#1 Hormone Doctor: The Ultimate Guide to Perimenopause, Fertility, Birth Control, PCOS, & Menopause

Today’s episode is your ultimate women’s hormone health guide for every age. If you are dealing with painful periods, infertility, endometriosis, PCOS, struggling with perimenopause, menopause, or confused about birth control - this episode is a MUST listen. From PMS to menopause, this episode will teach you how to use science to hack your hormones, reset your body, and feel amazing again. Today, Mel sits down with Dr. Sharon Malone, MD, one of the most trusted medical experts in women’s health today, to cover health topics we have never discussed on this podcast before. Whether you’re 25, 35, 45, 65, or even 85 - this is your playbook to understanding what is happening in your body so you can take better care of your health. Dr. Malone is a board-certified OB-GYN, a nationally recognized expert in menopause, perimenopause, and reproductive health, and she has been in clinical practice for almost 40 years. And today, she is unpacking the science of women’s hormones in a way you’ve never heard before. Dr. Malone answers the questions women everywhere are asking and explains, step by step, exactly what is happening in your body and how to get it back in balance. You’ll learn: -The symptoms that deserve your attention -Why painful periods are not something you should just push through -The truth about birth control and your long-term health and fertility -What you need to know about natural birth control and how to think about your options -What you need to know about fertility and infertility -How endometriosis and PCOS impact women’s health -What perimenopause really is and why so many women miss the signs -What to know about menopause and HRT -Why weight changes happen as hormones shift -How muscle loss impacts your health as you age -What every woman needs to understand about osteoporosis -The two specific questions you need to ask your mom -The misinformation online that is hurting women’s health This is your science-backed step-by-step guide to balancing your hormones for health, happiness, and longevity. No matter how old or young you are, this episode is relevant for you and for every woman you love. For more resources related to today’s episode, click here for the podcast episode page: https://www.melrobbins.com/episode/episode-417/ Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast I’m just your friend. I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I’ll see you in the next episode. In this episode: 00:00 Meet the Guest 02:42 What Every Woman Needs to Know About Hormones 06:53 Birth Control vs. Natural Birth Control 09:25 The Best Birth Control Options Explained 11:01 The Science Behind Birth Control 15:53 Does Natural Birth Control Work? 24:11 PCOS Explained from an OB-GYN 28:56 How to Know If You Have Endometriosis 33:33 The Best Age to Have Children 35:46 Should You Freeze Your Eggs? 39:32 Questions Every Daughter Should Ask Her Mom 42:51 Can You Get Pregnant With PCOS? 43:44 Why Do Women Have Hot Flashes? 49:58 When to Start HRT 56:11 Estrogen Patch Alternatives 58:28 HRT vs. Vaginal Estrogen 01:01:45 The #1 Exercise for Strong Bones 01:10:30 The Two Questions to Ask Your Doctor 01:13:36 How to Thrive After Menopause — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

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

• 0:00Mel Robbins?

  Hey, it's your friend Mel and welcome to the Mel Robbins Podcast.

• 0:08Mel Robbins?

  I am so excited for the conversation today because in the last two years, I am so proud to tell you that two of our episodes from the Mel Robbins Podcast have been among the most shared episode of any podcast in the entire world on Apple Podcasts and Spotify. And guess what the topic was? Women's health. Well, since then, we have been getting nonstop questions from listeners around the world, all about how hormones and the reproductive phases of a woman's life impact her health. Now, our team has analyzed thousands of questions from your fellow listeners, and there were eight topics that kept coming up over and

• 0:48Mel Robbins?

  over and over again. These are topics that affect women of all ages, from high school to your 80s and 90s. So today, we're answering all of them, and you're going to get a master class with one of the most trusted medical experts in women's health today. She has been a practicing OB-GYN for almost 40 years, and today, she's answering your questions in what is going to be an extraordinary, in-depth episode about women's hormonal health. Whether you're 25, 35, 65, heck, 85, this is your guide to understanding what's happening in

• 1:30Mel Robbins?

  your body. She's calling out all the misinformation online that is hurting women's health. You're going to learn what symptoms deserve your attention, two specific questions you need to ask your mom. She will also cover painful periods, birth control, fertility, infertility, endometriosis, PCOS, perimenopause, HRT, weight changes, muscle loss, osteoporosis, and so much more. So no matter how old or young you are, this is so relevant for you and the women you love, because there's one thing that women deserve. You deserve the facts. You deserve the truth. You deserve to be treated with respect, because you get

• 2:11Mel Robbins?

  to choose what you're going to do to take care of your health. But I want to make sure that you are informed and that you're getting it from a licensed and respected medical professional. And that's what we're doing today.

• 2:33Mel Robbins?

  Hey, it's your friend Mel and welcome to the Mel Robbins Podcast. I am thrilled that you're here today. I'm so excited about the topic. It's an honor to spend this time together with you. And if you're a new listener, or somebody shared this episode with you, I'm so glad that you're here, because today's episode is the women's hormone health episode for every age. I'm so glad that you're making the time to listen to this. And if you're not a woman, I'm thrilled that you're here, because you're listening on behalf of all the women in your life that you care about and love. So thank you. Thank you for listening to this, because you're about to meet one of the most trusted experts alive today in women's health. Her name, Dr. Sharon Malone. She is a board-certified OB-GYN and nationally-recognized

• 3:16Mel Robbins?

  expert in menopause, perimenopause, reproductive health, and women's health equity. Dr. Malone has spent nearly 40 years helping women understand their bodies, advocate for better care, and get the answers they deserve. She graduated from Harvard University, earned her medical degree from Columbia University, completed her residency in OB-GYN at George Washington University. She was also an associate clinical professor at George Washington University for 26 years. She's been in clinical practice in Washington DC for almost 30 years. She's a New York Times bestselling author, a leader in women's health, and she has more awards and accolades than we have time to list. So please help me welcome Dr. Sharon

• 3:59Mel Robbins?

  Malone to the Mel Robbins Podcast. Dr. Sharon Malone, welcome to the Mel Robbins Podcast.

• 4:05Speaker 01

  Well, thank you so much for having me.

• 4:07Mel Robbins?

  I am so thrilled that you're here. The team is buzzing, and we have so many questions from our audience, and we're going to go through them one by one. And I think one of the places that I would love to start is, I would love to have you speak directly to the person that's here right now and explain a little bit about what might change in their life for the better, or their health for the better, if they take everything to heart that you're about to share with us.

• 4:37Speaker 01

  I think the most important thing that women should understand is that we are hormonal beings, from the moment we start puberty to the day our periods stop forever. And these hormonal changes and undulations that happen affect every part of our body, and they're not disconnected. Puberty is not disconnected from your reproductive years, is not disconnected from perimenopause and menopause. It is one continuous story. And that the sooner you know the story, the better you're able to craft a better ending for you. Whether you're 20-something, 30-something, or 60-something, there will be something

• 5:18Speaker 01

  in this conversation that will apply to you, whether you're a mother dealing with a daughter with endometriosis, or struggling with infertility, or you're a daughter and you're watching your mother age, or worry about fractures as she gets older. There are multiple entry points into this conversation, and I hope that we will hit them all, and there will be something that we can all take away from it, because we're all grown women.

• 5:45Mel Robbins?

  As I'm sitting here in this chair, you are going to share things that I will likely learn about my body for the first time. And it startles me how much I didn't know about menopause, perimenopause. It startles me, as a mom of two daughters in their 20s, how much I don't even know how to explain to them about what's going on in their bodies. Why do you think there's so little education when it comes to women really understanding both the beauty and complexity and the very explainable things that are happening?

• 6:22Speaker 01

  Well, I think that we don't have the conversations. I mean, intergenerationally, we don't have the conversations. You barely got a period talk. And the period talk is not just about how to put in a tampon, or how to use a pad. It is a fundamental change in a girl's body. She is transforming from a girl to a woman, and all the things that sort of happen after that. Do we talk about cramps? Do we talk about PMS? No, we don't. Most of us are left to figure it out. And it starts there. We've gotten a little bit better about having the conversations about birth control and pregnancy. But really, when

• 7:04Speaker 01

  you get into the phase of life when you need the most advice, you're having that same sort of total body transformation in perimenopause and menopause. No one warns you. You don't even know what the signs and symptoms are. And most women are just caught, flat-footed on this. I think it has a lot of historical basis for it, in that women are taught that the things that our bodies do are either shameful or disgusting. And so, we don't have open conversations. And it starts at the beginning, and it goes all the way to the end.

