Hormone Doctor: The Ultimate Guide to Perimenopause, Fertility, Birth Control, PCOS, & Menopause

[00:00:00]Today, you're going to get a master class with one of the most trusted medical experts in women's health today.

[00:00:07]Whether you're 25, 35, 65, heck, 85, this is your guide to understanding what's happening in your body. Dr. Sharon Malone is a boardcertified OBGYn and nationally recognized expert in menopause, permenopause, reproductive health. I'm getting so many listener questions about PCOS with polycystic ovarian syndrome. A lot of women will find that they have signs of what we say androgen excess. That sounds terrible.

[00:00:35]What is that? Acne, facial hair, weight gain, higher levels of insulin, irregular cycles. Those are all signs.

[00:00:43]What uh Dr. Malone are surprising reasons for infertility? thing about uh infertility that we don't talk enough about is that it's not just a meat problem. Upwards of 50% of infertility cases sometimes is male factor infertility.

[00:00:59]What's the connection between fertility and permenopause? Suppose you've talked to your mom and you find out, oh, my mom had an early menopause. She was menopausal at 42. Back it up. That means that for you, you might be permenopausal in your 30s, your early 30s. And when you think relatively speaking, I should be pretty good on the fertility front.

[00:01:21]>> Let's talk about menopause. What do you want women to really know and take seriously?

[00:01:28]>> Well, women who have more severe hot flashes and more frequent hot flashes, sometimes it is a marker for impending cardiac issues. Women need to understand that misery should not be your resting place. The most effective treatment is hormone or estrogen particularly for the symptoms of menopause. What the hell was I doing? Why didn't I start this sooner?

[00:01:54]Why didn't I start this sooner?

[00:01:58]>> Hey, it's Mel. And before we get into this episode, my team was showing me 57% of you who watch the Mel Robbins podcast here on YouTube are not subscribed yet.

[00:02:10]Could you do me a quick favor? Just hit subscribe so that you don't miss any of the episodes that we post here on YouTube. It lets me know you're enjoying the guests and the content that we're bringing you because I want to make sure you don't miss a thing. And I'm so glad you're here for this episode because this is a really good one. All right, let's dive in. Dr. Sharon Malone.

[00:02:29]Welcome to the Mel Robbins podcast.

[00:02:31]>> Well, thank you so much for having me.

[00:02:33]>> I am so thrilled that you're here. The team is buzzing and we have so many questions from our audience and we're going to go through them one by one. And I think one of the places that I would love to start is I would love to have you speak directly to the person that's here right now and explain a little bit about what might change in their life for the better or their health for the better if they take everything to heart that you're about to share with us. I think the most important thing that women should understand is that we are hormonal beings from the moment we start puberty to the day we our periods stop forever. And these hormonal changes and and undulations that happen affect every part of our body and they're not disconnected. Puberty is not disconnected from your reproductive years is not disconnected from pmenopause and menopause. It is one continuous story and that the sooner you know the story the better you're able to craft a better ending for you. Whether you're 20some, 30some or 60some, there will be something in this conversation that will apply to you. Whether you're a mother dealing with a daughter with indometriosis or struggling with infertility or you're a daughter and you're watching your mother age or worry about fractures as she gets older, there are multiple entry points into this conversation and I hope that we will hit them all and there will be something that we can all take away from it because we're all grown women.

[00:04:11]As I'm sitting here in this chair, you are going to share things that I will likely learn about my body for the first time. And it startles me how much I didn't know about menopause, pmenopause.

[00:04:24]It startles me as a mom of two daughters in their 20s, how much I don't even know how to explain to them about what's going on in their bodies. Why do you think there's so little education when it comes to women really understanding both the beauty and complexity and the very explainable things that are happening? Well, I think that we don't have the conversations. I mean, intergenerationally, we don't have the conversations. You barely got a period talk. And the period talk is not just about how to put in a tampon or how to use a pad. It is a fundamental change in a girl's body. She is transforming from a girl to a woman and all the things that sort of happen after that. Do we talk about cramps? Do we talk about PMS?

[00:05:18]No, we don't. Most of us are left to figure it out.

[00:05:21]>> And it starts there. uh we've gotten a little bit better about having the conversations about birth control and pregnancy, but really when you get into the phase of life when you need the most advice, you are having that same sort of total body transformation in pmenopause and menopause, no one warns you. You don't even know what the signs and symptoms are. And most women are just caught flatfooted on this. I I think it has a lot of historical basis for it and that women are taught that the things that our bodies do are either shameful or disgusting and so we don't have open conversations and it starts at the beginning and it goes all the way to the end. Well, what I also love that you just said is that it's this continuum and it is true. When I think about being 57 or I think about my daughters who are in their mid20s, it is almost like episode by episode. I'm having problems with my period now, so now I'll go get help. Or I am having trouble losing weight or sleeping or brain fog, so then I'm going to go get help. But we don't think I've never really kind of thought about it like what's the whole picture here and how do the dots connect from the very beginning when you get your period all the way through till the end of your life. And that's why you're here, Dr. Malone. And so I want to go decade by decade and really have you talk about that sort of continuum medically speaking related to women, hormones, health, and let's just start with your 20s, okay? One of the things that I've noticed, Dr. Malone is there has been a wave of women in their 20s who are going off birth control who have a lot of fear that birth control is dangerous or that birth control is making them infertile and they're now using natural methods and I would love to have you just unpack this for us. I would love to do that because that drives me absolutely insane when I see these posts and they're saying, "Oh my god, birth control pills. They're going to give you, you know, you're going to be depressed or you're going to have sexual dysfunction as a result of taking birth control pills." And I would say this to the young women out there, you don't understand. Birth control pills are probably one of the greatest modern inventions in the history of womankind because it is the first time that we have reliably reliably been able to control when and what time we choose to have our families and that is something that you know historically we've never had. So being able to decide when and where to have your children, major innovation. So anything that really sort of chips away at that notion or takes away options from for young women about being able to make that decision is problematic for me. And if birth control pills, if the only thing they did was control your fertility, that's enough. But birth control pills are quite helpful whether or not you have cramps or you have heavy periods or for women who even have PMS. Believe it or not, birth control pills help even out some of the hormonal fluctuation with PMS. So, you know, I don't want to give the impression that birth control pills are for everybody. Every medication, it has benefits, it has some risks. The risks are small, particularly for young women. And I don't want them to shy away from the most reliable, accessible birth control option because they're afraid of something or a post that they've seen on social media. And here's the other good news is that now we have other options. If you choose not to do birth control pills, that's fine.

[00:09:14]We have lots of other contraceptives for young women that are reliable, much more reliable than these natural methods.

[00:09:26]What are the other methods other than taking a birth control pill that as a medical doctor you say these are options that you should consider before you look at the quote natural methods?

[00:09:38]>> Well, one of the things that's really kind of gone by the wayside are diaphragms and condoms. Those are considered barrier contraception. Now, either one alone is about 80% effective, but together they're actually quite good. That's probably the least used options in young in young girls today.

