S1: It's time for KPBS Midday Edition. It is a normal part of aging for women , and yet there are so many questions about menopause. Today , we'll speak with a panel of doctors who have answers. I'm Jade Hyndman with conversations that keep you informed , inspired and make you think. A new legislative proposal would make education about menopause more accessible to clinicians and women , while also making care easier to get.
S2: The word menopause isn't a dirty word anymore. You know , people are just talking. People talking to their friends. That's wonderful.
S1: Well , talk about ending the stigma around menopause and take some audience questions. That's ahead on Midday Edition. For many women , menopause and what to expect in all of its phases draws a big question mark. Because while most women will experience this phase of life , getting answers to questions and just finding care can be a challenge. Well , right now , state lawmakers are pushing legislation to make menopause care more accessible and to spread awareness about the transition. I'm joined now by a panel of doctors to talk about all of this. Doctor Cynthia Dunkel is a clinical professor of medicine at UC San Diego. In 1988 , she established one of the first menopause clinics in the U.S. at UCSD. Welcome back to the show.
S3: Thank you so much , Jane.
S1: Also , Doctor Catherine McAuley , clinical professor of medicine and ob gyn at UC San Diego. And she's also director of their Menopause Health program. Welcome to you. Thank you. And doctor Lisa Lipschitz , OB-GYN with Sharp Grossmont Hospital. Welcome.
S2: Thank you so much.
S1: All right. So , Catherine , there's two menopause related bills working their way through the California legislature right now. Let's first talk about AB 432 , which would expand what treatment insurance companies are required to cover related to menopause and perimenopause symptoms.
S4: So typically the estrogen can be either oral , transdermal through the skin or vaginal formulation. So there's a variety of different formulations. Um patches , gels um , like I said , rings , vaginal rings. So there's a variety of options for using hormones. But that would be what we usually start with in a patient who is a candidate and having bothersome vasomotor symptoms.
S1: Lisa , we hear these terms perimenopause , menopause and post menopause. What does different treatment look like um over that cycle.
S2: So perimenopause is when you still are producing your own hormones but very erratically. And so my goal during that time , if people are symptomatic with either irregular bleeding or hot flashes , night sweats , is to really try to make their hormones stable. And so if they're a good candidate , they I often prescribe , uh , oral contraceptives or sometimes I prescribe hormone therapy , although we can get into bleeding problems with that. So it's a discussion to be had with the patient. Yeah.
S1: Yeah.
S2: So there's birth control pills or hormones that we use to. Or hormones that those have different contraindications. But hormone therapy the major ones are unexplained vaginal bleeding , breast cancer. If you've had a history of a clot or , um , a clot in your lungs. Other contraindications. If you have cardiovascular disease , like you've had a heart attack or stroke.
S1: Wow , Cynthia. So back to that bill. AB 432. It requires health insurance coverage , evaluation and treatment options for perimenopause and menopause.
S3: And that has been a challenge with some of the the postmenopausal hormone therapies. I think people are used to giving younger women oral contraceptives. Um , now during the menopause transition or the perimenopause , there's also some interest , uh , especially if women are having bleeding issues of using something like a gestural IUD , which thins out the lining of the uterus and can really reduce those bleeding issues. And then if at the time , uh , the woman develops hot flashes or some mood changes , some of the other symptoms of menopause , then we can add an estrogen therapy on to that combination. So she gets contraceptive , she gets , uh , the bleeding cuts back , her symptoms can be relieved. And that leave an industrial IUD can help protect the lining of the uterus from the effects of estrogen. As doctor McAuley was mentioning that if a woman has a uterus , she needs to have a second hormone to protect the lining of the uterus from over growing and possibly even even developing it into an endometrial or uterine lining. Cancer. If she's had too much estrogen over a prolonged period of time. So the bill , I think , is going to be helpful because it's hard sometimes to get things like , for example , a transdermal patch , which is one of the options that is really coming into your favor now , because we know that it has very little negative metabolic effects on things like medicine and things like factors that affect our blood pressure , the lipid profile , blood sugar control. And so more and more , uh , experts are recommending transdermal therapies , but they haven't always been covered. So I think that , um , my goal or my hope would be that this would enable women to just be able to obtain these treatments in an easier way and to have it mostly covered as we expect our insurance to provide for us. Yeah.
