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Let's talk about Menopause!

 April 3, 2023 at 3:54 PM PDT

S1: It's time for Midday Edition on KPBS. So many women will be affected by menopause , but we don't talk about it. And the treatments can be elusive. I'm Jade Hindman. Here's the conversations that keep you informed , inspired and make you think. An empowering conversation about menopause.

S2: This is a change that most women will go through at some point in their lives , and we collectively still act like we're not really sure about it. And I think that as a result , women just often want someone to give them the answer.

S1: So we'll answer some of your questions. Plus , why some doctors avoid the topic of menopause. That's ahead on Midday Edition.

S3: Death , taxes and menopause. Well , it's inevitable that most women will eventually experience menopause if they're lucky. But there isn't a class or an official manual handed to women to teach us about the symptoms associated with perimenopause. Many women begin experiencing things like hot flashes , difficulty sleeping and mood disorders.

S1: Then a friend or a doctor eventually.

S3: Says , That sounds like perimenopause. It all got me thinking maybe I should have this conversation with my mom to.

S1: Find out what her experience has.

S3: Been like for. Menopause.

S1: Menopause. What have you been told ? Nothing.

S4: I've only been to all you get when the woman sitting up with a fan and she starts sweating. I've seen it. I've seen women do that. And I. And I. And I sat. I have literally sat and wait , waited. Is this going to happen to me ? And it never did. I never had , you know , hot flashes , what they call them , or I'm having a private summer. I never had those things. And , you know , so I you know , I couldn't I couldn't relate to anything. I'm just I was thinking , oh , gosh , I must I must be doing something really well because I don't have those problems.

S5: What did grandma tell you about menopause ? Nothing.

S4: She told she said absolutely nothing. Really ? That you when you through being a woman , you won't have no more periods when when it's over said. But I'm still a woman. Nobody is there to say , Hey , you need to go to this doctor or get this procedure. Or maybe this will work better for me. No , I had to figure it out.

S5: Right ? Yeah. I mean , it's it sounds like it was just so taboo. It's been so taboo to talk about menopause.

S4: It has been a women do not talk about it amongst each other , amongst themselves. And and the friends. You think you might have their friends in other ways. But when it comes to this , it's not talked about.

S5: So , Mom , what's the most.

S3: Important thing you think.


S4: And the best doctor is yourself.

S3: And that is great advice. Thanks , Mom. We asked you how menopause has affected your life. And much like my mom , no.

S1: One talked with you about it. No one prepared you.

S3: And now you have lots of questions. So today on Midday Edition , we have a panel of experts to answer your menopause questions.

S1: So joining me is Andrea Lacroix , a distinguished professor of epidemiology.

S3: At UC San Diego who specializes in.

S1: The health of postmenopausal.

S3: And older women.

S1: And Dr. Cynthia Dunkel , a clinical.

S3: Professor of medicine at the UC San Diego School of Medicine. She established one of the.

S1: First menopause programs in.

S3: The country , and Jill Wood , PhD. She teaches women's gender and sexuality studies at Penn State University.

S1: Her research includes the menopausal transition and sexual desire.

S5: So menopause is something that is or will affect about half of the people on the planet.



S6: Well , I think like so many health issues that primarily exist in in women or people who have vaginas , I think that it's embarrassing. There's stigma , there's taboos. I think so much of typically how we view girls and women's bodies in this culture is from this perspective of a male gaze. And in terms of women being attractive and serving the needs of others. And so I think , you know , conditions or health issues that involve kind of are quote unquote down. Theres menstruation , menopause , sexual changes I think are often embarrassing for individuals who experience them because we learned from a really , really early age to not talk about those things. They might make other people uncomfortable. We have a lot of socialization around what it means to act appropriately , how we should behave and keep other people feeling okay. And ultimately , I think that sometimes talking about them makes us feel like there's something wrong and then that's scary. So I think I love that we're having this panel to raise awareness and tell people listening , yeah , this happens. Let's talk about it. Yeah.

S5: Yeah.

