WHOOP Podcast - Redefining Menopause: Building The Blueprint for Women’s Health with Dr. Jessica Shepherd

Episode Date: June 18, 2025

Dr. Jessica Shepherd returns to the WHOOP Podcast for this month’s episode of the How To Series. Dr. Shepherd joins WHOOP Global Head of Human Performance, Principal Scientist, Dr. Kristen Holmes to redefine menopause. Dr. Jessica Shepherd is an OBGYN, menopause expert, and author of Generation M, guiding women through the various stages and lifestyle changes that come with menopause and peri-menopause. Dr. Holmes and Dr. Shepherd bring attention to the symptoms to look out for, create an understanding of the power of early preparation, and establish the importance of strength training and protein intake to support hormonal health. This episode brings to light the need for advocacy in the health space for menopause and peri-menopause care.(00:37) Introducing Dr. Jessica Shepherd(01:14) Reframing Menopause: Dr. Shepherd Personal Mission(03:22) Recognizing The Signs: Symptoms of Perimenopause & Menopause(04:10) Staying Ahead of Symptoms(06:55) What Women in Their 30s Should Know(09:26) Protein & Power: Building Strength for Hormonal Health(12:14) The Positive Role of Daily Activity(15:11) Menopause As A Metabolic Disease(19:12) Lifestyle Changes To Promote Metabolic Health(23:10) Important Biomarkers for Hormonal Health(29:44) Dr. Shepherd’s Toolkit For Women with Perimenopause(33:11) Estrogen Creams: Benefits and Practices(36:01) Understanding Hormone Replacement Therapy(39:27) Estrogen’s Effects on Cognitive Health, Sleep, & Longevity(42:14) When To Start Taking Estrogen(45:27) The Healthy Choices That Ease Menopause Symptoms(47:57) Birth Control & Peri-Menopause: Detecting Symptoms(51:15) Advocacy for Peri-Menopause and Menopause Care(55:15): Centering Dialogue Around Menopause(01:00:35): The Future of Research in Women’s Health(01:05:52): WHOOP as a Tool for Support(01:10:10) Exercise Options to Improve Overall Health(01:11:37) Dr. Shepherd’s Closing MessageDr. Jessica Shepherd:WebsiteInstagram LinkedInChanging the Conversation Around Menopause with Dr. Jessica ShepherdSpotifyApple PodcastsYoutubeSupport the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

All these pages I had written was really this love letter to women that I'd seen in my practice to myself going through it. I see this transition of menopause is so much more than clinical. It's this beautiful way in where we get to say, how do I want to restructure the rest of my life? Because 40% of our lives have lived in the postmenopausal phase. I really think a woman's journey has been so plagued with a lot of expectations, obstacles, stigma. We get to redefine that in this next chapter. I want women to approach menopause as something. that they get to take part in and have advocacy and awareness for themselves and self-love.

Dr. Jessica Shepard, welcome back. Yes, hi. It's so good to be here again. I know. Well, you know what? Your podcast literally was ranked in that year in our top three. Oh, I love it. Let's try and do it again.

Well, exactly. That's why we're going to repeat this. Because I think, like, I mean, that conversation was so full. But I really want to try to narrow this conversation down a little bit to, kind of perimenopause, menopause. That said, I really do want to talk about what do women in the 30s need to do to prepare for this transition. So I really, this is going to be just a big old deep dive right into it. I'm ready to dive in. So what inspired you, you know, because you're an OBGYN, you deal with women across the entire lifespan. Yeah. What inspired you to

just really go deep on kind of perimenopause and menopause specifically? Probably about 12 years into my practice. I realized that there was this gap. And the gap was these women coming in in their latter 30s, 40s, early 50s with complaints. But they were so subtle. It was the subtlety of I don't feel myself or something's off, but I can't really like put my finger on it. And as clinicians, you know, we are trained to see the worst. We got you if you die in. If your head's blown off or your heart stocks. It's little niggle wiggles. No big deal. Yeah. And so we are trained to look for, you know, pathology. And so when someone really is in a physiologic flux and something's happening, but it's not quite showing up on a lab or we can't like diagnose it as a disease, I think often

we're like, you're okay. But what I do know is that when you start to look at the biology and the chemistry of what happens during perimenopause and menopause, you do know that there's something going on with hormones, but we're really not equating it to the experience of it. And so that's when I really had to take a step back and saying, there's something going on. And the funny thing is, it wasn't my MD community who I was like, okay, we've got this figured out and let's try and, you know, take a deep dive. It was more my PhD colleagues who they were brilliant in the physiology of it and saying, you know, these are really like some profound changes that are going on, but then connecting it to the clinical space. And that's when I really was like, you know what, I'm going to focus on

women who are in this phase and feeling how to optimize them a lot through lifestyle because I have exercise physiology background but I was like there's also a lot in nutritional framework there's a lot in movement and exercise that I felt most people don't have a good handle on so I was like this is where we need to do that yeah I mean I think your clinical expertise is obviously super helpful and in being able to kind of rule things out and help narrow the focus for a patient what do you feel like are some of the symptoms that just keep coming up? Or is it really, is it widely variable? It is so broad.

Everyone walks in with this different template. I say it's like the cheesecake factory menu. You know, it's like never ending. Yeah, it's like I'm on page. Yeah, you're like, why would I choose this and why is this on this page? And so they come in with like these like varied symptoms of different intensity, frequency, severities. And so I think that's another reason why it's very hard to say it's not number base,

right? It's not hypertension. It's not diabetes based on a number. It's very experiential and subjective. And that time it's very hard for someone who is science-based and black and white and this is the number. This is right. This is wrong. To saying, I hear you.

Let's try and work with that. Yeah, there's this 38-page menu of symptoms, right? Like, I think there's like 175 at this point, right? But a lot of women, you know, you said that women come in and they're like, I feel off. They don't have the language. And that's really what I've seen in the last, like, a couple years is this kind of revolution in that, you know, we're starting to kind of have language. You know, as you were writing Generation M and thinking about how do we help women develop a better understanding what's happening with their body, where is the place to start for a woman

who is starting to experience these symptoms, can't quite put a language to it? You know, I think women often, like, they're finally in so much pain that they seek help. How soon, you know, does a woman need to start getting some help so she can stay ahead of it? Because I think, you know, if they're like, I'm just used to having these symptoms or, you know, these symptoms are different, but I don't really know what's going on. Like, how do you help a woman have a framework for, okay, it's get help so you can stay ahead of it? And that was a lot that went into Generation M was the fluidity of how you approach this topic, because one, it is very stigmatized. A lot of women put menopause in this bucket of old, so then they're like, I don't want to talk about it because I'm not old.

And we need to change that narrative of this is a transformation or a transition that's going to occur biologically. Like you can't stop it. You can't avoid it. But what we can do is educate, I call it like a rebranding, is this kind of education in the earlier phases, just like when we started, you're like, let's really look at how we can prepare. Better is starting at a younger age. Because truly, when you look at the fluctuations of the hormones, they really do start in the latter 30s into the 40s, but we're not really discussing it to maybe latter 40s into 50s when they're really symptomatic. Exactly. So if we kind of give. this. I say this all the time. If it were a screenplay, we have given it this horrific horror story

of a movie right now where, like, do not go down the street. You know, and you're like yelling at the TV, like, don't go down the street. It's crazy down there. Versus I'm like, I want it to be a comedic love story where there's just an authenticity to it. Right. Don't go to the basement. Yes. Like women should embrace these changes that are coming, not have it this like demonized thing that's coming with yelling and screaming and, like, running away from it. But as these things start to happen, what am I going to do in my authenticity, advocacy for myself that can help? And that's where I think we'll start to see the shift in how women prepare for it.

