Mayim Bialik's Breakdown - The Truth About Hormone Replacement for Menopause. You Don't Have to Suffer. Treat Symptoms & Achieve Hormonal Stability Before it's Too Late! -- Dr. Sharon Malone

Episode Date: November 26, 2024

You're likely NOT getting this information from your doctor.    Top Menopause Doctor, Dr. Sharon Malone (OB/GYN, Certified Menopause Practitioner, Chief Medical Advisor at Alloy Women’s Health, author of Grown Woman Talk) reveals the TRUTH about menopause, from its effects on physical, mental, & emotional health and avoiding the "inevitable" effects of aging, to debunking the wildest myths about sex & hormones.    Find out why waiting it out is NOT the answer, and discover the best treatments, including lifestyle hacks for a smoother ride.   Fellas and folks without uteruses - this one’s for YOU too! If you love a woman, you NEED to watch this. Learn how to support the women in your life through menopause!   Dr. Sharon Malone also breaks down:  - Menopause vs Perimenopause: What’s the difference? - Early symptoms you didn’t know were menopause-related! - The REAL scoop on hormone therapy: Is it safe or risky? - Why divorce rate peaks in menopausal years - Why piecemeal treatment is ineffective & a holistic approach is best - Why we weren’t told about the reality of menopause symptoms - Is it a lack of libido or is it your relationship? - Shocking connection between menopause and your brain, heart, skin, & sex life! - Benefits of social connection & weight training during menopause - Why this phase of life could be the start of a HAPPIER future   If you’ve ever wondered what’s really going on inside during menopause, TUNE IN to MBB for the best rundown of what menopause actually is that you’ve ever heard - Unlock the secrets to surviving and thriving through this life stage!   Dr. Sharon Malone's Book, GROWN WOMAN TALK: Your Guide to Getting and Staying Healthy: https://www.drsharonmalone.com/book   BialikBreakdown.com YouTube.com/mayimbialik Learn more about your ad choices. Visit megaphone.fm/adchoices

We've had an enormous amount of indifference to women suffering on the part of medicine, and we don't warn women because they don't know what to do when they start experiencing these things. If you go back to any history book, how they were describing the wives, bitches be cray! That's what they'd say. Biches be cray! There's been this tacit acceptance of women's suffering, rigidity for lack of libido. There's a reason why there's lack of libido because you don't have any hormones. I haven't slept in a month and I'm exhausted. We also accept suffering as our normal lot in life.

We have included the language of suffering into our very existence. We suffer from cramps. You suffer from migraines. You suffer from anxiety. That is not something that women have to endure. The suffering is not normal. I went into medicine to figure out how to all. alleviate women's suffering, not to observe it. So when I see it happening and I have a solution at hand,

I'm happy to share. It's Miami-Bi-a-Lix breakdown. She's going to break it down for you. Because you know she knows a thing or two. And now she's going to break down. So break it down. Hey, I just found out something astounding. Approximately 63% of those of you listening to or watching Myambialli's Breakdown are not subscribed. We know you're listening and we know you're watching because of all of the awesome comments you leave telling us how Myambiolx Breakdown is helping you lead a happier and healthier life. We love that. But the best way to support our show is to subscribe. It's also the only way to get latest updates and to know when new episodes drops. So anywhere that you

listen to podcasts and on YouTube, please subscribe, hit the bell icon so that you know when a new episode drops. Thank you so much and on to the episode. Hi, I'm Myambiolic. And I'm John Jonathan Cohen. And welcome to our breakdown. This is the place where we break things down so you don't have to. Today we're going to be breaking something down that affects almost everyone on the planet. In one way or another. But more specifically, more than one billion people worldwide will directly be affected by what we're going to talk about today by this time next year.

55 million people in the United States are impacted by what we're going to talk about. and nearly 75% of people experiencing what we're going to talk about today in the United States are not getting support or treatment for this. Now, you might be saying, is it the condition of being human? Pretty close. Only 6% of women who seek treatment for symptoms of menopause or perimenopause actually get it. And 47 million. women enter menopause each year. Seems like there's a discrepancy in our understanding of the significance of women and hormones. And we have today Dr. Sharon Malone, who is based in D.C. She's an OBGYN and certified menopause practitioner. She's on a mission to empower women to

take charge of their health. She's a nationally known expert in women's health. She's also the chief medical advisor at Alloy Women's Health, which is a telehealth company that focuses on women over 40. The endorsement on her book is from Michelle Obama, as well as Carrie Washington, Naomi Watts, and Lisa Musconi. So really an incredible authority and advocate for a larger conversation around what menopause is and what it's not, what perimenopause is and what it's not, what the actual early symptoms are that you may not even realize can be treated safely. And she also is going to break down the entire conflict that so many of us were raised with surrounding the use of hormones to treat the symptoms of perimenopause.

It's so wild in this conversation the list of symptoms that most of the most of the women don't even know, could be related. They just start having this type of symptom or that, and they don't see an underlying connection. Explain to us, before we get into this conversation, some of the ways that people might be affected that they may not realize. Well, I think the most common ones that many of you have, if you've not experienced yourself or known someone who has experienced them, you've probably seen them in commercials or on movies. You know, hot, flashes. People talk about hot flashes all the time. Night sweats. People talk about changes in libido. You'll hear people talk about vaginal dryness or painful sex. You sometimes will hear people start

talking about brain fog, right? But did you know that if you start having digestive issues, If you start feeling intense dread, panic, and anxiety in a new way, if you are having changes in body odor, changes in breast sensitivity, if you start feeling the sensations of like electric shocks in your body, if you have a shift in headaches or migraines, if you start having bizarro sleep challenges, if you are having weight gain, that seems a little bit unusual. Guess what? These things, including irritability, may not just be your lot in life. These things, even in your 30s, even in your 30s, could be an indication that you may qualify for safe, effective treatment. As Dr. Malone will talk about, there is no other treatment.

treatment for a hormonal deficiency or imbalance that gets the kind of scrutiny and an obsessiveness that the conversation around hormone replacement therapy gets for women. We're going to talk about all of those things and like the short take is that perimenopause is a 10-year process. It can take 10 years for you to go from starting to have symptoms to completing perimenopause and entering the stage of life that is then called menopause. So we're talking about 10 years that for many women can start in your late 30s. We're not trying to scare you. We're trying to help you feel comforted that there may be an explanation that doesn't

need to be piecemeal. Many of us go to a thyroid doctor for this and we go to a psychiatrist for this and we go to a therapist for this and then we want to lose weight and then we go to this and then we try microdosing, right? What if there's something else and a different understanding of your health that, might actually also prevent you from some of the degenerative components of aging that we've been taught aren't normal, such as bone loss and bone weakness and heart disease, the number one leading cause for women of death. What if there's more to hormones than we realized? If you are a man

listening to this and you think, oh, this doesn't apply to me, you likely have a woman in your life who is either experiencing this or will experience it, whether it's a partner or a friend. Or a family member, we need to know what they're going through in order to have a better understanding of both how to support them and how to recognize when there are factors coming into our relationship that could be impacting how we get along, how we have sex, how their health is going to be determined. It's very exciting to welcome a world leading expert on this topic to the breakdown, Dr. Sharon Malone. Break it down.

Oh, Dr. Malone. Welcome to the breakdown. Well, I feel like I'm about to have a breakdown, actually. So it's a good place to be today. Talk to us. What's going on? Oh, you know. You know what's going on in America.

Oh, sorry. Yeah. I'm in Washington, D.C. You're in it. Yeah, I'm in it. I'm in it. So we've been wanting to talk to you for a very long time. And I've been

enjoying grown woman talk. And the title alone made me laugh because, like, I don't feel like a grown woman, even though I am one. And my hormones have told me that I am a grown woman, but it's taken a little bit of adjusting to honestly become comfortable with the conversation that you really have been, you know, at the forefront of encouraging not just women, but people to have. In our intro, we, we, we talked about. We, we, we, talked about the enormous statistical significance of the importance of this conversation. But before we get started, I just want to acknowledge a little bit about your background, which I think is such a fascinating and significant component of the advocacy that you do.

You're the youngest of eight children, which that alone means you grew up with a lot of people's different needs in your house and your parents likely juggling a lot of different needs. Your parents were both raised in the rural South and moved to Mobile. Is that correct? That is correct. When I say rural South, I mean really, well, all of Alabama's rural, save for about three places. But, yeah, very much in what we call the country.

