0:01

Ted Audio Collective Hey

0:13

listeners, it's Ted Health and I'm Dr.

0:15

Shoshana Unger-Lighter. It's estimated

0:18

that by the year 2025,

0:20

over a billion people will

0:23

experience menopause globally. This

0:26

is far from a rare event, yet

0:28

it remains a topic often spoken

0:30

about in hushed tones. Why

0:34

does this vast subject still lurk in

0:36

the shadows of public discourse? For

0:39

many, menopause is vaguely understood

0:41

as an unspecified period or

0:44

hot flashes and brain fog. But

0:47

there are plenty of challenges that

0:50

remain under-discussed in public. In

0:53

this talk, Dr. Maria E.

0:55

Sophocles brings a refreshing, bold

0:57

voice to the menopause conversation.

1:01

Using humor and a wealth

1:03

of knowledge, Dr. Sophocles peels

1:05

back layers of misunderstanding and

1:08

stigma to bring the hidden

1:10

struggles of menopause into the

1:12

spotlight and challenge the status quo.

1:16

Tune in and then stick around

1:18

after the talk for my conversation

1:21

with OBGYN and women's health advocate,

1:23

Dr. Jessica Shepherd. Schwab

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wonderfulpistachios.com to learn more. So

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the other day, a woman walked

3:30

into my office and exclaimed, My

3:34

vagina has betrayed

3:37

me. Not

3:41

what most of us hear on a Monday

3:43

morning before coffee, but welcome to

3:45

my world as a gynecologist and sexual

3:48

medicine specialist. You

3:51

know, everybody thinks of menopause as

3:53

hot flashes, but for over half

3:56

of menopausal women, it's

3:59

accompanied by sexual issues, things

4:01

like loss of libido, or

4:03

painful intercourse, even total destruction

4:06

of a relationship, it's what

4:08

I call the bedroom gap. The

4:11

difference in sexual expectations

4:13

and capabilities of men

4:15

and women in midlife. Now the bedroom

4:17

gap is a combination of

4:20

the genital assets of menopause and

4:23

deeply entrenched cultural and historical

4:25

gender roles. To understand

4:27

how to close the bedroom gap

4:29

and to get the sex we

4:31

want, we have to examine its

4:33

root causes. So let's start

4:35

with some science. In

4:38

menopause, the ovaries

4:40

make estrogen less consistently and

4:42

eventually stop making it all

4:44

together. And this loss

4:46

of estrogen has two huge effects

4:48

in the vagina. The first is

4:51

on collagen. Less

4:53

estrogen means less collagen is

4:55

made. On the

4:57

quality of that collagen deteriorates

4:59

from strong and stretchy to

5:02

brittle. Ouch. The

5:06

second effect of the loss

5:08

of estrogen in the vagina is on blood

5:10

vessels. We need blood vessels for lubrication. When

5:13

I'm examining a patient, I

5:15

can literally see if

5:17

she's deficient in estrogen, the deterioration

5:20

from thick, ridgy, dark

5:23

pink, elastic, moist tissue

5:26

to thin, dry,

5:28

inelastic, pale pink,

5:31

even yellowish white tissue. We

5:34

also need blood vessels for

5:36

arousal. This is where you're

5:38

supposed to wake up. When

5:43

we're aroused, fluid moves from the

5:45

blood vessels through

5:53

the vaginal wall to

5:55

make lubrication. Without blood vessels,

5:57

you're not going to get wet no

5:59

matter. how turned on you are. So

6:03

where does this leave you? Well,

6:06

you feel dried up. You can't get wet.

