Half of the population spends 1/3 to 1/2 of their lives after menopause, so why is it so rarely discussed in the open? That’s about to change. In this episode, we’re breaking through the stigma and bringing menopause and mid-life to the forefront. We’ll be talking in detail about this important stage of life and why many women find the transition so challenging. Get educated on the menopause experience, including symptoms, myths and health tips for mid-life, as well as steps that women can take to ensure their health keeps pace with their aspirations. We chat with Dr. Mary Jane Minkin – host of the Menopause: Unmuted Podcast – to help us navigate this important topic. The opinions expressed are the opinions of the individuals recorded and not the opinions of UpJohn.
Menopause: Unmuted Podcast: https://www.pfizer.com/news/features/podcasts/menopause-unmuted
Disclaimer: This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of UpJohn. Individuals featured in this podcast may have participated in the past as or may be current members of an advisory group for UpJohn.
Dr. Mo Alsuwaidan: Hello and welcome to Listen Well, where we connect you to the world of health and wellness. I'm Dr. Mo Alsuwaidan. Today's episode is about menopause and midlife. We're going to talk about this important stage of life and why many women find the transition so challenging. We'll be exploring menopause symptoms, myths and health tips for midlife and beyond.
I'm joined today by Dr. Mary Jane Minkin, who is a WebMD menopause expert, and a professor at Yale Medical School and is also known as Madame ovary. Thank you for joining us, Mary Jane.
Dr. Mary Jane M...: Thanks so much, Mo. Great to be here with you.
Dr. Mo Alsuwaidan: So the burning question in my mind to start off with is why and how you got that nickname, Madame Ovary.
Dr. Mary Jane M...: Well, I guess it came about, because what would you call somebody who was a Biology major in college and a French minor who became a gynecologist? Madame Ovary.
Dr. Mo Alsuwaidan: So I understand Mary Jane that you actually host your own podcast series on menopause.
Dr. Mary Jane M...: Well, I'm working on a project called Menopause Un-muted and I'm very excited to be part of this project. We're basically listening to the stories of five women going through menopause with each with her own experience, and we're able to hear how women can experience menopause very differently depending on their circumstances, health issues, personal issues, and it's really very interesting.
2. Introduction to menopause and why it is important to talk about this life stage.
Dr. Mo Alsuwaidan: Some women can feel overwhelmed and unsupported during the menopause transition. Many healthcare providers aren't confident enough to discuss physical and emotional symptoms of menopause with their patients. Myths and misconceptions still persist about menopause, and we'll also be talking to Mary Jane about how we can make menopause and midlife a positive experience. We'll be getting some important tips and ideas on how to speak up about menopause and why this is a great moment to take a midlife health check and tackle the risk factors associated with this life stage. 4
[Narration: First, I wanted to get an idea of the scale of the issue – How many women are going through menopause right now?]
Dr. Mary Jane M...: Well, the numbers that I think we have here, basically, that in the United States alone, an estimated 64 million American women are experiencing menopause. And, of course, that means the change in life expectancy that the average woman is now postmenopausal for about a third of her life, maybe as much as a half. So, that's a real problem. By the year 2030, there will be an estimated 1.3 billion menopausal women worldwide. That's a lot of us.
Dr. Mo Alsuwaidan: I can see that it can be sometimes a difficult part of life for many women.
Dr. Mary Jane M...: Oh, it's a hugely difficult part of life for many, many women. And it's difficult because of course there are many social issues going on for women at mid-life on. That's why I do prefer to call myself midlife and menopause expert, because there are many things going on. Socially, women in the late 40s, early 50s are oftentimes dealing with issues work-wise, but they're dealing with changes in their work environment. They're dealing with kids either leaving home, or as I always joke when I give a lecture even worse, coming back. And they're dealing with relationship issues, their partner maybe experiencing changes on the job as we head into mid-life.
Dr. Mary Jane M...: And on top of all these social issues that women are dealing with, and emotional issues, now we're dealing with the hormonal issues. And the problem with menopause is it's not as simple, you go to bed one day, premenopausal, when you wake up the next morning, postmenopausal. It's a significant transition period that we refer to as perimenopause, where the hormones, although drifting downwards, are not doing this as a smooth curve, and they're sort of jagging all up and down all over the place, which can pose a lot of challenges to women symptomatically.
