The final episode of Season 2 brings different healthcare professional perspectives on menopause.
The final episode of Season 2 brings different healthcare professional perspectives on menopause. Series host, Dr Mary Jane Minkin, is joined by women's health nurse practitioner, Dr Shelagh Larson, and behavioural psychologist, Dr Sheryl Kingsberg. In a lively conversation, the three women’s health experts delve deeper into the breadth of symptoms and experiences shared by the women in Season 2, normalizing and contextualizing all the while encouraging women to speak up about their symptoms.
menopause: unmuted is designed to raise awareness, encourage communication, and share information. It is not designed to provide medical advice or promote or recommend any treatment option.
Links
menopause: unmuted
A podcast series to share menopause experiences
E5: Speak Up
It's time to unmute menopause.
Hello, and welcome back to menopause: unmuted, a podcast series sponsored by Pfizer.
Menopause is a time of huge change for women. And it can affect almost every aspect of our lives, from our health to relationships. And it can sometimes be hard to talk about it, and we're here to help make that easier.
I'm your host, Mary Jane Minkin. I'm an obstetrician gynecologist and clinical professor at Yale University School of Medicine. And for this special bonus episode, I've invited two of my colleagues to join me for a slightly different view on the menopause experience.
And I have to point out, of course, that because of the COVID situation, we are recording this remotely, we are not in the same room together, although we would love to be because we love to visit with each other, but we're not.
So, let me introduce Dr. Shelagh Larson. Shelagh, it's so great to have you here today. You’re a women's health nurse practitioner, could you introduce yourself and give our listeners an overview of what you do?
Thank you for hosting this very important conversation on menopause. Yes, I am a women's health nurse practitioner board certified. I currently work at a county hospital in Fort Worth, Texas, where I run the menopause clinic that I founded, as well as training the residents, the OB as well as family practice residents, in menopause. And I represent Texas for American Association Nurse Practitioners.
Thank you so much, Shelagh, and thanks for being here. And I'm also delighted to be joined by our colleague, Dr. Sheryl Kingsberg, Sheryl, somebody I work very closely with. Hi Sheryl, could you tell us a little bit about yourself and your work?
Well, certainly. And it's an honor to be here with you, Mary Jane and Shelagh. I am a clinical psychologist by training. But I am a professor in the departments of reproductive biology and psychiatry at Case Western Reserve University School of Medicine. But I have a division of Behavioral Medicine in the department of OB/GYN at University Hospitals, Cleveland Medical Center.
So basically, I treat the psychological consequences of medical conditions. The perfect fit for me is in the middle of an OB/GYN department where every department should have Behavioral Medicine. Unfortunately, that's not here yet. But hopefully across the country it will.
Well Sheryl, thanks so much for your descriptions there. And all you do. And I agree with you completely. I sure wish we had behavioral health as a component of every OB/GYN department in the, in this country, it'd be fabulous.
So, if we can, let's move on to talking about some specific examples. And we're gonna start with what can be the most unsettling time for a woman, diagnosing menopause. For many women, menopause can just creep up on them. And for others, it's like hitting a brick wall, boom, you're there. So, although it might be clear that something's not right, menopause isn't always the first thought. I want to start with this reflection from Carla, if we may.
I would say in the beginning stages, I probably experience mood swings, insomnia, slight depression, low energy. So those were the initial... and kind of just kind of like, blah. I don't know if blah, is blah a word? Just kind of, just kind of felt like I was in a cloud just not feeling my typical self.
Sheryl. Does that sound familiar to you?
All too familiar, Mary Jane. We're certainly not aging like women did a generation ago. Think about it. Ads for menopause hormone therapy from the 1960s showed images of little old ladies with blue hair and wrinkles. Now what do we see? We see models for menopause ads that are blonde, they're tanned, they have white teeth. They're dressed for their Pilates class or for their next 5k run.
So, no wonder Carla didn't realize that she was beginning to experience symptoms of perimenopause. And, you know, menopause is that moment in time reflecting 12 months after a woman's very last period. But it's that time leading up to and maybe sometimes just past that final period, that perimenopause, when the ovaries are slowing down and the hormones are shifting and changing, that many find the most difficult because that's the time when most women will have the most symptoms. They're going to have mood swings or what she called feeling blah, and they don't know to identify it as related to menopause. And I have to say clinicians they're not telling women what to expect, so you know, to be fair, we often don't get that training in medical school or nurse practitioner school or residencies, and so they don't know to ask about those symptoms, they don't know to warn women that they should expect that this might be coming.
Thank you so much, Sheryl on that, because I think that's really important, and to emphasize to our healthcare providers that might be listening to us too.
Shelagh, can I ask you what if the initial conversation with that healthcare provider is embarrassing or stressful for the patient, any, any idea - suggestions that she might use?
