Karol Markowicz Show: Going Menopostal with Amy Alkon

Summary

Podcast Summary: The Clay Travis and Buck Sexton Show

Episode: Karol Markowicz Show: Going Menopausal with Amy Alcon
Release Date: May 28, 2025
Host/Author: iHeartPodcasts
Duration: Approximately 40 minutes

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Introduction

In this episode of The Clay Travis and Buck Sexton Show, host Carol Markowitz interviews Amy Alcon, an award-winning investigative science writer, about her latest book, Going Menopausal: What You and Your Doctor Need to Know About the Real Science of Menopause and Perimenopause. The discussion delves into the often-overlooked scientific aspects of menopause and perimenopause, highlighting the gaps in medical education and the systemic issues within healthcare that affect women's health during this critical phase.

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The State of Medical Education and Menopause Care

Key Points:

• Lack of Scientific Training for Doctors: Amy Alcon emphasizes that the primary issue isn't sexism but rather a systemic problem in medical education. "Our medicine is not really evidence-based," she states at [11:11].
• Myths About Medical Practice: Alcon identifies three major myths:
  1. Doctors as Scientific Decision-Makers: Contrary to popular belief, doctors aren't adequately trained to interpret scientific research. "They're actually not taught to read science," she explains ([11:35]).
  2. Diagnostic Reasoning: Unlike the portrayals in shows like Dr. House, real-world doctors often treat symptoms superficially without investigating underlying causes ([12:09]).
  3. Risk Assessment: Physicians struggle with accurately assessing individual risks, frequently relying on generalized statistics that lack personal relevance ([12:52]).

Notable Quote:

"This is a moment to take a stand." - Carol Markowitz ([03:05])

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Challenges in Menopause and Perimenopause Treatment

Key Points:

• Insufficient Training in Gynecology: Almost no doctors receive dedicated training in menopause or perimenopause, leading to inadequate patient care ([13:40]).
• Mismanagement of Symptoms: Without proper understanding, doctors often mismanage perimenopausal symptoms, prescribing solutions like antidepressants that address symptoms rather than underlying hormonal imbalances ([17:15]).
• Progesterone Deficiency: Alcon discusses the critical role of progesterone during perimenopause and how its deficiency leads to severe symptoms like insomnia and bone health issues ([18:14]).

Notable Quote:

"Perimenopause is a transition period to menopause, 3 to 10 years leading up to menopause, when your hormones start to go wacko, basically." - Amy Alcon ([17:00])

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Personal Experiences and Advocacy

Key Points:

• Amy's Personal Journey: Alcon shares her struggle with perimenopause symptoms, particularly insomnia, and her battle with Kaiser Permanente to obtain the necessary progesterone treatment ([20:34]).
• Evidence-Based Solutions: She highlights the failures of the Women's Health Initiative study, labeling it as "methodological crap" and emphasizes the importance of the timing hypothesis in hormone therapy ([24:32]).
• Promoting Resilience and Confidence: Alcon encourages embracing menopause as a new beginning rather than a decline, sharing inspiring stories of women who have thrived post-menopause ([26:46]).

Notable Quote:

"I'm the child of Jim Crow, her husband, she was widowed, they had just adopted a baby ... she said, I choose Joy." - Amy Alcon ([35:02])

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Addressing Stigma and Empowering Women

Key Points:

• Breaking the Stigma: Alcon actively works to dismantle the negative perceptions surrounding menopause, promoting it as a phase of empowerment and personal growth ([26:22]).
• Practical Health Tips: She advises women to engage in weight-bearing and slow-speed strength training, coupled with a low-carb or carnivore diet to maintain health post-menopause ([35:48]).
• Importance of Evidence-Based Care: Continues to advocate for immediate, evidence-based medical care for women undergoing menopause, despite systemic barriers ([21:03]).

Notable Quote:

"If you live to be healthy, if you do this, if you do weight bearing exercises, slow speed strength training, and you eat a very low carb or carnivore diet, these are the two things you need to be healthy throughout your lifespan." - Amy Alcon ([35:48])

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Conclusion

The episode underscores the critical need for reform in medical education and practice regarding menopause and perimenopause. Amy Alcon's insights reveal significant gaps that leave many women inadequately supported during a pivotal life transition. Her advocacy for evidence-based treatments and holistic health approaches aims to empower women to take control of their health and well-being during menopause.

