4 myths about women's health

Do women really need to focus on cardio? Worry about heart health? Do a yearly mammogram? Meghan Rabbitt, author of the new book The New Rules of Women's Health, sets the record straight. Find the BCRAT calculator here: https://bcrisktool.cancer.gov/ In a previous audio version of this story, Meghan Rabbit incorrectly said that ventricles "go in and out of our heart." In fact, ventricles are chambers of the heart. Follow us on Instagram: @nprlifekit https://www.instagram.com/nprlifekit/?hl=en Sign up for our newsletter here. https://www.npr.org/newsletter/life-kit Have an episode idea or feedback you want to share? Email us at [email protected] mailto:[email protected] Support the show and listen to it sponsor-free by signing up for Life Kit+ at plus.npr.org/lifekit http://plus.npr.org/lifekit See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

  This message comes from Midi Health. Most women never get real answers about their hormonal health. Midi is changing that with virtual care covered by most major insurances. Understand your hormones. Visit joinmidi.com to book your first visit today.

• 0:16Marielle Segarra?

  You're listening to Life Kit from NPR.

• 0:21Marielle Segarra?

  Hey, it's Marielle. Did you know that if you're a woman, a mammogram is not the only tool you need to screen for breast cancer? Or that your gynecological health history can give doctors important clues about the health of your heart going forward?

• 0:39Marielle Segarra?

  Meghan Rabbit is a journalist. She wrote a book called The New Rules of Women's Health. And she says there's a lot that we, as women, were never taught about this stuff.

• 0:47Speaker 02

  I think that health class really falls short for so many of us. And even our young girls today are not getting a real adequate education about their bodies, their anatomy, their health.

• 1:00Marielle Segarra?

  And that means we might start to believe myths or ideas that have not been supported by evidence, like the idea that you can maximize your workouts based on where you are in your menstrual cycle.

• 1:10Speaker 02

  And this one surprises a lot of women, particularly young women, who I think we were targeted for a while with the algorithm saying, like, if you're in your luteal phase, you have to do this type of workout, or during your period, during your menstrual phase, take it down a notch. And there is no great data to back this up.

• 1:27Marielle Segarra?

  Megan says after interviewing more than 100 scientists and doctors and other clinicians, what she learned above all is that the health tips that sound the most obvious are the ones that tend to be backed by research.

• 1:39Speaker 02

  You know, it's the tried and true lifestyle advice that we hear a million times and that can make us roll our eyes, like, oh, I've heard this before. Don't tell me to eat well and sleep and exercise. But if we stay consistent with those things, it's actually going to pay off so much greater than following the latest wellness trend.

• 1:57Marielle Segarra?

  On this episode of Life Kit, Megan's going to tell us about four common myths when it comes to women's health. And through those myths, we'll learn more about what we actually need to be doing. That's after the break.

• 2:20Speaker 00

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• 3:10Speaker 00

  This message comes from Midi Health. Most women never get real answers about their hormonal health. Midi is changing that with virtual care covered by most major insurances. Understand your hormones. Visit joinmidi.com to book your first visit today.

• 3:28Marielle Segarra?

  All right, Meghan. So myth one is that all you need to do to detect breast cancer is get an annual mammogram. We've done a whole episode about breast cancer detection. I had breast cancer myself in 2024, so I know about this intimately. What's the bottom line here?

• 3:43Speaker 02

  When I interviewed Dr. Lisa Larkin for my book, who is a breast cancer survivor herself and an amazing women's health practitioner, she said something that really shocked me, which is that most women think I'm on it if I'm getting my annual mammogram. A mammogram is an amazing screening tool, so we should be getting our annual mammograms after a certain age or depending on our risk. But the catch is that most doctors aren't actually talking to us about our lifetime risk of breast cancer. And that score we can get, that can help inform our best screening plan.

• 4:17Marielle Segarra?

  OK, so part of this is about estimating your lifetime risk of breast cancer. And there are a couple of calculators you can use. We'll link them in the show notes. Based on those results, you might start breast cancer screening sooner, or do it more often, or you might need an MRI. But the calculators are just one tool here, right? Like even if they say your risk is low, some details of your situation could warrant a different screening plan. Like if you have a strong family history of breast cancer, or if you have dense breast tissue.

