What Every Woman (and Man Who Knows Her) Needs to Know About Menopause

BUY THE BOOK: The Book of Menopause https://amzn.to/4AuiuOy Millions of women continue to suffer in silence or confusion without the guidance or resources they need to feel prepared for perimenopause, menopause and post menopause. Oprah talks with Pilar Guzmán, Editorial Director of Oprah Daily, to discuss The Book of Menopause: Real Talk, Real Science, Real Strategies for Your Next Chapter - the new book from the editors of Oprah Daily. Drawing on insights from leading doctors, psychologists and women’s health experts, the book offers practical guidance to help demystify menopause. It offers help understanding how the body is changing, strategies for navigating symptoms and new perspectives to offer information and empowerment for what's next. Oprah and Pilar share their own personal experiences and explore why menopause is still surrounded in misinformation and shame. Joining them are board-certified OB/GYN and menopause practitioner, Dr. Mary Claire Haver and renowned neuroscientist, Dr. Lisa Mosconi, Director of the Women's Brain Initiative at Weill Cornell Medicine/New York-Presbyterian Hospital. 00:00:00 - Intro 00:00:43 - Welcome Editorial Director of Oprah Daily: Pilar Guzmán 00:02:55 - Oprah’s experience with menopause 00:04:30 - Why is there still stuff we don’t know about menopause 00:06:35 - How to take away the shame of menopause 00:08:37 - Welcome Dr. Mary Claire Haver 00:10:30 - What happened with the Women’s Health Intiative? 00:14:40 - GLP-1’s and Hormone Therapy are game-changers for Menopause 00:20:00 - Welcome Dr. Lisa Mosconi 00:22:48 - Brain fog in menopause 00:26:20 - Puberty, pregnancy, and menopause 00:29:40 - Alzheimer’s disease in women 00:37:55 - What all women should ask their doctor 00:40:25 - Menopause in relationships 00:45:00 - The biggest surprise in menopause research Subscribe: https://www.youtube.com/@oprah Follow Oprah Winfrey on Social: https://www.instagram.com/oprahpodcast/ https://www.facebook.com/oprahpodcast/ https://www.instagram.com/oprah/?hl=en https://www.facebook.com/oprahwinfrey/ Listen to the full podcast: https://open.spotify.com/show/0tEVrfNp92a7lbjDe6GMLI https://podcasts.apple.com/us/podcast/the-oprah-podcast/id1782960381

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

• 0:00Oprah Winfrey?

  Hi there. Great to be with you here on the Oprah Podcast. Whether you are in perimenopause, or menopause, or post-menopause, so that means millions of you, I have the book for you. It's called The Book of Menopause: Real Talk, Real Science, Real Strategies for Your Next Chapter. And believe me, it's the next chapter. The editors at Oprah Daily have curated the most crucial information that we've all learned over the years about menopause from doctors, and from psychologists, and from all of the health experts. Joining me in the tea house is the editorial director of Oprah Daily,

• 0:45Oprah Winfrey?

  Pilar Guzman. Hello, Pilar.

• 0:47Speaker 01

  Hello.

• 0:48Oprah Winfrey?

  You and I know that anytime we've talked about menopause on Oprah Daily, I mean, we were one of the first to start this conversation several years ago. I think The New York Times had done an article, and then we did a whole conversation about it in the Hearst Building in New York. And anytime we talk about it, it actually becomes the most read content. Women are in real need of, I think, reliable information, and also what we've seen from Oprah Daily, in need of community. So what have you been hearing from women?

• 1:23Speaker 01

  I think the storytelling, the sharing of people's experiences has been this incredible accelerator. You know, there is the research, there is the journalism, there is the storytelling that we do as a brand, but then the women themselves, talking to each other, and talking to us, and sharing their symptoms, and sharing their experiences, has been this incredible groundswell.

• 1:48Oprah Winfrey?

  Did you notice that there has been a moment of breakthrough when, like, there was before, and now there's this moment where it seems that more women are open to talking about it?

• 2:04Speaker 01

  Absolutely. And I think it is not unlike the Me Too movement, where it takes a few brave souls to kind of break the ice, and break the silence, and normalize the conversation. I think part of it is that it's still, you know, very, felt very shameful for a really long time, until recently. I mean, you're, you, 20 years ago, when you went through menopause and tried to get people to come on the show, they wouldn't do it. And now-

• 2:26Oprah Winfrey?

  Right. Nobody, particularly anybody famous, wanted to say they were going through it, yeah.

• 2:31Speaker 01

  And so it's like a Naomi Watts, who kind of, you know, broke, broke the ice.

• 2:36Oprah Winfrey?

  Halle Berry.

• 2:37Speaker 01

  Halle Berry, exactly. Drew.

• 2:39Oprah Winfrey?

  Drew.

• 2:39Speaker 01

  Yeah.

• 2:40Oprah Winfrey?

  Yeah.

• 2:41Speaker 01

  And Maria Shriver, and you, and, you know. And then it gives, it emboldens others to share their stories, and to normalize it, and to feel okay about it, and not feel so alone.

• 2:52Oprah Winfrey?

  Yeah. Well, I share my own story in the book. I was around, so you can find my story in this book, Menopause: Real Talk, Real Science. And I was around 48 when I started experiencing heart palpitations. And I went to, as I say in this book, I went to five different doctors, I mean, one after the other, after the other. And none of them had answers. And it wasn't until I picked up a book at the office that I, I learned that what I was experiencing, I'd been having these heart palpitations and sleeplessness, were indications of menopause. So what was it like for you?

