Menopause, Misogyny and the Medical System: Dr Sharon Malone Sets the Record Straight

This is what I want women to understand is that once you get to be 50, 60 years old, you have never been more experienced, you have never had more wisdom. You need to share that with someone. And the only thing that stands in your way is not being well enough, or not being physically bit enough for being able to pursue something, but it's not because you don't have the mental capacity to do it. And that's why I think it's so important about the work that we do with menopause is that showing women that there is a path forward that doesn't just lead to decrepitude and death, weakness, no, no, no, no. The views and opinions expressed on unposed are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Every time I hear our next guest, Dr. Sharon Malone speak, I learned something new. The first time this happened was three years ago when she was moderating a panel on the Women's Health Initiative and the misinformation that caused a generation of women to get incomplete menopause care. At that time, I thought, this is a message I need to spread. Up until then, my focus had been on nutrition and the Galveston diet, but that moment was the pivot. Everything changed, and I will forever be grateful to Sharon for opening that door for me. In the years since, Dr. Malone and I have become friends. We've shared stages at menopause conferences across the country, and every time I hear her speak, I learn something new. Her New York Times bestselling book, Rome Woman Talk, your guide to getting and staying healthy, was another lightning bolt of inspiration. At a stage of life when so many women are told to slow down, Sharon is doing more. She is the chief medical advisor of Alloy Women's Health, a telemedicine company built specifically to serve menopausal women. She's one of the leading global advocates for women in midlife, and she continues to fight for women's health both through education and policy. Recently, she was invited to deliver the keynote at the American College of OBGYN's annual meeting. Dr. Sharon Malone is one of the most accomplished, generous, and inspiring leaders in women's health today, and I am deeply honored to welcome her to the podcast. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner. I am also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unposed, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Welcome to Unposed. Thank you so much for having me. The history of all of this. Why did you go into medicine? You know, isn't that the $64,000 question when $64,000 was actually a lot of money? I don't have a doctor in my family. No one. I think probably from the time I was a little girl, when you're smart, there only a few things that you could think up to do. And I knew one person's dad who was a doctor, and it was like, well, you're smart. I guess I'll be a doctor. And that is really the power of modeling and seeing people do things. My parents weren't even college-educated. So I thought that was the highest you could be. And you're the baby of the family. I am the baby. Okay. And how many siblings do you have? I have seven. I had seven. Now we're down to four. There's just five of us. I've lost two of my sisters and a brother. I've lost three as well. We were eight. So we have that in common. Any of them, university, advanced degrees? Believe it or not, everybody, five of the eight went to college, graduate college. And my parents migrated from the rural south. So we were part of the great migration out of rural Alabama to the big city of Mobile. And a lot of my mother's brothers and sisters left and they went to, you know, the traditional roots. They went to Chicago. They went to Ohio, California. And when my parents moved, my parents had too many children. They had four children by then. So that was too many to be mobile. So they stayed in mobile. But imagine my parents were very old. And in a way, in a time when old parents were not a thing, my mother was almost 45 when I was born. And my dad was 66. Okay. So they grew up in the early 1900s in Alabama. So the lives that they lived were very different and very circumscribed. And what they really wanted for all of us was to get an education. And we did. You've talked in your book a lot about your mom and her journey with cancer. Can you talk about that? My mom died when I realized now how young that really was. She was only 57. And I was 12 years old. And it's a classic example of not having access to health care. Not knowing what the signs and symptoms were because my mom died in 1971. And colonoscopies were a thing. And it gets back to what I talk about all the time. And that is the acceptance of suffering. Yeah. And who knows how long my mother had had symptoms, how long she had been in pain before she even engaged because prevention and was not a thing. My mother never went to the doctor. You know, your head had to be hanging off before she would take you to the doctor because her experience in the rural south was very different. Yeah. You know, it was a place that you were never respected or never a place where you could go and feel that you were ever seen or heard. So by the time she came to medical attention, she already had metastatic cancer. How much of that journey of you growing up, you know, your teenage years without a mom, you think shaped your path in your decision making? I would say I had the advantage of having much older brothers and sisters. So after my mother died, I moved to Atlanta to live with my older sister. Okay. But I think I didn't know this part. Oh, I did. This is my sister who integrated the University of Alabama. So those iconic photos that you see of George Wallace standing in the door at the University of Alabama, that was my sister that he was trying to keep out of the University of Alabama. That was my, well, she was bold. And she managed, she integrated the University of Alabama and was the first black graduate of the University of Alabama in 1965. But it's all relative. I went to live with my sister. She was married. She had two little kids and she was only 29 years old. Yeah. And then she had a 12 year old. You know, and I'm, I thought I know things, you know, and you're my sister. You know, my mom, by the way. But she took me in and that was sort of that got me out of mobile. Yeah. And I lived in the big city and I actually lived in Dallas too. Oh wow. So you finished high school and then you went to Harvard for undergrad. I have been the classic example of a person who is like, was there a path that you had forward is like, no, I just kind of made it up as I went along and it makes what I'm doing now makes sense too, right? But no, I lived in Atlanta for two years. I lived in Dallas for a year. I went back to Mobile to graduate high school. And I was in love with Atlanta. So I was like, oh, I want to go back to college in Atlanta. So I went to Emory for my freshman year hated it and transferred to Harvard. So and that's been my sort of, I would say ping pong existence over, you know, my young years, but you know what it teaches you. It teaches you to be self-reliant. Yeah. You got to be a self-starter, particularly when you don't have parents. Sisters are not mothers. And you know, so I figured out what that I wanted to be. And I knew that where I what I didn't want to do. And I always lived with the expectation. My mother's voice has never not been in my head. And I knew that she expected things from me, big things for me. And even though she was not physically there spiritually and every way possible, I would all that would always run through my head like, what would my mother want me to do? And that's sort of how I patterned my life. It's it's incredible. So you're you're in your undergrad and you've you've found your place. Harvard was the right college for you. And then now you're like, did you go biology undergrad? Were you thinking med school the whole time? I did all of my undergrad pre-med requirements when I was in college. But when I finished college, I was like, you know what? I don't really want to go to med school. I sort of decided to go to med school when I was like in third grade, right? Yeah. And I said, you know, I did it, but I wasn't ready to go right that moment. So I said, you know what? I'm going to work for a little bit. And then I'll go back and everybody was so disappointed because they're like, I thought you were going to med school. And I was like, well, I will, but not right now. And they didn't believe me. So I worked for IBM for three years. Three years. Okay. And then I went to med school. Wow. And and best thing ever, I honestly think that if I if I could tell young people, this is like, take a moment, take a moment and decide if this is really what you want to do. And you know how this is, you get on a treadmill pre-med requirements, studying for your guests. And you just do the next thing on this merry go round. And I when I decided that I want to go back to med school, it was very clear to me that it was my decision. It wasn't just fulfilling what the world wanted for you. I my undergraduate geology. And I went to works as geologist and actually applied for a PhD program and was accepted, but heard a voice that said, this isn't your path. And my family was very disappointed that I was turning down this PhD went back to work for the oil company while I started applying to medical school. So I very quickly had to get on that treadmill. But fortunately, having a STEM major, I only needed a couple of classes. So I was able to knock out