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- [00:01]
Wendy Zuckerman
Hi, I'm Wendy Zuckerman and you're listening to science versus today on the show. Something huge that's coming for 4 billion people on this planet. It could be you, your partner, your mother, your best friend. And that thing is menopause.
- [00:22]
Listener
Menopause.
- [00:22]
Wendy Zuckerman
Menopause. When we asked all of you, our listeners, for questions about menopause, I didn't quite expect so many responses.
- [00:37]
Listener
Hi, Science Versus. I am so glad you're doing something on menopause.
- [00:41]
Wendy Zuckerman
I'm like out of breath because I'm like, I've got to call them right now. We heard from boomers and those just blossoming. I'm only 27. I am 37 years old, 55 year old, 61. Some of you hadn't started menopause yet, but were worried about what fresh hell was coming your way. Is it terrible?
- [01:01]
Listener
Is it going to make me want to murder my family?
- [01:04]
Wendy Zuckerman
My mom, my stepmom, my mother in law, they're all going through menopause and all they say about it is that it's the worst. And for a lot of you, it did sound like the worst. People were getting hot flashes, of course, but also periods were going completely bonkers.
- [01:21]
Listener
Instead of my periods slowing down, I get it like every two weeks, which.
- [01:26]
Wendy Zuckerman
Just seems obnoxious to me, I had more periods. It should be called Men are More Very Short cycles.
- [01:32]
Listener
Very heavy periods. Heavy. It was just a horror show, basically.
- [01:37]
Wendy Zuckerman
Some of you had this nasty brain fog where you couldn't hold a proper conversation. You were getting mood swings to the point where you didn't recognize yourself.
- [01:46]
Listener
And then I would just be upset for no reason. I never went through any of the things that they talk about. But I will say I gained weight and the weight that I had completely transformed my body and all settled right around my stomach. So it looks like I'm seven months pregnant. I have never struggled with weight in my life, but now that I'm in menopause, I've gained 40 pounds within three.
- [02:12]
Dr. Monica Christmas
Months without changing my diet or exercise.
- [02:16]
Wendy Zuckerman
But I have got one symptom that I have not read much about. Every morning when I wake up, there is so much dry skin inside my ears, unbelievable amounts. I can reach in and sort of peel off. Sorry if this is a bit disgusting. Peel off a large amount of dry skin and it just keeps coming. But symptoms. This is just one of the confusing things going on about menopause. There was also this big question that people had about what on earth they should do about it. And in particular whether or not you should take hormones. For years we've been hearing that hormones can be dangerous. But some listeners going through menopause thought that they worked almost like a miracle. Almost.
- [03:09]
Listener
Within days, I would say all of the symptoms went away. I mean, everything got better. So it's amazing.
- [03:16]
Wendy Zuckerman
And this tracks with what I'm hearing all over social media, with folks online saying that these drugs are great and in fact, doctors have been screwing it up for years. For the vast majority of women, hormone replacement therapy is safe and effective and can give a woman her life back. But that option has been taken off the table. It's ridiculous to me. So what's going on here? Are hormones safe or not? And if you don't want to take them, is there anything else you can do? When it comes to menopause, I'm hearing a lot of it was just a horror show, basically. But then there's science. Science versus Menopause is coming up just after the break. This episode of Science Versus is brought to you by Ford. There are few pickups more iconic than the F150, and the 2024 F150 Lightning truck is no exception. With an EPA estimated range of 320 miles with the available extended range battery, it's the only EV that's an F150. Visit Ford.com to learn more. Excludes Platinum models. EPA Estimated Driving Range based on full charge. Actual driving range varies with conditions such as external environment, vehicle use, vehicle maintenance, high voltage battery age and state of health. There's no better feeling than a personal win. And the State Farm personal price plan can help you do just that.
- [04:53]
Listener
Talk to a State Farm agent today.