• 7:38Mel Robbins?

  Well, what I also love that you just said is that it's this continuum. And it is true. When I think about being 57, or I think about my daughters who are in their mid-20s, it is almost like, episode by episode, I'm having problems with my period now, so now I'll go get help. Or I am having trouble losing weight, or sleeping, or bringing fog, so then I'm going to go get help. But we don't, I've never really kind of thought about it, like, what's the whole picture here? And how do the dots connect from the very beginning, when you get your period, all the way through till the end of your life? And that's why you're here, Dr. Malone. And so, I want to go decade by decade, and really

• 8:20Mel Robbins?

  have you talk about that sort of continuum, medically speaking, related to women, hormones, health. And let's just start with your 20s, okay? One of the things that I've noticed, Dr. Malone, is there has been a wave of women in their 20s who are going off birth control, who have a lot of fear that birth control is dangerous, or that birth control is making them infertile, and they're now using natural methods. And I would love to have you just unpack this for us.

• 8:57Speaker 01

  I would love to do that, because that drives me absolutely insane, when I see these posts, and they're saying, oh, my God, birth control pills, they're going to give you, you know, you're going to be depressed, or you're going to have sexual dysfunction as a result of taking birth control pills. And I would say this to the young women out there, you don't understand, birth control pills are probably one of the greatest modern inventions in the history of womankind, because it is the first time that we have reliably, reliably been able to control when and what time we choose to have our families. And that is something that historically, we've never had. So, being able to decide when and

• 9:42Speaker 01

  where to have your children, major innovation. So, anything that really sort of chips away at that notion, or takes away options for young women about being able to make that decision, is problematic for me. And if birth control pills, if the only thing they did was control your fertility, that's enough. But birth control pills are quite helpful, whether or not you have cramps, or you have heavy periods, or for women who even have PMS, believe it or not, birth control pills help even out some of the hormonal fluctuation with PMS. So, I don't want to give the impression that birth control pills are for everybody.

• 10:24Speaker 01

  Every medication, it has benefits, it has some risks. The risks are small, particularly for young women. And I don't want them to shy away from the most reliable, accessible birth control option, because they're afraid of something or a post that they've seen on social media. And here's the other good news, is that now we have other options. If you choose not to do birth control pills, that's fine. We have lots of other contraceptives for young women. That are reliable, much more reliable than these natural methods.

• 10:58Mel Robbins?

  What are the other methods, other than taking a birth control pill, that as a medical doctor, you say these are options that you should consider before you look at the quote "natural" methods?

• 11:10Speaker 01

  Okay, well, one of the things that's really kind of gone by the wayside are diaphragms and condoms, those are considered barrier contraception. Now, either one alone is about 80% effective, but together, they're actually quite good. That's probably the least used options in young girls today. But let's not forget the sexually transmitted infection issue, where condoms should always be a part of whatever that regimen is. So regardless of your birth control that you choose. But we also have something that has really taken hold with young women, and that is what we call LARCs, that's long-acting reversible contraception.

• 11:49Mel Robbins?

  What is that?

• 11:50Speaker 01

  IUDs.

• 11:51Mel Robbins?

  Oh, that's what I had.

• 11:52Speaker 01

  Yeah, that includes IUDs, you have either a hormone-releasing IUD, or you can have a copper IUD that has no hormone in it. There's also injectables, you can use the Depo-Provera, which is shot every three months, and then there are also the implants that young women can use, that you put them in, three years, change them out. So it takes the user error out of it with the LARCs. Because again, birth control pills are only as good as the person, the reliability of the person who's taking the pill. But these sort of take the user error out of it. And that's why they're a little bit more effective than the pill. So yes, we have options.

• 12:30Mel Robbins?

  What are the medical benefits, Dr. Malone, of taking birth control? Like, what are the positives? Because, you know, I think if you're in your twenties or your thirties, you do not remember a time when this was not something that was accessible to you. And I saw this chart that tracked what happened in society when birth control, safe birth control, became a viable medical option for women to have, so that you could control the most important decision that you may or may not make as a woman, which is when you want to have a family. And I found it incredibly striking. It is a hockey stick, I'm holding up a graph

• 13:12Mel Robbins?

  that shows that when birth control was first made widely available, you know, right around 1970, within a decade, there was a statistically significant hockey stick spike in women who were able to enter college, complete college, enter law school, medical school, because they were able to control when they had children. And so I would love for you, Dr. Malone, to just be very scientific about what are the medical benefits of birth control? And then I want to get into, what are the lies that are being spread

• 13:56Mel Robbins?

  about this important option for women that we need to know?

• 14:01Speaker 01

  Okay. Well, I think that the positives of birth control pills, one, is that suppose you have really heavy periods? And there are women who have very heavy debilitating periods, and there's no structural problem. So it's not like it's fibroids or something like that, that you could fix. It decreases the amount of bleeding that women have every month. So guess what? Not only is your life and your ability to do the things, you know, not impacted, but anemia is a problem for women who chronically bleed heavy. So you're able to control your periods, they're lighter, they're more predictable. That's a big plus.

• 14:42Speaker 01

  Also, as I said, with PMS, some women have really severe PMS, and it happens, you know, because it happens reliably about a week or a few days before their periods. And what's happening in that case, when you're in a natural cycle, your estrogen level goes up, it peaks around ovulation, and then if you do not conceive, it starts to go down. And we think the trigger for some of the PMS is not the estrogen itself, but the falling estrogen that triggers it. The same is true for migraines, for people who get menstrual migraines. It's the falling hormones. So when you take birth control pills, you can sort of even out that precipitous decline that you get. So that's very helpful.

• 15:23Speaker 01

  And it's also first line for even when there's suspected endometriosis or cramping, and some people have very, very painful periods, and birth control pills do help with that as well.

• 15:35Mel Robbins?

  Do birth control pills cause infertility?

• 15:38Speaker 01

  No, they do not. You're not accelerating the aging, you're not doing anything deleterious to the ovary itself, let's just say. You start birth control pills when you're 20, and you take them until you're 35, because you're not ready to have a baby until you're 35. Well, your fertility at 35, when you stop taking the pills, is not what it was at 20. So if you're having difficulty conceiving at 35, it's not the 15 years of birth control pills that did it to you, it is the fact that you are 35. And that is something that we have to take into account. Your fertility changes decade by decade, but it's not the pills. And sometimes we blame the pills for things that really, we shouldn't. But let me say, I think this is an important point to make,

• 16:23Speaker 01

  is that some women do react negatively to birth control pills. I get it, I have two daughters, one it works fine on, the other one, not. I believe her. But we find an alternative for, for women who do not tolerate birth control pills. And let's be clear, there are about 20 different birth control pill options out there, and you can play around. Sometimes this is not the science of it, it's the art of it. You may react better to one particular progestin that's in one pill, and not to the other. So if you have a little patience, don't say, "I took birth control pills once when I was 20, and I had a bad reaction, so I can't take them ever again." That's not true either.

• 17:06Speaker 01

  It's just knowing that we've evolved, we have different pills, they're lower doses, there are a lot of tweaks we can make along the way that will make that option a more viable one for you.

• 17:18Mel Robbins?

  Well, I think a lot of young women are worried about falling fertility rates, and are opting to go off this safe medication, right? Because they are reading online, or they're being told by an influencer, that birth control is responsible for falling fertility rates. And they're opting for quote "natural" birth control with the assumption that doing natural birth control somehow preserves your fertility for whenever it is that you think you're going to get pregnant. Is that what's happening when you use natural birth control? That you're protecting your fertility?

• 18:00Speaker 01

  You are not. And let me say another thing, I went to Catholic school. This new iteration of natural birth control is really nothing more than modified rhythm method. And having gone to Catholic school, let me tell you, rhythm method doesn't work that well. There are a lot of kids in Catholic school, and they were trying to follow the dictums of the Catholic Church, and to be able to say, okay, yes, no birth control. And it just is unreliable. And I think that when you use catchphrases or words like "natural", you automatically assume that it's better. And there are a lot of things that are natural. Death and disease are natural, but we don't really want to go down that path either, do we?