[00:09:57]But let's not forget the sexually transmitted infection issue where condoms should always be a part of whatever that regimen is. So regardless of your birth control um that you choose. But we also have something that has been that is really taken hold with young women and that are that is what we call larks. That's long acting reversible contraception.

[00:10:19]>> What is that?

[00:10:20]>> IUDs. Oh, that's what I had.

[00:10:22]>> Yeah, that includes IUDs. You have either um you know a hormone releasing IUD or you can have a copper IUD that has no hormone in it. Um there's also injectables. You can use the depo provera which is shot every 3 months.

[00:10:36]And then there also the implants that young women can use that you put them in 3 years, change them out. So it takes the user error out of it with the larks because again birth control pills are only as good as the person the reliability of the person who's taking the pill but these sort of take the user error out of it and that's why they're a little bit more effective than the pill.

[00:11:00]So yes we have options. Um what are the medical benefits Dr. Malone of taking birth control? Like what are the positives? because you know I think if you're in your 20s or your 30s you do not remember a time when this was not something that was accessible to you and I saw this chart that tracked what happened in society when birth control safe birth control became a viable medical option for women to uh have so that you could control the most important decision that you may or may not make as a woman which is when you want to have a family and I found it incredibly striking. It is a hockey stick. I'm holding up a graph that shows that when birth control was first made widely available uh you know right around 1970 within a decade there was a statistically significant hockey stick spike in women who were able to enter college, complete college, enter law school, medical school because they were able to control when they had children. And so I would love for you, Dr. Malone, to just be very scientific about what are the medical benefits of birth control and then I want to get into what are the lies that are being spread about this important option for women that we need to know.

[00:12:33]>> Okay. Well, I think that the positives of birth control pills, one is that suppose you have really heavy periods and there are women who have very heavy debilitating periods and there's no structural problem. So, it's not like it's fibroids or something like that that you could fix. It decreases the amount of bleeding that women have every month. So, guess what? Not only is your life and your, you know, and your ability to do the things, you know, not impacted, but anemia is a problem for women who chronically bleed heavy. So, you're able to control your periods.

[00:13:10]They're lighter. They're more predictable. That's a big plus.

[00:13:15]>> Also, as I said, with PMS, some women have really severe PMS. And it happens, you know, because it happen happens reliably about a week or a few days before their periods. And what's happening in that case when you're in a natural cycle, your estrogen level goes up. It peaks around ovulation and then if you do not conceive, it starts to go down. And we think the trigger for some of the PMS is not the estrogen itself, but the falling estrogen that triggers it. The same is true for migraines. For people who get menstrual migraines, it's the falling hormones. So when you take birth control pills, you can sort of even out that precipitous decline that you get. So that's very helpful and it's also first line for even when they're suspected indometriosis or cramping and some people have very very painful periods and birth control pills do help with that as well.

[00:14:09]>> Do birth control pills cause infertility? No, they do not. You're not accelerating the aging. You're not doing anything deletarious to the ovary itself. Let's just say you start birth control pills when you're 20 and you take them until you're 35.

[00:14:25]because you're not ready to have a baby until you're 35. Well, your fertility at 35 when you stop taking the pills is not what it was at 20. So, if you're having difficulty conceiving at 35, it's not the 15 years of birth control pills that did it to you. It is the fact that you are 35. And that is something that we have to take into account. Your fertility changes decade by decade, but it's not the pills. And sometimes we blame the pills for things that really we shouldn't. But let me say I I think this is an important point to make is that some women do react negatively to birth control pills. I get it. I have two daughters. One it works fine on the other one not. I believe her. Um but we find an alternative for uh for women who do not tolerate birth control pills. And let's be clear, there are about 20 different birth control pill options out there. And you can play around.

[00:15:22]Sometimes is this is not the science of it, it's the art of it. You may react better to one particular progesterine that's in one pill and not to the other.

[00:15:31]So if you have a little patience, don't say, "I took birth control pills once when I was 20 and I had a bad reaction, so I can't take them ever again." That's not true either. It's just knowing that, you know, we've evolved. We have different pills. They're lower doses.

[00:15:47]There are a lot of tweaks we can make along the way that will make that option a more viable one for you. Well, I think a lot of young women are worried about falling fertility rates >> and are opting to go off this safe medication, right? Because they are reading online or they're being told by an influencer that birth control is responsible for falling fertility rates.

[00:16:16]And they're opting for quote natural birth control with the assumption that doing natural birth control somehow preserves your fertility for whenever it is that you think you're going to get pregnant. Is that what's happening when you use natural birth control that you're protecting your fertility? You are not. And let me say another thing. I went to Catholic school. This new iteration of natural birth control is really nothing more than modified rhythm method. And having gone to Catholic school, let me tell you, rhythm method doesn't work that well. There are a lot of kids in Catholic school and they were trying to follow the dictims of the Catholic Church and to be able to say, "Okay, yes, no birth control." And it just is unreliable. And I I think that um when you use catchphrases or words like natural, you automatically assume that it's better >> and there are a lot of things that are natural. Death and disease are natural, but we don't really want to go down that path either, do we? So, you have to watch what the agenda is. And I think you have to go a little bit deeper into why is there when we are in a time when we have the most reliable and varied birth control options available in the history of womankind, why are we regressing and going back to something that we know for a fact didn't really work that well to begin with?

[00:17:46]>> Well, and as a medical doctor, Dr. Malone, you're stating that it's not reliable. And I I I guess I'm hovering here because, you know, I really want to respect somebody's decision, >> right, >> to do what they want to do with their body. And if you are using a method, whether it's called rhythm or it's called pull out or it is tracking your cycle or you're using some app that is marketed to you as quote natural birth control, then what that tells me is you don't want a baby right now.

[00:18:15]>> Exactly. And if you're doing it because you think it's safer than a, you know, birth control pill because you have been told by people that it will ruin your fertility. You have been told a lie. Is that what you're saying, Dr. Malone? I am saying that. And to give you an idea of like is it safer? And I and I think that safer than what? Okay.

[00:18:39]Pregnancy is a very complicated and can be a very dangerous time in women's life. Just from a health point of view, a lot of what comes up about birth control pills, it's like, yeah, but it increases your risk of blood clots by two to two to three times over not being on birth control pills. Pregnancy increases your risk of blood clotting six times over what it would be if you if you were not pregnant. So again, you have to look at it in terms of, you know, relatively birth control pills are way uh safer and less delotterious to your health than being pregnant. And that's why it's so important that you choose the timing.

[00:19:18]And you know, Mel, just like you said earlier, you gave that graph about what happened to women, you know, and what uh professionally and educationally they were able to pursue after birth control. It is it is a stark line for the person that thinks that okay I've got a journal I have an app. I can track my cycle. I can take my temperature. Um I've got the smartwatch and the ring. Will that prevent me from getting pregnant?