• 4:49Speaker 02

  Yeah. There are four categories of breast density, and your mammogram report should tell you where you fall. I'm in category D, which is extremely dense. It's as dense as you get. And that, combined with my lifetime risk assessment score, which was just under 20%, prompted my gynecologist to say, yeah, I think we should add a breast MRI to your screening plan. And so you're absolutely right. Breast density plays a role. Family history of breast cancer plays a role. So there's a number of different factors.

• 5:21Marielle Segarra?

  And I learned that MRIs are much more useful if you have dense breast tissue, because if you're getting a mammogram and it's not a mammogram with contrast, which those are not that common, you basically can't see through the breast density. Whereas with an MRI, you can. But doctors still recommend both, because mammograms can see things like calcifications, which can be an indicator as well of breast cancer, and that's something that MRIs don't catch.

• 5:52Speaker 02

  Yes. And what doctors will say is that if you do qualify for breast MRI, in addition to mammogram and possibly ultrasound, try to schedule them six months apart from each other. So you're actually getting two screenings a year. You're getting your mammogram, and then six months later, you're getting your breast MRI. So it gives you even more of a chance to do that early detection, because that's what we want with breast cancer. The earlier we detect it and can treat it, the better.

• 6:20Marielle Segarra?

  And when you do go to your annual doctor visits, whether it's to the gynecologist or to your primary care doctor, Make sure that they're doing a breast exam on you as well.

• 6:31Speaker 02

  Absolutely. You know, I try to schedule my gynecology visit and my primary care physician's visit about six months apart, and both of those doctors do a breast exam. And then I do my own breast exams. And then experts also say that when we're cycling still, if you suspect something's a cyst, or if there's a spot that kind of grows and then it shrinks, you can wait a cycle or two before going to make an appointment if you want to. But after menopause, that changes. And so it becomes crucial for us to do that self-breast exam, to make sure our doctors are doing that exam, so that we can really understand if there's changes and look into those.

• 7:09Marielle Segarra?

  Let's get to myth number two. The myth is that strength training is better for you than cardio, especially in midlife. So I know that both are important, but what do you think people are missing here?

• 7:23Speaker 02

  Yeah, I think it's great that we are talking more about the importance of strength training. Because when I was in college, when I was a younger woman, I was in the cardio room, and all of my guy friends were lifting weights. And so if I could rewind time, I would have hopped off the elliptical and headed straight for the weight room. So I do think it's really amazing that young women now are being told, and women of all ages are getting the message, that strength training is really crucially important for our bone health and many other benefits. That said, I wonder if in our focus on strength training that we're missing out on remembering how important cardiovascular exercise is as well.

• 8:06Marielle Segarra?

  Mm-hmm. You gotta do them both.

• 8:08Speaker 02

  You gotta do them both. You know, and when I talked to Dr. Suzanne Steinbaum, who's a preventive cardiologist in New York City, she really helped it make sense for me. And she said, you know, the thing is, when we get our heart rate up, it increases our heart's capacity to fill with blood. And this does amazing things for all the ventricles that go in and out of our heart. They stay more pliable, they dilate easily. And that flexibility, that pliability of those ventricles in a female heart, really goes a long way to helping prevent cardiovascular disease later on.

• 8:42Marielle Segarra?

  Yeah, this connects to another myth in your book, which is that heart disease is mostly a problem for men.

• 8:48Speaker 02

  Too many of us think that if we are moving our bodies and eating pretty well, Heart disease isn't something we're going to have to worry about. And if we do have to worry about it, let's say there's a family history, it's going to be something that happens way later. And this is something that expert after expert said, women in particular, need to be talking about. If you're a woman in your 30s, 40s, or 50s, there's a good chance that you're more focused on preventing breast cancer or screening for cancers, let's say. And these are really important things to do, right? And we need to add heart disease into the mix. Understanding what our family history is, talking to our doctors about that,

• 9:32Speaker 02

  and just really starting the conversation earlier than we have. I was really surprised by a study, it's actually a decade-long study by the American Heart Association, that found that fewer than half of all women recognize that heart disease is our number one killer. And our awareness that heart disease is such a risk for us has actually gone down. And so this is even more reason for us to be talking about it with each other. And also, unfortunately, we really need to proactively bring it up with our doctors.

