Hormone Therapy for Menopause: What Every Woman Should Know

Summary

Podcast Summary: The Tamsen Show – "Hormone Therapy for Menopause: What Every Woman Should Know"

Introduction to Menopause and Hormone Therapy In the episode titled "Hormone Therapy for Menopause: What Every Woman Should Know," host Tamsen Fadal engages in a comprehensive discussion with Dr. Sharon Malone, a renowned OB/GYN and menopause expert. The conversation delves into the complexities of menopause, the historical context of hormone therapy (HT), and the lingering misconceptions that affect women's health decisions today.

Historical Background of Hormone Therapy Dr. Malone provides a detailed history of hormone therapy, tracing its origins back to the FDA's approval of Premarin in 1942. She explains how hormone therapy was initially promoted for symptom relief and later for its purported long-term health benefits, such as reducing cardiovascular disease and osteoporosis risk.

“Estrogen was approved by the FDA in 1942… initially used for symptom relief, and later for long-term health benefits like reducing cardiovascular disease.” [26:27]

She highlights the pivotal role of Dr. Robert Wilson’s 1965 book, Feminine Forever, which controversially marketed hormone therapy as a means to preserve femininity and sexual attractiveness, leading to a significant increase in HT prescriptions.

Impact of the Women's Health Initiative (WHI) Study A turning point in the perception of hormone therapy was the 2002 Women's Health Initiative (WHI) study. Dr. Malone criticizes the study's design, noting that it included older women (average age 63) well past menopause, which skewed the results against HT by associating it with increased breast cancer risk and lack of cardiovascular benefits.

“They skewed it such that the women were much older at the start of the study… the average age was 63, which was not typical of who we normally prescribed hormones for.” [36:13]

The immediate media fallout from the WHI press conference led to a dramatic decline in HT usage—from approximately 38% of eligible women to less than 6%—a trend that persists decades later.

Understanding Perimenopause vs. Menopause The conversation distinguishes between perimenopause and menopause, clarifying common misconceptions:

• Perimenopause is the transitional phase leading up to menopause, lasting anywhere from four to ten years, characterized by fluctuating hormone levels and symptoms such as irregular periods, mood swings, and brain fog.

  “Perimenopause is defined when you are having symptoms and you are between the ages of 35 and 45.” [06:07]

• Menopause officially occurs after a woman has gone a year without a menstrual period.

Dr. Malone emphasizes that blood tests are unreliable during perimenopause due to hormone fluctuations and advocates for symptom-based diagnosis and treatment.

Efficacy and Safety of Hormone Therapy Addressing fears about HT, Dr. Malone explains that the increased risk of breast cancer from HT is significantly lower than lifestyle-related risks, such as drinking two glasses of wine daily or being overweight.

“The increased risk of you contracting breast cancer on HRT is less than the increase in the risk of breast cancer from drinking two glasses of wine a day.” [61:56]

She advocates for the safe use of hormone therapy, particularly low-dose options and transdermal estrogen, which pose fewer risks for blood clots compared to oral forms. Dr. Malone asserts that HT can be used as long as needed, especially for preventing osteoporosis.

“How long can you stay on hormone therapy? As long as you like.” [63:08]

Addressing Ethnic Disparities in Menopause Experience Dr. Malone discusses how menopause affects women differently across ethnic groups. African American women, for instance, experience menopause earlier, endure more severe symptoms, and are less likely to receive HT despite greater need.

“African American women tend to go through menopause earlier... their symptoms start earlier, they're more severe, they last longer, and they're the least likely to get a prescription for medication.” [48:42]

She calls for better education and inclusion in medical research to ensure all women receive appropriate care.

Navigating Menopause Today The episode underscores the importance of self-advocacy and informed decision-making for managing menopause. Dr. Malone encourages women to maintain a healthy lifestyle and consult knowledgeable healthcare providers about hormone therapy options tailored to their individual needs and health profiles.

“You have more control over how you age and how you age healthfully than you think… The more you know, the better you're able to advocate for yourself.” [68:21]

Key Takeaways and Advice for Women Dr. Malone offers practical advice for women approaching menopause:

1. Consult with Healthcare Providers: Discuss whether hormone therapy is appropriate for you and consider your family history and personal health risks.

2. Focus on Overall Health: Maintain a balanced diet, regular exercise, and healthy weight to mitigate menopause symptoms and long-term health risks.

3. Educate Yourself: Understand the differences between perimenopause and menopause and the benefits and risks of hormone therapy.

4. Advocate for Inclusion: Support and demand more inclusive research that represents diverse populations to improve menopause management for all women.

Conclusion: Empowering Women Through Knowledge Tamsen Fadal and Dr. Sharon Malone conclude the episode by reinforcing the message that menopause does not have to be a period of uncontrollable suffering. With proper knowledge and proactive healthcare, women can navigate this life stage with confidence and maintain their quality of life.

“You can stop feeling stuck and start taking charge… this is your moment.” [Final Remarks]

The episode serves as a valuable resource for women seeking to understand hormone therapy and make informed decisions about managing menopause, emphasizing the importance of accurate information and personalized healthcare.

Transcript

[A]

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In 2002, one study changed the way doctors treated menopause. Women were pulled off hormone therapy overnight.

[B]

There was a lot of nuance about the study that didn't really get explained. Women were angry, upset. It was picked up on every major news outlet.

[A]

Fear spread like wildfire. And two decades later, we're still living with the consequences.

[B]

It cemented this idea that doctors had been doing something really to the detriment of women's health, not to the benefit. And that if you took these awful hormones, you were going to get breast cancer. And women abandoned hormone therapy in droves.

[A]

Dr. Sharon Malone has spent more than 30 years helping women navigate menopause. She's not just an OB GYN, she's a nationally recognized expert, an author, and a longtime advocate fighting for better treatment for women. She's seen the fear, the confusion, the suffering, and the solutions. Doctors aren't talking about enough. Is that mind boggling to you that they cemented that idea that estrogen causes breast cancer?

[B]

The increased risk of you contracting breast cancer on HRT is less than the increase in the risk of breast cancer. Drinking two glasses of wine a day.

[A]

In this episode, we're breaking down the confusion, the contradictions, and the roadblocks keeping women from the treatment they deserve, whether.

[B]

They will admit it or not. Most female OB GYNs take hormone therapy.

[A]

Why are we denying hormones to women who are asking for them?

[B]

I tell you what the real problem was.

