Oprah & Dr. Sharon Malone: Menopause Solutions for Millennials, Your Weight, Sleep, Mood & Intimacy

Dr. Sharon Malone, OB-GYN menopause expert and author of the New York Times #1 bestseller, Grown Woman Talk, joins “The Oprah Podcast” to talk about why life only gets better after 50 and to remind women that although menopause is inevitable, suffering is not. Kim and Penn Holderness - the popular internet influencers with over 9 million followers - join to talk about Kim’s experience with perimenopause and how it has affected her sleep, anxiety and mood. Dr. Malone answer questions from women in their 30s about the menopause timeline, how endometriosis impacts menopause and the role of fibroids in both fertility and menopause. Oprah and Dr. Malone talk with women who have questions about weight gain, preventing symptoms before they begin and how to cope with the lack of libido and vaginal dryness that often accompanies all stages of menopause. BUY THE BOOK! “Grown Woman Talk” by Dr. Sharon Malone, published by Crown Publishing, is now available wherever books are sold. https://amzn.to/4z4KHLm Alloy Women's Health is a direct to consumer digital healthcare company revolutionizing the way women age by offering education, expertise, and safe, science-backed solutions for perimenopause & menopause symptoms, skincare, sexual health, gut health and more. Treatment plans are customized and everything is delivered with free shipping. Alloy customers receive unlimited follow-up care with their menopause-trained physician through the duration of their active prescription and access to community through member support groups and more all from the convenience of their home. Alloy offers a fast, easy, and 100% digital solution to help women find guidance and treatments wherever they are. Being with Alloy is like having a menopause doctor in one's pocket. https://www.myalloy.com. Head to https://www.myalloy.com and use code: OPRAH for $20 off your first order. Kim and Penn Holderness are award-winning content creators known for their original music, song parodies, comedy sketches, and weekly podcasts. Their videos have resulted in over 2 billion views and over 9 million followers since 2013. Kim and Penn are also authors of the New York Times Bestselling Book, ADHD Is Awesome: A Guide To (Mostly) Thriving With ADHD and winners of The Amazing Race (Season 33) on CBS. They host a weekly podcast called Laugh Lines with Kim & Penn Holderness every Tuesday. Kim and Penn have been featured by TODAY, People, TIME, NPR, Good Morning America, and now The Oprah Podcast! They live in Raleigh, North Carolina with their two kids and dog, Sunny. Follow Oprah Winfrey on Social: https://www.instagram.com/oprah/ https://www.facebook.com/oprahwinfrey/ Listen to the full podcast: https://open.spotify.com/show/0tEVrfNp92a7lbjDe6GMLI https://podcasts.apple.com/us/podcast/the-oprah-podcast/id1782960381

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Oprah Winfrey?

  Hello, everybody. So glad to have you join me on this, the Oprah Podcast. It is my hope that these conversations are somehow enhancing your life. It's great to spend time with you here. And I especially like hearing from listeners who zoom in. Talking with the audience was one of my favorite things during the years of the Oprah Show. So it's been fun vibing with you all here on the Oprah Podcast. Welcome back, Dr. Sharon Malone. Her New York Times bestselling book is called Grown Woman Talk. More than 47 million women enter menopause each year. And yet, I am still so surprised to learn this. Only 6% of those women are getting the help they need. That's 6%.

• 0:44Oprah Winfrey?

  And now, new studies are showing that women as young as their early 30s are starting to have symptoms of perimenopause. Dr. Sharon Malone is here for it. She has the answers for all your questions.

• 0:56Speaker 01

  You don't know when your ovaries are going to expire. Every person has a different end date on that.

• 1:02Oprah Winfrey?

  As a certified menopause practitioner and OB-GYN, Dr. Malone has been empowering women to take charge of their health for more than three decades. Dr. Malone is the chief medical advisor for Alloy Women's Health and the New York Times bestselling author of Grown Woman Talk. Every woman should have it. Grown Woman Talk, your guide to getting and staying healthy. And this is what we all want. And this is a manual for living your life as you're going through perimenopause and menopause. And it's a manual not just for you, but anybody you love or care about who's going through it. And that is every woman who lives to be old enough to go through it.

• 1:45Oprah Winfrey?

  And we are continuing our conversation around menopause. We'll be talking about specific treatments and sex after menopause a little later. But first, we saw this somewhat alarming new study that showed that more than half of women ages, listen up, 30 to 35, are suffering from moderate to severe symptoms of perimenopause. And they're suffering in silence. And one of the things that Dr. Malone says in Grown Woman Talk, for sure, is that you don't need to suffer and you certainly don't need to suffer in silence. And I'm sure there are a lot of reasons behind that, and we're going to dig into it. Dr. Malone, can you talk about these studies? What is your take on that?

• 2:30Speaker 01

  You know, I'm not really sure what to make of the fact that women are starting to experience symptoms earlier. But I think that stress is certainly a factor. I think that how we live, you know, the environment that we're in, you know, who knows, maybe it is some of the endocrine-disrupting chemicals that women are exposed to that are causing this. So it is a very interesting area that needs to be explored further. Because we are aging ourselves faster than I think that we should be, given this day and time.

• 3:03Oprah Winfrey?

  Well, one of the reasons why you should listen to Dr. Sherid Malone and read her book, Grown Woman Talk, is because Michelle Obama, one of the women we all admire so much in the world, listens to Dr. Malone, and she actually has a quote on the cover, "The first person I turn to for a whole host of issues, especially my health." And isn't it wonderful to see the light of Michelle Obama, and Michelle Obama being the age that she is, I'm sure now, having gone through menopause, and still being the vibrant force in the world that she is? I think having women like Michelle Obama, having women like Halle Berry, having women like yourself,

• 3:44Oprah Winfrey?

  is evidence for all of you who are 30, 35, 40, 45, getting ready to go through it, that there is not only life after, but life actually gets better.