Dr. Mo Alsuwaidan: So what is menopause exactly and why does it happen?
Dr. Mary Jane M...: Another excellent question, Mo. Indeed menopause can be simply defined as the pooping out of the ovaries. That's how I describe it to my patients, is that ovaries stop releasing eggs. We are born basically with all the eggs we're ever going to have. These are formed when we're in our mommies' tummies, at that point. And we keep losing eggs over the course of time and the ovary just runs out of eggs. That's really what menopause is about. And the process by which that over the final stage is is a little variable as far as hormonal secretion, but eventually the ovaries stop making very much estrogen.
Dr. Mo Alsuwaidan: So is there a lot about menopause that's often misunderstood?
Dr. Mary Jane M...: A lot is misunderstood, because of course menopause can give women symptoms that they've never experienced previously. And then of course the other problem that's out there is sometimes what we'll attribute to menopause, other things are going on physiologically to women. And for example, some women with menopause will experience palpitations and chest pain. Well of course, women can start getting a higher incidence of heart disease at that point. So we don't want to prescribe something, "Oh this is just menopause," when it's something out of the hormone area. And it's a challenge sometimes to figure out what's going on.
Dr. Mo Alsuwaidan: So in the 21st century, do you think menopause is still a taboo subject for a lot of people?
Dr. Mary Jane M...: Menopause is a very taboo subject, particularly I think in the United States, where one of the major goals of women is to stay youthful forever. Whereas in many societies where an older woman is revered, age is considered knowledge.
In a country where we revere youth, it can be very difficult for a woman, because as she's going through menopause, she's also getting older. And this can be tough for many women.
Dr. Mo Alsuwaidan: It's so interesting, these cultural perceptions, but it also makes me think, "What kind of myths exist that you've seen when speaking to people about menopause?"
Dr. Mary Jane M...: Oh, there are a tremendous number of myths. Women, for example, will think, "My life is over." I mean, that's the old school. And let's say should we go back 100 years, basically in 1900 the average age of menopause in the United States was 48, which was also the average female life expectancy. So as I tell my students, "Well, we're supposed to go through menopause, and die. That was easy." The problem right now is ... that was a good problem ... is that the average life expectancy fortunately is up into our 80s, so that women are now leading a third or sometimes even half of their lives postmenopausal, which is a real challenge to the healthcare system, to women's understanding, lots of challenges out there. So there are those issues. And then there are the issues, the exact issues that women experience with the loss of hormones.
Dr. Mary Jane M...: There's some women, for example, who get no hot flashes whatsoever. 20% of women get, no hot flashes. 20% of women get severe hot flashes, and the other 60% of us are somewhere in the middle, we get some, but they're not totally debilitating. We don't know why. We don't know why that happens, but we have to understand what these women are going through. And then attendant with the hot flashes and night sweats, many women have significant sleep disruptions, which as everybody knows, can be quite debilitating. And then there were some other issues going on, and the question is whether they're secondary to the loss of sleep, for example.
Dr. Mary Jane M...: Many women notice a change in mood, they have more anxiety and irritability. Now, of course when you don't sleep well, we know that you get anxious and irritable. So how much of it is loss of sleep? How much of it is independent just related to the loss of estrogen? And the other disturbing thing for many women are cognitive changes, that women who basically ... their brain is fuzzy. They're not thinking so well, and again, there are some women who call it menopausal brain. The good news there is that many of these cognitive changes actually are more prominent in the perimenopausal transition. And once we get through to the other side, the cognitive changes settle down.
3. Common misconceptions and menopause education shortcomings
Dr. Mo Alsuwaidan: You mentioned that women now live almost half or a third of their lives after menopause. When does it actually start, and how long does it last?
Dr. Mary Jane M...: Excellent question, of course. The average age of menopause in the United States is 51.4 years. However, the range of normal is quite wide. And I tell my patients, I would call 35 to 60 normal. But the trick also is, how do you diagnose perimenopause, these changes that are occurring prior to that last menstrual period? Oh, and by the way, I should mention that basically to define somebody who's fully menopausal, she has to have gone a year without her period to someone who has her uterus in place. A woman, who has had a hysterectomy, it's a lot trickier to define it. So basically, if you go full year without a period, you can say, "Now you are fully menopausal."
