Science Vs - Menopause: The Myths and the Madness

Episode Date: October 17, 2024

Something is coming for 4 billion people on this planet, and if you've been watching the news — it's horrifying. It can attack your brain, your heart, your bones and even your vagina. So what is this fresh hell? Apparently, it's menopause. So what's going on here? What are the real symptoms of menopause? How bad is it? And is hormone therapy the miracle cure that some are saying it is? To find out, we spoke to gynecologist Dr. Monica Christmas and Professor Susan Reed, as well as epidemiologists Professor Samar El Khoudary and Professor JoAnn E. Manson. Find our transcript here: https://bit.ly/ScienceVsMenopause  In this episode, we cover: (00:00) The Horror Show (04:12) The Most Common Symptoms of Menopause (13:00) Memory Problems and Weight Gain (19:10) The biggest screw-up of the entire medical field?  (26:00) Do Hormones Cause Breast Cancer and Heart Disease? (30:12) Which Menopausal Symptoms do Hormones help with? (33:00) Supplements, CBT and Menopause (36:27) Menopause isn't a disease This episode was produced by Wendy Zukerman, with help from Rose Rimler, Meryl Horn, Ekedi Fausther-Keeys, and Michelle Dang. We’re edited by Blythe Terrell. Fact checking by Diane Kelly. Mix and sound design by Sam Bair. Music written by Bobby Lord, Peter Leonard, So Wylie, Emma Munger and Bumi Hidaka. Thanks to the researchers we spoke to, including Dr Caroline Gurvich, Professor Martha Hickey, Professor Nancy Woods, Professor Cindy Farquhar, Professor Jayashri Kulkarni, Dr Rebecca Thurston, Dr Sioban Harlow, Dr Susan Diem and Dr Yana Vinogradova. And extra thanks to Suren Jayemanne, Penny Greenhalgh,  Imogen Hayes, Zukerman Family and Joseph Lavelle Wilson. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications.  Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus. Today on the show, something huge that's coming for four billion people on this planet. It could be you, your partner, your mother, your best friend. And that thing is menopause. When we asked all of you, our listeners, for questions about menopause, I didn't quite expect so many responses. Hi Science Versus, I am so glad you're doing something on menopause. I'm like out of breath because I'm like, I better call the media. We heard from boomers and those just blossoming. I'm like out of breath because I'm like, I better call the menopause. We heard from boomers and those just blossoming.

I'm only 27. I am 37 years old. 55 year old. 61. Some of you hadn't started menopause yet, but were worried about what fresh hell was coming your way. Is it terrible? Is it going to make me want to murder my family?

My mom, my stepmom, my mother-in-law, they're all going through menopause. And all they say about it is that it's the worst. And for a lot of you, it did sound like the worst. People were getting hot flashes, of course. But also periods were going completely bonkers. Instead of my periods slowing down, I get it like every two weeks, which just seems obnoxious to me.

I had more periods, it should be called men are more. Very short cycles, very heavy periods. Heavy. It was just a horror show basically. Some of you had this nasty brain fog where you couldn't hold a proper conversation. You were getting mood swings to the point where you didn't recognize yourself. And then bam, I would just be upset for no reason. I never went through any of the things that they talk about, but I will say I gained weight and the weight that I had completely transformed my body and all settled right around my stomach.

So it looks like I'm seven months pregnant. I have never struggled with weight in my life. But now that I'm in the menopause, I have gained 40 pounds within three months without changing my diet or exercise. But I have got one symptom that I have not read much about. Every morning when I wake up, there is so much dry skin inside my ears.

Unbelievable amounts. I can reach in and sort of peel off, sorry if this is a bit disgusting, peel off a large amount of dry skin and it just keeps coming. But symptoms? This is just one of the confusing things going on about menopause. There was also this big question that people had about what on earth they should do about it, and in particular, whether or not you should take hormones. For years, we've been hearing that hormones can be dangerous. But some listeners going through menopause, thought that they worked almost like a miracle. Almost within days, I would say all of the symptoms went away. I mean,

everything got better. So it's amazing. And this tracks with what I'm hearing all over social media, with folks online saying that these drugs are great, and in fact, doctors have been screwing it up for years. The vast majority of women, hormone replacement therapy is safe and effective and can give a woman her life back. But that option has been taken off the table. It's ridiculous to me. So what's going on here?

