The Importance of Feminine Forever By, Oh God... Robert Wilson?

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Hey, I'm Paige DeSorbo and I'm always thinking about underwear.

I'm Hannah Berner and I'm also thinking about underwear, but I prefer full coverage.

I like to call them my granny panties.

Actually, I never think about underwear.

That's the magic of Tommy John.

Same, they're so light and so comfy, and if it's not comfortable, I'm not wearing it.

And the bras, soft, supportive, and actually breathable.

Yes, Lord knows the girls need to breathe.

Also, I need my PJs to breathe and be buttery soft and stretchy enough for my dramatic tossing and turning at night.

That's why I live in my Tommy John pajamas.

Plus, they're so cute because they fit perfectly.

Put yourself on to Tommy John.

Upgrade your drawer with Tommy John.

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See site for details.

I'm Jane Marie, and this is the dream.

Guess what?

I'm 47 and in perimenopause.

I'm assuming a lot of you are too, even though you may not know it and probably don't want to know it.

Honestly, Part of me recommends not getting diagnosed for the simple fact that once you do, your entire algorithm becomes about menopause.

I'm talking non-stop back-to-back content from or about women who bleed or don't bleed in many different ways as their body lurches ever closer to the grave.

We are deteriorating and we do not like it.

And we are complaining very loudly at the moment.

And we're also quite interested in that one cream that's supposed to erase menopause from the front of my face, which is a place I wasn't aware it lived.

But now all I see when I look in the mirror are hollowed out eye sockets and cracking, itching skin.

Today, we're talking to a journalist who's been reporting on women's bodies for over 20 years.

And we're going to get to the bottom of what the hubbub's about.

My name is Danielle Friedman, and I am a health journalist and contributor to the New York Times well section.

I am based in New York City, and I am 44 years old.

So, in light of this conversation,

I'm very attuned to what might lie ahead for me.

Okay, great.

Will you describe your beat?

Generally speaking, I report about women's health and I have been an editor or reporter in the women's health space for over 20 years.

This is relevant to what I write about now.

A few years ago, I published a book about the history of women's fitness culture called Let's Get Physical, which was really kind of a feminist look at how exercise evolved from

something that was seen as really inappropriate and subversive for women to, you know, becoming almost a requirement of womanhood.

So My reporting for the Times since the book came out in 2022 has been this kind of nice fusion of the worlds that the book covered.

I also now write about wellness generally

and often how those things impact women's health.

Well, I'm going to ask you the question I hate answering the most.

What drew you to this work?

I would say for many years, my work has been focused on and I have been personally interested in shame around women's health and women's bodies and

how

shame

can interfere with our ability as women to advocate for ourselves, get quality medical care, be included in research.

And,

you know, I have sort of followed that thread through

different parts of a woman's life cycle.

It was really fascinating a couple years ago to see the conversation around menopause sort of start to explode

and in some ways, you know, see the kind of the veil of shame removed.

But then

also

I was just really interested in some of the contradictions and complexities that were emerging with this conversation.

Was there anyone you could look to when you first started looking into this as someone who's like doing the kind of work you wanted to do in this area?

Well, in I think it was 2023,

Susan Dominus, you know, published her really groundbreaking story for the New York Times magazine.

The headline was, Women have Been Misled About Menopause.

And it looked at the conversation around hormone therapy and ways in which women

had been underserved.

So that piece was, you know, definitely had an influence on me.

I also just, I mean, this is a little bit incidental, but

Kind of like right before

this whole menopause conversation exploded, and I think it was a few months before, actually it was in the year before the Susan Dominus piece, my book editor had sent me an early copy of a menopause guide that the same Emperor was publishing, you know, asking if I would read it to

provide a blurb.

And I happened to read it while I was pregnant with my younger son.

And that was really my first introduction to menopause.

It was kind of fascinating because I was dealing with, it felt like many of the same hormonal issues, but from a

different

perspective.

And so that was kind of my initial education.

That was for the book Hot and Bothered by Jancy Dunn.

And then the Dominus article.

And yeah, so I would say, I guess, I really had relied on

journalists

who I trusted.

As we get started here then, because this is, we're still demystifying this thing.

