Latest / Wellness in Today's World / Ep. 26: Menopause, Midlife, and Women’s Well-Being

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Ep. 26: Menopause, Midlife, and Women’s Well-Being · Wellness in Today's World

0:05
Welcome to Wellness in Today's World,
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the podcast where we discuss psychology,
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wellness, and everything in between.
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I'm your host, Debra Kawahara,
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and with each episode, we discuss how to live life better.
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Today we're exploring a topic that affects every woman who lives into midlife.
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Yet, for a long time, this topic has been either avoided,
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under-discussed,
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or simply just not focused on.
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Today, we're going to be looking at menopause and the broader experience
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of women during midlife. For many women,
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menopause is not just a biological transition.
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This stage of life actually affects many areas:
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physical health, emotional well-being,
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work,
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our relationships, our identity,
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and just quality of life. And yet this has been an area that
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has been kind of shunned, just not something that has been looked at.
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And today I am just so delighted that we have Dr.
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Rebecca Thurston here.
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a leading scientist, psychologist,
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and internationally known expert in women's health and menopause.
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Dr. Thurston is Associate Dean for Women's Health Research
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and Distinguished Professor of Psychiatry,
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Psychology, and Epidemiology at the University of Pittsburgh.
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I'm also so happy because Dr.
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Thurston served as a co-chair of My Presidential Task Force on Women's Health
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and Well-Being During Midlife and Menopause.
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And I'm just so thrilled to say that we have just recently released
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two groundbreaking reports: one on research
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in this area that also talks about the gaps and recommendations,
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and a second report that focuses on clinical care and recommendations
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for improving the health
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and well-being of women during this important stage of midlife and menopause.
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So Dr. Thurston, welcome to "Wellness in Today's World." I am just
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so pleased that you're here today.
2:31
Thank you so much for having me.
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It's a privilege.
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Okay, let's get started because I have a whole bunch of questions that I want
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to ask and I want to be able to tap into your expertise.
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You know, when I was first talking about doing a presidential initiative
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on this area, many women came up to me and just felt relieved that someone
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was saying that this was real.
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I just wanted to ask you, why has it taken so
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long for us to recognize this as something important since women
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are half the population? And you know,
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women have been going through this for millennia.
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So what do you think?
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Mm-hmm. Yeah. Yeah.
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Yeah, it's kind of striking, right?
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This sort of natural life transition that just about all of us,
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~ those who are born female, will experience.
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And it's a kind of extended duration,
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depending on how you measure it,
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accompanied by a lot of different health changes and symptoms,
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et cetera, et cetera. So it's really interesting.
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I think it
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reflects kind of the general shame that we've had around menopause,
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~ because it's kind of this confluence of reproductive health,
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~ gynecologic health, and aging and women's health.
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And I think we've kept this in the shadows for so long.
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And I really think it's wonderful that it's coming out of the shadows,
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that people are talking about it,
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that women are really demanding answers.
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And ~ it's losing that kind of
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flavor of secrecy and shame. So I think it's great,
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but it reflects our cultural attitudes towards women's health,
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aging, and anything kind of touching the space of gynecology.
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Yeah.
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And you know, when you have talked about it,
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'cause I've seen you present, I've seen your work,
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you talk about it as it is really important to not only think about this
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as a biological stage or biological transition.
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You kind of talk about it from a biopsychosocial framework.
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Mm-hmm.
4:32
And really to be careful not to just talk about,
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"Oh, this is a hormonal change that,
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you know, women go through." What does that biopsychosocial framework mean
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and why is that an important distinction?
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Yeah, I mean, I think what we've learned over the years,
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particularly with our longitudinal cohort studies where we follow women over
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the course of the menopause transition and see what changes,
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and also in my clinical work, how do we address this clinically?
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It's become clear that this is a major multi-system transition and it's impacting
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on multiple aspects of physical health,
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~ whether it's cardiovascular health,
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brain health, bone health, ~ muscle health,
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etc.
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Mental health, of course. And the underlying drivers of all of those changes
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are not only hormones. I think we've learned that the hormones matter,
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but there's other things like sleep,
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vasomotor symptoms, etc. While we're having menopause
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in this reproductive transition or multi-system transition,
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we're also having midlife aging.
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And that's where some of those role transitions come into play,
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midlife psychological development,
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perspectives on your future and your past,
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that kind of reflection. So all those things are happening at the same time,
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which I think makes it a really interesting and ~ beautiful time of life
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to both study, to be in, and to treat clinically.
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And one of the things that I know you talk about a lot and as I,
6:02
over time, have kind of followed you,
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you really do focus on kind of the more comprehensive impact
6:10
Mm-hmm.
6:11
that midlife, you know, and menopause have on women.