6:10

Your vagina seems to be on

6:12

fire. And your

6:15

partner perceives your discomfort. Then you feel

6:17

bad. Then your partner feels guilty. And

6:19

then you feel as if you have

6:21

wrecked the whole moment. I

6:24

will never forget, a patient said to me once,

6:28

Dr. Safa, please, when

6:30

my partner and I have sex, we

6:33

sing this Johnny Cash

6:35

song, Ring

6:37

of Fire. We

6:41

sing it. I sing it. Because I have

6:44

to sing and laugh, or

6:46

else I would cry. And it would

6:48

spoil the moment for him. For

6:52

him. So while

6:54

women are living in this Ring of

6:56

Fire, mercy sex world, on the other

6:58

side of the mattress, things

7:03

are a little different. See, for 25

7:05

years, men have had

7:07

a relatively safe, reliable, available

7:10

medical option for erectile

7:12

dysfunction. What was

7:14

first invented to firm up a

7:17

floppy penis has now become a

7:20

global phenomenon to

7:22

optimize male sexual

7:25

performance. Now

7:27

Viagra did not cause the bedroom gap, but

7:29

I believe it has widened it. And

7:32

by the way, it's not men's

7:34

fault. They are just availing themselves

7:37

of what gender bias modern medicine

7:39

has on offer. True.

7:42

But while middle aged men

7:44

are benefiting from a rock

7:47

hard, medically enhanced direction, their

7:49

female partners are literally left

7:51

hung out to dry. So

7:58

here's a good move. Women do

8:00

have options, but they just don't

8:03

seem to avail themselves of them.

8:06

Why? What's the holdup? Well,

8:10

one problem may be that

8:13

many doctors don't feel comfortable

8:15

talking to female patients about

8:18

menopause and sexual issues because

8:21

they feel they were never

8:23

properly trained. And

8:25

I think this is true. Our medical

8:27

system is woefully outdated. In

8:29

fact, one study showed

8:33

that two-thirds of

8:35

medical training programs in the

8:37

U.S. have just one lecture

8:40

on menopause. One. Which

8:42

may explain why doctors are

8:44

uncomfortable and why 75% of

8:48

women who go to

8:50

doctors to seek care for menopausal

8:52

problems come away

8:54

empty-handed. This has

8:57

to change. Because

8:59

every one of us is going to

9:02

go through menopause and experience the

9:04

loss of estrogen. And

9:06

there are a lot of us right now. Globally,

9:11

there are 1.1

9:13

billion women right now who've

9:15

reached menopause and post-menopause. And

9:18

almost half of them are

9:20

suffering from sexual issues largely

9:23

quietly, and it's probably underreported.

9:26

I know because for 28 years,

9:31

I have listened to your stories on

9:34

five continents, and

9:36

I can tell you that the bedroom gap

9:39

cuts across race, ethnicity,

9:43

economics, education, and

9:46

geography. It is universal

9:48

and ubiquitous. It's

9:51

also lasting a lot longer. See,

9:53

women are outliving men by five to

9:56

six years, and they're spending more than

9:58

a third of their lives. of

10:00

their lives after menopause. So

10:03

there are more post-menopausal women

10:05

who are single, widowed, divorced.

10:08

Some of them want to be intimate. They

10:11

go online. They swipe up. They

10:14

swipe right. They start

10:16

dating. They start having sex. And

10:18

this is great. But

10:22

between the issues

10:24

inherent in the bedroom death,

10:27

Viagra waddling that death, and

10:30

the complexities of online dating, it's

10:34

no wonder you feel your vagina

10:36

has betrayed you. But

10:39

it's not your vagina's fault. No.

10:43

What has betrayed you is

10:46

not only the biology of aging, but

10:49

history, and

10:52

culture, and

10:55

gender roles etched in

10:57

sexual stone over millennia.

11:00

Sexual dogma that decrees

11:03

that a woman's role in the

11:06

bedroom is to

11:08

please, to serve, to

11:11

not impede the sexual pleasure

11:13

that a man is entitled to. Now

11:17

we're not going to change a millennia of

11:19

sexual scripting in a TED Talk. But

11:23

I can offer you this. Since

11:26

we know that deficiency

11:28

of estrogen makes the vagina

11:30

dry and unpleasant,

11:33

then maybe one solution to closing the

11:36

bedroom death might be to replace that

11:38

vaginal estrogen. Uh-oh.