S7: We're more valued in during the phase of life when we're the most beautiful , the most reproductive , able to have babies , the most , you know , hot. So when we're not as hot anymore , I feel like I feel like we become progressively more invisible. And I think that's just a very societal. Kind of thing. As I said to Megan , you can hear our president's talk about this or our presidential candidates , and it's demeaning. And so we we're not out there being proud of getting older , even though , as you say , it's a privilege and we're smarter and more formidable and that's not necessarily desirable in a woman either. So I just want to push your your thinking , Jill , up the ladder of age and say that I think that there are certain individuals that I just really adore Maria Shriver , Jamie Lee Curtis , who are helping us to re-envision aging in a much less apologetic way , if you will , because we live longer than men and we have so much to offer society throughout our lives. And I just feel strongly that menopause is this pivotal moment when our life changes in a number of ways. It aging is a more gradual process , but there's this pivotal moment when our ovaries don't have enough eggs in them to keep functioning the way they were before. And there's this gradual sputtering of the ovaries. Dr. Dunkle can tell us more about that. But , you know , when we're little girls , we welcome that transition. Like when we first have our period , we're like , oh , wow , 50 years of this , when is this going to be over ? You know ? And then when it comes , we're a little sad about it because it means we can't have babies anymore. And there are other changes happening in our bodies that maybe nobody told us about. What a surprise. So anyways , those are just some additional thoughts.

S5: Jill Yeah.

S6: There's a lot of celebrities who are aging gracefully and I think they are really helpful models at the same time that I think in every women's magazine , even a cooking magazine , I see ads on on the left side for some sort of brand new aging retinol cream. And then on the right side , I see ads for diapers. We might call them something besides diapers , but basically we're being like sold products to make us hide our aging. And so I think part of why we're also not talking about menopause and changes related to it is really we consider it a disorder. Whether we talk about vaginal apathy , we should strike that from our language. I think really when we codify it as a disease or a disorder , it all of a sudden changes how we respond to it. We feel like there's something we have to do. And of course capitalism gives us tons of things to do.


S8: And if we went back to the 1940s and beyond , when the original estrogen primer was first approved , it was , um , it was like something to go in the drinking water such that by the. Early 1990s. Literally , estrogen was the most commonly prescribed drug in America. Not a diabetes drug , not a cholesterol drug , but this particular brand of estrogen. So people were buying into it. And we had all sorts of observational data that told us we were not only going to make women feel better , but we were going to like save their lives. We were going to reduce heart disease , reduce osteoporosis , and reduce risks of things like cognitive decline and Alzheimer's. So I was one of the crusaders in my early years. And my talks would say like is estrogen for everyone. And the answer would be probably yes. And so that was the tough part when between the early 1990s , when a clinical trial called the Women's Health Initiative started , and between 2000 and 2 when the first results came out. So a full decade because it just turned everything upside down and so what happened is , you know , I'm not sure women wanted to talk about menopause. A lot of clinicians said , I don't want to talk about menopause because I'm not sure what I can do to help people feel better or some of those great life preserving things that thought I was doing. And we I kind of feel like we really haven't completely recovered from that seismic event in women's health that occurred. Now we're talking 20 years ago that that initial result came out. And while I think we've come a long , long way with investigators such as Dr. Lacroix helping us to really tease out what this really means for the average 50 year old going through menopause. But we still have kind of a lag in both physician education and certainly , as you're all saying , in the education of women. So , you know , we have some of our work still cut out for us to accomplish these goals.

S9: And Jill.

S6: Yes , I want to say , isn't it so interesting that this is a change that most women will go through at some point in their lives and we collectively still act like we're not really sure about it. And I think that as a result , women just often want someone to give them the answer. So I'll say people will come to me and realize that I do work around sexual response and menopause and they'll say , What should I do ? Like , we just want someone to give us the answer. And I think. That's so interesting because I think we're living in a time right now where it would behoove all of us to give women more information and encourage them to make decisions about their own lives. Right. My hot flashes are different than your hot flashes. My sexual changes are going to be different this year than they will be in three years. And the right answer for me is different than the right answer for you. And we have to trust women to make their own right decisions.

S5: And Andrea , you are part of a research. Team.

S1: Team.

S3: Working on.

S5: A National Institute of Health funded project that's related to all of this. Will you.

S3: Tell us about the M.A.. Plan.

S5: Plan.


