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--:-- Noel King: Welcome to Today Explained. I'm Noel King. Today, we're talking about menopause. It's a huge deal. The FDA approved the first non-hormonal drug to treat hot flashes, a nasty side effect of menopause. It's called Fezolinotan, and everyone is rejoicing because it's extraordinarily effective.
--:-- Jancee Dunn: I mean, major, major reduction in hot flashes within an average of four weeks.
--:-- Noel King: Then in October, researchers in Uganda discovered that female chimps in the wild also go through menopause. This change affects a lot of people. And chimps, too. Us, our sisters, our moms.
--:-- Jancee Dunn: Yes, ma'am. I have gone through menopause. It took me a long time. Mine lasted about nine years. But no one talks about it. Did Grandma Helen talk to you about menopause?
--:-- Noel King: Oh, gosh, no. No. We're going to talk about it. All the menopause questions you didn't know you had. I had no idea.
--:-- Jancee Dunn: Coming up on Today Explained. Support for this show comes from ServiceNow. AI is only as powerful as the platform it's built into, don't you know? That's why it's no surprise that more than 85% of the Fortune 500 use the ServiceNow AI platform.
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--:-- Noel King: While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI, connecting every corner of your business. And with AI agents working together autonomously, anyone in any department can focus on the work that matters most.
--:-- Jancee Dunn: I've never met an AI agent. Learn how ServiceNow puts AI to work for people at servicenow.com.
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--:-- Noel King: Support for this show comes from strawberry.me. Be honest. Are you happy with your job? Or are you stuck in one you've outgrown? Or never wanted in the first place?
--:-- Jancee Dunn: Sure, you can probably list the reasons for staying, but are they actually just excuses for not leaving?
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--:-- Noel King: It's Today Explained. I'm Noelle King. Jancee Dunn writes a column called Well for The New York Times, and she also wrote this book. Hot and Bothered: What No One Tells You About Menopause and How to Feel Like Yourself Again.
--:-- Jancee 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. 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.
--:-- Noel King: 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. So that's decades and decades that you're in it. Yet, who knew?
--:-- Jancee Dunn: I didn't know either, and I write about health. Anyway, I told him 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.
--:-- Noel King: 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. But that is when perimenopause starts, most often in your 40s.
--:-- Jancee Dunn: And I remember I got a racing heart. That's one of the symptoms, the supposedly 35 symptoms. 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. And I didn't connect the dots because I just wasn't in that headspace.
--:-- Noel King: Like in your 40s, you know, sometimes people have young kids, they're working, they're taking care of elderly parents, they've got pets, they've got this, 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.
--:-- Jancee 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. Can you list all 35 symptoms?
--:-- Noel King: 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.
--:-- Jancee 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. 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.
--:-- Noel King: If you're in your 40s and some of these are starting to happen, put it together and maybe see your doctor.
--:-- Jancee Dunn: Hot flashes, of course, everyone knows about that, right? It's in all the sitcoms, women like fanning themselves and night sweats. 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.
--:-- Noel King: 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. Next, it's a trickle. Okay, anyway.
--:-- Jancee Dunn: Mood swings. Libido tends to go south. Breast soreness. Headaches. Vaginal dryness, a big one. 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, 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. And there might even be more, but those are kind of the major ones.
--:-- Noel King: And they certainly take people by surprise. 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 like you will get through them eventually. But yeah, I know you're, are you absorbing all that? It's, it's a lot. It's a lot. It's, it's a lot.
--:-- Jancee Dunn: And here the thing that that feels very weird to me Women girls even do talk about our periods and it actually even kind of fun when like you a teenager and you like oh we all getting it First Jenny got it Then stupid Vicky got it. And I tried everything to get my periods. We do talk about pregnancy. Some of that chat is less fun in my experience. But we don't talk about menopause. And that is really strange to me.
