Menopausa: ciência e cuidado | Ouvindo Vozes - 25/05/26

Ajouté : 2026-05-27

[00:00:24]Good evening to all, everyone, and everyone. I am Ana Laura Prates, presenter of Ouvindo Vozes (Listening to Voices) in partnership with TV GGN, a program that seeks to listen to the voices that sometimes murmur and sometimes you hear in the city of speeches.

[00:00:42]I'm going to give my self-description. I am a woman with fair skin and long, curly, light brown hair.

[00:00:52]Uh, I'm wearing brown-rimmed glasses, brown-rimmed prescription glasses, a brown shirt/t-shirt with a cream-colored blazer and a necklace. And behind me I have a divan with some cushions, and a bookshelf with books. Well, today we have a very special program. We're going to talk about a very delicate, very invisible subject, and we're going to try, with our guest, whom I'll introduce shortly, to bring some contributions and hopefully contribute so that we can not only bring some clarification to where we stand in terms of science, of what is known about this phase of life, which is menopause. We're going to, Patricia will explain to us better what this means, but also how we can take care of the mental health of these women who are going through this phase, and the whole surrounding society that ends up being impacted by it as well. So, to talk about menopause, science, and care, I have the immense pleasure of inviting Dr. Patrícia Valentine Melo.

[00:02:18]Patricia is a doctor, graduated from the Faculty of Medicine at USP (University of São Paulo), and specializes in gynecology, obstetrics, and mastology.

[00:02:28]She is a leading expert in women's healthcare for those over 40, with training in integrative health, herbal medicine, and nutritional supplementation.

[00:02:38]So, because of all this knowledge, she combines all this technical expertise with a humanized approach and natural practices for the benefit of women's well-being. She is a medical content consultant for the platform, is responsible for the creation of the Titox 40+ supplement formula, and is also a volunteer director of the NGO, CCAM, which is a union and support organization in the fight against breast cancer, in addition to the great privilege of her taking care of me.

[00:03:16]Patricia, welcome to listening to voices. Hey, if you could, you know, give me a self-description for visually impaired people, I would appreciate it.

[00:03:28]Thank you, Ana Laura. Good evening everyone.

[00:03:30]Goodnight my dear. also. Thank you for the invitation.

[00:03:34]Yeah, I'm going to unsubscribe, then. Yeah, I also have fair skin and long, light brown hair, which I love.

[00:03:48]Oh, I'm not wearing my glasses today. Uh, I'm wearing a pearl necklace, pearl earrings too, and a coral blouse.

[00:03:58]And behind me there's also a small shelf with some little ornaments here. And I'm very happy to be here.

[00:04:05]An honor, you know?

[00:04:06]Thank you so much, dear. Let's go. Let's talk. I think we could start from the beginning, right? So, what exactly is menopause? Let's talk about definitions, shall we? I think that's where the confusion starts, right?

[00:04:21]So, let's go. What is menopause?

[00:04:23]What is perimenopause? I think that's a great place to start, because there's a lot of confusion. Actually, we know this phase of a woman's life after she stops menstruating as menopause, right? But that term isn't correct. Menopause is simply a day in our lives. Uh-huh.

[00:04:49]It's the day of our last period.

[00:04:51]Less menstruation, pause for pause.

[00:04:54]So, menopause is the day our menstruation stops.

[00:04:59]Just like menarche is known as the date of the first menstruation, right? Well, menopause is a day that happens within a phase of a woman's life called the climacteric.

[00:05:12]Well, menopause is a long phase that lasts from 40 to 65 years of age. This is indeed a phase in a woman's life, but it's the period when she menstruates, but she already has symptoms related to hormonal imbalances that we can explore in more detail later. This phase is called perimenopause. So, this is the stage of menopause in which the woman still menstruates, but already has symptoms.

[00:05:43]And after the date of the last menstruation, we know it as post-menopause.

[00:05:51]The diagnosis is clinical. So, this date of the last menstruation, we don't actually know when the last menstruation will be, because a week later we can menstruate, a month later, six months later, how am I supposed to know that that was the last one, right? Uh-huh.

[00:06:07]So we say that after a year without menstruating, this woman is unlikely to menstruate again. So we go back and retrospectively we make that diagnosis. Ah, that really was the last period and the beginning of menopause, right? Uh-huh. Thank you, Patricia. I think that clarifies things quite a bit. Now, what I wanted to do was talk to you a little bit, and there's a paradox there, isn't there?

[00:06:35]For example, very little is known about the whole issue of female reproduction. So much so that, back in the 60s, the female contraceptive pill was discovered, right? So, for that, there was a whole study on the part of female hormones, uh, how much is known when, for example, someone has some reproductive problem, right? Well, for years we knew what the dysfunctions were, let's say, in women as well, so that they could be treated. Little was known about male dysfunctions.

[00:07:11]So, how much research has been done on this reproductive issue, you know?

