← unPAUSED with Dr. Mary Claire Haver
unPAUSED with Dr. Mary Claire Haver
Menopause, Misogyny and the Medical System: Dr Sharon Malone Sets the Record Straight
01:24:43
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- [00:00]
A
This episode is presented by Midi Health. Be sure to stick around for a MIDI pause. Presented by Midi Health. This is where I'll take a moment to discuss some of the hottest topics in women's health as I partner with MIDI to bring women the care they deserve. You know, when you throw on the simplest outfit, your favorite jeans, a tee, maybe a blazer, and somehow one piece of jewelry just pulls it all together? That's exactly what Ginny Bird does. I just ordered my first piece of jewelry, and I'm excited to wear it. The their pieces have this effortless way of standing out. You may even start getting compliments. People will notice and ask about them. They just have a way of pulling a look together without even trying. From bold hoops that step up a casual outfit to sleek bracelets and bangles that are perfect for stacking, there's something for every mood and style. And with the holidays coming up, gifting couldn't be easier. The pieces ship fast. They're comfortable enough to wear all day. Get 20% off your first order by going to jenny-bird.com and using the code unpaused at checkout.
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Hi, I'm Dr. Mary Claire Haver. If you're loving these bold, unfiltered conversations about what it takes to thrive in midlife, make sure you never miss an episode. Follow unpaused with Dr. Mary Claire Haver on Amazon Music. It's free and easy. Just tap follow in the Amazon Music app so every new episode is ready when you are.
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B
This is what I want women to understand, is that once you get to be 50, 60 years old, you have never been more experienced. You have never had more wisdom. You need to share that with someone, and the only thing that stands in your way is not being well enough or not being physically fit enough for being able to pursue something. But it's not because you don't have the mental capacity to do it. And that's what I think is so important about the work that we do with menopause is that showing women that there is a path forward.
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A
Yeah.
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B
That doesn't just lead to decrepitude and death and weakness. No, Francesca.
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A
The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Every time I hear Our next guest, Dr. Sharon Malone, speak, I learned something new. The first time this happened was three years ago when she was moderating a panel on the Women's Health initiative and the misinformation that caused a generation of women to get incomplete menopause care. At that time, I thought, this is a message I need to spread. Up until then, my focus had been on nutrition and the Galveston diet. But that moment was the pivot. Everything changed. And I will forever be grateful to Sharon for opening that door for me. In the years since, Dr. Malone and I have become friends, We've shared stages at menopause conferences across the country. And every time I hear her speak, I learn something new. Her New York Times bestselling book, grown Woman Talk, your guide to getting and staying healthy, was another lightning bolt of inspiration. At a stage of life when so many women are told to slow down, Sharon is doing more. She is the chief medical advisor of Alloy Women's Health, a telemedicine company built specifically to serve menopausal women. She's one of the leading global advocates for women in midlife, and she continues to fight for women's health, both through education and policy. Recently, she was invited to deliver the keynote at the American College of OBGYN's annual meeting. Dr. Sharon Malone is one of the most accomplished, generous, and inspiring leaders in women's health today, and I am deeply honored to welcome her to the podcast. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I am also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.
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Welcome to Unpaused.
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B
Thank you so much for having me.
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A
The history of all of this. Why did you go into medicine?
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B
You know, isn't that the $64,000 question, when $64,000 was actually a lot of money? I don't have a doctor in my family. No one? I think probably from the time I was a little girl. When you're smart, there are only a few things that you could think of to do. And I knew one person's dad who was a doctor, and it was like, well, you're smart. I guess I'll be a doctor. And that is really the power of modeling and seeing people do things. My parents weren't even college educated, so I thought that was the highest you could be.
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A
And you're the baby of the family.
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B
I'm the baby.
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A
And how many siblings do you have?
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B
I have seven. I had seven now we're down to four. There's five of us. I've lost two of my sisters and a brother.
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A
I've lost three as well. We were eight. So we have that in common. Any of them university, advanced degrees?
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B
Well, believe it or not, everybody. Five of the eight went to college, graduated college. And my parents migrated from the rural south, so we were part of the great migration out of rural Alabama to the big city of Mobile. And a lot of my mother's brothers and sisters left, and they went to, you know, the traditional routes. They went to Chicago, they went to Ohio, California. And when my parents moved, they. My parents had too many children. They had four children by then, so that was too many to be Mobile. So they stayed in Mobile. But imagine, my parents were very old, and in a way, in a time when old parents were not a thing. My mother was almost 45 when I was born. Wow. And my dad was 66.
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A
Okay.
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B
So they grew up in the early 1900s in Alabama. So the lives that they lived were very different and very circumscribed. And what they really wanted for all of us was to get an education, and we did.
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A
You've talked in your book a lot about your mom and her journey with cancer. Can you talk about that?
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B
My mom died when I realize now how young that really was. She was only 57, and I was 12 years old. And it's a classic example of not having access to healthcare, not knowing what the signs and symptoms were. Cause my mom died in 1971, and colonoscopies weren't a thing. And it gets back to what I talk about all the time, and that is the acceptance of suffering. And who knows how long my mother had had symptoms, how long she had been in pain before she even engaged. Because prevention and was not a thing. My mother never went to the doctor. You know, your head had to be hanging off before she would take you to the doctor because her experience in the rural south was very different. You know, it was a place that you were never respected or never a place where you could go and feel that you were ever seen or heard. So by the time she came to medical attention, she already had metastatic cancer.
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A
How much of that journey of you growing up, you know, your teenage years without a mom, you think shaped your path and your decision making?
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B
I would say I had the advantage of having much older brothers and sisters. So after my mother died, I moved to Atlanta to live with my older sister. Okay. But I think I didn't know this part. No, I did this is my sister who integrated the University of Alabama. So those iconic photos that you see of George Wallace standing at the door at the University of Alabama, that was my sister that he was trying to keep out of the University of Alabama. That was my. Well, she was bold and she managed. She integrated the University of Alabama and was the first black graduate of the University of Alabama in 1965. But it's all relative. I went to live with my sister. She was married, she had two little kids and she was only 29 years old.
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A
Yeah.
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B
And then she had a 12 year old, you know, and I'm. I thought I know things, you know, and I was. And you're my sister, you're not my mom by the way. But she took me in and that was sort of, that got me out of Mobile and I lived in the big city and I actually lived in Dallas too.
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A
Oh, wow. So you finished high school and then you went to Harvard for undergrad.
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B
I have been the classic example of a person who is like, was there a path that you had forward? Is like, no, I just kind of made it up as I went along and it makes what I'm doing now make sense too. Right. But no, I lived in Atlanta for two years. I lived in Dallas for a year. I went back to Mobile to graduate high school and I was in love with Atlanta. So I was like, oh, I want to go back to college in Atlanta. So I went to Emory for my freshman year, hated it, and transferred to Harvard. And that's been my sort of, I would say, ping pong existence over my young years. But you know what it teaches you? It teaches you to be self reliant. You gotta be a self starter, particularly when you don't have parents. Sisters are not mothers. And you know, so I figured out what that I wanted to be and I knew that what I didn't wanna do. And I always lived with the expectation. My mother's voice has never not been in my head. And I knew that she expected things from me, big things from me. And even though she was not physically there, spiritually in every way possible, that would always run through my head, like what would my mother want me to do? And that's sort of how pattern in my life.
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A
It's incredible. So you're in your undergrad and you found your place. Harvard was the right college for you. And then now you're like, did you go biology undergrad? Were you thinking med school the whole time?
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B
I did all of my undergrad pre med requirements when I was in college. But when I finished college, I was like, you know what? I don't really wanna go to med school. I sort of decided to go to med school when I was like in third grade, right?
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A
Yeah.
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And I said, you know, I did it, but I wasn't ready to go right that moment. So I said, you know what, I'm going to work for a little bit and then I'll go back. And everybody was so disappointed. Cause they're like, I thought you were going to med school. And I was like, well, I will, but not right now. And they didn't believe me. So I worked for IBM for three years.
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A
Three years. Three years, okay.
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B
And then I went to med school.
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A
Wow.
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B
And best thing ever. I honestly think that if I could tell young people this, it's like, take a moment, take a moment and decide if this is really what you wanna do. And you know how this is. You get on a treadmill, pre med requirements, studying for ncas, and you just do the next thing on this merry go round. And when I decided that I wanted to go back to med school, it was very clear to me that it was my decision. It wasn't just fulfilling what the world wanted from you.