And you were all raised, you know, in a time when negotiating health care was a life and death kind of conversation on a daily basis for many families. I just, I wanted to mention that because what you are doing and what you have done and continue to do is really kind of, you know, pull the lens back on some of the larger issues that are impacting not just women's health, but our health in general. I wonder if you can just give us a little bit of a tidbit, you know, about what it was like growing up and how that made you want to enter, you know, the industry of caring for people and how it's impacted how you care for for people. Well, I grew up not in a world where anything about medicine felt hospitable. Nothing felt like it was for you. It was difficult to access and to be quite honest with you. You know, most people and certainly of my mother's generation felt very disrespected even when they asked for care. Because the same sort of Jim Crow rules that were in place were in place for,

you know, how we access care as well. So you had to go to the colored entrance of, you know, hospitals. You had to, you know, if you saw a doctor, it was, you know, and no one had insurance then. So it was a matter of you could only, you had to pay to play. And so it made the experience of really trying to access care very difficult and very demeaning for most people. And that's why we grew up, not really going to the doctor. I mean, the doctor was your, a place of last resort, not the first place that you went to, because I don't think that there was anything about my parents' lived experience that made them feel welcomed or that there was anybody there that was really concerned about helping you. And that shaped how I sort of crafted my

career because I made sure that I wanted to make, you know, that I made sure that women and women of color in particular felt heard and seen, at least in my presence. Well, thank you so much for that. And, you know, I think it is important as we open this conversation about menopause, about perimenopause, because a large component of the lack of conversation surrounding this has been often at the expense of women being told, it's all in your head, or there's nothing wrong with you, or here, take this pill, go away, I don't want to hear about it. I grew up in the Kaiser system, which was designed as a real factory for medicine. And so often, if your problem couldn't be solved in five minutes, it might not get solved.

You know, that was just kind of how it was. I wonder if you can start with just some basic definitions and boundaries around what is menopause, you know, in terms of time and course, and what is perimenopause? Because we're hearing both of these. Menopause used to be like this big nasty word that you didn't want to say. And now we're hearing about it everywhere, but we're also hearing about perimenopause. Right. You know, menopause, when I was growing up, the only thing I ever heard about it was it was called the change.

You know, she's going through the change. And even as a young person, I was like, well, what is she changing into? And what is she going to be on the other side of that? I mean, that was the big mystery. And that was all we ever heard about it. And, you know, menopause for people who don't know what it really defines, what the definition of it is, menopause starts the moment you have had your last menstrual period. But you don't know when you've had your last one until you look back and you go, oh, I haven't had another one.

So the official definition is it starts the moment you've had your last period, but it's confirmed by not having had another cycle for another 12 months. Now, but you're in menopause, you know, the day after your last period, not, you don't have to do anything more than that. It's automatic membership. Now, menopause also lasts forever. And that's why I really don't like the term post menopause. I like how you say that. This is a terminal diagnosis. Once you have it, you got it till you die. Exactly. And so, you know, the notion that it is something to get over and if I just get over menopause or over, my symptoms, then I'm done with it. No, menopause is not done with you. So that's, you know, I think the first thing to understand. And I think that when we talked about menopause, we always thought of it as something that had to do with old women. And it's not. And let's say, the average age for menopause is about 51 and a half in this country. And we all know that 51 and a half is nowhere near old. Okay. Let's make that straight. But the part of it that I think think that that is confusing for women is this perimenopausal journey because it was a word that a lot of

people weren't really familiar with until we started talking about perimenopause. And Perry just means around. So it's that time around menopause before you've had your last menstrual period. It usually starts for most women in their early to mid-40s. Some women, though, can be perimenopausal as early as their mid-30s because, and this is, again, sort of a back-in-to definition, perimenopause actually starts anywhere from four to 10 years before you've had your last period. So perimenopause, if you're going to be menopausal

and have your last period at 45, then you may have started as early as 35. And you're definitely not thinking about menopause when you're 35 or 40 years old. And all of those sort of gnarly symptoms that we associate with menopause, such as, you know, hot flashes and mood swings and night sweats and vaginal dryness and changing libido. Have I scared you enough now? I would say I'm postmenopausal, but I'm just menopausal forever. You're menopausal.

But all of these things can happen when you're perimenopausal. And by definition, when you're perimenopausal, you're still getting your period. It may be once a month, it may be once every two or three months or twice a year, but you're still perimenopausal. And I think that in the early phases, it confuses women and doctors alike because all they're thinking of, oh, you haven't had a period in 12 months, so you're not menopausal. But all of the symptoms, all of the things that we associate with menopause can happen much earlier. And because it catches women sort of unaware, you are. are usually you're bothered by the symptoms, but you're seeking out care piecemeal.

You know, if you're depressed, you go to a psychiatrist. If you're, you know, having, if you're gaining weight, you might go to an endocrinologist. And so everybody's seeing a little piece of the picture and no one's really seeing the big picture, which is all just part of perimenopause. Miami-Biallax breakdown is supported by superpower. We all know the feeling of leaving a doctor's office

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And because I'm trained as a neuroscientist, I would like you to actually, can you explain hormonally what's happening in perimenopause and what has happened in menopause? Like talk estrogen to me. Yes, I will talk estrogen to you. When you are premenopausal, just in your normal, you know, when you're in your peak fertility years, you produce hormones on a cyclical basis. You know, they sort of peak when you ovulate, they go down after ovulation if you do not get pregnant. And that happens on a regular basis every 28 to 30 days for most women. Then you enter this phase of perimenopause. Perimenopause does not

mean that you don't have estrogen. You have estrogen. It's just produced erratically. So your estrogen may be too high one day, too low the next. And it's more kind of a sawtooth appearance of estrogen, not that nice, you know, undulating wave that you have when you're premenopausal. So that's why all of these symptoms and what you're responding to is not necessarily just the lack of estrogen. It's the erratic nature of the production of estrogen. And as you get closer to menopause, those times of estrogen, when the estrogen is low, increase. When you get to menopause, there's no estrogen produced by your ovaries at all. It's gone. It goes to zero. And that is why, you know, the symptoms that you have at menopause,

eventually you get used to them. Most people will. Hot flashes tend to go away because that's the thing that we associate most with menopause. But just because your hot flashes went away does not mean that that lack of estrogen isn't affecting your brain, your heart, your skin, your hair, your libido, everything else. And that's why I say you're menopausal forever, because you will be in that state of low estrogen forever unless you choose to do something about it. Okay, now talk progesterone to me because everybody's talking about progesterone too. There's a lot of hormones. I mean, duh. There's a lot of hormones involved. So people talk about estrogen. They talk about progester. There's also an importance of testosterone in talking about that. Because women have different enzymes and there's different catalysis that happens. So all these hormones are important, even though we think of testosterone as the boy hormone. Talk about progesterone and talk about testosterone. So we can also understand the course of that. So we're basically going from cyclical estrogen to none, as we say, just a big fat zero is where we're at. Talk about progesterone. Talk about progesterone.

and testosterone too. Yeah, well, progesterone. All right, so let's go back to our premenopausal time. And I told you where you've got this wave up and down, up and down every 28 days, nice and beautiful and nature intended it that way. Your estrogen levels sort of peak when you ovulate. That's right around mid-cycle. Then the predominant hormone that you produce becomes progesterone.

And if you think about progestation, that is the hormone that you will need to maintain a pregnancy should you conceive. So progesterone starts working. It gets everything ready for implantation. It doesn't happen. Both of them fall off and a period starts. But there's also something that happens around mid-cycle for women is that in addition to your estrogen peaking, you get a little burst of testosterone.

Because testosterone, nature's got this whole thing figured out. And it sort of increases your libido because nature wants you to have sex when you are maximally fertile because you'll get pregnant. That's how the baby. Yeah, it's how you perpetuate the species. But that's not our goal, but that's nature's goal. And that's why we make. Speak for yourself. That is what the purpose really of testosterone is.

Now, it has some other systemic effects, but just behaviorally, what is it there for? It sort of helps enhance libido. And then the progesterone, and these things go in a nice, orderly sequence until perimenopause and menopause. Then everything is out of whack. And I'll give you a little bit of an example of how testosterone works. It's responsible for those things that we call secondary sexual characteristics. So that's why you have pubic hair. That's why you have underarm hair.