S1: Yeah. Well , and even if they're not covered by insurance , do do. A lot of women are they even told about these therapies from their doctors if it's not covered.
S4: Not always. Not all women , in my experience , at least , are given the full sort of spectrum of options. It really is shared decision making in terms of when a woman decides what formulation she wants to use. But it is really nice to have coverage for all the different formulations. As I was saying , a patch , a gel , a pill , a ring because one formulation might work better than the other , but then sometimes , yes , where I'll discuss it , but then we go to order it and see it's not covered. And that just makes it tricky.
S3: It makes it expensive.
S4: And very expensive. Exactly. So the out-of-pocket costs for some of these products are really just out of range for the majority of women , and these are patients with insurance and able to afford health insurance. So it's just the price is is a challenge if they would actually pay out of pocket. So we really do need improved coverage.
S1: Well , you know , Catherine , let me ask you this , because this bill also , you know , it has that other component. It requires doctors to go through menopause specific continuing medical education.
S4: Um , I think that , yes , I agree with it. I think I'd like to see there be better menopause education earlier so that we didn't have to require continuing medical education for , you know , already licensed physicians or providers. So I do a lot of work at UCSD teaching the medical students and residents , as many around the country , are in different academic centers. That's starting to improve finally. But it's it's slow. So for now , yes , I think there is a need for , um , for better menopause education , especially now with more people talking about it , patients asking about it. So the bill , to my understanding , if the providers practice had more than 25% of women in their practice under the age of 65. Then they have a small percentage of their CME time that continuing medical education that that should be completed on a menopause topic , which I think is really appropriate. Um , if they have a large female population in their practice.
S3: I just wanted to say that we learned that , uh , one of the only randomized controlled trials , the gold standard scientific research to try to evaluate these , uh , post-menopausal hormones was first published more than 20 years ago , in 2002. And the results initially were surprising and they were negative , and they led to fear in women and clinicians. So it's not just our new providers in training , be they physicians or nurse practitioners or physician assistants. We got to get back at those practicing clinicians who just were in that wave when people said , we're not doing this anymore , and they kind of never learned. And so that's why this really appeals to me to tighten with CME CMMi , because many clinicians are just so busy that it's hard for them to prioritize what I'm going to do. But this might be a little nudge. And just by virtue of them having to. Do this , I think you can really increase their confidence and they'll do a better job being able to talk with women about the menu that's available that they could use for symptom relief , as well as the risks and benefits and how they know it's appropriate , what's most appropriate for each person. Right.
S2: Right. Or just even putting it on the radar for physicians because , like Doctor Dunkel said , in the past , there was so much fear because of this flawed study. And now you have all these doctors and other providers that just don't know what to do. So just as long as you if you just give them , hey , it's okay. And even if they don't do it themselves , at least they feel comfortable to refer to someone else. And it's in their wheelhouse of , hey , this is something important.
S1: Doctor Schenkel , speaking of that medical training piece. There's another California bill , AB 360 related to that , and it requires the state to report on gaps in health provider education around menopause.
S3: Sometimes women start having symptoms about this age. Anything going on ? Are you having hot flashes ? No one teaches us what these things feel like. And I've had patients say everything from I'm having panic attacks and I go , why don't you describe those to me ? Well , my husband's a psychiatrist. He says this. Your panic attacks. She's having just a standard run of the mill hot flash. So some clinicians may not be so familiar and either younger women or or our male colleagues. So I think that's going to be really helpful. Um , the other thing is that people need information to combat this Current rage of the influencers. Everyone's selling a supplement. Everyone's got a new formula. These things are not required by the Food and Drug Administration to be formally tested with placebo controlled trials. The sugar pill versus the active treatment. And we know that hot flashes are very responsive to placebos. So I want to know. I want to know that this stuff that's being sold has been tested. And I think that a clinician who's more informed and educated about kind of what the real experts are saying versus the like movie star experts or or other people who decide I'm a menopause expert now to help them say , you know , I hear what you're saying and you're bringing me this newsletter or whatever , but let's talk about this. And we could have a good conversation about what's evidence based and what's trendy , but we have no idea. Right.
