Sunday Pick: What happens to sex in midlife? A look at the "bedroom gap" | TED Health

Summary

TED Talks Daily: What Happens to Sex in Midlife? A Look at the "Bedroom Gap" | TED Health

Episode Release Date: March 30, 2025
Host/Author: TED
Description: This episode delves into the intimate and often stigmatized topic of sexual health in midlife, exploring the challenges and solutions surrounding the "bedroom gap." Featuring insights from gynecologist and sexual medicine specialist Dr. Maria Sophocles and a comprehensive conversation with Dr. Jessica Shepherd, this episode aims to destigmatize sex conversations, especially among older individuals, emphasizing that sexual pleasure and comfort are essential at every life stage.

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1. Introduction to the Episode

Elise Hu opens the episode by highlighting the importance of sex and sexual health for everyone, acknowledging the persistent stigma surrounding these topics. She introduces the episode's focus on the "bedroom gap" and sets the stage for the discussions to follow.

2. Dr. Maria Sophocles on the "Bedroom Gap"

At [06:20], Dr. Maria Sophocles begins her talk by sharing a poignant encounter with a patient who expressed feeling betrayed by her own body during menopause. She introduces the concept of the "bedroom gap," which refers to the disparity in sexual expectations and capabilities between men and women in midlife.

Key Points:

• Biological Factors: Dr. Sophocles explains that menopause leads to a decrease in estrogen production, affecting collagen and blood vessels in the vagina. This results in symptoms like vaginal dryness, loss of libido, and painful intercourse, making sexual activity uncomfortable for many women.

  "The second effect of the loss of estrogen in the vagina is on blood vessels. We need blood vessels for lubrication." ([07:58])

• Cultural and Historical Influences: She emphasizes that the "bedroom gap" isn't solely biological but is also influenced by entrenched cultural and gender roles. While treatments like Viagra have become widely available for men, similar options for women are limited and underutilized.

• Impact on Relationships: The lack of female-focused sexual health solutions can strain relationships, as women may feel unable to enjoy intimate moments, leading to feelings of guilt and inadequacy.

3. Conversation with Dr. Jessica Shepherd

Following Dr. Sophocles' talk, Elise Hu introduces a conversation between Dr. Shoshana Ungerlider and Dr. Jessica Shepherd, a board-certified OB/GYN and menopause expert.

a. Impact of the Women's Health Initiative on Hormone Replacement Therapy (HRT)

At [23:05], Dr. Shepherd discusses the pivotal Women's Health Initiative (WHI) study released over 20 years ago, which significantly impacted the prescription of HRT.

Key Points:

• Study Findings: The WHI study initially aimed to explore the benefits of HRT for preventing cardiovascular disease but was halted when it found an increased risk of breast cancer among women using estrogen and progestin.

  "The public heard through media was that estrogen and or hormone replacement therapy causes breast cancer." ([23:24])

• Public Perception and Decline in HRT Use: The study's media coverage led to widespread fear and a subsequent 84% decline in HRT prescriptions, leaving many women without effective treatment for menopausal symptoms.

b. Menopause and Increased Health Risks

At [25:15], Dr. Shepherd unravels the connection between menopause and heightened risks of conditions like heart disease, dementia, and osteoporosis.

Key Points:

• Estrogen's Protective Role: The decline in estrogen during menopause removes its protective effects on the heart, bones, and brain, leading to increased susceptibility to these conditions.

  "When you look at heart disease, heart disease is still the number one killer of women across the world." ([25:26])

c. Myths About Menopause and HRT

At [27:05], Dr. Shepherd addresses common misconceptions surrounding HRT.

Key Points:

• HRT Safety: Contrary to popular belief, vaginal estrogen does not increase the risk of breast cancer. The fear primarily stems from the WHI study's findings on systemic estrogen.

  "Vaginal estrogen works genitally, locally and has positive effects. Systemic estrogen can have positive or potentially negative effects, depending on the target tissue." ([09:00])

• Need for Education: There's a critical need to educate both doctors and patients about the differences between vaginal and systemic estrogen to restore confidence in HRT options.

d. Ethnicity, Socioeconomic Status, and Menopause

At [29:07], Dr. Shepherd explores how ethnicity and socioeconomic status influence women's experiences with menopause.