And that's what I named it actually in the book. I was like, you have your pregame, you have your main event, and then you have your, you know, you're kind of like after-party. And so that's how I kind of positioned perimenopause, menopause, and post-menopause. So it takes off the edge. Yeah, I love that. I love this idea. Of course, I like the sports analogy. I can identify with a pregame. So pregame, let's say you're in your early 30s. And the biggest group of women on our platform kind of is in that 30 bucket. So there's a lot of women who listen to this who are like, I know this is coming. As you pointed out, it's going to happen. What can women in their 30s do to protect themselves if that's even possible, right? I have to believe that the fitter you are, the healthy you are, the the more great food you put in your body, the better sleep architecture, like the more aligned circadian rhythms, all of that is going to mitigate some of these, I would imagine, help soften

the transition. Is that true? It is very true. And I think that's where we kind of missed it in the beginning, in the messaging. We were doing the messaging when they're already in the disease process or, you know, past that menopausal and that estrogen decline. So it was almost like we were playing catch up. Yeah. So now you already have sarcopenia. You know, your muscle mass is loss, but go ahead and do some things that's going to increase that. Or you're already becoming insulin resistant, so now we're going to focus on things. So the goal really is exactly what you said. And I think we are starting to see that, although I do have to remember sometimes I am in a very kind of narrow path. We're in an echo chamber. Yeah, we just hear each other

over and over again. And so many women actually don't know. No, they do not. That it could be as simple as let me try and restructure my workout into transitioning out of so much cardiovascular exercise and beefing up my, you know, my weight training so I can preserve my muscle my bone or my diet. How am I going to improve the protein intake, the quality of protein too? Because even now when I talk to my women in their 40s and 50s and I'm really trying to emphasize that protein intake, it's not easy to be like, okay, I want you to 1.5, you know, grams for KG and then we like figure it out. And they're like, how much? Oh, yeah. I mean, you're just off the reservation. Exactly. So imagine that transition can be over the course of

five to 10 years where we're getting you up to speed. And lifestyle change is probably one of the hardest things that anyone can do when it comes to personal life, your relationships, your health. So I would never expect anyone to do it overnight. Right. Especially in your 30s, you typically have younger children, potentially, you know, or they're kind of in that, you know, it's, I feel like took me until my kids were like eight or nine to kind of get out of that fog. You know, yeah. You're just like, oh, I have kids. Here I am. I am a human again. Yeah. Yeah. So I think there's a lot you know, we need to give some grace there. But I think, you know, there are some things that we can kind of do in parallel, you know, to kind of prepare. So we can't prevent. So this isn't a prevention thing, right? But it's easing the transition. So when we think about women in the 30s, up in the protein is a kind of a simple thing to do. And you would say as much as what would be your recommendation. So when you look at like your weight, say, and I'm going to use, you know, arbitrary numbers if you're 130. Usually it ends up being close to half of your weight in what you would want in your protein intake. which again, if you look at what you're taking in in protein, it actually is very difficult

to get to that number. Like even for myself, I wouldn't say that I'm at the ideal protein intake daily. And so I still work at it. But the goal is not for you to say, if I'm not here, one, I'm failing. But two is that I know what the expectation or what the goalpost is and I'm going to work towards that. And then it's always there in the framework and then stop working on this whole failure. You know, did you get there?

Did you not? You're still on the journey. This is lifelong work. This is not like, I stop it 45 and then I don't have to do anything again. It's a new way of thinking about your life. Yeah. And then resistance training. Yes.

22% of American women lift weights. It should be higher. I know. Talk about why does one have to resistance train if you're a woman? Why is that important? And then we can talk some specifics about what women should be striving towards. So the body, I always say it's this phenomenal machine that we are in charge of. and that machine runs on really delicate kind of systems.

And one of those systems is going to be like your musculoskeletal, which includes like your muscles and your joints and your bones. If we were to look ahead at your 80-year-old, 90-year-old self, what do we usually see? We see women who are frail, have increased risk of falls, breaking a hip, et cetera, and then they have decreased quality of life. So women typically live longer,

but they live more years in poorer health. And that has a lot to do with the estrogen decline. And so when we think of why it's so important to utilize resistance training as a form to help the body, this machine, is because they talk to each other. So the muscle is really good for strength and power, and your bone is for stability. And bone, I think people ignore because it's hard, but it's a living organ. And so we have to use resistance training as a way to tell the cells in the bone to being like, I need more bone. And that comes at the actual impact that you do with resistance training that actually triggers the bone to tell it.

right the machine we need more we need more strength we need more of those cells that are building the bone same thing that goes with the muscle and so if we're not stimulating this kind of complex of the bone and the muscle then that's when it starts to decline for multiple reasons i think you know with aging alone you start to see that decline but with estrogen now it's kind of compounded and so when women start to go through their 40s and their 50s estrogen is declining it's also impacting the strength of the bone and the ability to be strong but also the muscle as well and losing that muscle mass. You do lots of different types of movement.

We talked a lot about the resistance training. So I would love to get your thoughts on kind of polarized training. Because a lot of women have been doing the cardio and do love it and get mental health benefits from it. And then they're kind of like, oh, my God, I need to stop doing that. I need to lift. Right. We don't want to go.

No, all the other way on the scale. Exactly. I think right now, when I even hear the messaging, I do think it is a little, it's not that it's overkill, but because it's so important is why we can. keep emphasizing it until it becomes... And when we're short on time, the taxonomy, when you're in this stage of life, yeah. Yeah. You've got to prioritize like heavy weight lifting.

Exactly. That is like big, big. And so it's how do I get this thing that I really do enjoy? Because you want to take the enjoyment out of what they're doing. As I even do that, I say, okay, on certain days. So if it's four days that I'm working out, two of them, I will put in 20 minutes of cardio while still getting in maybe another 20 of weight training. within that whereas some days it may be straight weight training yeah and so also listen to the body

I think there are days that I'm like I really don't want to do any cardio yeah um and some days where I'm like I really feel like I'm going to do cardio today so being self-aware and listening to what your body is asking for to like don't go down the weight training thing where you just like plaguing yourself right like work into it and on the days where you're just like I don't want to do it today great get on the bike get on the treadmill I program with that like in mind like I'm like all right over the course of the seven days, I'm going to do sprint and rental training. I'm going to do a zone two, and I'm going to lift a few times. Right.

And I just kind of, I wake up, what do I feel like doing today? So I know what I've got the program, but I go based on how I feel. And I think like as women, we don't do that as much. Like, you know, we're not as intuitive with our training and frankly our eating too. And, you know, I think that that can be a really empowering way to think about it, you know, because we're working with kind of our, like our biology kind of tells us what we need in some ways. If we're like in tune with it, we can work with it. And you don't get a medal for, you know, because out of the four days you did all weight training and you deprived yourself.

So find joy. It's finding the joy in what you're doing. But also, you know, keeping a routine. Yeah. Routine is very helpful. You know, your body loves routine. But also sometimes just like go off the path a bit. Yeah.

Do what your body's asking. Bottom line, though, women need to work their heart. Yes. You know, like you need to get out of breath a couple times a week. I feel really strongly about that. Absolutely. I do too. My new thing is rowing.

I really love rowing. Oh, nice. Oh, interesting. Yeah. I used to be like all running and then I kind of went to cycling a bit that I do rowing. So I kind of like mix it up. Oh, nice. I mean, yeah. I think, you know, the brain actually really thrives on change and not doing something. New stimulus is like so powerful. That neuroplasticity is like, change it up for me. Yeah. And your body actually will respond better when you change it up sometimes too. So a lot of people, that's why in weight management when they're losing weight, they hit a plateau. Yeah. Because they have to do something different because the body can accommodate and remember anything. Yeah, yeah, yeah, yeah, for sure. Menopause is often referred to as a metabolic disease, right? So how does resistance training kind of offset that or help

prevent, you know, metabolic syndrome? You know, alluding to that analogy of the beautiful machine that our bodies are, really a pivotal part of it is, obviously, your mitochondrial health, your metabolic health, but that insulin and glucose machine, right? And our body, fuels off of glucose, which is very important. So it's not that glucose is bad. I want to, you know, kind of debunk that myth as that glucose is bad. It's how you're utilizing that glucose is really is the important part. So as we're starting to get older, again, because of aging, insulin and metabolic systems are starting to kind of being like, ah, not doing as well. Yeah. It's aging. But when we are not utilizing that glucose as fuel as best as we can,

and the largest organ system that utilizes glucose is your muscles. So if you're not building your muscle. It's not intaking that glucose. And then the machine is not running efficiently. Then the glucose sits around and then that's when our metabolic portion of our house starts to decline as well. And that's why we see our fat shifting. It's kind of like going a place where we never invited it. You're like, why are you in my midsection? Because I didn't want you here. And so that's what you start to see. So resistance training can kind of help prevent the body fat around the midsection. That doesn't have to happen. It doesn't. And I think you can slow it. Does the body want to do it? And is it going to start to do those mechanisms? Absolutely. Do we have the ability to thwart it and kind of like

hijack it in a way? We absolutely do. And those are the ways that we can do that with resistance training is just. How many times per week do you recommend women resistance train? I always say start go, start slow and work your way up to it. Just like anything, just like but that January phenomenon where everyone's in the gym and then by February we're like, where'd everyone go? Is the same thing of the mechanisms of getting to a place where it's sustainable, duration, sustainable. So something you can do weekly. So I would say work up to, ideally four times a week. Yeah.

