Emmenology (MENOPAUSE & PERIMENOPAUSE) Part 1 with Monica Christmas, Mary Claire Haver and Lara Durgavich

Hormones. Mood swings. Brain fog. Night sweats. And why doesn’t your shoulder work? The time is here for this whopper of a 3-part series on menopause with a total of five Ologists. No matter what your age or gender, you owe it to the people in your life who go through this to understand it. Brilliant and charming Dr. Mary Claire Haver is an OB-GYN who wrote bestsellers “The New Menopause” and the just-released “The New Perimenopause” and hosts the podcast unPAUSED. The wonderful and warm Dr. Monica Christmas is a professor and clinician with decades of experience in menopause treatment, and repeat guest Dr. Lara Durgavich is a primatologist who has some answers about why our species goes through “the change.” Part 2 covers what to DO about symptoms of menopause, from vagina creams to hormone replacement therapy to libido to brain clarity and the importance of lifting heavy stuff. And finally, Part 3 has advice for loved ones to help support people in their lives who are sailing the stormy seas of hormonal change.

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

• 0:00Alie Ward?

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• 0:44Alie Ward?

  It was one of the best investments I've ever made. And if you're like, I don't know where to find a career coach, I can help you. You need an experienced pro who asks the right questions, sets you down a path where you're most likely to succeed. And that's what you can expect from a coach at today's sponsor, strawberry.me. This is so cool. They match you with a certified coach who's been vetted to work closely with company founders. And yeah, sometimes I'm like, oh, wait, that's right, I am one. And if you're founding a business, even if you're along the way, and you're maybe stuck in a rut, or you have to make a decision about expansion, or what direction you want to take your company, that's what I did. I went to strawberry.me, and I was like, okay, can you help me pare down some stuff? I think I have too much on my plate. I'm not sure what to say yes to, and what to say no to.

• 1:28Alie Ward?

  And they were super helpful in helping me streamline, and now I get to sleep more, and I enjoy that. So get the help every entrepreneur needs. Go to strawberry.me/ologies. That's strawberry.me/ologies. You're the boss. Oh, hey, it's that Band-Aid floating in the public pool. Don't worry about it. Ally Ward, and I have been promising you this episode for seven years. So don't say that I never gave you anything. It just took a minute. Because this one is a three-parter, technically, five guests. Just an embarrassment of riches when it comes to information, and also guests. So, omenology, it's a study of menstruation, apparently, and its related disorders. And this episode...

• 2:10Alie Ward?

  We will get to what's natural in other primates, symptoms, tests, the latest research. And this one is also for people assigned male at birth, for partners and kids and coworkers of people experiencing perimenopause and menopause, because if you don't have info about it, your relationships will 100% be impacted. Also, don't call yourself an ally or like a feminist or someone who believes in gender-affirming care and then skip this one because it's about menopause. So I'm glad we're all here. Also, a note up top, trans men can go through menopause, non-binary people can go through menopause, not all women have uteruses, myself included. Many times you will hear the words female or women in

• 2:53Alie Ward?

  terms of describing a patient and just know that refers to the majority, but not the entirety of gender identities going through this. And we have an awesome episode with Dr. Daniel Fow called Neuroendocrinology. It talks a lot about hormones and the brain and gender. We'll link that in the show notes, too. But before we go further, let's say a quick thank you to patrons of Ologies who are signed up for $1 or more a month via patreon.com/ologies and who submit questions. That helps steer the show so much. Next week's part two will be wall-to-wall your questions. Also, if you do have kids, heads up, we have a spinoff podcast called Smologies. You can find it anywhere you get podcasts. Just search for S-M-O-L-O-G-I-E-S. No swears in that one. If you want to find other Ologites in the

• 3:36Alie Ward?

  wild, we have merch at ologiesmerch.com. For $0, you can help us out tremendously just by leaving a little review. I read them all for real. And to prove it, thank you, Fassi1900, who called Ologies "education without the boring polite part." And to Ben Fry14, who changed their major because of Ologies. Thank you, Ben Fry14, for being an environmental toxicologist. I wish we didn't need you so much, but hey. Also, people always say just pick an episode at random because they're all kind of weirder than you think. So for a complete list of all 500-plus episodes, you can go to ologies.com. We have a sorted menu there. And every episode, we donate to causes of the Ologist's choosing. Thanks to sponsors of Ologies. Okay, "eminology" comes from the Greek for "monthly."

• 4:21Alie Ward?

  And this week, in Part One, we're covering the symptoms and the biology and the cognitive effects and hot flashes and diagnostic tests and firsthand perspectives of two OB-GYNs who actually went through it. And next week, it's all about what to do about it. What do you do? Hormones? No hormones? How to deal with brain fog? What do you do or what can you take for the feelings of mood swings or depression? How to get better sleep? What to put on your vagina? Making whoopee with gusto again? And why you should think about your skeleton now? Like, now? That's all going to be next week. What do you do? So this week, we have one ologist, Dr. Monica Christmas. Monica Christmas, she/her.

• 5:06Alie Ward?

  An associate professor of obstetrics and gynecology and the director of both the menopause program and the Center for Women's Integrated Health at the University of Chicago. We also have on Dr. Mary Claire Haver. Dr. Mary Claire Haver, she/her. Who is a longtime healthcare provider in obstetrics and gynecology and a well-known advocate in this space. She authored the New York Times bestselling books, the new perimenopause book and the New York Times bestseller also, the new menopause book. And she hosts the podcast UnPaused. And for this Part One, we also have a message to you from Dr. Lara Durgavich, who is a visiting lecturer at Boston University's Department of Anthropology. And she shares why we, as apes, why our bodies even bother with menopause? Why are they doing it?

• 5:51Alie Ward?

  And how researchers study it and what we can potentially infer from orangutans going through a change of life. So take my hand. Let's dive in with some of the most experienced ologists on this planet about this. Dr. Haver, Dr. Christmas, and Dr. Durgavich, all of whom are excellent eminologists.

• 6:29Alie Ward?

  You have been on our list for a really, really long time. And every single week when we check in at our meeting, we go, have you heard from Dr. Christmas?

• 6:36Speaker 01

  Oh, my gosh.

• 6:37Alie Ward?

  Do we hear back? And so we're all like.

• 6:40Speaker 01

  Wow.

• 6:41Alie Ward?

  Yeah, we've been talking about you for months. So today is a big day for our whole team. You're a celebrity, Dr. Christmas. You get asked about that every single day, don't you?

• 6:52Speaker 01

  People ask me, what does it mean? I'm like, I don't really know. It's my married name and I'm a divorced person now. But the patients like it, especially during the holiday season. So it got me into a lot of trouble though. I had my maiden name through medical school, but I changed it to my married name right before residency. And it was not fair because everybody could remember Christmas. So I got called on all the time. And I would say that to my colleagues and they, oh, you're exaggerating. I get called on too. And then I was out for like vacation one week and one of my co-residents called and was like, yeah, Christmas, you're right. They are just calling on you because you got called on like 10 times today.

• 7:37Speaker 01

  And we kept saying, she's not here. So I was like, I told you, I told you that I was unfairly being targeted.

• 7:45Alie Ward?

  Like no one ever forgets, I'm sure.

• 7:48Speaker 01

  Right. I was like, I have more questions. I am.

• 7:53Alie Ward?

  Well, that's probably why you're so good at what you do. It's almost like you got one-on-one tutoring and so much one-on-one attention. And I know that you give very good attention to your patients. You have a very holistic approach. From what I understand, a lot of people I hear from, they're like, my doctor doesn't even know what's going on. What was it about gynecological health and obstetrics and menopause that kind of attracted you to this?

