What is this?

Brain fog?

Where are these mood swings coming from?

Why am I sweating overnight?

Where's my period?

Why am I so hot?

Unanswered questions by women feeling too uncomfortable to ask.

Until tonight.

On this community conversation.

Navigating menopause.

We get into the taboo topic with real life experiences.

Medical professionals and those helping fellow females feel empowered through the change.

Coming to you live from the Universal Public Media Center in Bethlehem, PA.

Here's your host, Brittany Sweeney.

Good evening and welcome to our community Conversation Navigating Menopause, presented by PBS 39 over radio 91.3 FM and Lehigh Valley News.com.

Over the next hour, we are bringing together women from varying backgrounds to unpack the truth about menopause, from misunderstood myths to the real life impact it has on women's mental health, relationships and even careers, with evidence based insights, candid conversations and personal stories.

We'll explore how perimenopause can begin in a women's late 30s, and often with confusing symptoms that go unrecognized or even dismissed.

Joining us now is a physician who helped guide women through this stage of life.

Doctor Christine Friel, an obstetrician gynecologist from Lehigh Valley Health Network, along with menopause mentor and psychotherapist Shonda morales.

Thank you, ladies both so much for joining us for this conversation.

Much needed.

There's not a ton of information out there about menopause.

I've said this before and I'll say it again.

We go through school, we learn the first stage of getting our periods and that kind of thing.

Then if you have children, you go through labor and delivery classes and then you're kind of left in the dark.

So, Doctor Friel, I'd love for you to start.

Let's get right down to the basics.

What is menopause and what are the symptoms?

Sure.

So, as many people know, menopause is really having a moment now as far as its presence and discussion in social media.

So I think that that's great for women as they are approaching this phase of life.

So essentially menopause itself is defined as one year without a period.

And the average age of menopause is around 5152.

In, in in our country.

Any woman who is born with ovaries will go through menopause as part of her physiologic aging process.

Now, it is true if you have had your uterus removed or you have a hormonal IUD in place or some other, you know, something called an enemy ablation, you might not have periods regularly, so you won't actually go through a year without a period for those reasons.

But in general, that is the the average age of menopause.

Now, it's also true that women don't just march along and have normal periods and then they stop.

There is this time or transition that we call the perimenopause that can happen typically 4 to 7 years prior to that final menstrual period.

And really, menopause is one moment in time.

And then after you go that year without a period, then you're in the post menopause.

Some people say you're in menopause.

You're postmenopausal.

Those words are sometimes used interchangeably, but essentially then you're in menopause for the rest of your life.

Sure, so it's not so cut and dry one day or not in menopause the next day or not.

It's kind of gradual.

Is it a certain age or does it vary from woman to woman?

Yeah.

So the average age is around 5152.

If you stop getting your period, if you go that year before the age of 40, that's a different story.

We call that primary ovarian insufficiency.

And that's really a medical, you know, not a physiologic process.

And then, menopause, you know, between 40 and 45 is considered early menopause.

And really any time after 45 is on average, and then by the age of 55, between 95 and 97% of women will be done having their periods.

Okay.

So average range 45 to 55 okay.

So how would they know that they're entering the perimenopausal stage or the menopausal stage.

Yeah.

So typical symptoms that women will have starting in the perimenopause will be changes in their menstrual cycle.

So they'll either start to skip some cycles.

Sometimes the cycles will be actually closer together.

So their flow will change as far as frequency duration.

And then there are the a bunch of other symptoms that can come along with that related to the hormonal fluctuations, which is really what's happening physiologically.

And perimenopause.

So those symptoms can include mood changes, hot flashes, waking, fatigue, joint issues, just all of those things, that we often watch the in menopause can start to present themselves in perimenopause.

Sure, sure.

Now we have some audience questions we're going to get to in just a moment.

But Shonda, I want to bring you into the conversation.

You are a menopause mentor.

And so for those who don't know what that is, what is it and why is it kind of important to have this role and almost have a friend to go through it with?

Right.

So my own experience is what kind of brought me to learning about this.

It took me 7 or 8 years to realize that I had actually gone through perimenopause and all of these seemingly unrelated symptoms.

I later learned, as I did, a deep dive into finding out more, had had been going on for me and so I don't want other women to be in that situation.

And so I really, have gone through a lot of learning and have a group program that I run where there are different pieces to this as what's happening to us, how can we, create lifestyle changes as well so that we can head into this next phase of life really well with well-educated and well informed?

Sure.

And what are you hearing from the women that you talk to, or do they feel well informed as they go into this next stage?

Not really.

I mean, despite all of the the, the mainstream media covering menopause, there's still so much confusion, which is understandable there.

There's a lot of, conflicting information out there.

It's hard to know who to trust, where to get that, the accurate information.

And so women are still confused where it's coming more, to be known.

But there's a lot that we still need to cover.

Sure.

And so we do have some audience questions.

As I mentioned, Doctor Friel, this first one is for you is from Christy in our audience tonight.

And she asks, when should younger folks start thinking about and preparing for menopause?

And, Shonda, you can chime into this conversation as well because I'm sure that you coach women on this as well.

Well, I think, you know, you know, women go through a variety of reproductive stages.

You know, as far as first getting your period, puberty, sort of the childbearing years or reproductive years when you're able to have a child and then perimenopause and menopause.

So I think as part of your understanding of your body, you know, it's never too young to start learning about this.

Certainly.

I think by your early to mid 30s is appropriate to start to have conversations with your physician or your clinician.

And hopefully those conversations are also being, you know, brought up by them.

You know, when when you go for your regular checkups.