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And I wanted you to talk a
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more about the relationship between menopause and perimenopause and health
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Mm-hmm.
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and well-being.
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Yeah, yeah. And maybe I should start with defining some terms,
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like what is the menopause, right?
6:28
Okay, Yeah!
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So, you know, and how we stage it.
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Between menarche and the perimenopause is called the premenopause,
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and that's when we have our regular reproductive cycling.
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Theoretically, ~ we have fecundity or the ability to have children during that time.
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And then your menstrual cycles become kind of irregular,
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usually in the 40s for most women,
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whether it's early 40s, mid-40s,
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and that's when you're starting to enter into this early perimenopausal period.
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~ And then when you start skipping menstrual cycles,
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once you skip two menstrual cycles,
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you've gone 60 days without a period,
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you are entering into the late perimenopause.
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And after 12 months of no menstrual cycles,
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you are in the postmenopause, and that's where you stay the rest of your life.
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And really, where a lot of the action that we see is during
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the perimenopausal period. And this can go on for quite a long time,
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between the early and the late perimenopause.
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On average, it's about four years,
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but it can extend much longer for some women.
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And then the early, those first couple years of the postmenopause,
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we see a lot of changes. This is both you see dramatic changes
7:33
in reproductive hormones. So your hormones may be bouncing around from
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one month to the next during the perimenopause.
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And then they kind of, especially estrogen,
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estradiol from the ovary, that will like decline very dramatically right around that
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final menstrual period, onset of postmenopause.
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But you also, 70 to 80 percent of women are having hot flashes,
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about half of women are having sleep problems,
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about half of women are having cognitive symptoms like brain fog.
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And then you're also seeing accelerations in underlying atherosclerosis,
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which is one of our drivers of cardiovascular disease.
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We're seeing pretty rapid declines in bone density right around that final menstrual
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period. And then we're investigating in one of our studies,
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we don't know this for sure yet,
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but we think you're probably gonna see also some changes in the brain when
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you image women serially
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Mmm.
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over the course of the menopause transition.
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Although those data used in neuroimaging are much more slim,
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and that's why we have this big MetaBrain study to do that.
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So there's a lot of different changes happening all at the same time.
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And then when it comes to mental health,
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you're seeing increases in depressive symptoms and major depressive disorder,
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particularly for women who've had symptoms in the past.
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And then we can get into all the other mental health diagnoses and how much
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we don't know actually, but also
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Mm-hmm.
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there's some data for increases in anxiety as well.
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~ So you're seeing all these changes on the mental health side,
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physical health side, and hormones,
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sleep, cognitive symptoms, also general urinary symptoms.
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So you're also seeing many women starting to have vaginal dryness,
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pain with penetration,
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Hmm.
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irritation of your genital tissues that also oftentimes accompany
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the menopause transition, whether it's during the peri or postmenopause,
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or sometimes for some women it comes on really later in the postmenopausal period.
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There's some variability around that.
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So that's also a common change we see.
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Okay, that was a whole lot of information!
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Yeah. Yeah.
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~
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But one of the things that I took is that you're really talking about this being
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a lifespan process, that it's
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Mm-hmm.
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not only this small stage. So you had talked about menarche
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to kind of perimenopause,
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Yeah.
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you know, and I guess one of the things that I have thought about,
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and just to organize my thoughts is
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in that stage, you know, because oftentimes I think people aren't thinking about
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menopause when you're in your 30s or 40s,
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and yet you're already saying in your 40s,
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you may already start experiencing symptoms.
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So
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Absolutely.
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At that stage, are there any indicators or protective factors
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in terms
10:07
Mm-hmm.
10:07
of then going into menopause that those women could do?
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Yeah, I mean one of the things that we know is that the earlier menopause
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is associated with a number of adverse health outcomes.
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So particularly a premature menopause.
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Now, premature menopause or premature ovarian insufficiency happens when
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you go through menopause before age 40.
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And we know that those women are at increased cardiovascular disease risk,
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~ fracture risk for bone health,
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neurocognitive risk, or they have their ovaries taken out very young,
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before 40 or before they reach menopause.
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So those women are definitely a group at risk.
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And maybe there's some data that sort of having postmenopause on the earlier side
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is not so great either. Now is there anything you can do to extend that
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and push that back? Is that kind of the question,
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is can you modify that timing?
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I mean the the most kind of consistent risk factors for an earlier menopause
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is smoking. Smoking is very toxic to the ovaries.
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So ~ if you're a smoker, to quit smoking.
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And beyond that, we know that oral contraceptives,
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at least the higher dose oral contraceptives sometimes delay menopause,
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but we're talking about plus or minus a year.