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A
My undergrad's in geology and I went to work as a geologist and actually applied for a PhD program and was but heard a voice that said, this isn't your path. And my family was very disappointed that I was turning down this PhD. I went back to work for the oil company while I started applying to medical school. So I very quickly had to get on that treadmill. But fortunately, having a STEM major, I only needed a couple of classes. So I was able to knock out everything and get the MCAT done in that one year and went to med.
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B
School the next year. But you know what the advantage also was because had I not taken that break?
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One, I met one of my dearest, dearest friends in the time I was working for IBM. And we're still like besties to this day. But it also gave me an opportunity to say to myself, I was much more mature, I'd done all the requirements, but I had the advantage of my classmates who had gone before me. Because when I started, my classmates were fourth year med students. Cause I had taken three years off and so I had their experience. That's how when I picked a med school, I didn't just pick it out of a hat. I had friends that were at Columbia and they loved it. And I don't think I would have lived in New York City had I not had friends here. It's not a place from, you know, when you're from the rurals, when you're from the south, and you're like, oh, let's go to New York City.
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A
New York sounds amazing. It's scary.
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B
And it was. But I. I loved it here, and I loved going to Columbia. So it ended up working out the way it was supposed to work out.
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A
So why obgyn?
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B
When I went to med school, and you're getting back to what you were saying about what I majored in college, I was actually a psychology major, but I was a psychology in the time where neuroscience was just really becoming a thing. So we were starting to look at psychology from the brain, not from the mind. And I did a lot of research work with one of the professors who was doing this thing of this physiological psychology where we did a lot of brain work. So I thought I wanted to be a neurologist.
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A
Oh, wow.
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B
Because I was fascinated with the brain. And then, you know what happens? I got to med school and I realized what neurologists did. And I think what was so disheartening for me was that so many of the neurological patients, they either got better or they didn't. And it really. We didn't have a lot to offer them. That was kind of depressing. And then I said, what's the feel of medicine? That's not depressing. Obgyn, it's the only time I can think that people are happy to go to the hospital, you know, yeah, it's.
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A
Time to have the baby. My first block on OBGYN was my last rotation, and I was kind of ruling things in and out in that third year, as we do. And I liked a little bit of this and a little bit of that, but I hadn't found, like, my thing yet, you know? And then my first block on OB was labor and delivery nights. And it's crazy. It's pandemonium. We were doing 5,000 deliveries a year at the hospital. I was at med school, and they let me catch babies. And, you know, I'm in the emotions of it all. And I remember calling my mother, crying. I found it. This is it. I know what I'm going to do. And it was obgyn.
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B
And you know what else I really liked about obgyn is that, you know, I'm also the last of five girls. So a lot of my life has been really female centric. So it was that. It was really. I like things that have solvable solutions. And a lot of what we do in obgyn, it's like, it's very clear what the next thing is. We know how to do this. Or if you've got fibroids or you need a hysterectomy, we can fix that. And I did not do very well, or it didn't fit with me. Things that went on and on, like the chronic diseases. Chronic diseases, yeah. That wasn't my thing.
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A
When you were in your training, so, you know, you're up at Harvard, how diverse was your class? Cause I think back to my first real taste of, you know, South Louisiana, where I grew up. My med school, you know, was in North Louisiana. But it was really the first time I'd spent time with a Jewish person. Like, I didn't know. I remember meeting him, and. Well, there was a few. But, like, this one guy who became my friend and, like, being so curious about what if. What do you do in the Jewish faith? You know, it just wasn't part of my world. Not a lot of people of color. And so was there a lot of diversity in your class? And were you noticing gaps?
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B
Oddly enough, you know, all right, so I grew up, spent a lot of my time in Mobile, but I also went to Catholic school. So I share with you that. That I did not know. I did not know a Jewish person. I didn't have my first bagel until I was a freshman in college. I was like, wow, look at that. But what was different is that I also am of the era when I moved back to Mobile to graduate high school. So I was there, and I graduated in 1977. So I was there in the busing era.
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A
Yeah.
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B
So I went to integrated school. So I was, you know, it was very clear there was a lot of. There was diversity in our class. However, when I went to Emory, that was the thing that was shocking to me about being at Emory. Emory was shockingly un diverse, really. There were 660 black undergraduates at Emory when I got there. There are no sports, sorority, fraternity, culture. And so it was very isolating. Even being from Mobile, Alabama, I had never been more isolated than when I was at Emory. And that was really one of the motivating factors for why I chose to leave. So when I got to Harvard, I was like, yay, this is the un it was the most diverse. There were a lot of black students. There were people from all over the world, and I found that that was way better for my spirit. I think I learned a lot. I think, being there, I think that being a person from Alabama, being a black person with my personal history, there were People who had never met people like me. So I think that that's the value of it. So we all understand that, yes, we're different, but not so much. Everybody kind of. We like to do the same things. And you learn a lot about a lot of people in a lot of places in the world that you would have never known just living in Alabama.
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A
So we talked a lot, well, recently, actually, about the experiences we were taught from an institutional standpoint of the black experience. You know, a black person will come into your clinic and present with X, Y and Z. And how that. That is kind of not exactly true. I mean, it takes away the humanness of what we all have in common and just focuses on race.
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B
Well, I explain to people all the time in medicine what we do, a lot of. Most of what we do, actually, and how we're taught is about pattern recognition. You see things, you know, oh, this goes with this goes with this. That's how you make a diagnosis. That's how you triage. That's how you do a lot of things. And unfortunately, so many of these things have become. They're racialized because of stereotypes, because of things about who. Who we think gets what and who we think deserves what. That's a big part of how we're all trained. And that just doesn't apply to white doctors and black doctors as well. We're all trained in the same system. And so, so many of the things that contribute to the disparities in healthcare are because of how we were trained. And breaking down some of those myths and some of those and addressing them is really our work to do today, because it's still there. We haven't dispelled them.
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A
So then you go onto your residency. Where did you do that?
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B
George Washington, the George Washington University in.
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A
D.C. and is that where you met your husband?
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B
Yes, I did. I met him probably in the first six months that I was there. And that's how, in my long, circuitous route, I thought I was eventually gonna get back to Atlanta, and I never did. And I been in D.C. now for 38 years. I love D.C. things work out. I'm a firm believer. My motto is, there are no accidents in the universe. You end up where you're supposed to be, whether you planned it or not. Somehow, some way, you end up where you're supposed to be, in D.C. s home.
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A
So residency for our listeners is really grueling and long hours. And this was before we had time limits on how many hours we could work per week. And there were times in my own Training that I was probably working well over 100 hour weeks. How did you meet and foster a relationship in residency with someone who wasn't a doctor?
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B
Yeah, well, you know, I met him and believe it or not, I met him internship year, which was the worst. Insane, just the worst. And we met on my one evening that I decided to go out and we were introduced by a mutual friend. And it worked out great because in a new relationship you're not trying to spend all your time together anyway. But the advantage of being older and at the time, 30 was older, it didn't take me long to figure things out either. I think that very shortly after I met my.
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We were pretty much clear about that. I was like, yeah, I think he's a keeper.
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A
Yeah, I was the same. Well, one date and I was cooked and done. So here you are, you find the love of your life, you marry him eventually and you start a family. I mean, you guys have had both really demanding careers. Her husband's an attorney, if you don't know. And how did you navigate three kids and raising them through all of that?
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B
Well, you know, that's one of the reasons why I have no hair. We were talking about this. So I got married, but I didn't have kids in residency because I knew I was like, that's a, that's a no. That's a, that's a hard no. I can't have a baby and go home. I can't be tired at home and tired at work and. But I had, when I had my first child, I was 34 and, you know, so chop chop. You're gonna have more than one.
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A
Meaning the biological clock is ticking.
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B
Oh, absolutely. So my kids are all two years apart, so one. And it was a lot. I remember being completely and totally overwhelmed. And I had a nanny, but she didn't live in. And she had a child.
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A
Yeah.
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B
And so I was very mindful of her time and not keeping her away from her child. And it was hard. I mean, it was a very hard 12 years. And unfortunately I had children just at the time that my husband's career was taking a turn. And he was gone a lot and not because he wanted to be, but that was just the demands of the job. And I spent a lot of time being very frustrated and tired and you know the story.
