Ep 50 | Menopause, Misinformation & Other Bullshit with Amanda Thebe

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Hello, and welcome to Ovary Active.
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I'm Dr.
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Rebecca Dunsmore-Sue.
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And I'm Dr.
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Amy Bodish.
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And we are your expert guides on the strange and
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often uncomfortable journey that is perimenopause. Hey, everybody. We've got
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some really exciting news. information and news for our California
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listeners of some events that are upcoming this month of
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October 2026. Rebecca, do you want to take it away?
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Yeah.
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So we're doing three intimate gatherings with listeners and book fans.
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The first will be in Los Angeles on October 19th, 2026.
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And I'll be appearing there. It's a dinner at a
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private house. It's got limited enrollment. So You'll get a
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lot of really great intimate time and we'll sign books
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and talk about the process. And then on the 24th
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of October, we'll both of us.
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Be in San Diego for a brunch, which will be
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really fun.
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And then on November 1st, we're going to be in
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Amy's Neck of the Wood in the Bay Area in Burlingame.
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And we'll be doing a dinner there. So sign up.
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The link is in the show notes. It's also on
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our website, The Prairie Menopause Doctors.com. And for the price
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of admission, you get a meal. You get to spend
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some intimate time with us talking about perimenopause. You get
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a signed book. So please come and join us. The
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signups end a week before the event. So sign up soon.
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Limited spots available. So get in there as fast as
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you can.
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We hope to see you there.
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Today, we are thrilled to have a guest to talk to,
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Amanda Thieb. So Amanda, will you please introduce yourself and
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talk about how you sort of came into this menopause space?
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So happy to be here. Thank you for the invitation.
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Congratulations on the book. I actually owe you guys a
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shout out on Instagram, but I've been traveling a lot lately.
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I am a personal trainer and nutrition coach and a
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certified health and wellness coach. All I have to say
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is that I've been doing health and wellness in the
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women's health space for about 35 years. And I really
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like it here and I really hate it here, both
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in equal measures. And I started talking about menopause after
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my own personal experience, which I think a lot of
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women do. Actually, being in the health and wellness space
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and really having a good understanding of human physiology from
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an exercise science standpoint, it sort of whacked me in
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the face and I was like, what on earth is
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going on? And I actually didn't have any idea. Nobody
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had ever told me in any of my education about menopause.
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And I spent about two years in this like medical...
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sort of hamster wheel trying to get answers off very,
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very kind and diligent doctors who just didn't know what
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menopause was. It was that simple. And then when I
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was 44, two years later, a gynecologist, I think I
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was in there for my cysts or something.
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Yes, we're in for one thing and we start talking
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about something else.
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I was like, I'm a cysty person. And then he
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was like, no, your cysts are fine, but are you okay?
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So I started crying. After going through my whole two-year experience,
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he basically just said, I see this every day. I
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think you have depression, quite sure. Quite sure you're struggling
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with migraines, with aura. And I think you're in perimenopause.
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I can help you. You're literally not losing your mind.
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You're losing your estrogen type thing. And I went, peri what?
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I actually swore at him, but I'm going to be
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really clean on this podcast. I was like, what the
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F is?
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No need.
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What the fuck is perimenopause? And he started laughing. And
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in fairness to me, I hadn't even considered it to
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be menopause. Nobody 12 years ago in any type of
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forum was talking about perimenopause. I'm 56 now. And so
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I just was like, I need to go down a
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rabbit hole. And I sort of did, came up with
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a community. And I just thought, I want to be
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the person that is advocating for women that finds the
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information and does that knowledge translation and helps them understand
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what's happening. I've never, ever positioned myself as an expert.
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I've never, ever positioned myself as a medical doctor. And
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I think because of that, the medical community are okay
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with me. I say that in the best possible taste
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because I'm not trying to be somebody I'm not, right?
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I just am like, this is what nobody ever told you. Why?
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Yeah.
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Yeah.
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You know, Amanda, you and I met several years ago
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because you were doing some content with us at GENEV.
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And you're right.
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As medical doctors, we feel very comfortable with you because
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you're very upfront. You're like, this is what I know about.
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This is what I don't know about. And I think
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what has always endeared you to me is that you
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call out the bullshit.
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You're like, don't talk about stuff we don't have.
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Evidence for, which I think is, Amy, in my biggest position.
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Yeah, I feel... super offended by it as well, because
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I think about the 10 years I've been talking about it.
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And obviously there's people have been doing this for decades
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and decades, but just in that social media space where
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it was like, nobody's talking about it. Let's all start
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talking about it. And a bunch of people did. And
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it was great. It was like, oh my gosh, we're
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finally having a conversation to 10 years along the line.
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And it's now an industry. It's a $ 16 billion global industry.
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with some of the top people on social media raking
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in $ 43 million a year selling shitty supplements that you
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don't fucking need. It drives me crazy. It drives me crazy.
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And so how is that helping women? It's actually anti-women,
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I think, because it's telling bold-faced lies to them for profit.
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I totally agree with you. And I actually wrote a
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piece today.
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To put out about how, you know, Coming on social
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media and saying that you can prevent dementia with hormones
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or you can prevent cardiovascular disease with hormones or testosterone
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is this new miracle cure, all based on really bad data,
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is harmful to women. We don't need you to claim
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those things. Hormones can be very good for some women
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for certain uses. Let's just be honest with what they
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do and don't do.
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Like, why is that so hard? I guess it's not
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a very good sales pitch.
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It's not fancy, right? You're not going to get the
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big clicks for that. I'm presenting this week at this
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conference at Stanford about sort of big ideas and different spaces.
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And what I'm taking my little chunk of time is
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to talk about how, as clinicians, what do we do
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in this age of misinformation? Our role is changing. It's
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no longer about us giving patients information. It's about us
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helping them discern and get through the information that they've
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brought to us, right? Because they've already, quote, done the research.
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And it's just, it changes the whole dynamic of your
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doctor-patient relationship because I'm no longer really viewed as like
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the place to get information. They're bringing their information to
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me and they want me to help them sift through it.
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It's a really interesting change in how we're practicing medicine,
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for better or for worse.
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Depending on where they get their information from as well,
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you're going to be spending most of your appointment unpicking
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and undoing the damage like that your brain is eating
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itself and you're going to get dementia. And then people
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who say these things are like, calm down. We're using
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it as an analogy. People know we don't mean it.
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And I'm like, stop it. What you're doing is you're
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treating women like a commodity, right? There's a reason you're
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doing this. And it's to get fame, to get money,
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to get people to your $ 4, 000 a year practice to
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help them. And there's always a path to money behind it,
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in my opinion. And I think it's super, super harmful.
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The idea of saying to someone, this is hormone therapy.
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This is what it does. It's so good for these things.
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And it can be a game changer for women, to me,
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is really empowering. Why do we need to oversell something
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that we just don't know yet? And then when these
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influencers say things like, well, the medical guidelines are too
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far behind. There's no data and they're actually weaponizing you.
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And they're not my words, by the way. I'm quoting.
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And then they sell them something without the data.
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Oh, yeah.
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That's my favorite justification. Science is behind. We have to
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push the boundaries. I'm like, push the boundaries with unfounded
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medical therapies that could harm you? What is happening right now?
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It's literally insane.
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I think the reason that we see so many of
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these grand claims with no data behind them is because
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we don't value women's quality of life enough to give
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them hormones just for that reason. Like, why is that
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not reason enough?
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So they're trying to make it more than it is
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because they're trying to justify using it.
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That's our society.
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We don't value how women sleep and them feeling good
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in their bodies and all those things enough that that's
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reason enough to use this medication.
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One of the messages that I heard in sort of
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the unethical field is that we had all of those
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women on the Premarin prior to 2002, and then everybody
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stopped using it. And now the uptake is still 4%
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to 6% in North America, or whatever the number is.
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I'm probably wrong. And one of the medfluencers had turned
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out and said, I actually don't care how I get
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women on hormones. I'm going to say what it takes
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to get them on it.
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That doesn't make sense to me. This should be a
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well-reasoned choice for women to make. We know ourselves, and
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if you give us good information.
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We make good decisions, shockingly enough.
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The goal shouldn't be to get people on hold. therapy.
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The goal is about making sure that women have the
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correct information they need to make the best choice for themselves.
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I mean, Becky, you and I have talked about this
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so many times. I love my estrogen patch. I think
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it's awesome. Do I think everyone on the planet should
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be on it? Absolutely not. I'm not going to go
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around and just start, like, you know, slapping it on people.
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Let's just roll it back and just make sure people
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have what they need in order to find out what's
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best for them.
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I think one of the things that we're seeing now
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is this fear of missing out. Like estrogen is supposed
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to do everything. And if you can't have it or
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you don't like it, because you've had that experience, right, Amanda?
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You tried it. It wasn't for you.
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Yeah.
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So, I mean, it's interesting because when I went to
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that gynecologist 12 years ago, he was really informed. And
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he said to me, I can help you. Here are
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your choices. I can start you on hormone therapy. I
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think that's a good fit for you. Even though my
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symptoms weren't sort of typical, it was then impacting my
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sleep and stuff. And he was like, I think we
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should give it a go. Otherwise, an antidepressant. And I
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turned around and said, I don't want cancer. Thank you
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very much. And I'll just take the antidepressants, whatever. then obviously,
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as I got to speak to experts and understood about it,
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I thought, okay, I'll try. So I started trying hormone therapy.
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And over a period of about four years, I went
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through many different formulations of hormone therapy. And every single
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time I went on for the first few weeks, I
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felt good. And then I nosedived. And it wasn't that
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I just didn't feel well. My symptoms got incredibly worse.
