Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause

Thank you all for joining the Oprah podcast and for watching us on YouTube. I appreciate you taking the time to spend it here with me.
And I am just so appreciative of the conversations we're having about things that impact all of our lives. And I'm guessing you all have been hearing a lot about menopause these days.
But the more I talk about it, the more I realize we need a menopause 101 because there's still so much, there's so much confusion still out there and we need reliable information and we need facts. Menopause is not a disease or a disorder, but a natural part of aging that all women born with ovaries will eventually experience.
Menopause occurs when a woman has gone 12 months without a period, which means her ovaries have stopped producing hormones and her body is no longer capable of reproduction. For most women, menopause occurs between the ages of 45 and 55.
But before you enter menopause, your body will go through a transitional period known as paramenopause, which can begin as early as your mid-30s. Paramenopause can last anywhere from 4 to 10 years and may include symptoms like hot flashes, fatigue, mood swings, dry skin, dry everything, and low libido.
To help us understand more about the menopausal journey, I invited Dr. Sharon Malone to the podcast.
Dr. Malone has been a pioneer and nationally renowned expert in menopause for over three decades.
She is the chief medical advisor for Alloy Women's Health and the New York Times bestselling author, A Grown Woman Talk. So happy to have you here, Dr.
Malone. Thank you so much for having me, Oprah.
You know, it's what we were saying before, that I feel like I've been talking about it and talking about it and talking about it. And you say you talk about it.
It's every day. And then there's still all these people who have never heard about menopause and what it means for all of our lives.
Right. You know, even for the women who are out there

who are currently going through menopause,

they haven't heard this conversation.

I know.

And there's another 6,000 women every day going into menopause.

And so the backfill is constant

because there are people

that just haven't had this conversation,

not with their doctors, not with their mothers,

and not even with their friends.

So I'm hoping those of you who are seeing this, if you're watching for yourself, that you pass it on to somebody who you also know needs it. Let's start by you explaining the four stages of women's reproductive and post-reproductive lives.
Can you walk us through what they are? Yes. You do that very well in Grown Talk, but I want you to share it with people who haven't read the book yet.
I would love to. The first stage that we're all familiar with is your premenopausal phase.
And that really starts at puberty. And that encompasses your reproductive life, the peak reproductive years, which starts somewhere at 12, 13, and it goes to women when they're early 30s.
That's premenopause. So when we're talking about that, that's the concern.
Then when you become perimenopausal, that is that amorphous phase between being your peak reproductive years and the end of your reproductive years. And the end of reproduction really starts at menopause.
So there's this great space in between the perimenopausal years where you start to have some of the symptoms of menopause, but you're still having your periods, sometimes regularly, sometimes not. But all of the things that we normally associate...
Isn't the sometimes regularly and sometimes not a real indication that you're in peri? Yes, because sometimes for women, that's the changes. So you're not in menopause until it has stopped.
You are not in menopause officially until you have had your last period. And how do you know when you've had your last period? Well, you know you're in menopause when you've gone 12 full months and you've not had another period.
Then it's official, You are menopausal. But what's confusing for women is that in-between state, because it can start as early as your mid-30s and it can go on until you've had your last period.
And that can go on from anywhere from four to 10 years for women. And that's where I think a lot of the confusion comes in.
Because if you're having your period and having hot flashes, well, then you go to your doctor or you're having sleeplessness or mood disturbances and you go to your doctor and the first question they ask you is, well, when was your last period? And if it was last month, they immediately get off the conversation of perimenopause or menopause.

