A (4:54)

I'm so excited to be here. Thanks so much.

B (4:57)

Me 2 I am thrilled that you are here because your book the New Rules for Women's Health I think is going to be something that is going to challenge the status quo, which I think was one of the original intentions of the book. But let's actually dive right in. I'll ask you kind of a big question and then we can start to narrow it down. What is Broken in women's health today.

A (5:21)

You know, I think one of the things that is. Has been broken, historically broken is, first of all, we really haven't focused on women, right? You know, we've considered women as small men. We haven't studied women in our own right. And I think when we did even start talking about women's health, we focused on what we now call bikini medicine, right? We looked at our gynecologic health, we looked at our breast health, our sexual health. These are all important aspects of our overall health. But we didn't really tuck in to really learn the differences in the female brain from the male brain, in the female heart from the male heart. So, thankfully, we are starting to make tracks on that front, though many of the experts, I'd say all of the experts I interviewed for my book say we have a long way to go.

B (6:07)

And there's a lot of people online, I gotta tell you, that are adamant that there is no difference, that there's no difference between men and women, that this is all just like predatory marketing. I actually saw this yesterday. Someone who just has it in for Stacey Sims, for whatever reason. I'm not sure what the ammo is, but it's like, women are not. Women are. We're exactly the same. And I'm infuriated by that message because, yes, there are some mechanistic ways that we function the same. The heart beats, we depolarize neurons. You know, there's no difference. But certainly like Lisa Moscone's work, which I think you're referring to with the bikini medicine and the brain, the changes in the brain as a woman goes through menopause is very distinct. And there are distinct even just. And I just did a talk on this a couple weekends ago on the different. Even just the biomechanics, right? Just like our Q angle, like, we have different. Our hips are wider. We have a different pelvic basin, we have different carry angles. Like, there's different ways that we move through the world both mechanistically and physically. And to continue this narrative of there's no difference between men and women is insulting and quite frankly, outdated and sexist.

A (7:23)

You know, yes, it is not progressive. We know more now. We just do. Yes, it's. You're. You're naming all the things that we finally are starting to know. Yes, there are some things that aren't, you know, that are the same. But there are so many differences that we once, I think, thought were little nuances that we're now learning are like, oh, wait, A second, maybe the differences in estrogen receptors in the brain is actually an explanation as to why women disproportionately suffer from Alzheimer's by 2/3. I mean, that is not small. You know, women are more likely to have knee problems and need knee replacements. And when we're athletic, we injure our knees more because of that Q angle you just referenced. And so I think it's not only misguided and sexist, but just frankly, wrong and not factual based on what we finally do know about the differences in women's health versus men's health.

B (8:17)

So let's talk about language. In addition to being a lover of languages, many languages, I also think that it's very important to use proper terminology. And in the book, you talk about this idea that. And I'll let you expand on it, that a lot of the body parts that we commonly refer to are named after men. You know, we would never. And this is like my love for Kelly Casperson coming out here. Like, we would never call the vast deferens in a male, like the Casperson tubes or like the Casperson whatever, totally shout out to Kelly there. But tell us about the power of language as it relates to anatomy.

A (8:54)

Yeah, well, I think, as Kelly Casper said, I'm also a fan girl. And, you know, if there is one cool group of medical doctors, it is urologists who are female because, man, they are doing so much for us because they see the differences again between men and women. But anyway, words matter, as Dr. Caspersen says, right? And, you know, I have been a health journalist for going on 25 years now. And when I interviewed a group of mostly female anatomists for my book, I had no idea that there is this group of anatomists who are on a mission to have us stop using collectively using what's called eponyms. So an eponym is an anatomical term named after the usually male, you know, older white male, or as one anatomist said, the pale male and stale, basically, people who laid claim to these body parts years ago. A common that we've all heard of is fallopian tubes. That was actually named after an old Italian priest many, many years ago who. Whose last name was Fallopia. And that's why we call them the fallopian tubes, ladies. And so what this group of anatomists is trying to do is say, wait a second, let's not use the eponyms. Let's use anatomical toponyms, which is the term based on where it is in the body. So instead of using Fallopian tubes, you'd say uterine tubes. And uterine tubes is very specific. You know exactly where they are because they come from the uterus. And the cool thing about it is not only are we working towards a progressive, more, you know, less sexist way of talking about our bodies and our health, but also for medical school students and anyone in the helping professions who has to learn anatomy for their job, it actually decreases cognitive load. So we're actually helping the next generation of people who are helping us by using these terms. So, yeah, pretty powerful.

B (10:47)

When you were saying fallopian tube, like, oh, there's another one. Kegels, right? We talk about Kegels, named after the gynecologist. And I had Sarah Reardon on the show, and we decided that we were going to call them Puss Ups instead.

A (10:58)

That's fantastic. I love that so much. Yes.

B (11:02)

So we can. You can use, like. You can use that. Take that. But Kegels is another example, right? It's like, this is an exercise for. I mean, men and women can do Kegels, right? So it's for the pelvic floor. But again, it's named after. Named after men, like, you know, Piagette's disease. Like, there's so many, like, you know, you can just go on and on and on and on and think about all the scientists who had the. I'm going to say it like. Like hubris to say I'm going to name this disease or this body part after myself, you know, or this process, this exercise, whatever, after myself.

