Transcript

The Menopause Timeline Most Women Never Learn Until Midlife | Dr. Jessica Shepherd

0:00 So here's a myth. Menopause is something to survive quietly and get through as fast as possible. Turns out that myth might be more dangerous than the symptom it describes because It's exactly what keeps women from asking the right questions at the moment that they have the most leverage. over the next several decades of health. In this conversation you'll discover why perimenopause itself

0:23 splits into an early, mid and late phase. And by the late phase carries the most weight in hormone decisions. You'll learn how to build the kind of symptoms storyline that gets a doctor to actually listen. The real risk versus benefit math behind hormotherapy beneath the headlines is You'll learn why the data on menopause symptoms looks different by race and what that means long term.

0:46 And why nearly half a woman's life happens? After menopause even begins. Sitting in as my guest host is a dear friend, author, and leadership consultant Karen Walwright. In conversation with board certified OBGYN and Generation M author, Dr. Jessica Shepard. I'm Jonathan Fields.

1:04 And this is Good Life Project. And we'll jump right in after this short break. Mm. Hi guys, it's Sophia and Chinsea from the Girls Bathroom and we are loving Hulu on Disney Plus this summer. So many amazing titles. First up, Rivals is everywhere right now. It really is. T V's raunchiest show is back for a new season. Have you seen the testaments? It's set fifteen years after the Handmaid's Tale taking place at Aunt Lydia's elite preparatory school for future wives. The girls are

1:34 rigorously trained for their position in the Gilead society, but resistance is brewing. Praise be. Praise be. All of these and more are now streaming with Hulu on Disney Plus this summer. Hey, quick note, we have been longtime fans of Apple Podcasts. They have been where so much of our community has grown. And Apple Podcasts now supports Good Life Project with full length video too. Find us there. Be sure to follow the show so you don't miss an episode and take just a few extra seconds to leave us a rating and review. It helps invite more people into the conversation so we can all make a bigger difference. Mm. I am so grateful that Jonathan asked me to do this. I'm just gonna tell you, um because I have so many questions. So it's like he knew that that I was gonna have all these questions for you. So um

2:22 I read your book. I love the book. Thank you so much for writing the book. Um I I want to start by sort of the myths of menopause. You argue that the most dangerous part of menopause isn't a single symptom, it's actually the myth. So can you talk a bit about what we have wrong about menopause and what that costs us by having that myth around menopause? Yeah, there are so many myths that are behind menopause and and that's really why I I wrote Generation M was to kind of broaden the view. I think one

2:54 there's a fear factor behind it, right? So it's been kind of categorized as something that we should be afraid of. So there's that that I want to change that narrative. But also we really look at Estrogen. The worth of women. uh what their ovaries are worth in the context of what they do To the pelvis.

3:14 Right. So it it's kind of like all this linear uh fashion of how we view women in who they are and what they're able to do. Mm. Outside of that, the context of menopause really is a whole body experience, right? So I'll I'll tell you like from you know from the head to the head to the toe is we have brain changes.

3:36 We have mood changes, but even going down to just our skin, we have Changes in how our skin feels Itchy skin. So Because women were not able to see it from that perspective, they were going through these symptoms of you know, whole laundry list but not connecting the dots to

3:53 This is a midlife transition that is biological is gonna happen. But what do I do in those moments where I feel Is it brain fog? Uh you know, do I have ringing in my ears. Am I irritable?

4:05 All of those play a part in it in the more that we understand, the more that we're able to make better decisions on how We navigate through it because we're all gonna experience it differently. As you know, w I said at the top, like so I'm in post menopause and I want to talk a little bit about that. But I feel like

4:23 So much of the experience that I've had in midlife Like The symptoms are things that I've remembered or figured out after the fact like oh that was probably paramet you know that kind of thing. So let's just let's just start from sort of the beginning, right? Like Menopause isn't one event. There's three different stages of menopause. So can you talk a little bit about like what is menopause and what are the three stages that that we're we go through?

4:50 The full range of it is hormonal in the sense of hormonal ships when they start. when they end or when the decline is is pretty significant. And so in our premenopause phase, I guess would be more of our reproductive. when our body is in default to get pregnant, right? That the ability to get pregnant is there.

5:09 Now when we go into perimenopause, is really where I use the gas tank analogy, it's the easiest to remember is where your gas tank is not uh at full, you know, at estrogen in this reproductive phase, and it's not any better. It's just where our hormones are. starts to go more into like three quarter tank, half tank. Because as estrogen and progesterone start fluctuating even as early as the age of thirty five. Well.

