Let's Talk Menopause (2020)

[bunniefuu]

You know, there really should be a mandatory master class

for midlife women's health to help prepare women

for the physical and emotional changes

that will inevitably occur.

I'm Dr. Tara Allmen, author of "Menopause Confidential,"

and a menopausal woman myself.

That means I'm old and wise enough to give you

the talk that every woman should have as she enters

the wonderful world of perimenopause and menopause.

There are as many ways of going through

perimenopause and menopause

as there are women who go through it.

For a lot of us, it's, like, as mysterious and as...

unsettling as puberty can be.

I do believe that it's our fundamental responsibility

to open up this conversation.

Today, you're going to learn from

experts in this highly specialized field,

as well as real women sharing

their unique stories.

By the end,

I have no doubt that you'll be all fired up

to get more information and make great decisions

about your own midlife journey.

So ladies and gentlemen,

crank up your fans and air conditioners

as we get this hot flash party started.

♪

I always knew I wanted to be a doctor.

I've known since I'm a ten-year-old.

And I trained to be an obstetrician-gynecologist.

But somewhere in my s, I realized

that I had a great passion for taking care of women

in their s, s, and beyond,

because there was so much confusion

for this group of women,

and nobody was teaching them anything about

perimenopause and menopause.

Could I just ask what this meeting is for?

Is this angry divorcees or...

[laughter] Croning?

No, menopause, Bo.

Oh, we don't have that in America.

[laughter]

We don't believe in it.

Perimenopausal women and menopausal women

absolutely express fear.

It's really fear of the unknown.

Am I going to get all wrinkled up

and shriveled up?

And is my sex drive ever coming back?

I tell all perimenopausal and menopausal women

not to be fearful.

Don't be hopeless.

There are so many great strategies,

and treatment options, and things that you can do

to have health and wellness from now

into your little old ladyhood.

Let's get started.

You start getting hot flashes,

you're about , a woman, not relevant to men.

About the way my mum is now, about .

[laughing]

Get very grumpy.

Well, it's known kind of for old age.

It's kind of when you get old

and you start to forget things or get really fussy.

Menopause is something older women get.

Um, I guess it's a change in their body?

Menopause literally means the end of menstrual cycles.

And the formal definition is that you don't have

any menstrual cycles for months in a row.

The average age of menopause is ,

but there's an age range anywhere from to .

And it never ends.

Menopause goes until death do us part.

And so many women don't realize that.

Menopause by definition is a year of not having a period,

so it's actually a retrospective diagnosis

made after a woman has stopped having her periods

for months.

And surgical menopause is if for any reason

somebody's ovaries are removed.

So they would go through menopause

immediately upon removal of their ovaries.

Perimenopause is different than menopause.

Perimenopause is the lead-in to menopause.

And it usually starts in our s.

And it's marked by changes in menstrual cycles,

although some women in their s can start

experiencing changes in their menstrual cycle.

And perimenopausal women will start to not feel well.

They won't know why they don't feel well,

but they may start having hot flashes,

and night sweats, and moodiness, and weight gain.

There is a relationship between when our mothers

made that journey through menopause

and when we will.

So if your mom is still around

and can remember,

you want to ask her, you know,

what went down when it was her turn.

Here's a really important point for the perimenopausal crowd.

You're still ovulating eggs, and therefore,

you still can get pregnant, so you better not

toss out your contraception just yet.

Turns out you were right.

You're perimenopausal.

You're also pregnant.

What?

Premature menopause

is when you stop having menstrual cycles

before the age of .

There are additional health concerns

associated with having menopause so early,

such as an increased risk of heart disease and osteoporosis.

The difference between post-menopause

and menopause is specifically that once a...

It's just a matter of terminology.

Once a woman has gone months without a menstrual period,

she is now in menopause or is post-menopausal,

and that's going to stay that way

for the rest of her life.

♪

There are about million

perimenopausal and menopausal women

in this country, and most of them are confused

and don't know where to go for information.