everything and get the MCAT down in that one year and went to med school the next year. But you know what the the advantage also was because had I not taken that break, one, I met one of my dearest, dearest friends in the time I was working for IBM, and we're still like besties to this day. But it also gave me an opportunity to say to myself, I was much more mature. I'd done all the the requirements, but I had the advantage of my classmates who had gone before me because when I started, my classmates were a fourth year med students because I had taken three years off. And so I had their experience. That's how when I picked a med school, I didn't just pick it out of a hat. I had friends that were at Columbia and they loved it. And I don't think I would have lived in New York City had I not had friends here. It's not a place from, you know, when you're from the rural, yeah south that you're like, oh let's go to New York City. New York sounds amazing. It's scary. And it was, but I loved it here and I loved going to Columbia. So it ended up working out the way it was supposed to work out. So why Obitioan? When I went to med school and you're getting back to what you were saying about what I majored in college, I was actually a psychology major, but I was a psychology in the time where neuroscience was just really becoming a thing. So we were starting to look at psychology from the brain, not from the mind. And I did a lot of research work with one of the professors who was doing this thing of this physiological psychology where we did a lot of brain work. So I thought I wanted to be a neurologist. Oh wow. I was fascinated with the brain. And then you know what happens. I got to med school and I realized what neurologist did. And I think what was so disheartening for me was that so many of the neurological patients, they either got better or they didn't. Yeah. And it really, we didn't have a lot to offer them. That was kind of depressing. And then I said, what's the feel of medicine that's not depressing? Obitioan? It's the only time I can think that people are happy to go to hospital. Yeah. It's time to have the baby. My first block on Obitioan was my last rotation and I was kind of ruling things in and out in that third year as we do. And I liked a little bit of this and a little bit of that, but I hadn't found like my thing yet. And then my first block on Ob was labor and delivery nights. And it's crazy. It's pandemonium. We were doing 5,000 deliveries a year at the hospital. I was at med school. And they let me catch babies. And I'm in the emotions of it all. And I remember calling my mother crying. I found it. This is it. I know what I'm going to do. And it was Obitioan. And you know what else I really liked about Obitioan is that I'm also the last of five girls. So a lot of my life has been really female centric. So it was that it was really, um, I like things that have solvable solutions. And a lot of what we do in Obitioan is like it's it's very clear what the next thing is. We know how to do this or if you've got five words or you need to hysterectomy, we can fix that. Yeah. Um, and I did not do very well or I did not, it didn't fit with me. Things that went on and on like the chronic disease diseases. Yeah. That when you were in your training. So, you know, you're up at Harvard. How diverse was your class? Because I think back to my first real taste of, you know, South Louisiana where I grew up, I'm at school, you know, was in North Louisiana. But it was really the first time I'd spent time with a Jewish person. I didn't know. I remember meeting him and well, there was a few, but like this one guy who became my friend and like being so curious about what do you do in the Jewish faith, you know, it just wasn't part of my world. Yeah. Not a lot of people of color. Yeah. And so was there a lot of diversity in your class? And were you noticing gaps? Oddly enough. Um, you know, all right. So I grew up, spent a lot of time in Mobile, but I also went to Catholic school. So I'm I share with you that that I did not know. I did not know a Jewish person. I didn't have my first bagel until I was a freshman in college. I was like, well, look at that. Um, but what was different is that I also am of the era when I moved back to Mobile to, um, to graduate high school. So I was there and I graduated in 1977. So I was there in the busing era. Yeah. So I went to integrated school. So I was, you know, it was very clear. There was a lot of there was diversity in our class. However, when I went to Emory, that was the thing that was shocking to me about being an Emory. Emory was shockingly undiverse. Really? There were 60, 60 black undergraduates at Emory when I got there. There no sports, it's a minority fraternity culture. And so it was very isolating, even being from Mobile, Alabama, I had never been more isolated than when I was at Emory. And that was really one of the motivating factors for why I chose to leave. So when I got to Harvard, I was like, yeah, it was the most diverse. There were a lot of black students. There were people from all over the world. And I found that that was way better for my spirit. I think I learned a lot. I think being there, I think that being a person from Alabama, being a black person with my personal history, um, there were people who would never admit people like me. So I think that that's the value of it. So we all understand that, yes, we're different, but not so much. Everybody kind of, we like to do the same things. And you learn a lot about a lot of people, a lot of places in the world that you would have never known, just living in Alabama. So we talked a lot, well, recently actually about the experiences we were taught from an institutional standpoint of the black experience, you know, a black, a black person will come into your clinic and present with x, y, and z. Right. And how that, that is kind of not exactly true. I mean, it takes away the humanness of what we all have in common and just focuses on race. Well, I explained to people all the time in medicine, what we do, a lot of most of what we do, actually, and how we're taught is about pattern recognition. That you see things you know, oh, this goes with this, goes with this. That's how you make a diagnosis, that's how you triage, that's how you do a lot of things. And unfortunately, so many of these things have become they're racialized because of stereotypes, because of things about who we think gets what, and who we think deserves what. That's a big part of how we're all trained. And that just doesn't apply to white doctors and black doctors as well. We're all trained in the same system. And so, so many of the things that contribute to disparities in healthcare are because of how we were trained. And breaking down some of those myths and some of those and addressing them is really our work to do today, because it's still there. We haven't we haven't dispelled them. So then you go onto your residency, where did you do that? George Washington University in DC. And is that where you met your husband? Yes, I did. I met him probably in the first six months that I was there. And that's how in my long, circuitous route, I thought I was eventually going to get back to Atlanta. And I never did. And I've been in DC now for 38 years. I love DC things work out. I'm a firm believer. You know, my motto is there are no accidents in the universe end up where you're supposed to be, whether you planned it or not. Yeah, somehow, some way you end up where you're supposed to be. And DC's home. So residency for our listeners is really grueling and long hours. And this was before we had time limits on how many hours we could work per week. And there were times in my own training that I was probably working well over a hundred hour weeks. How did you meet and foster a relationship in residency with someone who wasn't a doctor? Yeah, well, you know, I met him and believe it or not, I met him internship year, which was the worst. Just the worst. And we met on my one evening that I decided to go out and we were introduced by mutual friend. And it worked out great because in a new relationship, you're not trying to spend all your time together anyway. But the advantage of being older and at the time, 30 was older. It didn't take me long to figure things out either. I think that very shortly after I met my now husband, we were pretty much clear about that. I was like, yeah, I think I think he's a keeper. Yeah, I was the same. Well, one date and I was I was cooked and done. So here you are. You find the love of your life. You marry him eventually and you start a family. I mean, you guys have had both really demanding careers or husbands and attorney if you don't know. And how did you navigate three kids and raising them through all of that? Well, you know, that's one of the reasons why I have no hair. We were talking about this. So I got married. But I didn't have kids in residency because I knew that's like, that's a that's a no. That's a that's a hard no. I can't have a baby and go home. I can't be tired at home. I tired of work. And but I had when I had my first child, I was 34. And you know, so chop chop. You're going to have more than one the biological clock. Yeah. Oh, absolutely. So my kids are all two years apart. So one and and it was a lot. I remember being completely and totally overwhelmed. And I had a nanny, but she didn't live in. And she had a child. And so that I was very mindful of her time and not keeping her away from her child. And it was it was hard. I mean, it was a very hard 12 years. And