S1: Right. And let me ask about that. You know , because there are so many people online who , you know , will tell you they're a guru about menopause now. So many , you know , reels and videos. Um , and I think I'm wondering if , uh , the fact that a lot of doctors may not be educated on that right now , and perhaps more people are turning to the internet for information about menopause.
S4: And , and I think , yeah , with the education of providers , um , as Cynthia was saying , how important that is to get them sort of up to date with menopause. I've had some providers telling me they're looking at different , different online influencers or reading their books , and there's not always accurate information from some of those people who are even physicians. Some of them have turned it into a business with books and products and supplements and become very , very popular in social media and other outlets. But at the end of the day , it looks like a lucrative business. And so I have some issues with that.
S3: But I would say that the and I agree with everything that Catherine just said , but I think on the good side , it's getting people talking about it. It's getting it out there. Women are talking to their friends. Did you hear about this ? Did you know about that ? Do you know anybody who's tried this ? And I think just that opening it up and making it part of just what people are talking about is a really good thing.
S2: Doctor Lipschitz. I agree with that. You know , there's pluses and minuses. I think the plus is it's really out there now. The word menopause isn't a dirty word anymore. You know , people are just talking. People talking to their friends. That's wonderful. Now the next step is to make sure that what people are learning is really accurate and is beneficial for the overall health and causes no harm. I agree with Catherine. I mean , there's so many people out there making a buck and that's not quality care.
S1: Stay with us. Welcome back to KPBS midday Edition. I'm Jade Hindman. This hour we are talking about menopause. And right now two bills are making their way through the California legislature to expand treatment. We're joined by a panel of local physicians to talk about menopause and help us better understand this very common process. I'm speaking with Cynthia Dunkel , clinical professor of medicine at UC San Diego. Also doctor Catherine McCulley , clinical professor of medicine and ob gyn at UC San Diego and director of their Menopause Health program , and doctor Lisa Lipschitz , ob gyn with Sharp Grossmont Hospital. So Doctor Dunkel in general , what do many people get wrong about menopause.
S3: And that makes me so sad. I was fortunate when I started out in this realm a long time ago , that there was a woman named Margaret Mead , who was a very thoughtful anthropologist , and she said that women should embrace this time and celebrate their post-menopausal zest. So instead of looking like , oh gee , I'm older , I'm aging , you know , I want my sexy back kind of thing that women really. It's like a time. And we know that this transition occurs. We used to say that women have a third of their life after menopause. I think for some with our. Advances in aging medicine , we might be leaving half our life after menopause. So I don't want to be mourning for half my life. I want to be celebrating that. So the simple things. You're not in aisle number three of your Walgreens shopping for tampons anymore. You're not worried about contraception anymore. You're not having bleeding issues that , you know , necessitate that you've got to pick your wardrobe accordingly to the time of the month , or plan your activities based on , you know , terrible heavy bleeding. So in so many ways , and I think it coincides also with a really rich time of life for many of us that you're kind of getting really established professionally and hopefully established in your family and people that you love and the way you want to spend your life. And I would very much rather women look at this as kind of like a gift , a special time. And I think one thing that has helped is there's so many celebrities that are letting us in that they are menopause. You go really seriously. She's post-menopausal. So I don't know. I think the one of the main things that we need to do is kind of look for a little shift in how we think about this , how we approach it. You know , not so much with dread , but curiosity , you know , and ultimately celebration.
S1: So does the brain fog and mood swings , hot flashes.
S3: For the vast majority of women , I would say yes , but there are a group of women , probably 18 to 20% , who may have hot flashes , literally a very long time. The brain fog. My my best understanding of the data is that that clears , that this is something that is in your rearview mirror after a few years , and the mood changes often are reflective If you have hot flashes at night , you're not sleeping. Sleep deprivation can really contribute to a poor personality and tolerance for stress and anger management issues in all of us. So if those things are back in check , unless a woman really has a history of vulnerability to depression. So if she's had a postpartum depression or really has a rough time with the second half of her menstrual cycle , she may be more vulnerable. But for the most part , these things resolve.
S1: That's optimistic right there.
S3: That's coming from the other side , Jane. Okay.
S1: So there we go. All right. Well , you know , we asked our audience members what they wish they knew about menopause before they went through the process. Naomi Lake pointed to perimenopause. So take a listen.