[00:19:50]No, it won't. The circumstances that it works the best in are people that have extremely regular cycles. So if you say 28 days, I know where I am. My period's coming. I can feel it. I can feel ovulation. And there are people who feel that who say they do that. But what about if your period is 28 days this month, it's 31 the next month or your cycles are very irregular? Then all the temperature taking in the world is not going to help you prevent pregnancy.

[00:20:24]Because here's the thing about taking your temperature. your temperature goes up after you've ovulated, not before. So if you had sex yesterday and your temperature goes up today, oops, you know, that's a little that's a little too late for that information. So the cycle tracking is helpful in retrospect.

[00:20:42]You know, you do it and then you say, okay, 3 6 months, I see where it is and when ovulation may happen here. That's when it's helpful. Now we've progressed a little bit. We've got, you know, sticks you can pee on for ovulation.

[00:20:55]Those are way more helpful when you are trying to conceive than when you're trying to prevent pregnancy.

[00:21:03]>> And the amount of time that sperm will survive even before you've ovulated, it's like 72 hours.

[00:21:09]>> Wait, so if you're practicing the natural method and let's say your partner pulls out, if a little sneaks in there, it's going to live in there for 3 days.

[00:21:20]>> Yeah. Up to 72 hours. And so you're you're like, I'm good. I didn't ovulate today. Hey, well, what about tomorrow or the next day >> or the next day?

[00:21:28]>> Or the next day. So, that's why I said it's not as reliable. And I I I just want women to be able to make good choices.

[00:21:37]>> Make choices based on evidence, science, not fear. So, Dr. Malone. Um, if someone's listening right now >> Mhm.

[00:21:48]>> and they've been uh using the natural quote method and uh they're now thinking, "Wait a minute. I don't want to get pregnant right now. Wait a minute. Uh, the options that have been around for 60 years are medically safe and reliable. Wait a minute. Uh, they're not going to impact fertility. What are the top three things you would recommend to the person who's now thinking maybe I should consider the IUD? Maybe I should take a like what would you think about the time frame that you you know that you're trying to not get pregnant in? If you say absolutely I don't want to have a baby for 5 years then I think the larks or the IUDs or the implants are fantastic because again the margin error is so small because it's not like oh I forgot to take my pill but if you say I want I don't want to get pregnant now but maybe within the year then it doesn't make sense to get a long acting reversible contraceptive because they you can leave them in place for years. That's a situation where maybe a birth control pill may be useful. Um, but again, what are the consequences? This is also I think is really important. What are the consequences of you getting pregnant inadvertently? If you say, well, I want to get pregnant in a year, but if I got pregnant in 6 months, be like, oh, well, not what I planned, but it's okay.

[00:23:18]versus if I I am in the middle of finishing or defending my dissertation or I've got, you know, a trip planned to Antarctica.

[00:23:29]I mean, >> or I'm living paycheck to paycheck and I can barely take care of myself.

[00:23:33]>> What are the consequences? How, you know, what how would that affect my life if it happened? Not just if it, you know, what would happen if I did, what would happen if I didn't, how would my life be changed by that? And I think that central question will determine which one you choose and when. And how quickly could you get pregnant after you stop taking the pill? With the first time you ovulate, which is usually most women who have regular cycles will get another cycle, usually within a month or a month and a half of having stopped the pills. So, it's pretty quick. All you need to do is ovulate.

[00:24:12]PCOS has recently been uh renamed to PMOS and I'm getting so many listener questions about PCOS. Could you explain what this is? I happen to have a daughter that was diagnosed with this in her late teens. Um but there's a lot of misinformation and this is a really important thing that impacts a lot of women.

[00:24:37]>> I have thoughts on this, Mel. You know, um I'm not surprised, Dr. alone. But PCOS, I'll give you just a little bit of the the history of PCOS. PCOS is polycystic ovarian syndrome. Um before it was polycystic ovarian syndrome, it was polycystic ovarian disease.

[00:24:55]>> So we changed the name from disease to syndrome because disease makes yeah sounds terrible. So that was the first name change and then now we've gone from polycystic ovarian syndrome to polyindocrine metabolic syndrome.

[00:25:13]>> Okay.

[00:25:14]>> Ovarian syndrome. POS is what it is.

[00:25:17]Okay. Well, that's great. We've changed the name. Have we changed the diagnostic criteria for for PCOS? No, we haven't.

[00:25:25]It's the exact same things. The how I would make the diagnosis today is the same way I would have made the diagnosis 20 years ago. We just changed the name.

[00:25:33]>> Dr. Mullen, what are the symptoms that somebody who has PMOS or PCOS?

[00:25:38]>> PCOS. Okay. Generally speaking, that I think what get people derailed is when you say polycystic ovarian syndrome that means poly just means many. You've got normally in the course of a of a menstrual cycle, you know, you'll start recruiting eggs, one will take over and you'll ovulate from one egg. Well, with polycystic ovarian syndrome, you don't really ovulate regularly. So, they get the signal, okay, but no one takes over and it's not just one uh egg that ovulates. So, you get this sort of chronic overproduction of estrogen.

[00:26:16]Um, you also because you don't ovulate, you also don't get that second half hormone which is your progesterone that you kick in the second half. And so it makes your cycles irregular. They're irregular maybe once every 3 months and maybe once a year. So irregularity of cycles is usually the first point. The second point is that there are also other things going on. A lot of women will find that they have signs of what we say androgen excess. That just means that your ovaries are also making testosterone. They make more than just estrogen and progesterone. They make testosterone.

[00:26:54]>> And so when you don't ovulate, you get this sort of chronic overp production of testosterone. And what happens when you get a lot of testosterone? You >> grow hair.

[00:27:03]>> Acne acne.

[00:27:04]>> Acne facial hair. You know, you'll get uh women will find that they start to get chin hair or hair around the nipples. So there's a sort of a more of a a male pattern hair h growth. It can also lead because you've got that it can also lead to hair loss.

[00:27:23]But the the endocrine part of it is that we've also realized that it's not just again it's never just the ovaries. There are other organ systems that are affected and the endocrine part is there's an overp production of insulin.

[00:27:38]So there's a degree of insulin resistance because you're not responding to the insulin. So you're you're overshoot it and you're making too much insulin, you know. So acne, weight gain, higher levels of insulin, irregular cycles, those are all sign those criteria basically the same. And I think that when you get caught up on the polycystic part of it, you think you're going to do an ultrasound and see instead of seeing one follicle, you're going to see 20 little ones.

[00:28:10]>> Well, you don't see it. And you don't always that's not an integral part of making the diagnosis. So, we've made a lot of progress in terms of changing the name, >> but you know where we haven't made a lot of progress?

[00:28:24]finding out why it happens and having new treatments for how to how to deal with it. That's where the attention needs to be focused. So when I say I have thoughts, it's like yeah, great.