unfortunately, I had children just at the time that my husband's career was taking a turn. And he was gone a lot. And not because he wanted to be, but that was just the demands of the job. And I spent a lot of time being very frustrated and tired and you know, yeah, story. Yeah, I call it those years were the grind. Yeah, for me, just because Chris was my husband was working overseas. And he'd go away for 28 days, like gone. And it was just me and the two kids. And then he'd come home and he was off. So he did a rotational assignment for about 10 years. And so when he was gone, it was batten down the hatches, do just enough to stay alive and functional. And when he was home, he actually was all in. I have to give him that he was picking up the kitchen from school, bringing me coffee in the morning, checking on me when I was on call, just really try to make my life easier. And that's why I'm probably still married to him is that when he was home, he really jumped in with both feet. Okay, well, that was not my experience. Okay. That was not my experience. You know, this would be, this is how we go. Okay, are you coming home because I've got, you know, I'm gonna call tonight. Baby, sir is going, we get the famous, I'm on my way six hours later. I'm like, dude, you gotta go. But, you know, I have to, I look back on it now. I have to laugh because I was like, I wasn't laughing at the time. Yeah. But I realized that he had a mission. He was doing something was very important because he was, when I had my daughter was five months old and then he was, he was appointed the US attorney in Washington, DC. And that was when DC really didn't have a crime problem. We don't know, by the way, but we did then. And so that was a big job. And he was really trying to engage. And even though in my heart of heart selfishly, I wanted him to be home and to take a little bit of the load off me, I had to understand that he was doing something that was a little bit bigger than just our immediate family. So yeah, I learned to deal with it. It worked out a little, I'm still a little salty about it though. I was reading a book recently. And the tie, the first chapter says, I'm not gonna want to work when I'm 60. And it was Bobby Brown talking about signing a non-compete on her, you know, and how, how old she would be when the non-compete was out. And I laughed out loud because I thought, oh my god, I said the same thing. Like when I was 30 and thought about 60, 65, I would be a gray hair grandma. Like that was my perception of that age. What did you think 60 and 65 even would look like? Well, you know, I didn't even, you didn't have a model. I mean, I get my mom died. She was 57. And now we know how young 57 really is. But even my sister that I lived with, my sister Vivian, who in a way, the University of Alabama, she died. She was my second mother and she died at 63. And so looking at what that looked like and what does healthy aging look like, I didn't really have a model for that. But I knew that whenever I stopped working because I, let me prove this way, I didn't have a plan as you can tell I'm not a big planner. You know, it's like, well, let's see where that goes. But when I left my job, you know, and I had been in DC for, I don't know, 32 years, I've been in private practice. And I had no plans to leave at that point. I was 62 years old and it was COVID. And the upshot of that was when we were in the COVID shutdown and the emergency. And then I was doing gynecology only. And I had three months off in a row. And I had never had three months off in a row since elementary school. And that was the first time it dawned on me that I could not work and not be okay with that. So when I left after, you know, I came back after the emergency and I said, hey guys, I think I'm leaving at the end of the year. So the end of 2020, I put in my resignation left with no plan, no future. I was like, me, we'll see where it goes. And look, look at us now. Yeah. You know, five years later. And you, if you had asked me then, where would I end up, I would not have imagined this. So you are now the medical director. I'm the chief medical advisor okay at alloy health. Yeah. But when I first started, I was their chief medical officer. So I was their only doctor at that point. And now for those who don't know, alloy is a telemedicine platform built specifically, this is brand new to take care of the needs of men, apostle women because in as we all know, so many of those needs are not being met. And the interesting thing about it starts with the podcast. It ends with a podcast, right? That summer of COVID, Michelle Obama had, you know, she was launching her first, the Michelle Obama podcast. Okay. And she and our friends and needless to say, COVID changed everything about how she was going to record for her podcast. You know, Zoom wasn't a thing. She's trying to figure, how are we going to do this podcast because we can't do studio time. And they, we had this elaborate setup. We both live in DC and and she said, you know what? We had had many conversations about menopause over the years. And she said, let's do this. So imagine we set up. We're socially distanced. The engineers are in another room and we talked about menopause. And that was how Ann Fallenwater and Monica Mullin are even knew I existed. Wow. Because I'm in DC. Monica's in Rotterdam and in New York. And they were looking for a doctor. They each had their own journeys and menopause stories. But they needed a doctor to kind of say, okay, well, how do we actually, you know, put this together? They heard me on Michelle Obama podcast that find her. They tracked me down just at the moment that I was saying, I think I'm done with this part of my life. And that's how I came to be in all the way world. So was it scary? No, it wasn't. Or were you just like, I can do this. I've got this. Because it's different. Well, you know, here's the thing. Nothing ventured. Nothing gained. Yeah. And because at that point in my life, I wasn't really looking for the next thing. But it was an interesting opportunity. And I said, well, you know, hey, let's give it a shot. And I mean, I'm so happy that I did because the one thing that was clear to me is that I was done with that part of my life. Yes. But I wasn't done. I just didn't know what the next thing was going to be. This is what I want women to understand is that once you get to be 50, 60 years old, you have, you have never been more experienced. You have never had more wisdom. You need to share that with someone. Yeah. And the only thing that stands in your way is not being well enough or not being physically fit enough for being able to pursue something. But it's not because you don't have the mental capacity to do it. And that's why I think it's so important about the work that we do with menopause is that showing women that there is a path forward that doesn't just lead to decrepitude and death. Yeah. Wheatness. No. No, no, no, all the things. But we're here to model what that midlife and mid-career shift and pivot can be. And you can be as happy, as productive. Happier. Well, you're right. Happier. And as productive as you had been, say, 30 years ago, do you feel like this is like the best time in your life? You know what? I am happy to give you an idea. I am way happier at 66 than I was at 46 because I was in the middle of things. I was overwhelmed at that stage. And now I can step back. I look my children are grown. Yeah. I'm in control of my life. You know, my husband still works. But I'm like, you know, yeah, I'll see you. He has to stay late. It's not the end of the day. So I have the advantage of a full life. I have dear dear friends. You know, and to be able to do something that you enjoy and something that you feel is meaningful. I mean, I don't think it gets better than that. Perry Menopause is not early menopause. It is its own distinct biological phase. And it has been largely ignored. My new book, The New Perry Menopause is about the seven to ten years before your period stop. A transition that is anything but gentle. Hormones fluctuate wildly. And for many women, this is when the anxiety, brain fog, sleep disruption, weight changes, mood shifts, joint pain, and that unsettling feeling of, I don't feel like myself anymore, begin. Long before anyone says the word menopause. Perry Menopause often starts quietly. It shows up in the brain first, then the body, then everywhere else. And too often women are told nothing is wrong. I wrote the new Perry Menopause because you deserve answers before things spiral. You deserve care before burnout. And you deserve a clear roadmap for a transition that medicine has ignored for far too long. The new Perry Menopause is now available for pre-order everywhere books are sold. Learn more and pre-order your copy at thepaslife.com. Why did you write grown women talk? You know it's interesting because that's another one of those detours. I was like, I'm writing a book. Was it your idea or did someone tell you to do it? You know, people have been, there have been a couple people that have asked me to write a book because I've just had such an unusual life. It's part autobiographical. It's part prescriptive. Yeah, I tell stories because I tell stories because it's important to know that what you see and how you deal with people really depends on a lot of where you come from and how you see the world. And there's a lot about the my community and growing up and watching and seeing in real life what healthcare disparities look like, seeing what it looks like, knowing the mindset about why