A (11:33)

And what one of the anatomists told me is actually sometimes they didn't even discover, quote, unquote, the body part. They just laid claim to it. And they wanted their name in an anatomy book. And so this is really, you know, a history that we have to do right now and change course, you know, when it comes to words and words matter, I think another important one that I sense we're gonna start using more. And a lot of the menopause specialists I talk to say, you know, hormone replacement therapy, it's fine. But actually, it's not super accurate because in menopause, we're not actually trying to replace hormones to what they once were. We're just giving ourselves a little supplement. And so really, the better term is menopause hormone therapy, or even simply hormone therapy, if you're talking in relation to menopause. And I think that's another small way, you know, small change that I've been making in how I talk about it when I talk to My friends, about menopause hormone therapy. And then it starts a conversation, you know, because I think there's still a lot of women who are a little afraid to use hormone therapy. And I think when they hear the reasoning behind why we're not trying to replace it, actually, you may be getting less likely getting a lot less estrogen in hormone therapy than you did if you ever took the pill. It opens our eyes to say, oh, okay, wait a second. This, this is something I should stay open to.

B (12:52)

I really like that too, because I think whenever you use the term hormone replacement therapy or hrt, most women, at least of our age who would be thinking about it are going to come back to the Women's Health Initiative. Like there's a lot of residue. We'll say with HRT and breast cancer risk and cardiovascular risk and all of the, you know, we'll say the statistical failures of the, you know, the way that, the mathematical and logical fallacies from the who.

A (13:21)

Absolutely. Yeah. And I think the more thankfully we're talking about it more, I think, thanks in large part to a lot of, you know, correct messaging, now we're, we're starting to stay more open to it. But again, words matter. The language we use matters. The language we use, not only about things not related to us, but about our bodies and our health. Right. It leads us to feel when we have the knowledge of our bodies and the language we need to describe what we're feeling, what we're going through that it feels empowering.

B (13:50)

Yeah. And the other, the other piece I would love for you to talk about because I was chuckling because I actually thought this myself for years was the cow clitoris. So talk to us a little bit about, you know, we were talking about like, women are not small men. So talk to us about how women are not cows.

A (14:08)

Yes. So this one blew my mind. I was interviewing an amazing urologist, Dr. Maria Uloko, and she realized that we hadn't. The data we were using to understand nerve fatigue endings in the clitoris was based on research in cows. And because we are not cows, she decided, you know what, it's. And this was just a few years ago. So this, this is not like this happened back in the 90s or, you know, this is, we're talking single digit years. She said, okay, we need to study the, the, the female clitoris, human clitoris, and found out there were twice the nerve endings we thought, and now this is such an important organ, as we all know, ladies, and the fact that it has been, you know, since just far Too late in the game. That we knew how many nerve endings were there is just sad.

B (14:57)

Yeah. Yeah. And it's a really important. So the other thing I want to touch on as it relates to the clitoris is the anatomical homolog. So I think a lot of people think that the clitoris is just this, like, little button that's out that, you know, just sits, you know, in the vulvar area. So talk to us about how this is actually more of an. Of a homologue to the. To the penis than maybe just this little, like, pleasure button.

A (15:22)

Yeah, totally. I think, you know, most women do not know that the clitoris is a structure that. That is way more than what we can see or feel. It actually goes into the. The. The internal part of your body. And. And if you look at a picture of it next to a penis, the similarities are striking.

B (15:42)

It's striking.

A (15:42)

Striking. And there are illustrations in my book to show readers this. And I think what it's. Again, when you see how strikingly similar it is, you think, gosh, like, why. Why do we not also have all kinds of medications to help us with sexual function? And, you know, it's. Again, points to the sexism, this historically sexist nature of. Of, you know, health and. And how much more we need to study and go in order to really make some progress here.

B (16:12)

Yeah. And for my dark rose bettys, these are my. My community members who just, like, want all the details. Like, you go. One of the beautiful things about the book is there's a lot. Lots and lots of pictures because, you know, I remember my sex ed was like, here's a banana, everybody, and here's a condom, and here's how the condom goes on the banana. And like, that was. And then, like, women bleed. You know, here's the menstrual suck. It was a chart. And like, women. And so even just bleeding, even I remember having to hide, like, if I had to go into my locker to get like a pad or something, I would, like, hide it in my pocket or I'd put it in my bag. Like, no one could know that I was on my period. Like, that was like, the most mortifying thing.

A (16:49)

Totally.

B (16:50)

And I think that, Yeah, I mean, I feel like it's so important to have these conversations. So with the clitoris in particular, what's incredible about it is that it has a shaft. So in the same way that we think about, you know, the shaft of a penis, there is a shaft for the. For the clitoris as well. And it has anchors. And it anchors. It's this beautiful structure that I think has just been, you know, overlooked because, as you were saying, sexism, no interest in actually figuring out what is pleasurable for a woman, what the function is of the clitoris, et cetera, et cetera. Yeah.

A (17:24)

There is actually a chart in my book where multiple structures are actually. There's no differentiation in fetuses until a certain point. And so a lot of our sexual organs, there was no differentiation when we were first conceived. And so a lot of them, they change, obviously, but they have the same starting point. So when you think about it that way, it's not so surprising that, oh, the clitoris would be like the. The male penis. But we just aren't taught this to your point. That's not in health class. And that's fascinating information and useful to know, right?

B (17:59)

Yeah, yeah, yeah. Oh, my goodness. All right. Well, that's what the. That's what the point of podcasts like this are, because we want to be talking about the fact that we have a very immediate. Even though it's an internal structure. Right. So we can't see the clitoral shaft, let's say, but it is there. And what that might feel like with arousal and how, you know, what pleasure is for a woman. Because I think that, you know, there's always. There's always the joke, right? Like, there's always jokes about, like, oh, if you can't find the button, then there's so many. Like, there's such a plethora of nerve endings and structure there that there can be a lot of creative ways that we can. That we can help our women feel or at least understand how their bodies work.