[00:28:36]I'm glad you changed the name, but we need to focus on okay now what are we going to do about it? We need more research. It almost sounds like it's a hormone balance imbalance that is just wreaking havoc on your body, your menstrual cycle, your ovaries, other organs, insulin, sort of like menopause does.

[00:28:57]>> Yeah.

[00:28:57]>> You know, you write about uh endometriosis in your best-selling book, and I was really surprised to hear that it affects one in 10 women, and it's also one of the leading causes of painful periods and infertility.

[00:29:13]Can you explain what endometriosis is and what are the symptoms?

[00:29:18]>> Yes, endometriosis is simply that same tissue that lines the uterine cavity.

[00:29:25]This the tissue that gets stimulated every month with estrogen before you ovulate and sloughs every month if you don't conceive during that cycle. That's indometrial tissue, which is why it's called indometriosis. Well, it belongs in the lining of your uterus, but for reasons that we don't really know why, it can migrate or spontaneously generate in places where it doesn't belong. So, it can be in your it can be on your ovaries, it can be the lining of your abdominal cavity, it can be on your bladder, it can be on your bowel, anywhere, but it's just not supposed to be there. We don't know how it got there. There are a lot of theories, but it's there. And so those same hormonal um triggers that you are getting every month to tell the lining of your uterus to grow and shed is happening. Remember it's talking to the that indometrial implant that's on your bladder and it's doing the same thing. And chronically it can lead to scarring because remember when you get your period you're sloughing that tissue out. Well, what happens? It has nowhere to go. So it's there and that chronic inflammation really can cause pain, >> scarring and in the worst cases infertility and as I said a lot of a lot of women walk around I think it is probably uh more underdiagnosed than PCOS because when you say one of the signs is painful periods. Well, do you know how many women walk around with painful periods and they just figure, well, I'll just take, you know, I'll take more Motrin or I'll do something else or I just assume that that's normal. Now the the other thing about indometriosis is that it's called really the great masquerader because suppose you have it it's on your bowel and your symptoms may be oh I have you know really bad diarrhea or bowel issues or sometimes even on your bladder. So it is causing the problems where it lands. uh if you have really bad indometriosis, the scarring can make sex unbearable >> for women. So, you know, again, you need to have someone to talk to who says, you know, yeah, I kind of see the pattern here. But women are often treated individually for their symptoms. So, you've got bowel symptoms, you go see a GI doctor. Oh, you have a bladder thing, you go see, you know, a urologist. And not really understanding that it all goes together. And that's why it's a delay in diagnosis for most women. The delay in diagnosis is 7 to n years before they're adequately diagnosed and treated for their endometriosis.

[00:32:13]>> Yeah, it's a long time. Women with indometriosis have had multiple multiple trips to the doctor. It's not like they were not complaining about it. It's just that being able to make the diagnosis and and as physicians, we like objective data. We like to be able to do some lab work and see it or do an ultrasound and see it or a CT. Yeah. And the problem with indometriosis, the reason why a lot of times it's not visualized on a scan is because the little spots of indometriosis will be so small that they're below the resolution of whatever you're trying to do to to look at it. So you don't see you can't see it on a scan. Well, then how do you diagnose it?

[00:32:56]Well, you can you have the clinical uh presentation, but sometimes if you're really concerned, you need to do a laparoscopy, which is that's where you just take a look, go through a scope and look in there, and you see it >> and that's how you can definitively make the diagnosis. The one thing that the laparoscopy will allow you to do is that if you see it, in addition to being able to treat it medically, if I see indometriosis, I can go in with my laser and I can zap it and and correct the things that I see, then do the medical treatment afterward. That is so helpful.

[00:33:34]Um, since you also said that indometriosis is one of the big causes of infertility, um, let's just talk more about fertility. What do you want women in their 20s and 30s to understand about how fertility changes as you age?

[00:33:54]>> Well, your peak fertility years are really in your 20s, probably in your late teens to through your 20s. And then when you get into your early 30s, it's a little different, but it's not marketkedly different. You know, then what's the difference between 32 and 28?

[00:34:11]Probably not that much. But once you get to about 35, 36, then we start to see some of the more of the age related fertility decline. um our fertility is declining but it's more rapid once you get to your mid30s to the point where by the time you get to your early 40s then it's even lower I mean you know the likelihood that you will conceive at 40 is way less than what it would be if you try to conceive at 20 so we have two things we have number of eggs and that's more of an issue when you're 50 but when you are in that window of declining fertility like between 35 and your 40s.

[00:34:51]There's also uh another component that we don't think of that some of it's genetic, some of it's environmental, and that is your eggs have an expiration date stamped on them. So, you don't know when yours is. It is helpful to know your family history. That's why I encourage young women. I said, "Please talk to your mother. Ask your mother, mom, did you have trouble conceiving?

[00:35:17]How old were you when you had your last baby? When did you stop using birth control? That tells you a lot of things.

[00:35:24]It tells you, you know, knowing your family history about endometriosis, about fibroids, about infertility is important. It helps you be proactive going forward. It helps you perhaps make a decision. Maybe I won't have my first baby at 37. Maybe I'll have it at 34.

[00:35:41]It's kind of I say it's data and you do with that data what you what you will.

[00:35:47]Does freezing your eggs impact the expiration date?

[00:35:50]>> No, it does not. Remember, I told you your peak fertility years are in your 20s. So, if you were going to freeze eggs, if I were just saying theoretically, when when would I get the best yield from egg egg freezing and retrieval?

[00:36:05]It'd be in your 20s. But the flip side of that is, well, what's the likelihood that I would ever come back for those eggs? Because if you're in your 20s, you've got a whole life in front of you, you know? So, you meet someone at 30 and you get married and you get pregnant. If you get pregnant on your own, are you ever coming back for those eggs that you've spent tens of thousand dollars for? So, even though the the yield is better, the likelihood that you will ever need them goes down. Got it?

[00:36:33]>> So, I think the sweet spot is somewhere probably late 20s, early 30s for freezing. But let me be clear about egg freezing. Egg freezing gives you the possibility of pregnancy.

[00:36:48]It does not guarantee anything.

[00:36:52]>> That makes a lot of sense.

[00:36:53]>> Yeah. What uh Dr. Malone are surprising reasons for infertility?

[00:36:57]>> I think the most surprising and frustrating one is unexplained infertility.

[00:37:04]Now, we do a whole workup. You know, we've done an ultrasound and we looked at the lining of the uterus and we know your tubes are open, all of that. And sometimes every single thing checks off on the list. You're good. Your spouse or your partner is good and you're still not pregnant. That I think is is probably more frustrating to people than saying, "Oh, I have fibroids or I had a pileup or my tubes were blocked."

[00:37:29]Because everybody likes to have a reason. And I think that's frustrating.

[00:37:34]I think the other thing about infertility that we don't talk enough about is that it's not just a me problem, it's a US problem. And upwards of 50% of um uh infertility cases sometimes is male factor infertility.

