The Health Curve

Menopause Decoded: What's Really Happening & How To Navigate It - with Stacey Silverman Fine, MD at Maven Clinic

• Dr. Jason Arora • Season 1 • Episode 4

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Menopause is a natural biological transition that over 1 billion women worldwide are experiencing or have gone through. 

Yet, despite its universality, it remains widely misunderstood and rarely discussed. 

Each year, 1 million women in the U.S. enter menopause, and by age 55, 80% have gone through it. Symptoms are common and can be disruptive to life at work and at home. Examples include hot flashes (80%), night sweats (70%), vaginal dryness (60%), mood changes (50%), and sleep disturbances (40%).

But menopause isn’t just a health issue—it’s a workplace and societal issue. 1 in 4 women consider leaving their jobs due to symptoms, and many report stalled career progression or missed opportunities because of unmanaged health challenges. A lack of menopause support in the workplace contributes to gender inequality, as women at the peak of their careers face increasing barriers to leadership and personal economic stability. 

In this episode, we break down what menopause is, why it happens, what to expect, and—most importantly—what can help. 

Joining us is Dr. Stacey Silverman Fine, OB-GYN at Maven Clinic, who explains the science, debunks common myths, and shares practical strategies to help women and allies address menopause with greater awareness and support.

SPEAKER_01:

Hello, and welcome to The Health Curve. I'm your host, Jason Arora. This week, we're going to talk about the menopause. Now, this episode isn't just for women. It's for men and other allies, too. The menopause describes the stage of a woman's life when her menstrual period stopped permanently, and it signals the end of the reproductive years. It is diagnosed when a woman has not had a menstrual period for 12 consecutive months. It is not a disease. It is an entirely natural biological transition. The average age at which this happens is around 52 in the US, though this can vary widely. The menopause is preceded by what is known as the perimenopause which can last for several years and together with the menopause can be a particularly uncomfortable period in a woman's life with prominent symptoms which can cause a lot of discomfort and fatigue. It frequently impacts life at work and at home and there is currently very little support available to women as they attempt to navigate this. So for many reasons it can be a difficult topic to discuss And it often isn't discussed, which is partly why there's a lot of confusion and misinformation about it. So we're talking about it because we want to help women understand it better. We want to help men and other allies understand it better so they can provide better support. And we want to raise the profile of this topic in everyday conversation so we can make it less taboo. Today, we're very grateful to be joined by Dr. Stacey Silverman Fine, who is an OBGYN based in California. She's been practicing OBGYN for more than 20 years. She currently works full-time for Maven Clinic, which is the world's largest virtual clinic for women and families. Stacey, thank you so much for joining us.

SPEAKER_00:

Jason, thank you so much for having me. It's an honor and a pleasure to be here today.

SPEAKER_01:

We're very honored to have you. This is a very big topic, and we've been really excited to get this one recorded. Maybe we start with the basics. So what is menopause and why does it happen?

SPEAKER_00:

Absolutely. So the definition of menopause is one full year without a period, right? That's one year. If you've gone nine months without a menstrual period and then you have one, you're not menopausal and that clock resets, right? So sadly, this can go on for quite some time and it is defined after the fact, right? Once we haven't had that period for a year, then all of a sudden we're menopausal.

SPEAKER_01:

Do you often see patients who've had long periods of time, whether it's six months, nine months, or even more, but less than 12 months where there hasn't been a period and there is this gray area around the conversation?

SPEAKER_00:

So absolutely. I think more often than not, we see a lot of members in the perimenopause, right? And perimenopause is a little bit different. It's this period leading up to and surrounding menopause, and it's really fraught with the biggest hormonal fluctuations. And this is when people really become horribly symptomatic. And this period can really last anywhere from four to 10 years. So when we think about it, these are women that are either in their 30s, What's happening biologically

SPEAKER_01:

to the body? Why is menopause happening?

SPEAKER_00:

So biologic women are born with all the eggs we're ever going to have. We don't regenerate our eggs. And in fact, by the time we've gone through puberty, we've lost half of our eggs. So menopause happens when the ovaries actually run out of eggs and we no longer produce high levels of the hormones, estrogen and progesterone, which are the two main hormones that control menstruation.