Key Points:

• Variations Across Ethnicities: Studies show that Black women experience more severe and prolonged menopausal symptoms compared to Japanese women.

  "Black women tend to have a longer time at which they'll have their vasomotor symptoms, namely hot flashes and night sweats, whereas the least were Japanese." ([29:07])

• Socioeconomic Factors: Lower socioeconomic status exacerbates menopausal symptoms due to increased chronic stress and inflammation, highlighting the need for a more holistic approach to women's health.

e. Barriers to Menopause Research

At [31:04], Dr. Shepherd discusses the challenges facing menopause research today.

Key Points:

• Need for Comprehensive Studies: There's a lack of large-scale studies that explore different HRT modalities, dosages, and the inclusion of testosterone therapy for women.

  "We need FDA to approve testosterone therapy for women because it currently isn't." ([31:04])

• Public Trust and Safety Concerns: Overcoming the lingering distrust from past studies is essential to encourage participation and acceptance of new treatments.

f. Menopause and Sexual Health

At [32:26], Dr. Shepherd delves into how menopause affects sexual health and the available options to address these changes.

Key Points:

• Importance of Communication: Open dialogues between patients and healthcare providers about sexual health are crucial for effective treatment.

  "Providers to really, truly ask these really hard questions about sexual health." ([32:26])

• Treatment Options: Beyond HRT, there are various approaches, including nutritional changes, lifestyle adjustments, and addressing the biomechanics of exercise to improve sexual health.

g. Future of Menopause Management and Research

At [34:21], Dr. Shepherd shares her predictions for the future of menopause management.

Key Points:

• Inclusive Platforms: Initiatives like Modern Menno aim to provide comprehensive resources and support for women navigating menopause.

  "Modern Menno is... devoted to menopause information... focused on the lifestyle portion of menopause." ([38:34])

• Cultural Shifts: Increased representation of menopausal women in pop culture and media will help normalize conversations around menopause and aging.

h. Proactive Steps for a Healthy Menopause Transition

At [35:34], Dr. Shepherd outlines proactive measures women can take as they approach menopause to ensure a smoother transition.

Key Points:

• Embracing Change: Viewing menopause as a natural and manageable phase rather than a dreaded event can positively influence one's experience.

  "I'm going to embrace this phase and I'm not going to look at it as something that's scary." ([35:34])

• Lifestyle Adjustments: Implementing healthy habits early on can mitigate menopausal symptoms and enhance overall well-being.

i. Supporting Menopause in Others

At [36:54], Dr. Shepherd provides guidance on how individuals who aren't experiencing menopause can support those who are.

Key Points:

• Active Listening and Support: Offering a non-judgmental space for conversations about menopause can significantly aid those going through it.

  "Support alone is the biggest part of what can get women through." ([36:54])

• Challenging Societal Norms: Advocating for a more respectful and understanding view of women as they age can help reduce stigma and promote better support systems.

4. Conclusion

The episode underscores the critical need to address the "bedroom gap" and broader menopausal challenges through education, open communication, and improved medical practices. By fostering a more inclusive and informed environment, society can enhance the quality of life for women navigating midlife and beyond.

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Notable Quotes:

• Dr. Maria Sophocles ([06:20]):
  "So, what I call the bedroom gap. The difference in sexual expectations and capabilities of men and women in midlife."

• Dr. Maria Sophocles ([07:58]):
  "The second effect of the loss of estrogen in the vagina is on blood vessels. We need blood vessels for lubrication."

• Dr. Jessica Shepherd ([23:24]):
  "The public heard through media was that estrogen and or hormone replacement therapy causes breast cancer."

• Dr. Jessica Shepherd ([29:07]):
  "Black women tend to have a longer time at which they'll have their vasomotor symptoms, namely hot flashes and night sweats, whereas the least were Japanese."