- [04:55]
Wendy Zuckerman
To learn how you can bundle and save with a personal price plan. Like a good neighbor, State Farm is there. Prices are based on rating plans that vary by state. Coverage options are selected by the customer. Availability, amount of discounts, and savings and eligibility vary by state. Welcome back. Today on the show Menopause. So our adventure into menopause really starts when the number of eggs in our ovaries dwindles, which can kick off this cascade of hormonal changes. And this time in our lives is generally called perimenopause. And the hormonal changes that we're experiencing during this time are actually not the same for everyone. So studies have found that for some of us, our estrogen levels will actually go up during perimenopause. For others, they will go down. And then there's a group of us where our estrogen levels actually won't change that much during this time. So bottom line, do not believe those posts on social media that say we're all going on the same hormonal journey here, because we're not. But we are all heading for the same destination. At some point, our estrogen levels will drop. We'll also stop getting our period. And if your period has disappeared for 12 months, congratulations, you're officially in menopause. One huge analysis found that most of us will reach this milestone between our mid-40s and mid-50s, but it can happen sooner. And so our first question is just what are the real symptoms of menopause and the time leading up to it? Because you go on socials and people say that you can blame basically anything on menopause. I talked about this with Dr. Monica Christmas, a gynecologist at the University of Chicago.
- [06:59]
Dr. Monica Christmas
There's this whole litany of symptoms now, and you can look like, oh, my God, I have that. My joints ache. Oh, my goodness, my hair is thinning, my skin is dry, my big toe is throbbing. I mean, I'm being face. And I don't mean to be facetious because I'm actually in menopause right now, and I. And I'm having, you know, I'm taping ice packs to my neck and surgery and all kinds of craziness. So I actually am not minimizing anyone.
- [07:25]
Wendy Zuckerman
The most random thing is that last night I Woke up at 4am and my big toe was throbbing. And I was like, but literally when.
- [07:35]
Dr. Monica Christmas
People say that to me, I'm like, my big toes kind of throbbing too. I don't think that's menopause, but may.
- [07:40]
Wendy Zuckerman
You know, okay, but seriously, this idea of is this weird thing happening to my body because of menopause or something else is actually a huge question for people during this time. Because the thing is, estrogen does a ton of stuff throughout our whole body, and so it's easy to blame our hormones, but sometimes something else is going on. For me, I just needed to cut my toenails. To our listener with the dry skin in your ear. Well, estrogen acts on cells in our skin, so it could be that. But also, doctors told us maybe check if you have a fungal infection. And Monica says sometimes things are breaking down in our body just because we're aging.
- [08:32]
Dr. Monica Christmas
And it's hard to sometimes disentangle what's just you're getting older. And I'm, you know, grappling with that aspect in my life too, right now when I. The other side of 50 is real versus what really is due to, you know, menopause.
- [08:47]
Wendy Zuckerman
But in the trial of your symptoms versus menopause, there are a few things that menopause is absolutely guilty for. And the first thing I'm so sorry to say has to do with your vagina. This was my reaction. Oh, no. As we get older, our vaginas atrophy. Science's word, not mine. I would have chosen downsize. One reason this might happen is because once estrogen levels drop, it makes it harder for blood to reach the tissues in your vagina, which means that your vagina can shrink.
- [09:29]
Dr. Monica Christmas
Vaginal tissues become drier, they become thinner. The actual glands make less lubrication.
- [09:36]
Wendy Zuckerman
Because of this. Several years after your period has stopped, it might become a bit painful to pee or to have sex. For some, Monica says that's not the problem.
- [09:46]
Dr. Monica Christmas
Some people say, I'm not interested in sex. That's not the issue. But I still have a dry, itchy vagina. And they just keep thinking they have a yeast infection. And they keep getting treatment, and they'll say it works for a little bit, but then I feel itchy again. And the reason it works is because the yeast infection cream probably had a moisturizing effect. So that's why they felt like they had a little bit of relief, because the cream helped. But it's not that they really had a yeast infection.
- [10:13]
Wendy Zuckerman
In fact, research has found that even though changes to your vagina are one of the most common symptoms of menopause, because a lot of people don't know this, they don't get the proper treatment. Okay, so from your vagina to something coming out of it, your period. Estrogen and hormones obviously play a huge role in when you get your period, which is why menstrual cycles can go mental. In the time leading up to menopause, we often hear that you'll politely start skipping your period, but it's actually quite common for your menstrual cycles to get heavier and to come more regularly. As a general rule, if your cycle is about a week shorter or longer than it normally is, that's a sign you're in early perimenopause. If you start skipping cycles completely, you're getting close to menopause. Next up, hot flashes. Tons of folks transitioning into menopause are going to get them. And while for some they're not a big deal at all, for others, they are a very big deal. Here's how one of our listeners described it. She said, picture this.