• 3:55Speaker 01

  That's exactly right. You know, I was thinking, Oprah, when I got to the end of my career, after practicing for 30 years, and when I decided it was time to stop doing that, I had no idea what the next chapter was going to be. But I knew I was done with that. And I created a whole new life for myself.

• 4:14Oprah Winfrey?

  Yes.

• 4:14Speaker 01

  After 60. I mean, I wrote my book when I was 62 years old. I have, you know, a new career, really taking the message of menopause and women's health outside of just the office, when you're just talking to people one-on-one. There are only so many people you can get to.

• 4:32Oprah Winfrey?

  That's right.

• 4:32Speaker 01

  But to be able to take that message and to amplify it and to get out.

• 4:36Oprah Winfrey?

  Doesn't it feel like your life kind of blew up?

• 4:38Speaker 01

  Oh, absolutely. And that's what I want to tell young women. Don't think that you need to know everything that's going to happen to you and to your life when you're 30 years old. You will have many chapters. And I want them to be encouraged by looking at people like you and Gail and Michelle and all these wonderful women who are out there recreating a life that they want to live. And we're doing it on our terms.

• 5:03Oprah Winfrey?

  Absolutely. We wanted to hear from women in their early and mid 30s who are finding out that they have these concerns. And so Chandler, hello, lives in Santa Monica and was in an audience that I did the ABC special on menopause with her mom. Chandler, what's your question? Hi, welcome.

• 5:23Speaker 02

  Thank you. You know, I think I walked away after that show feeling like a lot of the symptoms that everybody was describing were really similar symptoms to when you hear about like right before you're about to get your period or while you're on your period or just being a third year old woman in your car having a bad day. And I was sitting in the audience and I was thinking, wait, like I have rage, I scream in my car, am I going through menopause? So I think, Dr. Malone, my question is, how do you know the difference between those menopausal symptoms, especially if you're still getting your period versus just like being a woman having a bad day?

• 6:04Speaker 01

  I think this is something that should reassure you because only about 1% of women will actually go through menopause before age 40. So that's very uncommon. So it has to be some other circumstances. Sometimes, though, we're seeing a lot of young women who are diagnosed with cancer. We're seeing a lot more breast cancers in young women in their 20s and 30s even. And so sometimes it's a result of chemotherapy. But I think that you should take some comfort from the fact that it's unlikely. And if you are having problems with either with your menstrual cycle or with mood or rage, sometimes you have to take a step back and go. Well, sometimes you're mad and you have a reason to be mad. You know, you have to look at what was your day.

• 6:49Speaker 01

  But what happens in when you're perimenopausal, the symptoms are more persistent and pervasive when there's no reason why you should be having those symptoms. You see, you know what I mean?

• 7:01Oprah Winfrey?

  And let's talk about what the symptoms are. You talk about 34 symptoms in Grown Woman Talk.

• 7:05Speaker 01

  Mood swings, hot flashes, depression, anxiety, vaginal dryness, changes in libido, frequent urinary tract infections. There's a lot of overlap between things that young women can experience and things that perimenopausal women experience. But I think so you could take a look at it and say, how much of this is due to the situation? And how much am I sitting here and I'm depressed or I'm having these issues when there's no apparent reason? It should at least raise a flag for you. But for younger women, you really, before you jump to just this might be perimenopausal,

• 7:46Speaker 01

  I think you should look at things like there are other things such as what's called PMDD, which is premenstrual dysfunction, which is basically PMS. And that's not, so young women can have all those symptoms, but they only happen.

• 8:01Oprah Winfrey?

  But it does mean your hormones are fluctuating.

• 8:04Speaker 01

  But that is the natural fall in your hormones. It happens with a normal menstrual cycle that happens. But if you say, is this consistently happening the week before my period? Yes or no? Then that's probably more likely to be PMDD. There are other situations, what's called polycystic ovarian syndrome, which is PCOS, where women can start to have, again, irregular periods that, you know, that you can have periods twice a year. And you think, oh, my God, am I going through menopause? Well, these are things that can be easily ruled out. You know, so as younger women, yes, can you have some of those symptoms? Is it an overlap? But I think one of the things that young women tend to show up with sometimes, and that is infertility.

• 8:49Speaker 01

  That's the, that's the thing about.

• 8:53Speaker 01

  Perimenopause and this menopausal transition. And again, as I said, you don't know when your ovaries are going to expire. Every person has a different end date on that. And sometimes it's the delay in getting pregnant that is the first sign that things are going.

• 9:08Oprah Winfrey?

  Something is going wrong. Yeah, yeah, something's off.

• 9:10Speaker 01

  Yeah.

• 9:10Oprah Winfrey?

  Yes, not wrong, but off.

• 9:12Speaker 01

  Off.

• 9:13Oprah Winfrey?

  Yes, off, off. Thank you so much. Did that help?

• 9:17Speaker 01

  Yes.

• 9:18Oprah Winfrey?

  OK, thank you so much. Thank you so much. After these messages, we have more of my conversation about how to treat the symptoms of menopause with Grown Woman Talk author Dr. Sharon Malone. There is no need to suffer in silence. There just isn't any need for it. And if you're suffering, come back and find out how to stop because there's help for you. That's next. Thank you for joining us. I'm talking to women's health expert Dr. Sharon Malone. If you were born with ovaries, you will one day face the impact of perimenopause and menopause on every part of your body. I am so glad you're here because this conversation is intended to empower you with information about your own well-being. Let's get back to it.

• 10:02Oprah Winfrey?