[A]

This is a conversation that should have happened 20 years ago, but we're having it now on the Tamsen Show. Let's get into it. November 2021. I was at work reading the news like I did every day, and I started to sweat during the newscast a lot. I felt dizzy, I felt sick. I literally had to be escorted off the set and I found myself laying on the bathroom floor mid newscast. The truth is, I had not been feeling like myself for a while. My brain felt foggy, my body had been changing. I was gaining weight. I wasn't sleeping, and I was really anxious. I was tired all the time. I went to see a number of doctors, one after another, until finally one of them wrote in my patient portal in menopause. Any questions after blood panels were done? To say I was shocked is an understatement. I was devastated and I was really angry because I had no idea that that was coming. No one had ever talked to me about it. And now, after talking to so many of you, I hear the same words over and over again. No one ever talked to me about this. And you're right, no one has. Most medical schools and residency programs, they don't teach this. They don't teach your students about menopause. No wonder so many of them are lost when women come in gaining weight, not sleeping, feeling anxious, sweating. There have been so many advocates for women's reproductive health, including menopause, and we are here with one of the best in the world. Let's welcome Dr. Malone to the Tamsen Show.

[B]

It is so good to see you. It is always a pleasure to see you, Tamsen.

[A]

I have notes, and I know I have no reason for them when it comes to you. I know you've had a lot going on and we've had a lot of conversation over the years. There's no question about that. I think we've seen a lot change and we've seen a lot not change. But coming off of your book Grown Woman Talk, I Feel like you're out there hearing a lot of conversations. Has a lot changed since you left your practice a few years ago and are now hearing more talk? And we're finally uttering the word menopause publicly?

[B]

Yes, I think a lot has changed, and I mean this sincerely. And a lot of it has to do with people like you who've been out there really elevating the message, because, you know, I've been having this conversation, but in the office, one on one, and it doesn't. Rarely does it get outside of that room. And so now we've got a bigger stage. So, yes, I think that there are way more women interested in this conversation, young and old. And I think that people aren't afraid to utter the word menopause. So yay on that. Lot's changed.

[A]

It really has. And I know you. You've been talking about the word menopause and treating women for so many years. And I want. I want to go into all that because I know there's kind of this before and after. So if someone says, okay, I'm starting to experience something, I don't know what it is. I'm early 40s, most likely without a blood test. Is that right? You could tell somebody pretty certain you're probably starting in perimenopause. Can you define perimenopause? Menopause. And I know you're not a fan of post menopausal because it's all kind of menopause. I've known you long enough, as you.

[B]

Know, you know the drill.

[A]

I'm not a fan of it now either. Postmenopausal after that.

[B]

I think perimenopause is the most confusing of these stages because perimenopause just simply means around the menopause. And it is also called the menopausal transition, where you go from your peak fertility years to no fertility. And it's that gap in between. And for most women that can last anywhere from four to 10 years. If you're African American woman, your symptoms and that period last more closer to 10 years than four. It is characterized by a lot of things, but the one thing that it is not characterized by is a lack of periods. And we think of menopause as being, okay, that's when my period stops. Right. Well, in perimenopause, you may be getting your period regularly. It may be different. It may be heavier, maybe lighter. They may be closer together, further apart. That's sort of the first signal that there's really something going on. Is there changes in irregularity. And if you don't understand that the presence or absence of bleeding is not a defining feature of perimenopause, then you'll think, oh, it's not. It doesn't have anything to do with menopause. But all of those symptoms that we talk about, that we associate with menopause can start during perimenopause. And the reason why it's not helpful to get blood work during perimenopause is because your hormones during perimenopause are fluctuating. They may be too high one day, too low the next. And it is that sort of erratic hormone production that really produces a lot of the symptoms that women have, particularly the brain fog, the irritability. Imagine it's like having PMS every day. That is sort of what perimenopause is like. And for a woman to come in with all those, any combination of the symptoms that we talked about, but you're still getting regular periods. And you go see your doctor, you're like, what is wrong with me? And your doctor says, well, when was your last period? If that's your first question, and you say, two weeks ago. And they've immediately taken anything to do with menopause off the table. That is not correct. And I think that's where there has to be some adjustment with doctors. So they understand that perimenopause and menopause are different things and they occur at different times. And it's not a blood test. You don't need a sonogram. You don't need a soothsayer. You don't need anyone to tell you, you know, who decided all those things are now available.

[A]

It seems out there in menopause, you.

[B]

Don'T need to pee on a stick. You don't need to do any of that stuff to tell you if you're perimenopausal. Perimenopause is defined when you say it is when you are having symptoms and you are between the ages of 35 and 45. That's sort of typically when perimenopause starts. But because there's no bright line that signals the beginning of it, that's where I think the confusion is. And I think that there is also this misperception that you can't start hormone therapy until you've gone a whole year without a period. Why?

[A]

Why would that be? Because your hormones are fluctuating. So you can start hormone therapy in.

[B]

Perimenopause, you can start hormone therapy in menopause, or, and I say or we get back to, you can use low dose birth control pills, because remember, I told you birth control pills and hormone therapy are just two. You know, they're sort of different. You know, same but different. Because sometimes you need a low dose birth control pills. Because birth control pill. Because when you are perimenopausal, if you're 42 and having symptoms, the one thing that you are not yet is infertile. So unless you are actually actively trying for a baby and you need birth control, then a birth control pill will kill two birds with one stone. It'll give you birth control. It'll control symptoms. If your periods are too heavy or too long or too erratic, then a birth control pill may be more appropriate at that particular time. But as you progress through this transition, then, yeah, as you get closer to menopause, then sometimes if you don't have those other things, then, yes, you can use menopausal hormone therapy.

[A]

Can you get pregnant in perimenopause? The answer is yes.

[B]

Yes, yes. And I've told you this, Tamsin. Yes, yours truly. Now, I did not get pregnant in perimenopause, but I am the product of a perimenopausal woman who probably thought she was going through menopause. And here I am. And here's Sharon, and here I am. And so the answer is yes, you can get pregnant. My mother was almost 45 when I was born.

[A]

Wow. Okay. So she was. I think that. I think that women get confused about that sometimes. They go from, you know, having, having babies or, or, you know, those reproductive years that overlap and, no pun intended, bleed right into perimenopausal years.

[B]

Exactly.

[A]

Without question.

[B]

Exactly. But you know what? You know, there are certain things that you know it, but you didn't know you knew it. You know, but when I tell you that it is sort of that, that in between phase, that, that is why as we have made different lifestyle choices, you know, as women, and we're getting pregnant later and later. That's why there's more fertility. There are more fertility challenges because many of us, unbeknownst to us, have entered that perimenopausal phase where your fertility is not gone, but it's not what it was when you were 20.

[A]

It's not as easy. Yes, it's not as easy. Then menopause. Menopause is when you've gone a year without a period. Is that right?

[B]

They define menopause as once you have had your final menstrual period. Well, how do you know you don't know until you look back. It's just confirmed when you've gone a year and you haven't had another one. Because when you're. Even when you're perimenopausal, you can have a period, not have one, think, oh, I'm almost done six months later, and then have another period that's not abnormal. But you can officially say, I'm done when I've gone 12 months. But that has nothing to do about treatment options and when to initiate therapy. You initiate when you are symptomatic and when you decide, okay, this is enough, I need to be treated for whatever my symptoms are.

[A]

You have a line about suffering that I always appreciate, but can you talk about that? Because we do know that you don't have a choice when it comes to menopause.