I believe perimenopause hit me

around or years old,

and I just figured, "Oh, menopause?

"I'm kind of looking forward to that.

"I won't have to buy feminine hygiene products anymore,

won't that be great?"

I was a supermodel in the 's,

I've worked for every designer,

I've been on the cover of a lot of magazines,

I had a great career.

And then I kind of hit a wall when I turned , .

I started to become perimenopausal

and going into menopause, and I was, like...

in the dark.

It's a huge gap in our education.

I wish I had read more, understood more,

and been able to get out ahead of it,

rather than being surprised by it.

I think the most important thing

about perimenopause and menopause and women

is that we have to band together

and support one another,

and tell each other that it's going to be okay.

I like to think of menopause as

ovarian retirement.

Our ovaries have a job to do.

They have to ovulate eggs.

They have to make estrogen, progesterone, and testosterone.

And they have to do that for to years.

Estrogen is so important for the health of women.

I like to think of that expression, you know,

"Women are made of sugar and spice and everything nice."

Well, the "everything nice" is estrogen.

Estrogen really is in charge

of health from basically your head to your toe.

From your hair to your toenail and everything in between

is dependent on estrogen.

Hormone levels in perimenopause

tend to be variable for people.

Generally what happens is,

if they are having regular menstrual cycles,

they are having the same amount

of estrogen and progesterone.

However, if they are missing periods,

those months, they may have low levels of estrogen.

And some months, they may actually have

a lot of estrogen, and during those months,

sometimes they'll have heavier and prolonged bleeding, as well.

So hormone levels in perimenopause

are very variable for most women.

The fluctuation in estrogen levels

appears to be the underlying cause

for many of these menopausal symptoms,

such as hot flashes, night sweats.

In particular, it's the fluctuating levels.

Many of these symptoms will actually get better

after a prolonged period of having low but stable levels.

It's important to remember that hot flashes

and night sweats can last on average for seven years,

and some unlucky women can suffer for more than .

That statistic alone is giving me a hot flash!

Do you think men should be educated about menopause?

Sure, we got to deal with it.

They should know, because it's, like, uh...

It's a normal... I don't know, I don't want to say issue...

It's a normal stage of the woman,

and you have to understand...

You got to understand that a stage

that is the end of the fertility of the women.

Do you have any menopausal women in your life?

I do. I do.

That's why I drink. [laughs]

You guys have a great day.

I like to say that every man needs a gynecologist,

and this is why: every man has a grandmother,

a mother, a wife, a sister, an aunt, a daughter.

There's some woman in his life.

Maybe now is a good time for me

to explain a few things to you about menopause.

[laughter]

And lucky for you, I'm a nurse,

so I can use the proper terms,

like epithelial lining and uterine wall.

[men groan, audience laughter]

In my experience, men really do want to know

a little bit about this topic.

I think it's really important that men know about menopause.

My husband is a really smart guy,

and he's a really caring guy,

but he knew a lot less than I did

about menopause when I started going through it.

I think men know more about almost everything than

how their female partners work.

I think they know... ask them about

who the second-string quarterback

of their favorite team is,

and then ask them to explain perimenopause,

and watch what happens.

I've tried to educate myself,

but I think the most important thing is

to be there and not, you know,

run away and stick your head in a bag.

I got to tell you,

a lot of the things I was going through

inconvenienced him.

And continue to inconvenience him to this day.

I sleep with the window open even when it's degrees out.

I mean, just a crack, just a crack.

I wear thick socks.

I wear sweatpants.

And I wear a hoodie if necessary,

because that bedroom is freezing.

I feel like Nanook of Harlem.

♪

So many women struggle with hot flashes,

night sweats, mood changes, weight gain, brain fog,

poor sleep, fatigue, vaginal dryness,

and a decreased interest in sex.

But not all of us are going to

experience symptoms the same way.

Some of you are going to be lucky

and have mild and manageable symptoms,

but the rest of you are going to complain vociferously

about this and that-- I can hear you now.

Could I bother you for a glass of water?