• 8:17Speaker 01

  Well, the menopause stuff kind of fell into my lap serendipitously, which is always the best way for things to come your way because that means the universe conspires for good. But my first job out of residency, I worked with two fabulous doctors. They were really great guys and they were great obstetricians. I mean, they were gynecologists too, but they had a really big obstetrical following. Women came to them. So when I first started with them, like, I didn't have any patients, really. I mean, because all of the pregnant patients saw them. So what I was left with was a lot of women that were going through this midlife transition. And not going to claim that I knew everything,

• 9:01Speaker 01

  but what they really loved is that, one, I had a lot of time. I had a lot of time because I didn't have any patients. So I could spend an hour or more just shooting the breeze, listening to them. And then I would call them back later that day, which they loved, like, oh, my gosh, my doctor, she's so sweet. She called me at home. And I tell them, well, you know, these are the options that we could try. And if this doesn't work, we could do this next thing. And so before I knew it, they had told all the people at the train stop or at the water cooler at work that they met this nice, great young doctor, and she's so good. She just really listens. Little did they know, like, all I had to do was listen. I had all this time. But anyways, I built this patient following.

• 9:44Speaker 01

  And a lot of midlife women too have issues with bleeding. And sometimes it was fibroid related or adenomyosis or, you know, a host of things. And so then I had a big surgical patient population too. And it turned out that I really love surgery and I really loved taking care of women or helping them traverse through this thrive, I should say, thrive through the menopause transition. And my mom was also going through menopause at the same time and having a horrible time of it. But like, I'm having these issues and what does this mean? And, you know, is it my thyroid? Is it this? Is it that? And sometimes it's all of the above. That's the thing is that. Menopause happens at a time when we are aging.

• 10:27Speaker 01

  And when I say everything isn't just menopause, I mean, everything isn't just due to your ovaries not making the reproductive hormones anymore. It is very difficult to sometimes disentangle what's truly due to chronological aging versus what is actually due to menopause. And there's not one menopause syndrome that every single person gets. Some people have very few symptoms, if any at all, and then there are other people that have everything under the sun. So, you know, it's important not to unnecessarily scare people and think that this horrible thing is going to happen to you, you know, because that's not true either. And I think we are creating a sense of hysteria for people now that shouldn't happen.

• 11:10Alie Ward?

  Hysteria, side note, comes from the Greek word, meaning uterus. And hysteria was a condition thought to be caused by a wandering womb that was an animal living inside your body, just sauntering around and lured to and fro by pleasant smells, or stomping around angry because it's lack of a child inside. You're like, okay, dude, sounds pretty solid. But interestingly enough, actually, there's a very real condition, endometriosis, caused by uterine-like tissue that just up and grows anywhere in the body, can grow in the bowels or the pelvis, sometimes a lung or the brain.

• 11:52Alie Ward?

  And thousands of years after our boys in togas were contemplating an entity wandering about the cabin, we still don't have any readily available tests or good answers for this excruciatingly painful and debilitating condition of endometriosis, which on average takes seven to 10 years of pain to diagnose. If it's ever clocked by a doctor, not to get like hysterical about it. But yes, menopause. That's such a good point off the bat because I know that it looms for some people. It's like, when is this thing gonna hit me like a specter, like a hormonal goblin waiting to pounce? And you know, I'm wondering for you personally, because you started out obviously such like a young,

• 12:36Alie Ward?

  inquisitive and hardworking doctor. And I don't, you're probably not at that age yet, but as you age, are you like looking out for those types of signs?

• 12:45Speaker 01

  Oh, no, I'm in my mid 50s and I'm menopausal, so.

• 12:50Alie Ward?

  Yay, you don't look like it.

• 12:52Speaker 01

  Oh, bless your heart.

• 12:54Alie Ward?

  No, you didn't. I thought you were much younger than I am. I happen to have gone through it in my mid 30s. I have POI, so like didn't know what was going on. So now my friends are starting to go through it and I'm like, done that. But I'm also the friend that they're like, hormone patches, what do you use? But I'm wondering, how do you, for you going through it, has it changed at all? Having experienced things firsthand, like, do you feel like you're more keyed into seeing these symptoms on a smaller detail?

• 13:23Speaker 01

  You know, it's always different when it's yourself too, you know? I started to experience menopause related symptoms really early too, earlier than the natural you mentioned, premature ovarian insufficiency. And so I remember being like, oh my goodness, waking up with night sweats and I thought I had tuberculosis. Right?

• 13:44Alie Ward?

  Yes.

• 13:45Speaker 01

  I'm only whatever age, like I've got TB. You know, when you're a healthcare professional, you can give yourself all kinds of bad diagnoses. And you go to the extreme. It doesn't necessarily make you smarter. So I'm like, oh my God, I have TB. You know, who coughed on me?

• 14:03Speaker 01

  I didn't, I don't have TB.

• 14:06Alie Ward?

  But of course, you're not expecting it at a younger age, but.

• 14:09Speaker 01

  No, then the other funny when you don't think it's you too, is that um, so I have frozen shoulder in both my shoulders, right? And I love Pilates and yoga. And if there was ever a fountain of youth, it's actually not hormone therapy. It's probably Pilates or yoga, I would say. But I think I'm in shape. You know, that's my life saver, whatever exercise. But so anyway, started having this pain initially is on the right shoulder and it got really bad, though, like I couldn't get my arm in and out of a jacket, let alone I wasn't wearing any dress that had a zipper in the back because I couldn't get my arm around the zip. I'd roll over a certain way in bed, it hurt. And so I was convinced that like, again,

• 14:50Speaker 01

  with the TV diagnosed self diagnosis, I was convinced I had like torn my labrum or something, you know, like I'm so dramatic. And so I went to like an ortho colleague of mine and got the million dollar work up. And he comes in the room, he's much younger than me too. And he sits down and he says, well, you know, Dr. Christmas, women of a certain age. Immediately I was like, all right, if that's all it is, I'm fine with it. But I thought this was much worse than I thought a frozen shoulder could be. So that did make me more sympathetic to the patients that came in with joint pain. And I don't have a fix for it.

• 15:32Alie Ward?

  Frozen what now? Yeah, frozen shoulder. You can call it also adhesive capsulitis if you want. If you're screaming, this can happen into your potting soil or your windshield right now. Yes, it can. News to me. And according to a very recent paper, frozen shoulder, diagnostics and treatment of adhesive capsulitis in the American Journal of Medicine, corticosteroid injection and physical therapy can provide meaningful benefit in appropriately selected patients while surgical intervention is reserved for the tougher cases.

• 16:09Alie Ward?

  What else can work? Why? So hormone replacement therapy could. Newer research is suggesting that estrogen is protective against inflammation and fibrosis of tissues. And the small Duke University study found that the prevalence of frozen shoulder was about half of that in the group on hormonal replacement therapy. But again, small sample size, more research is needed if they can get the funding. But Dr. Christmas, afflicted and helping those afflicted, sees clinically that some people will respond to hormone therapy in cases of the frozen shoulder, but the vast majority of people don't.

• 16:47Speaker 01

  Some people will respond to hormone therapy, but the vast majority of people don't. And so, you know, people will come in and they'll say, great, my hot flashes and night sweats are gone, I'm sleeping much better, but I still have this terrible joint pain or am I P S? I still have shoulder pain. And I'm like, yeah, but I never told you it was going to fix that.

• 17:05Alie Ward?

  There's only so much it can do. You're like Dr. Heald himself.

• 17:09Speaker 01

  Right.

• 17:10Alie Ward?

  Especially when you're like, I'm an athlete, okay? I'm an athlete. This is from yoga.

• 17:16Speaker 01

  Right.

• 17:17Alie Ward?