SPEAKER_01:

So... If that's what's happening biologically, how does that tend to show up?

SPEAKER_00:

So given this decrease in the hormones that we see during menopause, symptoms develop, right, and lead people to turn desperately to treatment. And when we're talking about symptoms, they can be really quite varied and also really pervasive. So we talk about, you know, these, what are we called, somatic or physical symptoms. These are your typical ones, the hot flashes, the night sweats. Those are the main ones, although people will report things like hair loss, weight gain, brain fog, which I also think is not only as a physical or somatic symptom, but also really goes along with a psychological or emotional symptom. We can also see decreased libido in this time. When we look at the psychological or emotional, the brain fog, the mood swings, anxiety, palpitations. And then sadly, we also have these urogenital symptoms that can be things like urinary urgency or frequent or incontinence and vaginal dryness. So really quite pervasive. If

SPEAKER_01:

we go back to the biology, what's the main cause of all these symptoms?

SPEAKER_00:

Yeah, so it's really the lack of the hormones, estrogen and progesterone, that we normally make as throughout our lives, but then as we stop producing eggs, we stop producing those hormones. In the perimenopause, it looks a little different. What we're seeing is we're seeing surges in estrogen and progesterone and plummets in the estrogen and progesterone. And when we look at perimenopause, really it's those psychological symptoms that tend to be more predominant. It's the anxiety, it's the palpitations, it's the irrational behavior. I'm with somebody the other day and she said, you need to deal with my moods. People are now calling it by my first name. For me, they would say it's my Stacey moods. And we see more of that in the perimenopause, interestingly, and it's really that rollercoaster of those hormones that is creating that.

SPEAKER_01:

How do the symptoms of perimenopause and menopause compare to those that occur during the menstrual cycle? Because I think some folks have mentioned that there are some similarities there that can be better recognized.

SPEAKER_00:

Absolutely, Jason. And that is the case. So oftentimes in a normal menstrual cycle, as estrogen and progesterone levels decrease, if an egg is not fertilized, what happens is if the egg doesn't get fertilized, estrogen and progesterone hormones plummet. And remember, it's that drop in estrogen and progesterone that is ultimately what happens in menopause. But so what we can see during a or the change in the behaviors that we experience right before a cycle. We can also see hot flashes and night sweats before a menstrual period starts. And so what we find in Perry is those symptoms sometimes get magnified as the estrogen levels are really swinging high and swinging low. I kind of joke with members that have children and will say, you know, imagine you're talking to your kids and you're telling them to clean up their room, right? And you might be initially saying, hey guys, you need to clean up your room and you're being really nice and really quiet about it and then they're not cleaning it up and they're not cleaning it up and the voice goes up a little bit and a little bit and eventually you're like, clean up your stuff, you know, and you get really upset about it and then they look at you and they're like, why are you yelling? Well, ultimately, the same thing is going on in the body, right? They're saying, your body is saying, make eggs, make estrogen, make progesterone and And initially in the normal lifestyle, they barely tell us that. And okay, we're making our estrogen and we're making our eggs and everything's going well. But as we're running out of eggs, right? The body starts yelling a little bit more, right? To get the body and the body will keep up with it in perimenopause and eventually produce those eggs. But that yelling is that surge, right? And then maybe we overshoot because we yell a little too much. We create too much estrogen, right? And Then if it's really high, it has a long way to plummet. So remember that plummet during peri, you know, as we're coming down, it could be massive changes in the mood and increases in hot flashes and night sweats.

SPEAKER_01:

And how can you differentiate between a bad period and I'm in the perimenopausal phase? Like, can you do that?

SPEAKER_00:

You may not be able to. You actually may not. However, the treatment is really the same. So when we're looking at managing perimenopause, the mainstay of hormonal treatment is a birth control pill or a birth control patch or a birth control ring. And what is the mainstay of hormonal management for those bad periods, right? It's birth control. How do you diagnose menopause? How can you be

SPEAKER_01:

sure that you're in it?