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A
Yeah, I call it. Those years were the grind for me of just cause. Chris was. My husband was working overseas and he'd go away for 28 days, like gone. And it was just me and the two kids. And then he'd come home and he was off. So he did a rotational assignment for about 10 years. And so when he was gone, it was batting down the hatches due just enough to stay alive and functional. And when he was home, he actually was all in. I have to give him that. He was picking up the kids from school, bringing me coffee in the morning, checking on me when I was on call. Just really trying to make my life easier. And that's why I'm probably still married to him, is that when he was home, he really jumped in with both feet.
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B
Okay, well, that was not my experience. Okay, that was not my experience. This would be, this is how it would go. Okay, are you coming home? Because I've got, you know, I'm on call tonight. Babysitter's gone, we get the famous, I'm on my way. Six hours later I'm like, dude, you gotta go. But you know, I have to, I look back on it now, I have to laugh because I was like, I wasn't laughing at the time, but I realized that he had a mission. He was doing something was very important because he was, when I had, my daughter was five months old. And then he was appointed the U.S. attorney in Washington D.C. and that was when D.C. really didn't have a crime problem. We don't now, by the way, but we did then. And so that was a big job. And he was really trying to engage. And even though in my heart of hearts, selfishly I wanted him to be home and to take a little bit of the load off me, I had to understand that he was doing something that was a little bit bigger than just our immediate family. So I learned to deal with it. It worked out. But I'm still a little salty about it though.
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A
I was reading a book recently and the first chapter says, I'm not gonna wanna work when I'm 60. And it was Bobbi Brown talking about signing a non compete on her, you know, and how old she would be when the non compete was out. And I laughed out loud because I thought, oh my God, I said the same thing. Like when I was 30 and thought about 60, 65, I would be a gray haired grandma. Like that was my perception of that age. What did you think 60 and 65 even would look like?
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B
Well, you know, I didn't even.
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A
You didn't have a model, even your sisters.
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B
But my mom died, she was 57. And now we know how young 57 really is. But even my sister that I lived with my sister Vivian, who integrated the University of Alabama, she Died. She was my second mother, and she died at 63. And so looking at what that looked like and what does healthy aging look like, I didn't really have a model for that. But I knew that whenever I stopped work, because, let me put it this way, I didn't have a plan. As you can tell, I'm not a big planner. It's like, whoa, well, let's see where that goes. But when I left my job and I had been in D.C. for, I don't know, 32 years, and I've been in private practice, and I had no plans to leave at that point. I was 62 years old, and it was Covid. And the upshot of that was when we were in the COVID shutdown in the emergency, and then I was doing gynecology only, and I had three months off in a row, and I had never had three months off in a row since elementary school. And that was the first time it dawned on me that I could not work and not be okay with that. So when I left after, you know, I came back after the emergency, and I said, hey, guys, I think I'm leaving at the end of the year. So the end of 2020, I put in my resignation, left with no plan, no future. I was like, we'll see where it goes. And look. Look at us now, you know, five years later. And if you had asked me then where would I end up? I would not have imagined this.
- [26:05]
A
So you are now the medical director.
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B
I'm the chief medical advisor at Alloy Health, but when I first started, I was their chief medical officer, so I was their only doctor at that point.
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A
And now, for those who don't know, Alloy is a telemedicine platform built specifically. This is brand new to take care of the needs of menopausal women, because.
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B
As we all know, so many of those needs are not being met. And the interesting thing about it, it starts with a podcast. It ends with a podcast, right. That summer of COVID Michelle Obama had. You know, she was launching her first the Michelle Obama Podcast. And she and I are friends, and needless to say, Covid changed everything about how she was gonna record for her podcast. You know, zoom wasn't a thing. She's trying to figure, how are we gonna do this podcast? Cause we can't do studio time. And. And they. We had this elaborate setup. We both live in D.C. and she said, you know what? We had had many conversations about menopause over the years, and she said, let's do this. So imagine we set up we're socially distanced. The engineers are in another room. And we talked about menopause. And that was how Ann Fallenwater and Monica Mollenauer even knew I existed. Wow. Because I'm in dc, Monica's in Rotterdam, Ann's in New York. And they were looking for a doctor. They each had their own journeys in menopause stories, but they needed a doctor to kind of say, okay, well, how do we actually, you know, put this together? They heard me on Michelle Obama podcast, said, find her. They tracked me down. Just at the moment that I was saying, I think I'm done with this part of my life. And that's how I, I came to be in Alloy World.
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A
So was it scary taking this on or were you just like, I can do this, I've got this. Cause this is different.
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B
Well, you know, here's the thing. Nothing ventured, nothing gained. And because at that point in my life, I wasn't really looking for the next thing, but it was an interesting opportunity. And I said, well, you know, hey, let's give it a shot. And I mean, I'm so happy that I did. Because the one thing that was clear to me is that I was done with that part of my life. Yes. But I wasn't done. I just didn't know what the next thing was going to be. This is what I want women to understand, is that once you get to be 50, 60 years old.
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You have never been more experienced, you have never had more wisdom. You need to share that with someone. And the only thing that stands in your way is not being well enough or not being physically fit enough for being able to pursue something. But it's not because you don't have the mental capacity to do it. And that's what I think is so important about the work that we do with menopause, is that showing women that there is a path forward that doesn't just lead to decrepitude and death. Weakness. No.
- [29:17]
A
For example, all the things.
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B
But we're here to model what that midlife and mid career shift and pivot can be. And you can be as happy, as productive.
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A
Happier.
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B
Happy. Well, you're right. Happier and as productive as you had been, say, 30 years ago.
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A
Do you feel like this is like the best time in your life?
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B
You know what I am. To give you an idea, I am way happier at 66 than I was at 46 because I was in the middle of things. I was overwhelmed at that stage. And now I can step back, I look, my children are grown, I'm in control of my life. You know, my husband still works, but I'm like, you know, yeah, I'll see you. He has to stay late. It's not the end of the day. So I have the advantage of a full life. I have dear, dear friends, you know, and to be able to do something that you enjoy and something that you feel is meaningful, I mean, I don't think it gets better than that.
- [30:24]
A
In midlife, so many women struggle with fatigue, brain fog, weight changes, hot flashes, and they're still being told these symptoms are just a part of getting older. I hear about it every day from women who were searching for real answers and not getting the care they deserve. That gap in menopause care is exactly what midihealth is here to close. Midihealth is a telehealth clinic serving women in midlife with expert evidence based care. Their clinicians and medical leaders are professionals, I trust, committed to treating the whole person. And as the only national women's telehealth clinic covered by major insurance, they make high quality care accessible and affordable. When you work with midi, you'll get a personalized plan built around your unique needs. This might include hormone therapy, nutrition, lifestyle guidance, or support for weight management. Everything is designed to help you feel better now and protect your long term health. We're seeing the difference MIDI is making with patients everywhere, and women are getting the answers, relief and care that truly makes an impact on their daily lives. It's such an encouraging moment for women's health. We're finally seeing menopause care evolve into what it should be thoughtful, informed and centered on women's real experiences. I'm so thrilled by what MIDI Health is doing to help women feel supported and empowered. You deserve care that supports you now and protects your long term health. Visit joinmitti.com to meet with a MIDI clinician and start feeling your best for the years ahead. Menopause changes a lot. Your mood, your sleep, even your hair. For so many women, thinning and shedding come as an unexpected part of the journey. And it's not something a new shampoo or styling trick can always fix overnight. That's why virtue created Flourish, a hair care collection made specifically for women experiencing hair thinning or loss, often tied to hormonal changes, stress or aging. At the heart of flourish is virtue's key ingredient, alpha keratin 60 Ku clinical. This is a combination of two bioidentical proteins that are recognized by the body as its own keratin. Unlike typical bonding or coding formulas, the keratin repairs the scalp and hair from within, restoring the strength, elasticity and resilience that can decline with hormonal shifts. Flourish helps create a healthy foundation for new growth while improving the look and feel of your hair you already have. It's a gentle, restorative approach to help your hair feel like yours again. Every formula is free of sulfates, parabens, and phthalates. Save 20%@virtualabs.com with promo code VIRTUE20. Somehow, the holidays always seem to arrive faster than we expect. So this year I'm doing my best to stay ahead of the rush. And one thing that's made gifting feel simpler and a lot more intentional is Jenny Bird. I've added a few of their pieces into my own rotation, and I love how they can pull an outfit together with zero effort. If you're looking for a gift that feels thoughtful and elevated, Jenny Bird is such an interesting, easy place to start. Their pieces are beautifully designed, timeless, and truly wearable. Think bracelets, earrings, and even monogram necklaces if you want something a little more personal. And if you're someone who shops closer to the deadline, their fast shipping makes everything feel a lot less stressful. Everything arrives in elegant, ready to gift packaging, so it feels special right from the start. The pieces are comfortable, simple to style, and they're the kind of gifts she'll reach for again and again, something that fits effortlessly into her everyday look. You can get 20% off your first order with Jenny Bird by visiting jennybird.com and using the code unpaused at checkout. Why did you write Grown Woman Talk?
