Episode 331: The Truth About Perimenopause with Dr. Arianna Sholes-Douglas

Summary

Forever35 Podcast Episode 331: The Truth About Perimenopause with Dr. Arianna Sholes-Douglas

Release Date: December 2, 2024

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Introduction

In Episode 331 of Forever35, hosts Dorie Shafrir and Elise Hu delve deep into the intricacies of perimenopause with their distinguished guest, Dr. Arianna Sholes-Douglas. This episode, part of a themed series on midlife and menopause, offers listeners a comprehensive understanding of perimenopause, debunking myths, and providing actionable advice for navigating this significant life transition.

Guest Introduction: Dr. Arianna Sholes-Douglas

Dr. Arianna Sholes-Douglas is a seasoned obstetrician-gynecologist with over two decades of experience in high-risk obstetrics. She is the author of The Menopause Myth and the founder of Tula Wellness, where she emphasizes integrative women's health and fosters healing partnerships between patients and physicians.

Notable Quote:

"If I'm a gynecologist, I'm supposed to be trained, which I was not and most gynecologists are not."
— Dr. Arianna Sholes-Douglas [19:08]

Main Discussion

1. The Menopause Myth and Its Origins

Dr. Sholes-Douglas recounts her personal journey through perimenopause in her late 30s, which was devoid of adequate preparation and understanding despite her medical background. This gap in knowledge inspired her to author The Menopause Myth, aiming to fill the void of information available to women.

Notable Quote:

"If I'm a gynecologist, I'm supposed to be trained, which I was not and most gynecologists are not... there's a serious void of information that women had."
— Dr. Arianna Sholes-Douglas [19:08]

2. Education Gaps in Medical Training

A significant portion of the discussion highlights the insufficiency of menopause education in medical curricula. Dr. Sholes-Douglas cites studies revealing that less than 2% of residency programs dedicate time to menopause education, often limiting it to a mere two hours.

Notable Quote:

"Less than 2% of any curriculum. I mean, we're talking less than... it's two hours."
— Dr. Arianna Sholes-Douglas [20:42]

This lack of training has broader implications, leading to many gynecologists being ill-equipped to address perimenopause symptoms effectively. Consequently, patients often face dismissive attitudes or lack of proper treatment when seeking help.

3. The Role of Social Media in Raising Awareness

Elise Hu observes a positive shift in the awareness and discussion surrounding perimenopause, attributing it partly to the influence of social media. Dr. Sholes-Douglas agrees, noting that online platforms have empowered women with information and connected them to knowledgeable healthcare providers.

Notable Quote:

"It's a huge shift... there are providers who... are giving some really good information to people and they're getting empowered."
— Dr. Arianna Sholes-Douglas [22:56]

4. Navigating Conversations with Healthcare Providers

Listeners often struggle with how to approach their doctors about perimenopause. Dr. Sholes-Douglas advises focusing on symptoms rather than lab results, as hormonal levels fluctuate and may not provide clear diagnostic information.

Notable Quote:

"It's not about the labs, it's about the symptoms... if you have insomnia, irritability, you have brain fog, night sweats, like, like I don't need labs to determine that you're perimenopausal."
— Dr. Arianna Sholes-Douglas [23:57]

She emphasizes the importance of being prepared and empowered during medical consultations, encouraging women to seek providers trained specifically in menopause care through resources like Menopause.org.

5. Listener Questions and Expert Responses

a. Hormone Replacement Therapy (HRT) Timing and Considerations

A listener inquires about the optimal time to start HRT, especially concerning family history of breast cancer. Dr. Sholes-Douglas clarifies that hormone therapy should commence when symptomatic, rather than preemptively, and addresses concerns related to breast cancer risk.

Notable Quote:

"Your family history of breast cancer has nothing to do. We've already pretty much established that estrogen doesn't cause the breast cancer."
— Dr. Arianna Sholes-Douglas [38:11]

She reassures that the risk associated with HRT is minimal compared to the benefits, such as bone health, and encourages women to consider HRT based on individual health profiles and symptoms.

b. Lesser-Known Perimenopause Symptoms

Beyond common symptoms like hot flashes and night sweats, Dr. Sholes-Douglas highlights lesser-discussed manifestations of perimenopause, including burning mouth syndrome, musculoskeletal pains, anxiety, depression, and even ADHD-like symptoms.

Notable Quote:

"Joint pain is actually more prevalent for the population than hot flashes. It's one of the most frequently recorded symptoms of perimenopause."
— Dr. Arianna Sholes-Douglas [32:53]

c. Estrogen Face Creams

A listener asks about the safety and efficacy of estrogen face creams. Dr. Sholes-Douglas affirms their safety, explaining that topical application on the face results in minimal systemic absorption, making them a viable option for symptom relief without significant risks.

Notable Quote:

"The way the skin that we're putting it on doesn't really absorb as well. And so we're not getting so much of the systemic impact of it."
— Dr. Arianna Sholes-Douglas [37:00]

Positive Aspects of Perimenopause

Shifting focus from challenges, Dr. Sholes-Douglas and the hosts explore the empowering aspects of perimenopause. She describes this phase as a time of personal growth and self-discovery, where women can embrace their true selves free from societal expectations.

Notable Quote:

"This is an opportunity for you to explore and transform and in my opinion, to step into who you really came here to be."
— Dr. Arianna Sholes-Douglas [40:28]

Intention Zone: Gratitude and Self-Care Practices

The latter part of the episode transitions into the hosts and guest sharing their personal intentions and gratitude practices. Dr. Sholes-Douglas emphasizes the importance of gratitude in maintaining mental well-being, especially during significant life transitions.

