
2/13/25 Understanding Menopause
Season 2025 Episode 5 | 56m 56sVideo has Closed Captions
Menopause is a natural, yet misunderstood and rarely talked about, part of a woman’s life.
Menopause is a natural part of a woman’s life. It is accompanied by a range of symptoms including hot flashes, mood swings and even hysteria. It is misunderstood and rarely talked about which can lead to a perceived void of information, support and care.
Insights on PBS Hawaiʻi is a local public television program presented by PBS Hawai'i

2/13/25 Understanding Menopause
Season 2025 Episode 5 | 56m 56sVideo has Closed Captions
Menopause is a natural part of a woman’s life. It is accompanied by a range of symptoms including hot flashes, mood swings and even hysteria. It is misunderstood and rarely talked about which can lead to a perceived void of information, support and care.
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Learn Moreabout PBS online sponsorship>> FROM HOT FLASHES TO MOOD SWINGS TO HYSTERIA.
MENOPAUSE IS OFTEN MISUNDERSTOOD AND GETS A BAD RAP.
IT'S A NATURAL PART OF A WOMAN'S LIFE AND CAN BE ACCOMPANIED BY A RANGE OF SYMPTOMS.
BUT WITH THE STIGMA ATTACHED TO IT, MANY WOMEN ARE IN THE DARK WHEN IT COMES TO INFORMATION, SUPPORT AND MEDICAL CARE.
WE'RE BRINGING THE MENOPAUSE CONVERSATION OUT OF THE SHADOWS.
TONIGHT'S LIVE BROADCAST AND LIVESTREAM OF INSIGHTS ON PBS HAWAI'I START NOW.
∂∂ >> Yunji: ALOHA AND WELCOME TO INSIGHTS ON PBS HAWAII...I'M YUNJI DE NIES.
THE CHANGE.
THE PAUSE.
THE BIG M. WHATEVER NICKNAME YOU MAY HAVE FOR MENOPAUSEÖ IT'S A NATURAL CYCLE OF LIFE.
MENOPAUSE OCCURS WHEN A WOMAN'S MENSTRUAL PERIOD STOPS FOR GOOD AND SHE CAN NO LONGER GET PREGNANT.
BUT MENOPAUSE IS MORE THAN JUST THE END OF MENSTRUATION.
THE HORMONAL CHANGES CAN AFFECT A WOMAN'S PHYSICAL, EMOTIONAL AND MENTAL HEALTH.
FOR DECADES, MENOPAUSE HAS BEEN SHROUDED IN SHAME, DESPITE THE FACT THAT NEARLY 2-MILLION WOMEN IN THE U.S. WILL REACH MENOPAUSE EACH YEAR.
TONIGHT, WE'RE TACKLING THE ISSUE OF MENOPAUSE TAKING IT FROM TABOO TO TREATMENT.
WE LOOK FORWARD TO YOUR PARTICIPATION IN TONIGHT'S SHOW.
YOU CAN EMAIL OR CALL IN YOUR QUESTIONS.
AND YOU'LL FIND A LIVE STREAM OF THIS PROGRAM AT PBSHAWAII.ORG AND THE PBS HAWAII YOUTUBE PAGE.
NOW TO OUR GUESTS.
DR. MELISSA LAWRENCE IS AN OBSTETRICS AND GYNECOLOGY PHYSICIAN.
SHE'S BEEN AT KAISER PERMANENTE FOR MORE THAN TWO DECADES AFTER COMPLETING HER EDUCATION AT THE JOHN A. BURNS SCHOOL OF MEDICINE AND HER OBGYN RESIDENCY AT THE UNIVERSITY OF HAWAII.
DR. SARAH CANYON IS A PRIMARY CARE PHYSICIAN WITH BOARD CERTIFICATIONS IN FAMILY MEDICINE AND LIFESTYLE MEDICINE.
SHE IS THE FOUNDER, CEO AND MEDICAL DIRECTOR OF BOTH CANYON PRIMARY CARE AND OLAKINO CENTER FOR LIFESTYLE MEDICINE IN KAILUA.
DR. EMILY GOULET IS A REPRODUCTIVE ENDOCRINOLOGIST AND INFERTILITY SPECIALIST WHO PRACTICES AT THE FERTILITY INSTITUTE OF HAWAII.
HER PAST RESEARCH CENTERED ON HOW MENOPAUSE AFFECTS HORMONES IN THE BRAIN, WITH PARTICULAR ATTENTION TO SLEEP AND THE CIRCADIAN RHYTHM.
AND DR. LEIGHANN FRATTARELLI IS A GYNECOLOGIST WHO HAS BEEN SEEING MENOPAUSAL AND PERIMENOPAUSAL PATIENTS FOR MORE THAN 25 YEARS.
SHE BELIEVES BETTER EDUCATION FOR PROVIDERS AND PATIENTS IS THE MOST IMPORTANT STEP TOWARDS A HEALTHY AND HAPPY MENOPAUSAL TRANSITION.
THANK YOU ALL FOR BEING HERE TONIGHT, DOCTORS.
I'M SO EXCITED ABOUT THIS CONVERSATION.
DR. FRATTARELLI, I WANT TO START WITH YOU.
WE BRIEFLY DESCRIBED WHAT MENOPAUSE IS AT THE START OF THE PROGRAM.
CAN YOU TELL US MORE WHAT ACTUALLY HAPPENS TO A WOMAN'S BODY WHEN SHE STARTS MENOPAUSE.
>> STARTING MENOPAUSE FOR MOST PEOPLE, MEANS ENTERING THE PERIMENOPAUSAL PHASE.
OVARIES BECOME OLDER.
EGGS DON'T COME OUT REGULARLY.
AND HORMONE LEVELS CAN VARY WIDELY.
THAT HAPPENS ANYWHERE BETWEEN TWO AND TEN YEARS BEFORE THE FINAL MENSTRUAL PERIOD.
SO PEOPLE SAY MENOPAUSE, THEY OFTEN ARE MEANING THE TIME -- THAT WHOLE PERIOD OF TIME.
WE HAVE THE PERIMENOPAUSE AND MENOPAUSE, WHICH IS EXACTLY 12 MONTHS AFTER THE FINAL MENSTRUAL PERIOD AND AFTER THAT, WE HAVE OFTEN CALLED POSTMENOPAUSE.
OVARIES ARE NO LONGER WORKING AND WE'RE NO LONGER GETTING THE ESTROGEN WE HAD IN OUR YOUNGER YEARS.
REPRODUCTIVE YEARS.
>> Yunji: TWO TO TEN YEARS FOR PERIMENOPAUSE.
THAT'S AN AWFULLY LONG TIME.
WE'RE GOING TO INTO SOME OF THE SYMPTOM, BUT DR. LAWRENCE, WHAT AGE DOES THIS START TO HAPPEN IN WOMEN?
WHAT DO YOU SEE IN YOUR PATIENTS WHEN THEY START TO ENTER FIRST THE PERIMENOPAUSE AND THEN MENOPAUSE CYCLE?
>> SO THE AVERAGE AGE FOR MENOPAUSE IN OUR COUNTRY IS 50, 51.
SO FOR A FEW YEARS PRIOR TO THAT, FIRST THING YOU'LL NOTICE IS CHANGES IN YOUR MENSTRUAL CYCLE.
AND OFTENTIMES THEY'LL BE ASSOCIATED WITH OTHER SYMPTOMS LIKE HOT FLASHES AND NIGHT SWEATS AND MOOD CHANGES AND THINGS LIKE THAT.
AND YOUR MENSTURAL CYCLES WITH PHASE OUT AND STOP.
IF YOU GO A WHOLE YEAR WITH NO MENSTURAL BLEEDING, YOU'RE IN MENOPAUSE.
>> Yunji: DR. GOULET, CAN YOU TELL US A LITTLE BIT ABOUT THAT PERIMENOPAUSAL CYCLE.
WHAT DO YOU SEE AS THE INITIAL SYMPTOMS THAT PEOPLE START TO REPORT.
HOW DO YOU DIFFERENTIATE BETWEEN BEING A HARD-WORKING WOMAN, MAYBE A MOTHER WHO'S VERY BUSY AND TIRED FROM RAISING CHILDREN AND ACTUALLY BEING IN PERIMENOPAUSE.
>> THE TEXTBOOK DEFINITION WOULD BE CYCLE IRREGULARITIES.
BUT IN THAT TRANSITION, BECAUSE OF THE HORMONE FLUCTUATIONS WE OFTEN GET OTHER SYMPTOMS INCLUDING HOT FLASHES, NIGHT SWEATS INCLUDING MOOD CHANGES, WHICH COULD MEAN DEPRESSION, ANXIETY, ESPECIALLY IF YOU HAD A HISTORY OF THAT BEFORE.
WE SEE AN INCREASE IN MEMORY PROBLEMS, IN SLEEP DISTURBANCES.
THE TRANSITION OF MENOPAUSE IS OFTEN ASSOCIATED WITH LOT OF CHANGES IN THE PHYSICAL BODY AS WELL AS MENTAL BRAIN.
>> Yunji: AND HOW CAN WE DISTINGUISH WHAT'S HAPPENING TO US?
I'M 46.
I HAVE TWO KIDS.
I KNOW THAT I'M VERY BUSY.
HOW DO I KNOW THAT THIS IS PERIMENOPAUSE AND THIS IS JUST BEING A TIRED MOM?
>> I THINK THERE'S A -- DIAGRAM.
THERE'S A LOT OF OVERLAP.
AND CERTAINLY LOOKING AT OUR LIFESTYLE AND OPTIMIZING THE THINGS THAT WE KNOW HOW TO AND WE CAN OPTIMIZE IS ONE WAY WE CAN IMPROVE THINGS.
HORMONE AND HORMONE THERAPY IS MISLABELED AS FOUNTAIN OF YOUTH OR CURE ALL, BUT I'M NOT GOING TO BE ABLE TO REVERSE AGING.
