get you a bone density early. >> What I'm so glad Dr. Vonda said is that it's not too late to build bones because you hear that you've reached your peak of bone mass by 30 and you're thinking like, "Great. What am I supposed to do now?" There are things that you can do now, and knowing your own risk is a great place to get started.
(29:46) Okay, so I'm sure you're wondering, let's talk about sex because that is a big thing that changes during this time. If it hurts when you have sex, if things feel different, if you've looked down there and gone, um has something changed? This is a conversation that I think is really going to resonate. When Dr.
(30:05) Kelly Casperson told me that parts of our anatomy can actually change as we lose hormones, I was blown away. I had no idea what changes, why, and what to do about it because nobody ever talked to me about it. Dr. Kelly Casperson is a urologist, and one of the things I love about talking to her is that I can literally ask her anything.
(30:25) There are no awkward questions when it comes to Dr. Kelly. >> [music] >> Well, I mean, it all boils down to we did not get a good sex education. And when you have a gap of knowledge, what do you do? You try to fill it in, right? Fill in the knowledge. Where are we filling this in from? We're filling it in from country music, Hollywood, religion, our parents, our first romance, all shitty ways of getting sex education, right? Um you know, possibly a disease and pregnancy prevention plan when you were in eighth grade that mostly made you afraid of it
(31:01) and taught you about ovaries. Although it didn't teach you that ovaries make testosterone. Um I mean, where was the clitoris and the labia in any sort of sex education? Pleasure, right? Why do people have sex? It feels freaking good. And you're not taught that? >> Right? We're not taught anything about our bodies.
(31:19) I mean, most of us >> never looked at our bodies, right? >> The biggest show If you want a reaction on Instagram with hormones, you tell women that their labia minora goes away. And it's like you're tell like to be a again, not not to say that sex is extra, but it's like, "Dude, also osteoporosis, heart disease, dementia, like all these bad medical things.
(31:36) " They're like, "But the labia minora." Like, "Dude, women care." >> Explain what that is. Explain what the labia minora is and and why it goes away. And how to stop it from going away. >> Yeah, exactly. Labia minora is the inner lips, so non-hair-bearing genitalia. So, the the area with hair, that's labia majora. On the inside before you enter the vagina are these little I I hate the word flaps, but they're pieces of tissue and that's labia minora.
(32:03) And they're incredibly responsive to hormones. They're there because you went through puberty and you had huge surges of testosterone and estrogen. Perimenopause, birth control, postmenopause, these hormones are blocked in the pelvis, and so the hormone-responsive tissues can resorb, go away, atrophy, whatever horrific words you want to use.
(32:26) But many women they'll say it's just it takes a lot longer to get turned on, to get aroused. Um the clitoris has some skin that goes over it, kind of like a turtleneck. Um that can become kind of stuck to the clitoris, and we call it phimosis or adhesions, making orgasm a lot more challenging, right? And to be fair, women are not examined.
(32:48) Like, they come in complaining of this, they're told, "Oh, everything looks normal down there." And or they're just like, "Drink a glass of wine." And like, there are anatomic, biologic things that happen when hormones leave the body. We must get an education about this because every time women freak out about their labia minora on Instagram, I'm like, we didn't get a good sex ed.
(33:08) >> Mhm. >> And what does the labia minora do? Number one, there's nerve endings, uh erectile tissue, incredibly responsive for arousal. It's how you we feel pleasure. Also, it's protective to the inner workings of the urethra. Helps it prevent it from having microtrauma. Maybe it helps recurrent UTIs.
(33:26) It's just a protective structure as well. So, sexual and protective goes away. The second The next question is, can it come back with hormones? Probably. There's no studies on this. You think anybody's You think the NIH is researching like getting your labia minora back after you weren't on hormones for a while? >> I mean, we got so many other things to focus on.
(33:47) I I that's probably the last thing on the list right now, right? >> extra, right? >> It's extra. >> Women really do care about it. >> Of course. >> Uh you know, that's why the people like me, the female urologists who care a lot about GSM, we're like, "Why don't we just be starting vaginal estrogen around age 50 so we don't have to play catch-up once you've suffer suffered enough?" >> If Kelly just told you something that you've never heard before, ask about it at your next appointment.
(34:12) Even if you have to pull up this episode and say, "Hey, can we talk about this?" You should be able to have that conversation with your doctor. So, I told you we're going to cover a lot of topics. This is a conversation that comes up a lot when hormones come up. Some of you immediately think about breast cancer. I did, too.
(34:29) I lost my mother to breast cancer. So, when I was considering hormone therapy, that fear for me was very, very real. And I needed someone to take my questions seriously and then walk me through the research. Dr. Avrum Bluming is that person, an oncologist and co-author of Estrogen Matters. And so many of the doctors that I've interviewed told me how much they've learned from all of his work over the years.
(34:52) Every time I sit down with him, I feel like I learn something new. In this part of our conversation, he explains why we need to be specific about which hormone treatment we're talking about when we discuss breast cancer risk. If this is something you have been afraid to consider, I want you to hear the explanation and then maybe bring your own questions to your doctor.
(35:12) Here's Dr. Avrum Bluming. >> [music] >> We have to separate hormone therapy, also called hormone replacement therapy, now called menopausal hormone therapy. >> Yes, all the same. >> Is made up largely of two drugs, and we're not going to be talking about testosterone, because that's a different subject.
(35:37) Estrogen is the backbone of menopausal hormone therapy. Most of the very good results that we'll talk about are due to estrogen. The problem with estrogen is estrogen does increase the risk of uterine cancer if it's given alone. And that caused a drop in the use of estrogen until it was found that if progestogen is given together with estrogen, that increased risk is eliminated.
(36:06) So, women who still have a uterus get both drugs. Women who don't usually get estrogen alone. And in 1997, there was a consensus development conference that said that from the National Institutes of Health, that said estrogen doesn't increase the risk of breast cancer. We now know from the Women's Health Initiative, which I don't quote positively too often, that women randomized to estrogen alone in this largest prospective randomized trial ever done in this country, have a 23% reduced risk of developing breast cancer, and even
(36:47) more importantly, a 40% reduced risk of death from breast cancer. >> So, let's go back to that again because I think it's really important. A lot of people that are listening, you know, we're going to go into the 2002 study. But, at the end of the day, when we talk about a woman, I'm 55 years old, I take hormone therapy, my mom had breast cancer, I was afraid of it at first, you know, just like so many other women are.
(37:10) And then I learned what what I know now. If a woman is taking hormone therapy, and she doesn't have a lot of the contraindications that but we we can talk about how is it going to help her? Can you repeat those numbers again? >> Sure. Uh, we know that heart disease kills seven times as many women as breast cancer.
(37:31) And what women usually say when I say that is, "Well, old women die of heart disease, and young women die of breast cancer, and I'd rather die when I'm old than die when I'm young." That's not true. In every decade of a woman's life, starting at age 40, her risk of dying of heart disease is greater than her risk of dying of breast cancer, and that difference widens with every successive generation.
(37:59) So, if you look at women from age 40 and compare them overall to the ones who die finally by 80, seven times as many women die of heart disease as die of breast cancer. >> Why are we so much more afraid of breast cancer than heart disease? >> Because the word cancer is a red flag. We're frightened of cancer. And bad news spreads very quickly.