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And at some stages, I even had some suicidal ideology.
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Like I really had a very poor response to it.
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And I remember going, I had a terrible perimenopause and
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now I can't even do hormone therapy. I just felt
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like I was failing at that too. But it was
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my husband that just said, every time you go on it,
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this happens. And I can't stand the way it's making
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you feel. Ultimately, I ended up speaking to a doctor
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who said, It's probably just hormone sensitivity. You know, not
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everybody responds well to it. It's fine. And there's other
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stuff we can try. And I was like, oh, that's
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a thing. And he went, that's a thing.
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It's fine.
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And I was like, OK. And so I didn't end
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up going on hormone therapy. I did actually then leave
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it a couple of years and try again. Same response.
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So I just was like, OK, I'm finally done. You know,
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it was like one of those. And I think I
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try and use my message now to sort of reassure
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women that I'm eight years post-menopause. My symptoms have basically gone.
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I do struggle with migraines and depression to a very
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minor extent. And I take medication for that. And it's manageable.
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But for the most part, I'm stronger and healthier than
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I've ever been. And I do not feel for more
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for hormone therapy. I do not feel like I'm going
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to get dementia or cardiovascular disease. Or that I'm going
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to become insulin resistant or all of the other things.
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Because I take care of myself. I understand the full picture.
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And I wish women would be fed the full picture.
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I know you guys do it. But like in fear-based
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social media posts and fear-based marketing, that doesn't work.
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It really doesn't because it's a complicated picture. And like
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you said, you're going to be fine because you take
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care of yourself. But that's much harder than selling somebody
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a supplement or a pill. It's much harder to say, hey,
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here are 14 modifiable factors that might decrease your.
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Risk of dementia.
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Here are seven lifestyle factors that can improve your cardiovascular health.
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Those are hard things to do, and they're not saleable.
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And they take time.
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Yeah, you got to put the effort in. We are busy.
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I would much rather there be a pill.
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For sure. Go the easy route, right? You want the
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path of least resistance. Amanda, you originally started kind of
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on social media talking about like exercise and fitness and
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perimenopause for perimenopause and menopausal women. So why was that
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your focus and why was that your focus?
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Well, it wasn't on my bingo card. It was literally
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after that appointment. I remember doing a sociology test on
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myself and it was like, it came out that I
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was curious and I was like, oh, that's so boring.
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But then I thought about it and was like, Actually,
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that's one of my strengths. I really want to find
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out stuff and I go down that rabbit hole and
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then want to tell everybody everything. And so that's what
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I did. And so I ultimately just did a blog post.
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I had sort of a small following and I did
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this blog post called all the shite that nobody ever
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told you about perimenopause. And it went viral-ish, right? And
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I just thought, looking at all of the comments, I
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was like, I'm going to start a Facebook community and
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just allow women to come in and ask questions. And
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even if we don't have the answers, they find that sisterhood.
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Nobody's allowed to sell anything. Everybody can just come in
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there and talk. And that's the rules. Them's the rules.
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Very quickly, I had like 20, 30,000 women in there.
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Because they were just like, I don't know what's going on.
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And it was really just a case of like, yeah,
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me too. So I started talking about it there. And
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then I moved out to my social media. And I
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was getting a lot of people rolling their eyes originally.
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And I was just trying to be honest about it.
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Just going, yeah, menopause is kicking my butt today. This
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is why. And I also know as a coach, I'd
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been dismissive of menopausal women in my own coaching practice.
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When they'd said menopause is kicking my butt, I'd go, oh,
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that sucks.
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It's amazing what we don't know till we know it.
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I have a Pilates instructor like that. She's 10 years
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younger than me, and I'm watching her. I'm like, oh,
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remember when I talked about that 10 years ago? You
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just wait, sweet pea.
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You just wait. It was sort of like that. Like,
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it sucks to be you, and then it sucked to
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be me. And I just started talking about it. But
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I was also being really realistic going, you know, you
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can't green smoothie your way out of this. We really
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do need to look at this whole thing, this whole picture.
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And it might be hormone therapy for you. It wasn't
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for me. I very much stayed in that gray zone.
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And then I saw other people talking about it and
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we sort of got together. And it was a really
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nice place when it started. It was like, okay, I'm
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okay talking about this because it was well-received. It then
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ended up writing The book about it, because I actually
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just moved locations from Canada to Texas and I had
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a bit more time on my hands. I didn't want
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to do online coaching. So I wrote a book based
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on the articles that I'd been writing. And then where
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there was massive gaps, I would lean into the experts
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and just go, what does it mean from a psychological perspective?
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What does it mean from a registered dietitian's perspective about
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our ghrelin and leptin? And I just gathered all of
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this information and it did well. But it took me
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two years for someone to pick the book up because
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nobody wanted to write a book about menopause.
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And your book was The Menopocalypse, right?
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Yeah.
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Check it out, you guys. Menopocalypse. I mean, that's what
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a great title.
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I wanted to write your best mate's guide to menopause,
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but without being dismissive and without being too sciencey. I
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sort of wanted to find my voice in it. And
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it really is a book of two halves, one where
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it's like, this is what the menopause crap is. But
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this is some lifestyle stuff that you can do because
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it doesn't matter if it doesn't feel like it's doing
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anything in the moment. Your current and future health really
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depends on it. And I wanted to frame that in
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a way that really recognized where women are because when
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some coach comes along and says, yeah, you've got all
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those symptoms, but you really should be doing a 5K
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run and you really should be strength training. I wanted
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to say to people, But you know what? Some days
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you can't and that's fine too. And we really need
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to help you frame that so that you can keep
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moving forward and find those small wins, even when you
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don't think you can.
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So people have been asking us how they can help
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support this podcast. We are really thrilled to let you
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know that you can actually help us support the podcast now.
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00:18:07.859 --> 00:18:11.359
We have just set up a Patreon account, which is
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00:18:11.400 --> 00:18:14.180
where you are able to subscribe for a small amount
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00:18:14.289 --> 00:18:17.470
every month in order to help support the podcast. The
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00:18:17.650 --> 00:18:20.319
URL is down in the show notes. And for those
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that subscribe, there will be some subscriber benefits. And also
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I want to ask, do you know someone in your
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life who might be going through perimenopause and have symptoms
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and they're thinking to themselves, what in holy hell is
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going on?
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Please share this podcast with them.
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00:18:38.160 --> 00:18:39.980
Go on and rate our.
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Podcast, review our podcast, subscribe to our podcast and share
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it with your friends. because you can be somebody's hero
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and make their perimenopause just that.
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Little bit better.
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We've been wanting to do a podcast with you for
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a long time because we love your content. One of
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the things I saw recently online that you put out
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was about reframing our goals in this time of life
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and really thinking about how to reframe things because I
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think that's really important. We hold ourselves to these standards
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and these goals that may not be reachable during this timeframe.
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How do we work with women to say, okay, you know,
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You may not be able to do a 10K anymore,
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but let's think about what we can do.
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It's about being really, really respectful of your body, but
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also feeling capable. It's a really hard balance. The way
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I like to talk about this is that menopause is
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probably one of the most challenging things you're going to
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go through. And when you fight and resist what's happening,
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it's going to be a lot worse experience than if
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you lean into it and go, okay, it's going to
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be hard. So what can I do to feel better today?
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And one of the things I like to do to
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say to women is, let's find a win, a small win.
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And it doesn't matter how big or small, I feel
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like Dr. Seuss there. It doesn't matter how big or small,
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but like find something that You can say, yeah, I
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did that today and you tick off your to-do list
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or whatever. And how I would frame that to people
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is that when I was at my worst and I
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had really chronic depression, terrible and really bad fatigue as well,
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I couldn't barely get off the sofa to make a
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cup of tea. And so on those days, a big
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workout was out of the question. Eating well was out
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of the question. I was stressed to the gills and
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I wasn't sleeping. And so it was like all of
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the things I lean on all the time and not
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accessible to me. So those days I would go out
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for a 10 minute walk.
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That's it.
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And that was my win. And I always felt better afterwards.
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And so it's looking for these tiny wins and keeping
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the momentum going forward because consistency trumps everything, right? It's
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always going to win everything. And then Not being a
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complete dick to yourself is the second part of that, right?
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Because we're terrible, aren't we?
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Right.
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We're so bad. We're awful to ourselves.
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I would never say to you, Amy, oh, you're such
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a loser because you didn't do your 5K today. Oh,
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my God. But you would say that to yourself, right?
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And we have to stop. It just doesn't do anybody.
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But we've been conditioned to just always keep pushing, pushing, pushing.
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And I don't think that that serves us.
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It's such a wonderful point.
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It's kind of that idea of like, how do you
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separate acceptance from giving in? Because some people will be like, well,
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I'm just giving in. I'm giving up. I'm not pushing myself.
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Instead of being like, this is where I'm at today
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and that's okay. How do we get people to accept that,
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that idea of acceptance and not giving up? I don't know.
427
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I think it's by.
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Doing the baby steps. I do behavioral coaching and I
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truly believe that's the way forward. James Clear is a
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great example of this, you know, finding habits that are doable.
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And the first thing I think is that the not
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being addicted to yourself is really important. Like when we
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look in the mirror, rather than finding something we hate
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about ourselves, just focus on something that is positive. Just
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find something. It might be you have nice eyelashes. It
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might be you like your teeth.
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I don't care.
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Find something that just changes the narrative. That really matters.