A (18:39)

Yes, A hundred percent. And when we know how our bodies work and, you know, when we have doctors who we see who we can trust, who can walk us through some of these things. You know, I. I remembering right now, I interviewed a sexual medicine specialist who said, when I really describe the structure to my patients and I talk about how much stimulation is actually needed in order to have orgasm, a lot of my patients realize, oh, like, that's. I don't actually need a pill or I don't actually need all these things I was gonna ask you about. I think I might just need a little more stimulation. And so I think that's really interesting as well. Again, it points to the more information we have, the more we can understand how our bodies work so that get solutions for our problems.

B (19:24)

I don't know if you'll be able to talk to this, but I'll just throw this out there. As an idea. And then maybe you have some thoughts on it as well. I think that what I hear a lot from my community as well, just building on what you just said is that there's a lot of. How will I frame this? I'll say shame around how long it might take a woman to climax. An orgasm, relative to. If she has a. Assuming she has a male partner or she's with a man, relative to the man. Right. So the male will, let's say, climax in a different, slightly different way or the time to climax is shorter. And I think that there's this. I'm behind. I'm. I got like, we gotta rush. We gotta get there. And again, you know, Kelly, who's. Dr. Caspersen, who's, you know, colleague friend of mine, she's like, why would you wanna rush this? You know, like, would you rush, like, having the best time of your life? Like, would you rush, you know, getting married? Would you rush, you know, think about, like, a dream trip that you've been planning. Like, you would never rush things that give you pleasure. So why is it that women translate that into the bedroom? Like, oh, I have to come as fast as my partner is because, you know, he came in, like, whatever amount of time, so I have to do that too. Or we have to. We have to orgasm together. That's another one that I hear, that we have to climax together. And that's like the. That's the indication somehow of like, an amazing session that we've had together. Yeah.

A (20:45)

You know, I think when I worked on the sexual health chapter of this book, I interviewed a lot of experts in that area. And what's coming to mind right now, something that also really, it wasn't a surprise because I knew the research was there, but it really was eye opening to me. And something I remember, I think for a lot of women, especially in midlife, it's really important to understand the difference between spontaneous desire and responsive desire. And I think that, you know, the expectation bit, right, where it's like, well, I should be able to come as fast as my male partner, or I should be as horny as he is, where, you know, and it's like the shoulder we put on ourselves around this. When really, when you understand spontaneous desires, when you have that, oh, lusty, I have to have you feeling. But responsive desire is just as great. And I interviewed Dr. Emily Nagoski, who is just a fantastic researcher in this area. And what she said is she often thinks. And this comes from a sex therapist that she had interviewed for her one of her books. You know, she thinks of responsive desire as like going to a party on a Friday night. You might not be super excited to go, but, you know, if your friends are gonna be there, you know, you put the dress on, you hire the babysitters, you get in the car. Once you get there, you're probably gonna have fun, right? And so, like, if we can start to think of it like that, like.

B (22:03)

Why don't I do this more often?

A (22:04)

Why? Oh, my gosh, I'm dancing. I'm having so much fun. And so I think maybe, you know, yeah, it's like you finally get there and it's like, all right, let me relax, let me kick back, Let me enjoy this party that I'm now at and drop all of these expectations about what it should look like and just, just lean into what it looks like for you.

B (22:21)

Yeah. So good. So good. I love that. If you've listened to me for any length of time, you know that I am not a fan of aggressive fasting. For most women in midlife, perimenopause and menopause is already a stress test. And piling on long fasts can leave you wired, tired, and frankly, ravenous. But here's the nuance. I do love what fasting pathways can do. They help with cellular cleanup. They help with steadier energy, fewer cravings, and better focus. And that's why I'm into mimeo. It's basically fasting in a pill. Mimeo is a biomimetic formula designed to support your body's natural restorative systems with ingredients that your body naturally elevates during a longer fast. And you can use mimeo in three ways. The first is with food as a fasting mimetic. So this is going to help activate fasting pathways even during a meal and support less inflammation, brain fog, and sluggishness. And frankly, this is how I use it. The second way is during a fast as a fasting enhancer. This will help to support appetite control, energy, mood, and motivation. And finally, you can use it before performance about an hour, wherever you need to be on if it's a big presentation or big meeting for sustained energy flow state and recovery support. If you want the benefits of fasting without the fasting misery, go to mimeohealth.com better and use code esteema. That's my last name at checkout to save 20 20% off of your first order. That's M I M I O health.com better and use code ESTEEMA E S T I M A at checkout. I stand before you a woman corrected I never thought I was a Matcha person. I thought those was exclusively for women who just did Pilates and I swore that cappuccinos were my birthright. And turns out I am both a cappuccino and a matcha girly. Go figure. I absolutely love the Sun Goddess Matcha by Peak and have one pretty much every afternoon around that one two o' clock midday slump time. Peak's Matcha is packed with powerful antioxidants that work to firm and brighten your skin. You know, I'm a skincare girly as well, giving you a healthy natural glow from the inside out. And maybe my favorite thing is the the calmer energy that it gives. I like this as my afternoon drink because I get that smooth, focused lift without the jitters or crash that caffeine sometimes can give you. That I don't want to admit but is totally happening. And it also helps to support your metabolism and fuel your workouts and your lifestyle. Are you ready to gift yourself or someone you love the glow of Sun Goddess Matcha? You can unlock 20% for life Bettys yet for life for yourself and everyone on your Give the gift of glowing health this holiday season and get started@peaklife.com better. That's P I Q U E life.com better. Okay, let's pivot a little bit because we could talk about sex all day long. I do want to talk about women's health risks as it pertains to you mentioned heart and brain. I want to. I would love for you to talk about heart disease as the number one health risk. I know we've talked about this. Maybe not ad nauseam yet, but we've talked about it enough on the show. Women are so scared of breast cancer. So scared it comes like that bikini medicine that we were talking about before. It's like we are worried about our boobs and our butts. So talk to us about heart disease and why women should be focused on preventative measures around cvd around cardiovascular disease. If as much as, if not more than breast cancer risk.