Are hormones safe or not? And if you don't want to take them, is there anything else you can do? When it comes to menopause, I'm hearing a lot of... It was just a horror show, basically. But then there's science. Science vs. Menopause is coming up, just after the break. This episode is brought to you by Shopify. Managing a business is no small feat,

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nothing will. Get your Ghost Pepper Sandwich today at Popeyes before it ghosts you for another year. Take it from Popeyes. Welcome back. Today on the show, Menopause. So our adventure into Menopause really starts when the number of eggs in our ovaries dwindles, which can kick off this cascade of hormonal changes. And this time in our lives is generally called perimenopause. And the hormonal changes that we're

experiencing during this time are actually not the same for everyone. So studies have found that for some of us, our estrogen levels will actually go up during perimenopause. For others, they will go down. And then there's a group of us where our estrogen levels actually won't change that much during this time. So bottom line, do not believe those posts on social media that say we're all going on the same hormonal journey here. Because we're not.

But we are all heading for the same destination. same hormonal journey here. Because we're not. But we are all heading for the same destination. At some point, our estrogen levels will drop. We'll also stop getting our period. And if your period has disappeared for 12 months, congratulations, you're officially in Metapause. One huge analysis found that most of us will reach this milestone between our mid-40s and mid-50s.

But it can happen sooner. And so our first question is just what are the real symptoms of menopause and the time leading up to it. Because you go on socials and people say that you can blame basically anything on menopause. I talked about this with Dr. Monica Christmas, a gynaecologist at the University of Chicago. There's this whole litany of symptoms now and you can look like, oh my God, I have that, my joint ache. Oh my goodness, my hair is thinning, my skin is dry, my big toe is throbbing. I mean, I'm being facetious and I don't mean to be facetious because I'm actually in menopause

right now and I'm having, you know, I'm taping ice packs to my neck and surgery and all kinds of craziness. So I actually am not minimizing anyone's menopause experience. The most random thing is that last night I woke up at 4am and my big toe was throbbing! But literally when people say that to me I'm like my big toe is kind of throbbing too. I don't think that's menopause, but maybe it is. Okay, but seriously, this idea of is this weird thing happening to my body because of menopause or something else is actually a huge question for people during this time. Because the thing is, estrogen does a ton of stuff throughout our whole body. And so it's easy to blame our hormones.

But sometimes something else is going on. For me, I just needed to cut my toenails. To our listener with the dry skin in your ear, well, estrogen acts on cells in our skin, so it could be that. But also, doctors told us, maybe check if you have a fungal infection. And Monica says, sometimes things are breaking down in our body just because we're aging. And it's hard to sometimes disentangle what's just you're getting older. And I'm, you know, grappling with that aspect in my life too right now when I put the other

side of 50 is real versus what really is due to, you know, menopause. But in the trial of your symptoms versus menopause, there are a few things that menopause is absolutely guilty for. And the first thing, I'm so sorry to say, has to do with your vagina. This was my reaction. Oh no! As we get older, our vaginas atrophy. Science is word, not mine.

I would have chosen downsize. One reason this might happen is because once estrogen levels drop, it makes it harder for blood to reach the tissues in your vagina, which means that your vagina can shrink. Vaginal tissues become drier, they become thinner. The actual glands make less lubrication. Because of this, several years after your period has stopped, it might become a bit painful to pee or to have sex. For some, Monica says, that's not the problem. Some people say, I'm not interested in sex, that's not the issue, but I still have a dry,

itchy vagina. And they just keep thinking they have a yeast infection and they keep getting treatment. And they'll say it works for a little bit, but then I feel itchy again. And the reason it works is because the yeast infection cream probably had a moisturizing effect. So that's why they felt like they had a little bit of relief because the the cream helped. But it's not that they really had a yeast infection. In fact, researchers found that even though changes to your vagina are one of the most common symptoms of menopause, because a lot of people don't know this, they don't

get the proper treatment. Okay, so from your vagina to something coming out of it. Your period. Oestrogen and hormones obviously play a huge role in when you get your period, which is why menstrual cycles can go mental in the time leading up to menopause. We often hear that you'll politely start skipping your period, but it's actually quite common for your menstrual cycles to get heavier and to come more regularly. As a general rule, if your cycle is about a week shorter

or longer than it normally is, that's a sign you're in early perimenopause. If you start skipping cycles completely, you're getting close to menopause. Next up, hot flashes. Tons of folks transitioning into menopause are gonna get them. And while for some, they're not a big deal at all, for others, they are a very big deal.

