The Tamsen Show
Episode Summary: "Perimenopause Explained: What’s Happening, What Tests to Ask For, and What Actually Helps"
Release Date: July 9, 2025
Hosts: Tamsen Fadal
Guest: Dr. Heather Hirsch, Harvard-trained internist, perimenopause specialist, and author
Introduction to the Healthcare Crisis in Women's Midlife
Tamsen Fadal opens the episode by highlighting a significant healthcare gap: “There are not enough trained doctors who understand how complex perimenopause is and then there are just too many women being left without clear answers or support.” This sets the stage for a deep dive into perimenopause, its challenges, and the solutions available.
Understanding Perimenopause vs. Menopause
Dr. Heather Hirsch emphasizes the importance of distinguishing between perimenopause and menopause. She clarifies, “Menopause is when it's been 12 months of no period,” and explains that perimenopause encompasses the transitional phase leading up to menopause with varying symptoms. This distinction is crucial for accurate diagnosis and effective treatment.
The Importance of Early Education and Awareness
Fadal and Hirsch discuss the need for early education about perimenopause. Hirsch states, “If we can help you understand what's happening to your body beforehand, hopefully we have less women ending up in crisis mode.” They advocate for starting conversations about perimenopause in a woman's mid to late 30s or after childbearing ends.
Common and Silent Symptoms of Perimenopause
The discussion moves to the spectrum of perimenopausal symptoms. Hirsch highlights that while hot flashes are commonly recognized, other symptoms like brain fog are more impactful: “Brain fog was the number one symptom that most significantly influenced quality of life in my studies” (11:10). Silent symptoms, such as bone density loss and vascular changes, often go unnoticed until severe issues arise.
Hot Flashes: Causes, Triggers, and Cardiovascular Implications
A significant portion of the episode focuses on hot flashes. Hirsch explains the physiological mechanism: “Estrogen is what controls the thermostat in the hypothalamus... as we lose estrogen, the window... will narrow” (12:13). They discuss triggers like spicy foods, caffeine, and stress, and explore the link between hot flashes and heart health, noting that untreated hot flashes can increase cardiovascular disease risk.
Physical Changes: Hair, Skin, and Vision
Hirsch delves into other physical changes during perimenopause, such as hair thinning and adult-onset acne, attributing these to hormonal fluctuations: “Estrogen is really the grow and glow hormone... as we start to lose estrogen, we will have more hair breakage and changes in texture” (19:08). They also touch upon vision changes linked to estrogen receptors in the eyes.
Mental Health: Mood Swings, Anxiety, and PMDD
The conversation shifts to mental health challenges, including mood swings and Premenstrual Dysphoric Disorder (PMDD). Hirsch emphasizes the overlap between perimenopausal mood symptoms and depression, advocating for hormone therapy as a more effective treatment compared to traditional antidepressants: “Women should have autonomy to pick which one... estrogen was better” (29:13).
Treatment Options: Hormone Therapy vs. Supplements
Hirsch discusses treatment modalities, advocating for hormone therapy (HT) as the most effective treatment for many perimenopausal symptoms. She explains the benefits and challenges of supplements like black cohosh, noting that while they can provide temporary relief, HT offers a more comprehensive solution: “Hormone therapy... does a more effective job” (16:58).
Importance of Accurate Diagnosis and Avoiding Misdiagnosis
Misdiagnosis is a significant issue, with women often being incorrectly treated for anxiety or autoimmune diseases instead of perimenopause. Hirsch shares her experiences: “I've seen women misdiagnosed... It means you could be reading the wrong books, looking at the wrong information” (38:04). Accurate diagnosis is essential for effective treatment and long-term health.
Racial Disparities in Perimenopause Experiences
The episode addresses how Black women often enter perimenopause earlier and may experience more intense symptoms. Hirsch notes, “Research currently shows... These things have to be researched” (39:25). She calls for more studies to understand the underlying causes and to develop tailored treatments.
Advocating for Yourself: Tips for Women
Fadal and Hirsch offer practical advice for women to advocate for their health. Hirsch suggests:
- Journaling and Tracking Symptoms: “Your journaling and tracking can be very, very valuable” (45:05).
- Bringing Informational Resources: “Bring in one of the incredible books... and something from our professional society” (46:08).
- Engaging in Shared Decision-Making: Encouraging open conversations with clinicians to explore treatment options.
Diagnostic Tests and Hormonal Assessments
While clinical diagnosis based on symptoms is primary, Hirsch outlines recommended lab tests for women interested in a comprehensive hormonal profile: estradiol, FSH, progesterone, testosterone, thyroid hormones, A1C, cholesterol, and vitamin D (42:11). However, she emphasizes that no single blood test can diagnose perimenopause.
Educating Clinicians and Expanding Medical Training
The episode highlights the crucial role of educating healthcare providers. Hirsch points out the lack of extensive training in medical schools regarding menopause: “The pyramid's completely upside down” (35:40). She advocates for incorporating more comprehensive education on women's midlife health into medical curricula.
Conclusion: The Path Forward for Women's Midlife Health
Tamsen Fadal wraps up the episode by underscoring the importance of ongoing conversations and education about perimenopause. She urges listeners to subscribe, rate, and review the show to help reach more women navigating midlife challenges. The episode concludes with a call to action for women to take charge of their health and advocate for better support and resources.
Notable Quotes
- Tamsen Fadal: “You deserve a roadmap. Consider this your starting point.”
- Dr. Heather Hirsch: “Perimenopause is really crucial because it's really easy to get misdiagnosed.” (01:41)
- Dr. Heather Hirsch: “Brain fog... was the number one symptom that most significantly influenced quality of life” (11:10)
- Dr. Heather Hirsch: “We know that checking on their metabolic health. This time is also a crucial time.” (42:11)
- Dr. Heather Hirsch: “Perimenopause, menopause is almost like what to expect, like, before you're expecting.” (35:57)
Resources Mentioned
- Books on Menopause: Numerous recommended by Dr. Hirsch for patient education.
- Menopause Society (menopause.org): For reliable information and resources.
- Dr. Heather Hirsch’s Book: Offering in-depth knowledge on perimenopause and menopause.
How to Advocate for Your Health
- Journaling: Keep a detailed record of symptoms to discuss with your healthcare provider.
- Educational Materials: Bring books or reputable sources to appointments to facilitate informed discussions.
- Professional Societies: Utilize resources from organizations like the Menopause Society to stay informed and support your case.
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For more information or to suggest future guests, email team@podcasttamsenshow.com.