  Speaking of athletes, we do have a whole team of experts for this three-part episode. So let's meet Dr. Mary Claire Haver, author of The New Menopause and The New Perimenopause, globally known advocate for menopausal awareness, who communicates a lot on the topics of hormone replacement and increased research for women's health and the role that physical activity can play in staying healthy. So let's roll back a little, let's learn more about her. You know, from your book, I know that you were doing a lot of reproductive care, a lot of care for women and other people with uteruses. And it wasn't until you went through some hormonal changes yourself that you were like, oh shit, what?

• 17:57Speaker 02

  Yeah. I wish I could tell you that, you know, I noticed the patterns from my first day of clinical practice that, you know, women after reproduction and were getting the shaft. But no, no. I was a horrible menopause doctor for probably 15 years.

• 18:12Alie Ward?

  Really?

• 18:13Speaker 02

  And I was aging along with it. So I didn't have that many menopausal-ish patients because when you start out, you get all the OB patients.

• 18:20Alie Ward?

  Yeah.

• 18:20Speaker 02

  And I was having babies with them. So I'm aging along with my patients. So, you know, it took 10 to 15 years for me to start going, huh. I run with this woman.

• 18:30Alie Ward?

  Mm hmm.

• 18:31Speaker 02

  We've run marathons together. We do book club. Like, she's not lying. I know what she eats. I know how much she exercises. Like, this weight gain stuff, her brain fog, like, this is real. Then the divorces started happening in our, like, friend group and all around the same age. And I'm like, hmm, you see people's resilience start crumbling when you watch the lives that they built and they were managing everything, the ups and downs, the stressors. And then all of a sudden, they've just, like, hit a wall. So those were really when I was like, something is not right. And then it was happening to me, too, of course.

• 19:07Alie Ward?

  Mm hmm. Do you feel like you're people's frontline person for questions about menopause like more so than our own doctors?

• 19:15Speaker 02

  Uh, yeah, and that's okay. I don't mind it. What kind of freaks me out is I've been doing this 10 years and I get the same questions every day.

• 19:24Alie Ward?

  Really?

• 19:24Speaker 02

  Yeah.

• 19:25Alie Ward?

  Really? Okay, let's launch into them. What, just rattle off, like, what are some of the most common ones that people have?

• 19:31Speaker 02

  I mean, I now get thousands of DMs a day and we can't answer them, right? But just the most basic stuff, like, is it okay for me to be on hormone therapy? Is it safe? Am I in menopause if I have X, Y, and Z? Just, I'm like, wow. It's crazy to me that, gosh, there's still women out there who aren't getting access to the basics. So.

• 19:54Alie Ward?

  For sure. So let's start with those basics to save your sanity and also your bones and your heart.

• 20:01Speaker 02

  So the best way I can explain it is in a pre-menopausal woman, before menopause enters the chat or perimenopause, you know, females are born with their entire egg supply. Males make their stuff fresh every day. So big difference between the testicles and the ovaries. The ovaries are just waiting for instruction. They don't actually do anything on their own. The instructions come from the brain. So we have two glands in the brain, the hypothalamus and pituitary. The hypothalamus is basically looking for estradiol. Okay, where is it? Where is it? Where is it? When it runs low naturally in a normal cycle, it starts saying, hey, we want those estrogen levels back. Come on. So it starts sending signals from the hypothalamus to the pituitary. Then the pituitary pumps out FSH and LH that go and bind to the cells around the eggs.

• 20:44Speaker 02

  And those cells, the follicular and granulosa cells around the egg, are where the sex hormones are made. I'm simplifying a very complicated process. So when you look at LH, FSH, estradiol, and progesterone in a healthy woman who has regular cycles, right? You at 23, I'm assuming, you have this very predictable ebb and flow, EKG-like, month after month after month. Of day 12, you're going to do this. Day 14, you're going to do the outside of starvation, pregnancy, heavy exercise, stress. You know, that process is meant to happen month after month after month until we reach a critical egg threshold level, which you met very young.

• 21:21Alie Ward?

  Yeah.

• 21:21Speaker 02

  Something destroyed the eggs, autoimmune disease usually, in your body before they would have run out on their own. And that's what POI is. And so we reach this critical threshold. With the signals coming from the brain, the ovaries become resistant. And they don't work as well. Okay, there's not enough eggs to respond. So the brain starts flipping out. Like, where's my estrogen? Starts pummeling the pituitary. Give me more, give me more. We get these much higher levels of pulsatile LH and FSH to force those few last, you know, the eggs remaining to make the ovulation happen. Sometimes we have these loop ovulations where we have two back to back with no break. So we end up getting a very sporadic, much higher than outside of pregnancy.

• 22:05Speaker 02

  So we'll get estradiol levels, sometimes 300, 400, like pregnancy levels, like early pregnancy levels. Well, then we get these crashes and progesterone never keeps up. So what used to look like EKG predictability now becomes chaos, which is why we call it the zone of chaos. We've known this since 1996. That paper came out in 1996. I'd never heard of it.

• 22:26Alie Ward?

  Oh, the rage, the flames on the side of my face.

• 22:30Speaker 02

  Flames, flames on the side of my face, breathing, breathing, breathing breaths. Until 2023.

• 22:39Alie Ward?

  Insane.

• 22:40Speaker 02

  And I'm reading this paper and I'm like, what the fuck? Like.

• 22:46Speaker 02

  So all of that chaos of our hormone levels, our neurotransmitters are affected, our estrogen receptors and where they're located, we up-regulate in certain areas. How we process glucose in the brain, the amygdala that controls our emotional centers, the frontal lobe where memories are consolidated, all of that takes a hit, the brain stem, how we sleep, cortisol, stress, like it all becomes this whirling dervish. So perimenopause is the brain. And so, brain fog, mental health changes, anxiety and depression, rage, and sleep disruption, that is the beginning of perimenopause. Not cycle, cycle disruptions are at the end for most women.

• 23:22Alie Ward?

  Oh my God. Oh dear Lord, there's so much to learn. Okay, so let's talk timing, let's talk symptoms. If you're not me with a wonky early condition, Dr. Christmas lays it out.

• 23:34Speaker 01

  And what is natural menopause? The median age is about 51 and a half, 52. The range that 95% of people fall into is between the ages of 45 and 55. And we start to experience symptoms related to hormonal fluctuations up to four to seven years beforehand.

• 23:50Alie Ward?

  Oh God.

• 23:50Speaker 01

  So it is actually true that potentially for some people in their late 30s or early 40s, you might start to have some symptoms. The first symptom is usually changes to your menstrual cycle. So if your cycles are changing by more than seven days consistently, not a one-off, but consistently, that's the early perimenopause phase. And once you start skipping more than 60 days consistently, that is the late perimenopause.

• 24:16Alie Ward?

  And then do you cross that sort of checkered flag when it's been a year since you've had a period? Or is there a certain amount of time where it's like, okay, it's definitely, it's jig is up?

• 24:28Speaker 01

  Yeah, it's a full year and it's retrospective because you don't know when you're having the last menstrual cycle. In fact, Mother Nature has a very cruel sense of humor and people can go many months without having a period. They give all of their protective things away and they're like, I'm here. And then they'll get like a last hurrah or two. So that part of it really burns me up because it's like, why didn't you stop? Like, why does it have to do that? Just stop.

• 24:53Alie Ward?

  Yeah, nobody asked for an encore.

• 24:56Speaker 01

  No, nobody did. It's not fair at all.

• 24:58Alie Ward?

  Hey, heads up, perimenopause can last between two to 14 years. And even though your egg supply might be diminishing, it only takes one egg to get pregnant, folks. And when I didn't know what was happening in my 30s, my period took a little hike, took a hiatus. It's like gone fishing for a bit. And I thought, what if there's a uterus intruder in there? Is that why I don't have my period? And I was forced to go to a Walmart where I bought a diet Dr. Pepper and a pregnancy test. And the weird thing about buying a pregnancy test when you're in your 30s is like the cashier, who was a younger woman, she gave me a really encouraging, "Good luck," as I left. And readers, I did not want a child, but I peed on it in a nearby gas station bathroom.