5:35 carrying on it's going through this shift preparing for menopause. And so that shift can be anywhere from ten years, twelve years. From when you start. All the way up until that menopausal shift which is where estrogen has completely declined. And now it is not giving off.

5:53 Enough estrogen to elicit A possibility of pregnancy. Right, so see how it kind of reverts back to The body is going through

6:02 Pregnancy, it can get pregnant. Perimenopauses where It could, but it's less likely because of the shift into menopause where it's not. So that's on a pregnancy hormonal level. Okay. But during all of those times is where we start to have symptoms. And the moment you start to have fluctuations in hormones is where women will start to exhibit symptoms. Granted that can be differences in severity, intensity

6:25 uh frequency duration. And so that really is the struggle of figuring out Oh, this is the symptom that I'm gonna go through and it might be more severe and frequent than my You know, sister. or the colleague that I work with. And that is where the conversation really needs to build Into

6:43 I'm having this happen. What can I do to navigate it? And it should be no blame or shame behind it. Yeah. You know, it's I I remember um At one point and having like

6:55 heart palpitations, right? Um And like really sort of freaking out about it. And this was way before I thought I was in perimetopause, right? I was probably in my forties And uh

7:08 Like can you just talk a little bit of like what are some of the symptoms'cause I feel like that might have been a symptom of it. Like like the symptoms are really wide ranging, right? Oh yeah. And the reason is because estrogen receptors and testosterone and progesterone I wanna show them love as well. But ostrogen really is our kind of predominant, I guess you can say hormone when we Speak in the context of of menopause and perimenopause.

7:32 А all over the body. So the the best place to Think of how I have these symptoms, why am I having these symptoms? are because there are estrogen receptors all over The body, brain, muscle, heart.

7:47 Boom. Well, and so a hormone all it is is a chemical messenger. It's really just sending out a signal every day, and usually it follows a very tight schedule. But when you go through perimenopause and menopause, that schedule gets very jolted, shifted Some it shows up one day doesn't

8:04 So if it's sending a message to a part of your body, brain, heart, all the things I mentioned before And all of a sudden that message is not as clear. Not as frequent. Not as consistent. then the the organ that receives the message to do what it needs to do, whether that's with cognition or my bone being strong or my muscle mass being strong.

8:25 Then it can't do that. And that what is happening over time is we are feeling the symptoms of something that is deficient Not as often. declining, et cetera. So okay, so this is so interesting to me. How

8:39 Can you discern whether or not what's happening, the brain fog, whatever else is happening Like I feel like a lot of times we're like is it Is it menopause? Is it paramenopause? How do we get to a point where we can be like oh this is probably what that is. I need to go talk to my doctor about it. Uh granted most people get there. Um and

9:00 It's it's more of an art of I'm aware. Yeah. What's going on? Uh How severe is it? Is it impacting my daily life? Is it something that I felt three months ago and now I feel it now? And I can maybe give it some pause to see if it's gonna happen again. Uh those are moments that that people can have. And then also finding a provider that will actually listen. And I know that sounds I mean that's cute.

9:25 Well, And even being a physician myself, you know I understand How we were trained and and not excusing it, but we were there to like fix a problem and you know the hierarchy of medicine of we really know everything and you're coming in and we're gonna fix you. Right. That is in in kind of in the culture of of how we practice medicine. Well, we are starting to see now, you know, uh very small numbers and it's growing. is this experienčal

9:53 part of perimenopause and menopause that was really never addressed before. Before we were addressing it, Context of Is your hormone here or is your hormone here? Okay. Yep. What we were not bringing into the conversation was how do you feel? How was your experience different than the lady who came to me before with the same numbers.

10:12 Right? The labs can be all the same for a group of ten women, but they all will experience it differently. And that's where we need to shift the conversation. Into How are you actually experiencing it and where can I meet you there? Okay, so if I'm so imagine I'm I'm in my forties or something and things are seem feeling weird, right? I'm getting those things like

10:33 And I start to think, you know what, maybe maybe I'm starting to enter into perimenopause or something like that. Like What do I need to do? Like how do I prepare myself to go to the doctor? What do I what do I need to do in order to prepare for that? Like any visit I would say, even outside of menopause, to really have a good story behind it like we work well with data

10:54 Right. So it doesn't help us when a patient comes in and is like, I'm having a hot flash and we're like, Oh my goodness, how long have you been having it? How often? How does it feel? And people are like, I don't know. I just know I have a hot flash. We're like Yeah, guilty. Being like no I noticed it Six months ago is very slight. Now I notice that I have to stop what I'm doing. Now it wakes me up at night.