[B]

You do not. And you know what I always say, menopause is inevitable. Suffering is not. Because, you know, I think that that is something that we, as women do. We accept a certain baseline of suffering that just comes with womanhood, whether we're talking about cramps or childbirth or pregnancy or PMS or depression. That is sort of what we think comes along with being a woman. And, you know, and I'm here to say no, it does not have to be. So. The one message I want to leave women with, Tamsin is this is that you do not have to suffer. But by the same token, I don't want you to think that, oh, here, take this pill, and it's all going to be fine. There is a lot of work that you need to do on the front end. And I don't care whether you're talking about menopause or whether you're talking about cancer prevention or whether you're talking about decreasing your risk of cardiovascular disease. Healthy lifestyle matters. So, yes, this is a both and not an either or. So do the things that you need to do on the front end. And when you've done all those things and you are still suffering, do not feel as if you have failed. You have not. You are going through an experience that all of us, if we live long Enough, Will. And 80% of us will. Spring is here, and you can now.

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[A]

Whatever those are.

[B]

Whatever those are.

[A]

I talked to two young girls that were in their 30s, like in the same week, last week and both said, I'm so scared about men. I'm so nervous about this. I'm dreading this. And I said, wait, we're not talking about this so you're afraid of it? We're talking about this, so you're not afraid of it. So it made me think like, do, do we need to rephrase some of these things? And so I said, what would you want to know? They said, when does it all end? When do the symptoms end? I said, oh well, let me find.

[B]

Out because I'm going to do a few.

[A]

I'm going to be talking to some people. When can we say that we start to see. Because I do feel now that I am, you know, I've gone through menopause. I'm feeling some of the, a little more clarity. I feel like my memory is not as bad as it was in my late 40s. Late 40s was a pretty brutal time. Like I couldn't have sat here and had a conversation with you without drifting off or trying to remember what I was gonna ask next. When do we start seeing some of those symptoms either taper down, go away, or is it only if you are treating it well?

[B]

You know, some of the things, particularly the brain fog that tends to get better, you don't, you know that you're not just on the inevitable slide to dementia from brain fog, which is so important to say. It is, it is not.

[A]

Cause it feels like that it gets.

[B]

Very confusing and you know, and that's a very scary feeling for a lot of women. But that sort of hormonal tumult that's going on during perimenopause is really wreaking havoc on your brain. And, you know, and our friend Dr. Lisa Moscone has really shown us pictures of what it's doing to your brain, how it affects not only the structure, but the metabolism in your brain changes. And then eventually, months, years later, your brain adjusts. So whether you take hormones or not, the brain fog tends to get better. And then you just have to deal with normal aging. That thing which we. Unfortunately, we have not found a solution for that yet. But that brain fog gets better. Hot flashes will eventually get better. There are certain things that won't. Osteoporosis will continue. You know, these symptoms of what we call the genital urinary syndrome of menopause that gets worse, and that's painful sex, frequency of urination, frequent urinary tract infections, pain, dryness in the vulva that gets worse with time. That's not going to get better.

[A]

How important is it to pay attention to that as that not just being a vanity thing or. I don't. I have a low libido and I'm not feeling so great. That's something really to pay attention to.

[B]

That's really something to pay attention to. Because, again, it's not just quality of life. There's that. But for whether you have sex, you know, five times a week or never, the genital urinary syndrome of menopause is still affecting you. Because the one thing that we don't really think about and we don't talk about enough is the impact of urinary tract infections in the elderly. If you go to a nursing home population, most of the people there are women. And of those women, one of the more frequent causes for hospitalizations is urinary tract infections. And we know what happens. Urinary tract infections can lead to sepsis, mental status, changes in the elderly. So it is not just a oh, nice to have. This is really a health issue that we have to address. And whether or not you choose to do systemic hormones, which is what we've been talking about, basically every woman can use vaginal estrogen. You know, it maintains the integrity of the vagina. You know, cuts down on urinary tract infections and all those other sort of uncomfortable things that happen with aging.

[A]

I want to break down HRT and hormone therapy and menopause hormone therapy. And there's a lot of things going around. There's a lot of confusion right now. There's a lot of information. You can go to Instagram. You know, everybody's now hearing the word perimenopause and menopause. And so what is hormone therapy?

[B]

Okay, so I want to make it clear because I still use the old term. I say hormone replacement therapy. I don't think replacement is a bad word, but obviously someone objected to it.

[A]

Sharon tells it like it is, and that's what I love about it.

[B]

Yeah. I'm like, what's wrong with that? I don't have a problem. But hormone replacement therapy, menopausal hormone therapy. Same, same. Yes. And all it means is that when you reach either perimenopause or menopause, then you are using hormones to treat hormonal problem. And, you know, because we know at menopause, the. It is. It is really defined by a persistently low lack of estrogen and lack of ovulation into fertility forever and on. So you are just giving back, not at the same levels that you had when you were ovulating and you were premenstrual, but you are giving back just enough to take care of the symptoms. All those gnarly symptoms that come up with menopause. Hot flashes, mood swings, night sweats, sleeplessness, brain fog, the list goes on and on, and we know it. So you are giving back a smaller dose of estrogen and progestin, too, for women who have a uterus. And if you've had a hysterectomy, then you can be treated with estrogen only because estrogen is really the secret in the secret sauce that controls the symptoms that women have during menopause. So that simply is all menopausal hormone therapy is. But to give you an idea, women are so afraid of menopausal hormone therapy. Women are afraid of menopausal hormone therapy who've been on birth control pills for 20 years. And I just look at them and I'm like, girl, you've been on estrogen and progestin since you were 25. Why do you. And you're going to be taking far less of it in menopause than you did before. And somehow, you know, again, it's a perception problem.

[A]

Of course it is. And it's a branding problem.

[B]

Menopausal hormone therapy is anywhere from a third to a quarter of the dose of what's in a standard birth control pill. It is. Yes. Same components. The components are different because they have different missions, but there are still estrogen and a progestogen, Estrogen and a progestogen. Just different types and different, smaller amounts.

[A]

As a doctor who has seen all sides of this what the before and after and the fear of hormone therapy has been.

[B]

There was a very different conversation about menopause really when I started in private practice and I finished medical school in the late 80s and started practice in 92. And there was really a lot of conversation about menopause. And we were starting to look at it more from the long term health benefits. And that was where, when the data was coming in about cardiovascular disease and it was looking very favorable for women who were taking hormones. But to give you an idea of the. So the arc of estrogen therapy, Premarin was approved by the FDA in 1942. So we had, you know, 50 years by the time I started of at least being familiar with the concept of using estrogen for the treatment of symptoms. And it's interesting what's happened is that the perspective has changed. You know, Premarin was out there. Women knew, but very few women had access to it because again, there weren't a lot of doctors who knew how to prescribe and treat even then. And then something happened in the 1960s, I think it was 1965, when a gynecologist, Dr. Robert Wilson, wrote this book, Feminine Forever. And the menopause was discussed really not from the perspective of women, but from the perspective of men. Because, you know, he wrote a book, you know, all gynecologists were men then, but he wrote a book and he was, you know, did this sort of ode to femininity and oh, ladies, you don't want to be a dried up little shrew, do you? And that was the thing, be alluring for your husband. That was how hormone therapy was really sold in the 60s. And there was a huge uptick in prescriptions because not because of anyone cared about what you felt like, but who doesn't want to be alluring and sexually available. That was the, that was the big thrust. It was really about making sure that women were able to remain alluring to their partners. That was the whole, that was the thrust of it. And who wanted to. You wanted to be young, you want to be feminine forever? Because otherwise why would anybody. What's your value?