What is menopause?

Yeah.

Well, with menopause, it's technically you have entered menopause when it's been 12 months since your last period.

Perimenopause is

much more kind of vaguely defined, very poorly understood.

There's very little to no research on it.

And it's the years leading up to menopause when

women experience hormonal changes and can experience some of the

can basically become symptomatic as a result of changing hormone levels.

I also just want to mention, as far as menopause,

it can be surgically induced as well.

So

if you have your ovaries removed.

Right.

So you just mentioned that it's not very well studied.

What's up with that?

Perimenopause or menopause?

Or all of it.

Okay.

Women's health historically has been very understudied.

It was only in 1993 that the NIH required that women be included in clinical trials.

Before that point, women were often

well, I mean, this is still true to a large extent today, but a lot of research that was only performed on men,

the findings were then used to treat women clinically.

Women's bodies have been seen as too complicated

because of all of our fluctuations

to be included in trials.

So in general,

we don't have a great track record as far as research into women's bodies.

And

I think also, isn't the statistic also that it's young white men that they do almost every study on?

I believe so.

Yeah.

Yeah.

Cool.

And so, you know, in general, we're still sort of making up for catching up for so much less time in terms of,

you know, properly studying women's bodies.

Menopause,

you know, I mean, like so many aspects of women's bodies that could be viewed as unappealing to men or not in the service of men's needs and desires.

I think menopause especially has

suffered because of the some of the cultural and medical stigmas around it.

Because we're not, it's a

period of life where we're not useful anymore.

Yeah, yeah.

I mean, yeah, reproductively that that

ability to bear children goes away.

And then who cares?

Yeah, yeah.

I mean, I mean, sadly, at least historically, you know.

Aren't we one of just a few species that stays alive after menopause?

Ooh.

I believe there's only like us and elephants and bees or something like that.

That does ring a bell.

I would want to, I would have to factor that.

But I think that there's just like three species on Earth that like don't die the minute they can't make babies.

And you raise a good point, too, which is that as we,

you know, we are living so much longer into the menopausal stage of our life than women were

a few generations ago.

Right.

So, the fact, you know, this you can spend half of it.

Yes, exactly, which is, you know, in the scope of history, relatively new.

But, you know, I'll just to give a little bit more context.

So, and again, this might be biting off more than I should be chewing right now, but I'll, you know,

I'll just give you a quick overview.

It's not live radio, don't worry.

Okay.

So,

just looking at kind of the arc of

research into menopause, interestingly to me anyway, the first kind of

hormonal treatments were prescribed to women in the 40s and 50s.

But it wasn't until the 60s that it really took off, you know, basically.

estrogen as a treatment for menopause.

And it was thanks to this book, which is really something called Feminine Forever by an OBGYN named Robert Wilson.

And

this book, I mean, I actually have a copy sitting next to me right now.

I had to own this just so that I could kind of see it with my own eyes.

But, you know, he describes women who've gone through menopause as being like chemically castrated and just completely kind of undesirable and useless.

And by taking estrogen, you know, will not only feel better,

look better,

be more sexually appealing, but yeah, generally just be like a lot more pleasant, you know, for the men in their lives.

It came out years later that he was also being funded by the drug company that

produced that the type of estrogen that he was selling.

So after this book, taking hormones became extremely popular,

but there was still not a lot of research.

And then

in the mid-90s, recognizing that so many women were taking hormone therapy, the NIH launched its first sort of massive study into

the effect of hormones on women's health.

And famously in 2002, that study, the Women's Health Initiative, was cut short because of

some risks that turned out later to be kind of overstated, but to women's health when it came to breast cancer and cardiovascular issues.

And after that, there was just a major chilling effect both on women taking the medication, but even on research.

So it's been this real, there's been this pendulum swing with women and hormones and research

going back for 80 years.

I think many of us, and myself included,

who are entering perimenopause or menopause had moms that were in that same position around 2002 when that study came out.

My mom would have been in her mid-40s anyway, when the news started swirling that if you did hormone replacement, you would get cancer.

So then all of our moms became complete bitches

in the early aughts.

Yeah.