- [34:27]
B
You know, it's interesting because that's another one of those detours. It's like, oh, I'm writing a book.
- [34:33]
A
Was it your idea or did someone tell you to do it?
- [34:35]
B
You know, people have been. There have been a couple people that have asked me to write a book because I've just had such an unusual life.
- [34:42]
A
It's part autobiography, it's part prescriptive.
- [34:46]
B
I tell stories because I tell stories because it's important to know that what you see and how you deal with people really depends on a lot of where you come from and how you see the world. And there's a lot about.
- [35:03]
My community and growing up and watching and seeing in real life what healthcare disparities look like, seeing what it looks like, knowing the mindset about why people would not approach a medical professional in the way that is healthy. I get it. You know, I understand that from the ground level, as I say, from the other side of the table, not just on the doctor Side. So it was really part love letters. And that was the original title of my book, was a Love Letter to my Sisters. Because I wanted people to understand that I want to give you some health advice, but it comes from a place of love. Not. I'm not trying to chastise you. I'm not trying to finger wag. I want you to understand that. I do. I see you, I hear you. I understand what the obstacles are. And I want you to be able to do better. And honestly, everybody wants to do better. Yeah, they just sometimes they don't know how or to even how approach this, how to approach the system. Because medicine has changed tremendously, tremendously in the 30 years that I practiced. It was a very different world then than it is now. And the more you know about how to navigate this system, then the better you'll be able to get what you need to get out of it. But we're working on old assumptions and medicine is not the way it used to be.
- [36:25]
A
We've talked a lot about the Women's Health Initiative. You were the first person that taught me. You and Dr. Blooming and Dr. Tavris at my very first menopause meeting. I remember that all those years ago. And I sat in the audience and watched. And I was a little bit blindsided by that talk. I had never heard any of those statements that anything had been walked back. And I had religiously done my board recertification every year. And I thought I was good. I read the articles they put in front of me. I answered the questions, you know, and got my abog check year after year after year.
- [36:57]
B
Right. Because they didn't really talk about menopause. They're just now getting questions and articles into our recertification process despite 51% of.
- [37:05]
A
The population going through menopause. Just briefly, because I really feel like you tell the best story. What happened with the whi? Well, you know, think about the Women's Health Initiative.
- [37:16]
B
The Women's Health Initiative, you know, very well intentioned study, you know, and what I try to, you know, tell people that there was a different story pre and post.
- [37:26]
A
Okay.
- [37:27]
B
And I had practiced for 10 years before the Women's Health Initiative came out in 2002. And we had a very different story that we were telling about hormone replacement therapy. It had been approved for symptoms of menopause since 1942. So when this study was conceived, we had 50 years of observational data about hormones. And we learned a lot along the way. Some of the things that were done were not correct. It's like, oh, yeah, by the way, we need to add a progestin too. Estrogen. Don't just give it by itself. So we did learn, and we've learned and adjusted. But the overall message prior to the WHI was that hormone therapy relieved the symptoms of menopause. It decreased the risk of cardiovascular disease. Because we had all of this observational data that said that women who took it did better. So that was a given. Of course, the reason why this study was done, and I am convinced the only reason why it got the attention and the. Well, at least the reason why it was done, was because that was the first female director of the nih. See, it matters who's in charge.
- [38:35]
A
Yeah.
- [38:35]
B
And she was a cardiologist, and she said, you know what? We've got this data about hormones and decreasing the risk of heart disease. That's the number one killer of women in this country and people around the world. So if we have a medication that will decrease the risk of Cardiovascular disease by 30 to 50%, we should shout it from the mountaintops. But she needed to do the date. She needed the data to be able to say that. So that's where the WHI really came from. It was supposed to be a prevention study. And the primary question it was answering was, does indeed hormone therapy decrease the risk of cardiovascular disease as we have observed for the past 50 years? That was the central question. So when they recruited for the study and it was massive, there were 40,000. Yeah, we have 40,000 women. And it was randomized and double blinded and everything. That is the hallmark of a great study to prove something. Right. But here's the problem. If you have a study that's only gonna last eight years and for women in menopause, you start to see the uptick in cardiovascular disease about 10 years after menopause. Well, if you enrolled people at 50, you wouldn't even see them. You wouldn't even see the heart disease risk because the study would be over and you couldn't answer the question. So they intentionally enrolled women who were much older. So you could be anywhere from 50 to 79 and be in this study. But also, if you're gonna do a double blinded study, you can't have women that have a lot of hot flashes, because if you had hot flashes, you know, whether you got the placebo or whether you got estrogen. So they took. There were symptomatic, they were much older. I understand why they did it that way, but it skewed the results so much because when the, when they stopped the Study about five years into an eight year study in the women who had estrogen progestin, what they found was that they didn't see the decrease in the risk of heart disease. And why not? Because if you're 79, you either have heart disease or you don't. It doesn't matter. What I give you is not gonna change that outcome. So they were too old. And the other thing about it, and I think that really the nail in the coffin, they had all of this sort of safety stops. And in addition to not being able to show that decrease in the risk of cardiovascular disease, there was a slight uptick in the risk of breast cancer. And it was really the breast cancer scare that really called all the attention, made women stop taking hormone therapy. And you and I have discussed, but that increase in the risk of breast cancer in real numbers amounted to less than one in a thousand additional cases of breast cancer.
- [41:27]
And that sounds a whole lot less scary than a 26% increase with no increase in the risk of dying from breast cancer.
- [41:34]
A
Yet that press conference with those headlines changed the course of women's health for a generation.
- [41:40]
B
For a generation. And being in practice at that time now, I had been prescribing hormones, telling women, you know, it's great, and they were feeling great. Oh, and by the way, we knew about the osteoporosis, that it would decrease his risk of osteoporosis and the symptomatic relief. But when you said breast cancer, our phones, I mean, they lit up like you wouldn't believe. And women stopped taking their hormones overnight. Women who had been doing beautifully on them, they were so afraid of that. Less than one in a thousand cases per year with no increase in risk of dying. That fear was so firmly entrenched that they stopped taking their hormones. Doctors stopped prescribing hormones.
- [42:26]
A
They stopped. And the residency programs, which I was the director, stopped teaching anything really clinically relevant about the nuances of hormone therapy or how to, you know, when to best prescribe. I knew it was there. So it was my chief year, my last year of training, when the study broke.
- [42:43]
B
You know what's funny is that when you know, this is pre Internet and you had to wait, they announced the findings, they announced the conclusion. They said, oh, it doesn't decrease your risk. Cardiac increases your risk of all these other things, cancer, strokes, it went on and on, dementia, none of which, none of which were statistically significant. And in medical world, if it's not statistically significant, it's not, not a finding you don't get to say it if it's not. Well, you and I understand that. But what I was gonna say is that that was so pernicious and it rebounded around the world. It wasn't just in the United States. Because the terrible thing was that not only did it disadvantage a generation of women, it disadvantaged an entire generation of research because people took the Women's Health Initiative as the definitive word.
- [43:40]
A
Look, what happens when you study women is what I think. Women weren't even mandatorily involved in clinical trials till 1993. 94. Here we are, 98, beginning to recruit for the study. This was huge. We had just started allowing women forcing women to be in studies. And then we do this big, huge billion dollar study. And to date, I think it is the most expensive study the NIH has ever taken on.
- [44:03]
B
And they've never done another study on postmenopausal women of that magnitude. And still not of perimenopau.
- [44:10]
A
There's not even anything on the radar.
- [44:11]
B
And there were studies ongoing around the world that were halted.
- [44:16]
A
Yeah.
- [44:17]
B
And that's why the information that we have today. And you know, and I want to say, to be fair, there are things that we did learn from the Women's Health Initiative. Yeah. That were helpful.
- [44:27]
A
Safety data.
- [44:28]
B
Safety data.
- [44:29]
A
Data on frailty data. They followed these women for. Until, like, they're still following some of the patients.