(38:21) >> Dr. Blooming, you're a leading oncologist. You spent decades studying breast cancer, wrote the book other doctors turn to on estrogen. Your own wife had breast cancer, your sister-in-law had breast cancer. So, I want to ask you this, does hormone therapy cause breast cancer? Yes or no? >> Not according to my current knowledge base.
(38:41) >> Why are women so afraid of it? >> Cancer is a frightening word. Breasts help define femininity. Um we sell clothing uh accentuating breasts. The idea of strapping the chest so that all women look flat-chested, that went out more than a hundred years ago. >> What do you think would happen if every woman on this planet went on hormone therapy? >> [laughter] >> I I'd love to see it, uh but I have no idea.
(39:17) Um that's not really true. Uh we know that uh 40% of the British health force uh the women in the British health force are retiring early because of symptomatic menopause. What an incredible loss that is. As a woman is just reaching the peak of her performance ability, she's finally no longer taking care of her parents, the kids are getting old enough that they are more self-sufficient, her husband isn't yet senile requiring that she care for him.
(39:58) That's when she gets hit with menopausal symptoms and her productivity is curtailed. What a loss. >> So true. Oh, so true. How does it make you feel when you hear there are still doctors shutting down the conversation about hormone therapy? >> Sad. And motivated to make a difference. >> Well, you are, sir. >> I'm doing the best I can.
(40:22) >> I know that conversation with Dr. Blooming is going to bring up a lot of questions for a lot of you. And I know some of you are thinking, but what about me? I can't take hormones, or maybe you don't want to. Maybe you've already started taking them and still have symptoms that you need help with. I want to make sure that we're talking to you as well.
(40:39) Another big conversation, supplements. You deserve to understand your options. And when you start looking, there are so many supplements that are being sold for sleep, for brain fog, for hot flashes, for all of them together. It's easy to spend a lot of money hoping something's going to help. My friend, Dr.
(40:57) Suzanne Gilberg-Lenz, is an OB/GYN who also practices integrative medicine. We sat down to talk about options beyond hormone therapy. This part of our conversation is about supplements specifically. What those labels actually tell you, what you should look for, and why it matters about talking to your doctor about what you're taking. Here's Dr. Suzanne.
(41:17) >> [music] >> Are most of most of these are capsules or something you can get in a health food store? >> But I So, let's actually, before we even have this conversation, let's start with the basics. >> Yeah. >> The health food store is okay. What you want to do is you want to look for third-party testing in any of these medications. They're medications.
(41:40) >> Mhm. >> So, you also want to talk with your physician because some of them can interact with other medications that you're taking. >> Okay. >> A lot of them will use liver enzymes to just like all your meds. So, the thing is, if you're inducing liver enzyme activity, you may be metabolizing other medications faster or differently.
(42:01) So, third-party testing is really, really, really important if you're buying it at a store or you're buying it online. And if it's not obvious that it is third-party tested, then you that's not your brand. >> I'm probably going to ask a dumb question to you, but what is it How do you know if it's third-party tested? >> They have labels on there.
(42:19) They'll Any any good supplement company will make that very clear. Because now we're getting it This is important stuff. So, medications are approved by the FDA, right? You know this. The company the pharmaceutical company has to do all sorts of testing, meet very specific criteria, show that it is effective for the use that they are trying to prove that it's useful for and that it is safe, okay? And then they continue to do post-market surveillance, right? Once it's out on the market, are there any reports or we're seeing any
(42:50) signals that are negative? >> [snorts] >> The supplement world is regulated as food. It is not pre-market tested. So, you can bring something to the market. You can't make specific claims like you would with the FDA because the FDA would have to approve that you >> [clears throat] >> that you met the criteria to make those claims.
(43:12) So, that's why you see things like hormone balance. What is that? It's not a thing. >> So, if you see hormone balance, so do >> You can't say that it is decreasing vasomotor symptoms. You can't actually say that because you didn't prove it. >> You have to know and you have to do your research on this, right? Or you have to And then you have to listen to Dr.
(43:29) Suzanne. >> What do they rely on? Post-market >> Sure. >> reports. >> Okay. >> So, that's why when there's third-party testing involved, there are several labs that go in, they test them at the the I mean, it is a medication, but they test the botanical, let's say. They say, "Okay, yes, it is what they said it is.
(43:45) " That that's it. So, it's not that they're not regulated, but they are definitely not regulated at the same level, which is why having that extra literal seal of approval is very important. >> So, if you're going to wherever you're going to get your supplements, online, health food store, the website that they are whatever it is, third-party testing is the first and foremost what you need to look for.
(44:04) >> Yeah, definitely. >> And then, be aware of what these things do because the label might not always be super clear. >> Exactly. And they also do a lot of things called like proprietary blends, which means they blended a whole bunch of stuff and it's proprietary to them. They're not telling you how much of X, Y, and Z is in there.
(44:21) >> Should you stay away from that? >> I would because it's not so necessarily that it's dangerous. I mean, but it may not be doing much of anything. >> It might not It might not even have a It might be wasting your money. >> If you're a woman that is miserable with hot flashes and hormone therapy is the only thing you keep hearing about over and over, what can you do in the botanical sense to help with hot flashes? >> Yeah, I think the top ones would be black cohosh.
(44:43) >> Um okay, so black cohosh. You're you're dealing with hot flashes. About how long cuz this you want to like work pretty quickly and you need 6 weeks. >> I would say no, it's a little faster acting, 2 to 4 weeks for maybe a you know, 30 to 50% reduction in your hot flashes. It's probably not going to make them go all away completely, but early on maybe early in perimenopause with earlier hot flashes, maybe it will be more beneficial.
(45:06) The other one that I really like is something called Siberian rhubarb and there's a very specific formulation. I think it's ERR 731. Um so this matters too. Like what is the formula? Um and that also is fantastic for hot flashes. >> That's great to know though because these are These are the areas that I mean just there's very little conversation if not If 100% of menopause conversation, is it 10% even that we really don't talk about this? >> No.
(45:34) >> I am so glad Dr. Suzanne Gilberg-Lenz explained what to look for because when you just want to feel better, it is so easy to just buy whatever seems like it's going to work. Whatever you decide about hormones, you're still going to have questions about what else might help and you deserve information more than a promise on the front of a bottle.
(45:53) So I know we covered a lot today. If there was one moment where you're like, wait a minute, that is happening to me, start there. Write it down. Bring it to your doctor. You don't have to remember everything that these eight experts said or try to figure out this next chapter on your own. But when I think back to how confused I was at the beginning of my menopause journey, I wish I could have heard these conversations, any of them.
(46:15) I wish I'd known what to ask about before I spent so much time wondering why I couldn't get it together. That's why I really love bringing these conversations and these people to you. I still have questions myself. I still learn everything every time I sit down with somebody in that chair. And I also get to ask the follow-up.
(46:32) The wait, what does that mean? Question. Because I know you're probably wondering the same thing I am. If you want to hear more from any of these guests today, we're going to link their full conversations in the description. My book Had a Menopause is also there. If you'd like something you can read at your own pace and come back to.