--:-- Noel King: It's like we got two out of three that we talk about a lot, all the time. And then suddenly we go silent. You're right. There are so many rituals around different life transitions. And I received the talk. I remember my mom took me out to dinner. It was a big thing. And I had the period talk. You receive the talk for their first period. No one gives a talk for your last period. Never. It's just not part of these life rituals that we have.
--:-- Jancee Dunn: Baby showers, bat mitzvahs, you know, there's all kinds of different rituals that you go through. I had a baby shower where people would share knowledge with me and tips and, oh, here's what happened when I went through it, you know, and absolutely nothing for this life transition. And I was thinking, wouldn't it be so great if there was like a menopause shower where people could share what's going on with them and what worked for them? And maybe you could even get some gifts like neck cream because your neck really starts to dry out or, you know, vaginal lube or whatever.
--:-- Noel King: But just to normalize it and to let people know what's coming, because the really important part of this is how we're still like, I love so much that you're having me on and we're talking about it and you're helping to further the conversation. That's how it's going to be normalized, right? It's not going to happen with policy. It's going to happen with us all talking about it.
--:-- Jancee Dunn: I mean, the question is, were you open with your family about how the symptoms were affecting you? But obviously, I didn't know that you were having those symptoms for 10 years.
--:-- Noel King: I think, no, I think I wasn't open at all. I don't talk about, I didn't talk about myself that much about it. Why? It's one of those topics that everybody jokes about, like, oh, God, menopause. Like, we all, we know it's the worst.
--:-- Jancee Dunn: I just tolerated it. I want it to not be a shock. I want it to be familiar because part of the shock is that you don't know what it's about and you don't know when it's coming and you don't know that there are treatments out there.
--:-- Noel King: So my mother and I had a really long conversation and that's also good for your health records. Like it's good to know when, if they can remember. My mom, it took a lot of prompting from my mom. I was like, okay, when did you go through menopause? Was it the Carter administration? Do you remember any, how old was I?
--:-- Jancee Dunn: It took a while because she was kind of, she's in denial about it, but it's helpful to know. And if your mother is no longer living, other relatives who had it, you know, it's just that's helpful information if you go to your doctor to talk about menopause, which is another thing that I recommend.
--:-- Noel King: What I think I hear you saying is that what's behind all the silence is that generationally speaking, the generations that have come before us have been hesitant to talk about a lot of things that are quote unquote women's issues, including maybe periods and pregnancies, things that Gen X, myself, a millennial, are much more comfortable talking about.
--:-- Jancee Dunn: And so what's happening here really is just a generational shift in the ways that Gen X has pushed us forward, in the ways that older millennials have pushed us forward. We're doing that again. We're doing it with menopause. Exactly.
--:-- Noel King: And I have such high hopes for the generations that are coming up because they are so much more transparent. You know, celebrities talk about it, and half the time they are pushing products.
--:-- [Sound effects: A quick clip of a celebrity speaking]
--:-- Jancee Dunn: Stripes was formulated specifically for perimenopausal and menopausal skin. Our patent-pending ectoine and squalene formulation provides superior moisture and hydration where you need it the most.
--:-- Noel King: So what is the criteria right what are the criteria for menopausal clothing? Well, you want clothing that breathes. You need clothing that you can layer because you go from hot flashes to cold flashes.
--:-- Jancee Dunn: And we we want to make sure that you know we've got something for both. I talked a little bit about the menopause middle. They see that there's money to be made and fine. I don't care because they're still talking about it and they still carry some weight and it gives people permission, like it or not, to talk about it themselves.
--:-- Noel King: I used to write about health and also beauty, so I would get sent these menopause products. And I noticed that back when I was growing up, the few things available for menopause symptoms that you could buy in a store, they were always in these like sad brown plastic containers and there would be like a picture of a sunset on them if it was like a supplement or like dried leaves, you know.