S7: Like this stuff works great at the menopause. Maybe we should take it our whole life because it could prevent disease. We could be young forever. And there was a book written by isn't it Robert Wilson , The Forever Feminine. There was this belief that estrogen might be the fountain of youth for women. And in the Women's Health Initiative , both of the trials on estrogen. And it's more complicated than I can say in a quick soundbite here , but both of the trials were stopped early for harm , which was a tremendous surprise to many of us. For the women with the uterus who took estrogen plus progestin. The trial was stopped for harm because it was causing breast cancer , strokes and heart attacks and blood clots. And there were other benefits as well for the estrogen alone trial , which can only be taken by women without a uterus because it's a uterine carcinogen , a very powerful uterine carcinogen. The risks were really related to stroke. There was an increased risk of stroke and blood clots and breast cancer , less so than for estrogen plus progestin. In fact , when we looked at the longer term follow up , there really wasn't an increased risk of breast cancer associated with estrogen alone , which was fantastic. We never knew that before. So we learned about the harm that was being done by taking this. And that's what scared women and their health care providers away from using it. And the sense of betrayal that Dr. Dunkle talks about is really related to we thought it was good for prevention. How could we have been so wrong ? And that's worth introspecting about in the biomedical community. But how could we have been so wrong really relates to not ever doing a trial that would have told us this many , many years earlier. So with respect to my Menno plan , we then did this series of randomized trials on treatments , including low dose estrogen therapy , which we think is less harmful than the dose that we were using back in the early 90s. SSRIs arise. What about exercise , yoga , cognitive behavioral therapy for insomnia ? We did a whole bunch of different trials. What about vaginal treatments ? How does how does vaginal estrogen at a lower dose compared to a moisturizer , a vaginal moisturizer like repellents or a lubricant like K-Y jelly ? So we've done these trials and other people have done other trials. And my menopause plan is meant to. Make the information that we've learned from largely NIH funded trials available to women everywhere to explore in an unbiased framework , meaning we're not making money on it , we're not selling a single thing in this website. We are just wanting women to be aware of the scientific evidence that relates to menopause. You can learn about your menopause there. You can learn about. We actually thought it was important to have a shopping cart where you could select the symptoms that you're having and put them in the shopping cart. We call this is the essence of my menu plan. And then you can look at the various treatments and whether they have been shown with rigorous scientific evidence to improve any of those symptoms. And we try to include as many symptoms as as we could without going outside the box of menopause symptoms. So it's got things like brain fog , it's got things like joint pains , vaginal dryness , um , urinary incontinence. Um. Hot flashes and night sweats , of course , mood changes. All those symptoms are in my mental plan , and we do the best we can to translate the evidence so that it's available to all of us. The other feature I would encourage people going out there to check it might look at is there's interviews with women talking about. What were they told by their mothers about the menopause transition and what is what is this experience like for them ? How do they talk to their doctors about it ? What is their husband ? Think about it. So the voices of women , we wanted to be very prominent in my mental plan.

S3: We'd love to hear from you all about how menopause has impacted your life.

S1: Give us a call at (619) 452-0228 and leave a message or you can email us at midday at Coming up , the latest in medical research related to menopause.

S8: There's actually an entire spectrum of things available for women depending on their symptoms , their degree of bother and other health conditions.

S1: You're listening to KPBS Midday Edition. You're listening to KPBS Midday Edition.

S3: I'm Jade Hindman. Today on the show , we're talking about menopause. Joining me is Andrea.

S1: Lacroix , a distinguished professor of epidemiology at UC San Diego who specializes in.

S3: The health of. Postmenopausal.

S1: Postmenopausal.

S3: And older women.

S1: And Dr..

S3: Cynthia Dunkel , a clinical professor of medicine at.

S1: The UC San Diego School of Medicine. She established one of the first menopause programs in the country , and Jill Wood. PhD.

S3: PhD. She teaches women's gender.

S1: And sexuality studies at Penn State University. Her research includes the menopausal transition and sexual desire.