S5: I am through menopause , and I wish I had known more about perimenopause. It's all about possible symptoms and when it can possibly start , and how long it can last. That would have been very helpful. I know it varies woman to woman. It can last up to ten years prior to full blown menopause. But I think it's crucial women understand these possible symptoms better so they can talk to their Gyn or primary care person and not feel like they are losing their minds.
S1:
S2: So really what's happening is it's the it's the end of a woman's reproductive potential. And those ovaries are slowing down. And eventually when you hit menopause , you no longer are able to get pregnant. Sometimes makes people very happy. Um , so what are the symptoms ? So what's happening is your ovaries are really acting erratic , and you're having major or fluctuations in your hormones. The results of this varies for every person , but I would say the biggest one that I see is irregular periods. And at first the periods kind of clump together and get closer together. And then as you get closer to menopause , they kind of space out. And so this irregular bleeding is really bothersome to a lot of women. And while this is going on , all the symptoms of perimenopause that you also see in menopause , you see those as well , which is like the hot flashes , the night sweats , the irritability , mood changes. Um , that's especially common in people who are prone to mood disorders and then , um , difficulty sleeping. And as we said before , when we're having trouble sleeping , our whole life falls apart. So if we can help women sleep better and help them manage their mood better , so many other things are going to fall into place. Now. The hot flashes , too , can contribute to sleep disturbances , and at this time , you're getting older and you're aging. And as you as you ask me , you know , maybe it's a maybe it's your thyroid. So you should get some labs checked as well to make sure you're not getting confused of what you're actually treating. And that's why a trained doctor or advanced practice provider can really do the other test to make sure that there's nothing else going on.
S1:
S2: That's a great question. There is no actual test that really confirms perimenopause or menopause. We do have a hormone that we sometimes use for patients who who have had their ovaries taken out , who don't have bleeding , so we really don't have other ways of telling if they're perimenopause or menopause.
S3: Well , I was going to say the problem with doing a test , because I think every we have so many tests for so many things. You're just like , can't you do the test ? But as everybody's been saying , it's not like an on off switch for this transition. And so you're kind of chasing a moving target that women might go a couple of months without a period and have some hot flashes and come in and go , I'm sure I'm postmenopausal. And then you order the pituitary hormone , follicle stimulating hormone that regulates the ovaries , and it comes back completely normal. She goes , doctor , uncle , I needed to tell you I had a period two weeks later. So you just catch them and it can be a waste of money. It doesn't help. And so that's why in general , most of the medical societies and expert groups say , you know , try to resist the temptation to measure these things because it doesn't necessarily help us in the management. But I really agree with what you said , Lisa , about other things are happening in our bodies. So we don't want to just blame it on menopause. And there's some other blood disorder that's causing all this bleeding or thyroid disorder. You know , we have to be smart about evaluating just , um , overall health of women at this time. So.
S1: So.
S4: So it's 12 , as I mentioned earlier , 12 consecutive months without a period. And a woman who's in that right age range , then she's reached menopause. So that's how she knows I don't need contraception anymore. I've reached menopause. Any bleeding after that point should be reported to a provider. That wouldn't be expected. But the general guidelines for prescribing hormone therapy , um , we have a lot of different dose ranges for estrogen , and that's shared decision making with the patient as well. If they feel more comfortable starting with a low dose. And then we usually titrate the dose up to relieve their symptoms , because that's really what we're interested in is symptom relief , not levels.
S1: I do want to get back to some more of our listener comments. As you've all laid out , there can be a whole range of symptoms associated with menopause. And our listener , Julia Nemeth had something to say about that. Take a listen.
S4: I wish my health care provider would.
S6: Have recommended HRT first , given my age , the weight gain should have been obviously menopausal rather than wasting precious time and money on weight loss programs. Given my age , the sudden onset of anxiety , depression , and disordered sleep should have been obviously menopausal. Rather than putting me on water pills , blood pressure medicine , and sleeping pills. I feel like I'm fighting a war with various doctors to treat menopause rather than all the separate symptoms.