THAT'S NOT SOMETHING THAT WE HAVE THE ABILITY TO DO.
>> Yunji: DR. CANYON, LET'S TALK ABOUT WHAT WE CAN DO IF WE'RE EXPERIENCING THESE SYMPTOMS.
WHAT ARE SOME TREATMENTS THAT ARE OUT THERE?
>> THERE'S A WHOLE VARIETY.
THERE'S NO ONE SIZE FITS ALL, I THINK.
THAT'S A VERY IMPORTANT TAKE HOME MESSAGE.
BECAUSE AS YOU'VE HEARD, THE RANGE OF SYMPTOMS COULD BE ATTRIBUTABLE TO PERIMENOPAUSE OR LIFESTYLE OR PRESSURES IN THEIR LIFE IS QUITE WIDE.
AND SO WHEN IT COMES TO THIS STAGE OF LIFE, I THINK THE IMPORTANT THING IS TO FIND OUT WHAT IS MOST IMPORTANT TO THE PERSON BEFORE YOU.
AND WORK FROM THERE.
SO IF AT THE TIME THAT THEY SEE YOU, THEY'RE REPORTING VASOMOTOR SYMPTOMS OR HOT FLASHES AND THAT'S DISTURBING THEIR SLEEP.
THAT'S CAUSING THEM TO NOT PERFORM TO THEIR OPTIMUM THE NEXT DAY, THEN SURE, HORMONE THERAPIES MIGHT BY THE ANSWER AND ESTROGEN IS TYPICALLY WHAT WE ASSOCIATE OR HAS THE STRONG EVIDENCE FOR ADDRESSING THAT.
IF YOU HAVE A WOMAN HAVING SYMPTOMS THAT MAY BE MORE, LET'S SAY IRRITABILITY, ANXIETY, MOOD SWINGS.
WELL, HORMONE THERAPY MAY BE INAPPROPRIATE.
THERE ARE OTHER OPTIONS, TOO, FOR SOMEONE WHO DOESN'T WANT TO GO DOWN THE HORMONE PATHWAY.
SO SOME MEDICATIONS THAT ARE KNOWN TO BE ANTIDEPRESSANTS OR ANTIANXIETY MEDICATIONS DO HAVE A PLACE, A VERY GOOD PLACE IN THIS TIME OF LIFE.
SO THOSE ARE SOME OF THE PRESCRIBED MEDICATIONS, BUT WHAT ALSO COMES TO MIND IS THERE A NATURAL THERAPIES WHERE WE HAVE LIMITED EVIDENCE THAT SOME WOMEN MIGHT WANT TO TRY, TOO.
AND THERE'S LIFESTYLE TREATMENTS, TOO, WHICH IS MY GREATEST PASSION.
>> Yunji: TELL US ABOUT SOME OF THOSE.
IF YOU DON'T NECESSARILY WANT TO GO DOWN THE PRESCRIPTIVE ROUTE.
COULD IT BE DIET, COULD IT BE SLEEP, COULD IT BE EXERCISE.
WHAT WOULD YOU SUGGEST?
>> ABSOLUTELY.
THE CLEANEST DIET THAT YOU CAN HAVE IS GOING TO BE BENEFICIAL FOR THE SYMPTOMS THAT YOU MAY EXPERIENCE IN PERIMENOPAUSE.
WHAT I MEAN IS AVOIDING PROCESSED OR ULTRA-PROCESSED FOOD FOR A GOOD REASON.
WE HAVE VERY STRONG EVIDENCE THAT EATING WHOLE FOOD PLANT-BASED DIET.
WE'RE TALKING FOODS THAT YOU CAN RECOGNIZE AS COMING FROM THE EARTH.
GOOD OLD-FASHIONED FRUITS, VEGETABLES, GRAINS, NUTS, LEGUMES.
THERE HAVE BEEN STUDIES HAVE SHOWN EATING IN THIS MANNER MAY DECREASE YOUR VASOMOTOR SYMPTOMS, IMPROVE SLEEP, AS WELL AS GETTING ADEQUATE EXERCISE.
THERE'S WONDERFUL STUDIES ON HOW EXERCISE IMPACTS ANXIETY.
ANXIETY IS SOMETHING THAT WE SEE A LOT IN THE PERIMENOPAUSE PERIOD, WHICH IS RELATED TO HOMICIDE FLUCTUATIONS.
BUT THESE ARE THINGS THAT YOU CAN DO WITHOUT HAVING TO TAKE MEDICATION.
ADEQUATE EXERCISE, SLEEP, CHALLENGING FOR ALL OF US.
WE LIVE IN A DARK, DEPRIVED SOCIETY.
AND STRESS MANAGEMENT IS SOMETHING THAT WE CAN ALL LEARN TO DO BETTER.
WHAT I'M SAYING HERE, I'M SAYING THE PILLARS OF LIFESTYLE MEDICINES, WHICH ARE NUTRITION, STRESS MANAGEMENT, SLEEP AND SOCIAL CONNECTIONS, WHICH IS A VERY IMPORTANT THING THAT I THINK WHAT HAPPENS IN THE PERIMENOPAUSE, MENOPAUSE PERIOD.
BECAUSE WE HAVEN'T BEEN TALKING ABOUT IT, BECAUSE HAVEN'T BEEN FORTHRIGHT, WE'RE MAYBE NOT REACHING OUT TO OUR PEERS ABOUT THAT.
SO WOMEN BECOME ISOLATED AT THIS TIME.
I SEE A LOT OF WOMEN IN MY PRIMARY CARE PRACTICE WHO EVEN FEEL SHAME THAT THEY PUT ON WEIGHT.
WEIGHT CHANGES WHEN WE START TO LOSE OUR HORMONES.
BELLY FAT DEVELOPS.
HOW THE DISTRIBUTION OF WEIGHT IN OUR BODIES CHANGES.
SO WOMEN BECOME ISOLATED AND THEY FEEL ASHAMED OF THESE CHANGES IN THEIR BODIES.
IT'S REALLY SAD.
>> Yunji: DR. FRATTARELLI, YOU'VE BEEN HELPING PATIENTS WITH THIS FOR SOME TIME.
HOW DO YOU THINK CONVERSATION AROUND MENOPAUSE CHANGED?
WHAT ARE SOME MISCONCEPTIONS WE STILL HAVE ABOUT THIS?
>> WELL, MANY -- LIKE, EARLY ON, HORMONES WERE KIND OF PROMOTED AS SOMETHING THAT'S GOOD FOR EVERYONE.
AND THAT WOULD MAKE WOMEN MORE SEXY AND THEN THEY STARTED TRYING TO USE IT FOR PREVENTION OF HEART DISEASE, AND WE THOUGHT IT WAS BETTER FOR THE BRAIN AND HEART.
AND BE THE LARGEST STUDY EVER DONE, THE W.H.I.
STUDY CAME OUT.
IT WAS A RANDOMIZED CONTROLLED STUDY.
GREAT PLAN, NOT THE RIGHT POPULATION.
NOT LOOKING AT THE RIGHT THINGS.
BUT WHEN THE STUDY RESULTS CAME OUT IN THE EARLY '90s, IT DID SHOW IN THIS ONE STUDY, AN INCREASED RISK OF BREAST CANCER AND AN INCREASED RISK OF HEART DISEASE FOR WOMEN TAKING HORMONES AND THE CONVERSATION STOPPED.
PEOPLE WENT OFF HORMONES AND PRETTY MUCH STOPPED TALKING ABOUT IT.
AND FINALLY, WE'RE REALIZING THAT EVEN THAT BIG, WONDERFUL STUDY THAT WAS DONE, WE KIND OF RELOOKED AT IT AND LOOKED AT THE APPROPRIATE AGE GROUP.
THE WOMEN WHO WERE HAVING SYMPTOMS, WE LOOKED AT IT AND REALIZED WE WERE USING DIFFERENT FORMULATIONS, AND THERE WERE SOME BIG CHAMPIONS FOR NOT SAYING NO TO HORMONES AND TALKING ABOUT THE MENOPAUSAL TRANSITION.
AND NOW THE PENDULUM IS SWINGING THE OTHER WAY.
AND PEOPLE ARE COMING IN, ASKING.
A LOT OF THINGS ON SOCIAL MEDIA, TIKTOK VIDEOS FROM PEOPLE WHO REALLY KNOW WHAT THEY'RE TALKING ABOUT.
SOME DOCTORS LIKE HEATHER HERSCH, A BIG SOCIAL MEDIA PERSON.
MARY'S BEEN DOING A LOT OF THAT.
IT'S BEEN TALKED ABOUT A LOT MORE, AND THESE PEOPLE ON SOCIAL MEDIA ARE TELLING PATIENTS TO COME TO YOUR DOCTOR.
TAKE THIS INFORMATION.
COME ARMED WITH KNOWLEDGE.
AND ASK THEM FOR WHAT YOU NEED.
AND ASK THEM FOR INDIVIDUALIZED THERAPY FOR YOU, THAT YOU WANT TO DO EVERYTHING YOU CAN.
THAT'S WHAT WE'RE SEEING.
WE'RE SEEN WOMEN COMING IN AND ADVOCATING FOR THEMSELVES.
>> Yunji: WE'VE GOT A LOT OF YOU WRITING IN WITH YOUR QUESTIONS TONIGHT.
THANK YOU FOR SO MANY OF YOU WRITING IN AND CALLING IN.
LET'S GET TO SOME OF THESE, DR. GOULET, I'D LOVE FOR YOU TO TAKE THIS ONE.
DOES BIRTH CONTROL HELP MENOPAUSE?
YOU MENTIONED IRREGULARITIES BEFORE MENOPAUSE HITS.
WHAT HAPPENS IF YOU'RE ON BIRTH CONTROL?
>> WE DON'T REALLY THINK AFFECTS THE TIMING OF MENOPAUSE.