• 18:44Speaker 01

  So you have to watch what the agenda is. And I think you have to go a little bit deeper into why is there, when we are in a time when we have the most reliable and varied birth control options available in the history of womankind, why are we regressing? And going back to something that we know for a fact didn't really work that well to begin with?

• 19:09Mel Robbins?

  Well, and as a medical doctor, Dr. Malone, you're stating that it's not reliable. And I guess I'm hovering here, because, you know, I really want to respect somebody's decision

• 19:20Speaker 01

  Right.

• 19:20Mel Robbins?

  to do what they want to do with their body. And if you are using a method, whether it's called rhythm, or it's called pullout, or it is tracking your cycle, or you're using some app that is marketed to you as quote "natural" birth control, then what that tells me is, you don't want a baby right now.

• 19:38Speaker 01

  Exactly.

• 19:39Mel Robbins?

  And if you're doing it because you think it's safer than a birth control pill, because you have been told by people that it will ruin your fertility, you have been told a lie. Is that what you're saying, Dr. Malone?

• 19:52Speaker 01

  I am saying that. And to give you an idea of like, is it safer? And I, and I think that safer than what? Okay? Pregnancy is a very complicated and can be a very dangerous time in women's lives, just from a health point of view. A lot of what comes up about birth control pills is like, yeah, but it increases your risk of blood clots by two to three times over not being on birth control pills. Pregnancy increases your risk of blood clotting six times over what it would be if you were not pregnant. So again, you have to look at it in terms of, you know, relatively, birth control pills are way safer and less deleterious to your health than being pregnant. And that's why it's so important that you choose the

• 20:36Speaker 01

  timing. And Mel, just like you said earlier, you gave that graph about what happened to women and what professionally and educationally they were able to pursue after birth control? It is a stark line.

• 20:51Mel Robbins?

  For the person that thinks that, okay, I've got a journal, I have an app, I can track my cycle, I can take my temperature, I've got the smartwatch and the ring, will that prevent me from getting pregnant?

• 21:05Speaker 01

  No, it won't. The circumstances that it works the best in are people that have extremely regular cycles. So if you say, 28 days, I know where I am, my period's coming, I can feel it, I can feel ovulation, and there are people who feel that, who say they do that. But what about if your period is 28 days this month, it's 31 the next month, or your cycles are very irregular, then all the temperature taking in the world is not going to help you prevent pregnancy. Because here's the thing about taking your temperature, your temperature goes up after you've ovulated, not before. So if you had

• 21:47Speaker 01

  sex yesterday and your temperature goes up today, oops, you know, that's a little, that's a little too late for that information. So the cycle tracking is helpful in retrospect. You do it, and then you say, okay, three, six months, I see where it is and when ovulation may happen here. That's when it's helpful. Now, we've progressed a little bit. We've got, you know, sticks you can pee on for ovulation. Those are way more helpful when you are trying to conceive than when you're trying to prevent pregnancy. And the amount of time that sperm will survive even before you've ovulated, it's like 72 hours.

• 22:23Mel Robbins?

  Wait, so if you're practicing the natural method, and let's say your partner pulls out, if a little sneaks in there, it's going to live in there for three days?

• 22:34Speaker 01

  Yeah, up to 72 hours. And so you're, you're like, I'm good, I didn't ovulate today. Well, what about tomorrow, or the next day?

• 22:41Mel Robbins?

  Or the next day.

• 22:42Speaker 01

  Or the next day. So that's why I said, it's not as reliable. And I just want women to be able to make good choices. Make choices based on evidence, science, not fear.

• 22:57Mel Robbins?

  So Dr. Malone, if someone's listening right now, and they've been using the natural quote, "method," and they're now thinking, wait a minute, I don't want to get pregnant right now. Wait a minute, the options that have been around for 60 years are medically safe and reliable? Wait a minute, uh, they're not going to impact fertility? What are the top three things you would recommend to the person who's now thinking, maybe I should consider the IUD, maybe I should take, like, what would you?

• 23:34Speaker 01

  Think about the timeframe that you, you know, that you're trying to not get pregnant in. If you say, absolutely, I don't want to have a baby for five years, then I think the LARCs or the IUDs or the implants are fantastic, because again, the margin error is so small, because it's not like, oh, I forgot to take my pill. But if you say, I don't want to get pregnant now, but maybe within the year, then it doesn't make sense to get a long-acting reversible contraceptive, because you can leave them in place for years. That's a situation where maybe a birth control pill may be useful. But again, what are the consequences? This is also, I think, is really important. What are the

• 24:16Speaker 01

  consequences of you getting pregnant inadvertently? If you say, well, I want to get pregnant in a year, but if I got pregnant in six months, it'd be like, oh, well, not what I planned, but it's okay. Versus, I am in the middle of finishing, defending my dissertation, or I've got a trip planned to Antarctica. I mean,

• 24:38Mel Robbins?

  Or I'm living paycheck to paycheck, and I can barely take care of myself.

• 24:41Speaker 01

  What are the consequences? How would that affect my life if it happened? Not just what would happen if I did, what would happen if I didn't? How would my life be changed by that? And I think that central question will determine which one you choose and when.

• 24:57Mel Robbins?

  And how quickly could you get pregnant after you stopped taking the pill?

• 25:02Speaker 01

  The first time you ovulate, which is usually, most women who have regular cycles will get another cycle usually within a month or a month and a half of having stopped the pills. So it's pretty quick. All you need to do is ovulate.

• 25:16Mel Robbins?

  PCOS has recently been renamed to PMOS, and I'm getting so many listener questions about PCOS. Could you explain what this is? I happen to have a daughter that was diagnosed with this, and her late teens. But there's a lot of misinformation, and this is a really important thing that impacts a lot of women.

• 25:40Speaker 01

  I have thoughts on this, Mel, you know?

• 25:44Mel Robbins?

  I'm not surprised, Dr. Malone.

• 25:46Speaker 01

  But PCOS, I'll give you just a little bit of the history of PCOS. PCOS is polycystic ovarian syndrome. Before it was polycystic ovarian syndrome, it was polycystic ovarian disease. So we changed the name from disease to syndrome, because disease makes us sound like,

• 26:04Mel Robbins?

  Sounds terrible.

• 26:05Speaker 01

  Yeah, sounds terrible. So that was the first name change. And then now we've gone from polycystic ovarian syndrome to polyendocrine metabolic syndrome.

• 26:17Mel Robbins?

  Okay.

• 26:18Speaker 01

  Ovarian syndrome. PMOS is what it is. Okay, well, that's great. We've changed the name. Have we changed the diagnostic criteria for PCOS? No, we haven't. It's the exact same things, how I would make the diagnosis today is the same way I would have made the diagnosis 20 years ago, we just changed the name.

• 26:37Mel Robbins?

  Dr. Malone, what are the symptoms that somebody who has PMOS or PCOS?

• 26:42Speaker 01

  PCOS. Okay, generally speaking, I think what get people derailed is when you say polycystic ovarian syndrome, that means, poly just means many, you've got, normally in the course of a menstrual cycle, you know, you'll start recruiting eggs, one will take over, and you'll ovulate from one egg. Well, with polycystic ovarian syndrome, you don't really ovulate regularly. So they get the signal, okay, but no one takes over, and it's not just one egg that ovulates. So you get this sort of chronic overproduction of estrogen. You also, because you don't ovulate, you also don't get that second half hormone,

• 27:24Speaker 01

  which is your progesterone that you kick in the second half. And so it makes your cycles irregular. They're irregular, maybe once every three months, and maybe once a year. So irregularity of cycles is usually the first point. The second point is that there are also other things going on. A lot of women will find that they have signs of what we say androgen excess. That just means that your ovaries are also making testosterone. They make more than just estrogen and progesterone. They make testosterone. And so when you don't ovulate, you get this sort of chronic overproduction of testosterone. And what happens when you get a lot of testosterone?

• 28:04Mel Robbins?

  You grow hair?

• 28:04Speaker 01

  Acne, yeah.

• 28:05Mel Robbins?

  Oh, acne.