I'm burning up. Yes.

[whispers]: Hot flashes.

Mm!

Hot flashes are the most common menopausal symptom

and the second-most common perimenopausal symptom,

and % of women will get to enjoy them...

[laughs]

...on average for about seven years.

Hot flashes are a sudden, intense feeling of warmth,

usually starts in the chest

and goes up into your neck and to your face.

Then you can start flushing, and sweating,

and then the chills can come.

You may feel anxious.

You might even have some heart palpitations.

I'm a skin health expert; I co-founded

a multilateral organization that supports

beauty entrepreneurs around the world.

I do a lot of public speaking,

and to be on my mental game

is of the utmost of importance.

Perimenopause hit me in the summertime.

I was , which wasn't that long ago.

And it just came out of nowhere.

And it was really the hot flashes

and the night sweats that I couldn't control.

And I was about to go on stage to moderate a panel,

and I had to tell my team, like,

"You have to watch me because I think I'm going to pass out."

And it was so scary not to have any control

over these symptoms.

What happens when hormones are fluctuating,

estrogen is fluctuating and declining,

is that the thermostat,

which is in the brain, begins to be

very, very sensitive to any change in body temperature.

So, if there's a small increase in body temperature,

women will feel uncomfortable

and begin to have that sensation of warmth.

And the reason you have the flushing and the sweating

is that the body's trying to dissipate heat

and to cool off.

Every hot-flashing woman knows

that you have to start dressing in layers

so that you can remove clothing

when you start to have a hot flash.

This is very important.

So there are some strategies.

You want to drink cool liquids.

You want to be in an air-conditioned and fanned room.

Night sweats are the same hot flashes

occurring at night,

but sometimes they can be quite severe

and awaken a woman from sleep, often many times a night,

where she wakes up in a drenching sweat.

And that can be very disruptive to sleep

and can actually lead to fatigue

and decreased concentration and focus.

All of a sudden, you wake up

and it's, like, your hair's wet,

and your nightgown's wet, and the sheets are wet.

One way to minimize these hot flashes

is to understand what the personal triggers are,

such as alcohol, spicy foods, hot coffee.

It's also been found that there are emotional triggers,

and sometimes when a woman is very upset

about something that's just happened,

that will precipitate a hot flash.

So treatment strategies are based on frequency

and disturbance and disruption,

which is so personal, of course.

We have at the mildest level,

you know, lifestyle changes about what people wear

and how they cover themselves.

Wearing light clothing,

getting air movement

in their, you know, bedrooms for nighttime.

There's also some cognitive strategies

about how to be mindful about what's happening

in a way that doesn't bother them so much.

The mood changes happen, and it's, like...

[sighs]

You have to kind of stay conscious

of the fact that sometimes, your mood

will absolutely not match anything that's going on.

Like, you know, it's an okay day

and everybody's fine and nobody's insulted you

and nobody's on your nerves that much, but,

you know, you start to go very dark.

And you start to feel really irritable, um...

I'm pretty good at saying to,

you know, my husband and my kids, uh...

"I'm sorry, I can't control my mood.

"I don't like the way I feel.

"And I don't know why I feel this way

and I can't control it."

So about once a week, I hear a woman say to me,

"My husband thinks I'm crazy."

But I always say, "You don't need a husband,

"your partner, your co-workers, your children.

You yourself feel like you're going crazy."

Mood and depression problems

are, are common across the perimenopause transition.

The good news is that most people

do not have severe mood problems.

It is very treatable and can be managed

with lifestyle changes, with counseling,

and when it's more severe, with medication treatments.

The mood changes for women,

in that perimenopausal transition, especially,

can really be, "I feel a little blue.

"I'm not really that interested

"in the activities that used to bring me pleasure.

I feel more anxious for some reason."

If you suffered from PMS symptoms as a younger woman,

or you had postpartum depression after you had babies,

you're actually more at risk

for mood symptoms in perimenopause.

