It's time we talk about perimenopause and menopause | The Excerpt
On Sunday’s episode of The Excerpt podcast: Can we talk about “the change”? Former First Lady Michelle Obama recently joined talk show host Gayle King and comedian Samantha Bee in speaking publicly about the hormonal and physical changes that come with perimenopause and menopause, a natural part of the aging process that up until now, has rarely been discussed openly. The question is, why not? As millennials age into perimenopause, how is their activism changing the conversation? Dr. Judith Joseph, a psychiatrist and chair of The Women in Medicine Initiative for Columbia University, joins The Excerpt to talk about "the pause."
Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.
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Dana Taylor:
Hello, and welcome to The Excerpt. I'm Dana Taylor. Today is Sunday, December 1st, 2024.
Can we talk about the change? Former First Lady Michelle Obama recently joined talk show host Gayle King and comedian Samantha Bee in speaking publicly about the hormonal and physical changes that come with perimenopause and menopause, a natural part of the aging process that up until now has rarely been discussed openly. The question is, why not? As millennials age into perimenopause, how is their activism changing the conversation? Here to discuss the pause is Dr. Judith Joseph, a psychiatrist and chair of the Women in Medicine initiative for Columbia University, and author of High Functioning, a book about breaking the cycle of depression coming out next April. Thanks for joining me, Dr. Judith.
Dr. Judith Joseph:
Thank you for having me today.
Dana Taylor:
Let's talk about perimenopause and menopause. Every woman will have her own journey, but before we discuss symptoms, give us an overview of perimenopause. When does it start? How long does it last? And what's going on inside of a woman's body at that time?
Dr. Judith Joseph:
Every woman who ovulates will go through a period when they stop ovulating and they stop having their period, and then they're considered menopausal or postmenopausal. The leading years up until your last period can last anywhere between five to 10 years in which you experience hormonal fluctuations and progesterone and estrogen. And those hormonal fluctuations lead you to have changes in your period, you may have bodily changes, you may experience changes psychologically, that are all reflective of the hormonal fluctuations that are occurring with the progesterone and the estrogen, and not every woman has the same experience. So we all have different symptoms that can reflect these hormonal changes are happening.
Dana Taylor:
When does menopause happen, and are the terms menopause and postmenopausal interchangeable?
Dr. Judith Joseph:
So menopause happens when after one year of having no periods, you can then say that you are in menopause, and after the loss of your period for one year, you are going to be postmenopausal for the rest of your life. And that's important because being postmenopausal means that you may have certain risk factors such as being more prone to osteoporosis or fractures, and being postmenopausal, you may be more prone to having higher risk of heart disease. And the studies are looking at postmenopause as being a period of vulnerability in terms of dementia. And leading up until the loss of that period, your perimenopause can last anywhere between five to 10 years for people.
What we're seeing is that certain groups may experience this period longer with more severe symptoms, and specifically African-American women tend to have more severe symptoms. So I think we need to really understand what these symptoms are and how they can present, because sometimes they can be confusing. For example, if you're experiencing brain fog, which is forgetfulness or a lack of planning or organization, you may think, oh, I'm just getting older, or maybe I'm getting dementia, or maybe I have ADHD. But you're not understanding that this could actually be a reflection of what's happening in your body related to the hormonal fluctuations and their impact on your brain. So it's important to know what these are so that you don't get a misdiagnosis and you don't get the wrong supports, and you get the correct supports.
Dana Taylor:
Okay, so we're going to dig into some of these symptoms. Sticking with menopause though, so we're at a place where we're no longer having menstrual cycles or well on our way to no longer having them. A woman's reproductive hormones don't go quietly into the night. What are some of the symptoms of perimenopause that hit first, where you know, okay, my body is starting to change?
Dr. Judith Joseph:
I hear a lot of sleep issues. In fact, in some studies, the number's as high as 50% of problems with your sleep. And this is important because poor sleep can really impact all of the elements of the mental health symptoms of menopause. So I used an acronym that I created, TIES. T is the thinking. So that's the brain fog or the forgetfulness. I is your identity. You feel as if you don't know who you are anymore, things are changing and you feel as if your sense of self is shaken. E is emotion. So symptoms of depression such as moodiness or sadness or irritability, or even symptoms of anxiety like worrying excessively. And the S in ties is sleep. Sleep impacts all of those. And if you get poor sleep, it impacts the way that you think, it impacts how you feel about yourself, it impacts your emotions.
So I tell the people that I treat with to really pay attention to your sleep habits. Don't take it for granted. We are all human beings who fall asleep and who are checked out from the world for X amount of hours in a day for a reason, because sleep is restorative. During the sleep cycle, our brain is clearing toxins out, our immune system is getting revamped, and also, it's impacting the way that we think, it's impacting the way that we feel. So when you notice that your sleep is really starting to change, pay attention to it.
Dana Taylor:
Dr. Judith, I'm going to let you be the bearer of bad news here. Do these symptoms linger well into menopause? And are there symptoms that are unique to perimenopause versus those in menopause?
Dr. Judith Joseph:
The mood symptoms may actually be more intense during perimenopause, because if you think about it, you have more hormones, there's more fluctuation. So I think that knowing that these can happen in your early 40s or late 30s, and knowing to look for these things, it's really important. And a lot of times you're thinking, well, I don't look like a menopausal person in your late 30s or your early 40s, we have to change the way we think about that, because when we know that this can start at this time in our life, the blame starts to change. We're not saying, oh, something's wrong with me. I'm moody. I'm a bad person. I blew up at someone. You're understanding your physiology better.