[00:07:16]And paradoxically, despite how little was known, I remember that in the first consultation I had with you, you mentioned this, right? Back when there was little knowledge about it, you even went to improve your skills and try to fill that gap that existed in gynecology itself. What you think you should do is pretty obvious, right? Here on "Listening to Voices," we've already talked about the policing of women's bodies, about ageism, right? We've already had incredible people speak here about this, but I wanted to hear from you, you know, from the medical field and so on, how you've been following this and also how things are today, the changes that have happened, because it seems that in the last 10 years there has been good progress, we're not yet at the ideal moment, but I think there has been good progress, right? So I wanted you to talk a little about that history as well, about the studies regarding that period in a woman's life. Look, we've only really learned about this period in a woman's life for a short time, because in the 20th century women, or the general population, had a very low life expectancy. People used to die at 40 years old at the beginning of the 20th century, right?

[00:08:34]And so it was from this century onwards, with the increase in general technology, vaccines, and basic sanitation, that we began to have a higher life expectancy, and recently we have increased this life expectancy even further; today, women reach 79 or 80 years of age, right?

[00:08:59]But it's only in the last 50 years that we've come to understand this phase of a woman's life; in fact, we didn't even know that women would enter this period of menopause and that it would be so different.

[00:09:13]Women have always been underrepresented in science, haven't they? But it's even more so in something that nobody knew about because we didn't survive that long, right? And there's also a certain invisibility, right? pathetic. I mean, if it survived, it would be as if it had also been discarded, because, you know?

[00:09:32]No, even so, this study of the reproductive phase of women, because the greatest importance of women has always been that of reproduction, right?

[00:09:42]Menopause is also known as a reproductive transition. Point.

[00:09:48]Hmm. Hmm.

[00:09:49]Yes, even today that's the description of menopause.

[00:09:54]Well, menopause is a hormonal fluctuation caused by ovarian failure, always focused on reproduction. And today we know that the hormones produced by the ovaries are much more than just reproductive, right?

[00:10:12]So, in these last 10 years, science has really advanced, especially because 20 years ago there was a major failure in science with a misinterpretation of a large study that ended up making women invisible afterwards, you know, in relation to the symptoms of menopause itself.

[00:10:36]It was that 2002 study that caused the American Federation to retract, not advise against, its recommendation. Tell us a little about that, Patricia. So, before that, a little bit back in the 60s, just to provide historical context, women started using hormones, they started using hormones and they became beautiful, and the doctors, mostly men, prescribed hormones for women to become beautiful for their husbands, because they wanted not only to be beautiful, but also available, including sexually, right?

[00:11:15]That was the intention at the time. Then it started becoming a craze; they wanted to put the hormone in women's drinking water.

[00:11:23]Hmm.

[00:11:24]Until the cardiology society got concerned and said: "Listen, now you 're trivializing estrogen, giving hormones to all women, but is that good? Is it not good?

[00:11:36]What will be the impact on the cardiovascular health of these women?" And the cardiology society commissioned this study, which is the WH study.

[00:11:45]Well, it started in 1991 and was all conceived in a way that, upon closer analysis, we discovered was conceptually flawed. But, in the end, they called in women who were going through menopause to give them hormones in order to monitor and understand what would happen to them.

[00:12:12]So, women over 50, come on over, we'll give you the hormones.

[00:12:19]Women over 50, period. They did not differentiate them according to pathologies, nor did they stratify the risk of each one. There were women in their 50s, 60s, 70s, and 80s who had never received hormones before, receiving them for the first time.

[00:12:34]There were obese women, women with heart disease, diabetic women, and they were all placed in a single group. They separated only women who had a uterus and those who did not have a uterus.

[00:12:47]This is important for hormone replacement therapy because those who have a uterus, in addition to receiving estrogen, need to receive progesterone to protect the uterus from the effects of estrogen itself. And those who didn't have a uterus didn't need progesterone, only estrogen. All good? In that group of women receiving estrogen and progesterone, 5 years later, they saw an increase in the number of cases of breast cancer, thrombosis, and heart attack. There were only a few cases, but before they could study exactly what was happening and understand what was going on, it was on the front page of the New York Times.

[00:13:27]Medical procedures like hormone replacement therapy for cancer, thrombosis, stroke, heart attack, and so on. The next day, thousands of women around the world stopped using estrogen, you know, hormone replacement therapy. There was a great deal of demonization surrounding the use of hormone replacement therapy, and today, two decades later, nobody wanted to prescribe these hormones or treat menopause with or without hormones. So menopause was forgotten because, oh my god, how awful, treating a woman during menopause. Uh-huh.

[00:14:08]There's a problem. So what happened?

[00:14:10]They removed that phase of a woman's life from medical school curricula.

[00:14:16]So there is a knowledge gap because no one else has pursued it. But in parallel, there were revisions to that very study.

[00:14:23]Of course.

[00:14:24]The group of women who did not have a uterus and who did not use progesterone showed a decrease in the risk of breast cancer 5 years later, that is, 10 years after use. It didn't make the front page of the New York Times.

[00:14:40]Other remedies, let's say, like hormone replacement therapy, came along; those used at that time were actually hormones that weren't our own, right? They were made from the urine of a pregnant mare. So, much more potent hormones, which were not the same as ours, were administered orally, which is inflammatory. In other words, it was a series of errors. Today we know this, but at the time we did n't, right? But in the end, they made the woman's suffering invisible, because any symptom related to that phase of life, that alteration in the woman's health, wasn't taken seriously, right? It was just women whining, because menopause is physiological, menopause is a normal phase in a woman's life. Why bother with all this? You're going to have to go through this, it will happen, and that's okay. Uh-huh.