People who are likely to have significant mood problems,

severe mood problems that warrants,

you know, more intensive treatment,

are women who have a history of mood disorders

before midlife and menopause.

And it would be very atypical for somebody

to go into a very severe depression

if she's never had that kind of problem before.

So many perimenopausal

and menopausal women will think

they're getting Alzheimer's disease

because they become a little more forgetful

and they're having a hard time with focus

and concentration.

So immediately, they think they have Alzheimer's disease.

But it is so common during this menopause transition

to experience what I call brain fog.

It's important to think about

whether they're having hot flashes and night sweats,

sleep disturbances, anxiety, mood changes,

because all of that can affect brain activity

or cognitive abilities, as well.

My husband and I have a duo cabaret act together.

And when I started getting brain fog,

when I started not to be able to come up with words,

when I started not to be able to remember my own jokes,

I was really angry.

Trying to learn new material

just became much more of a challenge.

And coming up with jokes off the cuff

is a big part of what we do in our act.

Are you, a woman, correcting me, a man,

in front of all these nice people?

Okay, look.

First of all, I know a lot of these people,

and they are not nice.

[laughter]

Especially him. [laughter]

I started to feel dumb, and that's...

the kiss of death for what I do,

to start to feel dumb or dull.

Some of the best things to do

when women are experiencing brain fog

is just to be physically active,

having a healthy diet, avoid alcohol,

and try to improve the quality of the sleep.

The good news is that

once the hormones stabilize,

even at a lower level, it does tend to get better.

Are you wondering if you'll ever feel like yourself again,

like the you you knew and loved

when you knew and loved you?

The answer is absolutely yes.

Many women in their s and s

show up to the perimenopause and menopause party

without a clue as to why they feel so miserable.

But not all of us are going

to experience symptoms the same way.

Some of us are going to be lucky and have mild symptoms,

and some of us are going to have pretty severe symptoms,

and there's really no rhyme or reason about

which one of us has which journey.

There are three lucky women who don't gain weight

and then there's all the rest of us.

So what happens when we're not feeling well

is, we're not making the same healthy choices

that we might have otherwise made.

We're not getting good sleep,

so we're not eating well the next day.

So, yes, ladies, you are going to gain weight,

you're going to redistribute it to your middle,

and you're going to be very cranky about it.

Hey, how are you?

Can I get a regular coffee with half-and-half

and one Splenda, please?

I have always had trouble with my weight.

When perimenopause hit,

all of a sudden, I put on, like, pounds.

And I felt so defeated.

And I was working out very hard--

high-intensity interval training--

and I was not losing an ounce.

Unfortunately, there are some of these

unfavorable changes in body composition

that have been identified at the time of menopause transition.

I think one of the things that happens

with a change in estrogen level and in menopause

is that we tend to lose our muscle mass.

So it is important for women to do weight-bearing exercises

or some sort of resistance training.

If they have more muscle,

they're gonna have an increased metabolic rate,

which is gonna help them avoid weight gain.

There is actually data

that if women are overweight and they lose weight,

they tend to have less menopausal symptoms

such as hot flashes and night sweats.

Every midlife woman needs to know

that it's going to be next to impossible

to have the same interest in sex

that you did when you were in your s and s,

because you're no longer making estrogen, progesterone,

and testosterone in the same quantity that you did before.

However, I don't want women to be dismayed

about issues with libido.

If you want to have an enjoyable sex life, you can.

There are some changes that occur,

especially with vaginal health, as we get older.

So we have to start tending to our vaginas, ladies.

There are vaginal changes that do occur for women

that can start even before they are,

they go through menopause.

Some women may notice that they are having more vaginal dryness

and discomfort with intercourse.

The treatment for vaginal dryness is to use

a small amount of estrogen,

which is available in a cream, a tablet, a ring,

or an insert that can be placed in the vag*na.

And it is % local treatment, just in the vag*na.

So it's not absorbed,

and there aren't as many systemic health risks

associated with it.

Over time, if it's used regularly,

it increases the collagen content

and the health of the vag*na.