SPEAKER_00:

So truly, menopause is diagnosed as that one full year without a period versus in perimenopause, we're still having some sporadic periods. And actually, some people in perimenopause are actually having regular periods, right? But they're developing all of those other symptoms that are going on. We don't usually recommend hormone levels in the perimenopause because they're doing that roller coaster, that up and down, up and down. They're going to cross normal on the way up and on the way down, and So they're very likely to be normal. The problem that arises is when we have somebody who's maybe had a hysterectomy, but the ovaries were left in place, right? And so they're not having periods and they haven't had periods for years, but yet they're still producing estrogen and progesterone. So for those individuals, the question is, do we check hormones? Do we not check hormones? Do we just go with a clinical gestalt, you know, and try and figure out where we're at there? And really that's where the What are

SPEAKER_01:

some of the broader health implications of these hormonal changes? So beyond what we might call the reproductive system and the symptoms that people experience, what else happens in the body during this time?

SPEAKER_00:

Yeah, so this is a wonderful question, Jason. And what we're starting to see as women go into menopause is we see increased risks of bone thinning, right? Osteoporosis or osteopenia, as it's called. we also see an increased risk of cardiovascular disease, right? And really still, that is the number one cause of morbidity and mortality in women is cardiovascular disease. And so really, this is when, you know, the levels of that in women start to approach that of men. It's at menopause. We really need to be shifting into looking into the importance of maintaining our bone health, our heart health through nutrition, through exercise, through weight bearing exercise, concentrating on building muscle and maintaining muscle, right? We also see a lot of weight gain during this time. And there's lots of reasons for this. Primarily, we know that as estrogen levels decline, metabolism declines. And if that was solely the answer, we'd just give everybody estrogen and they'd lose weight. And the fact of the matter is that doesn't happen. But what's actually happening as, you know, women with ovaries age is that essentially we see a shift in muscle being converted to fat and muscle is where that metabolism occurs. So clearly there's new rules to the game. We need to figure out what these new rules are in terms of diet and in terms of exercise. This may mean diets that are higher in protein, higher in fiber, maybe some intermittent fasting, exercise to build muscle and to strengthen the So

SPEAKER_01:

what else could it be if it's not the perimenopausal period or the menopause?

SPEAKER_00:

patients that need to be checked, especially in our patients that are still having cycles but are having symptoms, right, is to check a thyroid and make sure that the thyroid is normal. Hormones, as we stated, aren't necessarily useful because they're going up, they're going down, they're going to cross normal on the way up and the way down. However, thyroid should really be checked. It is kind of that masquerader. It's what makes us feel normal. And so thyroid abnormalities can cause hot flashes. So it can be

SPEAKER_01:

helpful to rule other things out at this stage too.

SPEAKER_00:

Absolutely. Absolutely. And when somebody is on the younger side and approaching me in their 30s, that's something that I will say to them. However, we're also seeing that if perimenopause is four to 10 years and menopause isn't defined until we haven't had a period for a year, we might have somebody who's going to go through this process early and is in their 30s and is going through perimenopause. But Just cross those T's, dot those I's with a provider, make sure we're checking other things.

SPEAKER_01:

So what do we not know and where are there some emerging areas of research in women's health with respect to menopause?

SPEAKER_00:

Yeah, so I think this is an area that is really exploding. There was a really large study that came out about 23 years ago called the Women's Health Initiative Study. And this study had a large number of patients, which was fabulous. But there was a little bit of misinformation in how the data was released, right, into what they found. And what that study came out and showed, or what they released, was that there was a higher risk of breast cancer and those taking hormones. But when we looked at the data, it was really really a minuscule number in those taking estrogen with progesterone. They did find an increased risk of blood clot and stroke in people taking oral estrogen therapy. And they found an increased risk of cardiac events. The problem was when we looked at the data, the average age of the participant in that study was 63. And if average age of menopause is 51, this was a much older population. This has now resulted in what is called a timing hypothesis. We know if you're 10 or more years out from menopause, probably not a good time to start hormones for the first time. But I think what we're finding is that if we start hormones at or around the time of menopause, there might be some wonderful cardiovascular benefits. And even more so now, the estrogen and progesterone that we're using more is what we call bioidentical or body identical. And we think there might be some more benefits there. So I think, you know, research now into what are the effects of starting body identical or bioidentical hormones early? What are the effects on the heart? What are the effects on the bones? More importantly, what are the effects on the brain, right? What does this do for mentation as women are aging? And I really think this is an area we're going to see a whole lot more on over the next few years.