A (26:21)

Yeah. One of the biggest surprises to me when I tucked into the reporting of this book was interviewing a preventive cardiologist who said not only do not enough women know that heart disease is their number one risk of death, but awareness of that fact has actually gone down in recent years. So we really, you know, we are moving backwards unfortunately.

B (26:46)

Another why do you think that is? Sorry to interrupt you, but why do you think that our awareness is going down?

A (26:51)

I Wonder if we aren't talking about it enough. You know, we're not. I don't see articles all the time about that. Whereas in a beautiful way, I do see a ton in my social media feeds online about menopause. And that's great. Right? Look at what it's doing for awareness. Look at how many women we are turning on to very real solutions and really great research and what we need to know about it. I don't think we're doing the same. And I'll speak as a journalist here. I think I, as a journalist and my peers are not talking enough about heart disease in women. In a way that's sticking. And so I think we have some work to do there.

B (27:29)

Yeah.

A (27:29)

I mean, the other big eye opener for me in terms of heart health is I think not enough women know that actually our gynecologic history impacts our risk of heart disease later on. So pregnancy complications is huge. A lot of women think I had pregnancy complications, a complication, and then it went away after I gave birth, so I don't have to think about this. Whereas, actually, that part of your health history should be brought up with every doctor you see and can really influence how your doctors in the future take care of your heart and do preventive things.

B (27:59)

Are we talking about GD here? Like gestational diabetes? Is that what you're referring to?

A (28:03)

Preeclampsia. You know, really, any kind of pregnancy complications. You should talk to a doctor about that. You had this complication. It went away after you gave birth. And that's because, you know, many people think of pregnancy as the body's first. The heart's first stress test. You know, it is really hard work to be pregnant. And if you had a complication that could indicate that something went a little awry in your system, it's not like it's a, you know, sentence to something terrible happening with your heart. It's just knowing this can help you bring it up with your doctor.

B (28:37)

It's a risk. Just knowing it's a risk factor. Right. And then did your mom have breast cancer? If so, that puts you at a high. It's not guaranteed, but it puts you at a higher risk of breast cancer yourself. It's the same kind of.

A (28:47)

Bingo.

B (28:47)

Yeah. Thinking. Yeah, okay.

A (28:49)

Bingo. And, you know, if we know this, then we can bring it up. But I think, unfortunately, not enough women know this as a risk factor. We are, as you said, focused on breast cancer, and we're terrified of colon cancer now, which is happening in younger and younger people. And you know, all these other cancers, which we should be concerned about. We should be getting our screenings for those cancers, but we have to think about our heart health as well.

B (29:09)

Well, yeah, And I would also. I would probably throw into the hat there, like, night sweats, hot flashes.

A (29:16)

Right.

B (29:16)

So this is also, I would say, as a risk and coming back to the clitoris, because I can always do that. I would also say changes in your ability to climax. Right. Like, the clitoral artery is. You know, when we look at men, Ed, like, erectile dysfunction is one of the early signs of cardiovascular. It's an early warning. It's like the. In the canary in the coal mine. I would say that the clitoral artery, or your inability to climax as easily as you once did. I would also be discussing that, of course, with a doctor that, you know, like, and trust. But that is also something for you to be thinking about, too.

A (29:49)

Absolutely. And. And again, points to this, you know, the importance of being with a doctor, having feeling like you are in care with a doctor, in communication with a healthcare provider who you can talk to about these things. Right. They've heard everything. What every doctor I interviewed for my book said to me is, like, you can't say anything that's gonna make us blush or that's gonna shock us.

B (30:12)

They don't care that your toenails aren't done, you know?

A (30:14)

No, they don't.

B (30:15)

They don't care that your legs are not shaved.

A (30:17)

No.

B (30:17)

Like, they just want to go in and see what's going on. Yeah.

A (30:19)

Yeah, totally. And they've seen it all. And so talk about these things, even if you feel a little ashamed. And maybe especially if you feel a little ashamed. Right. Because this way, they won't fly under the radar.

B (30:30)

Yeah. I remember talking to a bunch of women a while ago, and the question I posed was, how many of you have used a hand mirror just to look at your vulva? Like, just to look at how the external genitalia. It was, like, one person in the room, and maybe there was. I don't know, there's, like, maybe 50 women that we were having a discussion with.

A (30:54)

Yeah.

B (30:55)

It, like, broke my heart. I'm like, y' all need to get a hand mirror. Like, all your makeup comes with, like, a little mirror mirror, perfect for your eyeshadow and your blush. Like, just, like. Just go in the bathroom and have a look. What does she look like?

A (31:06)

Totally. Totally. Yeah.

B (31:09)

Okay. So I always bring it back to, like, I probably should have been an ob GYN in another life, but. Okay, so let's, let's talk about autoimmune disorders. Another disease category that I would say unilaterally affects women I see especially in midlife. This is often when we often get the diagnosis of Hashimoto's thyroiditis, multiple sclerosis, rheumatoid arthritis, and on and on and on. What is happening either at that sort of menopausal like that perimenopausal, menopausal transition and what is it, do we know or do we have an inkling of understanding around why women are so disproportionately affected with autoimmune disease?

