You're listening to Life Kit from NPR. Hey, it's Marielle. Did you know that if you're a woman, a mammogram is not the only tool you need to screen for breast cancer? Or that your gynecological health history can give doctors important clues about the health of your heart going forward? Megan Rabbit is a journalist. She wrote a book called The New Rules of Women's Health. And she says there's a lot that we as women were never taught about this stuff. I think that health class really falls short for so many of us, and even our young girls today, are not getting a real adequate education about their bodies, their anatomy, their health. And that means we might start to believe myths or ideas that have not been supported by evidence, like the idea that you can maximize your workouts based on where you are in your menstrual cycle. And this one surprises a lot of women, particularly young women, who I think we were targeted for a while with the algorithm saying like, if you're in your luteal phase, you have to do this type of workout or during your period, during your menstrual phase, take it down a notch. And there is no great data to back this up. Megan says after interviewing more than 100 scientists and doctors and other clinicians, what she learned above all is that the health tips that sound the most obvious are the ones that tend to be backed by research. You know, it's the tried and true lifestyle advice that we hear a million times and that can make us roll our eyes like, oh, I've heard this before. Don't tell me to eat well and sleep and exercise. But if we stay consistent with those things, it's actually going to pay off so much greater than following the latest wellness trend. On this episode of Life Kit, Megan's going to tell us about four common myths when it comes to women's health. And through those myths, we'll learn more about what we actually need to be doing. That's after the break. All right, Megan. So myth one is that all you need to do to detect breast cancer is get an annual mammogram. We've done a whole episode about breast cancer detection. I had breast cancer myself in 2024, so I know about this intimately. What's the bottom line here? When I interviewed Dr. Lisa Larkin for my book, who is a breast cancer survivor herself and an amazing women's health practitioner, she said something that really shocked me, which is that most women think I'm on it if I'm getting my annual mammogram. A mammogram is an amazing screening tool, so we should be getting our annual mammograms after a certain age or depending on our risk. But the catch is that most doctors aren't actually talking to us about our lifetime risk of breast cancer. And that score we can get, that can help inform our best screening plan. Okay. So part of this is about estimating your lifetime risk of breast cancer. And there are a couple calculators you can use. We'll link them in the show notes. Based on those results, you might start breast cancer screening sooner or do it more often. or you might need an MRI. But the calculators are just one tool here, right? Like even if they say your risk is low, some details of your situation could warrant a different screening plan. Like if you have a strong family history of breast cancer or if you have dense breast tissue. Yeah. There are four categories of breast density and your mammogram report should tell you where you fall. I'm in category D, which is extremely dense. It's as dense as you get. And that combined with my lifetime risk assessment score, which was just under 20%, prompted my gynecologist to say, yeah, I think we should add a breast MRI to your screening plan. And so you're absolutely right. Breast density plays a role. Family history of breast cancer plays a role. So there's a number of different factors. And I learned that MRIs are much more useful if you have dense breast tissue, because if you're getting a mammogram and it's not a mammogram with contrast, which those are not that common, you basically can't see through the breast density. Whereas with an MRI, you can, but doctors still recommend both because mammograms can see things like calcifications, which can be an indicator as well of breast cancer. And that's something that MRIs don't catch. Yes. And what doctors will say is that if you do qualify for breast MRI, in addition to mammogram and possibly ultrasound, try to schedule them six months apart from each other So you actually getting two screenings a year You getting your mammogram and then six months later you getting your breast MRI So it gives you even more of a chance to do that early detection because that what we want with breast cancer The earlier we detect it and can treat it, the better. And when you do go to your annual doctor visits, whether it's to the gynecologist or to your primary care doctor, make sure that they're doing a breast exam on you as well. Absolutely. You know, I try to schedule my gynecology visit and my primary care physician's visit about six months apart. And both of those doctors do a breast exam. And then I do my own breast exams. And then experts also say that when we're cycling still, if you suspect something's a cyst or if there's a spot that kind of grows and then it shrinks, you can wait a cycle or two before going to make an appointment if you want to. But after menopause, that changes. And so it becomes crucial for us to do that self-breast exam to make sure our doctors are doing that exam so that we can really understand if there's changes and look into those. Let's get to myth number two. The myth is that strength training is better for you than cardio, especially in midlife. So I know that both are important, but what do you think people are missing here? Yeah, I think it's great that we are talking more about the importance of strength training. Because when I was in college, when I was a younger woman, I