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--:-- Noel King: The FDA just approved the first non-hormonal drug to treat hot flashes, which are a particularly nasty side effect of menopause. It's a huge deal. It's called Fezolinotan, and everyone is rejoicing because it's extraordinarily effective.
--:-- Noel King: I mean, major, major reduction in hot flashes within an average of four weeks. This news got us thinking about menopause, a change that half of the humans on planet Earth will enter into.
--:-- Noel King: Um, yes, ma'am. I have gone through menopause. It took me a long time. Mine lasted about nine years. But honestly, no one really seems to talk about it. Did Grandma Helen talk to you about menopause?
--:-- Noel King: Oh, gosh, no. No. We're going to talk about it. Menopause in your feed, menopause on your radio, all the menopause questions you didn't know you had. I had no idea.
--:-- Noel King: Coming up on Today Explained. Support for Today Explained comes from BetterHelp.
--:-- Noel King: Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained?
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--:-- Noel King: It's Today Explained. I'm Noelle King. When news of the hot flash medication broke we called Jancy Dunn.
--:-- Noel King: She writes a column called Well for the New York Times, and conveniently, she just wrote this book. Hot and Bothered, What No One Tells You About Menopause and How to Feel Like Yourself Again.
--:-- Jancy Dunn: I can remember when I was putting together this book, I thought, okay, well, what books are out there on menopause? Seemingly thousands of books on pregnancy.
--:-- Jancy Dunn: I mean, there was just, you know, shelf after shelf. And then there was one book. I have a nice library too. There was one book on menopause. One, it was written in the 90s. The pages were yellow. It was very old.
--:-- Jancy Dunn: And I thought, wow, given the proportion of time that women spend in menopause, you enter it and you don't leave. You stay in it. So the average age of menopause is 51 and the average lifespan for women is 80.
--:-- Jancy Dunn: So that's decades and decades that you're in it. Yet who knew? I didn't know either. And I write about health.
--:-- Noel King: Anyway, I told them about my fever and my insomnia and my brain problems, you know, how I can't remember anything. And he told me he thought I could be at the beginning of menopause.
--:-- Jancy Dunn: No. Yeah, that's what I said. I started getting symptoms when I was 45. And, you know, when you're in your 40s, you're not thinking about that at all.
--:-- Jancy Dunn: But that is when perimenopause starts, most often in your 40s. And so I remember I got a racing heart. That's one of the symptoms, the supposedly 35 symptoms.
--:-- Jancy Dunn: And I thought, oh, okay, I'm going to have a heart attack. And then I got other symptoms. My skin dried out. I went to the dermatologist. All these things were happening.
--:-- Jancy Dunn: And I didn't connect the dots because I just wasn't in that headspace. Like in your 40s, sometimes people have young kids. They're working. They're taking care of elderly parents. They've got pets. They've got this.
--:-- Jancy Dunn: You're just not there. And I also had equated menopause with, oh, that happens when you're older. You know, oh, that's kind of like golden girls territory.
--:-- Jancy Dunn: I didn't realize that it was in my 40s. And when I finally put it together, I had seen I don't even know how many doctors.
--:-- Jancy Dunn: Can you list all 35 symptoms? I can. Are you ready for some fun? I don't mean to scare people to death. I really don't mean to scare people to death.
--:-- Jancy Dunn: I interviewed I don't even know how many experts for this book. And they would say, please tell readers, sometimes you don't have any symptoms. Some women absolutely sail through it with no symptoms.
--:-- Jancy Dunn: Sometimes you just get a cluster of symptoms and it's not so bad. But here are all the symptoms because it is helpful to know. If you're in your 40s and some of these are starting to happen, put it together and maybe see your doctor.
--:-- Jancy Dunn: Hot flashes, of course, everyone knows about that, right? It's in all the sitcoms, of women like fanning themselves and night sweats.
--:-- Jancy Dunn: Well, it don't feel very beautiful. I feel like I'm jumping in and out of a hot bath and somebody's twisting a rubber band around my head.
--:-- Jancy Dunn: Irregular periods, I'll go back to that because that's a major tell when you have perimenopause. It's just one month, it's the mighty Mississippi River.
--:-- Jancy Dunn: Next, it's a trickle. Okay, anyway, mood swings. Libido tends to go south. Breast soreness, headaches, vaginal dryness, a big one.
--:-- Jancy Dunn: Burning mouth, huh? But yes, tingling in hands and feet. I got that one. Gum disease, extreme fatigue, bloating, digestive problems, joint pain, depression, muscle aches, itchy skin, electric shocks, another who knew, but quite common apparently.
