- [Announcer] Major funding for this program was provided by the HEAL Alliance and Central Texas Health and Wellbeing Network, Continuous Cultural Improvement Method.

Additional funding was provided by Jackie Lee, Planned Parenthood, Power Pivot, and Second Act with Carol.

(relaxing rhythmic music) (relaxing rhythmic music continues) - [Announcer] And now, please welcome Keocha K. LaFleur-Anders, founder of Coffee Milk Media and host of "The Pause."

(audience applauding) - Hi, everybody.

(audience laughing) Thank y'all so much for spending your Friday night with us, and we're gonna get right into it.

The first segment, what we're gonna talk about is what actually is perimenopause and menopause?

I don't think that many of us know.

I know I didn't.

Two years ago, what kind of happened was someone said, "Oh, you're in perimenopause," 'cause I was sweating like a pig after drinking a glass of wine.

It wasn't even a whole glass, I was sipping on some wine.

And I think now that I'm thinking about it, she actually said premenopause.

And I'm like, "What is premenopause?"

I mean, I hadn't heard of peri either, but then I started researching it and it made so much sense as to why I was a little short-tempered.

(audience laughing) Sorry, babe.

(audience laughing) He was so patient.

But many things.

And what we're gonna talk about tonight, it's more than just hot flashes because many of us have been told, "Oh, you start getting hot flashes, that's what it is."

It's more than that.

And so we're gonna get into that in this segment.

And I would like to welcome to the stage Dr.

Susan Hardwick-Smith and Karen Cerezo.

(audience applauding) Thank y'all so much for being up here with me.

I feel so smart with glasses on when really it's 'cause I can't see.

We're gonna dive right into the questions.

And the first one, Dr.

Susan, is what is actually happening in our bodies during perimenopause and menopause?

- Well, to answer that question, I go back to puberty.

Somewhere around about 12 or so, we started releasing eggs and we started having periods.

So starting about that time, we were producing three critical hormones, estradiol, progesterone, and testosterone, which is often overlooked, but also really important.

Now, there's a lot of variation.

Not everyone had perfect periods, but let's just say we had periods every 28 to 30 days or so during the time that we were fertile, breaks in between when we're on birth control or when we were pregnant.

And then let's just hold that thought and jump to menopause.

At that time, our period stops.

We're no longer releasing eggs.

We're not producing any estradiol or progesterone and very little testosterone in many cases.

That's pretty easy to define, it's still defined as exactly one year after your last period, which doesn't even make sense for a lot of women if we've had a hysterectomy, maybe we have an IUD or other reasons, but that's still the way it's defined.

So if we put menopause over there and kind of young and fertile over here, there's this big gap in the middle.

And I can tell you, practicing as a traditional OBGYN now, I've been in practice since 1999, we were taught absolutely nothing about this.

Maybe we knew about fertility.

If we were lucky, we knew a little bit about menopause, but very little, but we weren't taught about the in-between.

It was almost like just one day it stops, But it's not like that at all.

Typically, during our 40s, but with a huge range, things start changing.

So we're not releasing an egg every month on time anymore.

Our periods might get more irregular.

Instead of a nice gentle curve, estrogen can go up really high and down really low.

And so, whatever symptoms we might have had with our period are accentuated.

I heard you saying you felt a little snippy.

I mean, PMS can turn into rage, anxiety, depression, even suicidality goes up.

So a lot of mental health challenges, which have typically we've been told just put up with it or maybe there's something wrong with you or just go get help, go to a psychologist and we're told something's wrong with you.

That message is still very prevalent.

And it's not just in your head at all.

Our brains are actually changing in response to these massive hormone swings.

Often we call it hormone chaos or roller coaster and it feels like that.

- Yeah.

- I know I had times where I would act like a completely different person.

I had young preteens at the time and would like scream at them like, "Get in the car."

- They'll do it to you.

- Yeah.

(guests and audience laughing) One of my 11-year-olds at the time was like, "Mommy, we're just going to school."

And I'm like being counseled by an 11-year-old.

- Yeah.

- It's quite distressing.

Sleep can be disrupted.

Moods, obviously, temperature sensitivity, as you mentioned.

Basically everything our brain does for us can be disrupted.

Now during that time of perimenopause, during that in between, and there's no lab test or no diagnosis, no certain tests that you can have done to say you're perimenopausal.

It's more listening to the patient and just their constellation of symptoms but typically in our 40s.

I have never heard a patient describe it as being pleasant, just to say.

- Right?

- It's some kind of a combination of various different discomforts that have traditionally just been pushed aside.

Like, "Oh, she's just being hormonal" or "Don't make such a big deal of it."

So, really excited that there are now avenues to talk about this so that we can share our stories and not feel like there's something wrong with me.

'cause if you say, "Hey, I had that too.

Like, I remember that happened to me."

It really gets rid of that idea that I'm alone and something's wrong with me because many or most of us share a lot of these same symptoms.

- Yeah.

Isn't it fun being a woman?

(Karen and audience laughing) - It's a lot of work.

- And I love us, but I'm just like, what is happening?

Like there's so much happening.

And I think to your point, that's one of the reasons why I really wanted to do this is because when you start talking to different people, they go, "Oh my God, like I didn't know frozen shoulder until I was on a call was a symptom of that, right?

Because we've only been talking about hot flashes."

Anything to add to that, Karen?

- I think that is probably one of the biggest issues with trying to figure out where we are in all of this because we don't have the language.

We didn't have the list of symptoms, like you mentioned puberty.

We took that health class and so we kinda knew, hey, this is what's gonna happen.

Or somebody at least addressed that at some point you're gonna have your period.

And so when it happened, you weren't totally surprised, right?