people would not approach a medical professional in the way that is healthy. I get it. You know, I understand that from the ground level. I say from the other side of the table, not just on the doctor side. So it was really part love letters. And that's that was the original title of my book was a love letter to my sisters because I wanted people to understand that I want to give you some health advice, but it comes from a place of love. Not I'm not trying to chastise you. I'm not trying to finger wag. I want you to understand that I do. I see you. I hear you. I understand what the obstacles are and I want you to be able to do better. And honestly, everybody wants to do better. Yeah. They just sometimes they don't know how or to even how approach this how to approach the system because medicine has changed tremendously tremendously in the 30 years that I practice. It was a very different world than than it is now. And the more you know about how to navigate this system, then the better you'll be able to get what you need to get out of it. But we're working on old assumptions and medicine is not the way it used to be. We've talked a lot about the women's health initiative. You were the first person that taught me you and Dr. Blooming and Dr. Tavris at my very first menopause meeting. I remember that all those years ago when I sat in the audience and watched and I was a little bit blindsided by that talk. I had never heard any of those statements that anything had been walked back. And I had religiously done my board recertification every year. And I thought I was good. I read the articles. They put in front of me. I answered the questions. You know, got my A-bog check here after year because they didn't really talk about menopause. They're just now getting questions and articles into our recertification process. Despite 51% of the population going through menopause just briefly because I really feel like you tell the best story. What happened with the WHO? Well, you know, the women's health initiative. You know, very well intentioned study. And what I tried to tell people that there was a different story pre and post. And I had practiced for 10 years before the women's health initiative came out in 2002. And we had a very different story that we were telling about hormone replacement therapy. It had been approved for symptoms of menopause since 1942. So when this study was conceived, we had 50 years of observational data about hormones. And we learned a lot along the way. Some of the things that were done were not correct. You know, it's like, oh, yeah, by the way, we need to add a progestian to estrogen. Don't just give it by itself. So we did learn. And we've learned and adjusted. But the overall message prior to the WHO, was that hormone therapy, relieved the symptoms of menopause. It decreased the risk of cardiovascular disease because we had all of this observational data that said that women who took it did better. So that was a given. Of course, the reason why this study was done, and I am convinced, the only reason why it got the attention and the, well, these, these and why it was done was because that was the first female director of the NIH. See, it matters who's in charge. Yeah. And she was a cardiologist and she said, you know what, we've got this data about hormones and decrease in the risk of heart disease. That's the number one killer of women in this country and people around the world. So if we have a medication that will decrease the risk of cardiovascular disease by 30 to 50%, we should shout it from the mountain tops, but she needed to do the date. She needed the data to be able to say that. So that's where the WHO really came from. It was supposed to be a prevention study. And the primary question it was answering was does indeed hormone therapy decrease the risk of cardiovascular disease as we have observed for the past 50 years? That was the central question. So when they recruited for the study, and it was massive, there were 40,000, yeah, 40,000 women and it was randomized and double-blinded and everything that is, that is the homework of a great study to prove something, right? But here's the problem. If you have a study that's only going to last eight years, and for women in menopause, you start to see the uptick in cardiovascular disease about 10 years after menopause. Well, if you enrolled people at 50, you wouldn't even see them, you wouldn't even see the heart disease. Right. Because it would just be over and you couldn't answer the question. So they intentionally enrolled women who were much older. So you could be anywhere from 50 to 79 and be in this study. But also, if you're going to do a double-blinded study, you can't have women that have a lot of hot flashes because if you had hot flashes, you know whether you got the placebo or whether you got estrogen. So they took, there were symptomatic women. They were much older. I understand why they did it that way. But it skewed the results so much because when they stopped the study about five years into an eight-year study in the women who had estrogen and progestin, what they found was that they didn't see the decrease in the risk of heart disease. And why not? Because if you're 79, you either have heart disease or you don't. It doesn't matter what I give you, it's not going to change that outcome. So they were too old. And the other thing about it, and I think that really the nail in the coffin, they had all of this sort of safety stops. And in addition to not being able to show that decrease in the risk of cardiovascular disease, there was a slight uptick in the risk of breast cancer. And it was really the breast cancer scare that really called all the attention made women stop taking hormone therapy. And you and I've discussed this a million times. But that increase in the risk of breast cancer in real numbers amounted to less than one in a thousand additional cases of breast cancer. Yeah. That sounds a whole lot less scary than a 26% increase with no increase in the risk of dying from breast cancer. Yeah, that press conference with those had lines. Yes. Change the course of women's health for a generation. For generation. And being in practice at that time. Now, I had been prescribing hormones telling women, you know, it's great. And they were feeling great. Oh, and by the way, we knew about the osteoporosis, that it would decrease the risk of osteoporosis, and the symptomatic relief. But when you said breast cancer, our phone, our phones, that mean they lit up like you wouldn't believe. And women stopped taking their hormones overnight. Women who had been doing beautifully on them, they were so afraid of that less than one in a thousand cases per year with no increase in the risk of dying. That fear was so firmly entrenched that they stopped taking their hormones. Dr. Stop prescribing hormones. They stopped. And the residency programs, which I was a director stopped teaching anything really clinically relevant about the nuances of hormone therapy or how to, you know, when to best prescribed. I knew it was there. So it was my chief year, my last year of training, when the study broke. You know what's funny is that when, you know, this is pre-internet and you had to wait, they announced the findings. They announced the conclusion. They said, oh, it doesn't decrease your risk, parties, increases your risk of all these other things, cancer, strokes, it went on and on. The none of which, none of which were statistically significant. And in medical world, if it's not statistically significant, it's not a finding. Yeah, you don't get to say it if it's not, well, you and I understand that. But what I was going to say is that that was so pernicious. And it rebounded around the world. It wasn't just in the United States because the terrible thing was that not only did it disadvantage a generation of women, it disadvantage an entire generation of research. Yeah, because people took the women's health initiative as the definitive word. Look what happens when you study women is what I think women weren't even, you know, managerally involved in clinical trials. So 1993, 94, here we are 98, beginning to recruit for the study. This was huge. We had just started allowing women, forcing women to be in studies. And then we do this big huge billion dollar study and to date it, I think it is the most expensive study the NIH has ever taken on. And they've never done another study on postmanopausal women of that magnitude or nor and still not a perimeter. There's not even anything on the radar. And there were so, there were studies on growing around the world that were halted. Yeah. And that's why the information that we have today. And, you know, and I want to say to be fair, there are things that we did learn from the women's health initiative. Yeah, that were helpful. Safety data, safety data on frailty data. They follow these women for until like they're still following some of the patients. But imagine what the information we would have had had those women who were enrolled in the in the women's health initiative had they continued their hormone therapy. The overwhelming majority of the women who were in the study stopped them because they too were afraid. We would have now 30 years of data. What does it look like for women who've taken hormone therapy continuously for 30 years? We would know so much more about brain health. We would know so much more about cardiovascular disease. But water under the bridge now. But what I want people to understand is that even in real time, at the moment that study