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I'm getting ads for weighted vests and warnings to watch out for rising cortisol levels. It's a lot, even for a health journalist like me to wade through. But thankfully, I'm not alone. I recently sat down with Emmy-winning writer and comedian Samantha Bee, who shared her journey leading up to menopause with me, and how the way we talk about it is changing.
Less than 10 years ago, nobody was talking about menopause. And I mean like zero people. So we're all kind of talking about it now and you can read about it and people are like, yeah, but eight years ago, zip. Like zero information. Nobody in the conversation. Not cool. Very unsexy. Mention it and you are just like a witch crone who lives in a cave. Don't come out. Okay.
If you missed it, that's last week's Chasing Life episode. And during our chat, Samantha told me there's one person who's really helped her navigate all of this. I would say that Dr. Gunter is my spirit animal. She told me that some of what happens when you are in perimenopause is that your brain is creating new neural pathways because it is
It's kind of cleaning itself out. It's kind of scrubbing out all of the neural pathways related to like getting pregnant, feeding a baby, like all of those like early childhood maternal pathways in your brain. It clears a little bit of space so it can be a time of tremendous creativity.
Dr. Jen Gunter is a gynecologist and author. Her book, The Menopause Manifesto, is a New York Times bestseller. She's earned a name for herself as the Internet's OBGYN for her work debunking some of the myths that surround this stage of life.
And these days, there seem to be plenty of those. So today, Sanjay has once again agreed to pass me the mic for part two of our deep dive into menopause. And I decided to sit down with Dr. Gunter to get her help demystifying all of it. If you want a little help separating menopause myths from the actual medicine, this one's for you. This is Chasing Life. Dr. Jen Gunter, thank you so much for being with us today. Thank you for having me.
So last week we talked with Samantha Bee, who is a big fan of yours. I'm sure you already know that. You know, and one of the things we talked with her about is that as she was going through all of this, it took her a long time to know what it actually was. Is this a common experience that you hear from people? Yeah.
Yeah, I mean, I think that it's related to several different factors. So first of all, we don't talk enough about the menopause experience. So if you've never heard about it, how would you really know what's going on with your body, right? So there's that. A lot of women get their symptoms dismissed, but also the symptoms can be really nonspecific. You can have irregular periods for other reasons. You can have heavy bleeding for other reasons. You can have hospitalization.
Hot flashes for other reasons, brain fog, just not feeling yourself. So there's, I think, a combination of reasons that a lot of people don't realize that's what it is until they're in the middle of it. And, you know, we don't talk about menopause or really...
human physiology in general in any kind of good way. And I think that most people probably graduate high school knowing more about frog biology than human biology. And then if you look at human biology, they probably know the least about the reproductive tract. And then if you look at about sort of the reproductive tract, they probably know the least about menopause.
That is such a good point. Well, let's talk about it and really try to kind of demystify, I think, what this process is. So I turned 40 at the end of last year, and I have been led to believe by social media that now I need to wear a weighted vest, like not do too much cardio because my face is going to puff up because of all the cortisol.
And there's just a lot of stuff coming at people of my age about what to expect with perimenopause. Right?
Well, can you tell us what we actually should expect, what to expect when you're expecting perimenopause? Sure. Well, first of all, you're still a human. So things like, oh, cardio is bad for you, that doesn't apply. Those are people trying to sell like coaching services or, you know, they're cherry picking one.
bad article, fear-mongering. That's what it's all about because that's what gets attention on social media. So menopause is your last menstrual period. That's around the age of 51 in the United States. And then if you look at the range where that can happen, that's kind of age 45 to 55. And the menopause transition is sort of the hormonal changes that start to lead up. And we might refer to that as perimenopause.
In perimenopause, the average age it starts is 45, so for some people it can be younger, some people it can be older. It can last about 4 to 10 years and that's when symptoms can start, but they don't always. It's really a wide range of experiences.