So all of the symptoms that we typically associate with menopause that people are familiar with, like hot flashes, mood swings, sleeplessness, painful sex, can start in perimenopause. And women think of menopause as something that happens to old ladies.
The average age is 51. But a 35-year-old having these symptoms is very much in that menopausal transition, that in-between state.
That could go on for another 10, 15 years. It can go on for another 10 years.
And I think what is also confusing is that when women say, all right, so we've got premenopause, perimenopause, menopause, and postmenopause. And I don't really like the term postmenopause because it implies that at some point you're over it.
You're done. You're not over it.
You're never over it. You're never over it.
And people think that because your hot flashes stopped or you didn't have hot flashes that you didn't have menopause. And I'm saying, yes, you did.
Yes, you did. Yes, you did.
Yes, because menopause is what I've learned. It is losing the eggs.
So you no longer have eggs. You have automatically gone into menopause.
That's right. But there are other ways that women can go through menopause other than just the natural process that happens.
But the natural process is losing your eggs, which means you are no longer able to produce a child. Absolutely no longer fertile.
And sometimes it's not just the complete loss of eggs, it's the loss of function of your eggs. Because the other thing that happens that people don't talk enough about during perimenopause is that there's a change in your fertility.
Because when you're perimenopausal, when you're 40, you still have eggs, you're still having your period, but your fertility is not what it was at 20. It's not what it was at 25.
Because you've already lost eggs. It's not because you've lost them.
It's because they are less responsive. Oh, they're less functional.
There's less functional. And I'll give you an example.
I like to say for you're born with all the eggs you're ever going to have. You don't get any more, you don't make any more.
And then over time you ovulate some, but you're not losing them because you've run out of them. You only ovulate about 500 times in your lifetime, but you had a million when you were born.
Those eggs become less functional. And every woman has a different expiration date stamped on your eggs.
So you don't know, are my eggs gonna last until I'm 45? Or are they going to expire when I'm 35? And that's why we start to see the fertility changes. And for each individual, when you reach the end of that road, it's going to be different from person to person.
I thank you for taking the time out of your busy day to listen to this episode about our health and well-being. We'll have more of my conversation about menopause with the author of Grown Woman Talk, Dr.
Sharon Malone, after these messages. This episode of the Oprah podcast is sponsored in part by Alloy Women's Health.
Are you confused about menopause and perimenopause? Alloy has all the answers and experts you need to feel like yourself again. With Alloy, you get safe, effective FDA-approved solutions to your menopause and perimenopause symptoms prescribed by menopause-trained doctors with unlimited ongoing care with your own personal doctor.
You can message Thank you. healthily.
Feel like yourself again. Go to myalloy.com to start your consult with a menopause-trained expert today.
Use code Oprah to get $20 off your first order. Welcome back to more of my conversation with Dr.
Sharon Malone about the latest science on menopause. I want to bring in actress and activist Naomi Watts to this conversation.
She too has a new book, Dare I Say It, Everything I Wish I'd Known About Menopause. It's a New York Times bestseller.
Naomi, I hear you're on set. Thank you for joining us.
Thank you for having me, Oprah. Yes.
What was the inspiration for you to write it? Because you were going through it or had been through it? Yeah, I was told at 36 when I was trying to start a family that I was going to be going into early menopause and that I was close to it and probably wouldn't be able to have children naturally. So it sent panic through me.
I had heard from my mother long ago. I remembered that she had said I went into menopause at 45, but I didn't know she had a multitude of symptoms that carried the years and years.
So again, to Dr. Malone's point, hi, Sharon.
There's just was no conversations anywhere, no preparation with your doctor, no real details from your mother, and certainly friends weren't talking about it. And which symptoms were the most frustrating for you? Well, I had been having night sweats and ticking those medical questions, those boxes for night sweats for several years before the doctor told me that.
So that meant I had disrupted sleep, which can lead to all kinds of things, anxiety, depression. I certainly had brain fog and I had migraines.
And then the worst one that was kind of intolerable was dry skin because I was on camera all the time. And it wasn't just dry, but it was itchy and aggravated

and red and sensitive all the time.

And being under hot lights and makeup, everything aggravated it.

And I didn't know that was connected to menopause at all.

I went to multiple dermatologists who gave me ointments,

which worked for a day or two,

but then the same thing would just keep cycling. Was HRT hormone replacement therapy recommended to you? Yes, it was.
And very early on. And I mercifully, because my doctor understood it and he gave me the full education, you know, as I understand it still to this day, doctors are gatekeeping that because of the bad studies in 2002.
But my doctor was ahead of the curve. And I've been on HRT successfully and safely for over 10 years.
I know we're going to talk about HRTs with Dr. Malone because there is so much confusion, misconception about HRTs.

I've been on them for, I think, now, well, whenever I was 54, that's when I went on HRT.

So I believe them.

What is HRT?

Can you explain that, Dr. Malone?

Yes.

Hormone replacement therapy, typically it is comprised of estrogen, which is the secret sauce in hormone replacement therapy, and a progestin, which is the second hormone that you take when you have an intact uterus. Now, for women who've had hysterectomies and don't need to have the progestin, you can just take estrogen alone.
But most of what we associate with the symptomatic relief really comes from the estrogen component of HRT. And I hear some women are also now taking a little bit of testosterone also.
Yes, they are. But all of the studies that have been done really basically are with estrogen and progestin.
We are sort of behind the curve. We're finding out a lot more about testosterone because women make testosterone too.
And I think that that's sort of the misconception is that, well, estrogen is a female hormone and testosterone is a male hormone. And that is not true.
Women make almost as much testosterone in the course of our reproductive lives as we make estrogen. That's really responsible for that sex drive that you get right around mid-cycle.

So we're coming back around to understanding that maybe there should be more to hormone replacement therapy than just estrogen and progestin, but we need a lot more studies about that. Okay, we're going to talk more about that.
But in your book, I think this is really an interesting aspect, Naomi, because in your book, chapter 12 is titled Mino Boss and how to deal with ageism in the workplace.

What advice would you give menopausal women who, I think, in many cases, start to feel invisible at work and also feel a level of embarrassment and shame about going through this change because there is no understanding. Number one, they don't understand it and the culture doesn't understand it.
I would say the first step is communication and then education, like owning your story and sharing it with those around you. We come with experience.
The workplace needs us there, whatever industry we're talking about. So it's important to own your story and say what it is that you're going through so people know how to behave and help.
I find most of the time people want to be um they're curious and they want to act with compassion.

So for me, it certainly felt like a big risk to tell my story.

But once I named it and owned it, I feel nothing but embrace actually from my industry,

despite the fact that I was told I should conceal my secret.

