January 30, 2024 • 43 mins
In this episode, Sarah interviews Dr. Gillian Goddard, an NYC-based endocrinologist who will soon be launching a newsletter on navigating your health and hormones in the post-reproductive years.
They discuss perimenopause and the late reproductive years, contraception at 40+, weight gain and perimenopause, estrogen + dementia, and more.
In the Q&A, Laura and Sarah answer a listener query about charitable giving.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Hi. This is Laura Vandercamp. I'm a mother of five,
an author, journalist, and speaker.
Speaker 2 (00:08):
And this is Sarah Hartunger. I'm a mother of three,
a practicing physician and blogger. On the side, we are
two working parents who love our careers and our families.
Speaker 1 (00:17):
Welcome to best of both worlds. Here we talk about
how real women manage work, family, and time for fun.
From figuring out childcare to mapping out long term career goals.
We want you to get the most out of life.
Welcome to best of both worlds. This is Laura. This
episode is airing at the very end of January. In
twenty twenty four, Sarah is going to be interviewing doctor
(00:40):
Gillian Goddard, who has been a prior guest on the show.
She was talking about her life as a practicing physician
in New York and as she's raising four children. She
particularly talked about having op pars with her family and
how that had worked as a childcare solution. But she's
back because she has a new newsletter that is out
very recently called The Hot Flash, dealing with medical issues
(01:05):
associated with women who are about our age. Sarah, as
we hit our mid forties, so looking at issues for
women in their forties. So why don't you tell us
a little bit about what you and Jillian cover in this.
Speaker 2 (01:18):
Yeah, so this has been requested many times. We had
a prior guest shout out to doctor Laura Erdman who
talked about some of these topics, kind of focusing on
the obigui in side. But doctor Goddard is an endecnologist,
so kind of like a different medical field and perspective,
and great timing since she is starting this amazing newsletter
which I think came out last week when this episode airs,
(01:40):
and it's part of Emily Oster's parent Data collection of newsletters,
so it's going to be awesome. And yeah, I was
super curious about a lot of things, including whether or
not I'm in perimenopause spoiler. I think the answer is no.
But it was a really it was a really, really
fun conversation. If you are triggered by discussion of cycles
(02:03):
and fertility and other things like that, this may be
an episode to skip. We do talk about those kinds
of things, So yeah, I guess it does make sense
for me to give that as a little bit of
a trigger warning. You can check out all of our
prior episodes if you need something else to listen to
this week.
Speaker 1 (02:20):
Yeah, but very exciting because this is a topic that
I know a lot of our listeners are curious about
as we get a little bit older and watch our
bodies change again, it's just a constant thing of figuring
out what's going on, and many of us are helping
our teen daughters through the first part of that to
sort of stage, but we are entering into the other
(02:41):
one of it. So we'll be excited to hear what
Jillian Goddard has to say and excited that this is
a topic that more people are talking about and is
coming into the cultural consciousness.
Speaker 3 (02:52):
So let's hear what she has to say.
Speaker 2 (02:54):
I am so excited to welcome doctor Gillian Goddard to
Best of Both Worlds for this second time. But Jillian
was on this podcast previously, not as physician Gillian. She
was on as parent Gillian, talking all about the O
pair lifestyle. But we decided we needed to have her back,
and we beg to have her back because there have
been so many questions from our audience about perimenopause and hormones,
(03:17):
and doctor Goddard happens to be an expert in that field.
She also was an attendee of Bestly Plans Live. Had
so much fun hanging out with me and Laura in
Fort Lauderdale last fall. And she's an endocrinologist in private
practice and the author of hot Flash, which is the
best name ever. That is a newsletter from Parent Data
(03:38):
by Emily, auser who we've also had on the podcast.
So welcome, doctor Gillian Goddard.
Speaker 3 (03:44):
Oh, I thank Sarah. It's so glad to be back
on Best of Both Worlds.
Speaker 4 (03:47):
I am a very regular listener, so it's great to
be here again.
Speaker 3 (03:51):
I love it.
Speaker 2 (03:51):
We love having our listeners and Patreon members and just
people who have kind of gotten to know the show
really well on It always feels really really smooth, So
super excited with the conversation. Plus I'm personally excited about
the topic. So because it's actually funny, I will say, like,
people think I know adult in new chronology, and I
know very very little adult in necronology. Someone asked me
for something about menopause, and I'm like, you realize my
(04:13):
patients go up to like age twenty. I mean, yes,
there are some patients that have sort of menopausal scenarios.
For different reasons, but it's not my forte Okay. So
with all that said, what is the difference between menopause
perimenopause and like, is there even like a perimenopause before that,
like take us through the journey. Sure, So I think
(04:35):
that this is really.
Speaker 4 (04:36):
Important to make a distinction among all these different phases
that our bodies go through in our forties and fifties.
Speaker 3 (04:44):
A lot of my patients come.
Speaker 4 (04:46):
In and say they're having all these symptoms and they
thought they were having perimenopause, but they went to their gynecologists,
and their gynecologists checked their labs and we're like, no,
you're not in perimenopause. And then they're like, well, then
why do I feel so crummy? And so I think
it is a really important thing to sort of make
all these distinctions. So let's just talk through them from
(05:07):
the beginning. So you go from being in your thirties
and you're having regular periods and you're having your babies
and your breastfeeding and life is going on as normal.
And if you're anything like me, you hit forty and
you are.
Speaker 3 (05:21):
Like, forties are going to be the best. I don't
have little babies.
Speaker 4 (05:26):
I'm going to sleep at night, I'm going to feel amazing,
and you know, there's no diapers, there's no breastfeeding, there's
none of that. And what I found, and what a
lot of my patients mind.
Speaker 3 (05:37):
Is sure that that works great for.
Speaker 4 (05:40):
A few years, and then all of a sudden, you
start having like weird headaches and all your periods change,
and you're not sleeping at night, and none of it
makes any sense. And what that actually is typically is
something called the late reproductive phase. So this is a
phase that typically starts for women in their early forties
(06:01):
and can go on for five years, maybe even more.
And what defines the late reproductive phase is that you
are still having regular periods, but your cycles are changing.
Speaker 3 (06:16):
So even though your period is about the.
Speaker 4 (06:18):
Same length every month, it might go from being thirty
two days to twenty eight days to twenty six days,
and along with that you can have heavier periods and
you can have a lot more symptoms. Some women even
get more irritable or don't sleep as well. A lot
(06:39):
of women got hormonal headaches in this time period, and
some women even get hot flushes, but they only get
them around their period when our hormones drop and the
reason all this happens in our forties is because unfortunately,
as we get into our forties, we still have eggs in.
Speaker 3 (06:59):
Our own but they're not like they're like the last
guy's picked.
Speaker 4 (07:03):
They're not the most amazing eggs, and it takes a
lot of stimulus or juice as it were, from our
pituitary gland to get those eggs to be ready to ovulate.
So we have this hormone called FSH or follicle stimulating hormone,
and it goes up higher, and that hormone makes our
(07:24):
estrogen go up higher, and high estrogen is fine, but
then that estrogen has to come back down, and it's
actually the drop that makes us feel really, really grummy.
And so even though our estrogen levels are rising and
falling at the same times of the month as they
used to, they're going higher and they're falling lower, and
(07:45):
all of that makes us symptomatic. So we trundle along
with that for five years, and then we typically see
people transition to perimenopause. Perimenopause is when our cycle length
starts to vary. So maybe we had gone down to
having a twenty six day cycle, but it was a
(08:07):
twenty six day cycle every single month. Perimenopause is a
twenty two day cycle followed by a forty three day
cycle followed by a thirty four day cycle, And the
technical definition is that there's a greater than seven day
variability from cycle to cycle. And so again, we may
(08:28):
be ovulating, we may be having periods intermittently.
Speaker 3 (08:33):
They might still feel.
Speaker 4 (08:34):
Kind of regular, but they're much more all over the
place than they used to be. And we might go
through times when we feel fine, and we might go
through times when we're having lots of symptoms like hot flushes,
night sweats, eared ability, dissleep disruption and all those things.
Speaker 3 (08:54):
Are not so fun.
Speaker 4 (08:56):
And then the cycles tend to space out further and
further and further, and eventually you will have.
Speaker 3 (09:06):
A last period and enter menopause.
Speaker 4 (09:09):
The funny thing about menopause, though, is you can only
diagnose it in retrospect, so you have to go twelve
months without having a period before you can officially say
you're in menopause. So if you go eleven months and
then you have a period, you're still in perimenopause.
Speaker 2 (09:25):
The funny thing about that is like the idea that
you would just never know when it's the last one.
I never really thought about that, But I don't know
how I feel about that.
Speaker 5 (09:34):
That has some really important implications too, because there are
some studies that show that at least twenty five percent
of cycles that are more than six months long, So
say you haven't had a period in six months and
then all of a sudden you have a period, twenty
five percent of those cycles you.
Speaker 4 (09:49):
Actually ovulate, which I think has really important implications when
you're thinking about things like contraception. The other thing is,
we used to think that this was like a very
orderly progression from the late reproductive phase to perimenopause to menopause,
and it turns out actually more than half of women
(10:10):
seesaw between the late reproductive phase and perimenopause, and that
can go on for quite a while. And so just
because your cycles start to lengthen out doesn't mean that
all of a sudden you won't start having regular twenty
eight day cycles.