I think also, you know, seeing an ObGyn or someone who's familiar with the reproductive stages on a regular basis, to have those conversations to check in, where are you with all these variety of symptoms is important?

Shonda.

What age are women are coming to you saying, I need to know about this.

Yeah.

I'll often 40s, sometimes in their late 30s because again, this is becoming more talked about.

I would love to see this part of the mainstream sort of education, even if it's not a deep dive into what's happening during menopause, that it becomes more of the vernacular and teaching in schools and so forth that it's just part of, everyone has that information.

Wonderful.

We do have an audience member question.

We have Bill, who's going to step right up here to our microphone here.

And he has a question about navigating this right with your family.

So I have two questions you want me to ask both.

If you could ask the one about your family right now and we'll get to the other one in just a little bit.

Sure.

So, education for women is this is the one you want to.

Right?

Education for women is absolutely severely lacking.

No doubt about that.

Since menopause affects people in a woman's life, spouse and kids, what kinds of education is needed for them to help support her and seeing how difficult difficult it is to even get women educated on this.

Educating the family may be even more of an uphill struggle.

Is there any work being done to help educate those in the women's circle?

I mean, I think it's a great question and I think, sometimes a forgotten piece of this story.

And I do think that, you know, just to be open and transparent about sort of the biology and the physiology and that this, you know, especially, I think some of the mood issues when can sometimes come out at home or, you know, sleeping issues.

I think just to sort of call it what it is.

And for the, the folks in the family to be aware of what's happening and supportive, you know, of the of the woman, both getting information, getting therapy, getting support as they, you know, trans, transition in this process.

Sure.

Shonda, what do you tell families, you know, husbands or significant others of people who are going through this?

Yeah, I appreciate the question and I appreciate it.

Having a man in the audience, I say approach it with compassion, curiosity and a little bit of caution.

So just to be aware of that, but, you know, show them that you're, you're want to be a supportive ask the questions and say, you know, is it okay if I share what I'm noticing, if she's not quite aware of what's going on yet and the partner is more so, sometimes they notice before we notice what's going on in the changes.

So, but delicately and know that you were on the same team.

This is not about fixing you.

There's nothing wrong with you.

I really want to support you in getting the treatment that you deserve.

Doctor Friel, I want to get back to the basics of menopause and why this happens.

Why are we feeling some of those symptoms, like night sweats or getting really hot or, you know, the brain fog, as everybody describes it?

Why do these happen?

So you know, what's happening physiologically, essentially, is that the ovary, you know, prior to menopause, does this beautiful dance of hormonal production with a combination of estrogen and progesterone.

And we have estrogen receptors all over our body.

And once we go through menopause and we no longer have our period, the ovary essentially really diminishes its production of estrogen.

And it's really the lack of estrogen in our bodies that's causing these symptoms.

And, you know, it's it's interesting because the other thing to remember is part of the menopause, process is also the aging process.

And sometimes it can be hard to figure out what's actually being caused by low estrogen levels versus what's being caused by getting older.

And maybe it's a combination of both.

Sure.

And so how does this stage of life impact a woman's overall health moving forward as she does age?

You know, menopause and aging go hand in hand, especially when it comes to bone density or heart disease.

How does that all play in?

Yeah.

So I think there are a couple of things to think about.

And how I really try to approach this with patients is I don't like the word menopause because it sort of sounds like we're stopping.

But I do like the idea of pausing and really taking, account of what you're feeling in the moment.

As far as the menopause transition and how that can be managed.

But then thinking about long term and what can I do to think about my health 20, 30, 40 years down the road?

I also don't like the term anti-aging, but I really like the term anti frailty.

And that speaks to what can I do now to help my bones 40 years from now?

What can I do now to help my heart 40 years ago, 40 years from now, as well as my brain?

Some of that is hormone dependent and some of it is lifestyle, which is, I think, so important.

And if the menopause transition can be like a wake up call for women to say, oh my gosh, I see my body is changing, let me figure out how to manage my symptoms.

Now, but let me get educated and think about how I can prepare for the future in the long run.

And some of that might be hormonal, you know, management, but it's a lot of other things, too.

Sure.

So this is a marathon here.

It's a marathon.

Absolutely.

Okay.

And you know, we're talking about these different aspects of our life, our overall health, how our families are involved and how we react to our families.

But there's another element to the Shonda that you talk about your career in the workplace and the workplace is starting to recognize that this is a new phase for women, not a new phase, but a new phase that women go through.

Right?

Or we're talking about it more.

Sure.

Right.

Absolutely.

So unfortunately, the US is kind of lagging behind here up in menopause, in the workplace programing and education.

But we are catching up and places are having our companies are having people come in and talk about this.

It's all about education because my women are informed and can get proper treatment and get to the root cause of what is causing them issues, then workplaces don't need to make as many accommodations, and we know that $1.8 billion is lost, is estimated to be lost every year due to menopause related absences.

So this is health care costs.

It's, retaining talent because women actually will leave the workforce thinking they're burning out, when really it's sometimes related to perimenopause symptoms.

So we really want to educate everyone in the workplace to open up this dialog.

Sure.

And what are you seeing workplaces do to accommodate this?

For women who, you know, who maybe don't know how to navigate this?

Are there are there programs being set into place?

Yes.

So occasionally I'm invited in to talk and do, workplaces, workplace, workshops for an hour or so here and there.

And then they're bringing in other programing.

So it's slow to start, but it's beginning, especially in the Lehigh Valley and across the US.

And just opening that dialog again and having resources on their website so that, families, family members, and leadership, especially with leadership, we want to have menopause champions in the workplace, in leadership positions because they can model this.