came out when we finally got our hands on the study to read it, it was like, well, wait a minute. That's not what it said. That's not what it said. These are older women. They took the information from much older women on average 12 years after menopause and applied it to all women. It matters when you start in terms of how much benefit you're going to get. But to be honest with you, even if you started later, it's still not that much excess harm either. That's the thing about it. Right. People I can't stop after 60. I can't do it for 10 years after and then they stop abruptly. What I want our listeners to understand is that when you stop the hormone therapy, the benefits you were enjoying go away. Your bones will reset into deterioration mode when we take the estrogen away. A lot of women, even after they've taken for 10 years, they will stop their hormones and their hot flashes will come back. So it's not don't think that they've magically disappeared because you've been on, oh, I've taken it for 10 years and my hot flashes are gone. No, I think of it this way. It's like hitting the pause button as we're talking about unpause. And you unpause it when you stop it and guess what? And that process still has to play itself out. So if it's going to take you two years, three years, or however long it takes for your hot flashes to go away, that's when they'll go away. And people are shocked by that. It's like, wait a minute, I thought they were gone. It's like, no, just hit pause. So a lot of women feel like they're done with menopause. Yeah. That there's some kind of a symptom window and that's called menopause, but that's not actually true. You know, I always say you are never done with menopause because menopause is never done with you. And all of the things that are going on between your metabolic changes, what's happening with your bones, what's happening with your heart, all of the aging throughout your body, your brain, your skin, all of it's still happening. And if all you think of menopause is that it's over when your hot flashes stop, or I didn't have hot flashes. So they're poor. I didn't have menopause. Yes, you did. And you still are. And I think that the one message that I really want women to get is this, you know, I want women to have the information that they need. And you can choose to do it or not do it. And I don't want to give anyone the impression here that I think, oh my god, 100% all women need to take hormone therapy. All women should have the opportunity and have the information, right, such that they can make a decision about whether or not this particular medication meets my treatment goals and is in line with what my health goals are for me as I age. That's all I ask. Then you make the decision, but I firmly believe, and have always believed that given good information, women are more than capable of being able to make good decisions for themselves. And whatever you choose is fine with me as long as you're good with that. And to give you an example, Mary Claire, I was talking to a friend of mine yesterday. Okay, yesterday menopause of awareness month. And she is my age. And you are 60. I'm 66. I'm 66. And we've had numerous conversations about HRT. She shouldn't she, her bone density is worsening. She decided to go on. We've had this discussion. She's talked to her doctor. I'm not a doctor. I'm just her friend. Her doctor is like, I agree. She's on it. She went to see an endocrinologist who berated her. This was last week, not 10 years ago. I don't know if you should be on those hormones. That's the part that really distresses me. Why are you speaking about that? Because you're that's a that's very disrespectful to the doctor that prescribed for you first of all. But everybody feels that they can weigh in on this when they don't know what they're talking about. They haven't read the studies. They are subject to the same misinformation. And these are our other colleagues, you know, if our OBGYNs don't know, it's less when you get to primary care when you get to OBGYN. Even cardiologists, endocrinologists, they don't follow our literature. Guess what? I don't follow theirs. So I don't feel as if if a person came to me and they were on an insulin dose, I wouldn't say, well, my goodness, why are you taking that? You should be taking oral. That's not my lane. And this is what I would urge all doctors who are out there who are might be listening to this. If you don't know, I don't blame you for that. But go get educated before you're giving medical advice to patients before you comment. Exactly. I want to know if this is the same for you when you were practicing and with your patients and all the way. When we talk about the longevity conversation, it's, you know, hot, it's all over my social media platforms, heavily, heavily heavily male driven and really in the wellness side of the world. But, you know, even with Peter Atiyan, the MDs who are there, a lot of that data I know was not done on women. But when my patients come into me, especially now, we put out the fire of menopause. We get their symptoms under control to where they can sleep. They can think they can move again. They're not hurting. And then we start kind of looking at the next 30 to 40 years. I don't have a single patient yet, who looks at me and says, I want to live to 120. All right. She has no desire to outlive all of her people, her children. What she wants by and large is to not suffer like her mother did, her grandmother did, her aunt's did. Because when you look at the data when McKenzie published the study, women are living 20% of their lifespan in poor or health. So we can't not age. That's happening to all of us. But when we look at the numbers, including endometriosis and PCOS and all these diseases in us that are understudied, when we look at the end of life, women are much more likely to end up losing their independence for longer periods of time than their male counterparts. And that is driving their healthcare decisions. That is a carrot that will drive a patient is not to have her daughters have to stop their lives to come and take care of mama for a protracted period of time, which is what is happening today. There's many reasons for this. I think WHO is bearing with the osteoporosis point of it. I think we have an epidemic osteoporosis and women being afraid of estrogen is probably part of that. But also the way that women are constantly in service to others and not putting their own health first. So how would you counsel her? She came to you and said, Darjeem alone, I don't want to be in a nursing home like my mom. Well, you know, here's something that when we're talking about the longevity and how you live out the remaining years of your life in poor health, this is where again that the disparity thing rears its ugly head. If you think that women live 20% of their lives in poor health, whatever, it's probably twice that for black women in this country. And for a lot of reasons. And that's because, you know, there's more cardiovascular disease, there's more strokes. And the things that we think that black women are not at risk for, like osteoporosis, the reality is is that, and I read a study that said that for black women who fracture a hip, their outcomes are far worse than their white counterparts. All-timers, dementia, women make up two-thirds of the dementia cases, black women have twice the risk of dementia, this white woman. So that is a huge component of what I want to talk about because, but this conversation needs to be had when you're 40. Yeah. Not when you're 60. That is really the thrust of my book is to say to women, look, there are a lot of things that are in your control. And when you just focus on what the outcomes are, it paints a very negative story because you think that, oh, well, that's just how it is. And even modeling behavior, if all you've seen is your mother get old and frail and be in a nursing home or your grandmother get old and frail, you think that that is the inevitable outcome for you. It is not. And that's the message that I think should be very hopeful. And I think that we should always give women the same basic lifestyle advice that we give all the time. It's not rocket scientists, exercise and eat right and get a good night's sleep. And all the things that you need to do, cut down on alcohol, don't smoke, manage your blood pressure. But there's so many things that we just accept as normal and they shouldn't be. And I think that it gets back to what I talk about a lot. And you've heard me say this. And that is for women, we have accepted suffering as our lot in life. And we suffer through a lot. We suffer through migraines and depression and anxiety and pelvic pain. And the list goes on and on and on where you think we don't even think to complain about it because we have so sort of integrated this suffering model into our existence. You're like one awarded or quietly suffering. You're not hysterically. You're so tall. You're so strong. And I say, you know what? There's no suffering Olympics. You don't get a medal at the end because someone you suffered 20 years and someone else was only suffered 10. How about less not? That's my that's my message. And so for people who try to over complicate things, it's not that complicated. But it requires some effort. And it requires that you start early. Yes, start early. But is it ever too late? No, it's not. But we also have to remove some of the societal barriers that keep people from being able to live their best life. People need help insurance. They need access to a clean, healthy