  Fallon is 35, and I hear you actually had an aha moment during that ABC special, Fallon. Hello?

• 10:09Speaker 03

  Hi, yes, I did. You may even catch me crying somewhere in the audience.

• 10:14Oprah Winfrey?

  Yes.

• 10:15Speaker 03

  My aha moment was that I finally found some understanding and a new sense of sympathy from my mother in what she went through.

• 10:23Oprah Winfrey?

  Oh.

• 10:24Speaker 03

  You know, through menopause. Because we didn't really talk about it. We just saw her getting hot and the air conditioning is always at 68 and we don't understand why. Or she's, you know, having moments that she's just angry. I'm like, well, we didn't do anything. Or, you know, and just I could see the changes, but we didn't understand what that was. And so, yeah, there was moments that I was in the audience and coming to tears because I wanted to hug her.

• 10:46Oprah Winfrey?

  To say, I get it now. I get it now. And she's talking about a special that I did recently with ABC. It was called The Menopause Revolution, and you can now find it on Hulu. So I'm glad you had that aha moment. Do you have a question?

• 11:00Speaker 03

  Yeah, so my question is, being a 35-year-old woman, I have been experiencing a lot of the premenopausal symptoms. But I've also been diagnosed with endometriosis at the age of 21. And I wanted to know, having endometriosis, will that affect the symptoms that I have? And my premenopausal development? Am I at higher risk for certain things because of my endometriosis? And maybe is that something that's bringing, you know, the premenopausal on sooner?

• 11:31Oprah Winfrey?

  Before you answer that, can you tell our audience what endometriosis is?

• 11:33Speaker 01

  Yes. Endometriosis is, can be a very debilitating condition for women, where normally, the endometrial tissue, or the tissue that lines your uterus, that is what gets stimulated every month, and then you slough it if you don't get pregnant. You know, that's what your period really comes from, the stimulation and actually elimination of that tissue. Well, that works fine if that tissue is in the lining of your uterus. It has a way out. But if that tissue is on your ovaries, or it's on your bowel, or it's in other places that has no exit, then that can be very painful, because the same process, it gets stimulated every month with your cycle. But it has nowhere to go.

• 12:16Oprah Winfrey?

  I got it.

• 12:16Speaker 01

  So it actually, it can be on your bladder, your bowel, and it causes pain. It can cause infertility. If it's on your ovaries, it causes scarring. And women who have endometriosis often have suffered for years before they get an adequate diagnosis about what's going on. Because pain is a hard thing to, you can't see it all the time. And, you know, they'll go get a scan or a sonogram, and they go, "Well, it looks normal." And you have no idea, but they say, "I'm in pain, I'm in pain." The average woman with endometriosis has gone to the ER five to seven times for relief of their pain. And this gets back to not believing women. And there's also this trope that we have been taught,

• 13:01Speaker 01

  is that endometriosis is a disease of thin, white women. So again, when you are complaining of the, "I have pain, I have pain with sex, I have pain when I'm having a bowel movement or urinary issues," they're not thinking about that because their image of who they think has endometriosis may not be you. And that's why there's often a delay in diagnosis with endometriosis.

• 13:25Speaker 03

  Yeah.

• 13:26Speaker 01

  So that's-

• 13:26Speaker 03

  It took three years.

• 13:27Speaker 01

  Yeah, it took three years. And that is typical, to be quite honest with you.

• 13:31Oprah Winfrey?

  All right. So I interrupted, so you can explain what it was to the audience. Now, what's the answer to her question?

• 13:36Speaker 01

  But endometriosis, in and of itself, we don't know that that is going to alter the course of menopause for you. Not necessarily, it may not come earlier, it's going to come when it comes. But what happens for a lot of women with endometriosis, they end up going through menopause prematurely because once your symptoms have gotten to be so severe, and you've tried medication for it, sometimes we try birth control pills. Actually, one of the medications that we use to sort of keep endometriosis at bay is actually a medication that puts you in menopause.

• 14:13Oprah Winfrey?

  Which is?

• 14:14Speaker 01

  Lupron. It's a Lupron, it's a shot, and now there's a newer pill that you can do. But basically, what it does, it shuts your ovaries down. So that cycling and all that stuff that's going on in your body, it just goes away. Well, it's great. It helps with your endometriosis, but it gives you menopausal symptoms. So that's where menopause and the endometriosis connection comes in. And also, for young women who have endometriosis, once the symptoms get to be so bad, and you've tried all those medical management things, and you may even try surgery to go in and remove some of the endometrial tissue, but if it comes back, often the definitive treatment for endometriosis is a hysterectomy.

• 14:56Speaker 01

  And it's a hysterectomy with removal of the ovaries.

• 15:00Oprah Winfrey?

  What you mean, now you're going into-

• 15:02Speaker 01

  Now you're in menopause forever. So that's sort of the endometriosis, you know, menopause connection. Either some of the medications that you're on will throw you in menopause temporarily, and/or if that's not working, then you're having a surgical menopause. And this can happen, again, for young women. They may be in their 30s and 40s, and that's devastating from a lot of different standpoints.

• 15:25Oprah Winfrey?

  Yeah, yeah, yeah. Childbearing.

• 15:27Speaker 01

  Yeah.

• 15:27Oprah Winfrey?

  Yes.

• 15:28Speaker 01

  And just symptom relief. But- The one thing I want you to understand is because once you get to menopause, if that is the route that ultimately you're on and it ends up with the hysterectomy, you can be treated with menopausal hormone therapy. That is, that does not mean that, oh, I'm 35 years old. I've had a hysterectomy and my ovaries are out. So I just must endure. No, you can be treated with menopausal hormone therapy.

• 15:55Oprah Winfrey?

  Did that answer your question?