- [11:28]
Listener
You've got a lasagna in the oven on 450 degrees or something, and you open the oven and get that blast in your face.
- [11:38]
Wendy Zuckerman
And this blast in your face, which can last for up to several minutes, can mess with your sleep, which can then really affect other things like your mood. And a lot of listeners were asking us, why does this happen? It's weird, right? And amazingly, scientists only discovered the mechanism about a decade ago. So as estrogen levels change, we think that it stimulates these neurons in our brain called candy neurons, and it makes them kind of crazy. So they start sending messages to brain regions that control temperature, telling your brain you are hot, and so bam, you feel hot. And some people can experience these flashes of heat on and off for years. In fact, for the unlucky ones, they'll continue even after you've finished menopause. So meet what one paper described as the super flashes. Here's Monica again.
- [12:42]
Dr. Monica Christmas
My poor mom is one of them. That they always have them. They might not be as severe as they were when they first went through menopause transition, but they will always have them.
- [12:52]
Wendy Zuckerman
How's your mom now?
- [12:55]
Dr. Monica Christmas
She is better, but she will still, like, she will still have a hot flash. And if I say her age, she would kill me. So I won't say her age. I'll just say I'm in my 50s. And she did not have me when she was 16.
- [13:10]
Wendy Zuckerman
Right. And she's still having hot flushes. Yeah.
- [13:13]
Dr. Monica Christmas
All the grandkids are like, how old is grandma? And I'm like, who the heck knows? But she used to tell everybody that she was 45. And when I turn 45, I'm like, Mom, you at least need to be older than your oldest child. And she looked me straight in my face and said, that sounds like a you problem, not a me problem.
- [13:34]
Wendy Zuckerman
And researchers found that black women, like Monica's mum, are more likely to be super flashes compared to white and Asian women. We're not sure why. Okay, so if you are getting hot flashes, your menstrual cycle is being weird. Chances are you are on the train to menopause. And there's other stuff, too, like joint pain and stiffness. But then there's two symptoms that I hear about a lot in the context of menopause, where things aren't so simple. So now let's look at memory and brain fog. This was a really big issue for a lot of you out there. In an email, someone told us, quote, the brain fog was absolutely awful. I lost confidence in even carrying on a conversation because I couldn't find the words to use. So to find out what's going on here, we Need Professor Samar El Kudari at the University of Pittsburgh and she's been studying menopause for almost 20 years.
- [14:32]
Professor Samar El Kudari
I see how I used to study it without fear, but now I could see that I'm living it. You know what I mean?
- [14:39]
Wendy Zuckerman
Yes.
- [14:39]
Dr. Monica Christmas
So if that's what study it without fear.
- [14:42]
Wendy Zuckerman
Yeah. That even when I'm building this episode, I completely understand. Understand where you're coming from. Yeah, yeah, yeah. So a lot of people in perimenopause, around 60% say they're having attention and memory problems.
- [14:58]
Professor Samar El Kudari
You know, sometimes you are talking and you want to remember name of someone, you feel like it's there, you want to say the name and you are not able to remember.
- [15:09]
Wendy Zuckerman
And it makes sense that changes to your hormones could affect how you think. Because we know that estrogen does really important stuff to our brains, like it helps memories to form. But for the average person going through menopause, how bad is this? So let me tell you about this amazing study that Samar works on. It's tracked more than 3,000 women for decades and it's measured their hormones and all kinds of things. But it's also given the memory tests over and over again over many years. And here's what it's found.
- [15:45]
Professor Samar El Kudari
So you expect as you repeat the test, you should get better on the test.
- [15:50]
Wendy Zuckerman
Right, right.
- [15:51]
Professor Samar El Kudari
However, what we found is during the perimenopause, women actually are not getting better. So their learning is not, you know, as you would expect for someone younger.
- [16:06]
Wendy Zuckerman
Mm. Yeah. Their test scores didn't drop, they just didn't go up. So it's not like going through menopause trashed their memory. And other research finds this kind of thing too. So for example, one study gave women a list of words to remember and found that during perimenopause they weren't so good at this. But again, it was subtle. The women had trouble remembering one or two words out of 16. And the good news is that in some of these kinds of studies, including Samars, it shows that this so called menopause brain, it doesn't last forever, it's.