(46:51) I'd love to know what surprised you today. What did you hear today? What questions do you still have? Please leave a comment if you're watching on YouTube. And if you're listening, I would be grateful if you'd rate and review the Tamsen Show. For World Menopause Month, if you could do me a favor, send this episode to one woman that you've been having these conversations with.
(47:07) Maybe it's your sister, maybe it's your best friend, maybe it's somebody who keeps telling you she just doesn't feel like herself. You don't need to have the answers for her. You can say, "I heard this and I thought of you." I really want to thank you for spending this time with me today. I'm Tamsen Fadal and I will see you next time on the Tamsen Show.
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Title: The World’s Leading Menopause Experts on Belly Fat, Brain Fog & Hormones
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Menopause and perimenopause can leave you with questions about belly fat, brain fog, sleep problems and whether hormone therapy could help. Your jeans fit differently. You’re losing your train of thought. You’re exhausted, but you can’t sleep. Where do you start when so much feels unfamiliar?
For World Menopause Month, Tamsen brings eight leading doctors and researchers together in one episode to help you understand what’s changing and what deserves attention. These are the conversations she wishes she’d heard before she was struggling to read the teleprompter at work, leaving herself notes and wondering why she didn’t feel like herself.
You’ll hear from Dr. Sharon Malone, Dr. Lisa Mosconi, Dr. Shelby Harris, Dr. Rocio Salas-Whalen, Dr. Vonda Wright, Dr. Kelly Casperson, Dr. Avrum Bluming and Dr. Suzanne Gilberg-Lenz. Eight experts, different perspectives and answers you can come back to—all in one place.
Inside the episode:
Why you can still have periods and be in perimenopause—and why a single hormone blood test may be misleading
Whether menopause brain fog can improve, and why women’s experiences vary
Why more time in bed may not mean better sleep, and how cognitive behavioral therapy for insomnia (CBT-I) works
The difference between visible belly fat and visceral fat around your organs
Why bone health needs attention earlier than you might think
How menopause can affect sexual anatomy, arousal and orgasm
What to understand about hormone replacement therapy (HRT) and breast cancer risk
How to evaluate menopause supplements and “hormone balance” claims before spending your money
You don’t have to remember everything or make eight changes tomorrow. Start with the moment that makes you think, “Wait, that’s happening to me.” Write down your question and bring it to your next appointment.
If a woman in your life keeps telling you she doesn’t feel like herself, share this episode with her. And if these conversations have helped you, follow The Tamsen Show and leave a rating and review.
This episode provides general education. Speak with a qualified healthcare professional about your symptoms and treatment decisions.
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What We Talk About:
0:00 Intro
05:11 Perimenopause Symptoms Can Start While You’re Still Getting Your Period
09:51 Menopause Brain Fog: Can Your Memory and Focus Come Back?
15:24 How to Treat Menopause Insomnia and Finally Sleep Better
21:37 Belly Fat After 40: Visceral Fat vs. Subcutaneous Fat
25:59 Bone Health After 30: How to Prevent Osteoporosis in Midlife
30:30 How Menopause Changes Your Vaginal Anatomy and Sexual Pleasure
35:17 Does Hormone Therapy Increase Breast Cancer Risk?
41:19 How to Choose Safe Menopause Supplements
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Medical Disclaimer:
The information provided in this podcast is for educational and informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional regarding any medical concerns or treatment options. The views expressed by guests are their own and do not necessarily reflect those of The Tamsen Show.
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Transcript:
(00:00) Hi friends, this is the Tamson show and I'm Tamson Fidel. I have spent my career asking questions and this is where I ask the ones women need answered now. Every week I get to sit down with experts and people who have lived through the moments that change us. That's where today's conversation begins. If you're trying to figure out why you can't sleep, why your body feels different, or why you keep losing your train of thought, I want you to try to stay with me today.
(00:24) All year on the Tamson show, I have been sitting down with leading doctors and researchers asking the questions women send me every day about menopause. And for World Menopause Month, I'm bringing some of their most important answers together for one full episode. We're talking eight experts, the conversations that surprised me the most, and information I wish I'd had years ago before I was trying to figure it all out for myself.
(00:48) Because I know you don't necessarily have time to listen to eight different interviews, especially when you're tired, when your brain is foggy, and you're already getting a different piece of advice every time you open your phone. So I wanted to make this easy. I've pulled out the parts I most want you to hear, and we're going to go through them together one conversation at a time.
(01:05) So when I started going through menopause, I didn't know that's what was even happening. I couldn't read the teleprompter at work. I would lose words. I would lose my train of thought. I couldn't remember names. Things I had done comfortably for decades suddenly started making me nervous. I started putting notes literally on my computer because I was afraid I would forget something.
(01:27) I wasn't sleeping the way I used to and my confidence was crap because I couldn't explain why I felt so different. I'd spent a career as a journalist asking questions for other people and now I needed to ask them for myself. Why couldn't I think clearly? What was happening to my body? And who was going to help me with all of this? The more answers I found, the more I wanted other women to have them too.
(01:49) That journey led me to write this book, How to Menopause. This is the book I wish I'd had when I was awake in the middle of the night wondering what was wrong with me. By the way, it's on sale now. I actually put a link in the description if you'd like a copy. Those questions are a big reason I keep bringing these doctors onto the Tamson show each week because writing a book about menopause doesn't mean I've stopped having things happen in my own body that I don't understand.
(02:13) Sometimes I'm sitting in this chair asking your questions. Sometimes I'm asking mine. And a lot of the time I'm stopping somewhere halfway through an answer saying, "Wait, explain that to me again cuz I just didn't know it." I love the fact I get to sit across from people who have spent decades studying this and asking them everything that we want to know and then help bring it back to you, especially when they explain something that helps make sense of what we're going through.
(02:37) So, first of all today, you're going to hear from OB/GYN Dr. Sharon Malone about why you can still be getting your period and already be in perimenopause. That's one misunderstanding that keeps so many women from even considering what could be happening. Then neuroscientist Dr. Lisa Mosconi is going to talk about our brains. She is brilliant.
(02:56) I told her I'd started feeling sharper again recently and some of my confidence and memory were coming back and then asked, "Is this real? Like could this really be happening?" If brain fog has scared you, I really want you to hear that conversation. Sleep psychologist Dr. Shelby Harris is going to explain why spending more time in bed might not be helping you sleep and I had questions about that one, believe me.
(03:18) We're also going to hear from endocrinologist Dr. Rocio Salas-Whalen. She's going to explain the difference between the belly fat that we see and then the fat around our organs. And then orthopedic surgeon Dr. Vonda Wright explains why our bones need attention much earlier than any of us even thought. Urologist Kelly Casper is going to take us through changes to our sexual anatomy that I certainly was not taught growing up.
(03:42) These are the things that women deserve to understand before they're experiencing them and wondering what's going on. Oncologist Dr. Avrum Bluming is a the of Estrogen Matters. He helps us look more closely at hormone therapy and breast cancer fears. Having lost my own mother to breast cancer, I brought my own fears into that conversation, and I know how personal those decisions are, so I don't take them lightly. And details really matter.