• Dr. Jessica Shepherd ([35:34]):
  "I'm going to embrace this phase and I'm not going to look at it as something that's scary."

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Resources Mentioned:

• Modern Menno: A platform dedicated to providing comprehensive menopause information and support.
  Instagram: @JessicaShepherdMDShepherdMD
  Website: modernmenno.com

• North American Menopause Society (NAMS): Provides guidelines and recommendations for hormone therapy in menopausal women.

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Final Thoughts:

This episode of TED Health sheds light on the often-overlooked aspects of menopause and sexual health in midlife. By bringing expert voices to the forefront, it advocates for a more informed, supportive, and proactive approach to women's health, ensuring that the journey through midlife is both empowering and fulfilling.

Transcript

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[Elise Hu]

Hey Ted Talks Daily listeners. I'm Elise Hu. Today we have an episode of another podcast from the TED Audio Collective handpicked by us for you. Sex and sexual health is important for everyone, and yet there's still immense stigma around these topics. This week we're bringing you an episode from TedHealth where we hear from gynecologist and sexual medicine specialist Maria Sophocles. Maria is a mission to destigmatize sex conversations, especially among older individuals, because sex should be pleasurable and comfortable for everyone, no matter your life stage. After the talk, listen in on host Shoshana Ungerlider's conversation with OB GYN and women's health advocate Dr. Jessica Shepherd. If you like TED Talks Daily and want to hear more TED content from a health perspective, look no further than TED Health. You can check out TED Health wherever you get your podcasts and learn more about the TED audio [e-mail] hey listeners.

[Dr. Shoshana Ungerleiter]

It'S Ted Health and I'm Dr. Shoshana Ungerliter. It's estimated that by the year 2025, over a billion people will experience menopause globally. This is far from a rare event, yet it remains a topic often spoken about in hushed tones. Why does this vast subject still lurk in the shadows of public discourse? For many, menopause is vaguely understood as an unspecified period or hot flashes and brain fog, but there are plenty of challenges that remain under discussed in public. In this talk, Dr. Maria E. Sophocles brings a refreshing, bold voice to the menopause conversation. Using humor and a wealth of knowledge, Dr. Sophocles peels back layers of misunderstanding and stigma to bring the hidden struggles of menopause into the spotlight and challenge the status quo. Tune in and then stick around after the talk. For my conversation with OB GYN and women's health advocate Dr. Jessica shepherd.

[Elise Hu]

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[Dr. Maria Sophocles]

So the other day, a woman walked into my office and exclaimed, my vagina has betrayed me. Not what most of us hear on a Monday morning before coffee, but welcome to my world as a gynecologist and sexual medicine specialist. You know, everybody thinks of menopause as hot flashes, but for over half of menopausal women, it's accompanied by sexual issues. Things like loss of libido or painful intercourse, even total destruction of a relationship. So what I call the bedroom gap. The difference in sexual expectations and capabilities of men and women in midlife. Now, the bedroom gap is a combination of the genital effects of menopause and deeply entrenched cultural and historical gender roles. To understand how to close the bedroom gap and to get the sex we want, we have to examine its root causes. So let's start with some science. In menopause, the ovaries make estrogen less consistently and eventually stop making it altogether. And this loss of estrogen has two huge effects in the vagina. The first is on collagen. Less estrogen means less collagen is made, and the quality of that collagen deteriorates from strong and stretchy to brittle.

[Dr. Shoshana Ungerleiter]

Ouch.

[Dr. Maria Sophocles]