environment. They need to have access to fresh vegetables and whole foods. All of these things that are not deficiencies of the individual. They are deficiencies of the environment that we find ourselves in. And so that's why it requires two things. And I say the little advocacy, which is us, you know, you as an individual going and showing up and knowing how to advocate for yourself. And I talk a lot about that in the book. But there's also the big A advocacy, which is the stuff that we do, which is making sure that our legislators, that the government, that they respond to the needs of women. And we've been woefully underserved. And that's got to change. But now we're at least having the conversation. The first step is always awareness. Yep. And that's what we're doing. And I think that that's what you've done such a phenomenal job about because I mean, and I say this sincerely because I've been saying what I've been saying. And there have been people, Ovarim's been saying what he's been saying. I just say I became a microphone for other people. Jim Simon has been saying this. You know, we have. So it's not like this was unknown. But when you're having a conversation one on one in a doctor's office, it doesn't get out of that space. Right. So social media has been a huge boom. I mean, it opened my eyes because we're in individual exam rooms and say 10 people tell me something, but it's actually happening 10 times 10 times 10. And then social media just allowed those things to be amplified. Right. Good and bad. And then women realizing there's a common experience here. Exactly. For us in shoulder, one of the kind of no one kind of put two and two together. If some people had, but they weren't being heard. Right. I mean, skin, hair, all of it. It's like there's nothing in your body that's not affected by this menopausal transition. And we've spent too much time just talking about the rep. Oh, it's the end of reproduction. Oh, it's the yeah, okay. Well, good news is that no more periods. Yay. Yay. You know, there's some good side of the of menopause. But we've acted as if that's the only part of it that was important. Right. And it's so much more than that. And that we have got to get women to understand it. And and not that we are looking for a fountain of youth. This is not feminine forever. Why don't you take hormones so you can be sexually attractive to your husband. That's not why we're doing it. We're doing this because we want to be our best selves as we age. What do you tell a woman who's been dismissed or ignored by her doctors? Well, you know, this is where I say speak up. But it requires you to have the good information when you walk into a doctor's office. And that's why my podcast is called the second opinion and it's called the second opinion because if someone is telling you something, a doctor, first off, the assumption is the doctor knows everything. They don't and they certainly don't know everything about you. You are the expert of you. They maybe have expertise in more than thing. But what we forget is that there are a lot of things in medicine that are opinions. We are all sort of looking at some data, some of which is definitive. Some is not. Some is up for interpretation. And we get opinions. That's why I say get one. If someone tells you something or someone denies you something that you think you need. And that's one of the things that really gets my goat about hormone therapy is that people will go in to see their doctor. They're educated. They listen to your podcast. They listen to a lecture or something I've done. And they're like, okay, great. I want that. And you go to your doctor and you have the experience that my friends had had last week. You can't have it. You can't have it or you're on it and you should get off it because it's dangerous. Well, this is where you know, I think access is so important. We've got to use technology. We've got to use innovation. That's why alloy and digital health because it allows us to give this information to many. It's a speed ramp. Yes. For us to go through the traditional system, my daughter's in medical school. And she's getting more than I did, but it's still not a lot. Right. And the current curriculum for OBGYN does not include a robust clinically relevant menoboss curriculum as of yet. We're getting there. But even then we start. So say in 2026, we start graduating everyone with PhDs and menoboss. It's still going to take an entire generation for all of that to filter down and for guidelines to change. So digital health is really taking that control. Seeing we've got about 20 years before the rest of how much sin is is given catches up. Right. And I think that it's required of those in power and those in charge of medical education. We've done this before. When I say we've done this before, OBGYN used to be just OBGYN. And now we have we have minimally invasive surgery. All the different subspecialties. Yeah. We have subset. We have reproductive endocrinology, which does fertility. We have high risk OB, all of which because we've understand that OBGYN is too much. Right. It's too broad. We're asking doctors on any given day. You need to be a surgeon. You need to be a psychiatrist, a counselor. You need to be a social worker. You need to do, I mean, it's too a primary care doctor. It's too much. And I think that it is probably past time that we realize that if women are going to spend 30 to 40% of their lives in their post reproductive years, then maybe we need a specialty that is just that that deals with women in midlife. And not when they're having babies and not because it's too much. And it's you're pulled in too many directions. And like I said, it's you would never ask a doctor to say, what do you do? Oh, I'm a man doctor. I just do I just do men, men things. No, you have a cardiologist. You have all these different things because that's what you need, right? But we have asked OBGYNs. You just be the, you just be the lady doctor. Anything that that woman needs from puberty to death, you're supposed to know how to take care of it. I think that's asking. And I just think the medical system assumed it's not that complicated. Right. So, but it is very, very, very complicated. You see, they're not that complicated or nothing we can do about that. Right. So women being women. I met someone who is a liaison for the ACGME, which is who decides the medical school curriculums. And she brought up menopause. Like, where's the menopause curriculum? And they said, oh, we just don't have enough information. And that person is no longer sitting who said that. But at the time, when she first got there in her first year, that was the prevailing thought, the people who control the medical school curriculums for alopathic MD schools. There just wasn't enough. We don't know enough about menopause to really, you know, give it much time in medical school. And we know better when I was doing the research for my book. And I'm sure it's worse now. But, you know, I have the 20, 22 numbers, $45 billion in medical research, less than 11% of that went to conditions that affect women. And that's my grains. That's autoimmune diseases. It's depression. It's anxiety. All of these things. And we get less than 11% of that budget because the assumption is, well, that's just women. Yeah, that's all underhand. Yeah, that's just what women, you know, whatever, or it's complicated. And that's why women were kept out of studies for so long because they didn't like the idea that one, that you were just a vessel for reproduction. And we don't want to do anything. They'll give you any medication that would that would interfere with your ability to reproduce. Okay, I get that. That was from the philidamide studies back in the 60s. But the other thing is that they don't take into account the physiology of women that is different than the physiology of men. And yes, it involves our hormones. And they look at that not as a feature, but as a bug in the system. So they're like, no, that will just mess up all the things. If I have to deal with the fact that you're a pre-menstrual or you're, you know, or where you are in your menstrual cycle and where your hormones and that plays very importantly in how we react to things, even for heart disease. Right. Even for how we, how we respond to statins versus how men respond to statins. You're preaching to the choir. Different. Totally different. Different. But we want to act as if, well, we did it on men. So it worked for them. So it must work for you. And they're still, unfortunately, too much of that because even though they mandated that women be included, a lot of times the data isn't disaggregated. Right. And disaggregated means they just report the general results, but they don't say, well, how did the women do versus how did the men do? And when they looked at those top four statins studies, the statins and the female patients did not prevent a primary heart attack. The cholesterol went down, but turns out women's risk of heart disease or why we have heart attacks and how that mechanism goes is different than men. And it's complicated. And you know you and I both are on the same page of this because when we start talking about hormone therapy and prevention of heart disease, I don't know what the major resistance is to saying that because guess what hormone therapy does? It does the same favorable things to your cholesterol profile that a statin does. And what's the combination of the two like? Maybe that's better than either of them alone. Where's that study? Exactly. So the establishment, I'm just