Dr. Sharon Malone

But there is no discussion or apparent connection between the two. Sharon, can you talk a bit about sort of the state of the current state? What's keeping you up at night of the many things that keep you up at night about the state of women's health? Yes, I think that.

But there is no discussion or apparent connection between the two. Sharon, can you talk a bit about sort of the state of the current state? What's keeping you up at night of the many things that keep you up at night about the state of women's health? Yes, I think that.

And despite the fact that we grew up in such an open household for that time in life or that stage of our lives, I'm still surprised at how little I know about my own body. uh, you know, and, and how many things we didn't talk about, not because our parents weren't open to it, but they didn't know, you know, so we're going to talk more about this.

And despite the fact that we grew up in such an open household for that time in life or that stage of our lives, I'm still surprised at how little I know about my own body. uh, you know, and, and how many things we didn't talk about, not because our parents weren't open to it, but they didn't know, you know, so we're going to talk more about this.

Um, uh, but let's introduce, let's get, let's get Sharon in on the, on the conversation.

Um, uh, but let's introduce, let's get, let's get Sharon in on the, on the conversation.

Well, we're seeing more and more conversations from anti-vaxxers, right? We saw it during COVID, right? What's that about? Why are we all of a sudden, after all these generations now, pushing against vaccines that have saved lives for decades?

Well, we're seeing more and more conversations from anti-vaxxers, right? We saw it during COVID, right? What's that about? Why are we all of a sudden, after all these generations now, pushing against vaccines that have saved lives for decades?

And we're seeing that with this measles outbreak. So what's going on there? This is in Texas, correct?

And we're seeing that with this measles outbreak. So what's going on there? This is in Texas, correct?

Welcome to IMO, Sharon.

Welcome to IMO, Sharon.

So if you're a mother that's vaccinated, does that protect your unborn child?

So if you're a mother that's vaccinated, does that protect your unborn child?

I mean, it's just mind-boggling to believe that with all that we know, with all the resources, with the wealth in this nation, that we are going to go backwards in time, that we are walking backwards with our eyes wide open, with sirens blaring. It's just unbelievable to me that in a short period of time, we're here having these kind of conversations.

I mean, it's just mind-boggling to believe that with all that we know, with all the resources, with the wealth in this nation, that we are going to go backwards in time, that we are walking backwards with our eyes wide open, with sirens blaring. It's just unbelievable to me that in a short period of time, we're here having these kind of conversations.

Thank you for having me. Thank you. Road warrior, because this woman here has been... all over the country promoting grown woman talk. I am so proud of you for so much. But you did the thing, writing this amazing, creative, fun, funny, informative, open, honest book about women's health with a particular focus on women of color, but it's a book for everyone, men, women, women,

Thank you for having me. Thank you. Road warrior, because this woman here has been... all over the country promoting grown woman talk. I am so proud of you for so much. But you did the thing, writing this amazing, creative, fun, funny, informative, open, honest book about women's health with a particular focus on women of color, but it's a book for everyone, men, women, women,

Yeah, and Craig, you know, that piece of advice cannot just be directed to women. You know, this is why I implore the men in the world who have women that they say they care about, daughters that they are raising, that this is their issue too.

Yeah, and Craig, you know, that piece of advice cannot just be directed to women. You know, this is why I implore the men in the world who have women that they say they care about, daughters that they are raising, that this is their issue too.

I mean, for men to sit on their hands over this issue and trade out women's health for a tax break or whatever it is, is a sad statement about that man's... level of value of the women in their lives. And there are a lot of men who have big chairs at their tables. There are a lot of women who vote the way their man is going to vote. It happened in this election.

I mean, for men to sit on their hands over this issue and trade out women's health for a tax break or whatever it is, is a sad statement about that man's... level of value of the women in their lives. And there are a lot of men who have big chairs at their tables. There are a lot of women who vote the way their man is going to vote. It happened in this election.

So just to direct this at women, unfortunately, we've seen is not enough.

So just to direct this at women, unfortunately, we've seen is not enough.

people of all races and all ages, because you cover the spectrum of just some of the things that women go through. Can you talk a bit about why you wanted to write the book and how you're feeling about things? Yes.

people of all races and all ages, because you cover the spectrum of just some of the things that women go through. Can you talk a bit about why you wanted to write the book and how you're feeling about things? Yes.

This is a question that we are getting around our kitchen table from the next, because we're in that generation. Our daughters are in that stage in life where it's- Both of us. Yeah, all of us, where they're deciding between pursuing a career, how long do they have to wait, finding a mate, All of those questions feel more existential.

This is a question that we are getting around our kitchen table from the next, because we're in that generation. Our daughters are in that stage in life where it's- Both of us. Yeah, all of us, where they're deciding between pursuing a career, how long do they have to wait, finding a mate, All of those questions feel more existential.

But even given that, I met a young woman that's a part of our world who just froze her eggs and she's in her 30s. And very enlightened, very educated. She just did it. But she said she only did it because she heard other people doing it. She had never heard in all of her enlightened years on this planet about the importance of freezing eggs.

But even given that, I met a young woman that's a part of our world who just froze her eggs and she's in her 30s. And very enlightened, very educated. She just did it. But she said she only did it because she heard other people doing it. She had never heard in all of her enlightened years on this planet about the importance of freezing eggs.

That it was even a possibility that she could or even should freeze her eggs. So that in today's young women... She said she had never been in a conversation about the importance or the possibility of freezing her eggs. 30-something, early 30s.

That it was even a possibility that she could or even should freeze her eggs. So that in today's young women... She said she had never been in a conversation about the importance or the possibility of freezing her eggs. 30-something, early 30s.

And just so that we're not assuming things, the difference between egg freezing and embryo freezing is... Okay, so embryo freezing is just a regular IVF.

And just so that we're not assuming things, the difference between egg freezing and embryo freezing is... Okay, so embryo freezing is just a regular IVF.

Surprise!

Surprise!

But that's why the research is so unclear about the viability of frozen eggs.

But that's why the research is so unclear about the viability of frozen eggs.

It's the same procedure. The only thing is there's no fertilization. That's all.

It's the same procedure. The only thing is there's no fertilization. That's all.

I'm here for you.

I'm here for you.

Does it make sense for young women, young men to start getting sort of a sense of their fertility, you know, sort of before all of this? Like, you know, should young women go in and have ultrasounds to see, does that make any sense to have that fertility? on their minds?

Does it make sense for young women, young men to start getting sort of a sense of their fertility, you know, sort of before all of this? Like, you know, should young women go in and have ultrasounds to see, does that make any sense to have that fertility? on their minds?

You didn't show it to me, but it took so many, it's like, okay, Sharon, I know you have a rough draft. I was getting a little insulted for a second there. Well, you know what it is and you can appreciate this, Craig.

You didn't show it to me, but it took so many, it's like, okay, Sharon, I know you have a rough draft. I was getting a little insulted for a second there. Well, you know what it is and you can appreciate this, Craig.

We always get in the short end of something. I'm telling you, isn't it? We get all we have. Sperm after sperm after sperm.

We always get in the short end of something. I'm telling you, isn't it? We get all we have. Sperm after sperm after sperm.

Like smoking.

Like smoking.

We might have to.

We might have to.

Well, speaking of that, I don't want to jump away from the question, but I am curious about what is the connection between aging sperm and birth defects? Or are there any correlations? Because they're going to cut out research in that too. Yeah. It's like, no, I'm 80 and I'm good. I'm still good.

Well, speaking of that, I don't want to jump away from the question, but I am curious about what is the connection between aging sperm and birth defects? Or are there any correlations? Because they're going to cut out research in that too. Yeah. It's like, no, I'm 80 and I'm good. I'm still good.

It's like you're just coming in on the last of everything. Sharon's just squeezing out the last of her brain cells. Who knows?

It's like you're just coming in on the last of everything. Sharon's just squeezing out the last of her brain cells. Who knows?

That may be the key behind all the defunding everything. It's just like, let's just blow it up. We can't let them find this stuff. Old men can keep marrying 20-year-olds. Exactly. It's like, I'll give you the baby you want. We don't have to keep that baby.

That may be the key behind all the defunding everything. It's just like, let's just blow it up. We can't let them find this stuff. Old men can keep marrying 20-year-olds. Exactly. It's like, I'll give you the baby you want. We don't have to keep that baby.

Yeah, but why would they sit at the inn? It's just weird. Just sit up by your wife's head. I know. Be where she is.

Yeah, but why would they sit at the inn? It's just weird. Just sit up by your wife's head. I know. Be where she is.

Go to the head of the table. All right.

Go to the head of the table. All right.

This is educational for men. Yeah.

This is educational for men. Yeah.

Don't need that. No, you don't need that. Yeah, that sounds about right. Yeah.

Don't need that. No, you don't need that. Yeah, that sounds about right. Yeah.

Hey, Mish. Hey, Craig Robinson. Today's topic is one that's near and dear to me. Now, one of the reasons why I'm excited about, one of the many reasons I'm excited about our platform IMO is that we really get to talk about whole array of issues that we both care about. But this topic today is particularly of note for me because we're going to be talking about women's health.

Hey, Mish. Hey, Craig Robinson. Today's topic is one that's near and dear to me. Now, one of the reasons why I'm excited about, one of the many reasons I'm excited about our platform IMO is that we really get to talk about whole array of issues that we both care about. But this topic today is particularly of note for me because we're going to be talking about women's health.

Why?

Why?

And I want the men out there, be involved. It doesn't have to be your partner. If you've got any women in your life who are willing and open to help educate you, seek it out. Sharon? Thank you for the book. And we have to talk about your podcast that's coming up.

And I want the men out there, be involved. It doesn't have to be your partner. If you've got any women in your life who are willing and open to help educate you, seek it out. Sharon? Thank you for the book. And we have to talk about your podcast that's coming up.

But well, to give some folks some context, I mean, Sharon and I, we've known each other since that day at the, that evening at the Black Caucus when we first, actually our eyes first met. Because this was a time where, what was, Sharon's husband happens to be former Attorney General Eric Holder. He's a non-factor. He is not a non-factor. He's a non-factor in our relationship.

But well, to give some folks some context, I mean, Sharon and I, we've known each other since that day at the, that evening at the Black Caucus when we first, actually our eyes first met. Because this was a time where, what was, Sharon's husband happens to be former Attorney General Eric Holder. He's a non-factor. He is not a non-factor. He's a non-factor in our relationship.

Because we're going to be able to hear from Sharon a whole lot more and dig deeper into a whole range of issues because you are working on your podcast. your own podcast. Tell us all about it.

Because we're going to be able to hear from Sharon a whole lot more and dig deeper into a whole range of issues because you are working on your podcast. your own podcast. Tell us all about it.

So exciting. And I would be remiss to say that TSO is a part of the Higher Ground Audio family. And as proud as I am of all the work you put into Grown Women Talk, I know that TSO is going to have the same level of candor, humor. Are you going to have some good music to your podcast?

So exciting. And I would be remiss to say that TSO is a part of the Higher Ground Audio family. And as proud as I am of all the work you put into Grown Women Talk, I know that TSO is going to have the same level of candor, humor. Are you going to have some good music to your podcast?

Because we didn't mention that sharing the book, Grown Woman Talk, comes with a playlist because my girl loves her music. And sprinkled throughout every story, she has a song that

Because we didn't mention that sharing the book, Grown Woman Talk, comes with a playlist because my girl loves her music. And sprinkled throughout every story, she has a song that

That goes with it, you know. And it is a fun, it's a fun playlist.

That goes with it, you know. And it is a fun, it's a fun playlist.

I wasn't even thinking about it. I wasn't even thinking about it. What I was thinking about is that I am looking forward to having Sharon back on IMO. I am looking forward to having some great conversations with you, more candid, more focused on TSO. Because this issue, if... anyone couldn't tell is near and dear to my heart.

I wasn't even thinking about it. I wasn't even thinking about it. What I was thinking about is that I am looking forward to having Sharon back on IMO. I am looking forward to having some great conversations with you, more candid, more focused on TSO. Because this issue, if... anyone couldn't tell is near and dear to my heart.

Health and women's health has been at core of my advocacy since I've been in the public eye. I believe strongly that we as women have to take ownership over our health. I live my life by that motto and I've been better off. I mean, my physical health is directly linked to my mental health. And what got me through so many

Health and women's health has been at core of my advocacy since I've been in the public eye. I believe strongly that we as women have to take ownership over our health. I live my life by that motto and I've been better off. I mean, my physical health is directly linked to my mental health. And what got me through so many

of the tough times over the last decade was the fact that, you know, I felt good inside. And I think it's incumbent upon us to share that good news with other women because it's something we can do. You know, we don't have to be athletes climbing up a mountain. We just have to get up and move a little bit, eat better, be advised, believe in science and

of the tough times over the last decade was the fact that, you know, I felt good inside. And I think it's incumbent upon us to share that good news with other women because it's something we can do. You know, we don't have to be athletes climbing up a mountain. We just have to get up and move a little bit, eat better, be advised, believe in science and

and have candid conversations with the people that we love, it's doable. I just want us to do it. So I'm grateful, Sharon, that you are going to be the voice of that conversation. So, so excited. And thank you for welcoming me to the family. Yeah. Yeah, absolutely.

and have candid conversations with the people that we love, it's doable. I just want us to do it. So I'm grateful, Sharon, that you are going to be the voice of that conversation. So, so excited. And thank you for welcoming me to the family. Yeah. Yeah, absolutely.

Well, I think you need to be in, or more guys, I shouldn't say you, but that's going to be a part of it, right? Sharing, having those male voices around the table, people who are educated, but those men who are totally clueless so that the men can feel comfortable in their cluelessness, that it doesn't prevent them from being at the table asking all kinds of questions.

Well, I think you need to be in, or more guys, I shouldn't say you, but that's going to be a part of it, right? Sharing, having those male voices around the table, people who are educated, but those men who are totally clueless so that the men can feel comfortable in their cluelessness, that it doesn't prevent them from being at the table asking all kinds of questions.

It's better to ask and be wrong than not ask at all.

It's better to ask and be wrong than not ask at all.

Let's contextualize that, please.

Let's contextualize that, please.

Because we were both reluctant spouses attending one of these huge dinners. Okay. And where were they? Was Barack a U.S. senator at the time?

Because we were both reluctant spouses attending one of these huge dinners. Okay. And where were they? Was Barack a U.S. senator at the time?

Well, and the things were, there was a line of people waiting to shake hands with our respective husbands. You know, people like reaching over our heads and spilling water on us, trying to get to these two, you know, illustrious men, you know. And she had the same look on her face as I did. Like, here we go. And I looked over at this beautiful woman. Did we even have a conversation?

Well, and the things were, there was a line of people waiting to shake hands with our respective husbands. You know, people like reaching over our heads and spilling water on us, trying to get to these two, you know, illustrious men, you know. And she had the same look on her face as I did. Like, here we go. And I looked over at this beautiful woman. Did we even have a conversation?

Not until later in that afternoon.

Not until later in that afternoon.

We hadn't met. But I just saw the look on her face, which expressed the sentiments that I felt, which was...

We hadn't met. But I just saw the look on her face, which expressed the sentiments that I felt, which was...

No, it was just kindred spirits. You see this, don't you? You see this. I see you. This is crazy, isn't it, girl? That was the look. And it was like, without words spoken, I was like, I want to get to know this woman. So when Barack got into office and appointed Eric as his attorney general,

No, it was just kindred spirits. You see this, don't you? You see this. I see you. This is crazy, isn't it, girl? That was the look. And it was like, without words spoken, I was like, I want to get to know this woman. So when Barack got into office and appointed Eric as his attorney general,

There were just a couple of women like that, particularly sisters, black women in DC, that I knew I was gonna need my kitchen table there. And I had to do what I've told people to do in my books, which is like, you gotta go out and find your friends. You gotta find your people.

