Talking Menopause at Work
Episode 488 | Host: Emilie Aries | Guest: Dr. Jen Gunter
How much do you really know about menopause?
Disclaimer: This episode discusses medical topics but is not a substitute for professional medical advice.
Menopause is as natural as puberty and affects almost everyone with a uterus, and yet it’s long been a taboo subject in polite society. For centuries, women suffered in silence, but that’s slowly beginning to change.
Dr. Jen Gunter is a big instigator in this shift to the dissemination of good intel on menopause. Dr. Jen is an obstetrician and gynecologist with more than three decades of experience. Her first two books, The Vagina Diaries and The Menopause Manifesto, became popular bestsellers, and she recently released her third book, Blood: The Science, Medicine, and Mythology of Menstruation.
Through channels such as her 2020 TED Talk, her blog The Vajenda, and her podcast Body Stuff with Dr. Jen Gunter, she is elevating facts above fiction and teaching women about their reproductive systems—something we should have learned in high school. In our conversation, Dr. Jen and I dig into the myths and realities of menopause and how this transition affects women in the workplace.
Menopause is finally getting its due
Dr. Jen is well-known today for educating women about menopause. Her first book, however, didn’t focus on this topic. During the book tour for The Vagina Bible, interview after interview wound up circling back to the single chapter she had devoted to menopause, and she realized people don’t know as much about this life stage as she had assumed.
For centuries, ageism has affected women uniquely, and our relevance has been perceived to drop when we can no longer become pregnant. This perspective isn’t helped by blatant inequities in the U.S. healthcare and health insurance systems, which offer far better coverage for issues that impact mostly men than those that impact mostly women.
When we reach menopause, we have already gone through an under-explained puberty, and a lot of us have experienced under-explained pregnancies. By the time we hit the third kick of the natural-processes-we-don’t-know-enough-about can, we’re fed up.
Today, Gen X is coming up on or already experiencing menopause. Because they’re more comfortable sharing their experiences on social media than previous generations, we are beginning to hear more and more about the real experiences of real people. Dr. Jen and the other medical professionals who have recently released books on menopause are more than willing to meet us where we’re at and lend their expertise to further our knowledge.
What is menopause?
Without a decent education in the menstrual cycle, it’s pretty tricky to understand what happens in menopause. But just like puberty and pregnancy, menopause is totally normal and vastly different for everyone. For example, Dr. Jen points out that some people cite pregnancy as the best they ever felt, while others barely get through it. Either of those options and anything in between—that’s mirrored in the menopause experience, too.
This is not to pooh-pooh the fact that the menopause transition can be really chaotic. Your hormones are all over the place, and this upset can last anywhere from four to ten years. Contrary to popular belief, symptoms of menopause don’t start after the last period—they can begin well before this and last throughout.
Menopause at work
One big indicator of just how much menopause has grown in the public eye is the section dedicated to it in Deloitte’s 2024 Women @ Work Report (which I explored in episode 469, Surprising Trends Impacting Women at Work). Specifically, the report notes that “more women are working through the symptoms [of menopause], and far fewer feel supported.” A striking 40% of women (compared to 20% in 2023) who report high levels of menopause-related pain and discomfort work through it, and only 19% feel supported when sharing the reason for their symptoms with their employers. While those numbers aren’t great, the recognition of them could be a sign of changes ahead.
Dr. Jen outlines some of the common symptoms that are a bit less well-known than the highly publicized hot flashes, any of which can impact the workday. In the transition phase, periods continue, but they often become more erratic. As such, unexpected heavy bleeding spells can develop at inopportune times.
Brain fog is another big one, and while the cause isn’t clear—it could be hormone level changes, poor sleep due to hot flashes, or disruptions in brain chemistry—Dr. Jen stresses that experts do know that it reverses and that studies show women are often performing better than they think they are during these murky moments.
Depression is another symptom of menopause, and it’s most likely to affect those who already have a history. In fact, this is true of most of the symptoms. Menopause uncovers biological vulnerabilities, Dr. Jen explains, so “if it’s something that’s only going to be appreciated at a low tide, and you have more low tides, that’s going to manifest itself.” While this is concerning, it’s also comforting to know that it’s normal and, in most cases, will pass.
Advocating for better workplace accommodations
I asked Dr. Jen about her vision for an ideal workplace where menopause and similar experiences are accepted or even celebrated.