Notable Quote:

"I am trying to be less grouchy to the kids and be more grateful for them and have more like mother-daughter time."
— Dr. Arianna Sholes-Douglas [44:09]

Conclusion and Resources

Dr. Sholes-Douglas concludes by directing listeners to her resources for further information:

• Instagram: @DoctorAriana
• Podcast: Stay Juicy
• Book: The Menopause Myth (available on Amazon)

Moreover, hosts Dorie Shafrir and Elise Hu express their gratitude towards their Patreon supporters, acknowledging the community that sustains their mission to educate and empower women in midlife.

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Additional Resources Mentioned:

• Menopause Society: Menopause.org – Find trained providers specializing in menopause care.

• Stay Juicy Podcast: Dr. Sholes-Douglas's podcast focusing on empowering women through midlife transitions.

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Connect with Forever35:

• Website: forever35podcast.com
• Instagram: @forever35podcast
• Patreon: patreon.com/forever35
• Newsletter: forever35podcast.com/newsletter
• Contact: Call or text at 781-591-0390 or email at [e-mail]

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This episode serves as a vital resource for women navigating perimenopause, offering expert insights, personal anecdotes, and practical advice to foster a healthier and more informed midlife experience.

Transcript

[Dory Shafrir]

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[Elise Hu]

Hello and welcome to Forever 35, a podcast about the things we do to take care of ourselves. I'm Dory Shafrier.

[Dr. Ariana Scholz Douglas]

And I'm Elise Hu. And we are just two friends who like to talk a lot about serums.

[Elise Hu]

And this is our last midlife and menopause episode.

[Dr. Ariana Scholz Douglas]

Oh, I mean, it has gone so fast.

[Elise Hu]

It has gone so fast. I was gonna say, like, it's not like we will never talk about these things again. No, no, no. But yeah, we've had, we've had some amazing guests on this. Actually went a week longer than we were anticipating just because we had so many great people that we wanted to get to them all.

[Dr. Ariana Scholz Douglas]

So we have spent the month of Nove, our very first themed series that was selected by you all by popular demand. You all wanted us to talk more about midlife and menopause. And so we have, we've had these amazing guests. We had Lynn Slater kick it off, then Caroline Paul, Reshma Sajani, and then Emily Nagaski. And today we have an extra bonus guest, essentially because this is beyond our original announcement.

[Elise Hu]

It's true. We talked to Dr. Ariana Scholz Douglas. We were, we were like, oh, wait, we should an actual medical doctor on the show.

[Dr. Ariana Scholz Douglas]

Yeah, yeah, that might be good.

[Elise Hu]

And she was. Oh, she was just so. She was so great. She was so good. She was wise, she was funny, she was compassionate, she was charming. I mean, I'm obsessed With her.

[Dr. Ariana Scholz Douglas]

So I wish she could be our doctor. She is based in Tucson, Arizona, Arizona.

[Elise Hu]

Be a bit of a schlep, too.

[Dr. Ariana Scholz Douglas]

It would be a bit of a schlep.

[Elise Hu]

Although I will say, like, after I moved to LA from New York, York, I continued seeing my dentist for, like, quite some time.

[Dr. Ariana Scholz Douglas]

You would fly back to New York?

[Elise Hu]

I mean, every six months? No, I would just. I was. Well. And I was going back to New York a lot for work. So every time I knew I was going back, I would. Or, like, you know, if the timing was right, I would schedule a dentist appointment.

[Listener]

Yes.

[Elise Hu]

And, you know, that's kind of nice. It was nice. I really loved my dentist. And then I was like, this is. This is ridiculous. I need to get a dentist in Los Angeles. Anyway, how's it going?

[Dr. Ariana Scholz Douglas]

Speaking of medical, I am allergic to cats and dogs, but I have both. So every once in a while, I have. These mornings, my thing about allergies and my intolerances is just like, well, I'm just gonna eat through it or I'm just gonna, like, fight my way through it. I know that I'm allergic because I did that pinprick thing. My back was just, like, inflamed. Apparently, I'm like the kid from My Girl. I'm allergic to every.

[Elise Hu]

Really?

[Dr. Ariana Scholz Douglas]

But I don't live that way. Yeah, I'm just like. I'm just going for it. I'm going for it anyway. And so I have this very hairy golden retriever, and I wake up, and my. My eyes are all itchy, and my skin is now, like. I don't know if you can see door. But, like, I'm all. I have a rash breaking out. And then I've been sneezing nonstop. So it's been kind of a thing. I am an accidental Flonase influencer. One time I. This is a true story. I tweeted about how much I rely on Flonase. I was like, I just. Due to all my allergies, I'm allergic to dust. I'm allergic to pollen. I'm allergic to cedar. I have to Flonase all the time. And Flonase saw it because this was back in the day. We were all on Twitter. Flonase saw it, and they sent to NPR West a box of Flonase. No, I don't know, like, 24. At least 24 of the little bottles of Flonase that I can shoot. Yeah. And then they had the missed kind and the original kind.

[Elise Hu]

That's so funny.

[Dr. Ariana Scholz Douglas]

From my friends at Flonase. It was so nice. This is not. I'm not asking to get another box. I'm just saying thank you. Sure. Yes. Anyway, what's going on in your corner of the world? You sound much less congested.

[Elise Hu]

Yes, I am not congested yet, thankfully. Knock on wood. I am allergic to dust and cats, though. Although I will say my cat. My cat allergy seems to have gotten a lot less severe. It was never super severe, but, like, if I. It used to be that if I, like, went to someone's house who had a cat, like, my eyes would start watering, my. My throat would get scratchy. Like, it. It. And it happened pretty quickly. And like, now I feel like that hasn't happened as much late, like, in the last, you know, 10 years or so. I didn't really do any exposure therapy. I don't have a cat. And I was never allergic to dogs, thankfully, so that was. And I never had seasonal allergies either, so that was also a. A big relief. But I did have a. A documented dust and cats allergy. Speaking of dust, this morning Matt had dropped his phone, like, under our bed and.