Speaker 2 (10:25):
Again, that doesn't seem fair, but good to know. So
question is there like a I don't know a way
of predicting when this is going to happen to you
based on medical history. Do people who start their medicare
earlier tend to have menopause earlier or is it more
related to like if your mother had earlier menopause, then
you will as well.
Speaker 4 (10:45):
So we used to think it was hereditary, but actually
newer cities suggests that there's not really a hereditary connection.
Speaker 3 (10:52):
It would make sense if you.
Speaker 4 (10:53):
Started having periods earlier that you would go through menopause earlier,
but that's not actually true. The late bloomers actually go
through menopause earlier, and the early bloomers have period typically
have periods for longer, and so it doesn't make a
lot of sense a lot of times. But so yeah,
(11:14):
so there's not a lot of prediction, So you just
get way you people super interesting gassing it. So okay,
so what we heard about hot flashes, we heard about
sleep disruption, irritability, things like pm d D I'm guessing
become more common in perimenopause. But one thing that women
tend to talk about a lot is weight gain. Is
(11:36):
that a myth is that more related to age. Is
there a hormonal component, what drives that and what can
counteract it? Since for most people it's probably not the
most welcome visitor. Yeah, so waking is something that women
really struggle with I feel like not a day passes
in my office where someone doesn't come in wanting to
talk about perimenopausal weight gain.
Speaker 3 (11:57):
It is real.
Speaker 4 (11:59):
There are studies that will follow women longitudinally over time
and show that women do, on average, gain about four
pounds over six years in the perimenopausal time period. It
is interesting largely in the mid section. So if you
(12:20):
look at something we call waste circumference, where you literally
just measure around somebody's waste in over and do that serially,
you see that women do tend to have an increase
in waste circumference. What's really interesting about it, though, is
waste circumference seems to be something that increases and then
(12:44):
levels out, but overall weight continues to creep up over time,
which means that you're then gaining weight in other places,
not just in your mid section. The issue though, is
that when you gain weight in your mid section, it
has implications for your metabolic health, so blood pressure, diabetes,
(13:10):
cardiovascular disease, and so that's why we care about it
beyond just vanity, and there are studies that look at
how it's tied hormonally.
Speaker 3 (13:22):
Estrogen is a player here for sure.
Speaker 4 (13:25):
The DroPIN estrogen in the perimenopausal and postmenopausal years, does
it shifts body composition so we are able to gain
more fat and we lose a small but significant amount
of muscle mass. And then the other thing that's been
shown to be have implications as actually the hormone FSH,
(13:47):
which I mentioned earlier. So FSH, which is follicle stimulating hormone,
is a hormone made in our pituitary glance to trigger ovulation,
and after we go through menopause, when we don't have
any eggs left to ovulate, our pituitary gland doesn't know
that and so it just keeps making FSH and FSH
(14:07):
does seem to have implications for perimenopausal we gain as well.
Speaker 2 (14:13):
Oh, that's interesting. It would be a hard study to
do because it seems like it would be a confounder,
but I'm sure they figured out ways to control for it.
And for those listening to this who are like FSH,
why do I know that that if you go to
your PCP and want a blood test for menopause, like
that's typically the one they'll do. I'm not saying that's
the way to diagnose menopauses. Doctor Goddard said, but for
those that got that diagnosis or not from their primary,
(14:34):
that maybe where things started, because it can be a
marker that at least send you down some path or another. Okay,
so we're going to talk about what will counteract that
weight gain. Perhaps in just a moment, we will be
right back. Okay, we're back. So understanding that both a
(15:01):
drop and estrogen as well as high FSH levels, plus
maybe the impact of body composition changes, because that's going
to then change your basal metabolic rate. I would assume drives.
The weight gain that is seen doesn't sound like a
huge amount of weight gain, but kind of like a
slow and steady weight gain during those menopausal years and
perimenopausal years. So what do you tell your patients when
(15:21):
they if and when they are looking for something to
counteract that?
Speaker 4 (15:25):
Sure?
Speaker 3 (15:26):
I mean, I think it depends on.
Speaker 4 (15:27):
The degree of wegain you're seeing and what your risk
factors for other diseases are. So if you are someone
with a with sort of a healthy weight and you're
seeing a modest wegain, and to me, a modest weaging
would be you know, five pounds, even ten pounds, Although
I appreciate that that feels like a lot to people.
(15:50):
Then really sort of lifestyle factors are the key, and
I think the biggest key is fighting the loss of
muscle mass. And this is where being sure that you're
doing strength training is absolutely key, because if you can
fight that loss of muscle mass, you can help maintain
(16:11):
a healthier body composition. And when you maintain a healthier
body composition, you don't have to the math of calories
in versus calories outworks much more in your favor because
your body naturally is burning more calories and it means
that you can consume a more typical diet and.
Speaker 3 (16:31):
Maintain your weight.
Speaker 2 (16:33):
That makes sense.
Speaker 4 (16:35):
It's also really important for bone density, which also decreases
in menopause, and so weight lifting is only going to
do positive things for you. In women who are looking
at a more significant weight gain or are looking at
maybe they've become pre diabetic or even diabetic, there are
blood pressures going up where there's really health concerns In
(16:59):
addition to waking. This is where we might think about
medications depending on the degree of wakaingin. There are several
medications that have been shown to be really effective, and
some of the newer medications like wigov or zep bound
can be really effective.
Speaker 3 (17:19):
For women in the perimenopausal years.
Speaker 4 (17:22):
I know that they've gotten a lot of press lately.
They're sort of the medications du jure. But for women
who've had really significant waking in midlife and who are
seeing their blood sugars creep up and their cholesterol creep up,
they really are a wonderful tool to help with that
perimenopausal waking.
Speaker 2 (17:44):
Always nice to have more potential solutions, even if it's
not always the solution for each person. All right, So
moving on to contraception. For those who haven't, you mentioned
that that earlier that sometimes your last period or close
to your last period can be an ovulatory, which means
you could get pregnant when you thought you were already
in menopause, which is super interesting longtime listeners this show,
(18:06):
I may know I got pregnant like between pregnancies, meaning
like I had never I'd stopped breastfeeding, never had a
cycle return, and then got pregnant before my cycle came back.
So I guess on the very first ovulation between Adabel
and Cameron, who are twenty two months apart, which for
me was amazing. I was thrilled because I had had
such infertility that I'm like, whoo, this is the best
(18:27):
surprise ever. But I imagine that might not be the
best surprise if you thought you were in menopause a
little bit of potentially, I mean maybe it would.
Speaker 3 (18:36):
I don't want to judge.
Speaker 2 (18:37):
Maybe that that was very welcome, but if for some
that's not the desired outcomes. So talk about contraceptive methods
for those over the age of forty, And I guess
one other side is that I personally have found that
ocps do not agree with me anymore, even though I
did rely on them for many years in my youth.
Speaker 4 (18:55):
Yeah, so I think you know, when I talked to
my patients about contraception, I say a few things. The
one is, because of what we just talked about, if
you don't want to be pregnant, you should be using
some form of contraception up until you are in menopause, and.
Speaker 3 (19:10):
Not only if you don't want to be pregnant.
Speaker 4 (19:12):
The eggs that we're ovulating at this point are not
the again, they're not the champs, and so your risk
of not just getting pregnant but then having a miscarriage
is definitely there. And that's a lot to put your
body through. So I do definitely recommend using a form
of contraception. When I talk to patients about contraception, I
(19:32):
like to think about what it can do for you,
sort of beyond just keeping you from getting pregnant, and
that can be different for everyone. Some of the forms
of contraception that we don't think about when we're younger,
that are irreversible or relatively irreversible, are great options when
you're in your forties and fifties and you're done having kids.
Speaker 3 (19:55):
So I'm thinking about.
Speaker 4 (19:56):
Things like tubal ligation or sealpingektamy, which is actually removing
the fallopian tubes completely. The benefit of that procedure is
that it really reduces your risk of ovarian cancer.
Speaker 5 (20:12):
And so.
Speaker 3 (20:14):
If you're having a c section and you know it's
your last.
Speaker 4 (20:17):
Baby and they're going to be in there anyway, like
maybe a sell pingekt tomy would be the right choice
for you. The other great option that doesn't involve you
at all if you're the mother of your children is vasectomy.
That is my favorite form of permanent contraception. Vaseectomy is
basically you cut and tie off the tubes that carry
(20:41):
sperm from the testicles. To the semen, and the semen
doesn't look any different, doesn't seem any different. It just
doesn't have sperm in it, which is great, and it's
such a minor procedure. My husband knows that I share
this information, but he had a sectam and went out
(21:05):
to dinner that night and coached soccer the next day,
and so really it was a big non event. The
key with that sectimy is you do actually have to
make sure he goes back and has the post procedure
seem an analysis to make sure that it actually worked
before you rely.
Speaker 3 (21:23):
On it for contraception.
Speaker 4 (21:26):
But then when we think about other forms of contraception
that you may have used before, things like iud's and
oral contraceptive pills, birth control pills are definitely still options.