Dana Taylor:
Treatments such as HRT or hormone replacement therapy, not been without controversy, is that controversy warranted, or is HRT a good option here?
Dr. Judith Joseph:
HRT is underutilized. Some of the reports are showing it's less than 2% of women who could actually access it are actually accessing it because of the fear. There was a study, the WHI study that made people very afraid to use HRT. And after that study results came out, which showed that it was misrepresented as having an increased risk of certain cancers and heart disease. After that, doctors became very afraid and they stopped prescribing. And so undoing that misrepresentation of that data has been a long haul, and that's where we're trying to change people's perception of that study and change and challenge that fear. So many people who would benefit from HRT are not getting it because of the fear from that study. But people can live better lives. They don't have to suffer in silence.
Dana Taylor:
And what about non-hormonal treatments like antidepressants? How effective have those been in the treatment of symptoms like hot flashes?
Dr. Judith Joseph:
The research really shows that when you're early in this transition, you really should be thinking about hormonal therapies. And some of the studies show that even regular birth control, oral contraceptive pills, may be protective enough. But as you go along in your menopause transition, if you're continuing to have persistent depression, SSRIs and antidepressants may be warranted, and the data shows that that may be very helpful. The data also shows that therapies like cognitive behavioral therapy, mindfulness-based therapies may be helpful in terms of supporting your mood, and cognitive behavioral therapy for insomnia to help you with your sleep has been very successful.
So it depends on the individual. I would say that if you're starting off early in perimenopause and you're having mood changes to first ask your doctor about the three Ps. And they're are you having period changes? If you're having period changes, it's most likely due to perimenopause or menopause. If physical changes, there's no physical changes in major depressive disorder. You're not going to have hot flashes, you're not going to have your hair thinning and so forth. And then past history, if you have a past history of depression or mental health issues, you're more likely to have a recurrence of a true depressive disorder in midlife.
Dana Taylor:
Are there serious health concerns that we should be aware of? You mentioned the risk of osteoporosis. What role does menopause play in the effect of age-related diseases?
Dr. Judith Joseph:
Yes, and I think a lot of people need to know how to prepare for aging. So osteoporosis and fractures is a major risk. Some of the studies shows something like 75% of women will experience these bone changes after the transition. So it is a vulnerable period for you. So try to prepare in advance. You may want to talk to your doctor about taking vitamin D, calcium supplements, doing more weight-bearing exercises to support your bone health to become stronger, working on balancing and strengthening your core so you have less risk of falls, eating more protein in your diet to build up your muscle mass to support your bones. You can't be eating the rabbit food you did in your 20s in your 40s and 50s because you need more protein, you need more fiber. So really nourishing your body to prepare your body for the best outcome for this change.
Dana Taylor:
As millennial women age into perimenopause, a new term, millenopause, has been trending. Are you seeing a shift with younger women when it comes to open conversations about the change as well as expectations in terms of treatment?
Dr. Judith Joseph:
Absolutely. Millennials were born into the world, and the first generation to have internet. So millennials have this access to knowledge, and they're seeking better ways to improve their health. And I'm seeing a lot more conversation around women's mental health, around women's physical health with millennials and wanting to take more charge and to use this knowledge to empower them to prevent things like osteoporosis, to prevent things like falls and dementia and heart disease by accessing this knowledge. And they're also less, I find, ashamed of talking about their age and about the aging process, because the 40 of today isn't the 40 that was 20 years ago, right? No one's thinking 40 is old, right? We see in the movies years ago, a forty-year-old was depicted as being over the hill, but now it's like you're just getting into the best part of your life in your 40s. So I think there's a shift in the way that millennials think about aging compared to previous generations, and also there's this abundance of knowledge that they have access to that they always had access to because they were born into the world with internet.
Dana Taylor:
Dr. Judith, if you were to suggest just a few things that women can do to understand and manage their symptoms, what would they be?
Dr. Judith Joseph:
I would say to understand your symptoms and to manage your symptoms, don't do it alone. This is the age of information, but it's also the age of community. So find your support group, find like-minded people who are on this quest for knowledge and for self-improvement, and really team up with them. So when you share and you have a sense of community, that decreases the shame, the blame, and the stigma. And also prepare. You don't start saving for your financial future in your 50s. If someone told you start saving in your 50s, you look at them like, "What are you... That's crazy." Right? So why are we saving for our physical bank, the most valuable bank we'll ever have, which is our bodies, we only get one, why do we wait until our 50s to prepare?
We should be preparing in our 30s, we should be getting that weight-bearing exercise, and eating more fiber, eating more protein. We should be cutting out toxic habits like smoking, drinking excessively, cutting out toxic people, because the number one predictor of longevity is the quality of your relationships. So really be mindful about protecting your brain from stress and really taking care of your body and preparing yourself for the best outcome possible.
Dana Taylor:
Dr. Judith, thank you so much for joining me on The Excerpt.
Dr. Judith Joseph:
Thank you so much for having me. It was a pleasure speaking with you today.
Dana Taylor:
Thanks to our senior producers, Shannon Rae Green and Kaely Monahan for their production assistance, our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts@usatoday.com. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.