• 28:06Speaker 01

  Acne, facial hair. Women will find that they start to get chin hair, hair around the nipples. So there's a sort of a more of a male pattern hair growth. Because you've got that, it can also lead to hair loss. But the endocrine part of it is that we've also realized that it's not just, again, it's never just the ovaries. There are other organ systems that are affected. And the endocrine part is there's an overproduction of insulin. So there's a degree of insulin resistance, because you're not responding to the insulin. So you overshoot it, and you're making too much insulin. You know,

• 28:48Speaker 01

  so acne, weight gain, higher levels of insulin, irregular cycles, those criteria are basically the same. And I think that when you get caught up on the polycystic part of it, you think you're going to do an ultrasound, instead of seeing one follicle, you're going to see 20 little ones. Well, you don't see it. That's not an integral part of making the diagnosis. So we've made a lot of progress in terms of changing the name. But you know where we haven't made a lot of progress? Finding out why it happens and having new treatments for how to deal with it. That's where the attention needs to be focused. So when I say, I have thoughts, it's like, yeah, great.

• 29:31Speaker 01

  I'm glad you changed the name, but we need to focus on, okay, now what are we going to do about it? We need more research.

• 29:39Mel Robbins?

  It almost sounds like it's a hormone imbalance that is just wreaking havoc on your body, your menstrual cycle, your ovaries, other organs, insulin, sort of like menopause does.

• 29:50Speaker 01

  Yeah.

• 29:51Mel Robbins?

  You know, you write about endometriosis in your bestselling book, and I was really surprised to hear that it affects 1 in 10 women. And it's also one of the leading causes of painful periods and infertility. Can you explain what endometriosis is and what are the symptoms?

• 30:12Speaker 01

  Yes. Endometriosis is simply that same tissue that lines the uterine cavity, the tissue that gets stimulated every month with estrogen before you ovulate and sloughs every month if you don't conceive during that cycle. That's endometrial tissue, which is why it's called endometriosis. Well, it belongs in the lining of your uterus, but for reasons that we don't really know why, it can migrate or spontaneously generate in places where it doesn't belong. So it can be on your ovaries. It can be the lining of your abdominal cavity. It can be on your bladder. It can be on your bowel, anywhere, but it's just not supposed to be there. We don't know how it got there.

• 30:56Speaker 01

  There are a lot of theories, but it's there. And so those same hormonal triggers that you're getting every month to tell the lining of your uterus to grow and shed is happening. Remember, it's talking to the endometrial implant that's on your bladder, and it's doing the same thing. And chronically, it can lead to scarring. Because remember, when you get your period, you're sloughing that tissue out. Well, what happens? It has nowhere to go. So it's there, and that chronic inflammation really can cause pain, scarring, and in the worst cases, infertility. And as I said, a lot of women walk around. I think it is probably more underdiagnosed than PCOS.

• 31:41Speaker 01

  Because when you say one of the signs is painful periods, well, do you know how many women walk around with painful periods? And they just figure, well, I'll just take more Motrin, or I'll do something else, or I just assume that that's normal. Now, the other thing about endometriosis is that it's called really the great masquerader. Because suppose you have it, it's on your bowel. And your symptoms may be, oh, I have, you know, really bad diarrhea or bowel issues, or sometimes even on your bladder. So it is causing the problems where it lands.

• 32:22Speaker 01

  If you have really bad endometriosis, the scarring can make sex unbearable for women. So, you know, again, you need to have someone to talk to who says, you know, yeah, I kind of see the pattern here. But women are often treated individually for their symptoms. So you've got bowel symptoms, you go see a GI doctor. Oh, you have a bladder thing, you go see, you know, a urologist, and not really understanding that it all goes together. And that's why it's a delay in diagnosis for most women. The delay in diagnosis is seven to nine years before they're adequately diagnosed and treated for their endometriosis. Yeah, it's a long time.

• 33:02Speaker 01

  Women with endometriosis have had multiple, multiple trips to the doctor. It's not like they were not complaining about it. It's just that being able to make the diagnosis. And as physicians, we like objective data. We like to be able to do some lab work and see it, or do an ultrasound and see it, or a CT.

• 33:24Mel Robbins?

  Yeah.

• 33:25Speaker 01

  And the problem with endometriosis, the reason why a lot of times it's not visualized on a scan, is because the little spots of endometriosis will be so small that they're below the resolution of whatever you're trying to do to, to look at it. So you don't see, you can't see it on a scan. Well, then how do you diagnose it? Well, you have the clinical presentation. But sometimes if you're really concerned, you need to do a laparoscopy, which is that's where you just take a look, go through a scope and look in there, and you see it. And that's how you can definitively make the diagnosis. The one thing that the laparoscopy will allow you to do is that if you see it, in addition to being able to treat it medically,

• 34:09Speaker 01

  if I see endometriosis, I can go in with my laser and I can zap it and, and correct the things that I see, then do the medical treatment afterward.

• 34:18Mel Robbins?

  That is so helpful. I could listen to you all day. I have so many more questions, but here's what I want to do. Let's take a quick pause, because I want to give our sponsors a chance to share a few words. And I also want to give you a chance to send this episode to your sister, your mom, your best friend, or like me, your daughters. I'm also going to send this to the women that I walk with on Wednesday mornings, because this is information we all need. And don't go anywhere, because after the break, Dr. Malone is going to talk about hot flashes in a way you may have never heard any medical professional explain them to you. They're trying to tell you something. And she's also going to tell you what the one thing is that prevents osteoporosis, and I think it's going to surprise you. So stay with me, we'll be right back.

• 35:13Mel Robbins?

  Welcome back. It's your friend Mel Robbins, and today you and I have the honor of learning from and being empowered by board-certified OB-GYN Dr. Sharon Malone. Today, she's answering your questions in an extraordinary episode all about women's hormonal health at every age. So, Dr. Malone, since you also said that endometriosis is one of the big causes of infertility, let's just talk more about fertility. What do you want women in their 20s and 30s to understand about how fertility changes as you age?

• 35:53Speaker 01

  Well, your peak fertility years are really in your 20s, probably in your late teens to, through your 20s. And then when you get into your early 30s, it's a little different, but it's not markedly different. You know, there was the difference between 32 and 28, probably not that much. But once you get to about 35, 36, then we start to see some of the, more of the age-related fertility decline. Our fertility is declining, but it's more rapid once you get to your mid-30s, to the point where by the time you get to your early 40s, then it's even lower. I mean, you know, the likelihood that you will conceive at 40 is way less than what it would be if you tried to conceive at 20.

• 36:38Speaker 01

  So we have two things. We have number of eggs, and that's more of an issue when you're 50. But when you are in that window of declining fertility, like between 35 and your 40s, there's also another component that we don't think of, that some of it's genetic, some of it's environmental, and that is your eggs have an expiration date stamped on them. So you don't know when yours is. It is helpful to know your family history. That's why I encourage young women, I said, please talk to your mother. Ask your mother, Mom, did you have trouble conceiving? How old were you when you had your last baby? When did you stop using birth control? That tells you a lot of things.

• 37:22Speaker 01

  It tells you, you know, knowing your family history about endometriosis, about fibroids, about infertility is important. It helps you be proactive going forward. It helps you perhaps make a decision. Maybe I won't have my first baby at 37, maybe I'll have it at 34. It's kind of, I say it's data, and you do with that data what you will.

• 37:45Mel Robbins?

  Does freezing your eggs impact the expiration date?

• 37:48Speaker 01

  No, it does not. Remember I told you, your peak fertility years are in your 20s. So if you were going to freeze eggs, if I were just saying theoretically, when, when would I get the best yield from egg freezing and retrieval? It'd be in your 20s. But the flip side of that is, well, what's the likelihood that I would ever come back for those eggs? Because if you're in your 20s, you've got a whole life in front of you. You know, so you meet someone at 30 and you get married and you get pregnant. If you get pregnant on your own, are you ever coming back for those eggs that you've spent tens of thousands of dollars for? So even though the, the yield is better, the likelihood that you will ever need them goes down.

• 38:30Mel Robbins?

  Got it.

• 38:31Speaker 01

  So I think the sweet spot is somewhere probably late 20s, early 30s for freezing. But let me be clear about egg freezing. Egg freezing gives you the possibility of pregnancy. It does not guarantee anything.