Here's how one of our listeners described it. She said, picture this. You've got a lasagna in the oven on 450 degrees or something, and you open the oven and get that blast in your face. And this blast in your face, which can last for up to several minutes, can mess with your sleep, which can then really affect other things like your mood. And a lot of listeners were asking us, why does this happen?

It's weird, right? And amazingly, scientists only discovered the mechanism about a decade ago. So as estrogen levels change, we think that it stimulates these neurons in our brain called candy neurons, and it makes them kind of crazy. So they start sending messages to brain regions that control temperature, telling

your brain you are hot. And so, bam, you feel hot. And some people can experience these flashes of heat on and off for years. In fact, for the unlucky ones, they'll continue even after you've finished menopause. So meet what one paper described as the super flashes. Here's Monica again. My poor mom is one of them, that they always have them. They might not be as severe as they were when they first went through menopause transition, but they will always have them. They might not be as severe as they were when they first went through menopause transition,

but they will always have them. How's your mom now? She is better, but she will still, like she will still have a hot flash. And if I say her age, she would kill me. So I won't say her age. I'll just say I'm in my 50s and she did not have me when she was 16.

Right, and she's still having hot flushes. Yeah, all the grandkids are like, how old is grandma? And I'm like, who the heck knows? She used to tell everybody that she was 45. And when I turned 45, I'm like, Mom, you at least need to be older than your oldest child. And she looked me straight in my face and said, that sounds like a you problem, not a me problem. And researchers found that black women, like Monica's mom, are more likely to be

super flashes compared to white and Asian women. We're not sure why. Okay. So if you are getting hot flashes, your menstrual cycle is being weird. Chances are you are on the train to menopause. And there's other stuff too, like joint pain and stiffness. But then there's two symptoms that I hear about a lot in the context of menopause, where things aren't so simple.

So now let's look at memory and brain fog. This was a really big issue for a lot of you out there. In an email, someone told us, quote, the brain fog was absolutely awful. I lost confidence in even carrying on a conversation because I couldn't find the words to use. So to find out what's going on here, we need Professor Samar Al-Qadari at the University of Pittsburgh.

And she's been studying menopause for almost 20 years. I see how I used to study it without fear, but now I could see that I'm living it. You know what I mean? Yes! Study it without fear. Even when I'm building this episode, I completely understand where you're coming from. Yeah, yeah, yeah. So a lot of people in perimenopause, around 60%, say they're having attention and memory problems.

You know, sometimes you are talking and you want to remember name of someone. You feel like it's there. You want to say the name and you are not able to remember. And it makes sense that changes to your hormones could affect how you think, because we know that estrogen does really important stuff to our brains, like it helps memories to form. But for the average person going through menopause, how bad is this?

So let me tell you about this amazing study that Samar works on. It's tracked more than 3,000 women for decades, and it's measured their hormones and all kinds of things. But it's also given them memory tests over and over again, over many years. And here's what it's found. So you expect as you repeat the test, you should get better on the test, right? Right, yes. However, what we found is during the perimenopause,

women actually are not getting better. So their learning is not, you know, as you would expect for someone younger. Mm-hmm. Yeah. Their test scores didn't drop. They just didn't go up. So it's not like going through menopause trashed their memory.

And other research finds this kind of thing too. So, for example, one study gave women a list of words to remember and found that during perimenopause, they weren't so good at this. But again, it was subtle. The women had trouble remembering one or two words out of 16. And the good news is that in some of these kinds of studies, including Samar's, it shows that this so-called menopause brain, it doesn't last forever. It's really temporary and it will go away once they become post-menopausal.

Interesting. So, I think bottom line, this is real, and while some of us might be hit harder by it than others, thankfully, on average, our brains will fare better than our vaginas. Okay, just quickly, the last symptom we need to dive into is weight gain. People sort of have this story that I went through menopause and I put on 50 pounds overnight. It's not because of menopause. You are not gaining weight because of menopause.