Well, I think it goes both ways. I start my conversation, usually around 35, I kind of give them a warning and say, you know, at 40, we start mammograms, and 40, you may start noticing around that time, along with your eyes going, your ovaries, hormones are going to start going.
If you have a patient that is starting to talk about, periods have become lighter, periods have become heavier, that's also a good time. Also, it's a good time, if they come in and say, you know, I've kind of had a loss of sex drive.
That's also a dive in to see what's going on with your hormones.
Hey, Mary Jane, can I jump in to what Shelagh just was talking about? Because, you know, my guess is if I walked into Shelagh, I would tell her every single thing that is in my head and in my heart. But there are so many women who go to their nurse practitioners or OB/GYNs and are uncomfortable. They don't know what they should be asking. They're uncomfortable about disclosing things like loss of sex drive.
And so, when I'm educating residents and physicians, I am always trying to tell them, please don't wait for the patient. Because oftentimes, they'll think, hey, my, my patients love me, they trust me, if they had a symptom or a problem, they would bring it up. And the patient is sitting there praying, would you please ask me about my hot flashes? Or would you please ask me about my sex life, because they don't know it's okay to bring it up. So, what I'm trying to do is teach clinicians bring it up, because patients are waiting, and they think either it’s a natural part of aging, so I should just learn to live with it, or it's not appropriate to bring up with my doctor or nurse practitioner, so I'm not going to.
So, there’s this conspiracy of silence. So, I really urge all the listeners, look, if nobody's asking you, please bring it up. It really is the place to ask. If nobody's asking, you bring it up, or find somebody who will.
Thank you so much, Sheryl, for that. And that's a wonderful point. And as I try to stress to anybody asking me about, you know, how do you handle menopause? Well, you want to be with a provider that listens to you. That's really important. And you just said that very eloquently.
And there's no sin in finding another provider if you don't feel comfortable with that provider. And that person can be your nurse practitioner, that person can be your nurse midwife, that person can be your OB/GYN, your primary care person, but just you want to be somebody you're comfortable with. So that's, that's very, very important.
I would like to just mention that there are a few other terms that your provider might pull out, and we want to make sure that you're comfortable and understand what they're talking about. Amenorrhea just means no periods, not a big fancy term. One of the other terms you might hear is a term called estradiol, and we've been talking about estrogen. There are a lot of different estrogens, let's put it that way, that are out there. But, what we'd like to do at this point is to get on to some other areas: hot flashes and their impact on sleep have a huge potential to cause disruption to a woman's life. Shelagh is this the number one complaint you hear as well?
Yes, this is what typically brings them in.
So, where some people it is just a sweat storm. Some of my ladies it's just a flush. And it's typically from the chest up. But the problem at night when it happens that's interrupting their sleep. One minute they're putting on their nice little, sweet little PJ's and they're sweating. They're taking it all off. Then they get cold because that hot flash is over, your body has a tendency to chill. They're pulling the covers back on, they're pulling the covers back off. If they have a partner in the bed with them, they're looking at them like ‘oh my gosh,’ so yes, it is really hard.
Many of my ladies are like how do I address this? What do I need to do? Have a fan, you know, have covers that are easy to pull on, pull off, there are cooling pillows out there now. There's fans that can go underneath your sheets. There's all kinds of different non-hormonal things that you can do, besides freezing your family out in the rest of the house. So, you can actually just do it to your bed. And a lot of my girls, I will tell them it also, before you go to eat, do not eat anything hot, real spicy or anything like that. Many times, anxiety can do it. So please don't … don’t watch the news, if it makes you anxious. Exercise during the day, that will help you perhaps sleep through some of this. We talked about estradiol, Mary Jane, you talked about estradiol, estradiol is our energy hormone. Hence when it spikes, that's typically when we get these hot flashes, or we get these anxiety, feelings of anxiety. Progesterone, I always call it my chill out hormone. So typically, that's the first hormone that we start to decrease in. And so that's our, that's what helps us sleep at night. I know you say try to lose some anxiety but breathe through it, is the best thing that you can do at the moment.
Excellent advice from Shelagh.
And I'd like to do a little more discussion on heat and sleep which had been brought up already, but let's talk a little bit more and we'll see what Catherine has to say.
I would wake up in the middle of the night, absolutely soaking wet, drenched in sweat, like I'd taken a shower. And that would happen sometimes three and four times a night. So that was really the first experience of menopause where I was like, whoa, okay, nobody told me about this. And from there it was obviously sleepless nights and more fatigue and brain fog.
Hot flashes and their impact on sleep have a huge potential to cause disruption to a woman's life.
Sheryl, how do you talk to your patients about handling hot flashes?