[00:15:39]And what you're saying about women's whining is very important, right? This truly impacted several generations. I remember when I went through perimenopause, I was terrified, and I have several friends in Latin America, not just in Brazil, where it was even more radical in terms of public health contraindications, and who went through all of that without any guidance, you know?

[00:16:08]And then I think there's something else you're saying that's very important, which isn't just the hormone issue, right, Patricia? There is the hormone issue, which is what you said, with all these issues that have to be looked at on a case-by-case basis, but it's not just that, right? I mean, there's something much broader than the question of whether or not to replace hormones.

[00:16:28]I mean, even those women who actually cannot receive estrogen have other treatments available, right?

[00:16:36]There are many treatments, many care strategies, lifestyle changes, that even protect these women from having cardiovascular risk later on, you know?

[00:16:50]But somehow that study, that result that was misinterpreted, impacted that issue, to the point that nobody could hear about any treatment anymore.

[00:17:08]This has become taboo. It became a taboo subject that could n't be discussed or talked about. It is good too. This is how it's meant to be, this is how God made it, and this is how it will continue to be.

[00:17:21]And it's really something we have to accept, is n't it? We have to put up with it, let's say, right?

[00:17:26]Yes, women are warriors, they can do it, especially because many generations have been warriors themselves, right? Many women, our ancestors, were such warriors, weren't they? And they endured so much, and it was normal, right?

[00:17:41]On the other hand, there were the teas, there was a support network, right? They had other things that they knew from their ancestors.

[00:17:48]Yes, ancestral knowledge has also been lost over time, right?

[00:17:51]That. AND.

[00:17:52]And then we were left with nothing, right?

[00:17:55]Well, there's also this phenomenon of gaslighting, right? Where you make the person believe that all those feelings, everything they say, isn't true, right?

[00:18:10]So either that, or disbelieve because of that too, you're just PMSing, right? It's used almost like an insult, right? Hysteria, she's PMSing. Oh, she must be PMSing, right? Or maybe she's going through menopause, she's crazy.

[00:18:24]It's something emotional, like a whiny, womanly thing. What I'm talking about isteria is uterine ister, right?

[00:18:30]So it is. So it's only women who are hysterical, right? This term is no longer used today, but it was for a long time.

[00:18:36]Even back when I was studying medicine, I heard about hysteria, which is a uterine issue; it's a woman's thing, it's all in her head, really, you know? And even today, in many doctors' offices or other healthcare professionals' practices, this phenomenon still exists of making women believe that it's nothing serious. Uh-huh. Well, menopause, this phase of life that we talk about, right, which is all this climacteric that I mentioned, does bring a lot of suffering to many women, it has many symptoms, there is, we call it metabolic chaos, right, a physical, real thing, that brings several symptoms that are even considered today as risk markers for several diseases later on. And we need to pay attention and care for these women in various ways, not necessarily by providing hormone replacement therapy. But it's important to make it clear that everything I said about this study today has already been debunked, okay? Okay, just to reinforce that, breast cancer cases increased by about 1,000 per year, because what came out was a percentage increase, a relative risk, but when we talk about absolute numbers, it was very small, even though everything was wrong, even high- risk women, who already had a risk of developing breast cancer, older women, obese women, and so on, right?

[00:20:09]So even thrombosis increased by one or two cases, that's because the viral hormone really does increase, right? The pill, for example, does that. So nowadays, with new technologies, that's no longer true.

[00:20:24]Well, even if it was very small, that wouldn't justify not doing it or being afraid to do hormone therapy, just to be clear. Uh-huh. Now, what are the other symptoms, Patricia? Because that's how it is, right?

[00:20:39]We generally talk about the more visible symptoms that are related to hot flashes and dryness, but as you said, it's a whole metabolic syndrome, right? It also has repercussions on the psychological aspect, sometimes called emotional, and therefore relational, right? Yes, with impacts on the family.

[00:21:08]Women are also having children later and later in life, right? Well, it's also common for women who are in perimenopause to have children at home. So, at the same time, they are experiencing motherhood in a phase of caring for a young child, and sometimes they are also entering menopause or perimenopause, and so on.

[00:21:32]Well, you could give a broader perspective, because there are so many symptoms that sometimes we don't even realize are related to menopause, right? Well, and also because of a lack of publicity, because it's not talked about much, right?

[00:21:49]Look, there are many, there are more than 80 symptoms, there are the most common ones, the less common ones, right? The most common ones, as you said, are the fogachos, the most well-known, right? It's intense, but it's much more than that, isn't it?

[00:22:04]Mood swings, anxiety, and depression worsen significantly during this phase of life. Well, sleep disturbances, waking up in the middle of the night at that time, 3 am, is a hormonal disorder or difficulty sleeping. Of course, worries and anxiety also get worse, right? But then the hot flash wakes this woman up; the anxiety itself, due to the lack of hormones, prevents her from sleeping. This woman, not sleeping, will experience significant fatigue, but the lack of the hormone itself worsens the fatigue. Then you end up with double the fatigue. And there's always an excuse.