You are gaining weight because you are getting older. Generally speaking, as we get older, we tend to put on weight. In the study Samar works on, women tended to put on around two kilos or four and a half pounds over three years. But when researchers followed the women to see who's perimenopausal, who's postmenopausal,

they can see that the weight gain isn't linked to where they are in that menopause journey, but rather how old they are. And other studies have found the same thing. So one big review paper wrote, quote, weight gain per se does not appear to be affected by the hormonal changes of the menopause. does not appear to be affected by the hormonal changes of the menopause. But then what about all those people at the start of the show talking about

how they had all this belly fat all of a sudden? Well, if that's you, you're not imagining it because menopause is doing something here. Menopause and the hormone would affect where this fat go in your body. So you see women start to accumulate more fat in their abdomen. Yeah, so the hormonal changes during menopause tell your body to change where it stores fat. And for some mad reason, it's redirecting that fat to your belly. In one study, postmenopausal women had around 50% more fat inside their abdomen compared to premenopausal women. So for those really feeling this menopausal belly fat,

it could be this one-two punch. We tend to gain weight as we get older, and then our body shoves it in our tum. So here's where we're at. The adventure into menopause can be a real drag. I mean for one it can dry out your vag, it can give you hot flashes, but for some of us will hang around for years. It can affect our memory, although for most of us that won't be too bad. And it can affect our body shape.

Our next question is, what can we do about all this? Cause on Instagram and podcasts and news reports, it feels like there is one message screaming from the rooftops. Just take hormones. So should you do it? That's coming up. A business is no small feat, but there are things you can use to help make it easier. Like Shopify. They're a commerce platform focused on one thing and one thing only. Commerce. They challenge the status quo so that your business can do bigger and better, and you

can focus on building what's next. For enterprise brands that believe there's a better way, there's Shopify. Learn more at Shopify.com slash enterprise, all lowercase. I am so dreading groceries this week. Why? You can skip it. Oh, what? Just like that? Just like that. How about dinner with my third cousin? Skip it.

Prince Fluffy's favorite treats? Skippable. Midnight snacks? Skip. My neighbor's nightly saxophone practices? Er, nope. You're on your own there. Could have skipped it, should have skipped it. Skip to the good part and get groceries, meals, and more

delivered right to your door on Skip. Welcome back. Today on the show, menopause. It doesn't sound like a barrel of laughs, but now we're asking, what can we do to make it funner? The treatment getting a lot of buzz right now is hormone therapy. And the idea is that you take a synthetic version of the hormones that your ovaries are no longer pumping out.

And what's confusing here is that for years, we've been hearing that these hormones can be dangerous and can cause things like breast cancer. But now the pendulum is swinging in the other direction, with folks online saying that these drugs are safe and can work wonders for your menopausal symptoms. And yet, doctors have been withholding these drugs from us. Why? Well, apparently, it's all because of one study. Scared-off say advocates buy an NIH-funded study called the Women's Health Initiative, or WHO, from two decades ago that they say dramatically overstated

the risk of hormones. The thought that estrogen causes breast cancer is the worst thing that came out of that study because it's not true. What we know, and this is not controversial, women that take estrogen alone have a decrease in getting breast cancer. And this is the message that is not getting out.

It's hands down the biggest screw up of the entire medical field in the last 25 years. That I won't be able to think of a bigger act of incompetence than what happened with the Women's Health Initiative. I've been involved with the WHO since the study inception. That last voice, that's Professor Joanne E. Manson at Harvard Medical School. She's been working on the Women's Health Initiative for more than 30 years.

She does not think that it is the biggest act of incompetence, but let's get into it. Because this study might be the single most influential study out there that's affected our perception of these hormones and whether or not they're going to help us or hurt us during menopause. Let's start our story in the 80s and 90s. Some early research had suggested that if you're an older woman and you took these hormones, it could prevent heart disease.

And so doctors were given out these drugs like jelly beans. But at that time, Joanne and a huge team of researchers wanted to find out if this was really true. Did taking hormones like estrogen and progestin, which is the synthetic version of progesterone, did that really prevent heart disease? So they launched this huge study. And because heart attacks was such a big killer in the US,

women were lining up to be involved. We had a slogan, be part of the answer. And so many women in the study would talk about, they just want to be part of the answer, not only for themselves, but for women of future generations, for their daughters, granddaughters. And it was very exciting. It sure was exciting.

More than 27,000 women over 50 signed up. Some were given hormones, others were just given a placebo. And this study was trucking along for five years. But then the researchers started analysing the data, and they found something that they really didn't expect. Instead of hormone therapy preventing heart disease and, you know, saving lives, they saw the opposite.