“I think people should approach it like it isn’t a big deal,” she says. Managers should think about the existing structure of their workplaces, Dr. Jen suggests, and consider how someone experiencing more medical issues than average would function in that environment. What could be added to existing initiatives to show that a wider range of temporary experiences are being considered? This could include allowances for taking an unexpected afternoon off (to deal with sudden bleeding) and adjustments to the ambient temperature (to address intense hot flashes).
Then, there are the obvious additions some workplaces are beginning to include but so many still need to embrace, such as having menstrual products in every washroom and remaining mindful of the variable financial burdens linked to our inequitable health care.
Dr. Jen shares so much more menopause medical wisdom in the episode, and I would love to hear your thoughts. If you’re navigating menopause at work right now—what’s it like? Or, if you have colleagues in this boat, what have you noticed about how your team is addressing the situation?
Chime in on the Courage Community on Facebook or our group on LinkedIn, or drop me a line right here to share what’s shifted for you after this conversation and what you’d like to hear discussed further on the Bossed Up podcast.
Related links from today’s episode:
The Menopause Manifesto: Own Your Health with Facts and Feminism by Dr. Jen Gunter
Blood: The Science, Medicine, and Mythology of Menstruation by Dr. Jen Gunter
The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine by Dr. Jen Gunter
Jensplaining with Dr. Jen Gunter
The 2024 Deloitte Women @ Work Report
Episode 469, Surprising Trends Impacting Women at Work
Episode 414, New Rights for Pregnant Workers
TAKE ACTION to advocate for workplace rights
throughout all stages of women's lives:
-
[INTRO MUSIC IN]
EMILIE: Hey, and welcome to the Bossed Up podcast, episode 488. I'm your host, Emilie Aries, the Founder and CEO of Bossed Up. And today we're tackling a long overdue topic, and that is menopause at work.
[INTRO MUSIC ENDS]
Joining me to break down the mythology around menopause, what we need to know about our own bodies, and how our workplaces can become friendlier places for those of us navigating the transition that is menopause is Dr. Jen Gunter.
Dr. Jen Gunter is an internationally bestselling author, obstetrician, and gynecologist with more than three decades of experience as a vulvar and vaginal diseases expert. Her bestselling books, The Vagina Bible and The Menopause Manifesto, have been translated into 25 languages. And just about a year ago in January 2024, Dr. Jen Gunter released her most recent book, Blood: The Science, Medicine And Mythology Of Menstruation. She has a blog called the Vajenda, is the host of Jensplaining, a CBC Amazon Prime Video series that highlights the impact of medical misinformation on women, and she is the recipient of the 2020 Media Award from the Menopause Society. Her TED Talk, Why Can't We Talk About Periods? was the third most viewed TED Talk of 2020, leading to the launch of her popular podcast on the audio collective Body Stuff with Dr. Jen Gunter.
Clearly, she is a very busy woman with a lot going on, so we're so delighted she made time to sit down with me for this discussion that I found riveting, and I hope you will, too. And as a quick disclaimer, today's episode definitely talks about medical subjects, and our guest today is a doctor, Dr. Jen Gunter. But as a reminder, a podcast is no substitute for professional medical advice, so let's not get them confused for one another. Talk to your doctor if you want to learn more about how menopause or anything that we talk about today is impacting you. So let's dive right in.
Welcome, Dr. Jen Gunter, to the Bossed Up podcast.
JEN: Thanks. Thanks so much for having me.
EMILIE: I'm delighted to sit down with you because the topic of menopause feels like it's really, as the New York Times put it, having a moment. Just a few years ago, it felt like menopause was having a moment where myths around menopause were being debunked and where this conversation was coming out from the shadows. And you've played a big role in making that happen. So first, tell me a little bit about how you found yourself as this, like, menopause manifesto, creator, author, speaker, who's podcasting and TED talking all about this topic. What inspired that focus?
JEN: Well, it was really, I think, from listening to what people wanted. So I had my second book in 2019 was called The Vagina Bible. And there was a chapter in about, you know, the changes of menopause for the vagina. But it was really very focused on vaginal and vulvar health. And it was really interesting both on book tour and in press interviews for it, anytime menopause came up, it was like record scratch, freeze frame, people wanted to, like, hear more about that and so much so that it would sometimes even derail, like, the interviews. And I was like, okay, well, like, we're talking about my book about the vagina.