The second effect of the loss of estrogen in the vagina is on blood vessels. We need blood vessels for lubrication. When I'm examining a patient, I can literally see if she's deficient in estrogen. The deterioration from thick, ridgy, dark pink, elastic, moist tissue to thin, dry, inelastic, pale pink, even yellowish white tissue. We also need blood vessels for arousal. This is where you're supposed to wake up. Now I'm excited. When we're aroused, fluid moves from the blood vessels through the vaginal wall to make lubrication. Without blood vessels, you're not going to get wet, no matter how turned on you are. So where does this leave you, well, you feel dried up, you can't get wet, your vagina seems to be on fire and your partner perceives your discomfort. Then you feel bad, then your partner feels guilty, and then you feel as if you have wrecked the whole moment. I will never forget a patient said to me once, Dr. Sophocles, when my partner and I have sex, we sing this Johnny Cash song, Ring of Fire. We sing it. I sing it because I have to sing and laugh or else I would cry and it would spoil the moment for him. For him. So while women are living in this ring of fire, mercy sex world, on the other side of the mattress, things are a little different. See, for 25 years, men have had a relatively safe, reliable, available medical option for erectile dysfunction. What was first invented to firm up a floppy penis has now become a global phenomenon to optimize male sexual performance. Now, Viagra did not cause the bedroom gap, but I believe it has widened it. And by the way, it's not men's fault. They are just availing themselves of what gender bias modern medicine has on offer. True, but while middle aged men are benefiting from a rock hard, medically enhanced erection, their female partners are literally left hung out to dry. So here's the good news. Women do have options, but they just don't seem to avail themselves of them.

[Elise Hu]

Why?

[Dr. Maria Sophocles]

What's the hold up? Well, one problem may be that many doctors don't feel comfortable talking to female patients about menopause and sexual issues because they feel they were never properly trained. And I think this is true. Our medical system is woefully outdated. In fact, one study showed that 2/3 of medical training programs in the US have just one lecture on menopause. 1. Which may explain why doctors are uncomfortable and why some 75% of women who go to doctors to seek care for menopausal problems come away empty handed. This has to change because every one of us is going to go through menopause and experience the loss of estrogen. And there are a lot of us right now. Globally, there are 1.1 billion women right now who've reached menopause and postmenopause. And almost half of them are suffering from sexual issues, largely quietly. And it's probably underreported. I know, because for 28 years I have listened to your stories on five continents and I can tell you that the bedroom gap cuts across race, ethnicity, economics, education and geography. It is universal and ubiquitous. It's also lasting a lot longer. See, women are outliving men by five to six Years. And they're spending more than a third of their lives after menopause. So there are more postmenopausal women who are single, widowed, divorced. Some of them want to be intimate. They go online, they swipe left, they swipe right, they start dating, they start having sex. And this is great. But between the issues inherent in the bedroom gap, Viagra widening that gap, and the complexities of online dating, it's no wonder you feel your vagina has betrayed you. But it's not your vagina's fault. No, what has betrayed you is not only the biology of aging, but history and culture and gender roles etched in sexual stone over millennia. Sexual dogma that decrees that a woman's role in the bedroom is to please, to serve, to not impede the sexual pleasure that a man is entitled to. Now, we're not going to change a millennia of sexual scripting in a TED Talk. But I can offer you this. Since we know that deficiency of estrogen makes the vagina dry and unpleasant, then maybe one solution to closing the bedroom gap might be to replace that vaginal estrogen. Uh oh, I know what you're thinking. You're thinking estrogen. What about the cancer risk? Well, I get it. We have to address this collective fear of estrogen and cancer. That fear stems from the Women's Health Initiative, the media storm that surrounded the release of that data 20 years ago. That study examined the risks of oral estrogen and cancer, among other things, not vaginal estrogen. So here's the key point. Estrogen behaves differently depending on where and how it's used. Check it out. Vaginal estrogen works genitally, locally and has positive effects. Systemic estrogen can have positive or potentially negative effects, depending on the target tissue. Vaginal estrogen has been out since 1946 and studied extensively and has never been shown to cause breast or other cancer. But we, the big we, have made vaginal and systemic estrogen falsely equivalent. We have thrown the baby out with the bathwater. Our fear does not discriminate. And now, far too many women don't use estrogen at all. So where does this leave us? Well, the thing is, we have a right to comfortable sex and a right to pleasurable sex. We talked about vaginal and systemic estrogen, and there are even other medications we can use, vaginal and oral, that will help us to close our bedroom gap. The other avenue to close the bedroom gap is advocacy. How can you close your bedroom gap so that you can enjoy sex? Or better yet, how can you never have one happen in the first place I'm talking to you millennials and gen zers. Well, one, get educated. Read credible sources. Find clinicians invested in sexual health. Two, talk about it to each other, to your clinicians, to your partners. Talk without shame or blame, and get specific. What hurts, what feels good, get sexually creative and don't do anything that doesn't feel good. And number three, reframe sexual and genital health as a lifelong maintenance project. And don't think that just because you can't get wet or you have wimpy orgasms that that can't be fixed. Because here's the deal, which you already heard in this talk. We have a right to comfortable sex and a right to pleasurable sex. So let's move the sexual equality needle forward. Let's start with young people, young men and women. It is time for sex ed to progress beyond getting a condom on a banana. It is time for sex ed to prioritize equal sexual pleasure for men and women so they learn it right from the beginning when they're starting to have sex. And it is time to revamp medical education to keep up with the demographic explosion of menopausal women so that doctors have the tools and the information they need to provide to women so they don't leave empty handed. And it is far past time for the concept of sexual pleasure to be gender neutral because it's never too early to start, it's never too late to improve equal sexual pleasure for men and women. And let's face it, sexual health is part of long term human health. We know that staying sexually active reduces blood pressure, improves cardiovascular health, decreases stress and depression and anxiety, and is linked to longevity. And we women, we must emancipate ourselves from the rigid roles of sex for procreation or male pleasure. My big hope is that in closing the bedroom gap, we take one small sexual step towards gender equality for all of us. Thank you.