They can give permission for employees to openly talk about it and not fear that there's going to be some, you know, lack of advancement or something in a woman's career.

Sure, sure.

And I just want to remind our audience this evening, if you do have a question, you can stand up at our microphone and ask our physicians and our specialists some questions.

Ladies, I want to continue the conversation about some of the signs and symptoms.

Weight gain is one of the ones that a lot of women kind of grapple with for this, for this time of life.

I mean, the most common symptom that we see and the most common symptom that women experience are the vasomotor symptoms, the hot flashes, which about 80% of women will experience.

Those as part of their menopause journey.

But the list is exhaustive.

Weight gain is, of course, what a lot of women are frustrated with.

We talk about brain fog, joint pain, mood changes for sure, headaches, palpitations, you know, dry skin.

The list kind of goes on and on.

And, you know, we have good data that, you know, certain therapies, meaning hormone therapy helps with some of those symptoms, primarily the vasomotor symptoms.

But whether or not hormone therapy helps with all of those symptoms is really less clear.

And I do think that there is some frustration out there now where, you know, like we talked about menopause is sort of having a moment, which is great.

But I also don't want women to walk away thinking that hormones are going to sort of fix everything because it's just it's just not the case.

Sure.

And we're going to talk more about some of the different treatments, the holistic ways that folks can, treat menopause.

But when it comes to the mental load of just everyday life, plus you add this on top of it, what are some coping skills that you offer?

Shonda.

Right.

So lifestyle with we can make very small tweaks and changes to lifestyle such as sleep, nutrition, exercise.

I always say to track what you're eating and because that can change, right?

So noticing your symptoms are signs of of what's changed in your body and how you're responding to foods.

Stress reduction is a huge one because what we know is when estrogen goes down cortisol the stress hormone goes up.

And that can lead to this this feeling that we're overwhelmed and not able to cope quite as much.

So stress reduction practices are really helpful as well.

Absolutely.

Some great information from both of you.

We're going to continue our conversation.

But again there may be some questions for you a little bit later in the program.

Doctor Kristen Friel and Shonda morales, thank you so much for all right.

Well, many women report not knowing they were of the age to be experiencing perimenopause or menopause.

That was the case for a Whitehall business owner and mother of two.

When Jenica Covington missed her period in her early 40s, she immediately thought she was pregnant.

She says the next stage of life never even crossed her mind.

I got in this Lehigh Valley style magazine because our kids go to school together.

My name is Jenica Covington, and I'm a small business owner.

I'm a certified birth doula, and I'm also the owner of Mama Nico's Homemade Things, which is a plant based company where I make all the things plant based that includes food and skincare.

I was about 42, 43.

I hadn't received my menstrual cycle.

It was about three months.

And so, you know, I waited after the first month and a second month and I'm like, okay, because I was thinking I was probably pregnant.

And so I go to the doctor and so she's like, yeah, you're not full on menopause.

But these are, you know, classic perimenopause symptoms.

I just was like, I kind of was like, there's no way.

Like, I just I didn't know a lot about menopause, but the little bit that I heard about it, it was like, oh, you get menopause when you're older, you know, when you're not in my 40s.

So I'm thinking, I didn't know that that can happen to me.

I didn't know I could start having symptoms, menopausal symptoms at my age.

So yeah, I was a little shocked.

She was like, have you experienced anything else?

And I told her, I said, yeah, I've gotten so overheated and I had to sit down.

I said, a couple of times, I've woke up and my shirt was completely drenched, or my pajama shirt, and she was like, yeah, you know, night sweats often, you know, hormonal imbalances, weight fluctuation, like all the things that I was going through.

And that was my first time that I had any knowledge of that.

I really, really see how it affects my body according to what I eat.

I've been mostly plant based now for six years.

Am I cooking?

And when I cater, it's all plant based.

I really, really try to balance that with, you know, having a balanced diet.

I try to if I don't do anything, I try to walk every day.

That helps me out a lot is I'll get night sweats every once in a while, but I don't really get a lot of symptoms because I try my best to manage it with how I eat.

And I really see the difference is really, really good.

It looks really good.

You're making me hungry.

Her food looked at her.

Food looked absolutely delicious, by the way, and we thank Tenika for sharing her story.

She's joining us in the audience this evening.

We're going to chat with her in just a few minutes.

But here now to continue the conversation and talk about holistic ways to treat menopause.

Is Doctor and Freeman from Saint Luke's University Health Network's Obstet Tricks and Gynecology department, along with pelvic floor physical therapist Erin Donahue, also from Saint Luke's and the owner of Twin Ponds Holistic Health, Katie Friel.

Ladies, thank you all so much for joining the conversation.

Doctor Freeman, we're going to start with you.

We heard Jenica talk about some of her diet and exercise routine to help her get through this stage of life.

How important is nutrition and making sure that you're getting your daily exercise when you are hitting this stage of life?

It's I can't emphasize how important it is.

I always and it's for menopause and non menopause reasons to when we go through menopause we start to be at increased risk for chronic diseases, diabetes, hypertension.

But then there's also the menopause related issues.

And I always kind of start the conversation in a menopause visit.

Talking about lifestyle doesn't mean that we're not going to treat patients symptoms with other means.

But lifestyle changes with diet, exercise and sleep are really important.

So most women, many women gain weight with menopause.

And we know that some of it is from loss of lean muscle mass and some increase in sedentary habits.

And there's other reasons as well.

And that's why it's really important to try to maintain their ideal weight or try to not gain weight or lose excess weight.

It will really decrease their risk of chronic diseases as well, as it decreases the risk of breast cancer as well.

That extra weight.