And then on the book tour, when people would ask questions, one person would eventually ask about menopause, and then everybody would ask about menopause. And it sort of be. So I was like, okay, obviously the universe is telling me something. As a physician, you don't know what the general public doesn't know, right? Like, that's your area of expertise. Just like a car mechanic doesn't know what I don't know about the car, right?
So I realized that maybe people didn't know as much about menopause as I thought, and maybe it was just as bad as information about the vagina and vulva and all that. And so that's when I decided my next book would be the Menopause Manifesto. And I think, well, my husband likes to say that I sort of started the trend. I mean, obviously I didn't start the menopause trend, but, you know, my book came out, and, you know, that piece in the Times came out, you know, a year or so later, and lots of other books on menopause kind of followed, which is great. The more people talk about it, the better.
EMILIE: But it's fair to say you are kind of the menopause OG, you picked up on this trend early, for sure. Why do you think this has been so, like, simmering under the radar for so long? Why has this conversation been hushed and in whispers for as long as half the world's population has been experiencing this?
JEN: Well, I think there's several factors. So I think ageism affects women uniquely. So there's that huge aspect of it, right? You. You're not allowed to have gray hair. You're not, you know, you can only age if you look like Jlo. You can only, you know, there's These very, very narrow definitions about what a woman is allowed to be, right? You stray on one two side and you're too loose on the other two side, you're too prudent. Like, there's no. It's. To be a woman is to walk on the edge of the knife.
However, when you get to menopause or when you start to age out of being like a breeder, if you will, then your relevance drops. And so I think there's. That there's a lot of women who don't understand what's happening to their bodies. And I would say that that's also the same in puberty and maybe also the same in pregnancy as well, right. We have these big phases and they're not talked about. It's just, you know, I think maybe when you go through menopause, you're like, okay, really, like the third time, like, can I have some more information now?
I think we have, you know, Gen X women going through menopause. And so we have this whole sort of generation that are used to share, more used to sharing on social media. We have more therapies, we have more women in medicine talking about it. And you know, in the United States, we like to talk about medical treatments a lot, right. Like, I think that, you know, we have a uniquely sort of, of medicalized approach to many things in the United States. So I think that we have all of these unique factors that are coming into play.
EMILIE: Yeah, that's so interesting. I never thought about the social media aspect, but of course, you know, when a generation of women start going through menopause who are more used to being online and chronicling our lives, and sharing, of course there's going to be more awareness about this.
You describe women understanding our bodies physiologically, whether it's, you know, around puberty, getting your period or menopause, as an act of feminism, what do you mean by that?
JEN: Well, I mean, it shouldn't have to be, right? Like, you should just be able to, you know, whatever, flip, open a book, be, you should learn it in school. It should be. It shouldn't be a secret, right. It shouldn't have to take any effort to do it. But that's not the case. I mean, your, you know, sex education in schools is literally how not to get pregnant. Maybe, like that's about it. You know, with. Within a narrow define, you can use these tools and I get pregnant. I mean, obviously there's probably exceptions, but for the most part.
And so people, I think, go through lives not knowing much about their bodies in general. And to try to find out about it feels like you have to climb mountains you shouldn't have to climb. And those exist because, you know, weaponizing women's bodies is of value to our society, be it, you know, the narratives about who you should have sex with or shouldn't have sex with, or when you should have sex, or how you should have sex sex or what you should use to prevent yourself from getting pregnant.
So there's all of those issues. But, you know, you also have to then think about how, if you have that ground or that, that lack of good knowledge, that just kind of compounds, right? So if you're trying to understand menopause and you don't really understand the menstrual cycle, it's actually harder.
EMILIE: And I've become so passionate about hormone health in the past few years, though I still very much would say I know very little about hormone health. But it seems like, there are so many systemic ways in which our hormones can impact our wellbeing as women, that there's usually a pill for that, you know, or just like take some antacids or, you know, here are some adaptive ways to not deal with the underlying issues, but just deal with the symptoms, that I think going into something as transformative as menopause without a grounding in hormone health, is such a disservice that we place most people in, you know, that position of just not, well, understanding what is actually going on.
JEN: I would say though, there isn't really like hormone health as sort of like a subspecialty to know about your body. Obviously there is from an Endocrinology standpoint, but what is good for your hormones is generally what's good for your heart and what's good for your brain. Like health is health. So if you want to parse out and say there isn't like a specific thing to do to like be healthy for estrogen, that's not going to be healthy for everything else in your body.