was in the cardio room and all of my guy friends were lifting weights. And so if I could rewind time, I would have hopped off the elliptical and headed straight for the weight room. So I do think it's really amazing that young women now are being told and women of all ages are getting the message that strength training is really crucially important for our bone health and many other benefits. That said, I wonder if in our focus on strength training that we're missing out on remembering how important cardiovascular exercise is as well. You got to do them both. You got to do them both. You know, and when I talked to Dr. Suzanne Steinbaum, who's a preventive cardiologist in New York City, she really helped it make sense for me. And she said, you know, the thing is when we get our heart rate up, it increases our heart's capacity to fill with blood. And this does amazing things for all the ventricles that go in and out of our heart. They stay more pliable. They dilate easily. and that flexibility, that pliability of those ventricles in a female heart really goes a long way to helping prevent cardiovascular disease later on. Yeah, this connects to another myth in your book, which is that heart disease is mostly a problem for men. Too many of us think that if we are moving our bodies and eating pretty well, heart disease isn't something we're going to have to worry about. And if we do have to worry about it, let's say there's a family history, it's going to be something that happens way later. And this is something that expert after expert said women in particular need to be talking about. If you're a woman in your 30s, 40s, or 50s, there's a good chance that you're more focused on preventing breast cancer or screening for cancers, let's say. And these are really important things to do, right? And we need to add heart disease into the mix, understanding what our family history is, talking to our doctors about that, and just really starting the conversation earlier than we have. I was really surprised by a study. It's actually a decade-long study by the American Heart Association that found that fewer than half of all women recognize that heart disease is our number one killer. And our awareness that heart disease is such a risk for us has actually gone down. And so this is even more reason for us to be talking about it with each other. And also, unfortunately, we really need to proactively bring it up with our doctors. What are some of the indicators of your heart health that your doctor might look at? Yeah. So a big one that most women don't understand is that our gynecologic health history plays a role in our future risk of heart disease. If we had a pregnancy complication, let's say preeclampsia or gestational diabetes, oftentimes these conditions clear up after we give birth and we think we don't have to include it in our health history going forward. It happened, it cleared up, no big deal. It actually might be a big deal for your heart and it's something that you should bring up to your doctors so that you can make sure you're doing everything you can to protect your heart. We have more Life Kit after the break All right, myth number three is that menopause is just years of misery with no upsides. Not true? Not true. What are the upsides? So there's the obvious, which is no more periods. And during the perimenopause, when you're in that transition, periods can get really wonky. They can become unpredictable in timing, which is no fun. They can become heavier, which is also no fun and can lead to things like anemia. So not bleeding, major upside, right? Also not worrying about birth control. This is something that is so front and center for women for so many years of our lives. that not having to think about that can be so freeing. But then some of the more subtle upsides I found in my reporting for this book were things like there is a real opportunity for us to press the reset button during this transition and say, what in my life is working? What's not working? What do I want to change to help me feel better physically, emotionally? I think there's a lot of ways that we as women come into our own in menopause. We stop worrying about things that we don't want to worry about anymore and get after what we really want. And I think that's really important to give voice to as well. Quick question. How do you know when you don't have to worry about birth control anymore? Like, how do you know for sure? Because I feel like there are women who thought they were done and then they got pregnant. Oops. That's such a great question. And one that I think so many gynecologists wish more of us would ask. And what I think everybody needs to understand is that menopause is one day when you've gone a full year with no periods. When you're past menopause, you're not ovulating anymore and pregnancy is not possible, right? Because you're not producing eggs that can then become a baby. But you really have to track your cycles. If you're cycling, you want to track very carefully when that last period was and know this, which I think surprises a lot of women, if you've gone, let's say, eight months with no period and you are like, menopause, here I come, and you start bleeding again, the clock resets to zero. And you have to, from that point in time, go another full year with no cycle, no bleeding, in order to be in menopause. I also wonder, I mean, some women don't have a period, but they're not in menopause. Is there another way to check this? Just from my experience, I feel like doctors could also test your hormones. Yeah. I fall into that category myself. So I had a hysterectomy about a year ago and I'm not in menopause because they were able, my surgeon was able to leave my ovaries, right? But I don't bleed anymore. And so I'm about to turn 47, which puts me in the perimenopause transition zone, right? But I