[A]

Who's going to want you?

[B]

Who's going to want you? You know, you're done having children and you're not available for sex. So what's the point? You know, that was really the perspective and it sold. And there was, that was the first real uptick in the use of estrogen was in the 60s. Little sort of tidbit that people didn't know is that the man who wrote it. Robert Wilson was a gynecologist. However, the book was paid for by the makers of Premarin. And that was the first marketing ploy for women and really told through from the perspective of a man and what we thought a man would want of a woman of middle age. So that was wave number one.

[A]

I wish I could be shocked by that. But when we say, where did this conversation. How did we get here?

[B]

You know what? The French have a saying plus a chance, which means the more things change, the more they remain the same. And we are still sort of going back and forth with this pendulum of estrogen is good, estrogen is bad, estrogen is good. And so after that, after the 60s, the one thing that we did find out was that women who were using Premarin or estrogen alone, we didn't really know that you needed to add a progestin to it. And so there was an uptick in the. In the incidence of endometrial cancer or uterine cancer for women who used estrogen alone. Now, bear in mind, there are lot of women in the 60s who had hysterectomies because, you know, it was hard to get beyond menopause with an intact uterus in those days. But for those women who did have a uterus, okay, so that was the first black eye for estrogen was, oh, it's gonna cause endometrial cancer. That problem got fixed somewhere in, I'd say, in the late 70s. And they said, oh, we need a progestin to protect the uterus. We're all good again. And now we're starting to accumulate data on women who had been using estrogen. And they found out, and probably the biggest one that came up was the nurses study, the Framingham Nurses study, where they just followed women, you know, nurses who were generally healthy. Estrogen, no estrogen. And they found out that the women who used estrogen had a lower incidence of cardiovascular disease. Okay, now we're on the upswing again.

[A]

Oh, and this is when.

[B]

This is probably in the. This is probably in the 80s. And so now we're using estrogen not just for the relief of symptoms, which it has always done. That's been the one consistent thing about estrogen for women who are symptomatic, it's the thing that works the best. And those symptoms are hot flashes, mood swings, vaginal dryness. We didn't really talk about brain fog then, because I think the notion was that all women were ditzy. You know, I mean, there's that Edith Bunker thing that's just how they come. That's just how women were. And so we didn't recognize brain fog really as a symptom of menopause, but all of the other things, the dry skin, the, you know, the itchiness, the irritability, the mood stuff was really what, you know, was really driving the use of estrogen. Always worked for that. But as we added progestin, now we're like, okay, we've not only got estrogen for relief of symptoms, but we have this great evidence that says, you know, even though it was not a random, you know, a randomized study, it was actually observational and said the women who used it had less heart disease. That's when we started to see the big push about not just the relief of symptoms, but actually long term benefit for cardiac disease. And, you know, and this is sort of when I entered the story, okay, because, you know, in the late 80s and early 90s, I actually was taught about menopause and I was taught about the use of estrogen because again, we were coming at it from a health point of view, not just a relief of symptoms, because we knew that already, right?

[A]

And that word was being used quite a bit. You were aware if somebody comes in your office that age.

[B]

And not only that, but I joined a practice that had been in existence for 30 years before I got there. So I still had that initial wave of women who had started estrogen in the 60s because the partners, and they were still there taking these little 80 year old ladies with their estrogen and they were like, no, don't take it away. And I'm like, okay, but you need some progestin. And there were a lot of women who had been on it at that point when I entered the story for 30 years. And they were happy, they were good, they looked great. And then so from 1992 to 2002, that was how we were prescribing and thinking about using hormone therapy, not just for symptomatic relief, but for. The data was coming in about osteoporosis and the data was coming in about cardiovascular disease both being favorable. And you know, the makers of Premarin, I said, I have to give it to them because they came back at it and they're like, okay, well we can't pay someone to write a book about it. So we will start with the spokesmodel. And believe it or not, the first spokesmodel for estrogen was Lauren Hutton, the beautiful Lauren Hutton. And she was out there and, you know, so now again, we're getting Back to that same sort of, you know, looks. Yeah, if you use estrogen, you could look like Lauren Hutton.

[A]

The vanity of it versus the health benefits of it.

[B]

And we on the doctor front were trying to really tout the health benefits. And so there was a lot. So, you know, the pendulum swings again. And now it's in favor of estrogen. And Bernadine Healy, Dr. Bernardine Healy, may her soul rest in peace, was the first female director of nih. And she was a cardiologist and a woman of a certain age. So she was very much interested in doing a study that involved women, postmenopausal women. And prior to her getting there, there had never been a large scale study involving women, postmenopausal women. Now that's hard to believe, but that was, that study was started in about 1991, 92.

[A]

So in the 90s, that's, that's when we've said over and over again, that's the first time that women were mandated to be in studies.

[B]

Correct, correct. And it was her urging that really got the focus on women in midlife. And so she started the study. Unfortunately, she was not there as the study progressed. But we said, oh great, now we're going to prove once and for all this little observational data that we have.

[A]

About cardiovascular disease, the nurses, the nurses.

[B]

Study, we're going to prove it because we are going to do a gold standard, randomized, double blind, placebo controlled study, and we're gonna manipulate it such that we're gonna prove once and for all that it does decrease the risk of cardiovascular disease. That was the point of the study. Not does it relieve hot flashes, not are women's lives improved by the, by taking hormones. That was never the point because again, that was established at that point.

[A]

So that study was set out for people who are just hearing about this 2002 study that we've heard over we just, we year. Right. Over and over again that was set out to say that, hey, there are some long term benefits of this when it comes to cardiovascular health. That was it.

[B]

Exactly. It was designed as a prevention study. It was going to, it was to ask the question, does the use of hormone therapy decrease the risk of cardiovascular disease, which we know is the number one cause of death for women in this country and around the world. Imagine what that would do and how that would change everybody's behavior. If you knew that I could give a medication that was readily available, been around for 50 years, and we could decrease the risk of cardiovascular disease by 50%, that would be huge. Huge.

[A]

And you and I were in that same room when Dr. Avram blooming said out loud, in a room we were at as a world renowned doctor that I know that you and he have done many, many talks together, said, is anybody worried about cardiovascular disease? Few hands went up. Is anybody worried about breast cancer?

[B]

Right.

[A]

The entire room raised their hand.