• 15:58Speaker 03

  It does. Thank you so much.

• 15:59Oprah Winfrey?

  Thank you so much.

• 16:01Speaker 03

  Having that information helps so much. Thank you.

• 16:03Oprah Winfrey?

  Thank you, Fallon. 35-year-old Sasha says she found the special inspiring also and educational. I'm so glad to hear that, Sasha. What's your question?

• 16:13Speaker 04

  No, well, I found it inspiring and very informative. I love that everyone was so vulnerable and sharing so much. I'm 35. I would like to have kids, but that probably wouldn't be for a couple of years. And that would put me into my, like, late 30s. And I'm a black woman, so, you know, fibroids are more common among black women. And I'm wondering the relationship between like later childbirth and fibroids and how that might affect menopause and kind of what that would look like.

• 16:49Speaker 01

  There is this study of women across the nation where they looked at women, different ethnic groups, and they found that black women tend to go through menopause earlier. Their symptoms are more severe and they last longer. So obviously, if you're going to go through menopause earlier, that means that perimenopause starts earlier. Because, you know, back that up 10 years. If you're going to be menopausal at 45, then you're perimenopausal at 35.

• 17:18Oprah Winfrey?

  Yes.

• 17:18Speaker 01

  One of the things that I always tell young women, particularly when they're concerned about what does this mean in terms of childbearing and will I be able to have a baby or not? First thing is know your family history. Because I think you should talk to your mother. Because at 35, if you talk to your, you say, Mom, when did you go through menopause? If she remembers and she shares that information. If she tells you you were menopausal, she was menopausal at 42? Well, then, that has some bearing for you because at 35, you are more likely to be perimenopausal and to maybe have some fertility challenges more than someone whose mother had menopause at 55. Do you see what I mean?

• 18:02Speaker 01

  So, yes, it has a direct implication on when your symptoms start, but what to do about it. And let me say, we have more options now than we have ever had. Because this is a situation, if you say, "I'm not really, I'm not ready to have a baby right now at 35. I may not have even identified a partner at 35." Then this is where we can use technology.

• 18:28Oprah Winfrey?

  Harvest those eggs.

• 18:29Speaker 01

  And egg freezing might be something that you would do because that at least preserves that possibility for you, that if you just wait, then time will make that decision for you, rather than you making that decision for yourself.

• 18:43Oprah Winfrey?

  Okay, that's helpful, right?

• 18:44Speaker 01

  Mm-hmm, very much.

• 18:46Oprah Winfrey?

  Yeah, and if you're unsure, I mean, I have a lot of daughters that I mentor, and several of them are, you know, 29, 30, and already have done the procedure to harvest the eggs because they're not sure when, or how, or if they really want kids, but at least are prepared, are prepared. Something to think about, something to think about. Thank you so much, thank you so much, Sasha. I am so glad you could join us for this episode of the Oprah Podcast. Next, Dr. Sharon Malone and I are joined by internet sensations Kim and Penn Holderness for a candid conversation about how perimenopause is impacting their marriage. I know this is relatable for so many couples. That's right after a quick break.

• 19:59Oprah Winfrey?

  Welcome back to the Oprah Podcast. I'm with OB-GYN Dr. Sharon Malone. She's answering your questions about everything related to menopause. This conversation is so important because there's still confusion and misinformation around this health issue that every woman will face. Let's get back to our conversation. We're going to move on to women beyond their 30s. I know you'll recognize internet stars Kim and Penn Holderness. They won the amazing race on CBS, and their song parodies have billions of views, including a series about perimenopause. Kim and Penn join us from North Carolina, one of my favorite states. Hi, Kim and Penn.

• 20:42Speaker 05

  Hi.

• 20:42Oprah Winfrey?

  I hear you call perimenopause the third person in your marriage. How is that?

• 20:48Speaker 05

  It felt like I had turned into a different person. There was another person in our marriage, but not in like the fun way. Sorry, babe. And I, there were moments where the mood swings were so wild. I was saying things and screaming things that were just not, it was like out of body experience. I wasn't really a crier, and everything was making me cry. So my darling husband, who's been very understanding through this process, he said, like, why don't we just call that person Perry? It's Perry's fault. So we just decided, like, if I was in a rage, he's like, well, Perry maybe is going to leave soon, so let's just stick it out.

• 21:28Speaker 05

  So, yes, we created a whole entire character on our platform called Perry for perimenopause. What is wrong with me? Brian and Gilmore Girls again, huh? Wait, who are you? Sorry, I'm Perry. Perimenopause.

• 21:46Speaker 05

  Can you get out of my house? Absolutely not. I'm going to be here for a while. How long? 15 years, give or take. You're making me really anxious. You catch on quick. What? I'm the reason you're feeling everything right now. What do you mean, everything? Probably easiest if I just give you this brochure. Oh, thanks.

• 22:04Oprah Winfrey?

  What is amazing is how well people responded to it, because I guess a lot of guys are like you, who are going through it or have been through it with their partners.

• 22:14Speaker 05

  That's you.

• 22:15Speaker 06

  Yeah, oh yeah, okay. So, look, I, I love my wife and, you know, she has anxiety and I've known that for a long time. And when you get an explanation of something, it's so much easier to live with, to understand and also to be able to provide some empathy. And so it was really nice for me to learn a little bit about perimenopause so that not only could I understand and have empathy, but also, and we do this a lot in our life, as long as she's okay with it, to laugh at it. And we want to give people permission to have a little fun and maybe laugh at it as well, which is kind of how our content came about, about perimenopause.

• 22:47Oprah Winfrey?

  I hear you're dealing with a lot of fatigue too, Kim, right?