One thing I do is I talk to women about why hot flashes happen. Hot flashes occur because estrogen helps the body control their temperature regulation. And that actually happens in the brain. So, when estrogen declines, then that kind of… that regulator goes a little bit off track, the body has a much narrower, or the brain, has a much narrower range of what is considered normal body temperature, and then often incorrectly perceives that it's warmer than it should be. And what happens? That sends a message to send blood flow to the skin surface, why? To heat it up and cause perspiration to cool it down, which is why you go from feeling hot to then sweating profusely.
So just a couple of words that we've brought up over the last few comments here. One word that you may hear—this is to our listeners—that you may hear your provider use are something like vasomotor symptoms. That's another very fancy word for hot flash. So, and by the way, some people use the term hot flush instead of hot flash. So vasomotor symptoms encourage all these temperature regulatory issues.
This is menopause: unmuted, where we talk about real women's menopause stories. I'm your host, Mary Jane Minkin. And I'm very pleased today to be joined by women's health nurse practitioner, Shelagh Larsen and behavioral psychologist, Dr. Sheryl Kingsberg.
And if you'd like to find out more, please visit www.menopauseunmuted.com, or talk with your healthcare provider.
Although these are frequently reported symptoms of menopause, the vaginal and sexual aspects are some of the hardest for women and their partners to talk about. But menopause doesn't have to mean the end of your sex life. And it doesn't mean that you have to live in long-term discomfort. Women who are able to talk about sex with their partners have higher self-esteem. So, these barriers are definitely worth tackling. Let's listen to Catherine.
So, one of the biggest things about menopause is dryness, I talked about on my skin, but it doesn't, it's not just dry on your skin, it's pretty much dry everywhere. And that means even in those, you know, private parts in your… in the vaginal tissues, so when I was going through the hot flashes and all that, I wasn't in a romantic relationship, but the way I experienced it, I would literally go and use the bathroom. I was up many times at night. And you know, part of the whole getting older thing is you're urinating really frequently. And when I would go to the bathroom and urinate, it was painful. It was… it was raw, it was dry. It was sore. It made me feel like, you know, I might have a urinary tract infection. And in fact, it was just menopause.
Shelagh, can we start with the basics? Could you explain what is going on in the vagina during menopause? And how that can feel for a lot of women?
Yes, thank you Mary Jane, I usually tell my ladies a kind of a little story. And that helps them understand. The cells with estrogen, are like big fat juicy grapes. And as we begin to lose estrogen, those grapes become raisins, and start to lose their moisture. Those raisins will ultimately become like crackers; nice and dry. So, it isn't your imagination, your cells have really literally dried out. And in the vagina with the big fat juicy grapes, you have lubrication. So, sex is not painful. It's got moisture, it has elasticity. And so therefore typically enjoyable.
You get those raisins? Now all of a sudden, oh, yeah, it started to pinch here, pinch there, and you're not going to want to do something that hurts.
Thank you so much, Shelagh. So yes, let's be honest, menopause can affect your intimate relationships and your sex life, as we hear from Chenoa.
But one night, I remember my husband was approaching me in an intimate way. And it just started to, rather than turn me on, make me really agitated. And that was really interesting, because there was nothing going on between us. Like we weren't having an argument or a fight. We were just in a very loving moment. But I just remember his touch started to feel almost like sandpaper, so irritating to me. And no matter what he started to do that night; it just increased my irritation. And then, as we started to move forward into intimacy, it became so uncomfortable, like so painful. And I remember going through it because I was waiting for my body to operate like normal and to get wet and to have that kind of satisfaction that I was so used to, but nothing occurred. And that was the very beginning.
Isn't she being really honest? But Sheryl, what's your response to her comments?
Well, too many women suffer like she did, they suffer in silence. And in fact, one study I published of women who had vulval vaginal atrophy showed that one fourth of them who were having pain with penetration were still having intercourse at least once a week anyway. So, I'd actually like to talk a little bit about what that term is when we talk about vulval vaginal atrophy, we actually call it genital urinary syndrome of menopause now, and we call it GSM for short. And most women don't know that it's related to menopause. Because while everybody knows hot flashes and night sweats, they don't know that it is that GSM is related to that same loss of hormone.
The couple is greatly impacted by sexual problems that it kind of takes two to tango. First of all, let me remind everybody out there even if you don't have a partner, you're entitled to good sex. And self-pleasuring is still something that you are entitled to. But if you do have a partner, once there's a problem, both partners are impacted. So do other things, which actually is helpful for the couple to figure out new ways to be erotic together, but I want to make sure that you pay attention to, is your loss of interest because it hurts, because nobody would want to do something that hurts.
That's terrific. And one of the other things just to clarify that, if you hear your provider talking about some fancy terms, the fancy word for painful intercourse that providers may often use is dyspareunia just means having painful sex, which, unfortunately, a lot of folks with menopause can develop. But the good news is lots of things that you can do about it. Shelagh, your thoughts on this topic?