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So ~ modifying that timing,
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there's not a lot of modifiable risk factors as far as we're aware besides smoking.
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That's unfortunately where we're at with that.
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Now, in order to forestall some of the health changes associated,
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the adverse health changes, such as the cardiovascular changes,
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~ that's an active area of inquiry.
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But we do know doing all of those positive cardiovascular ~ behaviors,
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such as managing blood pressure,
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treating diabetes, staying physically active,
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trying to maintain weight at within
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what we consider a healthy range,
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~ eating things like a Mediterranean diet.
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Those are all the things you want to do for your heart health that
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are going to apply at any time of life,
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and menopause as well. We do not know at this point whether taking hormone therapy
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will forestall those changes, except when it comes to bone.
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So for cardiovascular and brain,
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and this is probably a longer conversation around hormone therapy,
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the jury's still out and we can get into that.
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But you can forestall the bone changes with hormone therapy at an adequate dose.
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So you have to take enough ~ estradiol,
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but as soon as you go off the hormones,
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you will lose the bone density.
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So that's something to keep in mind.
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You know, as you were talking,
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I was thinking about, okay, from there,
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then moving into menopause. And I know you've done the SWAN study,
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which has studied women across their lifespan.
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And so I actually wanted you to talk about some of the research that you've done,
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some of the findings that you've done that would be informative.
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One of the things I've heard is women feel really underprepared
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for this stage of life.
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Yeah.
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Yeah. I will talk about some of the research we've done and then what would
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I say to women, right? So what can you do?
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Okay, excellent. Yeah.
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How do you prepare yourself, right?
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So some of the key findings have been,
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for example, those vasomotor symptoms,
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those hot flashes that so many of us get,
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whether it's hot flashes or night sweats collectively are known
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as vasomotor symptoms, that
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persistent severe vasomotor symptoms are associated with a 70% increased risk
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of heart attacks, strokes, and cardiovascular disease mortality over
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the subsequent 20 years. Also,
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persistent sleep problems, so trouble falling asleep,
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waking a lot during the night,
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waking up earlier than you wanted,
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you know, like five in the morning kind of thing;
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not due to your schedule, but rather insomnia,
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persistent insomnia symptoms are also associated with a similar magnitude
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of risk from a cardiovascular perspective and a doubling of risk of stroke.
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And also we see that those vasomotor symptoms are associated with poor
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neurocognitive health later in life as well.
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So greater circulating amyloid,
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~ as well as what we call white matter hyperintensities in the brain.
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So these are markers of cerebral small vessel damage in the brain.
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So risk factors for stroke, essentially,
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and dementia. So those hot flashes and night sweats are things,
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and the sleep problems, to not just kind of suffer through.
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These are symptoms that are both bothersome and disruptive to your daily life.
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And when they start interfering with your daily life,
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I would say get treatment for them.
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Mm.
14:27
And don't necessarily let them go on and on,
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particularly when it comes to the sleep problems.
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We have a pretty good body of research from other times of life that similarly
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reflect that persistent insomnia is something that has a widespread impact
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on the body and the brain, and that treating those sleep problems can be helpful.
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Now we lack data specific to the menopause transition,
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whether treating them can impact heart and brain health.
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And we don't yet know whether treating the vasomotor symptoms improves heart
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and brain health.
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But I also am of the mantra like,
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"Suffering is overrated." So if you're suffering with these symptoms,
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Okay. ~
15:00
~ get treatment. Okay, so
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what would I say to women?
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I would say, first of all, suffering is overrated.
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Don't just try to gut this out if it's really disruptive.
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Also, for some people, menopause is no big deal.
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Like they're fine.
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Mm-hmm.
15:14
They don't have severe symptoms.
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And in that case, it's fine. You know,
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you don't necessarily need to get treated.
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But if you are suffering, let's find you a good menopause-trained provider.
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Also, that the symptoms may start earlier than you think.
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So don't be surprised if you start having hot flashes or brain fog
15:33
or mood changes in your early 40s,
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or for some even their late 30s,
15:37
we see some
15:38
Yeah.
15:38
hot flashes; starts earlier than we think and it lasts longer
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than we think, particularly when it comes to the vasomotor symptoms.
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Those can last on average about seven to ten years.
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Also, women of color, particularly black women,
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will experience their vasomotor symptoms earlier,
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more severely, and for much longer,
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for reasons that we don't fully understand.
15:57
So I think there's a lot of variability in these symptom trajectories,
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but they can be quite bothersome for some women.
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And one of the earliest symptoms to emerge are those neurocognitive symptoms.
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The brain fog, the forgetting why you walk into the room.
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Many women think that they are dementing and losing their minds
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or developing early onset dementia.
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It's very rarely the case that that is what's happening.