[00:22:44]Ah, because I'm working too much, because I'm not sleeping, because I have a thousand worries in life, I have young children, I have elderly parents. And there's always a reason for having these symptoms, right?

[00:22:54]What else? Irregular menstruation, right? It's not by chance that menstruation starts to become irregular. This is during permenopause, right? Oh, what else? She has itchy skin, tingling, ringing in her ears, dryness in her hands, and dryness in her mouth. Some people have a burning sensation in their mouth, or rather, in the mucous membrane of their mouth.

[00:23:24]of the language.

[00:23:26]Oh my, there are so many symptoms, weight gain, a change in body composition, you know. We say, you know, that we stop having a pear shape and start having an apple shape because we start gaining fat in our belly.

[00:23:40]Well, a woman in menopause without treatment gains 1 kg of weight per year; after 10 years, she's 10 kg above her ideal weight, which increases cardiovascular risk on its own, right? It also increases the risk of breast cancer, right? Today we know that lifestyle factors have a much greater impact on the risk of breast cancer than hormones. So, obesity is the biggest risk factor. Today that's proven, right?

[00:24:09]Overweight, obesity. Imagine if menopause caused a woman to gain weight without treatment, right? Well, it's worth considering that within this change in body composition, we lose lean mass, right, and we also lose bone mass. So, we gradually progress to osteopenia, which is the beginning of this loss of bone mass, until we reach osteoporosis, which is the biggest risk, right?

[00:24:36]Because it increases the risk of fracture, and that's one of the leading causes of death among women, the femoral fracture, right?

[00:24:45]What else? Vaginal dryness and genitourinary syndrome of menopause, everything gets worse as it goes.

[00:24:53]So, if we don't take care of it, bone loss can eventually lead to osteoporosis. Vaginal dryness, if left untreated, is a problem, and few women associate vaginal dryness with menopause. It's so important, guys, because it's preventable and simple. Uh-huh. This dry vagina, it starts to bother you a little during sexual intercourse, it starts to sting a bit, a little pain.

[00:25:17]Gradually, the lack of estrogen leads to atrophy of this tissue, almost all the tissues in our body.

[00:25:24]But imagine the vagina, right? The vaginal mucosa, the vulva, everything starts losing layers of tissue, it atrophies, it becomes sensitive and, uh, it starts to tear and hurt. This greatly worsens the quality of life for both of them, right?

[00:25:43]Besides increasing the risk of infection, and not just in the vagina, this affects the entire genitourinary system. So the risk of recurrent urinary tract infections and urinary incontinence with urine leakage starts to increase, right?

[00:26:00]All of this greatly impacts a woman's quality of life. And today, if you use an estrogen cream twice a week—which isn't hormone replacement therapy, it acts locally in the vagina and vulva—you can prevent all of that. But this became demonized along with hormone replacement therapy, it's even in the package insert.

[00:26:21]Ah, that's why the FDA recently retracted its statement and apologized. Did you see that?

[00:26:27]Oh, apologizing to women, a public apology, right? Yes, publicly, the president of the American FDA, publicly, apologizes. It was the biggest mistake of all time in science to have almost made women's suffering invisible and not paid attention to it, right? Not valuing the suffering of that woman, who for two decades suffered there without being able to do absolutely anything, which is what we were talking about, right? That's right.

[00:27:01]And they asked to remove from the estriol label, this local hormone, all that black labeling about risk, because there's nothing to it. And women having this poor quality of life in relation to vaginal dryness and everything else. And then there was the taboo surrounding female sexuality, talking about it, talking about female pleasure, about female desire, about rights, you know, it all came together with desire, with eroticism, especially at a certain stage of life. Exactly.

[00:27:37]Older women, even worse, right?

[00:27:40]Even worse.

[00:27:40]Patricia, let's talk a little about the care, shall we? It's about how important it is, I mean, women too, who historically and culturally have always been associated with caregiving. She's the one who takes care of everyone, she does, like you said, she's either taking care of the children or taking care of the elderly parents, she's always taking care of everyone, right? And I think there's something really interesting here, because with all the description you gave of this phase, this period, how important care is, how important it is for her to be cared for, and how difficult it is for everyone to switch gears, right? For herself, for ourselves, let's speak in the first person.

[00:28:24]If we were excluding that, imagine, right? I mean, for us to accept being cared for, how difficult that is for us, and how difficult it is also for our partners, for our own children, in short, for those around us, and for public health itself, right? I was doing some research here to talk to you about. It seems that current data from the Brazilian Ministry of Health for 2025 indicates that there are 30 million Brazilians in menopause, right? That's a very significant number, isn't it? It seems that the Brazilian public health system ( SUS) has a national policy program for comprehensive women's health care, but there's still a lot of invisibility surrounding diagnosis, and even then, the treatment available through the SUS is still somewhat lacking, because, as you mentioned, it's often synthetic replacement therapy, and oral treatment is still far from adequate, including alternatives, which I know you also work with for those who can't take herbal supplements or other alternatives. But speaking of the comprehensive treatment program itself, which is the basis of the SUS, right?