[00:37:49]50%. Yeah, women get blamed, but you know, it's like it may not be me, maybe you. Um and but again but their answers even for how did that that's what you know IVF is for that's what what's something called Ixie when you have male factor infertility then that's just intracytoplasmic sperm injection Ixie you see why we say ixie.

[00:38:14]>> Yes I do.

[00:38:15]>> Yeah.

[00:38:16]>> But that all you're doing is now you're just giving that sperm some you're like I know you're not going to get there on your own so I'll just directly put it into the egg. That's >> you're giving it pre-workout basically.

[00:38:26]>> No, you're just going ahead giving it a whole head start. Um, but that's helpful and that has helped a lot of couples.

[00:38:33]So, it's not just like, oh, poor me. You know, the more you know, >> the better choices you were able to make. And I would also say to young women who are thinking about, you know, where they are in their careers and should I do it now? Should I do it two years from now? The other important point to make here is that freezing embryos, which is what we do in IVF, where you've already got a known egg and a known sperm, and then we freeze them and come back for them later, that's more successful than egg freezing.

[00:39:06]>> H the procedure is the same. We still have to you have to take all the same medications for IVF that you would for an egg retrieval.

[00:39:15]You're retrieving eggs. That part of the procedure is the same. The only thing is like what are you doing after you've retrieved the eggs? Are we fertilizing them now or are we freezing the eggs?

[00:39:25]And fertilizing them now with a known partner is always the better option if you have a known partner.

[00:39:33]>> Dr. Merlin, what's the connection between fertility and pmenopause?

[00:39:38]>> Oh, well, they go together and it's a age related thing. Now, here's the connection that I think a lot of people don't understand. Remember I told you there's a natural age decline in your fertility, right? Associated with age.

[00:39:50]Well, suppose I tell you, we'll do a little thought experiment here. We say the average age is 51 for having gone through menopause. Completed end of discussion. Shop is closed. Oh, nothing's happening there, right? No ovaries. Yep. No, no estrogen from those ovaries. 51. Well, pmenopause, that window, that long span between your peak reproductive years and the end of your reproductive years, okay? It can be 4 to 10 years. So, if I tell you you're menopausal at 50, all right, then permenopause can start as early as 40 and then it takes you 10 years to go through that process. And there is also diminished um ability to conceive because again now you're 40some in addition to these hormones are changing. But suppose you're menopausal. You've talked to your mom and you find out oh my mom had an early menopause. She was menopausal at 42.

[00:40:52]Back it up 4 to 10 years. That means that for you you might be permenopausal in your 30s, your early 30s. when you think relatively speaking I should be pretty good on the fertility front >> but you don't you can't predict where you are in that spectrum necessarily. So that's why I say it's important to know your family history.

[00:41:13]>> So you can say all right mom well I did not know mom that you were menopausal at 40. Then that you know it's not a onetoone but it is a very important data point if you're the daughter. If you're listening and you have not talked to your mom or your grandmother, she's still here. What are the questions you want every daughter to ask their mother?

[00:41:38]You want to know all about their um their medical history, but particularly you want to know about things. Mom, did you have cramps? That's a sign. Did you have these painful, awful periods that could be indicative of indometriosis?

[00:41:54]Because we know that daughters of women with endometriosis have a higher incidence of indometriosis. You want to know about whether or not your mom had fibroids. You want to know because again that increases your risk of having fibroids at some point in your reproductive life. You want to know what age she was when she conceived. Was it difficult? And you also want to know what was your pregnancy like?

[00:42:19]Because again, these are very very important points that may affect your history whether they do or do not. It it makes you aware such that if any of those things come up for you, you don't wait two or three years to go get that diagnosed. You mentioned that to your doctor, by the way. Oh yes, my mother had indometriosis. Well, guess what?

[00:42:40]That's going to help me make get to the diagnosis point with you sooner than if you don't know that. So even just knowing makes you recognize that, okay, this is something I need to pay attention to, which is really important.

[00:42:52]If you've gotten a diagnosis of PCOS or POS earlier in your life, will that potentially impact your fertility as well? It may because in PCOS, as I told you, the treatment depends on what your what's your goal. And if you have PCOS and you're trying to get pregnant, you may ovulate irregularly and you don't know when that is. So you may going to ovulate 3 months from now. So when you're trying to get pregnant and that's a very different situation than for someone who has a period once a year, your opportunities for pregnancy are less. You know, for someone who has a monthly cycle, well, at least you have the o opportunity every month. For someone who has PCOS, maybe you ovulate three times a year. So yes, that affects your fertility, but we do have medications that we can induce ovulation with. Let's talk about menopause. Um, what is it really? And Dr. Malone, what do you want women to really know and take seriously when this change starts to happen in your body?

[00:44:00]What I want women to understand is this is that menopause is not an event. It is a life stage. You will spend 30 to 40% of your life after you have completed menopause. You will spend more time in menopause than you did in your reproductive years. It is probably if you're lucky enough and you don't get hit by a car, that will be the longest uh of your reproductive phases that you were in. That's why I don't like the term postmenopause because when you say post-menopausal, and I get it why we say it that way, but I don't want you to think of it that way, is because that gives the impression that you're over menopause.

[00:44:42]>> Yes.

[00:44:43]>> And you're not. You're never over menopause. The effects of the lack of estrogen and hormones in your body will affect you from that point forward. your bones, your brain, your skin, your hair, all of it. So I that's why I said I don't want people to go, "Oh, I'm over it." And you know what they mean when they say, "I'm over menopause." They're usually they're saying that their hot flashes went away. And menopause is so much more than a hot flash. I mean, that's the least of the things. But hot flashes are often harbingers of things to come. Wait, hold on a second. because I harbingers of things to come sound like the orcs are rattling over the mountain. And I do have a question here.

[00:45:27]Why do I still have hot flashes at 58? I haven't had my period in over 2 years.

[00:45:33]So, if you're still having hot flashes, what is this a signal of things to come, Dr. Malone? Well, women who have more severe hot flashes and more frequent hot flashes, sometimes it is a marker for impending cardiac issues because what happens to women who have a lot of hot flashes and who has the most hot flashes? Black women do. They have hot flashes that are more severe, they last longer, and they start earlier. M >> so you know when I told you per menopause is 4 to 10 years if you're an African-American woman in this country is closer to 10 years so you are most symptomatic during permenopause so all the time you may be still getting your period that's the worst I'm getting my period and hot flashes but it can happen and then there's also about 20% of women whose hot flashes will continue into their 60s7s and beyond Dr. I'm alone.

[00:46:30]Don't be telling me this. Really?

[00:46:32]>> I'm Yes.

[00:46:33]>> Why?

[00:46:34]>> See, who knows why.

[00:46:36]>> Do you think there's a connection with stress? Like if Well, like when I hear the stat that you said about black women having uh more severe hot flashes, it's starting earlier, lasting longer. What came into my mind was the statistic that um Dr. Gabbor Mate shared on this episode about autoimmune diseases and the 4x rise of them in the last 20 years. And it was his theory, and I know there's a lot of research around this, that chronic stress and chronic caregiving and micro traumas and aggression and bias, >> um, that black women deal with that, you know, I don't have to deal with because I'm not being discriminated against in microaggressions every day.