16:22
Oftentimes it's this perimenopausal brain fog that we're still trying
16:26
to get our hands around, but we do not think it necessarily portends
16:30
~ a dementing process.
16:32
As you brought up the different symptoms that women may be experiencing
16:38
and not to ignore them or dismiss them,
16:40
but to actually get them assessed and treated if there is treatment
16:46
for them. What if you go to a provider and they're kind of not taking it seriously,
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for lack of a better
16:53
Yeah.
16:54
way of saying it? What should someone do in that case?
16:57
Yeah,
16:58
Yeah, for sure. And not to pathologize all the symptoms.
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If the symptoms are mild and they're not bothering you,
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fine, don't worry about it. But again,
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if it's really bothersome and disrupting your life,
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that's when you really want to,
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you know, make sure you're getting them treated.
17:08
Mm-hmm.
17:09
~ Now,
17:10
how to find
17:10
Yeah.
17:11
a good menopause provider. Now this is...
17:12
Now we completely have acknowledged that a big problem in the field is
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the lack of really well-trained menopause providers across subspecialties.
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And menopause knowledge
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doesn't exist or belong solely to gynecology.
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That's kind of where it lives right now.
17:29
But in my personal opinion is it really needs to ~ transcend discipline
17:35
and medical subspecialty, behavioral health subspecialty.
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And really we all need a little bit of training,
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at least a little bit in menopause,
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because, you know, again, this is a universal transition.
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So what do you do? Right now, the best-trained people are typically gynecologists.
17:49
So talk to your gynecologist first.
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Now, if your gynecologist isn't responsive,
17:53
isn't listening to you, or doesn't seem to know about menopause,
17:56
you know, you can talk to your PCP,
17:58
you may encounter the same issue.
18:00
So where I send people is The Menopause Society,
18:03
a nonprofit medical scientific organization.
18:06
They maintain a directory of providers who have gained certification
18:10
in menopause knowledge and care.
18:12
And that is a great place to go to find a good
18:15
menopause-trained provider ~ based upon evidence-based care.
18:19
One of the other big problems we're having in the menopause space
18:23
is people realizing that there's a real gap ~ in terms
18:26
Mm.
18:26
of the care that women are receiving and trying to meet this with non-evidence-based
18:31
care. And there's a lot of profiteering,
18:32
unfortunately, going on in the space.
18:33
No.
18:34
So buyer beware when it comes to these internet providers or just everybody
18:38
you see on Instagram or... Not to say that they're all bad.
18:41
It's hard to know as the layperson which is evidence-based,
18:45
which is not, which is why I send people to The Menopause Society website.
18:48
So being very careful about where you're getting your information.
18:53
Hopefully it's accurate and evidence-based.
18:53
Mm-hmm. Mm-hmm.
18:56
And The Menopause Society, which I know you're a past president,
19:00
is one place where you can go and get accurate resources and connect with providers
19:07
that are trained in this area.
19:07
Yep.
19:08
Excellent. I mean, I think that a lot of women are trying to figure out,
19:12
"How do I navigate this?"
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Because even your providers may not be trained in knowing what to do.
19:19
But one of the things that you
19:21
did in the report, and I was very pleased with,
19:24
is you talked about the positive impacts,
19:27
because we generally focus on the symptomatology and the treatment.
19:30
Yeah.
19:31
But you actually talked about the positive impact at this stage in women's lives.
19:37
So, talk about that.
19:37
Yeah.
19:39
You know, I think that there is all this gloom and doom around menopause.
19:43
And I honestly think that it's good to validate people's concerns,
19:46
but we also don't want to scare people,
19:48
particularly people who are coming into it and say that this is this horrible time
19:51
of life. Because, really, midlife aging,
19:53
you know, and this is where we have both menopause and midlife aging
19:57
as a developmental transition happening at the same time.
19:59
Even just menopause alone, I think particularly when the periods stop
20:03
and some of the symptoms abate,
20:04
there is a lot of relief and women really do report feeling quite freed.
20:08
So even menopause itself can be a freeing experience.
20:11
But also midlife aging; rarely do I speak to a midlife woman who wants
20:16
to go backwards and wishes she actually were in her twenties or thirties,
20:19
because you oftentimes gain a substantial amount of wisdom,
20:24
self-awareness;
20:26
you care a little bit less about what people think about you,
20:28
and that's incredibly freeing.
20:30
~
20:31
Mm-hmm.
20:31
And we have this kind of dialogue,
20:33
"Oh, midlife women become invisible,
20:35
and isn't that so sad?" For some people,
20:38
having a little bit- not being the object of so much either sexual harassment
20:43
or cat-calling, that kind of thing can be great.
20:46
When you're less the object of scrutiny,
20:50
you have a lot more freedom too.