Yeah, I'm so happy to hear that's changing.

We all know you husband is actor and producer, Billy Crudup. In the book, you write about honest conversations you've had with him.
I'm not going into details today, but what's your advice for women who have not talked to the men in their lives about this? I mean, it was one of your earlier conversations with him. Yes, I think that is the real sign of intimacy, to be able to share your truth, no matter how vulnerable it makes you feel.
And as I said before, even not just in the workplace, but your partner, your life partner, and, I had to share this with Billy at a very, very early stage, much more early than I was prepared for. But I just was like, what am I going to do? Like, am I going to hide? No.
And it was met with compassion and curiosity. And, you know, he wanted to help.
And that sort of opened up me in ways that led me to start a company, Stripes Beauty, which is creating hydration from scalp to vag, and then led me to having the confidence to write the book. And then the book I did, I wrote because it was the manual, the guide that I wished I'd had when I was flailing around trying to navigate bits of information from wherever I'd go.
So tell us a bit about this wellness brand you created, Stripes Beauty, from scalp to vag. What has been the response? It's been amazing, Oprah.
Honestly, I've been out on the streets and stopped by people who I think they're going to ask me for a selfie because they've seen me in King Kong or The Ring or something. And they, in fact, are coming at me with tears in their eyes and joy saying, Thank you for giving me the dialogue, the permission to speak with my partner, my family, and making it easier by sharing your story.
And also, thanks for the vag of honor because now the walls of my vagina are not so dry and sensitive.

Can you tell me what has been the most delightful surprise for you about sex post age 50 and how does your company Stripes play into that? Well, I think we're more experienced at everything and we know what we want and what we like and don't like. And I think at this age, you just are more, you know, leaning into that truth and more authentic and just say, able to say, you know, sorry, I've just got to get the lube or, you know, let's do it this way, you know.
And I think there's something very sexy about a woman who knows what she wants. And we still have desire.
We just need to get a little bit more organized. Well, dare I say thank you for joining us again.
Okay, Naomi, I know you have to get back to work. Thank you for joining us.
This is one of the many reasons I love Zoom. Thank you for taking the time out of your workday schedule to be with us.
Thank you. All right.
Well, I just want to make sure that everyone understands that this is a natural cycle of life. Yes.
You say this in grown woman talk, not a disease. And the hormonal changes during perimenopause are as significant as those in puberty and in pregnancy.
So imagine going into puberty and not knowing anything about what's going to happen to your body, which a lot of us women did. Nobody had said anything about what a period is and what the hormones were going to do and all of that.
And so many women are doing, experiencing the same going into menopause because their doctors don't even know. There's a lack of an awareness and information from doctors, from what I've learned from you and other doctors.
It's not even taught in medical school. You know, it used to be.
And let me say, because, you know, I'm in the old group of people and, you know, the study that really changed everything in 2002, the Women's Health Initiative, really did an about face on the conversation about menopause. Because let me just say, women have been going through menopause for as long as we've been alive.
Yes. The only thing that's changed historically is that more of us are living long enough to get to this phase of life.
But women have complained about menopause forever. But it was thought to be, you know, women just being hysterical with the symptoms, or you're losing your mind.
Women would go to sanitariums at that point where, because of the mental illness and the mental, the distress that it caused women. But we have known how to treat the symptoms of menopause since 1942.
That was when the first estrogen product was introduced. That was Primarin.
And so women have been using hormones for, since 1942, those who had access and the awareness of it. But it really changed everything in 2002.
In 2002. In 2002.
Okay. I was taught about menopause and what to do about it.
And then from 2002 on, doctors who were trained didn't really get that information. Yes.
Yeah. I was talking to Dr.
Haver who was saying she had an hour of training about it, a discussion about it, and was in another session that lasted six hours. So you come out of medical school with seven hours of training.
So since 2002, doctors have been trained about it. And obviously, so many doctors even, I think, are still confused about the Women's Health Initiative study done in 2002, which said, can you clear that up for us to understand what actually happened? You know, it's a...
This is one of the reasons.

The reason why this is so important is because this 2002 study

is the reason why so many people are afraid of hormone replacement therapy.

Exactly.

In a nutshell, you know, as I told you,

1942, we've been treating women who were symptomatic during menopause, typically the hot flashes and the mood swings, with an estrogen product. It worked.
So as we sort of got more women who were taking hormones, we found that there were some tweaks that need to be made along the way and added the progestin component to it. Because remember, estrogen and progestin go together.
Have to go together if you have a uterus. Yeah.
So we knew that it treated the symptoms of menopause. That wasn't new news.
But what we found was that there was a nurse's study where they just looked at a group of healthy nurses, young women, and watched them through menopause. And what they found is that the women who took estrogen therapy or HRT had half the risk of heart disease than women who didn't, the nurses who didn't take hormones.
So imagine now the thought was, okay, we're not only relieving the symptoms, but we are actually decreasing the risk of cardiovascular disease by 50%. Well, that would be a blockbuster, right? But you couldn't prove it because it was just an observational study.
So the Women's Health Initiative that was really initiated in 1991, the purpose of it was to sort of solidify that finding. Does hormone therapy really reduce the risk of cardiovascular disease by 50%? That was the question.
So we do a study, largest study ever in the history of NIH specifically for women. So they recruited women in that study that were anywhere from 50 to 79 years old.
The majority of the women, 90% of the women were over age 55. So it's not surprising that when they looked at the women, they said, well, there's really no difference here.
We don't see any improvement in the cardiovascular. It was like the same whether you took it or not, because they were starting it on women who were too old.
So that was problem number one with the study design. The second part was that when they were looking, they said, well, let's have some safety stops.
Let's make sure that women aren't having an increase in breast cancer because of this estrogen, because that was a thought. This is the point that got everybody, made everybody nuts.
So when they got to about five years in the study and they looked into the data to see how is this coming,