• 3:32Speaker 01

  Well, I didn't have heart palpitations, but I had sleepless nights. I was, my mind was racing, I had more than usual anxiety. I'm a little prone to anxiety, but it was more than normal. And I went to the doctor, and I have a wonderful OB-GYN, who I really trust, delivered both my children. And she said, "Oh, let's do, let's, you know, your, your levels are fine. We did the bloods, and the levels were fine." But I said, "No." I pushed back. And I, and I got hormones. But I think a lot of women don't feel brave enough to sort of push back against the, you know, the advice of their doctors. And I think she has even changed her tune in the, in the last few years, since I, since that first visit, when I first came to her about that.

• 4:17Speaker 01

  But I think about all the women who don't feel emboldened to say, "Wait a minute."

• 4:22Oprah Winfrey?

  Yeah. The moment their doctor say, "No, you shouldn't," which I've had doctors who said, "No, you shouldn't do hormones." The moment you hear that, you're just like, "Oh, okay, okay."

• 4:30Speaker 01

  Yeah.

• 4:31Oprah Winfrey?

  Well, women spend 41%, that's nearly half of their lives, in the post-reproductive state, you all. And even though, I have to say, I've been doing, I've been talking, and talking, and talking about this for a few years now. There's still so much that you all don't know, that a lot of people don't know. And why do you think that is?

• 4:51Speaker 01

  I think there's still a lag in education, in medical schools. I mean, you will talk to some of the experts we're having, we'll have on today. I think, you know, they will tell you that they didn't even learn this in medical school. So there is a lag in, you know, midlife women's health education, even among doctors. And then, of course, there was the famous Women's Health Initiative, which set, which set it back by, you know, two decades, essentially.

• 5:17Oprah Winfrey?

  That's right. So many women have suffered because of that.

• 5:20Speaker 01

  That's right.

• 5:20Oprah Winfrey?

  Because of that misrepresented study, actually.

• 5:23Speaker 01

  Yes, exactly.

• 5:24Oprah Winfrey?

  So many women did. So Congress has recently held its first ever hearing on menopause, calling for more research, more education. So does that mean that the tides are finally beginning to turn, do you think?

• 5:36Speaker 01

  I think I am cautiously optimistic that the answer is yes, but we cannot take our foot off of the gas pedal in terms of continuing to tell stories, continuing to write stories, continuing to put pressure on government, on, on our own doctors. I think even just our individual advocacy is so important when we go into the doctor's office and demand something else, and actually will leave a practice if they, they are, you know, even, even if there's a whiff of resistance. And I actually encourage women to say, to call if they're, you know, interviewing a new doctor, or they're going to see a new doctor, make sure that they are open, if they are of age, if they, that they're open to hormone therapy. Because many doctors are still resistant.

• 6:20Oprah Winfrey?

  If you have an older, older doctor, they're going to be resistant, because they are still basing it on the misrepresented study. So how do you believe, Pilar, we begin to just eradicate a lot of the shame that women have around menopause? You know, we've written about it consistently, on O Magazine, on Oprah Daily, I've talked about it. But there's, I can't believe that people are still, like, embarrassed about it.

• 6:48Speaker 01

  I feel the same way. And I think, I think the more, I think social media helps a lot.

• 6:53Oprah Winfrey?

  Yeah, it does.

• 6:54Speaker 01

  And this is where social media is a force of good, because you hear lots of women, women who you admire, powerful women, and regular women. And I think the more you hear it, the more the shame goes away. I think, you know, in some ways, I think storytelling is the antidote to shame.

• 7:12Oprah Winfrey?

  I agree.

• 7:13Speaker 01

  You know, the minute we circle up-

• 7:14Oprah Winfrey?

  Storytelling is the antidote to everything, because storytelling allows you to know you're not the only one that's ever gone through anything.

• 7:20Speaker 01

  That's right.

• 7:20Oprah Winfrey?

  Period.

• 7:21Speaker 01

  Yep.

• 7:22Oprah Winfrey?

  Every story we share on the Oprah Podcast comes from a place of intention. Each guest has their own journey. And my hope is that sharing it with us, here, can help light the way for somebody else. And as the official insurance partner of this podcast, Geico understands that every journey feels a little easier when you know you have support along the way. It's the time of year when the weather changes, days get shorter, calendars fill up, and you find yourself back in motion again, taking the kids to school, running errands, heading home after the sun sets. During these busy days, it's the people who show up in small, steady ways who make the season feel a little lighter. The friend who stops by with a home-cooked dinner.

• 8:06Oprah Winfrey?

  The partner who surprises you by filling up your gas tank. These are the everyday moments that remind us, we are supported. That kind of support matters on the road and in life. Geico helps you stay covered through the turns, the transitions, and the everyday miles. Because with the right support, we keep driving forward. And that, dear listener, is everything.

• 8:37Oprah Winfrey?

  Well, Dr. Mary Claire Haver is an OB-GYN and certified menopause practitioner. She's a regular contributor to O Daily, and a big contributor to this menopause book, and the author of The New York Times bestselling books, The New Menopause and The New Perimenopause. Dr. Haver, thanks for being here. Great to see you again. What's happening with our hormones during perimenopause? Because so many women are experiencing that at an early age. It starts like in their 30s now.

