Anita Rao
Menopause is having a moment, and it is so long overdue. With puberty, we're given a lot of foreshadowing about what to expect. I personally stocked up early on panty liners and menstrual pads, packing them in my school bag for months before my first period hit, just in case. And honestly, I was excited to join the community of friends who are already experiencing this new culturally celebrated body change.
But the closer I've creeped to the end of my menstrual cycle, the more I've started to feel nothing but dread. Hot flashes sound terrible. Unpredictable body changes, even worse. My mom has been in the thick of the menopausal period for the past seven years, and it's only because of her openness that I've learned anything about this tumultuous, uncomfy and sometimes empowering phase of life. The more I talked to her, the more I start to wonder why I'm so afraid of my aging body — and really start to question why the things that happen to our younger bodies, like puberty and pregnancy, are so worth celebrating while menopause isn't.
This is Embodied — our show about sex, relationships and your health. I'm Anita Rao.
We're slowly seeing more public conversation about menopause. Thanks in part to some of the folks you'll meet on the show today, but one easy, clear and accessible way to break the silence: Lots of folks in your own life have gone through it. Each body experiences menopause differently, so what better way to become well versed than to ask questions of people who are the experts in their own experience?
Sheila Rao (Anita's Mom)
As I'm just turning 50, I start having not really bad hot flashes, but hot flashes — and when I'm working at school with little kindergarteners, they sort of distract me from my work. I feel my face getting hot, heating up like a pan: boo, boo boo, hot, hotter, red, red, red.
Anita Rao
You probably recognize that voice —or at least you do if you've been hanging around with us on the Embodied podcast for a little while. It's my very own mom, the one and only, Sheila Rao. She's now in the post-menopausal phase of life, but I wanted her to take me back to the beginning when she first started noticing her body change.
Sheila Rao (Anita's Mom)
As you get more of these you're like: Oh, yeah, that's those things — hot flashes, man. These things are something.
Anita Rao
So, did you know that it was a hot flash until you had this light in your head that said: Okay, maybe this is the beginning of menopause?
Sheila Rao (Anita's Mom)
Oh, yeah, for sure. From books you've read clinically, you know the symptoms of menopause. And you think: Oh, you know, how can you handle that? But when they really start — It's a different story.
Anita Rao
So, you said you read it in books? How much did you know about it before it happened? Had you had any conversations with your own mom or people in your life? Whose experiences kind of informed what you might be going into?
Sheila Rao (Anita's Mom)
Short answer would be no. I never discussed menopause with my mom, but looking back, I feel that I can remember when she was in menopause because it was when you were born. They came to India and I was actually shocked to see my mom. She lost a lot of weight and she's looking super anxious and thin — and she was a little bit kind of grouchy and touchy. And I'm like: Yeah, she used to be like this, you know — this is odd. And now, when I was getting ready to talk to you for the show, I'm like: That's what it was? She was really going through menopause at that time.
Anita Rao
There's so many physical changes associated with it, and these things that are very obvious that we maybe hear about like hot flashes, but there's so much stuff that you're also going through mentally and emotionally that maybe Nana was going through on the inside. Talk to me a bit about that for you and how it started showing up in terms of your mental health.
Sheila Rao (Anita's Mom)
The physical symptoms over time compound, so you'll have some hot flashes, night sweats — very, very, very severe night sweats — your sleep is interrupted, you have palpitations, and I felt myself becoming increasingly anxious. I would worry about a lot of things, and irritable, and my mood would swing, and I'd have a headache and I'd be like: Wow, this is really bad. And I think I just tried to just jolly myself along.
And I think it got to a climax in about 2014 when I just knew that I needed some help. I'm like: this is really, you know — I'm having some mental health issues here. And I remember very clearly, I would just lay on the bed and started like: Holy, I'm really, oh my god, what's happening to me? Can you help me? Like literally said that: Please, help me? Like, I think you're okay. Okay, I'm just, you know — I really don't feel good, and I'm just anxious — and it just came to a pinnacle. And it was — I would call myself a hot mess at that point.
Anita Rao
So, what did you do? What did you do after having that realization?
Sheila Rao (Anita's Mom)
I actually went and saw my OBGYN and she, at that point —I started taking anti-depressant for a little while, which did help me. It really did help me, and, you know —I think I'm living with dad. He's a physician, but, obviously, he doesn't see me as a patient. And I'm like: I'm a patient. I'm really unwell.