So then sleep which is also affected by menopause and non menopause reasons.

And then exercise I believe in doing something every day.

And they recommend 150 minutes of moderate exercise weekly which is really important for sure.

I was just going to ask that you have to go from one day maybe taking walks around the neighborhood to all of a sudden you're doing a triathlon kind of thing, or is this gradual?

Can you just add a few things to your routine?

It should be gradual because it's too overwhelming to go from 0 to 60 in one day.

So I always tell people, start with something that's easy, like walking.

And then it's really important to do strength training 2 to 3 times a week.

But again, you don't have to start there.

You start early and you build up and really consistency is the key.

So you start out slow and make it your routine and then it gets easier to add on.

Sure.

And we're going to talk more about that in just a couple of minutes.

But I want to bring Danica into our conversation again Danica, thank you.

So much for sharing your story with us.

Such a, you know, a surprise to you.

And I'm sure a lot of women have that.

Am I pregnant?

No.

All of a sudden?

No, it's just menopause.

And so I know that when we spoke, you said you did a lot of research.

And I wanted to talk a little bit about being a woman of color going through this.

What were some of the things that you think that, you needed to know as you were going to these office appointments and that kind of thing as a woman of color?

Well, first of all, thank you for having me.

I enjoyed our time together.

So thank you again.

Brittany.

I think, in general, well, not even in general, but as women of color, we have felt, you know, unseen and not given information as our, you know, white counterparts.

And so for me, I just from an early age, I've always been very, you know, I'm going to go ahead and do my research and get the things that I need to know for myself.

But I think with this topic, because I had really never besides, you know, you go through menopause, I didn't know any symptoms or anything like that.

So when I was approached or told by my doctor that I was experiencing, oh, it's just menopause and not giving me really any more information, it just was a little daunting.

Like, wow, I wish somebody would have told me this.

And even in that appointment, I kind of wish she would have taken the time.

I did ask questions, but I just wish she would have like given me more information about it and not making it seem that this was something that I should have known.

Sure, absolutely.

And I want to come over here to Doctor Freeman.

If patients are feeling like they're not getting the information, how do they advocate for themselves, whether they're from, you know, different cultures or different backgrounds?

How do they make sure that they're getting the information and treatment that they need?

Well, I often tell patients that they really, if they are able, should try to see, someone who's familiar with menopause care.

There's menopause practitioners in the area, and often their ObGyn may be able to help them or their family doctor to at least point them in the right direction, but they really do need to really have their their concerns addressed with, a provider who's familiar.

It will make all the difference.

Sure, sure.

And I want to bring Danika back in this.

What was something that you wish you would knew when this first happened that you would share with other women?

I just wish I have known that, you know, menopause isn't really this scary topic.

You know, just like you mentioned at the beginning of the segment, you know, we learn about our periods, we learn about our cycles, and, you know, how we go through puberty.

And if they could have just added on and the next phase is menopause or perimenopause, this is what you know.

So we won't be so shocked.

And attributing these symptoms to God knows what you know, because we all know who who has experienced it.

I mean, it can be some traumatic things.

You wake up and you're all sweating, you know, you can think so many things.

But if they kind of was just told us at the beginning, you know, this is a part of life, you're going to experience it.

And these are the tools you can get through it.

I wish I would have known that some really great advice.

I see a lot of heads nodding throughout this room and some really great advice, and it seems so simple to do, right?

Just continue on that education.

But of course, that's why we're here tonight.

Jenica thank you so much for your insights.

And I want to come back over here.

Erin, I want to introduce you into the conversation here.

You are a pelvic floor physical therapist.

And so how does this fit into this conversation and why is this needed when you're going through this stage of life?

Great question.

So we have what is the genital urinary symptoms of menopause.

So with the loss of estrogen, we lose, kind of some tone in our tissue.

So, people frequently will complain of vaginal dryness, which can cause some difficulties with intimacy.

Or they'll notice all of a sudden they're leaking, and they're like, what the heck?

I haven't had a baby in years.

Why am I leaking all of a sudden?

Or they might notice some slowdowns, like with constipation or difficulty having a bowel movement.

And those are all things that we can address.

And pelvic floor physical therapy.

Sure.

So what is the pelvic floor and what does the pelvic floor therapist do?

So the pelvic floor is a group of skeletal muscles that sits at the base of our spine.

So it runs from the pubic bone in the front to the tailbone in the back and side to side between the hips.

And the important part about then being skeletal muscles is those are the same kind of muscles we have in our arms and legs, which means that we can train them so we can train them for endurance.

So both for sitting in long car rides or long meetings.

And we can also train them for strength.

So, not leaking when we get out of a chair or cough or sneeze or laugh and then pelvic floor therapists, our job is to figure out, are we dealing with, muscles that are overly tight and need to relax?

So, if muscles are overly tight, then we can have problems with leakage.

We can have painful intimacy.

We can have, just difficulty with starting a urine stream or a bowel movement, or are they overly loose?

And those can lead to problems such as leakage, again, or, symptoms of prolapse or weakening of the vaginal wall.

And those are all things that we can work on.

Sure.

Now, is this something that if you're only if you're experiencing an issue, that you then go to a pelvic floor therapist, or is this something that all women should consider?

My personal belief is that all women should consider this.

So, we've we've all been through changes in our lives, whether that's been, you know, having babies, whether that's been playing sports, whether that's just been life living on us.

I think that we all need to address our pelvic floor.

So I have many women that will see me.

Preventatively.

Say, hey, I saw what my mom and my grandma went through, and I don't want any part of that.

I want to be able to prepare my muscles for the rigors of what's coming.