Right. And the resistance training can come in a variety of different forms. So a lot of people are still very scared of weight training, like heavy weight training. And so if you can do that maybe three times of the four times or two times of the four times and then integrate other forms of resistance training, which would be like your Pilates, yoga, a little bit of like body weight to do resistance training. You can also implement that as well. The message, though, I think you'd agree, is people need to move heavy weight.

Heavy weight is going to get it. Yeah. It's just like that's the most efficient way to build muscle and to improve the quality. Let me tell you. This is like, it's not that it's new, new information for me. It's very new for a lot of people. But even up to, I would say maybe five years ago, I've always really been lifting weights, but I wasn't going as heavy as I now because I wasn't truly.

understanding the beauty of heavier weights. I had a patient yesterday. Talk about the same thing, resistance training. But I always go a step further. I'm like, how much weight? Because everyone won't be like, you know, if they are weight training, they'll say I'm weight training. And she's like, you know, about 8, 10, 10 pounds. I go, uh-uh. We're going to get you to doing 25, 30 pounds. And her eyes were big. But then I explained to her. And she was like, great. Let's start, let's start working up. You just have to. You know, I think we're obviously in very privileged position in that we can afford. We have resources. You know, if we want a coach, we can get a coach. And a lot of folks don't have that.

There are a ton of resources online. You know, a lot of, you know, I recommend folks follow you online, Dr. Jessica Shepard, you know, for inspiration. But there's a lot of apps that are really good. There are. I have seen a lot of apps. Yep. And so it's being curious, I think, is it's one of my favorite things is curiosity breeds growth. Yeah.

And so sometimes that's our homework. And I tell my patients, I can help you as much as I can here in the exam room or the O.R. But when you leave here, what is it that you're going to take that you're going to be your best cheerleader and start to do some things, turn some new leaves, do some new exercises? You have to do that work. Yeah, yeah. I think that's like the kind of the realization or that no one's going to put your running shoes on for you. No one's going to be in the gym. My sister always says this. It sounds really depressing, but it's actually really true, is that no one's coming to save you. I know. No one's coming to save you. I know. And so you have to find the ways that are going to save yourself. And at the end of the day, no one is going to care. about your health more than you are you know like it's just like you have to like just lock in you have

to lock in and just be like all right like these are just the things this is part of the human experience it's part of the journey part of the experience and that's where we get to drive that experience is really being in charge of ourselves for sure and I think that's also an act of service right isn't it that's such a great way to put that like you just I like whenever I feel my motivation wane I that's that that's what I that I play that back in my head this is an active service for my kids. Yeah. So 20 years down from now they're not having to like, you know, wheel me up a, you know.

Right. Because there's actually like a lot of guilt that comes with that. When you're just like later, you're just like, oh my gosh, this is something that now someone else has to carry that burden. That was preventable. Yeah. You know, it's like just take care of the things that you know that you can control. Right.

And, you know, getting in the weight room is the first step. Getting the protein is. It's not scary. I really encourage, especially people who are listening to this episode, but anyone I encounter is a lot of times it's out of fear, but once you kind of push through that or find someone who's going to, like you said, encourage you or kind of get you curious, do it because it's so much better when you push through that fear to do the thing. Yeah.

Don't be shy. You know, everyone has got their own thing. They're focused on. Like, they're not looking at you. Don't worry. Like everyone was there at one point. Absolutely. You know?

So it's just taking that first step. But, yeah, I mean, I think we really need to get, you know, women in this country. lifting wakes. We do. And just movement. You know, I always like to, I think exercise sometimes is scary. So sometimes I tell my patients, it's really movement. Like, park your car further and walk. I don't know. Take the stairs and sell of it. Like start somewhere and building into it. Yeah, I love that. You talk about this, you know, exercise snacks, I think is a great way. You know, just building movement in throughout the day, which can be even more effective than going to the gym for like an hour block. You know, I think a lot of folks are sedentary for really

long periods of time, which can exasperate a lot of the symptoms. associated with the paramedipause of menopause and just getting out and thinking about already over the course of the day how many little snacks can I build in you know whether it's set up your body weights and that's why you know when we think of you know decades or even centuries ago we were never really designed to sit and kind of be as sedentary as we are now we were really more of creatures that were movement we were movement creatures and that's how we survived yeah and the body is literally set up to function in that way. So now it's actually we're trying to do like work behind the scenes to get us back to that that place. But that's really what the human body is. It was really

meant to be moving. Yeah, totally. And the modern world is just not set up. We're not moving. We have elevators and we, you know, like there's so many conveniences. I mean, they are convenient. They're amazing. Especially when there's seven floors. Yeah. You know, it's a new, it's a modern thing. They were there weren't there weren't seven floors. Exactly. In the 1800s. Exactly. But yeah. I mean, I think it's just, I think you give us, like, I think our listeners a lot of ways to reframe. Reframe. Rebrand. Rebrand. I love that. You know, and I think sometimes it's like rebranding at the level of your life. Right. You know, it's all stages and phases. And, you know, you may be in a phase where you're really strong and you're able to go to the gym four times a week. And then you may hit like a little rut

where something happens to you. Maybe you get injured. Maybe it's your personal life. But once you keep it as part of like your mantra, it really will weave itself in natural. essentially, but consistency is never a straight line. But you want those fluctuations to be as minimal as possible, but there are going to be fluctuations. And that's when you were saying before, give yourself the grace, but always know that you're working back towards that consistency. I love that. What biomarkers should women be paying attention to as it relates to metabolic dysfunction, just kind of staying on this theme of our resistant training protein kind of is a path to kind of get us in a better place? You know, what biomarkers can women look to to understand? I would say, you know,

we have this kind of controversy of perimenopause, which is usually through your latter 30s into 40s of do we draw hormone labs or not? I want to start out with that one because that is a very common question. Yeah. And the answer really can be looked at from different perspectives. So for example, from a clinician, from a doctor's standpoint, when a patient comes in and says, I'm perimenopausal or I'm still having my cycle. I need you to draw my hormone labs. Just define what would be perimenopausal. Absolutely. Perimenopause is that time frame which can last anywhere from three years to 10 years prior to menopause. Menopause is such a clinical term. All it means is a woman has gone 12 months without a cycle consecutively. Like she's not had a bleed spotting nothing for 12 months.

Okay. And it's like right at that 12 month, we can be like you are now officially in menopause and we throw a party, whatever confetti. But that time frame before that can be from 39, 43, where you start to have fluctuations in your hormones as it's preparing for menopause. This is where you start to see those fluctuations and you get those symptoms subtly here and there hot flashed nights wet. But usually women will start to complain of changes in their cycles. Yeah. So it's not consistent. So heavier bleed. Yeah. Irregular. A regular lighter. Miss a month. Change in color. Like all these different nuances that they're like, what is going on? And that's the fluctuation. Okay. So that's a signal that. Yes. You might be entering into parameda plus. Okay.

As a woman comes in and they're asking about like, you know, my overall health, or maybe I want some labs, a clinician will stand and say, the labs are not necessarily going to help me because I know you have a cycle. So I know you're not menopausal. I know that your ovaries are still giving off estrogen, progesterone, and testosterone. So it's not always helpful for me to look at and say it's there or it's not there, it's high or it's low, because I know it's still there and it's fluctuating. It's hard to calculate. Now, is there a way to maybe give a woman reassurance in a baseline? Absolutely. So I'm never opposed to being like, I will not do it. But I love to give fundamental information behind it on why it may not be the best tool. Now, when I say those

labs, I'm usually talking about estradiol, progesterone, testosterone, and maybe follicle stimulating hormone, which is f-sh. Outside of that, that's a reproductive hormone panel. Outside of that is we should be looking at and asking for your thyroid panel, a full panel. So not just T-SH and T-4 or T-3, but the full panel to see what's going on in your thyroid on front office and back office, as I like to call it. Like, what is the full complete profile? Another one, Hymoglobin A1C. Hemoglobin A1C is one of those. We talked about metabolic health markers that really is telling us

most people are going to start to become insulin resistant. We're not quite sure how quickly do you have family history. What does your previous health look like? So it is a great marker for us to be like, hey, we've got to shore some things up because you're heading towards diabetes or pre-diabetes. And you can be eating really well and exercising and still experience. And still experience a shift. And this is because of just the hormone shift.