--:-- Jancee Dunn: And now they're very luxurious. They're meant to be displayed and not hidden away, you know, with your skin tag removal cream. They're meant to be like put, you know, right there on the counter for people to see. They'll say the word menopause on it instead of some like stupid euphemism.
--:-- Noel King: And I think that's great too. Even the doctors didn't really talk about the menopause, no. I just knew I was going to not have a period, so that was fantastic. But I was not really prepared for the other things that came with it.
--:-- Jancee Dunn: Okay, so you knew you weren't going to have a period and you knew you were going to be sweaty, but other than that, you were just kind of winging it?
--:-- Noel King: Completely winging it. Coming up, the reason we're all winging it, guess how much time gynecologists spend on menopause in medical school. You will not believe it.
--:-- [Sound effects: A quick clip of a gynecologist speaking]
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--:-- Jancee Dunn: So when you set up direct deposit through Chime, they say you get access to fee features such as free overdraft coverage getting paid up to two days early with direct deposit so much more.
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--:-- Jancee Dunn: You can work on your financial goals through Chime today. You can open an account in two minutes at Chime.com slash explained.
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--:-- Noel King: Support for this show comes from Macy's. It's almost fall. And that means it's time to cycle your wardrobe to the cold setting.
--:-- Jancee Dunn: Because while everyone loves a breezy summer outfit, let's be real, layering is even more fun. That's why Macy's Fall Fashion Guide has everything you need to piece together the perfect look for you.
--:-- Noel King: It's your one-stop shop for fall's latest trends and must-haves, curated by their experts. Add a statement shoe to your collection, like the calf-hair loafers from Steve Madden.
--:-- Jancee Dunn: Or tap into your romantic side with flowy dresses from CC and sheer pieces from INC. You can even throw in some textural layers for contrast, like a faux fur bomber jacket from Karl Lagerfeld Paris.
--:-- Noel King: Whether your old favorite sweater or coat is on its last threads or you're just craving a new vibe to switch things up, Macy's has got you covered this season.
--:-- Jancee Dunn: Find the perfect layering pieces for you by exploring the Macy's Fall Fashion Style Guide. Shop in-store or online at Macy's.com.
--:-- Noel King: Support for Today Explained comes from Upwork. If you run a business, you know that scaling your business requires the right expertise at the right time.
--:-- Jancee Dunn: I sometimes wonder how many of you are running businesses out there. I would love to know. Please email me, noelle at king dot com.
--:-- Noel King: With Upwork, you can find specialized freelancers in IT, web development, AI, design, admin support, marketing, and more. Experts who they say are ready to help you take your business to the next level.
--:-- Jancee Dunn: With more than two decades of experience, Upwork has a simple and ambitious goal to pioneer a better way of working. Companies at every stage turn to Upwork to get things done and find more flexibility in the way they staff key projects and initiatives by accessing a global marketplace full of top talent.
--:-- Noel King: Plus, Upwork makes posting your job easy with no cost to join. You can register, browse, freelancer profiles, get help drafting a job post, or even book a consultation.
--:-- Jancee Dunn: You can visit Upwork.com right now and post your job for free. That is Upwork.com to post your job for free and connect with top talents ready to help your business grow.
--:-- Noel King: I would heat up internally. I used to say it was like your body was in a microwave oven cooking from the inside out. That's how I would describe it. That's beautiful.
--:-- Jancee Dunn: It's Today Explained. Jancy Dunn, author of the new book about menopause, Hot and Bothered.
--:-- 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. So start with perimenopause.
--:-- Jancee Dunn: Perimenopause, which was not even part of the lexicon until the 90s. I know. I know it's so funny. Perry means around. And so that means the years around menopause leading up to menopause can be four to eight years, depending. And symptoms can be really faint at first. So it's not like it's this onslaught of symptoms for eight years.
--:-- Noel King: 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. 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.
--:-- Jancee Dunn: When it has been 12 months, then you are officially in menopause. And again, the average age is 51. 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. That tends not to get better, a lot of the doctors told me.