IT CAN HELP MASK THE ONSET OF SOME OF THE SYMPTOMS BECAUSE BIRTH CONTROL ARE SYNTHETIC HORMONES.
THEY'RE NOT BIO-IDENTICAL TO WHAT YOUR BODY WOULD NORMALLY MAKE.
BUT THEY DO DO THE JOB OF HORMONE RECEPTORS SO THAT YOUR BRAIN IS NOT SENSING THE DEPRAVATION OR THE LACK OF THOSE HORMONES.
OFTENTIMES WOMEN WHO ARE ON CONTRACEPTION THROUGH THEIR PREMENOPAUSAL CONDITION, IN THEIR 40s, IT'S RARE TO GET PREGNANT IN OUR 40s, BUT IT ABSOLUTELY CAN HAPPEN.
SO IF YOU NEED CONTRACEPTION, YOU SHOULD BE ON IT.
IF BIRTH CONTROL IS SAFE FOR YOU, OR ORAL CONTRACEPTION PILLS ARE SAFE FOR YOU, IT'S A GREAT OPTION, AND IT DOES A GREAT JOB OF HOLDING OFF A LOT OF PERIMENOPAUSAL SYMPTOMS SUCH AS HOT FLASHES.
>> Yunji: INTERESTING.
DR. LAWRENCE, THIS IS FROM KEALOHA IN HONOLULU.
THANK YOU FOR WRITING IN.
IS THERE A CONNECTION BETWEEN MENOPAUSE AND ADHD AND OLDER WOMEN?
WE HEAR A LOT OF ADHD THESE DAYS.
IS THERE ANY KIND OF CONNECTION THERE?
>> YOU'VE DONE A LOT OF RESEARCH.
>> Yunji: DR. GOULET, WE CAN TOSS IT OVER TO YOU.
>> THE BRAIN, ARCHITECTURE OF THE CELLS AS WE AGE, IT'S NOT LIKE IT WAS WHEN WE WERE IN OUR 30s OR 20s OR OUR YOUNGER YEARS.
WE SHOULD EXPECT IT'S GOING TO FUNCTION DIFFERENTLY THAN IT DID WHEN WE WERE YOUNGER.
WITH THAT DIFFERENT ARCHITECTURE, WITH THAT REMODELING OF THE NEURONS AND CONNECTIONS WE HAVE, ADHD SYMPTOMS IS SOMETHING WE CAN SEE AS SORT OF THE ONSET OF HOW OUR BRAIN IS GOING TO FUNCTION DIFFERENTLY AS WE AGE.
>> Yunji: DR. CANYON, THIS ONE SAYS, YOU MENTIONED LIFESTYLE.
DO CERTAIN FOODS AND DRINKS HELP WITH MENOPAUSE SYMPTOMS?
WHAT ABOUT SUPPLEMENTS?
WHOLE FOODS, PERHAPS MORE PLANT-BASED DIET.
STAYING AWAY FROM PROCESSED STUFF.
WE KNOW THIS IS GOOD FOR US.
WHETHER YOU'RE MALE, FEMALE, MENOPAUSAL OR NOT.
ARE THERE SPECIFIC FOODS AND DRINKS THAT HELP WITH MENOPAUSE?
WHAT ABOUT SUPPLEMENTS?
IF YOU'RE OVER A CERTAIN AGE, YOU GET A LOT OF TARGETED ADS.
>> ONE, YOU'RE TALKING TO SOMEBODY WHO REALLY DOES WHOLEHEARTEDLY BELIEVE THAT FOOD IS MEDICINE.
BUT DO I BELIEVE THERE IS A PLACE FOR SUPPLEMENTS?
THERE IS A PLACE.
WE RELY ON THE SUPPLEMENT INDUSTRY, FOR INSTANCE, WHEN WE DIAGNOSE PATIENTS WITH OSTEOPOROSIS, WHICH AFFECTS THE MENOPAUSAL WOMAN AND HORMONE THERAPY PRESCRIBED AT THE RIGHT TIME CAN PROTECT FROM THAT.
BUT THERE'S A LOT OF PITFALLS WITH THE SUPPLEMENTAL INDUSTRY THAT I STRUGGLE WITH.
ONE OF THAT IS IT'S AN UNREGULATED INDUSTRY.
IN MY OWN PRACTICE, FOR EXAMPLE, HAD A PATIENT ON VITAMIN D3 FOR HER OSTEOPOROSIS.
SAME BRAND MANY YEARS.
TIME AGAIN, WE'RE GETTING LOW VALUES FOR THE FIRST TIME IN HER LIVE.
THE ONLY CONCLUSION, THEY'VE CHANGED THEIR FORMULATION FOR VITAMIN D3.
SO I THINK THERE'S A WORD OF CAUTION I'M TRYING TO PRESENT WHEN YOU'RE DEALING WITH SUPPLEMENTS.
IN TERMS OF MANAGING MENOPAUSAL TYPE SYMPTOMS WITH SUPPLEMENTS, THERE ARE SOME THERAPIES.
THERE'S NOT A LOT OF STRONG EVIDENCE, BUT THINGS LIKE OILS USED QUITE FREQUENTLY IN AUSTRALIA AND ENGLAND.
HIT OR MISS IN MY EXPERIENCE.
FLAXSEED OIL DAILY.
HIT OR MISS IN MY EXPERIENCE.
I AM SAYING THERE ARE HITS.
ALOE VERA.
BUT BLACK COHOSH IS ONE FOR HOT FLASHES THAT HAS THE MOST EVIDENCE BEHIND IT BUT NOT ANYTHING NEAR WHAT WE CAN PROVIDE.
I SEE HER SHAKING HER HEAD.
IT'S NOT -- YEAH.
SO I THINK IT GOES BACK TO THERE'S NO ONE FOOD THAT YOU CAN TAKE EVER THAT WILL ADDRESS ANYTHING THAT YOU'RE HAVING.
IT'S A WHOLE PICTURE, WHOLE PERSON SCENARIO.
AND THAT'S WHERE THE AMERICAN COLLEGE OF LIFESTYLE MEDICINE IDENTIFIED THESE PILLARS OF LIFESTYLE MEDICINE.
YOU'RE A WHOLE PERSON WITH MULTIPLE ASPECTS TO YOUR OVERALL HEALTH.
IT WOULD BE REMISS OF ME, REDUCTIONIST OF ME TO JUST THROW -- SWEET POTATOES AT YOU.
>> Yunji: THANK YOU FOR THAT.
DR. LAWRENCE, A QUESTION FROM ERIC FROM KAILUA.
IT'S AN INTERESTING ONE.
THANK YOU FOR A MAN WRITING IN TONIGHT.
ARE THERE SUGGESTIONS FOR PEOPLE WHOSE PARTNERS ARE EXPERIENCING MENOPAUSE?
HOW DO DEAL WITH IT WITHOUT BEING MEAN AND INCENTIVE.
THIS AFFECTS THE WHOLE FAMILY OR A PARTNER.
NOT ONLY THE INDIVIDUAL GOING THROUGH IT BUT SUPPORTING MAN.
>> THAT'S WHY A LOT OF PEOPLE WILL COME IN.
THEY'RE HAVING RELATIONSHIP ISSUES, AND THEY'RE NOT THEMSELVES.
THEY'RE IRRITABLE, THEY'RE ANGRY.
HAVING OUTBURSTS AND THINGS LIKE THAT.
JUST EXPLORE IT IN A SUPPORTIVE WAY WITH A PARTNER.
MAYBE ENCOURAGE THEM COME IN AND TALK ABOUT IT TO THEIR GYNECOLOGIST OR PHYSICIAN.
>> Yunji: MONICA HAS THIS QUESTION, DR. FRATTARELLI.
WE'RE JUST BLAZING THROUGH HERE, BECAUSE WE HAVE SO MANY, WHICH WE LOVE TO HAVE YOUR ENGAGEMENT.
THANK YOU FOR THOSE OF YOU CALLING IN AND WRITING.
MONICA ASKS, IS THERE ANY PATTERN TO HOW LONG A WOMEN HAS TO DEAL WITH THE CHANGES BROUGHT ON MY MENOPAUSE?
THAT PERIMENOPAUSE WINDOW, TWO TO TEN YEARS IS QUITE A LONG TIME.
AND DOES THE SEVERITY OF THE SYMPTOMS, ARE THEY ON A STRAIGHT LINE UP OR IT VARY?
>> THAT IS -- THERE'S ACTUALLY STUDIES THAT SHOW THAT THE WOMEN WHO HAVE THE SEVERE SYMPTOMS, EARLY ONSET, THEIR SYMPTOMS TEND TO LOST LONGEST.
SO THERE IS ABOUT A 25% OF PEOPLE WHO HAVE SEVERE SYMPTOMS FOR TEN YEARS PERIMENOPAUSE AND AND IT WILL CONTINUE ON.
WE SEE WOMEN WHO CAN NEVER GET OFF THEIR HORMONE REPLACEMENT THERAPY SOMETIMES.
THEY TRY TO GO OFF.
THEY START GETTING HOT SWEATS, HOT FLASHES, NIGHT SWEATS.
AGAIN, IT COMES RIGHT BACK.
THERE'S NOT A SET PATTERN.
THERE'S THAT PATTERN, WHICH IS THE UNLUCKY ONES AND PEOPLE WHO DON'T GET ANY SYMPTOMS UNTIL RIGHT AROUND MENOPAUSE.
AND THERE'S PEOPLE WHO HAVE HAD MILD SYMPTOMS FOR SHORTER PERIOD OF TIME.
SO IT COULD BE ANY OF THOSE THINGS.
FOR THE MOST PART, IF SOMEONE COMING IN TO ME PERIMENOPAUSE, THEY OFTEN FIND THAT THEY'RE SYMPTOMATIC AND THEN IT GOES AWAY.
THAT'S WHAT THEIR ESTROGEN LEVELS ARE DOING.