going to call it the establishment. The establishment. Okay. The establishment, people who make guidelines and are in, you know, on committees and things. It's very clear and I are anti-establishment. First, seemed like they were loving all of the attention that the menopause press was getting. People were suddenly joining these organizations in droves, really. You've seen doubling, tripling, and that's great. You know, menopause is becoming a household name, talked about a lot of curiosity, a lot of clinicians wanting to learn, but it feels like after that initial wave, there is a wait a minute. Hold on. We haven't decided what the right messaging is. How do you, or you prepare to talk about that? Well, you know what? Change is always difficult for people, you know, and I think it requires a lot because I'm going to put myself, you and I are, you know, just medically a different generation. And 10 years is a big difference when it comes to how I was trained versus how you were trained. And so a lot of these people are 10 years, some of them even ahead of me. Oh, yeah. So they're very entrenched and they have been, I guess, sort of, they don't like upstarts, they like higher article stuff. And so when someone says something, if you want to have a debate about it, let's have a debate about it. But again, these are things that you, you and we're all looking at the same data. And you came to one conclusion, I come to another, who's right and who's wrong? I will not name any names or any societies. But I can say generally being sort of in the middle of those two, I think that the medical establishment owes this generation, your generation, a debt of gratitude for elevating these conversations because this is how we're going to get more attention. This is how we're going to get legislation passed. They had how much time did you have to get that done? And where are we? Okay. We're where we were. So you know what I mean, there should be some way that we could come together without people having to say, I'm right, you're wrong or you can't say that. Well, you know, as far as I'm concerned, it's still America. I can say what I want. That's the beauty of second opinions. Yeah. Doctors don't always agree. They're not always right. So you know what you as the educated consumer can look at it and say, either that makes sense to me or it doesn't make sense to me. And you do what you think. When no one's asking you to be the expert of anybody other than what you want and what your treatment goals are and how to best achieve that, sometimes you're going to get different opinions. So if you had a magic wand right now, and would pick three things that would really make a difference. You've got a 40-year-old and she's like, give me top three things that that can help me live my best health, my best life. I used to have these conversations and it's so it's so funny because every now and then I'll run into a patient of mine and she'll say, you know what, Dr. Mullen, you said that. You told me that. And it's this prevention is way better than trying to fix it. I agree. In case. So I would tell my patients who were in their late 30s and early 40s and we would literally have this conversation. I'd say, I'm just going to give you heads up here. I said, you're 40. I know you're great and you're cute and they're best. They're things good. I said between 40 and 50. I said, you will gain on average 10 to 15 pounds. If you do exactly what you're doing right now, you're not overeating, you're not underdoing anything but whatever I'm just saying, whether it's metabolism changes, whether it is the perimenopause or the menopausal transition, that's the normal course of things. Okay. And I said, so if you want that to not happen, then I'm just telling you now these are the things you can do. You've got to change your diet a bit, you've got to exercise more, you've got to manage to that expectation. Don't come in after you've gained 20 pounds and say, oh my god, how are we going to lose it? I'm telling you now, so you have the opportunity. It's far easier to not gain a pound a year than to lose 10 pounds 10 years later. 10 years later. So what I call anticipatory guidance, these are the kinds of things. Make sure you know what your family history is. So you know what things not that you're going to get, but what things you may be susceptible to. I have a family history of breast cancer. I have two sisters who've had breast cancer. So you know what? I screen a little bit differently than someone who doesn't have that family history. I'm making sure that I'm on top of my colonoscopy because my mother died of colon cancer. I want you to know that these are the things that are within your control and don't wait for something to happen to you. I want to make sure that they have the conversation about hormone therapy. So they know what the issues are and what things to expect. And if you have them, when to get treatment, and that's that other little persistent myth that you have to wait and suffer a while before you can get treatment, now you get treatment when you get them. If I have to say my messages are all focusing on prevention and talking about things ahead of time. And I think that regardless of what they choose, people are much more responsive to that message because they're not afraid. They're not afraid when they get brain fog that they think, oh my god, my mother had Alzheimer's. I'm on the road to dementia. No, you're not. It's a calming experience just to know, oh, okay, this is normal. And it may be normal. It may be common, but it doesn't mean that you have to live with it either. Now for a midi pause, sponsored by Midi Health. We've all heard it before. Exercise is good for you. But what it really is is a celebration of what your body can do. And when you dig into the science, especially for women in midlife and men of pause, it's not just good for you. It's transformative. Let's start with the basics. As estrogen declines, we naturally lose muscle and gain fat. That means our metabolism slows down even if we're eating the same. But here's the good news. You can take control. Regular resistance training, lifting weights, using resistance bands, or even body weight movements can actually reverse that trend. Helping rebuild muscle, burn more fat, and feel stronger than ever. Exercise also protects your bones. Weight bearing movement is one of the best defenses that we have against osteoporosis. It helps keep your joints lubricated, reduces pain, and even improves posture and flexibility. And let's talk about mood and sleep. Two things that get disrupted during men of pause, but regular physical activity boosts our serotonin, dopamine, and endorphins, helping you sleep better, think clearer, and feel more like you. So yes, exercise is good for you. It is one of the most powerful, evidence-based ways we have to support your body, your mind, and your future. So if you're wondering where to start, just start moving, and find something you love to do. Walk, lift weights, dance around your living room, stretch, take a yoga class, whatever keeps you moving consistently, three to five times a week. Because exercise isn't a punishment for aging. I'll say it again. It's a celebration of what your body can still do, and a promise to keep doing it for years to come. Because men of pause isn't the end of strength. It's the beginning of a stronger So recently you spoke at the American College, Vobici, YN, at their national meeting, and that was your biggest audience outside of being on TV. What was that like? It was actually very good, because you know what I talked about. I talked about the historical disparities in health care. And I think when we talk about disparities, particularly when it comes to Black and Brown people in this country, we focus so much of the conversation around maternal mortality, which is important. It is important. However, that's a small portion of what the disparity conversation ought to be. It persists from cradle to grave. And we have to talk about and address again some of these societal issues and things that we can that are outside the control of the patient. Because I think that when we have the disparity conversation and we look at it and we say, oh, Black people have two times the risk of this, three times the risk of that. And whatever, it gets back to the same thing that we talked about like with women, we just go, oh, well, that's just women. And there's a we blame the individual. And if we say, if you would just stop doing that, oh, Black women, if you would just stop perming your hair, if you would stop being so fat, if you would stop being any number of things that we blame people for. And this is where we get back and we'll be off on a tangent here. But just the whole obesity is a problem in this country. Okay. Do we have GLP ones now? But who's going to have access to GLP ones? That's a disparity issue. That's a health issue. And now we have a treatment. And the thing that I want people to be aware of is that when it comes to health outcomes, when things are bad across the board, you're equally affected. The disparity gets wider when the treatment options get better. Do you see? Because now we have a treatment. So one group of people is going to do better, but the people who can't get it are not. It was three times. Now it's five times. So my kids have this meme that they sent around. And it was before and after photos, usually of celebrities. And the title always goes, you're not you're just poor. And it's showing some plastic surgery and stuff. Now that you're not