20:52
So in general, women aging into midlife find it to be a time
20:57
of increased groundedness, empowerment,
21:00
and self-awareness,
21:02
and self-acceptance.
21:03
And that's why I kind of conceptualize
21:06
us treating the negative parts of menopause,
21:08
but really elevating that sort of personal psychological growth
21:13
and championing it and helping,
21:15
as mental health providers,
21:16
to further that and ~ support that I think is really important.
21:21
I guess I think about the strength-based approach in this period of life,
21:28
that it's almost as though you come into your own,
21:32
and
21:32
Mm-hmm.
21:33
really having that confidence and agency to
21:37
Mm-hmm.
21:38
now move forward in your life.
21:40
You know, one of the things that I did want
21:42
you to talk about a bit, because I know we also did clinical care
21:47
and potential treatments that are out there for women that
21:52
may be experiencing symptomatology from menopause.
21:57
So I wanted you to talk a little bit about that and some of the things that could
22:02
be considered in terms of treatment.
22:05
Yeah.
22:05
Yeah.
22:06
And what we really should do is pair the treatment with the symptom that we're
22:10
talking about. ~
22:11
Okay.
22:11
And there's no one magic bullet.
22:13
We so want one magic bullet, whether it's anti-aging
22:16
Mm-hmm.
22:17
or treating all the menopausal symptoms at once.
22:19
~ And we have fallen into this trap a couple of times when it comes
22:22
to hormone therapy over history,
22:24
but really we need to tailor the treatment to the symptoms.
22:28
So for example, for vasomotor symptoms,
22:30
the most effective treatment
22:32
is hormone therapy. Actually, one of the only FDA-approved indications
22:36
for hormone therapy is the treatment of vasomotor symptoms.
22:38
So hot flashes, night sweats. Now,
22:40
other treatments for vasomotor symptoms,
22:42
we have a whole class, a new class of agents called neurokinin 3
22:46
or neurokinin 1-3 receptor antagonists that have been FDA-approved that
22:50
are very effective in treating hot flashes non-hormonally.
22:54
So fezolinetant and elinzanetant are two of those drugs.
22:58
And those are something that you can take and there's increasing body
23:02
of literature around those. People will also use SSRIs and SNRIs
23:07
to help manage their vasomotor symptoms,
23:09
particularly if there is also a mood component involved with their menopause
23:14
experience. And other people use gabapentin in an off-label fashion,
23:18
especially if there's also a sort of sleep component.
23:21
Okay, so that's the vasomotor symptoms.
23:24
Yeah.
23:24
Now, sleep.
23:25
The most effective treatment for sleep insomnia at any time of life,
23:30
menopause included, is CBTI, Cognitive Behavioral Therapy for Insomnia.
23:35
So if your sleep problems are not exclusively secondary to your nighttime
23:40
hot flashes, then CBTI is really the way to go.
23:43
So oftentimes I'll like get people's hot flashes treated and then treat their sleep
23:48
through CBTI. I'll assess whether they have any evidence
23:51
of sleep-disordered breathing;
23:53
make sure they're getting a workup for that.
23:54
That's something like sleep apnea,
23:56
which also can increase during the menopause transition,
23:58
which we want to treat that through standard methods such as CPAP,
24:01
etc. So we want to understand what's driving the sleep problems.
24:04
Yeah.
24:04
And then CBTI is typically the way to go.
24:06
Genitourinary syndrome of menopause,
24:08
~ vaginal estrogen is the way to go with this.
24:11
So these are typically creams or tablets or rings that
24:15
are specifically acting locally at the genital tissues.
24:20
And that is really kind of our gold standard treatment.
24:23
And these are very low dose, they're not typically systemically absorbed,
24:28
so it doesn't necessarily raise your blood levels very much.
24:30
It's really acting at those local tissues.
24:32
So it's safe for even people who typically don't want to take hormone therapy
24:37
systemically. Cognitive symptoms,
24:39
we don't necessarily know what to do yet.
24:41
We're in the process
24:41
Interesting.
24:42
of developing, trying to understand what's driving them.
24:46
But what I do clinically is I first treat the sleep,
24:50
because the sleep can sometimes be driving the cognitive symptoms,
24:53
and treat any psychiatric symptoms,
24:55
mood and anxiety, because that's,
24:57
you know, cognitive symptoms are a feature of depression as well.
25:01
So I try to treat these other things that might be driving the cognitive symptoms.
25:04
So those are the most common symptoms that I see.
25:05
Yep. Yeah.
25:07
And I usually do a different path for each one.
25:09
Really helpful. I mean, I think just to know that it's not gonna be,
25:14
"Just take estrogen and you'll be-
25:16
it'll all go away," ~ which
25:18
Yeah.