There were just a couple of women like that, particularly sisters, black women in DC, that I knew I was gonna need my kitchen table there. And I had to do what I've told people to do in my books, which is like, you gotta go out and find your friends. You gotta find your people.

And I invited you and a couple of other people over to the Hay Adams, because it was before we were even able to get into the White House, just for like a girlfriend's lunch. And, you know, I don't know what that call was like for you, but for me, I was like, I just, you know, before this thing gets started, I need some info. I need to get a sense of where am I? What's this city about?

And I invited you and a couple of other people over to the Hay Adams, because it was before we were even able to get into the White House, just for like a girlfriend's lunch. And, you know, I don't know what that call was like for you, but for me, I was like, I just, you know, before this thing gets started, I need some info. I need to get a sense of where am I? What's this city about?

Who can I trust? And I instinctively thought of Sharon. She was on the top of my list of people that I wanted to know. Yeah. And we had an amazing, was it lunch or breakfast?

Who can I trust? And I instinctively thought of Sharon. She was on the top of my list of people that I wanted to know. Yeah. And we had an amazing, was it lunch or breakfast?

And that's when we really started having some really deep conversations about our health as women. how we neglected. Many of us were Black women around the table. We learned from Sharon all that we didn't know. So a lot of times those weekends would turn into Sharon advisory sessions because we'd bring her questions about health, things on our bodies, prescriptions.

And that's when we really started having some really deep conversations about our health as women. how we neglected. Many of us were Black women around the table. We learned from Sharon all that we didn't know. So a lot of times those weekends would turn into Sharon advisory sessions because we'd bring her questions about health, things on our bodies, prescriptions.

We would use her as a second opinion from our own doctors to make sure that that we were covered. But your book touches on more than just the medical side of things. I mean, your book opens up with something as simple as how do you choose a medical provider?

We would use her as a second opinion from our own doctors to make sure that that we were covered. But your book touches on more than just the medical side of things. I mean, your book opens up with something as simple as how do you choose a medical provider?

We've got one of our dear friends, Dr. Sharon Malone on. And she's going to talk about her new book, new podcast that we're excited about. And But we want to talk about a whole range of things. And in many ways, to have a guy like yourself on in the midst of this conversation, to some people might seem funny because a lot of men don't feel a connection to women's health.

We've got one of our dear friends, Dr. Sharon Malone on. And she's going to talk about her new book, new podcast that we're excited about. And But we want to talk about a whole range of things. And in many ways, to have a guy like yourself on in the midst of this conversation, to some people might seem funny because a lot of men don't feel a connection to women's health.

Well, and we were raised on the doctor's set. I mean, doctors- Doctors, for at least our generation and older, they're revered members of the community. They were second to God. And so the thought that you would question or even have the right or authority to question. So many of us, if in the black community you even ever saw a doctor,

Well, and we were raised on the doctor's set. I mean, doctors- Doctors, for at least our generation and older, they're revered members of the community. They were second to God. And so the thought that you would question or even have the right or authority to question. So many of us, if in the black community you even ever saw a doctor,

But if you did have a doctor, you just fell into the arms of that person and took everything that they said about you as being the truth. And if all these doctors or most of these doctors were men who are not even trained in understanding women's health in that same way. And I want you to talk a little bit about how that happens.

But if you did have a doctor, you just fell into the arms of that person and took everything that they said about you as being the truth. And if all these doctors or most of these doctors were men who are not even trained in understanding women's health in that same way. And I want you to talk a little bit about how that happens.

And this is the frustrating thing about the fight to protect women's reproductive health. Sadly, it has been reduced to choice, the question of choice. Right. And it's as if that's all of what women's health is. That's the only thing. And as I attempted to make the argument on the campaign trail this past election was that there's just so much more at stake.

And this is the frustrating thing about the fight to protect women's reproductive health. Sadly, it has been reduced to choice, the question of choice. Right. And it's as if that's all of what women's health is. That's the only thing. And as I attempted to make the argument on the campaign trail this past election was that there's just so much more at stake.

Because quite frankly, oftentimes we as women don't understand our own issues. And we're going to talk a little bit about that. But I think you are... in a unique position because we grew up in a household where women had voices.

Because quite frankly, oftentimes we as women don't understand our own issues. And we're going to talk a little bit about that. But I think you are... in a unique position because we grew up in a household where women had voices.

And because so many men have no idea about about what women go through, right? We haven't been researched, we haven't been considered, and it still affects the way a lot of male lawmakers, a lot of male politicians, a lot of male religious leaders think about the issue of choice as if it's just about the fetus, the baby. But women's reproductive health is about our life.

And because so many men have no idea about about what women go through, right? We haven't been researched, we haven't been considered, and it still affects the way a lot of male lawmakers, a lot of male politicians, a lot of male religious leaders think about the issue of choice as if it's just about the fetus, the baby. But women's reproductive health is about our life.

And it's about this whole complicated reproductive system that does the least of what it does is produce life. It's a very important thing that it does. But you only produce life if the machine that's producing it, if you want to whittle us down to a machine, if the machine is functioning in a healthy, streamlined kind of way. Right.

And it's about this whole complicated reproductive system that does the least of what it does is produce life. It's a very important thing that it does. But you only produce life if the machine that's producing it, if you want to whittle us down to a machine, if the machine is functioning in a healthy, streamlined kind of way. Right.

But there is no discussion or apparent connection between the two. Sharon, can you talk a bit about sort of the state of the current state? What's keeping you up at night of the many things that keep you up at night about the state of women's health? Yes, I think that.

And despite the fact that we grew up in such an open household for that time in life or that stage of our lives, I'm still surprised at how little I know about my own body. uh, you know, and, and how many things we didn't talk about, not because our parents weren't open to it, but they didn't know, you know, so we're going to talk more about this.

Um, uh, but let's introduce, let's get, let's get Sharon in on the, on the conversation.

Well, we're seeing more and more conversations from anti-vaxxers, right? We saw it during COVID, right? What's that about? Why are we all of a sudden, after all these generations now, pushing against vaccines that have saved lives for decades?

And we're seeing that with this measles outbreak. So what's going on there? This is in Texas, correct?

Welcome to IMO, Sharon.

So if you're a mother that's vaccinated, does that protect your unborn child?

I mean, it's just mind-boggling to believe that with all that we know, with all the resources, with the wealth in this nation, that we are going to go backwards in time, that we are walking backwards with our eyes wide open, with sirens blaring. It's just unbelievable to me that in a short period of time, we're here having these kind of conversations.

Thank you for having me. Thank you. Road warrior, because this woman here has been... all over the country promoting grown woman talk. I am so proud of you for so much. But you did the thing, writing this amazing, creative, fun, funny, informative, open, honest book about women's health with a particular focus on women of color, but it's a book for everyone, men, women, women,

Yeah, and Craig, you know, that piece of advice cannot just be directed to women. You know, this is why I implore the men in the world who have women that they say they care about, daughters that they are raising, that this is their issue too.

I mean, for men to sit on their hands over this issue and trade out women's health for a tax break or whatever it is, is a sad statement about that man's... level of value of the women in their lives. And there are a lot of men who have big chairs at their tables. There are a lot of women who vote the way their man is going to vote. It happened in this election.

So just to direct this at women, unfortunately, we've seen is not enough.

people of all races and all ages, because you cover the spectrum of just some of the things that women go through. Can you talk a bit about why you wanted to write the book and how you're feeling about things? Yes.

This is a question that we are getting around our kitchen table from the next, because we're in that generation. Our daughters are in that stage in life where it's- Both of us. Yeah, all of us, where they're deciding between pursuing a career, how long do they have to wait, finding a mate, All of those questions feel more existential.

But even given that, I met a young woman that's a part of our world who just froze her eggs and she's in her 30s. And very enlightened, very educated. She just did it. But she said she only did it because she heard other people doing it. She had never heard in all of her enlightened years on this planet about the importance of freezing eggs.

That it was even a possibility that she could or even should freeze her eggs. So that in today's young women... She said she had never been in a conversation about the importance or the possibility of freezing her eggs. 30-something, early 30s.

And just so that we're not assuming things, the difference between egg freezing and embryo freezing is... Okay, so embryo freezing is just a regular IVF.

Surprise!

But that's why the research is so unclear about the viability of frozen eggs.

It's the same procedure. The only thing is there's no fertilization. That's all.

I'm here for you.

Does it make sense for young women, young men to start getting sort of a sense of their fertility, you know, sort of before all of this? Like, you know, should young women go in and have ultrasounds to see, does that make any sense to have that fertility? on their minds?

You didn't show it to me, but it took so many, it's like, okay, Sharon, I know you have a rough draft. I was getting a little insulted for a second there. Well, you know what it is and you can appreciate this, Craig.

We always get in the short end of something. I'm telling you, isn't it? We get all we have. Sperm after sperm after sperm.

Like smoking.

We might have to.

Well, speaking of that, I don't want to jump away from the question, but I am curious about what is the connection between aging sperm and birth defects? Or are there any correlations? Because they're going to cut out research in that too. Yeah. It's like, no, I'm 80 and I'm good. I'm still good.

It's like you're just coming in on the last of everything. Sharon's just squeezing out the last of her brain cells. Who knows?

That may be the key behind all the defunding everything. It's just like, let's just blow it up. We can't let them find this stuff. Old men can keep marrying 20-year-olds. Exactly. It's like, I'll give you the baby you want. We don't have to keep that baby.

Yeah, but why would they sit at the inn? It's just weird. Just sit up by your wife's head. I know. Be where she is.

Go to the head of the table. All right.

This is educational for men. Yeah.

Don't need that. No, you don't need that. Yeah, that sounds about right. Yeah.

Hey, Mish. Hey, Craig Robinson. Today's topic is one that's near and dear to me. Now, one of the reasons why I'm excited about, one of the many reasons I'm excited about our platform IMO is that we really get to talk about whole array of issues that we both care about. But this topic today is particularly of note for me because we're going to be talking about women's health.

Why?

And I want the men out there, be involved. It doesn't have to be your partner. If you've got any women in your life who are willing and open to help educate you, seek it out. Sharon? Thank you for the book. And we have to talk about your podcast that's coming up.

But well, to give some folks some context, I mean, Sharon and I, we've known each other since that day at the, that evening at the Black Caucus when we first, actually our eyes first met. Because this was a time where, what was, Sharon's husband happens to be former Attorney General Eric Holder. He's a non-factor. He is not a non-factor. He's a non-factor in our relationship.

Because we're going to be able to hear from Sharon a whole lot more and dig deeper into a whole range of issues because you are working on your podcast. your own podcast. Tell us all about it.

So exciting. And I would be remiss to say that TSO is a part of the Higher Ground Audio family. And as proud as I am of all the work you put into Grown Women Talk, I know that TSO is going to have the same level of candor, humor. Are you going to have some good music to your podcast?

Because we didn't mention that sharing the book, Grown Woman Talk, comes with a playlist because my girl loves her music. And sprinkled throughout every story, she has a song that

That goes with it, you know. And it is a fun, it's a fun playlist.

I wasn't even thinking about it. I wasn't even thinking about it. What I was thinking about is that I am looking forward to having Sharon back on IMO. I am looking forward to having some great conversations with you, more candid, more focused on TSO. Because this issue, if... anyone couldn't tell is near and dear to my heart.

Health and women's health has been at core of my advocacy since I've been in the public eye. I believe strongly that we as women have to take ownership over our health. I live my life by that motto and I've been better off. I mean, my physical health is directly linked to my mental health. And what got me through so many

of the tough times over the last decade was the fact that, you know, I felt good inside. And I think it's incumbent upon us to share that good news with other women because it's something we can do. You know, we don't have to be athletes climbing up a mountain. We just have to get up and move a little bit, eat better, be advised, believe in science and

and have candid conversations with the people that we love, it's doable. I just want us to do it. So I'm grateful, Sharon, that you are going to be the voice of that conversation. So, so excited. And thank you for welcoming me to the family. Yeah. Yeah, absolutely.

Well, I think you need to be in, or more guys, I shouldn't say you, but that's going to be a part of it, right? Sharing, having those male voices around the table, people who are educated, but those men who are totally clueless so that the men can feel comfortable in their cluelessness, that it doesn't prevent them from being at the table asking all kinds of questions.

It's better to ask and be wrong than not ask at all.

Let's contextualize that, please.

Because we were both reluctant spouses attending one of these huge dinners. Okay. And where were they? Was Barack a U.S. senator at the time?

Well, and the things were, there was a line of people waiting to shake hands with our respective husbands. You know, people like reaching over our heads and spilling water on us, trying to get to these two, you know, illustrious men, you know. And she had the same look on her face as I did. Like, here we go. And I looked over at this beautiful woman. Did we even have a conversation?

Not until later in that afternoon.

We hadn't met. But I just saw the look on her face, which expressed the sentiments that I felt, which was...

No, it was just kindred spirits. You see this, don't you? You see this. I see you. This is crazy, isn't it, girl? That was the look. And it was like, without words spoken, I was like, I want to get to know this woman. So when Barack got into office and appointed Eric as his attorney general,

There were just a couple of women like that, particularly sisters, black women in DC, that I knew I was gonna need my kitchen table there. And I had to do what I've told people to do in my books, which is like, you gotta go out and find your friends. You gotta find your people.

And I invited you and a couple of other people over to the Hay Adams, because it was before we were even able to get into the White House, just for like a girlfriend's lunch. And, you know, I don't know what that call was like for you, but for me, I was like, I just, you know, before this thing gets started, I need some info. I need to get a sense of where am I? What's this city about?

Who can I trust? And I instinctively thought of Sharon. She was on the top of my list of people that I wanted to know. Yeah. And we had an amazing, was it lunch or breakfast?

And that's when we really started having some really deep conversations about our health as women. how we neglected. Many of us were Black women around the table. We learned from Sharon all that we didn't know. So a lot of times those weekends would turn into Sharon advisory sessions because we'd bring her questions about health, things on our bodies, prescriptions.

We would use her as a second opinion from our own doctors to make sure that that we were covered. But your book touches on more than just the medical side of things. I mean, your book opens up with something as simple as how do you choose a medical provider?

We've got one of our dear friends, Dr. Sharon Malone on. And she's going to talk about her new book, new podcast that we're excited about. And But we want to talk about a whole range of things. And in many ways, to have a guy like yourself on in the midst of this conversation, to some people might seem funny because a lot of men don't feel a connection to women's health.

Well, and we were raised on the doctor's set. I mean, doctors- Doctors, for at least our generation and older, they're revered members of the community. They were second to God. And so the thought that you would question or even have the right or authority to question. So many of us, if in the black community you even ever saw a doctor,

But if you did have a doctor, you just fell into the arms of that person and took everything that they said about you as being the truth. And if all these doctors or most of these doctors were men who are not even trained in understanding women's health in that same way. And I want you to talk a little bit about how that happens.

And this is the frustrating thing about the fight to protect women's reproductive health. Sadly, it has been reduced to choice, the question of choice. Right. And it's as if that's all of what women's health is. That's the only thing. And as I attempted to make the argument on the campaign trail this past election was that there's just so much more at stake.

Because quite frankly, oftentimes we as women don't understand our own issues. And we're going to talk a little bit about that. But I think you are... in a unique position because we grew up in a household where women had voices.

And because so many men have no idea about about what women go through, right? We haven't been researched, we haven't been considered, and it still affects the way a lot of male lawmakers, a lot of male politicians, a lot of male religious leaders think about the issue of choice as if it's just about the fetus, the baby. But women's reproductive health is about our life.

And it's about this whole complicated reproductive system that does the least of what it does is produce life. It's a very important thing that it does. But you only produce life if the machine that's producing it, if you want to whittle us down to a machine, if the machine is functioning in a healthy, streamlined kind of way. Right.

No, you can be treated with menopausal hormone therapy.

No, you can be treated with menopausal hormone therapy.