And so basically, yeah, at that point, the one really effective tool for managing the symptoms of menopause all but kind of went away.

And in its place,

there's a lot more to say about this.

Prozac?

Well, yeah.

I mean, it was basically like the, yeah, antidepressants, anti-anxiety drugs were sort of the only

real clinical solution.

So it's only years later that there has been a sort of re-evaluation of that data.

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Hey, I'm Paige DeSorbo, and I'm always thinking about underwear.

I'm Hannah Berner, and I'm also thinking about underwear, but I prefer full coverage.

I like to call them my granny panties.

Actually, I never think about underwear.

That's the magic of Tommy John.

Same, they're so light and so comfy, and if it's not comfortable, I'm not wearing it.

And the bras, soft, supportive, and actually breathable.

Yes, Lord knows the girls need to breathe.

Also, I need my PJs to breathe and be buttery soft and stretchy enough for my dramatic tossing and turning at night.

That's why I live in my Tommy John pajamas.

Plus, they're so cute because they fit perfectly.

Put yourself on to Tommy John.

Upgrade your drawer with Tommy John.

Save 25% for a limited time at tommyjohn.com/slash comfort.

See site for details.

What turned the tables back to, you know, reality and science?

Like, did something happen?

You know, I think what started to happen was as

Gen X women, you know,

entered perimenopause, entered menopause,

were struggling and

began,

you know, speaking to their doctors about what the options were and were often dismissed or told it was just sort of like, this is a natural process.

You just have to deal with it.

There was outrage that hadn't really existed, or at least existed as loudly and as publicly with previous generations.

I think, you know, this is, there's really been a shift

in the last few generations in terms of just kind of accepting the like doctor always knows best.

And medicine, you know, as we've talked about, has been so patriarchal.

But

I think thanks to a lot of cultural shifts, including just a much louder discourse around just like discussing all aspects of women's bodies, you know, destigmatizing all of these like normal life stages

and demanding better, suddenly

women were questioning the data and the lack of treatment.

And

that,

I think it's kind of like with

more

demand,

some of the researchers who had been studying hormone therapy even before the WHI

felt a little more emboldened to

start recommending it again, prescribing it again for certain women, because we were kind of breaking free from this just really

dominating narrative that hormone therapy was extremely dangerous.

Well, let's talk about what menopause or perimenopause can look like.

I can talk for days about what my early symptoms were, but aren't there something like 63 symptoms that have been identified or something?

Like a million things.

Everything can be menopause, right?

Yes.

Okay.

Yes, pretty much.

I mean, you know, kind of the most classic symptoms are hot flashes,

poor sleep, which is often a result of hot flashes keeping you up at night, brain fog, memory issues.

What's brain fog?

I never,

I hear about it, and we talk about it with like long COVID and stuff, but I'm like, what is it?

Am I just, is that just when I feel like a ding-dong?

Yeah.

Like what?

That's been my, yeah.

I mean, like, I feel like I know it when I'm experiencing it, you know, and I, I think I definitely experienced it.

postpartum.

Different people experience it differently, but just that feeling of kind of being underwater, or as the name suggests, you're just not as sharp as you know you can be, or as you've been in the past.

And then there's, I mean, like you said, there's dozens of symptoms or, you know, symptoms that could be menopause.

Some surprising ones like itchiness all over,

weight gain, oh, and also very heavy periods in the years leading up to menopause.

A lot of these symptoms can feel really scary and concerning, heart palpitations.

And

women have been historically dismissed by doctors are told either it's all in their head or again, prescribed an antidepressant or anti-anxiety medication, or they'll spend years trying to get a diagnosis when actually it was just part of menopause.

But because of the lack of education and

As of last year, only about a third of OBGYN residency programs, not even medical schools, residency programs for OBGYN offered a menopause curriculum um

yeah yeah

women end up kind of just going in circles for years

one condition that has not caught a lot of attention gotten a lot of attention historically is it's uh genitou urinary syndrome of menopause and it's basically vaginal atrophy and dryness that occurs with the

you know with the drop in

estrogen and progesterone.

And

yes, I mean, I don't have to probably convince you on the surface that

it sounds really unpleasant, but beyond just making sex painful or less enjoyable, it can also lead to chronic urinary tract infections in women.