• 25:43Alie Ward?

  Surprise, it was just menopause and it was thankfully negative. So if you're not looking to cultivate anything in your uterus at the moment, and you're like, "I should be fine. I'm like having hot flashes." I'm sorry, babe. Do not be the victim of a cruel hormonal joke where the punchline has two blue lines.

• 26:02Speaker 01

  One of my favorite things to do during perimenopause, though, is to use either continuous hormonal birth control or put in a progestin IUD, because it helps to kind of cheat our way through that erratic bleeding. Because even if your periods get shorter, lighter, and they start to space out and then politely go away, it's still, if you don't know when it's going to come, that can be extremely anxiety provoking for some people not knowing. I mean, it would be for me, so.

• 26:31Alie Ward?

  If you think that answering a call from an unknown number is daunting, I invite you to wear an outfit you like and then just roll the dice on spotting blood. I've always said that death is like wearing white jeans when your period is about to start. Just gnawing anxiety, a reminder that to be alive is to lack control. When it comes to those symptoms, what are some hallmarks to look for? Let's go through the physical symptoms that your patients come in with that you're like, obviously, hot flashes. Do those last like 10 minutes? Do they happen at night more? Dr. Christmas explains.

• 27:04Speaker 01

  So let's like look up the history of perimenopause, because that's Not typically something that people have always talked about. Like you talk about the menopause. So anyways, I found this stuff, this doctor in 1867. He kept a diary or chronological notes of all of his perimenopausal women. And so to answer your question, I was trying to find it because I was going to rattle off the 22 symptoms that they did. And I loved how they described some of them, too. So that's why I was looking for the little paper.

• 27:33Alie Ward?

  And of course, as I'm sure you know, this was the 1857 paper of Dr. Edward John Tilt titled A Clinical Treatise on the Diseases of the Ganglionic Nervous System Incidental to Women at the Decline of Life. And he comes in hot in paragraph one stating that some German doctors call this, quote, "the period of sexual involution." And he only slightly more softly notes that his female patients have called perimenopause "the dodging time." Now, the table of contents in this book includes some real whoppers of anachronisms as he describes patients who have experienced delirium caused by cessation, insanity occurring

• 28:15Alie Ward?

  at the change of life, fits and eruptions of the face caused by the change of life, successive fits of coma at the menstrual periods, hysteria caused by cessation, short and sudden fits of the impossibility of speaking after sensation, and plainly melancholia. But considering the period, if you will, he seemed to at least be a doctor who gave a shit because in chapter two, he writes, "The ovarian influence reaches the ganglionic center, which is in constant communication with the brain. So at the change of life, its undue influence is shown by distressing headaches, continued

• 28:54Alie Ward?

  fretfulness, peevishness, and capriciousness, called temper, by a temporary perversion of moral feeling, or by moral insanity. The disturbance is on the mental faculties, which are for a time in a state of misty haziness. The brain feels muddled, memory is faithless, and there is an inconquerable desire to sleep during the day, even when the night- Has been passed in repose. He concludes, having thus briefly sketched the varied phenomena, I am able to open the investigation of its terminal crisis. So yes, a person can feel like garbage in so many ways. And we've known that for years, but society at large has neglected to care.

• 29:39Speaker 01

  At any rate, about 80% of people will have like some sort of vasomotor symptoms, hot flashes, night sweats. Some people will say, I don't necessarily feel hot, but I get these cold like feelings too. So, you know, however you describe it, but it's usually kind of feeling like you're on fire from the nipple line up. And then as quickly as you feel warm, and it can come out of nowhere, you start to cool off and then people sweat. And then you feel really cold and shivering after that because you're wet from the sweat.

• 30:11Alie Ward?

  So these are called the vasomotor symptoms. And according to the JAMA article, duration of menopausal vasomotor symptoms over the menopause transition, they usually last between a minute to five minutes at a time. And up to 80% of people going through perimenopause have them.

• 30:28Speaker 03

  Those are pretty high odds.

• 30:32Alie Ward?

  What else do you look for? Dr. Christmas continues.

• 30:35Speaker 01

  The mood symptoms, and they can swing from having depressed mood to anxiety, to anhedonia, that not having the energy or the, you know, just the motivation to do things that were much easier for you to do. People will talk about sexual dysfunction, decreased libido. Sometimes it's tied to vaginal dryness. That could contribute to pain with intercourse. But sometimes people are like, no, I don't have any pain. I'm not dry. I just don't have desire for sex. And it happened pretty abruptly for me. The joint pain that I already talked about, me and my frozen shoulders, skin changes, hair thinning, maybe having acne when you never had acne issues before.

• 31:19Speaker 01

  A big one, huge one, I should have put this right underneath vasomotor symptoms. And maybe for some people, it should have been above that is weight gain. And it can seem like it's It happened overnight, like I woke up and I was 20 pounds heavier. It's probably not necessarily a menopause related thing, but an aging thing, but we do notice it. It can be pretty pronounced like the couple of years before the last menstrual period. And a couple of years after the menstrual period. So there's about a five year window where people notice this like, if you're not doing something about it, even 20 to 30 pound weight gain. That can be extremely distressful and people like, I'm not eating any differently. I'm not changing anything with my exercise habits. And I say, I get it, but we have to, we have to put in a little bit more effort because as we get older,

• 32:03Speaker 01

  we're losing muscle, that muscle is replaced by fatty tissue. Much of that fat deposits in the midsection from a vanity perspective, that's a horrible place for it to go. From a health perspective, it is too. So really counseling people about the importance of regular exercise, including weight bearing exercise is really important.

• 32:23Alie Ward?

  So this, again, this was news to me, but if it seems like your body composition is changing, but your diet hasn't, there are a few factors. So without enough regular physical activity, especially weight bearing exercise, women tend to lose up to eight percent of their muscle mass per decade. That's a lot. And less muscle mass means a lower resting metabolic rate, which leads to increased fat stores on the same diet. So low estrogen also directs that adipose tissue to just hang out and just kick it in the midsection, which can also lead to heart disease and further metabolic disruptions. So muscle mass really matters here. Also good for the bones. We'll talk about that later.

• 33:08Alie Ward?

  But if your sleep sucks also, or your stress levels are high, that can contribute to changes in your metabolic rates and eating patterns and thus body composition. And again, in part two next week, we're going to go over how that impacts your skeleton, why that should matter a lot to you, your risks later in life. And we talked to a researcher from Smith College, Dr. Sarah Wodkowski, all about the overlooked risks to heart health and menopause. And she will inspire you to just go out into the yard and start lifting logs. While screaming at the sky. You gotta wear gloves, though. No splinters.

• 33:42Speaker 01

  Overall, some people just, I just don't feel like myself. I don't know how to put my finger on it, but I just don't, I don't feel as confident. I've got this brain fog. Does that mean I'm gonna have dementia? It does not mean you're gonna have dementia. You know, I just have difficulty recalling things. I just don't think that I'm functioning like I normally do. And in my work setting, I just don't feel like I'm doing it as well, so.

• 34:04Alie Ward?

  Mm-hmm.

• 34:05Speaker 01

  I don't think I forgot anything. That was a lot, right?

• 34:07Alie Ward?

  No, yeah. I mean, and there's, I'm sure, so many more. The brain fog stuff is really interesting, and I, we had so many listeners ask about that. And I remember when I was going through, you know, my ovarian failure, I also thought I had early, early onset dementia. I like wrote down my address wrong. I remember I was at a family reunion and I could not remember my cousin's name. I was introducing her to my husband and I was like, uh, and I'm like, just blank, where you're like, Swiss cheese. Some people ask too, their ADHD seems to get a lot worse with a drop in estrogen. So, any idea why that brain fog and how those cognitive effects happen?