I think that there you want to really again think
about what you're getting from it. So if your periods
are really heavy and really causing problems from that perspective,
(21:50):
and a progesterone eluding IUD might be a really like
a marina or a Kaylina might be a really great
option for you because they work by thinning the uterine
lining and really really lighten up your periods. They also
last you can keep your marina in for seven years now,
so one or two marinas might get you from your
(22:10):
last kid to menopause without a lot of fuss. I
do actually still use a lot of birth control pills
in women in their forties. We used to think that
birth control pills were not safe after the age of
thirty five. Those are like really old studies from the
original birth control pills, which had pretty high.
Speaker 3 (22:31):
Doses of estrogen in them.
Speaker 4 (22:34):
I typically use the ultra lo doos pills in women
in their forties, and those have been shown to be
safe up until the average age of menopause, so early fifties.
Speaker 3 (22:46):
The key there.
Speaker 4 (22:47):
Though, is making sure that it's the right one for you,
and the nice thing about it is if you are
having a lot of symptoms like hot flushes or sleep disruption,
they essentially act like hormone replacement therapy. They're the same
hormones that are in hormone replacement therapy, just in a
slightly higher dose, and.
Speaker 3 (23:07):
So you can get a lot of benefit there.
Speaker 4 (23:09):
You can also skip periods with the low dose birth
control pills, which a lot of women find really really beneficial.
Speaker 3 (23:16):
The key though, is.
Speaker 4 (23:17):
Just to make sure that whatever you are using it's
working for you, and that you're not just sticking with
something because it's what you've always used when it maybe
isn't working for you anymore. So reassessing like, well, I
used to be on this pill, but maybe now a
different pill would be the right choice because of the dose.
(23:38):
Or I used to use a birth control pill, but
now maybe a moreno would be the right choice. And
so I think just being ready to kind of reassess
and reconsider is key. The one thing I would say
is while barrier methods can be great and are super reversible,
they might not be the right choice if a pregnancy
(23:59):
in your family would be catastrophic, because they do have
a much higher failure rate. The beauty of things like
IUDs and even sterilization procedures is they don't involve you
doing anything. You go to the doctor, have something done,
and you don't think about it, and so there's no
(24:19):
there's not a lot of dependency on your sort of
operating them appropriately.
Speaker 2 (24:26):
I mean you say barrier methods, I assume you mean,
like you know, traditional condoms, but then there's also some
newer there's also some newer medications that can be basically
placed up there that kind of serve the barrier method
that have gained popularity recently. Yeah, yeah, all right, so
that is all about contraception, and yeah, I didn't mean
to diss OCPS. I just tried two different ones and
(24:47):
cured my migraines by stopping them all. And so the
migraines were so bad and first went on for so
long on two different medications that I'm personally not willing
to revisit it. But to each their own. And I
not have ever had migraines if I didn't have a
probably predisposition to them. So all of that said, great
to have again, so many different options to think about,
(25:09):
So how about HRT in those like when do you
start thinking about hormone replacement therapy? And I feel like
I trained in medical school during the Women's Health Initiative
years and we were like HRT is charitable and nobody
should ever use it and it's just killing people. And
then it seems like finally the pendulum has really swung
(25:31):
in the other direction. And I would love you to
talk about how that has shifted and what kinds of
options are out there for people who might find themselves
in perimenopause and having symptoms.
Speaker 4 (25:42):
Sure, So I think the decision about whether to use
hormone replacement therapy versus something like a birth control pill
really depends on how regular your periods are and kind
of where you are in your life cycle. Having a
period every six months and you're having tons of hot flushes,
(26:05):
hormone replacement therapy is probably the better choice. If you're
forty five and you're still having super regular periods, probably
a birth control pill is the better option. The key
with hormone replacement therapy, though, is if you're having symptoms,
talk to your doctor about them, because there's just really
(26:25):
no reason to be miserable through menopause.
Speaker 3 (26:28):
I think a lot of women.
Speaker 4 (26:31):
Also came of age during the Women's Health Initiative, and
maybe they weren't in medical school like you and I were,
but they were seeing news articles and hearing their moms
talk about menopause and sort of getting the same message
that we were getting. And unfortunately, it's taken in twenty
years of a lot of women suffering unnecessarily to really
(26:52):
get the pendulum swinging back in the right direction. And
I think that if you are having hot flushes with.
Speaker 3 (27:01):
Sleep disruption, mood changes.
Speaker 4 (27:06):
It's all fodder for discussion with your GYN or primary
care doctor because all those things can be managed with
hormone replacement therapy. And actually part of the reason the
pendulum is swung back is because, well, we can talk
about the Women's Health Initiative study all day, and I
(27:26):
think everyone might be bored except for you and me.
Speaker 3 (27:28):
But there's been a.
Speaker 4 (27:31):
Lot of new data that's come out showing that there
may be significant benefits to hormone replacement therapy. There's some
new studies about dementia risk, especially in people at high
risk for dementia, and hormone replacement therapy. There's certainly positive
effects with hormone replacement therapy and bone and using hormone
(27:53):
replacement therapy in your fifties may actually be beneficial from
a cardiovascular point of view, which is directly as to
what came out in the Women's Health Initiative, and that
was probably because of their patient population. So I think
that we're really rethinking hormone replacement therapy. We also use
it really differently now, so we don't do a lot
(28:15):
of oral hormone replacement therapy anymore, although those options are
still out there. We do a lot with transdermal estrogen,
which means you put the estrogen on your skin and
it goes in through your skin. And there are patches
and gels and all kinds of different options for getting
the hormones into you in a way that seems to
(28:37):
be more beneficial in the perimenopausal years.
Speaker 3 (28:42):
That is awesome, all right.
Speaker 2 (28:44):
Now on to a question I get from patients as well,
and I'm sure it's not uncommon the adult population, but
what are the natural things one can do to combat
perimenopausal symptoms or menopausal symptoms? Are there supplements that are recommended?
I feel like, remember what it was? There was one
I heard about for a while, but now I feel
like I haven't heard about it. And then not to
(29:05):
like open Pandora's box, but kind of similar lines. What
about bioidentical hormones as well? As I feel like I've
heard a lot of women taking small doses of topical testosterone,
So I would love comments on all of that supplements,
natural hormones, bioidenticals, and testosterone.
Speaker 3 (29:22):
So let's start with supplements.
Speaker 4 (29:23):
The main supplements that people talk about are soy phido
estrogens and supplements like black cohosh. There's zero data that
they actually do anything. I wish they did because people
really would like an option like that, But there's really
when you drill down into the studies, there's not a
lot of there there, So I would skip it. If
(29:46):
you're looking for a non hormonal treatment, those do exist
at this point, and so I would go there before
I went with one of the sort of supplement options.
The one supplement I do recommend my page it's a
lot though, for sleep disruption and hormonal headaches is magnesium.
(30:07):
Magnesium is a great option for women. You take it
at bedtime, it actually helps you with sleep and it
reduces hormonal headaches as well. And there is actual data
supporting that the bioidenticals are really funny product because what
they are essentially is the same estrogen and progestins that
(30:29):
you can get in a commercially available hormone replacement patch,
but made in a compounding pharmacy, usually in a lotion
or cream that you put on topically. The issue there
is that pharmaceutical companies are required to go through all
(30:50):
of these checks with the FDA to quality assurance to
make sure that what you're getting in your estrogen patch
or in your there's a product called divvy jail, which
is in gel that those products have in them exactly
what they say they have in them, and nothing else
and nothing else. Compounding pharmacies really vary in their quality,
(31:14):
and it really varies even from batch to batch whether
you're getting exactly what you think you're getting. Add to
that that compounding pharmacies typically are not covered by insurance,
so bioidenticals are typically.
Speaker 3 (31:30):
An out of pocket purchase.
Speaker 4 (31:32):
And I've had patients come in and they've been spending
hundreds of dollars a month on bioidentical hormones, and it
turns out that if they used a pharmaceutical product approved
by the FDA, that it would be covered by their
insurance and they'd be paying like ten dollars a month.
Speaker 3 (31:49):
So I really caution people to.
Speaker 4 (31:52):
Think long and hard about bioidenticals because I'm not sure
that you really get a lot of value for the
money that you're spending, and you may not even be
getting what you think you're getting.
Speaker 2 (32:04):
Okay.
Speaker 4 (32:06):
Testosterone is a really fun new addition to.
Speaker 3 (32:11):
Hormone replacement therapy.
Speaker 4 (32:13):
So women have testosterone, they just have it in much
smaller amounts than men do orders of magnitude smaller, so
men have testosterone in the hundreds. Women during their reproductive
lives typically of testosterones around twenty and some women after
(32:35):
menopause their testosterone or in perimenopause their testosterone drops quite low.
Speaker 3 (32:40):
Other women have the opposite problem.
Speaker 4 (32:42):
Their testosterone levels get high and they get all scient.
Speaker 3 (32:45):
Types of symptoms that they don't like from that.
Speaker 4 (32:47):
For the women who get low testosterones, they can have fatigue,
low libido. A lot of times they can't even describe it.
They just don't feel good. There can be a lot
of mood effects that women have, and if testosterone is low.
Speaker 3 (33:06):
Then giving a little baby.