Or you can see me when you already have a problem, and we'll do our best to figure out what are some solutions in addition to, some of the medical interventions and the lifestyle changes that Doctor Freeman had mentioned?

Sure.

And, Doctor Freeman, how often are you recommending that, your patients go to pelvic floor therapy?

Is it something you incorporate into your routine with patients?

Yes.

So I ask every patient how they're doing with their bowel function and their bladder function.

And we send many, many patients to Erin and her colleagues.

They do a great job.

They do a great it's so beneficial.

I have really not had anyone come back and say that.

They didn't feel that it was helpful.

Sure.

And Katie, we're going to get to you in just a minute and talk about some other ways we can take care of our body.

But we do have an audience question right now.

Would you mind stating your name and your question?

Hi, I'm Lisa, and thank you for this is a great, whole symposium with lots of things to ask about.

But, Doctor Friel mentioned that there are estrogen receptors all over the body.

And then, Erin, you just talked about how it can affect different things, but I was wondering, how does menopause actually affect your gut health and your motility?

Because there are lots of changes.

I'm a physician, and I hear complaints from lots of patients that are off the normal beaten track and, you know, menopause seems to affect much more beyond just the hot flashes and the mood swings and those sorts of things.

And it's more than bone.

And part of the problem is that we don't really know enough about menopause, because not enough has been done actually testing on women.

Lots of things have just been tested on men.

Sure.

All right.

So the question is about gut health.

Doctor Freeman, would you like to weigh in?

Sure.

Well, as we know, there are estrogen receptors all over the body.

And we know that changes in hormones can affect the motility of the GI of the GI system.

We see that in pregnancy.

And it happens all really throughout life.

And then the other part of it, in terms of the, general, your urinary system, is that it can affect the muscles and the bladder, but that can also affect bowel and, continence a bowel and bladder.

So the best thing is usually a diet and exercise.

We do often have to send patients to talk to their family doctor or their GI doctor to rule out any other causes of issues, but often it's a matter of recognizing symptoms and trying to control it.

With exercise or changes in diet.

Sure, we talk about taking care of our bodies when we're exercising and eating healthy, but we also have to talk about our mental load and taking care of our body and making sure that we're calming down.

And Katie Friel from Twin Ponds, I want to introduce you into the conversation.

Why is it so important, especially us as women, when we're getting older, to take care of our bodies and what is there that we can do to do so?

I think we can do a variety of things to care for ourselves, but I think mindset is most important.

We as women have been taking care of others our entire lives.

Some of us have been caring for others since we were children, and this is our time to reclaim our selves.

To say, I am here, I am invisible, I am going to prioritize myself.

And, you know, Shonda talked about little things we can do, like starting a walking program, being more active.

And I'm going to really endorse meditation, mindfulness acupuncture.

And you can do a little bit of all.

You can do hormone replacement therapy and acupuncture.

You can do the HRT with the yoga, and the mindfulness.

So a little bit of everything is is okay.

Sure.

And I want to get into that a little bit.

You mentioned hormone replacement therapy.

Doctor Freeman, can you talk a little bit about that?

What is that we sometimes hear on the male side with testosterone replacement.

But what is it on the female side and how does it fit into menopause.

Well hormone replacement therapy or now we sometimes call it menopause hormone therapy or hormone therapy, which is shorter, is basically treating it's first line therapy for vasomotor symptoms, hot flashes, a night sweats.

So it's either estrogen or estrogen and progesterone.

Anyone who has a uterus needs both estrogen and progesterone.

And it works very well.

And many, many women are candidates for hormone replacement therapy.

It's underutilized for many reasons.

There are some women who cannot use it, such as women who have had an estrogen sensitive cancer like breast cancer or uterine cancer, if they've had a stroke or heart attack or a blood clot or something, that will put them at increased risk for a blood clot.

But there's many other women who are candidates for it, and it works very well.

It will eliminate or almost completely eliminate their hot flashes.

Sure.

And is this something you get from your family doctor or your gynecologist, or where?

Who would you talk to for that?

I would say most often gynecologists, I have seen family doctors who are well versed and comfortable with it, or they will refer the patient to their ObGyn.

Sure.

And I do want to come back to Katie here.

Katie, when you see people coming in for some of the other therapies that you talked about to making sure that they're they're taking care of their mind and body, what's kind of the response you're hearing from women when they come out of those things?

I think they feel supported.

They feel seen, and they're very open to a variety of treatment strategies.

And, as a psychotherapist, I'm also really encouraging people to connect with others, find peers who understand, talk to therapists to understand.

As Doctor Freeman said, find, a menopause specialist who can listen and help.

And of course, I'm going to endorse the Pennsylvania Menopause Conference, come to the conference in May of 2026, connect with other women and feel supported.

Sure.

And you've had this conference before.

What are you hearing from women there?

Are they hungry for this information?

Oh, absolutely.

We did a panel discussion at the end with questions.

That was one hour.

We could have continued for two more hours.

Sure, sure.

And we're going to continue this conversation tonight on YouTube after the broadcast.

And so if anybody wants to continue the questioning after that, they can do so on the PBS 39 YouTube page.

In the meantime, Erin, what is the, how often are women coming to pelvic floor therapy, and what does this entail in terms of a time, constraint?

You know, we have busy lives, right?

Absolutely.

We do an initial evaluation that's typically 45 minutes to an hour.

So as a physical therapist, it's really wonderful that we have that time to delve into all the different systems involved the urinary system, the musculoskeletal system, bowel system, reproductive health.

So we can really take the time to, kind of see how everything is impacting the client's life.

After that, we typically see people one time a week and then we taper it off.