• 22:51Speaker 05

  Oh my goodness. I think there, there was a time in my life where I could just go to bed and sleep. But that was so long ago. Sometimes I'll look over at him in the middle of the night and he's just sleeping, just uninterrupted. And I'm filled with rage. I, I, I cannot sleep unless, I finally found a doctor who has given me some wonderful medication.

• 23:13Speaker 06

  The real stuff. The real stuff.

• 23:15Speaker 05

  But without it, I cannot sleep. And so that means during the day, I'm so, I'm so tired. And then that just compounds every other symptom. So that has been, that honestly has been my biggest struggle.

• 23:28Oprah Winfrey?

  Yeah, I know, that was it for me too. I didn't sleep for two years during the Oprah show. I, I, and I thought I was going to lose my mind. Do you have a question for Dr. Malone, either of you?

• 23:38Speaker 05

  Okay, here's my question. Where, where, I found a great doctor. I'm on some Protest Drone now. I found medication to sleep. I finally got into medication for anxiety because that was just out of control. I'm still in perimenopause. Is it, can you give me a glimmer of hope? Like, once I hit menopause, like that full 12 months, does any of this get better? Or is this just my life now?

• 24:04Speaker 01

  Oh my, where to begin with that one? You're on at least three different medications, right? You've got progesterone, you've got something for anxiety, something for sleep. If we know that it's all perimenopause, then why don't we treat the perimenopause, which is with hormones? Estrogen is the common denominator of all the symptoms that you have there. And this is not uncommon during perimenopause, where women will say, "Okay, well, I need something for sleep." And then, "I'm depressed, and I need something for this." Right. And by the time you look at it, you're on five different medications for your five different symptoms, and still haven't adequately solved the problem.

• 24:47Speaker 01

  And I think that the first go-to ought to be able to say, "It's perimenopause. Let's go to the most effective treatment for the symptoms of menopause and perimenopause, which is estrogen therapy. And don't be afraid of that if there is, you know, unless there is a reason that I don't know why you should not."

• 25:09Speaker 05

  Yeah, there is. I have PCOS, and my estrogen levels are actually wildly high. And I had them tested throughout the month just to confirm. So that, but that's, I think that is more rare. But I went to the doctor begging for estrogen. I'm not opposed to it at all.

• 25:23Speaker 01

  Well, let me say that there is a different way that we give estrogen for women who are perimenopausal. I've said all the time that in perimenopause, your estrogen levels aren't consistently low. Sometimes they're too high. Sometimes they're too low, and everything in between, and in no particular order. So what works well for women who don't, you know, who are having these persistently high estrogens, you know what you do? You use a low-dose birth control pill, just a plain old oral contraceptive. Because what it does is that it shuts down all that extraneous estrogen production in your ovaries. And it will give you back what you need to quiet your ovaries and give you enough estrogen and progestin.

• 26:08Speaker 01

  So what you're doing is that you're tamping down all that background noise and just giving back the estrogen as you need it. And you can take... Birth control pills every day. And when I say every day, you don't even have to stop them to have your period. You can just go straight through. You're like, I would prefer not to be off the pill for a week, a month. Because your symptoms will come back when you're off your estrogen. Birth control pills is a very is a very easy way that we use commonly for women in perimenopause, particularly when one of the other symptoms in perimenopause tends to be irregular bleeding, or sometimes the bleeding is too heavy, or you need birth control.

• 26:52Speaker 01

  In those instances, a birth control pill, a low-dose birth control pill works better because you are getting cycle control and you're also controlling your symptoms and you get birth control. So, very commonly, to stay on that, and then, once you're finally menopausal, which who knows, maybe five, six years from now, then that's when we make the transition from birth control pills to menopausal hormone therapy. But I don't want you to think that those are two things that are separate and apart. Birth control pills have estrogen and progestin in them. It's a different estrogen than what we take in menopause, and it's in different amounts. There's more of it when you're perimenopausal.

• 27:36Oprah Winfrey?

  Now, suppose she goes to her doctor and says this, and the doctor says, "I don't even believe in that," or "I don't know about that," or...

• 27:42Speaker 01

  Well...

• 27:43Oprah Winfrey?

  Yeah, yeah, how do you find a doctor?

• 27:45Speaker 01

  I'm gonna say Dr. Malone told me.

• 27:47Oprah Winfrey?

  Yeah, do that, do that.

• 27:48Speaker 01

  There is a whole section in there on that. It is true. But that is, again, Oprah, we get back to our same access problem. Finding doctors who understand the subtleties of how to treat. Because, yes, can you take the levels of menopausal hormone therapy when you're perimenopausal? Yes, you can, but not if you need birth control, not if you have bleeding problems, because there's not enough estrogen in the menopausal hormone therapy to control those other symptoms. It may take care of your hot flashes, but it's not gonna take care of the other things. So, don't be afraid of using the type of estrogen that is appropriate for what your symptoms are.

• 28:32Speaker 01

  And once you get to, you know, cross that line in your menopausal, then we can switch it up and go back to menopausal hormone therapy.

• 28:39Oprah Winfrey?

  Thank you so much for that information. That feels solid. Penn, any advice do you have for men, Penn? Because we keep hearing... Guys have no idea how to handle this.

• 28:51Speaker 06

  Well, OK, a couple of weeks ago, you said that we all need a 101 on menopause.

• 28:55Oprah Winfrey?

  Yeah.

• 28:56Speaker 06

  Men need, I guess, whatever's below that, like a 000. We need to learn, right?

• 29:00Oprah Winfrey?

  Yeah.

• 29:00Speaker 06

  And I gotta give Dr. Malone credit. One of the first times I really started to learn about perimenopause, we were at South by Southwest, and we went to a symposium where Dr. Malone was with Dr. Haver and 100 other women, who were all very outspoken. They were very frustrated with the way that healthcare has let them down.