There is this study of women across the nation where they looked at women, different ethnic groups, and they found that Black women tend to go through menopause earlier, their symptoms are more severe, and they last longer. So obviously, if you're going to go through menopause earlier, that means that parents

There is this study of women across the nation where they looked at women, different ethnic groups, and they found that Black women tend to go through menopause earlier, their symptoms are more severe, and they last longer. So obviously, if you're going to go through menopause earlier, that means that parents

Perimenopause starts earlier because back that up 10 years, if you're going to be menopausal at 45, then you were perimenopausal at 35. Yes. One of the things that I always tell young women, particularly when they're concerned about what does this mean in terms of childbearing and will I be able to have a baby or not?

Perimenopause starts earlier because back that up 10 years, if you're going to be menopausal at 45, then you were perimenopausal at 35. Yes. One of the things that I always tell young women, particularly when they're concerned about what does this mean in terms of childbearing and will I be able to have a baby or not?

First thing is know your family history because I think you should talk to your mother because at 35, if you talk to your, you say, mom, when did you go through menopause?

First thing is know your family history because I think you should talk to your mother because at 35, if you talk to your, you say, mom, when did you go through menopause?

If she remembers and she shares that information, if she tells you you were menopausal, she was menopausal at 42, well, then that has some bearing for you because at 35, you are more likely to be perimenopausal and to maybe have some fertility challenges more than someone whose mother had menopause at 55. Do you see what I mean?

If she remembers and she shares that information, if she tells you you were menopausal, she was menopausal at 42, well, then that has some bearing for you because at 35, you are more likely to be perimenopausal and to maybe have some fertility challenges more than someone whose mother had menopause at 55. Do you see what I mean?

So yes, it has a direct implication on when your symptoms start, but what to do about it. And let me say, we have more options now than we have ever had, because this is a situation if you say, I'm not ready to have a baby right now at 35. I may not have even identified a partner at 35. then this is where we can use technology.

So yes, it has a direct implication on when your symptoms start, but what to do about it. And let me say, we have more options now than we have ever had, because this is a situation if you say, I'm not ready to have a baby right now at 35. I may not have even identified a partner at 35. then this is where we can use technology.

Egg freezing might be something that you would do because it at least preserves that possibility for you that if you just wait, then time will make that decision for you rather than you making that decision for yourself.

Egg freezing might be something that you would do because it at least preserves that possibility for you that if you just wait, then time will make that decision for you rather than you making that decision for yourself.

You know, I'm not really sure what to make of the fact that women are starting to experience symptoms earlier, but I think that stress is certainly a factor. I think that how we live, you know, the... environment that we're in. You know, who knows? Maybe it is some of the endocrine disrupting chemicals that women are exposed to that are causing this.

You know, I'm not really sure what to make of the fact that women are starting to experience symptoms earlier, but I think that stress is certainly a factor. I think that how we live, you know, the... environment that we're in. You know, who knows? Maybe it is some of the endocrine disrupting chemicals that women are exposed to that are causing this.

Oh my, where to begin with that one? You're on at least three different medications, right? You've got progesterone, you've got something for anxiety, something for sleep. If we know that it's all perimenopause, then why don't we treat the perimenopause, which is with hormones? Estrogen is the common denominator of all the symptoms that you have there.

Oh my, where to begin with that one? You're on at least three different medications, right? You've got progesterone, you've got something for anxiety, something for sleep. If we know that it's all perimenopause, then why don't we treat the perimenopause, which is with hormones? Estrogen is the common denominator of all the symptoms that you have there.

And this is not uncommon during perimenopause where women will say, okay, well, I need something for sleep and then I'm depressed and I need something for this. And by the time you look at it, you're on five different medications for your five different symptoms and still haven't adequately solved the problem. And I think that the first go-to ought to be able to say, it's perimenopause.

And this is not uncommon during perimenopause where women will say, okay, well, I need something for sleep and then I'm depressed and I need something for this. And by the time you look at it, you're on five different medications for your five different symptoms and still haven't adequately solved the problem. And I think that the first go-to ought to be able to say, it's perimenopause.

Let's go to the most effective treatment for the symptoms of menopause and perimenopause, which is estrogen therapy. And don't be afraid of that unless there is a reason that I don't know why you should not.

Let's go to the most effective treatment for the symptoms of menopause and perimenopause, which is estrogen therapy. And don't be afraid of that unless there is a reason that I don't know why you should not.

Well, let me say that there is a different way that we give estrogen for women who are perimenopausal. I've said all the time that in perimenopause, your estrogen levels aren't consistently low. Sometimes they're too high. Sometimes they're too low and everything in between and in no particular order.

Well, let me say that there is a different way that we give estrogen for women who are perimenopausal. I've said all the time that in perimenopause, your estrogen levels aren't consistently low. Sometimes they're too high. Sometimes they're too low and everything in between and in no particular order.

So what works well for women who don't, you know, who are having these persistently high estrogens? You know what you do?

So what works well for women who don't, you know, who are having these persistently high estrogens? You know what you do?

You use a low-dose birth control pill, just a plain old oral contraceptive, because what it does is that it shuts down all that extraneous estrogen production in your ovaries, and it will give you back what you need to quiet your ovaries and give you enough estrogen and progestin

You use a low-dose birth control pill, just a plain old oral contraceptive, because what it does is that it shuts down all that extraneous estrogen production in your ovaries, and it will give you back what you need to quiet your ovaries and give you enough estrogen and progestin

So what you're doing is that you're tamping down all that background noise and just giving back the estrogen as you need it. And you can take birth control pills every day. And when I say every day, you don't even have to stop them to have your period. You can just go straight through.

So what you're doing is that you're tamping down all that background noise and just giving back the estrogen as you need it. And you can take birth control pills every day. And when I say every day, you don't even have to stop them to have your period. You can just go straight through.

So it is a very interesting area that needs to be explored further because we are aging ourselves faster than I think that we should be given this day and time.

So it is a very interesting area that needs to be explored further because we are aging ourselves faster than I think that we should be given this day and time.

You're like, I would prefer not to be off the pill for a week, a month, because your symptoms will come back when you're off your estrogen. Birth control pills is a very easy way that we use commonly for women in perimenopause, particularly when one of the other symptoms in perimenopause tends to be irregular bleeding or sometimes the bleeding is too heavy or you need birth control.

You're like, I would prefer not to be off the pill for a week, a month, because your symptoms will come back when you're off your estrogen. Birth control pills is a very easy way that we use commonly for women in perimenopause, particularly when one of the other symptoms in perimenopause tends to be irregular bleeding or sometimes the bleeding is too heavy or you need birth control.

In those instances, a birth control pill, a low-dose birth control pill works better because you are getting cycle control and you're also controlling your symptoms and you get birth control. So very commonly to stay on that.

In those instances, a birth control pill, a low-dose birth control pill works better because you are getting cycle control and you're also controlling your symptoms and you get birth control. So very commonly to stay on that.

And then once you're finally menopausal, which who knows, maybe five, six years from now, then that's when we make the transition from birth control pills to menopausal hormone therapy. But I don't want you to think that those are two things that are separate and apart. Birth control pills have estrogen and progestin in them.

And then once you're finally menopausal, which who knows, maybe five, six years from now, then that's when we make the transition from birth control pills to menopausal hormone therapy. But I don't want you to think that those are two things that are separate and apart. Birth control pills have estrogen and progestin in them.

It's a different estrogen than what we take in menopause, and it's in different amounts. There's more of it when you're perimenopausal.

It's a different estrogen than what we take in menopause, and it's in different amounts. There's more of it when you're perimenopausal.

I'm going to say, Dr. Malone told me. Do that, do that. There's a whole section in there on that. It is true. But that is, again... Oprah, we get back to our same access problem, finding doctors who understand the subtleties of how to treat. Because yes, can you take the levels of menopausal hormone therapy when you're perimenopausal?

I'm going to say, Dr. Malone told me. Do that, do that. There's a whole section in there on that. It is true. But that is, again... Oprah, we get back to our same access problem, finding doctors who understand the subtleties of how to treat. Because yes, can you take the levels of menopausal hormone therapy when you're perimenopausal?

Yes, you can, but not if you need birth control, not if you have bleeding problems because there's not enough menopausal. estrogen in the menopausal hormone therapy to control those other symptoms. It may take care of your hot flashes, but it's not going to take care of the other things. So don't be afraid of using the type of estrogen that is appropriate for what your symptoms are.

Yes, you can, but not if you need birth control, not if you have bleeding problems because there's not enough menopausal. estrogen in the menopausal hormone therapy to control those other symptoms. It may take care of your hot flashes, but it's not going to take care of the other things. So don't be afraid of using the type of estrogen that is appropriate for what your symptoms are.

And once you get to cross that line in your menopausal, then we can switch it up and go back to menopausal hormone therapy.

And once you get to cross that line in your menopausal, then we can switch it up and go back to menopausal hormone therapy.

Why the weight gain? You know, that is one of the most common complaints that women come in with when the perimenopausal phase, when they start gaining the weight. And they're like, what is going on? I'm eating the same thing. I'm exercising the same way. And I've gained 10 pounds just for breathing. And I believe you because, you know, I've been through that myself.

Why the weight gain? You know, that is one of the most common complaints that women come in with when the perimenopausal phase, when they start gaining the weight. And they're like, what is going on? I'm eating the same thing. I'm exercising the same way. And I've gained 10 pounds just for breathing. And I believe you because, you know, I've been through that myself.

I, too, no longer weigh what I weighed 20 years ago. But the key to this is to understand what is happening to your metabolism and what is happening as your estrogen levels fall. Well, whether you have symptoms or not, and now you're having hot flashes, but let me just sort of walk you through the cascade of events that happens. Your estrogen levels fall.

I, too, no longer weigh what I weighed 20 years ago. But the key to this is to understand what is happening to your metabolism and what is happening as your estrogen levels fall. Well, whether you have symptoms or not, and now you're having hot flashes, but let me just sort of walk you through the cascade of events that happens. Your estrogen levels fall.

One thing that happens is that your body composition changes. So even when you don't gain a pound, and most people do, but even when you don't gain weight, you tend to lose muscle and you put on fat. And so that weight gets redistributed. Yeah. And now it's like, why do I have this belly fat? Why are my boobs bigger?

One thing that happens is that your body composition changes. So even when you don't gain a pound, and most people do, but even when you don't gain weight, you tend to lose muscle and you put on fat. And so that weight gets redistributed. Yeah. And now it's like, why do I have this belly fat? Why are my boobs bigger?

That's also happening because that's just deposition of body fat. That's a response to the lack of estrogen. So that's one. You have hot flashes, night sweats. You can't sleep. Sleeplessness and hot flashes lead to fatigue. It increases your blood pressure. Women who are estrogen, when their estrogen level is low.

That's also happening because that's just deposition of body fat. That's a response to the lack of estrogen. So that's one. You have hot flashes, night sweats. You can't sleep. Sleeplessness and hot flashes lead to fatigue. It increases your blood pressure. Women who are estrogen, when their estrogen level is low.

Oh, absolutely. And it also increases insulin resistance so more people will start to develop type 2 diabetes after menopause. So guess what happens when you're irritable, you're tired? Guess what you're not going to do the next day? exercise. Now you're fatigued. Now you've got more fat and less muscle. So everything that you eat, you don't have... Muscle is more metabolically active than fat.

Oh, absolutely. And it also increases insulin resistance so more people will start to develop type 2 diabetes after menopause. So guess what happens when you're irritable, you're tired? Guess what you're not going to do the next day? exercise. Now you're fatigued. Now you've got more fat and less muscle. So everything that you eat, you don't have... Muscle is more metabolically active than fat.

So it just continues to make more fat. And then the more depressed you are, and guess what happens when you are depressed and you're tired? You make bad choices the next day. You're not going to exercise. You're like, I know exactly what this feels like because as a resident, when I would be up all night... Yeah, I'd be up all night.

So it just continues to make more fat. And then the more depressed you are, and guess what happens when you are depressed and you're tired? You make bad choices the next day. You're not going to exercise. You're like, I know exactly what this feels like because as a resident, when I would be up all night... Yeah, I'd be up all night.

And you make bad choices about what you eat, what you drink, what your behaviors are. So it's a really complicated system, but it all goes together. And it happens to women, I would say, nine times out of 10. This is the complaint.

And you make bad choices about what you eat, what you drink, what your behaviors are. So it's a really complicated system, but it all goes together. And it happens to women, I would say, nine times out of 10. This is the complaint.

Well, knowing what you know now, I can say this. The better health you are in leading into this perimenopause and menopausal phase, the better you are going to be able to endure it. It won't say that you won't eliminate the need for medications, but the healthier you are coming into it, the better you're going to weather this process.

Well, knowing what you know now, I can say this. The better health you are in leading into this perimenopause and menopausal phase, the better you are going to be able to endure it. It won't say that you won't eliminate the need for medications, but the healthier you are coming into it, the better you're going to weather this process.

But I would say as a young woman who is watching her mother go through this, the one thing you can do is give her a little grace and understand that, you know, your mother's not maybe, she's not snapping at you because of something you did. It may be the day and you just have to sometimes maybe go up to your mom and give her a hug and say, hey, mom, I understand this may be a bad day for you today.

But I would say as a young woman who is watching her mother go through this, the one thing you can do is give her a little grace and understand that, you know, your mother's not maybe, she's not snapping at you because of something you did. It may be the day and you just have to sometimes maybe go up to your mom and give her a hug and say, hey, mom, I understand this may be a bad day for you today.

And sometimes it may be something you did now, so I'm going to let you distinguish between the two. But just understand that your mom has a whole lot less tolerance for the stuff that you do now than she may have had 10 years ago.

And sometimes it may be something you did now, so I'm going to let you distinguish between the two. But just understand that your mom has a whole lot less tolerance for the stuff that you do now than she may have had 10 years ago.

That's exactly right. You know, I was thinking, Oprah, when I got to the end of my career after practicing for 30 years, and when I decided it was time to stop doing that, I had no idea what the next chapter was going to be, but I knew I was done with that. And... I created a whole new life for myself after 60. I mean, I wrote my book when I was 62 years old.

That's exactly right. You know, I was thinking, Oprah, when I got to the end of my career after practicing for 30 years, and when I decided it was time to stop doing that, I had no idea what the next chapter was going to be, but I knew I was done with that. And... I created a whole new life for myself after 60. I mean, I wrote my book when I was 62 years old.

I'm going to say this, and this will surprise no one. I don't know how you are, but I know how I am. But I can tell you from personal experience that sex at 60 is not sex at 25. It's different. And you just accept that different does not mean worse. Now, I didn't say this. So there are two things that you need to understand that are happening hormonally.

I'm going to say this, and this will surprise no one. I don't know how you are, but I know how I am. But I can tell you from personal experience that sex at 60 is not sex at 25. It's different. And you just accept that different does not mean worse. Now, I didn't say this. So there are two things that you need to understand that are happening hormonally.

What's happening with your estrogen and the lack of estrogen after menopause is really responsible for things like vaginal pain. dryness, the discomfort. Now, it stands to reason that if sex is painful, you don't want to have it. You know, we are all sort of, you know, we're programmed to avoid pain and go towards pleasure, right?

What's happening with your estrogen and the lack of estrogen after menopause is really responsible for things like vaginal pain. dryness, the discomfort. Now, it stands to reason that if sex is painful, you don't want to have it. You know, we are all sort of, you know, we're programmed to avoid pain and go towards pleasure, right?

So the first part of what we need to do is to eliminate those barriers that are causing the discomfort. And vaginal estrogen is a great place to go at vaginal estradiol. And the estrogen in the vaginal estrogen is so low, it doesn't get absorbed systemically such that you don't need to take a progestin if you are just using vaginal estrogen. Sometimes that's enough.

So the first part of what we need to do is to eliminate those barriers that are causing the discomfort. And vaginal estrogen is a great place to go at vaginal estradiol. And the estrogen in the vaginal estrogen is so low, it doesn't get absorbed systemically such that you don't need to take a progestin if you are just using vaginal estrogen. Sometimes that's enough.