In general, we say perimenopause has started when you start to notice changes with your menstrual cycle that are happening like on a regular basis. So normally cycle to cycle, we say that you can have a seven-day swing. So it could be every 28 days and every 32 days and every 25 and that's all normal.
And with the very first start of the menopause transition or perimenopause, we're starting to see more than seven days. And so that means that you're likely in the early menopause transition. And then when you're skipping a period, then you're probably likely in the late menopause transition, late perimenopause, and you probably have about one to three years to go.
Hmm. And so we always hear about, you know, I'm in menopause or when we do see it represented in pop culture, it's usually things like hot flashes and things like that. But what you're telling us is actually menopause is really like one point in time that you can't really tell until like at least a year after it's actually happened. And what we think of as menopause and going through all of these different symptoms is actually sort of perimenopause. That's the time when you're experiencing all these things.
So I would tell people to not get too hung up on perimenopause and menopause because it's
There are only a couple of situations where it matters. So when we're studying something medically, we need to have a hard start date, right? Like if we want to study everybody who's similar in a group, we need to be able to say, okay, well, all these people are after their final period or all these people are before their final period. And it also matters because we can't tell you that you can't get pregnant until you're kind of a year past your last period. So for somebody who has concerns about fertility, it matters then.
And it also matters when we're investigating a regular bleeding. So if you have bleeding after your final period, when you're in menopause, we need to rule out cancer. So those are kind of the three reasons why it really matters. And for a lot of people, that doesn't matter day to day because you can have symptoms in both. I like to call it the menopause experience or the menopause continuum. What are some of the things that are most commonly experienced during this time that people should be aware of?
Yeah. So the most common symptom is a regular bleeding. I mean, I'm sure there's a rare unicorn who had regular periods and then boom, it stopped. Just like there's people who didn't have any pain during pregnancy and delivery. There's always one. So that can happen. Hot flashes are also very common, wide range of experiences. So maybe about maybe 75% of women, 80% will be bothered.
For some people, they can start earlier. Some people, not until after their final period. Some people, they can go on for more than 10 years. Other people, it's going to be shorter. Brain fog is another common symptom that we hear about, disturbed sleep.
Joint pain is another common symptom. Depression is something else that can happen. Heart palpitations, something that's reported. Vaginal symptoms such as dryness and pain with sex. And then irritation, things like that. And then as I alluded to, there's also sort of a change in health trajectories. So an increased risk of osteoporosis, a change in health trajectory for cardiovascular disease, diabetes, metabolic syndrome. And those are probably like the most common
the most common ones that we hear about. This sounds great. Well, think about all these things that are also with aging, right? So with aging, you have these increased risks as well. You just have to look at it as, well, this is how your body changes and isn't it good to know about how your body changes? I think the most important thing is to talk about it so people can be open and honest and then they can make educated decisions.
Yeah. Well, that was one of the things I really liked that I read in your book. You pointed out that women who live in cultures that use terminology that references a change of life instead of menopause tend to be less bothered by common symptoms of menopause. Can you talk us through that a little bit? Yeah. I mean, it's fascinating. But how you talk about something actually changes your thoughts about it.
And, you know, this doesn't mean people don't have hot flashes. It doesn't mean that people are making it upwards in their head. It means that we have a mind-body experience. So yeah, if you think about it, if everybody around you is telling you that you're an ugly old hag whose time has come and, you know, all you're seeing are 70-year-old men dating 20-year-old girls and you're going to start to feel like,
You could see how someone would feel worse about maybe the changes happening to their body. Although...