[00:29:39]Comprehensiveness is one of the foundations of the SUS (Brazilian Public Health System), which, by the way, is fantastic. Menosa, did you know?

[00:29:45]So it is. So, that's what I wanted you to talk about first, this care in public health that is so important for our population, and then in more individual terms as well, right? I'm just adding to what I've been saying here; I've been talking a lot with my fellow psychiatrists, you know? Well, because sometimes I'm in the office with a patient who's going through this period with symptoms of anxiety or depression, and the psychiatrist doesn't even order, you know, general tests, metabolic, hormonal, and so on, before prescribing anything. Not that an antidepressant or anxiolytic isn't sometimes necessary, but it would be very interesting because, of course, each case is different, it's very individual, but for example, I remember feeling typical symptoms of depression, even though I had never had depression before. My clinical type isn't depressed; I'm more distressed and anxious than depressed, you know? Well, I know myself, I've been in therapy for over 20 years and everything, and I used to say, "Wow, what's this thing where it feels like I wake up without wanting to get out of bed, right?" Yeah, and it was amazing how hormone replacement therapy solved that. I mean, in my specific case, it was really a hormonal issue, right? It's that tiredness, that malaise, so with sports, with supplementation, with all that, I managed, but of course, I also have access, you know, economically, to information, I also talked to a lot of people, it took me a while to look for it, you know, but how are we in terms of public health, right, and how could we, including, you know, even invite, I think, professionals in the health field in general, mental health and so on, to be attentive to women in this phase, right?

[00:31:47]I think professionals are paying more attention now, right? This has improved a lot already. Even the Brazilian public health system (SUS) is starting to create a booklet of manuals for women going through menopause.

[00:32:02]Well, it didn't exist until very recently. Furthermore, menopause was not included in all women's health programs, partly because healthcare professionals lacked the necessary training. As I said, there was a gap in the training of professionals who, for 20 years, learned absolutely nothing; it wasn't in their resumes. So, uh, now they are even training these professionals, starting, you know, to train these professionals and starting to include this phase of life in all the processes of the SUS (Brazilian Public Health System). But I think it will still take a while to get where we want to be. Medications too, that has n't really changed yet. There are very few medications offered by the SUS (Brazilian public health system) pharmacy in relation to hormone replacement therapy.

[00:32:56]Well, the waiting time is also quite difficult because it requires closer monitoring and tests.

[00:33:04]We can never offer hormone replacement therapy without the woman having had a mammogram, basic exams, you know, a pelvic ultrasound, uh, the Papa Nicolau test. OK. I think that's already pretty well resolved in the SUS (Brazilian public healthcare system), right?

[00:33:19]Yes.

[00:33:19]But it needs to be expanded a bit more. Yes, but it needs to be expanded a bit more because by the time she goes to the appointment, asks for the exam, takes the exam, brings the results back, then the doctor prescribes it.

[00:33:33]Then you have to do a whole dose adjustment control, because not every woman responds the same way, right?

[00:33:42]So I think all of this will have to be very well thought out for the SUS (Brazilian public healthcare system), right? But it's one thing, and the consultation time is also important, because in order for us to understand what that woman is feeling, which each one feels differently, we need to listen to that woman.

[00:33:59]It's about listening, right? I need to listen much more than I need to speak. And we see that even in private or insurance-covered clinics, appointments are very quick, and in the public healthcare system (SUS) they are even faster, because there's a gigantic waiting list outside as well. It 's not entirely the professional's fault, but they have a number to answer, right? And he needs to take care of everything. And in 15 minutes, we can't know exactly what that woman is going through, what the main symptoms are, what her entire life history is, her family history.

[00:34:34]All of this is so important when we're making our decision. So, uh, it's really a structural issue, right?

[00:34:42]But you mentioned mental health, right?

[00:34:47]Mental health professionals also need to be aware. In fact, all healthcare professionals in all areas should have training in menopause, because I mentioned dry eye, ophthalmologists need to understand menopause, dry mouth, dentists, rhinoplasty specialists.

[00:35:03]You know, in my case, Patricia, it's a curious thing, and today, talking to a friend about our program, she said: "Wow, the same thing happened to me."

[00:35:11]The first professional who spoke to me, asking if I had any hormonal problems or anything like that, was the ophthalmologist.

[00:35:19]So, that was the first symptom I recognized. I do n't know if it was the first one I had, but he actually recognized it, right? He said, "You have dry eyes, you need to check your hormones, and so on."

[00:35:32]Well, yes, but not all of them are either.

[00:35:35]How many women I see, oh my god, I'm just shedding tears, using eye drops, because my eyes are so dry, I don't know. I'm researching autoimmune diseases. I'm researching a thousand things. They hadn't thought about menopause, had they?

[00:35:47]Hail Mary. Yes.

[00:35:49]And in mental health, it's the same thing, as you said, right? You had symptoms of depression, and these symptoms are very common due to the drop in estrogen and progesterone. Estrogen and progesterone are the hormones responsible for the production and action of all neurotransmitters.

[00:36:09]The brain is greatly impacted by changes in these hormones. So, these mood swings are very common, and many people are prescribed antidepressants and anxiolytics, which I'm not against—quite the contrary, it's good that they exist and have their indications—but I think there's an over-prescription for people who perhaps do n't need them, whereas hormone replacement therapy, when properly evaluated and done in an individualized way, could be the only medication to treat everything.

