1 00:00:01,300 --> 00:00:03,333 - I am an actor and I was going to do like a character 2 00:00:03,333 --> 00:00:04,733 who was menopausal. 3 00:00:04,733 --> 00:00:06,566 And I was like, well, 4 00:00:06,566 --> 00:00:07,933 let me look up the symptoms and do research. 5 00:00:07,933 --> 00:00:09,900 And as I'm looking it up, I'm like, ha ha, 6 00:00:09,900 --> 00:00:12,233 that sounds like me, wait a minute. 7 00:00:14,600 --> 00:00:17,666 - I didn't notice the menopause stuff happening. 8 00:00:17,666 --> 00:00:21,333 I felt like an angry person and I'm not an angry person. 9 00:00:21,333 --> 00:00:23,733 - Menopause certainly changes your brain. 10 00:00:23,733 --> 00:00:26,466 - I was having a problem with words 11 00:00:26,466 --> 00:00:28,833 and I couldn't process the word, 12 00:00:28,833 --> 00:00:30,466 a word I've known my whole life. 13 00:00:30,466 --> 00:00:33,333 - You don't know that the reason you can't remember 14 00:00:33,333 --> 00:00:36,666 what you came into the room for is not your fault. 15 00:00:36,666 --> 00:00:38,933 - Changes in your mood, 16 00:00:38,933 --> 00:00:41,000 depressive symptoms and crying spells. 17 00:00:41,000 --> 00:00:42,766 - I started to feel crazy. 18 00:00:42,766 --> 00:00:44,666 - All of a sudden you get like heart fluctuations. 19 00:00:44,666 --> 00:00:47,933 - It's unpredictable and it's frightening. 20 00:00:49,566 --> 00:00:52,100 - Your ovaries are shutting down their production 21 00:00:52,100 --> 00:00:53,566 of hormones. 22 00:00:53,566 --> 00:00:55,533 We're simply outliving the lifespan of our ovaries. 23 00:00:55,533 --> 00:00:56,833 - Women come into my office 24 00:00:56,833 --> 00:00:58,066 because they thought they were dying. 25 00:00:58,066 --> 00:00:59,666 Something was horribly wrong with them. 26 00:00:59,666 --> 00:01:01,833 - I'm a board certified OB-GYN. 27 00:01:01,833 --> 00:01:04,500 I had four years dedicated to women's healthcare. 28 00:01:04,500 --> 00:01:06,466 I got a month of training of menopause, 29 00:01:06,466 --> 00:01:08,466 just think about that. 30 00:01:08,466 --> 00:01:12,266 - It's about bodily autonomy, it's about body sovereignty. 31 00:01:12,266 --> 00:01:14,900 And you can't pick menopause out of that 32 00:01:14,900 --> 00:01:17,666 and say you can be free all of your life, 33 00:01:17,666 --> 00:01:19,233 except for when you go through menopause. 34 00:01:19,233 --> 00:01:21,766 Like that's not the place where you can be free. 35 00:01:21,766 --> 00:01:23,066 You have to struggle through that. 36 00:01:23,066 --> 00:01:25,766 - Is the last third of my life, 37 00:01:25,766 --> 00:01:28,100 not as important as the middle third 38 00:01:28,100 --> 00:01:29,733 in my reproductive years? 39 00:01:30,900 --> 00:01:32,100 - It messed with me in ways 40 00:01:32,100 --> 00:01:34,500 that I totally was not expecting, 41 00:01:34,500 --> 00:01:37,000 totally was not expecting it, so. 42 00:01:37,000 --> 00:01:39,433 - Women are not gonna stand for it anymore. 43 00:01:39,433 --> 00:01:40,900 We don't have to suffer through. 44 00:01:56,233 --> 00:01:59,333 (audience clapping) 45 00:01:59,333 --> 00:02:04,566 - Menopause is the one universal female experience. 46 00:02:04,566 --> 00:02:07,300 If you are born with ovaries, you will be menopausal. 47 00:02:07,300 --> 00:02:08,966 You may or may not be pregnant. 48 00:02:08,966 --> 00:02:10,666 You may or may not have fibroids. 49 00:02:10,666 --> 00:02:12,400 You may or may not have a lot of things 50 00:02:12,400 --> 00:02:14,066 that primarily affect women. 51 00:02:14,066 --> 00:02:16,566 Menopausal, I guarantee you, you will be. 52 00:02:17,966 --> 00:02:20,466 - We go through puberty and everybody's happy and excited. 53 00:02:20,466 --> 00:02:24,233 And then you go through pregnancy and it's parties 54 00:02:24,233 --> 00:02:26,000 and you get celebrated and you get gifts 55 00:02:26,000 --> 00:02:29,333 and there's balloons and there's gender reveal parties. 56 00:02:29,333 --> 00:02:32,000 You go through menopause and nobody wants to hear about it. 57 00:02:32,000 --> 00:02:33,733 There's stereotypes, there's stigma, 58 00:02:33,733 --> 00:02:35,433 there's ageism, there's sexism. 59 00:02:35,433 --> 00:02:37,566 It undermines your own confidence. 60 00:02:42,500 --> 00:02:46,000 - Menopause is defined by the last menstrual period, 61 00:02:46,000 --> 00:02:48,766 no menstrual cycles for one year. 62 00:02:48,766 --> 00:02:50,900 Then a woman knows she's in menopause. 63 00:02:50,900 --> 00:02:52,366 The average age of menopause 64 00:02:52,366 --> 00:02:55,233 in the United States is about 52 years. 65 00:02:55,233 --> 00:02:58,700 Anything after the age of 45 is considered normal. 66 00:03:02,600 --> 00:03:04,633 - The most common complaints 67 00:03:04,633 --> 00:03:08,300 that I get about menopause are forgetfulness, 68 00:03:08,300 --> 00:03:10,666 anxiety, depression. 69 00:03:10,666 --> 00:03:12,500 - You know, hot flashes are the tip of the iceberg. 70 00:03:12,500 --> 00:03:15,100 - Vaginal dryness, bladder dryness, 71 00:03:15,100 --> 00:03:17,900 urinary tract infections, urinary incontinence. 72 00:03:17,900 --> 00:03:21,666 - Weight gain, joint pain, dry skin. 73 00:03:21,666 --> 00:03:23,333 - Night sweats, insomnia. 74 00:03:23,333 --> 00:03:25,266 - Depression, anxiety, brain fog. 75 00:03:25,266 --> 00:03:28,766 - Our skin, our blood vessels, dental and gum health. 76 00:03:28,766 --> 00:03:31,333 - Nearly 30% of women 77 00:03:31,333 --> 00:03:33,866 in menopause will lose a tooth 78 00:03:33,866 --> 00:03:36,766 within the first five years of menopause. 79 00:03:36,766 --> 00:03:39,766 You can't separate the mouth from the rest of the body. 80 00:03:39,766 --> 00:03:43,500 - Women say, I just don't feel like myself anymore. 81 00:03:43,500 --> 00:03:45,600 I'm just a different person, like who is this person? 82 00:03:45,600 --> 00:03:46,600 I've lost myself. 83 00:03:48,366 --> 00:03:51,766 - So every woman has a line drawn at a different place. 84 00:03:51,766 --> 00:03:53,700 This is tolerable. 85 00:03:53,700 --> 00:03:56,366 And now we've crossed over into the intolerable phase. 86 00:03:56,366 --> 00:03:58,433 The option should be, I'm gonna go, 87 00:03:58,433 --> 00:04:00,233 I'm gonna get this addressed. 88 00:04:00,233 --> 00:04:04,400 Not I'll just suffer through and it'll be over in a decade. 89 00:04:04,400 --> 00:04:06,800 You know, you are doing far more harm than good 90 00:04:06,800 --> 00:04:09,066 by just not addressing what the issues are. 91 00:04:10,466 --> 00:04:11,800 - With the executive order I'm about to sign, 92 00:04:11,800 --> 00:04:13,166 I'm directing the most comprehensive set 93 00:04:13,166 --> 00:04:16,466 of executive actions ever taken to improve women's health. 94 00:04:16,466 --> 00:04:17,933 - The president 95 00:04:17,933 --> 00:04:20,733 of the United States signed an executive order 96 00:04:20,733 --> 00:04:25,000 and that will allocate $12 billion 97 00:04:25,000 --> 00:04:27,733 to women's midlife research. 98 00:04:27,733 --> 00:04:29,266 So that's a start, that's a start. 99 00:04:29,266 --> 00:04:32,100 That's still not where we need to be. 100 00:04:32,100 --> 00:04:35,666 In 2022, the National Institute 101 00:04:35,666 --> 00:04:40,100 for Health Research budget was just over $46 billion. 102 00:04:40,100 --> 00:04:44,933 Of that $46 billion, just around 10% went to women's health. 103 00:04:45,600 --> 00:04:47,600 - A lot of that was breast cancer. 104 00:04:47,600 --> 00:04:50,566 A lot of that is pregnancy related conditions. 105 00:04:50,566 --> 00:04:52,766 How much of that really is dedicated 106 00:04:52,766 --> 00:04:56,933 to women over the age of 40? 107 00:04:56,933 --> 00:04:58,566 You know, I mean, we can't even find it. 108 00:04:58,566 --> 00:05:00,566 They don't even keep records 109 00:05:00,566 --> 00:05:04,100 on how much research is done on menopausal women. 110 00:05:04,100 --> 00:05:05,833 That's how little has been done. 111 00:05:09,800 --> 00:05:12,166 - I can tell you that even five years ago we had 112 00:05:12,166 --> 00:05:14,666 to beg people to talk about menopause. 113 00:05:14,666 --> 00:05:18,400 And I was told by a major news network 114 00:05:18,400 --> 00:05:20,900 that that wasn't their demographic. 115 00:05:20,900 --> 00:05:23,566 The generation going through menopause now, 116 00:05:23,566 --> 00:05:27,300 it includes the millennials and then we have the Gen Xers. 117 00:05:27,300 --> 00:05:30,100 They're not gonna suffer in silence. 118 00:05:30,100 --> 00:05:33,366 They really want solutions for what's going on with them 119 00:05:33,366 --> 00:05:35,733 and in fact they're going to demand them 120 00:05:35,733 --> 00:05:37,866 and they're gonna demand them on social media 121 00:05:37,866 --> 00:05:39,866 and other venues that we might not have used 122 00:05:39,866 --> 00:05:41,866 to talk about menopause in the past. 123 00:05:41,866 --> 00:05:45,366 Women are really driving the conversation now, 124 00:05:45,366 --> 00:05:46,766 which is so important. 125 00:05:46,766 --> 00:05:49,500 - Menopause is finally having its moment. 126 00:05:49,500 --> 00:05:52,266 - Some people have called it menopause's Me too moment. 127 00:05:52,266 --> 00:05:54,566 - Menopause explained. 128 00:05:54,566 --> 00:05:57,433 - It had been thought that HRT could increase 129 00:05:57,433 --> 00:05:59,166 the risk of breast cancer among other things. 130 00:05:59,166 --> 00:06:02,666 But new data being released now shows that is not the case. 131 00:06:02,666 --> 00:06:04,233 - When I first started, people would look at me 132 00:06:04,233 --> 00:06:07,433 and say, menopause medicine, that's a thing? 133 00:06:07,433 --> 00:06:10,600 And now, yes, menopause medicine is a thing. 134 00:06:10,600 --> 00:06:12,733 There has been a lot more research. 135 00:06:12,733 --> 00:06:16,800 So we have more evidence-based information 136 00:06:16,800 --> 00:06:19,933 and treatment options to share with patient. 