[Dr. Ariana Scholz Douglas]

Oh, no. Annoying.

[Elise Hu]

We have. We have a, like a. An adjustable bed, which I actually love. Like, I think adjustable beds are like, the secret to life. But we couldn't reach it. And then finally we, like, put up his side. Henry was in on it. Like, he was trying to get the phone. And I finally reached it, but there was so much dust under the bed.

[Dr. Ariana Scholz Douglas]

That I was like, yes.

[Elise Hu]

Oh, God, this, like, so gross. So, yeah, I'm sure there's TikToks for this.

[Dr. Ariana Scholz Douglas]

I'm sure there's cleaning tik toks. I. Every once in a while I get cleaning tik toks because I really. I'm also. My TikTok algorithm also shows me, like, restocking because I find it very calming just watching people who are organized stock their fridges with beverages or stock their drawers and organize their snacks. It's really. There's something very satisfying.

[Elise Hu]

I love that.

[Dr. Ariana Scholz Douglas]

And so I'm guessing my tick tock. Yeah, yeah. But I'm guessing my tick tock algorithm is soon going to start sending me, like, ways to get into nooks and crannies.

[Elise Hu]

Oh, my God.

[Dr. Ariana Scholz Douglas]

While cleaning.

[Elise Hu]

Totally. Yes, yes, yes. Well, my, my dad has been here.

[Dr. Ariana Scholz Douglas]

Oh, that's right. Yes, yes.

[Elise Hu]

And my mom gets here tomorrow. And it's been good. It's been nice to have, like, Henry hanging out with my dad. I like, there is an element of feeling like he needs to be entertained. Like he'll be like, what are we doing today? And I'm like, I don't know, I have to record what.

[Dr. Ariana Scholz Douglas]

What are you doing today?

[Elise Hu]

Yeah, exactly. And I'm also kind of like, you're like, you can take Henry somewhere. And he's like, well, now his whole thing is he doesn't like to drive in Los Angeles. And I think I mentioned this. No, maybe I mentioned this to you in an IRL conversation. And like, I sympathize with that. But I'm also like, we have the exact same car that you have at home, and it's not a hard car to drive. And like, you could drive like a couple miles and take him to a park he likes or something. You know what I mean? Like, I'm feeling, I'm. You know how we talk about, like, the sandwich generation?

[Dr. Ariana Scholz Douglas]

Yes.

[Elise Hu]

I'm feeling like the IRL embodiment of the sandwich generation just in this, like, microcosm of the Thanksgiving holiday. Now, a lot of people talk about the sandwich generation in terms of, like, their parents being sick and, like, having to take care of them. Like, knock on wood. My dad is in excellent health and he's very, like, physically able. But I am feeling this, like, oh, gotta, like, satisfy my dad.

[Dr. Ariana Scholz Douglas]

10. Yeah, tend to them.

[Elise Hu]

Yeah, tend to everybody. I'm also the only woman. I'm only the only female in the home.

[Dr. Ariana Scholz Douglas]

Oh, yes, you are outnumbered.

[Elise Hu]

I'm outnumbered. It's my dad, my husband, my son, and my male dog. So I'm like, so much testosterone. So much testosterone. And I'm like, does the woman have to do all the mental labor, like, the emotional and mental labor here?

[Dr. Ariana Scholz Douglas]

Well, yeah, you should definitely, yeah, you should definitely draw some boundaries there. And it sounds like you have. You're sort of like, I've got to work. I'm podcasting.

[Dory Shafrir]

Go find something to do.

[Elise Hu]

Well, I literally was like, here are my car keys. Go ahead, take him somewhere. I don't know. I went down, like, a whole rabbit hole of, like, Thanksgiving meals in Los Angeles. Needless to say, a lot of the good value ones were booked, you know, which I, you know, I get it. I. I started. I started doing this research, like, five days before Thanksgiving, but we did find one that is a buffet that I love.

[Dr. Ariana Scholz Douglas]

A buffet.

[Elise Hu]

Yeah. I was like, you know what? Because a lot of them were, like, quite expensive for a three course meal, which I was like, okay, that is like, it is a lot of food. But it also seemed like you were. You're definitely paying a Thanksgiving premium. And I was like, why don't we pay the same amount of money for what sounds like an amazing over the top buffet.

[Dr. Ariana Scholz Douglas]

Yeah. And all you can eat experience and extravagance.

[Elise Hu]

Yes. They also have, for, like, lower cost, they have a kids buffet also, so. Oh, Henry. And the kids buffet has, like, Mac and cheese, chicken tenders, tater tots, and broccoli.

[Dr. Ariana Scholz Douglas]

All my favorite foods.

[Elise Hu]

Yeah, yeah. Henry goes, I don't think I like tater tots. I was like, okay. He's like. He's like, can I get Mac and cheese, chicken tenders, and broccoli? I was like, yes, bud, you can.

[Dr. Ariana Scholz Douglas]

Yeah. Oh, sweet boy. So sweet.

[Elise Hu]

So, yeah. So I'm feeling like everything is.

[Dr. Ariana Scholz Douglas]

What a great idea.

[Elise Hu]

Do it.

[Dr. Ariana Scholz Douglas]

Do the thing.

[Elise Hu]

Because I was gonna bring stuff in, and then actually my parents were like, what if we went to a restaurant? Our treat. And I was like, okay.

[Dr. Ariana Scholz Douglas]

Yes. Yes to that.

[Elise Hu]

All right, Elise, before we introduce our guests and take a short break, I do just want to give an update on our giving circle because.