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[Dr. Shoshana Ungerleiter]

That was Dr. Maria Sophocles at TED Women 2023. And now I'm excited for you to listen to my conversation with Dr. Jessica Shepherd. She's a board certified OBGYN and a menopause expert. She's the founder of the Modern Menopause and the CEO of Sanctum Med and Wellness in Dallas, Texas. Before we jump in, a quick heads up that the audio quality in this interview isn't how we usually record. But I think this topic is so important, so I really want to still share it with you and I hope you find it as valuable as I did. Jessica, it was fantastic seeing you on stage at south by Southwest earlier this year, diving into all things menopause and women's health. A truly hot topic, it seems.

[Dr. Jessica Shepherd]

No pun intended, right?

[Dr. Shoshana Ungerleiter]

That's so true. That's finally getting the spotlight it deserves. It's Considering about half of the global population is female, billions will experience menopause with many of them having significant symptoms that'll drastically affect their quality of life. There's some progress happening in this space. I don't think we're there yet.

[Dr. Jessica Shepherd]

Yeah, I think, you know, you've brought up a beautiful point of you're glad that we're here. But I also want to highlight that we're here at the almost like dawn of understanding menopause. When we look at it from a perspective of even society, bringing it up is not a taboo topic. We are really just at the beginning stages of how we can really utilize this particular topic of hormones. Being comfortable with talking about menopause and now going out to educate not only physicians who, you know, we were basing this on research, but also the vast majority of the population, as you said, which is mostly women. So there's a lot of education to be done, a lot of kind of myths to debunk, and that takes time.

[Dr. Shoshana Ungerleiter]

So just over 20 years ago, results from this very large trial called the Women's Health Initiative, or whi, were released. Tell us about the results of that trial and how it influenced the prescribing of hormone therapy for menopause symptoms by doctors in America.

[Dr. Jessica Shepherd]

Yeah. You know, going back to why that study was even launched, it was supposed to be the largest study in preventative health for women for cardiac disease. And with that, they had a cohort of women, and they were looking at how hormone replacement therapy was going to benefit or how it would impact cardiovascular disease. During that study, when they had women who were on estrogen and progestin, they realized that there was an increase in breast cancer. So from that, they did stop the study because they were like, we do see an increase in breast cancer, albeit, if you look at the numbers weren't enough that we should have gone the route that we did. But what the public heard through media was that estrogen and or hormone replacement therapy causes breast cancer. So if you can imagine from like a sound bite perspective, it literally was like everyone running around like a chicken with their head cut off, being like, oh, my God, we're all going to get breast cancer. So there wasn't really any time to look at how there were some cardioprotective benefits. And then, oh, by the way, it decreases risk of colon cancer. So, you know, there were all these different things that came out from the study, but the damage had been done. And this is where we are now, you know, 20 plus years later. And just looking at statistics, you know, if you want to put numbers to it, when we used to prescribe HRT or hormone replacement therapy, that was what we were doing at that time. Right. And from that 2002 halt of that study, we've seen an 84% decline in the prescription of hormone replacement therapy. So it was kind of like the streets are empty, all the buildings are abandoned, and hormone replacement therapy is like this tumbleweed, just kind of like going down the street in a western. And that's where we are now.