Because of the hormones. And so that's why estrogen is such a key player in all of the different functions of the body, including metabolic health. So that's another thing that we used to do is wait until someone was like, oh my gosh, like my sugar on, you know, just a normal panel was really high. And they've been diabetic for who knows how long. Yeah. So the hemoglobin A1C really gives us like this prediction of what's going on.

The other thing that I would say is your vitamin D levels. We see a lot of drops in vitamin D and B12. so those are two key vitamins that I always say are very important to draw a lipid panel we do see usually in the later perimenopausal in the early menopause phase of a shift in the lipid panel specifically in your total cholesterol and then your LDL which is not your low density lipoproteins so that again is something that could start because of two things aging and feature of menopause where you start to see these shifts again we don't want you to be hyperclosterlemic we want you to catch you before you are. So that's a great time to do that as well. I would say that's the

most basic. There's a lot of other cardio metabolic kind of markers that I draw and that's usually kind of like a little bit of an extension, maybe if I have maybe a perceived notion, but then it usually comes with a lot of privilege as well because those labs are really expensive. The one that I gave is really nice and basic. Anyone could ask for those. Amazing. Do primary care physicians like actually like if someone goes in and asks for them like can you get them and can insurance cover them like are those man this is this is a whole other session of this podcast is because this is why health care in America to me is not great yeah is because insurance should be covering these things right because what are we talking about prevention and I feel that there are a lot of instances in

health care in general that is not covered because we're waiting for the disease to appear and so it does depend on insurance coverage. It does depend on what are the recommendations noted by a body that says at this age we'll start to do these things. And so it's not always covered. I always say I would advocate for a patient sometimes to be curious and say, what is actually the cost if I didn't use my insurance? Right. And sometimes it's actually less than you might think. But even if you just had a screenshot or a snapshot of what you are in that time, think about how much you could do with more knowledge. And so I always advocate for patients to ask how much it is if it's not covered. And then for clinicians to, even if you don't think that it might be the best tool for

that patient, reassurance and education for a patient is one of the best things that you can do for them. And sometimes it's okay to draw a lab. Do you need to draw it every three months? Absolutely not. We don't need to go overboard. But sometimes it's okay to do that for a patient. What's up, folks, if you are enjoying this podcast, or if you care about health, performance, fitness, you may really enjoy getting a whoop. That's right. You can check out whoop at whoop.com. It measures everything around sleep, recovery, strain, and you can now sign up for free for 30 days.

So you'll literally get the high performance wearable in the mail for free. You get to try it for 30 days, see whether you want to be a member. and that is just at whoop.com back to the guests what would be your kind of toolkit for women in perimenopause who are experiencing irregular cycles heavy bleeding like just some of like the very typical kind of features of peri metapause that are totally annoying and like you know just can really are debilitating in a lot of ways they're debilitating from like an emotional aspect or from quality of life so this is where that's a tricky time for frame in where you can still get pregnant, but you're less likely to. Yeah. And so for a lot of women,

I do say you have the opportunity to still continue on a form of birth control or not. And there are some medications that are non-hormonal and are not a form of birth control rather, and also non-hormonal that do deal with heavy bleeding that are not a form of birth control. And then also deal with just during the cycle portion of decreasing that bleeding. Then there are obviously your hormonal birth controls that you can still navigate through. And then there are, well, there's really one, but one non-hormonal form of birth control, which is the IUD. It's the copper IUD, which can help prevent pregnancy. It doesn't necessarily always help with the bleeding profile. Yeah. But the other thing, the other aspect of that. And can, in fact, increase the bleed. That is one of the things of the copper

I would say. But it's one of the ones where people are really like, I don't want to take birth control. Because then the other thing is you're like, we've had, we've had, uh-oh, pregnancies. So that's like a little feature I always make a nod to to not forget that even though your cycles are irregular that you can't get pregnant, you can't. But looking at maybe non-hormonal forms of birth control and there are medications that just deal with heavier cycles that you can take. If for women who are concerned about birth control, what would be the taxonomy for those folks? And obviously very individual, but just at the highest level. Right. I would say very individual advice. And again, not medical advice. because you really have to like narrow it down to where you are.

I would say most women who I encounter and, you know, in my practice, who are in that time frame of perimenopause are really looking for convenience. And they're like, I have too much to do. I want something that's not going to interfere with my daily life. So the IUD usually kind of ranks in that top frame of something that they can put in and not have to worry about. It gives them really good protection from decreased bleeding but also from endometrial carcinoma because it has that kind of protective

gesture of the endometrial lining. Yeah, yeah, to the endometrial lining. And it really allows someone to stay flexible in their life and not have to worry about something. The next thing that I would say is actually the NUVA ring, which is what you insert. Okay. Again, that is you wear it for three weeks, one week off, right?

So then now we're looking at what do you have to do that's less occupying of your time and you still get the best benefit from it. And now that's a birth control. It is. With both estrogen and progesterone. And so that's a combined, whereas the IUD is just progesterone. Just progesterone.

Just progesterone. And then you have your birth control pills, which obviously a lot of people actually still just do it because it's so rote. It's like part of their muscle memory. They're like, this is fine. And the good thing about birth control pills, I would say, because that was our first version of Perth control, we've had so many reiterations of it. Right.

There are actually a lot of combinations that have really low levels of estrogen. Yeah. That you don't really necessarily get those shifts and moods. And it's just giving you that baseline to kind of calm the bleeding down and then also prevent pregnancy. Yep. Yeah. I think that's super helpful.

Let's talk about estrogen, the vaginal creams. Yeah. When does a woman start that? Why would they want to? Yes. And, you know, just give us the lay of the land there. I know that's really popular now. Yeah, the vaginal estrogen cream, I feel as like a condiment.

It's like ketchup. It's like everything can have ketchup on it. Pretty much everything. It's like there's not a lot of contraindications because when you bring up like estrogen, whether it's birth control or HRT, a lot of people get a little nervous, sweaty palms. And so when you think of the least, the one that could cause maybe the least hesitation is vaginal estrogen because the absorption rate is much less than you see in systemic estrogen when you take a pill or a patch, etc.

It is super efficacious. It is super efficacious. It really dryness and all sorts of, yeah. Because it's local. Yeah. So it's at the site in which it's doing its best work, which is vaginal insertion or even on the outside. it really helps with decreasing vaginal dryness, which is a really big part of this whole experience of perimenopause and menopause. The thing that I love about it is this is where I really like

talking to my breast cancer patients because breast cancer survivors are usually the kind of like this hard line, you can't have hormones anymore. And there is a really pivotal study that was done at the end of 2023 that was looking at what is the recurrence rate in people who have had, breast cancer in using vaginal estrogen and there was no increased recurrence of breast cancer which then makes it safe for breast cancer survivors to have some form of estrogen especially when they're going through this really severe shift in their hormones a lot of them have vaginal dryness right that's why I really love the feature of the condiment of HRT which is vaginal estrogen and even if you're not experiencing vaginalditis yet it's such a great it is

And also prevents, and also that's been shown to reduce the risk of certain cancers. Yeah, it actually can. And so I love that it replenishes the vaginal mucosa. Yeah. Right? So the vagina, if you think about your childbearing ears, right? Yeah. In your reproductive years, the vagina obviously has a lot of rich blood supply,

which is why you're able to push a baby out your vagina. Yeah. And then it goes back. It's funny, right? A lot of elasticity and flexibility. Yeah. But that has a lot to do with estrogen. Yeah.

Right. Yeah. And so once you lose that, you lose the distensibility. the elasticity. So it actually is a great way to be preventative, but also for women who are suffering. I'm like, we do not have to live like this. Yeah, yeah, yeah. And it's, it's super easy to use. I met Kelly Casperson. Yeah. And ever since then, I was like, okay, where do I get this vaginal estrogen cream? Right, right. Yeah. She loves talking about vaginal estrogen. She sure does, and I have been putting it on my skin. Yes. You can use it for your skin because we have estrogen

receptors. I put it with my retic all over our body. I know. Exactly. Yes. Yes, estrogen receptors are everywhere. Yeah. So yeah. Okay. Amazing. Hormone replacement therapy. Yeah.