- [44:34]
B
But imagine what the information we would have had had those women who were enrolled in the Women's Health Initiative had they continued their hormone therapy. The overwhelming majority of the women who were in the study stopped them because they too were afraid we would have. Now 30 years of data. What does it look like for women who've taken hormone therapy continuously for 30 years? We would know so much more about brain health. We would know so much more about cardiovascular disease. But water under the bridge now. But what I want people to understand is that even in real time, at the moment that study came out, when we finally got our hands on the study to read it, it was like, whoa, wait a minute.
- [45:21]
A
That's not what it said.
- [45:22]
B
That's not what it said. These are older women. They took the information from much older women, on average 12 years after menopause, and applied it to all women. It matters when you start in terms of how much benefit you're gonna get. But to be honest with you, even if you start it later, it's still not that much excess harm either. That's the thing about it.
- [45:46]
A
Right. Right. People might be like, I can't stop after 60. I can't do it for 10 years after. And then they stop abruptly. And what I want our listeners to understand is that when you stop the hormone therapy, the benefits you were enjoying go away. So your bones will reset into deterioration mode. You know, when we take the estrogen.
- [46:07]
B
Away, a lot of women, even after they've taken for 10 years, they will stop their hormones and their hot flashes will come back.
- [46:13]
A
Yes.
- [46:13]
B
So it's not. Don't think that they've magically disappeared because you've been on, oh, I've taken it for 10 years. My hot flashes are gone. No, I think of it this way. It's like. It's like hitting the pause button as we're talking about unpause. And you unpause it when you stop it, and guess what? And that process still has to play itself out. So if it's gonna take you two years, three years, or however long it takes for your hot flashes to go away, that's when they'll go away. And people are shocked by that. It's like, wait a minute. I thought they were gone. It's like, no, just hit pause.
- [46:43]
A
So a lot of women feel like they're done with menopause, that there's some kind of a symptom window, and that's called menopause. But that's not actually true.
- [46:51]
B
You know, I always say, you are never done with menopause because menopause is never done with you. And all of the things that are going on between your metabolic changes, what's happening with your bones, what's happening with your heart, all of the aging throughout your body, your brain, your skin, all of it's still happening. And if all you think of menopause is that it's over when your hot flashes stop or, I didn't have hot flashes, so therefore, I didn't have menopause. Yes, you did, and you still are. And I think that the one message that I really want women to get is this. You know, I want women to have the information that they need, and you can choose to do it or not do it. And I don't want to give anyone the impression here that I think, oh, my God, 100% all women need to take hormone therapy. All women should have the opportunity and have the information such that they can make a decision about whether or not this particular medication meets my treatment goals and is in line with what my health goals are for me as I age. That's all I ask. Then you make the decision. But I firmly believe, and have always believed that given Good information. Women are more than capable of being able to make good decisions for themselves. And whatever you choose is fine with me, as long as you're good with that. And to give you an example, Mary Claire. I was talking to a friend of mine yesterday. Okay, yesterday. Menopausal Awareness Month. And she is my age. And you are 65. I'm 66.
- [48:29]
A
Six. Okay.
- [48:30]
B
I'm 66. And we've had numerous conversations about HRT. Should she, shouldn't she? Her bone density is worsening. She decided to go on. We've had this discussion. She's talked to her doctor. I'm not her doctor. I'm just her friend. Her doctor's like, I agree. She's on it. She went to see an endocrinologist who berated her. This was last week, not 10 years ago. I don't know if you should be on those hormones. That's the part that really distresses me. Why are you speaking about that? Because you are. That's a. That's very disrespectful to the doctor that prescribed for you, first of all. But everybody feels that they can weigh in on this when they don't know what they're talking about. They haven't read the studies. They are subject to the same misinformation. And these are our other colleagues. You know, if our obgyns don't know, it's less when you get to primary care, when you get to. Even cardiologists, endocrinologists, they don't follow our literature. Guess what? I don't follow theirs. So I don't feel as if. If a person came to me and they were on an insulin dose, I wouldn't say, well, my goodness, why are you taking that? You should be taking oral. That's not my lane. And this is what I would urge all doctors who are out there who might be listening to this. If you don't know, I don't blame you for that. But go get educated before you are giving medical advice to patients.
- [50:07]
A
Before you comment.
- [50:08]
B
Exactly.
- [50:09]
A
I want to know if this is the same for you when you were practicing and with your patients in Alloy. When we talk about the longevity conversation, it's, you know, hot. It's all over my social media platform. It's heavily, heavily, heavily male driven and really in the wellness side of the world. But, you know, even with Peter Attia and the MDs who are there, a lot of that data I know was not done on women. But when my patients come into me, especially now, we put out the fire of Menopause, we get their symptoms under control to where they can sleep, they can think of, they can move again, they're not hurting. And then we start kind of looking at the next 30 to 40 years. I don't have a single patient yet who looks at me and says, I want to live to 120. She has no desire to outlive all of her people, her children. What she wants, by and large, is to not suffer like her mother did, her grandmother did, her aunts did. Because when you look at the data, when McKenzie published the study, women are living 20% of their lifespan in poorer health. So we can't not age. That's happening to all of us. But when we look at the numbers, including endometriosis and pcos and all these diseases in us that are understudied, when we look at the end of life, women are much more likely to end up losing their independence for longer periods of time than their male counterparts. And that is driving their healthcare decisions. That is a carrot that will drive a patient is not to have her daughters have to stop their lives to come and take care of mama for a protracted period of time, which is what is happening today. There's many reasons for this. I think whi is bearing with the osteoporosis point of it. I think we have an epidemic of osteoporosis, and women being afraid of estrogen is probably part of that, but also the way that women are constantly in service to others and not putting their own health first. So how would you counsel her if she came to you and said, Dr. Malone, I don't want to be in a nursing home like my mom?
- [52:05]
B
Well, you know, here's something that when we're talking about the longevity and how you live out the remaining years of your life in poor health, this is where, again, that the disparity thing rears its ugly head. If you think that women live 20% of their lives in poor health, whatever, it's probably twice that for black women in this country and for a lot of reasons. And that's because, you know, there's more cardiovascular disease, there's more strokes. And the things that we think that black women are not at risk for, like osteoporosis. The reality is, is that. And I read a study that said that for black women who fracture a hip, their outcomes are far worse than their white counterparts. Alzheimer's, dementia. Women make up two thirds of the dementia cases. Black women have twice the risk of dementia as white women. So that is a huge component of What I want to talk about because. But this conversation needs to be had when you're 40, not when you're 60. That is really the thrust of my book is to say to women, look, there are a lot of things that are in your control. And when you just focus on what the outcomes are, it paints a very negative story. Because you think that, oh, well, that's just how it is. And even modeling behavior, if all you've seen is your mother get old and frail and be in a nursing home or your grandmother get old and frail, you think that that is the inevitable outcome for you. I am. It is not. And that's the message that I think should be very hopeful. And I think that we should all always give women the same basic lifestyle advice that we give all the time. It's not rocket scientists. Exercise and eat right and get a good night's sleep and all the things that you need to do. Cut down on alcohol, don't smoke, manage your blood pressure. But there's so many things that we just accept as normal and they shouldn't be. And I think that it gets back to what I talk about a lot. And you've heard me say this, and that is for women. We have accepted suffering as our lot in life. And we suffer through a lot. We suffer through migraines and depression and anxiety and pelvic pain. And the list goes on and on and on where you think. We don't even think to complain about it because we have so sort of integrated this suffering model into our existence.
- [54:44]
A
You're rewarded for quietly suffering. You're not hysterical. You're so tough. You're so strong.
- [54:51]
B
And I say, you know what? There's no suffering Olympics. You don't get a medal at the end because someone you suffered 20 years and someone else has only suffered 10. How about let's not? That's my message. And so for people who try to overcomplicate things, it's not that complicated, but it requires some effort, and it requires that you start early. Yes, start early. But is it ever too late? No, it's not. But we also have to remove some of the societal barriers that keep people from being able to live their best life. People need health insurance. They need access to a clean, healthy environment. They need to have access to fresh vegetables and whole foods. All of these things that are not.
- [55:39]
Deficiencies of the individual. They are deficiencies of the environment that we find ourselves in. And so that's why it requires two things. And I say the little a, advocacy, which is us. You as an individual, going and showing up and knowing how to advocate for yourself. And I talk a lot about that in the book. But there's also the big A advocacy, which is the stuff that we do, which is making sure that our legislators, that the government, that they respond to the needs of women. And we've been woefully underserved, and that's gotta change. But now we're at least having the conversation. The first step is always awareness.
- [56:18]
A
Yep.