(04:08) An OB/GYN, Dr. Suzanne Gilberg-Lenz, who also practices integrative medicine. I love her. She helps make sense of the supplement aisle. When a bottle says hormone balance, what are we actually buying? What do you look for? And what are the questions that are worth asking before we spend so much money on supplements? These are some of the moments from The Tamson Show that made me think, "We need to make sure more women hear this.
(04:32) " So, that's what we're doing today. You don't have to remember every term or make eight changes starting tomorrow. I want you to understand more about your body, know what deserves attention, and have better questions to bring into your next appointment. And by the way, if you hear something you want to come back to, this whole episode is here for you.
(04:49) Before we start, if these conversations have helped you, make sure to subscribe to The Tamson Show podcast right here on YouTube. I want to keep bringing you the experts and answers you have been looking for. Let's start with Dr. Sharon Malone today because if you've been thinking, "I'm still getting my period, so this cannot be perimenopause," this first conversation is something you need to hear.
(05:08) >> [music] >> So, if someone says, "Okay, I'm starting to experience something. I don't know what it is. I'm early 40s. Most likely, without a blood test, is that right? You could tell somebody pretty certain you're probably starting in perimenopause. Can you define perimenopause, menopause? >> I think perimenopause is the most confusing of these stages because perimenopause just simply means around the menopause.
(05:38) And it is also called the menopausal transition where you go from your peak fertility years to no fertility, and it's that gap in between. And for most women, that can last anywhere from 4 to 10 years. If you're African-American woman, your symptoms and that period last more closer to 10 years than 4. Um it is characterized by a lot of things, but the one thing that it is not characterized by is a lack of periods.
(06:07) And we think of menopause as being, "Okay, that's when my period stops, right?" Well, in perimenopause, you may be getting your period regularly. It may be different. It may be heavier. It may be lighter. They may be closer together, further apart. That's sort of the first signal that there's really something going on is there changes in irregularity.
(06:28) And if you don't understand that the presence or absence of bleeding is not a defining feature of perimenopause, then you'll think, "Oh, it's not it doesn't have anything to do with menopause." But all of those symptoms that we talk about, that we associate with menopause, can start during perimenopause. And the reason why it's not helpful to get blood work during perimenopause is because your hormones during perimenopause are fluctuating.
(06:58) They may be too high one day, too low the next, and it is that sort of erratic hormone production that really produces a lot of the symptoms that women have, particularly the brain fog, the irritability. Imagine, it's like having PMS every day. Um that is sort of what perimenopause is like. And for a woman to come in with all those any combination of the symptoms that we talked about, but you're still getting regular periods, and you go see your doctor, and you're like, "What is wrong with me?" And your doctor says, "Well, when was your last
(07:28) period?" If that's your first question, and you say, "2 weeks ago." And they've immediately taken anything to do with menopause off the table. That is not correct. And I think that's where there has to be some adjustment with doctors. So, they understand that perimenopause and menopause are different things, and they occur at different times.
(07:51) And it's not a blood test, you don't need a sonogram, you don't need a soothsayer, you don't need anyone to tell you You know who decides >> things are now available, it seems, out there in menopause world. >> need a pee on a stick, you don't need to do any of that stuff to tell you if you're perimenopausal. Perimenopause is defined when you say it is, when you are having symptoms.
(08:12) And you are between the ages of 35 and 45. That's sort of typically when perimenopause starts. But because it There's no bright line that signals the beginning of it, that's where I think the confusion is. And I think that there is uh also this misperception that you can't start hormone therapy until you've gone a whole year without a period.
(08:35) Why? >> Why would that be? Because your the hormones are fluctuating. So, can you You can start hormone therapy in perimenopause. >> You can start hormone therapy in menopause. Or and I say or, we get back to you can use low-dose birth control pills, cuz remember I told you birth control pills and hormone therapy are just two, you know, they're sort of different you know, same but different.
(09:01) Um because sometimes you need a low-dose birth control pills because birth control pill because when you are perimenopausal, if you're 42 and having symptoms, the one thing that you are not yet is infertile. So, unless you are actually actively trying for a baby and you need birth control, then a birth control pill will kill two birds with one stone.
(09:23) It'll give you birth control, it'll control symptoms. If your periods are too heavy or too long or too erratic, then a birth control pill may be more appropriate at that particular time. But as you progress through this transition, then yeah, as you get closer to menopause, then sometimes if you if you don't have those other things, then yes, you can use menopausal hormone therapy.
(09:44) >> That's why I wanted to start with Sharon. I was still getting my period. So, menopause, it wasn't even a word on my radar. Meanwhile, though, I was struggling to find words and wondering what was happening in my brain. Dr. Lisa Mosconi is a neuroscientist who studies exactly that. When we sat down, she showed me brain scans from before, during, and then after the menopause transition. It's fascinating.
(10:08) But I also had something I wanted to ask her. I'd started feeling sharper again after starting hormone therapy. I wasn't reaching for my notes as much. Could my brain fog actually be getting better? Here's a piece of the conversation with Dr. Lisa Mosconi. >> [music] >> And so we really see, you know, for people who are listening, we see the pre-menopause scan with a lot of red, a lot of brain energy.
(10:34) Perimenopause >> And in between. >> In between, post-menopause, we see a lot more green and blue, but not as much red, which is a brain energy. Now, does that come back after we are in post-menopause, after we've hit menopause and post-menopause? Because I have to say, when you and I first met, which was a few years ago now, I had really debilitating brain fog to a point that I'd be very nervous.
(10:59) I didn't feel my confidence like it used to be because I didn't have the memorization skills that I used to have. >> Mhm. >> Over [clears throat] the course of the past maybe 6 to 8 months, I felt those coming back. And I And I have really felt them. And I I was like, am I imagining it? Am I just wanting to feel them? But I definitely feel them.
(11:16) I definitely feel that I don't hesitate, right? I don't hesitate when I'm speaking. I don't feel like I need cards. I mean, I I was to a point where I would put notes on the top of my computer because I would be nervous that I would forget something. And so, that's very nice, but is that what happens? Is there a a bounce back after you've been in menopause for a little while? >> You may not be surprised to hear that there isn't a lot of research done on >> Dr.
(11:43) Lisa Mosconi, I'm shocked by this breaking news. >> Yes. So, we are now following our patients over time and the results are not published yet, but what we do find, and this is until peer review allows publication, um we do find at least descriptively that it depends. So, after menopause, there can be different outcomes. For some women, cognition rebounds.
(12:08) In other studies, clinical studies have shown that that after the final menstrual period, there's still the early postmenopausal phase where the brain is kind of settling down, it's trying to adjust. And then for quite a few women, actually, cognition bounces back. That's usually between two and four and maybe six years after the final menstrual period.
(12:30) >> It starts to bounce back to where you were before you went into menopause? >> Sometimes. >> You don't have your 26-year-old brain again, most likely. >> Well, [laughter] at that point, you're also older, right? So, it would be a lot to ask, I think, over and over again. But I think just getting to where you were before you started having the brain [clears throat] fog, more or less, I think it's a good it's a good thing.
(12:52) For many women, it just stabilizes. Doesn't get any worse, but it kind of remains a little bit lower than it used to be. >> Does every woman go through these changes? >> No. No, not necessarily. So, about 62% Between 34 and 62% of women that we have surveyed, not me personally, but the field, uh report cognitive changes, which other scientists have shown, and we have shown too, that they are actually measurable.