We hear this a lot. My relationship’s great, except I just don't have the drive. How do I tell them it doesn't feel good? I give them homework, their homework is: I need you to, to learn how to flirt again. And to remind them that there are little things that you can do. And they start putting life back into the relationship. It's not all horizontal in the bedroom. And that's the problem is so many people think sex is just in the bedroom. It's really how you treat each other all day long. And it's really interesting because Sheryl said, I had one lady that every time her husband touched her, she recoiled because she thought that meant he had sex, or he wanted sex. But realizing that was his love language his touch and that didn't necessarily meant let’s get in bed. She had to hear that from someone else. And they had some… much more open conversations about what they want. So, it's really exciting to work with couples on other ways to have intimacy that isn't necessarily in the bedroom.
Thank you for those terrific comments Shelagh. At this point, I'd like to move on to the final chapter of this bonus episode. And I’d like for us to talk about something that no healthcare professional can prescribe. But it really can make a huge difference to navigating menopause positively: community and relationships. Shelagh, what's your experience of women who build a support network versus those who try to go it alone?
Interesting that the women that try to go alone go in silence. A lot of their feelings are based on shame that there's something wrong with them. And it's really hard for a provider because you just want to reach out and say, ‘sister, and you are my sister, you are not alone’. And I often tell them to sit down, ‘it sounds like you've crossed over and you're into the menopause world. Welcome. Welcome to the menopause.’ And a lot of them are a little wary about, ‘I’m not, you know, blowing horns yet’. But I often tell them, ask your sisters, if you have sisters, ask your mom, ask your mother-in-law. Many of them have told me, ‘well, my mom had a hysterectomy early, my sisters did. I'm the only one that has it. I don't know what's normal, my mother's passed on’. Or perhaps ‘I'm adopted,’ they don't know their history. And I often, you know, will reassure them that every woman has to go through this, this is something we all have to go through it. I don't want you to feel that this is something that you do alone. This is normal. Every woman goes through it. This should be a time of no judgment, no judgment.
Well, that's terrific Shelagh. And we know that being open about menopause will impact how the younger women around us will feel about their future menopause journeys. And I really love this comment from Carla.
So, I think in many ways, it has brought a lot of women together and connecting and being able to communicate and believe it or not, my daughter is she's very informative. She's probably the one giving me information versus me giving her information. Which is great. I guess that mean I did a good job as a parent. But maybe like now if, if I'm having a symptom of menopause or if I'm going through something, she, she would bring up the conversation and say, oh, you know, do you think that's associated with menopause? Or, how you feeling? So, even though she's only in her 30s, she's probably more knowledgeable about the subject than I am.
Sheryl, do you get to hear comments like Carla's regularly?
I do. And I think it's wonderful that Carla feels like she's got a good relationship with her daughter, and they can bring it up. And she can validate and normalize her experience to get the next generation prepared. But I do think that the conversation is, is so important. And let me just say one thing about COVID-19. One of the only benefits of this horrible pandemic is the onset of these of like Zoom calls and, and having more interaction with people that you wouldn't normally be able to interact with. So, I think women being able to find each other and having communities that go beyond especially if they live isolated in very rural areas, now they can find each other and can find practitioners that specialize either in menopause or in in treating sexual function that moves beyond their, you know, small area where they live. So, let's look at that one benefit.
Every woman experiences the menopause journey differently. For some lucky women, it's a smooth ride. But for others, it can take time and effort to acclimatize to this new stage of life. I'd urge women to encourage those conversations as early as possible, and not to waste your energy trying to hide what you're going through.
I want to say a huge thank you to my guests today, Dr. Sheryl Kingsberg and women's health nurse practitioner Dr. Shelagh Larson. I'm Mary Jane Minkin. Thanks for joining us today.
Check out our show notes at menopauseunmuted.com.
Women should be able to discuss menopause with their healthcare providers. A woman can speak out about menopause with her OB/GYN, primary care provider, nurse practitioner or midwife.
There are even designated menopause practitioners that a woman can visit if she needs more information.
Thanks also to our Season 2 cohort of women, Chenoa Maxwell, Catherine Grace O'Connell, Shauna Robertson and Carla Kemp. Finally, special thanks to the Global Women's Health Team at Pfizer and to Studio Health for producing this series. Talk soon.
DISCLAIMER
This podcast is provided for educational purposes only and is not intended to replace discussions with a health care provider. Please speak with your health care provider regarding any health questions.
The opinions expressed in this podcast are the opinions of the individuals recorded and not necessarily opinions endorsed by Pfizer.
The health care practitioners appearing in this episode of menopause: unmuted have been compensated by Pfizer.
This podcast is only intended for residents of the United States.
This podcast is powered by Pfizer.