Anita Rao
Dad, come on! But the roller coaster ride my mom went through is the experience of so many folks in menopause. From the first sign of symptoms to the end of hormonal fluctuations — there is a lot going on, and getting used to the changes in your body can be a lot to handle.
Glenda
I've had hot flashes, I've had anxiety, I've had brain fog nightspots, but lots of people don't have those. And, you know, my period ended suddenly and didn't come back again — and lots of people have it gone for a long time. So, just knowing that everyone's different has been super helpful.
Su
The most surprising thing that I've learned about menopause since I started experiencing it is that it takes so long to actually get to menopause. I did not realize that perimenopause was a thing. The perimenopause parkway is long and full of lots of ups and downs.
Anita Rao
That's our listeners: Glenda and Su, and they point to something that's been the biggest education for me recently: Menopause is not one moment in time, but a phase of life that can last close to a decade.
It's comprised of three parts: perimenopause, menopause, and post-menopause. Perimenopause is the transition into your final menstrual period. It's when your levels of estrogen and progesterone start to fluctuate — and you probably start seeing some of those symptoms like hot flashes, night sweats and mood changes — and this phase can last five to seven years. Menopause itself means 12 consecutive months of no menstrual bleeding. The symptoms that may have started could get worse, and some new ones might appear.
Camille Moreno
The final menstrual period causes issues when it comes to what we call vasomotor symptoms: hot flashes, night sweats, sleep issues, and then also noticing vaginal symptoms. More vaginal dryness. Painful intercourse. Even, you know, symptoms of a urinary tract infection.
Anita Rao
A doctor that's not my dad: Camille Moreno. She's a certified menopause practitioner at Duke Health, who sees folks experiencing menopause day in and day out. This includes people like my mom who start experiencing menopausal symptoms in their 40s and 50s — but some people experience menopause earlier. You're going to meet one of those folks later. But first, a little more on the science from Camille.
Camille Moreno
When your periods stop before the age of 45 — and premature menopause was when your period stops before the age of 40 — and so, early menopause typically, naturally happens in about 5% of women, while premature menopause happens in a lower subset of women, so 1% of women, but there are other causes of early, as well as premature menopause.
This may include a surgery to remove your ovaries — and also there may be times where a woman goes through menopause after getting their uterus removed or having a hysterectomy — and those women who have gone through chemotherapy and radiation treatment may also go into menopause a lot earlier than the natural age of 52 — and for those women, who also have a family history of earlier premature menopause, this tends to run in families based on genetic predisposition.
Anita Rao
So, we've heard you talking, and my mom talking, about hot flashes and night sweats — but I'd love to talk a bit more about some of the symptoms that impact sex life and relationships, and what recommendations you get for folks wanting to continue comfortable sex life as they navigate menopause, but maybe are experiencing that huge drop in libido or a lot of vaginal dryness and discomfort. Talk to me about supporting patients through that period.
Camille Moreno
And this is, you know, very common — a lot of my patients come to me for this, but unfortunately, the symptoms related to what we call genital urinary syndrome of menopause progressively get worse without treatment — that's why I see these women in their 60s and 70s, well into their postmenopausal years, still having debilitating symptoms. And there are a variety of hormonal and non-hormonal treatment options. And so first would be non-hormonal, including the use of lubricants and moisturizers. And if those don't work, and if you've tried those first line treatment options, which most women have, because they read about it, they talk to their friends about it, then this is when you would seek help and counseling from a health care provider about hormonal treatment options.
Anita Rao
Yeah, I just wanted to pause you there and kind of help you orient as to when and how folks should make that call about whether to seek support? Some of these changes are natural and some symptoms are going to occur, but how would you talk to a patient coming to you with some of these symptoms and help them think through whether or not to seek treatment?
Camille Moreno
I think if you have tried lubricants and moisturizers that you have found over the counter for at least three to six months with no relief — and sex is not as pleasurable as it used to be or dryness vaginally has become more of like a paper cut sensation, a sharp sensation that really is unbearable — you can even sit down. Then that is when you would seek help, especially if you've tried the over the counter options.
Anita Rao
So there are some kinds of treatment options available. You've mentioned some of those specific for the symptoms of vaginal dryness, but I'd like to just talk about hormonal treatment generally. I know this got a really bad rap with the big study that came out in the early 2000s, and a lot of people were scared away from hormonal treatment to help with symptoms of menopause — there have been some updated research and findings, so kind of bust that myth for us: that hormonal treatment is not safe to talk about — who is well suited for hormonal treatment for menopausal symptoms?