[B]

Exactly. And you know, and that's the good news and bad news, I think, really about the, the public education effort about breast cancer. Because we're in a very different place now than we were 50 years ago in terms of awareness and screening. That's, of course, but it is so sort of elevated that in women's minds that we think that that is the only and most important thing that women are dying from. And it is not. It is still was then and is now still cardiovascular disease.

[A]

The study shows. To look at that. And then what happens that, that fateful day that I know you remember. Well, actually, the morning after, I feel like is what you remember best.

[B]

I do, I do. I remember it because, remember, at this point, I've been practicing for 10 years. Yes, yes. All right. So 10 years I've been telling patients one on one every day, oh, you've got to take this hormone. This is great. And investigators at NIH held a press conference at the National Press Club, invited everybody to come listen, and they said, by the way, you know, that everything that we've been telling you about hormones and how great it is, it's not. It not only doesn't decrease the risk of cardiovascular disease, it increases the risk of breast cancer. And when they said the words, it increases the risk of breast cancer, I mean, I wish I could tell you what a seismic effect it was because this really flew in the face of everything we had been saying about estrogen for time immemorial and. And just poof, it went away. Women were angry, they were upset. It was picked up on every major news outlet in this country and around the world. And it cemented this idea that doctors had been doing something really to the detriment of women's health, not to the benefit. And that if you took these awful hormones, you were going to get breast cancer. And women abandoned hormone therapy in droves.

[A]

From a large percent. Right.

[B]

Ingestion from about 38% of women who were eligible to take HRT, it went from about 38% to less than 6%. And it has persisted. It is still in about the 5% range even today, 22 years after that study came out. And, you know, that's never the end of the story because, you know, it's hard for people to realize, but there was a time before the Internet and before we had instant access to information. And when they held that press conference, even the investigators who were participating in 40 centers around the country had no say in the stoppage of that study. In the article that came out that made these claims about increased risk of breast cancer, it's sort of a group, a small group of regulators at NIH came up with this. They put it out, and immediately it wasn't like it was. Years later, the doctors who were involved in the clinical trials protested because they were like, wait, wait, wait, that's not really what it said. But again, 22 years later, we are still trying to, you know, put that genie back in the body. And it's been difficult.

[A]

They cemented that idea that estrogen causes breast cancer. What did they find in that study?

[B]

We did learn some things from the Women's Health Initiative. It was a large study. But here is what the basic flaw was. Oh, the basic misinterpretation of the data. If you are going to construct a study and say, we're trying to prove that it decreases the risk of cardiovascular disease, and we're gonna do it with healthy women, and we're gonna follow you over years to find out. Well, the reason, one of the reasons why they didn't choose younger women in the study was because women don't. You don't see the uptick in cardiovascular disease until about 10 years after menopause. So they can't start a study and say, all right, we're gonna start at 50, and I'll come back and check you out when you're 70.

[A]

Right.

[B]

So they, they skewed it such that the women were much older at the start of the study. So the average age of the woman entering the Women's health initiative was 63, and you could be anywhere from 50 to 79 and still be in the study. Well, that may have sounded, you know, I understand their reasoning. Sure. However, that was not typical of who we normally prescribed hormones for. We prescribed hormones for symptomatic women around the time of menopause, and that's sort of more typical of our population. But when you start it that far out, I don't think it takes a rocket scientist for anyone to see that. How are you going to do a prevention study on a 79 year old? She either has heart disease or she doesn't. And it doesn't matter what you give her at that point, you're probably not going to to affect that. That was the flaw number one. And I think flaw number two was that they took that data from older women who were more than 10 years on average after menopause and generalized it to everybody. So the same data that they got from a 63 year old, they applied it to a 50 year old. And they also only looked at one medication, one dose and nothing else. So all of the other nuance, you know, about dosing and, you know, timing, we didn't know. So it took a very specific finding. And maybe if they had said, wow, if you give it to women 10 years after menopause and the average age of 63, you don't impact their cardiovascular disease. If you had said that. But it didn't say that said everybody. But that wasn't really the thing that really turned women off. As I said, what really got them was the breast cancer, of course, and the breast cancer study. That part of it was confusing as well, because even though there was a slight increase in the risk of breast cancer for women who. In the women who took estrogen and progestin, not the women who took estrogen only. Even though there was a slight increase. There's this thing in medical studies. When you do a study, your results are either significant or they're not statistically right. You can't be like it's kind of. Or it's almost sort of, sort of, sort of significant. I bet it's kind of inching towards that. And that's what they did even at the beginning, the increase in the risk of breast cancer, even in that the first pass did not reach the level of statistical significance that you could even call that a positive finding.

[A]

But they still.

[B]

But they said that.

[A]

And all you need to do is say those two words.

[B]

All you gotta do is say it.

[A]

Wow.

[B]

And so there was a lot of nuance about the study that didn't really fully get explained because no decrease in heart disease and it increases your breast cancer. So why on earth would I take.

[A]

Why would I take. And that's all. Listen, most people don't know any of those details or understand them because they're very confusing. I'm calling my office and I wanna know why Dr. Sharon Malone put me. Did this to me. Right? So let me ask, what did you feel like as a doctor then? Was that moment just shocking to. I mean, it had to be shocking. I'm sure all doctors were like, what, what do we do next?

[B]

I tell you what the real problem was is that they had the press conference and nobody had read the Study. Because, you know, you're sitting there, you're like, well, wait a minute, it's on the Today show. But where can I actually read it? It took almost two weeks for us to get access because this was the days of snail mail where you had to wait on a journal to actually come to you and you had to open it up and read it. And even then, and that's the point I really wanna make, even then, when I read that article, I said it didn't say what they said. It said, wow, that's the part I think is missing in this story, is that there was immediate pushback to it. You know, when you talk to Avram Blooming, Avram said the same thing.

[A]

How did that get left out of the story? Because that immediate pushback I would have hoped was right up there at the top with what those headlines would be, right?

[B]

Well, if only we had the energy Internet back then, if we had had Instagram, I could have posted something right away.

[A]

I have to say, though, it is. It is stunning for. And I understand it was a different time back then. However, we've still had a lot of conversation about it now. But the fear is so overwhelming that it does not negate that in any way.

[B]

Well, you know what? I think what's happening, and I think the reason why we're going to really make some headway is that there is now a generation of women who never heard that story. Most obgyns, whether they will admit it or not, most female obgyns take hormone therapy. Of course the ones who did, I kid you not, I couldn't convince them. No matter what I said. I'm like, really? I read it. It didn't say that. It didn't say that. I couldn't convince my best friend that I wasn't telling her something.

[A]

Wow.