A (31:50)

Yeah, I mean this is a big area where we have some ideas. But again, every expert I spoke to said we need more research, we should have more answers. You know, we really have failed women in the fact that we don't have more, more specifics right now, which is really unfortunate. What I know, and I feel like, Dr. Stephanie, you could speak to this as well is, you know, in more detail. But what I know about it is hormones play a huge role and that menopause hormone transition, where you know, you are, you're declining estrogen, it impacts so many systems of the body. And the more again we know about the potentials diseases that the this changing hormone state can cause, the more we can stay alert to symptoms. But my understanding is that dip in estrogen really can mess with the immune system in a way that can make some of these autoimmune diseases become more prevalent or surface.

B (32:46)

Yeah, yeah, I think it's a perfect. Again, I think there's massive research gaps. I don't think we have the answer to it. I agree completely with the estrogen drop. I also think that there's something with central tolerance in the immune system and rising and cortisol. So cortisol is one of the ways that we keep our, you know, immune system in check. It rises in the morning, kind of go, you know, we have this car response which is cortisol awareness or I should say awakening response. It's like high in the morning and then it should kind of peter off as the day goes on. And I think as our like midlife is a really, for a lot of women, it's busy, it's full, it's stressful. It's sort of becoming the time now where we start seeing our parents health failing, which is incredibly stressful, incredibly traumatic. And then we're raising teenagers or children at whatever age because a lot of women in perimenopause are having children later in life. So there's just. And then your career, you're usually at the peak of your career. Like it's so. There's so much, there's so much in this time. And I think that that affects our, are like, we're so exquisitely sensitive to stress. And so when our sympathetic drive is like, when we are always in that drive, like that sympathetic state, I think that that can start to affect central tolerance, which is this concept that we talk about in the immune system where like cortisol is basically like every morning is like just looking at all the cells, like, yep, you're good to go, you're good to go, you're good to go. And so when stress is too high or too low, that central tolerance starts to get a bit messed up. So, so cells that are autoimmune, like attacking, like self attacking or self eating, I guess, get through, like they kind of pass through the, the gate that they shouldn't be able to get through. So I think that there's something there as well. But again, research, you know, that's. We still need to do so much more work. Totally.

A (34:38)

You know, you're reminding me. Another theory that, that comes up often when you interview experts in the immune system is differences in the female immune system, which we know. Right. Because of pregnancy. Right. Our immune system has to be different because it can this the fetus. Right. Which has pieces of DNA that are totally foreign from the sperm. And so I feel like that has to play a role as well. Right. And we, you know, again, I think we've got people working for specific answers for us. Until we have all of that research to really guide us, we have to stay aware of our symptoms. We have to know that in midlife these things can happen. Stress can ratchet up, up, you know, and then stay really clued into symptoms so that we're talking to our doctors about what's happening so that we, we try to get a diagnosis on the earlier side. Because that's the other thing is that, you know, especially autoimmune diseases, multiple other conditions, it takes women so long to get a diagnosis. It takes us a long time to be believed. In some ways. We get a lot of doctors saying, I don't know what's wrong with you? And then we don't get answers, and that's not good.

B (35:46)

I think the other big theme here, maybe one of the big themes from your book is that women will accept a staggering amount of suffering. So that could be in the form of autoimmune disease. It could be in the form of heart disease. It could be in the form of having menstrual pain. I mean, this is such a big thing. And there's big differences even in, unfortunately, how some physicians will treat black women versus white women, how we will assume that a black woman be able to have a higher tolerance, let's say, for pain. And we see this in the maternal wards. And I just watched an upsetting video the other day about a woman who. She's a black woman. She was like, just begging for a bed, and she ended up giving birth like 12 minutes later. But in triage, the doctor or the whoever was doing her, like, getting her settled into the hospital just was not addressing her pain at all. So I would. I would love to actually talk about hormones specifically. And of course, in perimenopause. Right. So the women who are going through perimenopause now, like myself, I'm in. I'm 47, so I'm very clearly in perimenopause. Maybe you can walk us through what is normal versus what's common. Right. So when something is normal and when something is maybe being dismissed from your doctor, and maybe you might even want to talk about your own story about this here, because I think it would be. I think it lends a little bit. Bit of credibility to what we're talking about here. Talk to us about how women often will internalize. So if someone tells them, like, actually this is just like part of aging, like, suck it up, buttercup. And when we can. When something is normal versus when it's common and we need to have more invest, like further investigation from there.

A (37:31)

Yeah. I think that we blame our hormones for a lot. And while our hormone fluctuations can be. Can explain certain symptoms that we have, I think we have to stop blaming ourselves. And certainly other people need to stop saying, you know, oh, it's probably because you're so hormonal right now. Right. It's like, our hormones are amazing.

B (37:52)

Hormones are helping us. They're actually good, good little. Good little soldiers.

A (37:55)

They're great little soldiers, and they're amazing. And we have to stop apologizing for them. Yeah. I ignored my own symptoms for years with the suck it up, buttercup approach. You know, you know, heavy periods. Gosh, it's just one of the downsides of being female. That monthly quote unquote hemorrhaging I used to, that led me to be anemic and low energy all the time. I just have to suffer through until I hit menopause and no more periods. And what I learned, what did hemorrhaging.

B (38:25)

I'm gonna interrupt you. What did hemorrhaging look like for you when you were like, oh, it's just my monthly hemorrhage. What was that?

A (38:31)

I was putting on an over. When I had my period. Day one, day two, sometimes day three, I was using an overnight size pad about every hour.

B (38:40)

Hour, wow, Okay.

A (38:41)

I took a flight once with my sister, and I just looked at her with wide eyes like, I have to run off this plane. I had to change. And that was after just an hour before I had. I had worn a tampon and an overnight pad, and I had still leaked through. So this is heavy bleeding. And. And frankly, I should have known better. I should have been like, this is unacceptable. This is too heavy. And I just thought, I guess it is.