• 29:18Oprah Winfrey?

  Yes.

• 29:18Speaker 06

  And the fact that they were being marginalized by doctors sometimes. But they were not mad at me. They were thrilled that I was there. I was the only dude there. And almost every single one of them came up to me and thanked me. So, guys, if you show a little curiosity and a little bit of empathy, your wives are gonna be grateful. And it's great when your wives are grateful.

• 29:41Oprah Winfrey?

  Thank you so much for joining us, Kim and Penn. Thank you so much. Thank you, guys. Tricia joins us from Woodland Hills, California, and her daughter, Leila, is zooming in from her college campus in New Orleans. Tricia and Leila, tell us what's going on with you guys.

• 29:57Speaker 03

  Sure. So, hi.

• 29:59Oprah Winfrey?

  Hi.

• 30:00Speaker 03

  I turned 50 last year. And right before I turned 50 in August, I started getting a lot of different perimenopausal symptoms, like hot flashes. Many of my friends had gotten them long before me, and I thought I'd escaped, but not so much. And the hot flashes kind of take hold sometimes. In addition to that, the last year, I've put on 30 pounds, and I have no idea how to stop it. I've gone up two sizes and counting, and I feel like I really need to understand all of these symptoms, the impact it's having on me, in particular, the weight gain and what I can do about it. I do walk. I do a little bit of exercise.

• 30:41Speaker 03

  But it seems like nothing is enough to curb some of the issues that I'm having, including constant need to go and go use the restroom. And I just went, and I'm in the car with my family. I'm like, I've gotta go again. And they're looking at me like, what's wrong with you? And my answer is always, I have no idea. So I would love to get a sense of why all of this is happening, and in particular, the weight gain and what I could do about it, if anything.

• 31:08Oprah Winfrey?

  Okay, the weight, why the weight gain?

• 31:10Speaker 01

  You know, that is one of the most common complaints that women come in with when the perimenopausal phase, when they start gaining the weight and they're like, what is going on? I'm eating the same thing, I'm exercising the same way, and I've gained 10 pounds just for breathing. And I believe, I believe you, because you know, I've been through that myself. I'm too, no longer weigh what I weighed 20 years ago. But the key to this is to understand what is happening to your metabolism and what is happening as your estrogen levels fall. Well, whether you have symptoms or not, and now you're having hot flashes, but let me just sort of walk you through the cascade of events that happens. Your estrogen levels fall. One thing that happens is that your body composition changes.

• 31:54Speaker 01

  So even when you don't gain a pound, and most people do, but even when you don't gain weight, you tend to lose muscle and you put on fat. And so that weight gets redistributed.

• 32:06Oprah Winfrey?

  Yeah.

• 32:06Speaker 01

  And now it's like, why do I have this belly fat? Why am I, why are my boobs bigger?

• 32:12Oprah Winfrey?

  Yeah.

• 32:13Speaker 01

  That's also happening because that's just deposition of body fat. That's a response to the lack of estrogen. So that's one. You have hot flashes, night sweats, you can't sleep. Sleeplessness and hot flashes lead to fatigue. It increases your blood pressure. Women who are estrogen, when their estrogen level is low.

• 32:35Oprah Winfrey?

  It certainly increases your irritability.

• 32:37Speaker 01

  Oh, absolutely. And it also increases insulin resistance, so more people will start to develop type 2 diabetes after menopause. So guess what happens when you're irritable, you're tired? Guess what you're not gonna do the next day? Exercise. Now you're fatigued, now you've got more fat and less muscle, so everything that you eat, you don't have, you don't have, muscle is more metabolically active than fat. So it just continues to make more fat. And then the more depressed you are, and guess what happens when you are depressed and you're tired? You make bad choices the next day. You're not. I'm going to exercise. You're like, I know exactly what this feels like because as a resident,

• 33:22Speaker 01

  when I would be up all night.

• 33:23Oprah Winfrey?

  It's a cycle.

• 33:23Speaker 01

  Yeah, I'd be up all night. And you make bad choices about what you eat, what you drink, what your behaviors are. So it's a, it's a really complicated system, but it all goes together. And it happens to women, I would say nine times out of 10. This is the complaint.

• 33:40Oprah Winfrey?

  Leila, you're, you're in college, very neat dorm room. You must have known we were zooming in. Very neat. But you also have a question for Dr. Malone.

• 33:49Speaker 03

  Yeah, I do. So everything that I've learned about menopause has definitely been through my mom and just hearing about her experiences with hot flashes and moodiness and just feeling overall uncomfortable in her body. But even though menopause isn't really on my radar right now, my question is, what can young people like myself start doing now to make that transition easier when it does come?

• 34:12Speaker 01

  Well, knowing what you know now, I can say this. The better health you are in leading into this perimenopause and menopausal phase, the better you're going to be able to endure it. It won't say that you won't eliminate the need for medications, but the healthier you are coming into it, the better you're going to weather this process. But I would say as a young woman who is watching her mother go through this, the one thing you can do is give her a little grace and understand that, you know, your mother's not maybe, she's not snapping at you because of something you did. It may be the day and you just have to sometimes maybe go up to your mom

• 34:54Speaker 01

  and give her a hug and say, hey, Mom, I understand. This may be a bad day for you today. And sometimes it may be something you did now. So let's, I'm gonna let you distinguish between the two. But just understand that your mom has a whole lot less tolerance for the stuff that you do now than she may have had 10 years ago.

• 35:13Oprah Winfrey?

  I also think that having the information makes everything so much more palatable. So I hope you have grown, women talk. If not, we'll send it to you because

• 35:23Speaker 01

  I would love to have.