• 9:07Speaker 01

  Yeah, so if the average age of menopause is 51 in the United States, but we have a pretty big window of when that might happen. So that's just average. We're looking 46 to 55. Now back that up seven to 10 years, when perimenopause begins. And as far as what hormones are doing, I wish I could tell you is this- Slow, beautiful, gentle decline till the end of ovarian function. But actually, it's a roller coaster, something we've named the zone of chaos. So on the way out, as the ovaries deplete their egg supply, the brain is working harder and harder to try to get the hormones out of the ovaries. And that is causing very erratic shifts in our hormone levels. So estrogen levels can get as high, you know, higher than they were in your entire life outside of pregnancy.

• 9:51Speaker 01

  And we see crashes in progesterone. And so that really manifests early on in our 30s and 40s. We see the brain symptoms first typically, not the hot flashes. Those come towards the end of perimenopause. We start seeing sleep disruption. We see mental health changes like Pilar was talking about, and we see brain fog. So those are usually when I'm really trying to dig in to see, is this, you know, are these symptoms going to be perimenopausal in the patient? Those are the ones I start focusing on early.

• 10:19Oprah Winfrey?

  And explain why hormone therapy is an effective. Well, first of all, you need to explain, I keep saying the misrepresented, you know.

• 10:28Speaker 01

  Women's Health Initiative.

• 10:29Oprah Winfrey?

  Yes.

• 10:30Speaker 01

  Women's Health Initiative.

• 10:31Oprah Winfrey?

  Can you explain that? That is what set us on a course of everybody having such great fear about it. And I think a lot of women weren't even around or thinking about that Women's Health Initiative at the time that it came out, but are living or experiencing the results of it because their doctors, their mothers, their aunts all saying, oh, no, no, no hormones. So let's talk about what happened with the Women's Health Initiative and why.

• 10:59Speaker 01

  Sure. So we knew from observational data in the 80s and 90s that women on hormone therapy, and that was about 38 to 40% of the population, seemed to have lower rates of heart attacks. They seemed to live a little bit longer. We knew that their bones would be stronger. But as far as the heart disease question, it was, well, are these women healthier and wealthier and just have a better lifestyle? And that's contributing to their decrease because they can afford hormone therapy? They can afford to go to the doctor, the time, the money, the access? Or is this really hormone therapy? So that's what the Women's Health Initiative set out to study. If we put women on hormones versus placebo, is this decreased risk of heart attacks due to the medication or just due to lifestyle?

• 11:43Speaker 01

  So the average age of the woman in the study was 63 years old, much older than a typical woman would be starting menopause therapy. We had two arms. If you had a uterus, you got estrogen plus a progestin. If you didn't have a uterus, you got estrogen only. And they started collecting data. They collected so many lifestyle factors. They collected heart disease data, breast cancer data. And what they saw was an early signal that in the estrogen and progestin group only, there was a very small signal, not great, that there was an increased risk of breast cancer. What happened was they called a press conference and announced to the world that hormone therapy causes breast cancer versus placebo.

• 12:28Speaker 02

  We got a 26% increase in breast cancer, and that's why we stopped the trial.

• 12:32Speaker 01

  But that really wasn't the entire story. This was an older population. They didn't have mammograms before starting hormone therapy. We didn't know how many of these women so may have had an early breast cancer before they started hormone therapy. And we didn't see that signal. This didn't make the news in the estrogen only arm. So it terrified women. It went viral before the internet, right? It was the number one medical news story.

• 12:54Oprah Winfrey?

  Everybody just dropped their medications the next day. Everybody just literally.

• 12:57Speaker 01

  They were calling their doctor in a panic. I remember I was a chief resident, so my last year of my training program, we were giving hormone therapy. It was expected to have that conversation with a patient, and then it was like, full stop. She's terrified of breast cancer. We don't want to give her breast cancer. And it took off like wildfire, and everyone was terrified. And all meaningful training in menopause stopped at that point, too. Education around menopause. I mean, it was just, yeah. And so it wasn't until I saw Sharon Malone speak in 2023 that I realized what the implications of the WHO actually were. I was still operating under the, well, hormone therapy might give her breast cancer, so we really want to look at alternatives.

• 13:42Speaker 01

  It's a last, you know, it's the last thing we're going to consider when she's having very disruptive hot flashes. No discussion around bone density preservation, no discussion around mental health or any of the other things we know the full body effects of estrogen loss can do.

• 13:55Oprah Winfrey?

  Wow. So it was that late in 2023 with Sharon Malone. You were one of those doctors who was tentative about it.

• 14:02Speaker 01

  Yeah, very tentative. And I remember sitting in the audience in tears, like, how did I not know this? I am board certified. I get recertified every year. I read all the journals. I do, I check all the boxes. And no one had put this information in front of me to say, it's actually really, really safe. For the vast majority of patients, it's going to be a huge benefit versus the risk. Every woman deserves the conversation. And just seeing it dismantled and taken down made me realize how much of a gap I had in my own education and knowledge and how I had really not been of full service to my patients.

• 14:38Oprah Winfrey?

  Well, so let's switch gears today. Dr. Haber, you say that the GLP-1s and hormone therapy are a game-changing duo for menopause belly fat.

• 14:52Speaker 01

  Uh huh.

• 14:53Oprah Winfrey?

  Why?

• 14:54Speaker 01

  So, great point. And we know that women on hormone therapy have less accumulation of visceral fat versus those not on hormone therapy. So visceral fat, for your listeners, is the very special fat that wraps around our organs. So I had, for years, had patients going through the menopause transition saying, something's happening in my belly. It's bigger. I've changed nothing in diet and exercise. And they would, in their little paper gowns at a well woman, kind of grab their tummies and like, Mary Claire, what's happening here? And I'd just be like, work out more, eat less. This is, you know, things get harder as we get older, et cetera, never knowing that there was a hormonal component attributed in here. When we add in the GLP-1, they work synergistically together.