[Dr. Ariana Scholz Douglas]

Yay.

[Elise Hu]

Yay. We were raising money for Arizona and we had set a goal of $25,000. And I am very happy to report that we got 92% to our goal. We raised over $23,000, and that was a stretch goal.

[Dr. Ariana Scholz Douglas]

We were like, that was just putting it out here to try and get here because this election matters so much.

[Elise Hu]

You know, over the course of doing all of our giving circle stuff, we've had 643 people donate to the giving circle to the various election cycles, which is so cool.

[Dr. Ariana Scholz Douglas]

It's a lot of people. Yes, yes. And then there has been coverage, I think, in Politico recently about the states project and how it's directed. Giving actually did keep so many legislatures in progressive hands or keep them very, very close. So, like, even having a narrow margin makes a huge difference. And that's because of really targeted giving to state legislative races that you all participated in. So thank you so much.

[Elise Hu]

Yeah, it's really cool. All right, let's introduce our guest, Dr. Ariana Schultz Douglas. She is the author of the book the Menopause My and the founder and visionary of Tula Wellness. She has practiced medicine for over 20 years and is board certified in obstetrics and gynecology and maternal fetal medicine. Dr. Ariana specializes in integrative women's health and honors a patient centered approach and healing partnerships between patient and physician. And we, like I mentioned at the top of the show, we just had such an amazing conversation with her. And just a reminder, we have our website forever35podcast.com we have links there to everything we mentioned on the show. We're on Instagram @forever35 have podcast. Our patreon is at patreon.com forever35. You can shop our favorite products at Shopmy US Forever35. Our newsletter is at forever35podcast.com newsletter and you can call or text us at 781 591-0390 and email us at forever35podcastgmail.com.

[Dr. Ariana Scholz Douglas]

We will be right back with our guest.

[Elise Hu]

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[Dr. Ariana Scholz Douglas]

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[Dory Shafrir]

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[Elise Hu]

We are so excited to have Dr. Ariana on Forever 35. Welcome to the show.

[Listener]

Thanks for having me guys.

[Elise Hu]

So we have a lot of questions for you about menopause, perimenopause, all the things. But we're going to start with a question that we ask all of our guests which is what is a self care practice that you have?

[Listener]

I mean I have several of them but most recently I light my fire pit and then I have a little standing gas lighter in the back. It's getting cool. I just sit on my patio and I'm in Tucson, Arizona and I just sit look out at the Catalina Foothill Mountains and I'm just, I just. There's just something so magnificent about looking at those mountains and the sunset. So that's I. That's what I would say. My Go to at these days for sure.

[Dr. Ariana Scholz Douglas]

Love it.

[Elise Hu]

I'm feeling like relaxed just hearing you describe that. So imagine how it is. Yes.

[Dr. Ariana Scholz Douglas]

Well, Dr. Ariana, you are the capstone of a month we have been devoting to midlife and menopause. So it is perfect to have you here as our kind of final interview in this series because you wrote a book recently called the Menopause Myth. So I'd love to know what is the big myth and what inspired you to write the book.

[Listener]

Well, thank you. That it's actually the menopause Myth. What your mother, doctor and friends never share it with you about life after 35. And so the subtitle is really what inspired me is because I'm a gynecologist, I'm an obstetrician, gynecologist, was practicing high risk obstetrics for the last 20 years and I started going through perimenopause in my late 30s, but it just never even entered my consciousness that that's what was happening. I had all of the symptoms and including night sweats and I just, I don't even know what I was thinking was happening. But I just, it never occurred to me. And as this kind of progressed and I eventually became menopausal, I was like, wait a minute, if I don't understand any of this. And I wasn't prepared and I had no idea, I didn't really know until literally a few years in. And I was like, wow, if I don't understand this, how is it that the average woman could even possibly understand this? If I'm a gynecologist, I'm supposed to be trained, which I was not and most gynecologists are not. So that's what inspired me to write it because I just knew that that was a serious void of information that women had. And I just, I couldn't in my mind even fathom that it was happening. And it's actually not a new book. It's. It's the fifth year anniversary of the book actually. But the knowledge, the information is still pertinent.

[Dr. Ariana Scholz Douglas]

How much education are medical students and residents getting in this area now?

[Listener]

It is very, very, very slowly changing in specific programs. But there was actually some, a study that was done about a year or two ago, looking, they, they looked, they surveyed residency directors to find out exactly how much of the residency curriculum is being dedicated to this topic. And less than 2% of any curriculum. I mean, we're talking less than, I shouldn't even say 2%. It's two hours. There's a few programs out there, and this is in medical school. I don't think they're getting much these days unless that's slowly changing. But in residencies, a good residency program had about five hours. That was probably what the average was for a good program. But there was no specific curriculum there. There just isn't. And what they did is kind of in some of their answers. I won't say they, they smudged the data, but it was like if there was a clinic where there was menopausal women, they included that, but it wasn't specific to menopause training.

[Dr. Ariana Scholz Douglas]

Wow. So that means this flows outward. This ripples outwards. Because then if patients are coming in, exhibiting or complaining of symptoms that might align with menopause, the doctors might not immediately. Like, their minds might not go to it.

[Listener]

Oh, not only with their minds not go there. They are, you know, in some cases they're just, maybe not intentionally, but they're gaslighting patients because the patients are coming in and they're saying, I have this. I, I think I'm perimenopausal. And I cannot tell you how many women have come into my office if I had, you know, a dollar for each one. But they come in and they've gone to their gynecologist who's either said, I don't believe in hormone therapy. Oh, basically just kind of suck it up, it won't last that long, or you're just too young. You couldn't possibly. Because they have had no formal education, they don't know.