And you can say, well, look at that. I'm not in pain. You know, this isn't difficult. I'm not getting a urinary tract infection every time I have sex. I'm not avoiding it the way that I would. There is also the issue of testosterone.

And you can say, well, look at that. I'm not in pain. You know, this isn't difficult. I'm not getting a urinary tract infection every time I have sex. I'm not avoiding it the way that I would. There is also the issue of testosterone.

And testosterone has been, you know, we talk about it a lot, but it's not readily accessible for most people because there is no FDA-approved version of testosterone that women can take. There is one for men, but not for women. So that would involve, you know, after you have taken care of the pain and discomfort issues and you say, it's still not where I want it. Pain, discomfort, dryness.

And testosterone has been, you know, we talk about it a lot, but it's not readily accessible for most people because there is no FDA-approved version of testosterone that women can take. There is one for men, but not for women. So that would involve, you know, after you have taken care of the pain and discomfort issues and you say, it's still not where I want it. Pain, discomfort, dryness.

And, you know, you need a good lube. And then you say, well, okay, well, then maybe testosterone might be appropriate for you for treating just what we call the hypoactive sexual disorder, okay? That's one.

And, you know, you need a good lube. And then you say, well, okay, well, then maybe testosterone might be appropriate for you for treating just what we call the hypoactive sexual disorder, okay? That's one.

I'm not thinking about sex. I don't want it. But here's another. I want to give you another frame for how to think about sex after 50 or sex after 60. Most women, once you eliminate their discomfort. OK, so we've taken that off. You're treated and you're fine.

I'm not thinking about sex. I don't want it. But here's another. I want to give you another frame for how to think about sex after 50 or sex after 60. Most women, once you eliminate their discomfort. OK, so we've taken that off. You're treated and you're fine.

I have, you know, a new career really taking the message of menopause and women's health outside of just the office when you're just talking to people one-on-one. There are only so many people you can get to. That's right. But to be able to take that message and to amplify it and to get out. Doesn't it feel like your life kind of blew up? Oh, absolutely. Absolutely.

I have, you know, a new career really taking the message of menopause and women's health outside of just the office when you're just talking to people one-on-one. There are only so many people you can get to. That's right. But to be able to take that message and to amplify it and to get out. Doesn't it feel like your life kind of blew up? Oh, absolutely. Absolutely.

most women will find that there's a difference in your desire, where there's a difference between spontaneous desire, where I'm just sitting here and, oh, I can't wait to go for my husband to come home or my partner to come home and have sex. But there is what changes as we age, it's more responsive desire. And by that, I mean, I called it the build it, they will come theory.

most women will find that there's a difference in your desire, where there's a difference between spontaneous desire, where I'm just sitting here and, oh, I can't wait to go for my husband to come home or my partner to come home and have sex. But there is what changes as we age, it's more responsive desire. And by that, I mean, I called it the build it, they will come theory.

And that is, I wasn't thinking about sex, but if you bring it up, and I'm going to say this to you, Husband Remember when you used to date your wife before you were obligated? Raymond, remember those days?

And that is, I wasn't thinking about sex, but if you bring it up, and I'm going to say this to you, Husband Remember when you used to date your wife before you were obligated? Raymond, remember those days?

Then you create the scenario by which your wife would be responsive to you. And most women will find under that circumstance is like, well, I wasn't thinking about it, but look at that. You put the dishes in the dishwasher and you came over and you were nice to me. All of those things that will make her more receptive. when you initiate.

Then you create the scenario by which your wife would be responsive to you. And most women will find under that circumstance is like, well, I wasn't thinking about it, but look at that. You put the dishes in the dishwasher and you came over and you were nice to me. All of those things that will make her more receptive. when you initiate.

So there is a lot, it's more complicated and that is also, that will get you in the right space. Novelty is important. You can't do the same things over and over and over again and expect anybody to get excited. That's just, it doesn't matter what you're talking about. Once you've done it a million times, you're not going to get the same response.

So there is a lot, it's more complicated and that is also, that will get you in the right space. Novelty is important. You can't do the same things over and over and over again and expect anybody to get excited. That's just, it doesn't matter what you're talking about. Once you've done it a million times, you're not going to get the same response.

So novelty, role-playing, sometimes you need a sexual therapist. But let me say this, what's really important, and I go back to for women, There's also a problem with arousal. And there is also the problem with inability to have an orgasm just because, you know, things are just less responsive. And to that, I would say, be playful. Invest. If you don't have one, get yourself a good vibrator.

So novelty, role-playing, sometimes you need a sexual therapist. But let me say this, what's really important, and I go back to for women, There's also a problem with arousal. And there is also the problem with inability to have an orgasm just because, you know, things are just less responsive. And to that, I would say, be playful. Invest. If you don't have one, get yourself a good vibrator.

There are lots of good lubes you can use. At Alloy, we have a cream called Omazing, which is actually a cream that's topical sildenafil, which is the same thing as topical Viagra, but it's for women. It's the same. So it's a cream that you use externally and it increases arousal. So, you know, you realize it's, yeah, it's going to require some potions. It's called O-mazing.

There are lots of good lubes you can use. At Alloy, we have a cream called Omazing, which is actually a cream that's topical sildenafil, which is the same thing as topical Viagra, but it's for women. It's the same. So it's a cream that you use externally and it increases arousal. So, you know, you realize it's, yeah, it's going to require some potions. It's called O-mazing.

I should have branded that. O-mazing. Exactly.

I should have branded that. O-mazing. Exactly.

You know what? You're absolutely right. You can be our spokesperson. O-mazing.

You know what? You're absolutely right. You can be our spokesperson. O-mazing.

And that's what I want to tell young women. Don't think that you need to know everything that's going to happen to you and to your life when you're 30 years old. You will have many chapters. And I want them to be encouraged by looking at people like you and Gail and Michelle and all these wonderful women who are out there recreating a life that they want to live. And we're doing it on our terms.

And that's what I want to tell young women. Don't think that you need to know everything that's going to happen to you and to your life when you're 30 years old. You will have many chapters. And I want them to be encouraged by looking at people like you and Gail and Michelle and all these wonderful women who are out there recreating a life that they want to live. And we're doing it on our terms.

The one message that I really want women to have is this, is that menopause is inevitable, suffering is not. And I think that every woman has a line drawn somewhere in the sand between what's tolerable and what's not. You don't let someone else tell you how you feel or how you're supposed to feel. If you are bothered...

The one message that I really want women to have is this, is that menopause is inevitable, suffering is not. And I think that every woman has a line drawn somewhere in the sand between what's tolerable and what's not. You don't let someone else tell you how you feel or how you're supposed to feel. If you are bothered...

If you are having any one of those 34 symptoms in any particular order or if you're not having those symptoms and you're at risk for things like cardiovascular disease or osteoporosis, you need to educate yourself and advocate for yourself because that's a big message that I want women to get is that don't be passive. sort of participants in your own life, in your own health.

If you are having any one of those 34 symptoms in any particular order or if you're not having those symptoms and you're at risk for things like cardiovascular disease or osteoporosis, you need to educate yourself and advocate for yourself because that's a big message that I want women to get is that don't be passive. sort of participants in your own life, in your own health.

You have way more power than you think. You just don't know how to exercise it. And so my book and my message and my mission is to make sure that women have all the information they need to be able to make good decisions for themselves and for their families.

You have way more power than you think. You just don't know how to exercise it. And so my book and my message and my mission is to make sure that women have all the information they need to be able to make good decisions for themselves and for their families.

I think this is something that should reassure you because only about 1% of women will actually go through menopause before age 40. So that's very uncommon. So it has to be some other circumstances. Sometimes, though, we're seeing a lot of young women who are diagnosed with cancer. We're seeing a lot more breast cancers in young women. in their 20s and 30s even.

I think this is something that should reassure you because only about 1% of women will actually go through menopause before age 40. So that's very uncommon. So it has to be some other circumstances. Sometimes, though, we're seeing a lot of young women who are diagnosed with cancer. We're seeing a lot more breast cancers in young women. in their 20s and 30s even.

And so sometimes it's a result of chemotherapy. But I think that you should take some comfort from the fact that it's unlikely. And if you are having problems with either with your menstrual cycle or with mood or rage, sometimes you have to take a step back and go, Well, sometimes you're mad and you have a reason to be mad. You know, you have to look at what was your day.

And so sometimes it's a result of chemotherapy. But I think that you should take some comfort from the fact that it's unlikely. And if you are having problems with either with your menstrual cycle or with mood or rage, sometimes you have to take a step back and go, Well, sometimes you're mad and you have a reason to be mad. You know, you have to look at what was your day.

But what happens when you're perimenopausal, the symptoms are more persistent and pervasive when there's no reason why you should be having those symptoms. You see, you know what I mean?

But what happens when you're perimenopausal, the symptoms are more persistent and pervasive when there's no reason why you should be having those symptoms. You see, you know what I mean?

hot flashes, depression, anxiety, vaginal dryness, changes in libido, frequent urinary tract infections. There's a lot of overlap between things that young women can experience and things that perimenopausal women experience. But I think so you could take a look at it and say how much of this is due to the situation.

hot flashes, depression, anxiety, vaginal dryness, changes in libido, frequent urinary tract infections. There's a lot of overlap between things that young women can experience and things that perimenopausal women experience. But I think so you could take a look at it and say how much of this is due to the situation.

And how much am I sitting here and I'm depressed or I'm having these issues when there's no apparent reason? It should at least raise a flag for you. But for younger women, you really, before you jump to just this might be perimenopausal, I think you should look at things like there are other things such as what's called PMDD, which is premenstrual dysfunction, which is basically PMS.

And how much am I sitting here and I'm depressed or I'm having these issues when there's no apparent reason? It should at least raise a flag for you. But for younger women, you really, before you jump to just this might be perimenopausal, I think you should look at things like there are other things such as what's called PMDD, which is premenstrual dysfunction, which is basically PMS.

And that's not, so young women can have all those symptoms, but they only happen.

And that's not, so young women can have all those symptoms, but they only happen.

But that is the natural fall in your hormones that happens with a normal menstrual cycle that happens. But if you say, is this consistently happening the week before my period? yes or no, then that's probably more likely to be PMDD.

But that is the natural fall in your hormones that happens with a normal menstrual cycle that happens. But if you say, is this consistently happening the week before my period? yes or no, then that's probably more likely to be PMDD.

There are other situations, what's called polycystic ovarian syndrome, which is PCOS, where women can start to have, again, irregular periods that, you know, that you can have periods twice a year and you think, oh my God, am I going through menopause? Well, these are things that can be easily ruled out. So as younger women, yes, can you have some of those symptoms? Is it an overlap?

There are other situations, what's called polycystic ovarian syndrome, which is PCOS, where women can start to have, again, irregular periods that, you know, that you can have periods twice a year and you think, oh my God, am I going through menopause? Well, these are things that can be easily ruled out. So as younger women, yes, can you have some of those symptoms? Is it an overlap?

But I think one of the things that young women tend to show up with sometimes, and that is infertility. That's the thing about... perimenopause and this menopausal transition. And again, as I said, you don't know when your ovaries are going to expire. Every person has a different end date on that. And sometimes it's the delay in getting pregnant that is the first sign that things are going wrong.

But I think one of the things that young women tend to show up with sometimes, and that is infertility. That's the thing about... perimenopause and this menopausal transition. And again, as I said, you don't know when your ovaries are going to expire. Every person has a different end date on that. And sometimes it's the delay in getting pregnant that is the first sign that things are going wrong.

Yeah.

Yeah.

You don't know when your ovaries are going to expire. Every person has a different end date on that.

You don't know when your ovaries are going to expire. Every person has a different end date on that.

Endometriosis can be a very debilitating condition for women where normally the endometrial tissue or the tissue that lines your uterus, that is what gets stimulated every month and then you slough it if you don't get pregnant. That's what your period really comes from, the stimulation and actually elimination of that tissue. Well, that works fine if that tissue is in the lining of your uterus.

Endometriosis can be a very debilitating condition for women where normally the endometrial tissue or the tissue that lines your uterus, that is what gets stimulated every month and then you slough it if you don't get pregnant. That's what your period really comes from, the stimulation and actually elimination of that tissue. Well, that works fine if that tissue is in the lining of your uterus.

It has a way out. But if that tissue is on your ovaries or it's on your bowel or it's in other places that has no exit, then that can be very painful because the same process, it gets stimulated every month with your cycle, but it has nowhere to go. Got it. So it actually, it can be on your bladder, your bowel, and it causes pain. It can cause infertility.

It has a way out. But if that tissue is on your ovaries or it's on your bowel or it's in other places that has no exit, then that can be very painful because the same process, it gets stimulated every month with your cycle, but it has nowhere to go. Got it. So it actually, it can be on your bladder, your bowel, and it causes pain. It can cause infertility.

If it's on your ovaries, it causes scarring. And women who have endometriosis often...

If it's on your ovaries, it causes scarring. And women who have endometriosis often...

have suffered for years before they get an adequate diagnosis about what's going on because pain is a hard thing to you can't see it all the time and you know they'll go get a scan or a sonogram and they go well it looks normal and you have no idea but they say i'm in pain i'm in pain the average woman with endometriosis has gone to the ER five to seven times for relief of their pain.

have suffered for years before they get an adequate diagnosis about what's going on because pain is a hard thing to you can't see it all the time and you know they'll go get a scan or a sonogram and they go well it looks normal and you have no idea but they say i'm in pain i'm in pain the average woman with endometriosis has gone to the ER five to seven times for relief of their pain.

And this gets back to not believing women. And there's also this trope that we have been taught is that endometriosis is a disease of thin white women. So again, when you are complaining of the, I have pain, I have pain with sex, I have pain when I'm having a bowel movement or urinary issues, they're not thinking about that because their image of who they think has endometriosis may not be you.

And this gets back to not believing women. And there's also this trope that we have been taught is that endometriosis is a disease of thin white women. So again, when you are complaining of the, I have pain, I have pain with sex, I have pain when I'm having a bowel movement or urinary issues, they're not thinking about that because their image of who they think has endometriosis may not be you.

And that's why there's often a delay in diagnosis with endometriosis. Yeah, it took three years. Yeah, it took three years. And that is... Typical, to be quite honest with you.

And that's why there's often a delay in diagnosis with endometriosis. Yeah, it took three years. Yeah, it took three years. And that is... Typical, to be quite honest with you.

But endometriosis in and of itself... We don't know that that is going to alter the course of menopause for you. Not necessarily. It may not come earlier. It's going to come when it comes. But what happens for a lot of women with endometriosis, they end up going through menopause prematurely because once your symptoms have gotten to be so severe... And you've tried medication for it.

But endometriosis in and of itself... We don't know that that is going to alter the course of menopause for you. Not necessarily. It may not come earlier. It's going to come when it comes. But what happens for a lot of women with endometriosis, they end up going through menopause prematurely because once your symptoms have gotten to be so severe... And you've tried medication for it.

Sometimes we try birth control pills. Actually, one of the medications that we use to sort of keep endometriosis at bay is actually a medication that puts you in menopause. Which is? Lupron. It's a Lupron, it's a shot, and now there's a newer pill that you can do. But basically what it does, it shuts your ovaries down.

Sometimes we try birth control pills. Actually, one of the medications that we use to sort of keep endometriosis at bay is actually a medication that puts you in menopause. Which is? Lupron. It's a Lupron, it's a shot, and now there's a newer pill that you can do. But basically what it does, it shuts your ovaries down.

So that cycling and all that stuff that's going on in your body, it just goes away. Well, it's great. It helps with your endometriosis, but it gives you menopausal symptoms.

So that cycling and all that stuff that's going on in your body, it just goes away. Well, it's great. It helps with your endometriosis, but it gives you menopausal symptoms.

That's where menopause and the endometriosis connection comes in. And also for young women who have endometriosis, once the symptoms get to be so bad and you've tried all those medical management things, and you may even try surgery to go in and remove some of the endometrial tissue, but if it comes back, often the definitive treatment for endometriosis is... A hysterectomy.