And that's what I think makes it really boring for people to talk about the good science. Because if the answer is always eat 25 grams of fiber a day or more and get your exercise and don't smoke, like, it's boring, and people, they want a pill, they want something special, they want to have levels checked. And the thing is, if those things made a difference, we'd be doing them.
I mean, we're not shy of doing tests in medicine. In fact, I would say there's a lot of over testing in medicine. So I think that's part of the problem is that your hormones aren't just this sort of separate entity. They're not like a fetus attached to you. Everything is connected and then when you look at the, what makes the system work the best, it's always about things that are good for your heart and your brain.
EMILIE: So when we think about the mythology around, like, the health misunderstanding that exists around menopause, like, what are some of the biggest misunderstandings around the foundational things that you want people to know and women in particular to know about their own bodies going into menopause? If menopause is on the horizon or it's already here, like, what do women really need to know that you think we don't?
JEN: So, first of all, that it's a normal biological process. And I think that you see so much fear on social media, like, everybody's gonna drop dead at age 55. And obviously everybody's had a grandmother, you know, or, many people have had grandparents, right? Like, it's. People don't drop dead. Life doesn't end at 55. That's a patriarchal narrative. And I would be wary of people spreading that account, that information, that it can be very chaotic for some people that transition into menopause, just like puberty can be very chaotic for people, right?
So you had this time when your hormones were kind of all over the place. That's the same thing as the menopause transition. When you kind of go from your period of having regular cycles, they become irregular and then they finally stop. And during that transition period, which is anywhere from 4 to 10 years, things can be really quite chaotic. And they can be pretty much okay. It's a wide variation. Just like puberty, just like pregnancy, right?
There's people who go through pregnancy who love it. They love it so much. They say the best they ever felt was when they were pregnant. And then you see the exact opposite end of the spectrum. And you see people who say, I can never do this again. I did this once and this was hell on my body. And you see every permutation and combination in between. So I would say we've all probably forgotten what it was like when we went through puberty, because that was a long time ago. But that if you think about other, you know, if you've never been pregnant, but you probably had friends who've been pregnant, you can talk to them. You've probably heard a wide range of experiences. And so that would be the same in menopause.
And I would also say that a big myth is that symptoms don't start until after the final period. But that's incorrect. Many, many people have bothersome symptoms during the menopause transition.
EMILIE: Which can be almost a decade in length, you're saying, like, that can extend to an entire decade, that's a long time to be experiencing. What are some of the common symptoms besides the hot flashes, which I feel like have taken over the narrative, the public narrative around menopause? Like, we know hot flashes are part of it. What are other symptoms that are associated with menopause that might be less well known?
JEN: So irregular periods during the menopause transition, that's very, very, very common. Skipped periods, heavier periods. Brain fog is a very common description that people have during the menopause transition. And that can sometimes affect people at work. And so it's a good thing to talk about. The thing about brain fog, though, is it's not a sign of dementia. It's not a sign that you're going crazy. We don't quite understand what it is. We don't know if it's due to sort of disruptions in brain chemistry due to hot flashes or poor sleeping due to night sweats, or if it's actually due to changes related to hormone levels, we're not exactly sure.
But what we can say is that it reverses. It's not a permanent thing. And that women actually tend to perform better than they think they do when they have brain fog. So just something to keep in mind, when they're actually objectively tested, they perform better. So just that it may not be as bad as you think. And some people suffer from some more executive dysfunction during that time. So like an organizational, that type of thing, estrogen seems to have a role in that. But also if you're sleeping poorly or you're having a lot of hot flashes, that, that can play in as well.
Depression also is common in the menopause transition. It's a time of heightened risk. And the people who are more likely to get depression during that time are people who have previously had depression. So if you've previously had maybe postpartum depression or previously had depression at another time, you probably have an underlying biological vulnerability. So, a way to think about the menopause transition is something that uncovers biological vulnerability, right. So for a lot of people that if it's something that's only going to be appreciated at a low tide and you've got, you know, more low tides, then you know then that that's going to be something that is going to manifest itself. But depression and the menopause transition, joint pain, vaginal dryness, pain with sex. And many, many, many of these things are treatable. So I think there's also that caveat as well.