there was this dramatic press conference that they held because not only did they not see the expected decrease in cardiovascular disease, but they saw a slight increased risk in breast cancer. From these 60 to 79-year-olds.
Yeah, from these women who were on average 63 years old, more than 10 years after menopause.

So when you hold a press conference, and it's dramatic, and they stop the study, hold the presses, and they say, not only does hormone therapy not improve your cardiac profile, it increases the risk of breast cancer. And when they said that, I mean, women who were taking hormones happily...
Abandoned them. Overnight.
Well, I would understand why. Because I remember I was doing the Oprah show when this happened and it was a big announcement and everybody was like, oh, that's it.
Exactly. Hormone replacement therapy is dangerous.
It causes cancer. And now what we're hearing, what I hear you saying, and I've heard other doctors say, this was a flawed study.
It was a very much misinterpreted study. Because if you had said, I don't disagree, okay, your data is your data.
If you start women on hormone therapy later in life, you're not going to prevent their heart disease. I think that's probably true.
The problem is that they generalize that data to everybody. Well, what about a 50-year-old? Well, what about if I started when I'm 45, whenever I'm menopausal? Because that's when we clinically would start it.
That's a very different outcome. And that was the misinterpretation of taking very limited findings and applying it to everyone.
But it became the narrative. It's what people believe.
It's the reason why my best friend still won't do an HRT because she's like, you wrote about her in the book, still won't do an HRT because she's like, I don't know, I think it causes cancer. It has been, when you say the words breast cancer to women, I think that is their number one fear is breast cancer.
Despite the fact that the number one cause of death in women is cardiovascular disease, It is more than all cancers combined and all accidental causes of death for women. And do we know for sure that HRT, that hormone replacement therapy, helps now cardiovascular issues with women? There is everything.
When you take that same data, the largest study ever done, and you exclude the women who are older and only apply it to the women who are under 60? Yes. And within 10 years of menopause, guess what they find? The same findings that we had from the observational study that the cumulative data says that if you start hormone therapy within 10 years of your last period or before age 60, you decrease the risk of cardiovascular disease by anywhere from 30 to 50 percent.
Wow. Yeah, wow.
Wow. We've got people joining us on Zoom with questions.
Tricia and her husband, Stephen, are joining us from Edina, Minnesota. What's going on with you, Trish? I would say my perimenopausal symptoms started about two years ago.
I was 47. I didn't know that that's what was happening, but I had a 90-day period that was so heavy.
I really thought I might have uterine cancer. I was really freaked out.
Went to my doctor, got checked out, and she said, I think this might be the beginning of perimenopause, and suggested I try an IUD, which I did, which was great for a while. But then I started experiencing the most intense night sweats.
I mean, really just waking up, feeling like I had 104 fever, whole body shakes, soaked through to the mattress pad, trying not to wake up my husband, you know, putting a towel down. And then, you know, consequently having tons of daytime fog the next day and just feeling really, really bad about that.
So I went to my doctor, who is great and who I love. And she just kind of said to me, yeah, well, that's perimenopause.
And I remember saying to her, well, okay, is there, what should I do? And at the time she said, well, it's just, this is just kind of, it's kind of to get through it. And I said, well, are there blood tests or, you know, anything that could measure this for me? And she said, no, your hormones really fluctuate a lot.
So we can't really do those tests. So I left feeling like, oh my God, I guess this is just my future.
It just all felt so haphazard to me and sort of nebulous, especially as someone who gets their physical every year, gets their mammogram, you know, colonoscopies right on schedule. This issue to me felt like, oh my gosh, it doesn't feel like there's a rule book here.
Yeah, that's I think how so many women feel. And I'm so happy to see Stephen standing or sitting by your side in support of, I know you told the producers, Stephen, that if men went through menopause, things would be much different.
How do you think? I mean, it's ridiculous when you get into it because, you know, I don't know anything about it. My mom didn't talk to me about it.
When Tricia started describing her symptoms to me, I know that if there was symptoms anywhere from really annoying to, you know, debilitating over a course of, you know, there's tens of millions of women in the United States alone who are going through this, there would be a pill. There would be some kind of salve or poultice.
Something would be- They would have figured it out. They would have figured it out.
Yeah, if it was a men's problem, we would have this solved already. So it was really hard to, you know, again, just support Trisha as she went through it just to figure it out.
What did you think was happening? What did you think was happening? Since Trish didn't know what was happening, and I know, I don't know many men who've been raised with any idea of what it is. Yeah, I mean, it's really, well, and a lot of it's hidden from us, right? So, you know, Trish is a strong mother.
She's doing things all the time. She's super energetic.
And so a lot of it's hidden. She's, you know, she kept her symptoms to herself when we started to talk about it, the thing that kind of triggered for me is she goes through periods of, I would call it weariness.
She's not tired. She's weary.
Like we get to the end of the day and that's it. So she has to shut it down, right? She just has to shut it down is what I heard you say.
It's over. And so that's really the thing that struck me the most about it.
But as Trisha, and she's really open with me about it, which has been great, just to understand her and see if I can support her some way. But it's really, it's hidden to men for sure.
I mean, you know, and I assume I'm like... So what is your question for Dr.
Malone, Trish? My question is, I understand that the absence of a period for 12 months or longer is sort of the definition of, okay, you've been through menopause. But my question is, now that I have an IUD and I don't have a period every month, how is someone like me supposed to kind of know where they are in the process, especially because it's not like there are these blood tests that can sort of say, okay, here's your marker and here's where you are in this whole thing? That is an excellent question because, as I said, that perimenopausal period is the part that is most confusing for women.
But I would say this as a rule of thumb. If you are between the ages of 35 and 45 and you are having any one or any combination of those 34 symptoms that we associate with menopause, hot flashes, mood swings, sleeplessness, painful sex,