won't have that external cue when it comes to telling me, oh, for sure I'm in menopause. And so that's when hormone tests are important. Now, what I understand is that most doctors are going to test my hormones when I start to experience more symptoms, or I'm at a certain age where menopause is more likely. So at 47, I'm probably still in that perimenopause zone. 51, 52, 53 is probably when I'll get a hormone test. And what they look at is FSH, follicle stimulating hormone, skyrockets when you're in menopause because it's like your brain is sending a message to your ovaries saying, come on, ovulate, ovulate. But your ovaries are like, nope, I'm tired. I'm done. I gave you a lifetime of eggs. What do you want from me? And so that's when doctors will say, oh, okay, based on your symptoms, based on your age, based on where I see your FSH levels, you're in menopause. Okay, let's go to myth number four. And that is also about the menstrual cycle. The myth is that women can maximize their workouts based on their cycle. Not true? The truth is that there's really no good data showing that you can get these big changes in strength or endurance or recovery based on timing your workouts to your cycle. And this one surprises a lot of women particularly young women who I think we were targeted for a while with the algorithm saying like if you in your luteal phase you have to do this type of workout or during your period during your menstrual phase take it down a notch And there is no great data to back this up And actually when I interviewed Dr Megan Roche she said something that really was interesting to me which is that let say you feel like you're at a certain point in your cycle where you should be hitting it really hard. Go ahead and hit it hard. But there's so many other factors that play into whether or not you can hit that hard workout like you were planning. Like, do you have a young child who woke you up in the middle of the night? Do you have a big deadline at work that is stressing you out? These are all factors that should also play into us listening to our bodies to understand how we should be adjusting our workouts. And she also said something that I think is really important for those of us who are running 5K races or 10Ks or marathons or doing any kind of competitive sports, which is that we can't time our race day to our cycle. So there's a lot of benefits in training across the cycle at different levels of intensity. Yeah, I get that there's this impulse to optimize our health and to try to squeeze the gains out. But sometimes it just feels like doing too much. Like just try to be consistent with whatever you do. Bingo. And that's the thing is that if we get in our heads too much and we have this plan based on what point of the cycle we're at, it can just feel overwhelming and actually keep us from working out at all. And that's the opposite of what we want, right? There is something to be said for just focus on consistency, focus on starting where you are, focus on doing what you can and staying consistent. Megan Rabbit, thank you so much. Thank you. okay time for a recap here are four myths about women's health from megan rabbit myth number one all you need to do to detect breast cancer is get an annual mammogram not necessarily you should talk to your doctors about your risk factors including your family history your breast density and the results you get from online screening tools one of those calculators is called the BICRAT, spelled B-C-R-A-T, Breast Cancer Risk Assessment Tool. That's from the National Cancer Institute, and it's only available for women 35 and up. Another is called IBIS, International Breast Cancer Intervention Study Tool. Now, if your risk level is high, you may qualify for additional screening using an ultrasound or an MRI. Also, make sure your doctor is doing a breast exam during your annual visits, and be aware of your breasts, how they feel throughout a given month, what they feel like when you're standing up, when you're laying down, and make sure to tell your doctor about any changes. Myth number two, while strength training is important for your health, don't forget to do cardio workouts too. Heart disease is the leading cause of death for women in the United States. So keep your heart health in mind, get your heart rate up through regular exercise, and also talk to your doctor about your risk factors, including your family history and your gynecological history, like whether you had preeclampsia during pregnancy. Myth number three, menopause is just years of misery with no upsides. Not true. You won't have to deal with periods anymore. You won't have to worry about birth control. And some women say that this is a time of their life where they come into their own. And myth number four is that women can maximize their workouts based on their menstrual cycles. There's no good evidence for this. Megan says what you want to be doing is listening to your body and trying to stay consistent with exercise. That's our show. By the way, there are also a lot of myths about strength training. But you know what's true? Resistance training has huge benefits for your physical and mental health. We have a collection of Life Kit episodes that will be a starter pack to getting stronger at your own pace. Subscribe to LifeKit Plus now to get exclusive access to that and other LifeKit playlists that'll help you move your body, master your budget, get better sleep, and more. This episode of LifeKit was produced by Margaret Serino. Our digital editor is Malika Grieb. Megan Cain is our senior supervising editor, and Beth Donovan is our executive producer. Our production team also includes Andy Tegel, Claire Marie Schneider, Sylvie Douglas, and Mika Ellison. Engineering support comes from Tiffany Vera Castro. Fact-checking by Tyler Jones. I'm Mariel Segarra. Thanks for listening.