That's where menopause and the endometriosis connection comes in. And also for young women who have endometriosis, once the symptoms get to be so bad and you've tried all those medical management things, and you may even try surgery to go in and remove some of the endometrial tissue, but if it comes back, often the definitive treatment for endometriosis is... A hysterectomy.

And it's a hysterectomy with removal of the ovaries. Which means now you're going into menopause. Now you're in menopause forever. So that's sort of the endometriosis, you know, menopause connection. Either some of the medications that you're on will throw you in menopause temporarily. And or if that's not working, then you're having a surgical menopause. And this can happen again for young women.

And it's a hysterectomy with removal of the ovaries. Which means now you're going into menopause. Now you're in menopause forever. So that's sort of the endometriosis, you know, menopause connection. Either some of the medications that you're on will throw you in menopause temporarily. And or if that's not working, then you're having a surgical menopause. And this can happen again for young women.

They may be in their 30s and 40s. And that's devastating from a lot of different standpoints.

They may be in their 30s and 40s. And that's devastating from a lot of different standpoints.

And just symptom relief. But... The one thing I want you to understand is because once you get to menopause, if that is the route that ultimately you're on and it ends up with the hysterectomy, you can be treated with menopausal hormone therapy. That does not mean that, oh, I'm 35 years old, I've had a hysterectomy and my overs are out, so I just must endure.

And just symptom relief. But... The one thing I want you to understand is because once you get to menopause, if that is the route that ultimately you're on and it ends up with the hysterectomy, you can be treated with menopausal hormone therapy. That does not mean that, oh, I'm 35 years old, I've had a hysterectomy and my overs are out, so I just must endure.

You know, it used to be. And let me say, because, you know, I'm in the old group of people. And, you know, the study that really changed everything in 2002, the Women's Health Initiative, really did an about face on the conversation about menopause. Because let me just say, women have been going through menopause for as long as we've been alive. Yes.

You know, it used to be. And let me say, because, you know, I'm in the old group of people. And, you know, the study that really changed everything in 2002, the Women's Health Initiative, really did an about face on the conversation about menopause. Because let me just say, women have been going through menopause for as long as we've been alive. Yes.

The only thing that's changed historically is that more of us are living long enough to get to this phase of life. But women have complained about menopause forever. But it was thought to be, you know, women just being hysterical with the symptoms or you're losing your mind. Women would go to sanitariums at that point because of the mental illness and the mental distress that it caused women.

The only thing that's changed historically is that more of us are living long enough to get to this phase of life. But women have complained about menopause forever. But it was thought to be, you know, women just being hysterical with the symptoms or you're losing your mind. Women would go to sanitariums at that point because of the mental illness and the mental distress that it caused women.

But we have known how to treat the symptoms of menopause since 1942. That was when the first estrogen product was introduced. That was Primarin. And so women have been using hormones since 1942, those who had access and the awareness of it. But it really changed everything. In 2002. In 2002. Okay. I was taught about menopause and what to do about it.

But we have known how to treat the symptoms of menopause since 1942. That was when the first estrogen product was introduced. That was Primarin. And so women have been using hormones since 1942, those who had access and the awareness of it. But it really changed everything. In 2002. In 2002. Okay. I was taught about menopause and what to do about it.

And then from 2002 on, doctors who were trained didn't really get that information.

And then from 2002 on, doctors who were trained didn't really get that information.

Right. You know, even for the women who are out there who are currently going through menopause, they haven't heard this conversation. And there's another 6,000 women every day going into menopause. And so the backfill is constant because there are people that just haven't had this conversation, not with their doctors, not with their mothers, and not even with their friends.

Right. You know, even for the women who are out there who are currently going through menopause, they haven't heard this conversation. And there's another 6,000 women every day going into menopause. And so the backfill is constant because there are people that just haven't had this conversation, not with their doctors, not with their mothers, and not even with their friends.

Exactly. In a nutshell, you know, as I told you, 1942, we've been treating women who were symptomatic during menopause, typically the hot flashes and the mood swings, with an estrogen product. It worked. So as we sort of got more women who were taking hormones, we found that there were some tweaks that need to be made along the way and added the progestin component to it.

Exactly. In a nutshell, you know, as I told you, 1942, we've been treating women who were symptomatic during menopause, typically the hot flashes and the mood swings, with an estrogen product. It worked. So as we sort of got more women who were taking hormones, we found that there were some tweaks that need to be made along the way and added the progestin component to it.

Because remember, estrogen and progestin go together.

Because remember, estrogen and progestin go together.

So we knew that it treated the symptoms of menopause. That wasn't new news. But what we found was that there was a nurse's study where they just looked at a group of healthy nurses, young women, and watched them through menopause. And what they found is that the women who took estrogen therapy or HRT had half the risk of heart disease than women who didn't, the nurses who didn't take hormones.

So we knew that it treated the symptoms of menopause. That wasn't new news. But what we found was that there was a nurse's study where they just looked at a group of healthy nurses, young women, and watched them through menopause. And what they found is that the women who took estrogen therapy or HRT had half the risk of heart disease than women who didn't, the nurses who didn't take hormones.

So imagine now the thought was, okay, we're not only relieving the symptoms, but we are actually decreasing the risk of cardiovascular disease by 50%. Well, that would be a blockbuster, right? But you couldn't prove it because it was just an observational study. So the Women's Health Initiative that was really initiated in 1991, the purpose of it was to sort of solidify that finding.

So imagine now the thought was, okay, we're not only relieving the symptoms, but we are actually decreasing the risk of cardiovascular disease by 50%. Well, that would be a blockbuster, right? But you couldn't prove it because it was just an observational study. So the Women's Health Initiative that was really initiated in 1991, the purpose of it was to sort of solidify that finding.

Does hormone therapy really reduce the risk of cardiovascular disease by 50%? That was the central question. So we do a study, largest study ever in the history of NIH, specifically for women. So they recruited women in that study that were anywhere from 50 to 79 years old. The majority of the women, 90% of the women were over age 55.

Does hormone therapy really reduce the risk of cardiovascular disease by 50%? That was the central question. So we do a study, largest study ever in the history of NIH, specifically for women. So they recruited women in that study that were anywhere from 50 to 79 years old. The majority of the women, 90% of the women were over age 55.

So it's not surprising that when they looked at the women, they said, well, there's really no difference here. We don't see any improvement in the cardiovascular. It was like the same whether you took it or not because they were starting it on women who were too old. So that was problem number one with the study design.

So it's not surprising that when they looked at the women, they said, well, there's really no difference here. We don't see any improvement in the cardiovascular. It was like the same whether you took it or not because they were starting it on women who were too old. So that was problem number one with the study design.

The second part was that when they were looking, they said, well, let's have some safety stops. Let's make sure that women aren't having an increase in breast cancer because of this estrogen, because that was a thought.

The second part was that when they were looking, they said, well, let's have some safety stops. Let's make sure that women aren't having an increase in breast cancer because of this estrogen, because that was a thought.

So when they got to about five years in the study and they looked into the data to see how is this coming, there was this dramatic press conference that they held because not only did they not see the expected decrease in cardiovascular disease, but they saw a slight increased risk in breast cancer. From these 60 to 79-year-old women.

So when they got to about five years in the study and they looked into the data to see how is this coming, there was this dramatic press conference that they held because not only did they not see the expected decrease in cardiovascular disease, but they saw a slight increased risk in breast cancer. From these 60 to 79-year-old women.

From these women who were on average 63 years old, more than 10 years after menopause. So when you hold a press conference, and it's dramatic, and they stop the study, hold the presses, and they say... Not only does hormone therapy not improve your cardiac profile, it increases the risk of breast cancer. And when they said that, I mean, women who were taking hormones happily... Abandoned them.

From these women who were on average 63 years old, more than 10 years after menopause. So when you hold a press conference, and it's dramatic, and they stop the study, hold the presses, and they say... Not only does hormone therapy not improve your cardiac profile, it increases the risk of breast cancer. And when they said that, I mean, women who were taking hormones happily... Abandoned them.

It was a very much misinterpreted study because if you had said, I don't disagree, okay, your data is your data. If you start women on hormone therapy later in life, you're not going to prevent their heart disease. I think that's probably true. The problem is that they generalize that data to everybody. Well, what about a 50-year-old?

It was a very much misinterpreted study because if you had said, I don't disagree, okay, your data is your data. If you start women on hormone therapy later in life, you're not going to prevent their heart disease. I think that's probably true. The problem is that they generalize that data to everybody. Well, what about a 50-year-old?

Well, what about if I start it when I'm 45, whenever I'm menopausal? Because that's when we clinically would start it. Yes, yes, yes. That's a very different outcome. And that was the misinterpretation of taking very limited findings and applying it to everyone.

Well, what about if I start it when I'm 45, whenever I'm menopausal? Because that's when we clinically would start it. Yes, yes, yes. That's a very different outcome. And that was the misinterpretation of taking very limited findings and applying it to everyone.

It has been, when you say the words breast cancer... to women, I think that is their number one fear, is breast cancer, despite the fact that the number one cause of deaths in women is cardiovascular disease. It is more than all cancers combined and all accidental causes of death for women.

It has been, when you say the words breast cancer... to women, I think that is their number one fear, is breast cancer, despite the fact that the number one cause of deaths in women is cardiovascular disease. It is more than all cancers combined and all accidental causes of death for women.

There is everything. When you take that same data, the largest study ever done, and you exclude the women who are older and only apply it to the women who are under 60? Yes. And within 10 years of menopause, guess what they find?

There is everything. When you take that same data, the largest study ever done, and you exclude the women who are older and only apply it to the women who are under 60? Yes. And within 10 years of menopause, guess what they find?

The same findings that we had from the observational study that the cumulative data says that if you start hormone therapy within 10 years of your last period or before age 60, you decrease the risk of cardiovascular disease by anywhere from 30 to 50%. Wow. Yeah, wow.

The same findings that we had from the observational study that the cumulative data says that if you start hormone therapy within 10 years of your last period or before age 60, you decrease the risk of cardiovascular disease by anywhere from 30 to 50%. Wow. Yeah, wow.

Yes.

Yes.

I would love to. The first stage that we're all familiar with is your premenopausal phase, and that really starts at puberty. And that encompasses your reproductive life, the peak reproductive years, which starts somewhere at 12, 13, and it goes to women when they're early 30s. That's premenopause. So when we're talking about that, that's the concern. Yes.

I would love to. The first stage that we're all familiar with is your premenopausal phase, and that really starts at puberty. And that encompasses your reproductive life, the peak reproductive years, which starts somewhere at 12, 13, and it goes to women when they're early 30s. That's premenopause. So when we're talking about that, that's the concern. Yes.

That is an excellent question because, as I said, that perimenopausal period is the part that is most confusing for women. Yes. But I would say this as a rule of thumb. If you are between the ages of 35 and 45 and you are having any one or any combination of those 34 symptoms that we associate with menopause, hot flashes, mood swings, sleeplessness, painful sex, irregular heavy periods, bloating,

That is an excellent question because, as I said, that perimenopausal period is the part that is most confusing for women. Yes. But I would say this as a rule of thumb. If you are between the ages of 35 and 45 and you are having any one or any combination of those 34 symptoms that we associate with menopause, hot flashes, mood swings, sleeplessness, painful sex, irregular heavy periods, bloating,

Brain fog. If you have any of those things in no particular order.

Brain fog. If you have any of those things in no particular order.

Yes. Then you are perimenopausal. Now, the question then becomes, well, I'm still having my period. And this is the part that really makes my head explode because there are still doctors out there who are saying, well, you're not menopausal yet because it hasn't been 12 months since your last period. Right. That's ridiculous. You should be treated when you are symptomatic.

Yes. Then you are perimenopausal. Now, the question then becomes, well, I'm still having my period. And this is the part that really makes my head explode because there are still doctors out there who are saying, well, you're not menopausal yet because it hasn't been 12 months since your last period. Right. That's ridiculous. You should be treated when you are symptomatic.

And no one can tell you when your symptoms are intolerable, but you know. And that's the point at which you should engage and ask someone to please fix this for me. And to be honest with you, we do know what the answer is. It's not like we're waiting to figure out for someone to discover something. It's hormone therapy in some form or fashion.

And no one can tell you when your symptoms are intolerable, but you know. And that's the point at which you should engage and ask someone to please fix this for me. And to be honest with you, we do know what the answer is. It's not like we're waiting to figure out for someone to discover something. It's hormone therapy in some form or fashion.

Then when you become perimenopausal, that is that amorphous phase between being your peak reproductive years and the end of your reproductive years. And the end of reproduction really starts at menopause. So there's this great space in between the perimenopausal years where you start to have some of the symptoms of menopause.

Then when you become perimenopausal, that is that amorphous phase between being your peak reproductive years and the end of your reproductive years. And the end of reproduction really starts at menopause. So there's this great space in between the perimenopausal years where you start to have some of the symptoms of menopause.

And we may use different types and different dosages for women who are perimenopausal than when they are after when they've had their 12 months of no period. The doses may change, the types may change, but the concept is still the same. You treat a hormonal issue. with hormones. And that's why we say hormone replacement.

And we may use different types and different dosages for women who are perimenopausal than when they are after when they've had their 12 months of no period. The doses may change, the types may change, but the concept is still the same. You treat a hormonal issue. with hormones. And that's why we say hormone replacement.

Some people don't like that phase, but I'm old, so I still say hormone replacement.

Some people don't like that phase, but I'm old, so I still say hormone replacement.

I've been on hormones for 15 years. And I knew exactly what was happening. And I was like, okay, well, that's enough of that. And just go right on. And I have no intention of stopping unless and until there's a reason, a medical reason why I should stop hormone therapy. But...

I've been on hormones for 15 years. And I knew exactly what was happening. And I was like, okay, well, that's enough of that. And just go right on. And I have no intention of stopping unless and until there's a reason, a medical reason why I should stop hormone therapy. But...

Right. When you are bothered, when you are either you find out that it's either affecting the quality of your life, the quality of your work, the quality of your relationships. When you reach that level, then that is the time that you should seek care. Right.

Right. When you are bothered, when you are either you find out that it's either affecting the quality of your life, the quality of your work, the quality of your relationships. When you reach that level, then that is the time that you should seek care. Right.

But here's the reality is, as we said, I say it over and over again, there are not enough doctors who are out there who know how to treat menopause and perimenopause. So what's a woman to do when you have read everything that you need to read and you are clear and you know exactly what's happening to you? And it's not uncommon for you to go to a doctor's office and the doctor will tell you,

But here's the reality is, as we said, I say it over and over again, there are not enough doctors who are out there who know how to treat menopause and perimenopause. So what's a woman to do when you have read everything that you need to read and you are clear and you know exactly what's happening to you? And it's not uncommon for you to go to a doctor's office and the doctor will tell you,

No, or I don't believe in hormones, which is not an uncommon thing.

No, or I don't believe in hormones, which is not an uncommon thing.

And that is really why when I left my private practice that I, you know, joined the women that I work with at Alloy Women's Health. Alloy, yes. Because what it is, is really giving women access who don't have access to doctors who know what they're doing.

And that is really why when I left my private practice that I, you know, joined the women that I work with at Alloy Women's Health. Alloy, yes. Because what it is, is really giving women access who don't have access to doctors who know what they're doing.

Or it's too expensive to go to those doctors because, you know, everyone should have access, in my mind, to the same quality care, whether you live in New York City or whether you live in New Mexico. It shouldn't matter. Or in Dyma. Absolutely. Exactly.

Or it's too expensive to go to those doctors because, you know, everyone should have access, in my mind, to the same quality care, whether you live in New York City or whether you live in New Mexico. It shouldn't matter. Or in Dyma. Absolutely. Exactly.

And, you know, and here's the other thing is that for people who are just sort of getting into this hormone therapy game, a lot of them don't have the experience of knowing what to do. So they give you the answer based on, okay, well, this is what it's supposed to do, but every person's different. Yes.