irregular heavy periods, brain fog.

If you have any of those things in no particular order.

And you list the 34 symptoms in grown woman talk.

Yes. Then you are perimenopausal.

Now the question then becomes, well, I'm still having my period.

And this is the part that really makes my head explode because there are still doctors out there who are saying, well, you're not menopausal yet because it hasn't been 12 months since your last period. That's ridiculous.
You should be treated when you are symptomatic. And no one can tell you when your symptoms are intolerable, but you know, and that's the point at which you should engage and ask someone to please fix this for me.
And to be honest with you, we do know what the answer is. It's not like we're waiting to figure out for someone to discover something.
It's hormone therapy in some form or fashion. And we may use different types and different dosages for women who are perimenopausal than when they've had their 12 months of no period.
The doses may change, the types may change, but the concept is still the same. You treat a hormonal issue with hormones.
And that's why we say hormone replacement. Some people don't like that phase, but I'm old, So I still say hormone replacement.
You've been on hormones for 15 years. I've been on hormones for 15 years and I knew exactly what was happening.
And I was like, okay, well, that's enough of that. And just go right on.
And I have no intention of stopping unless and until there's a reason, a medical reason why I should stop hormone therapy. And I have read too that the moment the symptoms start, that's when you start, you need to start getting help, therapy, assistance with it.
The moment you get the first symptom. Right.
When you are bothered, when you are either, you find out that it's either affecting the quality of your life, the quality of your work, the quality of your relationships. When you reach that level, then that is the time that you should seek care.
But here's the reality is, as we said, I say it over and over again, there are not enough doctors who are out there who know how to treat menopause and perimenopause. So what's a woman to do when you have read everything that you need to read and you are clear and you know exactly what's happening to you.
And it's not uncommon for you to go to a doctor's office and the doctor will tell you no, or I don't believe in hormones, which is not an uncommon thing. I've heard that too.
I don't believe in them. I don't believe in them.
And that is really why when I left my private practice that I, you know, joined the women that I work with at Alloy Women's Health. Alloy.
Because what it is is really giving women access who don't have access to doctors who know what they're doing. Or it's too expensive to go to those doctors because everyone should have access, in my mind, to the same quality care, whether you live in New York City or whether you live in New Mexico.
It shouldn't matter. Or in Dima.
Any Dima. Exactly.
Exactly. So are you on hormones? I did start the patch, the estradiol patch.
I had to kind of go up a few notches, but it really has definitely helped with night sweats. I've seen a big change there.
And, you know, and here's the other thing is that for people who are just sort of getting into this hormone therapy game, a lot of them don't have the experience of knowing what to do. So they give you the answer based on, OK, well, this is what it's supposed to do.
But every person's different. Yes.
Thank you, Tricia. Thank you, Stephen.
Thank you both for joining us. Thank you.
I hope it gets better. I hope it gets better.
Getting there. Thank you.
You're getting there. Thank you.
My hope is that this conversation with Dr. Sharon Malone will help you become more informed about your own body and menopause, which is a natural part of aging that 1 billion women all over the world are experiencing right now.
Stay with us. We'll be back in a moment.
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That's BetterHelp, H-E-L-P dot com slash O-P-R-A-H-P-O-D-C-A-S-T. I welcome you back to the Oprah podcast.
We're talking with guests who are in the throes of menopause and have questions for our renowned health expert, Dr. Sharon Malone.
Kylie is a mom zooming in from Tampa, Florida. Kylie, you say you feel like an alien in your body.
And I hear that from a lot of women when we're talking on this subject, an alien in your body. Tell us what's going on with you.
I do. Hi, Dr.
Malone, thank you so much for your book. It is not just a guide, but it is a travel guide.
It is a, you know, we're on a journey here through life and it is just an incredible book. So thank you.
You were ready for some grown woman talk, right? Yes, grown woman talk. It is conversational.
I feel like I'm in the room talking to you. So thank you so much for that book.
Yeah, you're right about that. This has been going on for a few years, obviously, and that's why I call it a journey, because it took a while to figure out.