An increased risk of heart attack, stroke, blood clots in the legs and lungs, and breast cancer. Yeah, so not only did hormones not prevent heart disease, but they also increased a woman's risk of breast cancer. A press conference was set up, they announced the results and said that the trial would be stopped early. And suddenly people were freaking out about these hormones. Here's an interviewer on the Today Show talking to a researcher at the time. You actually found heart disease, the risk increased by 29%, the risk of strokes increased by 41%, invasive breast cancer risk increased by 26%.

So what are we telling women, the six million women in America today, who are taking HRT? Well, it was a shocking finding. It was seismic. So women were calling their doctors, frantically they were tossing their pills in patches. Were you getting calls from people who were in the trial

from your patients? Yes. I received calls from my own patients as well. It was very stressful and led to a sea change in clinical practice. Many clinicians were telling their patients to stop. So it was a big, it was a royal pain in the ass. Susan Reed, a professor of obstetrics and gynecology at the University of Washington,

was in the middle of a different clinical trial using hormones. And she told me she had to stop because of all this. We had to stop. Oh! So yeah, I remember it very well. Because my POPI was in England singing with a choir and I was left holding the bag. It was horrible. So I remember it. Was literally singing with a choir or metaphorically? Literally.

So this WHI study, it really set the stage for hormone therapy not to be given to loads of folks suffering through menopause because doctors thought it was too dangerous. But now you fast forward 20 years and you have people saying that this was a huge mistake. Why? Well, some say that the study was flawed and it's 20 years old. It's irrelevant. I asked Susan about this. There is this feeling that the Women's Health Initiative was this sort of old study done using hormones

that we don't even prescribe anymore, and this is bunk science and we shouldn't trust it at all. What do you think of that? Is this still a useful study? It's totally a useful study. And so that mantra is coming from people who want to sell hormones sometimes. And people shouldn't say the study was horrible because it was incredibly well done and it answered questions that it was set out to answer. But unfortunately it showed there were risks for those people in that study. It's good data.

Use it, right? Use it. But don't twist the message. Don't twist it. Without twisting the message, the second complaint that people have is that the press conference overstated the risks here. So let's look at what happened with breast cancer. In that press conference all those years ago, they said that for the women who took the

hormones estrogen and progestin, they had a 26% higher incidence of breast cancer compared to those who got a placebo. Which could sound pretty scary, right? A 26% increase. But if you tell people the stats in a different way, it can feel pretty different. So for example, if you look at it like this, out of 10,000 people who take these hormones,

how many extra folks are going to get breast cancer? A recent Lancet paper calculated that it was six, six more cases compared to what would have happened naturally. Six out of 10,000. Here's Susan. How big is the risk? If you look mathematically, it's Susan. How big is the risk if you look mathematically? It's small. Super small.

Less than one in a thousand per year attributed to the hormones. They are small. But you need to know about them. Any risk might be scary to someone if they had three family members, diet, breast cancer. They don't want it. But then, what's up with these people on social media getting loads of views for claiming that these hormones lower your risk of breast cancer? Well, I think what they're doing is cherry picking the facts in a way that actually could

be quite dangerous. So they're telling you about a particular group of women in that study. And it was women who didn't have their uteruses. They'd been removed. And this is important, because the thing is, if you don't have a uterus, Susan says... You're my favourite patient to give hormones to. Yeah, that's because you can just take estrogen.

You don't have to take this other hormone called progestin as well. months too. Yeah, that's because you can just take estrogen. You don't have to take this other hormone called progestin as well. If you have a uterus, you can't do that because just taking estrogen increases your risk of uterine cancer, something you don't have to worry about if you don't have a uterus. Right, it really increases my risk. Oh yeah, you can only take estrogen alone if you don't have a uterus. And the thing is, in that WHO trial, if you just zoomed in on the women without uteruses who just took estrogen, they actually did have a lower risk of breast cancer.

And not all, but some smaller studies have since come along and found this too. It's real. It's science. So, in a nutshell, or a boob shell, if you have a uterus taking hormones, estrogen and progestin, that will slightly increase your risk of breast cancer. If you don't have a uterus, you're good here. And then, just quickly, remember how early in the WHI study they saw that hormones up your risk of heart disease? You actually found heart disease, the risk increased by 29%,

the risk of strokes increased by 41%. So, the latest science marches to the beat of a slightly different drum. OK, so if you are over 60, it's still bad news. Here's Susan. If you start hormones at age 60, you have an increased risk for a heart attack, increased risk for a stroke, increased risk for leg clots and lung clots. So those are real risks.