- [16:48]
Professor Samar El Kudari
Really temporary and it will go away once they become postmenopausal.
- [16:53]
Wendy Zuckerman
Interesting. So I think bottom line, this is real. And while some of us might be hit harder by it than others, thankfully, on average our brains will fare better than our vaginas. Ok, just quickly, the last symptom we need to dive into is weight gain. People sort of have this story that I went through menopause and I put on 50 pounds overnight.
- [17:20]
Professor Samar El Kudari
It's not because of menopause. You are not gaining weight because of menopause. You are gaining weight because you are getting older.
- [17:28]
Wendy Zuckerman
Generally speaking, as we get older, we tend to put on weight. In the study Samar works on, women tended to put on around two kilos or four and a half pounds over three years. But when researchers followed the women to see who's perimenopausal, who's postmenopausal, they can see that the weight gain isn't linked to where they are in that menopause journey, but rather how old they are. And other studies have found the same thing. So one big review paper wrote, weight gain per se does not appear to be affected by the hormonal changes of the menopause. But then what about all those people at the start of the show talking about how they had all this belly fat all of a sudden? Well, if that's you, you're not imagining it, because menopause is doing something here.
- [18:26]
Professor Samar El Kudari
Menopause and the hormone would affect where this fat go in your body. So you see women start to accumulate more fat in their abdomen.
- [18:37]
Wendy Zuckerman
Yeah. So the hormonal changes during menopause tell your body to change where it stores fat, and for some mad reason, it's redirecting that fat to your belly. In one study, postmenopausal women had around 50% more fat inside their abdomen compared to premenopausal women. So for those really feeling this menopausal belly fat, it could be this one, two punch. We tend to gain weight as we get older, and then our body shoves it in our tum. So here's where we're at. The adventure into menopause can be a real drag. I mean, for one, it can dry out your vag. It can give you hot flashes that for some of us will hang around for years. It can affect our memory, although for most of us, that won't be too bad. And it can affect our body shape. Our next question is what can we do about all this? Because on Instagram and podcasts and news reports, it feels like there is one message screaming from the rooftops. Just take hormones. So should you do it? That's coming up. This episode is brought to you by Ford. I'm here with our editor and electric vehicle owner, Blythe. Yes, I'm recording inside my Ford F150 Lightning truck to chat about the Ford power promise. What's that? It is Ford's commitment to getting electric vehicle drivers started with confidence. When you buy or lease one of their electric vehicles. You get a complimentary home charger and standard installation. Wow, that's pretty impressive. Which models are included? The Ford Mustang Mach E F150 Lightning and E transit cargo van. You can visit FordPowerpromise.com to learn more. Must purchase or lease a new Ford F150 Lightning Mustang Mach E or E Transit cargo van vehicle from a participating ford dealer between October 1, 2024 and January 2, 2025 to be eligible to receive a one complimentary Ford charge Station Pro Ford Charger model may vary based on availability with complimentary home installation or B2000 bonus cash. No trade in required offer not available to fleet or commercial customers. Complimentary home installation must be performed through qmerit Electrification LLC at a residential LOC with a dedicated electrical meter. Restrictions may apply based on structural and electrical limitations. Installation must be completed by June 30, 2025 for all offers. Must take retail delivery from an authorised Ford dealer's stock by January 2, 2025. See your Ford dealer for details and terms.
- [21:43]
Professor Joanne E. Manson
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Wendy Zuckerman
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- [22:29]
Professor Joanne E. Manson
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- [23:03]
Wendy Zuckerman
Welcome back. Today on the show Menopause. It doesn't sound like a barrel of laughs, but now we're asking what could we do to make it funner? The treatment getting a lot of buzz right now is hormone therapy. And the idea is that you take a synthetic version of the hormones that your ovaries are no longer pumping out. And what's confusing here is that for years we've been hearing that these hormones can be dangerous and can cause things like breast cancer. But now the pendulum is swinging in the other direction with folks online saying that these drugs are safe and can work wonders for your menopausal symptoms. And yet doctors have been withholding these drugs from us. Why? Well, apparently it's all because of one study scared off, say advocates, by an NIH funded study called the Women's Health Initiative, or whi, from two decades ago that they say dramat overstated the risk of hormones. The thought that estrogen causes breast cancer is the worst thing that came out of that study because it's not true.