That's why you get acne, why you get a lot of other things. It's why it helps with muscles, building muscle and strength, in addition to libido. So that's our testosterone journey. Well, remember I told you when you get to menopause, all your estrogen goes away. All your testosterone doesn't go away. It's much less, but it starts going down really in your 30s. And that lack of testosterone, that sort of gradual decline starts to happen in your 30s, and it eventually goes down.

Not quite zero, but for most people it is. But that's why when you think about your estrogen goes away and you've still got a little bit of testosterone in your system, right? Well, what happens? This is why women complain of, why am I growing a mustache? Why do I have chin hairs? Because you don't have that estrogen to counterbalance that little bit of testosterone that's still hanging around. So all of those things that women don't like during perimenopause, why do I have acne all of a sudden? Well, it's because that there's a little bit more testosterone relative to the estrogen, even though both of them are low. So I hope that makes some sense.

But a normal functioning woman produces three. You produce estrogen, you produce progesterone, and you produce testosterone. And how those sort of play out really not only affect what happens in menopause, but it also affects sort of how we other conditions such as polycystic ovarian syndrome. which is also something that's an imbalance of the hormones, where there's a predominance of one over the other. So I think when we talk about hormones, we can't think of them as gender-specific.

You know, women over the course of their lifetimes will produce more testosterone than they produce estrogen. But we don't think of that. We think that that's only a male hormone and not true. That's a super helpful framework. You know, in your book, you have this master list. it's 34 things. And, you know, if you were to look at a Venn diagram, you know, of these symptoms with basically a lot of other conditions, there's going to be a lot of overlap, right?

So I'm just going to give an example. You know, let's just take mood swings, just one that, you know, just off the top of my head. There's a lot of reasons that you can have mood swings, right? That doesn't always mean it must be perimenopause, right? allergies. I'm like, I have those my whole life, right? But when you look at all of these together and you look at the other, you know, kind of components of a culture that is finally talking about these things, I mean, I don't want to sound like a downer and like this is your job and your life work, but like, this is depressing as fuck because you are literally listing, you know, 34 things

that many of us are experiencing, like, that as you, you know, you know, that as you're listening, you said, we've been told to piecemeal. So if you have allergies, go get shots. And if you have body odor, get injections so that, you know, your glands don't produce, you know, odor. Don't do that. Don't do that. If you're having, I mean, the mood, the mood stuff is my favorite. The dread, the um, irritability, the panic attacks, you know, all these things, which like then you'll go to a psychiatrist and they'll give you, name it, you know, name the big pharma thing that they say is going to fix you. And if that's not working, let's add an atypical neuroleptic because maybe that'll boost it, right? Or just drink more wine, smoke more weed, right?

Like we're told all of these things. And it's astounding, you know, to look at these and be able to finally say there's something going on that needs a larger framework. So I'm going to ask you a dumb question. Why did no one tell us? why did no one tell me about these 34 things that I might experience, I don't know, 29 of them? Why were we not told? Like, I'm not asking for you for a conspiracy theory, but why were we not told? Well, I think that we have known these symptoms.

I mean, if you, as a matter of fact, if you go back to any history book or you just read, I was reading a team of rivals. and how they were describing the wives, you know, Mary Todd Lincoln, you know, who always, you know, this reputation of being this very difficult woman. Biches B. Cray. That's what they'd say. Biches be craye. Right. And but the women, I mean, you can go back to Aristotle and all these same symptoms of menopause have been described for time immemorial. We just didn't know, you know, we kind of, we accept. it. That's the point. There's been this sort of tacit acceptance of women's suffering. So the fact that these things exist, that's not new news. It's just the fact that we didn't feel they were worthy

of addressing in a lot of cases where you just kind of go, oh, well, you know, that's just women being women or you're being hysterical. Freud built an entire practice around them. Frigity, you know, for lack of libido. Well, there's a reason why there's lack of lack of libido because you don't have any hormones. And also, I don't like you and you're mean to me. And I haven't slept in a month and I'm exhausted. All of those things happen. So, you know, I say that this is not new news. I think that there is a new awareness and there's a new, we have the ability to get this information out beyond just the one-on-one doctor-patient interaction. Because to be honest with you, I have been discussing this for my entire career because I was really taught something very different

than what we have been led to believe about hormones being bad and, you know, nothing we can do about it. Well, that's sort of how I started. And then hormones kind of got a black eye about 22 years ago. And we have been trying to recover from that because this is something that we do know for all of these symptoms that women have. And let me say, you don't need a blood test. you don't need a special body scan to diagnose perimenopause. If you're between the ages of 35 and 50 and you're having any of those symptoms in any particular order, they don't, you know, not everyone's menopause journey is the same. But if you have them, then guess what?

You get to diagnose that you're in perimenopause yourself. It doesn't require anything sophisticated. And whether or not to do anything about any of those things really depends, upon how much you are bothered by it and how much it's affecting the quality of your life. And I think that what we've been doing is we've been waiting too long and we don't warn women because they don't know what to do when they start experiencing these things. They think it's something else or something's really wrong with them. Well, and this gets to sort of, you know, more of a systemic and structural problem because

where I come from, and my grandparents are immigrants from Eastern Europe, where I come from, everyone suffers, meaning you come from poverty, like you scrape by half of the siblings die before they're three years old, like, then there's pogroms and a world war, and you are refugees, and you work in sweatshops, and you don't speak English. So where I come from, like, what do you have to complain about? Do you know what I mean? Like, this kind of creates, and I'm not saying that people who don't have my specific story also don't feel this, because I think women do. I think women of color in particular are the most impacted by this. But I think this is my sort of question to you.

How do we own this and be able to say this is not me being complainy? This is not me being weak. I'm not just hypersensitive. There's something legitimately going on that deserves attention. How do we teach women to believe that? Well, you know, and that's what we're doing. I mean, having conversations. like this is really, you know, it is really important because it is making women be aware of the fact that,

oh, I'm not alone. It's not just me. There's not something wrong with me in particular. I am going through a normal physiological change, which all women, if you live long enough, will go through, whether you have all 34 of those symptoms or you have zero of those symptoms, you will go through menopause. And once you sort of frame that as normal, you know, then we say, okay, the process is normal. The suffering is not normal. You know, that is not something that women have to endure because I think that, you know, like I said, we've had an enormous amount of indifference to women suffering on the part of medicine,

but we also, as women, sort of accept suffering as our normal lot and love. life. Because just as you say, you think about the language that we use, about women's conditions, we suffer from cramps, you suffer from migraines, you suffer from anxiety. It's all that. We have included the language of suffering into our very existence. And I'm saying, no, that should not be the normal. Yes, you will go through menopause and that's normal. The suffering part of it, no, let's not do that. what it's affecting, the quality of your life and your health, physically, emotionally, spiritually, all of that.

Well, and I think that's sort of also the point. You know, Jonathan and I were talking about this, like, what did our moms do? What did our grandmothers do? You know, my parents were born during World War II, but obviously people have parents spread out over the age spectrum. But, you know, what it was was that I wonder how much of my mother's irritability, impatience, and I don't know, maybe unhappiness, I wonder if she was going through something that at the time, she was told there was no cure for, you're just, that's just you. And when my mom was

kind of dealing with this, hormones were, it was like satanic to imply that a woman should take hormones. You're going to get cancer, and especially if you're an Ashkenazi Jewish woman, you know, there's this like higher risk. Can you talk a little bit about, What was this enormous push that ingrained in a generation of women that we are not supposed to take hormones? I'm still skeptical. Like now they're like, hormones for everybody. Let's put it in the water. What was going on that people got so cuckoo crazy that we can't have hormones?

And now literally, like, they're possibly coming in this drink that I just purchased at the store. hormones, estrogen as the antidote to the symptoms of menopause has been known. The first medication that was FDA approved for the treatment of menopausal symptoms was primarin and it was approved in 1942. So the notion that we have at hand, what is the most effective treatment for the symptoms of menopause? That's not no news. So women were taking hormones, started in the 40s, peaked in the 60s when this guy, Robert Wilson, wrote a book called Feminine Forever.

And he wrote this really sort of this ode to hormones. Well, it turns out he was paid by the people who make women. Shocking, Dr. Malone. A little aside. But it was menopause as told through the eyes of men. And he was a gynecologist, and he talked about it like, yes, women, you should. always, you know, you should take hormones because you should make yourself sexually alluring. This is the way to stay feminine and don't turn into this old hag after menopause.

