Today, Explained - Still hot and bothered

Episode Date: December 6, 2023

Earlier this year the FDA approved a game-changing drug to treat hot flashes, a symptom of menopause. But menopause is much more than just hot flashes, as health writer Jancee Dunn explains. We talked to her in May about why a transition that happens to half the world’s population still feels like a mystery. This episode was produced by Victoria Chamberlin, edited by Amina Al-Sadi, fact-checked by Laura Bullard, engineered by Michael Raphael, and hosted by Noel King. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Earlier this year, the FDA approved the first non-hormonal drug to treat hot flashes, a nasty side effect of menopause. It's a huge deal. It's called fezolinatan, and everyone is rejoicing because it's extraordinarily effective. I mean, major, major reduction in hot flashes within an average of four weeks. Then in October, researchers in Uganda discovered that female chimps in the wild also go through menopause. This change affects a lot of people. And chimps, too. Us, our sisters, our moms.

Um, yes, ma'am, I have gone through menopause. It took me a long time. Mine lasted about nine years. But no one talks about it. Did Grandma Helen talk to you about menopause? Oh, gosh, no. No. We're going to talk about it. All the menopause questions you didn't know you had.

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Get more everything with FanDuel Sportsbook and Casino. Gambling problem? Call 1-866-531-2600. Visit connectsontario.ca. It's Today Explained. I'm Noelle King. Jancy Dunn writes a column called Well for the New York Times, and she also wrote this book. Hot and Bothered. What No One Tells You About Menopause and How to Feel Like Yourself Again. You know, I can remember when I was putting together this book, Hot and Bothered, What No One Tells You About Menopause and How to Feel Like Yourself

Again. You know, I can remember when I was putting together this book, I thought, okay, well, what books are out there on menopause? Seemingly thousands of books on pregnancy. I mean, there was just, you know, shelf after shelf. And then there was one book, I have a nice library too, there was one book on menopause. One, it was written in the 90s. The pages were yellow. It was very old. And I thought, wow, given the proportion of time that women spend in menopause, you enter it and you don't leave. You stay in it. So the average age of menopause is 51.

And the average lifespan for women is 80. So that's decades and decades that you're in it. Yet, who knew? I didn't know either, and I write about health. Anyway, I told him about my fever and my insomnia and my brain problems, you know, how I can't remember anything. And he told me he thought I could be at the beginning of menopause. No. Yeah, that's what I said. I started getting symptoms when I was 45. And, you know, when you're in your 40s, you're not thinking about that at all, but that is when

perimenopause starts, most often in your 40s. And so I remember I got a racing heart. That's one of the symptoms, the supposedly 35 symptoms. And I thought, oh, okay, I'm going to have a heart attack. And then I got other symptoms. My skin dried out. I went to the dermatologist. All these things were happening, and I didn't connect the dots because I just wasn't in that head space. In your 40s, sometimes people have young kids.

They're working. They're taking care of elderly parents. They've got pets. They've got this. You're just not there. And I also had equated menopause with, oh, that happens when you're older. You know, oh, that's kind of like golden girls territory. I didn't realize that it was in my 40s.

And when I finally put it together, I had seen I don't even know how many doctors. Can you list all 35 symptoms? I can. Are you ready for some fun? I don't mean to scare people to death. I really don't mean to scare people to death. I interviewed, I don't even know how many experts for this book, and they would say, please tell readers, sometimes you don't have any symptoms. Some women absolutely sail through it with no symptoms. Sometimes you just get a cluster of

symptoms and it's not so bad. But here are all the symptoms because it is helpful to know if you're in your 40s and some of these are starting to happen, put it together and maybe see your doctor. Here we go. Hot flashes, of course, everyone knows about that, right? It's in all the sitcoms, women like fanning themselves and night sweats. Well, it don't feel very beautiful. I feel like I'm jumping in and out of a hot bath and somebody's twisting a rubber band around my head. Irregular periods. I'll go back to that because that's a major tell when you have perimenopause. It's just one month, it's the mighty Mississippi River. Next, it's a trickle. Okay, anyway. Mood swings. Libido tends to go south.

Breast soreness. Headaches. Vaginal dryness. A big one. Burning mouth, huh? But yes. Tingling in hands and feet. I got that one.