[Elise Hu]

Do you think that social media is starting to change this? Like, to me, it feels like there's just so much more awareness of parent. Maybe it's because I'm of the age and I'm getting targeted for it, but it does seem like there is so much more discussion of it than there was.

[Listener]

It's a huge shift. It's. It. I mean, I've been in the space five years now, and within the last two years, it's just taken off and in, in every direction from anywhere. From, you know, the providers that are available, these virtual online clinics that are, you know, popping up, up to the ability to just, you know, have. Just get good information. There's still some, some bad players out there, but for the most part, you know, there are, there are some great doctors, nurse practitioners, just providers out there that are just giving some really good information to people and they're, they're getting empowered and yeah, I see it. It's, it's, it's a big shift so.

[Elise Hu]

If someone thinks that they are in perimenopause and they want to talk to their doctor about what to do, how do you suggest they approach it? Like what should they be asking for? You know, what is, what is the conversation they should be having with their doctor?

[Listener]

So this gets a little tricky too because at the end of the day, you know, you're going to have a couple of different possible responses, right? So if you're going to a doctor that seems informed, one thing that a lot of women or patients think is that, oh, I need to have my labs checked, I need to know what's going on. And the reality is, is that your labs are fluctuating just like they were during puberty. So I tell patients, think of this like kind of a reverse puberty during puberty. You know, we kind of expected people to be, you know, have these mood swings and do all the things, but you know, they got to sleep in or just have an attitude and do whatever, could just, just kind of suffer through it. But these days we're working, you know, where we got jobs, we got maybe we have kids, we got other things. And so at the end of the day where we are having the symptoms of perimenopause, which are going to last longer than puberty on average and they're going to be as erratic. So any point in time where you're checking the labs, they're not necessarily giving you any clear cut information. It's all based on symptoms. So one thing is you don't necessarily want to go in and say, hey, I want you to check my labs. Because oftentimes either they'll say, hey, well I'm not going to check your labs or labs aren't going to tell me anything. And that makes, that frustrates people. But it's not about the labs, it's about the symptoms. So if you have insomnia, irritability, you have brain fog, night sweats, like, like I don't need labs to, to determine that you're perimenopausal. Right. But I'm still going to get your basic labs because I want to know what are your lipids, what are your, what's your thyroid doing? There's all of these other factors that are going to contribute to how you're feeling. It's not always just, you know, what is my estrogen level? That's just not a piece of information that's going to guide any real type of therapy. So you want to have the conversation that you're having these symptoms, you think it's perimenopause. And at that point, if your provider isn't like, I don't know how to put this, but if your provider doesn't get it, if they're telling you no, or don't worry about it, or dismissing you in any way, you either need to decide to have a conversation with your provider and say, here, this is why I know, and it's a shame that as women we have to do this in 2024, but the amount of time and attention that has been placed on women after they're reproductive is almost Nothing. Right? Like 0.03% of all research on women is done for women after age 50. So, and we only get 10% of all our research dollars for anything. So we're really not equipped in this area to help women and navigate this the same way. So unfortunately, as a patient, you got to walk in prepared and empowered and have all your information. If you know that your provider isn't like, if they're not jiving, then you got to make a decision there.

[Elise Hu]

I think that's so helpful and I think we are so conditioned to not push back on medical providers, especially as women, that I think it's so important to hear this from a medical provider. So thank you.

[Listener]

And I will also add that if you, if your provider is not doing it, then you can go to a site called Menopause.org and that is the website of the Menopause Society. And so there are providers who have done special training in this area. And unfortunately, that's probably your best bet at this point is to go look on that site, find a provider in your area. So at least you're talking to somebody who has knowledge about this. I'm not saying they're necessarily going to be your perfect provider, but at a minimum, they've been trained and they're not going to, they're going, they're going to give you the latest data, they're going to suggest, you know, what is the most current, you know, recommendations. And they're not going to be living in 2002, which is when that Women's Health Initiative study came out and basically poo pooed estrogen. And, and since that point, we've just kind of just everybody stopped prescribing the estrogen, women stopped taking it. And so that mentality of that study has just continued to affect, I think, in my opinion is one of the worst things that could have happened to women's health because it informed whole generations of doctors on how they're going to approach this topic. And then we just stopped talking about menopause at all. Just because there was no estrogen, then why bother?

[Elise Hu]

So we're just going to take a short break and we will be right back.

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[Elise Hu]

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[Dr. Ariana Scholz Douglas]

Well, this actually leads to one of the listener questions that we got. And our listener writes, my question is regarding hrt. How do I know when to start it before perimenopause symptoms begin or wait until I'm experiencing them? Is HRT which stands for hormone replacement therapy? Is that out of the question if I have a family history of breast cancer? Also, how do I find a knowledgeable doctor? You just kind of addressed that, Dr. Ariana. Sorry, lots of questions. But I'm so glad that we're finally talking more openly about menopause.

[Listener]

Yeah, so the last question we, we talked about, so how do you know? So we're not going to start. And then we, we actually call it in the medical community now mht, Menopause, hormone therapy, or ht, just, it's just semantics. But we don't, we don't generally use HRT because of the word replacement and we're not really replacing. So just point of fact. So hormone therapy, once you are symptomatic, even in perimenopause, that is an indication to start hormone therapy if you are so inclined. But before we even start hormone therapy, I'm going to ask, how are you sleeping? What are you eating? What are your stressors? Because this is a time of life when all of these things kind of just coincide, right? There's this intersection of I got a 22 year old child on the spectrum, I got aging parents, I have work stress, I have life. Right? And so all of this is happening at the same time. My hormones are changing. And so what are those things in my life that I'm not doing that or that I am doing that are exacerbating it? So, for example, having a glass of wine at night to help me relax is actually going to disrupt my sleep and give me more hot flashes. So I'm not saying that hormone therapy is the answer to everything. We have to look at this much more holistically. But if at the end of the day you're ready and you think this is for you, then once you are symptomatic, specifically with hot flashes and night sweats. But I would also say that if you're having difficulty with sleep, oftentimes that sleep is disrupted because of the night sweats. And so when we treat the night sweats, we treat the sleep, which then will help treat the brain fog that came because you didn't sleep. And all the things that kind of, you know, escalate as a result. So getting that sleep hygiene, and if that means hormone therapy to assist, to help with sleep, then you would start there. But you're not going to just start it. Oh, I think I'm going to be getting perimenopausal. So let me just get ahead of this. It doesn't work that way.