B (39:05)

It's.

A (39:06)

This is normal for me, me, you know. And finally I talked about these symptoms with a doctor who said, you know, let's do a little investigating here. Turns out I had a uterus full of fibroids. Luckily, fibroids are benign, but you still get this sense that your body has betrayed you, that I've got all these growths making my wounds super lumpy and inflamed and causing me all these problems. And still I thought, I'll deal with, with it. You know, fibroids tend to shrink once you get to menopause because oftentimes they're. They're fed by hormones like estrogen. And so I just thought, I'll deal with it. And so it just. Symptoms got worse and worse and, you know, I finally made the choice for me to have a hysterectomy. Turned out to be the best medical decision I've ever made for myself. It's about a year since I had that surgery, and I feel like a new person again. That was the right call for me. It's not for everybody. And there are other treatments for fibroids, but I do think it points to even again, as a health journalist for 20 some odd years at that stage, I was ignoring these really intense symptoms. And I think it was really eye opening to me, like, wow, if I'm ignoring, like, I know other women are doing this left and right, you know, putting others first, just dealing with what we're facing. And that's a new role of women's health. You know, it's time to stop that. You know, we matter. Our symptoms are important. It's crucial to talk to a doctor who listens and does the appropriate testing and tries to help get you the answer you need.

B (40:39)

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A (43:52)

Yes, yes. And poetically, my hysterectomy happened right after I turned in the draft of this book. You know, and I think working on this book, I spent three years reporting and writing and rewriting and fact checking. And really what it comes down to is I do relate to my body totally differently now because I have more knowledge about. You know, I. I gave a chapter to a friend who said I had no idea that the menstrual cycle worked this way, even though I cycle about every 28 days. And now I'm gonna talk to my doctor because I realize what I've been feeling may not be, quote, unquote, normal. You know, it's. It's hard to talk about normal because things are so varied for so many of us. Again, it points to really establishing with a doctor who you trust and respect and. And who you can figure out what. With what's normal for you. But, yeah, I relate so differently in the way that I take care of myself, in the way that I listen to symptoms I have. That's not to say it's like, oh, gosh, I'm worried all the time. It's more like with this newfound knowledge, I can talk about my symptoms from a place of empowerment and confidence, which I think is really important. I also think that I've stopped apologizing for my body. I think in some ways, when we should on ourselves, like, oh, I shall. This. This should just be, you know, whatever it is. I think we weave in what women too often do, which is, I'm so sorry I didn't shave my Legs when we go to the gynecologist or.

B (45:21)

Right. They don't care. They don't care.

A (45:23)

And if anything, if. Especially if they're a woman, they feel bad because they're like, gosh, you know, I interviewed Dr. Elizabeth Komen, a breast oncologist, who says, I can't tell you how many times I sit at the bedside of a woman with breast cancer and she's apologizing for not putting deodorant on. I mean, think about that for a moment. And I just feel like when we understand our bodies, we just come from this new found place of. No, I'm not gonna apologize for my body. I'm not gonna apologize for my physiology or my biology for being human.

B (45:54)

Like, you're apologizing for growing hair on your legs. Like, that's what happens to the human. Like, it's just society that's told women that you shouldn't have hair there. So that's why we shave it. Right. So it's like, that's what the human, the female human and man do. It grows hair to protect the skin, to keep you warm.

A (46:10)

Totally. Yeah. It's. It's pretty mind blowing how, you know, even having hearing you reflect back to me, like, wow, what you said and how you just brushed it off, it's. It's sad, actually. And I think we have to give ourselves space to feel sad about, like, how we've related to our own health for many years. And then after the sadness passes, it's like, okay, how am I going to change that now?

B (46:32)

Yeah, yeah. I think for so. I mean, this is maybe a side tangent and discussion for another time, but I think for, like, health for so many women for so long has just been. Has been about, like, how skinny can I be? Like, that's. That's their health. You know, it's like, I'm gonna do Pilates and I'm gonna do this and that, but to see how skin, like, that's what health meant to them. And I think that there's this much more robust, colorful, wholesome circle of things that. That maybe we can start to get into. And this book certainly does that as well. So talk to me a little bit about how you would love if someone picks up your book, how you would want this book to help women speak to their doctors. So if you have someone endometriosis, pcos, or you just, like, your labs are normal, but you feel like garbage, what are some ways that we might think about communicating with our doctors who are also human and they're doing the best that they can with. With the resources and capacity that they have. How can we do this? And how might we also expand this to. I always say that this podcast is for women and the men who love them. You know, it's like, and how can we help our beautiful men who are often sometimes forgotten another topic for another time? How can we also help them understand what is happening to us mechanistically, physiologically, emotionally, et cetera? So what? Talk to us first about the doctor and then maybe, maybe husbands, sons, daughters, go.