• 38:49Mel Robbins?

  That makes a lot of sense.

• 38:50Speaker 01

  Yeah.

• 38:50Mel Robbins?

  What, Dr. Malone, are surprising reasons for infertility?

• 38:54Speaker 01

  I think the most surprising and frustrating one is unexplained infertility. Now, we do a whole workup. You know, we've done ultrasound, and we looked at the lining of the uterus, and we know your tubes are open, all of that. And sometimes every single thing checks off on the list. You're good, your spouse or your partner's good, and you're still not pregnant. That, I think, is, is probably more frustrating to people than saying, oh, I have fibroids, or I had a pileup, or my tubes were blocked. Because everybody likes to have a reason. And I think that's frustrating. I think the other thing about infertility that we don't talk enough about is that it's not just a me problem, it's an us problem.

• 39:39Speaker 01

  And upwards of 50% of infertility cases, sometimes it's male factor infertility.

• 39:46Mel Robbins?

  Fifty percent?

• 39:47Speaker 01

  Yeah. Women get blamed, but you know, it's like, it may not be me. Maybe you. And, but again, but their answers even for how did that? That's what, you know, IVF is for. That's what, what's something called ICSI. When you have male factor infertility, then that's just intracytoplasmic sperm injection. ICSI. You see why we say ICSI?

• 40:10Mel Robbins?

  Yes, I do.

• 40:10Speaker 01

  Yeah. But all you're doing is now you're just giving that sperm something. You're like, I know you're not going to get there on your own, so I'll just directly put it into the egg. That's helpful.

• 40:21Mel Robbins?

  You're giving it pre-workout, basically.

• 40:22Speaker 01

  No, you're just going ahead, giving it a whole head start. Um, but that's helpful. And that has helped a lot of couples. So it's not just like, oh, poor me. You know, the more you know, the better choices you were able to make. And I would also say to young women who are thinking about, you know, where they are in their careers and should I do it now? Should I do it two years from now? The other important point to make here is that freezing embryos, which is what we do in IVF, where you've already got a known egg and a known sperm, and then we freeze them and come back for them later. That's more successful than egg freezing.

• 41:02Mel Robbins?

  Hmm.

• 41:02Speaker 01

  The procedure is the same. We still have to, you have to take all the same medications for IVF that you would for an egg retrieval. You're retrieving eggs. That part of the procedure is the same. The only thing is like, what are you doing after you've retrieved the eggs? Are we fertilizing them now or are we freezing the eggs? And fertilizing them now with a known partner is always the better option if you have a known partner.

• 41:29Mel Robbins?

  Dr. Malone, what's the connection between fertility and perimenopause?

• 41:33Speaker 01

  Oh, well, they go together and it's an age-related thing. Now, here's the connection that I think a lot of people don't understand. Remember I told you there's a natural age decline in your fertility, right? Associated with age. Well, suppose I tell you, we'll do a little thought experiment here. We say the average age is 51 for having gone through menopause, completed, end of discussion, shop is closed. Oh, nothing's happening there, right? No ovaries.

• 42:00Mel Robbins?

  Yep.

• 42:01Speaker 01

  No, no estrogen from those ovaries. Fifty-one. Well, perimenopause, that window, that long span between your peak reproductive years and the end of your reproductive years. Okay, it can be four to 10 years. So if I tell you you're menopausal at 50, all right, then perimenopause can start as early as 40, and then it takes you 10 years to go through that process. And there is also diminished, um, ability to conceive because again, now you're 40-something in addition to these hormones are changing. But suppose you're menopausal, you've talked to your mom and you find out, oh, my mom had an early menopause. She was menopausal at 42.

• 42:46Speaker 01

  Back it up four to 10 years. That means that for you, you might be perimenopausal in your 30s, your early 30s. When you think relatively speaking, I should be pretty good on the fertility front. But you don't, you can't predict where you are in that spectrum necessarily. So that's why I say it's important to know your family history. So you can say, all right, Mom, well, I did not know, Mom, that you were menopausal at 40. Then that, you know, it's not a one-to-one, but it is a very important data point if you're the daughter.

• 43:19Mel Robbins?

  If you're listening and you have not talked to your mom or your grandmother, she's still here, what are the questions you want every daughter to ask their mother?

• 43:31Speaker 01

  You want to know all about their, um, their medical history, but particularly you want to know about things. Mom, did you have cramps? That's a sign. Did you have these painful, awful periods that could be indicative of endometriosis? Because we know that daughters of women with endometriosis have a higher incidence of endometriosis. You want to know about whether or not your mom had fibroids. You want to know, because again, that increases your risk of having fibroids at some point in your reproductive life. You want to know what age she was when she conceived? Was it difficult? And you also want to know what was your pregnancy like?

• 44:13Speaker 01

  Because again, these are very, very important points that may affect your history, whether they do or do not. It makes you aware such that if any of those things come up for you, you don't wait two or three years to go get that diagnosed. You mentioned that to your doctor, by the way. Oh, yes, my mother had endometriosis. Well, guess what? That's going to help me make, get to the diagnosis point with you sooner than if you don't know that.

• 44:39Mel Robbins?

  So even just knowing makes you recognize that, okay, this is something I need to pay attention to, which is really important. If you've gotten a diagnosis of PCOS or PMOS earlier in your life, will that potentially impact your fertility as well?

• 44:54Speaker 01

  It may. Because in PCOS, as I told you, the treatment depends on what's your goal.

• 45:01Mel Robbins?

  Yep.

• 45:01Speaker 01

  And if you have PCOS and you're trying to get pregnant, you may ovulate irregularly and you don't know when that is. So you may are going to ovulate three months from now. So when you're trying to get pregnant, and that's a very different situation than for someone who has a period once a year, your opportunities for pregnancy are less. You know, for someone who has a monthly cycle, well, at least you have the opportunity every month. For someone who has PCOS, maybe you ovulate three times a year. So yes, that affects your fertility. But we do have medications that we can induce ovulation with.

• 45:36Mel Robbins?

  Dr. Malone, I am learning so much, and I know as you're listening, you're nodding along thinking, I wish I had had this sooner. I'm so happy I have this as a resource right now. And I want to take a quick break so that we can have our sponsor share a few words with you. Do not go anywhere because we're going to return and Dr. Malone is going to explain why you should consider hormone therapy way sooner than you may think. So stay with me.

• 46:12Mel Robbins?

  Welcome back. It's your friend Mel Robbins. And today you and I are here with board-certified, OBGYN, and world-renowned women's health expert, Dr. Sharon Malone. And today she's answering your questions in this extraordinary episode all about women's hormone health. I'm loving it. I know you and every woman you love is loving it too. So thank you for being here. So Dr. Malone, let's talk about menopause. What is it really? And Dr. Malone, what do you want women to really know and take seriously when this change starts to happen in your body?

• 46:48Speaker 01

  What I want women to understand is this, is that menopause is not an event. It is a life stage. You will spend 30 to 40% of your life after you have completed menopause. You will spend more time in menopause than you did in your reproductive years. It is probably, if you're lucky enough and you don't get hit by a car, that will be the longest of your reproductive phases that you were in. That's why I don't like the term post-menopause. Because when you say post-menopausal, and I get it why we say it that way, but I don't want you to think of it that way. It's because that gives the impression that you're over menopause.

• 47:30Mel Robbins?

  Yes.

• 47:31Speaker 01

  And you're not. You're never over menopause. The effects of the lack of estrogen and hormones in your body will affect you from that point forward. Your bones, your brain, your skin, your hair, all of it. So that's why I said, I don't want people to go, oh, I'm over it. And you know what they mean when they say I'm over menopause? They're usually, they're saying that their hot flashes went away. And menopause is so much more than a hot flash. I mean, that's the least of the things. But hot flashes are often harbingers of things to come.

• 48:08Mel Robbins?

  Wait, hold on a second. Because I, harbingers of things to come, sound like the orcs are rattling over the mountain. And I do have a question here. Why do I still have hot flashes at 58? I haven't had my period in over two years. So if you're still having hot flashes, what is this a signal of things to come, Dr. Malone?