[Dr. Ariana Scholz Douglas]

And then are there certain symptoms that you haven't talked about that people might not recognize as possibly perimenopausal symptoms?

[Listener]

Absolutely, I hear them. I hear a different one literally like every month. So the, the most recent one that, I mean, I've heard about it, but I'm hearing it more recently is a whole burning mouth, burning mouth syndrome. I've, I've had personally had some patients. And then I was speaking somewhere recently and somebody was like, I had the burning mouth. And I was like, oh, okay. And then I literally just talked to somebody today and they're like, I have burning mouth. I was like, get out of here. So burning mouth. There's what we call musculoskeletal syndrome of menopause, and that is encompasses all of the muscle aches and pain. So joint pain is actually more prevalent for the population than hot flashes. It's one of the most frequently recorded symptoms of perimenopause. It's joint pain, but not only joint pain. Frozen Shoulder. Now, there's this another one I just saw on Facebook. Somebody text me and was like, something about the gluteal tendonitis. I was like, okay, there's one. But if it's musculoskeletal and you're having, like, these weird symptoms, for sure, those are ones that I think don't get discussed a lot. I think another one is, we can't really dismiss is the anxiety and depression that really, if you had a history of a depressive episode prior to this, then you're three times more likely to have a more significant episode during this transition. And so in addition to the hormone therapy that may be helpful, you're going to want to think about all the other ways to help with mental health, whether it's therapy and medication, but the anxiety, the palpitations, and the sense of women just feeling like they're getting early Alzheimer's, like the brain fog. And another phenomenon is adhd. So we don't know if it's women who just didn't get diagnosed with adhd and we've just kind of been working through it, or is it just another kind of weird neurocognitive change that's happening? But there are some women, myself included, that I think for me, I had. I'm pretty sure I had 80. Well, I did, because I've now been tested, and it's official. But something happens when our estrogen levels fall. And, I mean, in one way, it's beautiful, because I think the fog of just people pleasing and giving a damn about certain things goes away. But the other thing that comes with that is this lack sometimes of that clarity, this ability, your executive function, your cognition, your disability to be sharp. And for some people, that significantly affects their productivity. And then we treat them basically like their adhd. It doesn't really matter what the diagnosis is per se. We know that the same treatments, specifically stimulants, can be helpful. So I have several patients that, you know, it's like, no, it's not. You haven't gone and had official diagnosis, but you meet all of the criteria. This is happening during this time period. And so once I make sure we've got all the other things on board, if stimulants are going to be helpful for them. I have several patients where it's changed their lives.

[Elise Hu]

Wow, that is fascinating. I've never. I've never heard about that before.

[Listener]

Yes, adhd.

[Elise Hu]

That's really, really interesting. Okay, this is another question from a listener. They are asking about estrogen face cream. They said they've read about it lately and this morning had an appointment with my hormone specialist. I'm 45 and am on. They refer to it as HRT for progesterone and testosterone. Thus far, my estrogen is still hanging in there. Ha. And had planned to ask about it, but she brought it up before I even did. Anyway, I'm going to give it a try. She said she uses it two to three times a week. Just wondering. She was asking if anyone in our community has any experience with it and I would love to hear what, what your thoughts are on estrogen face cream.

[Listener]

Yeah, it's a thing and it actually, it's. It's fairly safe because the way the skin that we're putting it on doesn't really absorb as well. And so we're not getting so much of the systemic impact of it. And just like with vaginal estrogen cream, there's actually a study that just came out in the beginning of November that vaginal estrogen cream, not only does it not cause breast cancer, but it doesn't increase the risk of recurrence of breast cancer in patients that are using it. So you can liken the vaginal cream, just you can to your face, because we're putting basically the same formulation or something similar to it, but it's even getting less absorption just because of the skin that. That's on the face versus the mucosa that's in the vagina. And yeah, I have patients on it. I could probably promote it more because I have aesthetics in my clinic, but yeah, it's a thing. Do it.

[Elise Hu]

Okay. Okay.

[Dr. Ariana Scholz Douglas]

And this brings me back to the earlier listener question about is hormone therapy out of the question if I have a family history of breast cancer?

[Listener]

Absolutely not. Absolutely not. Your family history of breast cancer has nothing to do. We've already pretty much established that estrogen doesn't cause the breast cancer. But if you have an estrogen positive cancer, by taking estrogen, you are at risk of increasing the risk of accelerating that growth of that cancer. But I want to put this in perspective because when we talk about the risk of breast cancer and estrogen, we're talking about. Even if you use that data from that WHI study, we're talking about a risk of less than 0.01%. So we're not talking about risk of, you know, anything, Nothing. It's well below 1%. So this is how I try to reassure patients in general that even if it did cause cancer, let's just go with, okay, maybe it does. We're talking less than 1%. And when we talk about the bone health, that. That we're losing bone significantly, 3 to 5% of muscle mass every decade. I mean, these are real significant health issues. So somebody who is at risk for osteoporosis should take estrogen or consider estrogen, even if they're not symptomatic. That's another indication. If you are, or if you've had your uterus or ovaries removed or your specifically your ovaries removed before 35 or 35, at least by 35, then we're recommending that you're going to start hormone therapy and be on that at least till age 50, 52. So I know that's kind of a convoluted answer, but the answer for the breast cancer is no. There's. That's a big myth. That's another myth that if my mother had breast cancer, it has no bearing on you taking hormone therapy.