So, going considering the muscles and the pelvic floor, it typically takes about 4 to 6 weeks just for the brain to start talking to those muscles again and start making those connections at about 8 to 12 weeks for those muscles to get stronger or for them to relax, depending on what the condition is.

But we find that after we start people off on a good, program, they can sometimes taper off.

And we always try to make a home program that goes with the person's busy life, and not just adding one more thing on their to do list.

Sure.

Because we all know as women were being pulled in a million different directions.

Is there things that women can do at home to make sure that they are making sure that they are staying healthy when it comes to not just pelvic floor, but aging through menopause?

Absolutely.

Biggest one is make sure you're staying hydrated.

I know you hear from everybody.

Oh, we should be drinking more water, but really, we should be staying hydrated for our, our gut health and our bladder health.

Also the mindfulness that, both Shonda and Katie had recommended because our pelvic floor works with our breathing muscle.

So when we breathe in our pelvic floor and our breathing diaphragm both drop down.

And when we breathe out, they both come up together.

So if there's time for nothing else in their life, just taking a nice deep breath a couple times a day to get some range of motion through the pelvic floor and to calm down the nervous system is a huge change.

Some great advice.

And Doctor Freeman, finally, is there any other ways that women can combat some of these symptoms of menopause without, you know, medications or that kind of thing at home?

Besides diet and exercise?

Well, there are some ways, I get asked all the time about supplements and natural natural, medications to take the issue with those is that they're really not regulated and there's very limited or inconsistent studies.

So many of the things that you see on the shelf in the drugstore are really not recommended by the Menopause Society, and they use very evidence based, criteria to recommend things.

One thing that works very well that I'm sure Katie is familiar with is cognitive behavioral therapy.

It works well for hot flashes.

And also there is evidence that clinical hypnosis can help with hot flashes.

There's also non-hormonal medications that we use, such as certain low dose antidepressants.

There's a new medication called boza.

There is gabapentin.

There's several medicines that are non-hormonal for patients who can't take hormones or don't want to take hormones.

There are many options.

It just has to be a conversation that you have where you can find what works for you.

It sounds like the medical side and then the holistic side all come together to create a treatment plan.

And it's something you have to discuss with your with your, personal physician.

Wonderful.

Ladies.

Thank you so much.

I have Doctor and Freeman, Aaron Donahue from Saint Luke's.

You ladies, thank you so much for joining us.

And Katie Friel from Twin Ponds Holistic Health.

Thank you so much for joining the conversation.

Thank you.

Thank you.

Absolutely.

And medical advancements have come a long way when it comes to treating potentially deadly diseases such as cancer.

But those treatments and surgeries can have other side effects, such as early menopause.

That was the case for Kim Bonner, a mother and counselor living in Shanksville.

This was a scrapbook that I started to do to document my journey of my cancer experience.

I was diagnosed with breast cancer when I was 42.

My son was in fifth grade when I was diagnosed.

We also need to set plans for your birthday, and we know that, if you want to go out for dinner, you figure something out.

In that process, I found out that I'm a bracket carrier.

The bracket gene also affects ovaries, so it was kind of, do I want to have to try to deal with this again or not?

At some later point, and after some conversation with my gynecologist, opted to have a full hysterectomy done.

I went from one day, maybe not even being perimenopausal full on into menopause.

I didn't really have a lot of information as to what I should expect and what I was going to go through, and in that time.

So I kind of just felt like I was floating out there.

I never very fortunately had the, like, full on drenching sweat that a lot of women get.

I would get this sensation kind of out of my back and spread out.

I would glisten a little bit, have to take on and off, layers.

But for the most part, that was the worst of it, because I was also kind of going through my cancer surgeries and all of that.

So there was a lot going on.

The weight gain, has been probably my biggest, demand that I've had to like, deal with.

I was always I've always been a, like, really physically fit person.

And I don't get so worried much about my weight, per se, but like, where I'm holding it just really hard to keep the non flabby, away.

So that's been like one of the biggest struggles.

The brain fog was also I mean, if you could see my office upstairs, I have sticky notes everywhere.

Because if I, if I don't write it down, the likelihood that I'm going to forget it is is pretty significant.

I found out that women in menopause, get a lot of UTIs.

So that's been a journey.

I had never had one before, and one year I had like five of them, like right in a row, which, you know, when I finally got to the urologist, they were like, well, this is something that happens in women that are men, you know, in menopause.

My husband and I celebrated 25 years just a couple months ago.

So we've been together for a long time.

There's been some trying to figure out new ways to make things comfortable.

In the bedroom.

So that's been a little trying, at times, you know, trying to, you know, express like, it's not that I don't love you.

It's, you know, the libido goes out the window.

That's that's a big part.

As little as women.

No men, no less.

So, they need an education, too.

Menopause is one of those taboo topics, but so is sex.

People get hangups around talking about it.

And I think, you know, this is a person you love.

It's about just being honest and open about how you're feeling.

My body went through a lot in in just a short period of time.

I heard a woman describe it the other day as the quiet unraveling of yourself, and I was like, that's it.

Like in a nutshell, it's that quiet unraveling.

And it really struck home with me because it's like, you don't know yourself and suddenly you're this different person.

And it's a natural process.

And I think that when we don't talk about things and we make them kind of taboo, then we feel bad about ourselves.

And I think that, you know, just talking about it, if you have questions, talk to your doctor, talk to your friends.

I think that sense of community is so critical.

And we thank him for sharing her story with us.

Joining us now to talk about how some medical treatments and health issues can affect the menopause timeline, is the chief of obstetrics and gynecology at Lehigh Valley Health Network, doctor Susan Haas.