137 00:06:19,933 --> 00:06:23,833 - And not every woman is gonna decide to treat her symptoms. 138 00:06:23,833 --> 00:06:26,466 But really every woman needs to understand 139 00:06:26,466 --> 00:06:29,000 what menopause means, what it means 140 00:06:29,000 --> 00:06:31,933 for health going forward, how they can best manage it, 141 00:06:31,933 --> 00:06:34,766 whether it's with medications or not with medications. 142 00:06:34,766 --> 00:06:36,333 - Something is bothering you 143 00:06:36,333 --> 00:06:37,933 and someone says is in your head. 144 00:06:37,933 --> 00:06:41,400 It's like, of course it is, everything is in my head. 145 00:06:41,400 --> 00:06:43,166 And hormones affect your brain. 146 00:06:46,433 --> 00:06:50,733 - Women or XX carriers are born 147 00:06:50,733 --> 00:06:54,166 with a ton of estrogen receptors, 148 00:06:54,166 --> 00:06:58,100 not just in the body, but specifically in the brain. 149 00:06:58,100 --> 00:07:03,000 So our brains run on estrogen starting at puberty, 150 00:07:04,633 --> 00:07:07,466 and they keep doing that until the end of their lives. 151 00:07:07,466 --> 00:07:10,066 I think what people are most surprised about 152 00:07:10,066 --> 00:07:13,466 from our finding is the extent 153 00:07:13,466 --> 00:07:16,466 by which menopause can impact your brain. 154 00:07:16,466 --> 00:07:17,800 - During this transition, 155 00:07:17,800 --> 00:07:20,166 that horrible voice that we all carry 156 00:07:20,166 --> 00:07:21,733 with us has gotten very loud. 157 00:07:21,733 --> 00:07:24,500 See how your voice has changed? 158 00:07:24,500 --> 00:07:26,500 Can't hit those notes like you used to. 159 00:07:26,500 --> 00:07:28,566 Even two days ago it happened to me 160 00:07:28,566 --> 00:07:31,833 and I just was, the voice was loud 161 00:07:31,833 --> 00:07:34,566 and especially a perimenopausal ragey voice was very loud 162 00:07:34,566 --> 00:07:39,633 in my head and I was like, okay, brain, knock it off. 163 00:07:40,533 --> 00:07:41,900 And then I tried to find something nice 164 00:07:41,900 --> 00:07:43,100 to say about myself. 165 00:07:43,100 --> 00:07:46,400 (upbeat music) 166 00:07:46,400 --> 00:07:51,233 ♪ There's a place for us ♪ 167 00:07:53,400 --> 00:07:57,933 ♪ Some where a place for us ♪ 168 00:07:58,633 --> 00:08:00,733 You know, the freakouts you have start 169 00:08:00,733 --> 00:08:03,566 to feel like panic attacks coming on 170 00:08:03,566 --> 00:08:05,766 because like my heart is pounding too fast 171 00:08:05,766 --> 00:08:09,500 where you're like, how come I can't remember anything? 172 00:08:09,500 --> 00:08:12,766 What I never knew is that is a symptom of menopause. 173 00:08:12,766 --> 00:08:15,600 All of a sudden you get like heart fluctuations 174 00:08:15,600 --> 00:08:16,866 and I thought, okay, it's just 175 00:08:16,866 --> 00:08:18,066 that I'm having a panic attack. 176 00:08:18,066 --> 00:08:21,000 So then that messes with your mental psyche, 177 00:08:21,000 --> 00:08:22,700 you know, all of it, all of it. 178 00:08:26,400 --> 00:08:30,366 - Brain fog is a very weird phenomenon 179 00:08:30,366 --> 00:08:34,533 that doesn't even actually have a term in medicine, 180 00:08:35,466 --> 00:08:39,166 we refer to that as cognitive fatigue or mental fatigue, 181 00:08:39,166 --> 00:08:41,700 where you feel like your brain just won't turn on 182 00:08:41,700 --> 00:08:43,833 that everything takes a huge effort 183 00:08:43,833 --> 00:08:46,900 and you're having trouble accessing information. 184 00:08:46,900 --> 00:08:49,766 Words won't come to mind, really. 185 00:08:49,766 --> 00:08:53,733 What is really concerning I think, is 186 00:08:53,733 --> 00:08:58,033 that these changes can be so severe to prompt fears 187 00:08:58,033 --> 00:09:02,933 of either going crazy or being developing dementia. 188 00:09:06,466 --> 00:09:11,133 The purpose of the clinical trial is to test the efficacy 189 00:09:11,133 --> 00:09:15,600 of a selective estrogen receptor modulator for hot flashes, 190 00:09:15,600 --> 00:09:18,666 but also for support of cognitive function 191 00:09:18,666 --> 00:09:22,500 and potentially for prevention of Alzheimer's disease. 192 00:09:22,500 --> 00:09:26,133 And the way that we test this is by working with women 193 00:09:26,133 --> 00:09:28,133 who are going through menopause. 194 00:09:33,166 --> 00:09:37,866 Menopause has been historically pigeonholed 195 00:09:37,866 --> 00:09:41,666 as an issue with the ovaries, which means that you go 196 00:09:41,666 --> 00:09:46,433 to your OB-GYN and OB-GYNs don't do brains, right? 197 00:09:46,433 --> 00:09:49,000 It's not their fault, they're just not trained. 198 00:09:49,000 --> 00:09:51,433 Those are neurologists, psychiatrists, 199 00:09:51,433 --> 00:09:52,866 neuroendocrinologist, 200 00:09:52,866 --> 00:09:55,600 neuropsychologists, anything with the neuro in there. 201 00:09:55,600 --> 00:09:56,900 We do brains. 202 00:09:56,900 --> 00:10:00,333 Obviously we need to change the framework around menopause 203 00:10:00,333 --> 00:10:04,033 where it's understood that there's an ovarian component 204 00:10:04,033 --> 00:10:05,533 and the brain component. 205 00:10:07,166 --> 00:10:12,266 From a basic science perspective, there is a lot 206 00:10:12,266 --> 00:10:15,766 of evidence that supplementing hormones 207 00:10:15,766 --> 00:10:18,566 that ovaries no longer make with hormones 208 00:10:18,566 --> 00:10:21,466 that come from the outside has potential 209 00:10:21,466 --> 00:10:23,433 to support brain health 210 00:10:23,433 --> 00:10:28,100 and even possibly lower the risk of some neurological 211 00:10:28,100 --> 00:10:32,066 or psychiatric concerns like depression, anxiety, 212 00:10:32,066 --> 00:10:34,233 Parkinson's disease, Alzheimer's disease. 213 00:10:34,233 --> 00:10:36,333 Matilda's looking at associations 214 00:10:36,333 --> 00:10:38,266 between testosterone 215 00:10:38,266 --> 00:10:41,933 in blood and blood flow in the brain. 216 00:10:41,933 --> 00:10:46,033 So here she's comparing men and women in terms of 217 00:10:46,033 --> 00:10:49,433 where testosterone has an impact inside the brain. 218 00:10:49,433 --> 00:10:52,366 So the clusters in green are the regions 219 00:10:52,366 --> 00:10:54,066 that are impacted in men. 220 00:10:54,066 --> 00:10:56,433 Whereas for women it is more central. 221 00:10:56,433 --> 00:10:59,566 And this bit of red spots are the memory centers 222 00:10:59,566 --> 00:11:00,566 of the brain. 223 00:11:00,566 --> 00:11:04,366 So for women it's more memory centric in a way. 224 00:11:04,366 --> 00:11:07,666 And for men it is more association cortex. 225 00:11:07,666 --> 00:11:10,500 Is the female brain different from the male brain? 226 00:11:10,500 --> 00:11:12,933 I'm saying in some ways yes. 227 00:11:12,933 --> 00:11:17,033 And I'm not thinking behavior or intellectual potential. 228 00:11:17,033 --> 00:11:19,266 I'm talking about raw biology 229 00:11:19,266 --> 00:11:22,700 because for women, hormonal aging is not linear. 230 00:11:22,700 --> 00:11:26,300 We lose some of the power of estrogen 231 00:11:26,300 --> 00:11:29,200 or estradiol as we go through menopause. 232 00:11:29,200 --> 00:11:32,633 And losing the estrogens in a way is a trigger 233 00:11:32,633 --> 00:11:37,666 for accelerated cellular aging in the body and in the brain. 234 00:11:38,700 --> 00:11:40,200 This part that used to be there was really, 235 00:11:40,200 --> 00:11:43,366 really red before menopause is now more like yellow. 236 00:11:43,366 --> 00:11:45,233 The same thing up here. 237 00:11:45,233 --> 00:11:48,566 Women's brains age differently than men's brains 238 00:11:48,566 --> 00:11:52,766 in some ways which are not indicative 239 00:11:52,766 --> 00:11:55,766 of differences in behavior or personality 240 00:11:55,766 --> 00:11:57,966 or anything psychological, 241 00:11:57,966 --> 00:11:59,766 but they're just biological differences 242 00:11:59,766 --> 00:12:01,933 that do matter for health. 243 00:12:01,933 --> 00:12:04,166 This was our study, right? 244 00:12:04,166 --> 00:12:06,633 There are women who go through perimenopause 245 00:12:06,633 --> 00:12:11,366 who don't show any changes, but in our study they did. 246 00:12:11,366 --> 00:12:15,000 So this is broadly what happened, right? 247 00:12:15,000 --> 00:12:17,266 And then there's a rebound on average 248 00:12:17,266 --> 00:12:21,700 where some women go back to premenopausal levels. 249 00:12:21,700 --> 00:12:24,666 Most women do not, but at least they're stable. 250 00:12:24,666 --> 00:12:27,500 And then some women keep deteriorating. 251 00:12:27,500 --> 00:12:31,466 Actually the idea the menopause puts a woman 252 00:12:31,466 --> 00:12:34,400 at a disadvantage has nothing to do with biology 253 00:12:34,400 --> 00:12:37,933 and everything to do with culture and medical history. 254 00:12:40,633 --> 00:12:42,966 (calm music) 255 00:12:52,533 --> 00:12:56,433 The history of medicine that we physicians 256 00:12:56,433 --> 00:12:59,233 and scientists were really determined 257 00:12:59,233 --> 00:13:03,466 to prove the women's brains were inferior to men's brains. 258 00:13:04,033 --> 00:13:06,866 And menopause was the last blow in a way. 259 00:13:06,866 --> 00:13:09,600 Because at that point, if people think 260 00:13:09,600 --> 00:13:13,166 that your only purpose in life is to birth children to men, 261 00:13:13,166 --> 00:13:15,266 then once you're no longer able to do that, 262 00:13:15,266 --> 00:13:17,000 then you're really, really useless. 263 00:13:17,000 --> 00:13:19,433 And that's what medicine has been saying 264 00:13:19,433 --> 00:13:20,633 to us for centuries. 265 00:13:23,700 --> 00:13:26,633 Women have been taught to really just fear their hormones 266 00:13:26,633 --> 00:13:27,966 and doubt their brains. 267 00:13:29,266 --> 00:13:31,566 (calm music) 268 00:13:34,466 --> 00:13:37,333 There's new science and new research, including some 269 00:13:37,333 --> 00:13:41,266 of my own research showing that some of the brain changes 270 00:13:41,266 --> 00:13:42,633 that take place 271 00:13:42,633 --> 00:13:45,466 during the menopause transition are actually improvements 272 00:13:45,466 --> 00:13:48,133 in some ways from a neurological perspective. 