Speaker 4 (33:08):
Dose of a testosterone gel can actually be life changing
for some women. So if we think about sort of
again orders of magnitude, testosterone is manufactured for men and
it comes in little packets that a man uses one
packet each day. My patients, I typically start them on
(33:33):
a fifth of a packet, so a one packet lasts
them five applications, and they do it every other day
or three days a week, and so that tiny, tiny
bit of testosterone is enough to make them feel much better.
It is not typically covered by insurance for women, even
though there's lots of studies looking at off label use
(33:55):
of testosterone and women and it does seem to show benefit.
It is something that women typically have to pay out
of pocket for, but a thirty day supply for a
man lests the woman the way I described it for
almost a year, and testosterone gel is generic at this point,
so it tends out to be a big investment when
you think about amateurizing it over the course of the year.
Speaker 3 (34:19):
Totally cool.
Speaker 2 (34:19):
And I feel like that's one that definitely, like ten
years ago, nobody was talking about and now it's out there,
so who knows what else will be coming down the pike,
probably even more exciting options, because I feel like this
is an area that just was kind of ignor well,
I guess I wasn't ignored. I mean they were trying,
but I just don't feel like there was a lot
of new knowledge coming out for a while.
Speaker 5 (34:39):
Yeah.
Speaker 4 (34:39):
No, And I think there's a lot of really interesting
things going on now.
Speaker 3 (34:43):
There's a new.
Speaker 4 (34:45):
Non hormonal treatment for hot flushes called Veoza, which is great.
That's wonderful if you really have contraindications to using hormones
and you're having lots of hot flushes, so I think there's.
Speaker 3 (35:01):
Lots of interesting things happening.
Speaker 4 (35:03):
It's a much better time to be a woman in
your forties or fifties than it was twenty years ago.
Speaker 2 (35:07):
I think, yay, good timing for us. Well, Doctor Gillian,
thank you so much for coming on. Tell our listeners
a little bit about hot Flash before you head off,
because I have a feeling it's going to be of
interest to at least some of them in our wonderful
age range.
Speaker 3 (35:24):
Yeah.
Speaker 4 (35:25):
So, Hot Flash is a weekly newsletter that is under
the Parent Data by Emily Oster Umbrella.
Speaker 3 (35:34):
So Parent Data is Emily Auster's.
Speaker 4 (35:37):
Newsletter that she puts out regularly about data for pregnancy
and early childhood. Hot Flash is an extension of that
really focused on the years after you're done having your kids,
your forties and fifties, just exactly what we've been talking
about today, and our goal there is really to provide
(36:01):
evidence based analysis of different topics just like those we've
been talking about today, where the focus is really making
sure that we're breaking down the data and helping you
to make better decisions and helping you to have a
(36:22):
better conversation with your doctor about your symptoms and what
you're experiencing as a woman in your forties or fifties.
Speaker 2 (36:30):
Awesome, Well, thank you so much for coming on. This
has been a very instructive conversation. I'll I'll have to
kind of bookmarkt and remember to re listen as symptoms
crop up as they as I'm sure they will.
Speaker 3 (36:42):
So thank you again, my pleasure. So we are back.
Speaker 1 (36:46):
That was awesome listening to doctor Gillian Goddard talk about
perimenopause and other hormonal related topics. So exciting to get
more information on that. So today's question comes from a
listener who is interested in financial topic. She says, you've
both mentioned your family upbringing with regards to money. I mean,
just spoiler alert, both very middle class sort of upbringing.
(37:08):
She finds the conversations about how you've learned to use
money some of the most interested. I'm specifically interested in
your philanthropy plans as you are talking about leveling up
and doing more with that, and also any resources for
getting into angel investing, because she has no idea where
to start. So Sarah, maybe you can talk a little
(37:29):
bit about the giving side of this, because I know
you guys have been a little bit more organized in
terms of your budgeting categories and stuff like that.
Speaker 2 (37:36):
Yeah, so we use the software. You need a budget,
and giving is just one of the categories, just like
anything else. So the way you need a budget works
is every single month you create your budget. So I'll say, okay,
I want to give. I need to put two hundred
in my electric bill budget or whatever. And then you know,
I have a category for gifts, which is like birthday gifts,
and then all kinds of other things including giving, and
(37:56):
I just dump a standard amount in there every month,
but it accumulates, so I don't necessarily need to say like, oh,
I'm gonna give X dollars every single month, and I'm
gonna give you know, to a different cause. We don't
do it that way. Instead, we just kind of like
put the same amount in every month, and then when
something comes up that seems worthwhile, we can just be like, ooh,
let's like give a bigger contribution and empty out this
(38:17):
category to whatever. So like, for an example, recently, I
just got some like email, as one does, from a
cause that was like, oh, I'm gonna triple donations. It
was like an anti gun violence type of thing, and
it was it was Bloomberg who said he would triple
all the donations. I was like, you know what, our
donation will go three times as far if I do
it now. So let's just empty the category out. I
(38:39):
you know, wanted to donate to that, and so we
did it. Sometimes it'll be like, you know, a disaster
happens and we'll be like, oh, let's let's give to
this to help these victims of whatever just happen, et cetera.
And so you know, we're not like huge philanthropists. It's
not some giant chunk of our income. I see it
kind of as twofold, like we give some now, and
(39:01):
then I also hope too, as we accumulate more money
at have it invested money and our secure in our
future to give even more later out of what we've invested.
So that's kind of how we do it. It's not
super super systematic.
Speaker 3 (39:12):
But it works.
Speaker 2 (39:13):
And I like having a category that's just dedicated to that.
It's kind of similar to holiday, Like I like to
collect the money throughout the year and then use it.
And I liked for their whenever a cause comes up,
like we have money in there, we can give it
and feel really good about that, but also know we've
budgeted for it.
Speaker 1 (39:29):
Yeah, I think this is the kind of thing that
it just pays to put some thought into it. So
especially as you're in kind of the wealth accumulation, although
maybe you're not, maybe you're totally into the giving it
away stage at this point of your life, but you know,
be thinking about what causes really inspire you. And I mean,
I know there's a sort of utilitarian argument of like,
(39:49):
give it to the thing where it can go the
furthest and there's something to that, but there's also so
many problems in the world that you want a cause
that inspires you and so because then you'll keep giving
to it and you'll get involved with it personally and
use whatever social capital you have as well to make
a difference in that. So really be thinking about what
(40:10):
inspires you, like, what causes make you think like this
is a change I'd like to see in the world
beyond the lookout for ones where again most of us
are not going to be giving billions away, so we're
looking for ones where maybe a smaller amount of money
could make a significant difference. So maybe that's because it's
something local, right, you can make a big difference in
your own local community. But start really thinking about these things,
having a conversation with your partner if you have one,
(40:34):
and then thinking about like what amount of money would
we be interested in giving to make a difference in this.
And I'm with Sarah that I think you're better off
giving a bigger amount to a smaller number of things
versus a small amount to a lot of things, partly
just because it keeps you very invested in that small
number of things. So you then follow the topics and
(40:55):
if you're working with a nonprofit, you might get involved,
you might get on their board or whatever else like that.
Not an investing podcast, so I don't think you want
to get all your invested you know, angel investing information
from here, but I will just do a quick discussion
of it for anyone who is looking into this. So
to invest in private companies, so ones that are not
publicly traded, and in startups and things like that, you
(41:17):
basically either need to know the founder or you need
to be what they call here in the US and
a credited investor, which means that you are well off
enough that the financial authorities assume you are a big
girl and can look it into it on your own
right that you're not going to be devastated if you
lose your investment. So there's a certain income requirement or
(41:39):
a certain net worth requirement minus your primary residence. It's high,
but it's not billionaire high. Again, so there's probably a
reasonable number of people listening to this whose households income
wise or net worth would fit into it. As for
finding companies to invest in, I mean, this is networking
like anything else. It's probably going to be former colleagues
(42:00):
of yours, for instance, who have gone the startup route,
and you get a business plan from them and think
it looks good, and you put a small amount of
money into.
Speaker 3 (42:08):
It, maybe people you went to school with.
Speaker 1 (42:11):
If you are in a reasonable sized city or near
a university, there might be you know, investing organizations that
various entrepreneurs can come pitch their idea too, and people
ask questions and then you can see what looks good
and all that. But as you start doing it, as
you make small investments in small companies, founders will hear
(42:34):
about you too, and so they will come and you know,
you'll start getting pitches and then you can evaluate what
do I think will grow? What do I think has
a reasonable exit strategy so that I, you know, would
hopefully make my money back, although again with this you're
probably not going to make your money back on the
vast majority of them. The ideas that maybe you know,
one in twenty might return twenty x and then you're
(42:54):
even or something are slightly ahead. So it's just more
of a fun way to get involved in investing, and
so again not an investing podcast, but there are plenty
of ones out there that are, so you know, recommend
you kind of google that and get the basics if
you are interested. Well, this has been best of both worlds.
Sarah was interviewing doctor Gillian Goddard about perimenopause and related topics.
(43:17):
We will be back next week with more on making
work and life fit together.
Speaker 2 (43:23):
Thanks for listening. You can find me Sarah at the
shoebox dot com or at the Underscore Shoebox on Instagram,
and you.