S8: Sometimes it awakens them from their sleep. Some women are bothered terribly by these , and another women go , What's the big deal ? So really , individually , how bothered is the woman ? And then number two , what does she want ? If women are aware of different treatments and then three , think asking whether or not it will be safe. So contrary to what we may be talking about , there's actually an entire spectrum of things available for women depending on their symptoms , their degree of bother and other health conditions that can range from hormone therapy , which , yes , is very effective , but through a number of other prescription therapies , some that are used for helping with sleep , some that are used for helping with mood that can both also help with hot flashes. There are a lot of things over the counter and unfortunately , these get a little tricky because there is an incredible placebo effect of hot flashes , meaning that if women take an active drug versus a sugar pill , the sugar pill might be almost as active or maybe even better in an actual trial than than the supplement or whatever they're taking over the counter. So these things have to be studied carefully. And then finally , there are some brand new things in the pipeline that have a whole new mechanism of action that affect things that we call the candy neurons , KISS peptide neuro kind and B and dimorphic , which sit up in the hypothalamus and help regulate hormones , but primarily regulate things like our heat management , which is a real problem for a lot of women in menopause. These aren't available yet , but they are in the pipeline and there are several in the pipeline and these are anticipated to be available soon. So these have the advantage of not being hormonal yet being very effective. And so these might be great options for women who haven't been able to use hormone therapy. For example , someone who has a history of breast cancer or other medical what we call contraindications reasons that women shouldn't think about hormone therapy. So fortunately , this is an area of very hot investigation right now. And I think this should give women interest and I think more hope that what I'd like to call the menu for menopausal health is continuing to expand. And this is a good thing for everyone.

S3: I'm curious.


S8: And for a lot of women , this brain fog is primarily during this transition time. And once you make it to the other , sure , thinking is clear again. So I think the real question is because when women have hot flashes , sleep is disrupted , mood changes can go along with that. And so , you know , if you've ever had a new baby at home or for those of us in medical training , bad things happen when our sleep is perpetually disrupted. And so some of this might be what I like to call the complex web of hot flashes and mood changes and sleep disruption. And if we can nip that in the bud , sometimes the fuzzy thinking just completely gets better. And if I could just say for a lot of women , I think they're afraid of like , oh my God , I need to make this huge decision. But it's , you know , I'm like , try it out for a month and you'll be able to tell very quickly if your symptoms are better or not. These can work quite promptly and someone will say it's not doing a thing for me. I'd like to try something else and appreciate that. It's very often a stepwise trial and error kind of. Process before we identify for that individual what's really going to work to kind of get her back in the equilibrium where she feels like , all right , I'm back in the game and now I'm moving forward and I'm going to handle this just fine.

S3: Jill , you had something you.

S5: Wanted to say to.

S6: I was nodding as you were talking about trial and error. It reminds me of of someone choosing a contraceptive method that you don't have to just because this is the method you start with. If you don't like it , try something different. So and I was thinking that I think a lot of women I'll say that I my experience of starting to go through the transition is I feel not like myself and I'm just very aware of the context in which women age through this process that at the very same time , I'm starting to have hot flashes and I'll say , I wish that someone had told me that a hot flash , at least my experience , it's not just feeling hot. It's like for me , it was like when I had my first contraction , I remember saying to my midwife , How will I know when I'm having a contraction ? She said , You'll know. And I sure did. I was sitting there working and I felt like all of a sudden I got this rush of heat in my face. I felt like someone was standing on my chest. I felt dizzy and nauseous and really , really anxious. And my first thought was , oh , my gosh , I'm getting the flu. Like , I just felt like I got hit by a wall and then I could feel it move away from me. And my first thought was , this kind of feels like a contraction , like a wave. I can feel it coming and peaking and going away. And I thought , Well , that's weird. That doesn't ever happen again. But sure enough , I realized I just started laughing. I thought , Oh , these are hot flushes. So but I feel like at the same time , at least for me , it was disconcerting to not feel like myself. At the same time , I have aging parents , right ? My kids are at this age where they're , you know , in college or getting ready to move into other transitions. I have different and more significant responsibilities at work. So I think that. There's a lot of maybe impossible disentangling to do from how much is hormonal and how much is just our lives at this place. And I think at least for me , that helps me be a little bit more self compassionate and give myself a little bit of grace if I can find some humor in it. Like , Oh , of course this is also happening today because I'm having lots of hot flushes today. I also have to , you know , go put the dog down or something. So I'm really aware of the intricacies in our lives and how.

S5: Andrea.