• 34:47Speaker 01

  Yeah, Dr. Polly Mackey has done a lot of work in that area. There does seem to be some brain changes, especially in our white matter densities with decrease in estrogen, but that doesn't necessarily mean that you're going to have dementia either. And it's hard to say if that's what causes kind of the concentration focus issues and the brain fog name recall. Interestingly, if your night sweats are keeping you up at night, and you didn't sleep as well because you keep waking up frequently with the night sweat, if I give you hormone therapy or any of the other non-hormone therapy modalities, and there's some good ones to get rid of your night sweats, you'll sleep better, then you'll probably feel more energetic, you may think better. So it's not necessarily that the treatment directly impacted

• 35:30Speaker 01

  the brain fog, but it might have gotten better because we managed these other things that might be contributing. You know, I have to remind people a lot to be kind and gentle with themselves, too. Like, at this stage, too, we've got a lot that we're doing. You know, they don't call it the sandwich generation for nothing.

• 35:46Alie Ward?

  So, as frustrating as it is to have perimenopause dismissed as like, it's just stress that's in your head, it's also not helpful to consider that all of your stress is just caused by hormonal shifts. Sometimes it really is just because Things are hard, but if you have sudden pains, like in your lower right abdomen, that could straight up be appendicitis and not hormones. Chest pain? Keep an eye out for cardiac symptoms. And if you've been feeling depressed or especially anxious, no matter what the cause could be, talk to a doctor and see if medication might be helpful. Paroxetine is an antidepressant that the FDA approved to treat phase O motor symptoms in menopause. Some clinicians also prescribe SNRIs

• 36:29Alie Ward?

  or other SSRIs for physical and the psychological effects of hormone changes. And Dr. Christmas mentioned Dr. Pauline Mackey's work. And in a 2022 paper titled, "Brain Fog in Menopause: A Healthcare Professional's Guide for Decision Making and Counseling on Cognition", it kicked down a definition for us on brain fog, given that the topic itself is murky and ephemeral. And the paper says that brain fog most frequently manifests in memory and attention difficulties. And it involves such symptoms as difficulty encoding and recalling words, names, stories, or numbers, difficulty maintaining a train of thought, distractibility, forgetting intentions, like the reason for coming into a specific room,

• 37:14Alie Ward?

  and difficulty switching between tasks. And if that sounds like, oh, wait, I've had ADHD all my life? Welcome, there's a lot of you. According to the 2024 Frontiers in Neuroscience paper, "The Impact of Estradiol on Serotonin, Glutamate, and Dopamine Systems", estradiol functions as a neuroactive steroid, and it plays a crucial role, it says, in modulating neurotransmitter systems, namely, those involving serotonin and dopamine and glutamate. That affects learning and memory, reward, and sexual behaviors. But researchers stress it's not all causal. Estrogen, remember, it affects phase O motor symptoms that interfere with sleep, which can cause brain fog. And not getting enough regular exercise

• 37:56Alie Ward?

  or adding in more habits to reduce midlife stress can also muddle your mind. So you might have to think more holistically, like zoom out a little bit more and think of ways that you could support your overall health and mental health. And there have been anecdotal reports that adequate omega-3s and magnesium glycinate supplements can help as well. But again, talk to a doctor. Now, a 2025 Journal of the International Society of Sports Nutrition titled Creatine in Women's Health: Bridging the Gap from Menstruation Through Pregnancy to Menopause notes that creatine supplementation has shown positive effects on muscle strength, exercise, performance, and body composition, particularly when combined with resistance training.

• 38:39Alie Ward?

  And it says additionally, creatine may improve mood and cognitive function, potentially alleviating symptoms of depression. But, surprising no one, it does conclude that data on perimenopausal women remains limited. So take that with a big grain of creatine. Once again, talk to your doctor. I'm not them. So on that executive function topic, Dr. Haver explains.

• 39:00Speaker 02

  So brain fog does tend to get better post-menopausal. It's worse in peri-menopause.

• 39:06Alie Ward?

  Oof. And I talked to Dr. Russell Barkley, who's an ADHD expert, and he mentioned that you do need estrogen to make dopamine, and a lot of people who weren't diagnosed with ADHD or had mild cases, it flares.

• 39:21Speaker 02

  It was masked.

• 39:22Alie Ward?

  Yes, it was masked by high performance and a lot of internal anxiety, which is what so many women go through. But are those levels of estrogen also executive function is impacted by dopamine?

• 39:34Speaker 02

  Yes, so when we look at 20% of women in the UK quit their jobs in peri-menopausal menopause.

• 39:38Alie Ward?

  Wow.

• 39:39Speaker 02

  Not because they hate their job, like if you hate your job, you need to go, but because they feel like they can't function. And the problem with brain fog is we don't measure brain fog. We measure for dementia, okay? Big difference. Brain fog is I can't find my keys. Dementia is I don't know what my keys are for. Dementia is severe cognitive, like inability to function. And brain fog is I can't function at my executive level. That I was functioning at before.

• 40:07Alie Ward?

  Yeah.

• 40:07Speaker 02

  Like, the happening's not happening. And we have a really hard time measuring that. It's called subjective cognitive decline. So it's really like, you tell me it's subjective. I'm not able to do the math at work, or I'm not able to juggle all the balls or do the things.

• 40:24Alie Ward?

  And I know that for your personal experience, a lot of it was masked by You were going through a difficult time caring for a family member who was very ill. And you know, they call the generation, the sandwich generation, where you're still taking care of kids and also your, say, your relatives, your parents are getting older. So is a lot of that kind of mixed in the soup of just incredibly high stress and high demand? And then on top of that, you're like, I don't know what's going on below my neck.

• 40:50Speaker 02

  Yeah.

• 40:50Alie Ward?

  I got a lot of shit going on.

• 40:51Speaker 02

  So it's like everything hits at once, right? For a lot of us. And so forever, everybody just blamed, oh, you're just stressed out, your parents, your kids, da, da, da, da. And like, these women are coming to my office going, no bitch, I built this life.

• 41:04Alie Ward?

  Yeah.

• 41:05Speaker 02

  And I had it managed. I knew this was coming, you know, like, this is different. We can't just blame stress on this. They're like, I had this managed two months ago and now we're not managing.

• 41:16Alie Ward?

  So how do you know if it's perimenopause? As you age, you know that the egg supply you were born with is diminishing. That's just life, just marching toward the shorter end of it. I'm sorry, but can we get some numbers on this? Is there a test? Dr. Christmas lays it out.

• 41:33Speaker 01

  And then once we really hit this pivotal point, you would think that the ovaries would slow down, but they almost rev up a little bit and you start losing, we call it atresia, you start losing more eggs even at a faster rate. And so that is why during that perimenopause transition especially, it's actually not very useful to get lab values because oftentimes women will have actually higher estrogen levels than you would expect. That's where those loop cycles come in, or people will say, I bled for 30 days or more, or I'll get my period, it'll go away, and then a week later, I started to bleed again. It is because of those spikes in hormone levels, too. And it's often the fluctuations during the menopause transition that really contribute

• 42:19Speaker 01

  to a lot of the tumultuous symptoms that people experience, especially the mood-related symptoms. Once you're in menopause and your ovaries aren't making it anymore at all, it's zilch, zero, a lot of people feel better.

• 42:31Alie Ward?

  Hmm. It's not the roller coaster.