Libido is complicated for women.

The highest levels of libido

are in younger people, in their s.

And there is a decline for most people throughout their lives.

The first things you want to think about

when women complain about low libido is to think about

whether there is pain or discomfort with intercourse.

Other things that we always think about

is woman's physical health, her psychological health,

relationship issues.

There are two medications

that are currently approved by the FDA

specifically for low libido in premenopausal women.

One of them is an oral pill,

which can be used on a daily basis.

And the other one is an injection

that is used as needed, which can be taken

minutes or longer prior to intercourse.

Sometimes I would only sleep five hours,

but even if I slept a lot,

I always felt like I needed more sleep.

I just didn't want to do anything but sleep.

And fatigue would hit me

in the afternoon at, you know, :.

Oh, you know, we all have a little bit of a crash at :,

but I mean, like...

So much fatigue that I wanted to cry.

For women across the menopause transition,

sleep is one of the most common symptoms

that is quite distressing.

The nature of the sleep problem in menopause

and the perimenopause transition is a waking up problem.

And the most common reason why women are waking up

in the middle of the night

is that they experience night sweats.

Even when they're not having a hot flash,

the rest of their sleep is rather disrupted.

Part of it is the amount of time that they're sleeping,

but a big part of it is that it's not a smooth flow

between all the sleep stages, that it's, that they...

They're very interrupted:

a short light sleep, a short deep sleep,

a short light sleep, a brief awakening,

so it's not, it's not a consolidated pattern,

which is really what you want to feel refreshed.

It was to the point where I was only getting

maybe one really good night's sleep,

where every single other night was riddled with anxiety

and then insomnia.

So they went hand in hand.

We know that when women are sleeping poorly

with hot flashes-- which is usually not just,

you know, one night, or one week or one month,

it happens over many years--

they accumulate a sleep deficit.

It also, in terms of brain function,

can really contribute to mood changes.

So low mood, you know, negative mindset,

feeling kind of blah or down,

or very sad, can-- are really linked

to this unrefreshing sleep and this sleep interruption.

The most important thing that women can do

to help preserve cognitive function, in my opinion,

is to get a proper night's sleep.

And that means that we have to go to bed

about the same time every single night of the week.

And no, you can't binge-watch your favorite shows.

And no, you can't check your last email.

You really have to be respectful and protective

of your sleep habits.

When you think about a menopausal woman,

what kind of images come to mind?

[laughing]

Angry face.

Uh...

Getting old.

Yeah.

Are there any women in your life

who have gone through menopause?

Uh, I guess, maybe my mom?

I guess-- she's in her, like, s.

Maybe she, maybe her menopause, uh, started, or...

When you think about a menopausal woman,

what kind of images come to mind?

Myself.

Once we hit menopause

and our ovaries are no longer making estrogen,

we're going to really see a lot of changes,

and not for the better,

in terms of overall health and wellness,

in terms of heart health, bone health, brain health,

the health of your hair, and your skin, and your nails,

and all your bits and pieces in between.

Osteoporosis and related fractures

are an enormous health problem for women,

and women are at four to five times the risk

of osteoporotic fracture compared to men.

Women who are at the highest risk of osteoporosis

are those who have a low body weight.

Women who smoke have an increased risk of osteoporosis,

and there are genetic factors, as well.

A mother with a hip fracture and a history of osteoporosis

may be a sign that you are at increased risk.

One of the most important ways to reduce the risk

of osteoporosis is to be physically active,

and strength training, resistance training,

will go a long way in improving bone strength.

Diet may play a role-- there's some evidence

that having adequate calcium,

vitamin D,

and avoiding very high intake of alcohol

or carbonated beverages also would be important

for maintaining optimal bone health.

The real key, the real secret here,

to not having an osteoporotic fracture or bone fracture--

a bone attack, you should think about it that way--

is to start introducing balance training.

Nobody tells women that.

So you can start with a nice tai chi class,

or you can do something as simple as standing on one leg

and balancing for a period of time,

and then switch your legs.