11:42

I know what you're thinking. You're

11:44

thinking, estrogen? What

11:47

about the cancer risk? Well,

11:50

I get it. We have to

11:52

address this collective fear of

11:55

estrogen and cancer. That fear

11:58

stems from the women's health. Health

12:00

Initiative, the media storm that

12:02

surrounded the release of

12:04

that data 20 years ago. That

12:07

study examined the risks

12:09

of oral estrogen and

12:12

cancer, among other things, not vaginal

12:14

estrogen. So here's the key point.

12:17

Estrogen behaves differently depending

12:20

on where and how

12:22

it's used. Check

12:24

it out. Vaginal

12:26

estrogen works generally, locally, and

12:28

has positive effects. Systemic

12:31

estrogen can have positive or

12:34

potentially negative effects depending on

12:36

the target tissue. Vaginal

12:39

estrogen has been out since 1946

12:42

and studied extensively and has

12:44

never been shown to

12:46

cause breast or other cancers.

12:50

But we, the big we, have made

12:52

vaginal and systemic estrogen

12:54

falsely equivalent. We

12:56

have thrown the baby out with

12:58

the bathwater. Our fear does not discriminate.

13:02

And now far too many women don't

13:04

use estrogen at all. So

13:06

where does this leave us? Well,

13:08

the thing is, we have a right

13:13

to comfortable sex and

13:15

a right to pleasurable sex.

13:19

We talked about vaginal and systemic

13:21

estrogen. And there are

13:23

even other medications we can use, vaginal

13:25

and oral, that will help us to

13:28

close our bedroom gap. The

13:31

other avenue to close the bedroom

13:33

gap is advocacy. How

13:35

can you close your

13:38

bedroom gap so

13:40

that you can enjoy sex? Or

13:42

better yet, how can you never have one

13:44

happen in the first place? I'm talking to

13:46

you, millennials and gensiers. Well,

13:49

one, get educated, read credible

13:51

sources, find clinicians

13:53

invested in sexual health. Two,

13:57

talk about it to each other, to

13:59

your... clinicians, to your partners,

14:02

talk without shame or

14:04

blame and get specific what

14:07

hurts, what feels good. Get

14:10

sexually creative and

14:12

don't do anything that doesn't feel good. And

14:17

number three, reclaim sexual

14:20

and genital health as a life-long

14:23

maintenance project and don't think that

14:25

just because you can't get wet or

14:27

you have wimpy orgasms that that

14:29

can't be fixed because

14:31

here's the deal, which you

14:33

already heard in this talk. We

14:35

have a right to

14:38

comfortable sex and a right to

14:40

pleasurable sex. So

14:42

let's move the

14:44

sexual equality needle forward.

14:48

Let's start with young people,

14:50

young men and women. It

14:53

is time for sex

14:55

ed to progress beyond getting

14:58

a condom on a banana. It

15:04

is time for sex ed

15:06

to prioritize equal

15:09

sexual pleasure for men and

15:11

women. So they learn it

15:14

right from the beginning when they're starting to

15:16

have sex. And

15:19

it is time to revamp

15:21

medical education, to keep

15:23

up with the demographic explosion

15:26

of menopausal women so

15:29

that doctors have the tools and the

15:31

information they need to provide to women

15:33

so they don't leave empty-handed. And

15:36

it is far past

15:38

time for the concept of

15:41

sexual pleasure to be gender neutral

15:45

because it's

15:47

never too early to start. It's never

15:49

too late to improve equal sexual

15:52

pleasure for men and women. And

15:55

let's face it, sexual health

15:57

is part of long-term human

15:59

health. We know

16:01

that staying sexually active reduces

16:03

blood pressure, improves cardiovascular health,

16:06

decreases stress and depression and

16:08

anxiety and is linked to

16:10

longevity. And

16:12

we women, we

16:15

must emancipate

16:17

ourselves from the

16:19

rigid roles of

16:22

salts for procreation or

16:24

male pleasure. My

16:28

big hope is that

16:32

in closing the bedroom gap, we

16:35

take one small

16:39

sexual stop towards

16:43

gender equality for all of us.