EMILIE: Right. So interesting. Well, I'm glad you mentioned work because I was surprised and frankly delighted to see menopause getting its fair due in the recent Deloitte Women at Work study. They put out a report every year. Not a study, but a report. And their 2024 report, Menopause, got an entire section devoted to it. The headline being More Women Are Working Through The Symptoms And Far Fewer Feel Supported. They found about 40% of women who report experiencing high levels of pain or discomfort due to menopause say that they work through it, compared to just 20% in 2023. So that number doubled year over year.
And then only about 19% of women in this section who experience menopause-related challenges say they felt supported by their employers. After disclosing menopause as a reason for taking time off work, what do you think the politics are, you know, related to how to even broach this topic, which is a significant for, for some women, more significant than others, but a significant health transitional phase that, like, still feels taboo to discuss in the workplace.
JEN: Yeah, I think that the more people talk about it, that's the first step. I mean, there used to be a point where you had to quit your job if you were pregnant, right? So that, you know that and things have progressed now. Still, you know what, there's still people in pregnancy, who are pregnant who are, you know, not getting treated correctly at work, who don't get the time they need. I still remember, I don't do obstetric anymore, but I still remember having to write somebody a note who worked at Walmart, so when she was nine months pregnant, she could sit at the cashier as opposed to stand.
EMILIE: And I have to just make a plug. For a recent episode we did last summer on the Pregnant Workers Fairness Act, that I'll drop a link to in the show notes, that has codified those rights legally as of a year ago. But even up until a year ago, she didn't have the legal right to a stool, which is insane. Yeah.
JEN: I mean, it's absolutely insane. So if you have a legal right to a stool, maybe you should also have a legal right to be able to reduce the temperature because you have hot food flashes, right? So maybe you should also have, you know, the legal right, like if you're bleeding heavily, like you've got to leave and take care of that, you know, these are sort of, so there's these sort of physical things that go along with menopause that can make it more challenging for some versus the other.
Then in the United States, we have some other issues that a lot of other countries don't have because we have more expensive healthcare rate. And women's healthcare is generally not as well reimbursed, not as well covered as men. So if you are at a time in your life and you're between your 40s and mid-50s where you have more doctors appointments than your male colleagues, right? You have higher co pays than your male colleagues, you might get called at last minute to go in for a pelvic ultrasound that you need to have, so, you're heavy bleeding, so you've got to go in.
So you have a greater likelihood that you're going to use the health care system between those time periods. So what are the accommodations for that? Is that going to be held against you? If you've already used 12 days because you had COVID twice, right. Then you start bleeding, then what? So I just think that. But these all need to be part of the conversation. And you know, clearly there's countries that do it. I mean, we, I don't think we hear and I don't know the data as well from the Scandinavian countries, but, it seems to me that having the time off to deal with the health issues that you have seems to be less of a concern in some places.
And you know, interestingly enough in those countries too, menopause is, you know, kind of viewed more as, you know, part of aging, as opposed to some women's aging, is not uniquely awful, let's put it that way. You know, that's kind of a, I think more of a trend. I hate to generalize, and certainly I'm not a social anthropologist, but you know, when you, you know, sort of hear about things.
So I just think that is really important for people to get the care that they need at work. And if you start thinking about like the insurance packages that are offered and things like that, if you're, if your co-payment for an ultrasound is such and such, that's going to uniquely affect women over men during menopause, right? So, there's other ways to think about, you know, the parody beyond just in the office.
EMILIE: Right. That's so interesting. So it's the office. It's the personal narrative that how you know your own body, how well you've been taught to know your own body. It's the public narrative about how we differentiate between aging women versus aging men. And it's certainly the medical insurance kind of situation that we have here in this country. There's many different layers to it, I can see.
JEN: And I'm not sure how all these accommodations can happen. But, you know, the thing is, if you don't try, you don't know. I mean, I think about my own situation. A couple of the rooms that I see patients in, in the afternoon, it can be if it's hot outside, the rooms are awful. They're just awful. And I can't leave the door open because I'm talking to patients about private things, right? We can't have the door open being like, hey, tell me about your vagina.
So, you know, so then why couldn't I have a fan in those rooms to a plug in fan to turn on in the afternoon when it's hot to keep, you know, to keep the temperature, because when you're hot, that can trigger a hot flash.
EMILIE: Right, that’s interesting. I also think it's just something to be aware of that obviously menopause affects most women at a later age in their lives, but that's not true for all women, right? Like some women experience menopause earlier on in their lives and they feel pretty invisible, I think in most conversations around this.