25:19
I think ~ oftentimes that's what's thought.
25:21
But there's
25:22
Yeah.
25:22
so much more. It's, you know, our bodies are complicated.
25:26
Yeah.
25:26
And there's a lot of variability in both the patterns of symptoms that people will
25:32
~ follow over time. We've characterized this from the SWAN studies.
25:36
So for example, some women
25:36
Uh-huh.
25:37
have their hot flashes when they're pre or perimenopausal,
25:39
some people have them largely after their periods have stopped,
25:41
some people have the entire time.
25:43
So even just that one symptom,
25:45
there's also a
25:46
really profound variability. Now with the cognitive symptoms,
25:49
some people anecdotally report benefit from hormone therapy,
25:53
but it really is going to depend on what's driving those cognitive symptoms,
25:56
Mm-hmm.
25:57
which is why I really try to do a pretty good workup to understand what some
26:01
of those other drivers would be.
26:03
But yeah, there's no magic bullet as much as we wish there were.
26:06
I know.
26:06
~ But sadly, sadly,
26:10
the world doesn't work that way.
26:11
Yeah.
26:11
Well, and in general, treatment doesn't work that way,
26:14
right? Everybody's so different and there's a diversity of how our bodies respond
26:21
to certain things. I think what you were kind of presenting is that depending upon
26:28
what is going on exactly, that the practitioner needs to really get
26:32
to what exactly the source of the
26:35
Mm-hmm.
26:35
symptoms and you may need to be treating
26:38
the symptom to then figure out,
26:40
okay, how is this interrelated or not related to what I'm seeing
26:44
for this other symptom?
26:46
And it's also very dynamic. So...
26:48
Yeah.
26:48
The symptom presentation in the early perimenopause may look really different than
26:53
those two years postmenopausal.
26:55
That's par for the course. Like these things
26:56
Yeah.
26:56
are changing over time. So also yourself and your own body,
27:00
if things start to feel different or things are,
27:02
all of a sudden you have a different symptom,
27:04
it's hard because you feel really out of control,
27:07
like what's happening with my body?
27:07
Yeah.
27:08
But it also is common and just keep
27:12
in touch with your providers as your symptom constellations change over
27:16
the course of this very dynamic transition.
27:19
And as the provider, we need to kind of continue to reassess and check
27:23
in and make sure that we understand the status at that point in time.
27:27
I'm so glad that you said that.
27:29
'Cause oftentimes, you know, you hear women saying,
27:32
"I'm going crazy. I don't know what's happening with me." And it's really gonna
27:37
be important that you have a good relationship with your provider that understands
27:42
this may change as you're going through it.
27:45
You may be reporting different things that are going on,
27:48
and you're not crazy. I guess that's the thing that I really want to hit home.
27:52
Yeah, you're not crazy. It's not all in your head,
27:55
so to speak.
27:56
Yeah.
27:56
You're not imagining things. These things do originate largely
28:00
in the central nervous system.
28:01
So there's that piece. It is in the level of the hypothalamus where a
28:04
lot the hot flashes are originating,
28:06
but it is not in your imagination.
28:08
And you deserve to have your experience validated and somebody to really listen
28:13
to you and take your concerns seriously.
28:15
And that's where that
28:16
patient-provider relationship is really important and making sure that you're seeing
28:21
somebody who you feel like listens to you and validates you.
28:25
And as I say that, I know that's really easier said than done.
28:28
But yet we also know that that quality of the relationship between
28:32
the patient and the provider is one of the strongest predictors
28:34
of positive outcomes across a range of different health conditions.
28:37
So, you know, keep at it. Don't give up.
28:39
Yeah. I mean, I think that part of the dialogue right now
28:44
is really important because you started our episode talking about the shame
28:49
and kind of
28:49
Mm-hmm.
28:49
the silence around menopause. As we talk about it more,
28:53
hopefully it does validate women like,
28:56
you're experiencing something real and to actually take what they're experiencing
29:02
seriously and not dismiss it.
29:04
Absolutely.
29:05
So I wanted to talk about kind of on the larger societal level,
29:09
because oftentimes I've also heard stories about,
29:13
how do I deal with work when these symptoms aren't exactly ~ acknowledged,
29:19
you know, like brain fog or, you know,
29:22
I'm not sleeping well or my mood is...
29:25
Let's talk about kind of the larger impact
29:28
on the societal level because I know you've talked about the losses just even
29:32
economically, the workforce, etc.,
29:34
Mm, yeah, yeah.
29:36
and why this
29:37
is important for employers to understand.
29:41
Yeah. I mean, this is pretty massive on a societal level because also when you're
29:45
hitting your forties and fifties,
29:47
for many women, this is when you're at the top of your game professionally,
29:50
depending on what your career is.