She's joined by therapist Michelle Adler, the founder of real, a business where she coaches women in this stage of life.

Ladies, thank you so much for joining us.

Thank you.

Thank you so much for having us.

This is such a critically important discussion.

And I think that like in the earlier parts of the discussion, we talked about how we want to educate, people to be, informed as they go through this transition, educate allies and partners and families.

And this is such a large part of doing that.

So thank you so much.

Absolutely.

We are so happy to have you, Doctor Haas.

And I'm going to start with you.

We just heard Kim story.

This is a little bit different way of, one woman's story about going into menopause early because of the cancer treatments and then the hysterectomy that she had to go.

And so do women with surgical menopause and early menopause, do they face different challenges than women who kind of go the traditional route?

Not that they're choosing to go the traditional route, but, you know, if that's how it happens for them.

Absolutely, absolutely.

And everybody's journey is a little bit different.

But surgical menopause in particular can be a challenge to a woman because all of the symptoms and changes in her body happen all at once.

So menopause occurs when a woman's ovaries stop producing hormones, stop producing estrogen levels fluctuate and then eventually decline.

But when that happens because of surgery in a young woman who is in the middle of her reproductive years, all of those hormone levels drop very dramatically all at once, and the symptoms can sometimes be much more severe.

Oh, okay.

So what are some of the symptoms that they most often, tell you that they're experiencing same ones that they would go through ten, 20 years later, probably not unlike the symptoms that they will go through later.

Right.

So the typical symptoms, the ones that are the most correlated with dropping estrogen would be things like hot flashes, night sweats, sleep difficulties, vaginal dryness that can cause bladder problems and difficulty with intimacy.

And all of this can be particularly problematic in someone who is maybe younger when they go through all this and doesn't have other, people in their circle experiencing this at the same time, so they feel a little bit more alone.

Sure, some of them are a lot more alone, and that's what Kim had.

Had described as well, that she was, you know, in her late 30s, early 40s, and her friends weren't going through it.

And she didn't necessarily want to talk to her mom's friends.

Michelle, I want to bring you into the conversation and ask you, how do you address this with women, whether it's either the trauma of going through early menopause because of a surgery or cancer treatment, or if it's just someone coping with, the, the the thought that I can no longer have children.

Well, like so many other women have mentioned, this transition into away from fertility.

We are, to use the term that we've all been dancing around the crone phase of of our lives.

It's not recognized.

It's not heralded.

We're in a man's world.

And yet this is the phase that 100% of women who are assigned female at birth will go through, even though 87% of females go through, childbirth, only 100% will go through menopause.

And as we do that, it's very validating to hear other women say that, to say like, this is coming.

This is part of it.

I know Janica had mentioned in her segment, so when clients come to me, I try to bring it into their awareness, whether they have been exposed or whether it's a very gentle introduction that this might be something, this might be something to bring into your awareness.

This is a standard practice.

This is absolute okay.

You're not crazy.

And we can get through this.

Absolutely.

We do have, an audience member who would like to ask a question right now.

Please state your name and ask your question for us.

Hi.

Thank you.

My name is Lisa.

First, I'd like to thank PBS 39 for putting this together and for all of the panelists for bringing your expertise.

I've already learned so much.

My question is, I've been on progesterone 200mg daily for about four months now, and I'm not really sure it's having an impact.

How would I know?

And what do I do if it's not?

Yeah.

Doctor Haas, would you like to take that one?

Absolutely.

Lisa, that's a great question.

So the classic sort of role that we've all been taught that progesterone plays in hormone therapy is that when we treat a woman with estrogen, we if she has her uterus, we can't give her just estrogen because that estrogen can increase our risk of uterine cancer.

So we give progesterone along with the estrogen in order to prevent that risk in order to keep the estrogen safe.

However, in some cases, there are reasons to treat a woman with progesterone alone.

Some women who have medical conditions that make it unsafe for them to take take estrogen, take progesterone and get some relief from it.

Others, find that it's not as helpful.

And then one of the main, benefits we have from progesterone alone is really taking advantage of a side effect.

So one of the side effects of progesterone is that it tends to be sedating.

It tends to make people sleepy.

And so we often give progesterone in the evening.

And it tends to help with sleep.

Sure.

Lisa, thank you for your question.

I think along the same lines, we have Bill, who wants to ask another question about some of those, some of the topics that you just discussed.

Bill, if you could ask your question, that would be great.

Thank you.

All right.

So, is there any chance the FDA will remove the black cancer label from estrogen therapy medication?

Has the FDA ever removed a black label like this in the past?

I know that label deters my wife from even trying it, along with a fear of temporary bleeding.

The fear is paralyzing, and words without evidence provide little comfort.

I watch her suffer because of this fear and is no fun to witness.

Thank you Bill.

And so, Doctor Haas, what would you say to that?

Yes.

Thank you Bill.

It is a huge problem.

It really is.

So the black box warning on estrogen has to do with the potential risks of systemic estrogen.

Systemic estrogen, meaning a pill or a patch that we take that gets absorbed into our blood and goes to every cell in our bodies.

Right.

So this for some, or for some treatments of some menopausal symptoms that's required.

Flashes come from your brain.

So the estrogen needs to get to your brain in order for us to treat the hot flashes.

But for other symptoms, particularly what we call genitourinary syndrome of menopause.

So this is the vaginal symptoms.

The bladder symptoms, the pelvic floor symptoms.

These are treated very effectively with low dose vaginal estrogen.

And the reason that low dose vaginal estrogen is beneficial for these type of symptoms is that it's not absorbed into the bloodstream.