And you hear that from every woman that you talk to, right? You have these symptoms, you go to the doctor, you're not really getting any answers. And then it was actually my girlfriends that mentioned to me, hey, you know, maybe you're going through perimenopause.
And I was like, I'm not old enough to go through perimenopause. And so that's kind of how it happened.
But, But, you know, for me, it was dry skin, red skin, brittle hair, headaches, you know, all of those things. And the big thing for me was mood.
Your mood, this can render you absolutely powerless. And the reason why is because it doesn't just affect you, but it affects the people around you.
And so it's the one symptom that actually affects others. And so, you know, I'm constantly asking my family for grace all the time because I will say things that, you know, I'm like, did I just really say that? And so it does.
It leaves you feeling powerless. So why does menopause impact your mood so much? And what is it that causes the more anger-prone part of the mood? That's a great question.
You know, when we talk mood, mood encompasses a lot of things. It's anxiety.
Sometimes it's depression. Sometimes it's just mental fatigue or brain fog.
And sometimes- And weariness, as we're hearing with Tricia. And sometimes it is irrepressible rage.
You can see and hear yourself and say, now I know that that should not be my response. It is inappropriate for the situation at hand.
But you really, what I think is worrisome for women is that they feel out of control in that situation. But here's the connection.
We think of estrogen and our reproductive hormones as just having to do with reproduction. It's only about our breasts and ovulating and being pregnant.
But the reality is our reproductive hormones affect most major organ systems in our body. And what's the one that needs estrogen the most? Our brains.
So the areas of our brains that really are responsible for mood, for sleep regulation, for temperature regulation, all of those areas are responsive to estrogen or lack thereof. And when you're in perimenopause, it's not so much that on any one given day, you have too little estrogen.
Some days you have too much. Some days you have too little.
So it is the wild fluctuations that is really scrambling your brain about how to react to situations. And every woman, every perimenopausal woman I know has had that feeling where you're talking and right in the middle, it's just out of your head.
And it's very distressing because women think, am I going crazy? Is Alzheimer's on the horizon for me? And it's just your brain trying to adjust. It's used to regular hormones in a cyclical fashion.
Well, it's why a lot of women are put on antidepressants. Exactly.
That is exactly right. When they really need hormones.
Exactly. Yes.
Because, you know, if you have never had depression in your life or anxiety in your life or, and now all of a sudden you have it, that should be the first, second, and third thoughts about what could be causing this. I was depressed and didn't even know it.
I was just, I would just reach the, first of all, I could no longer read. I could no longer concentrate on reading.
And I felt like, whatever, just, I just, I was just, my life went into like a flat line. I just felt like, okay, so what? Whatever.
And I now realize that that was a form of depression. Yes.
Absolutely. And when you add to that the fact that most women who are perimenopausal are also having other symptoms, it's not just in isolation because you're having hot flashes, you're having night sweats, your sleep is disturbed.
All of those things affect your mood as well. Because I can tell you, if you haven't slept in three months, you're not going to be in a good mood the next day, nor are you going to have any sort of tolerance for that.
Or the fatigue factor comes in. So it's all interrelated and it is something that

we don't really pay enough attention to. And women, a lot of times will suffer in silence

about this because you're afraid to say something. And if your expectation is that this is just what

part of being a woman is about, that you're just supposed to suffer. And then as I get older,

yes, I'm tired. Yes, I'm fatigued.

If you accept that as normal, then you won't seek care. And that to me is probably the most

heartbreaking thing that women suffer silently. Well, thank you so much.
Thank you for joining

us and sharing your story. Thank you, Kylie.
Thank you so much. Thank you.
Amina is a mom

of two joining us from Lawrenceville, Georgia. Hello, Amina.
What's going on with you? Hello. Hi.
Hi. Nice to meet you.
Nice to see you. I guess the main thing that I had a big problem with was work and actually going through the symptoms at work, but my male manager not understanding.

Like I actually get written up at work for not being in compliance, uniform compliance,

because I have my sweater off or unzipped.

And your sweater is off because you're hot, right?

You're fleshing.

Well, yes.

Like, I mean, it was it was ridiculous. And it kind of got me because I'm like, hello, I'm 54.
I had to remind this person like how old I am and it still didn't matter. um so my family says i'm in denial of of being uh in menopause because

my symptoms have been all over the place

or up and down or not.

Like, I don't wake up wet.

So you think because you don't have that,

you're not going through it?

I don't.

Well, I don't have that and a couple other things.

Right.

But then I just heard you say...

You sit and work with a fan on your phone.