Final Thoughts: Carol Markowitz wraps up the interview by encouraging listeners to read Amy Alcon's book for an in-depth understanding of menopause and to challenge the existing stigmas associated with it. The conversation leaves listeners with actionable advice and a renewed perspective on women's health during menopause.

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Notable Quotes with Timestamps

• Carol Markowitz ([03:05]):

  "This silence is not an option. This is the moment to take a stand."

• Amy Alcon ([11:11]):

  "No, it's not sexism at all. Many of the researchers are women."

• Amy Alcon ([17:00]):

  "Perimenopause is a transition period to menopause, 3 to 10 years leading up to menopause, when your hormones start to go wacko, basically."

• Amy Alcon ([24:32]):

  "It was methodological crap. And it was fraud, basically."

• Amy Alcon ([26:22]):

  "I do not accept the stigma that we are less, you know, when we age."

• Amy Alcon ([35:48]):

  "These are the two most important tips I can give you."

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Additional Resources

• Amy Alcon's Book: Going Menopausal: What You and Your Doctor Need to Know About the Real Science of Menopause and Perimenopause
• Contact Information: Listeners are encouraged to reach out to Amy Alcon via her provided email for further discussion and feedback.

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This episode provides a comprehensive look into the challenges surrounding menopause and perimenopause, advocating for informed, evidence-based medical practices and empowering women to embrace this natural life stage with confidence and knowledge.

Transcript

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[Carol Markowitz]

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[Carol Markowitz]

Welcome back to the Carol Markowitz show on iheartradio. My guest today is Amy Alcon, an award winning investigative science writer who specializes in science help using scientific evidence to solve real world problems. Amy's new book is called Going what yout and you'd doctor need to Know about the Real Science of menopause and perimenopause. Hi, Amy. So nice to have you on.

[Amy Alcon]

Hi. This is great. Come on. Thank you.

[Carol Markowitz]

I'm a longtime fan. As you know, I have read your previous books. I'm extremely excited to read this one. Your new book is a serious look at menopause and perimenopause and the way that it's often ignored by doctors and researchers. So why is that? Is it just sexism?

[Amy Alcon]

No, it's not sexism at all. Many of the researchers are women. The problem is that, first of all, there's a whole medicine wide problem that our medicine is not really evidence based. And people find this really hard to believe. But there are three big myths about our medical care. One is that doctors are able to read science and make decisions based in science. They're actually not taught to read science.

[Carol Markowitz]

No.

[Amy Alcon]

In med school. Med schools and medical institutions are so at fault here. You know, people think, oh, you're going to bash doctors. I don't actually. This is the responsibility of med schools and providers to provide. If the doctors aren't trained in science, someone needs to be there, you know, nerds to, you know, say, okay, here's what the science says and to generate practice standards, which are the guidelines doctors go by to treat you. And then the other, the other two myths are that doctors are trained in diagnostic reasoning a la Dr. House. If anyone's seen that show, I love that show.

[Carol Markowitz]

I have never watched it, but I watch like the clips of it now are going viral again for some reason.

[Amy Alcon]

Well, they do this differential diagnosis where they look to see what is the underlying condition causing your symptoms. And what doctors do, this is a big medical error. They will treat your symptoms without looking for the underlying disorder. So if you have a headache, you know, maybe you just are stressed out and you need some, whatever Tylenol, or maybe you have a brain tumor. Now if we cure headache, you've lost an important signal. So it's vital that we look for underlying conditions. And then the third one is that doctors, this is so horrible. They are not trained to correctly assess risk.

[Carol Markowitz]

Right.

[Amy Alcon]

So they can't tell what's my risk of this or that. They either will not get it right or they rely on these overblown pharmaceutical company rep percentages that are actually not, not meaningful to individuals at all. They're, they're comparisons of one group to another. So when they say like 50% less risk, well, that might be, you know, it's a very small number. You know, it's, it's not Your risk, it's just this group to the other one. And so these are huge problems. And then there's a scandal in gynecology that people don't know about. So in gynecology, almost no doctors have any training, not even an hour of training in menopause or perimenopause science.