S1:
S4: I think it's it's challenging when we have menopausal hormone therapy , if we , you know , correctly identify that the woman is in menopause and recognize the symptoms. And Um , we have menopause hormone therapy that really can can cover a lot in terms of symptom relief , in a lot of different systems in the body. Um , and I don't like the idea of adding multiple medications to treat one thing at a time. I'd rather use one , um , hormone therapy that would cover a multitude of different symptoms and , um , would really get to the root of it. So I agree with her. It's very frustrating. And , um , I see a lot of patients come to me having been offered non-hormonal treatments first rather than being given the full spectrum of there are non-hormonal treatments that you may prefer , but there's also menopausal hormone therapy. But as I think Cynthia was talking about earlier , there was just so much fear after that 2002 Y study. Um , and a lot of providers were just very concerned about risk , um , that they became averse to prescribing hormones. So we're now just seeing that tide changing.
S3: I was just going to say that I think Julia's comment reflects , and really kind of brings this full circle to this issue about clinician education. Some clinicians just didn't learn it. They don't know it. They don't want to necessarily reinforce that this is menopause because they're not sure what to do with it. And so I think that , um , women should also , uh , know that , um , hopefully that they have the resources to get a second opinion if they feel like she's , she's slamming into this door and then that door and this problem and that drug to , to just step back and go , something's not right here. And at least you ask , uh , sometimes and sometimes a clinician will even say , you know , I haven't had a lot of experience with this , but I've got this person in our plan who really is into menopause. So let's get you in to see her or him. And so , um , pushing back and looking for a second opinion if they're having such a rough time. Mm.
S1: Mm. Well , this next comment is from Leslie in San Marcos. Let's take a listen.
S7: I wish there was more information relayed by health care providers or from the media , on the relationship of menopause and osteoporosis and other postmenopausal related diseases. I've learned too late that osteoporosis could have been prevented if better educated at the time of menopause. Hmm.
S1: Hmm.
S2: Ah , we are losing bone. Slowly. Slowly , slowly. And one of the ways to prevent bone loss is with menopausal menopause , hormonal therapy primarily the estrogen. And of course you need the progestin if you have a uterus. When we stop the estrogen , the bone loss continues. Now to actually treat bone loss. At this point , we're not using estrogen to actually treat what we call osteoporosis , which is severe bone loss , but to prevent it. Estrogen does wonders and I really appreciate that. I really appreciate Leslie's comment because I think what's happening , unless women bring it up , lots of patients get left behind. And I think just like we have preventative exams for certain times of life , like you're supposed to be getting mammograms , you're supposed to be getting pap smears.
S1:
S3: Lifestyle is considered. And we had a meeting at the Menopause Society meeting a few years ago , and we had a talk that was called lifestyle The Silver Bullet. Uh , implying that it's so important on so many aspects of life. I like to think that the menopause transition or the menopause itself is , um , what we've called it sometimes the portal. So a passageway to the second half of life. And so even if for the women who are listening , who go , gosh , I feel lucky , I'm not having a lot of symptoms. It's still happening. And so it's a really good time to step back , take stock and look at your health. Overall , I think it's an opportunity if you're going to be seeing somebody about your symptoms to say like , is my blood sugar okay ? How's my blood pressure ? Uh , women , our number one concern is heart health. So we need to be focusing on those kind of standard risk factors. Um , is there cancer in my family ? Do I have a genetic predisposition to cancer ? What kind of screening should I be doing ? You know , how's my mental health ? And then again , the lifestyle kind of things. It's never too late. It's never too late to to engage in moving your body. If you haven't been a fan of doing that. And so I think , again , looking at this as an opportunity , not just the sad bad news of a reduction of ovarian function , there's a lot of good things that can happen.
S1: All right. Well , doctor McCauley , one listener who wanted to remain anonymous , asked what a husband can do to support his wife going through this process. He says her mood swings have caused him to seek counseling and that he misses his wife. So how can concerned loved ones support people who are going through menopause ? Hmm.
S4: That's a great question. Um , well , I mean , I think if they can , um , be understanding about the need for a cool bedroom and keeping the temperature really low , and maybe understand that , uh , yeah , that that that may improve over time , but that , well , it might be a permanent thing with a cool bedroom and sleep , but , um , supporting their partner in encouraging them to , to find a doctor they're comfortable with , um , to talk about the symptoms. And I sometimes have spouses come to the appointments to , um , we haven't talked that much about sexual function , but sometimes it's it's related to that. Um , but a lot of times , um , yeah , they're there for support or they're to maybe describe what they see , you know , if the wife is comfortable with that in terms of mood changes or other symptoms. Um , but I think just , um , yeah , keeping keeping communication open and just being supportive and encouraging them to see , see their provider.