29:53
You know, and there's always a fine line when talking about menopause
29:57
in the workplace, because the last thing I want to do is stigmatize women,
30:01
or at least I definitely don't want to give
30:05
uUs any more ammunition against aging women in the workforce,
30:08
Yes.
30:09
right? Because there also is so much discrimination as it is,
30:12
which is why I think in many times there was so much silence about this,
30:15
and women were just sort of trying to gut through.
30:19
But there are some really wonderful resources from the Society
30:22
for Women's Health Research that has a whole compendium of resources for employers.
30:26
And in the UK, there's actually quite a lot of work going on on the workplace level
30:32
about how to better support this very important aspect of their workforce,
30:39
right? Like there's a huge amount of knowledge and skill and productivity that
30:45
can be gained by supporting women,
30:48
midlife women, transition through this time from the workplace perspective.
30:52
There's been some economic modeling of the profound cost
30:56
that menopause and untreated menopausal symptoms are,
31:00
both on a societal level and also on a workforce and workplace level.
31:04
So the estimates range, but they're just big numbers,
31:07
let's just say that, depending on what you include in that.
31:10
Whether it's lost days, whether it's partial days,
31:13
whether it's leaving the workforce,
31:15
whether it's declining a promotion,
31:18
whether it's healthcare expenses,
31:19
all these things really add up to the billions.
31:22
What do we wanna do about that?
31:24
There are resources available,
31:26
and I think this is an area where there's also a lot of active development,
31:30
but employers can really have adaptations depending on the type
31:36
of work you're doing. If it's very hot,
31:38
if you're wearing a lot of heavy clothes,
31:40
if you need to take breaks, if you need to rethink the temperature
31:44
in the environment. I would say
31:46
good health insurance is a pretty basic thing that employers
31:49
Yeah.
31:49
can do. Make sure that things like reproductive health care,
31:52
particularly menopausal care, is covered.
31:55
And awareness, education,
31:58
dialogue, and listening to their employees around what the midlife women really need
32:03
in that particular work setting,
32:05
because it really needs to be tailored to the work setting.
32:07
So employers really should have this on their radar screen as something that,
32:11
if you want
32:14
to have the most productivity from your employees,
32:16
be sure you're addressing the midlife and menopause-related needs of your workforce.
32:21
Okay. I think that's a charge ~ that you're giving,
32:25
Yeah. Yeah. Yes.
32:27
right?
32:28
Because many women, like you said,
32:30
many women work and this is when kind of they're at the height of their career
32:35
and really making strides. And so you want them to continue to be able
32:40
Right. Right.
32:41
to work optimally. ~
32:43
When you're sleeping four hours a night,
32:45
it's very hard to work optimally.
32:48
Or if you're struggling with depressive or anxious symptoms,
32:50
it's very hard. In fact some of the estimates,
32:52
particularly the Mayo Clinic estimates,
32:54
one of the strongest predictors of workplace cost were the mental health symptoms
32:59
associated with menopause.
32:59
Hmm.
33:00
We can't dismiss those; that's part of the picture.
33:03
And I think rather than use this as a cudgel to discriminate against women or
33:08
Yeah.
33:08
prevent them from promoting them,
33:10
I think employers really need to be thinking about how to support and meet
33:15
the needs of the midlife women in the workplace.
33:18
I'm gonna give you a magic wand.
33:20
Yeah.
33:21
And if you could, you know, at the societal level,
33:24
I'm thinking of federal regulations or policies because you wrote about research
33:30
gaps and recommendations and,
33:32
Yes.
33:32
you know, clinical care and what we could be doing to improve women's health
33:37
and well being.
33:39
And so I'm giving you a magic wand.
33:41
What would you wish would happen in order for women to be able to be supported,
33:48
to live their best lives?
33:49
Yeah. And I think that this has to happen at multiple levels of society.
33:54
And I do not claim to be a policy expert,
33:56
but I'll tell you just
33:56
Yeah, yeah.
33:57
from what I would like to see,
33:59
and it's quite systemic. First of all,
34:02
how do we continue to- and I think we're doing this and just continue
34:06
the momentum of destigmatizing menopause,
34:09
destigmatizing midlife aging for women,
34:12
I think is crucial. I think we kind of really need to continue
34:15
to support women's rights and well-being and their reproductive rights across
34:22
the full lifespan, not only during the reproductive years,
34:26
but during the post-reproductive years.
34:28
Some of this is really about women's stature in society.
34:32
So that's just
34:34
kind of a backdrop. When we start
34:35
Yeah.
34:35
to erode women's rights across the board,
34:37
whether it's the right to vote,
34:39
whether it's rights to access comprehensive health care,
34:41
we're eroding their rights across the board and it'll make everything worse.