[Carol Markowitz]

Why?

[Amy Alcon]

Because it's medical education. Medical education is so terrible. These schools are lazy. There's no reason to change them because they're just dodgy bureaucrats who run them, taking in the donation dollars. And why start these programs? And diagnostic reasoning and proper risk assessment, these cost money. These require change, new hires, we'll just do what we're doing. And this is horrible. This is horrible because the father of evidence based medicine, David Sacket, 50% of what you learn in med school will be wrong. The problem is we don't know which 50%. And it changes. The medicine changes so quickly now. So doctors, they, when you go to the doctor, they treat you. They will send you, Gynecology departments will send you to a baby doctor. Doctors who are maternity specialists. And those doctors are made to treat you in something they have zero training and expertise in. And this is medically unethical. This is unethical. They should. I write about this in the book by a cardiologist, I think her name is Sarah Holland. She said, you know, I, she's doing these massive cardiovascular operations and she said, if my patient wants me to prescribe allergy medicine, I apologize and say, I know it would be more convenient, but I don't know that area. She might prescribe the wrong thing. And so because of this, doctors, you go to your doctor with perimenopausal symptoms, you know, and the doctor doesn't know what they are, dismisses you, ignores the symptoms, doesn't treat you or missed treats. You doctors will give patients antidepressants. This is terrible. I, I think people have been reading in the news, you know, there, there are great tapering problems for people. And what they don't do, they might. Antidepressants can bring down hot flashes, but they don't, they, they don't solve all these problems that you have and unhealth, underlying unhealth. In perimenopause, for example, your bones, they don't protect your bones the way our natural hormones do. And what doctors don't know the cause of great suffering during perimenopause. And I should name some of the symptoms. So women get hot flashes. This is how I started the book. I was sitting here, I live in Venice California. This is like the most temperate place in the world. You know, it's breezy summer day and all of a sudden I'm sitting here at my desk and I, I'm sure I'm like, why do I feel like I'm locked in a trunk in the Everglades? I mean, it's crazy. I thought, oh my God, I have hot flash. And you know, you want to go to your doctor and say, I'm uncomfortable, what should I do? But I know better. I've been coached since around 2007 by this very generous epidemiologist and biostatistician, Sandra Greenland. He's the co author of the seminal book in the field. And he has helped me learn how to critically evaluate research and look and see if the methodology is adequate. All studies are flawed, but are they so flawed that you cannot, you know, that they're not conclusive about anything? And you look for a body of work, you don't just go by one study. This is a problem where people say, oh, do your own research. Well, you have to know what to look at. And you have to look at a great deal of research to know, you know, where you need to know the whole landscape. So all of this is so terrible. So you go to your doctor. I, oh, so sorry. I cut my, I cut off my story. Basically, I started doing this deep dive into the research to figure out what the science is. And I saw this just massive gap between the practice standards, the, the, these are the standards for treating you, the guidelines for treating you that these doctors, I mean, they just read them off a list because they're, they don't know, right? No training, and they're victims in this. It is horrible to expect a doctor to do this. And this is, you know, status quo in these departments. So people don't say no. They want to keep their jobs. They just get there. They're young and new, so they just, okay, do the best I can. That's horrible. That's horrible. You know, and so they don't have any ability to really know what's going on with you. And so women are left with these symptoms and some of them. One of the things I went through a horrible perimenopause. Now, perimenopause, I should say, is a transition period to menopause. 3 to 10 years leading up to menopause, when your hormones start to go wacko, basically. And what people don't know, what doctors don't know, they think that perimenopause is this menopause light that your estrogen is.

[Carol Markowitz]

That's what I always thought it was.