But if you're in your 50s, taking hormones actually lowers your risk of heart disease, which is interesting, right? And the reason this might be happening is because if you take hormones like estrogen when you're older, you might already have dangerous plaques in your arteries. And we think that estrogen can help to rupture those plaques, increasing your risk of a nasty blood clot forming. But if you take estrogen before those plaques form, we think it might be protective.

Okay, so that is basically the tea on that big study that people like to crap on. But now, let's look at which menopausal symptoms hormones can actually help with. Because Monica hears over and over again these stories about the magical powers of these drugs. That hormone therapy is going to fix everything. It's going to make me sunny. It's going to make me happy again. I'm going to have all this energy. The truth is that hormone therapy can be great for a few different things. Like, it can help your poor, downsized vagina. Researchers found that estrogen put straight into your vagina,

which is quite safe even if you have a uterus, can even increase the number of blood vessels in your genital area, which is exciting. Treatment with local vaginal estrogen can be extremely helpful. Hormones are also great for hot flashes and night sweats. One review found that hormones reduce hot flashes in peri- and post-menopausal women by around 75% compared to a placebo. And Monica says that this means other stuff can get better too. If I give you hormone therapy and your hot flashes and night sweats resolve or get better

and you're sleeping better, then you probably will have more energy. You will have more clarity, right? But if that's not actually the trigger, just taking hormone therapy isn't gonna make your brain fall go away. Which takes us to the stuff that hormones don't really help with. Studies find that they don't seem to improve memory problems. Research on depression isn't great either, but it might help if you're in perimenopause. Hormones are also not particularly great at helping you shed that belly fat.

So, should you take them or not? Well, over and over again, I heard basically the same advice from academics and doctors. You look at what your symptoms are, ask yourself, how bad are they? Can hormones actually help with them? And then you balance that against the small but real risks here. And generally speaking, take the lowest dose that helps with your symptoms, and don't stay on these hormones any longer than you need to. Here's Monica again.

We don't want to mislead people by saying, this is safe, it's like jelly beans, everybody should be on it. It's still a low risk. It's not zero, but it's still a pretty low risk. And I don't think that that's in a really symptomatic individual that's really having problems, their quality of life is just terrible. think that that's in a really symptomatic individual that's really having problems, their quality of life is just terrible. Those people should not be afraid or doctors should

not be withholding hormone therapy from them because vast majority of people will be fine. And I think that's the key point there. Okay, so our last question on this menopause bonanza is what if you want to try something more natural? You don't want to take the hormones. Well, Susan Reed has studied a bunch of options out there. We like to take herbs, right? We like vitamins.

We like herbs. We think it's going to be natural. We think it's going to be good. How's the data on that? Not so hot. That's just not so great. That's really a bummer. it's going to be natural. We think it's going to be good. How's the data on that? Not so hot. It's just not so great. That's really a bummer. It's really a bummer.

So Susan did a big clinical trial to see if one of the most popular supplements for menopausal stuff, black cohosh, could help with hot flashes or vaginal symptoms against a placebo and? It did bupcus. What do your patients tell you when after you did this study and you're like, and I don't see it helping? They hated us. They hated us.

They wanted their black coho. In fact, our naturopathic physician who was part of our team, who really helped us with all this, she sobbed. She sobbed. She sobbed. She sobbed. Oh. She was so sad because this was what she told all her patients. I mean, it was really sad.

Susan has also looked into phytoestrogens. Sometimes people take them as a supplement or eat foods high in them, most famously soy or tofu. And this might work. It's actually kind of cool because special bacteria in the gut can take that soy and then transform it into a molecule that acts a bit like estrogen in your body. The thing is though, it only works if you have those special gut bugs, and a lot of us don't, plus you need to eat a lot of phytoestrogens.

You can't just drink soy lattes. It's not going to, it's not going to do it. Instead of supplements, try exercise, including weight training. It can help with loads of things like your sleep, your mood, your bones, and maybe even it might help you to maintain your weight. But it doesn't look like you can outrun your hot flashes. And when it comes to hot flashes, there is actually a new drug that doesn't muck about with hormones, but instead tweaks that candy neuron system that we talked about at the start of the show.