273 00:13:54,666 --> 00:13:56,266 - A woman's estrogen level 274 00:13:56,266 --> 00:13:59,466 after menopause drops down to less than 20. 275 00:13:59,466 --> 00:14:01,833 Prior to menopause, it could be up to 500. 276 00:14:01,833 --> 00:14:04,600 Think about that, that's like being on six cups of coffee 277 00:14:04,600 --> 00:14:06,366 and all of a sudden you're on zero. 278 00:14:06,366 --> 00:14:08,666 Those who drink caffeine, they get that. 279 00:14:08,666 --> 00:14:11,700 They're like, that makes so much sense, right? 280 00:14:11,700 --> 00:14:14,500 And so after menopause, 281 00:14:14,500 --> 00:14:18,133 the goal is greater than 20, less than a hundred. 282 00:14:18,133 --> 00:14:21,266 I used to be up to 500, of course this is safe, 283 00:14:21,266 --> 00:14:25,033 but that's enough to protect bone, brain, 284 00:14:25,033 --> 00:14:26,966 heart and the symptoms. 285 00:14:32,733 --> 00:14:35,133 - You are in menopause forever, let me just say this. 286 00:14:35,133 --> 00:14:37,766 It is not like you're gonna be like, oh well I'm good. 287 00:14:37,766 --> 00:14:39,400 I only had my five years of menopause. 288 00:14:39,400 --> 00:14:43,433 Now I guess we're done, you are in menopause forever. 289 00:14:43,433 --> 00:14:45,233 That's why I don't like the term when someone says, 290 00:14:45,233 --> 00:14:46,933 oh, I'm post-menopausal. 291 00:14:46,933 --> 00:14:49,866 I'm like, no you're not, you're still in menopause. 292 00:14:49,866 --> 00:14:53,233 You take medication to relieve your symptoms. 293 00:14:53,233 --> 00:14:55,800 There's nothing that says that you should only take 294 00:14:55,800 --> 00:14:57,466 for a certain amount of time. 295 00:14:57,466 --> 00:15:00,533 I'm 65 years old, I've been taking for 15 years. 296 00:15:00,533 --> 00:15:04,366 I think that our quality of life matters. 297 00:15:06,433 --> 00:15:08,766 (calm music) 298 00:15:10,833 --> 00:15:13,433 - My appointment with you, honestly, 299 00:15:13,433 --> 00:15:15,300 I thought was gonna be a waste of time 300 00:15:15,300 --> 00:15:18,500 because everybody else turned me away. 301 00:15:18,500 --> 00:15:22,033 So when you agreed that I could try hormone replacement 302 00:15:22,033 --> 00:15:26,600 and after two weeks of being on hormone replacements, 303 00:15:26,600 --> 00:15:29,600 it has completely changed my life. 304 00:15:29,600 --> 00:15:31,466 I'm sorry to be upset, but it is just, 305 00:15:31,466 --> 00:15:35,300 I felt like it was, I was my old self 306 00:15:35,300 --> 00:15:38,766 and that I was thriving in this world again. 307 00:15:38,766 --> 00:15:40,700 And I'm glad I went through with the appointment 308 00:15:40,700 --> 00:15:41,566 with you. 309 00:15:43,133 --> 00:15:45,233 - So am I. - Yes, yeah. 310 00:15:45,233 --> 00:15:49,066 - For the most part, patients who were suffering as much 311 00:15:49,066 --> 00:15:52,033 as you were do get good benefits 312 00:15:52,033 --> 00:15:54,600 from being on treatment 313 00:15:54,600 --> 00:15:56,266 - Again, I thank you. 314 00:15:57,333 --> 00:15:59,766 - Baby boomers a lot are still working 315 00:15:59,766 --> 00:16:04,033 and also want to stay active, contribute. 316 00:16:05,233 --> 00:16:10,000 There is a lot more expectation for healthy aging 317 00:16:10,000 --> 00:16:14,833 in addition to managing the symptoms of menopause. 318 00:16:15,766 --> 00:16:18,333 - When you are making a menopause plan for patients, 319 00:16:18,333 --> 00:16:21,033 you have to take a thorough history and physical, 320 00:16:21,033 --> 00:16:24,100 make sure you know what other medications there are, 321 00:16:24,100 --> 00:16:26,500 what other medical problems there are. 322 00:16:26,500 --> 00:16:28,533 And then once you know that, 323 00:16:28,533 --> 00:16:30,500 you can offer them safe options. 324 00:16:32,800 --> 00:16:34,900 - You said in your workup, you know, 325 00:16:34,900 --> 00:16:38,133 it's really affecting how you see the world. 326 00:16:38,133 --> 00:16:39,433 - You bring up perimenopause, 327 00:16:39,433 --> 00:16:40,566 the things that are happening to you. 328 00:16:40,566 --> 00:16:42,566 And either you get the, everybody's going through it, 329 00:16:42,566 --> 00:16:46,100 it's just a part of life or like kind of a glazed overlook. 330 00:16:46,100 --> 00:16:48,800 I went to my gynecologist and I had a conversation with him 331 00:16:48,800 --> 00:16:51,233 and his tone completely changed 332 00:16:51,233 --> 00:16:53,800 the moment I mentioned hormone replacement therapy. 333 00:16:53,800 --> 00:16:56,100 I just need to figure this out because I don't feel well. 334 00:16:56,100 --> 00:16:59,200 - You're not your best you. - No, no. 335 00:16:59,200 --> 00:17:01,200 - So we'll start the hormone therapy, 336 00:17:01,200 --> 00:17:02,333 and see how you do. 337 00:17:11,000 --> 00:17:13,166 Menopause society came out in 2022. 338 00:17:13,166 --> 00:17:15,600 Clearly for most women, 339 00:17:15,600 --> 00:17:18,833 especially in those first (indistinct) years of menopause, 340 00:17:18,833 --> 00:17:21,366 the benefits are to outweigh the risks. 341 00:17:21,366 --> 00:17:23,000 We know that it is protective 342 00:17:23,000 --> 00:17:24,533 against cardiovascular disease. 343 00:17:24,533 --> 00:17:26,966 We know it's protective against neuro dementia. 344 00:17:26,966 --> 00:17:29,200 If you start in the window of opportunity, 345 00:17:29,200 --> 00:17:32,600 it will always, for your whole life, protect your bones. 346 00:17:32,600 --> 00:17:34,066 It will always for your whole life, 347 00:17:34,066 --> 00:17:35,933 protect your genital urinary system. 348 00:17:35,933 --> 00:17:38,233 - Hormone replacement therapy got a bad rap 349 00:17:38,233 --> 00:17:42,733 because of a WHI study that was done a long time ago 350 00:17:42,733 --> 00:17:45,266 that really scared not only women 351 00:17:45,266 --> 00:17:47,566 but scared providers as well. 352 00:17:49,866 --> 00:17:51,233 - They called a press conference 353 00:17:51,233 --> 00:17:53,366 and said estrogen causes breast cancer. 354 00:17:53,366 --> 00:17:57,233 - It increases the risk for breast cancer 355 00:17:57,233 --> 00:17:58,966 and for blood clots. 356 00:17:58,966 --> 00:18:02,133 - And that's just not what the data supports. 357 00:18:02,133 --> 00:18:05,166 - Women were upset, they called the office, they were like, 358 00:18:05,166 --> 00:18:07,300 oh my god, I can't believe you gave me this stuff 359 00:18:07,300 --> 00:18:09,533 and it's gonna kill me and gimme breast cancer. 360 00:18:10,800 --> 00:18:13,000 So we were all caught flatfooted. 361 00:18:15,133 --> 00:18:19,433 - Women basically stopped using menopause hormone therapy 362 00:18:19,433 --> 00:18:23,533 on mass because of the misinterpretation of the data 363 00:18:23,533 --> 00:18:26,033 with regards to heart attacks, 364 00:18:26,033 --> 00:18:28,666 cardiovascular events, and breast cancer. 365 00:18:28,666 --> 00:18:30,666 - What we didn't explain to women is 366 00:18:30,666 --> 00:18:32,633 who are we seeing these adverse events in? 367 00:18:32,633 --> 00:18:34,200 It was the older patients. 368 00:18:34,200 --> 00:18:36,633 - Women were allowed to participate in this study. 369 00:18:36,633 --> 00:18:40,466 They can be anywhere from 50 to 79 years of age. 370 00:18:42,033 --> 00:18:43,800 More than two thirds of the women 371 00:18:43,800 --> 00:18:46,766 already had established cardiovascular disease. 372 00:18:46,766 --> 00:18:49,600 And if you are trying to do a prevention study, 373 00:18:49,600 --> 00:18:51,233 it doesn't take a rocket scientist 374 00:18:51,233 --> 00:18:53,933 to figure out is that you can't prevent something, 375 00:18:53,933 --> 00:18:55,366 in a 75-year-old. 376 00:18:56,366 --> 00:18:57,633 - Women come into my office 377 00:18:57,633 --> 00:19:00,033 and ask me if hormone therapy is safe. 378 00:19:00,033 --> 00:19:02,500 For most healthy women, the benefits 379 00:19:02,500 --> 00:19:04,966 of hormone therapy are going to outweigh the risks. 380 00:19:04,966 --> 00:19:08,300 And this is very reassuring and a very different message 381 00:19:08,300 --> 00:19:10,833 than the message that was first put out 382 00:19:10,833 --> 00:19:14,366 after the publication of the WHI trial results. 383 00:19:14,366 --> 00:19:16,633 - Most women now were not around 384 00:19:16,633 --> 00:19:19,633 for the Women's health initiative, but it stuck. 385 00:19:19,633 --> 00:19:22,133 Doctors still think that, you know, 386 00:19:22,133 --> 00:19:24,766 this is a funny but true story. 387 00:19:24,766 --> 00:19:26,133 I went to see my internist 388 00:19:26,133 --> 00:19:29,200 and I've been on hormones since I was 50. 389 00:19:29,200 --> 00:19:30,833 You know, she's, oh, you take medications. 390 00:19:30,833 --> 00:19:32,333 And I said this and she looked at me 391 00:19:32,333 --> 00:19:35,266 and she said, you know, I'm not a fan. 392 00:19:35,266 --> 00:19:38,800 And I was like, you know, I didn't ask you. 393 00:19:38,800 --> 00:19:43,100 The point is that if she would say that to me, 394 00:19:43,100 --> 00:19:47,666 knowing what I do, knowing then I can only imagine 395 00:19:47,666 --> 00:19:50,200 how actively discouraged women are 396 00:19:50,200 --> 00:19:53,100 or who will never get prescribed hormones 397 00:19:53,100 --> 00:19:55,333 because it just never comes up in the conversation. 398 00:20:02,133 --> 00:20:05,000 - I definitely have patients who come to me and say, 399 00:20:06,033 --> 00:20:09,633 I don't want any prescriptions, be it hormones 400 00:20:09,633 --> 00:20:14,633 or other medications for my menopause symptoms. 401 00:20:14,633 --> 00:20:17,600 What can I do to help myself? 402 00:20:17,600 --> 00:20:19,433 - Hormones aren't the answer for everything. 