• 48:28Speaker 01

  Well, women who have more severe hot flashes and more frequent hot flashes, sometimes it is a marker for impending cardiac issues. Because what happens to women who have a lot of hot flashes? And who has the most hot flashes? Black women do. They have hot flashes that are more severe, they last longer, and they start earlier. So, you know, when I told you perimenopause is four to 10 years, if you're an African-American woman in this country, it's closer to 10 years. So you are most symptomatic during perimenopause. So all the time, you may be still getting your period. That's the worst. I'm getting my period and hot flashes, but it can happen.

• 49:08Speaker 01

  And then there's also about 20% of women whose hot flashes will continue into their 60s, 70s, and beyond.

• 49:18Mel Robbins?

  Dr. Malone, don't be telling me this.

• 49:19Speaker 01

  Really? I'm, yes.

• 49:21Mel Robbins?

  Why?

• 49:22Speaker 01

  See, who knows why?

• 49:24Mel Robbins?

  Do you think there's a connection with stress? Like if, well, like when I hear the stat that you said about black women having more severe hot flashes, it's starting earlier, lasting longer. What came into my mind was the statistic that, um, Dr. Gabor Maté shared on this episode about autoimmune diseases and the 4X rise of them in the last 20 years. And it was his theory, and I know there's a lot of research around this, that chronic stress and chronic caregiving and micro-traumas and aggression and bias, um, that black women

• 50:05Mel Robbins?

  deal with, that, you know, I don't have to deal with because I'm not being discriminated against and microaggressions every day, that that chronic stress creates conditions in your body that impact your immune system. Do you think that that is contributing to these symptoms?

• 50:21Speaker 01

  I think it is a big factor because I think that the reason why black women tend to experience these symptoms more, and this would be true of any chronic diseases, not just perimenopause and menopause, is that chronic stress is toxic to whether you're talking about weight gain, whether you're talking about your cancer risk. It accelerates the aging process, even for Alzheimer's or dementia.

• 50:50Speaker 01

  People who have chronic stress, all of this, tend to have a risk. And who has higher risk of stress, if anything? Black women. We have twice the risk of dementia than white women. I did not know that until I wrote the book. Because I was like, wow, I never knew that. I never knew that women had twice the risk of Alzheimer's or dementia than men. So it's clearly something that's happening. And it starts somewhere in our midlife. But getting back to the hot flash and the connection to chronic disease. The hot flash is women who have higher incidence of hot flashes. This is what we know. Women who have hot flashes have night sweats. People who have night sweats have disrupted sleep.

• 51:33Speaker 01

  We know that disrupted sleep is a risk factor for cardiovascular disease. We know that women who have disrupted sleep are more likely to have hypertension. Women who have disrupted sleep are more likely to develop type 2 diabetes. Because it leads to, when your sleep is disrupted for months, years on end, chronic fatigue. If you've got, you're chronically fatigued, guess what you're not going to do the next day? You're certainly not going to go to the gym. You're not going to get up in the morning like, I think I'm going to go on a three mile run. So that's why I said a hot flash is often the inciting event for a lot of other things and behaviors that will increase your risk for heart disease as you age.

• 52:18Mel Robbins?

  I would love to hover just a little longer on the hot flashes. And maybe it's selfish, because this was something that was chronic for probably seven years for me. I would wake up and the entire side of my bed, it was almost as if somebody had thrown a bucket of water under me. And they've mitigated, thanks to HRT. What would you say, Dr. Malone, are the thing, like, the top three things you want someone to be aware of? That you should be checking out to mitigate this?

• 52:53Speaker 01

  One, I would say this. Know that hot flashes are not benign. That's what we've been socialized to believe. That suffering, pain, misery, they're just part of womanhood. So we should just grin and bear it. And don't worry, close your eyes, it'll be over in a decade or so. That's ridiculous to me. And I do this all the time. Because, you know, now people have these little portable fans that they walk around with.

• 53:21Mel Robbins?

  Yes, I had one.

• 53:23Speaker 01

  And I will see a portable fan and I will just walk up to somebody and say, girl, you know, we have something for that, don't you? We don't, we don't have to walk around with a fan. Fix it, do it. I mean, and

• 53:35Mel Robbins?

  What do I do?

• 53:37Speaker 01

  It's hormone therapy. I mean, the most effective treatment. FDA approved, is hormone or estrogen particularly, for the symptoms of menopause, basal motor symptoms or hot flashes. It works. But it's the fear factor that keeps women away from the most effective treatment for the symptoms of menopause.

• 54:01Mel Robbins?

  You know, what's interesting is it's happening to women in their twenties. Because there's so much misinformation and lies being spread about birth control.

• 54:09Speaker 01

  Right.

• 54:10Mel Robbins?

  Which in many cases is low doses of estrogen.

• 54:12Speaker 01

  Yes.

• 54:13Mel Robbins?

  And the same thing is happening to women in our 40s and 50s. When it comes to the misinformation and lies related to hormone replacement therapy, which is not only safe for the vast majority of women, but it is shockingly effective. Like, I remember this, when I started hormone replacement therapy, it took about five weeks and all of a sudden I thought, oh, my God. Like, I feel like myself.

• 54:39Speaker 01

  Yeah.

• 54:40Mel Robbins?

  What the hell was I doing? Why didn't I start this sooner?

• 54:43Speaker 01

  Why didn't I start this sooner? And, and there's, there's really even more of a medical benefit for starting sooner. Because the sooner you start and treat those symptoms, the more benefit you get in the long term.

• 54:56Mel Robbins?

  What do you mean?

• 54:57Speaker 01

  I mean, in terms of your cardiovascular risk, in terms of weight gain, in terms of being able to sleep, all of those things. Perimenopause does not have a bright line that defines it the way menopause has a bright line that says, when you're done. Okay. But when to start treatment? When to use hormone therapy in some form or fashion in perimenopause? Again, depends on what your treatment goals are. And it depends on how bothered you are by your symptoms. And that is what I want women to understand. If you're between the ages of 35 and 45, which is usually about the time that perimenopause or the menopausal transition starts,

• 55:39Speaker 01

  you seek treatment when you are bothered by your symptoms.

• 55:43Mel Robbins?

  Like, I wish I had known you, like, five years ago.

• 55:46Speaker 01

  Yeah.

• 55:47Mel Robbins?

  Because when I think about how revelatory it is to me, that I didn't even consider the age range of 35 to 45. And that there's no benefit to waiting until you're suffering. And if you just don't feel like yourself, the world is hard enough.

• 56:04Speaker 01

  Right.

• 56:05Mel Robbins?

  And if this is something that can help you feel like yourself again, it's going to make you feel better equipped to handle what's going on in your life. Instead of, like, because what ends up happening is you describe any of those symptoms. I can't really sleep. Like, something's wrong, I'm gaining weight, I don't know what's going on. Oh, here's, here's an SSRI.

• 56:25Speaker 01

  Right.

• 56:25Mel Robbins?

  You might be depressed.

• 56:26Speaker 01

  Right, here's a sleeping pill.

• 56:27Mel Robbins?

  Yes, versus, this is clearly something going on with hormones. Because women's entire life, in fact, when we did a poll online, have you ever felt like your hormones are affecting your mood, energy, sleep, weight, or cycle? 98% yes.

• 56:42Speaker 01

  See, they could have just asked women. We would have told you, you know? I think the reason why women tend to wait, there are probably two reasons. One is they don't realize that this is all part of perimenopause and the menopausal transition. And the, the second thing is that we have been laboring, women have been laboring under the misconception for a very long time, that they can only take hormone therapy for a small amount of time. Because the direction once was, we'll take the smallest amount for the least amount of time possible. That's not true. You can start getting treated when you're symptomatic. You can take it for as long as you like.

• 57:23Speaker 01

  There is no time limit on how long you can take hormone therapy. Now, bear in mind, there may be some subtle differences in terms of how we prescribe in perimenopause and how we prescribe in menopause. Because you remember, sometimes we have different mission. You're perimenopausal, remember, I told you, your fertility is decreased. It's not gone. So do you need birth control or no? The bad PR campaign that's going on about birth control pills in 20-somethings is also happening about people, it's sort of really disparaging the use of birth control pills in perimenopause.

• 58:02Speaker 01

  So women need to understand that misery should not be your resting place. Lord knows, there's enough of that in the world that you cannot control. But for things like this, when you are feeling out of control, why wouldn't you fix that? I don't get it.