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Terms and more at applecard.com. Ted

18:00

Women's 2023. And

18:03

now I'm excited for you to listen

18:05

to my conversation with Dr. Jessica Shepherd.

18:08

She's a board-certified OBGYN and

18:10

a menopause expert. She's

18:13

the founder of the Modern Menopause and

18:15

the CEO of Sanctum Med and Wellness

18:17

in Dallas, Texas. Before we

18:19

jump in, a quick heads up that

18:22

the audio quality in this interview isn't

18:24

how we usually record. But

18:26

I think this topic is so important,

18:28

so I really want to still share it

18:30

with you. And I hope you find it as valuable

18:32

as I did. Jessica,

18:35

it was fantastic seeing you

18:37

on stage at South by

18:40

Southwest earlier this year, diving

18:42

into all things menopause and

18:44

women's health. A truly

18:46

hot topic. It is, and no

18:48

pun intended, right? That's so true.

18:51

That's finally getting the spotlight it

18:53

deserves. It's considering about half

18:56

of the global population is female.

18:58

Billions will experience menopause with

19:02

many of them having significant symptoms

19:04

that will drastically affect their quality

19:06

of life. There's some progress happening

19:09

in this space. I don't think

19:11

we're there yet. Yeah, I think, you know, you've

19:13

brought up a beautiful point of you're glad that

19:15

we're here. But I also want

19:17

to highlight that we're here at the

19:19

almost like dawn of understanding

19:22

menopause when we look at it from

19:24

a perspective of even society bringing it

19:26

up as not a taboo topic. You're

19:28

really just at the beginning stages of

19:31

how we can really utilize this

19:34

particular topic

19:36

of hormones, being comfortable with

19:38

talking about menopause and now going

19:40

out to educate not only

19:42

physicians who, you know, we were facing

19:44

this on research, but also the vast

19:47

majority of the population, as you said,

19:49

which is mostly women. There's a lot

19:51

of education to be done, a

19:53

lot of kind of myths to debunk, and

19:56

that takes time. So just

19:58

over 20 years ago, results... from

20:00

this very large trial called the

20:02

Women's Health Initiative, or WHI, were

20:05

released. Tell

20:07

us about the results of that

20:09

trial and how it influenced the

20:11

prescribing of hormone therapy for menopause

20:14

symptoms by doctors in America. Yeah.