- [24:14]
Susan Reid
What we know, and this is not controversial. Women that take estrogen alone have a decrease in getting breast cancer. And this is the message that is not getting out.
- [24:27]
Professor Joanne E. Manson
It's hands down the biggest screw up.
- [24:29]
Wendy Zuckerman
Of the entire medical field in the.
- [24:31]
Professor Joanne E. Manson
Last 25 years that I won't be able to think of a bigger act of incompetence than what happened with the Women's Health Initiative.
- [24:41]
Susan Reid
I've been involved with the WHI since the study inception.
- [24:46]
Wendy Zuckerman
That last voice, that's Professor Joanne E. Manson at Harvard Medical School. She's been working on the Women's Health Initiative for more than 30 years. She does not think that it is the biggest act of incompetence. But let's get into it, because this study might be the single most influential study out there that's affected our perception of these hormones and whether or not they're going to help us or hurt us during menopause. Let's start our story. In the 80s and 90s, some early research had suggested that if you're an older woman and you took these hormones, it could prevent heart disease. And so doctors would giving out these drugs like jelly beans. But at that time, Joanne and a huge team of researchers wanted to find out if this was really true. Did taking hormones like estrogen and progestin, which is the synthetic version of progesterone, did that really prevent heart disease? So they launched this huge study and because heart attacks were such a big killer in the US Women were lining up to be involved.
- [25:54]
Susan Reid
We had a slogan, be part of the answer. And so many women in the study would talk about they just want to be part of the answer, not only for themselves, but for women of future generations, for their daughters, granddaughters. And it was very exciting.
- [26:16]
Wendy Zuckerman
It sure was exciting. More than 27,000 women over 50 signed up. Some were given hormones, others were just given a placebo. And this study was trucking along for Five years. But then the researchers started analyzing the data, and they found something that they really didn't expect. Instead of hormone therapy preventing heart disease and, you know, saving lives, they saw the opposite.
- [26:45]
Susan Reid
An increased risk of heart attack, stroke, blood clots in the legs and lungs, and breast cancer.
- [26:55]
Wendy Zuckerman
Yeah. So not only did hormones not prevent heart disease, but they also increased a woman's risk of breast cancer. A press conference was set up. They announced the results and said that the trial would be stopped early. And suddenly, people were freaking out about these hormones. Here's an interviewer on the Today show talking to a researcher at the time.
- [27:18]
Listener
You actually found heart disease. The risk increased by 29%. The risk of strokes increased by 41%. Invasive breast cancer risk increased by 26%. So what are we telling women? The 6 million women in America today who are taking HRT?
- [27:35]
Susan Reid
Well, it was a shocking finding. It was seismic. So women were calling their doctors frantically. They were tossing their pills in patches.
- [27:49]
Wendy Zuckerman
Were you getting calls from people who were in the trial, from your patients?
- [27:52]
Susan Reid
Yes, I received calls from my own patients as well. It was very stressful and led to a sea change in clinical practice. Many clinicians were telling their patients to stop.
- [28:08]
Listener
So it was a big. It was a royal pain in the ass.
- [28:11]
Wendy Zuckerman
Susan Reid, a professor of obstetrics and gynecology at the University of Washington, was in the middle of a different clinical trial using hormones, and she told me she had to stop because of all this.
- [28:22]
Listener
We had to stop.
- [28:23]
Wendy Zuckerman
Oh.
- [28:24]
Listener
So, yeah, I remember it very well because my Pope was in England singing with a choir, and I was left holding the bag. It was horrible. So I remember it was literally singing.
- [28:35]
Wendy Zuckerman
With a choir, or metaphorically.
- [28:37]
Listener
No, literally.
- [28:42]
Wendy Zuckerman
So this WHI study, it really set the stage for hormone therapy not to be given to loads of folks suffering through menopause because doctors thought it was too dangerous. But now you fast forward 20 years, and you have people saying that this was a huge mistake. Why? Well, some say that the study was flawed, and it's 20 years old. It's irrelevant. I asked Susan about this. There is this feeling that the Women's Health Initiative was this sort of old study done using hormones that we don't even prescribe anymore. And this is bunk science and we shouldn't trust it at all. What do you think of that? Is this still a useful study?