• 58:22Mel Robbins?

  I love that you're reminding us that you don't need things to get worse before you can start feeling better. And that there are such safe, effective, and almost immediate things. I love my patch so much, I will be wearing it on my deathbed. Like, I am not ever spending any time without that sticker on my body because it has made such a difference. And in fact, you know, it has been on the headlines, that there's a shortage of estrogen patches. What is going on, Dr. Malone? And what should you do if that's affecting you? Women are waking up!

• 58:57Speaker 01

  I know. I mean, I'm delighted, because it means that there's more demand for it. And I think what is distressing to me is that you didn't see this coming. I mean, when I tell you, I have personally been out here in this space talking about menopause publicly for over five years. I've been talking about it privately for 35 years. So the notion that now that women are aware, that's the only difference, that more women are aware, we've knocked down a lot of the misconceptions about breast cancer and all the bad, negative press about HRT. Could you not have seen, can you like, read the room here? That there was going to be more demand for hormone therapy?

• 59:42Speaker 01

  Well, you know, again, I, I think that there's not a lot of attention being paid to women's health. But that's another issue. But the point is, is that the estrogen patch is not your only option. Systemic estrogen falls into two categories. There's transdermal, of which the patch is transdermal, which just means it just goes through the skin. So if you're out of patches, if you want to say, oh, but I really want to stay with the transdermal, you can use a spray, you can use a gel. Those are readily available. And even different doses of the patch are available. So I don't think anyone needs to panic because you can't find a patch. We have options.

• 1:00:26Speaker 01

  Then there's also oral. And again, oral hormone therapy gets maligned as if that's something terrible. It's like, you can use oral. Most of the information, the data that we have on the benefits, all of the things about hormone therapy, really comes from the data that we have on oral.

• 1:00:43Mel Robbins?

  I really just appreciate that you are explaining this in a way that's easy to understand with a level of depth that doesn't make me feel like an idiot for really going either, I've never heard it that way, or I actually understand it at a deeper level. And one of the topics that I recently feel like, oh, wait, I never really understood that there's a difference between HRT and what vaginal estrogen might do. And it was after learning about the benefits of vaginal estrogen for UTIs, for overall health in your sexual health,

• 1:01:27Mel Robbins?

  that I started taking vaginal estrogen as a supplement. I can't believe the difference. And so could you explain?

• 1:01:38Mel Robbins?

  Dr. Malone, what the vaginal estrogen supplement is for, how it relates to HRT, and how you want women to think about this, especially as we get older?

• 1:01:54Speaker 01

  Right. That's an excellent point because, you know, sometimes it gets all mushed in together. But when I'm talking about HRT, generally, we're talking about systemic, which means that you are using estrogen and a progestogen of some type at a level that, again, controls the symptoms, hot flashes, the mood swings, all the brain fog that we typically associate with perimenopause and menopause. So we're taking estrogen at a level that will take care of those symptoms.

• 1:02:24Mel Robbins?

  Okay.

• 1:02:25Speaker 01

  Okay. So you can do it orally, you can do it transdermally as a patch, but it is going, it's systemic because it is going throughout your body.

• 1:02:33Mel Robbins?

  Got it.

• 1:02:34Speaker 01

  Okay. Topical or vaginal estrogen is used just locally. You put it in your vagina and it, and you can use it even on the outside, on the vulva, on the labia, on the labia, basically, because it is addressing the genital urinary syndrome of menopause, or GSM. That's vaginal dryness, painful sex, urinary frequency urgency, and frequent urinary tract infections. You can treat that using local topical vaginal estrogen, and it will take care of those symptoms, but it basically stays where you put it.

• 1:03:11Mel Robbins?

  Okay.

• 1:03:12Speaker 01

  It's not going anywhere. And so you don't, it's not enough in vaginal estrogen. If you have hot flashes and you're using vaginal estrogen, you'll still have hot flashes. You'll still have sleeplessness.

• 1:03:21Mel Robbins?

  Because it's not systemic. It's not going through your whole body.

• 1:03:23Speaker 01

  No.

• 1:03:24Mel Robbins?

  It's like a pimple patch. You're like putting it here, but it's not in your whole body.

• 1:03:27Speaker 01

  You put it where you want it to work.

• 1:03:29Mel Robbins?

  Got it.

• 1:03:29Speaker 01

  Okay. And the same is true of like topical estrogen that you use for your face. Remember, one of the things that happens in menopause with estrogen depletion? You lose 30% of your collagen in your skin in the first five years of menopause. So what we know is that the skin has estrogen receptors. Your vagina, your vulva, has estrogen receptors in it. So you can use it at a level that increases the hydration, collagen formation. And again, we've known this for quite some time. But again, it's not enough to treat your other symptoms. So that's why even women who are on systemic hormone therapy may still need to use a little bit of extra vaginal estrogen.

• 1:04:13Mel Robbins?

  Wow. Dr. Malone, talk to us about the importance of muscle loss and bone health and strength.

• 1:04:22Speaker 01

  That is so important because one of the things that happens in menopause is you start this cycle of bone loss. Because remember, estrogen affects everything, your skin, your muscles, your bone.

• 1:04:35Mel Robbins?

  So that starts in menopause?

• 1:04:37Speaker 01

  That really starts in late perimenopause and certainly continues through menopause at a more rapid clip, once you are finally done with menopause. You tend to lose muscle, you lose bone, and you gain fat. So that even when you are weight neutral in menopause, you are still changing your body composition. That's why it's like, wait a minute, why do I all of a sudden have this weight around the middle? Why do I have this spare tire? It is because the lack of estrogen causes this sort of redistribution of body fat and loss of muscle. So now, if you go through the next 20 years and you're losing muscle and you're losing bone,

• 1:05:20Speaker 01

  well, now you're more susceptible to osteoporosis. Why is that important? Because then you're more likely to fracture a bone, be it your spine, be it your hip, or risk. Your bones are thinner and more fragile. Now, this is where it's a dangerous combo. If you are not careful and mindful of your muscle mass, now you're weaker. So now you've got less muscle, less bone. What happens if you trip and fall? You're weak. You've got no cushioning, you're doing whatever. So when you go down, you go down like a tree, and you break things. And that is really why I think our goals as we age, yes, we do hormone replacement therapy

• 1:06:04Speaker 01

  because hormone replacement therapy of the estrogen component is the only medication that we have that prevents osteoporosis.

• 1:06:13Mel Robbins?

  Wait, estrogen is the only thing that we have that can prevent osteoporosis?

• 1:06:18Speaker 01

  Estrogen and the hormone replacement therapy that you take has an FDA indication for the prevention of osteoporosis. So if you are at risk for osteoporosis.

• 1:06:31Mel Robbins?

  Aren't we all?

• 1:06:32Speaker 01

  Well, not everybody. Not everybody's going to break something. I mean, it just depends. And see, there's a genetic component that you bring to. I have, you know, bone density, great bone density because I'm a bigger person and I have, but it's dependent on your exercise level that you have growing up. How did you, how much bone did you form in the first place? Some of it's genetics, some of it's from your activity. How much calcium, were you a milk drinker as a kid? That's why your mom always says, drink your milk. Whether or not you've had enough calcium and vitamin D to actually create that bone, and then whether you've been able to maintain it. And exercise matters, not just cardiovascular exercise, but that's where the weight training comes in

• 1:07:15Speaker 01

  because your bones will respond to whatever load you give it. So the more stress you put on it, the better your muscles are, the more weight bearing you can do, you tend to preserve more of your bone mass. So that's where you enter menopause. But regardless of where you start, you're going to start to lose it after menopause. And if your bone density is really high, it may take me 35 or 40 years to get to the fracture point. But if you start really low, you're going to get there sooner.

• 1:07:47Mel Robbins?

  If you're already losing bone density, maybe you have a diagnosis or not. Maybe you just feel frail or like nervous about it. Will weight training pause what's happening? Will it help you regrow?

• 1:08:01Speaker 01

  Here's the thing about most bone loss. Most of it, when it happens, you very rarely get back to where you started. So once you're coming in 10 years after the fact, you may be able to sort of slow the train down a little bit. But for the most part, what's lost is lost. You can maintain your bone density.

• 1:08:21Mel Robbins?