34:45
So that's that's sort of the backdrop.
34:46
Mm-hmm.
34:47
Now, menopause-specific things,
34:49
there's so many things. ~ In thinking through a medical lens,
34:53
we have to make menopause treatments accessible and affordable.
34:57
And this is not only hormone therapy,
34:59
this is a full range of menopause care.
35:01
Although we do need to fix the problems we're having with the patches,
35:05
and we do need to train our providers in menopause care,
35:09
which I'm gonna come to in a second.
35:10
But the full range of menopause care,
35:12
accessible, affordable, for all.
35:14
We do need to also ~ train our providers in menopause care.
35:20
And this is not only OB/GYNs, which I think is crucial,
35:24
it's internal medicine, family practice,
35:26
psychologists, social workers,
35:29
neurologists, cardiologists, rheumatologists,
35:32
across the board. So each subspecialty should learn the thing that's relevant
35:36
to their subspecialty, just some basics.
35:38
So they don't need a deep, comprehensive menopause education like you might
35:41
do with the OB/GYNs or the internal medicine,
35:43
but they do need to understand how this relates,
35:46
given that they're gonna be seeing menopausal women.
35:48
And I don't know how one goes about this,
35:50
because I think this is a problem across multiple realms,
35:53
is the problem of misinformation and profiteering
35:55
Mm-hmm.
35:56
with non-evidence-based care. This is a problem.
35:59
Do I know how we should address this as a society?
36:02
No, but we start at least with education and awareness.
36:08
And it would be wonderful to have some sort of comprehensive education for
36:14
women and their partners, the men in their life as well.
36:17
So kind of like we do with pregnancy or kind of like we do with menarche,
36:21
you get like a little training module before you go into that.
36:24
Why not? Why aren't we doing this with menopause as well?
36:28
I think it's also the backdrop of how much do we value women and how much
36:31
do we value aging women in our society?
36:33
Absolutely. I mean, as you were saying that,
36:35
it's like, yeah, fifth grade. You learn about the menstrual cycle.
36:40
Why not add on the rest of the lifespan transition kind of events?
36:46
I really appreciate that. As we're closing up,
36:50
you know, we started with, you know,
36:53
talking about women feeling unprepared,
36:56
feeling as though they can't talk about menopause.
36:59
So I wanted to end our
37:02
conversation with two or three key takeaways from today's episode,
37:07
what would you want that to be?
37:09
Trust yourself, trust your experience.
37:12
It's like, everybody goes through this in their own way and their
37:16
own constellation of symptoms.
37:17
And if your symptom doesn't look like your friend's symptoms
37:20
or your mother's symptoms, that's fine.
37:21
~ You are having your experience,
37:23
and your experience may change over time.
37:25
Advocate for yourself, get the care that you need,
37:28
beware of non-evidence-based care and treatments that you're seeing online.
37:33
Remember, it's not all bad. That this is actually an incredible time of life.
37:39
And while you can feel really out of control,
37:43
things are changing and they're not always changing for the bad.
37:47
Continue to look for those ways in which you feel like this is
37:51
an opportunity to either make changes in your life or to embrace a part
37:55
of yourself that you haven't been able to before.
37:58
Lean into it.
37:59
It's a wonderful time of life and when you come out the other side of it,
38:03
you're gonna feel great.
38:04
Powerful. Powerful. You know, Dr.
38:07
Thurston, thank you so much for being here today and sharing your wisdom,
38:12
your insight, and your passion for advancing women's health and well-being,
38:17
particularly during midlife and and menopause.
38:22
I think one of the things that I take away is that this is a very complex
38:27
and complicated period of time for women,
38:30
but
38:32
that there can be positives to it.
38:34
Trust yourself in knowing what your body's telling you,
38:37
to get good information
38:40
and to work closely with your provider
38:42
Absolutely.
38:43
Thank you so much for being here.
38:45
I just feel like this conversation is just scratching the surface,
38:49
but it's
38:49
Is this?
38:50
one of the small steps that we need to make in order for women to feel empowered
38:56
to take action when they are maybe suffering.
38:59
I also believe you don't get a medal at the end of your life for
39:03
the amount of suffering that you're doing.
39:06
So, get it addressed. Hopefully you feel better and that you can live your life
39:11
thriving. So thank you again. And to the listeners,
39:12
Absolutely.
39:15
I hope that you can take some of this information that we talked about today
39:19
and continue to learn, address anything that you're going through,
39:25
and share it with others as well.
39:28
As we end, as always, remember that wellness is a journey,
39:33
not a destination. And I hope that you will take care of yourself and others.
39:38
So until the next time, please take good care.