And especially as women

really get older,

those infections can be more serious, you know, and can lead to more,

you know, can lead to really

consequential health issues.

So there's that.

And having a dry vagina, whether or not someone wants to put their penis in it, like is uncomfortable.

Yes.

Yes.

Yes.

Living your life, walking.

Yes.

You know, and I mentioned like I write about movement and exercise science a lot of there.

There are so many barriers, you know, this is yet another reminder that it's not as simple as just like, get up and move.

You know, like if every step feels like you have a knife in your vagina.

Osteoporosis and bone health is a big concern.

I broke my foot a couple months ago doing the laundry.

Oof.

There's,

I want to say, you know, it's like 50% of women who have gone through menopause will break a bone at some point.

I would want to check that.

I checked it.

And according to the Endocrine Society, one in two post-menopausal women will have osteoporosis.

So that's 50%.

And most will suffer a fracture during their lifetime.

So if you haven't broken a bone yet, Just wait.

And, you know, there's really scary statistics, too, about women, about falling, basically.

And when you

experience a hip fracture, you know,

your chances of dying within a year, once you get to a certain point, go dramatically up.

Yeah.

So pretty much everything that I've mentioned has to do with primarily with estrogen.

But there's a big conversation happening now around testosterone for women as well.

One thing that's kind of interesting, what I was surprised to learn, I assumed that testosterone, like estrogen, like there was this big drop-off at menopause.

And in fact, women's testosterone,

which I, by the way, you know, obviously it's mostly associated with men, but is crucial to menstrual cycle, to ovulating.

We need it, you know, as much as men do.

But it actually starts to decline very gradually from like a woman's 20s through age 60.

And then women actually see a rise in testosterone again

after age 60, which is sort of why you see maybe a lot of kind of like older grandmothers with chin hairs and you know, receding

receding.

Yeah, yeah.

And there is a lot of misinformation out there about testosterone.

And well, it's also not part of the standard of care for hormone replacement therapy.

Like, I can't get it through my insurance.

I have to buy it from a compounding pharmacy.

It's $200 a month.

Oh, wow.

Yeah.

Well, there's no FDA-approved testosterone for women in the U.S.

Yeah.

For women, period.

In the U.S.

And so, yeah, you either have to take, you know, you either your options are a compounded version or you take, you get a prescription for a male testosterone product and you take a tenth of it, basically.

And I should just say

the only thing that it has been, you know, scientifically proven to help with is low libido.

And it helps in about 50 to 60% of women who take it for that purpose.

My doctor said, though, it was more like energy during the day, you know, not feeling that brain fog and that tired, like exhausted feeling.

I don't know if that, you know, if it has been proven or anything, but.

Many women report that, but officially, you know, officially

it hasn't.

We can't say that for sure.

Can we talk a little bit about the industry around menopause?

Like what's happening now?

I feel like there's a lot of

money being made all of a sudden by Naomi Watts.

Yeah.

And some and, you know, several other celebrities as well.

And it's all happened really fast.

You know, it's, it's in the past like

two to three years.

So very suddenly, the dialogue around menopause and perimenopause kind of went public and exploded.

And it was, it has definitely been kind of accelerated, normalized by celebrities like Naomi Watts and Hallie Berry

and

women who

I would say really defy the stereotypes that we've always had around menopause

as well as a

growing number of very powerful physician influencers who are speaking out about menopause on social media on Instagram and TikTok.

There's been also, there's, I think I was sent maybe, I don't know, six to seven new books about menopause this year.

So basically, you know,

as the cheesy saying goes, you know, menopause is hot.

Menopause became hot.

It's a multi-billion dollar industry.

And in the past few years, as there's been more awareness, as women are saying, you know, sort of are feeling validated in their symptoms,

a massive crop of entrepreneurs has kind of risen up to basically offer solutions for women who might not be getting the help that they need from the mainstream medical system.

And it ranges, those solutions range everything from

estrogen face cream.

I mean, Naomi Watts, hers is like scalp to vad, she calls it.

So it's like from flaky scalp, yeah, neutrophil.

