No one's talking about this.
No one's talking about the multi -organ system failure that a lot of women are going through and they're suffering in silence and physicians aren't helping, we're not trained.
We need to bring it to the forefront.
For people that don't understand menopause, they might think that it's a small issue affecting a small group of people.
But how many women are affected currently by perimenopause, menopause, and post -menopause?
Sure. So right now about a third of the female population of the world is in peri - or post -menopause.
It's not optional. All of us go through it and because we have such individual expressions of how it affects our bodies, what we know now is that there are estrogen receptors in every organ system of our body and when those levels start declining, we see a very wide variety of a spectrum of syndrome
where it used to just be thought it was a few hot flashes and some night sweats.
Maybe your sleep's disrupted.
Your genital urinary system is going to take a hit.
Your bones are going to get weaker.
But what we know now is how much it's affecting our mental health, our capabilities, our skin, our bones, our kidneys, vertigo, tinnitus, frozen shoulder.
Anytime I post about those on social media, the internet explodes and women by the thousands are like, oh my God, I had no idea.
Just the validation piece was so huge for them because they've been dismissed for so long and told it's all in their head.
If we think about from peri to post -menopause, what is that typical, and I know that's a tricky word to use, but what is the average typical age range?
Then also what is the more possible age range?
It could start between this age and this age range.
In the US and in most of Europe, the average age of menopause, which means one year after your last menstrual period is 51.
Peri -menopause, which is when your body recognizes there's some declining estrogen levels and you're beginning to be symptomatic, can start seven to 10 years before that.
Normal menopause is still 45 to 55.
If you do the math and back that up seven to 10 years, it is completely reasonable for a 35 -year -old woman to begin to experience some of the symptoms of peri -menopause.
Let's start with what is it?
I would love you to explain this to me like I'm a 10 -year -old because I'm sure there's some people that are both men and women that aren't.
We're going to talk about gonads.
In men, it's the testes, and where you're making your genetic material to where you're making sperm.
In a female, it's going to be ovaries, her ovaries.
The big differences between male and female and how that process happens is that males make their genetic material fresh constantly, the minute they go through puberty until basically they die unless they have some medical issue.
Females, on the other hand, our eggs develop while we're in utero and our mothers.
While we're in the womb, she's five months pregnant with us, we have our maximum eggs that we're ever going to have.
Those are meant to last us until we go through menopause.
They lay dormant until we go through puberty and then they wake up again and we start ovulating.
We have this monthly, in a healthy person, cyclical hormones rise and ebb and flow with our cycles each month.
We have a period. You get pregnant, you don't get pregnant, and the whole process starts over again.
Well, because we're born with that egg supply, through time we're decreasing the amount and the quality of those eggs.
When a woman hits the age of 30, she is down to about 10 % of the egg supply that she had at birth.
When she's 40, it's down to about 3%.
It gets harder and harder for that ebb and flow of the natural hormones to do its job.
We start seeing fluctuations in her periods and then organ systems that are beginning to notice the lack of estrogen.
Estrogen is a really powerful anti -inflammatory hormone in most of our body systems.
The musculoskeletal syndrome of menopause is really starting to be talked about quite a bit now.
We're looking at things like frozen shoulder, arthralgias, generalized aches and pains.
Most physicians aren't aware of this.
Most know about hot flashes and night sweats and sleep disruption, but now that we're really opening the conversation as to how many organ systems are affected, we are seeing people coming out of the woodwork.
Just so happy to know that they're not crazy and they're being validated.
What's happening at these three stages?
We have the perimenopausal stage, which is from what I've understood there, when estrogen levels start to drop.
We start seeing disruptions in the forest.
Instead of that nice monthly estrogen surge with ovulation and then the progesterone goes up, the elongation sometimes, or they even get closer together, I call it the zone of chaos.
What used to be a very reproducible, dependable system starts failing.
Some women will have irregular periods, meaning they're spacing out, they're skipping periods.
Others will have really heavy periods like hemorrhagic almost.
Again, the way the body reacts to this is very individualized from patient to patient.
Doctors love something that follows a checklist.
We have all these complicated things we have to learn and we have these checklists.
Menopause, it's like pinning the tail on a moving donkey.
In perimenopause, it's very, very chaotic.
Estrogen surges, then it goes away for a while.
A woman in perimenopause can feel completely fine for a few months.