And, you know, and here's the other thing is that for people who are just sort of getting into this hormone therapy game, a lot of them don't have the experience of knowing what to do. So they give you the answer based on, okay, well, this is what it's supposed to do, but every person's different. Yes.

But you're still having your periods, sometimes regularly, sometimes not.

But you're still having your periods, sometimes regularly, sometimes not.

Yes, because sometimes for women, that's the... You're not in menopause until it has stopped. You are not in menopause officially until you have had your last period. And how do you know when you've had your last period? Well, you know you're in menopause when you've gone 12 full months and you've not had another period. Then it's official. You are menopausal.

Yes, because sometimes for women, that's the... You're not in menopause until it has stopped. You are not in menopause officially until you have had your last period. And how do you know when you've had your last period? Well, you know you're in menopause when you've gone 12 full months and you've not had another period. Then it's official. You are menopausal.

Thank you.

Thank you.

Thank you. Thank you. Thank you. Thank you. Thank you.

Thank you. Thank you. Thank you. Thank you. Thank you.

Thank you. Thank you.

Thank you. Thank you.

But what's confusing for women is that in-between state because it can start as early as your mid-30s. And it can go on until you've had your last period. And that can go on from anywhere from four to 10 years for women. And that's where I think a lot of the confusion comes in.

But what's confusing for women is that in-between state because it can start as early as your mid-30s. And it can go on until you've had your last period. And that can go on from anywhere from four to 10 years for women. And that's where I think a lot of the confusion comes in.

Because if you're having your period and having hot flashes, well, then you go to your doctor or you're having sleeplessness or... mood disturbances and you go to your doctor and the first question they ask you is, well, when was your last period? And if it was last month, they immediately get off the conversation of perimenopause or menopause.

Because if you're having your period and having hot flashes, well, then you go to your doctor or you're having sleeplessness or... mood disturbances and you go to your doctor and the first question they ask you is, well, when was your last period? And if it was last month, they immediately get off the conversation of perimenopause or menopause.

,,,,, It's not just annoying and they're not funny. They actually are harbingers sometimes of long-term health implications of menopause, such as increased risk for cardiovascular disease, such as increased risk for weight gain, for hypertension.

,,,,, It's not just annoying and they're not funny. They actually are harbingers sometimes of long-term health implications of menopause, such as increased risk for cardiovascular disease, such as increased risk for weight gain, for hypertension.

So all of the symptoms that we typically associate with menopause that people are familiar with, like hot flashes, mood swings, sleeplessness, painful sex can start in perimenopause. And women think of menopause as something that happens to old ladies. The average age is 51. But a 35-year-old having these symptoms is very much in that menopausal transition, that in-between state.

So all of the symptoms that we typically associate with menopause that people are familiar with, like hot flashes, mood swings, sleeplessness, painful sex can start in perimenopause. And women think of menopause as something that happens to old ladies. The average age is 51. But a 35-year-old having these symptoms is very much in that menopausal transition, that in-between state.

All of these long-term things that we talk about, a hot flash is sometimes the first signal to saying, hey, maybe you're at risk for these things, which again will affect not just the quality of your life in the short term, but in the long term. So that's why I say if you have them, treat them. And you don't get any bonus points for having endured them.

All of these long-term things that we talk about, a hot flash is sometimes the first signal to saying, hey, maybe you're at risk for these things, which again will affect not just the quality of your life in the short term, but in the long term. So that's why I say if you have them, treat them. And you don't get any bonus points for having endured them.

I think that is very important when we talk about Alzheimer's, what we know and what we think we know. And what we do know is that women are twice as likely to be diagnosed with Alzheimer's in their lifetime than men are. And the women who are more likely are women who have a female relative with Alzheimer's. It's not to mean that you will because it's very much a multifactorial process.

I think that is very important when we talk about Alzheimer's, what we know and what we think we know. And what we do know is that women are twice as likely to be diagnosed with Alzheimer's in their lifetime than men are. And the women who are more likely are women who have a female relative with Alzheimer's. It's not to mean that you will because it's very much a multifactorial process.

What we also know is that the same things that we tell you to do that decrease your risk of cardiovascular disease decrease your risk of Alzheimer's. So regular exercise, good night's sleep, cutting back on alcohol, don't smoke. And for goodness sake, watch your diet. Weight is important.

What we also know is that the same things that we tell you to do that decrease your risk of cardiovascular disease decrease your risk of Alzheimer's. So regular exercise, good night's sleep, cutting back on alcohol, don't smoke. And for goodness sake, watch your diet. Weight is important.

All of these things, just lifestyle, whether we're talking about heart disease prevention or Alzheimer's prevention, or whether we're talking about just the rules that you need to observe for healthy living and aging. So all of that.

All of these things, just lifestyle, whether we're talking about heart disease prevention or Alzheimer's prevention, or whether we're talking about just the rules that you need to observe for healthy living and aging. So all of that.

But what we do know, and I'll tell you what we know and what I think, there's a brilliant neuroscientist by the name of Dr. Lisa Moscone who has written a book called The Menopause Brain.

But what we do know, and I'll tell you what we know and what I think, there's a brilliant neuroscientist by the name of Dr. Lisa Moscone who has written a book called The Menopause Brain.

And what we know is that for women who have an early menopause, and early means you have had your last period before age 45, or it's a premature menopause if you've had your last period before 40, those women who do not get hormone replacement, because they are so young, are at increased risk for cardiovascular disease and Alzheimer's.

And what we know is that for women who have an early menopause, and early means you have had your last period before age 45, or it's a premature menopause if you've had your last period before 40, those women who do not get hormone replacement, because they are so young, are at increased risk for cardiovascular disease and Alzheimer's.

That could go on for another 10, 15 years. It can go on for another 10 years. And I think what is also confusing is that when women say, all right, so we've got premenopause, perimenopause, menopause, and postmenopause. And I don't really like the term postmenopause because it implies that at some point you're over it.

That could go on for another 10, 15 years. It can go on for another 10 years. And I think what is also confusing is that when women say, all right, so we've got premenopause, perimenopause, menopause, and postmenopause. And I don't really like the term postmenopause because it implies that at some point you're over it.

Now, do we know for a fact that estrogen therapy is a preventative measure for Alzheimer's? Maybe. That's where we need a lot more data on that.

Now, do we know for a fact that estrogen therapy is a preventative measure for Alzheimer's? Maybe. That's where we need a lot more data on that.

It certainly does.

It certainly does.

No, ma'am. No, ma'am. That is not a contraindication to HRT. It is not. And as a matter of fact, not only is it not a contraindication to HRT, to estrogen therapy, I should say, because you've had a hysterectomy. Remember I said you don't need the progestin. All you need is the estrogen. So, yes, you can have estrogen.

No, ma'am. No, ma'am. That is not a contraindication to HRT. It is not. And as a matter of fact, not only is it not a contraindication to HRT, to estrogen therapy, I should say, because you've had a hysterectomy. Remember I said you don't need the progestin. All you need is the estrogen. So, yes, you can have estrogen.

The only reasons, the only contraindications that we have for HRT are if you personally have breast cancer or an estrogen-dependent cancer such as endometrial cancer, if you have undiagnosed vaginal bleeding, if you currently have a heart attack, you, not a family history of a heart attack or stroke. or you have active liver disease.

The only reasons, the only contraindications that we have for HRT are if you personally have breast cancer or an estrogen-dependent cancer such as endometrial cancer, if you have undiagnosed vaginal bleeding, if you currently have a heart attack, you, not a family history of a heart attack or stroke. or you have active liver disease.

And the issue about blood clots is debatable, but we'll leave that aside for now. But that's it. Those are the only contraindications. So you might go back to your doctor and say, well... Or go to another doctor.

And the issue about blood clots is debatable, but we'll leave that aside for now. But that's it. Those are the only contraindications. So you might go back to your doctor and say, well... Or go to another doctor.

I honestly don't think that doctors are trying to do a bad job. I really don't, because I worked for... I don't think that they're trying to do a bad job.

I honestly don't think that doctors are trying to do a bad job. I really don't, because I worked for... I don't think that they're trying to do a bad job.

They don't know and they don't even know what they don't know. And they don't know what they don't know. And that's the problem is that you've got to keep current. And that's why I really would advocate that menopausal care and care of women in midlife should be separate and apart. from all the other things that OBGYNs have to do. It's a lot to keep up with.

They don't know and they don't even know what they don't know. And they don't know what they don't know. And that's the problem is that you've got to keep current. And that's why I really would advocate that menopausal care and care of women in midlife should be separate and apart. from all the other things that OBGYNs have to do. It's a lot to keep up with.

You know, you've got to do surgery and you've got to deliver babies and you've got to, you know, get birth control. But this phase of our life that we will spend anywhere from 30 to 40% of the rest of our lives in this menopausal phase deserves its own area of inquiry. We need more research. We meet more doctors who are knowledgeable about it because that's what they do. We deserve...

You know, you've got to do surgery and you've got to deliver babies and you've got to, you know, get birth control. But this phase of our life that we will spend anywhere from 30 to 40% of the rest of our lives in this menopausal phase deserves its own area of inquiry. We need more research. We meet more doctors who are knowledgeable about it because that's what they do. We deserve...

As women in midlife.

As women in midlife.

We deserve better and we deserve to have the attention paid to the issues that have historically not been paid attention to.

We deserve better and we deserve to have the attention paid to the issues that have historically not been paid attention to.

Because it is a celebration of a time of life where I think we should all look forward to. And I do say this in my book, Oprah. I said when people have a different vision of what that time of life is like, people think of it as, oh, I'm getting old or dread. But I mean this sincerely.

Because it is a celebration of a time of life where I think we should all look forward to. And I do say this in my book, Oprah. I said when people have a different vision of what that time of life is like, people think of it as, oh, I'm getting old or dread. But I mean this sincerely.

I mean, for people like Michelle Obama, Naomi Watts, you, Halle Berry, all the people, Gayle, who are out here showing young women what this phase of life looks like, it should be something that we look forward to because I don't know about you, but I am happier now At 66. For sure. Then I was at 46. So I look at people sometimes like, oh, don't feel sorry for me.

I mean, for people like Michelle Obama, Naomi Watts, you, Halle Berry, all the people, Gayle, who are out here showing young women what this phase of life looks like, it should be something that we look forward to because I don't know about you, but I am happier now At 66. For sure. Then I was at 46. So I look at people sometimes like, oh, don't feel sorry for me.

You're not over it.

You're not over it.

You're never over it. And people think that because your hot flashes stopped or you didn't have hot flashes that you didn't have menopause. And I'm saying, yes, you did.

You're never over it. And people think that because your hot flashes stopped or you didn't have hot flashes that you didn't have menopause. And I'm saying, yes, you did.

We deserve a celebration.

We deserve a celebration.

Yes, you did.

Yes, you did.

But there are other ways that women can go through menopause other than just the natural process that happens.

But there are other ways that women can go through menopause other than just the natural process that happens.

Absolutely no longer fertile. And sometimes it's not just the complete loss of eggs, it's the loss of function of your eggs. Because the other thing that happens that people don't talk enough about during perimenopause is that there's a change in your fertility.

Absolutely no longer fertile. And sometimes it's not just the complete loss of eggs, it's the loss of function of your eggs. Because the other thing that happens that people don't talk enough about during perimenopause is that there's a change in your fertility.

Because when you're perimenopausal, when you're 40, you still have eggs, you're still having your period, but your fertility is not what it was at 20. It's not what it was at 25. Because you've already lost eggs. It's not because you've lost them. It's because they are less responsive. Oh, they're less functional. They're less functional. And I'll give you an example.

Because when you're perimenopausal, when you're 40, you still have eggs, you're still having your period, but your fertility is not what it was at 20. It's not what it was at 25. Because you've already lost eggs. It's not because you've lost them. It's because they are less responsive. Oh, they're less functional. They're less functional. And I'll give you an example.

I like to say, you're born with all the eggs you're ever going to have. You don't get any more, you don't make any more. And then over time, you ovulate some, but you're not losing them because you've run out of them. You only ovulate about 500 times in your lifetime, but you had a million when you were born. Those eggs become less functional.

I like to say, you're born with all the eggs you're ever going to have. You don't get any more, you don't make any more. And then over time, you ovulate some, but you're not losing them because you've run out of them. You only ovulate about 500 times in your lifetime, but you had a million when you were born. Those eggs become less functional.

And every woman has a different expiration date stamped on your eggs. So you don't know, are my eggs going to last until I'm 45? Or are they going to expire when I'm 35? And that's why we start to see the fertility changes. And for each individual, when you reach the end of that road, it's going to be different from person to person.

And every woman has a different expiration date stamped on your eggs. So you don't know, are my eggs going to last until I'm 45? Or are they going to expire when I'm 35? And that's why we start to see the fertility changes. And for each individual, when you reach the end of that road, it's going to be different from person to person.

Yes, hormone replacement therapy, typically it is comprised of estrogen, which is the secret sauce in hormone replacement therapy, and a progestin, which is the second hormone that you take when you have an intact uterus. Now, for women who've had hysterectomies and don't need to have the progestin, you can just take estrogen alone.

Yes, hormone replacement therapy, typically it is comprised of estrogen, which is the secret sauce in hormone replacement therapy, and a progestin, which is the second hormone that you take when you have an intact uterus. Now, for women who've had hysterectomies and don't need to have the progestin, you can just take estrogen alone.

But most of what we associate with the symptomatic relief really comes from the estrogen component.

But most of what we associate with the symptomatic relief really comes from the estrogen component.

Yes, they are. But all of the studies that have been done really basically are with estrogen and progestin. We are sort of behind the curve. We're finding out a lot more about testosterone because women make testosterone too. And I think that that's sort of the misconception is that, well... Estrogen is a female hormone and testosterone is a male hormone. And that is not true.

Yes, they are. But all of the studies that have been done really basically are with estrogen and progestin. We are sort of behind the curve. We're finding out a lot more about testosterone because women make testosterone too. And I think that that's sort of the misconception is that, well... Estrogen is a female hormone and testosterone is a male hormone. And that is not true.

Women make almost as much testosterone in the course of our reproductive lives as we make estrogen. That's really responsible for that sex drive that you get right around mid-cycle. So we're coming back around to understanding that maybe there should be more to hormone replacement therapy than just estrogen and progestin. But we need a lot more studies about that.

Women make almost as much testosterone in the course of our reproductive lives as we make estrogen. That's really responsible for that sex drive that you get right around mid-cycle. So we're coming back around to understanding that maybe there should be more to hormone replacement therapy than just estrogen and progestin. But we need a lot more studies about that.

No, you can be treated with menopausal hormone therapy.

There is this study of women across the nation where they looked at women, different ethnic groups, and they found that Black women tend to go through menopause earlier, their symptoms are more severe, and they last longer. So obviously, if you're going to go through menopause earlier, that means that parents

Perimenopause starts earlier because back that up 10 years, if you're going to be menopausal at 45, then you were perimenopausal at 35. Yes. One of the things that I always tell young women, particularly when they're concerned about what does this mean in terms of childbearing and will I be able to have a baby or not?

First thing is know your family history because I think you should talk to your mother because at 35, if you talk to your, you say, mom, when did you go through menopause?

If she remembers and she shares that information, if she tells you you were menopausal, she was menopausal at 42, well, then that has some bearing for you because at 35, you are more likely to be perimenopausal and to maybe have some fertility challenges more than someone whose mother had menopause at 55. Do you see what I mean?

So yes, it has a direct implication on when your symptoms start, but what to do about it. And let me say, we have more options now than we have ever had, because this is a situation if you say, I'm not ready to have a baby right now at 35. I may not have even identified a partner at 35. then this is where we can use technology.

Egg freezing might be something that you would do because it at least preserves that possibility for you that if you just wait, then time will make that decision for you rather than you making that decision for yourself.