A (48:02)

I love this question. So the. My book, the New Rules of Women's Health is a big book. It is a thick book. It is 700 pages. So my hope is that you'll have this book on your bookshelf, your coffee table, and then when something is up for you, you can use it as a reference. So, prime example of myself again. Actually, I did find out when I had the hysterectomy that I had a diagnosis of adenomyosis. And if that happens to a woman, it's like, I've never actually heard of that. We don't talk about that a lot. And so I flipped to that section of my book and I was like, oh, okay, at least I have a little bit of background now so that when I have my post op appointment, I can say, ah, I saw in my chart that I have adenomyosis. What does this mean? Let's talk about this for me. And so, you know, frankly, when you can reference a book like mine, to be able to have a baseline knowledge, I think you start to have different appointments with your doctor. So along the course of reporting this book, I had a new appointment with. An appointment with a new primary care physician. And at the end of our appointment, I felt like her eyes were sparkling and I was like, what's happening? And she was like, this was a fun appointment. You came with so much baseline knowledge that we were able to cover a lot of ground. We were able to talk about things that I don't get to talk to all my patients about when it comes to being proactive about health. And so I think what's just amazing about that is, like, you, again, you come to these appointments feeling super empowered and you walk away feeling more satisfied, you know, after an interaction with your doctor, which I think is huge when it comes to the men in our life, our sons, our brothers, our husbands, even our fathers. So I have given my book to my husband. And again, it's a big book. So it's not like I'm saying, read this whole Thing. But every time I get a mammogram, I usually have to do a follow up sonogram. I have very dense breast tissue issue and that is part of my breast health journey, is follow up sonos. Ever since my husband has read the breast health chapter, he's able to support me in better ways when I have the inevitable freakout when my mammogram report comes back or when I'm talking to him about potential follow up testing. And so the more our men in our, you know, the men in our lives who love us so much know and also have that baseline understanding of our health, women's health, the more they can support. And I think that's a beautiful thing.

B (50:18)

And 700 pages. Commissioned, I should say, or maybe not originally commissioned with Maria Shriver. I would love for you to tell that story as well. Because we love, I mean, I love Maria Shriver. She's such a great, great human.

A (50:29)

She's an amazing human. And yes, I had the privilege of being commissioned to write this book by Maria Shriver. I wrote it for her imprint at Penguin Random House called the Open Field. And Maria and I were having a salad in la. And the way that that happened is I interviewed her for a story for Prevention mag on women and brain health. I learned that she founded the Women's Alzheimer's movement, now part of the Cleveland Clinic. And I learned a little bit about the journey of how that came to be. And when the piece came out, she called me and my heart sank. I thought fact checking had missed something. And I got something wrong in the article and she said, I loved the piece. Will you come work for me at my Sunday paper? She runs a newsletter that goes out every week. And so about a year into working for her, we were having a salad and she said, I'd like you to write this book because we don't have a comprehensive women's health book. We've got amazing women's health titles, but something really comprehensive that looks at not only the bikini medicine aspects of women's health, but also our brains, our digestive tract, our everything. And so that's how this book came to be. And Maria wrote the forward. And it really was a labor of love for many years, but yeah, and now it's out in the world.

B (51:39)

Fantastic. I mean, it's like you had me at salad, Maria.

A (51:43)

Totally.

B (51:44)

You just had to blink in my direction. I would have done it for you.

A (51:47)

When Maria Maria shrieked me. Shriver asks you to, to write a women's health manifesto. You're mid salad. But you say, okay, Marie Shriver.

B (51:54)

You say, yes, I'm on it. There's no other answer, but yes. All right. You know, the other thing that I would love to actually cover with you, I think sometimes we talk about perimenopause and menopause and I gotta tell you, I am kind of tired of it personally, is this idea that menopause is this like, ho, hum, we're all gonna, we now we're not fertile anymore and now we're just past our, our prime and now we have to medicate and now we're just like a problem to be solved. It's like the, you know, it's like the Sound of Music. How do you solve a problem like menopause? You know, it's like. Or Maria, for the original line there. But tell us about some of the upsides. Like, what are some of the things we have to look forward to? I can't tell you. I speak to so many women, colleagues, friends who have made the transition, and they're like, I'm having the best sex of my life. I feel so good in my body. I finally feel comfortable in my skin. So those are just some of the things that I'm hearing. I would love maybe for you to outline with people that you have spoken to, maybe your own, your own experience, what, what is meant. Like, what are some of the things we have to look forward to with menopause?

A (53:01)

I interviewed a gynecologist and menopause specialist, Dr. Heather Bartos, who I think put it so beautifully, which she said, you know, the thing about perimenopause is that you're on a whitewater rapid ride and you're going through the rapids and, man, you hit. And it can be fun, it can be scary, it can be all the things, right? And then you get to menopause and it's like you're at the bottom of that river or whatever. You've just white water, rapid your way down, and it's peaceful and it's calm and it's, you know, you feel proud of yourself. And I think, I think that's the thing, the way that I'm going into the menopause transition, like, sure, there may be some bumps along the way. Mindset can really help in terms of, like, okay, as long as I'm getting treatment for, for the very real symptoms, that can have very real impacts on my future health, the more I can sort of say, well, what are the upsides? And I think for me, some of that is, you know, aside from, you know, the whole like, don't have to worry about birth control. Don't have periods, which, again, the hysterectomy took care of. It's also like, wow, like, I just noticed myself coming into my own. I feel embodied in a new way. I feel more myself. I feel like just. Yeah, like I'm entering Megan 2.0. And I think that that is something I know a lot of my friends are feeling as well. Like the phrase we're just sort of giving fewer Fs about things and just really getting laser focused on what makes our own lives meaningful, who we want in our lives. And I think, you know, the thing for me as it relates to my physical health is I'm really taking the opportunity of menopause to double down on not only the healthy lifestyle habits we know work, but frankly, to line up my preventive appointments to really make sure that I'm taking care of my health. Because as you pointed out before, in midlife, man, we get pulled in all different directions, right? Kids, family obligations, aging parents who need us in a new way. And again, as one doctor I interviewed said, usually the dog gets more vet appointments than we get healthcare appointments in midline life. And the problem with that is that in midlife, we have this beautiful opportunity to actually make changes that will help us prevent heart disease later on or osteoporosis later on. And so I'm prioritizing myself in a new way. And that feels really good.