11:19 Uh I'm also having some anxiety which I never had before. And that's how we can like discourse and being like okay, I'm gonna bring in my medical perspective and ask you questions that are gonna help the story evolve. Yeah, and that's where we can have a good starting point. into what is really going on with you?'Cause it's gonna be different than the the lady who walks in behind you. What's your story?

11:42 There are some good apps out there actually. One is Natural Cycles. Okay. And it actually helps you kind of like uh put less work it and build more efficiency into building that story of hot flashes night sweats. Not only does it help you identify them But then it will track it for you. So that when you do go to a doctor, you're like Look at my spreadsheet. Right. And and that's that leads into a better conversation, especially since in medicine we don't really give time.

12:11 Right. Tell me in thirty seconds your whole life. Right, right, right, right, right. So like Should we Like do you w want a month of data? Do you want six months of data? Like if s'cause what sort of panics me about that is like if I sit there and I think it's paramenopause but it's actually something serious and I should be in an emergency room because it's it's something different, like I don't want

12:35 to feel like, oh, you should be keeping track of things for a year, right? And something's deteriorating or something like that. So what's the most helpful? I think what is most helpful and this is actually a a harder question to answer is because everyone walks in at different intensities. Yeah. So even outside of the menopause experiencing. Like we see that in heart disease. People will be like, Oh my gosh, I've had this pain in my chest for two years we're like Why didn't you come see us? different just with their acuity, their awareness, they're like I had so then you have the other extreme of that. I had a pain

13:09 At lunchtime today and I'm here to see you. And we're like But is that the first thing I think? Okay. Them evaluating How long do I typically that usually is a very personal thing. Like people will

13:26 Either procrastinate or they'll be like I had it done today and I need it done and fixed right now immediately. Right. So that that's where, you know, I don't know if I have a correct answer, but what I will say is, you know, for anyone who's listening when we are just speaking about perimenopause and menopause is the uh attunement of awareness in your body is always helpful. Yep. Not letting it go too long before you address it because it can always be monitored. It could always maybe go away and not come back for some time, maybe years. But the goal really is to kind of get some eyes on it.

14:01 Yeah. And the more that we can do that, the more that I've had patients, for example, come to me and they're like You know They're annual. So they're not even there for perimenopause, menopause. I typically will bring it up because I know that you know, not everyone is aware of it. And they'll be like, you know what? Now that you've said that, I have noticed some hot flashes or sleep disturbances

14:22 And I'll be like, Great, how long have you been having that? And they're like, You know, maybe three months. I'll be like, Okay, let's even bring in does it disrupt you Three nights a a a week, seven and they're like, No. Not that significant. I'm like, that's okay. If it starts to now get worse, or you're noticing that it does these things and disrupting your sleep.

14:42 I need you to come back to me. And they're like got it. Yeah. So those are, you know, ways of of creating storyboards and and enhancing this conversation because before it was just very I've hit a wall Yeah. Or I don't have a symptom. Yeah. I mean I think what's really been helpful about what you're saying here is also that you can start having symptoms as early as thirty five or forty. And so

15:03 I think just b us by us talking, sort of having that cognition that oh You know, if something is weird happening, just note it. And be able to talk to your doctor about it the next time that you s you see it. So that's that's really helpful. Okay. We don't get into the big stuff now, all right? HRT, hormone replacement therapy. I wanna talk a little bit about that. And I'm gonna admit to myself, I'm gonna admit to you.

15:26 Like Not that I'm skeptical. I'm not skeptical. I believe you know hormone replacement therapy definitely helps with stuff like that. But I will say that I've been very wary about it. And sort of my Thinking is

15:40 If my body is naturally supposed to be getting rid of estrogen and all this other stuff Is it really healthy for me to be putting it back in, or am I supposed to just sort of Like this is life and just like Getting my period was life, like this is sort of the a life cycle. So can you talk a little bit about like What is HRT? What are the options? Who should get it? Like

16:05 Just sort of demystify it for me. And we'll be right back after a word from our sponsors. Hi guys, it's Sophia and Chincy from the Girls Bathroom and we are loving Hulu on Disney Plus this summer. So many amazing titles. First up, Rivals is everywhere right now. It really is. T V's raunchiest show is back for a new season. Have you seen the testaments? It's set fifteen years after the Handmaid's Tale taking place at Aunt Lydia's elite preparatory school for future wives. The girls are rigorously trained for their position in the Gilead society, but resistance is brewing. Praise be. Praise be. All of these and more are now streaming with Hulu on Disney Plus this summer. Yeah, I love you framed it that way and brought in your own personal experience so that I can fire back and you can be like, Oh, I didn't know. Um

16:57 Where I I I will challenge you on a few things. This is this is why we have this conversation. Yeah. bring uh awareness, curiosity, and challenge into it is One, you said something.