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Because as a society, really, Midlife women, if we're not young, smooth, wrinkle-free, skinny,
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all of those things, we hold those dear to us
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and we think we're failing and we have to push
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back against that. We're in a very privileged time of
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our lives and it's important to acknowledge that. And then
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those women, once they feel good about themselves, and that's hard,
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is then just going, We want to find something that
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you can do, do consistently and actually makes you feel
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good about yourself and gives you that joy. And so
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when I hear people say, all menopausal women need to
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be able to do 11 pushups and only lift heavy
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shit and not do zone two and only do hitting.
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And if John down the street only wants to do Zumba,
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I'm like, do Zumba because it makes you happy. Like,
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do you like it? Yes. Is it the best exercise
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you can do?
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I don't know.
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Who cares? You're moving and moving is so important for
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your health. Then when John's been doing that for like
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a month or two, I'll be going, oh, you're getting
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quite strong. You know, I'll make Zumba easier if you're stronger.
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And we can work in like some strength training into
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there too. But I think that a starting point for
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women during a very challenging time is to look for
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small wins that are.
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Going to propel them forward.
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Amy and I have been very upfront with our listeners that...
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Neither of us is a runner or really actually even
467
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likes exercise all that much.
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Okay, we hate it.
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Every minute of it.
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But like you said, we find those small things that
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we can tolerate or do. And we always feel better afterwards.
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And we recognize it's important to health. I think one
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of the things I always hated about exercise is I
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never seemed to get, you know, really skinny or be
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back in that body I had when I was 18.
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You know what?
477
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I am never going to have that body I had
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when I was 18 because I was 18, not 55.
479
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And just reframing from I'm doing this to get thin
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to I'm doing this to get strong was the biggest
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motivational change for me. Exactly.
482
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And also the reason we did it to get skinny
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when we were younger is because every magazine in the
484
00:24:38.109 --> 00:24:41.529
supermarket said to us, You can't have cellular and you
485
00:24:41.569 --> 00:24:43.230
need to be skinny and you need to have a
486
00:24:43.269 --> 00:24:46.579
cabbage suit diet two weeks before your bikini holiday. And
487
00:24:46.619 --> 00:24:49.599
it was that all of the time. And it fucked
488
00:24:49.640 --> 00:24:52.599
with our heads, right? And I think now the Gen
489
00:24:52.700 --> 00:24:55.549
Xers are like, you know what? We're done with that.
490
00:24:55.990 --> 00:24:58.029
I don't think we've done enough personally, but I think
491
00:24:58.049 --> 00:25:00.710
there's enough of us fighting back and then ideally looking
492
00:25:00.799 --> 00:25:04.259
forward to future health, knowing that frailty is probably one
493
00:25:04.279 --> 00:25:07.079
of the worst things that can sort of take over us.
494
00:25:07.140 --> 00:25:09.380
It's like, how can we move the needles so that
495
00:25:09.460 --> 00:25:12.789
we're healthier longer? And I know a lot of people
496
00:25:12.809 --> 00:25:16.069
don't like exercise because they haven't found the thing that
497
00:25:16.109 --> 00:25:20.089
they like or potentially they feel intimidated and don't know
498
00:25:20.109 --> 00:25:22.730
where to start. And so that's why I'm like, what's
499
00:25:22.769 --> 00:25:24.990
something you could do with your mix? Might be hiking.
500
00:25:25.029 --> 00:25:27.089
It might be swimming. It might be, who knows? It
501
00:25:27.109 --> 00:25:29.029
might be just going for a walk with a coffee.
502
00:25:29.809 --> 00:25:32.539
But I think that just doing that regularly and just
503
00:25:32.619 --> 00:25:36.880
getting into the habit of movement and actually just talking
504
00:25:36.920 --> 00:25:39.720
from a health perspective, you ladies know this, but when
505
00:25:39.740 --> 00:25:42.779
you look at like your calorie expenditure for the day
506
00:25:42.920 --> 00:25:48.079
or TDEE, total daily energy expenditure, after you've got rid
507
00:25:48.099 --> 00:25:51.400
of BMR, like the stuff that just like keeps us going,
508
00:25:51.900 --> 00:25:56.359
Non-exercise activity thermogenesis is the lion's share of calories that
509
00:25:56.380 --> 00:26:00.700
we use. And that's the non-intentional exercise. All of the
510
00:26:00.740 --> 00:26:04.559
calories and movement that we do outside of our planned
511
00:26:04.700 --> 00:26:07.740
exercise actually sort of is the thing that sort of
512
00:26:07.799 --> 00:26:11.450
keeps the engine moving and roaring. And so I'm like
513
00:26:11.490 --> 00:26:13.890
a big fan of that. Do you like gardening?
514
00:26:14.069 --> 00:26:14.609
Well, good.
515
00:26:14.809 --> 00:26:18.349
It can be strenuous gardening. Like if just play with
516
00:26:18.390 --> 00:26:22.269
your grandkids, move more, do more. That's a good place
517
00:26:22.329 --> 00:26:22.769
to stop.
518
00:26:23.109 --> 00:26:23.579
I talk a.
519
00:26:23.589 --> 00:26:26.890
Lot with women in my practice about just adding in
520
00:26:26.950 --> 00:26:29.789
those little bites of movement because all of.
521
00:26:29.809 --> 00:26:32.990
Us sit in these chairs all day long.
522
00:26:33.589 --> 00:26:35.970
And just getting up, going up and down the stairs,
523
00:26:36.289 --> 00:26:38.390
doing 10 squats when you go to the bathroom. Just
524
00:26:38.430 --> 00:26:39.400
do a little something.
525
00:26:40.099 --> 00:26:41.180
Exercise snacks.
526
00:26:41.980 --> 00:26:42.319
Jinx.
527
00:26:43.559 --> 00:26:44.339
We love snacks.
528
00:26:44.519 --> 00:26:45.599
I love all the snacks.
529
00:26:46.119 --> 00:26:46.359
Yeah.
530
00:26:47.400 --> 00:26:48.079
That's part of the problem.
531
00:26:48.660 --> 00:26:51.660
These movement snacks to me are key. And even the
532
00:26:51.819 --> 00:26:55.059
American Council of Sports Medicine have even encouraged that as
533
00:26:55.099 --> 00:26:57.920
well this year with their strength training guidelines by saying
534
00:26:57.960 --> 00:27:00.720
to people, if you can do two or three minutes
535
00:27:00.789 --> 00:27:03.490
every day, it sort of beats being a weekend warrior,
536
00:27:03.849 --> 00:27:06.690
like actually showing up and doing a little bit every day.
537
00:27:07.029 --> 00:27:09.430
So I highly encourage that. And it could be things
538
00:27:09.529 --> 00:27:12.630
like you said, while the potatoes are boiling, run up
539
00:27:12.670 --> 00:27:15.410
and down the stairs once or do some pushups against
540
00:27:15.450 --> 00:27:16.289
the kitchen counter.
541
00:27:16.349 --> 00:27:16.930
I don't care.
542
00:27:17.069 --> 00:27:17.430
Dance.
543
00:27:18.099 --> 00:27:20.180
I dance a lot and I mortify my children. I
544
00:27:20.220 --> 00:27:23.339
feel really good about that. Like I'm embarrassing them and
545
00:27:23.380 --> 00:27:27.400
I'm getting exercise. Double bonus. I know. They're so mortified
546
00:27:27.420 --> 00:27:30.240
by me. So what do you think is one of
547
00:27:30.259 --> 00:27:34.069
the most common stories that women tell themselves kind of
548
00:27:34.109 --> 00:27:36.849
in this midlife transition that just isn't true?
549
00:27:37.329 --> 00:27:40.150
One of them is, this is it. This is how
550
00:27:40.230 --> 00:27:42.430
it's always going to be. And so I think it's
551
00:27:42.450 --> 00:27:44.750
really difficult. You must see this as doctors that when
552
00:27:44.769 --> 00:27:46.950
you're in your practice and people come to see you,
553
00:27:47.869 --> 00:27:51.309
They don't recognize themselves. They don't like what's happening. And
554
00:27:51.349 --> 00:27:54.859
they think that this is it. I also had the same, like,
555
00:27:55.099 --> 00:27:57.740
I don't like this Amanda, this version of her. She's
556
00:27:57.779 --> 00:28:00.440
a bit of a bitch, right? And I wasn't happy.
557
00:28:00.940 --> 00:28:03.539
Life didn't fill me with joy. I didn't want to
558
00:28:03.579 --> 00:28:06.359
wake up in the morning. It was pretty rough. And women,
559
00:28:06.619 --> 00:28:09.980
I hear that not just with regard to the symptoms,
560
00:28:10.059 --> 00:28:13.700
but that psychological aspect of like, who is this person?
561
00:28:14.329 --> 00:28:16.869
I think that's one of the hardest things. And I really,
562
00:28:16.910 --> 00:28:19.950
really want to lean into that and say, it's not
563
00:28:20.009 --> 00:28:21.730
a cave, it's like a tunnel with a light at
564
00:28:21.750 --> 00:28:24.910
the end and look towards it because most women, and
565
00:28:24.970 --> 00:28:28.519
you read the studies in their 50s on that U-curve
566
00:28:28.559 --> 00:28:33.180
of happiness, they're their most content. And I want women
567
00:28:33.220 --> 00:28:37.039
to know that that's something to look forward to for most, mostly, right?
568
00:28:37.559 --> 00:28:40.900
I told so many women in the last like week
569
00:28:41.279 --> 00:28:43.319
that I was saying that perimenopause is the worst part.
570
00:28:43.339 --> 00:28:45.319
And we get to menopause and it's so much better.