Gum disease. Extreme fatigue. Bloating. Digestive problems. Joint pain. Depression. Muscle aches. Itchy skin, electric shocks, another who knew, but quite common apparently, terrible sleep, brain fog, memory lapses, thinning hair, brittle nails, mine were like baklava, weight gain, incontinence, oh yes, dizziness or vertigo, me too, increased. Loss of bone density. That's a big one to keep an eye on. Irregular heartbeat, which I mentioned I had. Weird new body odor. Also common. Irritability, anxiety, and panic disorder. And there might even be more, but those are kind of the major ones, and they certainly take people by surprise. I am fucking furious right now.

I know. It's a lot. It's a lot. And I don't mean to put a menopositivity spin on these things, but you will get through them eventually. But yeah, I know. Are you absorbing all that? It's a lot. It's a lot. It's a lot. And here's the thing that's, that feels very weird to me. Women, girls even do talk about our periods. And it's actually even kind of fun when like you're a teenager and you're like, oh, we're all getting it. First, Jenny got it. Then stupid Vicky got it. And I tried everything to get my period. We do talk about pregnancy.

Some of that chat is less fun in my experience. But we don't talk about menopause. And that is really strange to me. It's like we got two out of three that we talk about a lot, all the time. And then suddenly we go silent. You're right. There are so many rituals around different life transitions. And I received the talk. I remember my mom took me out to dinner.

It was a big thing. And, you know, I had the period talk. You receive the talk for their first period. No one gives a talk for your last period. Never. It's just not part of these life rituals that we have. Baby showers, bat mitzvahs, you know, there's all kinds of different rituals that you go through. I had a baby shower where people would

share knowledge with me and tips and, oh, here's what happened when I went through it, you know, and absolutely nothing for this life transition. And I was thinking, wouldn't it be so great if there was like a menopause shower where people could share what's going on with them and what worked for them. And maybe you could even get some gifts like neck cream because your neck really starts to dry out or, you know, vaginal lube or whatever, but just to normalize it and to let people know what's coming because the really important part of this is how we're still like, I love so much that you're having me on and we're talking about it and you're helping to further the conversation. That's how it's going to be normalized, right?

It's not going to happen with policy. It's going to happen with us all talking about it. I mean, the question is, were you open with your family about how the symptoms were affecting you? But obviously, I didn't know that you were having those symptoms for 10 years. I think, no, I think I wasn't open at all. I didn't talk about myself that much about it. Why? It's one of those topics that everybody jokes about, like, oh, God, menopause.

We know it's the worst. I just tolerated it. I want it to not be a shock. I want it to be familiar because part of the shock is that you don't know what it's about and you don't know when it's coming and you don't know that there are treatments out there. So my mother and I had a really long conversation and that's also good for your health records. It's good to know when, if they can remember. My mom, it took a lot of prompting for my mom. I was like, okay, when did you go through menopause?

Was it the Carter administration? Do you remember any, how old was I? It took a while because she was kind of, she's in denial about it. But it's helpful to know. And if your mother is no longer living, other relatives who had it, you know, it's just that's helpful information if you go to your doctor to talk about a lot of things that are, quote unquote, women's issues, including maybe periods and pregnancies, things that Gen X, myself, a millennial, are much more comfortable talking about. And so what's happening here really is just a generational shift in the ways that Gen X has pushed us forward, in the ways that older millennials have pushed us forward. We're doing that again. We're doing it with menopause.

Exactly. And I have such high hopes for the generations that are coming up because they are so much more transparent. You know, celebrities talk about it and half the time they are pushing products. Stripes was formulated specifically for perimenopausal and menopausal skin. Our patent pendingpending ectoene and squalene formulation provides superior moisture and hydration where you need it the most. So what is the criterion for menopausal clothing? Well, you want clothing that breathes. You need clothing that you can layer because you go from hot flashes to cold flashes. And we want to make sure that we've got something for both.