- [29:28]
Listener
It's totally a useful study. And so that mantra is coming from people who want to sell hormones sometimes. And people shouldn't say the study was horrible because it was incredibly well done, and it Answered questions that it was set out to answer, but unfortunately, it showed there were risks for those people in that study. It's good data. Use it. Right, Use it, but don't twist the message. Don't twist it.
- [30:04]
Wendy Zuckerman
Without twisting the message. The second complaint that people have is that the press conference overstated the risks here. So let's look at what happened with breast cancer. In that press conference all those years ago, they said that for the women who took the hormones estrogen and progestin, they had a 26% higher incidence of breast cancer compared to those who got a placebo, which could sound pretty scary, right? A 26% increase. But if you tell people the stats in a different way, it can feel pretty different. So, for example, if you look at it like this, out of 10,000 people who take these hormones, how many extra folks are going to get breast cancer? A recent Lancet paper calculated that it was six. Six more cases compared to what would have happened naturally. Six out of 10,000. Here's Susan.
- [31:05]
Listener
How big is the risk? If you look mathematically, it's small. Super small. Less than one in a thousand per year attributed to the hormones. They are small, but you need to know about them. Any risk might be scary to someone if they had three family members die of breast cancer. They don't want it.
- [31:24]
Wendy Zuckerman
But then what's up with these people on social media getting loads of views for claiming that these hormones lower your risk of breast cancer? Well, I think what they're doing is cherry picking the facts in a way that that actually could be quite dangerous. So they're telling you about a particular group of women in that study, and it was women who didn't have their uteruses. They'd been removed. And this is important because the thing is, if you don't have a uterus.
- [31:59]
Listener
Susan says you're my favorite patient to give hormones to.
- [32:03]
Wendy Zuckerman
Yeah, that's because you can just take estrogen. You don't have to take this other hormone called progestin as well. If you have a uterus, you can't do that because just taking estrogen increases your risk of uterine cancer. Something you don't have to worry about if you don't have a uterus. Right. It really increases my risk.
- [32:24]
Listener
Oh, yeah. You can only take estrogen alone if you don't have a uterus.
- [32:29]
Wendy Zuckerman
And the thing is, in that WHI trial, if you just zoomed in on the women without uteruses who just took estrogen, they actually did have a lower risk of breast cancer. And not all but Some smaller studies have since come along and found this, too.
- [32:46]
Listener
It's real. It's science.
- [32:49]
Wendy Zuckerman
So, in a nutshell, or a boob shell, if you have a uterus taking hormones, estrogen and progestin, that will slightly increase your risk of breast cancer. If you don't have a uterus, you're good here. And then just quickly remember how early in the WHI study they saw hormones up your risk of heart disease.
- [33:12]
Listener
You actually found heart disease. The risk increased by 29%. The risk of strokes increased by 41%.
- [33:19]
Wendy Zuckerman
So the latest science marches to the beat of a slightly different drum. Okay, so if you are over 60, it's still bad news. Here's Susan.
- [33:31]
Listener
If you start Hormones at age 60, you have an increased risk for a heart attack, increased risk for a stroke, increased risk for leg clots and lung clots. So those are real risks.
- [33:42]
Wendy Zuckerman
But if you're in your 50s, taking hormones actually lowers your risk of heart disease, which is interesting, right? And the reason this might be happening is because if you take hormones like estrogen when you're older, you might already have dangerous plaques in your arteries. And we think that oestrogen can help to rupture those plaques, increasing your risk of a nasty blood clot forming. But if you take estrogen before those plaques form, we think it might be protective. Okay, so that is basically the tea on that big study that people like to crap on. But now let's look at which menopausal symptoms hormones can actually help with. Because Monica hears over and over again these stories about the magical powers of these drugs.
- [34:32]
Dr. Monica Christmas
That hormone therapy is going to fix everything. It's going to make me skinny. It's going to make me happy again. I'm going to have all the this energy.
- [34:40]
Wendy Zuckerman
The truth is that hormone therapy can be great for a few different things. Like it can help your poor downsized vagina. Researchers found that estrogen put straight into your vagina, which is quite safe even if you have a uterus, can even increase the number of blood vessels in your genital area, which is exciting.