[00:47:24]>> That that chronic stress creates conditions in your body that impact your immune system. Do you think that that is contributing to these symptoms? I think it is a big factor because I think that the the reason why black women tend to experience these symptoms more and this would be true of any chronic diseases not just permenopause and menopause >> is that >> chronic stress is toxic to whether you're talking about weight gain whether you're talking about your cancer risk it accelerates the aging process even for Alzheimer's or dementia People who have chronic stress, all of this, tend to higher risk. And who has higher risk of stress if anything? Black women.

[00:48:12]We have twice the the risk of dementia than white women. I did not know that until I wrote the book. Um because I was like, "Wow, I never knew that. I never knew that women had twice the risk of of Alzheimer's or dementia than men."

[00:48:28]So it's clearly something that's happening and it starts somewhere in our midlife.

[00:48:33]>> But getting back to the hot flash and the connection to chronic disease, >> the hot flash is women who have higher, you know, a higher incidence of hot flashes. This is what we know.

[00:48:45]>> Women who have hot flashes have night sweats. People who have night sweats have disrupted sleep. We know that disrupted sleep is a risk factor for cardiovascular disease. We know that women who have disrupted sleep are more likely to have hypertension. Women who have disrupted sleep are more likely to develop type 2 diabetes because it leads to when your sleep is disrupted for months, years on in chronic fatigue. If you've got you're chronically fatigued, guess what you're not going to do the next day? You're certainly not going to go to the gym. You're not going to get up in the morning like, I think I'm going to go on a three- mile run. So that's why I said a hot flash is often the inciting event for a lot of other things and behaviors that will increase your risk for heart disease as you age.

[00:49:35]I would love to hover just a little longer on the hot flashes and maybe it's selfish because this was something that was chronic for probably seven years for me. Mhm. Like >> I would wake up and the entire side of my bed, it was almost as if somebody had thrown a bucket of water under me and they've mitigated thanks to HRT.

[00:49:59]>> What would you say, Dr. Malone, are the thing like the top three things you want someone to be aware of that you should be checking out to mitigate this?

[00:50:11]>> One, I would say this. Know that hot flashes are not benign. That's what we've been socialized to believe. That suffering, pain, misery, they're just part of womanhood. So, we should just grin and bear it. And don't worry, close your eyes. It'll be over in a decade or so. That's ridiculous to me. And I do this all the time because, you know, now people have these little portable fans that they walk around with.

[00:50:40]>> I had one. And I will see a portable fan and I will just walk up to somebody and say, "Girl, you know we have something for that, don't you?" We don't we don't have to walk around with a fan. Fix it.

[00:50:53]Do it. I mean, and >> what do I do?

[00:50:55]>> It's hormone therapy. I mean the most effective treatment FDA approved is is hormone or estrogen particularly for the symptoms of menopause vasom motor symptoms or hot flashes. It works but it's the fear factor that keeps women away from the most effective treatment for the symptoms of menopause.

[00:51:21]You know what's interesting is it's happening to women in their 20s because there's so much misinformation and lies being spread about birth control, >> right?

[00:51:30]>> Which in many cases is low doses of estrogen.

[00:51:33]>> Yes.

[00:51:33]>> And the same thing is happening to women in our 40s and 50s when it comes to the misinformation and lies related to hormone replacement therapy, which is not only safe for the vast majority of women, but it is shockingly effective.

[00:51:48]Like I remember this when I started hormone replacement therapy. It took about five weeks and all of a sudden I thought, "Oh my god, I I like I I feel like myself."

[00:52:02]>> Yeah. I What the hell was I doing? Why didn't I start this sooner?

[00:52:06]>> Why didn't I start this sooner? And and there's a there's really even more of a medical benefit for starting sooner because the sooner you start and treat those symptoms, the more benefit you get in the long term.

[00:52:19]>> What do you mean?

[00:52:20]>> I mean, in terms of your cardiovascular risk, in terms of weight gain, in terms of being able to sleep, all of those things. Permenopause does not have a bright line that defines it the way menopause has a bright line that says when you're done.

[00:52:35]>> Okay?

[00:52:36]But when to start treatment, when to use hormone therapy in some form or fashion in pmenopause, again depends on what your treatment goals are, and it depends on how bothered you are by your symptoms. And that is what I want women to understand. If you're between the ages of 35 and 45, which is usually about the time that perry menopause or the menopausal transition starts, you seek treatment when you are bothered by your symptoms. Like I wish I had known you like 5 years ago.

[00:53:09]>> Yeah. Because when I think about how revelatory it is to me that I didn't even consider the age range of 35 to 45 and that there's no benefit to waiting until you're suffering. And if you just don't feel like yourself, the world is hard enough, >> right? And if this is something that can help you feel like yourself again, it's going to make you feel better equipped to handle what's going on in your life instead of like because what ends up happening is you describe any of those symptoms. I can't really sleep. Like something's wrong. I'm gaining weight. I don't know what's going on. Oh, here's a here's an SSRI. You might be depressed, >> right? Here's a sleeping pill. Good night.

[00:53:50]>> Yes. versus >> this is clearly something going on with hormones cuz women's entire life in fact when we did a poll online have you ever felt like your hormones are affecting your mood, energy, sleep, weight or cycle? N 98% yes. See, they could have just asked women. We would have told you you know I think the the reason why women tend to wait there are probably two reasons. One is they don't realize that this is all part of uh of pmenopause and the menopausal transition. And the the second thing is that we have been laboring women have been laboring under the misconception for a very long time that they can only take hormone therapy for for a small amount of time because the direction once was we'll take the smallest amount for the least amount of time possible.

[00:54:42]That's not true. You can start getting treated when you're symptomatic. You can take it for as long as you like. There is no time limit on how long you can take hormone therapy. Now, bear in mind there may be some subtle differences in terms of how we prescribe in pmenopause and how we prescribe in menopause because you remember sometimes we have different mission. Your permenopausal, remember I told you your fertility is decreased. It's not gone. So, do you need birth control or no? The bad PR campaign that's going on about birth control pills in 20somes is also happening about people sort of really disparaging the use of birth control pills in perry menopause.

[00:55:28]So, women need to understand that misery should not be your resting place. Lord knows there's enough of that in the world that you cannot control. But for things like this when you are feeling out of control, why wouldn't you fix that? I don't get it. I love that you're reminding us that you don't need things to get worse before you can start feeling better.

[00:55:57]>> And that there are such safe, effective, and almost immediate things. I love my patch so much I will be wearing it on my deathbed. like I am not ever spending any time without that sticker on my body because it has made such a difference and in fact you know it has been on the headlines that there's a shortage of estrogen patches what is going on Dr. Malone and what should you do if that's affecting you?