JEN: There's a couple of ways that can happen, though, there are some women who, because they've gone through cancer and they've had chemotherapy or radiation that damages their ovaries and they go through early menopause. There also are situations where people choose to have their ovaries removed to reduce their genetic risk, right? Like maybe they are carrying genetic markers and so they're going through an early surgical menopause. And then there's a condition called Primary Ovarian Insufficiency where it's not really a premature menopause because it's a little bit different, but people go through that before age 40.
And so we know that with abrupt drops with surgical menopause, with, you know, with after chemo or radiation, that people can often suffer with far worse symptoms, partly because it's an abrupt drop and partly because it's happening to you when you're 35 or 32, and there hasn't been some kind of slower winding down process, right.
EMILIE: For those people, we would never expect them to suffer in silence and not get reasonable accommodations at work, right. So why do we kind of classify aging women in a different bucket of like, this is a personal problem you should be dealing with on your own, as opposed to how can we accommodate like, how can we support you through this?
JEN: Oh, I completely agree. Although I suspect most of those people are suffering in silence. I absolutely bet they are. So, I think that a manager might sound more like, oh, my gosh, of course, because they've heard it, because it was because of chemotherapy, right? So I think that maybe. But I could. I could be completely wrong. But sadly, actually, a lot of people who go through early menopause don't get the, you know, we recommend hormone therapy for everyone who goes through an early menopause till at least the age of 51. And then you can make a decision at that point.
And so, you know, a lot of people are actually suffering because of bad medical care because sometimes they don't have any more time off or funds to go to the doctor, and sometimes they're just sick of going to the doctor. Which you can absolutely understand, right? You can understand. You had a bone marrow transplant, you had years of chemo, you had all this awful thing happen to you and you don't want to go in for one more thing. It's all completely understandable. But I suspect there's actually a lot of people suffering.
In fact, when in my book, the Menopause Manifesto, you know, I wrote a whole chapter about primary ovarian insufficiency, and my editor was like, you know, that happens to like 1% of women. Why is there a whole chapter about it? And I said, well, because those women are actually suffering more, and if I can help one person, and then the number of lovely messages from women with primary ovarian insufficiency who are like, I can't believe that, you know, there's a whole chapter dedicated to this. So, yeah, I think, I think it's really important to talk about and how they're uniquely affected.
EMILIE: Yeah, so, so important. So when we talk about suffering and then we talk about hormone therapy, hormone replacement therapy, I know there was some medical kind of divergence in the literature or sort of like a flip flop on hormone replacement therapy in the past few decades. Help me understand that and help me understand what amount of suffering here is optional. Like what interventions should we be normalizing for women going through menopause to reduce the suffering? And what are symptoms that maybe we just have to, like, live with and work through the process of. And tolerate. Because I think there's this defaulting to the latter that has been the norm for so long. Because a lot of women don't know that there are solutions available for solving some of these symptoms.
JEN: Yeah. So you know, what you can or should do are very personal decisions. And there are many people who actually have terrible symptoms who just don't want to take a pharmaceutical. And there's people who have what I would consider to be very mild symptoms who want to take a medication. So it's all about understanding the risks and benefits, and can this medication do what you want it to do? And is that in a reasonably safe thing to do?
So, for example, you would never take a Tylenol to grow an inch in height, right? So even though Tylenol is an incredibly safe medication, you would not take that, you know, on a regular basis for something that it absolutely could not do. So you have to also think about, can this medication do what I want it to do? So briefly, in the 1980s, we told everybody that they should be on menopausal hormone therapy. Basically, we said, it's going to protect your heart. Your brain is like, it's like the fountain of youth. And that there was a small risk of breast cancer associated with it. But that risk was far outweighed by the benefits. The Women's Health Initiative was designed to test that hypothesis. It was the largest randomized, double-blinded, placebo-controlled trial that's ever been done, actually. And it had arms that also looked at calcium and vitamin D and a low fat diet to prevent breast cancer. I mean, it was a massive trial out.
And what they found was that estrogen did not, in fact protect the heart. And so the trial was stopped. There was two arms, if you have a uterus, you have to take a progesterogen, which is either progesterone or progestin, to protect your uterus, from estrogen, or the estrogen will give you cancer. If you have a hysterectomy, you can just take estrogen alone. So they stopped the estrogen and progestin arm quite earlier. I think it was like at 5.1 years. I can't. I can't actually remember off the top of my head, but it was about three years early they stopped it. And because they were never going to get the metric of improving heart, in fact, it looked like it was going in the wrong direction and they had reached the predetermined threshold for breast cancer.