--:-- Jancy Dunn: Terrible sleep, brain fog, memory lapses, thinning hair, brittle nails, mine were like baklava, weight gain, incontinence, oh yes, dizziness or vertigo, me too, increased allergies, loss of bone density, that's a big one to keep an eye on, irregular heartbeat, which I mentioned I had, weird new body odor, also common, irritability anxiety and panic disorder.
--:-- Jancy Dunn: And there might even be more. But those are kind of the major ones. And they certainly take people by surprise.
--:-- Jancy Dunn: I am fucking furious right now. I know. It's a lot. It's a lot. And I don't mean to put a menopositivity spin on these things, but you will get through them eventually.
--:-- Jancy Dunn: But yeah, I know. Are you absorbing all that? It's a lot. It's a lot. It's a lot.
--:-- Noel King: Jancy, you said you started perimenopause in your 40s. And I want us to suss out what perimenopause is, what actual menopause is, and medically what's going on during this time.
--:-- Jancy Dunn: So start with perimenopause. Perimenopause, which was not even part of the lexicon until the 90s, is— I know. I know it's so funny. Peri means around, and so that means the years around menopause leading up to menopause.
--:-- Jancy Dunn: Can be four to eight years, depending. And symptoms can be really faint at first. So it's not like it's this, you know, onslaught of symptoms for eight years.
--:-- Jancy Dunn: And again, that happens most often in a woman's 40s. Menopause means that you've gone an entire year without your period. So 12 months with no period whatsoever.
--:-- Jancy Dunn: If you get your period, if you're counting up and you get it on month nine, you have to start over. So it has to be a full 12 months.
--:-- Jancy Dunn: When it has been 12 months, then you are officially in menopause. And again, the average age is 51.
--:-- Jancy Dunn: Then after that, you stay in menopause. You're sort of post-menopausal and the symptoms kind of can continue. The one that can continue for a while is vaginal dryness.
--:-- Jancy Dunn: That tends not to get better, a lot of the doctors told me. So if that's one of your symptoms, worth checking out.
--:-- Noel King: Your sexual life really suffers. You're not interested in sex. It was really diminished.
--:-- Jancy Dunn: So you had to tell Todd so he could go get some girlfriends. Yes, I had to tell him as my excuse and then to leave me alone.
--:-- Noel King: Women are socialized not to pay attention to their quality of life. And sometimes with some of these symptoms, if they're being deranged by hot flashes, or night sweats, that can affect your quality of life if you're not sleeping for weeks at a time.
--:-- Jancy Dunn: And, you know, I would urge everyone, if they're beaten down by these symptoms, please see a doctor.
--:-- Noel King: This is going to sound like a bizarre question, Jansi, but what is the point of menopause? Why does it happen? I always get excited when I hear it. This is going to be a bizarre question.
--:-- Jancy Dunn: I love it. Researchers aren't exactly sure. You know, some people say that our lifespan keeps extending and our fertility hasn't caught up with that.
--:-- Jancy Dunn: It's oversimplifying. But you can think of menopause as reverse puberty. That's what some doctors call it. And it makes a lot of sense because in puberty, you've got those hormonal changes, kind of everything's ramping up, right?
--:-- Jancy Dunn: If you can remember back then. When you go through puberty, your system is being flooded with estrogen and other hormones. And when you're going through menopause, it's leaving your system.
--:-- Jancy Dunn: So it's reverse puberty. Again, that is oversimplifying and I'm not a doctor, but that's a good way to explain it to other people.
--:-- Noel King: You cycle through natural fertility and then perimenopause, sort of the opposite of puberty.
--:-- Jancy Dunn: What do gynecologists learn in medical school about menopause? I mean, really, it's only an hour of training and it's not much at all.
--:-- Jancy Dunn: I know, and you think like when you pull back and you just think even just, you know, systemically, just knowledge about menopause, it's very interesting.
--:-- Jancy Dunn: The UK is ahead of us in many ways and menopause is taught in schools for kids. Whoa. We've been able to ensure that menopause has been added to the school curriculum in England.
--:-- Jancy Dunn: If menopause is something that will happen to you or somebody you know or love, then this does matter to you.
--:-- Noel King: In terms of medical school, it is kind of shocking how little it's addressed when the ramifications of menopause, when the symptoms can just go on for years at a time and can be really severe.
--:-- Jancy Dunn: If you're paying attention to the conversation around menopause, you do hear some about hormone therapy. What is that? And is that something that if I feel like I'm in perimenopause, I can just go in and ask for?
--:-- Jancy Dunn: You can. And I know people are a little bit leery of hormone therapy after the Women's Health initiative studies came out in the early aughts, linking it to breast cancer.
--:-- Jancy Dunn: And it since been reanalyzed and there were a lot of flaws in them. There was just a lot of things that have not skewed the results but made them a bit more extreme.