THEY FEEL HORRIBLE, THEY HAVE HOT FLASHES AND NIGHT SWEAT AND MAYBE HEART PALPITATIONS AND THEY GET BETTER.
OH, IT WENT AWAY.
I'M DONE.
I'M LIKE, SORRY.
IT'S REALLY NOT DONE UNLESS YOU'RE COMPLETELY MENOPAUSAL.
IF YOU HAVE SYMPTOMS PERIMENOPAUSAL, IT'S GOING TO CONTINUE TO COME BACK UNTIL AT LEAST YOU'RE DONE WITH ALL YOUR PERIODS.
>> Yunji: AND OTHER SIDE OF THAT ONCE YOU'RE FULLY THROUGH MENOPAUSE, IS THERE RELIEF?
>> NOT NECESSARILY.
FOR MORE THAN HALF, THERE ARE.
THERE'S A LOT OF WOMEN WHO CONTINUE ON WITH THAT.
>> SO YOU'RE SAYING THIS IS GOING TO GO ON FOREVER?
>> IT REALLY VARIES.
>> IT'S ABOUT SEVEN YEARS.
NOT EVERYBODY HAS IT LIFE LONG, BUT MANY CAN.
>> THE YEAR BEFORE LAST, I WAS AT AMERICAN COLLEGE OF LIFESTYLE MEDICINE CONFERENCE, AND WHEN WE GO TO THESE REALLY BIG MEDICAL CONFERENCES, THERE'S THESE KEYNOTE SPEAKERS.
HUGE CONVENTION CENTER, HUGE THING.
THERE WAS A SIDE TALK ON MENOPAUSE.
IT SHOULD HAVE BEEN A KEYNOTE.
THERE WERE DOCTORS LINING THE WALLS.
I WAS SITTING ON THE FLOOR.
THAT SAID TO ME, WOW.
WE'RE INTERESTED AND WE ALL WANT TO DO BETTER BY WOMEN.
KIND OF GOT CHICKEN SKIN NOW BECAUSE I REALLY THINK WE DO.
A LOT OF PEOPLE THINK THEY'RE NOT BEING HEARD BY THEIR DOCTOR.
I THINK YOUR DOCTOR DOES WANT TO DO THE BEST FOR YOU.
WHAT WAS SUPER NEAT ABOUT THAT TALK, THE WOMEN PRESENTING IT SHOWED QUALITY OF LIFE SCORES.
IT STARTED WITH WOMEN IN THEIR 30s UP IN THE THEIR 70s.
WHEN IT GOT TO THE PERIMENOPAUSE OR MENOPAUSE PERIOD, THERE'S THIS HUGE DIP IN QUALITY OF LIFE SCORES.
BUT THEN THE GRAPH STARTED TO GO UP AND UP AND UP AND THE WOMEN WERE REPORTED A BETTER QUALITY OF LIFE INTO THEIR 60s AND 70s THAN THEY HAD IN THEIR 30s.
I FEEL LIKE THERE'S A SILVER LINING.
LIGHT AT THE END OF THE TUNNEL.
>> Yunji: THAT IS ENCOURAGING.
>> ONE OF THE SYMPTOMS, BRAIN FOG, THAT TENDS TO GET BETTER ABOUT A YEAR AFTER MENOPAUSE.
ABOUT TWO YEARS AFTER YOUR FINAL MENSTRUAL PERIOD.
THAT DOES GET BETTER.
>> Yunji: THAT HAPPENED FOR ME WHEN I HAD MY KIDS.
[LAUGHTER] >> THAT HASN'T STOPPED.
>> YOU MENTIONED THAT.
BECAUSE HAVING A CHILD, THOSE HORMONES ARE SIMILAR TO THE -- YOU HAVE THIS HUGE PLUMMET IN YOUR ESTROGEN LEVELS, IN YOUR PROGESTERONE LEVELS, WHICH IS THE SAME THING AS WHAT WOMEN ARE GOING THROUGH THEIR PERIMENOPAUSE TRANSITION ARE EXPERIENCING.
SO THE BIRTH OF A BABY OR BREAST FEEDING IS A LITTLE BIT OF A TASTE OF WHAT'S YET TO COME.
>> Yunji: WOW.
BETH FROM THE BIG ISLAND, I'LL STICK WITH YOU, DR. GOULET, SAYS SO MANY OF US MISSED THE OPPORTUNITY FOR BIO-IDENTICAL HORMONES.
HOW OLD IS TOO OLD TO START?
IT'S BEEN PROVEN THAT HORMONES HELP CHOLESTEROL, OSTEOPOROSIS, HEART DISEASE, ALZHEIMER'S.
I FEEL LIKE I MISSED THE BOAT.
>> THERE'S TWO THINGS I WANT TO HIT ON HERE, BIO-IDENTICAL AND THE CORRECT AGE RANGE.
THE WORD BIO-IDENTICAL WAS THIS GENIUS MARKETING EVENT THAT HAPPENED THROUGH A BOOK AND THROUGH SOME CELEBRITIES THAT WAS REALLY KIND OF MISDIRECTED ON HOW HORMONES SHOULD BE PRESCRIBED AND TREATED.
BUT I LIKE TO TAKE BACK THAT WORD AND DEFINE IT AS MOLECULES, HORMONES, MEDICATIONS THAT ARE EXACTLY IDENTICAL TO WHAT YOUR BODY IS MAKING.
WHEN WE'RE PRESCRIBING BIO-IDENTICAL HORMONE, THAT'S THE SAME YOUR BODY IS MAKING.
IT HAS A BETTER BENEFICIAL PROFILE FOR YOU THAN SOME OTHER TYPES OF HORMONE THERAPY WE CAN PRESCRIBE.
AS FAR AS THE APPROPRIATE AGE, THE BEST TIME TO BE PRESCRIBED HORMONE THERAPY WOULD BE WHEN YOU'RE IN THAT TRANSITION.
WHEN YOU'RE STARTING TO EXPERIENCE THOSE HOT FLASHES OR MAYBE IN THAT YEAR OR WITHIN FIVE YEARS AFTER YOUR FINAL MENSTRUAL PERIOD.
WE DO HAVE DATA THAT SAYS, AND THIS IS THAT WOMEN'S HEALTH INITIATIVE.
THE BIG TRIAL.
THE NIH FUNDED SO MUCH MONEY.
IT WAS THE LARGEST STUDY THAT OUR GOVERNMENT EVER -- MORE THAN COVID, MORE THAN HIV EVER FUNDED.
IT WAS A HUGE STUDY, BUT UNFORTUNATELY IT LOOKED AT THE WRONG HORMONES AND AGE RANGE.
WHAT WE LEARNED IS HORMONES ARE NOT SAFE WHEN WE START THEM FAR OUT FROM WHEN YOU'RE GOING THROUGH THAT FINAL MENSTRUAL PERIOD.
SO IT THINK THAT SHE HAS A VALID CONCERN BUT EVERYTHING IS A RISK BENEFIT RATIO.
I WOULD ENCOURAGE INDIVIDUALS WHO WANT TO GET STARTED ON HORMONES BECAUSE THEY'RE HAVING SEVERE SYMPTOMS TO SPEAK TO THEIR DOCTOR, THEIR LIFESTYLE, THEIR GYNECOLOGIST, OR PRIMARY CARE DOCTOR TO TALK ABOUT WHETHER OR NOT THE RISK OR THE BENEFITS IS SOMETHING THAT COULD BE APPROPRIATE FOR THEM.
>> Yunji: THANK YOU FOR THAT.
DR. LAWRENCE, SHANNON IN HONOLULU SAYS, WHAT ABOUT SURGERY-INDUCED MENOPAUSE.
WHAT TYPES OF SURGERY MIGHT INDUCE MENOPAUSE AND HOW DOES IT DIFFER FROM NATURALLY OCCURRING MENOPAUSE?
>> PRIMARILY HYSTERECTOMY, SO REMOVING OVARIES DURING SURGERY WILL REDUCE YOUR ESTROGEN LEVELS.
AND SYMPTOMS ARE USUALLY QUITE ABRUPT AFTER SURGERY AS OPPOSED TO NATURAL TEND TO BE GRADUAL AND FLUCTUATING.
YOU CAN SEE IT AFTER CERTAIN MEDICATIONS AND LIKE FOR INSTANCE CHEMOTHERAPY CAN ALSO INDUCE MENOPAUSAL SYMPTOMS.
>> Yunji: SO THAT TWO TO TEN-YEAR WINDOW THAT WE WERE TALKING ABOUT IS GREATLY REDUCED AND YOU GO THROUGH IT QUICKER.
>> UH-HUH.
>> IF YOU'RE YOUNGER WOMEN, YOUNGER THAN 50 OR 45, HORMONE REPLACEMENT THERAPY IS VERY IMPORTANT BECAUSE WE'RE SUPPOSED TO HAVE THOSE HORMONES UNTIL THOSE EARLY 50s.
AND SO IF YOU ARE HAVING LOSS OF THOSE HORMONES, OVARIES ARE BEING TAKEN OUT OR THEY'RE BEING DAMAGED BY CHEMOTHERAPY AND MEDICATIONS, THOSE INDIVIDUALS SHOULD TALK TO THEIR DOCTORS TO SEE IF HORMONE REPLACEMENT THERAPY, A TERM WE DON'T USE VERY MUCH ANYMORE.
WE TRY TO STICK TO WORDS HORMONE THERAPY, BUT THOSE INDIVIDUALS THEY NEED REPLACEMENT OF HORMONES THAT ARE AGE APPROPRIATE.
>> Yunji: OKAY.
DR. CANYON, LISA WANTS TO KNOW SHOULD COMPANIES HAVE POLICIES OR PROCEDURES TO SUPPORT EMPLOYEES GOING THROUGH MENOPAUSE?