- [35:02]
Dr. Monica Christmas
Treatment with local vaginal estrogen can be extremely helpful.
- [35:07]
Wendy Zuckerman
Hormones are also great for hot flashes and night sweats. One review found that hormones reduce hot flashes in peri and postmenopausal women by around 75% compared to a placebo. And Monica says that this means other stuff can get better, too.
- [35:23]
Dr. Monica Christmas
If I give you hormone therapy and your hot flashes and night sweats resolve or get better and you're sleeping better, then you probably will have more energy. You will have More clarity. Right? But if that's not actually the trigger, just taking hormone therapy isn't gonna make your brain fog go away.
- [35:40]
Wendy Zuckerman
Which takes us to the stuff that hormones don't really help with. Studies find that they don't seem to improve memory problems. Research on depression isn't great either, but it might help if you're in perimenopause. Hormones are also not particularly great at helping you shed that belly fat. So should you take them or not? Well, over and over again, I heard basically the same advice from academics and doctors. You look at what your symptoms are, ask yourself, how bad are they? Can hormones actually help with them? And then you balance that against the small but real risks here. And generally speaking, take the lowest dose. That helps with your symptoms. And don't stay on these hormones any longer than you need to. Here's Monica again.
- [36:30]
Dr. Monica Christmas
We don't want to mislead people by saying, this is safe. It's like jelly beans. Everybody should be on it. It's still a low risk. It's not zero, but it's still a pretty low risk. And I don't think that that's in a really symptomatic individual that's really having problems. Their quality of life is just terrible. Those people should not be afraid or doctors should not be withholding hormone therapy from them because vast majority of people will be fine. And I think that's the key point there.
- [37:03]
Wendy Zuckerman
Okay, so our last question on this menopause bonanza is what if you want to try something more natural, you don't want to take the hormones? Well, Susan Reed has studied a bunch of options out there.
- [37:20]
Listener
We like to take herbs, right? We like vitamins. We like herbs. We think it's going to be natural. We think it's going to be good. How's the data on that? Not so hot. It's just not so great. That's really a bummer. It's really a bummer.
- [37:31]
Wendy Zuckerman
So Susan did a big clinical trial to see if one of the most popular supplements for menopausal stuff, black cohosh, could help with hot flashes or vaginal symptoms against a placebo. And it did.
- [37:45]
Listener
Bupkus.
- [37:46]
Wendy Zuckerman
What do your patients tell you when. After you did this study, and you're like, I don't see it helping.
- [37:53]
Listener
They hated us, right? They hated us. They wanted their black co host, in fact, our naturopathic physician who was part of our team, who really helped us with all this. She sobbed. She sobbed.
- [38:07]
Wendy Zuckerman
Wow.
- [38:09]
Listener
She was so sad because this was what she told all her patients. I mean, it was really sad.
- [38:15]
Wendy Zuckerman
Susan has also looked into phytoestrogens. Sometimes people take them as a supplement or eat foods high in them, most famously soy or tofu. And this might work. It's actually kind of cool because special bacteria in the gut can take that soy and then transform it into a molecule that acts a bit like estrogen in your body. The thing is, though, it only works if you have those special gut bugs, and a lot of us don't. Plus, you need to eat a lot of phytoestrogens.
- [38:48]
Listener
You can't just drink soy lattes. It's not going to. It's not going to do it.
- [38:53]
Wendy Zuckerman
Instead of supplements, try exercise, including weight training. It can help with loads of things like your sleep, your mood, your bones, and maybe even it might help you to maintain your weight. But it doesn't look like you can outrun your hot flashes. And when it comes to hot flashes, there is actually a new drug that doesn't muck about with hormones, but instead tweaks that candy neuron system that we talked about at the start of the show. Just quickly, Susan has found something recently that she thinks is really awesome and just might help you with your trouble sleeping and your hot flashes. It's perfectly safe, and it is your mind. Susan and other teams have found that cognitive behavioral therapy. So just using your brain to reframe your hot flashes as not being so bad can help.
- [39:51]
Listener
Our minds are powerful. It's exciting. You literally can change your perception of that hot flash and how bothersome it is for you. And we saw a benefit that was better than you might have seen with a pill.