20:17

You know, going back to why that

20:19

study was even launched, it was supposed

20:21

to be the largest study in preventative

20:23

health for women for cardiac disease. And

20:26

with that, they had a cohort of women and

20:28

they were looking at how hormone

20:31

replacement therapy was going to benefit

20:33

or how it would impact cardiovascular

20:35

disease. During that study, when they

20:37

had women who were on estrogen

20:39

and progestin, they

20:41

realized that there was an increase

20:43

in breast cancer. So

20:45

from that, they did stop the study

20:47

because they were like, we do see an

20:50

increase in breast cancer, albeit if you look

20:52

at the numbers, weren't enough that

20:55

we should have gone the route that we did. But

20:58

what the public heard through media was

21:00

that estrogen and

21:03

or hormone replacement therapy causes breast

21:05

cancer. So if you can imagine from like

21:08

a sound bite perspective, it

21:10

literally was like everyone running around like a

21:12

chicken with their head cut off being like,

21:14

oh my God, we're all going to get

21:17

breast cancer. So there wasn't really any time

21:19

to look at how there was some cardio

21:21

protective benefits. And then, oh, by the way,

21:23

it decreases risk of colon cancer. So you

21:25

know, there were all these different things that

21:27

came out from the study, but the damage

21:30

had been done. And this is where we

21:32

are now, you know, 20 plus

21:34

years later. And just looking at statistics,

21:36

you know, if you want to put numbers to it,

21:39

when we used to prescribe HRT

21:41

or hormone replacement therapy, that

21:44

was what we were doing at that time. Right? So

21:47

from that 2002 halt of that study, we've

21:49

seen an 84% decline in the prescription of

21:54

hormone replacement therapy. So it was kind

21:56

of like the streets are empty, all

21:59

the buildings are empty. abandoned and hormone replacement therapy is

22:01

like this tumbleweed. So it's kind of like

22:03

going down the street in the Western and

22:05

that's where we are now. Now

22:07

can you unravel the connection

22:09

between menopause and increased risk

22:11

for conditions

22:14

like heart disease, dementia and

22:16

osteoporosis? Yeah. I'm glad you

22:18

brought up those specific conditions,

22:22

which we do see impacting women later

22:24

on in life and morbidity, mortality rates.

22:27

And what we do know is

22:29

that the depletion of estrogen is

22:31

almost like this body's

22:34

kind of vacuum. And when it leaves the

22:37

aging process and the inflammation

22:39

process in the body significantly

22:41

increase. And so that's

22:43

why we start to see that if you

22:46

do look at heart disease, heart disease is

22:48

still the number one killer of women across

22:50

the world. And looking

22:52

at the correlation between the decline in estrogen

22:54

and women and average age of menopause of

22:57

52, then looking

22:59

at heart disease and when it kills

23:01

is because we don't have the

23:03

benefit of having the protection of estrogen. And

23:06

the same thing goes for bone and the

23:08

same thing goes for brain and dementia. I

23:11

think we really hyper focused

23:13

on reproductive hormones, namely estrogen,

23:16

progesterone and testosterone as

23:18

being like hormones that are only in the pelvis.

23:21

And there are estrogen, progesterone and

23:24

testosterone receptors all over the

23:26

body in the brain and the heart and

23:28

the breast and like everywhere in the bone.

23:31

And so when you start to see

23:33

this relationship kind of crumbling between hormones

23:35

and the target organ, that's where you

23:38

start to see the disconnect and why

23:40

these diseases and conditions manifest so rapidly

23:43

after menopause in women. And

23:46

what are the most stubborn myths

23:48

about menopause that you confront? Where

23:51

it related to hormone therapy and otherwise

23:53

and how do you confront them in

23:56

your practice? This is

23:58

why I love medicine for what it is. the

24:00

ability to use fundamental research,

24:03

evidence-based research and statistics that

24:05

truly help patients understand where

24:07

they lie individually within those

24:10

statistics for me. So

24:12

most things that I hear

24:14

is that hormone replacement therapy is bad. That's

24:17

literally the statement. And so, you know,

24:19

my job is to extract out of that,

24:21

well, in that statement that you heard, what

24:25

did you hear and why? And

24:27

when I can meet patients where they are

24:29

in their understanding and information level of what

24:31

they have, then that's when

24:33

the conversation starts. And so that's

24:36

why I take the time to help, you

24:38

know, understand their discomfort with the

24:40

information, miss education

24:43

on the information, and then we start

24:45

to build. We start to build from

24:47

that and scaffold for them. So

24:50

important. And

24:52

so more granular and ask you,

24:54

based on the latest North American

24:56

Menopause Society, the NAMS guidelines, what

24:59

are some of the key considerations

25:01

for using hormone therapy in

25:03

perimenopausal women? Yeah, most

25:06

of the key considerations when you look at

25:09

the NAMS recommendation is really

25:11

for symptom relief, right? I don't think

25:13

we're at the stage yet when we're

25:15

looking at HRT as something that is

25:17

preventative in how you give it to

25:19

a patient to prevent disease. Do

25:22

I think we'll get there? Absolutely. But

25:25

where we are right now is

25:27

being more verbose and robust with

25:29

saying it is okay to

25:31

take hormone replacement therapy. Because remember, we're coming

25:33

off of a 20-year desert of not giving

25:35

it, so now we have to get everyone

25:37

back on board to being like, it's

25:40

safe. That's where we

25:42

are. The start of point of saying

25:44

it's safe and you can take it

25:47

and we want to help your symptoms.