[Dr. Shoshana Ungerleiter]

Now, can you unravel the connection between menopause and increased risk for conditions like heart disease, dementia, and osteoporosis?

[Dr. Jessica Shepherd]

Yeah, I'm glad you brought up those specific conditions which we do see impacting women later on in life in morbidity, mortality rates. And what we do know is that the depletion of estrogen is almost like this body's kind of vacuum. And when it leaves, the aging process and the inflammation process in the body significantly increase. And so that's why we start to see if you do look at heart disease, heart disease is still the number one killer of women across the world. And looking at the correlation between the decline in estrogen in women and average age of menopause is 52, then looking at heart disease and when it kills is because we don't have the benefit of having the protection of estrogen. And the same thing goes for bone and the same thing goes for brain and dementia. I think we really hyper focus on reproductive hormones, namely estrogen, progesterone and testosterone as being like hormones that are only in the pelvis. And there are estrogen, progesterone and testosterone receptors all over the body, in the brain and the heart, in the breast and like everywhere in the bone. And so when you start to see this relationship kind of crumbling between hormones and the target organ, that's where you start to see the disconnect between and why these diseases and conditions manifest so rapidly after menopause in women.

[Dr. Shoshana Ungerleiter]

And what are the most stubborn myths about menopause that you confront related to hormone therapy and otherwise? And how do you confront them in your practice?

[Dr. Jessica Shepherd]

This is why I love medicine for what it is. The ability to use fundamental research, evidence based research and statistics to truly help patients understand where they lie individually, within those statistics. For me, so most things that I hear is that hormone replacement therapy is bad. That's literally the statement. And so my job is to extract out of that, well, in that statement that you heard, what did you hear and why? And when I can meet patients where they are in their understanding and information level of what they have, then that's when the conversation starts. And so that's why I take the time to help, you know, understand their discomfort with the information, miseducation on the information. And then we start to build, we start to build from that and scaffold.

[Dr. Shoshana Ungerleiter]

For them, so important and so more granular. And ask you, based on the latest North American Menopause Society, the NAMS guidelines, what are some of the key considerations for using hormone therapy in perimenopausal menopausal women?

[Dr. Jessica Shepherd]

Yeah, most of the key considerations when you look at the NAMS recommendation is really for symptom relief. Right. I don't think we're at the stage yet when we're looking at HRT as something that is preventative and how you give it to a patient to prevent disease. Do I think we'll get there? Absolutely. But where we are right now is being more verbose and robust with saying it is okay to take hormone replacement therapy. Because remember, we're coming off of a 20 year desert of not giving it. So now we have to get everyone back on board to being like, it's safe. That's where we are the starting point of saying it's safe and you can take it, and we want to help your symptoms.

[Dr. Shoshana Ungerleiter]

So how do factors like ethnicity and socioeconomic status play a role in a woman's menopause experience and. And maybe her access to care? Have we observed any patterns here?