• 10:04Marielle Segarra?

  What are some of the indicators of your heart health that your doctor might look at?

• 10:09Speaker 02

  Yeah, so a big one that most women don't understand is that our gynecologic health history plays a role in our future risk of heart disease. If we had a pregnancy complication, let's say, preclampsia or gestational diabetes, oftentimes, these conditions clear up after we give birth and we think we don't have to include it in our health history going forward. It happened, it cleared up, no big deal. It actually might be a big deal for your heart and it's something that you should bring up to your doctors so that you can make sure you're doing everything you can to protect your heart.

• 10:48Marielle Segarra?

  We'll have more Life Kit after the break.

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• 12:03Marielle Segarra?

  All right, myth number three is that menopause is just years of misery with no upsides. Not true?

• 12:12Speaker 02

  Not true.

• 12:13Marielle Segarra?

  What are the upsides?

• 12:15Speaker 02

  So there's the obvious, which is no more periods. And during the perimenopause, when you're in that transition, periods can get really wonky. They can become unpredictable in timing, which is no fun. They can become heavier, which is also no fun, and can lead to things like anemia. So not bleeding, major upside, right? Also, not worrying about birth control. This is something that is so front and center for women for so many years of our lives that not having to think about that can be so freeing. But then, some of the more subtle upsides I found in my reporting for this book were things like, there is a real opportunity for us to press the reset button during this transition and say, what in my life is working? What's not working?

• 12:58Speaker 02

  What do I want to change to help me feel better physically, emotionally? I think there's a lot of ways that we, as women, come into our own in menopause. We stop worrying about things that we don't want to worry about anymore and get after what we really want. And I think that's really important to give voice to as well.

• 13:16Marielle Segarra?

  Quick question. How do you know when you don't have to worry about birth control anymore? How do you know for sure? Because I feel like there are women who thought they were done and then they got pregnant. Oops.

• 13:29Speaker 02

  That's such a great question and one that I think so many gynecologists wish more of us would ask. And what I think everybody needs to understand is that menopause is one day when you've gone a full year with no periods. When you're past menopause, you're not ovulating anymore and pregnancy is not possible, right? Because you're not producing eggs that can then become a baby. But you really have to track your cycles. If you're cycling, you want to track very carefully when that last period was and know this, which I think surprises a lot of women. If you've gone, let's say, eight months with no period and you are like, "Menopause, here

• 14:10Speaker 02

  I come," and you start bleeding again, the clock resets to zero. And you have to, from that point in time, go another full year with no cycle, no bleeding, in order to be in menopause.

• 14:22Marielle Segarra?

  I also wonder, I mean, some women don't have a period, but they're not in menopause. Is there another way to check this? Just from my experience, I feel like doctors could also test your hormones.

• 14:35Speaker 02

  Yep. I fall into that category myself. So I had a hysterectomy about a year ago and I'm not in menopause because they were able, my surgeon was able to leave my ovaries, right? But I don't bleed anymore. And so I'm about to turn 47, which puts me in the perimenopause transition zone, right? But I won't have that external cue when it comes to telling me, "Oh, for sure I'm in menopause." And so that's when hormone tests are important. Now, what I understand is that most doctors are going to test my hormones when I start to experience more symptoms or I'm at a certain age where menopause is more likely. So at 47, I'm probably still in that perimenopause zone.

• 15:17Speaker 02

  51, 52, 53 is probably when I'll get a hormone test and what they look at is FSH, Follicle Stimulating Hormone, skyrockets when you're in menopause because it's like your brain is sending a message to your ovaries saying, "Come on, ovulate, ovulate." But your ovaries are like, "Nope, I'm tired. I'm done. I gave you a lifetime of eggs. What do you want from me?" And so that's when doctors will say, "Oh, okay. Based on your symptoms, based on your age, based on where I see your FSH levels, you're in menopause."

• 15:52Marielle Segarra?

  Okay, let's go to myth number four. And that is also about the menstrual cycle. The myth is that women can maximize their workouts based on their cycle. Not true?