B (55:24)

I love it. And you know what I love the most? I mean, there's a lot of things I love about this book, but I love that it's a coffee table book because it's so damn big, you gotta keep it on the coffee table. And I don't think that I've ever seen another woman's health book that can function as a coffee table book. So that I think is really great. And that really, literally brings the conversation right into the living room where it belongs. Not in the bedroom, not in the office crying or in the bathroom crying, like, right in the heart of the home. So I just love that so much.

A (55:53)

I love that, too. And bring in the boys and the men and show them the illustration of the clitoris. Right? Like, we all should have this information and this knowledge to live our best lives.

B (56:05)

Fantastic. Where can people find you? Where can people find the book? Give them all the places. We'll make all. We'll make sure these are all clickable links in the show notes. But if anybody wants to jump on it right now, where can people find you?

A (56:15)

Yeah, hop on to new rules of womenshealth.com that's where you can order the book and learn a little bit more about me. MeganRabbit.com at this point, it pushes you right to the book page. But yeah, I absolutely loved chatting with you today, so thank you so much.

B (56:31)

Much. Me too. Thank you so much for your time today. It's been a pleasure. Hello. Hello. Welcome to the afterparty where I give you my synopsis, my true thoughts and feelings. Now that the guest has hung up and probably no surprise here, I really enjoyed this conversation. I thought that she did such a good job of covering so much information in a a short amount of time. Like, this is maybe on the shorter side of some of our podcast episodes. As you know, we like to go deep roast whenever we can. But she did a really good job of getting through a lot of stuff in an efficient way. So really just, you know, hat tip to. To you, Megan, for your just being a great podcast guest and answering things very clearly and very concisely. Some of the things I really loved right at the beginning of our conversation, we were talking about what's wrong in women's health. And this conversation around language really matters, right? So we talked, obviously, the fallopian tube versus the uterine tubes. I think that the uterine tubes is much more neutral, and it actually describes. You don't have to remember what it is. You know, I brought up the example of Kegels, et cetera. So I think that terminology and language is very, very important in women's health, particularly because I'm not super in love with the idea of some rando person who's like, oh, I'm just gonna name these after myself. My name is Fallopian. We're gonna call this the fallopian tubes. Like, no, thanks. I love Italians, but you're not gonna name my uterine tubes after yourself. Thank you very much. So loved that. And then, of course, guys, come on. I loved the clitoris conversation. I kind of half joked with her that I feel like I can bring. And I think I actually said this, like, I can bring any topic back to sex. So I really did. I. I do. And I think it's important because what a disservice to women. So that. So much so that for years we were modeling the female clitoris after the nerve endings that are in the cow, you know, so we often say, like, you hear Stacy Sims, who's been on the show many times. Love her. She's like, you know, women are not small men. And it's like yes. And women are also not small cows, you know, so it's like we have a different, there's different innovation. There's like some, you know, subtle differences between female, human females and female cows. So really, really loved that. I think that as well. You know, on a more serious note, I think that the conversation around internalizing what's normal for you. So when Megan was talking about, oh, it's just my monthly hemorrhage, you know, and she couldn't get on a plane because she had a tampon and an overnight pad and she still bled through all of that and she had to get, get off the plane because she'd soak through her pants or whatever. I mean, for me, I also relate to that because that was for, that was me for many years. I definitely like when I was in physical practice, I definitely brought a different pair of pants. I brought three or four pads, tampons and I was like layering it up like mad. And I remember always having to get up out of the desk. Like if I was doing like a report of findings with someone or an initial assessment, I would always, if I was on my bleed week, I would always turn the chair away just in case I had already bled through. And I didn't want the patient in the room to see that. So I totally relaxed related to that. And that was just like, oh, that's like my curse. Like that's just what I have to deal with. So I really, really appreciated her honesty around how she would speak to herself and how she just normalized what was very clearly an abnormal condition. And she later revealed in the show, if you, I mean, if you're listening to this, you've listened to the whole thing where she talked about having a diagnosis of adenomyosis, right? So which is almost like a cousin to Endo. So there was that. And then I think that the other big idea here is that this is a mother of a book. You know what I'm saying? Like this is a 700 page book. And there's something that I love. Like I froth at the mouth at and I'm salivating a little bit. Maybe you can hear it in my voice as I'm saying it about having a book like this in the living room. Like what a friggin concept to have, have women's health front and center in the heart of your home. Like where you sit on the couch to scroll Netflix, where you watch movies together as a family. Maybe it's right off of the kitchen where you can say, oh honey, I Just went for my mammogram and let's kind of look up again. Like, let's reference what it is to have dense breasts. Like, how amazing is that? Like, that maybe is. I mean, we talked about a lot of great things, but just that philosophical shift to bring women's health, like, right into the heart of the home where everybody sees it a hundred times a day. I love that. Those are my thoughts. Those are my thoughts. I really enjoyed this conversation. I thought it was short and sweet, but also chock full of good stuff. This is kind of like the primer to all the deep. Like, if you're a dark rose bed and you're like, I want all the deep details. Good, we have. I have that for you. If you're a light rose Betty, this is a really good episode. Like, this is a really good introduction to pretty much what the entire podcast is about because we covered such a vast amount of material in here. So I really hope that you will, if you found this episode really striking, if it spoke to your heart in any way that you'll consider sharing it. The more Betty's I can accumulate in the Betty army, the better. We are your light roast, your medium roast, your dark roast, it doesn't matter. We want all the Betty's. Listening to the podcast, sharing the podcast, talking about the podcast, that's the most important thing. So with that, I bid you adieu and I will see you next time. All right? All right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for Jo general information only, and the advice recommendations we discuss do not replace medicine, chiropractic, or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor. And these conversations, conversations are meant for educational purposes only.