(13:20) That you can see that if if we have we have this test, it's called the MoCA, like coffee. >> [laughter] >> Oh, MoCA, I'll remember that. >> Yeah, with a C. Moca is the Montreal Cognitive Assessment, where the scores range from 0 to 30. Most women around age 40 are between 28 and 4 and 30.
(13:41) But also women in their 50s, more or less between 27 and 30. So, if you're a 30, when you're going through menopause, you may end up being a 29 or a 28. And you may then bounce back up to 29. >> Okay. So, >> 30, you know. But the variability is small. However, the two-point drop is the difference between needing notes and not needing them.
(14:03) For most women, cognition may either bounce back or stabilize, but for some women it does not. And that's when we start really talking about Alzheimer's prevention and what we should do to try and either really reduce the risk of Alzheimer's or try to prevent or delay onset and progression. So, there are different strategies depending on each woman.
(14:28) So, there is no specific answer >> Okay. >> after menopause. There's a lot of different factors that come into play and they do need to be assessed thoroughly. And then an individualized plan can be made for all women. But on average, on average, things do tend to get better. >> If you've been wondering whether you're going to ever start feeling sharp again, I hope hearing Dr.
(14:48) Lisa Mosconi explain that cognition can improve or stabilize stays with you. I really needed to hear that as well. The truth is though, it's so hard to even think about any of these things or feel like yourself when you're not sleeping. Sleep can be one of the first things to change and then it touches everything else.
(15:06) I spent years sleeping on my couch because I was flipping over in my bed back and forth and couldn't get to sleep. So, I'd just go out on my couch and lay there. So, when sleep psychologist Dr. Shelby Harris told me that spending more time in bed could actually make it harder to sleep, I needed her to explain. Here's Here's of our conversation.
(15:22) >> [music] >> Okay, so you talk about um CBT-I therapy. Can you explain that that's a specialty and something that you focus on with with people that come to you? >> Yeah, so CBT-I, cognitive behavioral therapy for insomnia, is really it's the gold standard treatment. It's the first-line treatment for insomnia ahead of medication, believe it or not.
(15:47) And that even is important for women in perimenopause and menopause. So, we might sometimes use hormone replacement. We might also use CBT-I. It really does work really well, even for women who are having hot flashes. We don't fully know why it works, but it does help with hot flashes in in a number of women.
(16:03) So, what it is um is it's people often think it's sleep hygiene, it's not. Sleep hygiene is just a tiny piece. So, you start with the sleep hygiene, but then we limit the time in bed. So, a lot of times people are in bed 8-9 hours a night, but they're only sleeping 6 hours. So, I might actually limit that at first.
(16:21) It goes against common sense to help really make them sleepier and increase their sleep drive so that they sleep throughout the night. They might have a quick awakening and go back to sleep. I might have them go to bed later because that might actually help them fall asleep faster, and then we move it earlier once they're falling asleep faster so that they can get more sleep.
(16:37) We also work on what people are doing in the middle of the night. So, are you getting up? Are you laying in bed trying to force sleep to happen? All those sorts of things. Then we work on like the thoughts about sleep, like if I don't sleep I can't function tomorrow. We'll challenge some of that stuff. >> Yeah, let's talk about I would like to go into it.
(16:52) So, if somebody comes and says like listen, I need uh CBT-I and I want I have insomnia or I'm just not able to sleep. Is it possible you can do it for a number of different things? Would you recommend that if you're a woman in perimenopause and just can't sleep? You've tried everything, nothing else is working. >> It's very effective for people who have insomnia.
(17:08) >> Yeah. So, you come in and you adjust you adjust sleep schedule. That's the first thing. >> Yep. Then I will also talk about what they're doing in bed. So, a lot of times people never thought about sleep before, and now it's preoccupied. Like they're preoccupied with it. So, when the night comes, I often hear people say, "I dread the night as it gets closer.
(17:24) " >> Yeah. >> It's so true. >> I I understand that feeling, though. >> so true. So, they might be tired but wired at night. So, they were like, "I'm so exhausted. I just want to get in bed." But they're not sleepy cuz they're not falling asleep. So, I might adjust what they're doing before bed and have them go to bed later so they're not putting as much effort into it.
(17:42) >> So, what would they do instead of panic? >> I don't care. It really doesn't matter. There's no magic thing. It's They can They can watch TV, even, believe it or not. They can do I have a People will say like I'll have them go to bed a few hours later and they're like, "I don't know what to do. I'm so bored.
(17:56) " Is there a drawer you can clean out? >> Wow. Okay. >> Right? It doesn't matter. Just stay up later and maybe unwind a little bit before but not hours before. And so, I'll have them change that. Getting up at the same time every single morning and not compensating for a bad night of sleep is super important.
(18:13) So, we're going to pick a wake time. We're going to pick a way that they can use an alarm clock, not their phone because a lot of people just if use their phone as the alarm clock, they're looking at that in the middle of the night. No. So, we're going to use an alarm clock, maybe. And then, we'll also talk about maybe if they're up in the middle of the night, what are they doing.
(18:29) So, getting out of bed. It really there's no magic answer. It's Some people read. I honestly, if I have a rough night, I get out of bed, if it's really bad, and I go through I collect cookbooks. I go through my cookbook collection. >> You do? What do you do with them? >> I literally just look through them and I earmark things that pretty pictures and things that I want to make in the coming few weeks, months, whatever.
(18:48) It's >> That's your >> Yeah. People laugh at me, but it works for me. >> And then you go back to bed cuz >> I go back to bed, right? >> I think I feel like I could have had my whole house decluttered by now with the amount of sleep that I don't get, but I just lay I lay there and panic. >> Right.
(19:01) But what happens is the less time that you spend in bed and if you restrict that time a little bit with the guidance of someone who or an app or someone who can help you, you fall asleep faster and you stay asleep more in the middle of the night so you don't have to get out of bed as much in the middle of the night. Your brain is just not as active because you're spending less time in bed.
(19:17) >> I got to be honest, I could have used that advice on so many nights. So, if you have been laying there night after night trying to force yourself to sleep, I hope Shelby gave you something new to bring up to your doctor. I love hearing there's actual treatments that can help you through that part of life.
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(20:58) Let's talk about getting dressed. You reach for a pair of jeans you've always worn and suddenly they don't fit anymore. And now you're going through your closet in a panic thinking, "Oh my gosh, what's changed? I'm eating the same. I'm still working out." I've had that conversation with myself more times than I can count.
(21:16) When I sat down with endocrinologist Dr. Rocio Salas-Whalen, she explained that the fat that we can see, and then the fat around our organs, they're totally different. And that really matters when we're talking about our health. Her explanation of what liposuction does and doesn't change really stayed with me as well.
(21:33) Here's a part of that conversation. >> [music] >> I want to go back to fat and inflammation and some of the other dangerous kinds of fat. Um I know you mentioned visceral already. When we talk about fat and we talk about inflammation, can we talk about the difference between those two and how they show up in the body? >> So, we have subcutaneous fat that is basically what's under our skin.