[B]

And I kept thinking, I was like, you know, come on. On. When I. I was so convinced that that was not the case, that at the time, I was not menopausal. I was only 42 years old. But when the time came and we were still having this negative, I was like, I would. I take hormones. And it didn't. I didn't give a moment's hesitation because I knew it didn't say that. And most. Most obgyns, whether they will admit it or not, most female ob GYN spring savings are in the air. And at Ross, where they have savings on all the brands you love, from the latest fashion to outdoor decor and even pet supplies, savings are in every aisle. Go to ross and save 20 to 60% off other retailers prices on your favorite spring finds. I think you're on mute. Workday is starting to sound the same. I think you're on mute. Find something that sounds better for your career on LinkedIn. With LinkedIn job collections, you can browse curated collections by relevant industries and benefits like Flexpto or hybrid workplaces so you can find the right job for you. Get [e-mail] jobs finding where you fit. LinkedIn knows how take hormone therapy, of course, because we know and we're like, no, I didn't say that.

[A]

You know what no one told me about menopause? That it doesn't just happen. It hits you. The brain fog, the sleepless nights, the exhaustion. I felt like I was losing control of my own body. And for a while I thought, maybe this is just how it is. But then I realized it doesn't have have to be. I started digging into the science, talking to experts and trying real solutions that actually work. And that's why I wrote how to Menopause. Because you and I deserve answers. This book is your blueprint for navigating menopause with confidence, understanding your body, and feeling stronger, healthier, and even better than before. If you're ready to stop feeling stuck and start taking charge, this is your moment. Grab your copy of how to menopause [e-mail] and unlock some exclusive bonuses to help you get started today. You have a story and we talked about it in the documentary the M Factor. It's the part of the film, I think, where everybody, everyone comes into this film. It's an hour long film. I interviewed you for it a few years ago on your birthday. Sharon kindly came to my home on her birthday to do this interview. And we didn't really know what we were doing then. We just knew that we wanted to try to get this out there. And you tell a story in that where you as an ob GYN go to your general practitioner, I think, and you're discussing having your follow up. But I would like you to tell the story about somebody telling you what they thought about your decision of taking hormone therapy.

[B]

Yeah. And I'll give you a follow up to that story too.

[A]

Oh, I like that.

[B]

Okay. This was a new internist and she and I, and I knew her, we and I knew each other from before. And she said, you know, she's just taking your history and what medications do you take? And I tell her, I said, yes, and I take HRT and I told her what I'm taking and she looked at me and she said, you know, I'm not a fan. And I was like, you do know what I do for a living, don't you? I didn't ask you that. I need some other advice, but I pretty much got that. And I. All I could think to myself is said, if you would say that to me, then I can imagine how forcefully you would discourage anybody else who didn't know better. And that would make them go home and say, oh, well, maybe I shouldn't be on this stuff and throw it away. And the follow up to that is, I just saw her not too long ago and guess what she said to me? And this is almost a direct quote, I got all my lab work back and everything. And she said, says, oh my God, I don't know what's going to happen. But she said, one thing you're not going to have is a heart attack. Okay. My heart stuff was perfect.

[A]

I love that. I love hearing that. Well, you do have a heart of gold. I do know that for sure. Dr. Malone, we have three questions to ask our menopause provider. What are we asking them?

[B]

I think the first thing that you need to ask is that whether or not they think that hormone therapy is right for you, because that's going to tell you a lot. Because you're going to come into that conversation loaded for bear and you're going to know whether or not it's a good idea and whether or not you want it. So the response is important. I think the second thing is to make sure that you know, to ask them and make them aware of all the things about your family history that are important to know. And again, make sure that you come in loaded knowing what those things are and to ask what are the things that I need to be screened for personally based on that family history.

[A]

If you had to give advice for younger women, how should they prepare for menopause right now?

[B]

You know, I say things over and over and again because I think that hopefully they'll sink in. Take care of yourself, exercise, watch your weight. Make sure that you're having a diet that's not full of, of, you know, ultra processed foods, but again, there's some joy. Not everything, but try to do better. And if you do these things, because I think it's so important, because the better shape you are getting into this process, the better you're going to come out on the other end of it. And the other thing I would tell you is stop obsessing about weight. I want you to pay attention to what is healthy for you. And you go to your doctor and your doctor will tell you, is my blood pressure good? Is my blood sugar good? Am I not showing any signs of metabolic syndrome? Then that's good. And we've got to leave that sort of impossible image behind. Focus on health, not on weight.

[A]

I want to talk about age and I want to go back to one thing that we've talked about before and we addressed in the documentary, but I'd like to address it here. We talk about African American women having perimenopause longer, but also, I know we've talked about the fact that there's not enough research there, but more intense symptoms as well. Can we address that?

[B]

Yes. There was a study called the Study of Women across the Nation, or the Swan Study, where they actually just followed for over 25 years a group of women, you know, before you know, when they are premenopausal through perimenopausal and beyond. And that's where we got. We've got a lot of this information about how long does it take to get through this transition really came. And it has a very representative, a very diverse group of women that they followed. And that's what we have found, that the experience of menopause is different, depending upon different ethnic groups. African American women tend to go through menopause earlier, about a year earlier, Hispanics a little bit earlier, but not as much as African American women. Their symptoms start earlier, they're more severe, they last longer, they complain about them the least, and they're the least likely to get a prescription for medication, even when they complain of them. So the experience. And is it something so different about being, you know, is there something biologically different between African American women and white women in this country? Probably not so much, but there are a lot of other things about the lived experience and the other health, health issues that we come to it with. So it's not menopause per se, it's how you enter menopause. And to know that women who are most at risk for a lot of the things that we talk about that happen in menopause and for have that population of women not know that they are at risk to not have the opportunity to say yes or no about whether to do hormone therapy, because that's where I think the misinformation takes hold. And I think that there is also the. A problem with the medical community. And that, because that was really what I was taught, is that black women didn't have hot flashes as badly as white women did. Now and let me just say they had a rationale for it. It wasn't correct, but the thought was that after menopause, because black women have a higher weight, that some of that they're going to convert some of that peripheral estrogen in fat tissue so they don't need estrogen. That was what I, that was the rationale of.

[A]

That's what was taught.

[B]

You're also taught things like black women don't get osteoporosis. Not true. The issue of whether or not you have osteoporosis has nothing to do with your race. It has to do with your body build. So a thin black woman is as much, if not more at risk for osteoporosis than a thin white woman. But we're looking at that color of skin and not the person in front of you.

[A]

How do we stop that and start getting that access into communities to hear this information? Because it should, the bare minimum, should be able to have the education of hearing all of these things and be able to have access to that at the bare minimum. We can go into insurance and access to doctors and access to care, but the bare minimum should be access to this, being able to be educated about this and understanding it and hearing it.

[B]

One, we have to educate doctors better. But even when we do, we're really faced with the reality is that the reason why all women don't generally get the conversation about menopause is, you see, see how long we're talking about menopause here? It is an iterative conversation. It's not a one and done. It's something you should be talking about preparing for, knowing what to do when that happens. And that's the one thing that is in short supply in medicine today is time. And doctors don't have time to talk about it because they'd rather like, you know, if, like, if I can just move along or you're taking too long, or it takes me too long to explain to you, it's so much easier to just skip it. And I don't think it's because doctors are trying to be. Trying to do a bad job.