17:09 And I'm glad you just like were like really honest about how you asked the question is why would I want to put it back if it's naturally going away. Or you know, or or give a storyline behind is the advancement of life in women, right? So in the early nineteen hundreds, the life expectancy was about fifty nine. Okay. Right for one.

17:32 And a lot of that from the science I'll I'll talk about later. is it's pretty much if you think of reproductive kind of You know Cavemen. We

17:43 reproduce, right? And then we're like oh okay, well we're just done with that. And life expectancy. Now, what we have done in science and technology and innovation for both men and women is advanced Life expectancy. So now it's about seventy nine for women. Right. So

18:01 Twice, say. We've expanded that. What we haven't done For those twenty years of being like you can live longer, whether that's antibiotic Use or just like how we have our food, all of that. Yeah. We did not account for the loss of estrogen.

18:16 at the end of reproductive and now that the science clearly shows us That estrogen really is a proponent of longevity in how our organs function from head to toe. It makes sense. That For twenty year gap.

18:32 Without estrogen We really haven't done much for how our organs Preserve Or function. For that time frame, which is why women

18:44 We did well'cause women live longer than men. But there is about a ten year to twelve year gap. At that end of life stage where women live. poorer health than men. Oh wow.

18:57 That is where, you know, when you kind of like demystify it and look at it from, you know, a a broad lens is You don't actually do not have to take estrogen. Or any warm. Right. That is a a personal choice.

19:10 Okay. What we do know now is, you know, from the WHI study twenty years ago, which was the worst PR campaign for women, is that hormones Even if You know, it what people's mind usually go to is the risk associated with it. Whatever it is. Yep. Because we now know the benefits clearly outweigh all of the risk that could ever come with taking hormones. Why is that? Бика цеча вital парт в хаоті функціону.

19:39 And the ability for us to Give it its best opportunity to do its good work. And I'm not shaming anyone if they don't take it. But here's another question I pose to you. When we have thyroid disruption decline not

19:53 Functioning. What do people not have a problem with doing? Taking thyroid medic medication taking medication. Yeah. Thyroid is a hormone. What?

20:03 Yeah. Thyroid hormone, thyroid stimulating hormone. Why would Secretes hormone. It's the same thing. It secretes that messenger that I was talking about earlier to tell the body what to do. It's our metabolism.

20:17 But we don't treat the ovary like that. It gets such a bad rap. It's still cute. I do not. And when I look at the over, I'm like, You're just so cute hanging out there by yourself, just dangling cute little buy it. And we're like, You are dead and we will not help you. So now the thing's like You need.

20:36 The meds you are. So wait, so are you saying that we should all be taking HR T? Like if like I wanted to get on a soapbox and be that type of advocate. I would be like I am a complete advocate for hormones and see the benefit and feel that women get Really good bang for their buck.

20:57 When they aren't HRT, not only for symptoms. But for longevity, an improvement in how body's The long term. Do I think that everyone should has to be needs to be on it. No,'cause it's personal choice. That's where I kinda

21:12 Let you decide. What journey would you like to take? What adventure do you pick? Up to you. So what are the options? Like what are the different types of HR T that we can look into? Well, the three hormones which I mentioned earlier, estrogen, progesterone, and testosterone all start to shift decline

21:29 From the age of thirty five, progesterone's actually the first hormone that starts to decline. And then we have testosterone, which, you know, kind of for both men and women steadily over the decades start to decline. And then estrogen does take a a pretty good hit in the forties and then completely declines by fifty. All of those can be Taken. Careful discussion obviously. Yeah. In what I want to take

21:53 what uh modality I want to take it in, which I'll go over. And which combination of it, right? Some some of my patients are on all three. Some patients are just on testosterone, some people aren't just progesterone and testosterone, some people aren't estro estrogen and progesterone. Like it it really is like a menu of options. And how you can take it. Estrogen typically has most of the modalities'cause it's our most kind of vital.

22:16 Жадеві uh uh hormone, so you can take it an oral, patch, palette, sublingual, cream like What It's so full of variety and that's why I love being able to have these discussions'cause most of them are like What?