- [56:18]
B
And that's what we're doing. And I think that that's what you have done such a phenomenal job about. Because, I mean, and I say this sincerely, because I've been saying what I've been saying, and there have been people. Avram's been saying what he's been saying.
- [56:31]
A
I just say I became a microphone for other people's work.
- [56:34]
B
Jim Simon has been, you know, we have. So it's not like this was unknown, but when you're having a conversation one on one in a doctor's office, it doesn't get out of that space.
- [56:45]
A
Right.
- [56:45]
B
So social media has been a huge boom.
- [56:49]
A
I mean, it opened my eyes.
- [56:50]
B
Right.
- [56:50]
A
Because we're in individual exam rooms and say, 10 people, tell me something. But it's actually happening 10 times. 10 times 10. And then social media just allowed those things to be amplified, good and bad. And then women realizing there's a common experience here. Frozen shoulder. One of the kind of. No one kind of put two and two together. Some people had. But they weren't being heard.
- [57:12]
B
Right. I mean, skin, hair, all of it. It's like there's nothing in your body that's not affected by this menopausal transition. And we've spent too much time just talking about the, oh, it's the end of reproduction. Oh, it's the. Yeah. Okay. Well, good news is that, oh, no more periods.
- [57:29]
A
Yay. Yay.
- [57:30]
B
You know, there's some good side of the. Of menopause, but we've acted as if that's the only part of it that was important.
- [57:37]
A
Right.
- [57:37]
B
And it's so much more than that. And that we have got to get women to understand it. And not that we are looking for a fountain of youth. This is not feminine forever. Why don't you take hormones so you can be sexually attractive to your husband? That's not why we're doing it. We're doing this because we want to be our best selves as we age.
- [58:01]
A
Taking care of your mental health can feel isolating. There are days when scrolling through advice online just doesn't give you what you need. And let's be honest, reaching out for support can be overwhelming. It can be hard to know where to start, but that's where ALMA comes in. With a nationwide network of over 20,000 diverse licensed therapists, 99% of whom accept insurance, ALMA makes finding the right care simple and affordable. You can search without creating an account, then filter by what matters most, like gender, race or therapeutic approach, and even see the session costs upfront with their free insurance estimator. On average, people using Alma Save 80% on their sessions. What stands out most about ALMA is that this isn't about quick fixes or generic advice. It's about real human connection, which means you can schedule free 15 minute consultations with as many therapists as needed to find one who truly fits your goals. Building a meaningful relationship over time leads to better mental health outcomes, and ALMA makes that easier than ever. Better with people, better with Alma. Visit helloalma.com unpaused to get started and schedule a free consultation today. That's helloama.com unpaused hormones affect more than how you feel.
- [59:23]
C
They affect your skin too. As estrogen drops in midlife, your skin can lose collagen, hydration and elasticity. That's where Alloy Health comes in. Alloy makes evidence based menopause care accessible, connecting women with menopause trained doctors. And now they're redefining skin care with M4, their prescription line made with estrogen, a form of estrogen that only works on the skin. It started with the M4 Face Cream RX and now Alloy's added two game changers, the M4 Face Serum RX and the M4 Eye Cream RX. Getting started is easy. Head to myalloy.com that's my a l l o y.com answer a few quick questions and a licensed physician will review your info. Use code MCH20 that's MCH20 for 20 bucks off your first order, your personalized skin care ships right to your door. No appointments, no pharmacy lines. Because your skin's changing and your routine should too. Visit myalloy.com and use code MCH20.
- [60:19]
B
That's MCH20 this holiday season, gift giving.
- [60:24]
A
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- [61:39]
What do you tell a woman who's been dismissed or ignored by her doctors?
- [61:44]
B
Well, you know, this is where I say speak up. But it requires you to have the good information when you walk into a doctor's office. And that's why my podcast is. It's called the Second Opinion. And it's called the Second Opinion because if someone is telling you something, a doctor, first off, the assumption is the doctor knows everything. They don't. And they certainly don't know everything about you. You are the expert of you. They maybe have expertise in more than things. But what we forget is that there are a lot of things in medicine that are opinions. We are all sort of looking at some data, some of which is definitive, some is not, some is up for interpretation. And we get opinions. That's why I say get one. If someone tells you something or someone denies you something that you think you need, and that's one of the things that really gets my goat about hormone therapy, is that people will go in to see their doctor. They're educated, they've listened to your podcast, they've listened to a lecture or something I've done and they're like, okay, great, I want that. And you go to see your doctor and you have the experience that my friends had last week. You can't have it. You can't have it or you're on it and you should get off it because it's dangerous. Well, this is where, you know, I think access is so important. We've gotta use technology, we've gotta use innovation. That's why Alloy and Digital Health, because it allows us to give this information to many people.
- [63:18]
A
It's a speed ramp, you know, for us to go through the traditional system. My daughter's in medical school and she's getting more than I did, but it's still not a lot.
- [63:27]
B
Right.
- [63:27]
A
And the current curriculum for OBGYN does not include a robust, clinically relevant menopause curriculum as of yet. We're getting there. But even then we start. So say in 2026, we start graduating everyone with PhDs in menopause. It's still gonna take an entire generation for all of that to filter down and for guidelines to change. So digital health is really taking that control, seeing we've got about 20 years before the rest of the. Of how medicine is given catches up.
- [63:56]
B
Right. And I think that it's required of those in power and those in charge of medical education.
- [64:03]
We've done this before. When I say we've done this before. OBGYN used to be just obgyn, and now we have minimally invasive surgery, all the different subspecialties. Yeah. We have substance. We have reproductive endocrinology, which does fertility. We have high risk, obviously. All of which because we've understood that OBGYN is too much.
- [64:23]
A
Right.
- [64:24]
B
It's too broad. We are asking doctors, on any given day, you need to be a surgeon, you need to be a psychiatrist, a counselor, you need to be a social worker, you need to do. I mean, it's just a primary care doctor. It's too much. And I think that it is probably past time that we realize that if women are going to spend 30 to 40% of their lives in their post reproductive years, then maybe we need a specialty that is just that. That deals with women in midlife and.
- [64:57]
A
Not when they're having babies and not.
- [64:59]
B
Because it's too much and you're pulled in too many directions. And like I said, you would never ask a doctor to say, what do you do? Oh, I'm a man doctor.
- [65:10]
I just do men. Men things. No, you have a cardiologist. You have all these different things because that's what you need. Right. But we have asked OBGYNs, you just be the. You just be the lady doctor. Anything that that woman needs from puberty to death, you're supposed to know how to take care of it. I think that's asking too much.
- [65:28]
A
And I just think the medical system assumed it's not that complicated, Right? So. But it is very, very, very complicated.
- [65:34]
B
It's either not that complicated or nothing we can do about that.
- [65:39]
A
Right.
- [65:39]
B
So that's just women being women.
- [65:42]
A
I met someone who is a liaison for the acgme, which is who decides the medical school Curriculums. And she brought up menopause, like, where's the menopause curriculum? And they said, oh, we just don't have enough information. And that person is no longer sitting. Who said that? But at the time, when she first got there in her first year, that was the prevailing thought, that people who control the medical school curriculums for allopathic MD schools, there just wasn't enough. We don't know enough about menopause to really give it much time in medical school. And we know better.
- [66:16]
B
When I was doing the research for my book, and I'm sure it's worse now, but I have the 2022 numbers. $45 billion in medical research. Less than 11% of that went to conditions that affect women. And that's migraines, that's autoimmune diseases, it's depression, it's anxiety, all. All of these things. And we get less than 11% of that budget because the assumption is, well, that's just women.
- [66:43]
A
Yeah. You know, it's all in her head.
- [66:45]
B
Yeah. That's just what women. Whatever. Or it's complicated. And that's why women were kept out of studies for so long, because they didn't like the idea that one. That you were just a vessel for reproduction. And we don't want to do anything that will give you any medication that. That would interfere with your ability to reproduce. Okay, I get that. That was from the thalidomide studies back in the 60s. But the other thing is that they don't take into account the physiology of women that is different than the physiology of men. And yes, it involves our hormones. And they look at that not as a feature, but as a bug in the system. So they're like, no, skew the results. That will just mess up all the things. If I have to deal with the fact that you're premenstrual or you're, you know, or where you are in your menstrual cycle and where your hormones. And that plays very importantly in how we react to things. Even for heart disease. Right. Even for how we. How we respond to statins versus how men respond to statins.