571
00:28:45.400 --> 00:28:48.460
Everything works again. You know, our kids are up and
572
00:28:48.529 --> 00:28:51.490
out of the house. Our brains are even on the hormones,
573
00:28:51.529 --> 00:28:52.730
whether we're on them or not.
574
00:28:52.890 --> 00:28:53.730
It just gets better.
575
00:28:54.250 --> 00:28:57.509
But I think we feel like when we're presenting to
576
00:28:57.549 --> 00:29:01.880
the world that like everything's falling apart and everyone can
577
00:29:01.950 --> 00:29:04.859
see it. What I tell women, and I wonder how
578
00:29:04.920 --> 00:29:08.660
you approach this with them, is like you feel less
579
00:29:08.759 --> 00:29:12.420
capable than you have in the past. But you're still
580
00:29:12.700 --> 00:29:16.759
operating at such a high level. Like nobody is seeing this.
581
00:29:17.420 --> 00:29:20.019
Like you're still getting it all done. You're still getting there,
582
00:29:20.119 --> 00:29:22.619
even if it's less organized in your head than it
583
00:29:22.680 --> 00:29:25.440
was before. How do we get women to recognize like
584
00:29:25.720 --> 00:29:27.980
how much at baseline we do and how we're still
585
00:29:28.029 --> 00:29:28.430
doing it?
586
00:29:28.609 --> 00:29:31.549
Yeah, we're still doing it. And then we're really hard
587
00:29:31.609 --> 00:29:34.150
on ourselves when we don't feel like we're doing the
588
00:29:34.210 --> 00:29:36.410
best job that we've always done. And I think it's
589
00:29:36.450 --> 00:29:39.609
because as women, we just take so much on, don't you?
590
00:29:39.700 --> 00:29:43.900
Because we're always juggling balls. And I just think that
591
00:29:44.000 --> 00:29:47.480
I know I got to the point personally where I
592
00:29:47.529 --> 00:29:50.670
was just like, I actually don't think I can anymore.
593
00:29:50.769 --> 00:29:52.890
And I know that people leave work. I've always worked
594
00:29:52.930 --> 00:29:56.150
for myself, but people leave work or think about leaving
595
00:29:56.190 --> 00:29:58.150
work because they don't think they can stay to the
596
00:29:58.190 --> 00:30:01.460
top of their game anymore. And what I would sort
597
00:30:01.500 --> 00:30:04.359
of like say, and the thing that worked for me
598
00:30:04.440 --> 00:30:07.109
was that, have a look at your to-do list and
599
00:30:07.180 --> 00:30:09.089
see what you can just get rid of. What are
600
00:30:09.109 --> 00:30:12.069
the big rocks that you need to move today? Usually
601
00:30:12.089 --> 00:30:14.930
within a workplace, you don't have a lot of choice.
602
00:30:15.390 --> 00:30:18.849
But at home, think about asking for help. I mean,
603
00:30:18.890 --> 00:30:21.210
I remember saying to my husband once, I can't today.
604
00:30:22.170 --> 00:30:24.039
He went, can't what? And I went, I just can't.
605
00:30:25.980 --> 00:30:26.359
None of it.
606
00:30:28.640 --> 00:30:30.660
Well, they don't even have a night like my husband.
607
00:30:30.920 --> 00:30:35.869
God bless him. Great dude. No idea what is going
608
00:30:35.940 --> 00:30:37.869
on in my brain and all of the things that
609
00:30:37.890 --> 00:30:41.529
I'm juggling to run our household. It's just it is inconceivable.
610
00:30:42.150 --> 00:30:44.509
Like that is not even something I mean, and I've
611
00:30:44.569 --> 00:30:47.640
used this analogy so many times in this podcast about
612
00:30:47.660 --> 00:30:50.579
the landing of the planes and how when women are
613
00:30:50.599 --> 00:30:53.400
air traffic controllers, we have 900 planes were landing at
614
00:30:53.519 --> 00:30:56.660
one time. They're working just as hard. They're just playing
615
00:30:56.680 --> 00:30:59.410
the one plane, just like the one plane is coming in.
616
00:30:59.990 --> 00:31:03.369
And it's just like it's just such an unrealistic expectation
617
00:31:03.390 --> 00:31:06.309
of how we're supposed to function. And I have that conversation, too,
618
00:31:06.329 --> 00:31:08.490
because all the patients that will say, like, I've left
619
00:31:08.539 --> 00:31:10.640
my job. I can't do it the way that I
620
00:31:10.700 --> 00:31:12.880
always used to. I'm like, the way you were performing
621
00:31:12.940 --> 00:31:15.319
is so much higher than we would ever expect of
622
00:31:15.460 --> 00:31:18.599
other members of our society. Why do we have these
623
00:31:18.660 --> 00:31:21.119
unrealistic expectations for us? And not only are we supposed
624
00:31:21.140 --> 00:31:24.019
to achieve that, but we're supposed to do it for decades. Exactly.
625
00:31:24.359 --> 00:31:25.019
Not happening.
626
00:31:25.279 --> 00:31:27.769
A couple of things can be helpful is open communication
627
00:31:27.789 --> 00:31:30.109
with your partner, whether that's a male or female or
628
00:31:30.230 --> 00:31:34.250
with your children. Have open communication so people are aware
629
00:31:34.329 --> 00:31:36.170
that there's going to be times when you're going to say,
630
00:31:36.910 --> 00:31:38.869
I need help and you're going to give me it.
631
00:31:39.069 --> 00:31:41.759
Because we don't ask for help. We never do. And
632
00:31:41.799 --> 00:31:45.200
I think that for me, taking... a bit of time
633
00:31:45.220 --> 00:31:47.500
for myself, I started doing this thing where I would
634
00:31:47.539 --> 00:31:50.119
get up 10 minutes before everyone else, go and get
635
00:31:50.160 --> 00:31:52.660
a cup of coffee and then just like sit down
636
00:31:52.720 --> 00:31:55.900
and be with myself and just go, okay, what's the
637
00:31:55.940 --> 00:31:58.660
things I really need to do today? And I sort
638
00:31:58.720 --> 00:32:02.049
of was like putting my own mask on first and
639
00:32:02.069 --> 00:32:04.890
then everybody else, and nobody ever said, why is she
640
00:32:04.950 --> 00:32:08.630
taking time off for herself ever? By the way, nobody
641
00:32:08.970 --> 00:32:11.289
is going to hold that against you. But I think
642
00:32:11.490 --> 00:32:14.730
open communication, taking time for yourself where you can, that
643
00:32:14.789 --> 00:32:18.730
little bit of self-care, which is really self-preservation. And then
644
00:32:18.750 --> 00:32:22.589
I just would lean into the post-menopause thing again. That
645
00:32:22.690 --> 00:32:25.740
gave me clarity. That made me go, I'm doing a
646
00:32:25.779 --> 00:32:28.619
whole crap ton of things I shouldn't be doing. I'm
647
00:32:28.660 --> 00:32:31.940
going to start delegating way better than I ever did before.
648
00:32:32.319 --> 00:32:34.420
The one thing that's still in there, though, and what
649
00:32:34.519 --> 00:32:38.059
I've recognized, especially as my household has come down to
650
00:32:38.099 --> 00:32:41.309
just me and my spouse, and nobody's going to die
651
00:32:41.380 --> 00:32:44.650
if I don't do stuff because he's a perfectly capable
652
00:32:44.690 --> 00:32:49.569
human being and can survive on his own, is how
653
00:32:49.630 --> 00:32:53.029
many things were in my head that needed to get done.
654
00:32:53.630 --> 00:32:55.619
And at some point it was easier to do it
655
00:32:55.680 --> 00:32:59.460
myself than to nag somebody else to do it. And
656
00:32:59.519 --> 00:33:02.660
I had to realize that Certain things either didn't need
657
00:33:02.680 --> 00:33:04.779
to get done if he didn't see them as important,
658
00:33:05.880 --> 00:33:08.099
or I needed to let go until he realized they
659
00:33:08.140 --> 00:33:10.240
were important, and he started.
660
00:33:09.980 --> 00:33:11.079
Taking up the mental load.
661
00:33:11.339 --> 00:33:14.759
We're also our own worst enemy. I have been folding
662
00:33:14.819 --> 00:33:18.359
the boys' underpants in a Japanese manner, like little envelopes,
663
00:33:18.819 --> 00:33:21.259
and I line them all up forever. And I don't
664
00:33:21.279 --> 00:33:23.599
know why. Someone showed me once. I thought it was cute.
665
00:33:23.700 --> 00:33:25.660
And now I don't want anyone else to do the
666
00:33:25.700 --> 00:33:28.700
laundry unless they fold them the way that I want.
667
00:33:29.119 --> 00:33:31.660
Well, that's true, right? A lot of dads, like they're
668
00:33:31.680 --> 00:33:35.220
almost intimidated by taking care of their kids because we
669
00:33:35.259 --> 00:33:37.559
have a particular way we want to do it. They
670
00:33:37.599 --> 00:33:40.579
don't do it the same way. And then we criticize them.
671
00:33:40.680 --> 00:33:41.980
And then they're kind of like, well, fuck it. Why
672
00:33:42.019 --> 00:33:43.440
am I even doing this if you're just going to
673
00:33:43.480 --> 00:33:44.119
criticize me?
674
00:33:44.210 --> 00:33:44.430
Right.