[Amy Alcon]

Yeah, I did, too. Believe me. All these things I was just abused of when I read the science. What actually happens is that your estrogen spikes and. And dives, and this causes a release of stress hormones. This is the most horrible thing. And then if you don't have the second hormone of the menstrual cycle, estrogen's partner, progesterone, being made, you can get really sick, which is what happened to me. And the reason progesterone is not made in perimenopause is that not all of our cycles are ovulatory. This is one third throttle throughout our lives. And this is all the stuff on progesterone and perimenopause comes from the research of Geralyn Pryor, who is this fierce woman who grew up in Alaska with no running water, electricity, daughter of missionaries, and brings that fierceness to science. She's an endocrinologist and has tried to put perimenopause on the map for its unique hormonal state and also have progesterone research, which is very important. So progesterone is made when you ovulate, when the little egg sac ruptures and the egg is released. So, but in perimenopause, and then sometimes before you don't have ovulation, you know, normal. You have a normal period. It doesn't seem any different, but there's no exact rupture. And what happens that is that you don't have progesterone made because it's made from the litter that's left behind called corpus luteum, this yellow, waxy stuff. And then you have a. You have days of progesterone, you know, where you. If you have an adequate number where you have progesterone, you know, from the ovulation, then you are protected, your bones are protected, you're able to sleep, which I lost. This insomnia is a huge thing.

[Carol Markowitz]

Yeah.

[Amy Alcon]

And you're not.

[Carol Markowitz]

Insomnia is actually. I would say I'm in my late 40s. The sleeplessness is the only symptom that I recognize right now. But even going to the doctor for that, it's very like, well, you know, maybe wear yourself out more, go on more walks. Or I'm like, no, no, my sleep is not. I was an amazing sleeper. I was a champion sleeper. And now I've got. Gotten to where, you know, I. I definitely have an issue. And it's. It's clearly because I'm heading In the menopausal, menopausal direction. Like you say, doctors just don't know what to do about it.

[Amy Alcon]

So this is what's so important. This is what I did with this book going menopaustal. What I do medicine is not going to change. Doctors, institutions, they are not going to be evidence based overnight. But we need care now. That is evidence based. So what I do is, is I bring the evidence to all of us in ordinary language I have right over there on my router. Write every page of this book for Pamela D. That is a note to myself to not be a jerk or you know, write things to, to show like look how smart I am.

[Carol Markowitz]

Right.

[Amy Alcon]

Shut up. We don't care. Write it in the most accessible, understandable language because it's hard stuff. And I also put in all this humor because you cannot read a book like this, it's terrifying stuff without having these vacations.

[Carol Markowitz]

Right.

[Amy Alcon]

And so with the sleep thing, what's really important is to do the, this quantitative basal temperature testing. Now people test their first morning temperature to see if they're ovulating. Now the book contains this horrible fact that we do not have a 28 day menstrual cycle. This is wrong. Some women have much longer ones or shorter ones and these, all of these ovulation apps, I mean they're leaving women who are expecting to know when they're fertile with the wrong information. It's really horrible. So but what, what is effective is measuring your first morning temperature through this quantitative basal temperature taking. And then what happens is, and this is a bit detailed so you can look this up in the book, but you want to see if you have enough days where you having progesterone and it's indicated by temperature rise that you are protected, that you have this really important protective hormone. And because I didn't, you know, I didn't have enough progesterone, I wasn't, I wasn't ovulating. My sleep was so horrible. I had terrible brain fog. I was waking up like you. I mean I never. Nothing I champion. It was like someone hit me with a large frying pan.

[Carol Markowitz]

Same. And then I'm so good at it. Yep.

[Amy Alcon]