Just quickly, Susan has found something recently that she thinks is really awesome and just might help you with your trouble sleeping and your hot flashes. It's perfectly safe and it is your mind. Susan and other teams have found that cognitive behavioral therapy, so just using your brain to reframe your hot flashes as not being so bad, can help. Our minds are powerful. It's exciting.

You literally can change your perception of that hot flash and how bothersome it is for you. And we saw a benefit that was better than you might have seen with a pill. Have you had any pushback of like, getting women to do therapy for menopause is telling them it's all in their head once more? Oh, no, you know, I flip that. I don't say it's in their head at all.

It is real. But I flip it to say, your mind is powerful and look what you can do with it. You can do with your mind more than you could do with a pill. So when it comes to science versus menopause, what is going on? Well, the most common symptoms are hot flashes, bonkers periods and vaginal troubles. And while it might not make you pour on the pounds,

it can put those pounds on your belly. As for a cure, hormone therapy is far from the panacea that people might claim, but it can be really helpful for some things, including hot flashes and itchy vaginas. But you know what, because everyone's estrogen journey is different, it's possible that it could be really helpful for your symptoms. There are just a few risks you need to know about, particularly breast cancer and if you're over 60, heart disease. Meanwhile, there are other things you can try, like CBT. Here's how Monica, who if you'll remember is icepacking her way through menopause,

thinks about this whole wild ride. It is unavoidable if we're lucky to live long enough, you're going to go through menopause. Menopause isn't a disease. It's a natural process. And I think with this whole monetization of menopause right now, it makes it seem like there's a fix for it. And yes, by and large, there's treatment to help certain symptoms,

but there's no magic pill to stop the aging process. So I hope you feel a bit better and more prepared for what's going on with menopause. And if you are still feeling very freaked out about all this, Susan told me, you know, menopause, it's not all bad. If you are someone that gets moody around your period, if you feel bloated, if you get painful cramps, for a lot of us.

It all stops. Life is one nice smooth ride. There's none of that up and down. Oh yeah, some people love it. Some people are totally psyched. You don't have to think about contraception anymore. It's liberating. It's very liberating.

Great. One listener told us that she can wear white jeans again and she looks really cute in white jeans. Yeah. And you don't have to buy new sheets. Yeah. That's Science Versus. This episode on Menopause has 158 citations. 158, oh my gosh.

If you wanna see these citations, if you want to read more about anything I've said on this show, then just go to the show notes and there's a link to the transcript. I really hope that this helps you understand what's going on because there is so much garbage on social media about this. I just really want to thank all of our listeners who got in touch, whether it was on email or voicemail. I listened to all of those voicemails and I just, my heart went out to every one of you. I cried a couple of times. I just really appreciate you getting in touch and trusting us with your story.

We always love hearing from you, so if you want to get in touch, I'm on TikTok at Wendy Zuckerman, and we are on Instagram, science underscore vs. This episode was produced by me, Wendy Zuckerman, with help from Rose Rimler, Meryl Horn, Aketti Foster-Keys and Michelle Dang. We're edited by Blythe Terrell. Fact checking by Diane Kelly. Mix and sound design by Sam Bear. Music written by Blythe Terrell, fact-checking by Diane Kelly, mix and sound design by Sam Bear,

music written by Bobby Lord, Peter Leonard, So Wiley, Emma Munger, and Bumi Hidaka. Thanks to all of the researchers that we spoke to for this episode, including Dr. Carolyn Gurvich, Professor Martha Hickey, Professor Nancy Woods, Professor Cindy Farquhar, Professor Jayashree Kulkarni, Dr. Rebecca Thurston, Dr. Siobhan Harlow, Dr. Susan Diem, and Dr. Jana Zinagridova.

An extra special thanks to Suren J. Amana, Penny Greenhalt, and Imogen Hayes for our brainstorming session about a better word for vaginal atrophy. We threw a bunch out there, but went with downsized in the end. Thanks, guys. Also, thanks in the end. Thanks guys. Also, thanks to the Zuckerman family and Joseph Lavelle Wilson. Science Versus is a Spotify Studios original.

Listen to us for free on Spotify or wherever you get your podcasts. But if you are listening on Spotify, you can follow us and tap the bell icon so you get notifications when new episodes come out. And wherever you are listening to us, please and review us give us a five star review one for every million citations we have on the show I'm Wendy Zuckerman back to you next time