• 42:33Speaker 01

  And so when is it helpful? It's helpful if I have a 25-year-old or 35-year-old that comes in and they haven't gotten their period and/or they're experiencing symptoms that we would typically relate to menopause, then I want to know because that's unusual. Why are you at 35 not getting a period? So I am going to get a whole battery of labs because I want to understand, is this premature menopause? Is this polycystic ovarian disease? Is it some other endocrine abnormality? And so that's actually very useful information. If I have somebody that's of the natural age range and they are doing exactly what I expect them to do, then the lab value is really not helpful.

• 43:17Speaker 01

  It's helpful that they're having symptoms because I want to help them have a better quality of life, but what the value is doesn't matter.

• 43:23Alie Ward?

  And just a fun, this is good news, side note. Since we chatted just a few weeks back, the journal Lancet published a huge paper titled "Polyendocrine Metabolic Ovarian Syndrome: The New Name for Polycystic Ovary Syndrome: A Multi-Step Global Consensus Process." So PCOS, the big news is finally has a rebrand to PMOS. And this study, which was co-authored by over a dozen top experts in the world, acknowledges that PMOS affects 1 in 8 women and that the term PCOS is inaccurate because it implies pathological ovarian cysts while it says obscuring the multi-system pathophysiology. So it's like, oh, you've got some cysts on your ovaries.

• 44:07Alie Ward?

  Well, really, it's like, it's way more than that. It's caused by different stuff. And it says, "It's not simply a gynecological or ovarian disorder. It's actually underpinned by endocrine disturbances in insulin, androgens, and neuroendocrine and ovarian hormones." It's the whole system. But getting back into menopause, hormones are fluctuating a lot. Your ovaries Are not, they're not quiet quitting. They make themselves known as they pack up their stuff. They're slamming some drawers. They're taking time to sleep between taping up their boxes. They're hiding their desk plants in the break room fridge. They're letting the entire department know they are out the door.

• 44:51Alie Ward?

  Now, mine left early and unbeknownst to me and like at least seven doctors. My symptoms in my early 30s were in fact my bewildered ovaries regrettably giving notice early. What I thought, I thought they were like fevers. Those were just hot flashes arriving a decade early. I had no clue. My, I had weird cycles. They were getting longer in between. And then the doctors were like, it's simply stress. All these weird, totally menopausal symptoms, I was told were just stress. And couldn't I quit my job in TV and find a rich man to marry? One elderly physician asked me without even proposing to me. I had mood swings. I had crying jags. I forgot my own address.

• 45:35Alie Ward?

  And when a female doctor finally did a hormone panel, four years into this mystery agony, it revealed that my follicle stimulating hormone was jacked through the roof. And this is important. So what that number represents, FSH, follicle stimulating hormone, is inverse to your ovarian function. So if it's high, your brain is flooring the gas pedal to get the car to move. It's saying like ovaries, hey, hey, hey, where are you? But your ovaries are like, eh, my motor's not going anywhere. So pre-menopause, your FSH varies by day, but it's usually between the numbers four and 21. Now, once it's up around 30, it's pretty high.

• 46:15Alie Ward?

  Your endocrine system is mashing that gas pedal with FSH to wake your ovaries up, but they are sleeping perhaps forever. So any FSH over 30 is typically like a yes for menopause. So knowing my FSH was helpful, but I didn't have a normal timeline. Cause again, in my early 30s, I had what doctors called primary ovarian insufficiency. My ovaries, they took that personally. And what kind of tests are people requesting versus which are effective? I know for me with POI, they tested my FSH and it was like 130 or something. Oh, God bless your heart. I was like, I was. Yeah.

• 46:53Speaker 02

  I mean, we know how to diagnose POI fairly well.

• 46:55Alie Ward?

  Yeah.

• 46:56Speaker 02

  But like for perimenopause, we don't have a blood test. We don't have a urine, a saliva test. Save your money, okay? We can diagnose postmenopause. So like your FSH is above 50 consistently, you're postmenopausal. That's it.

• 47:07Alie Ward?

  Mm-hmm.

• 47:07Speaker 02

  Okay? Above 100, faux show.

• 47:09Alie Ward?

  Yeah.

• 47:10Speaker 02

  You know, like ovaries have left the building. Eggs have left the building. So because of the chaos, these hormone tests are rarely, rarely diagnostic. So we diagnose perimenopause by, guess what? Listening to the patient.

• 47:23Alie Ward?

  Oh.

• 47:24Speaker 02

  Believing her, doing blood work to rule out other things like autoimmune disease, hypothyroidism, inflammation, nutritional deficiencies, et cetera. We do a lot of blood work in our clinic. But we're not like chasing hormones in perimenopause because tomorrow it could be something totally different.

• 47:40Alie Ward?

  Mm-hmm. We're going to continue in just a second, but first we're going to donate to a cause of the ologists choosing. And this week, we are splitting it between Dr. Christmas's pick of Center for Food and Equity Medicine, an excellent organization that helps lift the burden of food insecurity off of cancer patients and their care providers. They note that in addition to soaring treatment costs, there's also just a high cost of being present during the hospitalization of a loved one. There's parking. You have to bring your own food or buy your own food. There's lost wages that can add up quickly. So the Center for Food and Equity Medicine helps out with those costs. As a fresh food pantry, they distribute meals to immunocompromised people via their grocery brigade. They do much more. And Dr. Haver selected St.

• 48:25Alie Ward?

  Jude's Children's Hospital, which works to advance cures and means of prevention for pediatric catastrophic diseases through research and treatment. And they say, consistent with the vision of their founder, Danny Thomas, no child is denied treatment based on race, religion, or a family's ability to pay. An actor, Danny Thomas, just side note, was born Amos Muziyad Yakub Karoush in Michigan to Lebanese Catholic parents and established St. Jude with money that he made as an actor and a singer. And I never knew that, but it's pretty cool. Okay, so those donations were made possible by sponsors of ologies. This podcast is brought to you by Squarespace. If you haven't heard me gushing about Squarespace for years, it's an all-in-one website platform. Whether you're trying to grow a business you have,

• 49:09Alie Ward?

  or if you're just a baby business getting started, it has everything you need. That's where I secured my domain name. It helped me build a professional site. I can update it so easily. I've been using Squarespace since before Ologies existed. After procrastinating for years, I literally built my website in one evening. They have templates. They have flexible editing tools. Squarespace also makes it easy to share your work. You can book clients. You can get paid. They have built-in tools for scheduling and invoicing and email, all in one place. Whenever someone I know needs a website, whether they're a scientist that needs to put their work up, or someone who's just starting a business, I'm like, dude, Squarespace. So head to Squarespace.com/Ologies for a free trial. And when you're ready to launch,

• 49:53Alie Ward?

  use offer code OLOGIES to save 10% off your first purchase of a website or domain. You can do it. Peppa Pig is your preschooler's best friend. Give the gift of bike riding confidence this year and help Peppa learn to ride her bike. Kids can imagine learning to ride a bike with the Ready Pedal Go Peppa Bicycle Playset. Put Peppa's helmet on, attach the push stick to her bike, and push to make her pedal. Ready Pedal Go Peppa and more from Peppa Pig are now available at all major retailers this holiday season.

• 50:29Alie Ward?

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• 51:01Alie Ward?

  Listen, sometimes you get out of your routine. That happened to me recently when I went out of town and I realized I forgot my Ritual Essential for Women 18+. It's a multi that I've been taking for years. And guess who landed in another country without them? Me. Didn't feel right. They contain nine key nutrients, two delayed-release capsules designed for optimal absorption. But Ritual, why do I love them so much? They have a team of scientists. They poured over thousands of studies to figure out what are common gaps that people need in their diet, but they don't actually consume. It's also designed to be gentle on the stomach. You can take it with or without food, which I love. Plus, I like that it looks like a tiny lava lamp. I tell you that every time, but it has these beads and oil, and it tastes like mint. Easy down the hatch. I usually take them in the morning.

• 51:46Alie Ward?