And I'm not saying that's, you know, 100%, but for the most part we were kind of aware.

I think the same thing, when it started happening to me, I was like, I have no idea what is going on with my body because I was doing all of the same things and my body was reacting so different to what I was doing.

And like one of, you said frozen shoulder.

The itchy ear and the vertigo, what is that?

- I know.

- Like that was probably my worst symptom.

- I know 'cause itching is crazy.

- And then nobody told me that's all tied into your estrogen.

And so I think if we have the language and we have the knowledge by talking about it, then it makes a huge difference as to how we can prepare ourselves for this.

- I agree.

Even being on the phone with Dr.

Susan for the first time, I think we were on the phone longer than... We were going down a rabbit hole, which I love.

Same thing with Dr.

Orr.

It was just like, I was like, "Oh my God, really?

Oh, I'm doomed."

That's what I was thinking at first.

(audience laughing) But what I love is, you know, even with hot flashes and they get the spotlight, what are women experiencing that are unnamed or dismissed?

- Well, up until recently, all of this has been mostly unnamed and dismissed.

But as you mentioned, menopause has been associated with that one particular hot flash and night sweat symptom that not every woman has.

But those of us who have had them, I had those, I would wake up soaking wet, you know, really not a small thing.

It's not a minor inconvenience.

It really is, can be a major life altering experience.

- [Keocha] Yeah.

- So, that particular symptom happens during times that our estrogen is low.

So I'm not quite answering your question yet, but for perimenopausal patients, I did not know this when this was happening to me.

I'm a gynecologist at that time, had been in practice for 20 years, and I started having those symptoms just for three days a month, and then they would go away and then they would come back.

And it took me six months before I put it together that that was around the time of my period because we were not taught that.

We were not taught to tell patients.

You know, even when you're still having periods, you're 42 maybe, you could still have those symptoms way before menopause.

So that's one of the things that's really overlooked, that perimenopausal patients can have significant symptoms, not to be told, "You're fine.

You're having periods."

- You're too young.

- Yeah, you're too young, you're fine.

Come back when you haven't had a period for a year, which is truly the old-fashioned way that we treated patients.

She was extremely dismissive and it gave patients years of suffering where now good news is we can offer help very early on.

So nowadays, all of these symptoms that were still currently often are dismissed, we have solutions so you don't have to suffer with it.

So the answer isn't anymore, you know, this is just something that you have to suffer through.

The answer is there are options that you can choose to feel better if you want to.

- Yeah and it's important for everyone to know 'cause I think that this show has caused me to do so much research that has really made me love myself better, to be a better steward of my body.

For everybody who is just like, "I'm not aging," and you don't wanna talk about it, you're aging.

- [Karen] Yeah, yeah.

- Let's just go ahead and put that on the table and accept it with grace and love and appreciation for still being here.

But the reality is we need to be informed.

We have to have the language.

We need to be able to ask the questions, but we need to know what to ask, right?

- It's so confusing.

- Yeah.

- So, you might say premenopause or perimenopause.

I mean, these are not technical terms that have a lab test to define them.

They're really representing a constellation of symptoms that the patient presents with.

You might say menopause or postmenopause.

So I went through menopause some time ago, so you might say I'm menopausal or you might say I'm postmenopausal.

All of these words mean the same thing.

So if menopause is the single day on the calendar when you're after your last period, every day after that you're postmenopausal.

I'll be postmenopausal every day for the rest of my life.

- For the rest of your life.

Yeah.

- The rest of your life.

- Everybody needs to understand that.

It doesn't go away.

Yeah.

- It wasn't until Karen and I had a conversation one day that I actually was like, "Oh, postmenopause."

Because of the conversation of, "Okay, you don't have your period and then you're done, then it's done."

- Then you're done.

- Right?

And so, I've never heard of postmenopause before that, but what type of symptoms did you have, Karen?

'Cause we talk a lot about how we're going crazy.

- I always tell people I could take you like head to toe of what I was experiencing.

My hair changed, my eyesight changed, my smell changed.

I had dry mouth all the time.

My ears were itchy.

I had vertigo.

My joints hurt.

I had heart palpitations.

I had frozen shoulder.

My gut health changed.

Like, literally it was all the way down.

I had issues with the bottom of my feet.

Plantar fasciitis came out of nowhere.

And so, we won't even get into libido and what was going on down there because- - [Keocha] Somebody in the audience go, oh.

- We'll just save that for the second half.

But yes, I mean, there was like a whole list of symptoms and I'm checking this off and I'm like, "What in the world is happening to my body because I'm still eating right and I'm working out and I'm meditating and I'm journaling and I'm red light therapy and I'm running through the sand and shaking my hands and whatever it is, you know?

Whatever TikTok is telling me to do, I'm doing it.

And so what is happening?"

- Yeah.

- So head to toe.

Hello, welcome.

- Yeah, head to toe.

You know, my friend Ja nifer, I remember her telling me when I started experiencing symptoms, I was just thinking about it.

She's like, "You're gonna feel like you're crazy."

And I remember her saying, "Take my husband with me to the doctor."

That's one of the reasons why I wanted guys to be here because I'm like, "You also need to know what's happening."

- Yeah, do we have some?

- Even though we feel like we're going crazy, you also need the information.

I think our sons need it.

I think the men in our lives just need to know as well because it sparks grace, right?

I can say we're not going crazy, but then sometimes it kinda feels that way.

I think what started it for me when I really noticed it, it wasn't the wine while I'm thinking about it.

I was crying and my husband was like, "Why are you crying?

What's wrong?"

And I'm like, "I don't know."

He's like, "You don't know?"

- No.

- And I'm like, "No."

And he's like, "Well, did somebody say something?"