[Dr. Ariana Scholz Douglas]

Okay, Dr. Ariana, we have talked about some unpleasant physical symptoms, so I kind of want to flip it since we are broadening this to just this life transition and this life stage of midlife. What's awesome about this phase and this time in our lives?

[Listener]

What's awesome? Yes. What's awesome is that you are coming into your own. You are really. I mean, I call it Stay Juicy. So that's actually the. I started a podcast just to help educate women not only on what's happening, but also to help them see that this is a time to really embrace your juicy life. So my tagline is Juicy lives, Juicy experiences, and juicy vaginas. We want all of it, right? And so at the end of the day, think about it like this. As your estrogen levels fall in your brain, your brain chemistry actually changes. And there's a book out there, the Female Brain, and Luann Brizendine really just eloquently describes how we basically lose the veil of estrogen and we kind of really step into our own upgrade. And you have a choice at this point. You can either bemoan the whole experience and really look at all the, you know, your aging, this and that, or you can just really realize that I'm not tethered to the same things, right? I get to create. I don't have the quote, unquote burdens of maybe these little kids are a menstrual cycle, or I just. This is an opportunity for you to explore and transform and in my opinion, to step into who you really came here to be. And so I know that there are the challenges that come with it. But I also think it can be a magical time to upgrade and to embrace your true self and just to really, you know, it's a time when I say we go from being the necessary nurturers, you know, worrying about taking care of every single person to being the people that we came here to be and saying, you know what, I'm not doing that anymore. Or, you know, pick up your own damn socks. I'm not. I'm not doing any of this.

[Elise Hu]

Do you have any other tips or advice for women who might either be about to enter this phase of their lives or are in this phase of their lives?

[Listener]

I would say educate yourself and be empowered, because unfortunately, our medical system is not where it needs to be in terms of helping you navigate this the most effectively. So educate yourself, find a good resource and find a trusted resource and learn. And really, we take ownership because oftentimes, you know, we hand our health and other responsibilities to other people. And it's like at the end of the day, it's your body, it's your experience, and we want. If you want to age with grace and be as healthy as you can so that you can have the best quality of life, you have to take ownership of that. And it's nobody else's fault. You have to take that time for yourself. You have to just. You have to take it like nobody's giving it to you. So you gotta go get it.

[Dr. Ariana Scholz Douglas]

And stay juicy, of course.

[Listener]

Oh, absolutely.

[Elise Hu]

And always stay juicy.

[Listener]

Stay juicy, girl.

[Dr. Ariana Scholz Douglas]

Dr. Ariana, thank you so much. Where can folks find you and your book?

[Listener]

They can find me on Instagram @Doctor Ariana and on my podcast, which is new and budding, but it's called Stay Juicy.

[Dr. Ariana Scholz Douglas]

And the book is called the Menopause Myth.

[Listener]

The book is called, and that's on Amazon, the Menopause Myth, which your mother doctor friends never share with you about life after 35.

[Dr. Ariana Scholz Douglas]

Okay, thank you so much. That part.

[Listener]

Thank you, guys.

[Elise Hu]

All right, Elise, we. We are in the intention zone.

[Dr. Ariana Scholz Douglas]

We're in the intention zone. And stick around because we want to thank all of our Patreon supporters as well. So if you are one of our Patreon subscribers at the $5 or the $10 tier, stick around after intentions.

[Elise Hu]

Yes, please do that. How did your intentions go this week?

[Dr. Ariana Scholz Douglas]

Mine was just to show gratitude. Note gratitude. And I think I did pretty well. I have a special thank you to my Polish tennis teacher. I am now playing tennis every once in a while with a former LMU tennis player, you know, a tennis team member from Loyal Marymount and she is Polish. And her partner went back to Poland over the last couple of weeks and picked up a copy of my book Flawless in Polish, because the Polish transit translation is the first international translation. And she brought it back. Oh, it was so nice. It was her treat. It was like such a surprise. So not only does my new tennis coach not stiff me on lessons, oh my God. She bought me a book and I was like, what? Can. Can I venmo you? She's like, no, it's my treat. So anyway, I'm just really especially grateful for her. And because it was kind of an international mission, she went on and got it.

[Elise Hu]

So cool.

[Dr. Ariana Scholz Douglas]

Very sweet. And then I've been, been. I've been trying to be less grouchy to the kids and be more grateful for them and have more like mother daughter time. So that's been pretty good this week. It's especially a week, you know, it is the week of gratitude and taking time for family. But my intention is actually going to be a little bit more specific. It is that my posture is terrible. I often work from my bed. And so not only do I have like the neck from looking at my phone, but also from my computer. I also just like my lower back. There's a lot of pressure on my lower back. So I'm just going to make my intention to be like, strengthening my back. I'm gonna do some more like, back specific exercises and training. I will remain grateful for everybody and all of the things and moments in my life. But. But my intention for the purposes of this is back. What about you? Yours was last week. It was about family, right?

[Elise Hu]

It was about family. It was about Thanksgiving. As I mentioned at the top of the show, I'm feeling like, okay, we've got Thanksgiving under control. I know this is airing after Thanksgiving, but we're recording it before Thanksgiving. I will report back on how it actually went, but I'm feeling like pretty good about it. We have some other plans. We're going to go to the Descanso Light show and yeah, we're gonna just kind of do some stuff but not be like over scheduled and. Yeah, so feeling good about that. This isn't like really an intention, but I did read this article in the Wall Street Journal called the Case for being ungrateful.