Girl, you sit and work with a fan on your phone

and taking your sweater off

because you can't be in the uniform and you don't think you're going through it? Because it lasts like five minutes. Other people are like, oh my God, this is so much.
Okay, we need some grown woman talk with you right now. All right, Dr.
Malone, have at it. I know, I need to read that book.
Have at it, have at it. Every woman is going to experience these symptoms maybe differently.
Someone has drenching night sweats. Someone has none.
Someone has 100 a day. Someone has two.
But once you start to realize that this is a problem, I'm hot and no one else is in the room that's hot, or it's 50 degrees outside, then you must say, hmm, maybe this is perimenopause. But let me just say that you said you're in denial because there is also this stigma and shame associated with it.
You know, like you're afraid. The reason why your family is telling you and you don't want to admit it is because you think there's, you are attached to the stigma around it, that it means something.
It's true. Yes.
Because I actually, I actually hate the word, oh, I'm flashing. It just makes me feel so old.
Well, see, and that's ageism, and then that's just shame around women's bodily functions. But let me say something, because I think it's really important when it comes to women in the workplace.
First off, menopause is not a disability. You know, we don't need special dispensations for menopause.
What you do need is access to treatment when you are having these symptoms and you are bothered by them. Now, can the workplace be more sensitive and be more aware of the fact that if you are a woman and you are within a certain amount of, you know, certain age range, a hundred percent of your workforce, if they stay there from 45 to 55, we'll go through this, of your female population.
I mean, that is just taking into account. Think about the things that have changed in the past 20, 25 years.
Women, you have breastfeeding rooms now where you can come in, you could, 50 years ago, you couldn't even be pregnant in the workplace. It is just acknowledging the fact that women, our bodily functions, our physiology is different.
It doesn't mean that it's worse. It's a natural phase of growing and maturing.
It doesn't make you inferior. It doesn't make, because you are having hot flashes, it does not mean that you're old.
Because remember I told you, some women will have symptoms as early as 35. It's just a matter of not allowing yourself to suffer.
And once you realize that, again, this is affecting the quality of your work, then this is the time at which you should really engage and get treatment for these things. And don't be embarrassed about it.
As a matter of fact, don't be embarrassed. Once you feel better, you should tell your friends.
I do that all the time. When I see people, I don't even know them.
And I see them and they're like, whoo, and they're fanning. And I will just go up to them and say, girl, you know, we have something for that, right? You don't have to do this for 10 years.
I don't know why we think that suffering is what we should be doing. When it's also, you were mentioning black women.
After I started HRT, I started to notice other women in particular who had this, like, they were three notches down from normal. There's this like this dullness that comes over a lot of women who are going through this and don't even recognize that that's what it is.
There's a lifelessness, a lack of vitality, a lack of feeling like, you know, I can take on anything in the world. It's a dullness.
Right. And you don't feel like yourself.
And you don't feel like yourself. You don't feel like yourself.
Or you've been that way so long that that now becomes yourself. Exactly.
Yes. You know, but one of the things that we found out too from the study of women across the nation, just observing women as they go through this process, is that they did break it down by ethnic groups.
And they looked at white women, black women, and Asian women. And what they found is that black women go through menopause on average about a year, almost a year earlier than white women do.
Their symptoms start sooner. And that transition, as I told you, that perimenopausal phase can last anywhere from four to 10 years.
For black women, it's on the 10-year end of that spectrum.

So can you imagine for 10 years,

before you've had your last menstrual period,

hot flashes, mood swings,

all of these things that you talked about,

and then you get to menopause and you're like,

ooh, had my last period.

Well, no one told your body that,

okay, well, we're done with that now.

Then you can still have hot flashes

and all those things for another decade after that.

And let me tell you, that has huge... Get your fan or get your hormones, okay? But let me say, hot flashes, the thing that I want to say, hot flashes are not benign.
It's not just annoying and they're not funny. They actually are harbingers sometimes of long-term health implications of menopause, such as increased risk for cardiovascular disease, such as increased risk for weight gain, for hypertension, for, you know, all of these long-term things that we talk about.
A hot flash is sometimes the first signal to saying, hey, maybe you're at risk for these things, which again, will affect not just the quality of your life in the short term, but in the long term. So that's why I say, if you have them, treat them.
And you don't get any bonus points for having endured them. You're not going to say, oh, well, guess what? You get no bonus points, Amina, for having endured it.
All right?

I get it now. I get it.
I mean, everything you have to talk about. Tell your family.
Tell your family. They were right.

Yeah.

Yeah. Thank you so much, Amina.
Thank you.

Thank you for having me. Thank you.

Thank you. Thank you for listening.
I'm glad you joined me here on the Oprah podcast. We'll be back.

There are some common questions for menopause expert and Alloy chief medical advisor, Dr. Sharon Malone, after this.
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Use code Oprah to get $20 off your first order. Hi, and welcome back.
So glad to be with you here. I'm with New York Times bestselling author, Dr.
Sharon Malone, talking with people who have questions about their menopause symptoms. Esther is a mom of two, zooming in from one of my favorite places.
Maui, hello. Welcome.
Thank you. Thank you both for your continued discussion on this topic.
I have learned so much about menopause just listening to all this information. My mom is in her late stages of Alzheimer's, so I can't talk to her about her experience with menopause.
I can't help but feel like when I walk into a room and forget why I walked in or a word doesn't roll off the tip of my tongue, that this is the start of dementia? Or will this brain fog improve?