  And the reason why I've stuck with Ritual for so many years is because my schedule's all over the place. Sometimes I'm eating breakfast. Sometimes I'm running through an airport with one shoe. So instead of striving for perfect health, aim for supporting foundational health. Save 25% on your first month at ritual.com/ologies. That's ritual.com/ologies for 25% off your first month.

• 52:09Speaker 04

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• 52:55Alie Ward?

  And let's get back to it with Dr. Haver and why learning about this is important for all genders. And in the last, you know, 10, 15 years with social media, have you just seen people who are much more tuned in?

• 53:10Speaker 02

  Totally.

• 53:10Alie Ward?

  Yeah.

• 53:11Speaker 02

  Yeah. So I really feel like social media has become the female water cooler. And it is a way for us to share stories and to realize that we have commonalities where we never talked about it before because we didn't have the opportunity. And so someone mentions, you know, her frozen shoulder and that it's in menopause. And like 10,000 people asked me, could my frozen shoulder be related to menopause? I go dig through the data. I find correlations. I find Jocelyn Whitstein's work and Vonda Wright. And then that video goes viral, you know, millions of views. So with tens of thousands of women in the comments going, oh, my God, this happened to me and no one mentioned it.

• 53:48Alie Ward?

  Where is the research at? You know, I know you're digging through research, but how well funded is it? How up to date is it?

• 53:56Speaker 02

  Before or after this administration? So. No, let me be clear. Nobody was doing menopause well. It was a bastard stepchild in the research world. So after the WHOI, no one was doing this amazing.

• 54:16Alie Ward?

  Yeah.

• 54:17Speaker 02

  Okay. So when we look at women's health, so in 2023, McKinsey came in, the Gates Foundation hired the McKinsey Group to look at women's health and funding and spending. The total NIH budget was 43 billion. I may not get the numbers exactly right. So women's health got 10 to 15% of that. Okay. So 85% did not go to women's health.

• 54:37Alie Ward?

  47 billion, but that's close enough. So yes, roughly 10% of funding goes toward women's health. But hey, did you know that before 1993, you didn't even have to include a woman? A woman?

• 54:51Alie Ward?

  A woman in your clinical trials? So this 1993 change was called the Revitalization Act. And before it, pharma companies just didn't have to include women while testing for drugs and vaccines and stuff. Too complex, they said. Those bodies, we can't figure them out. So it's fine. Again, this was until 1993. And it wasn't mandatory for the US to test automotive safety with crash test dummies with typically female proportions until, do you want to guess what year? Ever. It's still not mandatory. Crash tests, car safety tailored toward taller, heavier male bodies. And as a result, as reported in the recent federal report, sex-based differences in

• 55:36Alie Ward?

  odds of motor vehicle crash injury outcomes. Quote, "Females had significantly higher odds of injury than males. Males did not have significantly higher injury odds in any crash models." So women get in the shaft from so many angles. Live or die? Eh, don't worry about it. And so many medical trials still are skewed disproportionately toward white people. In the United States, Native American and Black women are two to three times more likely to die from a pregnancy-related cause than white people. And according to this 2024 McKinsey report, "Closing the Women's Health Gap: A $1 trillion Opportunity to Improve Lives and Economies."

• 56:19Alie Ward?

  Menopause is an area of highly unmet needs globally. It says it's estimated that more than 450 million women worldwide have menopause or perimenopause symptoms. And based on the prevalence, this report says, "The estimated market potential for medication is up to $230 billion globally." Hmm. The paper notes, "Investments addressing the women's health gap could add years to life and life to years and potentially boost the global economy by $1 trillion annually." So hey, we should figure that out, America, because that's a lot of money to be made from menopause. Your uterus matters because your wallet does.

• 57:05Speaker 02

  The lion's share of that women's health bucket went to pregnancy. Pregnancy is important. And then breast and ovarian cancer. Okay. When we talk about autoimmune disease that 80% of women have, when we talk about endometriosis, polycystic variances, like diseases that specifically affect menopause, it was like dust, like pixie dust. So how does that translate? So if you go to the NIH website to look up research articles, so that's PubMed in the US or worldwide, we can do it worldwide. And I type in the word pregnancy. Okay. Right now, it's around 1.2 million articles. Now, those articles represent brain power, academics, research funding, you know, think of everything it takes to like create a research article and all the money and preparation

• 57:50Speaker 02

  that goes into that. Okay. Now I'm going to type in the word menopause. We're about 99,000, maybe close to a million now. That is 12 to 1. Okay. Now I'm going to type in the word perimenopause. And we are at 9,000.

• 58:07Alie Ward?

  Dude. Dude. And perimenopause can last like 10 years, right?

• 58:13Speaker 02

  Yeah. So just to give you an idea of this much funding, so 85% is taken away. Now we're going to, most of it's going to pregnancy and that, you know, so here is the dust and the crumbles and the cobwebs that women's health after reproduction ends, which affects more women than it will bear children.

• 58:30Alie Ward?

  Yeah.

• 58:32Speaker 02

  So that's kind of like my inspiration.

• 58:35Alie Ward?

  Are you constantly having to refresh and see what papers are coming out and get abstracts?

• 58:40Speaker 02

  Yeah. So the coolest thing about PubMed is that they let you put alerts in. So I have an alert for the word menopause and I have an alert for the word perimenopause. And every morning I get my coffee, I get back in my bed, I flip open my laptop and I review every single article, and there's not that many, shabbily, that comes out. So every day I see what has been published with the word menopause or perimenopause in it.

• 59:05Alie Ward?

  That's so baller.

• 59:06Speaker 02

  And it's awesome. And I'm like, okay, and I read every abstract. There's still a lot on cancer and menopause, so that's fine, you know, but like really clinically relevant stuff, we have a long way to go. Women are over centuries of research here.

• 59:19Alie Ward?

  Yeah. Oh, 1,000%. So who is doing that research? We're going to link to so. Many studies on our website, which is linked in the show notes, or you can just go to alliewar.com/ologies/ menopause. Well, do animals deal with this shit? I reached out to biological anthropologist Dr. Laura Durkovich, who you may remember from our episode on the sex lives of apes other than ourselves, and she studies menopause in orangutans. So at least someone's health is funded for that.

• 59:48Speaker 05

  Hello, Ms. Ally. Thank you again for inviting me to comment on this stuff. I'm very excited to be back on the show. And my research focus is on the life cycle of female orangutans, and specifically how their reproductive hormones and their menstrual cycles, which are pretty much the same as ours, change across their lifespan? And if or how those hormones impact the female's motivation to mate or the male's interest in mating with them? Hello, ladies. But the other thing I want to know a lot about is whether perimenopause and menopause are a standard part of the female life cycle? And if so, how long they tend to live afterward?

• 1:00:25Alie Ward?

  Okay, awesome.

• 1:00:26Speaker 05

  Menopause is definitely rare in the animal kingdom. From an evolutionary perspective, the more offspring you have, the more copies of your genes you pass on to the next generation, and the more you are winning, so to speak, at the game of evolution. So it's super puzzling to see a life cycle evolve where individuals stop reproducing long before the end of their lifespan. There is evidence that some female orangutans, gorillas, and chimpanzees reach menopause, and also some species of toothed whales, like orcas and narwhals.

• 1:01:02Alie Ward?

  Well, I asked her, how long are humans supposed to live? Are we even supposed to go through menopause? Or should we be dead by then?

• 1:01:09Speaker 05

  Humans have actually had a longer lifespan for longer than most people appreciate. I think a lot of people think that the only reason we have a long post-reproductive lifespan today is because of modern medicine, that otherwise we'd typically be dead by 50. But actually, in the past, a lower life expectancy was skewed by high rates of death at young ages. So if they survived childhood, it wouldn't have been unusual in ancient times for a person to live to something like 70, which for a woman means two solid decades of life post-menopause.