Dr. Mo Alsuwaidan: I find that healthcare providers in general know a lot about heart disease or diabetes, whatever your specialty is. But menopause is one of these more esoteric topics and I always wonder, I want your input on, why is that the case that it's not a topic that's so well-known across different specialties?
Dr. Mary Jane M...: I wish I could say it's better known even among OB/GYNs, unfortunately, that there was actually a revolution in menopause, and teaching about menopause that occurred about 18 years ago, when a large study got released that really, called the Women's Health Initiative, which really downplayed the use of hormone replacement therapy. And we can talk more about that if you want to. But what happened is that about 18 years ago, many residency training programs in North America said, "Well, women aren't going to be using hormone therapy very much, and we need to cut back our teaching time anyway, because residency hours were being cut." So, the best thing to cut was menopause education. So unfortunately, in the United States, currently only 20% of the residency programs in gynecology actually have a formal menopause curriculum. 80% have at least menopause. And as I always say, it's really terrible, because you wouldn't think of letting an OB/GYN resident get through a program without knowing how to deliver a baby. But, we unfortunately graduate OB/GYN residents these days who haven't had much training on how to handle women for about 30% to 50% of their lives, yes.
4. The impact of menopause on women’s lives
Dr. Mary Jane M...: Women have tremendous impacts from the hot flashes and night sweats, as far as their sleep. And some of these women are chronically exhausted, which makes them a lot moodier, and a lot more irritable on dealing with themselves, dealing with their families, dealing with their work issues, tremendous impacts. There are also other issues that we haven't discussed. For example, some women going through the menopause transition developed significant arthritic-type complaints, achiness, both muscle and joint aches. And again, what's also very interesting about menopause to me is the different societies tend to note these problems in greater frequency. So for example in the Philippines, the achiness is actually the number one complaint, whereas in the United States, hot flashes and the night sweats tend to be the number one complaint. But the achiness is a real problem for a lot of women.
Dr. Mary Jane M...: …in the United States itself, that there are significant differences in symptomatology in certain ethnic groups. For example, there's a study of women across the nation called the Swan Study, which has longitudinally looked at many women throughout the United States of different ethnic groups. And we know from that, that indeed African American women carry the most significant burden of hot flashes, Caucasian women in the middle, and Asian women the least. We don't know why, and that's, again, a very ripe area to be investigating. But we do know that the burden of hot flashes is very different.
Dr. Mo Alsuwaidan: And I can imagine how that then impacts relationships, which impacts emotions, and already the emotions, as you mentioned, because of hormones have changed. So it's all connected in a way, isn't it?
Dr. Mary Jane M...: It's all tremendously connected. And it's a huge problem, and there's a total lack of communication oftentimes between partners. And sometimes, for example, when a woman is experiencing dryness and pain, her partner will interpret it as, "Oh, she doesn't care about me anymore," you know?
Dr. Mo Alsuwaidan: Mm-hmm (affirmative).
Dr. Mary Jane M...: So this drives this wedge in the relationship. And the really sad thing about it, is it's such an easy problem to take care of. And I just feel so badly when somebody has been dealing with it for a long time and hasn't wanted to talk about. I'm sad to see it happening, but I'm always happy when one of those women comes in, because I know that we can help her.
Dr. Mo Alsuwaidan: Why is it that women don't want to talk about it? Is it stigma? Is there shame?
Dr. Mary Jane M...: Oh, I think there are many reasons that women don't want to talk about a vaginal dryness and problems like that. One, of course, is that the United States is a very puritanical country, so that we're not allowed to talk about sex. It's just, no, we don't talk about it. Babies come from the store, we know that. So anyway, so, women don't want to talk about sex. They're embarrassed. They think it's something maybe shameful. So they're reluctant to talk about it. And then the other thing, of course, to get back to the aging issue
Dr. Mary Jane M...: ... is that many women just view this as, "Oh, I'm getting older. This is something that naturally will happen to me, and I'm supposed to stop having sex anyway." Which of course is not the case. So there's all these stigma around there as far as talking about these issues and women won't bring it up.