25:49

So how do factors like ethnicity and

25:51

socioeconomic status play a role in a

25:53

woman's menopause experience and maybe her access

25:55

to care? Have we observed

25:57

any patterns here? Yeah, we definitely have.

26:00

And the form study was a pivotal

26:02

study that really looked at women and

26:04

their experience in menopause. And they were

26:07

able to extract ethnicity based on Japanese,

26:09

Chinese, Caucasian, Hispanic, and black

26:11

women. And what they

26:13

were able to show is the severity

26:15

and frequency, but also duration.

26:18

And when they looked at factors starting

26:21

with duration, they found that black women

26:23

tend to have a longer time at

26:25

which they'll have their vasomotor symptoms, namely

26:27

hot flashes and night sweats, whereas the

26:30

least were Japanese. And also when they

26:32

looked at severity, it was also seen

26:34

that black women had more severe hot

26:37

flashes and night sweats, and also started at

26:39

an earlier age. Now here's the

26:41

caveat to all of that. And

26:44

that's where the socioeconomic kind of plays

26:46

a role in exactly those

26:48

statistics that I just mentioned. When we

26:50

look at aging and how it has

26:53

an impact on the body internally through

26:56

micro stressors and chronic inflammation,

26:58

over time, that it starts

27:01

to diminish the body's ability

27:03

to have response systems or

27:05

the immune system, social stressors,

27:08

emotional stressors, which is what

27:11

we see in lower socioeconomic

27:13

communities, does play

27:15

a part on the internal

27:17

biologics of the body and how that

27:19

shows inflammation. And therefore, you

27:22

start to see some of those symptoms occur

27:24

earlier. And I wish that we looked more

27:26

at medicine in a way where we're bringing

27:29

into it the actual experience and

27:31

stresses of someone's life, dictating

27:34

their possibility of having

27:36

a disease, which we could see even outside of

27:38

menopause when you look at hypertension and diabetes and

27:40

asthma. Same thing as what

27:42

you're seeing for those disease states as well. And

27:46

much more research is needed, right? So

27:49

what hurdles do we face

27:51

in menopause research today and

27:53

how can we overcome them?

27:56

I think most times when you look at

27:58

studies, you really want significant. So

28:01

you want a study that has a lot of women

28:03

and that's where we need the buy-in,

28:06

right? We need the subjects to be

28:08

able to look at the differences between

28:10

different types of hormone replacement therapy because

28:12

there's different modalities, there's different doses, there's

28:15

different medical histories that might fall

28:18

into why someone can or can't take

28:20

anything. I'm going to make a

28:22

very big shout out right

28:24

now to testosterone is that we need FDA

28:26

to approve testosterone therapy for women because it

28:28

currently isn't. That's a big

28:31

part of hormone replacement therapy as well. But

28:33

I think that in order for this to

28:35

happen, we have to have the buy-in of

28:37

people being safe. And that's why

28:40

I was saying this is a slow

28:42

shift into getting everyone to understand the

28:44

benefits of it because the reason it

28:46

was stopped, right, or the reason

28:48

people believed that hormone replacement therapy wasn't

28:50

good is because it put them in

28:52

an unsafe category. And

28:55

so people will never just jump all in if

28:57

they feel unsafe. They want to be safe. Yes,

29:00

definitely. I

29:02

want to switch gears and talk

29:05

a little bit about sexual health.

29:07

So how does menopause

29:10

impact our sex lives and

29:13

what are the options for addressing some

29:15

of the changes that happen with menopause?