And by not being not absorbed into the bloodstream, it keeps it very, very safe.

Patients aren't at risk for uterine cancer.

They aren't at risk for breast cancer or heart attack or stroke or serious blood clots.

They're not at risk for ovarian cancer or dementia or any of the other things.

On this warning label.

So one place that I do see a role for, the potential for the black box warning on estrogen to be removed would be for vaginal estrogen products.

Okay.

All right.

And I wanted to just bill, I don't want to point you out, but I think it's important to note that Bill is here supporting his wife, learning more about this menopause process.

And so, Michelle, how do we bring our partners into this conversation?

How do we express to them?

You know, I'm not going crazy right now.

It's just a new stage of life.

And and we're all laughing because it is it has been so demonized the our mothers, we're talking about the change and all of these, you know, things to be feared.

About one third of our lives.

We will spend one third of our lives in menopause.

And yet it's this dark phase that we're supposedly in.

And I think, like you're saying, folding your partner in with conversations, whether you are being supported by a therapist or within your, gynecology journey with your doctors and folding them in and having conversations, supportive communities, as much as it is, you know, the toilet of the internet, social media does allow exposure to information.

I know it's terrible to advocate for it, but.

But pastor's bowing her head.

I apologize to the internet.

I'm sorry, I'm sorry.

I'm sorry.

But it it it is a method of quick education.

There are some amazing resources.

I, I got access to a Euro gynecologist at the menopause conference that I've been following on Instagram for years, but she was there and it was.

And she even shared that she was grateful because she had a medium to communicate to other people.

And that's what I'm saying with with partners, communicating with your partner that okay, you might think that I'm making this up, but this is real, and we're in this together.

And, and we heard Janica say earlier that it's so important to do your research as the patient.

Are you seeing that and hearing that from different people, different women of different backgrounds?

Are they doing their research?

Are they getting the information?

Are the different communities getting the information that they need?

Is what are you seeing from the women who are talking to, you know, is the easy answer.

No.

Because situations like this, what we're doing right now haven't existed before.

People don't want to talk about what was a taboo topic.

People are not willing to talk about women's bodies unless they're talking about like, lust objects and these sorts of things.

The health and wellness of women hasn't been a priority in our culture for a long time.

So it's important for us to just have a normal conversation.

It's okay to say the word vaginal dryness, and it's a good thing for all of us.

Everyone's happy when we address those things.

Sure.

And, doctor, where do we start if if women are starting to experience this, or maybe they're just in their early 30s and want information, where do they start?

I think certainly talking to their physicians, to their health care providers is important.

But I know that patients are going to look on the internet.

This is normal.

This is how we all find information.

You know, this is the the encyclopedia of the 2020s.

So I think what's really important is to be able to, look for accurate, accurate sources of information because there's tons of accurate information out there.

There's also some misinformation, people trying to sell supplements and products and, and, and things that are not really evidence based.

So, the Menopause Society website is a very good place to start.

The Swan study website is a very good place.

The Swan study is, is a huge study looking at menopausal women throughout the United States and just following them over time.

And that's where a lot of these statistics that we've talked about throughout the night come from, in terms of how many years a woman has hot flashes, what's the average age of menopause, how things vary in different ethnic groups, all that type of stuff.

The Office of Women's Health of the Department of Health and Human Services has a great website as well.

And then, people finding people on social media who have the proper credentials to be giving us accurate information.

Sure.

And when it comes to mental health, what are some of the best tools in our toolkit, Michelle, to offer folks that we can offer ourselves?

We can offer our friends who are going through this.

What are some of the tools in that toolkit?

Well, like Katie had mentioned earlier, mindfulness, different body centered.

I know Doctor Friel mentioned the vasomotor symptoms paying attention to your body.

CBT was mentioned earlier utilizing resources of mental health therapists.

And you know, you need an Lcsw w an LPC to support you when you're going that route because most of us feel like we were going crazy when those symptoms began.

So utilizing those kinds of resources, I toot my own horn.

I run the menopause minute every month so that we have women come in and talk about their symptoms and just develop community, just finding people that you can talk to.

And like doctor House was mentioning, vetting your sources, knowing who to trust.

If you if someone on the coffee shop mentions mentions a supplement, that doesn't mean it's going to work for you.

You should do your work too.

Absolutely.

And Doctor Haas, I know you mentioned supplements.

One of our audience members asks what natural supplements should women be taking when they are perimenopausal, menopausal or postmenopausal?

A quick answer for that, please.

Sure.

You know, supplements are, a little bit controversial in that many of the supplements that are marketed that are sold, the supplement industry is not really regulated.

So we don't really know what's in the bottle.

You know, you can go and get a bottle and says black Cohosh on it, but nobody's testing to see if there's actually black cohosh or is it rice powder or potato starch or some other, ingredient ingredient that can have some kind of adverse effect on you in there?

The it's just not regulated.

But there are some things that are important to look for.

Calcium and vitamin D are really important for bone health.

Fiber is really important for our GI tract and for our overall health.

I recommend patients get at least 25g of fiber a day, which is a lot of fiber.

Wonderful doctor processes, wonderful information.

We are going to continue this conversation on our YouTube channel so folks want to join that.

But I just want to say Michelle Adler and Doctor Haas, thank you so much for these.

This wonderful information.

Thank you so much for the opportunity.

Absolutely.

And that'll do it for this community conversation.

Navigating menopause.

These are the important conversations we hope to continue to provide to viewers like you here at Lehigh Valley Public Media.

Now more than ever is the time to support PBS 39 as a public media station.

We've had so many questions.

We're going to continue this over online at PBS 39.

Have a wonderful evening and have a good night.