Dr. Mo Alsuwaidan: You just remove the shame from it and talk about it openly, I guess.
Dr. Mary Jane M...: I try to, I really try to. And then the other thing that's out there, which many women do not realize at all. And I hate to say that physicians don't realize, is that the vagina is literally attached to the bladder and the urethra. That many women can develop bladder issues, things like recurrent infections. They can develop problems with leakage, things like that. Again, which are not nice things to talk about quote unquote for many women. But to bring out the fact that this is a common problem and that some women will go on for three or four infections in a year who would never previously experienced them, now it's just because she's menopausal. Well, the tissue that lines the bladder is the same kind of tissue that lines the vagina. So it's not surprising that when estrogen levels go down that this tissue becomes dry.
5. Health risks at midlife
[NARRATION: With these types of symptoms, some people, may find menopause embarrassing to talk about with partners or at a doctor’s appointment, but keeping silent prolongs suffering and unwarranted shame. Speaking openly is the first step to shedding the stigma around the topic and can open the door for other important conversations about the impact of menopause on overall health.]
Dr. Mary Jane M...: So many women are fine when they go through menopause. However, there are certain health risks that women need to be aware of. So, for example, two entities that we know that are directly impacted by the loss of estrogen are osteoporosis, bone loss or bone health, and cardiovascular disease. That we know that women, once we go through menopause and not having estrogen on board, are at higher risk of developing heart disease. So those are two things that I always discuss with my patients as they go through the menopausal transition. And we always talk about things like nutrition and exercise, which are really important for both bone issues and heart issues and that we can help everybody.
Dr. Mo Alsuwaidan: And they're really long-term investments, aren't they?
Dr. Mary Jane M...: Long-term investments and the other thing of course is that what you do early in menopause can have an impact later on.
…there are certain health-wise issues that can be done to impact that. So if somebody really is saying, "I should lose weight, I should do this, but okay now I'm going through menopause, I really have to work on this. Or I should start doing this exercise, now's a good time to do it." Because we all know that exercise helps prevent bone loss. So there are certain lifestyle issues that women are willing to think about, I think as they go through the menopause transition.
Dr. Mo Alsuwaidan: Would you say it's never too late? Let's say someone didn't start early, what if they start later? Is that still helpful?
Dr. Mary Jane M...: Absolutely. It is never too late. Never ever ever too late to begin good health activities. And so yeah, if you haven't started it when you're 50 well, you can start it when you're 60 or 70. I mean, that's fine. There is no reason to not do a good health intervention. And your nutrition is always important. Exercise is always important. For example, one thing that I will do is obtain a bone density test. Now there's some discussion exactly when the best time to do a bone density test is. But I try to do it actually not too long after somebody has become fully menopausal because I can show it to the woman, "This is what your bones look like." And most of us have a little bit of bone loss and to say, "Yeah, now's a really good time to impact it."
Dr. Mo Alsuwaidan: What would you tell a woman who's going through midlife or through menopause about what kind of health screening tests she should be doing?
Dr. Mary Jane M...: Now there's different guidelines as far as frequency schedules, but most menopausal women who benefit by regular mammography’s every year, every two years, wherever you are, and health issues may impact on your family history and how often you should be doing this. One other thing that we definitely want to monitor is their lipid profile, their cholesterol, their good cholesterol and their bad cholesterol because we do know that going through menopause and losing estrogen can impact your levels of cholesterol 10 or maybe even 15%. Of course again there are things we can do about it , but you want to know about it, say gee, has my lipid profile been impacted significantly? So definitely you want to do some lipid screenings.
Dr. Mary Jane M...: And then there was a question I mentioned about bone density issues. Now there are different guidelines as far as when to do a bone density and, again, any of risk factors and things like that. The National Osteoporosis Foundation has a very good website discussing bone density testing, and that's a good resource out there.