--:-- Noel King: So if that's one of your symptoms, worth checking out. I'm so excited to tell you this as my daughter. Your sexual life really suffers. You're not interested in sex. It's really diminished.
--:-- Jancee 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. 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.
--:-- Noel King: And, you know, I would urge everyone, if they're beaten down by these symptoms, please see a doctor. This is going to sound like a bizarre question, Chancey, but what is the point of menopause? Why does it happen?
--:-- Jancee Dunn: I always get excited when I hear it. This is going to be a bizarre question. I love it. Researchers aren't exactly sure. You know, some people say that our lifespan keeps extending and, you know, our fertility hasn't caught up with that. It's oversimplifying.
--:-- Noel King: 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? If you can remember back then.
--:-- Jancee Dunn: 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. 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. What do gynecologists learn in medical school about menopause? I mean, really, it's only an hour of training.
--:-- Jancee Dunn: And it's not much at all. 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. The UK is ahead of us in many ways and menopause is taught in schools for kids.
--:-- Noel King: We've been able to ensure that menopause has been added to the school curriculum in England. If menopause is something that will happen to you or somebody you know or love, then this does matter to you.
--:-- Jancee Dunn: 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.
--:-- Noel King: If you 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?
--:-- Jancee 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.
--:-- Noel King: And it's 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.
--:-- Jancee Dunn: So anyway, it's replacing the estrogen that is leaving your body. And there's progesterone too, which sort of mitigates the effect of estrogen. If you just have estrogen, then you can get certain kinds of cancers.
--:-- Noel King: And so you can have it on a patch, which has been shown to be safer than a pill. 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.
--:-- Jancee 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.
--:-- Noel King: And when it leaves your body, your tissues get drier. And so sex can be incredibly painful. And that was another of shock to me because it was. 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.
--:-- Jancee 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. 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.
--:-- Noel King: Why? He's getting older too. Who cares? Who gives a crap? So I told him what was happening. And I also said, you know, so just be patient with me. Here's what's going on with my body. It's reverse puberty. Think of it that way.
--:-- Jancee Dunn: 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. You apply it topically. It's not in your system.
--:-- Noel King: And three months later, sex doesn't hurt and you're not peeing yourself. Peeing yourself is a quality of life issue. 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.
--:-- Jancee Dunn: Again, it is a personal choice. But another thing that I didn't know was out there. 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. What are some of the craziest things that women told you their doctors said to them or suggested?
--:-- Noel King: 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.
--:-- Jancee 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.
--:-- Noel King: 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. And so, you know, going back to your doctor, if you feel like you're being gaslighted or your symptoms are being minimized, see somebody else.
--:-- Jancee Dunn: How do you think this conversation and how do you think medical advances would be different if men were the ones who went through menopause instead of women?
--:-- Noel King: Well, I think that hormone therapy would be federally funded. I interviewed several urologists who treat both men and women. 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.
--:-- Jancee Dunn: It would just be a normal stage of life, just like everything else. And it would be much more normalized. 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.
--:-- Noel King: 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.
--:-- Jancee Dunn: And this one, 13 publishers were interested. And I thought, ah, okay, this is telling. I remember the blood flow being so heavy that it would push the tampon out. Jesus. Do you know what I mean? Like you'd feel the tampon starting to come out. Like, okay. You know, this is on NPR in a bunch of different cities. What if that isn't in the radio? Go ahead, put it on there. Someone will say, yes, that happened to me too. That's true. And that's important.
--:-- Noel King: Today's episode was produced by Victoria Chamberlain. It was edited by Amina El-Sadi and engineered by Michael Raphael. It was fact-checked by Laura Bullard. You heard Laura's mom, Anne Bullard, throughout the show.
--:-- Jancee Dunn: And we want to thank Anne for her frankness. And also, we want to thank her for Laura. I'm Noelle King. It's Today Explained. Thank you. Thank you.