Aposal replacement therapy. I know it goes by a couple of different names. Yeah. What is it? And when does it make sense for a woman to consider it? Yes. I love the way you phrase that question because we have had so much kind of stigma against it can't be used.

So we were like 20 years out from WHA study, which was a study done 20 years ago. Explain that real quick for listeners who might have be aware of just that very quick Overview. Disaster of a study. Which the funny thing is it was a great study in how it was proposed because it was actually looking at cardiovascular health and the implication of decreasing cardiovascular events, which is the number one killer of women and what hormones does for that. What happened during that study is that there was a slight increase in breast cancer cases. Like any study should do, if there is something that is occurring that can be a detriment to the population of women this case, then you stop the study so you can see why is this particular thing happening.

What got out to the press, the press was really the one who I feel kind of ruined the outcome of what the study was by just saying there's this huge study that's going on and estrogen causes breast cancer. Yeah. And then they just like let it sit. Like the headline with I know, I know. And then everyone is running in the streets being like, oh my gosh, everyone who's on HRT get off. You're going to get breast cancer. Everyone's getting breast cancer. Clinicians, I don't even think they were given the right information. No. Do you know that from the years of, so that would have been 2002, around, to 2024, saying. The amount of prescriptions that were dropped from that time, 84%.

84% of HRT prescriptions that were written had, like, had gone down by that much. So imagine the amount of women now who were on it, who wanted to be on it, or were considering it. We're denied. We're denied. It just wasn't even a topic anymore. It was like, it goes out with the bathwater. And so from that study, there was kind of this misnomerate. or that hormones are bad, but all the while, like true scientists do, which is why I love

bench research, is they did their due diligence and going back and looking at it retrospectively and being like, what the happened? Yeah, yeah. And when they looked at it, it actually wasn't the estrogen that increased breast cancer rates. It was a synthetic progestin that was used in the study that increased the breast cancer rates. Damn. And so now you had everyone being like, oh my gosh, this was not even what happened.

And also, we didn't maximize the benefits of the WHOI study was we had decrease in osteoporosis, dementia. When we look at colon cancer rates were decreased. And so from all of that, it was just messy. Yeah. You know, and so now, fast forward, we really have gotten to this point where we're like, we are so sure of what we are in HRT. We know the benefits. We know that estrogen does not cause or precipitate breast cancer. I like to rephrase that because there's never absolutes.

And what we do know is that it is very beneficial, not only for symptom resolution, which is hot flash, it's nice, so it's all the things we talked about, but longevity. So now we know what you want to show up as a version of your 80 or 90-year-old self when we think of the three things that probably kill women, cardiovascular disease, osteoporosis, and then you fall and have a fracture, and then also dementia, right? Those three things are actually significantly benefited and decreased when we put in estrogen replacement therapy. hormone replacement therapy, rather. When we age, estrogen declines, so does our sleep quality. Yes. Low sleep quality, increased risk of neurogenital disease. That's why women have more risk, I mean, cardiovascular and Alzheimer's risk, right?

Of all Alzheimer's and neurodigenic disease. Oh, it is. And that's why I love the book, The Menopause Brain by Dr. Lisa Moscone, because we are seeing the research that estrogen decline, that like that significant time frame in between the 40s and the 50s. 50s, you know, if I were to categorize it 45 to 55, estrogen declining is where we start to see increase in plaque formation, increase in inflammation, decrease in protection of the heart, which is why you have heart disease, and then you have atherosclerosis. So all of these things, it's just like clearing, cleaning mechanisms start to. The body does not, is not able to do the machine, going back to that beautiful machine, it can't function as well. And so you're going to have

these little blips and things that are happening more often. And that's what's happening in the body. and then it shows up in our 89-year-old self. Isn't it fascinating how the body works? That's why I love science. I know. The ability to look at how cells respond, how they act, how they tell the other thing to do. I know. You're in charge of this beautiful orchestra of communication.

And that's what I actually use that analogy of the orchestra. And then what happens during this time frame is like you. Every circadian physiologist uses the orchestra analogy. Isn't it? It's just like this beautiful thing. You never want to go to an orchestra if there's like. like this flute and this like trombone that sound horrible, you'd be like, this sounds wonky. Yeah.

And that's what happens with the body when we're not creating the synergy and the homeostasis that it deserves. Yeah. So we want to try to work with our body as much as humanly possible. Yeah. And women actually didn't live as long as they used to. Yeah. Because of estrogen.

So if you think of just ourselves as creatures, like way back in the cavemen days. Yeah. women, and even, you know, in the 1800s, the lifespan of a woman was actually in like late 50s. Right. A lot had to do with decline in estrogen. Right. So now we've kind of progressed society-wise or, you know, just like science-wise,

we live longer. Yeah. But the ovaries are still. Well, we can keep people alive with medications. Yeah. So, yeah. We keep people alive. But the ovaries are still like, I'm piecing out at 52, average age of menopause.

Decline of estrogen is going, but we didn't ever fill that gap of. estrogen going down. We're living until 80. And now this estrogen's like, I'm not even in the picture anymore. And your machine and your body's in your organ is like, what are we doing? And they're malfunctioning. They're dysfunctioning. And so that's really where we need to, what is going on in that gap? And why are we not educating women? And why is women's health not imperative when we think of research? When should a woman start taking estrogen? Is it like at the onset of paramedopause where you start to experience things is your regal cycles or is it, you know, once you get to that 12-month mark where you have not had a period? And I think the second question, for women who are on hormonal birth

control, who are not bleeding. Oh, I love this. Yeah. What do they do? I know. So I'll save the second question because it's very convoluted and individual. Like all of this is. Yeah, of course. But we have changed how we treat women with hormone replacement therapy. So even myself, when I was training in residency, we did not treat women with hormone replacement therapy until we were like you have to be confirmed to menopausal. Oh, interesting. And that makes me sad because there are a lot of women who came to see me and they would come with the symptoms of I'm having hot flashes. I don't feel great. Something's off.

Sleep is. Periods are really weird. Sleep is off. I feel depressed. I feel mood changes. And we were taught, have you had a period? Give them an S-S-R-S-R-I and send them on their way? Because we couldn't, we were like, well, we can't give one. We didn't have the correlation or the knowledge behind estrogen and mood. Yeah. But the other part of that was we were like, you're not menopause. so until you miss your cycle for 12 months, we can't really start HRT. But the beauty of that is now we know you're already starting that fluctuation. You're starting to have these symptoms.

You deserve estrogen or hormone replacement therapy, rather, even including testosterone, to give you that buffer back so that your fluctuations are not as severe and you're having these symptoms. It's definitely the gas tank analogy. Yeah, yeah. You don't wait till, I mean, I have a few times they're until it's completely empty and you're like oh my god my car is not running but ideally yeah you're when you get that little signal yeah that warning like comes on like comes on the dashboard that's why the signal is there yeah it's like you're close to empty you should probably yeah go to a gas station your car just stops working but we can like exactly and so why would I wait till menopause till the tank is empty as far as estrogen release to give you back

just a lovely low level of this hormone replacement that makes your fluctuate is not as severe and makes you just feel better. How about that? How about we just make it as simple as you are having symptoms and I want your quality of life to be great. Is it actually replacing estrogen? Can you clarify? Yes, I love this. And that's why we do have this difference between menopausal hormone therapy, MHT and HRT. It's a little bit of a rebrand in my opinion. And I think that is because HRT is very synonymous with WHOI study and people get nervous. But really what we're doing is we are not replacing because we're not replacing to the levels that you used to be maybe in your 20 or 30s. What we are doing is allowing you to have this kind of ambient level of hormones

that allows your organs to function to what they need to be. But we're not giving you like enough to we want to get you as high as when you're ovulating and when you're releasing a follicle. It really is more so for symptom resolution but also for organ function. So I've seen online. A lot of women who might not have gotten on board yet with the lifestyle stuff. Yeah. And are kind of thinking, all, all right, you know, MRT is going to be the all end all for me. Yeah. Can you have a lot of success with MRT without also in parallel taking care of the lifestyle?