SPEAKER_01:

Indeed, hopefully so. And we obviously don't want this to be all doom and gloom, that all these terrible things are happening to your body and we don't fully understand them and we therefore don't know what to do about them. So the encouraging thing is there is a lot of research being done now and we're learning lots every year that is going to inform the kinds of solutions that we build for menopause. In terms of misinformation, what are the kinds of things you come across often that you can help us debunk here today?

SPEAKER_00:

Unfortunately, there's quite a bit of misinformation, right? You know, I think that initial Women's Health Initiative study created a lot of misinformation and the thought that hormones are bad, they cause breast cancer. You know, when we looked at the women taking estrogen alone, and this is women without a uterus, they actually found a drop in breast cancer in that group. So I don't think the negative data that was released or the way the data was released is really as negative as it appeared, right? So I do think there's some beneficial effects for hormones. And I think that we're starting to debunk that now. We're starting to have people talking about it, which is so important, right? Having the time and the space and being open about it. We're having a lot of, you know, women coming forward and talking about it and allies supporting women talking about it, like you, Jason, right? You know, having the space and holding the space here to have the discussion. which is so important. One of the other myths I think we see a lot and that we're seeing a lot more now is we're seeing a lot of bioidentical non-FDA regulated hormones, unfortunately. And that really was a byproduct of that Women's Health Initiative study and how that data was released. And so really I think women in general were really looking and desperate to find relief of their symptoms. And so this allowed a lot of other treatments to pop up that maybe offer that glimmer of hope. And so I think putting it back to the data, really looking into these bioidentical, body-identical, FDA-regulated hormones, non-hormonal management, right? One in eight women gets a breast cancer nowadays, and maybe they can't take estrogen. Well, we have wonderful non-hormonal management This

SPEAKER_01:

can be a very challenging time in a woman's life, you know, psychologically, as well as physically. But psychologically, you know, things around loss of identity and these sorts of things barely touched on, I think, in our traditional healthcare system. So can you talk a bit about that?

SPEAKER_00:

So I think in general, something that is really important to note here and that I try to discuss with members is not all biologic women will be pregnant. Not all of them will maybe nurse, right? But if we live long enough... all of us will go through perimenopause and menopause, right? We are not alone. So starting these conversations, having these conversations, making it not taboo, discussing it, it is part of our lives, right? It is an end of our reproductive life, but it is just the start of the rest of our lives. And many of us are at the height of our careers during this time and really having really vital stages of our lives. So if we can really mitigate the symptoms support here, I think the impact is huge.

SPEAKER_01:

So what are the wider implications of this in a woman's life during this phase?

SPEAKER_00:

So we have to go back to the symptoms, right? If you think about it and women are having hot flashes, they're having night sweats, they're not sleeping, they're having brain fog, right? They may not be their best selves at home or in the workplace, right? Global productivity losses due to menopause top$150 billion a year. We have super high rates of attrition. One in 10 women will quit their jobs altogether due to these symptoms, right? High rates of absenteeism. 11% of people experiencing menopause will miss work. And truly, menopause symptoms, if left untreated, can truly shorten the career span We'll get back to

SPEAKER_01:

this conversation in just a moment. But if you're finding this episode helpful, Here's a quick ask. Take a second to follow or subscribe to the Health Curve podcast wherever you're listening. And if someone in your life would benefit from this episode or any of the others you've heard, please send it their way. All right, let's get back to it. What kinds of things are you seeing these days around supporting women in the workplace who are going through menopause? Because I think there's been a lot of activity in that in recent years. Probably not enough, but we're starting to see more.