[00:56:22]>> Women are waking up.

[00:56:23]>> I know. I mean, I'm I'm delighted because it means that there's more demand for it. And I think what is distressing to me is that you didn't see this coming. I mean, when I tell you I have personally been out here in this space talking about menopause publicly for over 5 years.

[00:56:43]I've been talking about it privately for 35 years. So the notion that now that women are aware, that's the only difference, that more women are aware, we've knocked down a lot of the misconceptions about breast cancer and all the bad negative press about HRT.

[00:57:01]Could you not have seen Can you like read the room here that there was going to be more demand for hormone therapy?

[00:57:10]Well, you know, again, I I think that there's not a lot of attention being paid to women's health, but that's another issue. But the point is is that the estrogen patch is not your only option.

[00:57:25]Systemic estrogen falls into two categories. Um there's transermal of which the patch is transermal, just means it just goes through the skin. So if you're out of patches, if you want to say, "Oh, but I really want to stay with the transermal," you can use a spray, you can use a gel. Those are readily available. And even different does doses of the patch are available. So I don't think anyone needs to panic because you can't find a patch.

[00:57:53]We have options. Then there's also oral, you know, um, and again, oral um, hormone therapy gets maligned as if that's something terrible. It's like you can use oral. Most of the information and the data that we have on the benefits, all of the things about hormone therapy really comes from the data that we have on oral. I really just appreciate that you are explaining this in a way that's easy to understand with a level of depth that doesn't make me feel like an idiot for really going either I've never heard it that way or I actually understand it at a deeper level. And one of the topics that I recently feel like, oh wait, I never really understood that there's a difference between HRT and what vaginal estrogen might do. And it was after learning about the benefits of vaginal estrogen for UTI, for overall health in your sexual health that I started taking vaginal estrogen as a supplement.

[00:59:01]>> Mhm.

[00:59:02]>> I can't believe the difference. And so, could you explain, Dr. Malone, what the vaginal estrogen supplement is for?

[00:59:14]how it relates to HRT and how you want women to think about this especially as we get older. Right.

[00:59:25]That's that's an excellent point because you know sometimes it gets all mushed in together. But when I'm talking about HRT, generally we're talking about systemic, which means that you are using estrogen and a progesterrogen of some type at a level that again controls the symptoms, hot flashes, the mood swings, all the brain fog that we typically associate with per menopause and menopause. So we're taking estrogen at a level that will take care of those symptoms. Okay? So you can do it orally, you can do it transermally as a patch, but it is going it says systemic because it is going throughout your body, your blood.

[01:00:04]>> Got it.

[01:00:05]>> Okay.

[01:00:06]Topical or vaginal estrogen is used just locally. You put it in your vagina and it and you can use it even on the outside on the on the vulva on the labia on the labia m basically because it is addressing the genital urinary syndrome of menopause or GSM. That's vaginal dryness, painful sex, urinary frequency, urgency, and frequent urinary tract infections. You can treat that using local topical vaginal estrogen, and it will take care of those symptoms, but it basically stays where you put it, okay?

[01:00:43]It's not going anywhere. And so, you don't it's not enough in vaginal estrogen. If you have hot flashes and you're using vaginal estrogen, you'll still have hot flashes. You'll still have sleep >> because it's not systemic. It's not going through your whole body.

[01:00:55]>> It's like a pimple patch. You're like putting it here, but it's not in your whole body.

[01:00:59]>> You put it where you want it to work.

[01:01:00]>> Got it?

[01:01:01]>> Okay. And the same is true of like topical estrogen that you use for your face. Remember, one of the things that happens in menopause with estrogen depletion, you lose 30% of your collagen in your skin in the first 5 years of menopause. So, what we know is that the skin has estrogen receptors. your vagina, your vulva has estrogen receptors in it. So, you can use it at a level that increases the hydration, collagen formation. Again, we've known this for quite some time, but again, it's not enough to treat your other symptoms. So, that's why even women who are on systemic hormone therapy may still need to use a little bit of extra vaginal estrogen. Wow. Uh Dr. Dr. Malone, talk to us about the importance of muscle loss and uh bone health and strength.

[01:01:55]>> That is so important because one of the things that happens in menopause is you start this cycle of bone loss because remember estrogen affects everything your skin, your muscles, your bones.

[01:02:08]>> So that starts in menopause. that start really starts in in late permenopause and certainly continues through menopause at a more rapid clip once you are finally done with menopause you tend to lose muscle you lose bone and you gain fat so that even when you are weight neutral in menopause you are still changing your body composition which means that's why is it's like wait a minute why do I all of a sudden have this weight around the middle why why do I have this spare tire it is because the the lack of estrogen causes this sort of redistribution of body fat and loss of muscle. So now if you go through the next 20 years and you're losing muscle and you're losing bone, well now you're more susceptible to osteoporosis.

[01:02:58]Why is that important? Because then you're more likely to fracture a bone.

[01:03:03]Be it your spine, be it your hip or wrist. Your bones are thinner and more fragile. Now, this is where it's a it's a dangerous combo. If you are not careful and mindful of your muscle mass, now you're weaker.

[01:03:19]>> So, now you've got less muscle, less bone. What happens if you trip and fall?

[01:03:25]You're weak. You've got no cushioning.

[01:03:27]You're doing whatever. So, when you go down, you go down like a tree and you break things. And that is really why I think our goals as we age, yes, we do hormone replacement therapy because hormone replacement therapy or the estrogen component is the only medication that we have that prevents osteoporosis.

[01:03:48]>> Wait, estrogen is the only thing that we have that can prevent osteoporosis.

[01:03:53]Estrogen and the hormone replacement therapy that you take has an FDA indication for the prevention of osteoporosis. So if you are at risk for osteoporosis, aren't we all?

[01:04:07]>> Well, not everybody. Not everybody's going to break something. I mean, it just depends. And see, there's a genetic component that you bring to it. I have, you know, bone density because great bone density because I'm a bigger person and I have but it's dependent on your exercise level that you have growing up.

[01:04:25]How did you how much bone did you form in the first place? Some of it's genetics. Some of it's you from your activity. How much calcium were you a milk drinker as a kid? That's why your mom always says drink your milk. Um whether or not you've had enough calcium and vitamin D to actually create that bone. and then whether you've been able to maintain it. And exercise matters, not just cardiovascular exercise, but that's where the weight training comes in because your bones will respond to whatever load you give it. So, the more stress you put on it, the better your muscles are, the more weightbearing you can do, you tend to preserve more of your bone mass. So, that's where you enter menopause. But regardless of where you start, you're going to start to lose it after menopause. And if your bone density is really high, it may take me 35 or 40 years to get to the fracture point. But if you start really low, you're going to get there sooner. If you're already losing bone density, >> maybe you have a diagnosis or not, >> maybe you just feel frail or like nervous about it. Will weight training pause what's happening? Will it help you regrow? Well, here's the thing about most bone loss. Most of it, uh, when it happens, >> you very rarely get back to where you started. So, once you're coming in 10 years after the fact, you may be able to sort of slow the train down a little bit, but for the most part, what's lost is lost. You can maintain your bone density.