[00:36:45]And many women are receiving not only antidepressants, but also sleeping pills.

[00:36:49]It's even worse, isn't it? Because these hypnotics, you know, Opidemsoloft and such, they are very hallucinogenic sometimes. AND.

[00:37:01]And why not think about it? It's simple, folks.

[00:37:03]If a woman is over 40, she doesn't need to have an exam, she doesn't need to do anything.

[00:37:07]The diagnosis is clinical.

[00:37:09]Just consider the possibility. Go to the gynecologist, get an evaluation, see if that's it, if that could be it. If that's the case, if that's what it is, try to treat it and let's see what's left. Of course, many women do experience depression, anxiety, and sleep disorders, and that's perfectly fine. It's good that there's treatment and all, but often the symptoms disappear. Uh-huh. And truth. And what about the lifestyle change issue, you see?

[00:37:40]Sorry.

[00:37:41]Ah, so that's what I wanted you to say. Exactly. There are two things, right? The first is this issue of lifestyle change, which I think is very important, because there are some behavioral changes, Patricia, that make a big difference, right?

[00:37:55]And the other is how you see the issue of the support network in your clinic, right? I mean, the fact that we're able to talk about it, like, "Wow, a truck's passing by here," the fact that we're able to talk about it, that we're making it visible, that programs are talking about it, that women are talking about it, there was also a sense of shame, right? It seemed like it was a flaw, and I was ashamed to talk about it.

[00:38:20]I'm getting old, I can't tell anyone because I stopped menstruating, I'm already old. How many times has this happened?

[00:38:27]That. So let's go, let's talk about it, shall we? It's about changing behavior, lifestyle, awareness, and self-knowledge. I think that part is also very important, right?

[00:38:37]Lifestyle change is essential.

[00:38:39]We're talking about hormone therapy here, but actually, I'd say hormone therapy is the icing on the cake, but you have to have the cake too, right? And the cake, each layer is a pillar of a healthy lifestyle, right?

[00:38:55]Hormonal modulation through lifestyle is also a factor. Some women wouldn't even need hormone replacement therapy if they had an exemplary lifestyle, which isn't easy, it's difficult, isn't it? Well, so it's about a proper diet, real food, and reducing processed foods that have a lot of chemicals. These chemical additives are highly inflammatory. And that story about metabolic chaos that I mentioned, that chaos leads to a lot of inflammation, and it's inflammation that leads to symptoms and increases the risk of disease later on. So when you already have a diet with an inflammatory basis, I don't even need to be going through menopause to be inflamed. Then I go through menopause, and that adds even more inflammation. This is dangerous. So a healthy diet and physical activity are fundamental, as I said, there is a change in body composition.

[00:39:46]We're going to lose lean mass, muscle, and bone.

[00:39:50]So, we have to build up a reserve, a muscle bank until we get there, because when we get there, if we lose a little, we'll still be in the positive, because we can't think that what we'll be in the future when we get older is what we're planting now, right?

[00:40:07]These are the choices we have to make now.

[00:40:09]We always say, "What do you want to be when you grow old?" Have you ever thought about it?

[00:40:13]If you want to be independent, you have to have muscle, otherwise you won't be able to walk alone, you'll fall, you wo n't be able to do anything without someone else's help, besides the risk of breaking something, fracturing something, the health risk itself. So, look at all this stuff, right? If you have a muscle bank, if you do weight training, for that you have to eat well, you have to have a protein base in your diet as well, you have to have the material to build tissue, right?

[00:40:40]So, those are two important pillars: nutrition and physical activity. Sleep is extremely important, right? But sometimes it's impacted by the lack of the hormone itself.

[00:40:51]Yes.

[00:40:52]So we need to take care of our sleep because we consolidate memories during sleep, we cleanse free radicals, it's the most antioxidant-rich time of our day. So what is the aging process? It's an excess of oxidation. We need to clean, right? It's about restoring the body, so we need to sleep.

[00:41:13]Oh, what else? Well, stress management, right?

[00:41:17]In fact, stress can bring on menopause earlier, because to keep cortisol levels high, to survive the stress, well, what happens? The body essentially stops producing other hormones in order to produce cortisol.

[00:41:32]So, these hormones start dropping before the others, right? Oh, Patricia, I'm going to interrupt you at this point, because there's something so important that you always tell me, and I think we keep talking about progesterone and estrogen, but there are several hormones, right? You mentioned that it 's not just that, but there's also that, right? It all revolved around estrogen and progesterone, but now testosterone has become fashionable too, with people using it to build muscle, and that has a lot of side effects as well. But you just mentioned the others, right? The thyroid hormones, cortisol, anyway, sorry to interrupt, but I didn't want to forget that part, which is also so important, right?

[00:42:15]Yes, we are a whole, right? I always say, we are a whole. Treating ovarian issues isn't always the priority, right?

[00:42:24]And it won't always work, because sometimes the problem is much bigger.

[00:42:28]There's a hormonal hierarchy to begin with, right? So, the mother of all hormones is melon, that's why we need to sleep.