--:-- Jancy Dunn: So anyway, it replacing the estrogen that is leaving your body. And there's progesterone too, which sort of mitigates the effect of estrogen.
--:-- Jancy Dunn: If you just have estrogen, then you can get certain kinds of cancers. And so you can have it on a patch, which has been shown to be safer than a pill.
--:-- Jancy Dunn: The current position with the North American Menopause Society and a bunch of other medical organizations is if you are within 10 years of menopause, if you're in good health, then you should explore the idea of systemic hormones, meaning you take a pill or you have a patch, that the benefits could well outweigh the risks.
--:-- Jancy Dunn: And there's also vaginal estrogen. When estrogen leaves your body, it leaves all the tissues in your body. It's not just your skin, which mine got really rough. It's the skin in your vulva, your vagina.
--:-- Jancy Dunn: And when it leaves your body, your tissues get drier. And so sex can be incredibly painful. And that was another shock to me because it was.
--:-- Jancy Dunn: Not only did I not tell my husband what was going on, I just started avoiding him when it came to sex because, I mean, who wants to talk about your vagina drying out, right? It's not the sexiest conversation.
--:-- Jancy Dunn: But I realized I was doing our relationship a disservice because I was avoiding him, and he thought that I didn't care about him anymore.
--:-- Jancy Dunn: And I finally had to tell him what was going on with my body. I thought, oh, I'm doing what my mother was doing, and I'm gritting my teeth about this. And I'm keeping quiet.
--:-- Jancy Dunn: Why? He's getting older too. Who cares? Who gives a crap? So I told him what was happening. And I also said, so just be patient with me. Here's what's going on with my body.
--:-- Jancy Dunn: It's reverse puberty. Think of it that way. This is the result of the estrogen leaving my body. And I went to my OBGYN and I got the frontline treatment for vaginal dryness and it's topical vaginal estrogen.
--:-- Jancy Dunn: You apply it topically. It's not in your system. And three months later, sex doesn't hurt and you're not peeing yourself. Peeing yourself is a quality of life issue.
--:-- Jancy Dunn: And I don't mean to scare everyone to death. You may not pee yourself. It may be fine. But topical estrogen was an absolute game changer for me.
--:-- Jancy Dunn: Again, it is a personal choice. But another thing that I didn't know was out there.
--:-- Jancy Dunn: When you spoke to women for the book, you talked about menopause and you talked about how doctors had, what doctors had told them, how doctors had treated the situation.
--:-- Jancy Dunn: What are some of the craziest things that women told you their doctors said to them or suggested?
--:-- Jancy Dunn: Oh my God. The two responses that I can't, I interviewed countless women that they got were yoga. Yoga's great. There's lots of research behind yoga, but you can't pose away everything that's going on with you when you're going through perimenopause or menopause.
--:-- Jancy Dunn: And the other was have a glass of wine. This came up again and again. So a lot of times for painful sex, just have a glass of wine or for hot flashes, which makes it worse, by the way, alcohol.
--:-- Jancy Dunn: So you can't drink your problems away. It might be fun to try. And you can't pose your problems away. But that was the two main things.
--:-- Noel King: If you feel like you're being gaslighted or your symptoms are being minimized, see somebody else.
--:-- Jancy Dunn: How do you think this conversation and how you think medical advances would be different if men were the ones who went through menopause instead of women?
--:-- Jancy Dunn: Well, I think that hormone therapy would be federally funded. I interviewed several urologists who treat both men and women.
--:-- Jancy Dunn: And they said to me that quality of life is not discussed with my female patients, but men are very upfront if something isn't working, if they're having sexual problems, if they're having problems urinating, you know, they'll come to me right away.
--:-- Jancy Dunn: It would just be a normal stage of life, just like everything else, and it would be much more normalized.
--:-- Noel King: And you know right now the onus is on women to change things it's not going to be at a policy level is it i mean you know not to be cynical but i don't see anything changing for years and years but the more we talk about it the better it will be and we are making progress it seems slow but maybe four years ago i tried to get a menopause book off the ground when i was just starting to figure out that i had symptoms and nobody was interested.
--:-- Jancy Dunn: And this one, 13 publishers were interested. And I thought, ah, okay, this is telling.
--:-- Noel King: Today's episode was produced by Victoria Chamberlain.
--:-- Noel King: It was edited by Amina El-Sadi and engineered by Michael Raphael.
--:-- Noel King: It was fact-checked by Laura Bullard.
--:-- Noel King: You heard Laura's mom, Anne Bullard, throughout the show.
--:-- Noel King: And we want to thank Anne for her frankness. And also, we want to thank her for Laura.
--:-- Noel King: Aw, thank you, Noelle. And happy birthday. I'm Noelle King. It's Today Explained. Thank you.
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