• 15:36Speaker 01

  So there was a recent study that came out looking at women on just a GLP-1 versus GLP-1 plus menopause hormone therapy. They lost 30% more weight.

• 15:44Oprah Winfrey?

  Wow.

• 15:45Speaker 01

  In that study. And when we look at body composition changes, it's the type of weight that we're looking at. So they're losing visceral fat, that belly fat, which is inflammatory, dangerous, leads to heart disease, diabetes, stroke, versus just subcutaneous fat. So all around the board, I mean, and in my clinical practice, it really is a game changer for my patients, combining the two.

• 16:08Oprah Winfrey?

  And what are the benefits of hormone therapy other than it easing hot flashes or allowing you to sleep at night? I mean, I didn't sleep for two years, and then I had a click of estrogen and the lights went on. I mean, the sky got clearer. I no longer felt like I was moving behind a veil. So all of that was worth it to me. But now I hear that there are actually improvements for, you know, your heart, for inflammation, for other things.

• 16:39Speaker 01

  So we know that women, so we have four approved, FDA-approved reasons. Hot flashes, premature menopause, preservation of bone density in a post-menopausal patient, and for the general urinary system. But we have estrogen receptors throughout the body. So our patients are telling us in observational data, brain fog is better. If your hot flashes are waking you up, it absolutely will help with sleep. When sleep gets better, as you know, everything gets better.

• 17:05Oprah Winfrey?

  Gets better, yes.

• 17:06Speaker 01

  Yes. And so we also know musculoskeletal symptoms can get better. Of course, the general urinary system, things like vaginal dryness, recurrent UTIs. There's a big push on social media to really spread the knowledge about the safety of vaginal estrogen and how you can safely use it with your systemic estrogen as well, and you probably should, to decrease the rate of, you know, vaginal dryness, painful sex, anorgasmia. Like, patients will come in and saying, I'm struggling with orgasm. It's taking longer. I can't have them anymore. I want to have them because the tissue is changing down there. So estrogen can go a long way there as well.

• 17:43Oprah Winfrey?

  Wow, wow. And you say osteoporosis is a silent threat to women after 40. And so what can we be doing to protect our bones?

• 17:51Speaker 01

  Great question. So the biggest rate of bone loss actually begins in perimenopause. And waiting till 65 for when that insurance-approved first bone density scan, I think is a mistake. You know, we start asking to screen our patients in perimenopause. We want to know what the baseline is. And so what can we do? Hormone therapy is FDA-approved for prevention. So that's one thing. But I think lifestyle is key here, and a lot of women don't understand, especially if they're on a GLP-1, right? You must eat adequate protein. So we need a stimulus for the bone, and we need to feed the bone. The bone needs calcium. The bone needs vitamin D. The bone needs protein, okay? And the stimulus is going to be movement, especially resistance training. The most effective way to protect your bones by moving your body

• 18:34Oprah Winfrey?

  Yeah.

• 18:35Speaker 01

  is weight training and jumping.

• 18:36Oprah Winfrey?

  Yeah.

• 18:37Speaker 01

  Okay?

• 18:38Oprah Winfrey?

  Well, I'm not jumping, but I will definitely do the weight training, yes. That's fantastic. Thank you, Dr. Haber. It's always so great speaking with you. Maybe you're feeling it too with so many ways to reach each other. It can be easy to mistake being reachable for being truly connected. But I've learned that what many people are longing for is just to be heard, truly heard by another person. That's what we're trying to do here on the Oprah Podcast. I see you contemplating, and I can see that you're seeing yourself a different way after he said that. Making space for real connection, because every time we stop and actually listen to each other, something shifts, something opens.

• 19:23Oprah Winfrey?

  AT&T believes that, too. The right connection at the right moment between the right people can change the course of a day, a relationship, and even a whole life. So the next time you reach for your phone to call someone you love, know that AT&T is with you, keeping that connection strong, because AT&T is there when the connection matters. And connecting changes everything.

• 19:56Oprah Winfrey?

  I want to bring in neuroscientist and director of the Women's Brain Initiative at Weill Cornell Medicine New York Presbyterian Hospital, also the author of the New York Times bestseller, "The Menopause Brain", Dr. Lisa Moscone. It's so nice to see you here.

• 20:11Speaker 03

  Hello, it's so good to see you. Thank you so much for having me. Hi, Kilar.

• 20:16Oprah Winfrey?

  Hi. Hi. So you've described menopause as a renovation project on the brain. Explain how women's brains change during menopause.

• 20:26Speaker 03

  Yes, I think that's a beautiful way to think of menopause, and also very graceful in some ways.

• 20:34Speaker 03

  So, most people associate menopause with the function of the ovaries, which is fair enough. But in reality, menopause is a neurologically active phase. It impacts the brain as surely as it does the ovaries. And I think many women intuitively know that. We have so many women in midlife coming to the clinic saying, "Something is going on with my brain." And then we start talking about symptoms. And when women say, and what you were saying with Mary Claire, heart flashes, night sweats, insomnia, depression, irritability, anxiety, brain fogs, memory lapses.

• 21:16Speaker 03

  Those are all possible symptoms of menopause. They have nothing to do with the function of the ovaries, but they come from the brain. Those are neurological symptoms. They come from the ways that menopause can change the brain. So I think that the notion that menopause is a renovation project on the brain is very appropriate. It takes some of the fear out of the word "menopause", to your point before. And it's very important to understand also as women that the hormones that we think of as sex hormones, like estrogen, progesterone, those are actually brain hormones as well.