I'm like, "No."

And he's like, "Well, did something happen?

No."

And then I know for him, he was probably thinking, "Oh, she's about to start her period."

But I knew it wasn't that.

It was just, I was like all over the place, kind of an emotional, just not regulated and didn't really know why.

I think it makes it kinda hard to win friendships, I think at work.

I know you talk a lot about workplace wellness and specifically with menopause.

Can you talk a little bit about that, the emotional regulation and just the, like, all over the placeness?

- You do feel like you're all over the place, but I do feel like it's important that we have these conversations, that we're saying it.

And I know that, you know, this is lighthearted and we're laughing and we're having fun, but I would say before we even really started talking about menopause, when we saw anything, it would be on sitcoms, it would be a joke, they'd be mocking us, or we're the old crazy lady, whatever it is, right?

We're putting our head in the refrigerator, which we might do, but I think it's important that when we have these conversations and we share what's happening with our body and the changes physically and mentally and emotionally, that we do share it with our kids and our partners and our friends and the people that are in our circle, our workplace, because then it becomes normalized and then it is no longer mocked, it is no longer shame.

We don't have the guilt.

We don't feel like we're alone in this.

And so, it is so important that we have this conversation.

So we talk about it at the dinner table.

This is what I'm experiencing and it's not anything to hide.

- Yeah, Dr.

Susan.

Thank you, Karen.

If we can kinda talk a little bit about the mental kinda emotional piece of it, that'd be awesome 'cause I think that's a big thing.

- It's a huge thing.

So perimenopause really does start with cognitive change.

Our peris might be changing and certainly they frequently do in perimenopause, but most patients will present with some type of cognitive change.

And it's very often misdiagnosed as depression.

Now it may coexist with depression because these hormones are critical for our brain to function optimally.

So you can imagine if estrogen's going up and down in this crazy manner, progesterone's dropping, testosterone's dropping.

Our brain just simply isn't able to function normally enough and that shows up as mood disorders.

So a patient, and I resonate with this, I've felt like this myself, who really loses the desire to socialize and becomes somewhat isolated and just sort of stops caring, that makes it very difficult to get yourself to the doctor.

In my role now as a menopausal specialist, I really love to get women before they get to that point.

So I encourage my patients to come in when they're 40 and set up a plan, not to say this will happen to you.

We hope that it won't.

Not everyone experiences symptoms that significant, but if that does happen, there's a path to feel better.

So all of these symptoms that we're talking about, I will tell you we do not have to have them anymore.

We have very safe treatments that can make them go away.

- Yes, you can.

Yes, you can.

(audience applauding) We can clap for that.

- Yes, you can clap for that.

That's awesome.

- Yeah, so I have two 21-year-old girls and I entirely anticipate they're gonna slide through this whole thing without having any symptoms whatsoever.

So it is very, very important to talk about what we might be feeling.

- Yeah.

- And I certainly had all these things too 'cause I was clueless 10 years ago.

I suffered for six months before I started on the appropriate therapy.

So I do know what it feels like and I'm glad in retrospect that I got to experience that so I can empathize with my patients.

But there's no rule that you have to suffer with this anymore.

We can treat those symptoms so that it's not normal anymore to be sitting around feeling suicidal and wondering- - Sad and- - Right, like wondering if you wanna live the next 40 years.

That is not, shouldn't be normal anymore.

You know, we've been told it's normal to feel horrible.

I tell my patients, you can suffer if you want to, but you certainly don't have to.

You know, we have very safe options to make all of that go away.

Personally, coming from a space of feeling absolutely terrible 10 years ago, I feel great.

And I'm using very safe, very well-studied, scientifically proven methods that will make my life longer and reduce the risk of a bunch of chronic diseases.

So good news is there is a happy ending to this story that we're telling you about, all the doom and gloom.

So we don't have to suffer.

- So what lifestyle habits make the biggest difference for women in midlife?

- I always, when I'm talking to women about this, before we jump into anything else, before we dive into is HRT good for you?

Are these the questions you should ask your doctor?

What supplements should you be taking?

All of that good stuff.

I always wanna talk about let's just look at your lifestyle first.

Number one, let's look at your sleep.

I know.

I know.

We've had this conversation and you should make that face.

Are we setting ourselves up for success when it comes to sleep?

Are we prioritizing sleep?

Are we going to sleep at a nice bedtime?

But also, are we setting our room up for good quality sleep, right?

Do we have the nice sheets, the cooling sheets?

Do we have good pajamas?

Do we have extra fans in there?

- Multiple pants on.

Yeah.

- You know, do we have these extra comforts that might help us get better sleep?

Are we getting off of our phones, right?

Those are all things that I always wanna talk about.

So, let's start with sleep and then let's look at stress.

What does your life look like?

The biggest thing about midlife is we do have these added stresses, right?

We're planning for retirement or we are retired.

We've got relationship changes in our own dynamics, especially if we're empty nesters.

Now we're trying to figure out who is this person I'm living with.

We've got launching kids, right?

We're trying to get them out there to be successful, helping them whether they're in college or on their own.

And then we've got aging parents that we're dealing with and we've got the stressors at work and then we've got hormones on top of all of that.

- Yeah.

- So I always wanna look at our stress levels, right, because what is that doing to your body?

And are those stress levels making you do things like eat foods that maybe aren't blessing your body or making you not in the mood to go work out?

So we need to look at your movement.

Are you getting strength training in there?

Y'all, if you are not strength training, you need to start yesterday.

So I'm gonna say it all the time.

You've got to be prioritizing strength training.

We've got to be moving our body.

And then we need to look at our nutrition.

What are we eating?

What are we drinking?