That was the push. So needless to say, a lot of hormones got prescribed in the 60s. But we had, we learned some things along the way. We do know that it's effective, but we also found that, yeah, you can't just give estrogen by itself to women who have uterus. You have to give that other hormone that we talked about. You have to give progesterone. Because it protects the lining of the uterus. You don't get uterine cancer. Okay, problem solved. We move along through the 80s.

And women are now understanding, okay, we've got a safe way to take it. We don't have to worry about the uterine cancer piece of it. Women are feeling better. About 40% of women who were eligible to take hormones and were symptomatic. We're taking hormones prior to, like I'd say up until the 1990s. And then as we had so many women that were on hormones, we said, okay, just to observe, let's look at this group of women who are on hormones versus not. And they found that, whoa, look at this, the women who are on hormones have half the risk of heart disease. We were never prescribing

hormones to decrease heart disease. That was just a, oh, look at that. There's this, you know, decreased risk in heart disease. Well, that's a really great reason to take hormones. Even if you don't care about how you feel, we're going to have the risk of the most, the number one killer of women in this country, heart disease. So that was how, that's a little bit of a backstory to give you where the women's health initiative came from. So 1993, Bernadine Healy, the first female director of NIH was a cardiologist and a big proponent of hormone. She says, you know what, it's not enough to just look at the observation. Let's do a study that. actually proves that hormone therapy decreases the risk of heart disease. Beautiful, right?

Then everybody's going to want to take them. Well, there were a few design flaws in the study because this was a billion dollar study ultimately that was supposed to prove the effectiveness in decreasing heart disease. Well, here's the problem. If you're going to do a randomized placebo-controlled, double-blinded study, and for your listeners, who may not know what that is, that just means that neither the doctor nor the patient can know which medication they're on. You don't know whether you get placebo or you get estrogen. And not only that, but we're going to follow up to do that. Let me just say to keep the blinding of a study, you have to have women who are not having symptoms. Because if you're having

hot flashes and I give you a placebo and two months later, you're still having the same hot flashes. you're like, okay, I guess I didn't get the estrogen. So what they did, the first problem, they included women who were mostly asymptomatic. That's one, which are not typical of the women who we've been giving hormones to. And then on top of that, they said they skewed much older because if you're trying to show that it decreases the risk of heart disease, you have to give it to women in their 60s. You don't give it to women in their 40s because they're not going to get heart disease anyway in the next, in the top. timeframe of your study. So the women were much older, they were asymptomatic and not typical of the

normal patients. So what did they find? With these older group of women, after five years, the regulators at NIH stopped the study. They're like, oh my God, we've got to stop this because there is no decrease in the risk of cardiovascular disease that we expected. But more importantly, there's all this harm in this group of women. And what was the harm? The big number one, two, and three things was the increased risk of breast cancer. And they held a whole press conference to announce that whole the presses were stopping the study and it's not good for women from cardiovascular disease and it's going to increase your risk of heart disease and blood clots and Alzheimer's and gallbladder disease, all of these things. And, you know, I think that for those of us who are a little

kind of political. It was the exact same playbook as the Mueller report in the sense that the headline was announced before anyone could read the study. Even the people who were, you know, involved in it didn't know that they were getting ready to stop the study. Well, the point is, is that that information was really not exactly interpreted correctly. it shouldn't have been applied to everyone, because to be in that study, you could be anywhere from 60 to 79. Now, riddle me this. How are you going to prevent heart disease by giving a 79-year-old estrogen? It's kind of like, duh. And your average 79-year-old's going to have a higher rate of cancer anyway just because they've lived that long, and that's how genes work.

Exactly. So you see where the problem is, but that was the beginning of the end of the hormone study. and the story, because I had been prescribing hormones for 10 years before that study came out. And what happened is that women panicked. It was hysteria. You say breast cancer. And they're like, I'm stopping it. And I can't believe. And they're calling me up and saying, Dr. Malone, I can't even believe you gave me this dangerous stuff.

But here's the reality. There's a difference between what we call relative risk and absolute risk. And you know this. and that increase, that 26% increase in breast cancer that they touted, well, what did that turn out to be in real numbers? Well, it went from 30 per 10,000 women per year will be diagnosed with breast cancer on any given year. What about the women who took estrogen and progestin? It went from 30 per 10,000 to 38 for 10,000. So an additional less than one in a thousand

additional cases of breast cancer attributable to the women who took estrogen and progestin, not estrogen alone. Because there's a whole bunch of women who've had hysterectomy. Remember, I told you, the only reason you need the progestin is to protect your uterus. You don't have a uterus. Don't need

to take the progesterone. And so those women who were in the estrogen only part of the study were allowed to continue. Well, they didn't tell you that the study was ongoing. And what we have with 20 years of now hindsight is that the women who took estrogen only not only had a decrease in the risk of breast cancer, but they had a decrease in the risk of dying from breast cancer. So as that unraveled, you can imagine how hard it is to put a

genie back in the bottle because we had all these years of women thinking that estrogen caused cancer. So therefore, I'll just have to suffer through my hot flashes because, you know, it's not doing anything for me and it's giving me cancer. And that has been so debunked. And we're trying to get that information out so everyone understands that you, whatever decision you make, and I respect any woman's decision to take or not take hormones. I think it's a good idea, I will give you that opinion. But we will, I will, you know, I will work with whatever it is you decide. But when you make that decision, do not make that decision based on faulty information. That's a, that's the only thing I say. I give you the facts and you decide. And I think that

most women really get an even-handed discussion of the pros and the cons of hormones. It makes it a much easier decision. So besides all of the, you know, the, the behavior. symptoms, right, and the physiological symptoms. You know, there's also, as you mentioned, this notion of heart health. There's a notion of bone health. And, you know, one of the things that this sort of, I don't want to call it new, but one of the things that this revised perspective on hormones and menopause is providing women, and it makes me a little bit emotional, is the opportunity to kind of seize what many of us thought was an inevitable process. of aging, degeneration, and deterioration. Meaning, this is not you can live forever. This is not

biohacking the way it's like, if I do six cold plunges in three days, like I'm going to reduce my biological age. The fact is, and this is just like science people, you know, our bodies, once they help perpetuate the species, are functional in certain components in primate society. Older women in particular are often the storytellers. They're the wisdom givers. They help teach other women how to parent children. They're often spiritual advisors. And in many traditional communities, women were revered in this stage of life. But functionally speaking, medically speaking, genetically speaking, we're not supposed to live forever with full vibrancy. And there's a, you know, a beauty to certain aspects of aging. But what these hormones are also,

kind of guaranteeing is that you don't have to deteriorate as quickly in terms of your heart and your bones and your strength and your stamina besides the sex, besides the libido, besides not wanting to, you know, drench your sheets at night. Can you talk a little bit about sort of the more philosophical perspective that this is providing for women and for the people who love women? Well, you know, let me tell you what the FDA has approved hormone therapy for. And I think it will make it a little bit clearer when you think about what the benefits are.

One is that for the relief of symptoms of menopause, basal motor symptoms, hot flashes, nothing more effective than that. So yay. It is also approved for the prevention of osteoporosis. And we underestimate what the effects of osteoporosis are as we age. And it is, and women are by far more affected by osteoporosis than men.

It is also approved for what we call the genital urinary syndrome of menopause or GSM. And that has nothing, it doesn't have to do with just sex. It has, it is anything, your vagina, your urinary system, your bladder. So that includes things like, you know, again, pain that includes, urinary tract infections, urgency, frequency. It's not an accident that there are that many products on TV that are advertising for, you know, incontinence products, because it's a big problem. And not only that, that women don't understand that this isn't just something that's embarrassing, but urinary tract infections are the number one reason for hospitalizations for women in nursing homes. Wow.

Urinary tract infections. My grandma had several. It's so funny. My grandma had several in her later years. This was like a thing. It kept happening. And you know what happens when you get urinary tract infections when you're elderly or you have dementia or you have any of these things? You don't recognize it. And now you've got a full-fledged kidney infection and it changes mental status. I'm sure you've seen this. So it happens all the time. Can be treated simply. You don't have to do full dose, full-bore, system. hormones, you can just use vaginal estrogen for that. Oh my goodness. Why not? Okay. So look at all these great things. You know, it relieves symptoms. It relieves your hot flashes. It, you know, it decreases the risk of urinary tract infections in GSM as you get. It prevents osteoporosis. And here's the kicker. The other thing that it is indicated for, and we're going to do some back-in logic on this. If you have either a premature menopause, And that means premature menopause means that there are some women out there who are menopausal at 40 or below 40.