Camille Moreno
Menopausal hormone therapy was a routine treatment until about 20-ish years ago in 2002, when the big Women's Health Initiative was published, and it raised some concerns about safety. But really since that time, we've learned more about the risks and benefits of menopausal hormone therapy, and now the consensus statement is that in most healthy, relatively young menopausal and perimenopausal women, the benefits of menopausal hormone therapy outweigh any risks.
And we do have more data and more evidence seeing this now and we call this the 'window of opportunity.' And so for those women who are very bothered by their menopausal symptoms, especially the vasomotor symptoms, they deserve some counseling on menopausal hormone therapy initiation, especially if they're within 10 years of going into menopause, and if they're cardiovascularly healthy.
Anita Rao
How about non-hormonal things that folks can do? Are there dietary changes or nutritional advice that you give to folks that help manage symptoms?
Camille Moreno
A healthy, well-balanced nutritious diet and exercising routinely can also help the symptoms related to menopause including mood changes, including the hot flashes and night sweats. And so overall, maintaining a healthy lifestyle, I would say, would be key — and my number one recommendation: avoiding smoking and too much alcohol.
But for those who are really not good candidates for menopausal hormone therapy, we have treatment options. And this would include your typical medications under the class of antidepressants, and so those medications are used off-label not just for mood changes that come with a transition and also into menopause, but also with the hot flashes. So, these are off-label treatment. However, we have one FDA approved antidepressant that is used for management of vasomotor symptoms and we use that commonly now and has been in the market in the last few years.
Anita Rao
You know your body best — if you're experiencing menopausal symptoms that are consistently uncomfortable and reducing your quality of life, pause this podcast and go get support. I am so glad my mom did, but talking to a doctor and getting on an antidepressant wasn't the end of her menopause story. There was still a lot she had to navigate with my dad.
Sheila Rao (Anita's Mom)
He was in his own world, doing his own thing. He always saw me as, you know, the rock, the capable person who was just going to take care of anything. So, you know, if I'm sort of melting around the edges, like a candle, he's like: Oh, wow. So, I had really pointed out to him because he's dealing with really tough situations on a daily basis. So, he looks to me as to be stable, and you know, I'm the one who's gonna take care of everything. And when I wasn't able to, I just really had to poke him in the eye and say: Hey, this is me. I need help.
But, then we chatted — like, when I felt better, we would have conversations, and he said: Oh, yeah, you're really grouchy. And he said: I just would not say anything - and whenever I would say anything, I said: Yeah. Okay. Whatever you say. - And like, yeah, really sorry about that.
Anita Rao
Well, no need to apologize for that. You're experiencing a lot, and it went on for some time. So, take me through — there was that climax moment where you then sought some support. You got on antidepressants, and then you kind of continued to move through the menopausal period. And you're now in the post menopausal period, and have told me recently that you're still working through some changes and symptoms. So, tell me about some of that - kind of how things have evolved as the years have passed.
Sheila Rao (Anita's Mom)
I just found that I had no libido at all, and I'm sure you're going to talk about this, but you know, you'd rather just eat a tree than have sex. None, whatsoever. And it's like: Oh, dear, this is not good. Then again, anxiety coming back, irritability — and really then, one of the main reasons I sought help is brain fogginess is like: just not feeling sharp. Like: Oh, what? Yeah, let me just read that again or knowing that: Hey, this is not right.
So, it was actually by happenstance. We met a friend of ours while we were out walking in, and he's a very experienced, endocrine gynecologist, and he started talking about patients who he has had a lot of success with these compounded estrogens. And I just burst out, I said: I want to be your patient. He said: For sure. And I'm like: Okay, I'm coming next week.
So, I made an appointment, and we had a discussion. And then he has this whole questionnaire about: Do you have these symptoms? And I'm like: Holy macaroni, I have like nearly all of them. He then did workup, and then checked all my hormone levels and found that I really was at a level below what postmenopausal women should be at. So, he started me on a cream, which is a combination of estrogen, progesterone, and testosterone, and I swear that within a month, I'm feeling so much better.
Anita Rao
She is on the up and up, and I hope it continues, but the debilitating anxiety and depression folks experience in menopause is not something to gloss over. The rates of suicide for women aged 45 to 54 are quite high, and some doctors associate that with the biological changes associated with menopause.