So we said this could cause breast cancer. We've set a predetermined safety threshold in the study and we hit that. We can't possibly get our cardiac outcome, we can't possibly get it in the time remaining in the study, and we've hit the safety threshold for breast cancer. Now that's a very different narrative than what was spun to the public. The whole idea behind releasing the results kind of in the way that it was done was apparently to shake things up. Because people were over prescribing it for the heart, not because they were over prescribing it for hot flashes, not because they're over prescribing it for poor sleep, because they were telling everybody they should be on it to protect their heart.
But what happened because the American press likes to scare women, is basically their narrative became hormones cause breast cancer, hormones are going to give you a heart attack, hormones are going to kill you. And then all the malpractice lawyers, you know, and then the whole thing. And then a couple of years later the estrogen only trial was stopped. Like I think it was just eight or nine months early for the same reason. They, there was no breast cancer threshold, but they weren't going to make the cardiac protection. So they stopped it.
Now, years later and after reanalysis, because the average age in the Women's Health Initiative, where women in their early 60s and starting people on estrogen after they've been off it for a while is a lot different than starting people on it while they're still having problems and while they're still having symptoms. And it turned out that the older you were when you started, the greater your cardiac risk and the greater your risk for your brain and that those risks got less the closer you were basically to your last period and having massaged it to the enth degree. And then there's other studies since, although none as large as that. What we think is that estrogen therapy, we all menopausal hormone therapy is not replacement, your OV shouldn't be making estrogen when you're 56, right?
So now we think that low dose estrogen therapy, meaning appropriate doses. There are of course some people who prescribe far higher doses than are recommended. Inappropriate doses is really very safe. If you have to take a progesterone or a progestin, there is a risk of breast cancer. And that does accumulate over time. It's about the equivalent of having a glass of wine a day. That can mean a lot to some people and mean not a lot to some people. But we would say that about 6 per 10,000 women per year, you know, might end up getting a breast cancer related to it. We consider that to be in a rare range for an outcome. You know, if you look at men getting blindness from Viagra, it's or Viagra-related drugs, it's not that much different. It's a little bit less, but do you know what I mean? But you don't read articles scaring men about that.
EMILIE: Right. So the risks are there. They're not non-existent, but they're not great.
JEN: I mean the risks are there. Every medication has a risk. If you drive a car, you're risking getting in a car accident. So the thing is that these risks are generally considered very low. If you're somebody at a much higher baseline risk of breast cancer because of multiple factors, you might have a higher risk based on that. That doesn't necessarily mean you shouldn't take it. It means that you should be advised about those risks so you can make an informed choice.
You also have to weigh it against the benefits of sleeping well and not having hot flashes and having your depression treated and having all these other things. And the data that we have now about hormones, about like protecting the heart, is really very contradictory. There are some people who believe that it does protect the heart if it started early. There's some people who say, you know, the quality of those studies isn't that great.
And so because there isn't consensus there, I tell people to move away from that and to think about things that we know hormones can do for sure because you don't want to assume a potential risk for something you don't know it can do for sure. But you would want to assume a potential risk if you're going to get a far, a definite benefit from it, right?
EMILIE: Right. And those benefits have to do with like the day to day symptoms, right?
JEN: Exactly. The day to day symptoms Also, you know, it can for some people who are at high risk of diabetes, it may reduce their risk of type 2 diabetes. So there's, there's a big conversation to have about things that hormones can definitely do, things that maybe they can do, and things that they can't do. And then to putting you know, the low risk in perspective. If you're someone who's had a previous stroke or heart attack, you can't take hormones. If you're somebody at very high risk for cardiovascular disease, you shouldn't take hormones. If you're at someone very high risk for breast cancer, you should have a conversation about that before you start hormones, like lots of medications, right? And we also have great medications to treat hot flashes that aren't hormones.
So we now have these neuro, called neurokinin three receptor antagonists. And these drugs actually work in the area of the brain that triggers the hot flash. So and they're very effective. And then we have some antidepressants that work and a few other drugs, they're maybe not quite as effective as these nero, neurokinin 3 receptor antagonists. And so there are options. And of course there's vaginal therapies. There's, there is vaginal estrogen and other types of vaginal therapies. If people's only concern is vaginal dryness or other things like that. So there's a whole host of treatments.