(21:56) Uh so, if somebody has liposuction, what they're going to remove is subcutaneous fat, right? That is not a bad fat. That is not a pro-inflammatory type of fat. Then we have intra-abdominal fat, which is inside of the men that attaches to your internal organs, to your liver, to your gut, to your pancreas.
(22:14) That's what we call the bad fat. >> And what was that one called again? That's >> Visceral fat. >> Visceral fat. Right, right, right, right. Okay. >> this can cause And visceral fat is a pro-inflammatory tissue. So, in that fat tissue, in the adipose tissue, there's cytokines, which are inflammatory cells, right? So, they promote inflammation in your body.
(22:36) This is the fat that can promote different types of cancer because of the constant state of inflammation that the visceral fat is on. Now, if it surrounds your organs, it can lead to in your liver, fatty liver, right? In your gut, in your pancreas, can cause insulin resistance. So, that's the fat that we want to target whenever we're talking about weight loss, we're really targeting visceral fat.
(23:02) That's why somebody, let's say with that overweight and they have high subcutaneous and high visceral fat, if they go with plastic surgery and they have liposuction, it's not going to touch the visceral fat. So, they're still at risk of disease. >> So, they'll have the vanity part might be somewhat happy. >> external part, but the metabolic part is not touched.
(23:20) >> So, how do you target both of those things? Cuz I know there are a couple different ways, I know there's some new ways, and there's a lot to to discuss with it. But, what are some of the ways to start targeting that if you're a woman that whether you're on hormone therapy, I guess or not. >> Yeah, so two easy changes that don't require any medication if we want to talk about and that first is going to be strength training, right? Building muscle.
(23:44) The more muscle you have, the more fat you burn for energy. >> Anywhere in your body, whether you're doing your arms, your legs, anywhere. >> you need to build muscle. Resistance training and then strength training, right? That's one. And the second is your diet. So, increasing protein in your diet is a must and this is for any age, but especially in midlife where we tend to lose more muscle mass, we need to up our protein intake in midlife, right? Also, and I'm talking about lean animal protein or whey protein.
(24:17) Why these two? Because they're complete protein, meaning it has all the amino acids for muscle protein synthesis. >> You give me the whey protein, I put it in my coffee like my creamer now. I mean, that's where I that's literally where I start my day because of you. >> it in. >> And and fiber.
(24:31) I think of you every morning. Every morning with my I'm having coffee [laughter] with you. >> Well, cheers. >> If you've been looking at your body and blaming yourself, I really hope this conversation gives you better questions to ask because you deserve to understand what is changing and what you can do about it. Also, I want to remind you my book How to Menopause is there for you if you want to spend more time with this information cuz I know we're covering a lot today.
(24:54) And here's why I wrote that book because I I sometimes you have got to sit with something, you have to read it again, maybe underline a sentence, and then even bring it into your next appointment to make sure that you're able to talk to your doctor about what's going on. Because I remember trying to explain how I felt myself when I didn't understand it.
(25:12) And it is so hard to ask for help when you don't even know what the hell to ask for. That's the woman that I was thinking about when I wrote this book, How to Menopause. And if that's where you are right now, I want you to have the information I wish I had had. It is on sale now, and the link is in the description to help you out.
(25:27) So, this next part is something I wish I'd understood sooner. How much we need to pay attention to our bones, which is something I never thought about. I just thought like, "Uh, maybe I should be careful not to break my bones." But, we notice when our jeans fit differently, bone loss is much easier to miss. Orthopedic surgeon Dr.
(25:44) Vonda Wright explains what our mothers and our grandmothers' experiences can tell us about our own risk when it comes to bone health, and why we should not wait until we break something to have that conversation. >> [music] >> If we have a woman who's in her 30s right now listening, is she in an incredible place to be >> god.
(26:06) >> building >> Ideally. So, it is estimated that we reach peak bone mass, the most bone we're going to build, between uh 15 and 25. Extends up to 30. So, I personally think that we should all be getting some kind of bone measurement, whether it's a DEXA scan or an ultrasound, REM scan for bone quality as a baseline then.
(26:28) Because I kid you not, every woman coming into my orthopedic office, no matter what her age, gets a DEXA scan. And I have 20-year-olds and 24-year-olds and 30-year-olds who come in with poor bone density, and they don't even know it. And they've never built enough bone as a young woman. If you carry that, you just assume you're fine, you're young.
(26:49) But, if you come in with low bone density, and we and it levels off, declines about 1% a year like a man, until you reach perimenopause. Within this 5 to 7 years of perimenopause, you're going to lose 15 to 20% of your bone density because of the mismatch that comes when we don't have estrogen. OMG. >> So, what do we do? What do we Where do we >> We help.
(27:12) >> Help. [laughter] >> When we're Let's say we're Let's talk to the young millennials right now. You want to do that? >> because I feel like Yes, I need you to talk to them. I need you to talk to them because they're important because you have four daughters who are millennials, but you hit your peak bone mass by the age of 30.
(27:32) >> 30. >> Yes. It doesn't mean it's too late, though, right? >> mean it's too late. There's never an age when we cannot build bone density, but you want to start from the highest level so that as we have the natural decline, we're not declining from osteopenia, we're declining from amazing bone density, right? So, what do I want 30-year-olds to do? I want you to look at your mother or your grandmother.
(27:57) Are they shrinking? >> What does that mean? >> That means that they have enough osteoporosis that their vertebrae are collapsing. So, if your mama used to be 5'6" and now she's 5'3", she's lost 3 in of bone height, probably due to osteoporosis because part of bone health is genetic. >> Mhm. >> So, the first thing a young woman can do is look at her female relatives.
(28:22) What happened to them? Do you have a grandmother who broke her hip? If you're 30, but you had a fracture, you fell off the the curb, or you fell and broke your wrist, fracture after 20 pre- predicts future fracture. >> It does No matter how it happened? >> Oh, yeah. Unless you wrap your car around a tree. Hi. But, lower impact, like falling from a standing position, falling off the curb, your dog pulls you down, break a bone.
(28:49) After 20, that's a predictor. >> Why is that a predictor? Because you have a low bone density? >> Yeah, because even low energy situations are enough um force to break your bone. >> Wow. >> Yeah. >> So, if you see that your mother or your aunt or your grandmother is shrinking or somebody broke um a bone, what does that tell you? That tells you that genetically you need to be paying attention.
(29:10) >> There can be a pre- a genetic predisposition because sometimes bone density has a component in that. So, we can't ignore that shrinking going on. >> Yes. >> It's one of the risk factors. >> to shrink. I'm 5'3" and 1/2. I don't know what I'm going to do. I don't know. I'm going to need a booster seat for this table.
(29:25) >> So, it's one of the risk factors that your doctor can use to get you a bone density early. >> What I'm so glad Dr. Vonda said is that it's not too late to build bones because you hear that you've reached your peak of bone mass by 30 and you're thinking like, "Great. What am I supposed to do now?" There are things that you can do now, and knowing your own risk is a great place to get started.
(29:46) Okay, so I'm sure you're wondering, let's talk about sex because that is a big thing that changes during this time. If it hurts when you have sex, if things feel different, if you've looked down there and gone, um has something changed? This is a conversation that I think is really going to resonate. When Dr.