403 00:20:19,433 --> 00:20:22,466 And every woman, regardless of what you choose, 404 00:20:22,466 --> 00:20:25,466 you should institute the lifestyle modifications 405 00:20:25,466 --> 00:20:27,200 between exercise and diet. 406 00:20:27,200 --> 00:20:29,433 - You know, leafy greens, almonds, 407 00:20:29,433 --> 00:20:33,366 lots of foods high in calcium content, 408 00:20:33,366 --> 00:20:36,800 watching your calories, boring, boring stuff. 409 00:20:36,800 --> 00:20:38,266 - Eating a diet rich in fiber. 410 00:20:38,266 --> 00:20:40,033 - Enough antioxidants. 411 00:20:40,033 --> 00:20:42,900 - Loading your plate up, heavily plant-based 412 00:20:42,900 --> 00:20:45,033 with lots of color and lots of variety. 413 00:20:45,033 --> 00:20:48,033 - Lean protein and polyunsaturated fatty acids. 414 00:20:48,033 --> 00:20:49,166 - Don't smoke. 415 00:20:49,166 --> 00:20:52,466 - Limiting obesity and not drinking alcohol. 416 00:20:52,466 --> 00:20:54,200 - Address the bleeding gums. 417 00:20:54,200 --> 00:20:56,533 How to maintain meticulous home care. 418 00:20:56,533 --> 00:20:58,433 - You can take up to 4,000 international units 419 00:20:58,433 --> 00:20:59,800 of vitamin D a day. 420 00:20:59,800 --> 00:21:02,466 - Vitamin D is associated with a decrease in fracture risk. 421 00:21:02,466 --> 00:21:04,666 - Control your blood pressure, control your weight. 422 00:21:04,666 --> 00:21:07,533 - Exercise, keeping a more lean body mass. 423 00:21:07,533 --> 00:21:10,966 - Sleep hygiene is important. 424 00:21:10,966 --> 00:21:13,600 - There's also melatonin that can help with sleep. 425 00:21:19,766 --> 00:21:23,500 - But there are also a number of products that have emerged 426 00:21:23,500 --> 00:21:25,600 that are what we would refer to 427 00:21:25,600 --> 00:21:28,833 as more natural products and supplements. 428 00:21:28,833 --> 00:21:32,066 There is good information in the scientific literature 429 00:21:32,066 --> 00:21:33,733 about some of these supplements 430 00:21:33,733 --> 00:21:36,233 and the way in which they can support women 431 00:21:36,233 --> 00:21:38,633 who are in the menopause transition. 432 00:21:38,633 --> 00:21:42,633 Because it's an OTC product or a supplement, 433 00:21:42,633 --> 00:21:44,633 you should still have the conversation 434 00:21:44,633 --> 00:21:47,233 with your healthcare practitioner because 435 00:21:47,233 --> 00:21:48,133 you wanna be sure 436 00:21:48,133 --> 00:21:50,433 that there are no concomitancy issues. 437 00:21:50,433 --> 00:21:53,433 And what I mean by that is the interaction 438 00:21:53,433 --> 00:21:56,466 between perhaps a prescription drug 439 00:21:56,466 --> 00:21:59,400 and what you may be using with a supplement. 440 00:21:59,400 --> 00:22:00,800 - And you just have to figure out 441 00:22:00,800 --> 00:22:05,233 what are the trusted sources that you can go to to weed out, 442 00:22:05,233 --> 00:22:07,833 you know, the wheat from the chaff in terms 443 00:22:07,833 --> 00:22:09,200 of what's out there in the marketplace. 444 00:22:09,200 --> 00:22:10,700 - It's important to note 445 00:22:10,700 --> 00:22:13,200 that while there are some supplements out there, 446 00:22:13,200 --> 00:22:15,866 there is nothing that is as effective 447 00:22:15,866 --> 00:22:17,166 as menopausal hormone therapy 448 00:22:17,166 --> 00:22:19,533 for management of menopause symptoms overall. 449 00:22:22,200 --> 00:22:23,266 - Millions and millions 450 00:22:23,266 --> 00:22:26,600 of women are on hormone replacement safely. 451 00:22:26,600 --> 00:22:27,866 And that's where you talk 452 00:22:27,866 --> 00:22:30,633 to women about risk benefit analysis. 453 00:22:30,633 --> 00:22:33,133 Now, there are cancers that have estrogen, 454 00:22:33,133 --> 00:22:35,400 progesterone receptors 455 00:22:35,400 --> 00:22:38,166 that definitely hormone replacement therapy can feed 456 00:22:38,166 --> 00:22:39,533 and can cause those cancers 457 00:22:39,533 --> 00:22:42,200 and tumors to accelerate in their growth. 458 00:22:42,200 --> 00:22:43,966 But I don't believe that hormone replacement therapy 459 00:22:43,966 --> 00:22:47,800 actually causes the inciting event 460 00:22:47,800 --> 00:22:49,766 or factor that causes the cancer. 461 00:22:49,766 --> 00:22:50,700 - There are still a lot 462 00:22:50,700 --> 00:22:52,866 of misperceptions out there for sure. 463 00:22:52,866 --> 00:22:56,633 And you know, it ranges from hormone therapy 464 00:22:56,633 --> 00:22:57,833 as a fountain of youth 465 00:22:57,833 --> 00:22:59,800 and it's gonna make me stay young, 466 00:22:59,800 --> 00:23:01,533 which is not true, all the way 467 00:23:01,533 --> 00:23:03,833 to the other side hormone therapy is going to kill me, 468 00:23:03,833 --> 00:23:05,466 it's gonna give me breast cancer, 469 00:23:05,466 --> 00:23:08,300 it's gonna make me have a heart attack, which is not true. 470 00:23:08,300 --> 00:23:10,266 And the truth falls somewhere in the middle. 471 00:23:10,266 --> 00:23:13,033 But the reality again is that for most women 472 00:23:13,033 --> 00:23:14,933 who are relatively healthy, 473 00:23:14,933 --> 00:23:16,866 the benefits are gonna outweigh the risks. 474 00:23:21,333 --> 00:23:24,833 - A stigma of hormones is that we call 'em sex hormones. 475 00:23:24,833 --> 00:23:28,200 So people kind of think, well sex is extra, sex is a luxury, 476 00:23:28,200 --> 00:23:29,833 you're not reproducing anymore. 477 00:23:29,833 --> 00:23:31,700 What do you need these sex hormones for? 478 00:23:32,833 --> 00:23:36,133 It's a literal misnaming of what these compounds do. 479 00:23:36,133 --> 00:23:39,200 They are brain hormones, they profoundly affect the brain. 480 00:23:50,800 --> 00:23:53,766 - I ended up having to get a hysterectomy. 481 00:23:55,000 --> 00:23:59,533 Wow, you hear that silence, you could hear a uterus drum. 482 00:23:59,533 --> 00:24:02,933 The sexual side effects or something, I wasn't 483 00:24:05,133 --> 00:24:07,500 like I wasn't prepared for how it would make me feel. 484 00:24:07,500 --> 00:24:10,633 You know, there's so much of your like identity 485 00:24:10,633 --> 00:24:12,266 that's wrapped up and you're confident 486 00:24:12,266 --> 00:24:14,766 that's wrapped up in your sexuality 487 00:24:14,766 --> 00:24:17,133 and your ability to feel sexual 488 00:24:17,133 --> 00:24:21,166 and to have that just take that away 489 00:24:21,166 --> 00:24:25,366 before I've really been able to like fully explore. 490 00:24:25,366 --> 00:24:27,533 I just started to figure out who I am 491 00:24:27,533 --> 00:24:30,266 and then I have to figure it out again. 492 00:24:30,266 --> 00:24:32,366 It really, it messed with me in ways 493 00:24:32,366 --> 00:24:34,866 that I totally was not expecting. 494 00:24:34,866 --> 00:24:35,866 They removed my uterus 495 00:24:35,866 --> 00:24:37,700 and they didn't just remove my uterus, right? 496 00:24:37,700 --> 00:24:41,066 They cleared me the (bleep) out, okay. 497 00:24:41,066 --> 00:24:43,466 They took my uterus, they took my tubes, 498 00:24:43,466 --> 00:24:44,800 they took my cervix. 499 00:24:44,800 --> 00:24:46,766 If you put your ear up to my (bleep), 500 00:24:46,766 --> 00:24:48,300 you can hear the ocean. 501 00:24:49,766 --> 00:24:51,600 Why haven't I brought up the sexual side effects 502 00:24:51,600 --> 00:24:52,800 with my doctor? 503 00:24:52,800 --> 00:24:57,566 Because I think I too consider it mild and extra. 504 00:24:57,566 --> 00:24:58,700 You know what I mean? 505 00:24:58,700 --> 00:25:00,700 Like I almost feel like it's my responsibility 506 00:25:00,700 --> 00:25:04,833 to fix that part and not the doctors, I don't know. 507 00:25:04,833 --> 00:25:06,166 Yeah, I don't know. 508 00:25:06,166 --> 00:25:08,133 - When our eyes wear out, we get glasses. 509 00:25:08,133 --> 00:25:10,133 When we need help hearing, we get hearing aids, 510 00:25:10,133 --> 00:25:11,333 we're kind of repairing 511 00:25:11,333 --> 00:25:13,633 or renewing body parts as we go along. 512 00:25:13,633 --> 00:25:16,166 But when it comes to the ovary, it's like full stop, 513 00:25:16,166 --> 00:25:18,133 sorry you outlived your ovary. 514 00:25:18,133 --> 00:25:20,000 But why are we being so unique 515 00:25:20,000 --> 00:25:22,533 with one body part when we don't behave that way 516 00:25:22,533 --> 00:25:24,000 with all the other body parts? 517 00:25:31,933 --> 00:25:33,000 - Honestly, sitting here right now, 518 00:25:33,000 --> 00:25:35,133 I can't tell you the last time we had sex, 519 00:25:35,133 --> 00:25:36,733 that's terrible because I love him 520 00:25:36,733 --> 00:25:40,966 and I used to like sex, but it physically hurts 521 00:25:40,966 --> 00:25:44,900 and the pain that you have after isn't worth it to me. 522 00:25:44,900 --> 00:25:49,733 The lack of intimacy leads you to a lack of connection 523 00:25:50,133 --> 00:25:53,700 in your relationship and it's really hard 524 00:25:54,766 --> 00:25:57,200 because I love him, he's the best thing ever. 525 00:26:01,100 --> 00:26:02,333 - Tell me kind of what your goals were 526 00:26:02,333 --> 00:26:04,200 when you came in to see me in the beginning. 527 00:26:04,200 --> 00:26:07,466 - Well, no libido and I just thought, 528 00:26:07,466 --> 00:26:09,100 yeah, I gotta do something. 529 00:26:09,100 --> 00:26:12,166 I can't let this keep going, it's just not sustainable. 530 00:26:12,166 --> 00:26:14,266 I didn't know if I was a candidate for hormones 531 00:26:14,266 --> 00:26:17,133 because I'd had a blood clot 532 00:26:17,133 --> 00:26:19,933 before with a broken bone 533 00:26:19,933 --> 00:26:21,800 and my mom had breast cancer. 534 00:26:21,800 --> 00:26:23,133 - And those are really great to bring up 535 00:26:23,133 --> 00:26:24,966 because I think common misperceptions 536 00:26:24,966 --> 00:26:27,266 about systemic estrogen, 537 00:26:27,266 --> 00:26:29,700 everybody can be on vaginal estrogen. 538 00:26:29,700 --> 00:26:32,700 The misperceptions about systemic is family history 539 00:26:32,700 --> 00:26:35,400 of breast cancer does not disqualify a woman. 540 00:26:35,400 --> 00:26:38,700 A provoked blood clot does not disqualify a woman. 