• 1:01:42Alie Ward?

  I mean, organic foods, lots of exercise, healthy social environment, living in villages, weight-bearing activity, from carrying water and other people's babies and rocks, you're hanging out in your campfires, but you're skipping the vape and bottomless mimosas of our current epic. That all kind of checks out. But why shut things down before the party's over? What is the advantage of menopause?

• 1:02:08Speaker 05

  This one is a million-dollar question within evolutionary biology, and it is one that we still don't have a definitive answer for. In mammals, females are born with all the eggs they'll ever have already in their ovaries. And the physiological changes of perimenopause and menopause are the result of that number of eggs declining with age. This is called follicular depletion. The focus in evolutionary biology has shifted, and the question being asked isn't so much, why do we have menopause, but rather, why did natural selection favor an extension of the human lifespan beyond the age where we, or women at least, stop being capable of reproducing? The most common explanation

• 1:02:50Speaker 05

  is something called the grandmother hypothesis, which was popularized by a woman named Kristin Hawkes. And the idea here is that grandmothers can be particularly valuable in helping increase the reproductive success of their own offspring by helping to both provision and care for their grandchildren. By boosting their grandchildren's survival chances and possibly even helping their daughters have another baby more quickly, grandmothers are able to boost their genetic legacy indirectly through what's called inclusive fitness in evolutionary biology.

• 1:03:26Speaker 05

  Thanks, Rima. I know there was a well-studied female orca named Granny that was fit into this mold.

• 1:03:32Alie Ward?

  For more on that, yes, we need an orca episode, and I'm working on it. I know feelings are mixed on calling them killer whales, but I do feel like killer whales would be great for Spooktober. So, put a pin in that. But meanwhile, you can see the 2017 Current Biology paper titled Reproductive Conflict and the Evolution of Menopause in Killer Whales, which explains that the reproductive conflict hypothesis predicts that older females in a pod ceasing fertility is a benefit to the younger females, since males don't disperse from the pod, so that avoids more interrelated breeding. But the 2019 piece in Science.org titled Granny Killer Whales Pass Along Wisdom and

• 1:04:15Alie Ward?

  Extra Fish to Their Grandchildren touched on some new research showing the first non-human grandmother hypothesis in whales, noting that as wise grannies, they can help provide fish and knowledge of where to find them to the younger whales, and that greatly increases the survival rates of that young generation. Another effect, this has not been studied, but it's my hypothesis, is fashion, because in 2024, young whales off the northwestern coast of North America, they were cruising around, balancing dead fish on their head. No one really knows why, except that in 1987, this was also a fad. It disappeared for decades, and then boom, whales started balancing fish, maybe to amuse

• 1:05:00Alie Ward?

  each other. So I think perhaps a young whale was like leafing through a photo album, was like grandma looked hot, put a dead salmon on like a pair of grandma's acid-washed jeans, just like throwback, looks good, nature, it's a mystery. But orcas can go through the dodging event around their mid-40s, even though they can live into their 80s and 90s, some even past 100. What about the less wet mammals?

• 1:05:27Speaker 05

  I have a colleague who was a veterinarian at a zoo in Jersey, and he published a paper last year where they used hormone data and ultrasound data. And histology to document menopause in a 49 year old female orangutan. But we also know that female apes can continue to reproduce at ages that would be considered pretty late in humans. There was a female orangutan at the St. Louis Zoo who gave birth at 45. There was also a chimp named Suzie at a zoo in Kansas who gave birth when she was 56.

• 1:05:59Alie Ward?

  And as for Suzie, she was taken off birth control. Because that's right, apes in captivity, they're given regular old human birth control and a cup of juice every morning. We learned that in our primatology episode. But yeah, they took Suzie off birth control for some other health concerns and quote, zoo officials didn't think she would get pregnant at her age. But surprise, suckers, Suzie was still freaky and she had a kid at 56 and then she lived until the age of 71 and she just passed away in the fall of 2025. So RIP a legend.

• 1:06:29Speaker 05

  But we need more data to say whether the slope of the line is the same for hormone decline in humans and in other apes. As far as I know, there's no evidence that they experienced things like hot flashes or mood swings, but obviously we cannot ask them. I wish we could.

• 1:06:46Alie Ward?

  What about in convos with your human friends? Has research helped you or your friends and relatives in terms of their perspectives on the experience? And here.

• 1:06:57Speaker 05

  I have to say sadly, no. I'm not there yet myself, but I think this is one of those things where understanding it better does not make it any easier to go through.

• 1:07:09Alie Ward?

  You know what else makes it easier to go through, though, is part two. Next week, we're going to move on from these basics and symptoms and tell you what you can do about all this. There's hormone options, we talk flim flam busting, specific things to ask your doctor, alternatives, latest research, why you want to make sure your hips stay intact, vagina creams, libido, so much more. Meanwhile, Dr. Mary Claire Haver has the podcast UnPaused and wrote the books, the new menopause book and the new perimenopause book. Dr. Monica Christmas is on Instagram at DrMonicaChristmas. We'll also link her research gate as well as Dr. Dergovich's and of course, so, so many links will be up at aliward.com/ologies/ menopause.

• 1:07:52Alie Ward?

  And again, we're back next week with all the stuff you need to know what you can do for yourself and/or the people in your life who are going through this. It's very important. Now, we are at Ologies on Bluesky and Instagram. I'm at Ali Ward on both. Ali has just one L. We also have kid-friendly episodes in their own feed. That show is called Smologies. It's wherever you get podcasts, S-M-O-L-O-G-I-E-S. If your kids ever watch the show Brainchild on Netflix, that's me. I was their science friend on that. So there's a fun new podcast for them if they need one. Thanks again to patrons of Ologies. Next week, it's all your questions, wall to wall. And thank you, Erin Talbert, who admins the Ologies Podcast Facebook group. Aveline Malik makes our professional transcripts. Kelly R. Dwyer does the website. Noelle Dilworth tracks our weeks. As our scheduling producer, slamming

• 1:08:37Alie Ward?

  down on my gas pedal to get the episode out on time, is managing director Susan Hale, who also did an amount of research on this episode that is staggering. Just give her a PhD for this. Susan, I may not have ovaries or uterus anymore, but I could not survive without you. And editing so wonderfully that I do not have to quit my job to marry my endocrinologist, or Jake Chaffee. And lead editor Mercedes Maitland of Maitland Audio, Nick Thorburn, whimpered the theme music. And if you stick around until the very end, you know I may tell you a secret. This week, it's something I think I mentioned in the All Secrets episode recently, but it's that I bought one of those little sticks with a grabber on the end, like a claw grabber on the end to pick up trash on my street.

• 1:09:18Alie Ward?

  And it all started with these pee bottles that kept appearing in the bushes because multi-billion dollar corporations don't let their delivery drivers take breaks. So into the bottle it goes, into our bushes. I can't blame them. But I take this little trash picker on walks with Grammy and Jarrett down the street, and I just pick up trash. Honestly, here's the problem. Here's my thing. If I just took myself on walks around the neighborhood with this trash grabber, I would get so many steps. It just keeps your brain kind of searching for litter in a way that really feels like Pokemon Go, but with like hamburger wrappers and cigarette butts. But I know if I start doing that, which again, I like really want to, but I'll become... That lady in the big hat with a garbage grabber.

• 1:10:02Alie Ward?

  And I don't know if I'm ready to be that iconic and take on that kind of neighborhood lore right now. So if anyone else does that in your own neighborhood and just becomes it, just let me know how it goes. I'm tempted. Okay. Next week, we'll actually materially change your life. So much information. Okay, talk to you then. Bye bye.

• 1:10:45Speaker 06

  Well, I'll tell you, menopause was wonderful for me.