(30:05) Kelly Casperson told me that parts of our anatomy can actually change as we lose hormones, I was blown away. I had no idea what changes, why, and what to do about it because nobody ever talked to me about it. Dr. Kelly Casperson is a urologist, and one of the things I love about talking to her is that I can literally ask her anything.
(30:25) There are no awkward questions when it comes to Dr. Kelly. >> [music] >> Well, I mean, it all boils down to we did not get a good sex education. And when you have a gap of knowledge, what do you do? You try to fill it in, right? Fill in the knowledge. Where are we filling this in from? We're filling it in from country music, Hollywood, religion, our parents, our first romance, all shitty ways of getting sex education, right? Um you know, possibly a disease and pregnancy prevention plan when you were in eighth grade that mostly made you afraid of it
(31:01) and taught you about ovaries. Although it didn't teach you that ovaries make testosterone. Um I mean, where was the clitoris and the labia in any sort of sex education? Pleasure, right? Why do people have sex? It feels freaking good. And you're not taught that? >> Right? We're not taught anything about our bodies.
(31:19) I mean, most of us >> never looked at our bodies, right? >> The biggest show If you want a reaction on Instagram with hormones, you tell women that their labia minora goes away. And it's like you're tell like to be a again, not not to say that sex is extra, but it's like, "Dude, also osteoporosis, heart disease, dementia, like all these bad medical things.
(31:36) " They're like, "But the labia minora." Like, "Dude, women care." >> Explain what that is. Explain what the labia minora is and and why it goes away. And how to stop it from going away. >> Yeah, exactly. Labia minora is the inner lips, so non-hair-bearing genitalia. So, the the area with hair, that's labia majora. On the inside before you enter the vagina are these little I I hate the word flaps, but they're pieces of tissue and that's labia minora.
(32:03) And they're incredibly responsive to hormones. They're there because you went through puberty and you had huge surges of testosterone and estrogen. Perimenopause, birth control, postmenopause, these hormones are blocked in the pelvis, and so the hormone-responsive tissues can resorb, go away, atrophy, whatever horrific words you want to use.
(32:26) But many women they'll say it's just it takes a lot longer to get turned on, to get aroused. Um the clitoris has some skin that goes over it, kind of like a turtleneck. Um that can become kind of stuck to the clitoris, and we call it phimosis or adhesions, making orgasm a lot more challenging, right? And to be fair, women are not examined.
(32:48) Like, they come in complaining of this, they're told, "Oh, everything looks normal down there." And or they're just like, "Drink a glass of wine." And like, there are anatomic, biologic things that happen when hormones leave the body. We must get an education about this because every time women freak out about their labia minora on Instagram, I'm like, we didn't get a good sex ed.
(33:08) >> Mhm. >> And what does the labia minora do? Number one, there's nerve endings, uh erectile tissue, incredibly responsive for arousal. It's how you we feel pleasure. Also, it's protective to the inner workings of the urethra. Helps it prevent it from having microtrauma. Maybe it helps recurrent UTIs.
(33:26) It's just a protective structure as well. So, sexual and protective goes away. The second The next question is, can it come back with hormones? Probably. There's no studies on this. You think anybody's You think the NIH is researching like getting your labia minora back after you weren't on hormones for a while? >> I mean, we got so many other things to focus on.
(33:47) I I that's probably the last thing on the list right now, right? >> extra, right? >> It's extra. >> Women really do care about it. >> Of course. >> Uh you know, that's why the people like me, the female urologists who care a lot about GSM, we're like, "Why don't we just be starting vaginal estrogen around age 50 so we don't have to play catch-up once you've suffer suffered enough?" >> If Kelly just told you something that you've never heard before, ask about it at your next appointment.
(34:12) Even if you have to pull up this episode and say, "Hey, can we talk about this?" You should be able to have that conversation with your doctor. So, I told you we're going to cover a lot of topics. This is a conversation that comes up a lot when hormones come up. Some of you immediately think about breast cancer. I did, too.
(34:29) I lost my mother to breast cancer. So, when I was considering hormone therapy, that fear for me was very, very real. And I needed someone to take my questions seriously and then walk me through the research. Dr. Avrum Bluming is that person, an oncologist and co-author of Estrogen Matters. And so many of the doctors that I've interviewed told me how much they've learned from all of his work over the years.
(34:52) Every time I sit down with him, I feel like I learn something new. In this part of our conversation, he explains why we need to be specific about which hormone treatment we're talking about when we discuss breast cancer risk. If this is something you have been afraid to consider, I want you to hear the explanation and then maybe bring your own questions to your doctor.
(35:12) Here's Dr. Avrum Bluming. >> [music] >> We have to separate hormone therapy, also called hormone replacement therapy, now called menopausal hormone therapy. >> Yes, all the same. >> Is made up largely of two drugs, and we're not going to be talking about testosterone, because that's a different subject.
(35:37) Estrogen is the backbone of menopausal hormone therapy. Most of the very good results that we'll talk about are due to estrogen. The problem with estrogen is estrogen does increase the risk of uterine cancer if it's given alone. And that caused a drop in the use of estrogen until it was found that if progestogen is given together with estrogen, that increased risk is eliminated.
(36:06) So, women who still have a uterus get both drugs. Women who don't usually get estrogen alone. And in 1997, there was a consensus development conference that said that from the National Institutes of Health, that said estrogen doesn't increase the risk of breast cancer. We now know from the Women's Health Initiative, which I don't quote positively too often, that women randomized to estrogen alone in this largest prospective randomized trial ever done in this country, have a 23% reduced risk of developing breast cancer, and even
(36:47) more importantly, a 40% reduced risk of death from breast cancer. >> So, let's go back to that again because I think it's really important. A lot of people that are listening, you know, we're going to go into the 2002 study. But, at the end of the day, when we talk about a woman, I'm 55 years old, I take hormone therapy, my mom had breast cancer, I was afraid of it at first, you know, just like so many other women are.
(37:10) And then I learned what what I know now. If a woman is taking hormone therapy, and she doesn't have a lot of the contraindications that but we we can talk about how is it going to help her? Can you repeat those numbers again? >> Sure. Uh, we know that heart disease kills seven times as many women as breast cancer.
(37:31) And what women usually say when I say that is, "Well, old women die of heart disease, and young women die of breast cancer, and I'd rather die when I'm old than die when I'm young." That's not true. In every decade of a woman's life, starting at age 40, her risk of dying of heart disease is greater than her risk of dying of breast cancer, and that difference widens with every successive generation.
(37:59) So, if you look at women from age 40 and compare them overall to the ones who die finally by 80, seven times as many women die of heart disease as die of breast cancer. >> Why are we so much more afraid of breast cancer than heart disease? >> Because the word cancer is a red flag. We're frightened of cancer. And bad news spreads very quickly.
(38:21) >> Dr. Blooming, you're a leading oncologist. You spent decades studying breast cancer, wrote the book other doctors turn to on estrogen. Your own wife had breast cancer, your sister-in-law had breast cancer. So, I want to ask you this, does hormone therapy cause breast cancer? Yes or no? >> Not according to my current knowledge base.