Men get euphemisms. They have erectile dysfunction. We don't say penile failure. If we talked about men's bodies the way we talked about women's bodies, whew, that would be a whole different ballgame. And, you know, so I just think it's important that we have a level playing field in terminology as everything else. What are some of the things we hear so much about men?
hormone treatment, hormone replacement kinds of things. There's all these different supplements. I was recently told by my doctor to take vitamin D and a daily multivitamin. And I was sort of skeptical of it just because I was like, I didn't even know if I'm low on vitamin D. But then I checked with my OB-GYN and she was like, yeah, you probably do need vitamin D. And so what are the things that
have data to suggest you do need them and what doesn't? Sure. So if we want to start at the beginning, so the data would be you want to make sure you're eating a balanced, healthy diet with 25 grams of fiber a day. So that would be, so you want to talk about like your foundation and that would be part of your foundation because a lot of people don't. So you want to think about that. There's no special menopause diet. You
intermittent fasting or whatever, there's no special menopause diet. So that's one of the things. Getting your exercise in and you mentioned earlier hearing a lot about resistance training and it's true. Resistance training is really good for women, especially for protecting bone health and muscle health as we age because we all lose muscle as we age.
And women start out with less muscle mass than men. But you also need to work your cardiovascular system and also thinking about how active you are during the day, your daily movement, those three things. You don't have to be lifting heavy. You don't have to do whatever, this number of reps for this. There's so many people making it more difficult for people to enter into the
exercise, especially the resistance training sphere. I mean, imagine if I said, oh, you have to run a marathon. There's no other way to do cardio. Like, right? So, you know, we have to make it accessible for people because if you look at women in menopause and what they're doing, sort of these basics, eating healthy, exercising the recommended amounts and not smoking, think about those as the three basics, only 7% are doing all three.
So there's a lot of room to move. So that's kind of the basic. Then you think about the next level. What can you do? Well, what is bothering you? What's your bother factor? Are
Are you having irregular bleeding? Are you having hot flashes? Is your depression getting worse? What's bothering you? And so I think it's important to let people know that you have like a buffet of options and here are the options, here are the things that might work the best, here are the things that are studied. I encourage people to make a list and then when they come to the doctor, try to focus on the top two and then you can start to gradually work down the list. For supplements,
It depends what you're doing. Vitamin D is a little bit controversial in that people have done so many studies with it and it hasn't really panned out to do much except raise the vitamin D levels.
That being said, especially in places where people get little sun and in northern climates, taking 600 to 800 international units of vitamin D a day is not going to harm anybody. There is some possibility that high doses can cause harm. So, you know, you're taking 600 to 800 international units a day. That's great. You just want to take one that has been USP or NSF certified. Those are independent third party. And as for any other supplement,
You know, I think that if somebody's got an individual health concern, obviously, you know, you're low in iron, you need an iron supplement, right? Things like that. But is there another menopause supplement that we recommend? Not really.
Well, there's so much talk of them right now, you know, on social media. There was just an Oprah special about menopause. I read your blog posts about it. And one of the things I thought was really, you know, a good way of putting it was you mentioned we are in a menopause gold rush situation.
Right now with celebrities, medical professionals and influencers all trying to cash in. Can you tell us more about that and some of the things you think are most concerning that you're seeing out there?
Yeah. I mean, in the United States, if you want to get rich, supplements is a great way to do it. I actually went through the process and set up my own supplement company to see how much money and how much effort it would cost. I didn't go through with it because I'm ethical. And it's a stunningly little amount of work.
So it's very easy. It's like printing money. And so we see people moving more and more and more into this market and pushing it. There are influencers who have ads, you know, that they may be working with supplement companies. And the problem with supplements is they're generally understudied. They often don't contain what they claim. And people cherry pick the literature and there's a lot of money to be made. And so if these products really worked, people would study what they, you'd think they'd want to study them.
So I just tell people to not take health advice from people who are selling you stuff. Because if it was a pharmaceutical company that said, oh, you should take our hormone or, oh, you should take our antidepressant, you'd say, you know what? I should probably get independent information here. I probably shouldn't trust the company. So where can you go for reliable information? Dr. Gunter shares some resources after the break.
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I do a lot of reporting on like GLP medicines, the new weight loss drugs. And I've heard from a lot of people going through menopause that they associate recent weight gain with menopause. Is weight gain caused by menopause or is it another one of these things that can kind of happen at this time of life?