I mean, it basically spans everything from beauty products and face creams to

supplements, I think, are the biggest chunk of this this menopause gold rush that's happening.

There are summits and conferences that women can pay hundreds of dollars to attend, to learn about their bodies.

I mean, and it's it's, you know, I mean, on one hand, like how great that women are finally being taken seriously.

But there is a lot of really

among, you know, among all of the commercialization, there's a lot of really predatory stuff happening.

You know, the supplement industry is kind of notoriously

very lightly regulated.

And among doctors, I mean, among OBGYNs and women's health specialists who have been,

particularly those who have been treating menopausal women for a long time, they are very concerned about the misinformation.

They see it as kind of a misinformation crisis.

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Visit medicate.us.

That's M-E-D-I-K and the number 8.us.

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Hey, I'm Paige DeSorbo, and I'm always thinking about underwear.

I'm Hannah Berner, and I'm also thinking about underwear, but I prefer full coverage.

I like to call them my granny panties.

Actually, I never think about underwear.

That's the magic of Tommy John.

Same, they're so light and so comfy, and if it's not comfortable, I'm not wearing it.

And the bras, soft, supportive, and actually breathable.

Yes, Lord knows the girls need to breathe.

Also, I need my PJs to breathe and be buttery, soft, and stretchy enough for my dramatic tossing and turning at night.

That's why I live in my Tommy John pajamas.

Plus, they're so cute because they fit perfectly.

Put yourself on to Tommy John.

Upgrade your drawer with Tommy John.

Save 25% for a limited time at tommyjohn.com/slash comfort.

See site for details.

One thing that I resent quite a bit around the menopause industry is the push for like to maintain youth.

And I wish that people understood that like

you get a belly

when you go through menopause.

You gain weight in your middle, your skin becomes dry, and you want to to cut your hair off, which I just did, because you're sweating constantly and your hair is soaking wet all the time and it feels awful.

For those things to just be like, for it to be understood that those things are happening, not because you don't care about yourself or because you're letting yourself go.

Right.

That's what I, with the Naomi Watts stuff and, you know, these celebrity menopause influencers, I feel like they're focusing on, you know,

maintaining something that

kind of can't be maintained.

And I wish it was okay.

You know?

Yeah.

Yeah.

Well, and yeah, you know, as I've like through my reporting,

it's been really interesting.

Some of the experts I've interviewed have talked about how they see this as they've literally said it's a return to feminine forever, the book from the 60s, you know, where suddenly it wasn't just, it's not just about, you know, feeling good and being heard and having our medical needs addressed, but also

looking hot.

Exactly.

Exactly.

And

yeah, I mean, I think one of the just like the reactions that I've encountered regularly to this, to this push and this, this, you know, sort of emerging industry is like, you know,

when are we going to find, like, when are we going to get a break?

Give us a break, you know?

It's just, I want to, the word i'm i'm wanting to say is like mania you know it's suddenly it just feels like the pendulum has swung perhaps too far in the direction of now

you know giving women yet another like another list of a million things they need to be doing to be acceptable You know, so what has happened is since there's been this like re-evaluation of hormones and more of a recognition that actually for many, many women, they are both safe and they are extremely effective at managing symptoms and do allow them to live their lives again, feel like themselves.

There

are some very loud voices on social media that

even if they offer disclaimers, sort of paint the picture that every woman should be on hormones.

And if you're not, or if you can't, you know, you will probably,

you know, suffer as a result.

And so it's kind of this culture of fear, honestly.

Like, but that happens in every stage of womanhood.

I feel like there's, yeah, there's, and then there are women that scold me online for being on hormones.

Like, why are you not doing what's natural for your body?

Yeah.

Why aren't you just letting it happen?

Um, this is how God made you or whatever.

But it's the same as like, don't get an epidural.

Oh, God.

Yeah.

Yeah.

You know, like, have your baby at home.

What do you, why would you go to a hospital?

Like, there's just so much judgment at every stage.

Why, why would you you use tampons?

Why not pass?

You know, all of these things.

Right.

And again, I mean, so much of it just comes down to choice.

And like when I've interviewed these longtime menopause researchers, the few kind of scientists who have been trying to fill this void with science and study women's health.