Speaker 1 (43:31):
Can find me Laura at Laura vandercam dot com. This
has been the best of both worlds podcasts. Please join
us next time for more on making work and life
work together.
Hi. This is Laura Vandercamp. I'm a mother of five,
an author, journalist, and speaker.
Speaker 2 (00:08):
And this is Sarah Hartunger. I'm a mother of three,
a practicing physician and blogger. On the side, we are
two working parents who love our careers and our families.
Speaker 1 (00:17):
Welcome to best of both worlds. Here we talk about
how real women manage work, family, and time for fun.
From figuring out childcare to mapping out long term career goals.
We want you to get the most out of life.
Welcome to best of both worlds. This is Laura. This
episode is airing at the very end of January. In
twenty twenty four, Sarah is going to be interviewing doctor
(00:40):
Gillian Goddard, who has been a prior guest on the show.
She was talking about her life as a practicing physician
in New York and as she's raising four children. She
particularly talked about having op pars with her family and
how that had worked as a childcare solution. But she's
back because she has a new newsletter that is out
very recently called The Hot Flash, dealing with medical issues
(01:05):
associated with women who are about our age. Sarah, as
we hit our mid forties, so looking at issues for
women in their forties. So why don't you tell us
a little bit about what you and Jillian cover in this.
Speaker 2 (01:18):
Yeah, so this has been requested many times. We had
a prior guest shout out to doctor Laura Erdman who
talked about some of these topics, kind of focusing on
the obigui in side. But doctor Goddard is an endecnologist,
so kind of like a different medical field and perspective,
and great timing since she is starting this amazing newsletter
which I think came out last week when this episode airs,
(01:40):
and it's part of Emily Oster's parent Data collection of newsletters,
so it's going to be awesome. And yeah, I was
super curious about a lot of things, including whether or
not I'm in perimenopause spoiler. I think the answer is no.
But it was a really it was a really, really
fun conversation. If you are triggered by discussion of cycles
(02:03):
and fertility and other things like that, this may be
an episode to skip. We do talk about those kinds
of things, So yeah, I guess it does make sense
for me to give that as a little bit of
a trigger warning. You can check out all of our
prior episodes if you need something else to listen to
this week.
Speaker 1 (02:20):
Yeah, but very exciting because this is a topic that
I know a lot of our listeners are curious about
as we get a little bit older and watch our
bodies change again, it's just a constant thing of figuring
out what's going on, and many of us are helping
our teen daughters through the first part of that to
sort of stage, but we are entering into the other
(02:41):
one of it. So we'll be excited to hear what
Jillian Goddard has to say and excited that this is
a topic that more people are talking about and is
coming into the cultural consciousness.
Speaker 3 (02:52):
So let's hear what she has to say.
Speaker 2 (02:54):
I am so excited to welcome doctor Gillian Goddard to
Best of Both Worlds for this second time. But Jillian
was on this podcast previously, not as physician Gillian. She
was on as parent Gillian, talking all about the O
pair lifestyle. But we decided we needed to have her back,
and we beg to have her back because there have
been so many questions from our audience about perimenopause and hormones,
(03:17):
and doctor Goddard happens to be an expert in that field.
She also was an attendee of Bestly Plans Live. Had
so much fun hanging out with me and Laura in
Fort Lauderdale last fall. And she's an endocrinologist in private
practice and the author of hot Flash, which is the
best name ever. That is a newsletter from Parent Data
(03:38):
by Emily, auser who we've also had on the podcast.
So welcome, doctor Gillian Goddard.
Speaker 3 (03:44):
Oh, I thank Sarah. It's so glad to be back
on Best of Both Worlds.
Speaker 4 (03:47):
I am a very regular listener, so it's great to
be here again.
Speaker 3 (03:51):
I love it.
Speaker 2 (03:51):
We love having our listeners and Patreon members and just
people who have kind of gotten to know the show
really well on It always feels really really smooth, So
super excited with the conversation. Plus I'm personally excited about
the topic. So because it's actually funny, I will say, like,
people think I know adult in new chronology, and I
know very very little adult in necronology. Someone asked me
for something about menopause, and I'm like, you realize my
(04:13):
patients go up to like age twenty. I mean, yes,
there are some patients that have sort of menopausal scenarios.
For different reasons, but it's not my forte Okay. So
with all that said, what is the difference between menopause
perimenopause and like, is there even like a perimenopause before that,
like take us through the journey. Sure, So I think
(04:35):
that this is really.
Speaker 4 (04:36):
Important to make a distinction among all these different phases
that our bodies go through in our forties and fifties.
Speaker 3 (04:44):
A lot of my patients come.
Speaker 4 (04:46):
In and say they're having all these symptoms and they
thought they were having perimenopause, but they went to their gynecologists,
and their gynecologists checked their labs and we're like, no,
you're not in perimenopause. And then they're like, well, then
why do I feel so crummy? And so I think
it is a really important thing to sort of make
all these distinctions. So let's just talk through them from
(05:07):
the beginning. So you go from being in your thirties
and you're having regular periods and you're having your babies
and your breastfeeding and life is going on as normal.
And if you're anything like me, you hit forty and
you are.
Speaker 3 (05:21):
Like, forties are going to be the best. I don't
have little babies.
Speaker 4 (05:26):
I'm going to sleep at night, I'm going to feel amazing,
and you know, there's no diapers, there's no breastfeeding, there's
none of that. And what I found, and what a
lot of my patients mind.
Speaker 3 (05:37):
Is sure that that works great for.
Speaker 4 (05:40):
A few years, and then all of a sudden, you
start having like weird headaches and all your periods change,
and you're not sleeping at night, and none of it
makes any sense. And what that actually is typically is
something called the late reproductive phase. So this is a
phase that typically starts for women in their early forties
(06:01):
and can go on for five years, maybe even more.
And what defines the late reproductive phase is that you
are still having regular periods, but your cycles are changing.
Speaker 3 (06:16):
So even though your period is about the.
Speaker 4 (06:18):
Same length every month, it might go from being thirty
two days to twenty eight days to twenty six days,
and along with that you can have heavier periods and
you can have a lot more symptoms. Some women even
get more irritable or don't sleep as well. A lot
(06:39):
of women got hormonal headaches in this time period, and
some women even get hot flushes, but they only get
them around their period when our hormones drop and the
reason all this happens in our forties is because unfortunately,
as we get into our forties, we still have eggs in.
Speaker 3 (06:59):
Our own but they're not like they're like the last
guy's picked.
Speaker 4 (07:03):
They're not the most amazing eggs, and it takes a
lot of stimulus or juice as it were, from our
pituitary gland to get those eggs to be ready to ovulate.
So we have this hormone called FSH or follicle stimulating hormone,
and it goes up higher, and that hormone makes our
(07:24):
estrogen go up higher, and high estrogen is fine, but
then that estrogen has to come back down, and it's
actually the drop that makes us feel really, really grummy.
And so even though our estrogen levels are rising and
falling at the same times of the month as they
used to, they're going higher and they're falling lower, and
(07:45):
all of that makes us symptomatic. So we trundle along
with that for five years, and then we typically see
people transition to perimenopause. Perimenopause is when our cycle length
starts to vary. So maybe we had gone down to
having a twenty six day cycle, but it was a
(08:07):
twenty six day cycle every single month. Perimenopause is a
twenty two day cycle followed by a forty three day
cycle followed by a thirty four day cycle, And the
technical definition is that there's a greater than seven day
variability from cycle to cycle. And so again, we may
(08:28):
be ovulating, we may be having periods intermittently.
Speaker 3 (08:33):
They might still feel.
Speaker 4 (08:34):
Kind of regular, but they're much more all over the
place than they used to be. And we might go
through times when we feel fine, and we might go
through times when we're having lots of symptoms like hot flushes,
night sweats, eared ability, dissleep disruption and all those things.
Speaker 3 (08:54):
Are not so fun.
Speaker 4 (08:56):
And then the cycles tend to space out further and
further and further, and eventually you will have.
Speaker 3 (09:06):
A last period and enter menopause.
Speaker 4 (09:09):
The funny thing about menopause, though, is you can only
diagnose it in retrospect, so you have to go twelve
months without having a period before you can officially say
you're in menopause. So if you go eleven months and
then you have a period, you're still in perimenopause.
Speaker 2 (09:25):
The funny thing about that is like the idea that
you would just never know when it's the last one.
I never really thought about that, But I don't know
how I feel about that.
Speaker 5 (09:34):
That has some really important implications too, because there are
some studies that show that at least twenty five percent
of cycles that are more than six months long, So
say you haven't had a period in six months and
then all of a sudden you have a period, twenty
five percent of those cycles you.
Speaker 4 (09:49):
Actually ovulate, which I think has really important implications when
you're thinking about things like contraception. The other thing is,
we used to think that this was like a very
orderly progression from the late reproductive phase to perimenopause to menopause,
and it turns out actually more than half of women
(10:10):
seesaw between the late reproductive phase and perimenopause, and that
can go on for quite a while. And so just
because your cycles start to lengthen out doesn't mean that
all of a sudden you won't start having regular twenty
eight day cycles.