  And estrogen and resistance training, building muscle, helps you?

• 1:08:27Speaker 01

  Yes. The estrogen, I'll give you an example where I think it will be helpful for women to know. Right now, the current recommendation for getting a bone density is, they said, recommendation is do it at 65.

• 1:08:41Mel Robbins?

  Why would you do it that late?

• 1:08:43Speaker 01

  Isn't that a good question? Why would you wait? Remember, I told you, the most rapid phase of bone loss happens in the first five years after menopause. By the time you get it at 65, you've already lost, that's 15 years of bone loss that you're not going to be able to recoup. It makes more sense to me, and what I would advise my patients to do is that once you get to menopause, you don't need to do a bone density when you're 30. You know, but once you get to menopause, say, let's do a snapshot right now and see what my bone density is. It's going to be good, not so good, or maybe it's fantastic. If it's not so good, that doesn't necessarily mean, that also doesn't mean that you're going to fracture.

• 1:09:26Speaker 01

  But I would be more aggressive in terms of saying, all right, well, what we can do to prevent you losing further bone is to do hormone therapy at that point.

• 1:09:35Mel Robbins?

  Got it.

• 1:09:36Speaker 01

  You see?

• 1:09:36Mel Robbins?

  Yes, I do see.

• 1:09:37Speaker 01

  And if I wanted to say, oh, I don't know if I want to do it, then I would do it once at menopause, and I'd say, let's do it at 18 months to two years later.

• 1:09:44Mel Robbins?

  And see if you're declining.

• 1:09:45Speaker 01

  If it's declining, then now I can make the case to you that, see what's happening, and then you might want to reconsider at that point.

• 1:09:53Mel Robbins?

  Even if you are in a place where, all right, we blew it, and I now am in osteoporosis, or I am losing bone density, how would weight training or building up your muscles, how would that protect you and impact your health positively in that case?

• 1:10:16Speaker 01

  Your muscles help protect and support your bones. I think we kind of think of our bones as once you've grown to adult height and whatever, and your bones are just your bones. Your bones are constantly remodeling. They're being broken down, and they're building up. And they will build and break down depending upon the stress that you put upon them. So if you're exercising, if you're doing weight bearing exercise, you will build stronger bone in the earlier phases than someone who does nothing. I think about this a lot as being an older person and on the road and traveling all the time. It's like, I need to be able to put that carry-on in that overhead compartment here.

• 1:10:59Speaker 01

  And, you know, that's a matter of just being able to know that I have enough upper body strength to be able to lift. I need to know that if I trip, that I'm not going to go down like a tree. You have some core strength to be able to, to sort of prevent you going down like that. I mean, think about that. If you were, if you were 20 years old and you tripped on the sidewalk out front, you are very unlikely to break your hip.

• 1:11:28Mel Robbins?

  Correct.

• 1:11:29Speaker 01

  Because, one, you can break a fall, you can do all these things. Reaction time, all this stuff, as you're older, not there. And your bones are more fragile. So that's why you need strong bones and strong muscles. Got to have core strength for maintaining your balance.

• 1:11:44Mel Robbins?

  Wow, this is so, so good. You're so smart, and you have such an incredible way of explaining this. And I hear both the passion and the commitment to women's health and the anger and frustration that you feel on our behalf, that the information and the access to these tools has not been as readily available and understood as women around the world deserve it to be. And so I appreciate the depth to which you went in each of these topics. Because I think it can be really confusing. And, you know, we do live in a world

• 1:12:27Mel Robbins?

  where there is so much information flooded into the public space that it is easy to be gaslit. It's easy to have somebody prey on you and your fears, and to have you start to question established medical science to your detriment.

• 1:12:45Speaker 01

  Right.

• 1:12:46Mel Robbins?

  And, you know, I guess that brings me to a question I'm curious about. If there was one question... Dr. Malone, that you believe every woman could be asking her doctor after listening to this episode, what would that important question be?

• 1:13:03Speaker 01

  I think you should come into your doctor and you should actually ask them two questions. When you are even contemplating having the discussion about hormone therapy and aging, just aging in general, which God willing, we will all do. When you are having a discussion about hormone therapy and whether or not it's right for you, it's not right for everybody, but it's the most effective treatment for most women. The conversation that you really need to have is what are the benefits of taking hormone replacement therapy? And what are the negative things will happen if I don't?

• 1:13:40Mel Robbins?

  Oh, I love that if I don't, because most of us go, what's negative I do?

• 1:13:44Speaker 01

  Right.

• 1:13:44Mel Robbins?

  What if I don't?

• 1:13:45Speaker 01

  What if I don't? What am I, what am I at risk for? And what are the things that will happen if I don't? And I think we don't have two sides of that conversation.

• 1:13:55Mel Robbins?

  Well, Dr. Malone, thank you for not only educating us. Thank you for not only being a voice that has been both privately in practice over 40 years and very publicly sharing this information for free and advocating for women. Thank you for writing this remarkable guide, Grown Woman Talk, that gives you the medical and scientific facts that every woman needs to understand and know so you can make informed choices and understand the ramifications of doing them or not. And thank you for also putting your effort into solving the access problem.

• 1:14:38Mel Robbins?

  Because one of the things that I think a lot about is that I know with the global reach of this podcast, that step one is giving somebody access to a world renowned expert like you in a way that makes you feel empowered, that makes you understand what's happening, that makes you understand the various options that you can, and levers you can pull that can help you take control of your life, your health.

• 1:15:11Speaker 01

  You know, the message that I really want women to have is that you deserve to feel better. You deserve with every tool available to be able to age healthfully and gracefully. That should be the new goal, not all the negativity that's associated with aging. Some of that is going to come, but the reality is, is that you have way more control over how you navigate this final phase of your life than you think.

• 1:15:43Mel Robbins?

  That's why I'm grateful that you're here. Dr. Malone, what are your parting words?

• 1:15:48Speaker 01

  My parting words would be this. Menopause is inevitable. It is the one universal female experience. So know what that is. Know it's coming. Don't be afraid, because I will guarantee you this. I'll tell any 47 year old out there now, and I'm 67, I'm having way more fun at 67 than I was at 47, really. But you got to feel well enough to be able to do it.

• 1:16:17Mel Robbins?

  Well, Dr. Malone, thank you for giving us the no BS, science-backed, medical truth that we needed to hear so we can make informed decisions and understand what's going on. And I cannot wait to see how this impacts the lives of women and the people who love them around the world. Thank you, thank you, thank you.

• 1:16:43Speaker 01

  You are so welcome. And thank you for having me. I really enjoyed this conversation.

• 1:16:47Mel Robbins?

  I did too. And I also want to thank you. Thank you for taking the time and making the time to listen to something that will improve your health. I know you want to feel better. I know you want to do better. And what you learned today from Dr. Malone is going to give you the tools that you need to understand what's happening in your body and to make informed decisions so that you can feel better. And in case no one else tells you this today, as your friend, I wanted to tell you that I love you and I believe in you and your ability to create a better life. And as Dr. Malone just said, holy cow, you can create a better life, but you have to take responsibility for advocating for yourself and getting the support that you deserve.

• 1:17:32Mel Robbins?

  And I promise you, if you do that, you will have a better life because you're going to feel a lot better. All righty, I'll see you in the next episode. I'll welcome you in the moment you hit play.

• 1:17:45Mel Robbins?

  Not the most organized person.

• 1:17:49Mel Robbins?

  Because I'm burying myself in crops here.

• 1:17:53Mel Robbins?

  Thanks, Charlene. Appreciate it. Okay. Okay. That makes it better. All right, here we go. Everybody, how are we doing? Okay, excellent. I'm so excited you're here.

• 1:18:07Speaker 01

  I'm excited to be here.

• 1:18:09Mel Robbins?

  Oh, sorry, Scott's leaving. I'm like, where are you going, Scott? Do you need me to look at you? Do you want us to look at you? Dried up like the Sahara Desert.

• 1:18:16Speaker 01

  No, you will, no, I will not.

• 1:18:18Mel Robbins?

  Now, if I put the estrogen lotion on my face, what's going to happen? It's not going to turn into a vagina, right?

• 1:18:29Speaker 01

  No.

• 1:18:33Mel Robbins?

  Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.