[00:42:34]There, it coordinates the function of all the other hormones, but to produce melatonin, I need to turn off the light early, otherwise it's not produced.

[00:42:49]And we're stuck on our phones, right? The blue light, which is the worst of all, from electronic devices, even after midnight, we're asking for no melatonin, for not deepening our sleep and all that, but if there's no melatonin, I don't last, I don't get a deep sleep. During deep sleep, we produce cortisol, testosterone, and DHA. DHA is a precursor to progesterone, testosterone, and cortisol. That's when they fall.

[00:43:17]My thyroid isn't functioning properly due to cortisol. I'll say that without a thyroid, the ovary doesn't function. It's a hierarchy, the dominoes are falling, right?

[00:43:26]So, if everything is a mess and, most recently, estrogen levels have dropped, and I'm just going to fix the estrogen, I'm not going to get results, or at least not the best results. So, and the lifestyle is able to, you know, maintain all of that. If a person goes to bed earlier, if they manage stress, take breaks during the day to modulate cortisol, if they eat right, if they do everything correctly, then the dominoes don't all fall apart, right? But if everything is wrong, she may have many symptoms related to other things, including nutritional deficiencies.

[00:44:04]I talked about nutrition and everything, but sometimes when a person is stressed, they don't absorb nutrients because their digestion is impaired.

[00:44:11]Stress and gut issues too, right? That 's a whole other story; it's a lot of things happening at once, we have to stitch it all together. We separate them for educational purposes, right? But digestion is super important because all stress increases cortisol, and cortisol blocks digestion.

[00:44:33]Hmm. So, someone who is stressed isn't digesting well, therefore, they aren't absorbing nutrients.

[00:44:40]Menopause also causes a decrease in estrogen, slowing down the digestive process and increasing transit time, resulting in slower digestion. All of this hinders nutrient absorption, and a lack of certain nutrients worsens symptoms. For example, a lack of B12 causes a person to lose energy, as does a lack of iron. Uh-huh.

[00:45:06]Often during permenopause, women bleed more, so they lose even more iron, P12 isn't being absorbed, and they're exhausted from fatigue. And it's not just a symptom of perimenopause, it's a result of a lack of these nutrients.

[00:45:21]Besides the lack of estrogen, it's also a combination of factors, right?

[00:45:25]And then there's the gut you mentioned; hormonal changes alter the gut microbiota, and lifestyle changes also alter the gut microbiota. And the microbiota is fundamental for estrogen metabolism and the formation of neurotransmitters, which in turn lead to symptoms of mood swings. It's a whole set of issues that we have to look at as a whole. It's impossible to see a person in such a fragmented way, it's just not possible anymore, right?

[00:45:52]Exactly, exactly.

[00:45:55]And I think that, listening to you, it seems like something that sometimes even causes a little anxiety, in the sense that, wow, you have to take care of so many things and at the same time, fortunately we are still very active at this point in our lives, we continue working, as I said, many women even with young children and so on. Hey, how have you been seeing this, Patricia? So, this change in mindset, which can constitute, uh, that's what I was saying, right? This reversal, this support network, this possibility is for the women who are listening to us, but also for the men who are listening to us. I've invited many men to this conversation; in fact, I've been inviting many men to these conversations that sometimes seem like they're just women's conversations, right? But I think it's something everyone experiences, because we're talking about a society where men also have andropause, which is another thing that also has its taboos.

[00:46:54]We'll talk about this another time, but it's not unrelated, is it?

[00:46:59]How could we, uh, leave some words, even thinking about this issue of comprehensive care, this issue that this is something for everyone to take care of, right, and for women to be able to be cared for as well, right? And being cared for sometimes means having time for themselves to take care of themselves, right?

[00:47:20]But you know, this phase, I always say that this phase is an opportunity for us to start looking inward.

[00:47:29]Because before, it 's difficult, you know, for us to have that opportunity to go inside. We live very much for the outside world. It's family, it's work, right? Well, he's a son, a husband, a father, he's everything out there. We give a lot of ourselves, like you said.

[00:47:47]And it's time for that, right? Because all of this depends on us, but at this stage of life, when we're older, many of these issues, of course, still exist, but perhaps they don't entirely depend on us anymore, right? And it's also time to think that if we're not there, how are we going to make all of this happen, right? So we can keep spinning the plates. So, it's an opportunity for us to go inward, to get to know ourselves, because often we don't know ourselves, right?

[00:48:19]So, focusing on self-knowledge is key to understanding our real needs and seeking self-care that makes sense for us, because it's not the same for everyone, right?

[00:48:31]Sometimes I need to meditate, another person just needs to stop, listen to music, another needs more contact with family, I don't know, I'm just mentioning possibilities, but we need to be quiet for a little while, right, go inside and try to understand what we're missing, what we need to pursue. This phase is like a second chance for us to do this, because if we don't, we might not be in such good shape later on. Having this information, having this awareness, perhaps we gain more motivation to pursue it.

[00:49:15]So I think it's good to stop and think about that. Chinese medicine, have you seen how cute it is? They call menopause the second spring, which is a second chance, uh, it 's like taking all the wisdom you've gained from life experiences and throwing it out into the universe.