What they're saying is they have, they're very frustrated because they have patients coming to them who are basically demanding, you know, hormones.

And while

they, these,

the sort of older guard of physicians never saw themselves as,

they have been like pro-hormones for a very long time, but this idea that it's one size fits all

and everybody's risk profile is a little bit different, you know, and it's an individual, it should be a personalized conversation.

I didn't know for a year and a half that I could have more estrogen.

I didn't realize that the patches came in different doses.

I didn't have any idea.

Yeah.

I don't know why I thought or why I didn't think this through, but that once you're in perimenopause and you go on hormone replacement therapy, your natural hormones continued dropping.

So

the therapy you're getting from your supplemental

supplemental.

Yeah, you might need more.

It didn't occur to me until like way after I was back to experiencing horrible symptoms, you know?

And the thing is, too, it is important, you know, it's important to keep in mind that like,

so there's doctors have stopped using the term hormone replacement therapy oh they've replaced it with either just hormone therapy or m h t menopause hormone therapy okay

because

yes everyone will experience a drop you know through menopause but not everyone experiences symptoms and needs to have them replaced.

You know, I think they're often estrogen is often talked about like almost as if it were like

thyroid hormones or insulin where

you need it to

survive.

Like it has to be at a certain level.

Whereas different women will have totally different experiences based on just their genetics and biology.

So, yes, it could, you know, it does help estrogen and hormone therapy.

is so helpful for so many women.

And interestingly, like only

despite this conversation, as of last year, only about 4% of eligible women

were on hormone therapy.

So it's not like there's like a

problem with like too many women now getting prescribed,

but it is just important, you know, as a woman, you shouldn't feel like you have to go on it just because

you've gone through menopause and you'll be at risk if you don't.

Why don't we talk to each other about it?

I think that women have really been conditioned to suffer in silence.

Menopause has been the butt of jokes forever.

You know, it's very, it's very much like

golden girl style.

And it's represented as something that happens much later in life than it actually does.

That's another thing.

Exactly.

Yeah.

And it really, I mean, I think, you know, not to be too cliche, but like it's sexism and ageism kind of just at their most potent in convincing women that menopause is something to be ashamed of and means they're they're old and undesirable and no longer relevant.

Well,

I

part of me hopes that's true.

Well,

give me a break.

Yeah, yeah.

What

What do you hope happens with this whole menopause discussion?

Like, what's the best outcome of the craze?

Well, I

think generally, I think the more evidence-based science that we have as to what works,

the less of an opportunity that

some of these other solutions that don't necessarily work,

you know, the less of a chance that they'll thrive.

Less room for charlatans.

Yeah.

Exactly.

More science, less snake oil.

There we go.

That's the dream.

Yes.

Yes.

Something that's so interesting to me about this world is that among these position influencers, a lot of what they discuss is kind of couched in the language of feminism and of sisterhood.

But there's such kind of animosity toward anybody who questions them.

And it's just anyone who questions them is kind of automatically written off as being sexist or being part of this old guard of physician who isn't taking women's concerns seriously.

But when the whole world is stacked against you, you kind of have to come out swinging, you know?

Like, yeah, absolutely.

I understand that.

I don't think it's cool, but I get having to have like a strong,

you know, adamant take on things where no one has listened to us for hundreds of years.

Absolutely.

Absolutely.

Yeah.

I think there's just some, yeah, there's like, in some cases, there's maybe a little bit of over correction happening, but

in the case scenario, yeah, it'll get us to where we need to be.

Well, I really appreciate you talking.

That was wonderful.

I hope it was helpful.

Super helpful.

I mean, look, it's, it's a craze for a reason, right?

Because it's fun talking about it.

It's really interesting, But this has been really delightful and I appreciate you taking time out of your day to talk to me.

My pleasure.

Thank you so much.

The Dream is a production of Little Everywhere.

We really love the calls that we've been getting from all of you.

Some very, very cool stories out there, and we've been getting them on the show as fast as we can.

But please keep the tips coming.

It's so nice to hear from you, even if we don't get a chance to talk.

323-248-1488.

Okay, love you bye.

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