Podcast Summary: "You Might Also Like: The Tamsen Show"

Host: Tamsen Fadal
Guest: Dr. Sharon Malone, OB-GYN and Author
Release Date: March 21, 2025

Introduction

In this enlightening episode of "The Tamsen Show," host Tamsen Fadal engages in a profound conversation with Dr. Sharon Malone, a renowned OB-GYN, author, and advocate for women's reproductive health. The discussion centers around menopause, hormone therapy, and the pervasive misinformation that has shaped women's experiences over the past few decades.

Understanding Menopause and Perimenopause

Defining the Stages

Dr. Malone begins by elucidating the distinctions between perimenopause and menopause. Perimenopause, often a confusing phase for many women, refers to the transitional period leading up to menopause, typically lasting anywhere from four to ten years. During this time, hormonal fluctuations can cause symptoms such as irregular periods, mood swings, and brain fog.

"Perimenopause just simply means around the menopause. It is also called the menopausal transition, where you go from your peak fertility years to no fertility."
[05:08] Dr. Sharon Malone

Symptomatology and Diagnosis

Contrary to common misconceptions, the absence of periods is not a definitive indicator of perimenopause. Women may continue to experience regular, albeit irregular, menstrual cycles while grappling with menopausal symptoms. Dr. Malone emphasizes the unreliability of blood tests during this phase due to erratic hormone levels.

"Imagine it's like having PMS every day. That is sort of what perimenopause is like."
[07:12] Dr. Sharon Malone

Hormone Therapy: Separating Fact from Fiction

Historical Context and Misinformation

The conversation delves into the pivotal 2002 Women's Health Initiative (WHI) study, which dramatically shifted medical perspectives on hormone replacement therapy (HRT). The study prematurely concluded that HRT increased the risk of breast cancer and did not reduce cardiovascular disease, leading to a significant decline in HRT usage.

"It cemented this idea that doctors had been doing something really to the detriment of women's health, not to the benefit."
[01:35] Dr. Sharon Malone

Flaws in the Women's Health Initiative

Dr. Malone critiques the WHI study's methodology, highlighting that the average participant was 63 years old, well beyond the typical age of menopause onset. This age factor undermined the study's relevance to women in their 50s experiencing perimenopause.

"The average age of the woman entering the Women's Health Initiative was 63... So how are you going to do a prevention study on a 79-year-old?"
[35:22] Dr. Sharon Malone

Current Understanding and Recommendations

Contrary to the WHI's blanket statements, Dr. Malone asserts that HRT can be beneficial when initiated around the time of menopause onset. She clarifies that menopausal hormone therapy (MHT) is different from birth control pills in dosage and purpose, advocating for its continued use to manage symptoms and prevent osteoporosis.

"Menopausal hormone therapy is anywhere from a third to a quarter of the dose of what's in a standard birth control pill."
[20:34] Dr. Sharon Malone

Racial Disparities in Menopause Treatment

Impact on African American Women

Dr. Malone addresses the prolonged and more severe menopausal symptoms experienced by African American women, citing the Study of Women Across the Nation (SWAN). These women often face longer durations of perimenopause with intensified symptoms yet receive the least medical attention for their struggles.

"African American women tend to go through menopause earlier... their symptoms start earlier, they're more severe, they last longer, they complain about them the least, and they're the least likely to get a prescription for medication."
[47:06] Dr. Sharon Malone

Cultural and Medical Biases

The discussion touches on misconceptions perpetuated by the medical community, such as the false belief that black women do not suffer from osteoporosis or severe menopausal symptoms. Dr. Malone emphasizes the need for personalized treatment approaches that consider individual health profiles rather than generalized assumptions based on race.

"We are denying hormones to women who have a family history of breast cancer... because physicians are not offering, because they are thinking that the same contraindications for MHT are the same ones for birth control pills."
[58:05] Dr. Sharon Malone

Empowering Women Through Education and Advocacy

Self-Advocacy and Health Management

Dr. Malone and Tamsen Fadal stress the importance of women taking charge of their health by staying informed, advocating for themselves, and maintaining healthy lifestyles. Exercise, balanced diets, and regular medical check-ups are pivotal in managing menopausal symptoms effectively.

"You have more control over how you age and how you age healthfully than you think."
[66:45] Dr. Sharon Malone

Recommendations for Younger Women

For younger women approaching menopause, Dr. Malone advises adopting healthy habits early on and shifting the focus from weight to overall health metrics such as blood pressure, blood sugar levels, and metabolic health.

"Focus on health, not on weight."
[45:48] Dr. Sharon Malone

Practical Advice on Hormone Therapy

When to Start and Duration

Dr. Malone clarifies that hormone therapy can be initiated at any stage during menopause based on individual needs and does not have a strict end date. She debunks the myth of a "window of opportunity," emphasizing that starting hormone therapy early can offer both symptom relief and potential long-term health benefits.

"Why suffer for two or three years and then... get started?"
[64:04] Dr. Sharon Malone

Modes of Administration and Safety

Highlighting advancements in HRT, Dr. Malone explains the availability of transdermal estrogen options, which pose fewer risks concerning blood clots compared to oral estrogens. She advocates for personalized treatment plans that align with each woman's health profile and risk tolerance.

"We now know that there are other modes of delivery, such as a transdermal estrogen that you can use that does not affect the blood clotting factors as much as oral."
[57:12] Dr. Sharon Malone

Conclusion

The episode concludes with a heartfelt message from both Dr. Malone and Tamsen Fadal, urging women to educate themselves, seek out knowledgeable healthcare providers, and reclaim control over their menopausal journey. Dr. Malone emphasizes that menopause does not mark the end of vitality but rather the beginning of a new chapter characterized by informed health choices and empowered living.

"Women have options to help them manage menopause today that their grandmothers and mothers didn't have a decade ago. Your life is just beginning."
[65:39] Tamsen Fadal

Key Takeaways

• Perimenopause vs. Menopause: Understanding the transitional phase and its symptoms is crucial for timely intervention.

• Hormone Therapy Misconceptions: Historical studies have shaped outdated fears; current evidence supports the safe and beneficial use of HRT when appropriately managed.

• Racial Disparities: African American women face unique challenges during menopause that require tailored medical attention and culturally sensitive care.

• Empowerment Through Education: Women must advocate for their health by staying informed, maintaining healthy lifestyles, and seeking competent medical advice.

• Personalized Treatment Plans: Hormone therapy should be customized based on individual health profiles, with considerations for different administration methods to minimize risks.

By addressing longstanding myths and advocating for personalized, informed healthcare, this episode serves as a vital resource for women navigating the complexities of menopause, empowering them to make decisions that enhance their well-being and quality of life.