Because that could be making this so much worse if we look.

So I always say, let's look at all of that.

Let's look at the patterns, let's look at the triggers and then let's go from there.

Let's take all the information so we can take it to our doctor so she can get an idea or he can get an idea of what our lifestyle looks like because menopause really is very specific to you, but they have to have all this other information and we have to be honest about how we're setting ourselves up.

- Yeah, because we all have a formula, right?

Like I always say when I'm teaching on the wellness side that what works for you might not work for me.

So even on the physical side, if you catch me doing CrossFit, it's because somebody told me they were gonna give me like a million dollars.

(audience laughing) I tried it.

I almost died like four times.

I was like, this is not for me, but I'll do Pilates, right?

And so, my point for even bringing that up is I think a lot of times we make excuses on the physical wellness part.

- Well, the biggest thing is if we don't address those, anything she prescribes to me, I'm not doing it justice because I'm not living this healthy lifestyle.

So I'm negating all of this hard work that she's putting into me by not even caring for what's going on with my body to begin with.

- Exactly.

Thank you, Karen.

Dr.

Susan, anything to add to that?

- Yeah, and 80% of your health, I'll make up a number, big, big number is really squarely in nutrition, exercise, sleep.

20% is the other stuff.

If we haven't mastered that part, all these other whistles and bells, your weighted vest and your ashwagandha and your wearable devices are not gonna make a dent in anything.

But mastering that is really critical.

From my perspective, treating a patient who's really in a perimenopausal or menopausal crisis, that patient's not gonna be able to go to the gym today.

But getting her feeling better with safe menopausal hormone therapy, now she feels better.

She's got energy again.

She's sleeping again.

Now her cognition's returned to having normal sanity most of the time.

- It all trickles down.

- That patient's gonna be able to follow the healthy plan that she already knows about.

I don't have a patient.

I bet nobody in the audience doesn't know that lifting weights is a good idea, doesn't know what a healthy nutrition plan looks like.

It's not a lack of knowledge.

It's just that we lose our ability to follow through 'cause we feel terrible.

- Yeah.

- And from a mindset perspective, one of the things that has really helped me, like I said, it made me love myself more, we can't run from what's happening.

We just have to be a better steward.

- Well, there was a time a couple of decades ago where there was still a lot of confusion about menopause and the safety of menopausal hormone therapy.

Those days are gone.

The science is very clear that the root cause of all of these symptoms and problems that we're talking about is hormone depletion.

Any other type of hormone depletion, if you didn't have insulin being produced or you lost your thyroid gland, we would immediately replace it.

We wouldn't think twice about it.

When we lose the hormones from our ovaries, the treatment is to replace those hormones.

It's very safe to do.

It's not confusing.

Bioidentical estradiol, progesterone, and testosterone's also very helpful, actually makes those symptoms go away.

So I wouldn't try too hard buying fancy gimmicks on Instagram, just get on the appropriate hormones.

Problem is solved.

So it's just taking it back to the root cause instead of like in your grandmother's case, a pill for every other pill and the side effect of that pill and next thing you have a big bowl.

If we go back in medicine to what is the root cause of this symptom and treat it there, the problem is hormone depletion.

So let's replace them in a safe, responsible manner and we don't have to do any of these other things.

- Y'all heard that?

Trust your body.

- Yeah, yeah.

- Right?

And I've had a lot of conversations with women who have said to me openly, they don't know very much about their bodies.

And if that's you, get to know your body.

Trust what you feel.

Your body is sending you a message and you should trust it because it loves you.

- So many things.

- Yeah, so many signals are happening at the same time and even your body wants to be well.

So, trust your body.

- I love that.

- Thank you both so... Right, that was so poetic.

Thank you both so much.

- Thank you.

- Thank you, Dr.

Susan.

Thank you, Karen.

- Thank you.

- All Right, y'all.

(audience applauding) When I'm talking though to women and their lived experiences, a lot of that is about shame when it comes to sexual health.

A lot of it is not knowing their bodies, right?

Or being ashamed to even have a conversation with their doctors about what's happening in their bodies.

And with this, I don't want you to think about sexual wellness as just sex, right?

We wanna talk about comfort and nobody is going to explain that better than Dr.

Paula Orr and Gabriella Espinosa.

(audience applauding) So, I wanna start with you, Dr.

Orr, and talk about what messages did we inherit about aging and menopause?

- Wow, so I think there's many, but the one that I hear often is just power through it, right?

And it's a natural part of being a woman and you'll get through it, you know, just tolerate it.

Or we're not gonna talk about that at all.

We're just gonna pretend like it's not happening, that it doesn't exist.

And I think that's across all cultures and all the patients that I see.

Now we're talking about it more, right?

Menopause has become this household word.

So I actually have people coming in asking me more about it than they once used to.

I've been doing menopausal medicine for the last 15 years, but I've never talked about it more than I have in the last probably two to five years.

- That's good.

Thank you for that.

Gabriella, anything to add to the aging?

- Can I tell a story?

- Sure.

(Keocha and Gabriella chuckling) - I was sitting in my doctor's office.

I was living in the UK at the time, in London, and I was sitting in my doctor's office in my early 40s, mid-40s, explaining to her symptoms that I now know were perimenopause.

Back then I didn't know.

Brain fog, fatigue, just not feeling like myself.

She was listening quietly, the female doctor.

She paused and she said, "It's the menopause and you're going to become invisible."

Invisibility and I was stunned.

I was like, I felt so sorry for her 'cause she looked so sad as she told me that.

And I thought- - She was menopause.

- She believed this story that you become invisible.

- Invisible.

- And I was like, "Nope, not me.

Not on my clock for sure."

And so, I wanna reframe it and I've reframed it.