Weight gain itself, if you're just looking at the number of pounds that you're putting on, follows an age-related trajectory. Nobody likes to hear that. I often get a lot of insults about that. And it does. It follows an age-related trajectory. However, the weight that you put on tends to be more fat.
And so, and it tends to go around the middle. So body composition does change. And so it is true that you might say, I used to have this shape and now I have this shape. And that is related to menopause. So many people will notice that it's going around their waist. And we don't actually understand why that is. People have studied menopause hormone therapy for weight loss and it hasn't
It hasn't shown to be effective for that. But obviously, if you're sleeping poorly, that can be a co-factor for weight gain. And if you're sleeping better now, that could be helpful. So you kind of have to think beyond like what are your other symptoms or say you have a lot of joint pain from menopause and you can't
exercise and you're in the small percentage that hormone therapy helps your joint pain. Well, you know what? Maybe you can now exercise. So you kind of have to look at it that way. But yeah, there's a lot of predatory people out there telling you that, you know, hormones can help you lose weight or they can cause weight gain and people with all kinds of special programs related to it.
What have they shown that hormone replacement therapy, if that's what you call it here? Menopause hormone therapy. Menopause hormone therapy. What has it been proven to be helpful for with the caveats that, as you noted, not everybody has the same outcomes from this? Yeah. So it's the gold standard treatment for hot flashes and night sweats is estrogen.
which is part of menopause hormone therapy. If you have a uterus, then you also need another drug to protect your uterus because estrogen will cause cancer of the uterus over time. That's a property of the medication. It's a property of the hormone. Estrogen in your body can do that. So menopause hormone therapy, gold standard for hot flashes and night sweats.
Everything, and it's also helpful for prevention of osteoporosis, but everything else is not an FDA approved indication. And we have varying levels of quality data to support it. So in this area, we kind of have to say, well, it might be reasonable to try. I kind of call these like the yellow light indications. So for example, there's some data to show that estrogen can be helpful in the menopause transition for depression, but that it is not helpful after the menopause transition.
for depression, so once you're in menopause. Antidepressants are also effective and they get a bad rap. They're not a bad option, they're both different options and they are both effective in the menopause transition and even together they can be synergistic and give a greater effect. Brain fog, there are no studies looking at estrogen for brain fog. And so anybody claiming that estrogen can do that is literally just making that up because there are no studies.
Is it reasonable to try for brain fog? It wouldn't be unreasonable to try menopause hormone therapy to see if it helps, but it would be inappropriate for a doctor to go online or, you know, to say this is absolutely definitely going to help you, right? Those are slightly different things. You know, one is accurate and one is, you know, sensational. And so a lot of the symptoms are like that. You can say, well, it might be reasonable to give it a try and let's see how it works for you, understanding that there could also be a placebo response. And so we just have to be careful.
Because I often see people who have had a partial response and then they keep getting the dose escalated, they keep improving. And then all of a sudden now they're on doses that are equivalent to the birth control pill or sometimes even higher. And, you know, they're still not better. So I think it's just really important to just be open and honest, but also with something like brain fog, you know, you want to make sure it's also not like iron deficiency because estrogen is not going to help that.
One of the things we've talked about a little bit is the social media discourse around this right now. And I wonder your reflections on it, because in some ways, there's a lot more conversations about menopause. People are talking about it a lot more. Samantha Bee was telling us she thinks it's really Gen X that has said, we need to talk about this stuff. And this generation is doing things for my generation. And hopefully my generation will help the next generation. And we'll talk about it more. And that seems like a good thing.
thing. But at the same time, there's a lot of misinformation. There's a lot of what you said, causing fear often to try to sell things. How do you reflect on the social media discourse around the menopause transition? Yeah. So, you know, I've been pretty active on social media since 2010. And I would say that the discourse over the last
three to four years, you know, shortly after my book came out, I would say has really changed. And I think there's a lot of people realizing that there's a lot of money in menopause.