22:32 I didn't know that. And that's the beauty of picking your own adventure. But we have to give I think, you know, just society and doctors have to b build so much more foundational education. Around.

22:45 questions that you asked. Why would I take it? What does it mean? Am I replacing something that really should not be there? Those are great questions. So two questions. One is

22:55 Um If I feel generally fine. Is there any reason to do it? Like if I feel okay, um I'll use me as an example. Yes, I get hot flashes. Yes, I've woken up in the middle of the night. Um but

23:12 But I sleep fine. Like I sle I actually sleep eight hours a day, right? And if I wake up I go right back to sleep. And hot flashes, yeah, they're annoying, but uh you know, they're fine. Like if I feel generally okay. Should I still be talking to my doctor about it, or Um Is it really for people who are being impacted negatively by the symptoms? Is it too late for me? Why when is too late to start? Like t talk a little bit about that.

23:38 All great questions because I have most women, you know, typically asking those questions of My symptoms are not that bad. Yeah. Do we need to go on it? And I'm like, guess what? You have choice because Even if they're not that bad, you could minimize them a little bit more if you wanted to. You could actually not go on hormones and being like I I'm okay.

23:58 Yeah, that's choice. The other part of that. So that's like in a symptom bucket. I put them in two buckets. Symptom bucket, longevity bucket. Right. So the symptom bucket is like Oh my God, I cannot even go to work, right? Finish my day. It's because Correct. Yeah. That is where and I still have women who have that debilitating and still choose not to.

24:18 Their choice. Yeah, yeah. So not symptoms. Now when I was talking about that twenty year gap that our organs can do. Brain function. We know it's cardio protective. Estrogen is cardiotrote. cause breast cancer. We know that our bones are stronger.

24:36 when we're on estrogen, right? So when we get older. Do I particularly want to maybe give my bones the best ability to be strong. Testosterone when we're Trying to look at muscle mass and

24:49 Building muscle. So we're strong later and we have better metabolism older. Do I want to give myself testosterone to help with that, to aid with that? So that's a longevity discussion. One. Do you wanna be on it for internal things that may not even be symptomatic and not impacting your daily like how we see life and how we experience it.

25:11 How do you want to show up at seventy, eighty, and ninety? A lot of times to me is determined in midage. on what you do with nutrition, exercise and considering hormones. Wow. And is it Ever too late to start H R T?

25:24 That is a beautiful question. So what we typically have heard is Uh you can only go on it for a certain amount of time. and it if it's past a certain time it's too late. We are changing that conversation because of the longevity piece which I just spoke to But when women uh are older, I

25:43 Have a different conversation with them because they usually have gone now a a portion of time without hormones. What happens in that time frame. Із акселерайн в дз Um, plaque in the arteries, decline in bone. Right. So we kind of have to have a different conversation and before. Where are now? And what can we still offer you? Because most of my patients who start later, I do not say not have it. We just have to maybe do more testing.

26:13 do more maybe uh cardiac tests To see What are you still Not I don't want to use the word eligible. But what can still benefit you?

26:24 Everything I say when a person walks in a doctor's office is risk and benefit. Yeah. Assessing personal risk and benefit is really how people make decisions. Устканцер.

26:38 And even if I'm like, you know Is it estrogen or pro uh progesterone receptor positive or not? We have that discussion. How bad are your symptoms? And what are you willing to risk? If you want to start more modes.

26:51 And I have had women who have like my quality of life is so bad Even if there's a risk of maybe having breast cancer because I'm on estrogen, I'm willing to take that risk. Yeah, wow. If I took estrogen, I'm not going on hormones. I'm like, Okay.

27:17 So You know, you've talked about earlier and later, like When is the right time to at least even if you choose that you're never gonna do hormone replacement, like is there a specific age? Is there a s like is it as soon as you're expected uh experiencing perimenopause system, is it Um Is it like just you know, like how they do with with breast exams or anything else? Like at age forty three you should be talking to to your doctor about

27:41 Um H I T. Is there any sort of guidance you can give to listeners about when to have that? And and the good the good thing is we have data behind that. So when we look at a timing perspective, you know, timing really is what can I do before the gas tank is depleted, which would be Menopon. Mm-hmm. And what we do from a perspective of what's gonna give us our best cardio protection, bone protection Uh brain protection.