And this was like this. I mean now he lay me down to thrash five or six times a night. The torture. I tried every hot shower is cold. I mean, do my feet need to be colder? It was like all this voodoo, you know. And so science in this. I realized I needed progesterone and I had to fight three battles with Kaiser Permanente. My Medical provider to get the progesterone, to get the amount I need, which they do not give you in America. They don't give you an amount protective of the endometrium, which is 300 mg, milligrams of oral micronized progesterone per night. And then to get it covered, you know, And I should say, my gynecologist, he was wonderful. I have a male. I'm not like one of those patients, like, if you're. If you're my cancer. If you're my oncologist and you haven't had my lung cancer, well, I'm not going to go here. He's fantastic. And so he treated me with great respect. And listen, I am an annoying human being. And I threw just a mountain of studies at him and then at his boss, who was then the head of Kaiser Gynecology. And they actually met with me and listened and were persuaded by the evidence I provided. And so they covered the drug, gave me the amount I needed, which they take in France since 1980, safely, you know, and they said to me, well, that's not American, you know, research. I'm sorry. Like, are French women Martians, or do they just dress better and eat better food? You know, I mean, it's crazy. So that gave me my sleep back. What. It also does protect my bones, my cardiovascular system. And this is a huge thing I want to mention about menopause. We have this fraudulent research that came out around 2002, the Women's Health Initiative study, that basically said, you know, you're going to get breast cancer, your head's going to fall off.

[Carol Markowitz]

But that's been. I mean, I feel like I read so many articles about how that's been disproven, and that's just no longer considered the case in the medical world.

[Amy Alcon]

It was methodological crap. And it was. It was fraud, basically, because these researchers in 2002, I mean, if you tell the true story, you know, or if you actually, first of all do appropriate testing, you don't have women scared and, you know, throwing their estrogen prescriptions in the toilet. What they said is that healthy menopausal women will get, you know, breast cancer, Alzheimer's, et cetera. Well, wait a second. The women in the study were, like, 79 years old. 75. 79. You don't give this grandma going to the doctor to get hormones.

[Ryan Reynolds]

No.

[Amy Alcon]

And the thing is, what we know now, there's something called the timing. It's a critical window, the timing hypothesis. And it's there's good evidence behind this that if you are a healthy woman, you don't have plaque building up your arteries. You're not. You're healthy right at the right at menopause. And you start estrogen, you initiate it, then. Then it will be helpful and protective. And what doctors say. The head of Kaiser, the current head of Kaiser Gynecology. This is so appalling. My doctor, my excellent gynecologist, who listens and considers the science is out, you know, and so till August. So I had to meet with her. She tells me, you need to taper off estrogen at 60. I said, like, oh, this is such. So outdated and so disproven that even the menopause society, they're always behind the times. In 2022, my appointment was like, last three weeks ago. In 2022, they came out and they said, there is no stopping rule, you know, it's to be decided on individual health. And the thing is, people think, well, I should get off estrogen. No, if you are. If you're healthy, it needs to be. You need to be monitored. But if you're a healthy person, when you initiate it and you remain healthy and you're monitored for that, what you want is to be taking estrogen when you're old. Because when do we break bones at 79, and we break them because we fall.

[Carol Markowitz]

There's stigma around talking about menopause. There's nausea, there's bleeding. None of it is very attractive, right? But there's also this sense that menopause means you're ancient and it's the end of the road. And you kind of turn that on its head in the book and say that it could be the start of your new life or your new path. What do you mean by that exactly?

[Amy Alcon]

See, if you have your health, then you can just be you all your life and just be a little wrinkled, you know, and there are things that go wrong. But this is so important. I do not accept the stigma that we are less, you know, when we age. And so I go around telling people, I mean, I shove it at them. I'm 61. I'm 61. I'm61. Because I'm very.

[Carol Markowitz]

I'm 48, and I'm open about it, and I don't care. And I'm never gonna lie about my age.

[Amy Alcon]

And the thing is, I'm a better human being in every way, you know, except for my eyesight. Now it's 61 than I ever was. I'm. I'm kinder, you know, My work is better. It's just wonderful to be this age and be the person I am now. And I see this with so many women. Something happens at 50 women we have, we tend to be many of us timid in some ways, you know. And at 50, so many women develop this confidence almost out of nowhere where they will speak up, you know, pitch themselves, put themselves out there, stand up for things. And this is exciting. And you can, even if that's not naturally occurring for you, the thing is, you know, our emotions and our way of being, this is not a mandate. You can choose to be that way and you can choose to be this about age also to be this way. And the reason that it's important to do this is that we can have a whole like third or fourth act. And so my friend, I'll give my friend Debbie Levin as an example. She I met at the alternative weekly newspaper conference. I was selling my syndicated column. She was selling John Callahan, the cartoonist. And she was, she's an agent. She's really great at that. Well, she is now a pretty legendary ceramicist. She sells her work all over galleries, you know, the like designers. It's really sought after. And this just happened in a few years. And she developed this and this is the way and, and like a neighbor of mine, Mrs. Abbott Kinney, she used to be on Twitter. She does literacy volunteering for adults, teaching adults to read at our library here in Venice. So you can volunteer, you can move to Portugal. You know, there's so much you can do and you just have to decide, you know, that, that really, I call it old is the new black. I'm old. I'm old. I say it. I'm old and I'm fabulous. You know the thing. You're old. Yes, I am. I am.