I talked a little bit about the menopause middle. They see that there's money to be made, and fine. I don't care because they're still talking about it, and they still carry some weight, and it gives people permission, like it or not, to talk about it, you know, themselves. I used to write about health and also beauty, so I would get sent these menopause products. And I noticed that back when I was growing up, the few things available for menopause symptoms that you could buy in a store, they were always in these like sad brown plastic containers and there would be like a picture of a

sunset on them if it was like a supplement or like dried leaves, you know. And now they're very luxurious. They're meant to be displayed and not hidden away, you know, with your skin tag removal cream. They're meant to be like put, you know, right there on the counter for people to see. They'll say the word menopause on it instead of some like stupid euphemism. And I think that's great too. Even the doctors didn't really talk about the menopause. No, I just knew I was going to not have a period. So that was fantastic. But I was not really prepared for the other things that came with it. Okay. So you knew you weren't going to have a period and you knew you were

going to be sweaty. But other than that, you were just kind of winging it? Completely winging it. Coming up, the reason we're all winging it. Guess how much time gynecologists spend on menopause in medical school. You will not believe it. Thank you. designed to help you save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. And now you can get $250 when you join Ramp.

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That's beautiful. It's Today Explained. Janci Dunn, author of the new book about menopause, Hot and Bothered. Janci, you said you started perimenopause in your 40s. And I want us to suss out what perimenopause is, what actual menopause is, and medically what's going on during this time. So start with perimenopause. Perimenopause, which was not even part of the lexicon until the 90s. I know it's so funny. Peri means around. And so that means the years around menopause leading up to menopause can be four to eight years, depending. And symptoms can be really faint at first. So it's not like it's this onslaught of symptoms for eight years. And again, that happens most often in a woman's 40s. Menopause means that you've gone an entire year without your period. So 12 months

with no period whatsoever. If you get your period, if you're counting up and you get it on month nine, you have to start over. So it has to be a full 12 months. When it has been 12 months, then you are officially in menopause. And again, the average age is 51. Then after that, you stay in menopause. You're sort of post-menopausal. And the symptoms kind of can continue. The one that can continue for a while is vaginal dryness. That tends not to get better,

a lot of the doctors told me. So if that's one of your symptoms, worth checking out. I'm so excited to tell you this as my daughter. Your sexual life really suffers. You're not interested in sex. It's really diminished. So you had to tell Todd so he could go get like some girlfriends. Yes. I had to tell him as my excuse and then, you know, to leave me alone. Women are socialized not to pay attention to their quality of life. And sometimes with some of these symptoms, if they're being deranged by hot flashes or night sweats, that can affect your quality of life if you're not sleeping for weeks at a time. And, you know, I would urge everyone, if they're beaten down by these symptoms, please see a doctor.

This is going to sound like a bizarre question, Jancy, but what is the point of menopause? Why does it happen? I always get excited when I hear it. This is going to be a bizarre question. I love it. Researchers aren't exactly sure. Some people say that our lifespan keeps extending and our fertility hasn't caught up with that. It's oversimplifying, but you can think of menopause as reverse puberty. That's what some doctors call it. And it makes a lot of sense because in puberty, you've got those hormonal changes, kind of everything's ramping up, right? If you can remember back then. When you go through

puberty, your system is being flooded with estrogen and other hormones. And when you're going through menopause, it's leaving your system. So it's reverse puberty. Again, that is oversimplifying and I'm not a doctor, but that's a good way to explain it to other people. You cycle through natural fertility and then perimenopause, sort of the opposite of puberty. What do gynecologists learn in medical school about menopause? I mean, really, it's only an hour of training, and it's not much at all. I know, and you think, when you pull back and you just think even just systemically, just knowledge about menopause, it's very interesting. The UK is ahead of us in many ways, and menopause is taught in schools for kids.