675
00:33:44.529 --> 00:33:48.009
And so understanding that there's different ways of accomplishing the
676
00:33:48.049 --> 00:33:51.490
same goal and priority lists can be different, but it
677
00:33:51.549 --> 00:33:54.309
doesn't mean one is better than the other. That's an
678
00:33:54.329 --> 00:33:56.730
interesting conversation that we'll have because I'll be like, freaking
679
00:33:56.839 --> 00:33:58.720
out about something that we just have to do. And
680
00:33:58.740 --> 00:34:01.319
my husband's like, why do we have to do that today?
681
00:34:01.359 --> 00:34:03.339
And then I get mad because I said so. And
682
00:34:03.359 --> 00:34:05.940
he's like, no, let's actually talk about it like adults.
683
00:34:06.480 --> 00:34:07.319
And I'm like, okay.
684
00:34:07.599 --> 00:34:08.840
That's not what you were aiming for.
685
00:34:09.239 --> 00:34:11.409
No, I was like, no, just because I said so.
686
00:34:11.469 --> 00:34:13.230
And he was just like, I don't know. Let's just
687
00:34:13.269 --> 00:34:14.909
chalk it through. And then I'm like, yeah, okay, never mind.
688
00:34:15.130 --> 00:34:16.170
Letting go of control.
689
00:34:16.190 --> 00:34:19.710
It's hard, but I think perimenopause is all about letting
690
00:34:19.730 --> 00:34:21.789
go of control in reality.
691
00:34:22.349 --> 00:34:22.670
Yeah.
692
00:34:22.969 --> 00:34:23.710
Finding a new path.
693
00:34:24.269 --> 00:34:25.710
And knowing that the path is going to be different
694
00:34:25.730 --> 00:34:29.429
than you anticipated, and that's okay. Just giving yourself over
695
00:34:29.489 --> 00:34:31.769
to the process. I mean, I live in Silicon Valley.
696
00:34:31.789 --> 00:34:36.760
It's so many engineers, right? And engineers, like, we're an engineer. Like,
697
00:34:36.780 --> 00:34:39.079
things are supposed to go in a particular way. And
698
00:34:39.099 --> 00:34:42.280
when they don't follow the program that you've coded, you're
699
00:34:42.300 --> 00:34:43.840
just like, well, what's going on? I don't understand this.
700
00:34:43.860 --> 00:34:46.260
You're like, well, this is life. Like, you can't code this.
701
00:34:46.340 --> 00:34:48.239
It's just going to, you just have to let yourself
702
00:34:48.280 --> 00:34:50.539
go with it. And that is a very difficult transition
703
00:34:50.579 --> 00:34:50.989
for people.
704
00:34:51.610 --> 00:34:51.840
Agreed.
705
00:34:52.260 --> 00:34:55.269
The chaos is unpredictable and that's part of it, right?
706
00:34:55.309 --> 00:34:58.889
But I think it's less unpredictable when you have knowledge.
707
00:34:59.090 --> 00:35:01.349
And I think that that's what we're doing. That's what
708
00:35:01.610 --> 00:35:04.070
I do and you do. It's that we're not trying
709
00:35:04.090 --> 00:35:06.730
to like fix anything or it's more that we're trying
710
00:35:06.750 --> 00:35:09.389
to say, this is what's happening when you know you
711
00:35:09.449 --> 00:35:13.280
have more agency for choice. Like you can't make decisions
712
00:35:13.340 --> 00:35:15.500
when you don't know what you don't know, right?
713
00:35:15.659 --> 00:35:18.699
Yeah, it's really hard. It was so interesting when you
714
00:35:18.719 --> 00:35:20.980
were talking about, you know, 10, 12 years ago when
715
00:35:21.000 --> 00:35:23.400
you were going through this, People were just starting to
716
00:35:23.440 --> 00:35:27.159
have the conversation, and now it's a billion-dollar business. People
717
00:35:27.179 --> 00:35:29.360
are making millions and billions of dollars off of this
718
00:35:29.420 --> 00:35:32.699
menopause as a business. And how it's changed so much
719
00:35:32.860 --> 00:35:35.829
and how, like I said, as physicians, our roles have changed.
720
00:35:35.869 --> 00:35:38.289
And as people who are trying to help women through this, like,
721
00:35:38.929 --> 00:35:41.889
it's a whole different ballgame than it was a decade ago,
722
00:35:41.949 --> 00:35:43.289
for better or for worse, right?
723
00:35:43.409 --> 00:35:46.690
Yeah, now instead of no information, we have almost too
724
00:35:46.730 --> 00:35:48.590
much and some of it really not good.
725
00:35:49.000 --> 00:35:51.280
It's not a lack of information or a lack of
726
00:35:51.400 --> 00:35:55.150
access to information. That's the issue for the bulk of folks. Right.
727
00:35:55.170 --> 00:35:57.210
I would say in my practice, there certainly are some
728
00:35:57.250 --> 00:35:59.030
people who are like, I don't know what's going on
729
00:35:59.070 --> 00:36:00.710
at all. Like, I just I need you to start
730
00:36:00.730 --> 00:36:02.969
with the beginning with me. But mostly they're coming in
731
00:36:02.989 --> 00:36:06.079
and they're like, I'm more confused than I've ever been. Like,
732
00:36:06.179 --> 00:36:08.179
I don't know what to believe. Right. Because like the
733
00:36:08.199 --> 00:36:10.719
black box warning was lifted. And then, well, that means
734
00:36:10.739 --> 00:36:14.199
there's no risks associated. And you're like, well, no, that's
735
00:36:14.219 --> 00:36:15.030
not really what's happening.
736
00:36:15.050 --> 00:36:15.150
Right.
737
00:36:15.639 --> 00:36:17.210
Like, actually, actually.
738
00:36:17.230 --> 00:36:18.969
Did you catch my eye roll then?
739
00:36:19.710 --> 00:36:22.090
I'm like, oh, Lord, mercy.
740
00:36:22.730 --> 00:36:23.650
That was a whole thing.
741
00:36:24.110 --> 00:36:25.989
Amy and I are part of the Menopause Society, who
742
00:36:26.010 --> 00:36:28.250
has been advocating for 15 years to get the black
743
00:36:28.309 --> 00:36:31.610
box warning removed from vaginal estrogen.
744
00:36:32.050 --> 00:36:34.559
The whole time that was happening, I was like, well,
745
00:36:34.880 --> 00:36:37.500
at least it won't take off systemic. It'll only be off.
746
00:36:37.900 --> 00:36:40.000
And then I was like, what? What? And none of
747
00:36:40.019 --> 00:36:42.239
the doctors are going to, you're not going to say anything?
748
00:36:42.750 --> 00:36:45.050
But they didn't invite the doctors who actually would have
749
00:36:45.070 --> 00:36:45.670
said something.
750
00:36:46.150 --> 00:36:46.349
No.
751
00:36:46.469 --> 00:36:48.210
We don't get invited to this stuff.
752
00:36:48.570 --> 00:36:50.579
No, it was an FDA influencer panel.
753
00:36:50.880 --> 00:36:53.239
There's another one coming up all about testosterone.
754
00:36:53.519 --> 00:36:56.639
Already signed up. They may not let us in. We'll see.
755
00:36:56.659 --> 00:36:59.619
Yeah, I'm sure we're going to be banned. They'll be like, oh,
756
00:37:00.119 --> 00:37:03.489
those bitches from Overreactive, forget it. Not letting those ladies in.
757
00:37:03.869 --> 00:37:04.909
Those truth tellers.
758
00:37:05.409 --> 00:37:07.550
It's going to be a Jesus take the wheel.
759
00:37:08.289 --> 00:37:09.090
Yeah, I know.
760
00:37:09.750 --> 00:37:12.190
That's my only worry about going is that I'm going
761
00:37:12.210 --> 00:37:13.489
to be like, no, no.
762
00:37:13.510 --> 00:37:15.389
I'm going to hurt somebody by the end of it.
763
00:37:15.489 --> 00:37:16.070
I dissent.
764
00:37:18.349 --> 00:37:19.170
You shouldn't do that.
765
00:37:19.550 --> 00:37:20.010
Oh, God.
766
00:37:20.090 --> 00:37:22.570
I'm just going to throw up frowny face emojis at everything.
767
00:37:22.590 --> 00:37:23.610
Hey, everybody.
768
00:37:23.670 --> 00:37:25.929
Our book is here. We're so excited.
769
00:37:26.550 --> 00:37:28.550
And as a special treat, we have for you a
770
00:37:28.690 --> 00:37:30.789
bonus episode of our podcast where you get to.
771
00:37:30.719 --> 00:37:33.440
Hear the first part of our audio book. So please
772
00:37:33.619 --> 00:37:34.559
stay tuned and listen.
773
00:37:34.980 --> 00:37:37.400
So if you like the intro, go out, buy a
774
00:37:37.440 --> 00:37:39.739
copy for yourself, buy a copy for your friend, buy
775
00:37:39.760 --> 00:37:43.019
a copy for your cousin. And the URL to purchase
776
00:37:43.039 --> 00:37:44.179
the book is in our show notes.
777
00:37:44.300 --> 00:37:45.539
So I hope you guys enjoy it.
778
00:37:46.019 --> 00:37:50.860
So Amanda, as physicians, we often focus on treating symptoms.
779
00:37:50.900 --> 00:37:53.079
Like we're, as physicians, like we're like, okay, how do
780
00:37:53.099 --> 00:37:54.320
we make you feel better? How do we make you
781
00:37:54.340 --> 00:37:59.019
feel better? And your focus is on helping women change
782
00:37:59.900 --> 00:38:03.219
how they experience and transition through this phase of life.
783
00:38:03.280 --> 00:38:08.250
So what can medicine learn from coaching? Because we don't
784
00:38:08.309 --> 00:38:10.809
have that background, but I think it's really important.