• 22:01Speaker 03

  They serve very important functionalities in the brain. So when they come to, physically when they decline after menopause, the brain needs to shift gears and adjust to a different hormonal environment. But the important thing to realize is that the brain has the ability to adjust and to just carry on. The ovaries may close down shop, but the brain needs to keep working. And I find that to be really a sign of resilience and plasticity that we don't quite celebrate enough and we don't appreciate enough. And then, of course, the symptoms are no picnic. So those need to be addressed.

• 22:43Speaker 03

  But both things are really important to appreciate.

• 22:47Oprah Winfrey?

  What is happening when we're having brain fog? You know, we're just talking about how up to half of women report brain fog. So what is actually happening in our brain?

• 22:59Speaker 03

  So, brain fog is one of the most common symptoms of menopause, and one of those that we really don't talk about, but that is potentially even more disruptive to women than heart flashes and night sweats. In clinical terms, we talk about cognitive fatigue or mental fatigue, which I find to be a really good way to capture the experience that so many women have, that they're tired, then it takes them longer to do things, they have trouble multitasking, they have trouble with their memory, they have trouble even coming up with words.

• 23:34Oprah Winfrey?

  Right.

• 23:35Speaker 03

  The word "fumbles" can be very disruptive. What is happening?

• 23:39Oprah Winfrey?

  And concentrating too, right? Concentrating, because I remember when I was going through it and doing perimenopause, I did know that that's what I was experiencing. But I, you know, as much as I love to read, I couldn't finish a chapter. I couldn't like finish a chapter.

• 23:56Speaker 03

  And that is very upsetting to so many women. We need their brains to function. We need their brains to feel good also, and the quality of life. And we have so many women coming to the clinic with brain fog. I run an Alzheimer's prevention program. And we had so many women in midlife come to us with this brain fog, really worried that, number one, they could be going crazy. That would come up over and over. "I think I'm going crazy. I think I'm losing my mind." Or, "brain tumors." So many women come into us saying, "There's something wrong with my brain. I'm so worried that I'm having a brain tumor."

• 24:39Speaker 03

  Or even more so, early onset dementia. So, the symptoms, this brain fog that women can experience, can be so severe and so debilitating to really prompt serious concerns about mental health and brain health. So, I would like all women to know that brain fog can happen for many different reasons, menopause being one of them. It needs to be taken seriously without panicking. If it is menopause, and we can do all sorts of tests to understand where it's coming from and what to do about it. If it is menopause, very often it goes away temporarily.

• 25:21Speaker 03

  And it should go away when the transition is complete. If the symptoms persist or interfere with daily life...

• 25:30Oprah Winfrey?

  Or you're giving hormone, or you're giving therapy for it. You're giving hormone therapy for it. It can go away. Because my brain fog went away with estrogen and progesterone.

• 25:40Speaker 03

  That is very important information, I think, and something that we're looking into more thoroughly right now. It's tricky to measure brain fog. And some clinical trials have shown that estrogen therapy can preserve cognition. We do need to better understand if it can also bring it back, like you were saying, for you. It works so beautifully. For some women, it doesn't. So we really need to understand who responds and why, and then generate recommendations for all women.

• 26:18Oprah Winfrey?

  You talk about the three Ps, about puberty, about pregnancy and perimenopause. How are puberty and pregnancy relevant to menopause?

• 26:29Speaker 03

  Yes, and I find it so important to talk about it. So puberty, pregnancy, and perimenopause are all neuroendocrine transition states, which is a muscle, but it's really, it means that the brain and the hormonal systems are changing at the same time. And it's the same system. Women are born with the neuroendocrine system that directly connects the brain with the ovaries. And this is one of the most important systems that we have in our entire bodies. And this system is turned on at puberty with the arrival of sex hormones. And then it's really boosted during pregnancy, should a woman get pregnant.

• 27:13Speaker 03

  It crashes after pregnancy during the postpartum phase, and the brain needs to adjust another time. And then it is partially turned down after the transition to menopause, because at that point, reproductive life is over. And the brain needs to adjust to every one of these phases. And I will add that even just having a menstrual cycle is a little bit of a stress test on the brain, because every time the ovaries cycle, the brain microcycle. They're very small and subtle changes, but they're real. And some women really feel the effects. Other women are less impacted,

• 27:56Speaker 03

  but they are very real symptoms. And at each one of these transition states, we have actually similar symptoms. I think we all know that teenagers can be spacey, can be moody, could be sweaty, right? Pregnant women, likewise, there is potentially mommy brain or baby brain, which is the same thing, more or less, as brain fog. There can be depression, there can be mood changes, but also changes in body temperature. Almost 30% of pregnant women had heart flashes, but we never worry about it, right?

• 28:33Oprah Winfrey?

  Right.

• 28:34Speaker 03

  And then we go through menopause, and we experience some similar symptoms from the brain's perspective, but they could be more frequent, more severe, more disruptive, and they may last longer. So, the difference here is cultural, because puberty is celebrated. We're so happy about it. Pregnancy even more so. We throw parties, we have balloons.

• 28:58Oprah Winfrey?

  Right.

• 28:59Speaker 03

  And then menopause arrives, and nobody wants to talk about it. And you're basically left alone. But it's the same system that is changing over time. So I think it's important to appreciate that menopause is not an alien event that is hijacking your brain or...

• 29:18Oprah Winfrey?

  Yeah, women, we should have celebrations when women go into menopause. Halle Berry and I were talking about this on a special we did. I think there should be a big party when you transition into menopause, really.