I really love this question because I'm a firm believer that lifestyle medicine is going to get you best bang for your buck. Yeah. In society, we do see that lifestyle. is one of the hardest things to install in our own lives. And your body does, you know, it's a chemical messenger. Hormone is a chemical messenger. It's telling something what to do. So you will see a lot of benefit.

I've seen a lot of women who maybe have lifestyle issues or obstacles or journeys are just, quite frankly, don't care. Yeah. And do you feel better. Yeah. So you will get that outcome. Yeah. We'll have the decrease in the symptoms.

But that's why I like to put it in kind of two categories. And we talked about this before of symptom resolution. what your body is going through at the time. Yeah. And longevity. And so what we will start to see now that we're kind of, you know, putting a lot more women on hormone replacement therapy is in a few years we'll be able to see, you know, forecast, like now women have been on it for 10 years. What are we seeing in this data that's showing decrease in osteoporosis and atherosclerosis

in inflammation? A really good way that I like to categorize what is happening in the body because it's very hard to tell a patient, oh, your vessels are having more plaque in it. They're like, I don't see it. Right. And so that's why disease is such a prominent thing is because we don't see it. It just, when it happens to us, is when we're like, oh, my vessels are clogged. Right. So the goal really is, how can we allow people to have kind of a visual to what's going on in their body? And that's why I like some of these newer tests that look at our glycans, which are actually a feature of inflammation. Because then it gives someone a picture of what's happening internally.

And it actually is a bit more representative of the things that they can do rather than me just looking at a number on a lab and being like, oh, your total cholesterol is up. They're like, okay, well, I don't see my vessel. Yeah. So I'm not sure what's going on. And my heart might be like putering out, but until maybe I have an arrhythmia or I fall over or that's usually people's wake up call. Yeah, that's wow. I mean, I mean, that's where like data, like for example, it's just like so beneficial, right? It is.

your arteries really becoming clogged. Right. Like you would see that manifest in your resting heart rate very simply, right? Like you would see changes and they'd be pretty drastic, right? Which would be a nice call to action to, you know, get some help. But yeah, it's so if we've got a scenario where a woman is on birth control in pari metapause. Yeah, right. So she, yeah.

We're coming back to this question. Yeah, so let's come back to it. There's two separate discussions. You've got birth control so you're not bleeding and then so you don't even know if you're in menopause. And let's say you're not experiencing any symptoms at all. should you just go on HRT anyway? And then a woman who doesn't know they're in menopause, they're on birth control,

but they're experiencing a lot of symptoms. If there's an absence of symptoms, are you just good to go? Well, that's a great question. That's the individual's question. And this is how a clinician should really guide someone through that because we still associate that that whole transition with like symptoms. But not everyone has these severe symptoms,

or they may have it, but it's so subtle. They're like, ah, it's not really bothering me. Yeah. And they may be on a form of birth control to help with, you know, pregnancy prevention. Maybe they're bleeding is significantly decreased or they don't have any. So there's kind of like, you know, going through life, doing it well. Yeah. But they get to decide, do I want to do this now for the longevity reason?

Okay. Because they're not having symptoms. Right. And they get to decide, do I want to come off my birth control, even though there's a really small risk of me becoming pregnant? I've had a few patients like this. There are a lot of patients who come in, same question, I say, actually, you're, you have more decisions, but it does make it a little bit more hard because you don't have a symptom, and you're like, should I stay on birth control? So I usually tell them, you could do a trial without your birth

control, one to see if you're still bleeding, because maybe you don't even know that. I mean, we could do labs and the FSH would tell us if they're menopausal. But if they really want it to be like, I don't know where I am, I could draw a lab, or I could say, let's stop your birth control and see. Because birth control still does have hormones. So it could be actually suppressing some of the symptoms. Right. So if they came off, they may be like, oh, my gosh, I am having hot flashes and night sweats, which is why some women stay on birth control and some, you know, doctors and practitioners.

Because it corrects for that. It still does. It's just at a different level and usually a different source of hormones. HRT usually, it's going to be different types of estrogens. You know, you have three types of estrogen. But you also have your synthetic forms and then your bioidentical forms. So HRT is usually a lower level. of estrogen, usually going to be more of an estradial base, which is your E2. And then it's also

going to be, not all the time, but most of them are going to be bioidentical. Whereas birth control is going to be a synthetic. It's usually like ethanol estradial. It's going to be your synthetic progestins, higher levels, and its goal is to suppress ovulation. So it's doing a different task, but you're kind of getting a two-for. Yeah, yeah, yeah, okay. Because HRT is not birth control. You heard me say that here. because you don't want to mix the two and being like, I'll stop my birth control, go on H.R.T, and I'll be protected from pregnancy. And then we're like, oh, well, your belly is getting, I think, let's get an ultrasound. And that's the, uh-oh, pregnancy. So if the egg isn't getting released, you're retaining the egg.

With birth control? Yeah. It really just, in the physiologic form, it suppresses, it suppresses. It suppresses enough of the normal cycle of what your body is doing. Yeah. And so it's not like it came up with one and suppress it. It just never did it. Yeah. It was just like, oh, you suppressed me enough where I'm not going through the normal function. Yeah. And I didn't even, I didn't even do it. Yeah. How do you ask for this when you're at a very practical level? Like, what do I say to my OBGYN? Yeah. Yeah. Like, all right, I really want to give this a go. Maybe from the standpoint of, I mean, would you say at this point, like, every OBGYN in America is like onto this stuff? Absolutely not. Okay. I think. This is so depressing. It is. And, you know, I think there's two reasons. One, there was. such a kind of like whack-a-mole when the WHI came out. So you were, they were like, do not talk about it. We're not doing it. Abandonship. Yeah. And then also. Not to mention insurance implications. Like, I mean, poor doctors, you know, in a lot of

ways, right, in between a rock and a heart place. So it was kind of like, don't talk about it. There's a lot going on. It causes breast. I mean, that was really the prevailing message. Yeah. Yeah. So no insurance was going to be like, oh, yeah, put them on HRT. So there's no coverage. People were like, I'm not doing this. There's fear. It was very fear mongering. So I would say now coming out of that, people still are hesitant. You know, our data is there, but it's not as widespread as we would love it. And so people now have to come out of what they know, their practice, go learn something new, go to courses, figure out what the new literature is.

That takes time. And myself and my colleagues work so hard that sometimes the time is not even there to now go back and learn this. So for me personally, I had to step outside of my practice to do the studies and the research that I did to become a menopause expert, but not everyone has that. We are taking care of very sick people. And so it's not like the whole labor force is going to come out to learn about menopause. And then we're also not seeing it at the level of maybe organizations of saying, hey, we need to restructure our recommendations so that doctors will read those and change their practice.

So there's so much that needs to go on. Medicine is definitely the career or the kind of society that we have to be sure of what we're doing. So we go slow. We're not like tech where we're like, let's go. And then if you make a mistake, you're like, okay, well, that was kind of great. Medicine, we're like, we can't make mistakes. And so it usually takes like a good five to 10 year before you start to see a huge shift. That's just what science is.

I think we will see it. I think we're on the right course. For sure. But it's not for tomorrow. Yeah. So that's why we just have to keep talking about it. Yeah. I know. I just so grateful for women like yourself and Dr. Mary Claire Haver and, like, you know, Kelly Casperson and Dr. Rhonda Wright. Like, you know, there's a group of you, you know, who are just really at the tip of this beer in terms of like getting this message. Yeah. There's a message and it needs to be said. And the other thing that I want to make a nod to is it's no one's fault. Like no one should be blamed for. There's a lot of things that happened. And instead of focusing on the blame and who did what. And there is a lot of out there. And there is a lot of out there. there, you know, noise that we were wronged. Yes, there was something that occurred.

My goal really is, and I think that this has a lot to do with my messaging, especially for women in black and brown communities, is that a lot of times they are left out of what's going on. They're left out of the messaging. They're left out of the research, big time, left out of the research. Like in just ways that are just. Exactly. And so I need to focus. My focus really is on how do we make our lives better from here on? Yeah. And that's what we need to focus on, especially with hormones because we are going to save women's lives with what we are able to give them now in the pregame and the main event. Yeah.

And show what betters are 89-year-old selves. Yeah. And I think, you know, as, you know, you were a woman in midlife and you're just like, I'm like, me, me. And an insanely inspiring role model. And I think like what you, you know, what you show on Instagram is just this very balanced approach to life, you know. And I love that, you know, because I think anyone who follows you is going to be, you know, see you practicing the things that you preach, you know.