785
00:38:11.250 --> 00:38:14.349
I say this with love, but I truly mean this, that...
786
00:38:15.150 --> 00:38:16.889
You know, you're going to say something really shitty when
787
00:38:16.929 --> 00:38:18.429
you start saying that.
788
00:38:18.809 --> 00:38:20.170
I know, that's never a good start.
789
00:38:21.409 --> 00:38:23.800
It's like when we deliver everything in a shit sandwich
790
00:38:23.840 --> 00:38:29.219
to our kids. Well, I love you, but I truly
791
00:38:29.300 --> 00:38:32.699
do mean this respectfully. A doctor's appointment is not a
792
00:38:32.739 --> 00:38:37.519
menopause plan. What I mean by that is that regardless
793
00:38:37.559 --> 00:38:41.139
of what medical treatment a person gets from their doctor,
794
00:38:41.199 --> 00:38:45.929
hormones or non-hormonal, everything outside of that matters as much.
795
00:38:46.449 --> 00:38:49.769
And I think that encouraging doctors to look at the
796
00:38:49.769 --> 00:38:52.969
360 of a woman is very difficult in the short
797
00:38:53.010 --> 00:38:56.320
amount of time that they have. But the women that
798
00:38:56.500 --> 00:38:58.639
I will listen to will say, well, I went to
799
00:38:58.679 --> 00:39:00.579
the doctors and he told me I was fat and
800
00:39:00.599 --> 00:39:02.800
I don't move enough. What do I do about that?
801
00:39:03.159 --> 00:39:05.880
I'm supposed to sort my sleep out too. And they're
802
00:39:05.920 --> 00:39:09.329
left with too many How? How do I do that?
803
00:39:09.809 --> 00:39:12.630
There's a disconnect. I do see it changing a little bit.
804
00:39:13.090 --> 00:39:16.199
But I also then become very wary because you've got
805
00:39:16.300 --> 00:39:19.900
all of these functional doctors out there that aren't really
806
00:39:20.139 --> 00:39:24.469
doing doctoring. And they end up ultimately selling them products
807
00:39:24.550 --> 00:39:27.090
and stuff. And I find that only actually in America.
808
00:39:27.110 --> 00:39:28.969
I don't really see that much anywhere.
809
00:39:28.710 --> 00:39:29.969
Else at the moment.
810
00:39:30.280 --> 00:39:32.840
But I do wish that there was a bit of,
811
00:39:33.219 --> 00:39:35.159
it would be good if you exercise more, here are
812
00:39:35.199 --> 00:39:37.719
some good ideas. But I mean, how do they know that?
813
00:39:38.039 --> 00:39:40.980
That's just the whole like full conversation. Don't like just
814
00:39:41.019 --> 00:39:44.019
dismiss the lifestyle stuff as just being something they should do.
815
00:39:44.739 --> 00:39:47.190
Trying to sort of talk about it in a respectful
816
00:39:47.250 --> 00:39:51.099
way that really is going to show them that Cardiovascular disease,
817
00:39:51.239 --> 00:39:53.429
one of the number one killers of women, is literally
818
00:39:53.510 --> 00:39:57.429
something you can reduce by 80% with lifestyle interventions, and
819
00:39:57.469 --> 00:40:00.730
especially when you're high risk in postmenopause. That's a really
820
00:40:00.789 --> 00:40:04.349
valid conversation to have, not just go and exercise some more.
821
00:40:04.670 --> 00:40:06.429
We as doctors really want to be able to have
822
00:40:06.469 --> 00:40:11.130
those conversations, but we're missing a few pieces. One is time, honestly.
823
00:40:11.690 --> 00:40:14.159
In the American system, there is no time for that.
824
00:40:14.880 --> 00:40:18.059
One is education. We went through med school. We learned
825
00:40:18.780 --> 00:40:19.480
how the body works.
826
00:40:20.050 --> 00:40:23.260
How the body breaks and what medications to give you
827
00:40:23.300 --> 00:40:27.300
for it. But we didn't learn nutrition. We didn't learn
828
00:40:27.380 --> 00:40:29.920
exercise physiology. And it's one of the reasons I built
829
00:40:29.940 --> 00:40:32.519
the practice I have, which is very holistic. And we
830
00:40:32.559 --> 00:40:36.969
work with registered dietitian nutritionists who are exercise physiologists. We
831
00:40:36.989 --> 00:40:38.989
talk about all that because really that is the key
832
00:40:39.010 --> 00:40:42.110
to health. We know that's the key to health. And
833
00:40:42.369 --> 00:40:44.369
I am more than happy to admit there are people
834
00:40:44.389 --> 00:40:48.480
who are more expert than me in those things. It's
835
00:40:48.559 --> 00:40:51.679
just like somebody like me should never, ever give medical advice.
836
00:40:51.719 --> 00:40:55.239
It's the same scope of practice. But I'm definitely not
837
00:40:55.280 --> 00:40:57.800
crapping all over doctors when I say this, though, because
838
00:40:58.199 --> 00:41:00.880
like in Canada, women get eight minutes. In the UK,
839
00:41:01.099 --> 00:41:03.280
they're not getting to see their doctors. I know it's
840
00:41:03.300 --> 00:41:06.000
really difficult and I don't want to burden doctors more.
841
00:41:06.079 --> 00:41:09.019
I just think that the way it's portrayed or maybe
842
00:41:09.059 --> 00:41:12.090
the narrative could be just a little bit more open
843
00:41:12.269 --> 00:41:16.130
and sort of inclusive to everything. I really don't think...
844
00:41:16.820 --> 00:41:20.500
Apart from doctors having knowledge and education, there's much more
845
00:41:20.559 --> 00:41:23.300
that they need to do, though, because their job is
846
00:41:23.400 --> 00:41:25.739
to do that. Four to six appointments is what a
847
00:41:25.820 --> 00:41:27.840
woman will take before she gets to see someone.
848
00:41:28.360 --> 00:41:31.199
That's sucky, right? I actually send them to Geneva all
849
00:41:31.239 --> 00:41:32.980
the time in the U.S. because I feel like you're
850
00:41:33.039 --> 00:41:37.139
one of the only ones that's ethical anymore. It's just like,
851
00:41:37.639 --> 00:41:38.139
I know.
852
00:41:38.920 --> 00:41:41.719
It's a hard line to continue because ethics don't make
853
00:41:41.760 --> 00:41:42.199
you money.
854
00:41:42.829 --> 00:41:42.969
Yeah.
855
00:41:42.989 --> 00:41:45.070
I mean, Becca, that's got to be hard for Genev, right?
856
00:41:45.090 --> 00:41:48.429
Because there's a bottom line. There's investors. They want you
857
00:41:48.449 --> 00:41:48.989
to make money.
858
00:41:49.130 --> 00:41:50.190
Actually, we don't have investors.
859
00:41:50.730 --> 00:41:54.289
We're basically more a traditional medical practice anymore because we couldn't.
860
00:41:54.829 --> 00:41:56.670
We couldn't go to investors and say, hey, here's how
861
00:41:56.690 --> 00:41:58.570
we're going to make you back this big investment because
862
00:41:58.590 --> 00:42:01.980
we couldn't make back the big investment by providing genuine
863
00:42:02.019 --> 00:42:06.179
medical care and diet and exercise coaching. They wanted us
864
00:42:06.480 --> 00:42:09.260
to sell and sell a lot because that's where you
865
00:42:09.300 --> 00:42:11.210
make money. And we just Didn't think that was the
866
00:42:11.250 --> 00:42:14.690
ethical path. But I understand why the people who sell
867
00:42:14.750 --> 00:42:17.269
are selling. Like that's where the money is. It's not
868
00:42:17.329 --> 00:42:18.070
in medical care.
869
00:42:18.550 --> 00:42:22.590
And that's what happens when health care becomes a luxury good.
870
00:42:23.320 --> 00:42:26.059
And like that's where it starts to become a commodity.
871
00:42:26.199 --> 00:42:30.019
It starts to become something, you know, capitalism. And you're
872
00:42:30.039 --> 00:42:34.199
just trying to do quality health care, but you're also
873
00:42:34.280 --> 00:42:37.079
trying to make money. And those two things often just
874
00:42:37.179 --> 00:42:40.590
don't mix. And it's sad. It shouldn't have to be
875
00:42:40.650 --> 00:42:43.429
that way. And I've seen so many companies and folks
876
00:42:43.449 --> 00:42:47.420
that I know who've started concierge practices or they've started
877
00:42:48.139 --> 00:42:51.019
telehealth companies or whatever. And all the intention is there,
878
00:42:51.480 --> 00:42:54.280
all of the goodness and all of the like, I'm
879
00:42:54.300 --> 00:42:56.619
going to do this right. And it just goes off
880
00:42:56.659 --> 00:42:59.570
the rails because you have to make money. And it's
881
00:42:59.610 --> 00:43:00.409
a slippery slope.
882
00:43:00.690 --> 00:43:03.309
And I totally feel for my colleagues who've gone into
883
00:43:03.329 --> 00:43:05.750
concierge practice. And I understand why they've done it, because
884
00:43:05.789 --> 00:43:07.869
they want to be able to take 45 minutes to
885
00:43:07.909 --> 00:43:13.119
an hour. at every appointment to really dig deep and
886
00:43:13.159 --> 00:43:13.780
talk about.
887
00:43:13.619 --> 00:43:14.679
The lifestyle factors.
888
00:43:15.039 --> 00:43:19.030
And our medical system doesn't pay for that. But it
889
00:43:19.070 --> 00:43:21.190
then silos it to those who can afford it.