541 00:26:38,700 --> 00:26:41,566 We started you on the systemic estrogen, how did that go? 542 00:26:41,566 --> 00:26:43,966 - Oh my god, that was like a lifesaver. 543 00:26:43,966 --> 00:26:45,733 - I always worry when we tell women 544 00:26:45,733 --> 00:26:47,633 how they should feel about midlife. 545 00:26:47,633 --> 00:26:50,200 And one thing I see a lot is that you're no longer a woman 546 00:26:50,200 --> 00:26:51,766 'cause you either can't reproduce 547 00:26:51,766 --> 00:26:55,400 or you're not having periods, you're still a woman. 548 00:26:55,400 --> 00:26:57,100 It doesn't take it away. 549 00:26:57,100 --> 00:27:00,266 That's not, we don't have a limited definition like that. 550 00:27:00,266 --> 00:27:02,500 So I really, you know, want women to know, 551 00:27:02,500 --> 00:27:04,500 this gets to be whatever you want it to be. 552 00:27:12,366 --> 00:27:14,666 In my urology training we deal 553 00:27:14,666 --> 00:27:16,800 with male sexual dysfunction all the time. 554 00:27:16,800 --> 00:27:20,333 You know, we invented Viagra, it's been around since 1998. 555 00:27:20,333 --> 00:27:22,433 I went to a conference as a resident 556 00:27:22,433 --> 00:27:24,266 and they said, we'll never figure out women. 557 00:27:24,266 --> 00:27:25,833 They're too complicated. 558 00:27:25,833 --> 00:27:28,100 - I asked my primary care doctor when I was in 559 00:27:28,100 --> 00:27:31,966 for an annual, hey, can you check my testosterone level? 560 00:27:31,966 --> 00:27:34,966 And it was practically nothing like there was none. 561 00:27:34,966 --> 00:27:37,066 And then when I looked at what the symptoms 562 00:27:37,066 --> 00:27:40,800 of being low testosterone looked like I ticked every box. 563 00:27:40,800 --> 00:27:41,866 - What did you notice the most 564 00:27:41,866 --> 00:27:43,800 about being on the testosterone? 565 00:27:45,133 --> 00:27:48,366 - I got my brain back, I had an energy and a focus 566 00:27:48,366 --> 00:27:51,833 that I hadn't felt since my thirties probably. 567 00:27:51,833 --> 00:27:53,600 And that felt amazing. 568 00:27:59,866 --> 00:28:02,100 - I love the topic of testosterone. 569 00:28:02,100 --> 00:28:03,100 I'm a urologist, 570 00:28:03,100 --> 00:28:04,933 which gives me a very unique training coming 571 00:28:04,933 --> 00:28:06,633 into women's health and menopause. 572 00:28:06,633 --> 00:28:09,833 And the reason for that is I give people 10 times the dose 573 00:28:09,833 --> 00:28:11,633 of testosterone every day. 574 00:28:11,633 --> 00:28:14,533 They're called men, but I can't just come in and say, 575 00:28:14,533 --> 00:28:16,366 I wanna start you on testosterone 576 00:28:16,366 --> 00:28:17,466 because women don't know 577 00:28:17,466 --> 00:28:19,466 that they even have testosterone in their bodies. 578 00:28:19,466 --> 00:28:21,366 So I really have to do the education 579 00:28:21,366 --> 00:28:25,900 before a woman will accept testosterone, which is fair. 580 00:28:25,900 --> 00:28:27,700 The other unique thing about testosterone is 581 00:28:27,700 --> 00:28:30,866 it's really kind of been heralded as the 582 00:28:30,866 --> 00:28:32,366 hormone for libido. 583 00:28:33,366 --> 00:28:37,033 I would argue estrogen is also a very good libido drug. 584 00:28:37,033 --> 00:28:39,966 But testosterone's profoundly important for muscle, 585 00:28:39,966 --> 00:28:42,700 recovery after workouts, our bone health, 586 00:28:42,700 --> 00:28:45,466 our mental health, mood and depression. 587 00:28:45,466 --> 00:28:48,500 So we're starting to research the effects, 588 00:28:48,500 --> 00:28:51,900 but all you have to do is start giving women physiologic, 589 00:28:51,900 --> 00:28:55,133 female dose testosterone and they come back 590 00:28:55,133 --> 00:28:57,000 and they say, I feel like myself again. 591 00:28:57,866 --> 00:28:59,066 And you can't measure that, 592 00:28:59,066 --> 00:29:01,300 how do you measure I feel more like myself? 593 00:29:08,133 --> 00:29:09,700 So how does a woman get testosterone 594 00:29:09,700 --> 00:29:11,766 in the United States of America today? 595 00:29:11,766 --> 00:29:14,133 The most common option is to use a male product, 596 00:29:14,133 --> 00:29:17,000 just dose it for women's physiology. 597 00:29:17,000 --> 00:29:19,933 And that on average is about one 10th the dose. 598 00:29:19,933 --> 00:29:22,300 The tough part about that is it's very hard 599 00:29:22,300 --> 00:29:25,333 to dose a small packet of testosterone gel. 600 00:29:25,333 --> 00:29:28,766 So for women you have to say take one packet, 601 00:29:28,766 --> 00:29:31,466 which is like a ketchup packet and you have to open it up 602 00:29:31,466 --> 00:29:34,700 and then you dose it over 10 days. 603 00:29:34,700 --> 00:29:37,800 How do you dose this appropriately over 10 days? 604 00:29:37,800 --> 00:29:40,533 The other problem, you take it to Rite Aid, Walgreens, 605 00:29:40,533 --> 00:29:42,300 whatever your conventional pharmacy is, 606 00:29:42,300 --> 00:29:45,266 your insurance won't cover it 'cause it's non FDA approved. 607 00:29:45,266 --> 00:29:46,666 So men get it covered. 608 00:29:46,666 --> 00:29:49,533 People who are transitioning to men get it covered. 609 00:29:49,533 --> 00:29:51,833 Only the women don't get it covered by insurance. 610 00:29:56,133 --> 00:29:57,633 - When you gave me the testosterone, 611 00:29:57,633 --> 00:29:59,266 you said it could take two to three months, 612 00:29:59,266 --> 00:30:03,133 but at about two months it was very, very noticeable. 613 00:30:03,133 --> 00:30:04,800 - What'd you notice? 614 00:30:04,800 --> 00:30:07,900 - Well I had a friend just tell me, you are so different. 615 00:30:07,900 --> 00:30:09,966 And I said, well how am I different? 616 00:30:09,966 --> 00:30:13,333 And she said, you're just not negative anymore. 617 00:30:13,333 --> 00:30:15,866 I wasn't happy, and yeah, 618 00:30:15,866 --> 00:30:18,666 that's what my husband said too is you're just happier. 619 00:30:18,666 --> 00:30:19,800 I said, yeah, I am. 620 00:30:21,766 --> 00:30:23,800 - I think one of those most damaging things we did 621 00:30:23,800 --> 00:30:26,666 to women is that we made them afraid 622 00:30:26,666 --> 00:30:29,133 of something their body naturally makes. 623 00:30:29,133 --> 00:30:30,433 I think it's devastating. 624 00:30:40,966 --> 00:30:45,433 - You can't lump menopause into one basket 625 00:30:45,433 --> 00:30:48,566 for all races, ethnicities. 626 00:30:48,566 --> 00:30:52,033 There is more research coming out that is showing that women 627 00:30:52,033 --> 00:30:56,266 of color experience menopause very differently. 628 00:30:56,266 --> 00:31:00,666 - We did have a paper that looked at some 629 00:31:00,666 --> 00:31:03,933 of the differences or disparities in our black 630 00:31:03,933 --> 00:31:05,833 and white women because that's where some 631 00:31:05,833 --> 00:31:08,133 of the greatest differences exist. 632 00:31:08,133 --> 00:31:11,933 Our black women as well as our Hispanic women, 633 00:31:11,933 --> 00:31:14,733 are more likely to have frequent 634 00:31:14,733 --> 00:31:17,533 or bothersome hot flashes versus our white women or Chinese 635 00:31:17,533 --> 00:31:21,166 and Japanese women are less likely to have hot flashes. 636 00:31:21,166 --> 00:31:24,100 And the reason for the difference is something 637 00:31:24,100 --> 00:31:27,800 that is still an area of exploration. 638 00:31:27,800 --> 00:31:30,000 - With regards to Asian women, 639 00:31:30,000 --> 00:31:31,800 there's a lot of genetic differences. 640 00:31:31,800 --> 00:31:35,966 And so for Asian women, menopause tends to be a lot 641 00:31:35,966 --> 00:31:39,566 of bone pain, joint pain, headaches 642 00:31:39,566 --> 00:31:44,666 and less of the hot flashes and night sweats. 643 00:31:44,666 --> 00:31:46,933 But for Asian women, 644 00:31:46,933 --> 00:31:51,766 obviously with menopause comes the risk of osteoporosis. 645 00:31:52,700 --> 00:31:56,200 So a lot of care needs to be taken 646 00:31:56,200 --> 00:31:58,233 for Asian women going through menopause 647 00:31:58,233 --> 00:32:00,433 to preserve bone health. 648 00:32:00,433 --> 00:32:05,033 So there are many different ways of going 649 00:32:05,033 --> 00:32:07,833 through menopause and there needs 650 00:32:07,833 --> 00:32:12,300 to be individualized treatments. 651 00:32:20,633 --> 00:32:23,866 (woman speaks Spanish) 652 00:32:47,266 --> 00:32:51,866 - Latinas show positive attitudes towards menopause 653 00:32:51,866 --> 00:32:56,066 because it's, oh I don't have my monthly period anymore. 654 00:32:56,066 --> 00:32:58,266 But then in the conversations when you begin 655 00:32:58,266 --> 00:33:01,966 to discuss the actual experience and symptoms 656 00:33:01,966 --> 00:33:05,200 and when they begin to associate menopause with aging 657 00:33:05,200 --> 00:33:08,200 because they'll view menopause positively, Latinas, 658 00:33:08,200 --> 00:33:09,866 but aging negatively. 659 00:33:09,866 --> 00:33:12,666 I think that that's also why there's an opportunity 660 00:33:12,666 --> 00:33:17,600 to kind of empower people to change the perception 661 00:33:17,600 --> 00:33:22,300 of menopause and what positive aspects they can 662 00:33:23,866 --> 00:33:25,866 kind of take out of this time period. 663 00:33:32,533 --> 00:33:36,866 When I say the term Latinas, it's not a homogenous group. 664 00:33:36,866 --> 00:33:38,866 Latinas come from different countries, 665 00:33:38,866 --> 00:33:42,766 nationalities, languages, cultural influences, 666 00:33:42,766 --> 00:33:45,300 either you were born in the US or not. 667 00:33:45,300 --> 00:33:49,133 And these all impact the menopause experience 668 00:33:49,133 --> 00:33:51,466 and Latinas in particular have high levels 669 00:33:51,466 --> 00:33:54,100 of perceived stress and depressive symptoms 670 00:33:54,100 --> 00:33:57,133 and sleep disturbances during the menopause transition. 