That's pretty young. Or you have an early menopause, which means that you are menopausal before age 45. Then estrogen is indicated for the treatment because those women with early or premature menopause are at higher risk for, guess what? cardiovascular disease, they're at higher risk for developing osteoporosis, they're higher risk for developing Alzheimer's disease. So, you know, it doesn't take a rocket science to say, well, if it helps with those things if you're 45, why does it not help with those things if you're 47 or 50? That is the, we get to infer, you know, and I think that that is not an unreasonable place

to be. And that's why we said we want women to understand. No, you're not doing yourself a service by suffering long. Because this is the other thing about hormones. You'll say, okay, I'll just wait. I'll wait and see how long am I going to have hot flashes or how long am I going to have these things. What we do know is that the earlier you start, the more benefit there is. So there's no benefit in saying I'm going to suffer for 10 years and now I give. No, you treat the symptoms and you treat the issues when they develop, not 10 years, five years down the road. Okay, so this leads to my next question. And I think it's important to mention this. I'm a home birth mom. Like I gave birth in the living room next door to this room. Like, I'm a hippie person.

like I don't like Western medicine. You know, I see a midwife for care instead of an OBGYN because I like that kind of vibe. And, you know, there are purists, even doctor purists, you know, but in particular, you know, nurse practitioners, midwives, traditional Chinese medicine folks that I've spoken to. And there are some people who believe that you can make this, transition without hormones, that all of these changes are an opportunity to understand your

shifting needs and blah, blah, blah. Are those, like, let's just be honest, are those people who don't understand what it's like to be in my body? Are there people for whom the variation in symptoms is so different? Or, you know, also, I wonder if this does connect with, you know, the vast increase in autoimmune diagnoses for women, thyroid condition. like hormone dysregulation that many of us weren't told were linked to our grave's disease, right? Or other autoimmune conditions. Like there's this huge rise, which I think is for like maybe,

I don't know, the food we're eating, the way we're living, like lots of things. Is that confluence, you know, part of what leads to a discrepancy and how people are recommending that women deal with this? Like, just some people just have it worse? And some people just have it not as bad. And the people who have it bad take hormones. And the other people get to like kumbaya it. Well, you know what? There are, even though we talked about all those 34 symptoms of menopause,

well, some women don't have them or they don't have the outward symptoms that they are bothered by. And for those women, I said, great, I'm happy for you. I wouldn't prescribe a medication for you. I might prescribe it, though, if you're at risk, if you have none of those symptoms, but you're at risk for osteoporosis. You see, because there's nothing that's more effective than that. But should you, we all should be doing the basic lifestyle things that everyone should do. You know, exercise, get a good night's sleep, eat a healthy diet, you know, limit your alcohol intake. That's a given.

And for some women, that's enough. But that's not true for most women. And that's where I say sometimes when you let your good fortune, your menopausal good fortune influence how you talk about it with other people who may not be as lucky as you, are in this journey, then that's where I think that it's problematic. Don't, you know, I say, make the decision that's right for you, but do not discourage a person who is suffering or who is at risk for the things that we talked about from accessing something. Because, you know, and again, if we're going to get conspiratorial here for a moment, because, you know, we can do that.

There's something really peculiar about the discussion of hormones and women. And I don't No, we don't talk about any other medication with this much emotion. Then, I mean, we don't talk this way about statins. We don't talk this way about chemotherapy. I mean, drugs that have way more side effects and potential harm to you on a day-to-day basis than hormone therapy. So there's something about hormones and allowing, allowing, And I use that term because doctors will say, no, you can't have it.

And I'm like, wow, that's really weird. There is no other condition that I can think of that it involves a hormone deficiency or hormone lack, thyroid, insulin, you know, for diabetes. Would you say to someone who's a diabetic, well, you know, I don't believe in it? Or your thyroid is underactive. I think you should just be natural. Who does that? Men who have low testosterone get testosterone treatment. Easily, they just go in and say, hey, you get a test.

It's low T. Yeah, well, this is how I'm feeling. Here you go. But this sort of emotional, you know, sort of debate that we have about giving hormones for women is really strange to me. It's really strange because, as I said, I prescribed hormones. 30 years ago because I was taught the good things about hormones, not the bad things about it. When the study came out and said, oh, it's terrible, when I finally read the study, because there was a two-week gap between when that headline went out and when we were able to access the

actual journal article. Because remember, this is before the internet. So no one could just pull it up. You had to wait until your journal came in the mail. And when I read it, even in real time, I said, oh my God, it doesn't say that. It doesn't say what they just said. But boy, oh, boy, even though I would have this conversation again and again and again with women, they didn't believe me. I would say, look, I promise, I take hormones. I, you know, I wouldn't tell you anything that I did not honestly have the data to support. And if this is all you've got to say why hormones are bad, then that's insufficient. And that is sort of, you know, the weirdness about hormones.

And now I take this moment that we're having right now as really, I'm encouraged because it is empowerment, you know. And this is what I believe fervently, that women should be given the opportunity. I don't think you should be told what to do. you can be advised, but ultimately, every woman should have equal access to good information such that she can make a decision that's right for her. You get to choose how you age healthfully.

You get to choose how you feel on a day-to-day basis. And that shouldn't be anyone gatekeeping or keeping a solution from you that we know is effective and safe. Can you please issue a public apology to my children? And this lovely gentleman who's on the screen with us. You know, I think my story is probably what a lot of people's story is. I mean, I'm a little bit special. Just like in not a great way. Everybody's got their special.

You know, yeah, I also, I think it's important to point out that there are some people for whom hormones are not the entire solution. And that's been a really challenging thing. I'm really grateful I have a couple girlfriends older than me because I was the earliest bloomer of us all. But the girlfriends that I have, you know, they're much more savvy than I am with the internet and Instagram. And like they've been finding stuff about people like you, you know, for several years now and like trying to educate me and tell me and, you know, all these things. But I will say that, like, I have friends for whom, like, progesterone is the answer. They sleep through the night. Like, they don't have any symptoms. They're not depressed.

Like, I didn't even believe in brain fog. I'm a neuroscientist, and I didn't even believe in brain fog until I experienced it for myself. But there are some people for whom progesterone, estrogen, the right dosage fixes everything. And then there's people for whom that's not the whole story. So, can you speak a little bit about sort of that discrepancy and how, like, what are some of the other things that women should do if, you know, kind of a standard route is not working? Yeah. And remember I told you, all the lifestyle things that we talk about, everyone, you know, I'd say without exception, there is no one who's not going to benefit from regular exercise of good night's sleep, you know, a healthy diet, cutting out smoking and cutting down on alcohol use baseline. Okay. So that's where that's where we're, we all start. But you know what happens? This funny thing about perimenopause and menopause, it happens at a time and life that's, there's a lot of tumult going on in women's lives at that particular time. Children going to college. Yeah, children, you're dealing with elderly parents.

It's usually a time for marital stress because of all these other external factors that are going on. So sometimes, sometimes it's your hormones and sometimes it's your life. Okay. Your life stuff I can't fix. But what I can say is this, is that even when there's the life stress and all the things that are going on there, being sort of hormonally stable helps you deal with whatever those things are that will inevitably come up in every person's life, it gives you a little bit more bandwidth, you know? And just as you're saying, and this is a very common,

scenario where someone would say, I don't even know why I'm so mad or I shouldn't be this mad about that thing. It wouldn't have bothered me to this extent 10 years ago the way it bothers me now. Or five minutes ago. Yeah. It just cuts down on your ability to cope with things as they show up. So I say that to say, is it the answer for everything? No. You do whatever it is. Sometimes you need to meditate. Sometimes it's prayer. Sometimes it's whatever it is that is your stress reliever at this point in life. So it's not a one-stop shop. But it will certainly help at least, you know, sort of raise the threshold for when you're about to be homicidal. How about that? Well, and let's talk a little bit about sex because, you know, it's also what we're here for.