• 35:23Oprah Winfrey?

  it is a manual for being able to live well. And we'll make sure you get it.

• 35:30Speaker 01

  Thank you, Oprah. Thank you, Dr. Malone.

• 35:32Oprah Winfrey?

  Thank you, Leila and Tricia. Thank you. Thank you for zooming in from school. Thank you.

• 35:37Speaker 01

  Yeah, thank you for having me.

• 35:39Oprah Winfrey?

  All right. Next up in my menopause talk with Dr. Sharon Malone, we're going into the bedroom. Yes, we'll talk to a couple about how to navigate sex after 50. Stay tuned.

• 35:53Speaker 01

  This episode is brought to you by HBO Max. For your awards consideration, HBO Max presents Rooster. Starring Steve Carell, this new comedy series focuses on the complicated relationship between a successful author and his daughter. Don't miss the series IGN called hilarious and brilliant. Rooster is streaming on HBO Max. Watch now.

• 36:14Oprah Winfrey?

  We'll be right back. I welcome you back to the Oprah podcast and more of my conversation about how to navigate the most frustrating symptoms of menopause. I'm with renowned menopause expert, Dr. Sharon Malone. Nikki and Raymond are the parents of a 13-year-old boy, and they're zooming in from Thomasville, North Carolina. Hi, guys. What's going on? Hi.

• 36:34Speaker 01

  Hi. Thank you so much for having us.

• 36:36Speaker 06

  Yes, we appreciate it.

• 36:38Speaker 01

  Excited. So my issue is I vaginal dryness, lack of libido, lack of interest. You know, I thought it was something wrong with us. Is it, you know, our marriage is solid. However, the intimacy, the interest, it's just nonexistent. And so my question is about, is there a magic potion? Is there, are there drugs? Are there herbs? You know, what pills? And I've learned so much today in this conversation. So now I know what to ask my doctor. And I am using

• 37:23Speaker 01

  the estradiol cream and just wondering, is there something more I should be taking, asking for to help me with these symptoms? I'm gonna, I'm gonna say this, and this will surprise no one. I don't know how old you are, but I know how I am. But I can tell you from personal experience that sex at 60 is not sex at 25. It's different. And you just accept that different does not mean worse. Now, I didn't say that. So there are two things that you need to understand that are happening hormonally. What's happening with your estrogen? And the lack of estrogen after menopause is really responsible for things like vaginal

• 38:06Speaker 01

  pain, dryness, the discomfort. Now, it stands to reason that if sex is painful, you don't want to have it. You know, we are all sort of, you know, we are programmed to avoid pain and go towards pleasure, right? So the first part of what we need to do is to eliminate those barriers that are causing the discomfort. And vaginal estrogen is a great place to go, vaginal estradiol. And the estrogen in the vaginal estrogen is so low, it doesn't get absorbed systemically. So you don't need to take a progestin if you are just using vaginal estrogen. Sometimes that's enough. And you can say, well, look at that. I'm not in pain.

• 38:51Speaker 01

  You know, this isn't difficult. I'm not getting a urinary tract infection every time I have sex. I'm not avoiding it the way that I would. Okay? There is also the issue of testosterone. And testosterone has been, you know, we talk about it a lot, but it's not readily accessible for most people because there is no FDA-approved version of testosterone that women can take. There is one for men, but not for women. So that would involve, you know, after you have taken care of the pain and discomfort issues and you say, mm, it's still not where I want to be.

• 39:28Oprah Winfrey?

  Pain, discomfort, dryness.

• 39:29Speaker 01

  Dryness, yes. And, you know, you need a good lube. And then you say, well, okay, well, then maybe testosterone might be appropriate for you for treating just what we call the hypoactive sexual disorder. Okay? That's one.

• 39:44Oprah Winfrey?

  Hypoactive sexual disorder means?

• 39:47Speaker 01

  Just low libido.

• 39:48Oprah Winfrey?

  Yeah, low libido. I'm not interested in sex.

• 39:50Speaker 01

  I'm not thinking about sex. I don't want it. But here's another, I want to give you another frame for how to think about sex after 50 or sex after 60. Most women, once you eliminate their discomfort, okay? So we've taken that off. You're treated and you're fine. Most women will find that there's a difference in your desire, where there's a difference between spontaneous desire, where I'm just sitting here and, "Oh, I can't wait to go for my husband to come home, or my partner to come home and have sex." But there is what changes as we age, is more responsive desire. And by that, I mean, I called it the "build it, they will come" theory.

• 40:33Speaker 01

  And that is, I wasn't thinking about sex, but if you bring it up, and I'm gonna say this to you, husband, remember when you used to date your wife? When you, before you, you know, obligated it?

• 40:48Oprah Winfrey?

  Raymond, remember those days, yes.

• 40:49Speaker 01

  Then you create the scenario by which your wife would be responsive to you. And most women will find, under that circumstance, is like, "Well, I wasn't thinking about it, but look at that. You put the dishes in the dishwasher, and you came over and you were nice to me." All of those things that will make her more receptive when you initiate. So, there is a lot, it's more complicated, and that is also, that will get you in the right space. Novelty is important. You can't do the same things over and over and over again and expect anybody to get excited. That's just, it doesn't matter what you're talking about. Once you've done it a million times, you're not gonna get the same response.

• 41:33Speaker 01

  So, novelty, role-playing. Sometimes you need a sexual therapist. But let me say this, what's really important, and I go back to, for women, there's also a problem with arousal. And there is also the problem with inability to have an orgasm, just because, you know, things are just less responsive. And to that, I would say, be playful. Invest. If you don't have one, get yourself a good vibrator. There are lots of good lubes you can use. There are, we, at Alloy, we have a cream called Omazing, which is actually a cream that's topical sildenafil, which is the same thing as topical Viagra, but it's for women.