[01:05:57]>> Okay. And H and estrogen and resistance training, building muscle helps you.

[01:06:02]>> Yes. the estrogen. I'll give you an example where I think it will be helpful for women to know. Right now, the current recommendation for um getting a bone density is they said recommendation is do it at 65.

[01:06:17]>> Why would you do it that late? Isn't that a good question? Why would you wait? Remember I told you the most rapid phase of bone loss happens in the first 5 years after menopause.

[01:06:28]By the time you get it at 65, you've already lost. That's 15 years of bone loss that you're not going to be able to recoup. It makes more sense to me. And what I would advise my patients to do is that once you get to menopause, you don't need to do a bone density when you're 30, you know, but once you get to menopause, say, "Let's do a snapshot right now and see what my bone density is. It's going to be good, not so good, or maybe it's fantastic."

[01:06:56]If it's not so good, that doesn't necessarily mean that also doesn't mean that you're going to fracture. But I would be more aggressive in terms of saying, "All right, well, what we can do to prevent you losing further bone is to do hormone therapy at that point."

[01:07:11]>> Got it? You see?

[01:07:12]>> Yes, I do see.

[01:07:13]>> And if I wanted to do and if I wanted to say, "Oh, I don't know if I want to do it," then I would do it once at menopause. And I'd say, "Let's do it at 18 months to two years later."

[01:07:21]>> And see if you're declining. If it's declining then now I can make the case to you that see what's happening and then you might want to reconsider at that point even if you are in a place where all right we blew it and I now am in osteoporosis or I am losing bone density.

[01:07:44]>> Mhm. How would weight training or building up your muscles, >> how would that protect you and impact your health positively? In that case, your muscles help um protect and support your bones. I think we kind of think of our bones as once you've grown to adult height and whatever and your bones are just your bones. Your bones are constantly remodeling. they're being broken down and they're building up and they will build and break down depending upon the stress that you put upon them.

[01:08:16]So if you're exercising, if you're doing weightbearing exercise, you will have you will build stronger bone in the earlier phases than someone who does nothing. I think about this a lot as being an older person and on the road and traveling all the time. And it's like I need to be able to put that carry-on in that overhead compartment here. And you know, that's a matter of just being able to know that I have enough upper upper body strength to be able to lift. I need to know that if I trip that I'm not going to go down like a tree. You have some core strength to be able to to sort of prevent you going down like that. I mean, think about that. If you if you were 20 years old and you tripped on the sidewalk out front, you are very unlikely to break your hip. Correct. Because one, you know how you can break a fall, you can do all these things, reaction time, all this stuff as you're older, not there. And your bones are more fragile. So that's why you need strong bones and strong muscles.

[01:09:20]>> Got to have core strength for maintaining your balance.

[01:09:24]>> Wow. This is so so good. You're so smart. and you have such a incredible way of explaining this and I hear both the passion and the commitment to women's health and the anger and frustration that you feel on our behalf that the information and the access to these tools has not been as readily available um and understood as uh women around the world deserve it to be. And so I appreciate uh the depth to which you went in each of these topics um because I think it can be really confusing and you know we do live in a world where there is so much information flooded into the public space that it is easy to be gaslit. It's easy to have somebody prey on you and your fears and to have you start to question established medical science, >> right, >> to your detriment, >> right?

[01:10:27]>> And um you know, I guess that brings me to a question I'm curious about. If there was one question, Dr. Malone that you uh believe every woman could be asking her doctor >> after listening to this episode. What would that qu like that important question be? I think you should come into your doctor um with and you should actually ask ask them two questions when you are even contemplating having the discussion about hormone therapy and aging just aging in general which god willing we will all do when you are having a discussion about hormone therapy and whether or not it's right for you. It's not right for everybody but it's you know it is the most effective treatment for most women.

[01:11:15]The conversation that you really need to have is what are the benefits of taking hormone replacement therapy?

[01:11:24]And what are the negative things will happen if I don't?

[01:11:27]>> Oh, I love that. If I don't cuz most of us go, what's negative if I do, >> right?

[01:11:31]>> What if I don't?

[01:11:32]>> What if I don't? What am I what am I at risk for? And what what are the things that will happen if I don't? And I think we don't have two sides of that conversation. Well, Dr. Malone, thank you for not only educating us. Thank you for not only being a voice that has been both privately in practice over 40 years and very publicly sharing this information for free and advocating for women. Thank you for writing this remarkable guide, grown woman talk, that gives you the medical and scientific facts that every woman needs to understand and know so you can make informed choices and understand the ramifications of doing them or not. And thank you for also putting your effort into solving the access problem because one of the things that I think a lot about is that I know with the global reach of this podcast that step one is giving somebody access to a world-renowned expert like you in a way that makes you feel empowered, that makes you understand what's happening, that makes you understand uh the various options that you can and levers you can pull that can help you take control of your life, your health. You know, the message that I really want women to have is that you deserve to feel better. You deserve the with every tool available to be able to age healthfully and gracefully. That should be the new goal, not all the negativity that's associated with aging. Some of that is going to come, but the reality is is that you have way more control over how you navigate this final phase of your life than you think. That's why I'm grateful that you're here. Dr. Malone, what are your parting words?

[01:13:36]>> My parting words would be this.

[01:13:40]Menopause is inevitable.

[01:13:43]It is the one universal female experience. So know what that is. Know it's coming. Don't be afraid. Because I will guarantee you this. I'll tell any 47y old out there now and I'm 67. I'm having way more fun at 67 than I was at 47.

[01:14:02]Really? But you got to feel well enough to be able to do it.

[01:14:06]>> Well, Dr. Malone, uh, thank you for giving us the no BS sciencebacked medical truth that we needed to hear so we can make informed decisions and understand what's going on. And I cannot wait to see how this impacts the lives of women and the people who love them around the world. Thank you. Thank you.

[01:14:31]Thank you.

[01:14:32]>> You are so welcome and thank you for having me. I I really enjoyed this conversation. I did too. And I also want to thank you. Thank you for taking the time and making the time to listen to something that will improve your health.

[01:14:46]I know you want to feel better. I know you want to do better. And what you learn today from Dr. Malone is going to give you the tools that you need to understand what's happening in your body and to make informed decisions so that you can feel better. And in case no one else tells you this today, as your friend, I wanted to tell you that I love you and I believe in you and your ability to create a better life. And as Dr. Malone just said, holy cow, you can create a better life. But you have to take responsibility for advocating for yourself and getting the support that you deserve. And I promise you, if you do that, you will have a better life cuz you're going to feel a lot better. All righty, I'll see you in the next episode. I'll welcome you in the moment you hit play.

[01:15:31]And thank you for watching all the way to the end. And you're going to love this next video. And I'll be waiting to welcome you in the moment you hit play.