- [40:07]
Wendy Zuckerman
Have you had any pushback of, like, getting women to do therapy for menopause is telling them it's all in their head once more.
- [40:15]
Listener
Oh, no. You know, I flip that. I don't say it's in their head at all. It is real. But I flip it to say your mind is powerful. And look what you can do with it. You can do with your mind more than you could do with a pill.
- [40:32]
Wendy Zuckerman
So when it comes to signs versus menopause, what is going on? Well, the most common symptoms are hot flashes, bonkers periods, and vaginal troubles. And while it might not make you pour on the pounds, it can put those pounds on your belly. As for a cure, hormone therapy is far from the panacea that people might claim, but it can be really helpful for some things, including hot flashes and itchy vaginas. But you know what? Because everyone's estrogen journey is different, it's possible that it could be really helpful for your symptoms. There are just a few risks you need to know about, particularly breast cancer and if you're over 60, heart disease. Meanwhile, there are other things you can try, like cbt. Here's how Monica, who, if you'll remember, is currently ice packing her way through menopause, thinks about this whole wild ride.
- [41:30]
Dr. Monica Christmas
It is unavoidable. If we're lucky to live long enough, you're gonna go through menopause. Menopause isn't a disease. It's a natural process. And I think with this whole monetization of menopause right now, it makes it seem like there's a fix for it. And yes, by and large, there's treatment to help certain symptoms, but there's no magic pill to stop the aging process.
- [41:58]
Wendy Zuckerman
So I hope you feel a bit better and more prepared for what's going on with menopause. And if you are still feeling very freaked out about all this, Susan told me, you know, menopause, it's not all bad if you are someone that gets moody around your period. If you feel bloated, if you get painful cramps, For a lot of us, it all stops.
- [42:25]
Listener
Life is one nice, smooth ride. There's none of that up and down. Oh, yeah. Some people love it. Some people are totally psyched. You don't have to think about contraception anymore. It's liberating.
- [42:38]
Wendy Zuckerman
Great.
- [42:38]
Listener
It's very liberating.
- [42:40]
Wendy Zuckerman
Great. One listener told us that she can wear white jeans again. And she looks really cute in white jeans.
- [42:45]
Listener
Yeah, yeah. And you don't have to buy new sheets. Yeah.
- [42:52]
Wendy Zuckerman
That's Science Versus. This episode on menopause has 158 citations. 158. Oh, my gosh. If you want to see these citations, if you want to read more about anything I've said on this show, then just go to the show notes and there's a link to the transcript. I really hope that this helps you understand what's going on because there is so much garbage on social media about this. I just really want to thank all of our listeners who got in touch, whether it was on email or voicemail. I listened to all of those voicemails and I just. My heart went out to every one of you. I cried a couple of times. I just really appreciate you getting in touch and trusting us with your story. We always love hearing from you. So if you want to get in touch, I'm on TikTok, Wendy Zuckerman. And we are on Instagram sciencevs. This episode. This episode was produced by me, Wendy Zuckerman with help from Rose Rimler, Meryl Horn, Akedi Foster, Keys and Michelle Dang. We're edited by Blythe Terrell, Fact checking by Diane Kelly, Mix and sound design by Sam Baer Music written by Bobby Lord, Peter Leonard, so Wiley, Emma Munger and Bumi Hidaka. Thanks to all of the researchers that we spoke to for this episode, including Dr. Carolyn Gurvich, Professor Martha Hickey, Professor Nancy Woods, Professor C indi Farqua, Professor Jayashree Kulkarni, Dr. Rebecca Thurston, Dr. Siobhan Harlow, Dr. Susan Diem, and Dr. Yana Zinagradova. An extra special thanks to Suren Jay Amana, Penny Greenhalgh and Imogen Hayes for our brainstorming session about a better word for vaginal atrophy. We threw a bunch out there but went with downsized in the end. Thanks guys. Also thanks to the Zuckerman family and Joseph Lavelle Wilson. Science Versus is a Spotify Studios original. Listen to us for free on Spotify or wherever you get your podcasts. But if you are listening on Spotify you can follow us and tap the Bell icon so you get notifications when new episodes come out. And wherever you are listening to us, please rate and review us. Give us a five star review, one for every million citations we have on the show. I'm Wendy Zuckerman. Back to you next time.