• 29:30Speaker 03

  Yes, I told my husband.

• 29:32Oprah Winfrey?

  Yes.

• 29:32Speaker 03

  I was telling my husband, when I go through menopause, we're having a party.

• 29:37Oprah Winfrey?

  Well, one of the things, too, that has been so informative and that we talk about in the menopause book written by the O'Daly editors, that nearly two-thirds of all people living with Alzheimer's are women. I think that's a wake-up call. What have you discovered about women and Alzheimer's? You were saying you're working on Alzheimer prevention, and I keep reading that hormone therapy can actually lower Alzheimer risk. Is that true?

• 30:09Speaker 03

  It's a very big question. It's actually one of the most controversial and important questions they were asking right now in the field. My answer personally is that we need more research, we need more data. What we know right now is, like Mary Claire was saying, we have observational research suggesting that women on hormone therapy may experience a lower risk of Alzheimer's as compared to women who do not take estrogen therapy, especially those who experience menopause because of an oophorectomy, because of a surgery. Those are observational studies.

• 30:49Speaker 03

  They are very important, they are really good first step, but they do not provide definitive evidence. Definitive evidence comes from also other sources of other types of studies, like clinical trials. The question we should ask, and the question we are asking now, is what if women in midlife started taking micronized estradiol, micronized progesterone, the patch, other types of hormone therapy that are perhaps more prevalent and more commonly used now? Could that lower our risk of Alzheimer's? And the research is ongoing.

• 31:30Speaker 03

  I'm actually really happy to let you all know that we have launched a $50 million research program that looks exactly into this question.

• 31:40Oprah Winfrey?

  Well, that's good.

• 31:41Speaker 03

  It's called CARE.

• 31:42Oprah Winfrey?

  That's good to hear.

• 31:43Speaker 03

  Yes, I'm told is the largest global research program on women's health, menopause, and Alzheimer's disease ever attempted. I designed it, I have the honor of directing it. We're moving really fast. We have three years to give you this answer, and the year and a half is already gone. So very soon, I hope, we will have the answer that the women need. They need to have like the rigorous, evidence-based answer that also clinicians are comfortable with.

• 32:15Oprah Winfrey?

  I hear that female neuroscientists are also studying something called the cognitive load. Explain what that is.

• 32:21Speaker 03

  Cognitive load is a very interesting variable that is not typically assessed in cognitive science or neuroscience, which asks the question of how much are we asking this woman's brain to do? Right? Women in midlife are often a little bit squeezed between multiple responsibilities. There may be young children, aging parents, your career. There are so many things that are happening in midlife, and all of them require an enormous amount of cognitive reserve and resources which are not unlimited.

• 33:02Speaker 03

  And there's so much pressure and this mental overload for so many women that is not being taken into account. And I think it's really important to study women's brain health in relationship to the environment that the women are actually living in.

• 33:21Oprah Winfrey?

  Well, Pilar knows this very well, that Oprah Daily has covered the invisible mental load. We talk about this all the time. The invisible mental load that women carry. And I know you hear a lot about this from our subscribers. What are they saying?

• 33:38Speaker 04

  And I think as it relates to perimenopause and menopause, I think sometimes it's hard to distinguish what is just the complexity of modern life, to your point about being sandwiched generation, raising children, maintaining careers, maybe taking care of elders. It's a major, major load, and it's hard to know what's what when people think, am I losing my mind, or do I just have too much on my plate? It's a really simple question. And I think--

• 34:04Oprah Winfrey?

  Both can be true.

• 34:05Speaker 04

  Yeah, exactly right.

• 34:06Oprah Winfrey?

  Actually, both can be true, yes.

• 34:08Speaker 04

  And while we don't want to assign anything and everything to perimenopause or menopause, we need to, we need to pay attention to these things. And I think, you know, science will help us, even there's so many, you know, AI, AI for good. In this case, you know, looking at huge data sets and seeing sometimes atypical symptoms that, you know, start to form a pattern and, you know, can lead us to the conclusion that this symptom and that symptom that we never ascribed to perimenopause or menopause are actually symptoms of that.

• 34:38Oprah Winfrey?

  What are our readers saying? What are they saying?

• 34:41Speaker 04

  I think women are totally maxed. I mean, I think that's the, the short answer. I think, and I think, I think partners are coming along. I think they're, they're, you know, stepping in and sort of picking up some of the slack. But I think women just naturally, biologically, intrinsically, and also, you know, through societal pressures, take everything on. And, and I think they are, you know, now, once again, the power of sharing their stories with other women, at least now they're comparing notes and trying to figure out what's what? What's medical? What's just too much? And I think, you know, we are, these are the forever questions that we're asking.

• 35:23Oprah Winfrey?

  Dr. Moscone, you've said one of the more surprising things you've learned is that post-menopausal women are generally happier than younger women, and generally happier than they themselves were before menopause. And I'd have to agree with that. Why is that?

• 35:40Speaker 03

  Why? It's a very, very interesting question. I found that to be really surprising in terms of the research, which is still limited. But what those studies show is that when women are asked about life contentment and emotional well-being, they do tend to report higher levels of both after menopause than before. And we do know that happiness tends to take a dip in midlife and then go back up later on in life. There are some explanations, potential explanations for this. When it comes to menopause, one of the best studies that I've seen looks at the functionality

• 36:25Speaker 03

  of the brain, and there are some parts of the brain that are very tightly involved in emotional regulation. One of those is called the amygdala. And what scientists have found is that the function of the amygdala is specifically changed after menopause in that things that would drive you nuts before menopause don't quite have the same effect on brain activation. You don't react as much as you used to.