Well, I really appreciate that, friend, because I want you too. And I am inspired by you as well. But I think that's the goal is like showcasing what we do to let women know that it is possible. Yeah. Do we eff it up sometimes? Of course. Absolutely. Are there horrible days and weeks that we don't get it in? Yeah. But you keep going. And you just try to find a way, like you just try to love yourself enough. We are worthy of the time and space to move our bodies. And society has told us a lot of the opposite of that for years and years, that we're not worthy. Your worth is in your reproductive years. And after that, you're not. So I'm really trying to squash all of that. Well, I mean, you are a great example of, you know, just the possibility of this time period, you know, in life. And one of the barriers, I think, for a lot of women is figuring out how to build in that time

when you've got a lot of other demands, right? And how do you have that conversation with a partner? Yeah. You know, and what does that look like? You know, I think for women, I have this, I have a direct message. I have not yet answered. This woman who reached out, she's like, my husband works all day. She has a young child that was like an oopsie.

She's in her late 40s. So she's home with a baby. She has a 14-year-old and a 16-year-old. her husband works all day and she just is like struggling to figure out she feels her mental and physical health declining she has really bad symptoms yeah so she's just like in this place where she's like like when he gets home like she just is like cautious and how to have the conversation and be like he's worked all day you know and like she needs to cook dinner and like you know just is really struggling this is one of the other features of the perimenopause menopause phase is the

emotional aspect and the mood that comes with that because it is real. And there's changes in the neurotransmitters that interact with estrogen. This is where we start to see the highest diagnoses in women of anxiety and depression. And it makes sense because there is an internal shift going on, but we're also in a time in our lives where we're still taking care of families. Sandwich generation, she has a younger child. Sometimes it's taking care of older parents. Yeah. This is where we need to start to form the team around us that's going to help us. So, for example, and not to say that she has to do this, but when I, I have patients that come to me with those same kind of concerns,

is how do I empower now the people around me to help me? Because a lot of times we bear the burden. Yeah. And so even having the conversation with the 14 and the 16-year-old, if you can watch the little one for even half an hour, each of you just do half an hour where then now I can work out. Yeah, just go in the basement, do push-ups, body squats. And maybe, you know what, you just want to sit there with a book.

Right. That's okay, too. Even if you want to sit there and pick your nose, like I don't care. It's the time alone where we get to pull back and say, I need help. We are not very good at asking for help. I know, right? And then the partner question is incorporating that this is very hard. I have a lot of women who are in the same thing.

How do I now engage my partner with what is going on? And this is why men need to be a very important part of this conversation. Is because, again, I do believe that when we think of women's health and specifically this stage in our lives, patriarchy has a lot to do with, the empowerment of who we are, self-worth, and I can't ask for help because I'm supposed to be doing this and this alone. And so that's where you have to, and it's not going to be overnight, but it is this constant conversation of, this is what I'm going through, and I need help. How can you be of help to me while I'm still providing help for you? Right. So it's, it's the balance of we are doing this together, but I do need help. And then the other side of that

is the little ways that you can, we said it earlier with the movement, right? But now it's, not only the movement, but the nutrition. Yeah. And finding a doctor, because if you're having symptoms, she needs HRT exposure. Right. And I had a patient. This is like one of my most challenging stories, and she had a hysterectomy. So hers was different.

Her hormones were taken away through the surgery, and she literally just went like rock bottom within like a week after the surgery. And so it's the same thing of where this is a real occurrence. It is happening. women need to be seen and heard. And so she needs to have an advocate on the clinician side who's going to say, I need you taken care of, your symptoms resolved, but also for you to feel better here because it's a mind-body connection.

This whole thing is a whole body, whole mind connection. It's small changes. It's never for the big change. I never say we have a cruise ship and we're just going to turn due south. It takes time. It's a big wide turn. It's a big wide turn. And so it's the same thing with our lives, us have patience for ourselves.

and really like showcase it. This is we are doing this journey of life and self-love, but the journey is not overnight. Yeah, it takes time. Yeah, thank you. I think that's really beautiful advice. And yeah, just grace, grace, give herself grace as well. Yeah.

Asking for help is hard. I suffer from that, yeah. Yeah. And I think it's finding community inside your community, too, that can be really helpful. And asking, hey, I have this issue. How did you work through this? Yeah, yeah. What are some best ways?

What do you think I can ask for? And even if the answer or the question, rather, isn't received the best way, there's a lot of defense that comes with asking for help, right? And that may need to be refined, retuned, but it still needs to be readdressed. So, you know, as we think about the future, what study are you dying to see? Like, what needs to be done? Well, there's a lot. But if I, you know, when I think about where we are right now and where I would like us to be, is really. really looking at this preventative stage of what, you know, kind of what we started this discussion. We know a lot about the menopausal and from the WHOI, we actually had a good amount of information from 60-year-olds and a little bit older because those were the ages of the women in that study. But what I would love to see is a lot more data in that time frame as we're going through the decline of estrogen, progesterone, and testosterone, in what we can actually impact there and what it will show in 20 plus years if there is a difference between kind of

where we saw most of the studies, which were like you were menopausal or late perimenopause into early menopause. So we have good data on that. I think that we could do a better job at being preventative. And I think that's the age frame at which we could probably get even better outcomes from what we're thinking. Because again, estrogen is really that huge facilitator in what happens in our lives later. And so if we wait till it's depleted, what if we kind of push that back a bit and worked with estrogen.

I know that there's a lot of data and studies that are going on in ovarian preservation in the sense of not for fertility, but actually for this ovarian estrogen homeostasis. Because we do know that estrogen homeostasis can then be very profound in when we think of neuromodulation,

when we think of mood, brain health, bone health. 100%. And so now this is the beauty of science coming. And if we're able to prolong that estrogen kind of ability and availability, what would happen? I love that. Yeah. We send out these women's health surveys. I think now we're in kind of a cadence where it's like every November. So we're collecting lots of data on just different therapies. Women are on. And we have lots of menstrual cycle data. So one of the things that I'm really excited about is like, you know, understanding, okay, well, what actually is a healthy period? And what is the physiological profile of an individual with a healthy period? And what are they doing? What is their lifestyle? You know, we have all of this certainly movement. You know, we can auto classify like 125 activities or something. So now if you're able to kind of compile it into that.

We know when they're strength training. We know what kind of cardiovascular work that they're doing. We know if they're drinking and smoking for the most part. You know, we have like a broad data. So it's kind of like this lifestyle guide based on a period. Yeah. So using the healthy period as like or the period as an anchor of kind of health, right? And then we've got all this other contextual.

information. But with the idea that, because we'll basically have the data of we've got women who are in the reproductive years, having a period, transitioning to paramedopause and menopause. I mean, in a decade, we're going to have this entire. A lot of data, yeah. Right? Like a huge amount of data. And those changes too. Like what are those changes incur? Going from one phase to the next and understanding, you know, how do symptoms present in someone who is doing X, Y, and Z as lifestyle, right? And no understanding, of course, a lot of it is genetic, but how much actually is it genetic. And I think that's a question that we can potentially ask in our, you know, answer in our data. Do you have an idea when we think of like HRV, like how that progresses in the 30s into the 40s?

Yeah, yeah. I mean, it declines. And when women hit paramedopause, menopause, there's a sharper decline and quite a significant increase in resting heart rate. Which, again, goes to the cardiovascular disease. Yeah, you got to pay down that risk while, like, doing the right kind of cardiovascular work. Right. You know, and I think that that's, you know, doing a lot of the high intensity interval training is probably not, you know, I have Dr. Stacey Sims in my head. Yeah. Yeah. Yeah. You know, like just getting, don't get in that zone three, you know, it just is like counterproductive for women who are in that perimenopods, menopods, you know, where you really want to try to stay as polarized as possible, biasing toward that zone

five. But yeah, I think, I think there's a lot of promise in helping kind of women understand, all right, what do I need to do in the lead up? So I can maximize my chance of having, you know, the least, you know, amount of symptoms and I think combining it with, you know, just this idea of like preserving, like ovarian preservation, like this idea that we can extend that is just, like extending the beauty of our lives. Right. Longer, but then also enhancing the quality of life when we get older, too. I mean, that the aging biology is something that I think, one, we age longer. So that biological time frame of aging really has extended itself, but we haven't done so well in saying that just because we live longer, we're living better or healthier.