I don't want it to be about becoming, it's not about becoming invisible.

It's about becoming visible and how we become visible to ourselves.

- Yes.

- How we show up for ourselves every day and take care of our bodies, make sure we're connected to our bodies, to our pleasure, to other people.

And that's really what it's about.

It's not about becoming invisible to others.

It's becoming visible to ourselves and showing up for ourselves.

- I kinda wanna zero on the aging and postmenopause a little bit because that's something, as I mentioned before, that I have not heard of people talk about.

And I don't think that most people know about postmenopause.

If we could talk about that for a little bit.

- Sure.

So I think you heard Dr.

Susan talk a little bit about the definition of postmenopausal.

You know, you are postmenopausal 12 months and one day after you've had your last menstrual period.

- [Keocha] Right like a baby.

- And I think the other big myth is that it ends.

And so, I always educate my patients to let them know that menopause is a reproductive phase that you're in.

You'll be menopausal till you die.

That's a fact, right?

You don't come back from menopause.

And so, the symptoms will... (audience laughing) You don't transition into something else, right?

- No bouncing back, no bouncing back.

- But the symptoms will wax and wane.

So you may have hot flashes for a period of time and then the hot flashes may go away.

But then some of the other symptoms that people haven't always associated with menopause may persist, like the brain fog, the difficulty sleeping, the mood change, the frozen shoulder, the lack of sex drive.

Those things will still be with you.

And that's what I see.

And so, you know, when we think about menopause, my mother's generation called it the change, - [Keocha] Yeah.

- But, you know, we get to reframe what that change looks like, right?

We get to decide, are we gonna transition into something that is new and exciting and sensual or are we gonna just stay in that space where we are suffering?

And women don't have to suffer any longer.

- You don't have to suffer anymore and thank you for that, Dr.

Orr.

And you said sensual.

I was like, "Ooh, can't wait to get to that part 'cause I know Gabriella's going to dive on in."

- That's a big part.

- Yeah, it really is.

But also, from a cultural perspective, so as women of color, and you mentioned like, your grandmother, your mom, like the change, the different things, what have you been taught or not taught that you now know about menopause, like, from the generation before?

- Well, as a gynecologist, I wasn't taught anything, right, from my mom or my grandmother because like was said in the initial segment, they didn't know either, right?

And so, because I'm a medical doctor and much like Dr.

Susan, I wasn't taught anything about menopause either.

I had to go back and learn and study and do all the things.

Now that I know what I know, I now know that when I thought my mother was Attila the Hun, she was menopausal.

- Yeah.

- And so I now know that, but I didn't know it growing up and neither did she.

And so, I think that the difference now is that we have access to all these resources, you know?

You can just open up Facebook or TikTok and somebody's talking about menopause sometimes ad nauseum.

And sometimes what they're saying isn't even actually true, but we have access to resources that our mothers and grandmothers didn't have.

So, our daughters will be better prepared because we can instruct them and demonstrate for them and model for them what it really looks like to be menopausal.

You don't have to walk around in a muumuu and not getting out of bed and, you know, just wearing an apron around the house 'cause some of us are living our best lives.

- Okay, living our best lives.

Gabriella, anything to add?

- Yeah, I mean, I heard nothing.

I mean, there was a lot of silence around menopause.

I never heard of the word, but I did hear a lot of the women in my family speaking in whispers behind closed doors.

So, I know they were talking about something.

- Yeah.

- Right?

- And so, I feel that that silence is something that I'm trying to break free of that silence.

I'm really doing it through my advocacy, through my podcast, through holding space for women.

You know, something that our mothers did, all cultures have done for centuries.

Women have been so good about gathering and learning about being a woman from other women.

So, feeling seen, feeling heard in community, that is one of our greatest resources.

So, I think we should continue leaning into that minus the silence, minus the suffering.

Talk about it in your communities.

I always say that menopause needs a village.

So find yours, create yours, and I think that's what tonight is all about.

- Yes, I love that.

You gotta find your menopausal village.

(audience applauding) Yeah, everybody's going through menopause and hot and tired and confused.

(audience laughing) It's a lot of things going on.

So, what's different for women of color in the menopause transition?

- It's well-known that Black women begin to have menopausal symptoms earlier.

Their symptoms are more severe and their symptoms last longer.

And they are less likely to begin on hormone replacement therapy because of all of the misinformation.

And of course the mistrust with the healthcare system, rightfully so.

The healthcare system has earned the mistrust of people of color, but it translates into how they are managed when they go in for some of these visits.

So, they are very often dismissed.

Their symptoms are told, "Oh, you'll get over it.

You just need to go to sleep."

Or "Here, take these antidepressants," is what often is happening.

And they don't know what they don't know.

We don't know what we don't know and we're afraid of what we don't know.

So, we are less likely to ask questions because we don't even know what the questions are.

The piece that really drives me is that now that we have more research that shows that women who are started on hormone replacement therapy have reduction in their risk of cardiovascular disease.

And who's at the top of that list, right?

Is women of color at the top of the list for developing cardiovascular disease.

So beyond the hot flash and all the other symptoms, we know that it has some preventative benefits that we're missing out on from a wellness standpoint that if we begin it early enough, it can actually have significant impact on our lifestyles and longevity.

- Gabriella, anything to add?

- I grew up in a culture where you did everything naturally.

There was a home remedy for everything.

- Everything, yes.

- And so, I absorbed that story and for a long time I suffered, you know, I suffered with the symptoms and I resisted hormone therapy.

I just was like, I can't do this.

I can't do this.

I have to do it the natural way.

I have to just sort of suffer through it because that's part of being a woman.

That was a story I heard and I think that's kind of the story that a lot of cultures absorb.