THAT'S MORE OF A POLICY QUESTION, BUT WHEN WE THINK ABOUT HOW MANY WOMEN ARE IN OUR COMMUNITY EXPERIENCING THIS PERHAPS WITHOUT SUPPORT HOW MUCH OF THIS CONVERSATION SHOULD WE BE HAVING WITH THE WIDER COMMUNITY SO THEY UNDERSTAND THESE ARE NATURAL CHANGES.
IN SOME CASES UNAVOIDABLE.
>> WOW.
THAT'S A REALLY INTERESTING QUESTION.
>> THEY DO IN AUSTRALIA.
MY SISTER LIVES IN AUSTRALIA AND THEY GET TIME OFF FROM WORK FOR GOING THROUGH THE TRANSITION.
IT DOESN'T HAPPEN HERE, THOUGH.
>> THERE'S A LOT GOING THROUGH MY HEAD.
I CAN SEE THE CONTROVERSY THAT WOULD GET RAISED IF A COMPANY WAS TO DO THAT.
I DON'T MEAN TO BE A BROKEN RECORD, BUT I THINK THAT WORKPLACES COULD DO A LOT BETTER IN SUPPORTING PEOPLE WITH LIFESTYLE IN GENERAL.
AND I THINK THAT WOULD BENEFIT YOUR MENOPAUSAL WOMAN.
>> Yunji: THERE'S THIS QUESTION FROM THELMA.
WE'RE TOLD FAMILY DISCUSSIONS ARE SUPER IMPORTANT FOR SO MANY THINGS.
ILLNESS AND END OF LIFE.
SHOULD MENOPAUSE BE INCLUDED AND HOW DO WE GET THERE?
HOW DO WE HAVE THESE CONVERSATIONS?
MAYBE IT'S NOT WITH YOUR EMPLOYER, BUT MAYBE WITH YOUR SPOUSE OR YOUR KIDS OR PEOPLE SUPPORTING YOU.
HOW DO YOU SUGGEST BROACHING THIS TOPIC?
WE'LL START WITH YOU THEN GO TO YOU.
>> OKAY.
THERE'S SO MANY DIFFERENT THINGS CAME UP TONIGHT LIKE THE COMMENT ABOUT -- FROM ERIC FROM KAILUA.
I'VE HAD PATIENTS COME INTO THE CLINIC WITH THEIR PARTNER BECAUSE THEIR PARTNER WASN'T UNDERSTANDING WHAT THEY'RE GOING THROUGH.
SO THAT I COULD EDUCATE THEM ABOUT MENOPAUSE.
SO I THINK ONE THING IS IF YOU'RE SYMPTOMATIC.
YOU'RE TALKING TO YOUR PARTNER AND IF YOU'RE GETTING A LITTLE BIT OF PUSHBACK, COME SEE ME.
I'LL SUPPORT YOU.
WHAT WE'RE DOING HERE RIGHT NOW IS MORE EXPOSURE, MORE CONVERSATION.
HOW DO YOU START IT?
START IT.
WHY HOLD BACK?
THIS IS A NATURAL PART OF LIFE.
THIS IS 50% OR MORE OF THE POPULATION IS GOING THROUGH THIS.
THIS IS NOT CONTROVERSIAL.
THIS IS LIFE.
THIS IS NOT A DISEASE.
>> IT'S PROBABLY JUST AWARENESS.
>> A COUPLE COMMENTS ABOUT THE WORKPLACE.
WHEN WE KNOW THAT WE LOSE A LOT OF PRODUCTIVITY FROM WOMEN WHO ARE GOING THROUGH PERIMENOPAUSE AND MENOPAUSE.
SO THE WORKPLACE HAS TO BE, YOU KNOW, THEY'RE GOING TO GET MORE FROM THEIR WORKERS WHO WANT TO BE PRODUCTIVE IF THEY'RE MORE UNDERSTANDING, AND IF THEY HAVE THOSE PROGRAMS IN PLACE WHERE MAYBE THEY CAN PAY FOR SOME OF THESE MENOPAUSAL CONSULTS.
MAYBE HAVE NO CO-PAY.
HAVE SOME WELLNESS PROGRAMS.
THEY'RE GOING TO GET MORE FROM THEIR PERIMENOPAUSE AND MENOPAUSAL WOMEN WORKWISE IF THEY GO TO SOMETHING LIKE THAT.
MAYBE THAT'S A STARTING PLACE AS TO ENCOURAGING EMPLOYEES TO PUT SOMETHING IN PLACE.
FAMILY-WISE, I'M KIND OF THE THOUGHT THAT WOMEN SHOULD SEEK CARE FOR THEIR WHOLE FAMILY.
AND THEN THEY CAN -- AND DISCUSS IT WITH THEIR FAMILY THAT THIS IS WHAT I'M DOING.
MAYBE I NEED SOME MORE TIME IN MY LIFE TO DO THESE LIFESTYLE -- HEALTHY DIET AND EXERCISE.
IT'S VERY DIFFICULT IF YOU'RE WORKING 80-HOUR WORK WEEKS.
SO THEY NEED TO LET THEIR FAMILY KNOW WHAT THEY NEED, AND FAMILIES HAVE TO BE ABLE TO VALUE THAT.
THEY ALSO NEED TO SEEK CARE FOR THEIR ENTIRE FAMILY.
BECAUSE IF YOU'RE NOT FEELING GOOD, IT'S NOT JUST YOU THAT SUFFER.
THE WHOLE FAMILY SUFFERS.
>> YEAH.
TO LeighAnn'S POINT, PERIMENOPAUSE OFTEN COINCIDES AT A TIME IN LIFE WHEN WOMEN ARE STARTING TO FIND THEMSELVES AND THRIVE IN THEIR WORKPLACE AND THEN BOOM.
THIS HAPPENS.
AND I THINK EXACTLY WHAT LeighAnn SAID.
YOU HAVE TO COMMUNICATE YOUR NEEDS AND START TO TAKE TIME FOR SELF-CARE.
AND SAY I NEED TO DO THIS TO CONTINUE THAT THRIVING.
I DON'T THINK THIS NEEDS TO BE A CRUTCH THAT -- OR CROSS TO BEAR.
YOU JUST NEED TIME AND SPACE FOR THE SELF-CARE.
AND YOU NEED GOOD INFORMATION ON HOW TO ADDRESS IT.
>> Yunji: YEAH.
AND WE HAVE ANOTHER WORKPLACE QUESTION.
DR. LAWRENCE, WHETHER IT'S SEVERE PERIOD CRAMPS OR MENOPAUSE SYMPTOMS, SOMETIMES IT'S DIFFICULT TO GO INTO WORK.
BUT NEEDS TO BE DONE.
WHAT ARE TIPS OR ADVICE WHEN IT COMES TO DEALING SYMPTOMS IN THE WORKPLACE?
A LOT OF THIS IS DIFFICULT.
I DON'T KNOW, MAYBE I GREW UP IN A DIFFERENT TIME, BUT I REMEMBER HIDING TAMPONS.
NOT WANTING ANYONE TO KNOW THAT YOU'RE HAVING YOUR PERIOD.
TO THEN GO TO YOUR EMPLOYER BECAUSE I THINK I'M IN PERIMENOPAUSE SEEMS LIKES A PRETTY TOUGH CONVERSATION.
FOR THIS CALLER, WHAT WOULD YOU SAY?
SOME ADVICE ON DEALING WITH THE SYMPTOMS THEMSELVES WHEN YOU HAVE TO BE IN A PROFESSIONAL SETTING.
>> THAT'S A TOUGH QUESTION.
I THINK YOU PROBABLY WANT TO COME IN AND SEEK CARE.
MOST PEOPLE WILL SEEK CARE AND TRY TO FIND OUT WHAT'S GOING ON AND THEN GAIN SUPPORT FROM THEIR EMPLOYER AFTER THAT.
I'M NOT SURE I'M UNDERSTANDING WHAT THE QUESTION IS.
IF YOU'RE HAVING SYMPTOMS, YOU PROBABLY COME IN AND GET CARE.
>> Yunji: DR. GOULET?
YOU WANT TO ADD TO THAT?
>> I THINK THERE ARE EASY THINGS YOU CAN DO FOR COMFORT.
BRING EXTRA LAYERS IF YOU'RE HAVING CHILLS OR BRING A FAN TO KEEP AT YOUR DESK.
THESE AREN'T CURE ALLS, BUT IT'S NOT GOING TO START A WORKPLACE WAR WITH THE THERMOSTAT.
AND HAVING AN ICE COLD CUP OF WATER WITH YOU OR YOUR HOT CUP OF TEA, THESE ARE SIMPLE THINGS THAT MAY PROVIDE TEMPORARY ALLEVIATION OF SYMPTOMS.
I LIKE THOSE MINTY OILS.
>> Yunji: ESSENTIAL OILS.
>> ESSENTIAL OILS.
THANK YOU VERY MUCH.
SO THOSE ARE SOME EASY THINGS THAT YOU CAN DO.
THEY'RE NOT GOING TO BE THE END ALL, BE ALL.
THEY'RE NOT GOING TO BE PROVIDE MUCH RELIEF AS THE PRESCRIBED MEDICINES THAT WE HAVE IN THE TOOLBOX.
>> Yunji: THIS IS FROM PALOLO.
DO MEN HAVE A SIMILAR TYPE OF EXPERIENCE?
IS THERE SUCH A THING AS MALE MENOPAUSE?
>> ASIDE FROM THE TESTOSTERONE, THERE IS A SIGNIFICANT POPULATION OF GENTLEMEN WHO ARE BATTLING PROSTATE CANCER AND ARE ON ANTI-ANDROGENS IN ORDER TO TREAT THEIR CANCERS.
THOSE MEN AS WELL WILL EXPERIENCE VERY SIMILAR SYMPTOMS.
THEY WILL HAVE HOT FLASHES, COLD SWEATS.
THEY'LL HAVE A DECREASE IN THEIR WELL-BEING.