The secret to not getting a bone fracture,

really, is not to fall down.

And how do you do that?

You start practicing balance training.

I don't think women realize that

the number-one k*ller of women

in this country is heart disease.

And we're protected when we're younger,

reproductive-aged women with estrogen.

But once we stop making estrogen,

all of a sudden, we have the same risk as the men do.

And our risk of heart attack goes up.

We have a great deal of control

over our risk of heart disease.

Heredity is not destiny.

There are some genetic factors that will increase our risk,

but there's so much that we can do.

% of heart disease is preventable

by lifestyle modifications.

The highest risk of heart disease

are those who are smoking, sedentary lifestyle,

not being regularly physically active,

not having a healthy diet.

♪

I mean, when you have a lot to do, you know,

and you love the life you lead,

you know, you love your partner, you love your kids,

you love your job, feeling good, feeling back to normal,

feeling yourself, that's everything.

Menopausal women, perimenopausal women,

we're all different.

We have, many times, multiple symptoms.

So you really have to take the whole big picture

into consideration when you make your choices

for which strategies.

Not all women will need prescription medication,

so we also can be reassuring that most women

do not have symptoms that are so severe

that they require prescription medication.

So if you're a menopausal woman

with hot flashes and night sweats,

or you're at increased risk for osteoporosis,

the gold-standard treatment is FDA-approved hormone therapy.

And that means estrogen for the treatment of your symptoms

and the protection of your bones, and progesterone

if you also have a uterus, to protect the uterine lining

from getting overstimulated by the estrogen,

which has to do all the work.

Hormone therapy does have some risks

and benefits for women.

So it's important to talk to the patients about the risks.

The main risk it has if somebody is around the age of menopause

or less than years old is, there is a slight increase

in breast cancer, which is fairly minimal,

and it's particularly not as worrisome

if patients are on hormone therapy

for just three to five years after they stop their periods.

In terms of blood clots,

there's also a slight increased risk for blood clots,

but again, it's fairly rare.

So I think that talking to patients

and explaining that the risks are fairly small,

and especially presenting numbers,

a lot of people might be reassured

and may elect to choose hormone therapy.

♪

The use of hormone therapy has fluctuated a lot

over the past many decades.

We were prescribing a lot of hormone therapy

for women in the past.

Uh, in fact, up to half of all women

who were in menopause were on hormone therapy

at one point in the s and s.

What was so surprising was that

the Women's Health Initiative,

the largest randomized trial

of hormone therapy, suggested that

overall, the risks of hormone therapy

were outweighing the benefits.

With estrogen plus progestin,

there was an increased risk of breast cancer

that began to emerge after about

three to four years of treatment.

There was tremendous confusion and fear

surrounding those findings.

But after delving more deeply into the results,

we now have really clear evidence that the women

who were younger and closer

to the onset of menopause at the time

did better on hormone therapy than the women

who were older and very distant from menopause.

The women who should consider hormone therapy

are the symptomatic women.

So if you're hot-flashing

and you're sweating all over the place,

you're absolutely a candidate.

If you're less than ten years

from your final menstrual period,

you're generally healthy,

you are a candidate to consider hormone therapy.

There are some women who are not candidates

to consider hormone therapy.

So for instance, if you have breast cancer

or active heart disease,

if you've had a history of heart attack or stroke,

if you're having bleeding that's unexplained,

there's a group that really cannot use hormone therapy,

but the vast majority

of younger, healthier, symptomatic menopausal women

can consider it.

Some of the newer treatments that are available

include transdermal-- the patches, the gels,

the sprays-- which are less likely

to increase the risk of blood clots in the legs and lungs.

And also, there are lower doses that are now available.

For me, I just needed...

I needed an estrogen therapy.

So it's as simple as, you put a patch on it twice a week.

And it works really well.

It works really well.

The brain fog has lifted, energy better,

sleeping better, hot flashes are almost non-existent.

This is just me.