Speaker 2 (10:25):
Again, that doesn't seem fair, but good to know. So
question is there like a I don't know a way
of predicting when this is going to happen to you
based on medical history. Do people who start their medicare
earlier tend to have menopause earlier or is it more
related to like if your mother had earlier menopause, then
you will as well.
Speaker 4 (10:45):
So we used to think it was hereditary, but actually
newer cities suggests that there's not really a hereditary connection.
Speaker 3 (10:52):
It would make sense if you.
Speaker 4 (10:53):
Started having periods earlier that you would go through menopause earlier,
but that's not actually true. The late bloomers actually go
through menopause earlier, and the early bloomers have period typically
have periods for longer, and so it doesn't make a
lot of sense a lot of times. But so yeah,
(11:14):
so there's not a lot of prediction, So you just
get way you people super interesting gassing it. So okay,
so what we heard about hot flashes, we heard about
sleep disruption, irritability, things like pm d D I'm guessing
become more common in perimenopause. But one thing that women
tend to talk about a lot is weight gain. Is
(11:36):
that a myth is that more related to age. Is
there a hormonal component, what drives that and what can
counteract it? Since for most people it's probably not the
most welcome visitor. Yeah, so waking is something that women
really struggle with I feel like not a day passes
in my office where someone doesn't come in wanting to
talk about perimenopausal weight gain.
Speaker 3 (11:57):
It is real.
Speaker 4 (11:59):
There are studies that will follow women longitudinally over time
and show that women do, on average, gain about four
pounds over six years in the perimenopausal time period. It
is interesting largely in the mid section. So if you
(12:20):
look at something we call waste circumference, where you literally
just measure around somebody's waste in over and do that serially,
you see that women do tend to have an increase
in waste circumference. What's really interesting about it, though, is
waste circumference seems to be something that increases and then
(12:44):
levels out, but overall weight continues to creep up over time,
which means that you're then gaining weight in other places,
not just in your mid section. The issue though, is
that when you gain weight in your mid section, it
has implications for your metabolic health, so blood pressure, diabetes,
(13:10):
cardiovascular disease, and so that's why we care about it
beyond just vanity, and there are studies that look at
how it's tied hormonally.
Speaker 3 (13:22):
Estrogen is a player here for sure.
Speaker 4 (13:25):
The DroPIN estrogen in the perimenopausal and postmenopausal years, does
it shifts body composition so we are able to gain
more fat and we lose a small but significant amount
of muscle mass. And then the other thing that's been
shown to be have implications as actually the hormone FSH,
(13:47):
which I mentioned earlier. So FSH, which is follicle stimulating hormone,
is a hormone made in our pituitary glance to trigger ovulation,
and after we go through menopause, when we don't have
any eggs left to ovulate, our pituitary gland doesn't know
that and so it just keeps making FSH and FSH
(14:07):
does seem to have implications for perimenopausal we gain as well.
Speaker 2 (14:13):
Oh, that's interesting. It would be a hard study to
do because it seems like it would be a confounder,
but I'm sure they figured out ways to control for it.
And for those listening to this who are like FSH,
why do I know that that if you go to
your PCP and want a blood test for menopause, like
that's typically the one they'll do. I'm not saying that's
the way to diagnose menopauses. Doctor Goddard said, but for
those that got that diagnosis or not from their primary,
(14:34):
that maybe where things started, because it can be a
marker that at least send you down some path or another. Okay,
so we're going to talk about what will counteract that
weight gain. Perhaps in just a moment, we will be
right back. Okay, we're back. So understanding that both a
(15:01):
drop and estrogen as well as high FSH levels, plus
maybe the impact of body composition changes, because that's going
to then change your basal metabolic rate. I would assume drives.
The weight gain that is seen doesn't sound like a
huge amount of weight gain, but kind of like a
slow and steady weight gain during those menopausal years and
perimenopausal years. So what do you tell your patients when
(15:21):
they if and when they are looking for something to
counteract that?
Speaker 4 (15:25):
Sure?
Speaker 3 (15:26):
I mean, I think it depends on.
Speaker 4 (15:27):
The degree of wegain you're seeing and what your risk
factors for other diseases are. So if you are someone
with a with sort of a healthy weight and you're
seeing a modest wegain, and to me, a modest weaging
would be you know, five pounds, even ten pounds, Although
I appreciate that that feels like a lot to people.
(15:50):
Then really sort of lifestyle factors are the key, and
I think the biggest key is fighting the loss of
muscle mass. And this is where being sure that you're
doing strength training is absolutely key, because if you can
fight that loss of muscle mass, you can help maintain
(16:11):
a healthier body composition. And when you maintain a healthier
body composition, you don't have to the math of calories
in versus calories outworks much more in your favor because
your body naturally is burning more calories and it means
that you can consume a more typical diet and.
Speaker 3 (16:31):
Maintain your weight.
Speaker 2 (16:33):
That makes sense.
Speaker 4 (16:35):
It's also really important for bone density, which also decreases
in menopause, and so weight lifting is only going to
do positive things for you. In women who are looking
at a more significant weight gain or are looking at
maybe they've become pre diabetic or even diabetic, there are
blood pressures going up where there's really health concerns In
(16:59):
addition to waking. This is where we might think about
medications depending on the degree of wakaingin. There are several
medications that have been shown to be really effective, and
some of the newer medications like wigov or zep bound
can be really effective.
Speaker 3 (17:19):
For women in the perimenopausal years.
Speaker 4 (17:22):
I know that they've gotten a lot of press lately.
They're sort of the medications du jure. But for women
who've had really significant waking in midlife and who are
seeing their blood sugars creep up and their cholesterol creep up,
they really are a wonderful tool to help with that
perimenopausal waking.
Speaker 2 (17:44):
Always nice to have more potential solutions, even if it's
not always the solution for each person. All right, So
moving on to contraception. For those who haven't, you mentioned
that that earlier that sometimes your last period or close
to your last period can be an ovulatory, which means
you could get pregnant when you thought you were already
in menopause, which is super interesting longtime listeners this show,
(18:06):
I may know I got pregnant like between pregnancies, meaning
like I had never I'd stopped breastfeeding, never had a
cycle return, and then got pregnant before my cycle came back.
So I guess on the very first ovulation between Adabel
and Cameron, who are twenty two months apart, which for
me was amazing. I was thrilled because I had had
such infertility that I'm like, whoo, this is the best
(18:27):
surprise ever. But I imagine that might not be the
best surprise if you thought you were in menopause a
little bit of potentially, I mean maybe it would.
Speaker 3 (18:36):
I don't want to judge.
Speaker 2 (18:37):
Maybe that that was very welcome, but if for some
that's not the desired outcomes. So talk about contraceptive methods
for those over the age of forty, And I guess
one other side is that I personally have found that
ocps do not agree with me anymore, even though I
did rely on them for many years in my youth.
Speaker 4 (18:55):
Yeah, so I think you know, when I talked to
my patients about contraception, I say a few things. The
one is, because of what we just talked about, if
you don't want to be pregnant, you should be using
some form of contraception up until you are in menopause, and.
Speaker 3 (19:10):
Not only if you don't want to be pregnant.
Speaker 4 (19:12):
The eggs that we're ovulating at this point are not
the again, they're not the champs, and so your risk
of not just getting pregnant but then having a miscarriage
is definitely there. And that's a lot to put your
body through. So I do definitely recommend using a form
of contraception. When I talk to patients about contraception, I
(19:32):
like to think about what it can do for you,
sort of beyond just keeping you from getting pregnant, and
that can be different for everyone. Some of the forms
of contraception that we don't think about when we're younger,
that are irreversible or relatively irreversible, are great options when
you're in your forties and fifties and you're done having kids.
Speaker 3 (19:55):
So I'm thinking about.
Speaker 4 (19:56):
Things like tubal ligation or sealpingektamy, which is actually removing
the fallopian tubes completely. The benefit of that procedure is
that it really reduces your risk of ovarian cancer.
Speaker 5 (20:12):
And so.
Speaker 3 (20:14):
If you're having a c section and you know it's
your last.
Speaker 4 (20:17):
Baby and they're going to be in there anyway, like
maybe a sell pingekt tomy would be the right choice
for you. The other great option that doesn't involve you
at all if you're the mother of your children is vasectomy.
That is my favorite form of permanent contraception. Vaseectomy is
basically you cut and tie off the tubes that carry
(20:41):
sperm from the testicles. To the semen, and the semen
doesn't look any different, doesn't seem any different. It just
doesn't have sperm in it, which is great, and it's
such a minor procedure. My husband knows that I share
this information, but he had a sectam and went out
(21:05):
to dinner that night and coached soccer the next day,
and so really it was a big non event. The
key with that sectimy is you do actually have to
make sure he goes back and has the post procedure
seem an analysis to make sure that it actually worked
before you rely.
Speaker 3 (21:23):
On it for contraception.
Speaker 4 (21:26):
But then when we think about other forms of contraception
that you may have used before, things like iud's and
oral contraceptive pills, birth control pills are definitely still options.