671 00:33:57,133 --> 00:33:58,633 These are all things that are related 672 00:33:58,633 --> 00:34:00,533 to cardiovascular health later on. 673 00:34:05,366 --> 00:34:08,600 In Latinas we also see additional stressors in 674 00:34:08,600 --> 00:34:12,366 that there isn't in the family discussions about menopause. 675 00:34:12,366 --> 00:34:15,966 You also then sometimes have in terms of gender roles, 676 00:34:15,966 --> 00:34:17,200 that there are certain roles 677 00:34:17,200 --> 00:34:18,700 that you think you should fulfill 678 00:34:18,700 --> 00:34:21,000 that the symptoms are bothering and interfering 679 00:34:21,000 --> 00:34:23,766 with these roles such as cooking or cleaning 680 00:34:23,766 --> 00:34:25,500 or being the caregiver for others 681 00:34:25,500 --> 00:34:28,833 and you being unable to discuss it leads to stress. 682 00:34:30,266 --> 00:34:33,533 (woman speaks Spanish) 683 00:34:45,433 --> 00:34:48,066 - Women of color, particularly African-American women tend 684 00:34:48,066 --> 00:34:50,633 to experience menopause early 685 00:34:50,633 --> 00:34:55,400 on average about a year earlier than white women do. 686 00:34:55,400 --> 00:34:58,566 They have symptoms that are more severe 687 00:34:58,566 --> 00:35:00,300 and their symptoms last longer 688 00:35:00,300 --> 00:35:02,800 and that can go on for 10 years 689 00:35:02,800 --> 00:35:06,633 and that is a very long time to be that miserable. 690 00:35:08,000 --> 00:35:09,766 - There's a lot of research still going on, 691 00:35:09,766 --> 00:35:13,800 but a lot of it is felt to be due to weathering, 692 00:35:13,800 --> 00:35:18,166 an accumulated lifetime experiences 693 00:35:18,166 --> 00:35:21,833 of illnesses of stress 694 00:35:21,833 --> 00:35:29,100 that makes menopause more challenging for black women. 695 00:35:31,166 --> 00:35:34,200 - Every black person I know has a story of mistrust 696 00:35:34,200 --> 00:35:37,466 with a doctor and every black person I know keeps 697 00:35:37,466 --> 00:35:40,966 in the back of their mind the Tuskegee experiment. 698 00:35:40,966 --> 00:35:44,833 So we have a history that we need to remember. 699 00:35:44,833 --> 00:35:46,100 - They're least likely 700 00:35:46,100 --> 00:35:49,200 to get a conversation about menopause. 701 00:35:49,200 --> 00:35:52,300 They're least likely to get a prescription 702 00:35:52,300 --> 00:35:54,133 and less likely to take 703 00:35:54,133 --> 00:35:57,200 that prescription even when it is offered. 704 00:36:05,300 --> 00:36:06,500 - So we take our first breath. 705 00:36:13,100 --> 00:36:15,533 All right, so y'all know this deck 706 00:36:15,533 --> 00:36:20,366 that we created a couple of years ago was created 707 00:36:20,366 --> 00:36:22,966 to kind of help facilitate the conversation, right? 708 00:36:22,966 --> 00:36:25,533 So for tonight I pulled out questions 709 00:36:25,533 --> 00:36:27,700 that are specific to menopause. 710 00:36:27,700 --> 00:36:29,933 - What tools, resources, 711 00:36:29,933 --> 00:36:34,066 or provisions do you think people need 712 00:36:34,066 --> 00:36:36,933 to navigate their midlife awakening 713 00:36:36,933 --> 00:36:39,866 and journey through menopause? 714 00:36:39,866 --> 00:36:42,033 I think patience is the biggest thing 715 00:36:42,033 --> 00:36:45,766 that I needed with myself. 716 00:36:45,766 --> 00:36:48,133 Is not the same thing as patience for others. 717 00:36:50,066 --> 00:36:52,433 - We don't come from a place of problematizing 718 00:36:52,433 --> 00:36:54,233 or pathologizing menopause. 719 00:36:55,700 --> 00:36:58,100 The work that we do is to illuminate the uniqueness 720 00:36:58,100 --> 00:37:01,200 of your experience and to say that it's on a spectrum. 721 00:37:01,200 --> 00:37:03,833 There are some people who don't have any issues whatsoever. 722 00:37:03,833 --> 00:37:05,466 There are some people who are really struggling. 723 00:37:05,466 --> 00:37:08,200 When we say that black women 724 00:37:08,200 --> 00:37:11,000 and other women of color experience menopause differently 725 00:37:11,000 --> 00:37:12,500 than their white counterparts. 726 00:37:12,500 --> 00:37:13,633 It's not because there's something 727 00:37:13,633 --> 00:37:15,866 physiologically different from us. 728 00:37:15,866 --> 00:37:19,366 There is something different culturally from us. 729 00:37:19,366 --> 00:37:22,000 If you think about the impact 730 00:37:22,000 --> 00:37:26,466 of growing up in a racist society on your body, 731 00:37:26,466 --> 00:37:30,600 the trauma, it makes sense to me like as you get older, 732 00:37:30,600 --> 00:37:33,366 that trauma impacts your hormones. 733 00:37:33,366 --> 00:37:37,233 And I think that the medical field needs to catch up 734 00:37:37,233 --> 00:37:38,700 and taking into consideration 735 00:37:38,700 --> 00:37:41,366 this holistic experience of a person. 736 00:37:41,366 --> 00:37:43,733 And let's also think about the systems 737 00:37:43,733 --> 00:37:46,600 that are impacting your menopause experience 738 00:37:46,600 --> 00:37:49,000 and what we want to do together to disrupt that. 739 00:37:52,933 --> 00:37:56,366 - What has been rampant, you know, in the past 740 00:37:56,366 --> 00:37:59,466 and even now is this sense that women don't know 741 00:37:59,466 --> 00:38:04,333 what they're talking about, that men know better. 742 00:38:04,333 --> 00:38:06,433 I am in the perimenopause stage 743 00:38:06,433 --> 00:38:09,633 and it is interesting that I'm having to go 744 00:38:09,633 --> 00:38:12,333 through these informal kinds of networks, 745 00:38:12,333 --> 00:38:15,333 talking to other women my age, you know, 746 00:38:15,333 --> 00:38:18,133 where we're kind of comparing notes 747 00:38:18,133 --> 00:38:20,100 about the things that we're going through. 748 00:38:20,100 --> 00:38:23,533 It's almost reminiscent of me being in the archives 749 00:38:23,533 --> 00:38:26,300 and looking at those 18th and 19th century books 750 00:38:26,300 --> 00:38:28,200 and women's concerns have been written off 751 00:38:28,200 --> 00:38:29,933 as either superstitious 752 00:38:29,933 --> 00:38:33,400 or that they don't quite know what they're talking about. 753 00:38:33,400 --> 00:38:36,666 - Any person who studies medical history 754 00:38:36,666 --> 00:38:38,933 or has gone to medical school 755 00:38:38,933 --> 00:38:41,600 when they had their gynecological rotation, 756 00:38:41,600 --> 00:38:44,733 they learned about J. Marion Sims because he's been deemed 757 00:38:44,733 --> 00:38:48,966 and also was a self-proclaimed father of gynecology. 758 00:38:48,966 --> 00:38:52,666 Who they don't talk about are the mothers of gynecology, 759 00:38:52,666 --> 00:38:55,800 the enslaved women that he practiced on. 760 00:38:57,433 --> 00:39:00,266 (dramatic music) 761 00:39:10,666 --> 00:39:12,333 - That doesn't mean that gynecology 762 00:39:12,333 --> 00:39:14,800 or obstetrics didn't exist, 763 00:39:14,800 --> 00:39:16,900 but in the United States in particular, 764 00:39:16,900 --> 00:39:20,166 it was the Atlantic slave trade 765 00:39:20,166 --> 00:39:23,833 that made the advancement and the development happen 766 00:39:23,833 --> 00:39:28,033 even sooner because of the access to bodies 767 00:39:28,033 --> 00:39:30,500 that one essentially had free reign on. 768 00:39:36,166 --> 00:39:41,400 The mothers of gynecology are Anarcha, Betsey and Lucy. 769 00:39:41,400 --> 00:39:43,366 And these were young women from their late teens 770 00:39:43,366 --> 00:39:46,866 to their early twenties living in Montgomery, Alabama. 771 00:39:49,500 --> 00:39:51,300 In the 1840s, 772 00:39:51,300 --> 00:39:55,433 Dr. James Marion Sims enters their world 773 00:39:55,433 --> 00:39:59,166 because of a condition that these women all share. 774 00:39:59,833 --> 00:40:04,166 Vesicovaginal fistula, the condition that was created 775 00:40:04,166 --> 00:40:07,733 after a very prolonged child birthing session. 776 00:40:08,600 --> 00:40:10,366 The end result is incontinence 777 00:40:10,366 --> 00:40:12,333 and if there's tearing in the back, 778 00:40:12,333 --> 00:40:14,933 there's also incontinence there as well. 779 00:40:14,933 --> 00:40:16,866 He is experimenting on them 780 00:40:16,866 --> 00:40:21,200 by trying to create a surgical reparative technique 781 00:40:21,200 --> 00:40:25,600 that is innovative and new and advanced. 782 00:40:32,633 --> 00:40:37,266 Most doctors in the 1840s are not using anesthesia 783 00:40:37,266 --> 00:40:39,033 because anesthesiology 784 00:40:39,033 --> 00:40:41,566 as a medical branch has not been created. 785 00:40:41,566 --> 00:40:45,233 There are different kinds of interventions 786 00:40:45,233 --> 00:40:46,633 that doctors rely upon. 787 00:40:46,633 --> 00:40:48,600 Alcohol, Laudanum. 788 00:40:51,766 --> 00:40:55,566 Anarcha, Betsey and Lucy unfortunately do not receive 789 00:40:55,566 --> 00:41:00,600 any kind of pain relief through medication during the years 790 00:41:00,600 --> 00:41:02,600 that they spend as experimental patients. 791 00:41:04,166 --> 00:41:08,700 Dr. James Marion Sims is carrying on these surgeries 792 00:41:08,700 --> 00:41:12,933 for almost four years and one of the enslaved women, 793 00:41:12,933 --> 00:41:17,333 Anarcha, is operated on 30 times 794 00:41:17,333 --> 00:41:19,700 and that is considered excessive 795 00:41:19,700 --> 00:41:21,966 even for the Antebellum era. 796 00:41:21,966 --> 00:41:26,166 After a few years he continues to fail. 797 00:41:26,166 --> 00:41:29,100 The two white male surgical assistants, they walk away. 798 00:41:29,100 --> 00:41:33,533 Sims has to train his enslaved labor force 799 00:41:33,533 --> 00:41:34,566 how to perform the work. 800 00:41:39,200 --> 00:41:42,066 And so he teaches these enslaved women to assist him 801 00:41:42,066 --> 00:41:45,300 as nurses and also surgical assistants. 802 00:41:45,300 --> 00:41:47,066 And this is the incredible thing. 803 00:41:47,066 --> 00:41:50,133 Here you have a group of five to six women 804 00:41:50,133 --> 00:41:52,800 who are assisting him at any given moment 805 00:41:52,800 --> 00:41:54,466 who are illiterate. 