• 36:57Oprah Winfrey?

  Is it also because you just know more? You just know more?

• 37:01Speaker 03

  Yeah, you're done.

• 37:03Oprah Winfrey?

  It's true. What do you think?

• 37:05Speaker 04

  I think it's, I think it's both. I think this thing that we call wisdom probably does have some sort of neurological signature. I think when fear and reactivity goes offline, you prioritize things that are more important. I think there is something to, there's some truth to this. You just give fewer Fs--

• 37:24Oprah Winfrey?

  Yes.

• 37:24Speaker 04

  --later in life. I mean, you just do.

• 37:27Oprah Winfrey?

  Yeah.

• 37:27Speaker 04

  And, and I think it's what you're saying, Dr. Moscone, that, you know, the amygdala kind of takes a backseat. And I think our abstract thinking, our wisdom, what we call wisdom, is sort of this, you know, when, when, when we don't have interference from fear, anxiety, you know, annoyance, we can sort of come to full fruition in our midlife selves.

• 37:52Oprah Winfrey?

  You actually become more of yourself.

• 37:53Speaker 04

  Totally.

• 37:54Oprah Winfrey?

  More who you're supposed to be. What do you wish every woman would be asking her doctor?

• 37:58Speaker 03

  About prevention. It is so important for all women to be able to discuss prevention when it comes to brain health with their doctors, starting at a much younger age. You know, a woman can do everything right. She can get her PET tests, she can do her mammograms, she can do perhaps a colonoscopy, measure her cholesterol, insulin. But we're never asked about mental health. We're never asked about brain health, unless you just had a baby, right? And then you would go to the pediatrician, and they would do a little screening test to make sure you don't have postpartum depression or something worse. But there's really no framework to support women's brain health throughout life.

• 38:42Speaker 03

  So I really wish that all women would go to their doctors and say, okay, what can I do now--

• 38:47Oprah Winfrey?

  Now?

• 38:48Speaker 03

  --to support my brain today, tomorrow, and for the rest of my life? How do I prepare for things that will happen to me, like menopause or other? How do I really prepare for the rest of my life? And I really wish that doctors had the answers. So I hope that the research we're doing will contribute, and I hope that all women appreciate that there are so many things that we can do to support their brain health at any age, at any time of your life, and to really think more of your brain like a muscle, if you will. There are things that we can do to strengthen our brains and support their brain health. We can exercise our brains properly, we can feed our brain properly, we can take care

• 39:33Speaker 03

  of our brain properly, and their brains will do so much more for us in return.

• 39:38Oprah Winfrey?

  And what we're learning now is that exercise to the brain is its own medicine.

• 39:43Speaker 03

  Yes.

• 39:44Oprah Winfrey?

  Yeah.

• 39:44Speaker 03

  Yeah.

• 39:45Oprah Winfrey?

  Yeah. It's not just about staying fit. It's not just even about resistance. It is medicine for the brain.

• 39:50Speaker 04

  Mm-hmm.

• 39:51Oprah Winfrey?

  Also medicine for the brain.

• 39:52Speaker 03

  Yes, so when we exercise, actually, a specific protein is being released. It's called iodine that goes inside the brain and really supports the health of your neurons. So there's a direct chemical protection that goes from the rest of your body, inside your brain every time you exercise, which is one more reason to remain physically active.

• 40:15Oprah Winfrey?

  Dr. Moscone, you've been wonderful. Thank you so much. Thank you for your contribution here. And in our menopause book, thank you so much.

• 40:23Speaker 03

  Thank you very much.

• 40:24Oprah Winfrey?

  Okay, Pilar, there's a chapter on what menopause does to your relationships and another about what men are sharing themselves about menopause in the menopause book.

• 40:35Speaker 04

  Yep.

• 40:36Oprah Winfrey?

  So what have you and the other editors come to know about the people who are supporting their spouses?

• 40:42Speaker 04

  Well, first of all, the most supportive spouses are the ones who are actually reading up and hopefully buying this book and other books like it. I think, you know, information is power and understanding, I think, sort of baseline compassion rather than this business of just hormones. I think there's a lot of language that needs to be rethought. I think when we dismiss women's, you know, changes in women's health as just hormones, we're kind of dismissing the whole woman herself. Because in some ways, you know, hormonal health is women's health. This is something that I've learned. You know, Dr. Poynner, Elizabeth Poynner, who we talk about in the book, you know, sort of put it very plainly,

• 41:26Speaker 04

  that this notion of, you know, a woman's entire life really is a kind of series of, you know, inflection points, like the ones that we just heard about from Dr. Moscone, that we need to normalize that conversation, that it's not actually the exception. Like hormonal flux is the rule. And I think we need to kind of turn it upside down. I think we kind of think, oh, it's going to calm down. And it does. There are certain inflection points and things level out and, you know, normalize. But, you know, some of those inflection points can have, can be very disruptive to marriages. It can, you know, I don't like this conversation that, you know, divorce rates go up during midlife

• 42:11Speaker 04

  and this is all true. And sometimes, you know, sometimes women are sort of out of their heads and they are not who they want to be in certain moments. But sometimes the loss of estrogen, which is sort of the pleaser hormone, for lack of a better word, when that, you know, subsides, it reveals, you know, issues in the marriage that need to be addressed. And so, you know, both things can be true. I think there can be a lot of understanding and, you know, going along for the ride on the part of the partner. But also, I think, women need to look at the things that bother them, you know, when that sort of, you know, pleaser hormone starts to sort of subside.