S1: Doctor Lipschitz.
S2: I just love that question because I think men should be more involved. They should be educated to , the more our society really understands about menopause , the more as a society we can move through it. And so many women are in relationships with men , whether it's fathers or partners or sons. It's just important that we that everybody gets educated. So I love that question.
S3: One of the things that doctor McCauley mentioned was some sexual issues that come , come up when our estrogen levels decline , it can reduce the amount of moisture in our vaginal tissues. And so , um , it can become uncomfortable to have , uh , penetration or intercourse. And so this can be complicated. And someone either might not know that they're in this transition , or they just kind of feel like I lost that love and feeling , but it can make them avoid sex sometimes. And if when that happens , that can be very complicated to a relationship. And so again , keeping the conversation open , helping women to appreciate that this could be a symptom that they're having a vaginal dryness and that they don't necessarily need to take what we call systemic hormone therapy , though that certainly would help with hot flashes and vaginal dryness. But women can have a great deal of relief from vaginal estrogen application and a number of different ways to do that. And then there are a couple of other medications that are available that specifically address vaginal symptoms. So that's an important factor to have in mind. I think some of our clinicians I always tell the medical students , be bold , ask her , are you having vaginal dryness ? And they're like , oh , I don't know what I'll say , but I'll go just , you know , say , well , this isn't really my wheelhouse. I want to be a cardiologist , but I know who to recommend that , you see , because , you know , get it out there on the table so that they can get relief because it works really well , very safe. And , um , sometimes women have , uh , recurrent urinary tract infections. That's another thing that can kind of go on with some of the urogenital effects that can occur.
S1:
S4: I mean , it doesn't necessarily fluctuate , but it's a common complaint. There have been studies looking at this , um , decreased libido that causes distress. And the menopausal years is a time when it peaks for women. Sometimes the the decline. I mean , if sex doesn't feel good , then there's going to be probably not much desire for it. That's makes sense. So , um , we usually will address the pain first , as Doctor Stokoe was talking about using the vaginal estrogen or DHEA products that we have available. But if it's just a decline , I have many women who feel like no. Same partner. He's wonderful. There's no stress and no new stressors in my life. Um , no new medications that I've started. Sex doesn't hurt , but I just don't. I'm just not interested. So , um , it's something for women to be aware of and that the body may. Yeah , things may change , but can still be improved.
S1: Coming up after the break , how the menopausal transition is depicted in the media and how we can fight stigma. Stay tuned. Welcome back to KPBS Midday Edition. I'm Jade Hindman. On today's show , we've been talking about menopause and the transition before and after. The good , the bad , the ugly. I'm speaking with Doctor Cynthia Dunkel , clinical professor of medicine at UC San Diego. Also , Doctor Catherine McAuley , clinical professor of medicine and OB-GYN at UC San Diego. She's also the director of their Menopause Health program there. And doctor Lisa Lipschitz , ob gyn with Sharp Grossmont Hospital. So we left our conversation talking about libido and sexual function. And so we talked about some of the treatments to help with that. Are there any other treatments for.
S4: Yes , for libido. Um , for premenopausal women , there's actually two FDA approved treatments for low sexual desire or some another term is hyperactive sexual desire disorder. The name has changed a bit over the years. Um , in casualty we call it low libido. Um , but for postmenopausal women , those two products have not been extensively studied , so they're not FDA approved. So we do use some off label , um , therapies to help with low libido , such as testosterone. Um , just needs to be carefully dosed and and monitored properly to avoid side effects. For some women , that's the missing piece and that can be effective. I also talked to my patients about sex therapy and seeing a therapist who specializes their practice more in that area , and we see more providers out there that offer that type of therapy can be quite helpful. And I give them resources , books that are , um , helpful and just understanding the changes in sexuality over time. Um , so there's certainly , um , resources and treatment options that can be effective.