29:18

I discuss often because

29:21

there is a belief

29:24

that sexual health is not important

29:27

for women. I think

29:29

there's a belief that it can't

29:31

be addressed or shouldn't be addressed or it's

29:33

not important. And so I

29:35

would say both to society to

29:37

stop sharing that narrative and

29:40

also for providers to really,

29:42

truly ask these really

29:44

hard questions about sexual health because most people are

29:46

not going to be very, you

29:49

know, kind of forefront with saying I'm having some

29:51

issues with libido or I'm having vaginal dryness. And

29:53

so we have to bring it to the table

29:56

and say, you know what, how's your sex life

29:58

and how is your interest? in

30:00

sex life, how many times are you

30:02

having intercourse, are you having pain with

30:04

intercourse, instead of just it being

30:06

an intake form type of question, sex, yes or

30:08

no, and then we move on. It

30:10

needs to be a little

30:12

bit more introspective than

30:14

yes or no. And that's how

30:17

I question my patients, and it's amazing how

30:19

much information you can find out from them.

30:21

I think there's a lot about sexual health

30:23

that I would love to, you know, take

30:25

a lot of time to discuss, but really

30:27

it boils down to how do I feel

30:29

about myself and this new transition. A

30:31

lot of that starts to wane

30:33

because of the decrease in estrogen

30:35

and testosterone, but also

30:37

if I am having intercourse

30:39

or sexual relations with

30:42

themselves and or others, is it

30:45

painful or uncomfortable, and what can I

30:47

do to resolve that? I think those

30:49

are two good places to start. It's

30:51

the thought process behind it, which is

30:53

your libido and intimacy and wanting to

30:55

connect, and then also when I am

30:57

connecting, is there something that's

30:59

hindering me from having the full pleasurable experience?

31:03

Okay, so I want you to get out

31:05

your crystal ball for me, and what do

31:07

you predict for the future of menopause management

31:09

and research in the

31:11

coming years? What

31:14

I predict is that we are going to

31:16

have everyone on board. I

31:18

believe that this is something that we'll look

31:20

back in maybe 10 years, and we'll start

31:23

to see more of it in, I guess

31:25

you could say, pop culture

31:27

in TV shows where we're

31:30

not seeing older women in Hollywood being

31:32

shunned because they're older. We're seeing love

31:34

stories where it can be very spicy

31:36

because people can still have sex when

31:39

they're old. Then from a

31:41

provider standpoint, this is something that I'm really

31:43

invested in right now as I'm building

31:45

a tech platform called Modern Meno, is

31:48

that it's inclusive in the face

31:50

of all providers to be able,

31:53

whatever expertise that they're in, to

31:55

actually address the issue and

31:57

give their patients a really kind of...