[A]

No, I don't either.

[B]

It's just that they don't have time. And this is where I think, again, the work that you've been doing, the work that Mary Claire Haver's been doing, is realizing that we have to take the information to the source. We can't wait for people to, you know, lead me along on this. And I think that the better educated women are, the better they're able to advocate for themselves. That is why, you know, I joined Alloy Women's Health simply because it is a digital health company that is doing what I was trying to do in my office one on one. Because you realize that currently our medical system doesn't support the kind of conversations and the kind of access that we should all be.

[A]

I do want to go back to that in the. In the education of doctors, and we'll just touch on that briefly. But what you learned in Medical School versus what was. What was happening 20 years later, 10 years later in medical school, very different.

[B]

Yes. But there are a lot of things about medicine that have evolved, you know, and I think that that's the problem. We can't get stuck, okay? We may have believed one thing, but now we know better. We should do better by our patients. I mean, you know, we have to think about, you know, whenever I hear a doctor say something and they're so absolutely resolute about it, I was, you know, I remind them. I was like, you know, there was a time when we thought. Thought bloodletting was a good idea. You know, you know, leeches. How about that? You know, I mean, we've done a lot of things that have not turned a lot of. Didn't work out great. But so a little humility is in order. And I think that when you tell patients that I am giving you the best information that I have today, will that be true forever and on? Maybe not. Will there be something else that will. I, I hope, hope that we'll be able to refine what we're doing and to have better options for women 20 years from now, and we'll know something then that we don't know now. I mean, that's. That's what we do. You know, we learn, we do better.

[A]

And we have to do better. We have to do better in terms of inclusion and studies. We have to do better in terms of having studies and the money going toward them.

[B]

Right. I mean, women have been overlooked forever when it comes to how we are treated that we are not in. We were not involved in medication studies. We're not involved in even the trials for medical devices. They're done on men. And we have to really come to grips with the fact that our physiology is different, our hormones make us different. And I think that the reason why so many studies were done on men is because, again, they looked at your hormones and said, well, that's pesky, and that's gonna mess up our results. We need something that's more steady state, like men, you know, they pretty much have the same amount of testosterone and they didn't want those, all those hormonal things going on messing up their study results. Even the laboratory studies were done mostly with male laboratory rats because they just didn't want, you know, unless they were looking something specifically about fertility.

[A]

We didn't even have rats.

[B]

No.

[A]

Nothing.

[B]

No. They would do, you know, if they were trying to figure out about breast cancer or something like that.

[A]

But of course. But if it was, if it was women related, if it was female related. I want to do this real fast because we did this a while ago on Instagram when we talked about who can and who cannot take hormone therapy. If we can just. In a nutshell, let me tell you.

[B]

What, what the FDA has, you know, and we all know, but the FDA indicate, has indicated that hormone therapy can be used for vasomotor symptoms, the genital urinary syndrome of menopause. The things that we talked about. It can be used for the prevention of osteoporosis and it can and should be used for women who have either early or premature menopause. And early menopause means you're menopausal before age 45. Premature menopause means you're menopausal before the age 40, 40. Those are the four indications for hormone therapy by the FDA. Now they also give you some guidance on who can't or what are the contraindications to taking hormone therapy. One is a personal history of breast cancer or an estrogen dependent cancer like endometrial cancer. If you personally have had a heart attack or stroke, if you have liver disease because, because the oral medications are passed through and metabolized in the liver. And the fourth thing is undiagnosed vaginal bleeding because that's a sign, could be of endometrial cancer. So we need to know what that's about. That's it. Notice what's not on the list of contraindications. Hypertension, obesity, smoking. A lot of things that we use to not give women hormone therapy are not in the contraindications. And I think that we can all agree that the FDA is amongst the most conservative, you know, organizations that will tell you if they knew for a fact that you couldn't do it if you had these other things. But we are, we are denying hormones to women who have a family history of breast cancer. We are denying hormones to women who have hypertension, even though that hypertension may be treated. We are denying, when, oh, migraines. Oh, you can't have it. There's no. It's not in there.

[A]

Why are we doing it? Why are we denying hormones to women who are asking for them or want to take them?

[B]

And I'll tell you why. And I think some of it is extrapolating some of the contraindications to birth control pills, okay? To hormone therapy. You shouldn't smoke and take birth control pills.

[A]

Right, right, right.

[B]

But remember I told you that's three to four times the amount not true for hormone therapy. So we are, in addition to women, not really seeking out and being afraid. Then that's where this sort of gatekeeping comes in with physicians. Because physicians are not offering, because they are thinking that the same contraindications to for MHT or HRT are the same ones for birth control pills, and they are not. So there are all these women who are out there who are not being treated, and there's no real data to support that. So when you look at the four reasons why they can't. Oh, and the other thing I forgot, there was one more, and that was about blood clots. You know, if you've had a blood clot in your legs or lungs, but even the breast cancer and the blood clot issue, we've come back and we've revisited that because that was all based on oral estrogen only.

[A]

Okay.

[B]

And we now know that there are other modes of delivery, such as a transdermal estrogen that you can use that does not affect the blood clotting factors as much as oral. And you can also look at the issues with women who have had breast cancer and women who are breast cancer survivors who are years out from their diagnosis and are probably cured. Then that is a more nuanced conversation where women get to be involved in that conversation. It shouldn't ever be someone that tells you absolutely no, Never. It's a matter of your quality of life, what your risk tolerance is and what your treatment goals are.

[A]

And family history of breast cancer is not a reason to say it's not.

[B]

I have two sisters with breast cancer, and that gives me nothing, the slightest pause. Because the other part of that study that never really got out there was that even. Even if you took the Women's Health Initiative at face value, where there was a almost significant risk of, you know, increased risk of breast cancer, there was no difference, no difference in the mortality rate. So even of the women who took hormone therapy, you were no more likely to die of it, whether you took it or you didn't take it. It. But here's the part that never got the real. The press that it should have gotten, and that is for the women who took estrogen only in the Women's Health Initiative. The women who took estrogen only in that study not only had a 23% decrease in the incidence of breast cancer, but they had a 40% decrease in the risk of dying if they took. Took estrogen than if they did not if they could. If they got breast cancer. Now, that's huge.

[A]

It's huge.

[B]

That's huge. So you have to say that whatever the relationship with estrogen and breast cancer, it's complicated. It is not cut and dry. And here is something that I think is that I have said before and it's just come up again, and that is the relationship of alcohol and breast cancer.

[A]

Now talk about that relationship.

[B]

We make choices, you know, like, am I gonna go have a glass of wine? Probably. But to know that to give you an idea of how small the risk is, the risk of the increased risk of you contracting breast cancer on HRT is less, and that's estrogen and progestin, not estrogen only, is less than the increase in the risk of breast cancer of drinking two glasses of wine a day. It is less than the risk of being overweight. It is less than the risk of being physically inactive. So you. So you can.