[00:49:42]But for that, you calm down and have ti, right, which is vital energy, and you lose ti when you menstruate.

[00:49:51]very typical during pregnancy. So, a woman loses a lot of energy menstruating, getting pregnant, giving birth, and so on. And in menopause, since menstruation stops and fertility decreases, right? This energy returns; she does n't lose it, it returns to her body, and she has a second wave of energy to position herself, to pass on her wisdom to the world. That's really cool, isn't it? Uh-huh. That's really cool, because I think you specifically mentioned Chinese culture, but it shows us how much of a cultural aspect there is as well, right? right?

[00:50:29]That is to say, how much other cultures were able to deal with this in a different way, without having as many scientific resources as we have today. And fortunately we can and should, as far as possible, appreciate and benefit from all the progress of science, etc., right? Otherwise, we'll go back to that warrior narrative, the one about having to face challenges and blah blah blah.

[00:50:57]But at the same time, how much do we also need to learn from cultures that perhaps don't view old age, especially aging in women, as something almost like a flaw, right? It's like treating it like an illness or something wrong, I mean, almost a moralizing attitude, as if the person, on top of everything else, has to deal with a kind of guilt for aging, which is no longer accepted in society, much less in clinics, right?

[00:51:32]It's just ageism, isn't it? Well, we live in a society where youth is treated as if it doesn't belong at the center of everything, right? Compulsory retirement, purity, so many cultural, structural, aesthetic things, right? The aesthetics of youth, composition. Yes. So, all of this makes the woman feel excluded, completely excluded, like she's no longer useful, right?

[00:52:02]right? In other words, I'm not even going to tell anyone that I'm in this phase because they'll kick me out of all circles, not just professional ones, but social ones too. So it 's very cultural, right? That's how it is in the West; it's not like that in the East.

[00:52:17]Yes, yes, there are other cultures that deal with this in a different way. I think we've reached an interesting point here, heading towards the end of our conversation, which unfortunately has to end because when the conversation is good, time flies, right?

[00:52:33]Well, I think we're heading towards an interesting conclusion, which is good. It's not about romanticizing this moment as if, "Oh, how wonderful, now I'm older, now I've become the wise woman of the village."

[00:52:53]Yes, it isn't, it doesn't have to be that way either. The other day, a friend of mine here, our dear Mariana Nacif from GG, also said, Ana Laura: "Now that you 're an ancestor, have you realized this?" I said, "Wow, I'm the ancestor."

[00:53:10]Oh dear, I've become the ancestor, haven't I? There's no one else back there, but it's all good, right? Okay then.

[00:53:18]I liked. I said, well, I need to think about it. What does it mean to be ancestral?

[00:53:21]Responsibility, right? lack.

[00:53:27]But getting back to the point, it's not about romanticizing or silencing, and certainly not about presenting it as a dead end. I think neither one extreme nor the other. I think it's about facing the difficulties we're going to have to confront at this moment, just like we faced them in adolescence, like we faced them in other phases of life, during pregnancy, and so on, and not despairing, not romanticizing, and not remaining silent. But I think the word we chose for our podcast is a good one, right? Taking care in balance, right?

[00:54:15]Balance is the key word, right, in all phases of equilibrium. Balance, balance.

[00:54:20]Exactly. So, I think that's it, right, Patricia? You could leave a few words there, you know, in that sense of care, of how women can, what they can do. So, they can seek help through the SUS (Brazilian public healthcare system), they can ask where to seek care, right? Look, I think that right now, the first thing is to have this information. So everyone who is listening, listening to us, please share these messages, which are so important for women.

[00:54:54]By the way, Patricia's Instagram is full of information.

[00:54:58]What's your Instagram like, Patricia? Let me just mention here that it 's @dotora.Valentinemelo.

[00:55:05]Patricia Valentine and Melon.

[00:55:07]That. So, you can go there because there's always a lot of content, very interesting content about this phase of life, including all the care strategies. And that's it, right?

[00:55:22]So, in addition to quality information, because there's a lot of talk that we can't always trust, it's important to think about the issue and start thinking about the choices you're going to make from now on to build your health. Health is something that is built, right? I say that health is a spiral, that we start from the basics, and the basics are simple things, from diet and lifestyle, then we become more sophisticated, you know, and we look for other strategies and build health throughout our lives. But we have to start from the beginning, right?

[00:56:05]So I think that at least this basic stuff is something everyone can do with limited resources, right?

[00:56:12]Information, conversation, and care, right?

[00:56:16]That. A balanced lifestyle.

[00:56:20]Exactly.

[00:56:22]Dear Patricia, thank you so much! The conversation was great, excellent even. I am very grateful to you for all the care, affection, and the way you take care of me as well. I publicly express my gratitude here and say that the house is yours. We at GGN also have our doors open.

[00:56:45]When you have news, you can look us up because this topic is always being updated. Oh, and I'm so grateful to you all, to everyone who listened to us, and to you who invited me. It's a great pleasure for me to have you in my office, to have this opportunity to talk, to share a little of this information. Thank you from the bottom of my heart.

[00:57:10]Thank you so much, everyone. Until next time, listening to voices. Good evening everyone. Good evening, Patricia. See you later. Goodbye. Goodbye. Until.