But one day, another story, one day I went to a doctor, another doctor, an endocrinologist 'cause I was having these issues and I'm experiencing some bone pain, some bone ache.

Let's do a bone scan.

He did a DEXA scan.

I wasn't even 50 yet.

Luckily he did the DEXA scan and DEXA scans in this country aren't recommended until- - 65.

- 65, which is a sin, really.

- Ridiculous.

- It's ridiculous.

You should get a DEXA scan as soon as you're hitting, moving into that transition.

- Can you share what a DEXA scan is?

- And yeah, so a DEXA scan- - It measures the thickness in your bone, in your spine and hip.

There's some smaller ones that you can do that do the risk, but it really, when you think about estrogen, that is one of the benefits of hormone replacement therapy because there are hormone receptors in every organ system in your body and your bones are one of those areas that are deeply affected by hormone replacement therapy.

So again, in this country at 65, the train has already left the station at that point, right?

And so, a lot of women are already experiencing bone loss at that point.

- I'm like, oh, I need a DEXA scan.

- So that was my story.

- You know, go ahead.

- I wasn't even 50, the DEXA scan showed that I had early onset osteoporosis.

And the doctor said the only remedy for this is estrogen therapy.

And I resisted, but then I thought, you know, my bones are too important for me, right?

And so, I started reluctantly and he monitored me every 18 months.

I repeated my DEXA scan every 18 months.

So it was estrogen therapy along with progesterone and weight training, improving my diet to make sure I was eating enough protein, calcium-rich foods.

And I saw in real time my bone density improve.

And by the end of... It took time.

It doesn't happen overnight.

It took five years for me to bring my DEXA score scan up to a normal level.

And so, it's so effective.

It's the most effective tool in situation.

- I will add that there's a myth that Black women don't get osteoporosis because we have thick bones and that's not true, right?

- Yeah, big bone don't mean your bones are thick.

- Exactly but that is a myth.

- I get that.

Yeah.

- That is one of the myths.

So a lot of women of color have not had bone density testing for that reason 'cause they don't think that it can happen to them.

And so to that point, so osteoporosis, Alzheimer's disease, heart attacks are all three things that you don't know you have until you have them.

And guess what can reduce the risk of that?

Hormone therapy, right?

And so, again, it's beyond the hot flash.

Those are eventually going to go away for most people.

But your risk of developing those other three things never leaves you.

- What are some natural things, natural supplements or just like I know eating well, right, relying on the nutrients of food and all those things, but are there any other things that we could also look at?

- I have people come to me with these, you know, bags of supplements.

There's a whole market out there that's marketing to us because we're vulnerable and we want whatever we think is gonna make us feel better.

But reality is, is if you have a good diet, you don't need to take a whole bunch of supplements.

There's some stuff that specifically you might need just based on what your individual needs are.

Vitamin D, I would say is one thing that is critical for most people 'cause in this country 80% of people are vitamin D deficient and it is actually a hormone that actually helps in many different ways.

But you don't have to take all this, you know, extra stuff that people are taking, bags and bags of stuff.

- [Keocha] Yeah.

- And I will say this, I'm not pro-hormone, right?

I think I want as many people as can be on hormone replacement therapy to be on it.

I'm just anti-suffering.

So do what works for you.

- Yes.

- If you're somebody who is hormone averse or you can't take it because there's a small subset of women who it's not recommended for them to take hormone replacement therapy, then we can look at more natural ways.

- So Gabriella, when women hear the word sexual wellness, they often assume we're only talking about sex.

What does sexual wellness mean in midlife?

- Yeah, I mean, we think it's only about the bedroom and yes, that's part of it, but sexual wellness as we've been talking about other aspects of menopause, it's about how you feel in your body every single day.

Sexual wellness, your sexual health is essential.

- I'm telling you, like, even the conversations I've been having with women, for some of them, when you say something about that, like, just in the sexual wellness piece altogether, not even in intimacy with partner, but just your body, they go like this.

- Yeah and there's also too the thought that I'm too old for this, right?

Like, once you get to a certain age, you shouldn't desire to have sex or to be intimate with somebody.

And that's just not true.

And so to your point, you know, the vagina.

I can say vagina, right?

(audience laughing) - Vagina.

- So, the vagina loves estrogen.

And so, when those estrogen levels decline, we lose the elasticity, the vascularity.

There's more dryness and irritation.

I see more women who come in and they think they have an infection because they're having itchiness, but it really is genital urinary symptom of menopause.

And so, vaginal estrogen is an easy fix for that.

I mean, I have 40 year olds that are on vaginal estrogen and some of them are still having cycles.

So again, it goes back to knowing someone, knowing a physician who knows what they're doing and how to manage those kinds of things.

And you're right, if sex is uncomfortable, who's gonna wanna do that, right?

If your libido is low, they really don't wanna do it.

So I mean, there's so many multiple layers to it, especially in menopause.

- Before this, I'd never heard of vaginal estrogen.

That's good.

Thank you for adding that.

Anything you wanna add?

- Yeah, I've heard it described as liquid gold for your vagina.

(Dr.

Paula and audience laughing) - Vaginal estrogen.

- Vaginal estrogen is liquid gold for your vagina, yes.

- Yeah, it's like lubricant is not for you, but the vaginal estrogen is for you.

That's what it feels like.

- And it's been proven safe and effective by all the medical bodies.

The FDA has removed the black box warning.

So when you get home, you'll open it up and you won't see any warnings that it's, you know... - Causes cancer.

- Causes cancer 'cause it doesn't.

- Which is the most ridiculous thing.

- Yeah, it doesn't.

Again- - And there's a difference between lubricants and moisturizers, right?