Dr. Mary Jane M...: But basically, at some point you probably want to get a bone density done. So those are certain basic tests and then, of course, routine chemistries to be done. Glucose test, again, one other thing that women don't realize is that the incidence of diabetes goes up over time. Estrogen loss and estrogen has an impact there. So diabetes screening should be attended to, and perhaps a little more frequently. So there are all these tests we should be paying attention to.
6. Speaking up about menopause – Positive menopause
Dr. Mo Alsuwaidan: So you speak to women all over the world and doctors all over the world about menopause. How can we get the health information out there in a better way? How can we get people talking?
Dr. Mary Jane M...: Well that's an excellent question and one project that I'm also involved in is a project on health literacy to deal with these issues. How do you communicate things? And I think it's something that we can do. I think we need to educate women more. Again, this is a topic that, as you pointed out, has been considered taboo for many years. And I think if we can encourage women to speak more openly about what they're feeling, about what they're going through, to really improve their health literacy on this topic I think is really helpful. I think we also need to educate the healthcare providers at all levels. To basically, be able to relate to their patients, to understand what these women going through so that we can help understand what these women are going through, so we can help understand, formulate questions for them, understand what they're going through and then to provide guidance. And we want to provide guidance at a level that they can understand.
Dr. Mary Jane M...: We know from literature that almost 70% of menopausal women never discuss their symptoms with their healthcare provider.
Dr. Mo Alsuwaidan: So communication is so key. What can our listeners do to support a positive menopause?
Dr. Mary Jane M...: Lots of things that you can do. First of all, don't be afraid. Don't be ashamed, okay? And it's perfectly okay to say that to... If you're talking with your healthcare provider, and again, hopefully you'll be with somebody that you feel comfortable with, to say, "This is what's happening to me. Is this normal? Is this weird? Is this something that could represent something pathological going on? Or is this related to menopause? And how can I be of assistance to myself? What measures can I take. And are there things that might be helpful medically?" So I think having a good relationship with your provider and being willing to talk up about this and never be embarrassed. Don't be embarrassed. Sometimes people say, "Oh, I'm embarrassed to talk about it." I look at them and say, "I'm a gynecologist. What are you going to talk to me about that I'm going to be embarrassed by? Don't be ridiculous."
Dr. Mo Alsuwaidan: So what would you tell some of your patients about talking to their partners about going through menopause?
Dr. Mary Jane M...: Excellent question. How do you talk to your partner? Well, maybe they can play this interview and talk to their partner. And to realize that women can be dealing with issues, that things can be going on that their partner may not be attuned to and they haven't experienced previously. I mean, these are novel changes that the women may not have experienced previously. They may say, if they were together during pregnancy, "Remember during pregnancy there were certain things that happened that were a little strange. Well, guess what, we have some hormonal changes here to deal with. And a lot of these changes are quite normal, but we need to deal with them. And the reason I didn't sleep well last night is my physiology. It's what's going on with my hormones. So please cut me some slack when I'm not responding as I normally might."
Dr. Mary Jane M...: And I also strongly encourage patients to bring their significant others with them. I always encourage them to come in and to chat so that they can be part of the discussion.
Dr. Mo Alsuwaidan: So Mary Jane, you mentioned some of the emotional symptoms with menopause. Does that ever develop into anything more serious, mental health wise?
Dr. Mary Jane M...: It certainly can, Mo. Depression is a pretty significant problem for women, more experienced by women than men. And indeed, if somebody does have a history of significant depression, it may flare up again at the time of perimenopause. Particularly perimenopause tends to be more of a problem than the postmenopausal timeframe. Now not everybody gets depressed going through menopause, but it certainly can be seen. Again, of course part of the issue is people who feel down because they're not getting enough sleep and they feel depressed because they're just exhausted and certainly that's part of the issue as well. But again, the important thing is to get help. Talk to your GYN health care provider, anything you need to be referred to somebody who deals with psychological and psychiatric entities to get some therapy.
Dr. Mary Jane M...: Also, one of the things that can be helpful if some of the medications that are actually used to treat depression also help with hot flashes. So that's a good benefit there to have available to you.
Dr. Mo Alsuwaidan: What treatment options are there for women going through menopause?