806 00:41:54,466 --> 00:41:59,200 And yet this is a surgical team that helps Sims come up 807 00:41:59,200 --> 00:42:03,600 with a successful surgical reparative treatment. 808 00:42:03,600 --> 00:42:06,433 Sims did not give anyone credit except himself 809 00:42:06,433 --> 00:42:12,866 in his writings about the curing of vesicovaginal fistula. 810 00:42:16,966 --> 00:42:20,233 So Anarcha, Betsey and Lucy are ultimately returned 811 00:42:20,233 --> 00:42:21,600 to their owners. 812 00:42:21,600 --> 00:42:24,300 They are, at least from his writings, cured. 813 00:42:25,766 --> 00:42:28,366 We're not quite sure what happened. 814 00:42:29,700 --> 00:42:32,500 Based on my research of other enslaved women, 815 00:42:32,500 --> 00:42:34,066 they might have gone on to work 816 00:42:34,066 --> 00:42:35,700 as healers in their community. 817 00:42:38,133 --> 00:42:41,733 The campaign to usher in a reckoning where 818 00:42:41,733 --> 00:42:43,300 we honor the work 819 00:42:43,300 --> 00:42:45,933 and the lives of Anarcha, Betsey and Lucy 820 00:42:45,933 --> 00:42:50,466 and the other unnamed women that Sims worked on is afoot. 821 00:42:50,466 --> 00:42:53,733 It is not about saying Sims didn't create 822 00:42:53,733 --> 00:42:57,400 this particular kind of surgical development, 823 00:42:57,400 --> 00:43:01,666 but he didn't do so in isolation and that this is happening 824 00:43:01,666 --> 00:43:05,366 because he has access to enslaved bodies 825 00:43:05,366 --> 00:43:09,166 to be able to do this kind of work. 826 00:43:18,000 --> 00:43:20,533 - Just because you're post reproductive, 827 00:43:20,533 --> 00:43:24,300 you're not done contributing to society. 828 00:43:24,300 --> 00:43:28,033 At this point, we have a lot of life experience, 829 00:43:28,033 --> 00:43:34,633 a lot of spunk and a lot of great ideas 830 00:43:34,633 --> 00:43:36,433 to contribute to the workplace. 831 00:43:37,133 --> 00:43:38,233 - We need support 832 00:43:38,233 --> 00:43:40,533 and having a flexible workplace I think would be 833 00:43:40,533 --> 00:43:42,533 a great place to start. 834 00:43:42,533 --> 00:43:45,466 I'm sure that as I go through menopause, I'm gonna be like, 835 00:43:45,466 --> 00:43:47,533 I'm having hot flash, just shut up. 836 00:43:47,533 --> 00:43:50,866 And I'm fortunate that I can do it because I'm in charge, 837 00:43:50,866 --> 00:43:53,700 but I know that so many women cannot do the same. 838 00:43:59,533 --> 00:44:02,200 - I was hosting a meeting of 40 839 00:44:02,200 --> 00:44:03,966 of our senior leaders in the room 840 00:44:03,966 --> 00:44:07,100 and I came in that morning, you know, 841 00:44:07,100 --> 00:44:08,533 I had a terrible migraine. 842 00:44:08,533 --> 00:44:10,266 I was, you know, very nauseous. 843 00:44:10,266 --> 00:44:13,300 I felt really awful, from perimenopause 844 00:44:13,300 --> 00:44:16,966 and I had to make a decision, do I go home or what do I do? 845 00:44:16,966 --> 00:44:19,366 And we have conference rooms everywhere 846 00:44:19,366 --> 00:44:20,466 with little sofas in them. 847 00:44:20,466 --> 00:44:23,466 And I thought, well I'm gonna go lay on the sofa, 848 00:44:23,466 --> 00:44:26,200 not because that's a comfortable thing for me to do. 849 00:44:26,200 --> 00:44:28,866 You know, who wants to see their president laying 850 00:44:28,866 --> 00:44:30,533 on a sofa in a conference room? 851 00:44:30,533 --> 00:44:31,800 What are people gonna think? 852 00:44:34,100 --> 00:44:36,033 But again, I had this incredible opportunity 853 00:44:36,033 --> 00:44:40,433 to make it okay to take a break, you know, 854 00:44:40,433 --> 00:44:44,266 take whatever pause I needed to feel better. 855 00:44:44,266 --> 00:44:47,933 And therein is the opportunity to then be transparent. 856 00:44:47,933 --> 00:44:50,133 I hope it gives women permission 857 00:44:50,133 --> 00:44:55,233 to at least say I'm not having the best day today. 858 00:45:00,600 --> 00:45:04,433 - We have the cost of lost work productivity, 859 00:45:04,433 --> 00:45:06,133 women with lost wages, 860 00:45:06,133 --> 00:45:08,733 women who maybe didn't take a promotion 861 00:45:08,733 --> 00:45:10,700 because of their symptoms 862 00:45:10,700 --> 00:45:14,333 or who might step out of the workplace early altogether, 863 00:45:14,333 --> 00:45:17,100 which could jeopardize their ability to retire. 864 00:45:17,100 --> 00:45:20,100 This is an enormous loss of human capital. 865 00:45:21,633 --> 00:45:24,033 - We don't wanna pathologize someone getting older. 866 00:45:24,033 --> 00:45:27,033 We don't wanna pathologize someone experiencing menopause. 867 00:45:27,033 --> 00:45:29,800 - We initially started talking about this a few years ago. 868 00:45:29,800 --> 00:45:32,300 It scared me to death, the last thing we wanna do 869 00:45:32,300 --> 00:45:33,866 is handicap women in the workplace 870 00:45:33,866 --> 00:45:35,766 to where they're thought of 871 00:45:35,766 --> 00:45:39,300 as a liability to their employers. 872 00:45:41,466 --> 00:45:43,700 - I go back to my 35-year-old self. 873 00:45:43,700 --> 00:45:45,300 I was the mother of three 874 00:45:45,300 --> 00:45:48,233 and people I worked with, I didn't openly share that. 875 00:45:48,233 --> 00:45:49,800 I didn't want anybody to think 876 00:45:49,800 --> 00:45:53,033 that I was gonna be distracted from doing a great job 877 00:45:53,033 --> 00:45:55,366 because my child was sick. 878 00:46:07,300 --> 00:46:12,566 - We have a women's group and they get together regularly 879 00:46:12,566 --> 00:46:14,600 and talk about various topics. 880 00:46:14,600 --> 00:46:16,166 Some brave soul mentioned 881 00:46:16,166 --> 00:46:18,466 that she was having some menopause symptoms 882 00:46:18,466 --> 00:46:20,633 that were affecting her at work. 883 00:46:20,633 --> 00:46:23,166 And lo and behold, other members 884 00:46:23,166 --> 00:46:24,766 of the group started speaking up. 885 00:46:26,800 --> 00:46:29,000 - There was like a floodgate of women just sharing 886 00:46:29,000 --> 00:46:30,700 how this had impacted their lives. 887 00:46:30,700 --> 00:46:32,466 - And no one wants to go to their manager and say, 888 00:46:32,466 --> 00:46:34,366 I'm not feeling well and apparently I won't 889 00:46:34,366 --> 00:46:36,266 for the next five to seven years, 890 00:46:36,266 --> 00:46:39,233 women have really just suffered in silence not knowing 891 00:46:39,233 --> 00:46:41,700 what was going on with them in their bodies. 892 00:46:41,700 --> 00:46:43,733 - Someone stood up and said, 893 00:46:43,733 --> 00:46:47,566 have you ever thought about having some sort of support 894 00:46:47,566 --> 00:46:50,933 or company benefit for people going through menopause? 895 00:46:50,933 --> 00:46:54,233 No we hadn't, but what a great idea. 896 00:46:54,233 --> 00:46:57,566 - And this was the first time we'd ever been asked. 897 00:46:57,566 --> 00:46:59,133 So I was like, okay, where do we start? 898 00:46:59,133 --> 00:47:02,433 Not companies had put in menopause benefits at that time. 899 00:47:02,433 --> 00:47:04,533 - At the same time we ran our numbers 900 00:47:04,533 --> 00:47:06,333 on our employee demographics. 901 00:47:06,333 --> 00:47:09,933 What we found is that at Genentech, over 55% 902 00:47:09,933 --> 00:47:13,700 of our employees are women with an average age of 45. 903 00:47:13,700 --> 00:47:16,500 - At this age, many women are at the peak of their careers. 904 00:47:16,500 --> 00:47:19,333 Women are critical to the organization. 905 00:47:19,333 --> 00:47:22,166 And so I think the better it is for women of course 906 00:47:22,166 --> 00:47:24,666 and the better it is for the company. 907 00:47:24,666 --> 00:47:28,766 - And so the benefit that we provide provides 24/7 access 908 00:47:28,766 --> 00:47:33,033 to educational materials, webinars, provider led sessions 909 00:47:33,033 --> 00:47:36,866 and same day access to appointments with specialists. 910 00:47:36,866 --> 00:47:39,366 - So from my perspective, this is an improved way for us 911 00:47:39,366 --> 00:47:42,033 to ensure that all women have access to the care 912 00:47:42,033 --> 00:47:44,766 that they need and that they deserve. 913 00:47:44,766 --> 00:47:46,033 - So the irony of the fact 914 00:47:46,033 --> 00:47:49,533 that we have this benefit now is when it first came up, 915 00:47:49,533 --> 00:47:52,433 you know, I was part of the whole discussion, 916 00:47:52,433 --> 00:47:55,033 but I have to say it wasn't as real for me 917 00:47:55,033 --> 00:47:58,233 because I wasn't going through menopause at that time. 918 00:47:58,233 --> 00:48:01,200 And then fast forward nine months and I'm 919 00:48:01,200 --> 00:48:02,366 in the heat of it. 920 00:48:02,366 --> 00:48:04,633 I was just saying to my primary care physician 921 00:48:04,633 --> 00:48:08,133 who honestly wasn't as sympathetic when I would go talk 922 00:48:08,133 --> 00:48:10,666 to her about my issues, oh it's just aging. 923 00:48:10,666 --> 00:48:16,066 Finally got connected through our benefit to an OB-GYN 924 00:48:16,066 --> 00:48:18,800 who then said, hey, I want you to try estrogen. 925 00:48:18,800 --> 00:48:21,300 Literally my mood changed, 926 00:48:21,300 --> 00:48:23,833 my body wasn't as sore and aching. 927 00:48:23,833 --> 00:48:26,333 My husband was happy 'cause my libido was better. 928 00:48:28,366 --> 00:48:30,133 But that's what thriving looks like, right? 929 00:48:34,900 --> 00:48:36,733 - You know, if I were to say one piece of advice 930 00:48:36,733 --> 00:48:40,200 to companies is start the conversation. 931 00:48:40,200 --> 00:48:42,500 Again, it is a normal part of life. 932 00:48:43,100 --> 00:48:47,100 - We are pioneering the acceptance 933 00:48:47,100 --> 00:48:51,966 of these conversations, these behaviors 934 00:48:51,966 --> 00:48:55,066 and on occasion we're gonna have to push 935 00:48:55,066 --> 00:48:56,566 through a few barriers 936 00:48:56,566 --> 00:48:59,366 and invite others to come into awareness on this topic 937 00:48:59,366 --> 00:49:01,600 that we feel so passionate about. 