fat, you're just poor. Because they don't have access to the GLP ones. That is definitely an access problem. Stop blaming women. Stop blaming poor people. And the answer to that ought to be not what are you doing? That's so problematic. But the question ought to be, what are we doing to you because where you live, what your zip code is is more determinative of your health outcomes than what your genetic code is. So we want to keep blaming people. It's like, well, I have a family history of stroke and high blood pressure. And I'm like, duh, find me a black person in America who doesn't have a family history of that. What's the historical context? Why is it that the, you know, are you able to pay for your medication? Do you have any concerns? Do you have access to a clinician? Do you have a community clinic versus what do you live? You don't have a grocery store that you can get to. You don't have safe outdoor space. These are fixable problems. And we want to say, you know, we're trying to look for a genetic basis for things that really are environmental. Yeah. So we talk about second opinions. I tell you, I in my training was never taught to suggest a patient got a second opinion. I was taught to tell them what you think is best. And that is it. If they choose to get a second opinion, that's fine. But I was never taught. And I have the words of come out of my mouth, but not that often where, listen, you should go talk to someone else and see what they think. One in five people who have been advised to get a second opinion actually do it. Do you feel like this would be another leverage point for people, especially in menopause care? I mean, they're being told diametrically opposed things. Yeah. For me versus their chronologist, like your girlfriend, for me and their OBGYN who delivered their babies and did great care. And I was that doctor who heard the headlines, read the guidelines and practiced that way. And never would have thought to tell someone to get a second opinion for hormone therapy. Why? You know, it's going to give you a breast cancer. There's a couple of reasons why I think that we don't suggest second opinions. And one is because, you know, doctors think they know everything. They really do. And my opinion is always superior to anyone else's opinion. But here's where I think a little humility needs to be involved here. Know what you know and know what you don't know. And don't let those two cross very often. Because I would have patients, you know, I there are things that I actually do know, you know, if someone came to me and they said, do I need to have a hysterectomy or do I need to have a my make me? I'm very clear about what the answer should be. And that's the other thing. I was never hesitant to give my opinion about it because they had gone to another doctor. And the doctor said, you need to do blah blah blah. And they would come to me for a second opinion. And I'd say, well, I wouldn't do it that way. And this is why. And when patients weren't really clear or they weren't sure about what I was saying, I would say, you know what? I think you should get a second opinion because one, maybe I'm not right. But more importantly, I want you to be comfortable with what I said. Because usually what I'm saying is that there may be one out of 10 people that don't agree with it, but none out of 10 will. So that sort of, I think instills some confidence in your patients because I don't want you to do, you're not going to hurt my feelings if you go get a second opinion. And as a matter of fact, knowing what you don't know, like even with surgery, I mean, surgery in gynecology has become so much more complicated than it used to be. And I would say, you know what? I don't do that. I don't do that. That type of procedure. I'm going to send you to somebody who knows how to do that. Who had done mentally invasive and you robot. I don't see. I don't know how to do. You know, they've made some new equipment since the last time I did this. Go do that with someone else. So that's why I said, don't be afraid. And don't be certainly don't be afraid of hurting your doctor's feelings. I said, if your doctor's offended because you get a second opinion, then they're clearly not confident in what they said. So I'm like, go do it. So you change careers, you know, from bedside to digital. Mm-hmm. Pretty exciting. At alloy. At the age of 62. What would you tell another woman who's in her 60s and thinking, should I do this? Should I make this big career change? We have a lot of people in our world who have made career pivots at this point. And I would say, do not think that your life is over professionally. He is to be able to be, to feel well enough and have the energy and stamina to do it. So if you're healthy and you're good and you want to try it, as I said, I've never been smarter. Yeah. I've never had more wisdom and judgment than I have right at this moment. So yes, I think that we have to get society to catch up with us. So to not put women in a corner somewhere and think that, you know, oh, that a 20-year-old can do or knows what I know. They don't. You know, and I think that the more role models that they see, and that's the good news because we, I mean, look at the women that we know, Michelle Obama, Naomi Watts. I mean, I can think of all the beautiful, wonderful women who have done things and changed and pivoted and done other things and they are happy and productive. And when people see that, that being over 50 is not the end of your life. It may be the end of one part of your life, but you're on to bigger and better things. And don't let anyone tell you that that's the time of decline or sitting in a corner. No, we're out there. Now's the time to step into it. So, men of pause often feels like society wants us to hit pause. So you personally, what have you decided to unpause for yourself at this time of your life? The thing that I love about being this age is that you're freed from so many of the other societal, you know, I wear what I want to wear. I'm comfortable. I'm not saying this to say that from a sexist point of view, but you're free from not only the male gaze, but you're free from society's gaze. It's like, I don't really care. You know, when you're younger, you care about how do people say, oh, I don't know, what does my aunt look like? What does my hair look like? I think that's the best part of men of course. Yes, is that my filter's gone, my give-a-care factor's gone. I usually call it something else. I'm just like here, I'm present, I'm going to say it, I'm going to do it. I'm not going to worry about it. My children are grown, whoever they're going to be, they are. You know, I have no more influence over that. It's like whatever it is that cake is baked. And I think I did okay. I have, you know, three productive adult children. And you always worry about them, but I'm not worrying about them in the sense that I think I'm going to change who they are and make them into somebody else. That's freeing. You're at a different point in your relationship. I think that the partner that you're with, is either good or it's not, but you've weathered all that stuff along the way. And my husband and I look at each other and it's funny because I said, you know what, there are many times along the way that I'm not sure how this is going to work out. I said, but I said, we got over that. And now I'm like, too late. Sorry, we all had an ex-girlfriend that is now closed. We're sorry, dear. You're stuck forever now. We're there. We're not going anywhere. We're not arguing about those things that used to, you know, keep your part. But I really say that the key to it all is feeling true to yourself, feeling productive. That is why the work that I do with alloy is giving women access. And I do it not from the standpoint of, oh my goodness, I'm really not trying to sell you anything other than information. And then you do with that because we've got to be in the world of social media where you're bombarded with everything. You've got to be, all I want to be in this space is a trusted source where you can say, I'm 66 years old, I'm not coming in because I'm imagining that I'm going to have another career when I'm 76. Maybe I will, maybe I won't. But that's not the goal. The goal is now I get to step back and say, I want to do the things that feel true and good to me. And that in a way that hopefully I can be in service to others. And if I can do that, then I think I've done a good job. Well, thank you for sharing your wisdom with us today on Unposed. It was so awesome. It's always a pleasure. Always a pleasure. And like I said, thank you for doing what you do because as long as you keep talking and women keep hearing it, then I think that we have done what we need to do. And I think that, you know, we're all the better for it. Thank you. You are. As a reminder to our audience, you can follow Dr. Malone on Instagram at S Malone MD and catch her new podcast, the second opinion with Dr. Sharon wherever you get your podcasts. Also her book, Grown Woman Talk, Your Guide to Getting and Staying Healthy is available on Amazon. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness and navigating midlife at the pauselife.com. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unposed is presented by Odyssey and can judge them with pod people. I'm your host Dr. Mary Claire Haver. My new book, The New Perry Metapause, is available for pre-order everywhere you buy books. The views and opinions expressed on unposed are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis or treatment.