[Dr. Jessica Shepherd]

Yeah, we definitely have. Now, the Swan study was a pivotal study that really looked at women and their experience in menopause. And they were able to extract ethnicity based on Japanese, Chinese, Caucasian, Hispanic and black women. And what they were able to show is the severity and frequency, but also duration. And when they looked at factors starting with duration, they found that black women tend to have a longer time at which they'll have their vasomotor symptoms, namely hot flashes and night sweats, whereas the least were Japanese. And also when they looked at severity, was also seen that black women had more severe hot flashes and night sweats and also started at an earlier age. Now, here's the caveat to all of that. That's where the socioeconomic kind of plays a role in exactly those statistics that I just mentioned. When we look at aging and how it has an impact on the body internally through micro stressors and chronic inflammation over time that it starts to diminish the body's ability to have response systems or the immune system. Social stressors, emotional stressors, which is what we see in lower socioeconomic communities, does play a part on the internal biologics of the body and how that shows inflammation, and therefore you start to see some of those symptoms occur earlier. I wish that we looked more at medicine in a way where we're bringing into it the actual experience and stressors of someone's life dictating their possibility of having a disease, which we could see even outside of menopause. And you look at hypertension and diabetes and asthma, same thing as what you're seeing for those disease states as well.

[Dr. Shoshana Ungerleiter]

And much more research is needed. Right. So what hurdles do we face in menopause research today and how can we overcome them?

[Dr. Jessica Shepherd]

I think most times when you look at studies, you really want significant power. Right? So you want a study that has a lot of women, and that's where we need the buy in. Right. We need the subjects to be able to look at the differences between different types of hormone replacement therapy, because there's different modalities, there's different doses, there's different medical histories that might fall into why someone can or can't take anything. I'm going to make a very big, like, shout out right now to testosterone is that we need FDA to approve testosterone therapy for women because it currently isn't. That's a big part of hormone replacement therapy as well. But I think that in order for this to happen, we have to have the buy in of people being safe. And that's why I was saying this is a slow shift into getting everyone to understand the benefits of it. Because the reason it was stopped, right. Or the reason people believed that hormone replacement therapy wasn't good is because it put them in an unsafe category. And so people will never just jump all in if they feel unsafe they want to be.

[Dr. Shoshana Ungerleiter]

Yes, definitely. I want to switch gears and talk a little bit about sexual health. So how does menopause impact our sex lives and what are the options for addressing some of the changes that happen with menopause?

[Dr. Jessica Shepherd]

I discuss often because there is a belief that that sexual health is not important for women. I think there's a belief that it can't be addressed or shouldn't be addressed or it's not important. And so I would say both to society to stop sharing that narrative and also for providers to really, truly ask these really hard questions about sexual health. Because most people are not going to be very kind of forefront with saying, I'm having some issues with libido or I'm having vaginal dryness. And so we have to bring it to the table and say, you know what, how's your sex life and how is your interest in sex life? How many times are you having intercourse? Are you having pain with intercourse instead of just it being an intake form type of question? Sex, yes or no, and then we move on. It needs to be a little bit more introspective than yes or no. And that's how I question my patients. And it's amazing how much information you can find out from them. I think there's a lot about sexual health that I would love to take a lot of time to discuss, but really it boils down to how do I feel about myself in this new transition? A lot of that starts to wane because of the decrease in estrogen and testosterone. But also if I am having intercourse or sexual relations with themselves and or others, is it painful or uncomfortable and what can I do to resolve that? I think those are two good places to start is the thought process behind it, which is your libido and intimacy and wanting to connect. And then also when I am connecting, is there something that's hindering me from having the full pleasurable Experience.

[Dr. Shoshana Ungerleiter]

Okay, So I want you to get out your crystal ball for me. And what do you predict for the future of menopause management and research in the coming years?

[Dr. Jessica Shepherd]

What I predict is that we are going to have everyone on board. I believe that this is something that we'll look back in maybe 10 years and we'll start to see more of it in, I guess you could say pop culture in TV shows where we're not seeing, you know, older women in Hollywood being shunned because they're older. We're seeing love stories where it can be very spicy because people can still hum, have sex when they're old. And then from a provider standpoint, you know, this is something that I'm really invested in right now, you know, as I'm building a tech platform called Modern menno, is that it's inclusive in the space of all providers to be able, whatever expertise that they're in, to actually address the issue and give their patients a really kind of full menu of options that they can take, whether it's HRT or not, whether it's nutritional, lifestyle issues, looking into kind of the biomechanics of exercise and movement, because really, it has to work together to really get the big picture and the great outcome that we're looking for.