You know, I'm not really sure what to make of the fact that women are starting to experience symptoms earlier, but I think that stress is certainly a factor. I think that how we live, you know, the... environment that we're in. You know, who knows? Maybe it is some of the endocrine disrupting chemicals that women are exposed to that are causing this.

Oh my, where to begin with that one? You're on at least three different medications, right? You've got progesterone, you've got something for anxiety, something for sleep. If we know that it's all perimenopause, then why don't we treat the perimenopause, which is with hormones? Estrogen is the common denominator of all the symptoms that you have there.

And this is not uncommon during perimenopause where women will say, okay, well, I need something for sleep and then I'm depressed and I need something for this. And by the time you look at it, you're on five different medications for your five different symptoms and still haven't adequately solved the problem. And I think that the first go-to ought to be able to say, it's perimenopause.

Let's go to the most effective treatment for the symptoms of menopause and perimenopause, which is estrogen therapy. And don't be afraid of that unless there is a reason that I don't know why you should not.

Well, let me say that there is a different way that we give estrogen for women who are perimenopausal. I've said all the time that in perimenopause, your estrogen levels aren't consistently low. Sometimes they're too high. Sometimes they're too low and everything in between and in no particular order.

So what works well for women who don't, you know, who are having these persistently high estrogens? You know what you do?

You use a low-dose birth control pill, just a plain old oral contraceptive, because what it does is that it shuts down all that extraneous estrogen production in your ovaries, and it will give you back what you need to quiet your ovaries and give you enough estrogen and progestin

So what you're doing is that you're tamping down all that background noise and just giving back the estrogen as you need it. And you can take birth control pills every day. And when I say every day, you don't even have to stop them to have your period. You can just go straight through.

So it is a very interesting area that needs to be explored further because we are aging ourselves faster than I think that we should be given this day and time.

You're like, I would prefer not to be off the pill for a week, a month, because your symptoms will come back when you're off your estrogen. Birth control pills is a very easy way that we use commonly for women in perimenopause, particularly when one of the other symptoms in perimenopause tends to be irregular bleeding or sometimes the bleeding is too heavy or you need birth control.

In those instances, a birth control pill, a low-dose birth control pill works better because you are getting cycle control and you're also controlling your symptoms and you get birth control. So very commonly to stay on that.

And then once you're finally menopausal, which who knows, maybe five, six years from now, then that's when we make the transition from birth control pills to menopausal hormone therapy. But I don't want you to think that those are two things that are separate and apart. Birth control pills have estrogen and progestin in them.

It's a different estrogen than what we take in menopause, and it's in different amounts. There's more of it when you're perimenopausal.

I'm going to say, Dr. Malone told me. Do that, do that. There's a whole section in there on that. It is true. But that is, again... Oprah, we get back to our same access problem, finding doctors who understand the subtleties of how to treat. Because yes, can you take the levels of menopausal hormone therapy when you're perimenopausal?

Yes, you can, but not if you need birth control, not if you have bleeding problems because there's not enough menopausal. estrogen in the menopausal hormone therapy to control those other symptoms. It may take care of your hot flashes, but it's not going to take care of the other things. So don't be afraid of using the type of estrogen that is appropriate for what your symptoms are.

And once you get to cross that line in your menopausal, then we can switch it up and go back to menopausal hormone therapy.

Why the weight gain? You know, that is one of the most common complaints that women come in with when the perimenopausal phase, when they start gaining the weight. And they're like, what is going on? I'm eating the same thing. I'm exercising the same way. And I've gained 10 pounds just for breathing. And I believe you because, you know, I've been through that myself.

I, too, no longer weigh what I weighed 20 years ago. But the key to this is to understand what is happening to your metabolism and what is happening as your estrogen levels fall. Well, whether you have symptoms or not, and now you're having hot flashes, but let me just sort of walk you through the cascade of events that happens. Your estrogen levels fall.

One thing that happens is that your body composition changes. So even when you don't gain a pound, and most people do, but even when you don't gain weight, you tend to lose muscle and you put on fat. And so that weight gets redistributed. Yeah. And now it's like, why do I have this belly fat? Why are my boobs bigger?

That's also happening because that's just deposition of body fat. That's a response to the lack of estrogen. So that's one. You have hot flashes, night sweats. You can't sleep. Sleeplessness and hot flashes lead to fatigue. It increases your blood pressure. Women who are estrogen, when their estrogen level is low.

Oh, absolutely. And it also increases insulin resistance so more people will start to develop type 2 diabetes after menopause. So guess what happens when you're irritable, you're tired? Guess what you're not going to do the next day? exercise. Now you're fatigued. Now you've got more fat and less muscle. So everything that you eat, you don't have... Muscle is more metabolically active than fat.

So it just continues to make more fat. And then the more depressed you are, and guess what happens when you are depressed and you're tired? You make bad choices the next day. You're not going to exercise. You're like, I know exactly what this feels like because as a resident, when I would be up all night... Yeah, I'd be up all night.

And you make bad choices about what you eat, what you drink, what your behaviors are. So it's a really complicated system, but it all goes together. And it happens to women, I would say, nine times out of 10. This is the complaint.

Well, knowing what you know now, I can say this. The better health you are in leading into this perimenopause and menopausal phase, the better you are going to be able to endure it. It won't say that you won't eliminate the need for medications, but the healthier you are coming into it, the better you're going to weather this process.

But I would say as a young woman who is watching her mother go through this, the one thing you can do is give her a little grace and understand that, you know, your mother's not maybe, she's not snapping at you because of something you did. It may be the day and you just have to sometimes maybe go up to your mom and give her a hug and say, hey, mom, I understand this may be a bad day for you today.

And sometimes it may be something you did now, so I'm going to let you distinguish between the two. But just understand that your mom has a whole lot less tolerance for the stuff that you do now than she may have had 10 years ago.

That's exactly right. You know, I was thinking, Oprah, when I got to the end of my career after practicing for 30 years, and when I decided it was time to stop doing that, I had no idea what the next chapter was going to be, but I knew I was done with that. And... I created a whole new life for myself after 60. I mean, I wrote my book when I was 62 years old.

I'm going to say this, and this will surprise no one. I don't know how you are, but I know how I am. But I can tell you from personal experience that sex at 60 is not sex at 25. It's different. And you just accept that different does not mean worse. Now, I didn't say this. So there are two things that you need to understand that are happening hormonally.

What's happening with your estrogen and the lack of estrogen after menopause is really responsible for things like vaginal pain. dryness, the discomfort. Now, it stands to reason that if sex is painful, you don't want to have it. You know, we are all sort of, you know, we're programmed to avoid pain and go towards pleasure, right?

So the first part of what we need to do is to eliminate those barriers that are causing the discomfort. And vaginal estrogen is a great place to go at vaginal estradiol. And the estrogen in the vaginal estrogen is so low, it doesn't get absorbed systemically such that you don't need to take a progestin if you are just using vaginal estrogen. Sometimes that's enough.

And you can say, well, look at that. I'm not in pain. You know, this isn't difficult. I'm not getting a urinary tract infection every time I have sex. I'm not avoiding it the way that I would. There is also the issue of testosterone.

And testosterone has been, you know, we talk about it a lot, but it's not readily accessible for most people because there is no FDA-approved version of testosterone that women can take. There is one for men, but not for women. So that would involve, you know, after you have taken care of the pain and discomfort issues and you say, it's still not where I want it. Pain, discomfort, dryness.

And, you know, you need a good lube. And then you say, well, okay, well, then maybe testosterone might be appropriate for you for treating just what we call the hypoactive sexual disorder, okay? That's one.

I'm not thinking about sex. I don't want it. But here's another. I want to give you another frame for how to think about sex after 50 or sex after 60. Most women, once you eliminate their discomfort. OK, so we've taken that off. You're treated and you're fine.

I have, you know, a new career really taking the message of menopause and women's health outside of just the office when you're just talking to people one-on-one. There are only so many people you can get to. That's right. But to be able to take that message and to amplify it and to get out. Doesn't it feel like your life kind of blew up? Oh, absolutely. Absolutely.

most women will find that there's a difference in your desire, where there's a difference between spontaneous desire, where I'm just sitting here and, oh, I can't wait to go for my husband to come home or my partner to come home and have sex. But there is what changes as we age, it's more responsive desire. And by that, I mean, I called it the build it, they will come theory.

And that is, I wasn't thinking about sex, but if you bring it up, and I'm going to say this to you, Husband Remember when you used to date your wife before you were obligated? Raymond, remember those days?

Then you create the scenario by which your wife would be responsive to you. And most women will find under that circumstance is like, well, I wasn't thinking about it, but look at that. You put the dishes in the dishwasher and you came over and you were nice to me. All of those things that will make her more receptive. when you initiate.

So there is a lot, it's more complicated and that is also, that will get you in the right space. Novelty is important. You can't do the same things over and over and over again and expect anybody to get excited. That's just, it doesn't matter what you're talking about. Once you've done it a million times, you're not going to get the same response.

So novelty, role-playing, sometimes you need a sexual therapist. But let me say this, what's really important, and I go back to for women, There's also a problem with arousal. And there is also the problem with inability to have an orgasm just because, you know, things are just less responsive. And to that, I would say, be playful. Invest. If you don't have one, get yourself a good vibrator.

There are lots of good lubes you can use. At Alloy, we have a cream called Omazing, which is actually a cream that's topical sildenafil, which is the same thing as topical Viagra, but it's for women. It's the same. So it's a cream that you use externally and it increases arousal. So, you know, you realize it's, yeah, it's going to require some potions. It's called O-mazing.

I should have branded that. O-mazing. Exactly.

You know what? You're absolutely right. You can be our spokesperson. O-mazing.

And that's what I want to tell young women. Don't think that you need to know everything that's going to happen to you and to your life when you're 30 years old. You will have many chapters. And I want them to be encouraged by looking at people like you and Gail and Michelle and all these wonderful women who are out there recreating a life that they want to live. And we're doing it on our terms.

The one message that I really want women to have is this, is that menopause is inevitable, suffering is not. And I think that every woman has a line drawn somewhere in the sand between what's tolerable and what's not. You don't let someone else tell you how you feel or how you're supposed to feel. If you are bothered...

If you are having any one of those 34 symptoms in any particular order or if you're not having those symptoms and you're at risk for things like cardiovascular disease or osteoporosis, you need to educate yourself and advocate for yourself because that's a big message that I want women to get is that don't be passive. sort of participants in your own life, in your own health.

You have way more power than you think. You just don't know how to exercise it. And so my book and my message and my mission is to make sure that women have all the information they need to be able to make good decisions for themselves and for their families.

I think this is something that should reassure you because only about 1% of women will actually go through menopause before age 40. So that's very uncommon. So it has to be some other circumstances. Sometimes, though, we're seeing a lot of young women who are diagnosed with cancer. We're seeing a lot more breast cancers in young women. in their 20s and 30s even.

And so sometimes it's a result of chemotherapy. But I think that you should take some comfort from the fact that it's unlikely. And if you are having problems with either with your menstrual cycle or with mood or rage, sometimes you have to take a step back and go, Well, sometimes you're mad and you have a reason to be mad. You know, you have to look at what was your day.

But what happens when you're perimenopausal, the symptoms are more persistent and pervasive when there's no reason why you should be having those symptoms. You see, you know what I mean?

hot flashes, depression, anxiety, vaginal dryness, changes in libido, frequent urinary tract infections. There's a lot of overlap between things that young women can experience and things that perimenopausal women experience. But I think so you could take a look at it and say how much of this is due to the situation.

And how much am I sitting here and I'm depressed or I'm having these issues when there's no apparent reason? It should at least raise a flag for you. But for younger women, you really, before you jump to just this might be perimenopausal, I think you should look at things like there are other things such as what's called PMDD, which is premenstrual dysfunction, which is basically PMS.

And that's not, so young women can have all those symptoms, but they only happen.

But that is the natural fall in your hormones that happens with a normal menstrual cycle that happens. But if you say, is this consistently happening the week before my period? yes or no, then that's probably more likely to be PMDD.

There are other situations, what's called polycystic ovarian syndrome, which is PCOS, where women can start to have, again, irregular periods that, you know, that you can have periods twice a year and you think, oh my God, am I going through menopause? Well, these are things that can be easily ruled out. So as younger women, yes, can you have some of those symptoms? Is it an overlap?

But I think one of the things that young women tend to show up with sometimes, and that is infertility. That's the thing about... perimenopause and this menopausal transition. And again, as I said, you don't know when your ovaries are going to expire. Every person has a different end date on that. And sometimes it's the delay in getting pregnant that is the first sign that things are going wrong.

Yeah.

You don't know when your ovaries are going to expire. Every person has a different end date on that.

Endometriosis can be a very debilitating condition for women where normally the endometrial tissue or the tissue that lines your uterus, that is what gets stimulated every month and then you slough it if you don't get pregnant. That's what your period really comes from, the stimulation and actually elimination of that tissue. Well, that works fine if that tissue is in the lining of your uterus.

It has a way out. But if that tissue is on your ovaries or it's on your bowel or it's in other places that has no exit, then that can be very painful because the same process, it gets stimulated every month with your cycle, but it has nowhere to go. Got it. So it actually, it can be on your bladder, your bowel, and it causes pain. It can cause infertility.

If it's on your ovaries, it causes scarring. And women who have endometriosis often...

have suffered for years before they get an adequate diagnosis about what's going on because pain is a hard thing to you can't see it all the time and you know they'll go get a scan or a sonogram and they go well it looks normal and you have no idea but they say i'm in pain i'm in pain the average woman with endometriosis has gone to the ER five to seven times for relief of their pain.

And this gets back to not believing women. And there's also this trope that we have been taught is that endometriosis is a disease of thin white women. So again, when you are complaining of the, I have pain, I have pain with sex, I have pain when I'm having a bowel movement or urinary issues, they're not thinking about that because their image of who they think has endometriosis may not be you.

And that's why there's often a delay in diagnosis with endometriosis. Yeah, it took three years. Yeah, it took three years. And that is... Typical, to be quite honest with you.

But endometriosis in and of itself... We don't know that that is going to alter the course of menopause for you. Not necessarily. It may not come earlier. It's going to come when it comes. But what happens for a lot of women with endometriosis, they end up going through menopause prematurely because once your symptoms have gotten to be so severe... And you've tried medication for it.

Sometimes we try birth control pills. Actually, one of the medications that we use to sort of keep endometriosis at bay is actually a medication that puts you in menopause. Which is? Lupron. It's a Lupron, it's a shot, and now there's a newer pill that you can do. But basically what it does, it shuts your ovaries down.

So that cycling and all that stuff that's going on in your body, it just goes away. Well, it's great. It helps with your endometriosis, but it gives you menopausal symptoms.

That's where menopause and the endometriosis connection comes in. And also for young women who have endometriosis, once the symptoms get to be so bad and you've tried all those medical management things, and you may even try surgery to go in and remove some of the endometrial tissue, but if it comes back, often the definitive treatment for endometriosis is... A hysterectomy.

And it's a hysterectomy with removal of the ovaries. Which means now you're going into menopause. Now you're in menopause forever. So that's sort of the endometriosis, you know, menopause connection. Either some of the medications that you're on will throw you in menopause temporarily. And or if that's not working, then you're having a surgical menopause. And this can happen again for young women.

They may be in their 30s and 40s. And that's devastating from a lot of different standpoints.

And just symptom relief. But... The one thing I want you to understand is because once you get to menopause, if that is the route that ultimately you're on and it ends up with the hysterectomy, you can be treated with menopausal hormone therapy. That does not mean that, oh, I'm 35 years old, I've had a hysterectomy and my overs are out, so I just must endure.

You know, it used to be. And let me say, because, you know, I'm in the old group of people. And, you know, the study that really changed everything in 2002, the Women's Health Initiative, really did an about face on the conversation about menopause. Because let me just say, women have been going through menopause for as long as we've been alive. Yes.