EMILIE: So it's interesting to think, yes, you can kind of take the estrogen approach or the hormonal approach for symptom wide or system wide symptoms if that feels like the best course of action for you. Or if it's just sleep, like insomnia, maybe we target that, or maybe we target the hot flashes, or maybe we target vaginal dryness, depending on which symptom is really causing the most distress.
JEN: Yeah. So I encourage people to come in with a list of the symptoms that are bothering them and then we can kind of decide, well, which are the things that could potentially be treated. And it can become difficult because you sort of have this burden as sort of, I would say, like the straw that broke the camel's back. So if you're having hot flashes and you're not sleeping at night and you have depression, well, is the depression because you're not sleeping or you're not sleeping because of the depression, right?
Or all those things related? And so I always tell people, like, if you're having symptoms like that, and we know that estrogen in the menopause transition can treat depression, then it might be worthwhile treating those core symptoms and then seeing what happens to the other symptoms, right? Because we all know that when we're not sleeping well, our tolerance for lots of things changes. And, you know, your brain fog could be related to depression, it could be related to poor sleep. And so, you know, thinking about treating the core symptoms and then seeing what's left, but also if you're not having any symptoms to not really worry too much about it.
EMILIE: Yeah, I love that I could clearly talk all day with you about this, but with just our couple minutes that we have left, I guess, to bring it home for the workplace context and for the managers who are listening to this. Is there an ideal world? Maybe it exists in one of those Norwegian countries or maybe it doesn't. But is there an ideal world in which you could envision, like a different way that we would handle menopause at work? What could managers do, what could organizations do, to just make this transition A, not a taboo topic, but B, something that is, dare I say, celebrated if not tolerated, in a more appreciated kind of way.
JEN: Yeah. I mean, I think people should be able to approach it like it isn't a big deal. And I would. I would like managers to think about, you know, how is my workplace structured that somebody who is maybe having more sleep issues, or someone who's having a lot of hot flashes, or someone who's having more medical issues, how are they going to function in that environment? And, you know, how can I support them through this temporary change?
I mean, it could be as our work sends around every year. Do you want a heater for your office, right? For the winter? Could you not add a fan to that, just even? And that I think when people start they've been thought of, they really like that. Look at, you know, what your sick leave flexibility is like. Make sure your bathrooms are stocked with menstrual products because periods can be irregular. And if it happens all of a sudden, you know, people don't want to be bleeding all over their clothes. Think about, if you're in America, what your health insurance really covers, because there's also that financial burden. And just thinking about, you know, how you can be supportive in general, I think goes a long way.
EMILIE: Absolutely. Where can our listeners learn more about you and your incredible work and your incredible book all about this topic.
JEN: Yeah. So you can find me on Instagram, @DrJenGunter, on Twitter at Dr. Jen Gunter, Facebook, Dr. Jen Gunter. My blog is The Vajenda, V-A-J-E-N-D-A. You can find me at thevajenda.com and my book the Menopause Manifesto, and my new book, Blood, all about menstruation, you can find anywhere.
EMILIE: Amazing. Well, Jen, um, thank you so much for being here and for shining a light on this topic and really all the advocacy that you do on behalf of folks with vaginas. We appreciate it.
JEN: Oh, thank you so much. Have a great day.
EMILIE: For links to everything that Dr. Gunter referenced in our conversation just now, head to bossedup.org/episode488. That's bossedup.org/episode488. And now I want to hear from you. Are you someone who's navigating menopause at work? What has been helpful to you? What has been challenging throughout this journey thus far? And if you have colleagues who are navigating menopause, how is it being talked about on your team? Is it being talked about on your team? How familiar are you with the science that Dr. Gunter walked us through today. I certainly haven't been and paying that close of attention. And I feel like I haven't been really taught that much about my own reproductive system and my own vagina, for lack of a better word, right. I really feel like going into menopause blind is how most of us go into it.
So I'd be curious to hear what has shifted for you after this conversation. Is this something you're going to be more proactive about? Is this something you already kind of having to be proactive about? What did we leave out? What could we discuss further next time?
[OUTRO MUSIC IN]
As always, we'd love to keep the conversation going in the Bossed Up Courage Community on Facebook or in the Bossed Up LinkedIn Group. And until next time, let's keep bossin’ in pursuit of our purpose, and together, let's lift as we climb.
[OUTRO MUSIC ENDS]