SPEAKER_00:

Yes, absolutely. So I think we're seeing quite a bit in the workplace. I think we're seeing more discussion about it, right? It's a more popular discussion with HR. I think we're engaging workplace allies to discuss about this as well, right? And bring it to the table so people are aware of it and understand it. And at certain works, we're having these ERGs, the employee-related groups where people can come and discuss with other people in a similar situation. We're We're having webinars on this topic with people who really are skilled in the area of menopause to help bring the actual correct information to people. We're offering and seeing digital health really playing an impact here. Sadly, what we found is that there really has been very little training in the medical field on menopause. And so digital health, I think, is perfectly poised to really connect people around the globe to people that are experts in the field. So I think workplaces are really kind of noticing that and seeing that. I think we're changing it up in the workplace. Maybe we're giving some more workplace accommodations. Maybe we're allowing more hybrid work, right? Allowing some brain Thanks for

SPEAKER_01:

having me.

SPEAKER_00:

As you probably introduced, you know, I do work for Maven Clinic. Maven Clinic is the largest digital health platform for women and families. And we do offer menopause as a support for many of our members as well. And so I think that really helps connect members to those people that are really poised to assist here, whether it be OBGYNs, whether it be nutrition coaches or physical support coaches, or maybe it's a sex coach. What would

SPEAKER_01:

you say to women who are maybe in their 30s or 40s and are getting anxious about this?

SPEAKER_00:

So I think in general would be maybe, you know, be open to looking at the information, right? And listening to your body as well. If something doesn't seem right, it probably isn't. So if you're not feeling well, and remember the symptoms can be so varied, right? Talk to your provider, get help early, be proactive, right? Again, that diet, that lifestyle is so important, right? Making sure we're eating a healthy diet, making sure we're incorporating exercise, really taking the time here.

SPEAKER_01:

Right. And if you do all those other things well around your health that can make the symptoms for this feel less worse, you would say.

SPEAKER_00:

I think so. I think in general, diet and lifestyle is still the key here. I think in general, we know that eating those diets, I've mentioned this before, you know, high in protein, higher in fiber, healthy fats, antioxidants, right? Incorporating wonderful exercise, sleep-wake schedules, right? Maybe some meditation, maybe some yoga. You know, traditionally, women put themselves last, right? They take care of spouses. They take care of children. They take care of aging parents, right? And then themselves last. But I think really in our 30s and 40s, it's really time to kind of shift a little bit and make sure we're taking care of ourselves as well.

SPEAKER_01:

And I think right now in particular, because people are living longer, we have these millennial females who are part of this sandwich generation where they have growing children and aging sick parents. And so that caregiver role has doubled up in addition to having more access to a career than women would have in the past. And so when you put that all together, it can be a lot.

SPEAKER_00:

Absolutely. Kind of juggling it all, right? And trying to keep all those balls in the air all at the same time.

SPEAKER_01:

Okay. So let's start talking about some of the solutions out there, both to help with the symptoms, with tracking, but also maybe to directly impact the menopause itself. So we have the symptomatic treatments, we've got hormone replacement therapy, we've got supplements and herbal treatments, and then we've got digital health apps and wearables and that sort of thing that can help with both tracking and symptoms.

SPEAKER_00:

So you and I, Jason, already mentioned the diet and the lifestyle. Maybe that brings in the apps, right, and the digitals and things like that to really be tracking our sleep, you know? I think that's a really big one here. We know in general that in order to address sleep, right, there's a few things that we need to look at. Cognitive behavioral therapy, which is used to address issues with sleep outside of menopause, is still the mainstay of addressing sleep in menopause, right? Setting that consistent sleep-wake time, and that's seven days a week, right? Using the bed only for sleep and for sex, right? Making sure we're turning off electronics early, instituting a wind down routine, right? And so all of those things become big here, you know, and if we're dealing with symptoms, maybe we're sleeping in cooler clothing, maybe we have cooling sheets, maybe we have a window open, the temperature is turned down. So those are kind of some of the big ones there. But when we're looking at medication themselves, right, we have hormonal management, and we have non hormonal management. So to start with hormone right? In women with a uterus, we're talking about estrogen and progesterone. If we have a uterus, we have to take both. If we give somebody with a uterus estrogen alone, we can cause a uterine cancer. So if we have a uterus, we're giving estrogen with progesterone with the bias being bioidentical, right? And so what that means is the estrogen and progesterone is sourced from readily available things, usually plant sources. So our estrogen comes from soy and yam, our bioidentical Progesterone comes from peanuts, believe it or not. And so generally, we're giving estrogen now through the skin in a transdermal formulation. The reason being is then the risk of blood clot and stroke is not as high as if we give estrogen orally. And so usually it's a patch that people apply and they change twice a week. Sometimes it's a gel packet that they use every day. Progesterone, bioidentical progesterone, really only gives It gets absorbed well if taken orally. So we take this progesterone pill and that needs to be taken every night to oppose the estrogen. In general, that'll do a wonderful thing for hot flashes, night sweats, usually sleep, joint pain, brain fog, potentially also the hair. We can't take those things if we have a higher incidence of blood clot or stroke. If potentially we have a history of an estrogen sensitive breast cancer. If we have a large history of cardiovascular disease, right, with implications there. So somebody who has active cardiovascular disease, maybe they have cardiovascular stents in place, something of that nature, they may not be able to take hormone replacement therapy.

SPEAKER_01:

And with hormone replacement therapy, are we delaying the menopause? Are we putting it off or are we doing something different?

SPEAKER_00:

Yeah, so we're not delaying it. We're actually just treating and managing the symptoms, right? And so we're treating and managing it by adding that estrogen and adding that progesterone back on in.

SPEAKER_01:

Can you talk a bit about some of the kind of herbal treatments and supplements, ideally where there is some clinical evidence, because on this show, we're quite big on what's evidence-based versus not. And let's be honest and open about about where that line is. Like there might be some things that anecdotally work, but we don't have good scientific evidence for it. The risk is low, so give it a try. What kind of things have you seen work?

SPEAKER_00:

Yeah, so, you know, when we look at non-hormonal options, herbal starts out first, right? The problem with the herbal industry, unfortunately, is there's no FDA regulation or control of this industry. And so what we found is there isn't a whole lot of reliability, right, in a lot of these things. And what I always tell patients is just because they're natural doesn't mean they're safe, you know? I think... Most of us are under the assumption, oh, it's natural, therefore it's safe. And, you know, unfortunately, people can come in and they can be on five, six, seven herbal supplements. And I always warn, you know, these are all cleared by the liver. We can do damage to the liver with these herbal supplements. So if you're going to try one or two. consult with a physician first. Make sure it's safe for you to try those. Some interact with other medications and aren't safe, right? So really important to do that. But I think, you know, the ones that we hear about most commonly, black cohosh or evening primrose oil or ashwagandha or maca root, there's a really big list here. And again, just because they're natural doesn't mean they're safe. Definitely consult with a physician before taking.

SPEAKER_01:

So what are some of the other non-hormonal treatments available for this?

SPEAKER_00:

So remember, there are going to be some people that either can't take hormone replacement therapy or don't want to, right? And herbal supplements we just discussed don't really have any real regulation, not a lot of reliability, but we do have some pharmacologic medications that really can be helpful. For instance, there is a drug called gabapentin that is a generic for a drug called Neurontin that has traditionally been used for chronic pain syndromes in this country. And for pain, we know that you need really high doses in order to treat the pain. But they found that at these little baby doses, that gabapentin can really help with hot flashes, night sweats, sleep. joint pain, and anxiety. So really a very powerful medication. And the beauty with gabapentin is it can be started and stopped at any time, really doesn't have to be weaned. The real only downside is it can cause a temporary residual grogginess upon starting. So we'll usually start this in the evening or at bedtime and have somebody take it when they don't have a huge day the next day. So if they are a little groggy, they can move to every other day. Usually that grogginess will go away with in a week or so, but the sleep and all the other benefits will persist. So that is probably one of the most powerful. We also use a lot of antidepressants, selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors or SSRIs and SNRIs. There was a beautiful study out that showed that the brains of women in perimenopause and menopause lit up differently. And my response to that study was, see, it is in our heads, just not the way everybody told us it was in our heads. It's in our neurotransmitters, right? And so these SSRIs and SNRIs work on those neurotransmitters. And so we'll get a lot of benefit from those agents for hot flashes, night sweats, and then not surprisingly, the mood component. The problem with those, Jason, is those are a If you don't like them, you generally have to wean them. And so that might be the one downside of them, but really powerful as well. The last drug is a drug that, you know, has been doing quite a fierce ad campaign called Vioza. The generic is Fezolinitent. And this drug works directly on the brain. It's the only drug of its kind. And it resets the thermostat. So it resets when we feel hot. So it is strictly for hot flashes and night sweats. It is cleared by the liver. So we do have to monitor liver tests before taking and every three months for the first nine months of use. But again, another powerful non-hormonal management option.

SPEAKER_01:

And for these drugs that work on the central nervous system, there can be some side effects that are unwelcome. Can you talk a bit about that?

SPEAKER_00:

Yeah. So with the gabapentin, the biggest one is really that residual grogginess. Occasionally, patients will say they feel a little groggy or a little woozy or a little dizzy upon taking. Sometimes we need to drop the dose if that's the case. With the SSRIs and SNRIs, it really depends. Some of them are a little bit activating. One comes to mind that's a little more activating than others. And so for those individuals that have anxiety that might make it a want to use that one. We may want to use a different one. They can also increase appetite or decrease appetite. So that's a big one in this population. Really, nobody wants to have to deal with increased weight gain further here. So, you know, again, we may use a different one that would have less effects potentially on the weight.

SPEAKER_01:

So Stacey, what can men and other allies do to support women going through perimenopause and menopause?

SPEAKER_00:

So I think in general, it's to educate themselves on what might be going on with women. Because again, even if they're not experiencing the symptoms themselves, right? they are bound to have either a spouse or a mother or a sister or somebody in the workplace, somebody that they work with that is having these experiences as well. And so to educate themselves, to be open to talking about it, right? And understanding that this is going on and it really is affecting, you know, vast portions of a woman's life.

SPEAKER_01:

What else do your patients tend to ask you about the menopause? What else tends to come up? your conversations with them?

SPEAKER_00:

One of the questions and something that I try to make sure that they understand is, you know, they feel they're alone. And I think we briefly talked on this previously. You know, they feel like they're suffering and that they feel like they need to suffer in silence. And I think it's really important to know that they're not alone, that they don't need to suffer in silence, that there are you know, others that are in the exact same position as them. And, you know, what I found in general is raise it because the bottom line is if you're raising it, somebody else is thinking it too. And so raise it at work, raise it at home, make sure you're being vocal about it. Know that you're not alone. Know that there's a biologic basis for these symptoms, that there's wonderful ways to manage it and treat it.

SPEAKER_01:

So What are the last takeaways you would give our listeners on this topic? Because there's a lot there around the biology, the symptoms, the solutions. What would you say people should take away from this episode?

SPEAKER_00:

So again, that you're not alone, that it's normal, that we have treatments that are available to help. And then more importantly, if you're not getting answers from an in-person provider, keep looking. Maybe you reach out to your family provider, your family practitioner, and if they're not able to give those answers, maybe you ask for a referral to an OBGYN, right? Maybe you ask for somebody that's specifically trained in menopause. And the Menopause Society can be a wonderful place now to look for people that are trained in this area. Maybe you have digital health and have access to platforms that are really able to help you. in this time period, but really making sure that it's grounded in science.

SPEAKER_01:

Excellent. Stacey, thank you so much for joining us. This has been a tremendously informative episode and we hope that our listeners get a lot of value out of this. I'm sure they will. So thank you so much.

SPEAKER_00:

Thank you, Jason. Again, an honor and a pleasure. Thank you.