28:08 is before the hormone is completely depleted. So actually in that late perimenopause phase, if we were to kind of cut perimenopause into three stages, early, mid, and late, latter mid into late perimenopause is actually from a time in perspective when we're looking at organ functionality and being protective is the best time to start. But that does not mean that someone who's outside of that phase cannot be on hormones. That's two different statements. Okay. And so so we're having so I come into your office and I'm like, Okay, it's time it's time to have start having this conversation. Like

28:41 What kind of tests are there labs that I should get? Like what kinds of things should I be getting tested in order to figure out like where I am And what I might need. Labs typically in the perimenopausal phase, like once you're still having a cycle Whether it's regular or irregular.

29:01 Right. Yeah. The hormones say. Yeah, you're having a cycle. It's a regular, regular. I can still produce an egg. Which then makes your uterus shed. Yeah. I know this. Right.

29:10 So the lab is not gonna tell me if you're in Harry Menopause I already know you Now what I will say is I You know, for my personal

29:23 uh practice and and a few other physicians practice this way is we will still run labs'cause it still gives us a really nice foundation. for what you're gonna experience later and things that we can compare later. We think of labs is not always just the hormones. I actually Wanna look at your metabolic profile.

29:44 Okay. Your hemoglobin A one C. How are you metabolizing glucose and what is your fasting insulin like? What do your cardiovrotective labs look like? Because I know once you decline estrogen, you're gonna see an increase in cardiovascular kind of disease progression.

30:02 What does uh your thyroid look like? So I actually run a whole slew of other things outside of the How are your ovaries looking? Right. That's your starting. That estrogen once it declines is actually gonna come back and impact those other labs as well. And we

30:21 Can now do some work. Ін препараті не превентив мод. than waiting for everything to fail or start to kind of like being like now I'm having a symptom. A symptom really is Your body's already been depleted. It's just telling me outwardly now.

30:37 Very helpful. But we don't we should not chase trends when I mean it should not be every three months, six months. But this can be something that's annual, maybe every other year. Okay. Um because then then we start chasing numbers and that's not a good thing as well. Right. But trends are really helpful So we can say, Oh, my, you know, maybe in the last year I've noticed that your hemoglobin A one C has started to creep up

31:00 maybe your cardiovascular markers are starting to showcase something that they didn't last year. I do believe that trends help us give a better picture and lay a better protective layer. And we'll be right back after a word from our sponsors. Hi guys, it's Sophia and Chincy from The Girls Bathroom, and we are loving Hulu on Disney Plus this summer. So many amazing titles. First up, Rivals is everywhere right now. It really is T V's raunchiest show. It's back for a new season. Have you seen the testaments? It's set fifteen years after the Handmaid's Tale taking place at Aunt Lydia's elite preparatory school for future wives. The girls are

31:38 rigorously trained for their position in the Gilead society, but resistance is brewing. Praise be. Praise be. All of these and more are now streaming with Hulu on Disney Plus this summer. So this is great. I mean Let's be clear. You're a great doctor. And you are interested in this and you're an expert at this. But if I'm going to my GP or even if I'm going to like

32:05 They may not be as well trained as you. One. Um Or may think that it's a silly thing to even worry about, right? And oh That's cute little woman. You're in menopause, just deal with it, move along. So

32:21 Um What do you like, what are the things that you say in order to advocate for yourself with your doctor to say no, no I I know my body. This is something How do you pursue it? So what are the what's like the best thing to say to them?

32:36 That is a very important question because that is more of what we're seeing now than not. Right. Because yes, in the menopause landscape of curriculum, what we're taught how the experiential medicine part that I talked about early on. is not there. Mm-hmm. Uh well, we get there, I'm very hopeful and I think that I'm you know, seeing shifts in how we train and how we bring up menopause in midlife.

32:58 But this is the opportunity for In a way that says Like you said, no, I really am feeling this way. And I'm listening to my body and I'm I'm staying, you know, in tune with it.

33:14 The response is going to tell you. Do I stay here or do I now go elsewhere to find care? Right answer. Maybe I'm not as well versed in menopause, but I can refer you somewhere. Tell me more about that experience so I can see what what else we can look into.

33:31 Okay. In that family of answers. That's when without having, you know, like you know, angry attack maybe in the office as being like Our time has ended.

33:46 Here. I need to find relationship with a provider who is really going to addressed it. experiential portion of what I am going through. And that actually can be done in in various ways. Like there are websites that showcase doctors And you know, nurse practitioners that are uh

34:05 trained in menopause. And I will say that there are GPs There are internal medicine doctors, neurologists that actually have started and even cardiologists to change their focus in midlife in women. So there's that which I'm grateful for. Then there's telehealth platforms. So for example You know, I'm the chief medical officer at Hers. We implemented a perimenopause and menopause platform because we realized there is a need. There are other ones as well. There's about four or five other telehealth platforms that address this, right? So now we're kind of seeing the you know, extensions of what this looks like.