Yeah. And I think that's where if we were to focus more on that, we would start to decrease what we're seeing in outcomes of health, health predictors, and what people are actually really dying from. It really has a lot to do with things that we're not protecting in that preventative phase. Yeah, it's such like an important window of time to like capitalize on, you know? And it's like, you know, when you're talking like, there's a sense of urgency. You're just trying to like get this information.

Like, so we can set ourselves up for success, you know. Yeah, because no one's coming to save us. No one's going to save us. Yeah. So in your practice, do patients come in with a whoop? Like, how do you deal with, like, the data in your practice? I know, yes. You've been a science advisor.

I know. I just fell in love with you from the moment I saw you. We met at a tennis match. It was love at first sight. It was. It truly was. And I was like, I'm going to get this girl in our network. And look, here we are.

So the loop is. But you started using the technology. Oh, absolutely. Yeah, and like you're applying it. How does it show up in your practice? I'm just curious. Oh, it shows up because usually I'm bringing it up. Yeah. And it's a very organic conversation because I'm so big on lifestyle. So the question usually will come from them, well, what are best ways that I can accomplish ABC? And I'm like, that's why personalized data is the best way. Because some of the questions that you are even asking me, I don't necessarily have the best answer for you because I don't have your data. Right. And so when they understand the behind the scenes of, how much better I can do for them if I have data and then also for themselves right so this is something that they have outside I call it the homework of medicine yeah is when you leave my office and you're at home or you're at your your kids volleyball practice or on the weekends traveling you are now in charge of your own data and you get to see when you reach for that certain food when you don't do exercise when you drink alcohol when you're not sleeping what is that doing internally so it's kind of like to that pictorial of what I was saying earlier of like a lot of of people don't have a very good view of what's going on inside, but that's actually a way that they can. Just a quick story is I had where I cannot remember where I was, but it was a gentleman

and we were doing some work together. I was traveling. And of course, he had a whoop on. I was like, oh my gosh, I have a whip too and blah, blah, blah. And he said, oh my gosh, this has been such a game changer for my family because they link it all together. And so it actually creates community within their whole family of who's doing what, who worked out today, what was your, you know, it becomes like the scoreboard. Yep. And I was like so fascinated that he had incorporated it into a way that the family can be together in health.

Yeah. Yeah. I know. I mean, we experienced that same thing. Like my son just like texted in our little group chain. He's like, my restorative sleep. He's like, I'm like at five hours. He's like, I must be like growing.

Like, you know, so he's got this, you know, idea that he's got this big growth support. I'm sure his friends are like, what are you talking about? Well, it's so funny because so there are so many kids in his high school who wear who weep. Like, it's just kind of taken, it's spread like wild. So he's the trendsetter. I think he and my daughter are the trendsetter. Yeah, they both wear it religiously. But now you can't go to the basketball courts without like everyone's got a whoop on him.

Oh, I love that. Yeah, it's so cool. It's really neat to see this kind of emphasis on like they talk about sleep. They talk about recovery. I mean, I just, it's incredible, you know, to see at this young age, then, you know, kids starting to learn their body and understand their body in a way. Well, that's the way we are going to change medicine is if you change the consumers. Exactly. Right.

And the consumers then now demand, I need to know this about your body. Yep. I need this about my health. Yeah. My sleep is not doing well. It's only five, what is it, five hours of restorative sleep. Yeah. And so then it drives science and clinicians to do better.

Yeah. Absolutely. And so I see that as very promising, especially in one. women's health. I agreed. Yeah. The questions that my daughter asked, so I'm just like, wow, you know, I mean, I think it back to, I didn't know. I was like, what is a period? I know. I mean, just the depth of understanding. And that's where, you know, I push back. Like I hear you should not be using technology because it takes you further away from your body. But I'm like, I actually can learn more about your body. Absolutely. Like people, especially people who have not been, you know, athletic in their life and just haven't, I would even say some athletes don't actually have the somatic awareness because they're right. They've learned a disassociated. from their body to get through the pain. Yeah, because they're pushing themselves to another line. Yeah. Right. Yeah. So, yeah, I just see technology as this is amazing resource to actually bring us closer to our body. And it allows you to use two modalities. You know, if someone's truly doing it in a way that they can use both ways of self-awareness and what is my body feeling. But also what

is my body telling me that I wasn't aware of, but it's right here. Yeah, exactly. It showed me right here. Yeah. When it confers and when it disagrees, like that's a source of insight every time. You do a lot of different types of movement, which is cool, like Tai Chi and like you play tennis and like, you know, you do a lot of different things. Maybe just talk broadly about just because you're so playful, you know, like you have this wonderful, like joyful, playful way about you. And I think, you know, we're talking really strategically, but at the end of the day, it's about play, right? It's all about play. And realizing that as humans, we actually need play to grow, to thrive. And then the best way of learning is actually through play. I think,

I learned that through my kids. I mean, we were talking earlier about kids and boys especially. I have two boys. But, like, play is so part of their lives. But that really is allowing them to learn how to respond, interact, and grow. And it's a very essential part of brain growth, too. And so even though I may not remember that all the time, because I'm like, oh, my gosh, get off that couch.

You're falling over. Yeah. Is that is a really integral part that I think sometimes we lose that. in adulthood. Yeah. And I think that we have to come back to that. I'm learning that myself is like coming back to play, like not everything needs to be so serious, especially as a scientist and a physician.

I'm just like, oh my God, everything is so serious, right. And so learning that as we, especially as I progress through perimenopause, is taking a step, taking a breath, taking a moment to it's okay to play. Yeah, I love that. What's one message you would want every woman in her 30, 40s, and 50s to hear about her health and her future. Yeah, you know, writing Generation M was probably, you go into writing the book thinking,

I'm going to give all this information, scientific medical knowledge. And it is very cathartic writing the book, the process of writing the book, you know this, is that it requires an extra version of yourself. Outside of time, there's a lot of time that goes to it,

but it really pulls out things about you that you didn't know as you're writing it, you're having experiences that worked its way into the book. When I look at Generation M and when I completed it, I think it really hit home for me when I was doing the audio version. I had to read it. And that's really where it sunk with me, that all these pages I had written was really this love letter

to women that I'd seen when I practiced to myself going through it. And I see this transition of menopause is so much more than clinical, even though it's a clinical diagnosis. It's this beautiful way in where we get to say, how do I want to restructure the restructure the rest of my life? Because 40% of our lives have lived in the postmenopausal phase. And I really think a woman's journey has been so plagued with a lot of like expectations, obstacles, stigma. And we get to redefine that in this next chapter. And that's why I think that we have to do a really careful job at how we portray menopause, how we talk about hormone replacement

in therapy and how we also talk about the beauty of integrating all of it because all of us get to live this beautiful life. It's a gift. And so I want women to approach menopause as something that they get to take part in and have advocacy and awareness for themselves and self-love. So beautiful. Your book is amazing. Thank you. I think like it's important to call out that this is not just a book for women. You know, if you are a man who has women in your life, this is a book for you too. You know, like I think that we have to support each other, you know, is to learn about these different phases of life that are really transformational.

And I think like what you've done is you've done an absolute rebrand of menopause. So you have achieved your mission. And, you know, in the process have just inspired, you know, hundreds of thousands of women from Good Morning America to, you know, all the platforms that you have been able to grace you know and so just thank you for the work that you have done and are doing to empower women at every phase of life but particularly during you know what could be you know and is you know a difficult transition so thank you thank you I just love being here with you as a friend as a colleague but also as women who are going through that stage in our lives like it's it's real personal and upfront for us right now so I really appreciate the time with you and then

also your words. Yeah. Thanks, Jessica. If you enjoyed this episode of the WOOP podcast, please leave a rating or review. Check us out on social at Woop at Will Ahmed. If you have a question was answered on the podcast, email us, podcast to Woop.com. Call us 508-4434349.2. If you think about joining Woop, you can visit Woop.com. Sign up for a free 30-day trial membership. New members to use the code Will, W-I-L-L, to get a $60 credit on W-W-Acessaries when you enter the code at checkout. That's a wrap, folks. Thank you all for listening. We'll catch you next week on the WooP podcast. As always, stay healthy and stay in the green.