One of my favorite, this is page 211, for those of you following along at home, do you not want to have sex because you hate your partner? Or do you hate your partner because you've been experiencing irritability or rage and you haven't had a good night's sleep in a year? Good questions and perimenopause probably plays a role. How big? I'll leave that one to you to decide, but you get my drift. This is a really interesting one because there's many reasons that women do not want to have sex with their partners.

And I think that there's been, you know, a new, you know, our version of a new sexual revolution where women are kind of finally in a new way on a larger scale, on Instagram and TikTok being told, you don't have to fake an orgasm to communicate that he pleased you if he didn't, right? And a lot of women are like, oh, my God, you mean, I can actually pretend like I don't have to pretend like I'm enjoying myself if I'm not. So there's kind of also a really interesting intersection of, you know, women's empowerment in terms of understanding hormones and sexuality

and also kind of our cultures being like, oh, and also if you're not, not enjoying having sex with that person, it's your prerogative not to? Or are you happy in your marriage? Everybody's leaving their marriage, like at this phase of life, you often hear this. So can you talk a little bit about, obviously, there are changes that can happen that make sex painful, and there are very easy ways to remedy that without, as you said, like even the systemic stuff. But I do wonder if you can talk a little bit about the emotional component here. Like, are hormones going to make you like your husband again? No, they won't make you like your husband again.

I hate to be the bearer of bad news, but no. But what hormones will do, and particularly even when you're just using vaginal estrogen, it will make sex less uncomfortable. If sex is painful for you, no matter how much you love your partner, you're not going to want to do it. That's sort of the way we're wired. You know, we avoid pain and we seek pleasure. And if sex is painful and difficult for you, then no wonder you have no libido.

We also, so we have to address that part of it. We also have to look at, you know, again, the people don't realize how much chronic fatigue sets in in perimenopause. Because, again, women are not sleeping. And let me tell you what happens to you when you're not sleeping. And this has nothing to do with hormones. This is just lack of sleep. And I can speak to this because I've been a resident and I've been an obstetrician who's been up all night

and had to show up at work the next day. Let me tell you, you're not your best self. You're not your nicest self. You're not your most tolerant self when you are chronically sleep deprived. So who wants to have sex when you're tired, you're in a bad mood, your husband just left the dishwasher open with, you know, the clean dishes in it and put some dirty dishes on top.

Okay, now you're just in it. Now we're in a doomsday loop that this never going to happen tonight. I don't care how much I love you. No. So that's why I said you just sort of figure out where you're going to interrupt this cycle, you know. And it starts with, you know, again, relieving the physical discomfort that's associated with sex. And then we also have to look at sex as a different, we have to use a different sort of lens through which we view it. And I think that we've all been victim to the movies, you know, where, you know, you walk in the door and all of a sudden clothes are being ripped off.

You can't make it. And then, you know, you have sex for two seconds and then there's an, you know, immediate orgasm. That's not real life. And what we have to understand that even sexual desire, which is harder to fix or harder to explain than actual the physical part of it, is desire changes. And some of that is testosterone related. But some of that also has to do with just what I call partner fatigue. You know, you're not, we like novelty.

We crave novelty when it comes to sex. So when you have a long-term partner, you know, and then particularly, when you're not really creative, which most of us aren't because you're tired, who's got time for all that, it isn't rewarding in a lot of ways. So what we have to look at, this is what I tell my midlife women to think of sex as, is if you are waiting on spontaneous desire to overtake you and make you want to have sex, you may be waiting for quite some time. But there is a thing that's called responsive desire, which means in the difference between I'm walking in the door ripping clothes off and responsive desire was like, well, okay, well, I wasn't thinking about it, but now you brought it up.

Okay, that was nice, you know. You have to set the stage and you have to, you know, it's like, I call it the field of dreams theory, build it, they will come, you know. You can't just assume that it's going to, that spontaneous thought enters your head. but can you have very rewarding sex without that spontaneous spark? Yeah, you can, but you have to make sure that you have to create the scene. It may not just pop up in your head. So all of these things, I say that it's never going to be one thing. It is about understanding that our sexual behavior changes as we get older.

And it certainly is going to change if you don't feel well. you know, if you're depressed, irritable, sleeplessness, or pain, it's sex, painful. Every time you have sex, you have a urinary tract infection. Those things, those are the fixable things. And then for the relationship things and what's going on in the rest of your life, is hormones going to fix that? No, not really. That's the other work to do.

Can you tell us the top three myths about menopause that you experience most often from patients? Yes, top three myths. Menopause is something that happens to old ladies. Hormone therapy causes cancer. And I think the third thing that women is this myth that women, that there is some value in suffering. There is not. And let me tell you, I went into medicine to figure out how to alleviate women's suffering, not to observe it. So when I see it happening and I have a solution at hand, I'm happy to share. Amazing. Can you give us your top three? Sorry, this was fun and you did a really good job. What are the top three myths about sex that you hear? That sex is always spontaneous. It is not. It's planned. Even, you know, it's funny, did you say that? Because when you're thinking

about it. He said, well, but when we were young, and it's like, no, but you went on a date, you went to, someone took you to dinner, that's a plan. That's a, you know, and we don't think of that as we get older. So one, sex is not always, usually not spontaneous. That sex is something that, that orgasms are always the end result of sexual activity. It's nice. And if it happens, it happens, but the shocking statistic for me that only about 30% of women will actually have an an orgasm during intercourse. Everyone thinks it's just them, which is why so many women fake, because they think, well, it must be something wrong with me. I'm not doing, no, that's normal. And we've been led to believe otherwise. And the third is that old people don't have sex.

And I'm here to say, yes, we do. Okay. So don't. Don't think that there's a point in time where you go, well, we're done with that now. No, you can remain sexually active, and it's good for you as long as you feel physically well enough. You're not hobbled by disease and weakness, and you have some good vaginal estrogen. They're going for you to make sure this sex is not painful. And not too much competition at the old folks' retirement home. That's right. Stay out of the old folks home. You know, you hear about these communities, retirement communities, where everyone is sexually liberated

and there's STDs happening all over. Is everyone on hormones or they're just embracing the novelty of partner switching in old age? What's going on? You know what? I honestly don't know what's going on in these spaces, but I can tell you why there's this proliferation of STDs in sort of nursing homes. Because one, nursing homes are overwhelmingly female. So, you know, you go out walking in a nurse home, you're going to see way more women in there than you see men. So if you've got this one functioning dude, you know. He's cleaning up.

And you've got all these women, you know, I mean, come on. You know, you don't, you don't, it's not even, it's not even a fair game there going on. So that's why there's so much being transmitted because you have, so few partners for so many people. They're at my problem. I'm not saying the life goal of men should be to be the one guy in the nursing home, but if that's your jam, you've got something to look forward to.

Yeah. I think that, you know, we could do a whole other story about why, you know, about how women age. Because the thing that, and this is something that I think that would, gets back to about hormones and why they're important for the long term. You know, women live longer than men, not that much longer, two or three years. It's not enough to explain how poorly we do in old age. That's why, you know, we live longer, but we live unhealthfully longer. Well, we're serving other people for most of our lives. Yeah, between that and between osteoporosis and then you've got this and the

urinary tract infections and the weakness. That's the other part that we don't think about with menopause that, you know, of all the million things. But one thing, when you take the estrogen away, what we do know is this, is that women tend to gain weight. They gain weight more around the middle than any place else, which is why it puts you at higher risk for cardiovascular disease. But you gain fat and lose muscle. And that weakness, that muscle weakness that you develop, you know, again, comes back to bite you in the end because it is that, that weakness, the bone, imagine you've got osteoporosis, now you're weak, you fall, you're much more likely to break something. So it's that.