34:38 But it is not widespread. Mm. So in science what we are guilty of for good and bad Good because we wanna make sure that we are given good care and we are not harming patients.

34:51 In order to do that, typically we were like What is the study? What did the study show? Did the study confirm the other study to make sure that what we're advocating for is correct? Yep. And in menopause were so early in this kind of time frame it's very hard to be certain. Right. And that's what medicine.

35:08 You know And so guidelines are typically made on certainty. So because we're not all the way there of a thousand percent certainty, it is very hard to Training.

35:19 physicians who Хисториклі have been like we are the science tells us where we go. Yeah. Yeah, and you know, and also as I'm listening to you talk and and and and talking about, you know, some people some doctors are

35:32 well versed. Some boxers are getting well versed. One of the things in your book that really I don't think I I I got it. Um until I read it was The idea that menopause

35:45 can affect you differently not just as individual people. Obviously we're all different people, so it will affect us differently. But also there's different impacts um statistically based on race that Certainly and that it didn't even dawn on me that that could be A case, right? So

36:03 So how um Like I I think I I well, I don't want to quote you back to you, but I feel like Sometimes they s the that black women have h more severe um symptoms then

36:15 people who are Asian or white, um, which I th can you talk a little bit about that?'Cause that was really, really surprising to me. Yeah, it's it's surprising to a lot of people, even you know, physicians as we s start to see the literature, but there is a great study that was done, the Swan study, that really kind of pars out experience based on Ethnicity. And It was great to see, you know, for me for provider that that is helpful.

36:41 To know Contextual from data. what my patient might experience different to another and Obviously our biologies are you know function different, our DNA Allows us to experience so you will see in

36:56 Every Ethnicity, an increase in one disease versus another. Now what that study showed is when we look at just take hot flashes. In intensity and duration, meaning how many years women typically will experience it. We Blowest four Japanese women.

37:13 And highest for African American Black Afro Caribbean women. Mm-hmm. And what this shows is one, differences in experience. But now even linking that further is we do know that the more severe And as as far as increase in duration of hot flashes that a woman experiences

37:32 Actually Increases the risk for cardiovascular disease. Oh and also Later on in life dementia. So when you have this kind of science behind

37:45 Even as much as Ethnicity. Yeah that allows us to address women's health so much more intricately And allowing women the space and time to sit with it.

37:57 Yeah. And being like Now what do I wanna do? When I hear these numbers. Yeah. And obviously I mean As you I think point out in the book, like every person every person even with th with those statistics, every person is different.

38:10 Let's look let's move off from HRT and stuff like this. One of the things I think you said is that Um after menopause Like most of us have almost forty percent of our life still yet to live, right? So can we talk a little bit about the things especially now that you've talked to me about the fact that not only is the Um Are the symptoms things like whether or not in the moment that they're

38:32 debilitating, but it also has um knock on effects on how well you live in in later years. Like what are some of the non HRT things that we should be doing to help sort of survive symptoms to help us Prepare us for longevity, like what are some of the things that that we should all be doing for that? Yeah, that question is very important because what we typically see when something's new, you know, to culture or society, it seems like it's it's kinda like the fog horn.

39:01 alert, right? So most people are like only hearing about hormones right now. And so there's a lot of fixation on it. For good reason because it was so kind of negated in the past. So now we're seeing oh my gosh, we need to talk about it. We're gonna speak about it loudly. But the fact really remains when we look at Aging especially for women. I'm gonna like exclude men for this. both men and women age and with that comes disease progression and the ability to you know, as far as when we get older, what that really means as far as age related disease. And for women, we see that menopause is

39:37 Inextricably. intertwine with aging in how we live that last third of our lives. So this will show up in the form of when we think of cardiovascular disease still the number one killer of women and men, but for women But when we look at This sharp decline typically after the age of

39:55 Sixty five, seventy for women. Where now we have this consequence of frailty. uh decrease in physical mobility Alzheimer's disease. which is, you know, part of the the dementia kind of umbrella, but specifically for Alzheimer's is more in women than men.

40:13 Okay. Three times more. So Okay. Yes. So when we look at age related disease. Later on in life for women. Most women are admitted or uh not admitted but transition to a long

40:28 term care facility or aging facility. Because of U T I and Urcontin's. Yep. Right. Mm. So when you put all of this together, there is kind of like this model which we have already seen. It happens. It's Pretty true to number. What do we get to do?

