>> 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!