Everything goes haywire, then she's fine again.
Not only is her estrogen declining, her testosterone is declining as well.
We're seeing loss of muscle mass, we're seeing changes in her sexual function, we're seeing decreased strength.
There's some really good studies showing how testosterone also affects our mental health and our cognition as well.
Why does this happen, from an evolutionary or?
The anthropologists have looked at this heavily.
There's only a couple of species in the world that go through menopause.
Humans are one, there's a couple of species of whales and I think they've now discovered one of the giraffes, species of giraffes can do it, but by and large, most mammals will die while they're so ovulating.
They're not going to go through a menopause.
There's something called the grandmother hypothesis where there was an evolutionary advantage for a woman to survive if she stopped the ability to have children, at some point.
Now again, you have to temper this with humans have prolonged their lifespan and their health span because of modern medicine.
Probably when we evolved, we weren't living this long.
A woman my age was pretty rare, I'm 55.
It's hard to say, I think we have outlived how we were genetically built and so we're living longer and being forced to deal with the consequences of that.
So then the next stage is menopause.
So menopause itself is really that it's just really one day in your life.
It's when you can throw the hammer down and say, I'm never going to ovulate again.
I'm done. And so if a woman's over the age of 45 and she hasn't had a period for a year, that's the definition.
Now it gets confusing because what if she's had a hysterectomy or doesn't bleed because of a surgery or an IUD or something?
Well, then we can't use her periods to help judge and that's where we start doing blood work to see where she is in her menopause journey.
And then post -menopause is the rest of your life.
The hot flashes might go away, night sweats might go away, brain fog might get better, but pretty much everything else is going to continue to progress in a very linear fashion until you die without estrogen replacement.
To put it lightly, you seem somewhat dissatisfied with the current set of answers that the medical field, but just society at large are offering for women in this sort of peri and post and menopausal phase of their life.
And I've sat here with a lot of women who are experiencing menopause at one stage or the other.
And they also seem to be at a loss for answers.
I was sat here two days ago with a very, very successful woman who has all the resources in the world and this is someone that has all the answers.
People come to her because she has the answers.
And the one thing she doesn't seem to have answers on in her own words in her life at the moment is menopause.
She's rummaging around the internet, googling things, finding contradictory information.
And when you sat down, you had that same energy.
You feel like women have been, dare I say, let down by a system.
I think the medical system is letting them down.
I think society is letting them down.
Our value and our worth.
In medicine, I came through this wonderful training program.
I'm very proud of what I learned.
I'm very proud of the care that I gave except I was a horrible menopause provider for probably 15 years.
I knew what I knew.
I relied on my training and I didn't look outside of the traditional confines of training.
This is such a systemic problem that I'm going to tell you a story and this is true.
And it's embarrassing, but I think it needs to be said because I think it really highlights how women are treated in medicine.
When I was in training, we had these upper level residents.
We have a hierarchy where you have different years of training.
So I was in the early years, maybe my first year, and we had these clinics that we would run to take care of patients.
And so we have obstetrics and we have gynecology as divisions in our training.
In gynecology, everything gets lumped together, pediatrics, menopause.
We had no specific menopause clinic.
I maybe got six hours of lecture in a four year curriculum.
And so we'd have these women coming in in midlife and they had multiple complaints.
They didn't feel good, they weren't sleeping, they were gaining some weight.
They were aching. Just this laundry list of things that were a little on the vague side.
And my upper levels would say, oh gosh, good luck with that.
You've got a WW on your hands.
And that was code. We never wrote that in the chart.
This was not taught to me by faculty.
This was just kind of a handed down in the lure of training.
And a WW was a whiny woman.
And that was code. And now I know that she was perimenopausal, suffering from her list of symptoms of now which we've categorized about 70.
And they were frustrated because they didn't think they could help her.
Now remember the women's health initiative, which was a study that was supposed to do a lot of good for women.
It was originally designed, and it was stopped in 2002.
That was the end of my training program, was 2002.
So I come from one of the last groups of physicians in the US that were ever trained in hormone replacement therapy.
And then the rug was pulled out from under us.
So the WHO, there were mistakes.
There was misinformation in the reporting.
And there was misinterpretation of the results.
All of that has been walked back, re -looked at.
We know that for the vast majority of women, hormone replacement therapy is safe and effective and can give a woman her life back.