890
00:43:21.510 --> 00:43:23.210
That's what I was going to say. Then it becomes
891
00:43:23.269 --> 00:43:26.639
a privilege. And what's happened in menopause is the people
892
00:43:27.110 --> 00:43:30.739
who are getting the help get it because of privilege.
893
00:43:31.579 --> 00:43:31.940
They do.
894
00:43:32.579 --> 00:43:35.079
If you look at different healthcare systems, I mean, it's
895
00:43:35.320 --> 00:43:38.940
very different model in the US. It basically is all private, right?
896
00:43:38.980 --> 00:43:42.739
Like you have to reworking and have healthcare insurance to
897
00:43:42.800 --> 00:43:45.909
get care. Otherwise it's out of pocket. In Canada, we
898
00:43:45.929 --> 00:43:49.329
have a socialized healthcare system that is at risk of
899
00:43:49.369 --> 00:43:53.389
becoming a two-tier healthcare system because of private clinics. And
900
00:43:53.449 --> 00:43:57.230
that means access to care is hurting for those people
901
00:43:57.269 --> 00:43:59.739
who want to see a doctor and same in the UK.
902
00:44:00.139 --> 00:44:03.769
And so it's very, very difficult. I get really frustrated
903
00:44:03.969 --> 00:44:06.550
with the fact that the people that do talk about
904
00:44:07.309 --> 00:44:10.679
menopause and getting all the help are always the Western
905
00:44:10.739 --> 00:44:13.980
white woman. We never talk about any of the social
906
00:44:14.039 --> 00:44:18.719
determinants of health, of like location, education, ethnicity, any of
907
00:44:18.760 --> 00:44:22.519
those things in the US are literally barriers to getting care.
908
00:44:23.079 --> 00:44:26.360
And also make your experience of menopause worse because all
909
00:44:26.380 --> 00:44:29.460
of those social stressors increase your chronic stress level and
910
00:44:29.500 --> 00:44:31.039
that impacts your actual symptoms.
911
00:44:31.710 --> 00:44:32.550
And your health outcomes.
912
00:44:33.050 --> 00:44:36.030
It is all linked. And it's just like this concierge
913
00:44:36.070 --> 00:44:41.559
practice or elite menopausal care is really just for wealthy
914
00:44:41.599 --> 00:44:44.119
white women right now. And I think that is so
915
00:44:44.179 --> 00:44:45.340
incredibly problematic.
916
00:44:45.619 --> 00:44:47.800
Which is a shame because I think all women deserve
917
00:44:47.820 --> 00:44:49.739
that level of care. I really wish there were a
918
00:44:49.760 --> 00:44:53.230
way that our system could support that level of holistic
919
00:44:53.269 --> 00:44:56.230
care where everybody gets, you know, all of these pieces.
920
00:44:56.849 --> 00:44:58.510
I don't have the answer. I'm not an economist.
921
00:44:59.400 --> 00:45:01.380
I do have to say one thing about this, though.
922
00:45:01.500 --> 00:45:03.860
Being in the Bay Area, what I have found is
923
00:45:04.099 --> 00:45:07.300
the wealthier you are and the more access to care
924
00:45:07.360 --> 00:45:11.949
you have, you are not necessarily getting better care because
925
00:45:12.050 --> 00:45:16.829
that's where this idea that these elite practices are innovators,
926
00:45:16.869 --> 00:45:20.409
they're pushing boundaries, and they're starting to use things that
927
00:45:20.449 --> 00:45:24.130
are unsafe because somebody's willing to give them to them
928
00:45:24.170 --> 00:45:27.150
because they're paying them for it. All these peptides and
929
00:45:27.900 --> 00:45:31.619
All this stuff that's just absolute nonsense and completely unsafe.
930
00:45:31.920 --> 00:45:34.500
You know, I'm in Silicon Valley. I'll have, you know,
931
00:45:34.539 --> 00:45:36.219
wealthy folks reach out to me like, what do you think?
932
00:45:36.239 --> 00:45:38.929
I'm like, absolutely do not do that. And then, of course,
933
00:45:38.949 --> 00:45:41.329
they never come back and see me again because I'm like,
934
00:45:41.369 --> 00:45:42.969
I'm not going to do that. Like, I'm not going
935
00:45:42.989 --> 00:45:45.230
to tell you that's OK. And how is it that
936
00:45:45.269 --> 00:45:50.889
you have unlimited resources but are making such poor decisions
937
00:45:50.929 --> 00:45:52.510
with what you're doing for your care. I mean, we
938
00:45:52.550 --> 00:45:54.190
could be a whole episode just on that.
939
00:45:54.510 --> 00:45:57.329
When I lived in Texas, there's a real prevalence in
940
00:45:57.409 --> 00:46:01.190
Texas of the testosterone and pellets. And I actually went
941
00:46:01.329 --> 00:46:04.900
to a private practice because I was invited and I
942
00:46:04.929 --> 00:46:08.059
was curious. And oh my goodness, that's what they wanted
943
00:46:08.079 --> 00:46:10.340
to give me straight away. I was never going to
944
00:46:10.420 --> 00:46:13.400
do it. I just went in to be nosy. And
945
00:46:13.539 --> 00:46:17.519
these women think they're getting personalized care. They're getting compounded
946
00:46:17.739 --> 00:46:19.840
bioidentical hormones.
947
00:46:20.280 --> 00:46:21.179
All the buzzwords.
948
00:46:21.679 --> 00:46:24.409
All the buzzwords, right? And I know people who have
949
00:46:24.449 --> 00:46:28.369
got those practices that are absolutely raking it in. It's
950
00:46:28.469 --> 00:46:31.809
just easy money for them. And it's so unethical. And
951
00:46:31.849 --> 00:46:34.550
women feel good when they get that testosterone because, yay,
952
00:46:34.670 --> 00:46:38.110
because you're on an anabolic steroid. You could race against
953
00:46:38.309 --> 00:46:39.789
Usain Bolt with the amount.
954
00:46:39.809 --> 00:46:43.570
Yeah, exactly. You're basically the Incredible Hulk. You know, you're like,
955
00:46:43.969 --> 00:46:44.949
I can do everything.
956
00:46:45.230 --> 00:46:47.030
It feels great till it doesn't.
957
00:46:47.230 --> 00:46:48.289
Until it doesn't.
958
00:46:48.849 --> 00:46:49.070
And then.
959
00:46:49.690 --> 00:46:52.230
Wheels really go off the bus at that point. Well,
960
00:46:52.730 --> 00:46:53.469
on that note.
961
00:46:54.030 --> 00:46:56.469
On that note, I did want to give you a
962
00:46:56.550 --> 00:46:59.179
chance because I think you just started something new. And
963
00:46:59.199 --> 00:47:00.639
I want to give you a chance to promote it
964
00:47:00.699 --> 00:47:03.500
here with us because I love the things that you do.
965
00:47:03.619 --> 00:47:05.860
And I'm really excited for this new venture. I've just
966
00:47:05.880 --> 00:47:07.780
been seeing some things out there on social media. So
967
00:47:07.800 --> 00:47:08.679
please tell us about it.
968
00:47:08.980 --> 00:47:11.900
Yeah, it's just launched and it's very low key at
969
00:47:11.920 --> 00:47:15.400
the moment, but it's called Spring. And essentially, it's everything
970
00:47:15.440 --> 00:47:18.150
that we've just talked about. So The whole point of
971
00:47:18.610 --> 00:47:22.190
the platform was to run alongside whatever health care that
972
00:47:22.409 --> 00:47:25.349
women are getting through menopause. We don't do any health care,
973
00:47:25.389 --> 00:47:28.760
no telemedicine. But in there, I work with a medical
974
00:47:28.820 --> 00:47:32.280
menopause doctor and there's a whole educational series in there.
975
00:47:32.320 --> 00:47:36.079
But there's also guidance how to have a successful doctor's appointment,
976
00:47:36.139 --> 00:47:40.679
including we have reports and symptom surveys that do a
977
00:47:40.719 --> 00:47:44.480
personalized report for people. including the current medication so that
978
00:47:44.519 --> 00:47:47.360
they can have a valid conversation. And it also includes
979
00:47:47.440 --> 00:47:49.460
the language they should use. Like this is how to
980
00:47:49.500 --> 00:47:53.159
start a successful conversation. But in there as well as
981
00:47:53.219 --> 00:47:56.000
all the programs, like there's strength training, there's pelvic floor,
982
00:47:56.019 --> 00:47:58.590
there's nutrition, there's sleep. It's all of the stuff that
983
00:47:58.610 --> 00:48:00.849
when you leave the doctor, he goes, go and sleep,
984
00:48:00.989 --> 00:48:04.289
go and start your exercise. And then we also have
985
00:48:04.389 --> 00:48:07.050
a community. Maybe I have one of you two on
986
00:48:07.090 --> 00:48:10.659
or both of you together. but we have live experts
987
00:48:10.940 --> 00:48:13.820
come in and we have focused topics. And so it
988
00:48:13.880 --> 00:48:17.699
really is just a menopause resource that I wish I'd had.
989
00:48:18.239 --> 00:48:21.719
We don't sell any supplements. It's just evidence-based guidance. And
990
00:48:21.780 --> 00:48:24.219
I obviously needed to make money to build this. And
991
00:48:24.239 --> 00:48:27.150
so we tried to keep the price down. It's $ 24
992
00:48:27.090 --> 00:48:30.889
Canadian a month, which is about 20 or 18 US.
993
00:48:31.110 --> 00:48:34.349
It's a global app as well because we're not giving
994
00:48:34.610 --> 00:48:38.030
any telemedicine. So That's what we're working on at the moment.