[Dr. Shoshana Ungerleiter]

And, Jessica, what proactive steps should women take as they approach menopause to really ensure a healthy transition?

[Dr. Jessica Shepherd]

If I said if this were a screenplay, right now, menopause is like a horror story. This is where we'll make the biggest impact in the next years to come, is to change the screenplay to a comedic love story, one we cannot escape menopause. So if anyone is listening and thinks that they may, like, evade it in the sense of symptoms, but just menopause is like, characteristically what it is, which is just decrease in estrogen, not eliciting a period that we can't escape it. So that's going to happen. But as we start to get to that phase is to say, you know what? I'm going to embrace this phase. And I'm not going to look at it as something that's scary, but what are the things that I can start to do now that's going to make that transition easier? Not as rocky. I really feel that women are on this, like, smooth road, maybe a pothole here or there, and then it's like they hit menopause and, like, no one has fixed that road. It's like all these potholes are, like, falling all over the place. And I don't want the transition to be so abrupt. I want it to be this kind of like moving into the fourth quarter with grace and the ability to accept it for what it is, but to do it in a way where they take this ownership of it and embracing that change.

[Dr. Shoshana Ungerleiter]

And how can people who aren't going through menopause best support the people in.

[Dr. Jessica Shepherd]

Their lives who are have conversations that are a little bit more in depth? Because it's never just a one word answer when it comes to menopause. It usually is this confluence of answers which creates this experience for this woman. And many times we're not even able to express it either because we really haven't given this freedom or luxury to women to be okay and open in how they express the menopausal experience. So when talking to men is having them understand that the conversation, sometimes the support alone is the biggest part of what can get women through. Whether it's a hot flash or a night sweat or, you know, really trying to work on the sexual intimacy is just the support alone and being vocal with it as well. Then I would also say for society, I think we have to do better in how we look at women and aging in general. And also from that menopause perspective. I've seen this all throughout women's health is anytime there's anything to do with the pelvis, it becomes very demeaning, as if it's not true. And so many other features that really allow women to be like, well, if this is the reaction response I'm going to get from the outside world about this thing that I'm going through, then I'm not going to talk about it. Why would you? And so I think we need to change how society sees women, period. So I think there's a lot of work to be done. There really is. But again, I always say that I'm optimistic about the future.

[Dr. Shoshana Ungerleiter]

So, Jessica, where can people find you and find out more information about the work you're doing?

[Dr. Jessica Shepherd]

So Instagram people can find me at Jessica Shepherd M D S H E P H E R D M D But also what I've done over the last year, year and a half is extract all my menopause info from my personal page and put it on Modern Menno. So Modern Menno is my. My channel that is just devoted to menopause information. And then I hope that people join us there and ask questions, but also really look at all the information that's on there because it is actually very focused on the lifestyle portion of menopause.

[Dr. Shoshana Ungerleiter]

Dr. Jessica shepherd, thank you so much. For this conversation. I always learn so much from you. I really appreciate it.

[Dr. Jessica Shepherd]

Thank you so much for having me here and I hope that we can have even more conversations about women's health and looking at how perimenopause and menopause are going to be the new transition that we can look forward to and take that gracefully.

[Dr. Shoshana Ungerleiter]

And that's it for today's episode. Thanks so much for listening. TedHealth is a part of the TED Audio Collective. I'd love to hear your thoughts about the episode. Send me a message on Instagram hoshanamd. This episode was produced by me and Costanza Gallardo, edited by Alejandro Salazar and fact checked by Vanessa Garcia Woodworth. Special thanks to Maria Lajas Farra des Grandes, David Biello, Daniela Valarezo and Michelle Quint. I'm Dr. Shoshana Ungerleiter and I'll talk to you again next week.

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[Dr. Jessica Shepherd]

Forever.

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[Dr. Jessica Shepherd]

Even if your baby has a baby.

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[Dr. Jessica Shepherd]

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[Dr. Shoshana Ungerleiter]

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[Dr. Jessica Shepherd]

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[Dr. Shoshana Ungerleiter]

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[Dr. Jessica Shepherd]

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