938 00:49:02,433 --> 00:49:05,466 - My goal is 939 00:49:05,466 --> 00:49:10,433 to make menopause medicine a public health issue. 940 00:49:10,433 --> 00:49:12,266 Just like smoking cessation. 941 00:49:14,066 --> 00:49:17,166 Just like prevention of heart disease. 942 00:49:19,033 --> 00:49:23,500 When you look at how much Alzheimer's, 943 00:49:23,500 --> 00:49:27,100 dementia, osteoporosis, 944 00:49:27,100 --> 00:49:31,466 all of these medical morbidities cost the government 945 00:49:31,466 --> 00:49:33,966 so much money every year, 946 00:49:33,966 --> 00:49:36,433 we're talking about billions of dollars. 947 00:49:37,800 --> 00:49:40,300 - You know, I think the role of government is to make sure 948 00:49:40,300 --> 00:49:43,200 that the citizenry is able to live 949 00:49:43,200 --> 00:49:46,966 and thrive inside of the country that they live in. 950 00:49:46,966 --> 00:49:49,166 And part of that is health and healthcare. 951 00:49:49,166 --> 00:49:52,433 To be able to offer healthcare 952 00:49:52,433 --> 00:49:54,666 that supports their community, 953 00:49:54,666 --> 00:49:56,133 you need to do intersectional research. 954 00:49:56,133 --> 00:49:59,200 You need to understand what your community needs. 955 00:49:59,200 --> 00:50:02,533 - We will build a healthcare system that puts women 956 00:50:02,533 --> 00:50:06,533 and their lived experience at its center. 957 00:50:06,533 --> 00:50:10,600 Where no woman or girl has to hear that, 958 00:50:10,600 --> 00:50:13,700 oh it's all in your head, 959 00:50:13,700 --> 00:50:17,000 or it's all just stress. 960 00:50:17,000 --> 00:50:19,333 You know where women aren't an afterthought 961 00:50:19,333 --> 00:50:20,766 but a first thought. 962 00:50:20,766 --> 00:50:23,900 - First lady Joe Biden is making this investment 963 00:50:23,900 --> 00:50:26,433 and she's been really diligent about bringing people 964 00:50:26,433 --> 00:50:28,666 to the table as we move into this new place 965 00:50:28,666 --> 00:50:30,466 of intersectional research 966 00:50:30,466 --> 00:50:33,866 and government funding, that needs to be front and center. 967 00:50:33,866 --> 00:50:35,566 It needs to live on the table. 968 00:50:41,066 --> 00:50:43,033 - If you have somebody who's graduated 969 00:50:43,033 --> 00:50:45,300 from a residency program within the last 20 years, 970 00:50:45,300 --> 00:50:47,100 it is not their fault in a sense 971 00:50:47,100 --> 00:50:49,533 'cause they were not taught much menopause education. 972 00:50:49,533 --> 00:50:52,633 - You know, I had to go outside of my own training 973 00:50:52,633 --> 00:50:55,033 to learn about menopause care 974 00:50:55,033 --> 00:50:57,433 and I thought I was a good provider. 975 00:50:57,433 --> 00:50:59,700 Turns out I was a terrible menopause provider 976 00:50:59,700 --> 00:51:01,966 until I went through menopause. 977 00:51:01,966 --> 00:51:04,700 Started reading, realized there was a huge gap 978 00:51:04,700 --> 00:51:06,200 in my own education. 979 00:51:06,200 --> 00:51:08,866 - In my dental school training, we learned about 980 00:51:08,866 --> 00:51:13,633 how fluctuating estrogen levels can affect the gums 981 00:51:13,633 --> 00:51:15,333 and the impact on the mouth. 982 00:51:15,333 --> 00:51:17,500 But never once were we taught 983 00:51:17,500 --> 00:51:20,600 about the impact during menopause. 984 00:51:20,600 --> 00:51:22,800 - I have 23 years of formal education. 985 00:51:22,800 --> 00:51:26,633 Not once did someone mention menopause to me. 986 00:51:26,633 --> 00:51:29,166 - I was like a deer in the headlights. 987 00:51:29,166 --> 00:51:31,966 And after the patient would leave, 988 00:51:31,966 --> 00:51:34,300 I would hurry up and pull out all my books 989 00:51:34,300 --> 00:51:36,633 'cause back then we still used books. 990 00:51:36,633 --> 00:51:38,600 There will be maybe one paragraph 991 00:51:38,600 --> 00:51:40,433 in an entire book about menopause. 992 00:51:47,400 --> 00:51:50,066 - In medical school we really did not get 993 00:51:50,066 --> 00:51:52,733 any formal training at all on menopause 994 00:51:52,733 --> 00:51:55,033 as part of our women's health curriculum. 995 00:51:55,033 --> 00:51:57,800 A lot of it's focused on the reproductive age years, 996 00:51:57,800 --> 00:52:02,033 on pregnancy, on different like benign gynecology issues. 997 00:52:02,033 --> 00:52:04,533 But as part of our second year residency here, 998 00:52:04,533 --> 00:52:06,633 we get to rotate with Dr. Shen, 999 00:52:06,633 --> 00:52:10,600 who is our menopause expert, if you will, 1000 00:52:10,600 --> 00:52:12,966 in a clinic just dedicated to menopause, 1001 00:52:12,966 --> 00:52:14,366 which is really special. 1002 00:52:14,366 --> 00:52:18,266 - Here I could possibly effect a change, 1003 00:52:18,266 --> 00:52:21,000 at least train the next generation 1004 00:52:21,000 --> 00:52:24,500 and have more opportunity to learn 1005 00:52:24,500 --> 00:52:27,766 and to do research around menopause. 1006 00:52:27,766 --> 00:52:30,933 - So what does it take for menopause to be part 1007 00:52:30,933 --> 00:52:33,200 of medical textbooks and scientific textbooks? 1008 00:52:33,200 --> 00:52:35,100 It takes women in power. 1009 00:52:35,100 --> 00:52:36,766 - I try to trick my medical students 1010 00:52:36,766 --> 00:52:38,533 into going into OB-GYN 1011 00:52:38,533 --> 00:52:40,800 and going into particularly menopause research 1012 00:52:40,800 --> 00:52:43,900 because I guarantee you there's a Nobel Prize 1013 00:52:43,900 --> 00:52:45,466 for the person that can figure this out. 1014 00:52:47,566 --> 00:52:49,233 - I think the most important thing 1015 00:52:49,233 --> 00:52:51,300 that we are doing in this space right now is 1016 00:52:51,300 --> 00:52:52,900 really educating women 1017 00:52:52,900 --> 00:52:55,400 so they know how to go to their doctor. 1018 00:52:55,400 --> 00:52:56,800 And have this conversation, 1019 00:52:56,800 --> 00:52:59,600 do not wait until the doctor brings it up. 1020 00:52:59,600 --> 00:53:03,866 - I have two daughters and we talk about gynecologic health. 1021 00:53:03,866 --> 00:53:06,300 We talk about what's going on with their bodies. 1022 00:53:06,300 --> 00:53:11,366 So this is my biggest passion is education. 1023 00:53:11,366 --> 00:53:13,000 And I think the earlier the better. 1024 00:53:13,000 --> 00:53:14,366 I tell my patients all the time, 1025 00:53:14,366 --> 00:53:17,266 no one knows your body better than you do. 1026 00:53:17,266 --> 00:53:19,133 - I do want to empower people to feel like 1027 00:53:19,133 --> 00:53:22,933 when I go to my doctor, you are the expert of your body. 1028 00:53:22,933 --> 00:53:24,766 If you don't know the right question to ask, 1029 00:53:24,766 --> 00:53:27,200 you often don't get the right answer. 1030 00:53:27,200 --> 00:53:30,966 - Now if your doctor brushes you off in that conversation. 1031 00:53:30,966 --> 00:53:32,366 - Then you need a new doctor. 1032 00:53:32,366 --> 00:53:34,266 What perimenopause and menopause is, 1033 00:53:34,266 --> 00:53:36,900 and I say it's a profound hormone shift, 1034 00:53:36,900 --> 00:53:38,066 but we've done this before. 1035 00:53:38,066 --> 00:53:39,800 We do this every month with periods. 1036 00:53:39,800 --> 00:53:42,933 We do this with pregnancy, we do this with puberty 1037 00:53:42,933 --> 00:53:44,200 and kind of normalize it is 1038 00:53:44,200 --> 00:53:46,233 this is another event in our life. 1039 00:53:46,233 --> 00:53:47,733 This is not so unique 1040 00:53:47,733 --> 00:53:49,133 and devastating that we've never dealt 1041 00:53:49,133 --> 00:53:51,166 with something like this before. 1042 00:53:51,166 --> 00:53:52,600 - I'm optimistic. 1043 00:53:52,600 --> 00:53:55,233 I think that we're headed in the right direction 1044 00:53:55,233 --> 00:54:00,033 with regards to improving healthcare for women, 1045 00:54:00,033 --> 00:54:02,266 after the menopause. 1046 00:54:04,200 --> 00:54:06,933 - I hopefully have another 50 years left. 1047 00:54:06,933 --> 00:54:09,733 Am I gonna sit here and be at home and miserable 1048 00:54:09,733 --> 00:54:11,066 and yelling at everybody 1049 00:54:11,066 --> 00:54:12,700 or am I gonna go out and do something? 1050 00:54:12,700 --> 00:54:15,433 And you know, I'm just as valuable now 1051 00:54:16,966 --> 00:54:19,866 as I was in my twenties and I have a lot more to give 1052 00:54:19,866 --> 00:54:23,500 and I have a lot more wisdom. 1053 00:54:24,833 --> 00:54:28,366 - Menopause can actually be viewed as freedom. 1054 00:54:29,766 --> 00:54:33,366 Freedom from having menstrual cycles, 1055 00:54:33,366 --> 00:54:36,066 the freedom from fear of getting pregnant. 1056 00:54:36,066 --> 00:54:40,400 Women should celebrate the wisdom 1057 00:54:40,400 --> 00:54:44,766 and the knowledge that is gained from the decades lived 1058 00:54:44,766 --> 00:54:48,700 and carry herself with pride 1059 00:54:48,700 --> 00:54:52,266 that she is someone who has made it through 1060 00:54:52,266 --> 00:54:54,266 and she has a lot to give. 1061 00:54:54,266 --> 00:54:58,300 - The postmenopausal women are generally happier 1062 00:54:58,300 --> 00:55:03,100 than they themselves were before menopause. 1063 00:55:03,100 --> 00:55:04,766 You are more resilient at that point 1064 00:55:04,766 --> 00:55:08,266 and maybe you figured out your priorities 1065 00:55:08,266 --> 00:55:09,933 and you're just happier with yourself. 1066 00:55:09,933 --> 00:55:11,666 You're proud of Yourself. 1067 00:55:11,666 --> 00:55:14,200 - I am in some ways more valuable now 1068 00:55:14,200 --> 00:55:15,366 than I have ever been. 1069 00:55:15,366 --> 00:55:17,266 And that's what lays on the other side of this 1070 00:55:17,266 --> 00:55:19,500 and all the way through it, and power. 1071 00:55:19,500 --> 00:55:23,300 Empowerment lays on the other side as well. 1072 00:55:23,300 --> 00:55:28,200 ♪ Some time ♪ 1073 00:55:28,200 --> 00:55:30,533 ♪ Some where ♪ 1074 00:55:36,366 --> 00:55:38,700 (calm music)