Dr. Mary Jane M...: There are many treatment options out there for women, Mo. For example, some very simple things that some women just don't even think about is layered dressing. I always encourage my patients going through menopause to wear a shell underneath a sweater. So if she starts experiencing hot flashes, she can comfortably take off the sweater and still have the shell there. Another simple thing, keeping the temperature of your bedroom cold. Keeping your bedroom temperature significantly lower, particularly for the first four hours of sleep, seems to be very advantageous and I strongly advocate electric blankets with dual controls for couples, because you don't want to freeze your partner out. So, simple things like that and I always have many of those things on my website, madameovary.com. Also, I would recommend the website of the North American Menopause Society, which is menopause.org, has a lot of valuable information there. Again, the thing is we have a lot of over-the-counter remedies that can be helpful.
Dr. Mary Jane M...: There are certain nutrition interventions which might be helpful. The other thing to remember is if there are women who do not respond to some of these over-the-counter or simple remedies, we have a lot of medical options out there, both for systemic therapy, meds that can be taken as pills or patches. Or meds that can be used vaginally for women who experience vaginal dryness. So we have a lot of options out there. Please talk with your healthcare provider and she or he can give you some guidance as far as what to do, but again, in the meanwhile, madameovary.com, menopause.org. Lots of information out there.
NARRATION: From what we’ve talked about so far, it can seem like menopause, while inevitable for half of the population, is full of negatives. I asked Dr. Minkin if there were any positives to menopause for women – there have to be, right?
Dr. Mary Jane M...: There are many positives are that women can experience postmenopausally. For example, women who've had miserable periods for their whole lives because of endometriosis or bad fibroids, that the bleeding and the pain will get much better because they don't have estrogen feeding these conditions and they're going to get better. There are women who suffer from bad PMDD, premenstrual dysphoric disorder or sort of bad PMS, cyclical mood changes which can be devastating. These women can be significantly better postmenopausally. There are women who, unfortunately, have not been able to use contraception either for medical issues or for religious barriers, things like that, and these women will be liberated. They will have a sexual awakening postmenopausally because they can have sex when they want and not worry about getting pregnant. And indeed, the late great anthropologist, Margaret Mead, wrote considerably about an entity that she referred to as postmenopausal zest, that women who after menopause really took up their lives and really with great energy did and discovered great things. So we should be hopefully devoting ourselves to some postmenopausal zest as well.
7. Take-home messages
Dr. Mo Alsuwaidan: What do you want women listening to this podcast, and really anyone listening to this podcast, to take out of it as a final message?
Dr. Mary Jane M...: Can we have an hour on this? No. Many things I'd love to have women pay attention to here. I mean, the most important thing is that there are many changes that women might experience. You notice I don't say necessarily will because, as we talked about, some women do go by without symptomatology. But many women will experience symptoms. Don't be ashamed of talking about them. These happen to many, many people. The majority of women will have some symptoms, and you want to be with a provider that you feel comfortable discussing these issues with so that you can talk about it.
Dr. Mary Jane M...: Talk to your provider, and if your provider shakes his or her head, says, "No, nothing to do," go get yourself another provider because there are a lot of things you can do about it.
Dr. Mary Jane M...: And Mo, I would love to encourage all of our listeners to go to Menopause Unmuted. These series of podcasts that we're doing with interviews with women actually going through menopause to get their individual perspectives. A little commentary by me put in there, and I think it's a wonderful source of education and will be very helpful for women to communicate about how they're feeling.
Dr. Mo Alsuwaidan: Well, Dr. Minkin, thank you so much for joining us today. I'm sure people listening to this episode will be much more enlightened about menopause after listening and we really appreciate your time.
Dr. Mary Jane M...: Well, thank you so much, Mo. It's a pleasure being with you, and thank you for educating our folks.
Dr. Mo Alsuwaidan: Thank you to Dr. Mary Jane Minkin for talking to us about midlife and menopause. It's an important life stage for women and one we don't talk about enough. Let's tackle the stigma and silence around menopause. If you're experiencing symptoms or going through menopause, speak out about it and ask about steps to stay healthy in midlife. If you want to hear more, subscribe to the Menopause Unmuted podcast hosted by Dr. Minkin, which is available wherever you get your podcasts. I'm Dr. Mo Alsuwaidan. Thanks for listening.
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