S7: Well , I'd love this conversation because I think it embodies what we need to do , a lot more of which is share with each other about these experiences that we're having , just like we did when we were little girls , you know ? And I hope everyone out there will , if you're not already doing that , do that. It's it's the one of the reasons that placebos work so well is that you're being taken care of. You have the expectation of benefit and and that there's this beautiful thing that's really physiologic. It's not it's not it's not fake in any way. We experience benefit when we when we think we're going to have benefit. And we are healed by listening to each other to some extent. So I know some wonderful colleagues who are menopause doctors and they say that one of the most powerful things that happens when they talk to a woman about her menopause symptoms is. This sense of her relaxing as she's being listened to , that the being listened to is so therapeutic in itself that it has that it's its own medicine. That's one thing we haven't studied. I will comment that I also have hot flashes. I had some other things. I would describe my menopause as sort of medium. I don't think it was nothing and I don't think it was horrible. But , you know , it was , like you say , an interesting experience. And the experience of hot flashes itself is distracting. So like , it's like a learning process. Like all of a sudden you have these. For me , it was this feeling of anxiety that came first and I'd be like , What's happening ? What's happening ? Why am I so anxious for all of a sudden ? And then all of a sudden I'd have this sensation of heat rise through my body and then I'd say , Oh , it's a hot flash. But you you'd think you'd get used to that. No , every single one. It was like , what's happening ? What's happening ? I think it's like you don't you don't even get trained by these things. They just keep happening until they until they start happening less. And the other thing we could comment on is that the duration of this period does vary by women. But the study of women across the nation , which is the prospective study in the United States that we've learned so much from about the natural history of menopause shows that I think the range of duration of menopause symptoms is something like three to 9 or 10 years. Do you remember that ? Doctors even more so. So , you know , I remember my one of the girlfriends that I who's a colleague who I walked with for many years was having menopause symptoms. And her husband said , wait a second , I thought these would be over with in three months. You know , why are you still why are you still complaining to me about these symptoms ? This is supposed to be a temporary and a short phase , and it's not.

S1: We'd love to hear from you all about how menopause has impacted your life. Give us a call at (619) 452-0228. Leave a message or you can email us at midday at Coming up , your menopause questions answered. Yeah.

S8: Yeah. In general , we say the average age of menopause. And this is an important question because people are going , aren't I too young ? Could this possibly be happening to me yet ? Is between 45 and 56.

S1: You're listening to KPBS Midday Edition.

S3: You're listening to KPBS Midday Edition. I'm Jade Hindman. Today on.

S1: The show , we're talking.

S3: About menopause. And joining me.

S1: Is Andrea Lacroix , a distinguished professor of epidemiology at UC San Diego.

S3: She specializes in the.

S1: Health of postmenopausal.

S3: And older. Women.

S1: Women. Also , Doctor Cynthia.

S3: Dunkel , she's a clinical professor of medicine at the UC.

S1: San Diego School of Medicine. She established one of the first menopause programs in the country.

S3: And Jill Wood , PhD.

S1: She teaches women's gender and sexuality studies at Penn State University. Her research includes the menopausal transition.

S3: And sexual desire.


S8: And so by the term menopause , we mean having that last menstrual period. And we can only formally diagnose that in the rearview mirror. We need a year after to say , yep , that was your last menstrual period. So if you're 45 when you have your last menstrual period , you might be starting to have some symptoms in your in your late 30s , in your early 40s , because we did learn that women some women fortunately a minority of women will have symptoms for as much as a decade before menopause and another decade after. But the average age in the US right now is about 51. And so the factors about it are kind of , you know , people have looked at all sorts of things. But think two of the most relevant ones might be related to race. And we're finally learning from studies that have looked at racially diverse women over time that it seems like Hispanic women and black women might have menopause somewhat earlier than white women. Whether this might be a genetic thing or other health factors that could tie in. And then it might be that there are some relationships with how many babies women have. And so women who have more babies might have a later menopause a little bit. Women who start their periods earlier might have a little bit of an earlier menopause. But these you know , these aren't so precise. And so these can be some things that might be observed , but that we might not necessarily be able to figure out in an individual woman who's going to her doctor to talk about that. And so think that the other part of the question was the benefits of the risk or being early versus being late. Right. And there's been a lot of attention lately on earlier menopause. And this can be pretty interesting. We define early menopause as between the ages of 40 and 45. And premature menopause can can occur in women who are under the age of 40. And we know that women who kind of are short changed , if you will , in the total amount of years that they're exposed to their bodies , estrogen will have a higher risk of osteoporosis or thinning of the bone that can lead to fractures , heart disease and maybe some thinking or cognitive decline over time. And so we think it's really important that women who are experiencing this , if they're having trouble getting answers to the kind of questions about should I be treated and how long really , really push back , really persevere , trying to get those questions answered because we think that they might need earlier treatment. So you go , okay , does that mean that if I have a late menopause , then that I'll do better ? Well , in some ways you might , because that says that your body might have had a longer period of exposure to to your hormones. You might live a little longer , you might have better bones , you might have less in the way of heart disease. But , you know , there's always a flipside when we have a longer exposure to hormones. Over time , we might be more vulnerable to breast cancer because of that longer exposure. So I would say that the simple bottom line is , you know , the average age of 51 , if women have an earlier menopause , depending on how early , it's important to look for some other possible associated health concerns with that. And if you're later right now , I would say that it's just like , you know , for the most part , keep having your mammograms and the rest of the news is probably more positive for your health to be later than earlier.