So, you know, I'm not saying that there's...

a one-and-done cure-all for everybody,

but there is help if you go to a doctor

and you get an individualized treatment.

Perimenopausal women, remember,

are different than menopausal women.

They are still making hormones.

So they are not candidates for hormone therapy.

Instead, perimenopausal women who are symptomatic

do great on a low-dose birth control pill.

My solution?

Should I tell you my solution?

Was the pill.

I got the pill,

and within five days, every single symptom went away.

I got my life back %.

Not everyone gets to consider hormone therapy

for the treatment of their menopause symptoms,

but don't worry, there are other strategies.

For instance, they can consider

selective serotonin re-uptake inhibitors--

those are SSRIs--

or serotonin norepinephrine re-uptake inhibitors.

Say that three times fast.

These are antidepressants that we have used very successfully

for symptomatic menopausal women.

And, in fact, there is an FDA-approved, low-dose

antidepressant specifically for the treatment

of menopause symptoms.

Now, here comes a really important point:

you really have to partner with an expert

in midlife women's health in order to know

what is the right strategy for you.

I would say most symptomatic women really reach

for non-prescription strategies first.

Whatever your best friend tried,

you're more inclined to want to try.

But there are very few

scientifically studied strategies

that have been shown to be helpful.

A large percentage of women do use alternative

or over-the-counter products for menopausal symptoms.

There's many available on the market.

A lot of products that are over-the-counter

are not FDA-approved, and there's really very little data

for whether they work or not.

One of the most common is black cohosh,

which is a plant-based estrogen product

that has a weak binding to the estrogen receptors.

And it will be helpful in some women;

however, the data suggests that

it's not necessarily any better than using a placebo.

There's a lot of talk about whether midlife women

should eat more soy foods.

Will that help relieve menopause symptoms?

And soy foods are delicious.

You can get them in the form of tempeh,

or soy milk,

edamame-- they're all very healthy,

but they really won't help reduce hot flashes.

What I always say to women is, you can try

any natural strategy that you want.

Give it about three months.

If it's not going to work for you by that point,

it's probably not going to work for you ever.

There is a few studies

that have looked at acupuncture for treatment

of hot flashes and night sweats.

And there is some data that it seems to be

a little bit better than placebo for some patients.

I went to acupuncture really looking for help

with my menopause symptoms-- with the hot flashes

and the brain fog-- and I always felt better

after an acupuncture session.

I was having a lot less anxiety.

Some of the triggers for menopausal symptoms

like hot flashes can be related to anxiety and stress.

So if we can do anything to help patients

reduce their stress and anxiety,

such as meditation and yoga,

as well as cognitive behavioral therapy,

that's something that patients can also try.

I ended up finding a meditation app

that spoke to me, and something so simple

has changed my levels of anxiety.

And now I have more sleepful nights

than I do sleepless nights

because of that one simple act of meditating

before I go to bed.

Finding this meditation app was perfect-- was perfect.

Coupled with the pill,

I am just, like, in heaven.

[laughs]

♪

All perimenopausal and menopausal women

need to start making really great lifestyle choices

that we've put off because we've been so busy

taking care of everyone else,

but I like to think of perimenopause and menopause

as the chance to finally get yourself

on your own to-do list.

All menopausal women should be out, loud, and proud... [laughs]

And announce to everyone,

"I'm a menopausal woman and I'm really fabulous,

thank you very much."

My best advice is to speak up and don't be afraid.

Don't la-di-dah your way through it.

Um, forewarned is forearmed.

Own your age, own your beauty,

own your power.

And understanding your body is a beautiful thing.

And growing old with a lot of wisdom,

that's really powerful.

I really want all of you to know

that menopause is the best time of your life.

And I mean that sincerely.

In my opinion, there's all upside.

Now you get to be the woman

you've always wanted to be, but you've been putting it off.

Yes, there are some health challenges.

Yes, you're going to have to make some important decisions.

And, yes, you're going to be in charge, finally,

of your destiny, and now you know it.

So get started... [laughs]

On this really exciting time.

♪