and the menopause supplements, the leading with fear, that every six months it's a new thing, right? I mean, there's women coming in 32 saying, oh, I might be in perimenopause. And when you talk to them, they don't have any of the symptoms that will line up. And maybe they have depression and they've been led to believe by social media that depression at 32 is...
when they have rock solid normal periods and nothing, nothing else to suggest it is, is perimenopause. And that's doing women a disservice. That's the patriarchy, right? Giving people disinformation about their bodies serves misogyny. So I think that people need to be very careful about, first of all, researching laterally. So if you find information on social media, you can't
Use that same person to further research that topic. You need to move to a different browser and you need to research independently and find another source, find a vetted, reliable source. Does they say the same thing or not?
If somebody is selling you a product, it's a sales pitch. Like we're seeing now people offering bespoke coaching services, like where it's $1,200 a year to join or, you know, things like that. And I just, you know, I, we don't have any outcome data from any of this stuff. So how helpful it is, we don't know. And then the third thing I would say is if somebody is leading with fear,
be very mindful about that. You can absolutely talk about lots of subjects without leading into fear, but fear is what drives the algorithm on social media. So I think that you just have to kind of look at what they're selling and the whole totality. And I get it's really hard. It's very easy to get sucked in in social media. That happens to me about other topics. Yeah.
Yeah, I think that's such a good point. Even switching your browser, or let's say you're seeing something on Instagram, then you need to maybe move off of Instagram because, as you mentioned, the algorithm then starts to feed you similar things. Right. You think you are by just going to a different thing, but you may not be. Absolutely. And that is one of the hallmarks of reading laterally. You've got to open a new browser. You've got to get off that site and go somewhere else. Because
We all mistake repetition for accuracy. That's a human trait. And so what is Instagram? What is TikTok? It's repetition. That's what it is. And I would say that one of the best places people can look are the guidelines from medical professional societies. And so what I tell people is if you want to fact check something, put in your Google search
search weighted vests and then put in osteoporosis society, put in menopause society, put in something like that. The Canadian osteoporosis society is a fantastic site.
One of the things Samantha mentioned to us that she said you really helped her with was understanding what's going on in her brain during menopause and how that really does change and kind of gives you this new beginning in some ways where you're you are moving to a different stage of your life. And she said you really helped her think about that. Can you tell us a little bit more about what's happening there?
There are a lot of changes in the brain that are going on and whenever there's a change, people always paint it as dangerous or scary. I think that we're still trying to understand all of the impact of all of the changes with menopause. So I think that while that research is being sorted out, that people should cool their jets, we need clinical trials.
Many women describe a clarity in menopause once they've kind of done all this chaos. And whether it's because their brain has pruned all the pathways that are no longer needed for reproduction,
They've got all this like space left. I mean, that's a bad, you know, I'm butchering the, you know, the neurophysiology of it, but you do kind of get the point. Like you have a lot of your brain is occupied with, with reproduction, selling this, sending the signals back and forth. And who knows, maybe once that's not needed, maybe it's a clarity, maybe it's just aging and you don't care anymore. It's also possible that. Yeah.
But the thing that I would say is that, you know, menopause, women in menopause have historically been incredible contributors to their society.
Right. So if you look at studies from traditional hunter gatherers, women in menopause are providing the bulk of the calories for the family unit. They're the ones out there, you know, doing the gathering, bringing the food in. And if you think about a lot of work, like that's, you know, that's that's a lot of physical labor. Right.
Historically, what do you think is what's the value of somebody after they finish reproducing? We have this very patriarchal view that we're only a value if we're popping out babies, right? And the thing is, is women have been living far beyond their reproductive capacity for a long, long time. But if you think about it historically, right, that women in menopause were almost certainly the knowledge bearers in the tribe. They had the information, the wisdom, right?
If there's only a drought every 15 or 20 years, you need someone who's lived long enough to remember where to go get the water. And so I would say that there is a lot of
collective wisdom that we have as we age and our society has downplayed that and downplayed that value. But there's a lot of women thriving and super successful, you know, in their 50s, 60s and 70s and beyond. So it doesn't it doesn't stop with your last period. I also hear a lot about rage. Does that go away? Yeah.