The only thing that's changed historically is that more of us are living long enough to get to this phase of life. But women have complained about menopause forever. But it was thought to be, you know, women just being hysterical with the symptoms or you're losing your mind. Women would go to sanitariums at that point because of the mental illness and the mental distress that it caused women.

But we have known how to treat the symptoms of menopause since 1942. That was when the first estrogen product was introduced. That was Primarin. And so women have been using hormones since 1942, those who had access and the awareness of it. But it really changed everything. In 2002. In 2002. Okay. I was taught about menopause and what to do about it.

And then from 2002 on, doctors who were trained didn't really get that information.

Right. You know, even for the women who are out there who are currently going through menopause, they haven't heard this conversation. And there's another 6,000 women every day going into menopause. And so the backfill is constant because there are people that just haven't had this conversation, not with their doctors, not with their mothers, and not even with their friends.

Exactly. In a nutshell, you know, as I told you, 1942, we've been treating women who were symptomatic during menopause, typically the hot flashes and the mood swings, with an estrogen product. It worked. So as we sort of got more women who were taking hormones, we found that there were some tweaks that need to be made along the way and added the progestin component to it.

Because remember, estrogen and progestin go together.

So we knew that it treated the symptoms of menopause. That wasn't new news. But what we found was that there was a nurse's study where they just looked at a group of healthy nurses, young women, and watched them through menopause. And what they found is that the women who took estrogen therapy or HRT had half the risk of heart disease than women who didn't, the nurses who didn't take hormones.

So imagine now the thought was, okay, we're not only relieving the symptoms, but we are actually decreasing the risk of cardiovascular disease by 50%. Well, that would be a blockbuster, right? But you couldn't prove it because it was just an observational study. So the Women's Health Initiative that was really initiated in 1991, the purpose of it was to sort of solidify that finding.

Does hormone therapy really reduce the risk of cardiovascular disease by 50%? That was the central question. So we do a study, largest study ever in the history of NIH, specifically for women. So they recruited women in that study that were anywhere from 50 to 79 years old. The majority of the women, 90% of the women were over age 55.

So it's not surprising that when they looked at the women, they said, well, there's really no difference here. We don't see any improvement in the cardiovascular. It was like the same whether you took it or not because they were starting it on women who were too old. So that was problem number one with the study design.

The second part was that when they were looking, they said, well, let's have some safety stops. Let's make sure that women aren't having an increase in breast cancer because of this estrogen, because that was a thought.

So when they got to about five years in the study and they looked into the data to see how is this coming, there was this dramatic press conference that they held because not only did they not see the expected decrease in cardiovascular disease, but they saw a slight increased risk in breast cancer. From these 60 to 79-year-old women.

From these women who were on average 63 years old, more than 10 years after menopause. So when you hold a press conference, and it's dramatic, and they stop the study, hold the presses, and they say... Not only does hormone therapy not improve your cardiac profile, it increases the risk of breast cancer. And when they said that, I mean, women who were taking hormones happily... Abandoned them.

It was a very much misinterpreted study because if you had said, I don't disagree, okay, your data is your data. If you start women on hormone therapy later in life, you're not going to prevent their heart disease. I think that's probably true. The problem is that they generalize that data to everybody. Well, what about a 50-year-old?

Well, what about if I start it when I'm 45, whenever I'm menopausal? Because that's when we clinically would start it. Yes, yes, yes. That's a very different outcome. And that was the misinterpretation of taking very limited findings and applying it to everyone.

It has been, when you say the words breast cancer... to women, I think that is their number one fear, is breast cancer, despite the fact that the number one cause of deaths in women is cardiovascular disease. It is more than all cancers combined and all accidental causes of death for women.

There is everything. When you take that same data, the largest study ever done, and you exclude the women who are older and only apply it to the women who are under 60? Yes. And within 10 years of menopause, guess what they find?

The same findings that we had from the observational study that the cumulative data says that if you start hormone therapy within 10 years of your last period or before age 60, you decrease the risk of cardiovascular disease by anywhere from 30 to 50%. Wow. Yeah, wow.

Yes.

I would love to. The first stage that we're all familiar with is your premenopausal phase, and that really starts at puberty. And that encompasses your reproductive life, the peak reproductive years, which starts somewhere at 12, 13, and it goes to women when they're early 30s. That's premenopause. So when we're talking about that, that's the concern. Yes.

That is an excellent question because, as I said, that perimenopausal period is the part that is most confusing for women. Yes. But I would say this as a rule of thumb. If you are between the ages of 35 and 45 and you are having any one or any combination of those 34 symptoms that we associate with menopause, hot flashes, mood swings, sleeplessness, painful sex, irregular heavy periods, bloating,

Brain fog. If you have any of those things in no particular order.

Yes. Then you are perimenopausal. Now, the question then becomes, well, I'm still having my period. And this is the part that really makes my head explode because there are still doctors out there who are saying, well, you're not menopausal yet because it hasn't been 12 months since your last period. Right. That's ridiculous. You should be treated when you are symptomatic.

And no one can tell you when your symptoms are intolerable, but you know. And that's the point at which you should engage and ask someone to please fix this for me. And to be honest with you, we do know what the answer is. It's not like we're waiting to figure out for someone to discover something. It's hormone therapy in some form or fashion.

Then when you become perimenopausal, that is that amorphous phase between being your peak reproductive years and the end of your reproductive years. And the end of reproduction really starts at menopause. So there's this great space in between the perimenopausal years where you start to have some of the symptoms of menopause.

And we may use different types and different dosages for women who are perimenopausal than when they are after when they've had their 12 months of no period. The doses may change, the types may change, but the concept is still the same. You treat a hormonal issue. with hormones. And that's why we say hormone replacement.

Some people don't like that phase, but I'm old, so I still say hormone replacement.

I've been on hormones for 15 years. And I knew exactly what was happening. And I was like, okay, well, that's enough of that. And just go right on. And I have no intention of stopping unless and until there's a reason, a medical reason why I should stop hormone therapy. But...

Right. When you are bothered, when you are either you find out that it's either affecting the quality of your life, the quality of your work, the quality of your relationships. When you reach that level, then that is the time that you should seek care. Right.

But here's the reality is, as we said, I say it over and over again, there are not enough doctors who are out there who know how to treat menopause and perimenopause. So what's a woman to do when you have read everything that you need to read and you are clear and you know exactly what's happening to you? And it's not uncommon for you to go to a doctor's office and the doctor will tell you,

No, or I don't believe in hormones, which is not an uncommon thing.

And that is really why when I left my private practice that I, you know, joined the women that I work with at Alloy Women's Health. Alloy, yes. Because what it is, is really giving women access who don't have access to doctors who know what they're doing.

Or it's too expensive to go to those doctors because, you know, everyone should have access, in my mind, to the same quality care, whether you live in New York City or whether you live in New Mexico. It shouldn't matter. Or in Dyma. Absolutely. Exactly.

And, you know, and here's the other thing is that for people who are just sort of getting into this hormone therapy game, a lot of them don't have the experience of knowing what to do. So they give you the answer based on, okay, well, this is what it's supposed to do, but every person's different. Yes.

But you're still having your periods, sometimes regularly, sometimes not.

Yes, because sometimes for women, that's the... You're not in menopause until it has stopped. You are not in menopause officially until you have had your last period. And how do you know when you've had your last period? Well, you know you're in menopause when you've gone 12 full months and you've not had another period. Then it's official. You are menopausal.

Thank you.

Thank you. Thank you. Thank you. Thank you. Thank you.

Thank you. Thank you.

But what's confusing for women is that in-between state because it can start as early as your mid-30s. And it can go on until you've had your last period. And that can go on from anywhere from four to 10 years for women. And that's where I think a lot of the confusion comes in.

Because if you're having your period and having hot flashes, well, then you go to your doctor or you're having sleeplessness or... mood disturbances and you go to your doctor and the first question they ask you is, well, when was your last period? And if it was last month, they immediately get off the conversation of perimenopause or menopause.

,,,,, It's not just annoying and they're not funny. They actually are harbingers sometimes of long-term health implications of menopause, such as increased risk for cardiovascular disease, such as increased risk for weight gain, for hypertension.

So all of the symptoms that we typically associate with menopause that people are familiar with, like hot flashes, mood swings, sleeplessness, painful sex can start in perimenopause. And women think of menopause as something that happens to old ladies. The average age is 51. But a 35-year-old having these symptoms is very much in that menopausal transition, that in-between state.

All of these long-term things that we talk about, a hot flash is sometimes the first signal to saying, hey, maybe you're at risk for these things, which again will affect not just the quality of your life in the short term, but in the long term. So that's why I say if you have them, treat them. And you don't get any bonus points for having endured them.

I think that is very important when we talk about Alzheimer's, what we know and what we think we know. And what we do know is that women are twice as likely to be diagnosed with Alzheimer's in their lifetime than men are. And the women who are more likely are women who have a female relative with Alzheimer's. It's not to mean that you will because it's very much a multifactorial process.

What we also know is that the same things that we tell you to do that decrease your risk of cardiovascular disease decrease your risk of Alzheimer's. So regular exercise, good night's sleep, cutting back on alcohol, don't smoke. And for goodness sake, watch your diet. Weight is important.

All of these things, just lifestyle, whether we're talking about heart disease prevention or Alzheimer's prevention, or whether we're talking about just the rules that you need to observe for healthy living and aging. So all of that.

But what we do know, and I'll tell you what we know and what I think, there's a brilliant neuroscientist by the name of Dr. Lisa Moscone who has written a book called The Menopause Brain.

And what we know is that for women who have an early menopause, and early means you have had your last period before age 45, or it's a premature menopause if you've had your last period before 40, those women who do not get hormone replacement, because they are so young, are at increased risk for cardiovascular disease and Alzheimer's.

That could go on for another 10, 15 years. It can go on for another 10 years. And I think what is also confusing is that when women say, all right, so we've got premenopause, perimenopause, menopause, and postmenopause. And I don't really like the term postmenopause because it implies that at some point you're over it.

Now, do we know for a fact that estrogen therapy is a preventative measure for Alzheimer's? Maybe. That's where we need a lot more data on that.

It certainly does.

No, ma'am. No, ma'am. That is not a contraindication to HRT. It is not. And as a matter of fact, not only is it not a contraindication to HRT, to estrogen therapy, I should say, because you've had a hysterectomy. Remember I said you don't need the progestin. All you need is the estrogen. So, yes, you can have estrogen.

The only reasons, the only contraindications that we have for HRT are if you personally have breast cancer or an estrogen-dependent cancer such as endometrial cancer, if you have undiagnosed vaginal bleeding, if you currently have a heart attack, you, not a family history of a heart attack or stroke. or you have active liver disease.

And the issue about blood clots is debatable, but we'll leave that aside for now. But that's it. Those are the only contraindications. So you might go back to your doctor and say, well... Or go to another doctor.

I honestly don't think that doctors are trying to do a bad job. I really don't, because I worked for... I don't think that they're trying to do a bad job.

They don't know and they don't even know what they don't know. And they don't know what they don't know. And that's the problem is that you've got to keep current. And that's why I really would advocate that menopausal care and care of women in midlife should be separate and apart. from all the other things that OBGYNs have to do. It's a lot to keep up with.

You know, you've got to do surgery and you've got to deliver babies and you've got to, you know, get birth control. But this phase of our life that we will spend anywhere from 30 to 40% of the rest of our lives in this menopausal phase deserves its own area of inquiry. We need more research. We meet more doctors who are knowledgeable about it because that's what they do. We deserve...

As women in midlife.

We deserve better and we deserve to have the attention paid to the issues that have historically not been paid attention to.

Because it is a celebration of a time of life where I think we should all look forward to. And I do say this in my book, Oprah. I said when people have a different vision of what that time of life is like, people think of it as, oh, I'm getting old or dread. But I mean this sincerely.

I mean, for people like Michelle Obama, Naomi Watts, you, Halle Berry, all the people, Gayle, who are out here showing young women what this phase of life looks like, it should be something that we look forward to because I don't know about you, but I am happier now At 66. For sure. Then I was at 46. So I look at people sometimes like, oh, don't feel sorry for me.

You're not over it.

You're never over it. And people think that because your hot flashes stopped or you didn't have hot flashes that you didn't have menopause. And I'm saying, yes, you did.

We deserve a celebration.

Yes, you did.

But there are other ways that women can go through menopause other than just the natural process that happens.

Absolutely no longer fertile. And sometimes it's not just the complete loss of eggs, it's the loss of function of your eggs. Because the other thing that happens that people don't talk enough about during perimenopause is that there's a change in your fertility.

Because when you're perimenopausal, when you're 40, you still have eggs, you're still having your period, but your fertility is not what it was at 20. It's not what it was at 25. Because you've already lost eggs. It's not because you've lost them. It's because they are less responsive. Oh, they're less functional. They're less functional. And I'll give you an example.

I like to say, you're born with all the eggs you're ever going to have. You don't get any more, you don't make any more. And then over time, you ovulate some, but you're not losing them because you've run out of them. You only ovulate about 500 times in your lifetime, but you had a million when you were born. Those eggs become less functional.

And every woman has a different expiration date stamped on your eggs. So you don't know, are my eggs going to last until I'm 45? Or are they going to expire when I'm 35? And that's why we start to see the fertility changes. And for each individual, when you reach the end of that road, it's going to be different from person to person.

Yes, hormone replacement therapy, typically it is comprised of estrogen, which is the secret sauce in hormone replacement therapy, and a progestin, which is the second hormone that you take when you have an intact uterus. Now, for women who've had hysterectomies and don't need to have the progestin, you can just take estrogen alone.

But most of what we associate with the symptomatic relief really comes from the estrogen component.

Yes, they are. But all of the studies that have been done really basically are with estrogen and progestin. We are sort of behind the curve. We're finding out a lot more about testosterone because women make testosterone too. And I think that that's sort of the misconception is that, well... Estrogen is a female hormone and testosterone is a male hormone. And that is not true.

Women make almost as much testosterone in the course of our reproductive lives as we make estrogen. That's really responsible for that sex drive that you get right around mid-cycle. So we're coming back around to understanding that maybe there should be more to hormone replacement therapy than just estrogen and progestin. But we need a lot more studies about that.

Das ist wirklich ein Gesundheitsproblem, das wir beantworten müssen. Und ob oder nicht Sie systemische Hormone auswählen, von denen wir geredet haben, kann jede Frau vaginale Estrogen benutzen. Sie behält die Integrität der Vagina, schlägt auf Urinär-Traktinfektionen und all diese anderen unbedeutenden Dinge, die mit dem Alter passieren.

Das ist wirklich ein Gesundheitsproblem, das wir beantworten müssen. Und ob oder nicht Sie systemische Hormone auswählen, von denen wir geredet haben, kann jede Frau vaginale Estrogen benutzen. Sie behält die Integrität der Vagina, schlägt auf Urinär-Traktinfektionen und all diese anderen unbedeutenden Dinge, die mit dem Alter passieren.

So, I want to make it clear, because I still use the old term. I say hormone replacement therapy. I don't think replacement is a bad word, but obviously someone objected to it. Sharon tells it like it is, and that's what I love about it. I'm like, what's wrong with that? I don't have a problem. But hormone replacement therapy, menopausal hormone therapy, same, same.

So, I want to make it clear, because I still use the old term. I say hormone replacement therapy. I don't think replacement is a bad word, but obviously someone objected to it. Sharon tells it like it is, and that's what I love about it. I'm like, what's wrong with that? I don't have a problem. But hormone replacement therapy, menopausal hormone therapy, same, same.

Und all it means is that when you reach either perimenopause or menopause, then you are using hormones to treat hormonal problems. And, you know, because we know in menopause, it is really defined by a persistently low lack of estrogen and lack of ovulation in the fertility forever or not.

Und all it means is that when you reach either perimenopause or menopause, then you are using hormones to treat hormonal problems. And, you know, because we know in menopause, it is really defined by a persistently low lack of estrogen and lack of ovulation in the fertility forever or not.