[Carol Markowitz]

It gets me into my, my one of my three questions that I ask all my guests. What do you worry about?

[Amy Alcon]

Oh my God, I worry that I've missed something, that I'm not getting the science right. I have such a responsibility to people. And so luckily this worry and the lack of, you know, the sort of arrogance that comes with going, being formally educated, you know, has me looking at things and re looking at things and sending my workout to be fact checked. I tell people actually to like kick my ass, wipe the floor with me because they don't believe you when you say you want criticism. But that's really important to me and that is my terror.

[Carol Markowitz]

I love that. We're going to take a quick break and be right back on the Carol.

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[Carol Markowitz]

What advice would you give your 16 year old self? Like what did 16 year old Amy not know that you wish she did?

[Amy Alcon]

Self respect is not conditional on other people's behavior. I had no friends Till I was 15. And you become sort of a suck up. And the thing is you are not going first of all you're not going to get them to be your friends or like you. If you behave without self respect. If you're, you know, sucking up and trying to, you know, trying to get people like you. And so the best thing is to just be you proud. You not suck up, you know, not let it Ever be relative.

[Carol Markowitz]

I love it. I can't imagine you ever being a suck up, honestly. You're so independent and outspoken. I just feel like you're. I've never thought. Oh, Amy doesn't say what she thinks.

[Amy Alcon]

No, but this is the thing. We can all change. You know, I talk in the book about choosing resilience. You know, we have a lot of stuff go wrong with us, you know, and you can choose to have that attitude. I have this beautiful quote. I'm not gonna remember it, but my friend Leslie Gray Streeter talks about I'm the child of Jim Crow, her husband, she was widowed, they had just adopted a baby. All of this, but she said, I choose Joy. You know, it makes me tear up each time. And that's the way you can be. You can choose to have that attitude. And I think that it's really important to do that, to understand that.

[Carol Markowitz]

I love it. Well, I've loved this conversation. I can't wait to read Going Menopaustal. End us here with your best tip for my listeners on how they can improve their lives.

[Amy Alcon]

If you live to be healthy, if you do this, if you do weight bearing exercises, slow speed strength training, and you eat a very low carb or carnivore diet, these are the two things you need to be healthy throughout your lifespan. And this is the most, these are the two most important tips I can give you.

[Carol Markowitz]

I love that so much. Thank you so much for coming on Amy. Check out her new book going what you and your doctor need to know about the real science of menopause and perimenopause. Thank you so much Amy. Thanks so much for joining us on the Carol Markowitz Show. Subscribe wherever you get your podcasts.

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While others are sitting in lecture halls, you're already building your future at Ferris State University. Hands on training starts from day one. With real world skills that lead straight to careers in construction, engineering, automotive tech and more, you're not just learning, you're earning. Building a life you can be proud of. And with in state tuition for out of state students, success is within reach. Ferris State University. Unleash your potential. Register now at Ferris Edu. That's Ferris Edu.

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[Amy Alcon]

Just that, a tv.

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But what if it could be something more?

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May vary based on source content. Translation accuracy not guaranteed not everyone who.

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[Amy Alcon]

They include a lot more people than ourselves, loved ones, neighbors, the communities we call home, and the causes we hold in our hearts. At Thrivent, we help plan your financial picture with the bigger picture in mind. Because even though our business is helping guide your finances, our ambition is to make it mean so much more. Thrive Thrivent where money means more connect.

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With [e-mail] you're listening to an I Heart podcast.