SO IN GENERAL, AS WELL AS THE LOW TESTOSTERONE AND THAT WHOLE BOOM THAT WE'RE SEEING IN MEDICINE, THERE'S ABSOLUTELY A MEDICAL INDICATION WHERE WE SEE MEN GOING THROUGH A DEPRIVATION AS WELL.
>> Yunji: DR. CANYON, I SEE YOU NODDING OVER THERE.
WHAT SIMILAR SYMPTOMS DO YOU SEE IN MALE PATIENTS?
>> I HAVE HAD PATIENTS WHO HAD THE TREATMENTS YOU'RE TALKING ABOUT.
HOT FLASHES ARE SO SEVERE.
>> Yunji: IN MEN?
>> THIS IS WHEN WE GIVE TREATMENTS TO OPPOSE TESTOSTERONE.
SO THAT THE PROSTATE CANCER DOESN'T CONTINUE TO PROLIFERATE OR GROW.
YEAH.
IT IS REALLY -- IT KIND THE OF -- YEAH.
IT SHOWS WHAT WOMEN HAVE TO GO THROUGH AS A NATURAL PROCESS.
YEAH.
I'VE SEEN IT HAPPEN.
BUT ALSO, I'M ALSO THINKING ABOUT LOW TESTOSTERONE.
DO THEY CALL IT -- >> ANDROPAUSE.
>> OR MANOPAUSE.
>> Yunji: YEAH.
BUT NOT TO THE SAME SCALE AND SEVERITY IT SOUNDS LIKE.
>> UNLESS YOU'RE ON THESE MEDICATIONS.
>> YEAH.
DR. FRATTARELLI, BILLY ASKS HOW BIG A ROLE DO EXTERNAL ROLES PLAY IN MENOPAUSE, ESPECIALLY STRESS?
HOW BIG A ROLE DO EXTERNAL FACTORS PLAY IN MENOPAUSE, ESPECIALLY STRESS?
SO HOW MUCH COMING FROM THE INSIDE AND HOW MUCH IS THE ENVIRONMENT AROUND US.
WE JUST WENT THROUGH COVID.
WE HAVE A PRETTY FRAUGHT POLITICAL -- A LOT OF NEWS COMING FROM WASHINGTON DAY IN AND DAY OUT.
HAWAI'I'S IS AN EXPENSIVE PLACE TO LIVE.
ALL THESE FACTORS STRESS US OUT.
HOW MUCH DOES THAT EXACERBATE MENOPAUSE OR THE SYMPTOMS?
>> EXACERBATE, MY OPINION IS STRESS EXACERBATES ALMOST EVERY MEDICAL CONDITION AND THIS IS NO DIFFERENT.
BUT IT'S NOT LIKE STRESS IS WHAT IS CAUSING THE SYMPTOMS.
IT'S NOT WHY YOU GET HEART PALPITATIONS AROUND MENOPAUSE.
IT'S MENOPAUSAL SYMPTOMS.
IT'S NOT JUST THE STRESS.
SO YOU CAN DECREASE STRESS.
MAYBE IMPROVE YOUR SLEEP, WHICH MAY MAKE YOU FEEL BETTER, BUT IT'S NOT GOING TO TAKE CARE OF EVERYTHING BY BECOMING STRESS-FREE, WHICH WE WISH WE COULD TO.
>> Yunji: IF ONLY.
I'M INTERESTED, DR. LAWRENCE, ARE THERE THINGS THAT WOMEN SHOULDN'T DO WHEN WE'RE GOING THROUGH MENOPAUSE?
ANY TRIGGERS FOR HOT FLASHES OR LIFESTYLE.
SIMILAR TO THE STRESS QUESTION.
ARE THERE THINGS THAT WE SHOULD AVOID THAT EXACERBATE THESE SYMPTOMS?
>> YOU CAN'T AVOID GOING THROUGH MENOPAUSE.
YOU'RE GOING TO GO THROUGH THE TRANSITION.
AND SO YEAH.
ALTHOUGH SOME PEOPLE WILL HAVE SEVERE SYMPTOMS AND SOME PEOPLE WILL HAVE MILDER SYMPTOMS.
>> Yunji: AND I WONDER IF SOME OF THAT, WHAT OCCURS TO ME IS A LOT OF THIS IS BLAMED ON OTHER FACTORS.
THIS IS UNKNOWN.
WE KNOW HOT FLASHES ARE ASSOCIATED WITH MENOPAUSE.
BUT A LOT OF OTHER SYMPTOMS YOU GUYS ARE TALKING ABOUT, PEOPLE MIGHT NOT NECESSARILY CONNECT THAT DOT, RIGHT.
SO WE THINK IT'S ONE THING BUT IT ACTUALLY IS PERIMENOPAUSE.
ARE THERE TESTS THAT WE CAN DO SO WE CAN SEE, THAT YOU CAN CREATE A STRAIGHT LINE BETWEEN WHAT'S HAPPENING HORMONALLY?
ARE THERE LEVELS THAT CAN BE CHECKED?
YES, YOU ARE IN PERIMENOPAUSE?
WE HAVE THE ENDOCRINOLOGIST.
>> YES, THERE ARE IN THE PERIMENOPAUSAL PERIOD AND FEEL FREE TO JUMP IN.
IN THE PERIMENOPAUSAL PERIOD, THE HORMONE LEVELS THAT YOU COULD MEASURE ARE FLUCTUATING A LOT.
THEY'RE NOT VERY HELPFUL AND USUALLY WILL BASED ON THINGS CLINICALLY.
HOW SOMEONE'S FEELING AND BASED ON THEIR MENSTRUAL IRREGULARITY.
THERE ARE TESTS THAT YOU CAN DO.
>> I THINK AS YOU GO THROUGH THE MENOPAUSE TRANSITION, LIKE WITH THE STRESS QUESTION, I THINK IT LOWERS YOUR THRESHOLD TO MANAGE OTHER THINGS.
AND THE SYMPTOMS CAN BE WIDE RANGE.
A LOT OF DIFFERENT SYMPTOMS SO YOU DON'T REALLY KNOW WHAT'S GOING ON.
MOST PEOPLE WILL FEEL LIKE THEY'RE NOT THEMSELVES.
THAT'S USUALLY WHAT THEY SAY.
I DON'T FEEL LIKE MYSELF.
I CAN'T GET A HANDLE ON MY WEIGHT AND RELATIONSHIPS AND SLEEP.
WHAT'S GOING ON?
AND SO FOR THE PROPER CANDIDATE, TRIAL OF HORMONES MIGHT BE APPROPRIATE.
AND BASICALLY SOMETIMES IT'S A TRIAL TO SEE HOW THEY FEEL.
IF THEY'RE FEELING BETTER.
>> I THINK IT'S IMPORTANT TO ALSO DISSECT THE SPECIFIC COMPLAINTS THEY'RE HAVING.
IS THEIR MAIN COMPLAINT INSOMNIA?
COULD BE MAYBE THEY DRINK A CUP OF COFFEE AFTER DINNER?
THAT'S WHAT THEY'VE DONE THEIR ENTIRE LIFE, BUT NOW THEIR BODY CAN'T TOLERATE THAT.
AND IT COULD BE LIFESTYLE THINGS THEY NEED TO CHANGE OR IT COULD SOMETHING LIKE HORMONES MAY BE PLAYING A PART.
A LOT OF SYMPTOMS ATTRIBUTED TO PERIMENOPAUSE, WHETHER THAT BE INCONTINENCE, WHETHER THAT BE OTHER THINGS.
SLEEP APNEA IS VERY MUCH UNDER-DIAGNOSED.
SO THERE'S LOTS OF THINGS THAT WE CAN EXPLORE.
IT JUST DEPENDS ON THE SPECIFIC COMPLAINTS THAT ARE AT ISSUE.
>> Yunji: DR. CANYON, WE TALKED A LITTLE BIT ABOUT RELATIONSHIPS AND HOW THIS CAN AFFECT A RELATIONSHIP.
I'M ALSO INTERESTED IN INTIMACY.
THIS IS PBS SO IT'S A FAMILY SHOW, BUT I'M CURIOUS TO KNOW THE EFFECTS ON SEX DRIVE AND INTIMACY AND HOW YOU SEE THAT PLAY OUT WITH YOUR PATIENTS.
>> LOW LIBIDO IS A VERY COMMON COMPLAINT.
PART AND PARCEL OF THAT CAN BE THERE'S VAGINAL DRYNESS AND PAIN DURING SEX AS WELL.
YOU HAVE A LACK OF INTEREST AND UNCOMFORTABLE EXPERIENCE AS WELL.
AND SO THOSE CAN AFFECT INTIMACY RELATIONSHIPS, AND THAT CAN BECOME COMPLEX OR COMPLICATED.
THERE ARE A LOT OF TREATMENTS AND MAYBE OTHERS WOULD LIKE TO DISCUSS THE TREATMENTS WE HAVE FOR THAT.
BUT ALSO I WOULD ENCOURAGE PEOPLE TO SEEK HELP WITH A THERAPIST AS WELL BECAUSE WE KNOW A LOT OF THE PROBLEMS BEHIND INTIMACY HAVE NOT ONLY A PHYSICAL BASIS BUT A PSYCHOLOGICAL BASIS AS WELL.
I DON'T KNOW IF OTHERS WOULD LIKE TO COMMENT ON TREATMENTS FOR THE PHYSICAL COMPLAINTS.
>> THE QUESTION IS SPECIFICALLY MORE ABOUT -- >> Yunji: INTIMACY AND WHAT IT DOES TO YOUR SEX DRIVE AND OUR MENOPAUSE OR PERIMENOPAUSE IMPACTS THAT PART OF A WOMAN'S LIFE.
>> A LOT OF TIMES WHEN WE'RE TALKING ABOUT VAGINAL DRYNESS AND PAIN WITH SEXUAL INTERCOURSE IT IS A LATER SYMPTOM.
THERE ARE DEFINITELY SOME WOMEN IN PERIMENOPAUSE WHO GET THEIR DRYNESS EARLY.