S5: All right. Thank you. This next question is from Mikki , who says , My experience is that many doctors avoid this topic with their patients and I want to. Understand why.

S6: Jill , I think doctors don't talk about menopause because doctors are people , too. And they might also feel embarrassed about bringing something up that they're not really familiar about. And we were chatting a little bit before we started recording and saying that overall physicians continue to be pretty poorly informed about the menopausal transition , even OB GYNs.



S8: Yeah , I'm a I'm a physician , so I can take it on the chin if anybody gets upset with what I say. I really do think it comes back to if , as a clinician , if we're not educated , if we're not informed , we're going to feel uncomfortable with that topic. We don't want to tell women the wrong thing. It has become a quite nuance , if you will , a lot of details and a lot of if thens and deciding the right treatment and safe treatments for women. So I can see again why a number of clinicians would want to avoid maybe treating themselves. But what I would just ask would be that they would say to their patient , you know , you're getting to the age where you might be starting to go through this natural universal transition to menopause. And are you having any symptoms that you might that you think might be related ? Some women have hot flashes. Some women have vaginal dryness. And then listen to what she says , because I think chances are women will be so grateful to be asked about this , that they will explain what's going on. And then it's up to the clinician to say , I can tell this is something that's really on your mind and bothering you personally. This is not something in my wheelhouse that I treat , but I'd be happy to refer you to this colleague or this expert in our practice or in our system who I know is interested and really has studied up and stayed very current on this. You know , how does that sound ? And think most women and you you all can say what your responses think they would say , Thank you very much. I really appreciate you introducing this topic and helping me find my way. Right.

S5: Right. And you know , another question that we have and Andrea , I think you may be a good person to answer this.

S7: How do you go about figuring what that is for yourself and my mental plans ? A good , reputable website to start learning from the North American Menopause Society has good information about menopausal hormone therapy. It's very different for women with the uterus and women without a uterus in terms of the risk benefit equation. They're transdermal products. There are creams. There are so many different things that you might consider in the hormone replacement. We don't use the word replacement anymore. We just say hormone therapy realm. And it continues to be one of the main methods for treatment of menopause symptoms. The other thing that doesn't get mentioned very much that's so important to take in is that many of the treatments , even low dose estrogen , don't get rid of all your hot flushes. They don't get rid of all your symptoms. They just help a little bit. And so helping a little bit may be what this is all about. It's not cure. It's it's just a little assist to get through a stage in life that will the experience itself will likely change for you even individually over the years that you experience symptoms. So I myself had trouble sleeping. I had hot flushes , I had vaginal dryness. I think that trio is very , very common. And also , you know , one day my husband brought home my daughter , who had gotten a prescription. She was just a , you know , I don't know , a grade schooler gotten a prescription for glasses. And he said , my husband walked in and said , Anna's got glasses. And I broke into tears and said , that can't be possible. An eyeglass prescription for my daughter. A little overreaction on my part. You know , I ended up taking an SSRI , which is an antidepressant , and it helped me personally sleep better. It helped my mood. I wasn't depressed. It really , really helped that. And it helped my hot flashes because I was I think because I was sleeping better at night and was not as reactive emotionally on that medicine. And I still take it to this day because when I stop taking it , I don't do well. So that's what worked for me. But there's so many things that you can try.