I think that there you want to really again think
about what you're getting from it. So if your periods
are really heavy and really causing problems from that perspective,
(21:50):
and a progesterone eluding IUD might be a really like
a marina or a Kaylina might be a really great
option for you because they work by thinning the uterine
lining and really really lighten up your periods. They also
last you can keep your marina in for seven years now,
so one or two marinas might get you from your
(22:10):
last kid to menopause without a lot of fuss. I
do actually still use a lot of birth control pills
in women in their forties. We used to think that
birth control pills were not safe after the age of
thirty five. Those are like really old studies from the
original birth control pills, which had pretty high.
Speaker 3 (22:31):
Doses of estrogen in them.
Speaker 4 (22:34):
I typically use the ultra lo doos pills in women
in their forties, and those have been shown to be
safe up until the average age of menopause, so early fifties.
Speaker 3 (22:46):
The key there.
Speaker 4 (22:47):
Though, is making sure that it's the right one for you,
and the nice thing about it is if you are
having a lot of symptoms like hot flushes or sleep disruption,
they essentially act like hormone replacement therapy. They're the same
hormones that are in hormone replacement therapy, just in a
slightly higher dose, and.
Speaker 3 (23:07):
So you can get a lot of benefit there.
Speaker 4 (23:09):
You can also skip periods with the low dose birth
control pills, which a lot of women find really really beneficial.
Speaker 3 (23:16):
The key though, is.
Speaker 4 (23:17):
Just to make sure that whatever you are using it's
working for you, and that you're not just sticking with
something because it's what you've always used when it maybe
isn't working for you anymore. So reassessing like, well, I
used to be on this pill, but maybe now a
different pill would be the right choice because of the dose.
(23:38):
Or I used to use a birth control pill, but
now maybe a moreno would be the right choice. And
so I think just being ready to kind of reassess
and reconsider is key. The one thing I would say
is while barrier methods can be great and are super reversible,
they might not be the right choice if a pregnancy
(23:59):
in your family would be catastrophic, because they do have
a much higher failure rate. The beauty of things like
IUDs and even sterilization procedures is they don't involve you
doing anything. You go to the doctor, have something done,
and you don't think about it, and so there's no
(24:19):
there's not a lot of dependency on your sort of
operating them appropriately.
Speaker 2 (24:26):
I mean you say barrier methods, I assume you mean,
like you know, traditional condoms, but then there's also some
newer there's also some newer medications that can be basically
placed up there that kind of serve the barrier method
that have gained popularity recently. Yeah, yeah, all right, so
that is all about contraception, and yeah, I didn't mean
to diss OCPS. I just tried two different ones and
(24:47):
cured my migraines by stopping them all. And so the
migraines were so bad and first went on for so
long on two different medications that I'm personally not willing
to revisit it. But to each their own. And I
not have ever had migraines if I didn't have a
probably predisposition to them. So all of that said, great
to have again, so many different options to think about,
(25:09):
So how about HRT in those like when do you
start thinking about hormone replacement therapy? And I feel like
I trained in medical school during the Women's Health Initiative
years and we were like HRT is charitable and nobody
should ever use it and it's just killing people. And
then it seems like finally the pendulum has really swung
(25:31):
in the other direction. And I would love you to
talk about how that has shifted and what kinds of
options are out there for people who might find themselves
in perimenopause and having symptoms.
Speaker 4 (25:42):
Sure, So I think the decision about whether to use
hormone replacement therapy versus something like a birth control pill
really depends on how regular your periods are and kind
of where you are in your life cycle. Having a
period every six months and you're having tons of hot flushes,
(26:05):
hormone replacement therapy is probably the better choice. If you're
forty five and you're still having super regular periods, probably
a birth control pill is the better option. The key
with hormone replacement therapy, though, is if you're having symptoms,
talk to your doctor about them, because there's just really
(26:25):
no reason to be miserable through menopause.
Speaker 3 (26:28):
I think a lot of women.
Speaker 4 (26:31):
Also came of age during the Women's Health Initiative, and
maybe they weren't in medical school like you and I were,
but they were seeing news articles and hearing their moms
talk about menopause and sort of getting the same message
that we were getting. And unfortunately, it's taken in twenty
years of a lot of women suffering unnecessarily to really
(26:52):
get the pendulum swinging back in the right direction. And
I think that if you are having hot flushes with.
Speaker 3 (27:01):
Sleep disruption, mood changes.
Speaker 4 (27:06):
It's all fodder for discussion with your GYN or primary
care doctor because all those things can be managed with
hormone replacement therapy. And actually part of the reason the
pendulum is swung back is because, well, we can talk
about the Women's Health Initiative study all day, and I
(27:26):
think everyone might be bored except for you and me.
Speaker 3 (27:28):
But there's been a.
Speaker 4 (27:31):
Lot of new data that's come out showing that there
may be significant benefits to hormone replacement therapy. There's some
new studies about dementia risk, especially in people at high
risk for dementia, and hormone replacement therapy. There's certainly positive
effects with hormone replacement therapy and bone and using hormone
(27:53):
replacement therapy in your fifties may actually be beneficial from
a cardiovascular point of view, which is directly as to
what came out in the Women's Health Initiative, and that
was probably because of their patient population. So I think
that we're really rethinking hormone replacement therapy. We also use
it really differently now, so we don't do a lot
(28:15):
of oral hormone replacement therapy anymore, although those options are
still out there. We do a lot with transdermal estrogen,
which means you put the estrogen on your skin and
it goes in through your skin. And there are patches
and gels and all kinds of different options for getting
the hormones into you in a way that seems to
(28:37):
be more beneficial in the perimenopausal years.
Speaker 3 (28:42):
That is awesome, all right.
Speaker 2 (28:44):
Now on to a question I get from patients as well,
and I'm sure it's not uncommon the adult population, but
what are the natural things one can do to combat
perimenopausal symptoms or menopausal symptoms? Are there supplements that are recommended?
I feel like, remember what it was? There was one
I heard about for a while, but now I feel
like I haven't heard about it. And then not to
(29:05):
like open Pandora's box, but kind of similar lines. What
about bioidentical hormones as well? As I feel like I've
heard a lot of women taking small doses of topical testosterone,
So I would love comments on all of that supplements,
natural hormones, bioidenticals, and testosterone.
Speaker 3 (29:22):
So let's start with supplements.
Speaker 4 (29:23):
The main supplements that people talk about are soy phido
estrogens and supplements like black cohosh. There's zero data that
they actually do anything. I wish they did because people
really would like an option like that, But there's really
when you drill down into the studies, there's not a
lot of there there, So I would skip it. If
(29:46):
you're looking for a non hormonal treatment, those do exist
at this point, and so I would go there before
I went with one of the sort of supplement options.
The one supplement I do recommend my page it's a
lot though, for sleep disruption and hormonal headaches is magnesium.
(30:07):
Magnesium is a great option for women. You take it
at bedtime, it actually helps you with sleep and it
reduces hormonal headaches as well. And there is actual data
supporting that the bioidenticals are really funny product because what
they are essentially is the same estrogen and progestins that
(30:29):
you can get in a commercially available hormone replacement patch,
but made in a compounding pharmacy, usually in a lotion
or cream that you put on topically. The issue there
is that pharmaceutical companies are required to go through all
(30:50):
of these checks with the FDA to quality assurance to
make sure that what you're getting in your estrogen patch
or in your there's a product called divvy jail, which
is in gel that those products have in them exactly
what they say they have in them, and nothing else
and nothing else. Compounding pharmacies really vary in their quality,
(31:14):
and it really varies even from batch to batch whether
you're getting exactly what you think you're getting. Add to
that that compounding pharmacies typically are not covered by insurance,
so bioidenticals are typically.
Speaker 3 (31:30):
An out of pocket purchase.
Speaker 4 (31:32):
And I've had patients come in and they've been spending
hundreds of dollars a month on bioidentical hormones, and it
turns out that if they used a pharmaceutical product approved
by the FDA, that it would be covered by their
insurance and they'd be paying like ten dollars a month.
Speaker 3 (31:49):
So I really caution people to.
Speaker 4 (31:52):
Think long and hard about bioidenticals because I'm not sure
that you really get a lot of value for the
money that you're spending, and you may not even be
getting what you think you're getting.
Speaker 2 (32:04):
Okay.
Speaker 4 (32:06):
Testosterone is a really fun new addition to.
Speaker 3 (32:11):
Hormone replacement therapy.
Speaker 4 (32:13):
So women have testosterone, they just have it in much
smaller amounts than men do orders of magnitude smaller, so
men have testosterone in the hundreds. Women during their reproductive
lives typically of testosterones around twenty and some women after
(32:35):
menopause their testosterone or in perimenopause their testosterone drops quite low.
Speaker 3 (32:40):
Other women have the opposite problem.
Speaker 4 (32:42):
Their testosterone levels get high and they get all scient.
Speaker 3 (32:45):
Types of symptoms that they don't like from that.
Speaker 4 (32:47):
For the women who get low testosterones, they can have fatigue,
low libido. A lot of times they can't even describe it.
They just don't feel good. There can be a lot
of mood effects that women have, and if testosterone is low.
Speaker 3 (33:06):
Then giving a little baby.