32:00

full menu of options that they can

32:02

take, whether it's HRT or not, whether

32:05

it's nutritional lifestyle issues, looking

32:08

into kind of the biomechanics of exercise

32:10

and movement, because really it has to

32:12

work together and to really get the

32:14

big picture and the great outcome that

32:16

we're looking for. And

32:19

Jessica, what proactive steps should women

32:21

take as they approach menopause to

32:24

really ensure a healthy transition? If I

32:26

said if this were a screenplay right

32:28

now, menopause is like a horror story,

32:30

this is where we'll make the biggest

32:32

impact in the next years to come, is

32:35

to change the screenplay to a

32:37

comedic love story. One,

32:39

we cannot escape menopause, so if anyone is

32:41

listening and thinks that they may evade it,

32:43

it's not a sense of symptoms, but just

32:45

menopause is like, characteristically,

32:47

what it is, which is just decrease

32:50

in estrogen, not eliciting a period, but

32:52

we can't escape it. So that's going

32:55

to happen. And then when I start to get

32:57

to that phase is to say, you know what,

32:59

I'm going to embrace this phase and I'm not

33:01

going to look at it as something that's scary,

33:03

but what are the things that I can start

33:05

to do now that's going to make that transition

33:07

easier, not as rocky? I really feel that

33:10

women are on this smooth road, maybe

33:12

a pothole here or there, and then

33:15

it's like they hit menopause and no

33:17

one has fixed that road. It's like all

33:19

these potholes are falling all over the place. And

33:22

I don't want the transition to be so abrupt. I want

33:24

it to be this kind of like

33:27

moving into the fourth quarter with grace

33:30

and the ability to accept it for what

33:32

it is, but to do it in a

33:34

way where they take this

33:36

ownership of it and embracing that

33:38

change. And

33:41

how can people who aren't going

33:43

through menopause best support the people

33:45

in their lives who are? Have

33:49

conversations that are a little bit more in depth

33:51

because it's never just a one word answer when

33:53

it comes to menopause. It usually

33:55

is the confluence of answers which

33:58

creates this experience for the people. And

34:00

many times we're not even able to express

34:02

it either because we really haven't given this

34:05

freedom or luxury to

34:08

women to be okay and open in how

34:11

they express them in a possible experience. So

34:13

when talking to men is having

34:15

them understand that the conversation, sometimes

34:17

the support alone is the

34:20

biggest part of what can get women through, whether

34:23

it's a hot flash or a night sweat

34:25

or really trying to work on the

34:28

sexual intimacy is just the support alone

34:30

and being vocal with it as well.

34:33

And I would also say for society,

34:35

I think we have to do better

34:37

in how we look

34:39

at women in aging in

34:41

general. And also from that

34:44

menopause perspective, I've seen this all throughout women's

34:46

health, is anytime there's anything to do with

34:48

the pelvis, it becomes very demeaning as

34:51

if it's not true. And

34:53

so many other features that really allow women

34:55

to be more thoughtful, if this is the

34:57

reaction response I'm going to get from the

35:00

outside world about this thing that I'm going

35:02

through, then I'm not going to talk about

35:04

it. Why would you? And

35:06

so I think we need to

35:08

change how society sees women, period.

35:11

So I think there's a lot of work to be done.

35:14

There really is. But again, I always

35:16

say that I'm optimistic about

35:19

the future. So Jessica,

35:21

where can people find you and

35:23

find out more information about the work you're doing?

35:26

So Instagram, people can

35:28

find me at Jessica

35:31

Sheppard, M-D-S-H-E-P-H-E-R-D-M-D. But

35:33

also what I've done over the last year

35:35

and a half is extract all my menopause

35:38

info from my personal page and

35:40

put it on Modern Meno. So

35:42

Modern Meno is my

35:44

channel that is just devoted to menopause information. And

35:46

then I hope that people join us there and

35:48

ask questions, but also really look at all the

35:51

information that's on there because it is actually

35:53

very focused on the lifestyle portion of

35:56

menopause. Dr.

35:58

Jessica Sheppard, thank you. much

36:00

for this conversation. I always learn so much

36:02

from you. I really appreciate it. Thank

36:04

you so much for having me here and

36:06

I hope that we can have even more

36:09

conversations about women's health and looking at how

36:11

killing menopause and menopause are going to be

36:13

the new transition that we

36:15

can look forward to and take that

36:17

gracefully. And

36:26

that's it for today's episode. Thanks

36:28

so much for listening. TED

36:30

Health is a part of the TED Audio

36:32

Collective. I'd love to hear

36:35

your thoughts about the episode. Send me

36:37

a message on Instagram at ShoshanaMD.

36:41

This episode was produced by me

36:43

and Costanza Gallardo, edited

36:45

by Alejandra Salazar and fact-checked

36:47

by Vanessa Garcia Woodworth. Special

36:51

thanks to Maria Lajes, Farah

36:53

Dae Grunge, David Biello,

36:55

Bereniello Valarezo and Michelle

36:57

Quint. I'm Dr. Shoshana Ungerleiter and I'll

36:59

talk to you again next week.