[Listener]

Huh.

[Elise Hu]

That like, there is an element of gratitude. And like, we've talked, I, I think we've, we talked about this a bit on the podcast before you started, but there is an element of like a gratitude practice quote unquote, that does Kind of veer into like toxic positivity.

[Listener]

You.

[Elise Hu]

Know, And I'll just read from the article. Performative gratitude. Compelling ourselves to be grateful when we're not is a form of toxic positivity. The energy we expend trying to avoid the uncomfortable feeling will ironically keep us focused on problem. Then we feel guilty because we failed to be grateful. And so this is just about like kind of acknowledging that like sometimes there are things that are shitty and you don't have to be great. Like, you don't have to look past them and say, well, I'm, you know, just because this, I didn't get this job, I, I have a roof over my head. I'm grateful for that. You know what I mean? And, and, and I was kind of like, yeah, like I do think, I think as in all things, there is a balance.

[Dr. Ariana Scholz Douglas]

Yeah. Don't invalidate the experience. Yeah. By papering it with happiness.

[Elise Hu]

They quote this woman who started to keep an anti gratitude journal and she lists the things that bother her each day and says the list, the list helps her think through her problems and put them into perspective. A woman whose husband died said she got sick of people telling her that she should be glad she had time to prepare for his death.

[Dr. Ariana Scholz Douglas]

Wow. Okay.

[Elise Hu]

And she just said it was like really helpful and that like when she writes the stuff down, she asks herself, can she let her anger go? If so, she writes down three actions to take. Then she shreds the list so that no one will see it. And I just was like, oh, this is interesting. Like I, I, in our, in our season of gratitude, I think it, it's, I, like, I like this framing of like, well, we can still acknowledge when like things don't go our way or things are hard and not have to like always put this, this positive sheen on everything over it. Yeah. So, you know, my intention is not like, I'm going to be more negative, but it is just like, it is just helping me, I think, think about, oh, this didn't, this didn't go well. And like, I want to, I want to like name it. You know what I mean?

[Dr. Ariana Scholz Douglas]

Yeah, sure, sure. Accepting the regrets and.

[Elise Hu]

Yeah, exactly. And I think for me also, like a big practice over a long time has been like being able to feel vulnerable. And there is something about saying when things go wrong that is like very vulnerable. Like you're saying it. This didn't, this didn't go the way I thought it was going to. And so saying like, this didn't go the way I thought it was going to and I'm sad about it. Like, there is something sort of like powerful in that too. So of course, I don't know, just kind of like thinking about all of this in this season. We will link to this. It's in. I read it in my Apple News app. My Apple News plus app, which I pay 9.99amonth for. So I don't know if everyone will be able to.

[Dr. Ariana Scholz Douglas]

I can give a gift link, though. Yeah, I have a Wall Street Journal subscription. I can give a gift link. So I'll send that to Sammy so we can include it in our show notes.

[Elise Hu]

Fabulous. Thank you, Elise. And you know what? One thing that we are grateful for in this season is our Patreon supporters.

[Dr. Ariana Scholz Douglas]

Yes.

[Elise Hu]

And thank you. We thank our $10 a month and up supporters every month. So thank you to the following amazing Patreon supporters. Ashley Taylor, Teresa Anderson, Michelle Maya, Barbara Chiakalo, Amy Amy Schnitzer, Heather Hale, Megan Donald Brew Jr. Helen De Moy, Shelly Lee, Kim Beagler, Sarah Sarah Boozi, Allison Cohen, Susan Burseth, Melissa McLean, Lenny Jones, Fran Kelsey Wolf Donne, Laura Eddy, Pam from Boston, Jettle Apti, Valerie Bruno, Jane Thoreau, Julie Daniel, Katie Quattrone, E. Jackson, Alicia Merritt, Amy Maseko, Liz Rain, JDK, Jennifer Smith, Hannah M. Julia Putt, Maddie O'Day, Marissa Lauren Gitlin, Sarah Bell, Maria Diana, Becky Hobbs Hailer, Cocoa Bean, Laura Haddon, Josie H. Nikki Bossert, Juliana Duff, Chelsea Torres, Angie James, Tiffany G, Diane m. Martin, Emily McIntyre, Stephanie Germana, Elizabeth Anderson, Kelly Dearborn, Christine Bassis, Allison Marklaine, Zulima Lundy, Carolyn Rodriguez, Carrie Gold and T. Nikki, Katherine Ellingson, Kara Brugman, Sarah H, Sarah Egan, Jess Combin, Jennifer Olson, Jennifer hs, Eliza Gibson, Jillian Bowman, Brianne Macy, Karen Perelman, Katie Jordan, Sarah M, Lisa Travis, Kate M, Emily Bruyer, Josie Alkas, Tara Todd, Elizabeth Cleary and Monica.

[Dr. Ariana Scholz Douglas]

And Monica and Monica.

[Elise Hu]

Thank you all so much. We're so grateful for you.

[Dr. Ariana Scholz Douglas]

Thank you. The Patreon community has been so much fun. That's probably like one of my favorite things to do is just to pop in on the Patreon and hang out with you all. So thanks so much.

[Elise Hu]

Love that. Okay. And just a reminder that Forever 35 is hosted and produced by me, Dori Shafriar and A Hugh and produced and edited by Sam Hunio. Sammy Reed is our project manager and our network partner is Acast. Thanks, everybody.

[Dr. Ariana Scholz Douglas]

Talk next time.

[Dory Shafrir]

Bye.