- [67:51]
A
You're preaching to the choir.
- [67:52]
B
Different.
- [67:53]
A
Totally different.
- [67:54]
B
Different. But we wanna act as if. Well, we did it on men, so it worked for them, so it must work for you. And there's still, unfortunately, too much of that. Because even though they've mandated that women be included, a lot of times the data isn't disaggregated.
- [68:09]
A
Right. And disaggregated means they just report the general results. But they don't say, well, how did the women do versus how did the men do? And when they looked at those top four statin studies, the statins in the female patients did not prevent a primary heart attack. Their cholesterol went down. But turns out women's risk of heart disease or why we have heart attacks and how that mechanism goes is different than men. And it's complicated.
- [68:34]
B
Right. And, you know, you and I both are on the same page of this, because when we start talking about hormone therapy and prevention of heart disease, I don't know what the major resistance is to saying that, because guess what hormone therapy does. It does the same favorable things to your cholesterol profile that a statin does.
- [68:51]
A
Yes.
- [68:52]
B
And what's the combination of the two? Like, maybe that's better than either of them alone. Where's that study?
- [68:58]
A
Exactly. So the establishment. I'm just going to call it the establishment.
- [69:01]
B
The establishment, okay.
- [69:02]
A
The establishment. People who make guidelines and are on committees and things.
- [69:06]
B
Mary Claire and I are anti establishment.
- [69:10]
A
First seemed like they were loving all of the attention that the menopause press was getting. People were suddenly joining these organizations in droves. Really. We're seeing doubling, tripling, and that's great. You know, menopause is becoming a household name. Talked about a lot of curiosity, a lot of clinicians wanting to learn, but it feels like after that initial wave, there is a. Wait a minute, hold on. We haven't decided what the right messaging is. Are you prepared to talk about that?
- [69:44]
B
Well, you know what? Change is always difficult for people, you know, and I think it requires a lot because I'm gonna put myself. You and I are, you know, just medically a different generation. And 10 years is a big difference when it comes to how I was trained versus how you were trained. And so a lot of these people are 10 years, some of them even ahead of me.
- [70:04]
A
Oh, yeah.
- [70:04]
B
So they're very entrenched, and they have been.
- [70:11]
I guess, sort of. They don't like upstarts. They like hierarchical stuff. And so when someone says something, if you want to have a debate about it, let's have a debate about it. But again, these are things that you. You. And we're all looking at the same data, and you came to one conclusion, I come to another, who's right and who's wrong. I will not name any names or any societies, but I can say, generally being sort of in the middle of those two, I think that the medical establishment owes this generation, your generation, a debt of gratitude for elevating these Conversations, because this is how we're gonna get more attention. This is how we're gonna get legislation passed. They had. How much time did you have to get that done? And where are we? Okay, we're where we were. So you know what I mean? There should be some way that we could come together without people having to say, I'm right, you're wrong, or you can't say that. Well, you know, as far as I'm concerned, it's still America. I can say what I want. That's the beauty of second opinions. Doctors don't always agree. They're not always right. So you know what? You as the educated consumer can look at it and say, either that makes sense to me or it doesn't make sense to me. And you do what you think when no one's asking you to be the expert of anybody other than what you want and what your treatment goals are and how to best achieve that. Sometimes you're gonna get different opinions.
- [71:43]
A
So if you had a magic wand right now and would pick three things that would really make a difference, you've got a 40 year old and she's like, give me top three things that can help me live my best health, my best life.
- [71:58]
B
I used to have these conversations and it's so funny. Cause every now and then I'll run into a patient of mine and she'll say, you know what, Dr. Mullon, you said that. You told me that. And it's this. Prevention is way better than trying to.
- [72:12]
A
Fix it after case.
- [72:13]
B
So I would tell my patients who were in their late 30s and early 40s, and we would literally have this conversation. I'd say, I'm just gonna give you heads up here. I said, you're 40. I know you're great and you're cute and everybody's, everything's good. I said, between 40 and 50, I said, you will gain on average 10 to 15 pounds if you do exactly what you're doing right now. You're not overeating, you're not under doing anything, but whatever. I'm just saying, whether it's metabolism changes, whether it is the perimenopause or the menopausal transition, that's the normal course of things, okay? And I said, so if you want that to not happen, then I'm just telling you now, these are the things you can do. You've gotta change your diet a bit, you've gotta exercise more, you've gotta manage to that extra expectation. Don't come in after you've gained 20 pounds and say, oh, my God, how are we gonna lose it? I'm telling you now, so you have the opportunity. It's far easier to not gain a pound a year than to lose ten pounds ten years later.
- [73:18]
A
Ten years later.
- [73:19]
B
So what I call anticipatory guidance. These are the kinds of things, make sure you know what your family history is so you know what things. Not that you're going to get, but what things you may be susceptible. I have a family history of breast cancer. I have two sisters who've had breast cancer. So you know what? I screen a little bit differently than someone who doesn't have that family history. I'm making sure that I'm on top of my colonoscopy because my mother died of colon cancer. I want you to know that these are the things that are within your control and don't wait for something to happen to you. I want to make sure that they have the conversation about hormone therapy so they know what the issues are and what things to expect and if you have them, when to get treatment. And that's that other little persistent myth that you have to wait and suffer a while before you can get treatment. No, you get treatment or you deserve treatment when you get them. If I have to say, my messages are all focusing on prevention and talking about things ahead of time. And I think that regardless of what they choose, people are much more responsive to that message because they're not afraid. They're not afraid when they get brain fog, that they think, oh, my God, my mother had Alzheimer's, I'm on the road to dementia. No, you're not. It's a calming experience just to know, oh, okay, this is normal. And it may be normal, it may be common, but it doesn't mean that you have to live with it either.
- [74:54]
A
Now for a medi pause sponsored by Midi Health. We've all heard it before. Exercise is good for you, but what it really is is a celebration of what your body can do. And when you dig into the science, especially for women in midlife and menopause, it's not just good for you, it's transformative. Let's start with the basics. As estrogen declines, we naturally lose muscle and gain fat. That means our metabolism slows down, even if we're eating the same. But here's the good news. You can take control. Regular resistance training, lifting weights using resistance bands, or even body weight movements can actually reverse that trend, helping rebuild muscle, burn more fat, and feel stronger than ever. Exercise also protects your bones. Weight bearing movement is one of the Best defenses that we have against osteoporosis. It helps keep your joints lubricated, reduces pain, and even improves posture and flexibility. And let's talk about mood and sleep, two things that get disrupted during menopause. But regular physical activity boosts our serotonin, dopamine and endorphins, helping you sleep better, think clearer, and feel more like you. So, yes, exercise is good for you. It is one of the most powerful evidence based ways we have to support your body, your mind, and your future. So if you're wondering where to start, just start moving and find something you love to do. Walk, lift weights, dance around your living room, stretch, take a yoga class, whatever keeps you moving consistently, three to five times a week. Because exercise isn't a punishment for aging. I'll say it again, it's a celebration of what your body can still do and a promise to keep doing it for years to come. Because menopause isn't the end of strength. It's the beginning of a stronger you.
- [77:06]
So recently you spoke at the American College of Ob GYN at their national meeting and that was your biggest audience outside of being on tv. What was that like?
- [77:14]
B
It was actually very good. Because you know what I talked about? I talked about the historical disparities in healthcare. And I think when we talk about disparities, particularly when it comes to black and brown people in this country, we focus so much of the conversation around maternal mortality, which is important.
- [77:33]
A
It is important.
- [77:34]
B
However.
- [77:36]
That'S a small portion of what the disparity conversation ought to be. It persists from cradle to grave. And we have to talk about and address again some of these societal issues and things that we can that are outside the control of the patient. Because I think that when we have the disparity conversation and we look at it and we say, oh, black people have two times the risk of this, three times the risk of that, and whatever. It gets back to the same thing that we talked about. Like with women, we just go, oh, well, that's just women. And there's. We blame the individual. And if we say, if you would just stop doing that. Oh, black women. If you would just stop perming your hair, if you would stop being so fat, if you would stop being. Any number of things that we blame people for. And this is where, when we get back, and we'll be off on a tangent here, but just the whole. Obesity is a problem in this country. Okay, we have GLP1s now, but who's gonna have access to GLP1s? That's a disparity issue. That's a health issue. And now we have a treatment. And the thing that I want people to be aware of is that when it comes to health outcomes, when things are bad across the board, you're equally affected. The disparity gets wider when the treatment options get better. Do you see? Because now we have a treatment, so one group of people is gonna do better, but the people who can't get it are not. It was three times. Now it's five times.