And you know what? Before we leave, and I know you want to talk about this, and that is about what happens to women's brains during menopause. And if you have not read the book, the menopause brain, Dr. Lisa Mascone is a neuroscientist at Wild Cornell, and she is the first person that has really looked at what's happening to women's brains through the various reproductive stages of life, premenopause, perimenopause, and menopause. And she has pictures to show that the way women's brains are organized and responding and what it looks like and how it's metabolizing glucose is,

different at each of those phases of life. And that's why we think about, you know, when we talk about, oh, the brain fog and the mood swings and all that, yes, it's all in your head. It's called your brain. And that's where everything is registered. And estrogen has a really profound role in brain metabolism. I want to ask something that I feel very uncomfortable asking. And I don't want to make this like men are bad or partners are bad. But when you list all these things, like I have to say, like I get like a pit in my stomach because, you know, one of the things that many women fear is their partner leaving them when they get older. Like that's, I just, you know, like it's a thing that happens. And it's a real, you know, it's a cultural trope, but it's

also real. And of course, you want to believe, and I don't just want to make this heteronormative, you want to believe that your partner will, forget about, I can't even imagine two women in a relationship both going through menopause. Like, I don't even know how to wrap my head around that. It happens and like more power to you ladies. But, you know, everyone wants to believe that their partner is going to be like, I love you no matter what. Like, you're beautiful, no matter what. but to be honest, like, when you are experiencing these things, and like, I'm looking at the list of 34 things that I tried to piece, like, I'm done, you know, I'm done, meaning we're in the change. I have the menopause forever now. You know, when I think about, and I started my first hot flash,

I was, I think, 41, you know, when I think about this last decade of my life, which I was told, your sex drive's going to be amazing, and you're going to feel so smart, and you're finally going to know what you want, and you're going to understand things you didn't. And I'm kind of like, that really wasn't my story. You know, my story was my first autoimmune condition. I was 23. Then I had kids. That was like a whole hormonal, like, shitstorm of its own. I breastfed for, you know, a combined eight years, eight and a half years. Like, six years? Anyway, you know, when I think about that, I was like, well, then my 40s was dedicated to this bullshit, which we really didn't, I didn't know enough about.

And I'm kind of thinking, like, for a lot of women in those situations, like, I'm not, like, no one deserves to be left in this state. And also, I think a lot of women may be dealing with rifts in their relationship because of these complexities and not understand. standing them fully, not getting the treatment that they deserve. And also, a lot of partners might be like, fuck this. I can be with a woman who's 20 who's not complaining all the time and who isn't sick all the time. Like, that's sad to me. And I don't want to ask that question, but I want you to fix it. Well, imagine being in that scenario. And then you give this dude some Viagra. Okay.

Now, unless you deal with both people in that relationship, then what do you think, you know, okay, now, now what are we going to do? And I'm sorry, if I can just add to it, add to it a porn industry that has proliferated and started programming boys and girls from the time that they're tweens, right, to try and understand sex and sexuality in a certain way. I'm like maybe hair plugs was a mistake. It made them feel like they had a couple more years than them. It's true. It's true. And we've got to, that's the, that's the hard work of this whole thing of trying to figure out what is it about the relationships. What is it breaks down? Because what you're saying has been borne out in data, divorces go up in women who are in that perimenopausal and, you know, in menopausal years. So in their 50s, there's a peak in the divorce rate. And oddly enough, it's not, they're not, most of them are, you know,

initiated by women because, you know, they have gotten to the point where, you know, you're like, I am just fed up with this, you know, that all the things, all the, all the, the, the trappings that come along with, you know, relationships tend to fall away. And they really are laid bare in your perimenopausal in your menopausal years. And so, yeah, so that's real. But I have to tell you this. this is something that I do not want to leave anyone with the notion that, oh my God, then you get to perimenopause and it's all downhill from there. No, it's not. I mean, you know, a lot of how you approach this really and how you navigate, it really depends on the quality of your health, your physical, your mental health, you know, and I'm not, I'm not ashamed or embarrassed to say,

I'm 66 years old, almost. Okay, I'll be 660 years. I put myself. I put myself, head. Wait a minute. I've jumped a year. I'm almost 66 years old. And I am happier now at 66 than I was at 46 by a lot. Because, you know, and it's not just the menopausal thing. It's just that what was going on in my life when I was 46. You know, I had kids in the house. You know, I'm working full time, doing all this stuff. And so I want women to understand that the only thing that gets in the way of you not being able to be your best self when you're 55, 60, 65 is really not attending to your physical health and those symptoms that are giving you warnings all along the way that may have long-term health implications for you. Because, you know, if you're not feeling well, then yeah, you're going to be depressed. You're going to be lonely. If you can't, if you are immobile,

then you don't have the beauty of community. And I talk a lot about that in my book, is the importance of staying mentally and physically and socially engaged with other people. And we kind of had a little setback there during COVID. But these are all things that, to be honest with you, I enjoy my life more now than I did when I was 46. And I pivoted and I found a new community.

career. Who knew that I was going to be talking to you about menopause? If you had told me this 20 years ago, I'm like, you're nuts. I wasn't even planning to write a book. But while I was at it, I was like, yes, I can do that. But you've got to feel well enough and be well enough to be able to take advantage of those opportunities when they show up. Well, I mean, honestly, this is like exactly what we're so grateful, you know, that you've been able to do. I think a lot of women listening to this are probably going to start rethinking the way they've been approaching this phase of their life. And I think the fact that, you know, we're being told now to think about it before it's too late. You don't have to wait until you were suffering so greatly.

You don't have to wait until your marriage is on the rocks and your kids hate you. Like, you don't have to wait that long. And you can catch these things, you know, you can catch these things earlier and be able to get more support that will impact your health in general. general. Jonathan really wants us to give a shout out to weight training for women. That's just sort of like a general osteoporosis thing. The reason that I'm annoyed with him and have been typing to him that I don't want to make you talk about it is, you know, the reasons that women historically don't do those kinds of weight trainings is because we have been tasked with raising children and feeding people.

And even when we are the primary breadwinner, we are still responsible for housework and child care. And the fact is, men are encouraged culturally, and it is also more of amazing. thing to have these recreational sports and men play in groups differently, and it's an important part of play and aggression that women don't always resonate to in the same way. And also, I get a little resentful about a lot of the placement of these kinds of things, especially suggestions for women, because when I look at these Instagram accounts, it's these like super buff, you know, half-naked women who are like, I'm so pretty while I'm doing my, like, weight training. And it's like, I don't see them also like cooking dinner and picking up cats.

vomit and scrubbing the toilets. Like, it's this very, like, pristine, polished. Like, this is the way to ultimate women's health. And, like, it just, it doesn't resonate with me. But that being said, I'm so grateful that there are opportunities. Can you talk a little bit about the importance of shifting our perspective in this aspect of helping women with bone health, heart health, in addition to, you know, how we treat menopause? Yeah. Remember what I told you about, you know, you start to lose muscle during menopause, well, you've got to really fight to maintain it. But let me, I have always said this to my patients. Exercise and being physically active does not mean putting on gym shoes, gym clothes, going to a gym, paying thousands of dollars or getting a personal trainer. You know,

I find ways to be physically active just in the course of my day-to-day life, you know? Simple things. you're going you're going someplace and it's on the third floor do I take the elevator I take the stairs take the stairs you know if you're going to if you're going grocery shopping you know I take my cart I put my you know weightlifting I get my groceries I put them in the car I take them out I take my cart back I don't just leave it in the parking lot it's just that ways that you can figure out a way it's like well yeah it would be easier if someone else did it but there are things. I used to tell people, I said, look, I would only watch TV if I were going to. I said, you know what, I have a bike.

I have a Peloton. So I would say, as a reward for if I'm going to be sitting, let me just sit and then I'll watch TV and, you know, I can do an hour easy because I'm just sitting there. Get some handheld weights. You don't have to go, you know, get barbells, you know, graduated weights. do those while you're sitting, doing something that doesn't require your hands. I mean, you know, so I'm watching TV. You can do this.