[A]

What is going on?

[B]

You can put this any way you want. So, you know, this is how. This is how I choose to rationalize that I'm going to take my hormone therapy. I will exercise. I will make sure I get enough sleep. I will try not to be overweight if I can help it. And then I'm going to have a glass of wine. Okay? So, you know I love you, you know, I mean, come on, there's got to be some joy in the world, right?

[A]

There has to be some joy in the world. How long can you stay on hormone therapy?

[B]

As long as you like.

[A]

Okay.

[B]

And let me say this because there are some people that it really is that it makes more sense to stay on, because what we do know, osteoporosis and the prevention of osteoporosis for women who are on hormone therapy, if you stop your hormone therapy and they're used to. And I will put myself in this category that we used to think that. Oh, okay. Because of that, ooh, breast cancer thing, you should probably only be on it no more than five or 10 years and then come off of it. Not true. But what you lose by coming off hormone therapy is all that bone density that you preserved while you were on hormone therapy. If you stop your hormones when you're 60 or 65 years old, you will start to lose that bone again. And within five years, you will be right back to where you would have been had you not taken it. So if one of the reasons that you are really taking hormone therapy is that you are concerned about your bone density and not fracturing your hip when you're 80, then you should continue it indefinitely.

[A]

And what about when you can start after you. So you hit menopause and then you heard about the study and were scared and didn't take it for five years. So you're five years out of your last period.

[B]

Can you start hormone therapy now and again? This is data that we've got from the Women's Health Initiative. And of the few patients, and there were only about 10% or so that were actually in the 50 to 54 age range in the Women's Health Initiative. And they found that all those terrible things that we said didn't apply to those women. And so what we found is that for women, if you start hair hormone therapy before age 60 or not, and or within 10 years of natural menopause, then all those bad things that we said are not true about breast cancer. And it's not. And not only that, but there is some cardiac benefit the earlier you start. So I think that there is no benefit. And this is why I tell women all the time, it's not like you're doing yourself a favor. You're like, oh, I'm just going to hold out for as long as possible and then I'm going to take it because I only have five years to take it. No, you take hormones. Actually, there's evidence that the earlier you start it when you are experiencing symptoms, the better. And because there is no age limit on when you can stop, stop. But you know, you don't. Why suffer for two or three years and then, like, you know, say, and.

[A]

Then get started why? And then get started why?

[B]

Okay, but let me say this.

[A]

Yeah.

[B]

Because. But I'll say one thing too, because this is where it requires a little bit of more conversation. Because the question comes up, oh, I missed the window. You know, I'm 62. Can I take. Can I still take hormones? And again, I would say the answer to that is a qualified maybe, because again, it depends on whether or not, again, what your treatment goals are. If you're 62 years old and you're still having hot flashes and not sleeping, then I would say, provided you don't have any of those other contraindications that we talked about. Why not make sure that you are healthy enough to do it? But again, just know it gets back to the leeches things. Some of this stuff we know and some of the stuff we just kind of think and made it up or we've inferred.

[A]

Exactly. Exactly.

[B]

Know exactly.

[A]

And that, and that's what I. And that's what I worry about because I feel like sometimes we infer it and people get really confused.

[B]

Right.

[A]

Okay. I, I have to bring this up because you posted this on Instagram, not your mom's menopause. This is around 2001, I think, right before the women.

[B]

2001, before the women's Health Initiative. Dark hair.

[A]

But what I, but I, what I love about this, this is that you have been talking to women about all. This article could have been written today. This article, you said the good news is that women have options to help them manage menopause today that their grandmothers and mothers didn't have a decade ago. This is, this is the same conversation we're having.

[B]

Yeah. Yeah.

[A]

Is that mind boggling to you?

[B]

And we were talking about the onslaught of the baby boomers.

[A]

That's exactly right.

[B]

It was the baby boomers.

[A]

It's brand new to millions of female baby boomers experiencing what's known as the change of life. Sharon. Dr. Sharon Malone, you've been doing this for a long time and helped millions and millions of women as you continue to do now.

[B]

Thank you. And you know what, and Tamsen, thank you for getting the word out and elevating this conversation. Otherwise I'd still be sitting in my living room talking.

[A]

I don't think so.

[B]

To my best friend who I couldn't convince to take hormones.

[A]

We're gonna, we'll get her. We'll get her someday. If you want to leave women with one thing, and I know grown woman talked, we touched a little bit about it. But I think the most important thing about that book is you didn't write a book about menopause. You wrote a book about women understanding that they had to advocate for themselves and take care of themselves and fight for themselves and what they needed to know throughout the health span of their lives and be aware of in life in general. What is one thing you want to leave women with or that's surprising you as you come up and talk to different communities of women around the country.

[B]

Country. You know, the one thing that I want women to understand is that you have more control over how you age and how you age healthfully than you think. Because I think that so much of us are sort of, you know, seed that space, that either someone's going to take care of us or whatever outcome that I think is bad is something that's inevitable because, oh, I have a family history of this or that, that. And I'm here to tell you, no, that is not true. And I think the more you know, the better you advocate you can be for yourself, for your family. And I want women to not fear this next phase of life. I will be. We're almost spending our birth, my birthday, together. I know I will be 66 years old and, you know, in a couple weeks. And I want women to know that whatever you thought menopause was or whatever you think 65 or 70 looks like, my God, Gayle King was on the COVID of Sports Illustrated, for God's sake. This. We're out here and you are out here being positive role models so young women won't be in a position where they're thinking, oh, my God, my life is over. No, we're here to tell them your life is just beginning. All you have to do is stay healthy enough such that you can take advantage of this great time of life.

[A]

You're so wonderful. Thank you so much.

[B]

Thank you, thank you.

[A]

Here's what I know. Today, you cannot let anybody tell you your symptoms aren't real or that they're just a part of life and aging and that you don't know what's best for you. If your doctor says it's not a big deal or all women go through this, you better go find yourself another doctor. Seriously. I have had so many conversations with Dr. Sharon Malone and I learned something new every single time. I really hope this conversation was helpful to you and at least answered some of the basic questions about perimenopause and menopause so you don't go into the stage of life afraid or feeling confused. I just wanna thank you so much for listening and if you like what we're doing, and I hope you do, give us a five star review wherever you listen to your podcasts. Thank you so much for listening to the Tamsen show and I'll catch you guys on the next one. The Tamson show is an original production by Authentic Wave executive producers Scott Weinberger, Kevin Bennett and Rebecca Grierson. Brand director Johanna Ofznik. Our line producer is Sabrina Sarre, editing by Zach Smith and Marquis Harris. Time is precious, and so are our pets. So time with our pets is extra precious. That's why we started Dutch. Dutch provides 24 access to licensed vets with unlimited virtual visits and follow ups for up to five pets. You can message a vet at any time and schedule a video visit the same day. Our vets can even prescribe medication for many ailments and shipping is always free. With Dutch, you'll get more time with your pets and year round peace of mind when it comes to their vet care.