Whoa. We've been able to ensure that menopause has been added to the school curriculum in England. If menopause is something that will happen to you or somebody you know or love, then this does matter to you. In terms of medical school, it is kind of shocking how little it's addressed when the ramifications of menopause, when the symptoms can just go on for years at a time and can be really severe. If you're paying attention to the conversation around menopause, you do hear some about hormone therapy. What is that? And is that something that if I feel like I'm in perimenopause, I can just go in and ask for? You can. And I know people are a little bit leery of hormone therapy after the Women's Health Initiative studies came out in the early

aughts, linking it to breast cancer. And it's since been reanalyzed and there were a lot of flaws in them. There was just a lot of things that have not skewed the results, but made them a bit more extreme. So anyway, it's replacing the estrogen that is leaving your body. And there's progesterone too, which sort of mitigates the effect of estrogen. If you just have estrogen, then you can get certain kinds of cancers. And so you can have it on a patch, which has been shown to be safer than a pill. The current position with the North American Menopause Society and a bunch of other medical organizations is if you are within 10 years of menopause,

if you're in good health, then you should explore the idea of systemic hormones, meaning you take a pill or you have a patch, that the benefits could well outweigh the risks. And there's also vaginal estrogen. When estrogen leaves your body, it leaves all the tissues in your body. It's not just your skin, which mine got really rough. It's the skin in your vulva, your vagina. And when it leaves your body, your tissues get drier. And so sex can be incredibly painful. And that was another shock to me because it was. Not only did I not tell my husband what was going on, I just started avoiding him when it came to sex because, I mean, who wants to talk about your vagina drying out, right? It's not the sexiest conversation. But I realized I was doing our relationship a disservice because I was avoiding him.

And he thought that I didn't care about him anymore. And I finally had to tell him what was going on with my body. I thought, oh, I'm doing what my mother was doing. And I'm gritting my teeth about this. And I'm keeping quiet. Why? He's getting older too. Who cares?

Who gives a crap? So I told him what was happening. And I also said, you know, so just be patient with me. Here's what's going on with my body. It's reverse puberty. Think of it that way. This is the result of the estrogen leaving my body. And I went to my OBGYN and I got the frontline treatment for vaginal dryness and it's topical vaginal estrogen. You apply it topically. It's not in your system. And three months later, sex doesn't hurt

and you're not peeing yourself. Peeing yourself is a quality of life issue. And I don't mean to scare everyone to death. You may not pee yourself. It may be fine. But topical estrogen was an absolute game changer for me. Again, it is a personal choice, but another thing that I

didn't know was out there. When you spoke to women for the book, you talked about menopause, and you talked about what doctors had told them, how doctors had treated the situation. What are some of the craziest things that women told you their doctors said to them or suggested? Oh my God. The two responses that I interviewed countless women that they got were yoga. Yoga's great. There's lots of research behind yoga, but you can't pose away everything that's going on with you when you're going through perimenopause or menopause. And the other was have a glass of wine. This came up again and again. So a lot of times for painful sex, just have a glass of wine or for hot flashes, which makes it worse, by the way, alcohol. So you can't drink your problems away. It might be fun to try and you can't pose your problems away. But that was the two main things. And so,

you know, going back to your doctor, if you feel like you're being gaslighted or your symptoms are being minimized, see somebody else. How do you think this conversation and how do you think medical advances would be different if men were the ones who went through menopause instead of women? Well, I think that hormone therapy would be federally funded. I interviewed several urologists who treat both men and women, and they said to me that quality of life is not discussed with my female patients, but men are very upfront if something isn't working, if they're having sexual problems, if they're having problems urinating, you know, they'll come to me right away. It would just be a normal stage of life, just like everything else. And

it would be much more normalized. And, you know, right now the onus is on women to change things it's not going to be at a policy level is it i mean you know not to be cynical but i don't see anything changing for years and years but the more we talk about it the better it will be and we are making progress it seems slow but maybe four years ago i tried to get a menopause book off the ground when i was just starting to figure out that i had symptoms and nobody was interested. And this one, 13 publishers were interested. And I thought, ah, okay, this is telling. I remember the blood flow being so heavy that it would push the tampon out.

Jesus. Do you know what I mean? Like, you'd feel the tampon starting to come out, like, okay. You know, this is on NPR in a bunch of different cities. What if that isn't in the radio? Go ahead, put it on there. Someone will say, yes, that happened to me too. That's true, and that's important.

Today's episode was produced by Victoria Chamberlain. It was edited by Amina El-Sadi and engineered by Michael Rayfield. It was fact-checked by Laura Bullard. You heard Laura's mom, Anne Bullard, throughout the show. And we want to thank Anne for her frankness. And also, we want to thank her for Laura. I'm Noelle King. It's Today Explained. Thank you.