Speaker 4 (33:08):
Dose of a testosterone gel can actually be life changing
for some women. So if we think about sort of
again orders of magnitude, testosterone is manufactured for men and
it comes in little packets that a man uses one
packet each day. My patients, I typically start them on
(33:33):
a fifth of a packet, so a one packet lasts
them five applications, and they do it every other day
or three days a week, and so that tiny, tiny
bit of testosterone is enough to make them feel much better.
It is not typically covered by insurance for women, even
though there's lots of studies looking at off label use
(33:55):
of testosterone and women and it does seem to show benefit.
It is something that women typically have to pay out
of pocket for, but a thirty day supply for a
man lests the woman the way I described it for
almost a year, and testosterone gel is generic at this point,
so it tends out to be a big investment when
you think about amateurizing it over the course of the year.
Speaker 3 (34:19):
Totally cool.
Speaker 2 (34:19):
And I feel like that's one that definitely, like ten
years ago, nobody was talking about and now it's out there,
so who knows what else will be coming down the pike,
probably even more exciting options, because I feel like this
is an area that just was kind of ignor well,
I guess I wasn't ignored. I mean they were trying,
but I just don't feel like there was a lot
of new knowledge coming out for a while.
Speaker 5 (34:39):
Yeah.
Speaker 4 (34:39):
No, And I think there's a lot of really interesting
things going on now.
Speaker 3 (34:43):
There's a new.
Speaker 4 (34:45):
Non hormonal treatment for hot flushes called Veoza, which is great.
That's wonderful if you really have contraindications to using hormones
and you're having lots of hot flushes, so I think there's.
Speaker 3 (35:01):
Lots of interesting things happening.
Speaker 4 (35:03):
It's a much better time to be a woman in
your forties or fifties than it was twenty years ago.
Speaker 2 (35:07):
I think, yay, good timing for us. Well, Doctor Gillian,
thank you so much for coming on. Tell our listeners
a little bit about hot Flash before you head off,
because I have a feeling it's going to be of
interest to at least some of them in our wonderful
age range.
Speaker 3 (35:24):
Yeah.
Speaker 4 (35:25):
So, Hot Flash is a weekly newsletter that is under
the Parent Data by Emily Oster Umbrella.
Speaker 3 (35:34):
So Parent Data is Emily Auster's.
Speaker 4 (35:37):
Newsletter that she puts out regularly about data for pregnancy
and early childhood. Hot Flash is an extension of that
really focused on the years after you're done having your kids,
your forties and fifties, just exactly what we've been talking
about today, and our goal there is really to provide
(36:01):
evidence based analysis of different topics just like those we've
been talking about today, where the focus is really making
sure that we're breaking down the data and helping you
to make better decisions and helping you to have a
(36:22):
better conversation with your doctor about your symptoms and what
you're experiencing as a woman in your forties or fifties.
Speaker 2 (36:30):
Awesome, Well, thank you so much for coming on. This
has been a very instructive conversation. I'll I'll have to
kind of bookmarkt and remember to re listen as symptoms
crop up as they as I'm sure they will.
Speaker 3 (36:42):
So thank you again, my pleasure. So we are back.
Speaker 1 (36:46):
That was awesome listening to doctor Gillian Goddard talk about
perimenopause and other hormonal related topics. So exciting to get
more information on that. So today's question comes from a
listener who is interested in financial topic. She says, you've
both mentioned your family upbringing with regards to money. I mean,
just spoiler alert, both very middle class sort of upbringing.
(37:08):
She finds the conversations about how you've learned to use
money some of the most interested. I'm specifically interested in
your philanthropy plans as you are talking about leveling up
and doing more with that, and also any resources for
getting into angel investing, because she has no idea where
to start. So Sarah, maybe you can talk a little
(37:29):
bit about the giving side of this, because I know
you guys have been a little bit more organized in
terms of your budgeting categories and stuff like that.
Speaker 2 (37:36):
Yeah, so we use the software. You need a budget,
and giving is just one of the categories, just like
anything else. So the way you need a budget works
is every single month you create your budget. So I'll say, okay,
I want to give. I need to put two hundred
in my electric bill budget or whatever. And then you know,
I have a category for gifts, which is like birthday gifts,
and then all kinds of other things including giving, and
(37:56):
I just dump a standard amount in there every month,
but it accumulates, so I don't necessarily need to say like, oh,
I'm gonna give X dollars every single month, and I'm
gonna give you know, to a different cause. We don't
do it that way. Instead, we just kind of like
put the same amount in every month, and then when
something comes up that seems worthwhile, we can just be like, ooh,
let's like give a bigger contribution and empty out this
(38:17):
category to whatever. So like, for an example, recently, I
just got some like email, as one does, from a
cause that was like, oh, I'm gonna triple donations. It
was like an anti gun violence type of thing, and
it was it was Bloomberg who said he would triple
all the donations. I was like, you know what, our
donation will go three times as far if I do
it now. So let's just empty the category out. I
(38:39):
you know, wanted to donate to that, and so we
did it. Sometimes it'll be like, you know, a disaster
happens and we'll be like, oh, let's let's give to
this to help these victims of whatever just happen, et cetera.
And so you know, we're not like huge philanthropists. It's
not some giant chunk of our income. I see it
kind of as twofold, like we give some now, and
(39:01):
then I also hope too, as we accumulate more money
at have it invested money and our secure in our
future to give even more later out of what we've invested.
So that's kind of how we do it. It's not
super super systematic.
Speaker 3 (39:12):
But it works.
Speaker 2 (39:13):
And I like having a category that's just dedicated to that.
It's kind of similar to holiday, Like I like to
collect the money throughout the year and then use it.
And I liked for their whenever a cause comes up,
like we have money in there, we can give it
and feel really good about that, but also know we've
budgeted for it.
Speaker 1 (39:29):
Yeah, I think this is the kind of thing that
it just pays to put some thought into it. So
especially as you're in kind of the wealth accumulation, although
maybe you're not, maybe you're totally into the giving it
away stage at this point of your life, but you know,
be thinking about what causes really inspire you. And I mean,
I know there's a sort of utilitarian argument of like,
(39:49):
give it to the thing where it can go the
furthest and there's something to that, but there's also so
many problems in the world that you want a cause
that inspires you and so because then you'll keep giving
to it and you'll get involved with it personally and
use whatever social capital you have as well to make
a difference in that. So really be thinking about what
(40:10):
inspires you, like, what causes make you think like this
is a change I'd like to see in the world
beyond the lookout for ones where again most of us
are not going to be giving billions away, so we're
looking for ones where maybe a smaller amount of money
could make a significant difference. So maybe that's because it's
something local, right, you can make a big difference in
your own local community. But start really thinking about these things,
having a conversation with your partner if you have one,
(40:34):
and then thinking about like what amount of money would
we be interested in giving to make a difference in this.
And I'm with Sarah that I think you're better off
giving a bigger amount to a smaller number of things
versus a small amount to a lot of things, partly
just because it keeps you very invested in that small
number of things. So you then follow the topics and
(40:55):
if you're working with a nonprofit, you might get involved,
you might get on their board or whatever else like that.
Not an investing podcast, so I don't think you want
to get all your invested you know, angel investing information
from here, but I will just do a quick discussion
of it for anyone who is looking into this. So
to invest in private companies, so ones that are not
publicly traded, and in startups and things like that, you
(41:17):
basically either need to know the founder or you need
to be what they call here in the US and
a credited investor, which means that you are well off
enough that the financial authorities assume you are a big
girl and can look it into it on your own
right that you're not going to be devastated if you
lose your investment. So there's a certain income requirement or
(41:39):
a certain net worth requirement minus your primary residence. It's high,
but it's not billionaire high. Again, so there's probably a
reasonable number of people listening to this whose households income
wise or net worth would fit into it. As for
finding companies to invest in, I mean, this is networking
like anything else. It's probably going to be former colleagues
(42:00):
of yours, for instance, who have gone the startup route,
and you get a business plan from them and think
it looks good, and you put a small amount of
money into.
Speaker 3 (42:08):
It, maybe people you went to school with.
Speaker 1 (42:11):
If you are in a reasonable sized city or near
a university, there might be you know, investing organizations that
various entrepreneurs can come pitch their idea too, and people
ask questions and then you can see what looks good
and all that. But as you start doing it, as
you make small investments in small companies, founders will hear
(42:34):
about you too, and so they will come and you know,
you'll start getting pitches and then you can evaluate what
do I think will grow? What do I think has
a reasonable exit strategy so that I, you know, would
hopefully make my money back, although again with this you're
probably not going to make your money back on the
vast majority of them. The ideas that maybe you know,
one in twenty might return twenty x and then you're
(42:54):
even or something are slightly ahead. So it's just more
of a fun way to get involved in investing, and
so again not an investing podcast, but there are plenty
of ones out there that are, so you know, recommend
you kind of google that and get the basics if
you are interested. Well, this has been best of both worlds.
Sarah was interviewing doctor Gillian Goddard about perimenopause and related topics.
(43:17):
We will be back next week with more on making
work and life fit together.
Speaker 2 (43:23):
Thanks for listening. You can find me Sarah at the
shoebox dot com or at the Underscore Shoebox on Instagram,
and you.
Speaker 1 (43:31):
Can find me Laura at Laura vandercam dot com. This
has been the best of both worlds podcasts. Please join
us next time for more on making work and life
work together.
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Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.