So I have patients who, they're like, "Oh, I don't have that problem 'cause we use lubricants."

Well, lubricants are designed to be used when you're being intimate.

Moisturizers can be used all the time, even when you're not being intimate.

And so, a lot of people don't understand the difference between that.

- Pleasure in the pause.

Talk to me about that.

What actually... What, I guess, inspired you to have these conversations with women about sexual health as much as you do?

'Cause I love that you do that that's something that you lean into.

- Well, it was mostly came out of my own silence and shame around the changes that I was experiencing as I was moving through perimenopause and menopause, right?

Experiencing the symptoms of dryness, pain, irritation, and thinking, "Oh my gosh, is this the end?

Is it over for me?"

- You're like, "This is it."

- Right, "Am I getting old?"

And not having a language because frankly, we're not taught any education in school about our own sexual anatomy.

We're not taught about really that pleasure should be a priority for us.

And so just realizing that, just feeling that shame and that silence around my sexual health.

And so I said, "No more silence, Gabriella.

You need to start talking about it.

You need to start learning about it."

I have gone down rabbit holes studying and learning from some amazing experts in this space, and I've interviewed them on my podcast.

And so it's really that, it's about unsilencing this aspect of our health that is so fundamental to our overall wellbeing and vitality.

And it's about, like I said, connection, connection to ourselves and connection to others, which is a fundamental human need, right?

We're all wired for connection.

- Connection, yeah.

So much, so much.

Dr.

Orr, what would be your advice to women who may be having, like, experiencing some challenges in their sexual health?

How do they come in?

Like, what would you say how they come in and say to their doctor, how do they tell them?

Just come out and say it?

Because I've had some women go, "I don't even know how to start the conversation with my doctor."

- Yeah.

Well, that's a difficult question.

I ask my patients about it from the 20-year-old to the 89-year-old, because we make assumptions.

- [Keocha] Yeah.

- You know, we assume, "Oh, she's 75, she's not having sex."

Well, some 75-year-olds are, right, getting it in.

(Keocha and audience laughing) And so- - Alive and well.

- A lot of them are, and good for them.

You know what I mean?

But I do think that it has a lot to do, it starts with having those conversations early on.

And I say this often, but I think finding a physician is like finding a spouse.

You know, it has to be somebody that you feel comfortable with, that you feel like you can ask questions of, that they are listening to you.

And I'll be the first to admit, sometimes we are rolling in and out of there real fast because we don't have a lot of time, but come prepared with your questions and the things that you wanna leave there, knowing that we don't have two hours to spend with you.

So, be intentional about writing down the questions that you have.

But I know that at a certain age that those symptoms are kinda showing up.

And I also know that a lot of women are reluctant to bring it up.

And so, I make it easy for them and I just do.

And so, when I start talking about it, then they'll start talking about it sometimes, but sometimes they'll use little nicknames.

They're like, you know, "Down there."

And I'm like, "You mean your vagina?"

'Cause they don't wanna say it, right?

- Yeah, yeah.

- And so, you have some of that.

It's generational.

But I just think that, you know, finding a physician that you're comfortable with, be intentional about writing down your questions, think it out.

Like, you know, write down exactly what you wanna say, how you wanna say it.

You might have to rehearse it a couple of times.

And if you find that you can't have those conversations with your provider, then maybe it's time to find another one.

- Yeah.

Thank you for that.

One of the things that we talked about was comfort.

And I love how you were like something and everybody has said this, we don't have to power through the discomfort, right?

Speak a little bit about comfort and why you focus so much on that 'cause I love that you do.

You're just like, we need to be comfortable.

Like, it's more about comfort than it is anything else.

- Well, I don't know if I've said this already, but I think as women, we've been conditioned to prioritize the comfort of others.

And so, we override our own discomfort.

And so, I say that has to come to an end right now.

And so this is an opportunity for us to ask ourselves really, how can I be more comfortable in my body?

How can I feel more at home in my body?

The number one complaint that I hear from women who I coach is like, "I feel so disconnected from myself.

I don't feel like myself anymore."

And so, how can you feel more connected and more at home in your body?

And there are so many ways that we can do that.

Movement obviously is a way to do that.

You know, taking walks in nature, taking time to feel the sun on your skin, taking time to feel the warm shower on your skin.

I'm a bit advocate for self-pleasure.

Midlife is a wonderful way to explore our bodies because what worked and felt good when in our 20s and 30s may not work anymore, right?

So, our pleasure pathways are changing, I say.

So midlife, this time of our lives is a beautiful opportunity to explore our bodies.

And you can use beautiful massage oils, lubricants.

There are incredible amount of pleasure tools out there to do that, but it takes time and it takes intention.

It's not gonna happen overnight.

If you really care about your pleasure, and if it distresses you that you don't feel that sense of sexual pleasure or pleasure in your body anymore, you really have to do it just like you do, just like you take your body to the gym, just like you change your diet.

You have to put your intention and effort behind your pleasure.

And so, it means learning about it.

There's incredible books.

There's my podcast.

There's incredible amount of the sexual wellness industry is worth millions of dollars for a reason.

And they're effective.

They're incredibly effective tools.

So it's really about spending time connecting with yourself and exploring what feels good in your body now.

- Yeah, I love that.

And stand in the mirror naked.

- Yeah.

- Like seriously.

- Love your body, yeah.

- It goes back for me, even with this conversation, it's really about loving yourself and being a better steward.

A lot of times I think we have an issue with pleasure or we have an issue even with sexual health or wellness because we don't even like our bodies.

- Confidence.

- Yes, that confidence.

Can you speak a little bit to the confidence?

- Well, I mean, it just ties in with the whole conversation.