So my question is, what can I do now in menopause to be preventative? Okay. I think that is very important when we talk about Alzheimer's, what we know and what we think we know.
And what we do know is that women are twice as likely to be diagnosed with Alzheimer's in their lifetime than men are. And the women who are more likely are women who have a female relative with Alzheimer's.
It's not to mean that you will because it's very much a multifactorial process. What we also know is that the same things that we tell you to do that decrease your risk of cardiovascular disease, decrease your risk of Alzheimer's.
So regular exercise, good night's sleep, cutting back on alcohol, don't smoke, and for goodness sake, watch your diet. Weight is important.
All of these things, just lifestyle, whether we're talking about heart disease prevention or Alzheimer's prevention, or whether we're talking about just the rules that you need to observe for healthy living and aging. So all of that.
But what we do know, and I'll tell you what we know and what I think, there's a brilliant neuroscientist by the name of Dr. Lisa Moscone, who has written a book called The Menopause Brain.

And what we know is that for women who have an early menopause, and early means you have had your last period before age 45,

or it's a premature menopause if you've had your last period before 40,

those women who do not get hormone replacement because they are so young are at increased risk for cardiovascular disease and Alzheimer's. Now, do we know for a fact that estrogen therapy is a preventative measure for Alzheimer's? Maybe.
That's where we need a lot more data on that. We certainly know it helps you with brain fog.
It certainly does. But you can't take HRTs because of...
I had a hysterectomy seven years ago because I had a history of adenomyosis and endometriosis. So the doctor has been a little wary of giving me HRT because of the estrogen.
No, ma'am. No, ma'am.
That is not a contraindication to HRT. It is not.
And as a matter of fact, not only is it not a contraindication to HRT, to estrogen therapy, I should say, because you've had a hysterectomy. Remember I said- You don't need progestin.
You don't need the progestin. All you need is the estrogen.
So yes, you can have estrogen. The only reasons, the only contraindications that we have for HRT, or if you personally have breast cancer or an estrogen dependent cancer, such as endometrial cancer, if you have undiagnosed vaginal bleeding, if you currently have a heart attack, you, not a family history of a heart attack or a stroke, or you have active liver disease.
And the issue about blood clots is debatable. But we'll leave that aside for now.
But that's it. Those are the only contraindications.
So you might go back to your doctor and say, well... Or go to another doctor.
Yeah. I honestly don't think that doctors are trying to do a bad job.
I really don't, because I worked for... I don't think that they're trying to do a bad job.
I think that they just don't know. They don't know.
And they don't even know what they don't know. And they don't know what they don't know.
And that's the problem is that you've got to keep current. And that's why I really would advocate that menopausal care and care of women in midlife should be separate and apart from all the other things that OBGYNs have to do.
It's a lot to keep up with. You know, you've got and you've got to deliver babies and you've got to get birth control.
But this phase of our life that we will spend anywhere from 30 to 40% of the rest of our lives in this menopausal phase deserves its own area of inquiry. Absolutely.
We need more research.

We meet more doctors who are knowledgeable about it

because that's what they do.

We deserve, as women in midlife...

I was just going to say, we deserve better.

We deserve better, and we deserve to have the attention paid

to the issues that have historically not been paid attention to.

Esther, thank you.

Thank you for Zooming in from Maui. Have a beautiful day out there.
Beautiful day. Dr.
Malone, I know you believe that paramenopause should actually be thought of as a time for celebration. Tell us why.
Because, you know, it is a celebration of a time of life where I think we should all look forward to. And I do say this in my book, Oprah.
I said, when people have a different vision of what that time of life is like, people think of it as, you know, oh, I'm getting old or dread. But I mean this sincerely.
I mean, for people like Michelle Obama, Naomi Watts, you, Halle Berry, all the people, Gail, who are out here showing young women what this phase of life looks like, it should be something that we look forward to because I don't know about you, but I am happier now at 66. For sure.
Than I was at 46. So I look at people sometimes like, oh, don't feel sorry for me.
I know. When all the women are complaining about turning 40 and 45, I just go, oh, honey, if you only knew, it gets better.
It gets better. We deserve a celebration.
We do. We do.
Thank you, Dr. Malone.
Thank you for writing this really profound book, Grown Woman Talk. And thank you to all of my guests for joining us today.
Naomi Watts from Set, Trish and Stephen, Kylie, Amina, and Esther. Dr.
Malone's book, Grown Woman Talk, is available anywhere you buy your books. And it's filled with just, I would say, essential information and more insights on what it means to grow and age beautifully.
Dr. Malone and I are talking again in a few weeks about treatments for menopause in a new study that showed that more than half of women aged 30 to 35 are experiencing moderate to severe symptoms of paramenopause.
We'll be talking with women in their early 30s about their questions and concerns. So keep an eye out for that on the Oprah podcast.
Go well, everybody.

Thank you.

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Thanks, everybody.