I mean, that's been played out, but it hasn't been studied. So I think that it's hard to make a comment about something that hasn't been studied. There's a lot to be ragey about right now, right?
So I just think that's also important to acknowledge. It's enraging to not have your symptoms taken seriously. But if you want to think about it from a physiologic standpoint, there certainly are some women who can have a worsening of their PMS in their menopause transition. So that's an important thing to acknowledge. And, you know, anger and rage can be part of PMS.
Also, at the beginning of the menopause transition, there's a subset of women who have shorter cycles before they get longer. And that means that you're shorting the part of the cycle if you have PMS where you feel good. We also don't really understand the effect of some of the chaotic hormones. So you can have sky-high estrogen levels some cycles, which is...
as in the menopause transition, this is something called loop ovulation. And what's the impact of that? What's the impact of having sky high estrogen and then going back down? So is it conceivable or possible that people could have sort of, you know,
symptoms related to that behavioral neuropsychiatric type symptoms? Absolutely. Do I have good data to say what's causing it and what isn't? No. Do I have, you know, I also talked to women who are going through the menopause transition who are working full time. They're helping their kids with college essays and helping their kids get into college at night. And they're doing the bulk of the emotional labor in the house in a heterosexual relationship.
Yeah, I'd be angry too because you don't have time to take care of yourself or go out for a walk. So I just think that you have to sort of step back and say like what's going on holistically in your life? What are the other symptoms that are going on and what can we do about that?
The last question I have for you is not necessarily to do with menopause, although it could be if you would like. But of course, this is Dr. Sanjay Gupta's podcast called Chasing Life. And the question he loves to ask his guests is how they chase life. Oh, how do I chase life? Can I swear? Sure. I think we have a bleep.
I don't fucking care what anybody thinks about me. Be true to you. Like, like being your authentic you to me is the most liberating thing possible. So I would say that that's for me is like trying to, trying to be my authentic me and reveling in being my authentic me, I think is, is how I'm chasing it because that makes me super happy. And when I'm, you know, or it makes me less encumbered. I,
I would say. And when you're unencumbered, it's a lot easier to enjoy many other things. Such good advice. And I bet it took a while to get there. So I'd love to hear about that sometime. You know what? It's a long process. And maybe that's one of the clarities that I've had with menopause. So think about that. All right. A wonderful parting message. Dr. Jen Gunter, thank you so much. Thank you so much for having me.
That's all of my conversation with Dr. Jen Gunter, New York Times bestselling author and OBGYN. Dr. Sanjay Gupta will be back next week.
Chasing Life is a production of CNN Audio. Our podcast is produced by Aaron Mathewson, Jennifer Lai, Grace Walker, Lori Gallaretta, Jesse Remedios, Sophia Sanchez, and Kira Dering. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Seeley is our showrunner. Dan DeZula is our technical director. And the executive producer of CNN Audio is Steve Liktai.
With support from Jamis Andrest, John D'Onora, Haley Thomas, Alex Manasseri, Robert Mathers, Lainey Steinhardt, Nicole Pesaru, and Lisa Namarow. Special thanks to Ben Tinker and Nadia Kanang of CNN Health and Wendy Brundage.
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And now it's the Sleep Number Everything Smart Bed Sale. Every smart bed and base are on sale during our Memorial Day event. Up to 50% off. Limited time. Exclusively at a Sleep Number store near you. See store or sleepnumber.com for details. This week on The Assignment with me, Adi Cornish.
Christine Emba. She's a contributing writer for The New York Times and a senior fellow at the American Enterprise Institute. People are joining more traditionalist denominations or churches. Like, they're going for the hard stuff. The Pew Research Center reports that the decline of Christianity in the U.S. has slowed, maybe even leveled off. And that's thanks mainly to young people. But there are lots of questions about what's driving this trend and whether it will last.
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