• 16:04Speaker 02

  The truth is that there's really no good data showing that you can get these big changes in strength, or endurance, or recovery, based on timing your workouts to your cycle. And this one surprises a lot of women, particularly young women, who I think we were targeted for a while with the algorithm, saying like, if you're in your luteal phase, you have to do this type of workout, or during your period, during your menstrual phase, take it down a notch. And there is no great data to back this up. And actually, when I interviewed Dr. Megan Roche, she said something that really was interesting to me, which is that, let's say you feel like you're at a certain point in your cycle where you should be hitting it really hard. Go ahead and hit it hard.

• 16:47Speaker 02

  But there's so many other factors that play into whether or not you can hit that hard workout like you were planning. Like, do you have a young child who woke you up in the middle of the night? Do you have a big deadline at work that is stressing you out? You know? These are all factors that should also play into us listening to our bodies to understand how we should be adjusting our workouts. And she also said something that I think is really important for those of us who are running 5K races, or 10Ks, or marathons, or doing any kind of competitive sports, which is that we can't time our race day to our cycle. So there's a lot of benefits in training across the cycle at different levels of intensity.

• 17:30Marielle Segarra?

  Yeah, I get that there's this impulse to optimize our health and to try to squeeze the gains out. But sometimes it just feels like doing too much. Like, just try to be consistent with whatever you do.

• 17:46Speaker 02

  Bingo. And that's the thing, is that if we get in our heads too much, and we have this plan based on what point of the cycle we're at, it can just feel overwhelming and actually keep us from working out at all. And that's the opposite of what we want, right? There is something to be said for just focus on consistency. Focus on starting where you are. Focus on doing what you can and staying consistent.

• 18:13Marielle Segarra?

  Meghan Rabbit, thank you so much.

• 18:15Speaker 02

  Thank you.

• 18:19Marielle Segarra?

  Okay, time for a recap. Here are four myths about women's health from Meghan Rabbit. Myth number one: All you need to do to detect breast cancer is get an annual mammogram. Not necessarily. You should talk to your doctors about your risk factors, including your family history, your breast density, and the results you get from online screening tools. One of those calculators is called the BIC-RAT, spelled B-C-R-A-T, Breast Cancer Risk Assessment Tool. That's from the National Cancer Institute, and it's only available for women 35 and up. Another is called IBIS, International Breast Cancer Intervention Study Tool. Now, if your risk level is high, you may qualify for additional screening using an

• 19:04Marielle Segarra?

  ultrasound or an MRI. Also, make sure your doctor is doing a breast exam during your annual visits, and be aware of your breasts, how they feel throughout a given month, what they feel like when you're standing up, when you're laying down, and make sure to tell your doctor about any changes. Myth number two: While strength training is important for your health, don't forget to do cardio workouts, too. Heart disease is the leading cause of death for women in the United States, so keep your heart health in mind. Get your heart rate up through regular exercise, and also talk to your doctor about your risk factors, including your family history and your gynecological history, like whether you had preeclampsia during pregnancy.

• 19:44Marielle Segarra?

  Myth number three: Menopause is just years of misery with no upsides. Not true. You won't have to deal with periods anymore. You won't have to worry about birth control, and some women say that this is a time of their life where they come into their own. And myth number four is that women can maximize their workouts based on their menstrual cycles. There's no good evidence for this. Megan says what you want to be doing is listening to your body and trying to stay consistent with exercise.

• 20:15Marielle Segarra?

  That's our show. By the way, there are also a lot of myths about strength training, but you know what's true? Resistance training has huge benefits for your physical and mental health. We have a collection of Life Kit episodes that'll be a starter pack to getting stronger at your own pace. Subscribe to Life Kit Plus now to get exclusive access to that and other Life Kit playlists that'll help you move your body, master your budget, get better sleep, and more. This episode of Life Kit was produced by Margaret Serino. Our digital editor is Malika Gharib. Megan Kane is our senior supervising editor, and Beth Donovan is our executive producer. Our production team also includes Andy Tagel, Claire Marie

• 20:56Marielle Segarra?

  Schneider, Sylvie Douglas, and Mika Ellison. Engineering support comes from Tiffany Vera Castro. Fact checking by Tyler Jones. I'm Marielle Segarra. Thanks for listening.

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• 21:53Speaker 00

  This message comes from Midi Health. Most women never get real answers about their hormonal health. Midi is changing that with virtual care covered by most major insurances. Understand your hormones. Visit joinmidi.com to book your first visit today.