• 42:17Speaker 01

  It's the same, so it's a cream that you use externally, and it increases arousal. So, you know, you realize, it's, yeah, it's gonna require some potions.

• 42:27Oprah Winfrey?

  It's called Omazing? I should have branded that.

• 42:30Speaker 01

  Omazing, exactly.

• 42:32Oprah Winfrey?

  I should have branded that.

• 42:33Speaker 01

  You know what? You're absolutely right.

• 42:34Oprah Winfrey?

  Thank you, Al.

• 42:35Speaker 01

  You could be our spokesperson.

• 42:37Oprah Winfrey?

  Omazing. How does all this sound to you, Raymond?

• 42:40Speaker 06

  It sounds great. I mean, it sounds wonderful. But everything that we've been learning today and listening to the conversation has been extremely helpful. But I also want to say that as men, we don't often get the information so that we understand what's happening with our wives, with our partners.

• 42:56Oprah Winfrey?

  That's why we keep saying it.

• 42:57Speaker 06

  You know, her lack of interest, I thought was my fault. I thought I wasn't doing enough. I thought I wasn't being there, or I thought she didn't love me anymore. And truth be told, Nikki even thought it was me. Like, you're not doing enough. Maybe you need to do this. Maybe you need to do more. She once told me that, you know, the room that we were, our bedroom, was painted a chocolate brown. And she said, oh, the room's too dark. It's too gloomy. And she went away for a weekend and came back and the room was painted. So I took care of things. I was like, oh, no, you know, if that's the problem, then let me go ahead and solve the problem. But once we began to realize what was happening and that this had nothing to do with me or with her, you know, I wasn't the problem. Nikki wasn't the problem.

• 43:42Speaker 06

  The problem was the problem. And we began to understand, I began to understand what was happening with her body. Then I began to understand and be a little bit more sympathetic to how she was feeling, or what we were going through.

• 43:56Oprah Winfrey?

  I heard you shifted your own expectations about sex, too, Raymond.

• 44:00Speaker 06

  Absolutely. I shifted my own expectations because there was a part of me that thought she didn't love me. But no, everything else that she does shows me that she loves me. So when I shifted my expectations, actually... She began to meet me, um, meet me in the middle.

• 44:15Oprah Winfrey?

  That's great.

• 44:16Speaker 06

  It became a better, a better experience for both of us.

• 44:19Oprah Winfrey?

  Right, because communication is key.

• 44:21Speaker 06

  Now, my question for Dr. Malone is, is, uh, you know, grown talk for women, uh, recommended reading for men? Or should we have a grown talk about women for men? Um, book coming out? And, and, uh, what more can we do to begin to understand? I, let me just include, I have a husbands group that I meet with. And we met last night and I brought this whole topic of, of, um, of, uh, of menopause.

• 44:47Oprah Winfrey?

  What did they say? I'm curious.

• 44:48Speaker 06

  But I, I was shocked to see that everybody was very willing to talk about it because nobody ever talks about it.

• 44:55Oprah Winfrey?

  Oh, that's great.

• 44:56Speaker 06

  And we had two men in their sixties, three men in their fifties, and the young man in his thirties was taking feverish notes because he was like, oh, my goodness, what's going on? What do I have to look forward to? What, what should I be doing? And it was a great, it was a great conversation. And they even said, um, we, we need to talk about this more because if women aren't talking about it with other women, just know that men aren't talking about it at all.

• 45:19Oprah Winfrey?

  Yeah.

• 45:19Speaker 06

  And, and we had a great conversation.

• 45:21Oprah Winfrey?

  I think that's great. That's great, Raymond. That's great to hear. Thank you. Thank you both. I'm, I'm gonna make sure you get the book. Do you have the book?

• 45:30Speaker 01

  No. So, thank you, so.

• 45:31Oprah Winfrey?

  Okay, we will make sure you get the book. Thank you so much. Thank you both. I, I think, I'll send two copies because when, once you read the book, you will be so informed, you will be jazzed about the information and how that information applies to your own life. I'm really excited, really excited to be able to send it to you. All right. Thank you both. Thank you. Okay, so I'm gonna give you, Dr. Malone, the final word. What do you want to say to all the people like Raymond and Nikki, like all the women we spoke to this week and weeks ago, who are trying to figure it out for themselves?

• 46:10Speaker 01

  The one message that I really want women to have is this, is that menopause is inevitable, suffering is not. And I think that every woman has a line drawn somewhere in the sand between what's tolerable and what's not. You don't let someone else tell you how you feel or how you're supposed to feel. If you are bothered, if you are having any one of those 34 symptoms in any particular order, or if you're not having those symptoms and you're at risk for things like cardiovascular disease or osteoporosis, you need to educate yourself and advocate for yourself because that's a big message that I want women to get, is that don't be passive participants in your own life,

• 46:55Speaker 01

  in your own health. You have way more power than you think. You just don't know how to exercise it. And so my book and my message and my mission is to make sure that women have all the information they need to be able to make good decisions for themselves and for their families.

• 47:13Oprah Winfrey?

  And it's all right here in Grown Woman Talk. Thank you all. Thank you again, Dr. Malone. Thank you, our guests, for being so open with us about your experiences. Dr. Malone's book, Grown Woman Talk, grown woman, grown folks, okay? Is available anywhere you buy books. It has lots of important information about how we navigate the aging process from perimenopause and beyond. If you're listening to this podcast, you can head over to YouTube to watch the full video. Talk to you next week, everybody. Go well. You can subscribe to the Oprah Podcast on YouTube and follow us on Spotify, Apple Podcasts, or wherever you listen. I'll see you next week. Thanks, everybody.