BUT BECAUSE PERIMENOPAUSAL HORMONE LEVELS ARE FLUCTUATING, YOU OFTEN EVEN GET HIGHER LEVELS ESTROGEN AT TIMES.
SO THE VAGINAL TISSUE STILL HAS ADEQUATE BLOOD FLOW USUALLY THROUGH PERIMENOPAUSE.
AND IT CAN BECOME A SYMPTOM LATER IN LIFE.
SO THE FIRST THING WHEN THEY SAY, I DON'T HAVE LIBIDO, THERE ARE SO MANY FACTORS.
FIRST THING, IS IT BECAUSE YOU HAVE PAIN?
IS IT BECAUSE YOU'RE NOT SLEEPING?
IS IT BECAUSE YOU HAVE THREE KIDS CRAWLING IN BED AT YOU AT NIGHT WHEN YOUR HUSBAND ISN'T INTERESTED?
DO YOU HAVE MOM, WHO YOU'RE TAKING CARE OF WHO'S DOWNSTAIRS?
ARE YOU HAVING ANY TIME ALONE WITH YOUR PARTNER?
SO MANY FACTORS THAT GO INTO INTIMACY.
I'M LIKE HER.
I LIKE REFERRING TO A SEX THERAPIST.
WE'RE VERY LUCKY TO HAVE A SEX THERAPIST IN HAWAI'I.
DR. BRITO HAS A GROUP THAT'S EXCELLENT.
IT'S ABOUT CREATING THAT SAFE SPACE FOR INTIMACY, WHICH CAN BE VERY DIFFICULT BECAUSE OF THE OTHER THINGS GOING ON WITH PERIMENOPAUSE.
AGAIN, YOU DO HAVE TO ADDRESS, ARE YOU HAVING THE DRYNESS YET?
ARE YOU HAVING THE PAIN?
>> Yunji: SO INTERESTING.
SO MUCH IS RIDING ON ALL THESE WOMEN.
WHEN YOU'RE TALKING ABOUT ALL THESE FACTORS.
MAYBE SHE'S PARENTING, MAYBE SHE'S TAKING CARE OF AN OLDER RELATIVE.
MAYBE SHE'S WORKING A LOT.
IT'S JUST SO MANY THINGS.
>> WOMEN ARE ABLE TO LOOK AT THEIR PARTNER, WHO'S GOT THEIR LITTLE BLUE PILLS AND THERAPY.
IT'S TURNED THEM BACK TO LIKE THEY WERE IN THEIR 20s.
WHAT CAN WE GIVE OUR LADIES TO MAKE THEM LIKE THEY WERE IN THEIR 20s?
UNFORTUNATELY, WE DON'T HAVE A MAGIC PILL OR MAGIC PRESCRIPTION THAT DOES WHAT THAT LITTLE BLUE PILL DOES FOR MEN.
>> Yunji: OKAY.
WE NEED YOU TO MORE.
[LAUGHTER] I WANT TO STICK WITH YOU FOR THIS ONE.
THIS IS FROM JOAN.
SHE SAYS WAS TOLD THE RISK OF UTERINE CANCER IS HIGHER AFTER 65 IF YOU CONTINUE TO TAKE HORMONES SO I STOPPED.
I'M 72, I STILL GET HOT FLASHES.
>> I THINK THE CONCERN IS WHAT KIND OF HORMONE THERAPY ARE YOU ON?
IF YOU HAVE A UTERUS, WE WILL ALWAYS PRESCRIBE AN OPPOSING PROGESTIN TO GO WITH THAT ESTROGEN.
THAT IS GOING TO PROTECT THE UTERUS.
IT CAN BE SAFE TO CONTINUE.
WITH ALL MEDICATIONS THERE'S A RISK BENEFIT PROFILE.
NOTHING SHOULD JUST BE ON AUTO DRIVE.
A RESPONSIBLE PHYSICIAN WILL BE CHECKING IN AND ASK, HOW ARE YOU DOING ON THIS MEDICATION?
IS THIS IS YOU STILL NEED OR MAYBE YOU CAN DO WITH A LOWER DOSE.
OR MAYBE WE SHOULD DO WITHOUT.
IF YOU DON'T NEED IT ANYMORE, WHY ARE YOU TAKING IT?
>> Yunji: DR. CANYON, THIS IS FROM MAILE IN AIEA SAID HOW IMPORTANT IS STRENGTH TRAINING AND PROTEIN INTAKE, ESPECIALLY IN REGARDS TO BONE DENSITY AND BRAIN FOG?
>> VERY IMPORTANT.
IT STARTS IN YOUR LATE 30s BUT WE LOSE 5 OR 10% OF MUSCLE MASS PER DECADE.
AND SO ON OF THE THINGS WE KNOW WHEN WE HAVE PERIMENOPAUSAL WOMEN GAINING WEIGHT, FOCUS ON BUILDING YOUR MUSCLE BECAUSE YOUR MUSCLE IS YOUR WAREHOUSE OF CALORIE BURNING.
YOU'RE LOSING IT, YOU'RE GAINING WEIGHT.
IN ORDER TO GAME MUSCLE, YOU HAVE TO HAVE ADEQUATE PROTEIN.
THAT DOESN'T HAVE TO ALL COME FROM ANIMAL SOURCES OR PROTEIN POWDERS.
THERE ARE WAYS TO BALANCE THAT OUT.
IF YOU'RE BUILDING MUSCLE, WE GENERALLY RECOMMEND A GRAM PER KILOGRAM OF BODY WEIGHT.
WHEN YOU HIT YOUR 40s, YOU SHOULD TURN YOUR FOCUS ON STRENGTH TRAINING.
THE MINIMUM WE RECOMMEND PER WEEK IS TWO DAYS A WEEK, BUT ARGUABLY THREE OR FOUR DAYS A WEEK WILL BENEFIT MOST.
WHEN YOU BUILD MUSCLE, YOU BUILD BONE.
YOU'RE WORKING ON MAINTAINING MUSCLE MASS, PREVENTING YOUR WEIGHT GAIN, AND YOU'RE BUILDING BONE AT THE SAME TIME.
>> Yunji: LOTS OF GOOD BENEFITS THERE.
DR. GOULET, A QUESTION FROM LANCE IN KAIMUKI.
WHAT ABOUT NIGHT SWEATS.
I'M A MAN IN MY 60s.
I OFTEN WAKE UP SOAKING WET.
IS THAT A SYMPTOM OF SO-CALLED MALE MENOPAUSE?
>> MAYBE.
WE HAVE TO REMEMBER LIVE IN THE TROPICS.
THE MODERN GEL FOAM HYBRID MATTRESSES, THEY'RE NOT LIKE THE OLD SPRING MATTRESSES.
EVEN THOUGH THEY ALL INSIST THEY'VE COOLING.
THEY TRAP AIR AND HEAT.
THERE'S SOME COMFORT THINGS THAT CAN BE DONE TO HELP SLEEP EASIER.
TURNING UP THAT THERMOSTAT.
NOT ALL HOMES IN HAWAI'I HAVE CENTRAL A.C. OR THE ABILITY TO TURN DOWN THE TEMPERATURE.
IT MAY BE A SYMPTOM BUT, IT'S A HARD THING TO TREAT.
>> Yunji: THERE'S A CALLER FROM HONOLULU.
DR. LAWRENCE, CAN YOU ADDRESS MEDICAL MENOPAUSE?
WE TALKED ABOUT THIS A BIT EARLIER.
AFTER GOING THROUGH CANCER TREATMENT, MY DOCTOR INFORMED ME I'M DONE WITH MENOPAUSE AND I EXPERIENCED NO SYMPTOMS.
ALSO, THERE ARE SOME WOMEN WHO DON'T NECESSARILY DON'T GO THROUGH A LOT OF WHAT WE DISCUSSED TODAY.
HOW COMMON IS THAT?
>> SYMPTOMS OF MENOPAUSE?
YEAH, THERE ARE SOME WOMEN THAT DON'T EXPERIENCE IT AT ALL.
THEIR MENSTURAL PERIOD WILL JUST STOP AND THEY FEEL STOP AND THEY DON'T COMPLAIN ABOUT ANYTHING.
>> AND IT'S ETHNICALLY BASED AS WELL.
WE'VE HAD RESEARCH SHOWS ASIAN WOMEN TEND TO BE LESS SYMPTOMATIC THAN OTHER GROUPS.
HISPANICS AND AFRICAN-AMERICAN WOMEN TEND TO BE MORE SYMPTOMATIC.
>> SO INTERESTING.
THERE'S ANOTHER FOLLOW UP TO THE QUESTION ABOUT SEXUAL HEALTH.
JEN SAYS, PLEASE ADDRESS WHAT OPTIONS ARE AVAILABLE FOR WOMEN POSTMENOPAUSE TO ADDRESS DECREASED LIBIDO, DISCOMFORT, DRYNESS.
WHY AREN'T DOCTORS MORE FORTHCOMING.
THESE CAN BE HARD CONVERSATIONS TO HAVE.
WHAT ARE OPTIONS, DR. CANYON, THAT ARE OUT THERE?
>> IF WE'RE FOCUSING ON VAGINAL DRYNESS, VAGINAL ESTROGEN CREAM IS GENERALLY CONSIDERED VERY SAFE, AND IT HELPS TO MAINTAIN THE TISSUE LUBRICATION.
IF YOU'RE STARTING FROM A VERY DRY PLACE, IT'S GOING TO TAKE A WHILE FOR THAT TO SETTLE IN.
THAT'S ONE OPTION.
PELVIC FLOOR THERAPY, I WOULD ENCOURAGE WOMEN TO BE DOING OR KEGELS.
AND THERE ARE SOME TREATMENTS THAT WE CAN USE FOR LIBIDO.
UNFORTUNATELY TESTOSTERONE HAS BEEN SHOWN MORE ANECDOTALLY TO BE QUITE HELPFUL FOR WOMEN BUT THERE'S NO FDA APPROVED RIGHT NOW.