I think that when we go through this transition and we are often wondering what's happening to us and we see these changes, we do lose that confidence in ourselves because we don't feel like ourselves, we don't look like ourselves.

And so everything is different.

And so it is a process to get back to yourself.

But I do wanna say that I think I see some fellas in the room.

I think it's important for them to be here and to be a part of these conversations because one, it's helpful for them to understand what's happening to us.

And they have their own things that's going on.

I think that's another podcast or conversation.

They don't like to talk about it.

- [Keocha] I just learned about that too.

- But we know that they go through menopause.

- We know what y'all going through, yeah.

- They go through their own little menopause.

(audience laughing) But I have women who come in and see me, of course, all the time.

And sex drive is a big thing, a big change that happens as you go through the change.

And I often ask them, "Well, what is your partner experiencing in all of this?"

Because some of them are not having sex and they are very comfortable with not having sex.

And I'm thinking, "You're married, you're in a relationship.

And so how is that playing out?"

Because that connection to that person is affected by that.

So it is really critical for your partners to be involved in this conversation as you go through this change and for you to consider that it's not just affecting you, it's affecting the kids, it's affecting your partners, it's affecting your workplace.

That's a whole another conversation too.

Productivity in the workplace and menopause is a big thing.

- And people already get on your nerves at work.

- Right, so when you're menopausal, it's exponential.

- Yeah, it's 10 times worse.

I think that's a good point too though about, because I always go back to grace, really because the foundation of this, I have these words, relief, grace, and all these things, but just having the conversation with them so that they know what you're going through, but then also understanding that they go through their own, right?

And so, you know, some of the conversations I have with women, they're just like, "And he doesn't understand me and I am blah, blah, blah."

And I'm like, "Yeah, but he's probably going through his own changes too."

- 'Cause he ain't getting no sex.

(audience laughing) - Right.

And then also, isn't there like a. I don't wanna say the medical term 'cause I don't know if that's correct, but there is a term that describes what they also go through.

Like we have menopause, but they have something that they go through too.

- Andropause.

- Andropause.

Okay.

Up until this research, I never heard of that, right?

But I was also told and I know y'all are more in this space, that around this time is where people tend to get divorced because there's this, we're growing apart, you know, and that kinda thing.

And not saying that, you know, whatever reason they got divorced is not valid.

That's not my point.

My point is that we're going through all these different changes in our bodies.

And sometimes, especially if you're not taking care of yourself well or don't know how to, because you don't have the language for what's happening, you may not actually be growing apart.

It just may be all the things.

Have any of your clients ever experienced or come to you, especially in the pleasure piece with divorce or the changes?

- Oh sure, it's called great gray, they call it gray divorce, right?

(chuckles) - Happily.

(audience laughing) - But I think (chuckles) women at this age, between, you know, 45 to 60, and usually it's heterosexual women who initiate the divorce because, I mean, I don't think it's only related to sex.

You know, menopause is a big kind of identity shifting piece, right?

You one day look at yourself in the mirror and say, you know, "Who am I?"

And maybe you're not the same person that you were when you married your partner, right?

We change and evolve.

And if that person, if your partner is not able to change and evolve with you because it takes two to evolve together, then, you know, you have to make a decision for your own mental health, for your own sanity, for your own happiness.

And so a lot of women make that choice to initiate that divorce and they're happy.

They're free.

They're happy.

They can make their own decisions and they don't have to tend to anyone.

- [Keocha] That's what we said.

Amen.

- Right?

- What she said.

- Yeah.

(audience laughing) - But I think, you know, menopause is this wonderful invitation to ask again for a divorce.

What is it that I want?

(audience laughing) What is it that I want?

Right?

Women haven't been given permission to ask themselves that because they've been in service to others.

So it's a great invitation to say, "What is it that I want?

Who do I want to be in this season of life?"

And if your partner is not on board with that, then, you know, that's a big conversation.

That's a big conversation.

- I think we should celebrate getting older and celebrate midlife.

And that's really a part of this too, (audience applauding) because there is a confidence and grounding in knowing who you are.

- And things will change.

You know, intimacy will change as you get older.

And so it's a matter of having that conversation.

I like to define intimacy as feeling what there is to be felt with yourself and in the company of another person.

And sometimes that can just be sitting on the sofa together, removing penetration off the table, out of the bedroom, right, and having it be about presence, having it be about connection- - That's intimacy.

- That's intimacy, right?

And having it be having a conversation, cooking together, walking together, shifting your priorities around what it is to be intimate.

And so I think midlife, again, is a wonderful opportunity to change what pleasure looks like and having that conversation with your partner.

You can explore, you can get curious and explore different ways of exploring, of experiencing pleasure.

So it doesn't have to look like the way that it looked like before.

It can change and evolve in beautiful ways.

- For sure, 'cause really the pleasure for me is in the intimacy and being, you know, married to my best friend, I think the intimate parts of going for a ride or like, having conversation and just without the kids or just those type of things.

But it really, for me, it has been just a grounding in knowing myself and accepting I am aging.

That's a reality, but that's not like a dun-dun-dun.

You know, it's beautiful to age and age gracefully.

- The better you are for yourself, the better you'll be for everyone else around you.

- Exactly and that's where we're gonna end next 'cause that's a bar.

Thank you, Dr.

Orr and thank you, Gabriella.

(audience applauding) (uptempo music) (uptempo music continues) (uptempo music continues) (uptempo music continues) - [Announcer] Major funding for this program was provided by the HEAL Alliance and Central Texas Health and Wellbeing Network, Continuous Cultural Improvement Method.

Additional funding was provided by Jackie Lee, Planned Parenthood, Power Pivot, and Second Act with Carol.

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