• 42:53Oprah Winfrey?

  I hear a lot of our O'Daily community members are getting support from each other. Frida is joining us. Frida, hi there.

• 43:01Speaker 05

  Hi. Hi.

• 43:02Speaker 04

  Hi.

• 43:03Oprah Winfrey?

  Tell us about the support you've found in the O'Daily community.

• 43:07Speaker 05

  Oh, my goodness. First of all, thank Oprah and hi, Pilar. Thank you so much for bringing me into this such important conversation around menopause. I always heard my mom and her friends saying, the change, the change. And I never knew what this change was. And when I started going through perimenopause, I couldn't go to my mom. So I had to arm myself with some trusted source. And I came across Oprah Daily. And I was able to take that information to my doctor, get on hormone therapy. And I am running around here like a teenager now. I am so excited.

• 43:42Oprah Winfrey?

  Tell us what happened. Tell us what happened when... I often say, I did my first click, because I still do the creams. I did my first click and I was like, woo-hoo. Slept. The sky got clearer, bluer, veil dropped, all of it. So what happened with you, Frida?

• 43:59Speaker 05

  Oh, with me, what was happening is my mood. Like, I know what I'm saying is insane. And my husband thinks I'm insane. I think the kids were thinking I was insane. And I knew, I was going through a lot of different changes. Vaginal dryness, brain fog. And I said, okay, I can't do this anymore. And I took that information that I found on Oprah Daily to my doctor. I was confident enough to speak with my doctor about hormone replacement therapy. And I just, man, I just ran with it. And I just, I'm just excited. Like, I'm joyful. I feel like I'm in my 20s again, believe it or not. And I'm in my third year of law school. And so I need, you know, I have to focus. And that brain fog is just gone. And Oprah Daily has been a big part of that. And I thank you. And please keep bringing that information to Oprah Daily.

• 44:44Speaker 05

  Because if it helped me, I'm sure it's going to help other women.

• 44:47Oprah Winfrey?

  Well, we thank you. We thank you so much. And I know your husband thanks us, your children thanks us. Everybody thanks us. Thank you. So, Pilar, what is the biggest surprise you and the editors discovered while putting all of this information together?

• 45:04Speaker 04

  You know, I think I continue to be surprised by the same thing, that women still go to their doctor's offices and are discouraged from getting the care that they need. I know we've made huge strides and now there's, you know, greater access to doctors who are supporting midlife women's health. But I continue to be amazed that women are still fearful about hormone therapy and that doctors are still reluctant to prescribe. I think that continues to, you know,

• 45:38Oprah Winfrey?

  even hearing, yeah, even hearing here today that until 2023,

• 45:44Speaker 04

  Yeah.

• 45:45Oprah Winfrey?

  doctors, yeah, we're still tentative about it.

• 45:47Speaker 04

  We're still tentative. And I think it just, you know...

• 45:49Oprah Winfrey?

  And if you get the wrong doctor, you're not getting it.

• 45:52Speaker 04

  Right. And so I think, you know, it's changing. It's definitely changing. And that makes me very happy.

• 45:56Oprah Winfrey?

  And so you and the editors wanted to do this book because?

• 46:01Speaker 04

  Well, there are a million great books now that have been published. That we have actually, you know, from some of our, some of the guests that we're on today, we don't pretend to be doctors. We are journalists. And we have really kind of cherry picked and collected and distilled what goes on in your brain, your body, your mind, your spirit, your relationships with your spouse, with yourself, with your children. And really, it's a primer that you can dip in and out of. It is extremely accessible. Anyone can read this. And it should be passed along, I think, to spouses and children as well, so that they can get on board.

• 46:37Oprah Winfrey?

  The reason why I like it is because it's so readable. I mean, it's like, and you can just open to any page and find out the information that you want. It's so readable.

• 46:46Speaker 04

  It's packaged in a way that you can dip in and out of, so it doesn't, it doesn't feel like a textbook.

• 46:52Oprah Winfrey?

  Yeah. And if you know somebody who is going through it, is going to go through it, you're going through it, this is the perfect... It's a manual. I think it's like a manual.

• 47:01Speaker 04

  Yeah, absolutely.

• 47:02Oprah Winfrey?

  It's a manual for getting to it. Thank you, Pilar.

• 47:04Speaker 04

  Thank you for having me.

• 47:05Oprah Winfrey?

  Thank you. A big thank you to all of my guests for joining us. Dr. Mary Claire Haber, Lisa Moscone, Dr. Moscone, and to you, Frida, for being such an avid O'Daily subscriber and reader and viewer. The Book of Menopause: Real Talk, Real Science, Real Strategies for Your Next Chapter. And if you're a woman, it's coming. It's available anywhere you buy your books. And see you next time. Go well, everybody. If you want to learn more about what's going on in your body and brain during menopause, consider this book your guide, your here's what's real, here's what's changing, here's what you can do next companion. Just scan the QR code right there on your screen to get your copy of this Book of Menopause.

• 47:49Oprah Winfrey?

  This is actually a great time to take good care of yourself. I promise it's really, really helpful for getting to the other side. Our listeners tell us that the podcast is resonating with you and is serving as a bright spot in your day. That means a lot to me. So here's the thing. I would really appreciate it if you like and subscribe to the Oprah Podcast on YouTube or wherever you podcast. It's just a quick tap of the subscribe button. And that way, you won't miss an episode in your queue. You don't have to pay anything. I know subscribe usually means you're paying something. But this time, it means you just are notified when there's something new. There are many more to come that we're excited about. So thank you for watching and listening.