995
00:48:38.130 --> 00:48:42.269
And really it's about promoting this education and advocacy, right?
996
00:48:42.329 --> 00:48:44.489
We just want women to go in there going, all right,
997
00:48:44.610 --> 00:48:46.650
I got this. I'm going to go in all guns
998
00:48:46.690 --> 00:48:48.530
a blazing and take control.
999
00:48:48.269 --> 00:48:48.829
Of their health.
1000
00:48:49.389 --> 00:48:51.570
I think it's a great service. We did something very
1001
00:48:51.670 --> 00:48:54.150
similar at the end of our book, going through a
1002
00:48:54.150 --> 00:48:56.409
list of, okay, you're going in for an appointment. First
1003
00:48:56.449 --> 00:48:58.409
of all, make the appointment just for this.
1004
00:48:59.510 --> 00:49:01.369
Don't tack it on at the end of your annual.
1005
00:49:02.269 --> 00:49:02.750
And two.
1006
00:49:03.579 --> 00:49:05.619
Here's a list of things your doctor actually needs to
1007
00:49:05.659 --> 00:49:07.760
hear from you to understand what you're going through.
1008
00:49:08.090 --> 00:49:08.670
Exactly.
1009
00:49:08.690 --> 00:49:11.829
I know there's tons of like guides to your doctor
1010
00:49:11.849 --> 00:49:14.710
out there. It doesn't matter. Women still go in and go,
1011
00:49:14.730 --> 00:49:19.179
I don't know what's wrong and start crying. That's what
1012
00:49:19.280 --> 00:49:22.039
I do. If we could give them the language and say,
1013
00:49:22.099 --> 00:49:25.119
I'd like to talk to you about this. I've tried this.
1014
00:49:25.679 --> 00:49:28.909
This didn't work. I'd like to have a plan. I
1015
00:49:28.969 --> 00:49:31.340
think it just might be more successful instead of them
1016
00:49:31.380 --> 00:49:32.900
having four to six appointments.
1017
00:49:33.360 --> 00:49:36.460
Right, exactly. It can really optimize the time that you have, right?
1018
00:49:36.480 --> 00:49:39.340
It gives us the keywords, the key information that we
1019
00:49:39.380 --> 00:49:42.460
need in order to come up with whatever different options
1020
00:49:42.500 --> 00:49:44.539
we think might be appropriate and then help you work
1021
00:49:44.579 --> 00:49:48.030
through picking that right choice, right? So that's amazing.
1022
00:49:48.050 --> 00:49:50.250
I just want to sort of say as well, we
1023
00:49:50.289 --> 00:49:53.050
talk about partnering with your doctor. It's not like going
1024
00:49:53.110 --> 00:49:55.789
and tell your doctors this. It's about having a successful
1025
00:49:55.829 --> 00:50:01.679
partnership because I honestly, like, don't think doctors are gaslighting women.
1026
00:50:01.820 --> 00:50:04.260
I actually, in my heart of hearts, even though that's
1027
00:50:04.340 --> 00:50:08.170
another narrative on social media, I truly believe doctors get
1028
00:50:08.230 --> 00:50:10.969
in this business because they want to help people, but
1029
00:50:10.989 --> 00:50:13.030
they don't know what they don't know. And so I
1030
00:50:13.210 --> 00:50:16.969
feel as though if we can have more information going
1031
00:50:17.030 --> 00:50:21.199
into the appointments, I'm sure that most doctors would go, oh,
1032
00:50:21.239 --> 00:50:23.559
this is great. Let's have a conversation about it and
1033
00:50:23.599 --> 00:50:26.820
let's talk about it. That's the lens I'm coming at
1034
00:50:26.860 --> 00:50:27.559
this from, yeah.
1035
00:50:28.039 --> 00:50:30.300
And we encourage a lot of doctors to say, you know,
1036
00:50:30.420 --> 00:50:33.199
this is the extent of my knowledge. I'm not doubting you.
1037
00:50:33.460 --> 00:50:34.719
I just don't know about this.
1038
00:50:34.809 --> 00:50:37.289
So let me figure it out. That's a great thing
1039
00:50:37.329 --> 00:50:39.789
to say as a physician. Just say, this is what
1040
00:50:39.849 --> 00:50:42.389
I know. This is something I don't know, but I'm going.
1041
00:50:42.309 --> 00:50:43.000
To help you with it.
1042
00:50:43.610 --> 00:50:45.530
One of the most harmful things I've seen on social
1043
00:50:45.570 --> 00:50:48.820
media was like this whole series of posts by various
1044
00:50:48.860 --> 00:50:51.239
influencers saying, you go into your doctor and don't leave
1045
00:50:51.280 --> 00:50:54.559
without that patch. I'm like, that's not an appropriate thing
1046
00:50:54.579 --> 00:50:57.699
to say because it is not appropriate medicine for every person.
1047
00:50:58.579 --> 00:51:00.980
So why are you setting their doctor up to fail?
1048
00:51:01.059 --> 00:51:03.550
Like they may have a really good doctor who's not
1049
00:51:03.650 --> 00:51:07.389
gaslighting them. And I'm going to be a little more balanced.
1050
00:51:07.530 --> 00:51:09.309
I think there are some doctors who gaslight women.
1051
00:51:09.590 --> 00:51:12.150
Absolutely. I wish we were all perfect. We're not.
1052
00:51:12.889 --> 00:51:14.760
But the bulk of us really aren't. That's not what
1053
00:51:14.780 --> 00:51:17.699
we're trying to do. And I think what you're doing
1054
00:51:17.780 --> 00:51:19.260
is great. I think it'll help a lot of women
1055
00:51:19.280 --> 00:51:21.179
just have that conversation more successfully.
1056
00:51:21.519 --> 00:51:24.519
Yeah, that's the ultimate goal of And it's great that
1057
00:51:24.559 --> 00:51:26.760
it's in your book too as well. And by the way,
1058
00:51:26.840 --> 00:51:28.800
I love your book and I'm going to do you
1059
00:51:28.860 --> 00:51:30.760
a shout out. I sort of took it away with
1060
00:51:30.800 --> 00:51:32.539
me and I was reading and it was so good.
1061
00:51:32.599 --> 00:51:33.199
Oh, thank you.
1062
00:51:33.300 --> 00:51:34.159
No, thank you.
1063
00:51:34.320 --> 00:51:37.199
Very proud of you. I sort of got the book
1064
00:51:37.260 --> 00:51:38.989
and was already like, this is going to be a
1065
00:51:39.030 --> 00:51:41.449
great book because you know when you just trust somebody
1066
00:51:42.030 --> 00:51:45.190
and so it's almost like I don't need to read
1067
00:51:45.250 --> 00:51:46.909
everything because I just trust that when I go and
1068
00:51:46.929 --> 00:51:49.130
look something up, it's going to be true.
1069
00:51:49.429 --> 00:51:50.150
You know that way?
1070
00:51:50.230 --> 00:51:52.349
And it's not often you can say that these days,
1071
00:51:52.409 --> 00:51:53.699
I don't think. Yeah.
1072
00:51:53.960 --> 00:51:54.659
Well, thank you.
1073
00:51:54.699 --> 00:51:56.239
I mean, that's our whole goal. We're just trying to
1074
00:51:56.260 --> 00:51:58.369
be as truthful as we can and talk about the
1075
00:51:58.409 --> 00:52:00.230
limitations of the knowledge that we have. And this is
1076
00:52:00.269 --> 00:52:01.989
what we know and this is what we don't. So
1077
00:52:02.050 --> 00:52:04.070
I really appreciate you saying that. Thank you so much.
1078
00:52:04.449 --> 00:52:06.670
Before we go, I have a huge thank you to
1079
00:52:06.690 --> 00:52:10.659
say to Rebecca, because we met in person in real
1080
00:52:10.699 --> 00:52:14.460
life at the Menopause Society conference last year, and she
1081
00:52:14.519 --> 00:52:19.050
blew my mind and changed my life. Because She showed
1082
00:52:19.110 --> 00:52:21.550
me a portable Nespresso maker.
1083
00:52:21.730 --> 00:52:24.969
I remember this conversation, actually. We were sitting in the
1084
00:52:25.010 --> 00:52:25.590
hotel bar.
1085
00:52:25.889 --> 00:52:28.710
And I manifested that. And for my birthday, well, I
1086
00:52:28.750 --> 00:52:31.889
basically told my husband. And he bought me the same
1087
00:52:31.909 --> 00:52:34.340
model as yours. And I now am an owner of one.
1088
00:52:34.389 --> 00:52:36.780
And it's changed my life. Yes. I know.
1089
00:52:36.820 --> 00:52:39.380
I love that damn thing. A pack with that in mind.
1090
00:52:39.579 --> 00:52:42.079
I have different sized carry-ons that can fit that darn thing.
1091
00:52:42.920 --> 00:52:43.300
Oh, my God.
1092
00:52:43.340 --> 00:52:44.059
That's hilarious.
1093
00:52:44.579 --> 00:52:45.570
I'm so glad you got it.
1094
00:52:46.380 --> 00:52:47.360
Better living through coffee.
1095
00:52:47.880 --> 00:52:49.039
And that's a great place to end.
1096
00:52:49.519 --> 00:52:49.679
Yeah.
1097
00:52:49.820 --> 00:52:52.579
Thank you so much, Amanda. And for everybody who's listening,
1098
00:52:52.619 --> 00:52:53.280
just remember.
1099
00:52:53.300 --> 00:52:56.269
You're not crazy. This is really happening.