THIS IS PROBABLY MORE FOR DR. GOULET.
>> BUT I ALSO WANT TO MENTION MOISTURIZERS AND LUBRICANTS.
JUST LIKE WE WOULD PUT LOTION ON OUR HANDS, THEY MAKE MOISTURIZERS FOR OUR REPRODUCTIVE AREAS.
THOSE CAN ALLEVIATE SYMPTOMS QUITE A BIT.
AND THEY'RE AN EASY FIRST STEP TO DO THAT DON'T INVOLVE HORMONES, WHICH CAN BE CONTROVERSIAL.
>> Yunji: DR. FRATTARELLI, A QUESTION FROM SHERYL.
ARE THERE FREE INFORMATIONAL WORKSHOPS OR EXPO OR RESOURCES ON MENOPAUSE?
THIS SUBJECT IS SOMEHOW NOT SPOKEN OPENLY ABOUT.
WE'RE SPEAKING OPENLY TONIGHT.
WHAT RESOURCES ARE OUT THERE?
>> I THINK THAT MOST ARE ONLINE RESOURCES.
MENOPAUSAL SOCIETY HAS ONLINE RESOURCES.
THEY HAVE AN ONLINE LIST OF MEMBERS WHO ARE SEEING PATIENTS AND CERTIFIED PRACTITIONERS.
MENOPAUSE.org IS THEIR WEBSITE.
I'M TRYING TO THINK OF OTHER SPECIFIC RESOURCES ARE OUT THERE.
WE DON'T HAVE ANYTHING IN HAWAI'I SPECIFICALLY.
IT'S A GREAT IDEA.
IT'S MORE HIT AND MISS AS FAR AS FINDING SOMETHING.
LIKE TONIGHT.
IT'S NOT A CONTINUOUS THING.
THERE ARE ALSO SUPPORT GROUPS ONLINE.
SO MOST RESOURCES ARE GOING TO BE THERE.
>> Yunji: DR. CANYON, YOU MENTIONED COMMUNITY.
FINDING OTHER WOMEN.
BUT REALLY TALKING TO YOUR PEERS CAN BE HELPFUL, TOO, I WOULD IMAGINE.
>> THERE ARE GREAT BOOKS COMING OUT.
A LOT OF WOMEN ENGAGE IN BOOK CLUBS.
THERE IS THE MENOPAUSE SOCIETY DOES HAVE SHORT YOUTUBE VIDEOS THAT EDUCATE THE PUBLIC.
THAT CAN BE INFORMATIONAL.
YEAH, CONNECTION, TALKING TO YOUR FRIENDS, BEING JUST FORTHRIGHT AND OPEN ABOUT WHAT YOU'RE EXPERIENCING AND ASKING, DO YOU THINK IT'S MENOPAUSE?
WHAT'S GOING ON?
HOW ARE YOU FEELING?
I THINK WE HAVE TO SHED THE SHAME AROUND IT AND START TO ASK MORE QUESTIONS.
>> Yunji: YEAH.
DR. GOULET, WHAT WOULD BE YOUR ADVICE FOR FOLKS WHO FELL LIKE THEY WANT TO CONTINUE THIS CONVERSATION AND HOW TO DO THAT?
>> ABSOLUTELY.
REACH OUT TO YOUR HEALTHCARE PROVIDER, WHETHER THAT BE YOUR INTERNIST, YOUR GYNECOLOGIST, YOUR LIFESTYLE MEDICINE SPECIALIST.
THERE'S HELP OUT THERE.
I GET A LOT OF PHONE CALLS FROM OTHER HEALTHCARE PROFESSIONALS WANTING TO KNOW WHERE CAN THEY GO AND READ UP ON THE CURRENT GUIDELINES AND RECOMMENDATIONS?
WE DON'T JUST INVENT THINGS.
WE FOLLOW THE EVIDENCE-BASED MEDICINE THAT THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS ARE PUBLISHING.
THE MENOPAUSE SOCIETY, AMERICAN SOCIETY OF REPRODUCTIVE MEDICINE, THE ENDOCRINE SOCIETY.
THIS IS A VERY HOT TOPIC.
THE RESOURCES ARE THERE.
>> Yunji: THEY'RE THERE.
>> WE DEFINITELY WANT PEOPLE TO REACH OUT TO THE PROVIDER.
I'VE HAD SO MANY PEOPLE THAT SAY, I LOVE MY GYNECOLOGY.
SHE DELIVERED ALL MY BABIES BUT SHE DOESN'T WANT TO TALK ABOUT THIS.
>> Yunji: AND WHY DO YOU THINK THAT IS?
GIVEN ALL THAT WE KNOW AND WHAT FEELS LIKES A CHANGE, A CULTURAL SHIFT AROUND THIS TOPIC, ESPECIALLY IN THE LAST FIVE TO TEN YEARS.
WHY DO YOU THINK THERE WOULD BE DOCTORS WHO FEEL THAT WAY?
>> THERE'S MULTIPLE REASONS.
ONE IS A LOT OF THOSE PHYSICIANS WERE TRAINED DURING THAT TIME WHEN IT WASN'T TALKED ABOUT.
THEY DIDN'T GET THAT ADEQUATE TRAINING AND HAVE NOT GOTTEN COMFORTABLE WITH THAT DISCUSSION.
AND I THINK IT'S TIME INTENSIVE.
SO YOU CAN'T STICK A MENOPAUSAL PATIENT INTO A 15-MINUTE TIME SLOT.
IF THAT'S WHAT YOU'RE TRYING, YOU CAN DO A PAP SMEAR IN 15 MINUTES, BUT YOU CANNOT DO A MENOPAUSAL CONSULT IN 15 MINUTES.
THOSE ARE THE TWO BIGGEST REASONS.
THE COMFORT OF NOT HAVING BEEN EDUCATED AND THE TIME.
>> Yunji: AND DR. LAWRENCE, FOR WOMEN WHO WANT TO BROACH THIS TOPIC WITH THEIR DOCTOR AND TRYING TO DO IT IN THAT 15-MINUTE WINDOW, HOW DO YOU ADVISE THE PATIENT TO APPROACH THEIR DOCTOR ABOUT THIS TOPIC?
>> DON'T BE AFRAID TO BRING IT UP.
AND IF YOU NEED TO RESCHEDULE ANOTHER VISIT, FEEL FREE TO DO THAT.
WHEN I SPEAK TO MY PATIENTS TRY TO BE A LITTLE PROACTIVE.
I USUALLY BRING IT UP IN THE PERIMENOPAUSAL YEARS SO AS THEY APPROACH THE MENOPAUSE TRANSITION, THEY HAVE A LITTLE BIT -- THEY HAVE A BETTER IDEA OF WHAT TO EXPECT.
AND IF THEY'RE A GOOD CANDIDATE FOR HORMONES, THEY'LL KNOW IT AT THAT TIME.
IF THERE'S A LITTLE BIT OF LIFESTYLE CHANGE THEY NEED TO DO, THEY HAVE TIME TO DO THAT SO MAYBE THEY'LL BE A BETTER CANDIDATE.
YEAH.
>> Yunji: DR. GOULET, WHAT'S YOUR BEST ADVICE FOR FOLKS WANTING TO HAVE THIS CONVERSATION, SPECIFICALLY WITH THEIR DOCTORS AND HOW BEST TO DO THAT.
ESPECIALLY IF THEY ENCOUNTER SOMEONE WHO MAY NOT HAVE THE TIME OR ARE RELUCTANT TO HAVE THAT CONVERSATION?
>> YOU HAVE TO ADVOCATE FOR YOURSELF.
AND NOT EVERY DOCTOR CAN DO EVERYTHING.
THAT MAY NOT BE THE BEST DOCTOR TO HAVE THAT CONVERSATION WITH, BUT YOU CAN ASK, WHO SHOULD I TALK TO?
WHO WOULD YOU RECOMMEND?
WHO WOULD YOU REFER ME TO WHO DOES HAVE THE EXPERTISE AND ABILITY TO MAKE RECOMMENDATIONS FOR ME.
>> Yunji: YEAH.
AND DR. CANYON, WE'LL GIVE YOU THE LAST WORD.
YOUR BEST ADVICE TO PATIENTS OR TO WOMEN WATCHING TONIGHT WHO MIGHT FEEL A LITTLE LOST.
>> I THINK WE TOUCHED ON IT MANY TIMES.
START CONVERSATION, BUT I THINK MY BEST ADVICE TO WOMEN OUT THERE WHO ARE GOING THROUGH THIS OR THINK THEY MIGHT BE GOING THROUGH THIS, PRIORITIZE YOURSELF.
PRIORITIZE YOURSELF.
>> Yunji: AND THAT'S A GREAT PLACE TO LEAVE US.
THANK YOU SO MUCH.
WE WANT TO THANK OUR GUESTS TONIGHT.
THANK YOU TO OUR AUDIENCE FOR ALL YOUR QUESTIONS.
WE LOVED THEM ALL.
DR. MELISSA LAWRENCE AND DR. EMILY GOULET.
ALONG WITH DR. SARAH CANYON AND DR. LEIGHANN FRATTARELLI.
NEXT WEEK ON INSIGHTS, THE HAWAIIAN LANGUAGE OR OLELO HAWAII IS ONE OF TWO OFFICIAL LANGUAGES OF THE STATE BY LAW, ALONG WITH ENGLISH.
WHILE THOUSANDS OF NATIVE HAWAIIANS AND OTHERS ARE BECOMING FLUENT IN THE LANGUAGE, SHOULD THE STATE BE DOING MORE TO EXPAND ACCESS TO OLELO HAWAII?
PLEASE JOIN US THEN.
I'M YUNJI DE NIES FOR INSIGHTS ON PBS HAWAII.
UNTIL NEXT TIME, ALOHA!
Insights on PBS Hawaiʻi is a local public television program presented by PBS Hawai'i