I mean, so it doesn't, we make it hard, we make it expensive, we make it a bar that's hard to clear when it comes to physical activity. But here's another thing that really helps is that if you're going to do something, do it with friends. We will disappoint ourselves, but we will not disappoint our friends. So if you're saying, okay, we've got to, you know, we're going to meet once a week and we're going to walk. We walk and talk. Those are the kinds of things that don't cost you money that everybody can do and they don't take away any time from the normal activities that you have to do in your daily life. So that's what I say. I mean, you know, people don't even realize that, you know, you have, if you have cable TV, there's a whole fitness channel in there that you can just go and do 10. minute workouts. All you need is a yoga mat and a whatever. So, you know, don't make it hard and don't make it complicated. But that little bit of effort that you put in on the front end pays back

dividends that you cannot imagine on the back end. Dr. Sharon Malone, I highly recommend grown woman talk. We really appreciate you coming and talking to us and sharing your wisdom with our audience. And also thank you for really the service you've done for women everywhere. It's really so tremendous to get to speak to you and thank you. It was my pleasure. I mean, my Ambialx breakdown has no official opinion on what people should do with their lives, bodies, or health. But I will just say as someone who is in the forever condition, that I think Dr. Malone has some very sound points to be made for you all about things that we didn't know that we could advocate. for. Completely agree. Sometimes you turn to me and whatever you're going through, you just say,

I'm not supposed to be alive this long. Well, I also wonder, you know, Jonathan, I know that you didn't talk a lot in that episode, which is, you know, understandable. I got the most important points in. I figured you two had it covered. About elderly people having sex. I had other things, but you two were in a flow this episode and I felt it was important. Yeah, I do appreciate that. But I also you have a sister who's older than you. You have a mother. You are a person who functions in the world. I wonder if, you know, when you think back, let's say to your mom's behavior or what your mom was like, does it give you a new perspective on maybe what might have been going on for her? There's a whole world that she must have been going through that I had no idea about.

I actually would have to do the quick math to realize how old she was when I was born. and she was, you know, getting close to starting to go through some of these changes not long after I was born. Her behavior, you know, sometimes she had fluctuations, as many people do. Could those have been the result of a seesawing of hormones? I'm sure she was going through a seesawing of hormones. How would her life have been different if that seesaw was more of a straight line? line. I mean, I remember these conversations, you know, because at the time that my mom had started

thinking about it, this news, which, you know, kind of sounds like there was a lot more to it than we understood. I mean, that was the best explanation I've ever heard. I never heard that explanation of the sample, you know, the sample selection, the age selection, the, you know, kind of correlation causation challenges with that study that led people like my mother to be like, I shouldn't be on hormones. Like it's going to give, you know, cancer. And like, and it was this huge debate. I mean, it was like, I remember, remember all these conversations.

Do you remember those conversations at all or you were not part of them with your mom? No. I wasn't a part of them. I don't know if it was, you know, different in Canada versus the U.S. where there are just more options, if there was more of a standardized care. I don't know what it's like there now. I've been out of the country for long enough. that I just don't have experience of friends going through that system.

But, you know, this isn't a, I told you so, but like when I brought it up to you, you were, you're like, oh, that's not the, you know, there's all these risks. And like, you are an educated person and still the stigma from that study was still very confusing. And, you know, how would you navigate that to get the right information? That was the first time we've heard it broken down about the, biased in the study and the challenges of designing a study that is so complicated. Yeah, I mean, I'm thinking about, you know, also thinking about some of the people I know who have had a more gradual, you know, transition. And I sort of wonder like, oh, well, they have

a different stress level or they ate healthier than I did or I ate too much processed food. You know, like, I don't know. Like you start doing this like metapause math of like trying to figure out, like, how did I get here? And, you know, but I definitely think, yeah, I have a very different, very different understanding just after talking with her. And, yeah, it just, it makes a lot of sense. It makes a lot of sense that many of us are taught to kind of suffer or we're given kind of prophylactic solutions, like take edibles, microdose. Like, now I'm thinking maybe all the women who are like, you know, microdosing and like,

you know, wanting to, you know, have their mood improved, like might also benefit, you know, from, I don't know.

I don't know. And I don't have to know. You know, I'm in a very different stage of life. A lot of women report, like, increased amazingness, you know,

once they're in menopause. Like, this is not my experience yet, but there's always tomorrow. If you think about people in their 30s, mid-30s, she was mentioned. starting to have these changes where all of a sudden the regularity of your hormones are not producing at the same rate,

then that's way earlier than most people begin to understand that they're going through the types of biological and hormonal changes that are being addressed in this episode. So imagine you're 35, 36, maybe, you know, everyone is having kids later than they normally would. you're still in the process of being like, I'm going to find my family, but your level of emotional regularity is starting to shift and alter and you're trying to keep that together while also trying to push your life forward.

I think most women are just not thinking in those terms when they're looking at the symptoms that they're having. Well, and also when people talk about having kids later and later, obviously there's this notion of geriatric pregnancy, right? It's like I think anything over 35. and, you know, the one thing that we think about is like, oh, will I have enough eggs? Will I have healthy eggs? But, like, now that I hear her talk about hormones like this is a lot more complicated

because you have to have an egg, then you have to have the hormonal support to hold that egg. Then you have to have the, you know, hormonal proclivity to carry that baby, to give birth to it, to feed it, whatever, stand up at night, like, be exhausted. And I'm thinking about that intersection of, like, what if you're starting to also have these other hormone shifts, you know, and mood and sleep and marriages? Like, I don't know. I don't want to be like, hormones is the answer to everything, and everybody would be happy forever. Because I think also, I do think that there's a lot of partners who might not know how to handle these things when, you know, their lady, you know, is going through this. But I don't know. I think it's really important to keep talking about it. And I hope that

everyone, you know, has access to or can get access to this information, which is available. This information is available online. Dr. Malone has a women's health organization called Alloy. Like, there's a lot of ways that people can get this kind of information from a lot of different places. And I also know that finding a doctor who wants to talk at this level is also really challenging. So I'm grateful for people like Dr. Malone who are talking about it, people have written books about it so that people can, you know, try and get more information for themselves. I mean, I've heard it describe that men age, you know, in this kind of more linear fashion, and women have these larger disruptions to their hormone production and aging.

That is true, and it's also a reflection of the differences in the hormonal profiles of men and women leading up to this stage of life. Men produce sperm every day. It's like a thing that happens every day. And while men do have, you know, certain shifts and can have a cyclical nature to their libido and there's a lot of other factors, you know, generally speaking, men are sexually available and sexually receptive every day. Women can be sexually receptive every day, but if we're talking hormonally and if we're talking sort of, you know, in terms of neuroendocrinology, women are on a monthly cycle. And as Dr. Malone described, the hormones of that monthly cycle, roughly 28 to, I think she said 31 days or, you know, something like that, the hormones of that

cycle are primed to make you sexually receptive and interested to have someone fertilize your egg. That's what the hormones literally were designed for. And when you are not in a fertile state, that is when you typically have a different hormonal profile that may not make you as eager to make nice, have sex, and be close to people. You know, in the Jewish tradition, the time of having your period is actually a time for a notion of spiritual and physical separation of sorts from your partner so that you can experience all that you're experiencing without having to deal with another person's needs while you're in the middle of something kind of significant for your body.

So, yes, as we age, we're also seeing that women are going to keep having fluctuations, not just every month, but it gets kind of drawn out, contracted because of these cyclical hormones shifting into a new phase of cyclicality. Hollywood doesn't like to expose the underlying mechanism of desire as the need to procreate. I'm sorry, I didn't mean to do that. I'm just always thinking of rats. Like there's a time of the month When if you touch the rat on her hind legs

She doesn't do shit And then there's a time of a month When if you touch that rat on her hind legs She assumes the position She's like now's the time people It brings up the question though As you get into menopause And your drive is not to fertilize an egg

Where is that drive coming from? Emotional closeness Sorry I'm now mimicking lordosis, for those of you at home. If you're not watching the video, Maim literally stood up and pretended to be a female rat in heat. That's a first for us here. That's not a screen grab.

I don't know what is. So I also should acknowledge, yes, women can have sex any time of the month. When we talk about these kind of biological systems, we base them on, yeah, studies of rats and stuff. studies of animals that don't have a complicated, you know, cultural and social and societal, you know, expectations about relationships. A lot depends on, you know, kind of the state of nature that we find ourselves in. But in terms of the hormonal profile that Dr. Malone was talking about, that doesn't change because you're dating someone who lives out of town and he's only in

town once a month and it doesn't matter what stage of your cycle you're at. You're going to be sexually receptive. There's many other reasons, obviously, that we want to have sex, that we can have sex. The only reason to have sex for primate homo sapiens sapiens is not just to make babies, but I think it is important to realize that the hormones and those rhythms were made, you know, hundreds and hundreds of thousands and millions of years, like in the making of how the system was designed, that original plan of a hormonal profile that has led us to here did not include, you know, working in office buildings, wearing high heels and, you know, weightlifting. And with that being said, from our hormonal breakdown to the one we hope you never have,

we'll see you next time. It's my ambiolyx breakdown. She's going to break it down for you. She's got a neuroscience PhD or two. One fiction. And now she's gonna bring