S3: I think women need to also just cut themselves a little slack. This is an incredibly compressed time of life. A lot of women have teenage kids. They may have , um , older parents who need more attention. They hit that midlife level and may have some struggles or frustrations in their work or in their home. Uh , couples can have money issues come up for the first time looking at the tuition for their kids or whatever their house finally needs done and they can't put it off anymore. And so there's so many things that it's it's no wonder that , um , that people may lose interest or have challenges with sex. The other thing is , I think a lot of women , uh , have changes in their body. Uh , women don't all gain weight , but don't all gain weight. Excuse me , but things can move around a bit on a person. And so there's a redistribution of the fat on our bodies that can , um , alter , I think our sense of , you know , how sexy do I really look ? And things like that. So again , I think we need to just cut ourselves some slack and take a break from our lives. And things like that can be very helpful to for just putting some vim and vigor back. Yeah.
S1: Yeah. All right. Well , another question for you , doctor. Uncle , I want to circle back to something that came up earlier , which is the influence of media and pop culture. So here in the US , women are constantly bombarded with anti-ageing products , supplements , $100 skin creams.
S3: It's just kind of impossible. What I see that is most disturbing is women used to ask questions and they're when they hit 50 or maybe their 40s. And now women in their 30s are developing this like insecurity about impending menopause. And what should I do and will it be okay ? And I'm doing different , you know , Botox when they have perfect faces. So , um , I'm kind of concerned with that emphasis that's so pervasive now. And , um , kind of can erode women's self-confidence that I feel is unnecessary and certainly premature when they think about that. So having a you know , I guess we could talk to younger patients and say , maybe you've been thinking about this , maybe us. Be proactive. It's hard because not everyone has time in their practice to have these kind of longer conversations , but to kind of , uh , soothe a little bit , um , provide some reassurance that , uh , you know , they're on a good path with other things that they're doing in their lives to give them some confidence about coming up on this.
S1:
S4: That's one thing to talk about. But , um , I remind them that I see so many women. Um , I have a big busy practice , and not all women have terrible menopause symptoms. So I do remind them that , you know , this isn't always what it looks , what people describe with terrible moods and irritability. And yes , there's symptoms. And yes , you need to know what they are in case you have them and need to address those. But some women go through the transition very smoothly and don't have a lot of symptoms. Maybe they had a couple hot flashes , so it's not always a terrible experience. I have many women. They only come in once a year and they kind of laugh. Well , I , I did okay. I didn't need really much. And or maybe they just need some vaginal estrogen but not the full on hormone therapy. Um , so it's it's variable.
S1: All right. Before I let you go , I want to get final words from each of you. Doctor Lipschitz , I'll start with you.
S2: I'm just so excited to be sharing all our knowledge with the audience. And I hope everyone who's listening has gotten something out of it and will be proactive on their own journey.
S1: Doctor uncle.
S3: I like to challenge women to come up with three questions if they're going through this , if they're symptomatic and they want to look for a solution. Number one , how bothered are they ? Are they completely off the charts that they can't function ? Things aren't going well at work. It's a mess at home. Or it's just like. This isn't so bad. Number two. What do they want ? Do they have an idea in their mind of what that best solution is going to be for them ? And we know that women have a complete spectrum of , uh , based on their other interests and experiences. And then , number three , to ask their clinician , will my choice be safe ? Is this safe for me ? And I think that's part of what we can offer women , is to look carefully at the choices and what else is going on with their health , and then advise them about that.
S4: There's lots of good resources out there for education , An even if this bill , hopefully it will pass. But if it doesn't , that I think that we really , really need more providers in this space. And it shouldn't just be that there's a few experts that take ten months to get an appointment with. Really , we want more primary care doctors , endocrinologists , OB GYNs to feel and advanced practice providers to feel comfortable in this space. So , um , yeah , I would just really support that continuing medical education in that area.
S1: All right. This was a great conversation and I so appreciate you all. I've been speaking with Doctor Catherine McAuley , clinical professor of medicine and ob gyn at UC San Diego and director of their Menopause Health program. Uh , doctor McCauley , thank you so much.
S4: Thank you so much , Jade , for having me.
S1: Also , Doctor Cynthia Dunkel , clinical professor of medicine at UC San Diego , she established one of the first menopause clinics in the U.S. in 1988 at UCSD. Doctor uncle , thank you.
S3: Thank you so much for having me.
S1: Jade and Doctor Lisa Lipschitz. OB gyn with sharp Grossmont Hospital. Doctor Lipschitz , thank you.
S2: Thank you so much for having us.
S1: That's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.