40:46 In order to increase Awareness and recognition of what's happening is that time frame in midlife where we kind of get to turn the cruise ship. In a different direction. Okay. And that's why I think it's imperative, and I call it the magic of midlife

41:02 Is to look at aging for what it is. It happens to all of us, but what can we do? early on to be preventative in order to have better longevity and and longevity does not mean increasing life expectancy. It means that as we age, for as long as we're going to live, how do we improve our well span? Right. And the ability for us to live those later years. Strong.

41:28 Cognition. Yeah. It's Functionality more so than just I lived long great. Did you live long great? Yeah, exactly. So what do you do? Like what are some of the things we can do? to to make that happen.

41:45 Exercise and nutrition I think are some of the most fundamental things outside of hormones that someone could start to change in midlife. Okay. Our body just takes on fuel differently. It metabolizes food differently. It stores food differently. And that's how we get What our outcome is. So that is not easy to do. I would say lifestyle changes, you know, even for my patients are some of the hardest things to do'cause it sounds so easy. Yeah, yeah. We're like for going to pay attention. Or fiber intake. Increase our protein, you know, increase some of our supplementation in vitamin D, creatine, vitamin B twelve complex. Okay. And I'm gonna do it overnight. No, usually lifestyle changes I would say take three to five years.

42:26 Yeah. We were Typically taught you know, do cardiovascular exercise, which is still very important, but we were never understanding the muscle

42:37 and muscle building and how it contributes to strength and metabolism later on in life. So women were like, Oh, I don't wanna build muscle, I don't wanna get big So either you help it. Might as well build muscle. Or You're looking at like

42:56 Bye bye, you know, muscle, because it's already on its way out. And muscle really is the ability for women to maximize their longevity. And improve their life. even from the beginning stages in mid age. So I would say, you know, the kind of the pyramid or trifecta of what we see in aging is specific to menopause is

43:19 underlying with nutrition and Exercise specifically resistance training and weight training. And then kind of funneling up to the cherry on top with hormones and deciding how you want to do that, how long you want to do that. And that's what I would say is the building blocks and tools when we think of

43:38 Magic of midlife and longevity. Jessica, this has been s so informative and uh So helpful for me. I feel like I've learned so much. So You know, just to kind of wrap everything's up, can you just I'm gonna ask you the question that that Jonathan always asks every guest.

43:55 What do you think it means to live a good life? You know, what really comes up when I think about that is this ability to стратегізен чанс At a very strategic moment that we never have been given the opportunity to do that. And so I hope that this

44:12 conversation has enlightened and encouraged uh women to Take their lives into their own hands and having the curiosity to keep going so that we can create more well being in all of our lives. Doctor Jessica, this has been an amazing, amazing conversation. I am so grateful to Jonathan for asking me to to be the guest host on this episode. Thank you so so much for your time and your generosity and all your wisdom. Really, really appreciate it.

44:40 So let's talk about some of the big actionable takeaways from Karen and Doctor Shepherd's conversation. One thing that I've been sitting with after reviewing it is The gas tank, doctor Shepherd's image for perimenopause, was Hormones not broken, just slowly draining over years not overnight are Sometimes starting as early as your mid thirties.

45:00 And right alongside that, the symptom bucket versus the longevity bucket. This idea that Whether or not you ever go near hormony. There's a decision buried in there about Not just how you feel today, but about how you want the next forty years to go.

45:16 And that line about how Will medicate a tired thyroid? Without a second thought but Somehow treat a declining ovary like it's already done? That one really stuck too.

45:26 If you take one thing into your week, let it be this, start writing down what your body is actually doing so. Not to panic, just to start noticing. And hey, before you leave next week. We're sitting down with Priya Parker. To talk about why conflict handled well.

45:43 Fighting. Might be one of the things that makes your closest relationships stronger instead of weaker. And what most of us get backwards about the moment right before it happens is So be sure to follow Good Light Project wherever you get your podcast, so You don't miss that or any upcoming episodes.

45:59 Do me a quick favor, uh seven second favor. Share this conversation with just one person, or leave us a review wherever you get your podcast. It really helps us get discovered and reach more people. This episode of Good Life Project was produced by executive producers Lindsey Fox and me, Jonathan Fields. Guest hosted by Karen Walgren

46:19 Editing help by Troy Young Chris Carter craft our same music and of course If you haven't already. Follow us wherever you get your podcast so you never miss a conversation. Until next time. I'm Jonathan Field signing off for Good Life Project.

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