- [79:12]
A
So my kids have this meme that they sent around, and it was before and after photos, usually of celebrities. And the title always goes, you're not ugly, you're just poor. And it's showing some plastic surgery and stuff now that you're not fat, you're just poor because they don't have access to the GLP1s. That is definitely an access problem.
- [79:37]
B
Stop blaming women. Stop blaming poor people. And the answer to that ought to be not. Not, what are you doing? That's so problematic. But the question ought to be, what are we doing to you? Because where you live, what your zip code is, is more determinative of your health outcomes than what your genetic code is. So we want to keep blaming people as like, well, I have a family history of stroke and high blood pressure. I'm like, duh, Find me a black person in America who doesn't have a family history of that. What's the historical context? Why is it that the, you know, are you able to pay for your medication? Do you have insurance?
- [80:20]
A
Do you have all the insurance? All of these things to the clinician. Do you have to go to a.
- [80:22]
B
Community clinic versus where do you live? You don't have a grocery store that you can get to. You don't have safe outdoor space. These are fixable problems. And we want to say, you know, we're trying to look for a genetic basis for things that really are environmental.
- [80:37]
A
Yeah. So we talk about second opinions. I'll tell you, I, in my training was never taught to suggest a patient got a second opinion. I was taught to tell them what you think is best and that is it. If they choose to get a second opinion, that's fine. But I was never taught, and I have. The words have come out of my mouth, but not that often to where. Listen, you should go talk to someone else and see what they think. One in five people who have been advised to get a second opinion actually do it. Do you feel like this would be another leverage point for people to. Especially in menopause care. I Mean, they're being told diametrically opposed things for me versus their endocrinologist, like your girlfriend, for me and their obgyn who delivered their babies and did great care. And I was that doctor who heard the headlines, read the guidelines, and practiced that way, and never would have thought to tell someone to get a second opinion for hormone therapy. Why you know it's gonna give you breast cancer.
- [81:34]
B
There's a couple of reasons why I think that we don't suggest second opinions. And one is because, you know, doctors think they know everything. They really do. And my opinion is always superior to anyone else's opinion. But here's where I think a little humility needs to be involved here. Know what you know and know what you don't know, and don't let those two cross very often, because I would have patients. You know, there are things that I actually do know. You know, if someone came to me and they said, do I need to have a hysterectomy or do I need to have a myomectomy? I'm very clear about what the answer should be. And that's the other thing. I was never hesitant to give my opinion about it because they had gone to another doctor, and the doctor said, you need to do blah, blah, blah. And they would come to me for a second opinion, and I'd say, well, I wouldn't do it that way. And this is why. And when patients weren't really clear or they weren't sure about what I was saying, I would say, you know what? I think you should get a second opinion. Because, one, maybe I'm not right. But more importantly, I want you to be comfortable with what I said. Because usually what I'm saying is that There may be 1 out of 10 people that don't agree with it, but 9 out of 10 will. So that sort of, I think, instills some confidence in your patients, because I don't want you to do. You're not gonna hurt my feelings if you go get a second opinion. And as a matter of fact, knowing what you don't know.
- [83:11]
Like, even with surgery, I mean, surgery in gynecology has become so much more complicated than it used to be. And I would say, you know what? I don't do that. I don't do that.
- [83:22]
A
That type of procedure.
- [83:23]
B
I'm gonna send you to somebody who.
- [83:26]
A
Knows how to do that, who had done minimally invasive and neurobotic.
- [83:29]
B
I don't. I don't know how to. You know, they've made some new equipment since the Last time I did this, go do that with someone else. So that's why I said, don't be afraid and don't be, certainly don't be afraid of hurting your doctor's feelings. I said, if your doctor's offended because you get a second opinion, then they're clearly not confident in what they said. So I'm like, go do it.
- [83:52]
A
So you've changed careers, you know, from bedside to digital. Pretty exciting. At Alloy, at the age of 62.
- [84:01]
What would you tell another woman who's in her 60s and thinking, should I do this? Should I make this big career change?
- [84:08]
B
We have a lot of people in our world who have made career pivots at this point. And I would say do not think that your life is over professionally. The key is to be able to feel well enough and have the energy and stamina to do it. So if you're healthy and you're good and you want to try it, as I said, I've never been smarter. I've never had more wisdom and judgment than I have right at this moment. So, yes, I think that we have to get society to catch up with us though, to not put women in a corner somewhere and think that, you know, oh, that a 20 year old can do or knows what I know they don't. And I think that the more role models that they see, and that's the good news because we, I mean, look at the women that we know, Michelle Obama, you know, Naomi Watts, I mean, I can think of all the beautiful, wonderful women who have done things and changed and pivoted and done other things, and they are happy and productive. And when people see that, that being over 50 is not the end of your life, it may be the end of one part of your life, but you're on to bigger and better things. And don't let anyone tell you that that's the time of decline or sitting in a corner. No, we're out there.
- [85:30]
A
Now's the time to step into it. So menopause often feels like society wants us to hit pause. So you personally, what have you decided to unpause for yourself at this time of your life?
- [85:41]
B
The thing that I love about being this age is that you're freed from so many of the other societal, you know, I wear what I want to wear, I'm comfortable. I'm not saying this to say that from a sexist point of view, but you're free from not only the male gaze, but you're free from.
- [86:01]
Society'S gaze. It's like, I don't really care. You know, when you're younger, you care about, how do people see? Oh, I don't know. What does my outfit look like? What does my hair look like?
- [86:08]
A
I think that's the best part of menopause, is that my filter's gone, my give a care factor's gone. I usually call it something else.
- [86:17]
I'm just like, here. I'm present. I'm gonna say it. I'm gonna do it. I'm not gonna worry about it.
- [86:22]
B
Right. My children are grown. Whoever they're gonna be, they are. You know, I have no more influence over that. It's like, whatever it is, that cake is baked. And I think I did okay. I have, you know, three productive adult children, and you always worry about them, but I'm not worrying about them in the sense that I think I'm gonna change who they are or make them into somebody else. That's freeing. You are at a different point in your relationship. I think that the partner that you're with, it's either good or it's not. But you've weathered all that stuff along the way. And my husband and I look at each other, and it's funny because I said, you know what? There are many times along the way that I'm not sure how this is going to work out. I said. But I said, we got over that. And now I'm like, too late. Sorry. We all had an exagram that is now closed. We're sorry, dear. You're stuck forever now.
- [87:16]
A
That's where we are today.
- [87:17]
B
We're there.
- [87:17]
A
Yeah, that's it. Like, we're not going anywhere.
- [87:20]
B
We're not arguing about those things that used to, you know, keep you apart. But I really say that the key to it all is feeling true to yourself, feeling productive. That is why the work that I do with Alloy is giving women access. And I do it not from the standpoint of, oh, my goodness, I'm really not trying to sell you anything other than information. And then you do with that, because we've gotta be in the world of social media, where you're bombarded with everything. You've gotta be. All I want to be in this space is a trusted source where you can say, I'm 66 years old. I'm not coming at it because I'm imagining that I'm gonna have another career when I'm 76. Maybe I will, maybe I won't. But that's not the goal. The goal is now I get to step back and say, I wanna do the things that feel true and good to me and that in a way that hopefully I can be in service to others. And if I can do that, then I think I've done a good job.
- [88:25]
A
Well, thank you for sharing your wisdom with us today on Unpaused. It was so awesome having you here.
- [88:29]
B
It's always a pleasure. Always a pleasure. And like I said, thank you for doing what you do. Because as long as you keep talking and women keep hearing it, then I think that we have done what we need to do and I think that, you know, we're all the better for it.
- [88:43]
A
Thank you.
- [88:44]
B
You're welcome.
- [88:46]
A
As a reminder to our audience, you can follow Dr. Malone on Instagram malonemd and catch her new podcast the Second Opinion with Dr. Sharon, wherever you get your podcasts. Also, her book Grown Woman Talk, your guide to getting and staying healthy, is available on Amazon. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram @Doctor Maryclaire and get honest, accurate information on health, fitness and navigating midlife@thepauselife.com if you're loving this podcast, be sure to click Follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire unpaused is presented by Odyssey in conjunction with pod people. I'm your host, Dr. Mary Claire Haver. My new book, the New Perimenopause is available for pre order everywhere you buy books. The views and opinions expressed on Unpaused are those of the talent and gift and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.