S7: They having said that , they prescribed a lot of things that didn't work that well for me , that I tried vaginal estrogens , for example. I tried everything creams , pills , rings , anything you could put up there with hormones in it. It has been tried. And I will tell you , none of that worked for me. It just didn't change the situation for me. But it it may work for other women. So we're all our own experiment when it comes to managing these symptoms.

S5: We're going to come back to that , too. But , you know , we've received so many questions related to hormone therapy , and I know different experts have different thoughts on their use.

S1: Can you give us.

S3: A sense of the range.

S5: Of schools of thought on hormone use ? Dr. Dunkle. Yeah.

S8: Yeah. I think over these 20 years , things have really been honed. So on my side of things , I think the experts agree that if a woman is suffering and says , I need a treatment , if she is okay with the idea of taking hormone therapy , and then if we deem it to be safe for her , that this can be really helpful. And so if she is under the age of 60 or within ten years of menopause , because some of the findings from the Women's Health Initiative stem from the fact that there were women up to age 79 that enrolled in that trial. So maybe what's good for a 50 year old is really different than what's good for an almost 80 year old. And so we primarily focus on younger women close in time to menopause who haven't had breast cancer , haven't had a heart attack , haven't had a stroke or evidence of a blood clot , and who and we even recommend going through some pretty stringent evaluation to say what is your risk of heart disease ? And if you think about it in midlife , we should be doing that anyhow. And what is your risk of breast cancer ? Because we should be doing that anyhow , because we have things we can do to prevent breast cancer. So with that kind of study and it takes a little time to pull this together , but I think women learn a lot about the totality of their health. And then you can say , okay , you are a candidate for this if you're willing to take it. And as I said earlier , within a month or two , women are going to have a pretty good idea if this works for them or not. So I think some of the real concern and fear that we started out with has been largely diminished. The risks aren't zero , but they're pretty low. So , for example , breast cancer is probably one of the most fearful possible consequences of hormone therapy. And for that we say the absolute risk is three cases of breast cancer for a thousand women who use hormone therapy for five years. And so think when we put it in terms like that , women could go , seriously , that sounds like nothing to me. I thought it was 30% that thought that meant 1 in 3 women. Or they might say , I watched a good friend die of breast cancer. I could never take even that small of a risk. So this comes back to what we've all been saying about the individualization for the woman and based on her history , her ideas. And then we could say , great , we have other options. So I think women should be reassured that we do a better job , I think , than we ever had at trying to sort out risks and benefits , particularly if they're thinking about the possibility of hormones. And number two , the armamentarium we have is larger and more diverse so that we can find something for them than we've ever had. So , you know , no time like the present to be going through menopause.

S3: I'd like to thank our panelist.

S1: For this conversation today. We'd love to hear from you all , too , about how menopause has impacted your life. Give us a call at (619) 452-0228. You can leave a message or you can email us at midday at We will continue this conversation with more of your questions. And we'll hear from a woman who is advocating for menopause leave in the US. I'm Jade Hindman. Thanks for listening.

Women stand together in this undated image.
Women stand together in this undated image.

Death, taxes and menopause? It is inevitable that most women will eventually experience menopause, if they are lucky.

But it is one of those subjects that few people talk about, and that can leave women experiencing symptoms feeling confused, scared and alone.

On Midday Edition, we are pulling back the curtain on menopause, lifting the taboo, and talking about the sometimes debilitating, sometimes welcome changes associated with menopause, the state of modern treatment, and how we, as a society, can support women as they go through this stage of life.


Andrea LaCroix, a Distinguished Professor of Epidemiology at UC San Diego who specializes in the health of postmenopausal and older women.

Dr. Cynthia Stuenkel, a Clinical Professor of Medicine at the UC San Diego school of medicine. She established one of the first menopause programs in the country.

Jill Wood, PhD, teaches Women's, Gender, and Sexuality Studies at Penn State University. Her research includes the menopausal transition and sexual desire.

Catherine Balsam-Schwaber, CEO of Kindra, a self-care company for women in menopause, and supporter of employers offering employees menopause leave as a benefit.