(38:41) >> Why are women so afraid of it? >> Cancer is a frightening word. Breasts help define femininity. Um we sell clothing uh accentuating breasts. The idea of strapping the chest so that all women look flat-chested, that went out more than a hundred years ago. >> What do you think would happen if every woman on this planet went on hormone therapy? >> [laughter] >> I I'd love to see it, uh but I have no idea.
(39:17) Um that's not really true. Uh we know that uh 40% of the British health force uh the women in the British health force are retiring early because of symptomatic menopause. What an incredible loss that is. As a woman is just reaching the peak of her performance ability, she's finally no longer taking care of her parents, the kids are getting old enough that they are more self-sufficient, her husband isn't yet senile requiring that she care for him.
(39:58) That's when she gets hit with menopausal symptoms and her productivity is curtailed. What a loss. >> So true. Oh, so true. How does it make you feel when you hear there are still doctors shutting down the conversation about hormone therapy? >> Sad. And motivated to make a difference. >> Well, you are, sir. >> I'm doing the best I can.
(40:22) >> I know that conversation with Dr. Blooming is going to bring up a lot of questions for a lot of you. And I know some of you are thinking, but what about me? I can't take hormones, or maybe you don't want to. Maybe you've already started taking them and still have symptoms that you need help with. I want to make sure that we're talking to you as well.
(40:39) Another big conversation, supplements. You deserve to understand your options. And when you start looking, there are so many supplements that are being sold for sleep, for brain fog, for hot flashes, for all of them together. It's easy to spend a lot of money hoping something's going to help. My friend, Dr.
(40:57) Suzanne Gilberg-Lenz, is an OB/GYN who also practices integrative medicine. We sat down to talk about options beyond hormone therapy. This part of our conversation is about supplements specifically. What those labels actually tell you, what you should look for, and why it matters about talking to your doctor about what you're taking. Here's Dr. Suzanne.
(41:17) >> [music] >> Are most of most of these are capsules or something you can get in a health food store? >> But I So, let's actually, before we even have this conversation, let's start with the basics. >> Yeah. >> The health food store is okay. What you want to do is you want to look for third-party testing in any of these medications. They're medications.
(41:40) >> Mhm. >> So, you also want to talk with your physician because some of them can interact with other medications that you're taking. >> Okay. >> A lot of them will use liver enzymes to just like all your meds. So, the thing is, if you're inducing liver enzyme activity, you may be metabolizing other medications faster or differently.
(42:01) So, third-party testing is really, really, really important if you're buying it at a store or you're buying it online. And if it's not obvious that it is third-party tested, then you that's not your brand. >> I'm probably going to ask a dumb question to you, but what is it How do you know if it's third-party tested? >> They have labels on there.
(42:19) They'll Any any good supplement company will make that very clear. Because now we're getting it This is important stuff. So, medications are approved by the FDA, right? You know this. The company the pharmaceutical company has to do all sorts of testing, meet very specific criteria, show that it is effective for the use that they are trying to prove that it's useful for and that it is safe, okay? And then they continue to do post-market surveillance, right? Once it's out on the market, are there any reports or we're seeing any
(42:50) signals that are negative? >> [snorts] >> The supplement world is regulated as food. It is not pre-market tested. So, you can bring something to the market. You can't make specific claims like you would with the FDA because the FDA would have to approve that you >> [clears throat] >> that you met the criteria to make those claims.
(43:12) So, that's why you see things like hormone balance. What is that? It's not a thing. >> So, if you see hormone balance, so do >> You can't say that it is decreasing vasomotor symptoms. You can't actually say that because you didn't prove it. >> You have to know and you have to do your research on this, right? Or you have to And then you have to listen to Dr.
(43:29) Suzanne. >> What do they rely on? Post-market >> Sure. >> reports. >> Okay. >> So, that's why when there's third-party testing involved, there are several labs that go in, they test them at the the I mean, it is a medication, but they test the botanical, let's say. They say, "Okay, yes, it is what they said it is.
(43:45) " That that's it. So, it's not that they're not regulated, but they are definitely not regulated at the same level, which is why having that extra literal seal of approval is very important. >> So, if you're going to wherever you're going to get your supplements, online, health food store, the website that they are whatever it is, third-party testing is the first and foremost what you need to look for.
(44:04) >> Yeah, definitely. >> And then, be aware of what these things do because the label might not always be super clear. >> Exactly. And they also do a lot of things called like proprietary blends, which means they blended a whole bunch of stuff and it's proprietary to them. They're not telling you how much of X, Y, and Z is in there.
(44:21) >> Should you stay away from that? >> I would because it's not so necessarily that it's dangerous. I mean, but it may not be doing much of anything. >> It might not It might not even have a It might be wasting your money. >> If you're a woman that is miserable with hot flashes and hormone therapy is the only thing you keep hearing about over and over, what can you do in the botanical sense to help with hot flashes? >> Yeah, I think the top ones would be black cohosh.
(44:43) >> Um okay, so black cohosh. You're you're dealing with hot flashes. About how long cuz this you want to like work pretty quickly and you need 6 weeks. >> I would say no, it's a little faster acting, 2 to 4 weeks for maybe a you know, 30 to 50% reduction in your hot flashes. It's probably not going to make them go all away completely, but early on maybe early in perimenopause with earlier hot flashes, maybe it will be more beneficial.
(45:06) The other one that I really like is something called Siberian rhubarb and there's a very specific formulation. I think it's ERR 731. Um so this matters too. Like what is the formula? Um and that also is fantastic for hot flashes. >> That's great to know though because these are These are the areas that I mean just there's very little conversation if not If 100% of menopause conversation, is it 10% even that we really don't talk about this? >> No.
(45:34) >> I am so glad Dr. Suzanne Gilberg-Lenz explained what to look for because when you just want to feel better, it is so easy to just buy whatever seems like it's going to work. Whatever you decide about hormones, you're still going to have questions about what else might help and you deserve information more than a promise on the front of a bottle.
(45:53) So I know we covered a lot today. If there was one moment where you're like, wait a minute, that is happening to me, start there. Write it down. Bring it to your doctor. You don't have to remember everything that these eight experts said or try to figure out this next chapter on your own. But when I think back to how confused I was at the beginning of my menopause journey, I wish I could have heard these conversations, any of them.
(46:15) I wish I'd known what to ask about before I spent so much time wondering why I couldn't get it together. That's why I really love bringing these conversations and these people to you. I still have questions myself. I still learn everything every time I sit down with somebody in that chair. And I also get to ask the follow-up.
(46:32) The wait, what does that mean? Question. Because I know you're probably wondering the same thing I am. If you want to hear more from any of these guests today, we're going to link their full conversations in the description. My book Had a Menopause is also there. If you'd like something you can read at your own pace and come back to.
(46:51) I'd love to know what surprised you today. What did you hear today? What questions do you still have? Please leave a comment if you're watching on YouTube. And if you're listening, I would be grateful if you'd rate and review the Tamsen Show. For World Menopause Month, if you could do me a favor, send this episode to one woman that you've been having these conversations with.
(47:07) Maybe it's your sister, maybe it's your best friend, maybe it's somebody who keeps telling you she just doesn't feel like herself. You don't need to have the answers for her. You can say, "I heard this and I thought of you." I really want to thank you for spending this time with me today. I'm Tamsen Fadal and I will see you next time on the Tamsen Show.
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