Camille Moreno
We actually have, you know, evidence that women who've had a history of depression in their childbearing years, in addition to those who've had postpartum depression, you know, history of PMS and PMDD actually are, you know, more likely to develop depression in their menopausal years. And so those are also very important questions, you know, to ask, and also very important, you know, things to bring up to your healthcare provider, because there are options that could help manage not just, you know, the mood changes, but also your overall well being and, and the reasoning behind that is because, you know, there are estrogen receptors and targeted tissues all over our bodies, so they're just not within our reproductive organs. So not just her ovaries or uterus or breasts, so, you know, female reproductive organs, but also in our brain, you know, in our bone and our muscles. And so that's why there's a lot of, you know, mental health conditions that also arise or return in the menopausal years.
Anita Rao
I'm curious about some of the biggest changes that you would like to see, and how menopause is talked about culturally that you think could help make things better for folks who may end up becoming your patients or folks who currently are your patients?
Camille Moreno
Yeah. So, I would love to see more support groups that come from these work environments and work institutions that really support and empower these women, especially as they learn about this significant change in their lives [that has] really impacted their day to day, because we know that menopausal women in particular tend to lose productivity and fall off the work ladder, as well during this transition.
And so, you know, whether it's seeing their healthcare providers or their doctors multiple times a year during this transition and really missing work time and productivity — and so I think engaging these women and being able to create some type of support system or support group among other women, and having this space safe space for them — that they are not alone. If everyone else is going through it, we can all learn from each other. So, more of a shared support group, I think is the best way to start.
Anita Rao
Creating spaces for processing shared experiences is pretty much what the business card should say for Omisade Burney-Scott. Her name likely sounds familiar to you because she's been on the show before to talk about her experience as a death doula and her work to bring folks together to talk about menopause.
She's the creator of the multimedia project and podcast, the Black Girls Guide to Surviving Menopause. She shares the stories of Black women, women identified and gender expansive folks navigating menopause and aging. And it only felt right to learn more about menopause from her. So, we asked me Omisade to invite a friend into the studio for a conversation. And now we get to eavesdrop.
Here's Omi talking with Paris Hatcher, the founder and director of Black Feminist Futures. Paris went through menopause in her 20s because of premature ovarian failure. This is when ovaries stop working normally in folks under the age of 40. It's not the same thing as premature menopause, but it can cause menstruation to end — getting to the point of this diagnosis was far from linear for Paris.
Paris Hatcher
I always had an unusual period. My cycle was all over the place when I started menstruating when I was 12 years old. So, it would be around for a couple months, all the time, and then it would disappear. And so it was like this phantom that I was always chasing. So, my cycle was never really regular, but that didn't seem to be a problem for me until I went to college, and I decided to get on birth control for a variety of reasons. One was that: I wanted to have better control over my cycle because I just never know when it was going to happen, and I was on it for about six months, and I just decided to come off of it.
When I came off of the birth control, I had hot flashes like nobody's business. I was like: What is going on? Am I just having a hormonal response? And my doctor, when I was telling her this story, she was like: Actually, the birth control was masking your early symptoms of premature ovarian failure, so that already your ovaries weren't making all of the hormones it needed to regulate itself.
So, that had to be around 19 years old. Things started to normalize a little bit more. So, the hot flashes, they went away. But I would say around 26 years old was when it really hit me — where I was having full blown menopausal symptoms: Hot flashes, night sweats, lack of sex drive. I was so tired. I was so tired. I wasn't sleeping through the night, my hot flashes were every 30 minutes, so around 25 is when I really knew something was going on.
Omisade Burney-Scott
So, this is when you were 25 or 26 — and you started actually feeling something was not quite right with you at 19. When the doctor started diagnosing you: how challenging was it for you to get the proper diagnosis, so you actually knew what you were working with?
Paris Hatcher
It was so difficult, so I would go to the OBGYN, and they would say: Oh, you're too young. It'd be like: What's going on? This is too young to be happening to you. And so I really was not diagnosed until I was around 29, so I went several years without diagnosis. It was like a wild goose chase. It was a path of many doctors, of misdiagnosis — my own trying to treat through almost every single herb, every cohosh, every yam, every tea, every raspberry possible — and I finally got my diagnosis in my late 20s.
Omisade Burney-Scott
My goodness, so it was like a five year journey almost — five, six year journey between you figuring out what was going on with yourself and then getting a proper diagnosis around what that was. How did that kind of change your relationship with your physical body?
Paris Hatcher
I was not happy with my body. I felt really betrayed, like: What is going on? I'm having hot flashes every 30 minutes. I could feel it. For me, my hot flashes, it would feel like an internal heating, it's almost like a thermostat would get turned on the inside. It'd be like: Okay, here it comes. And like: Oh, my goodness, just covered in sweat. It was not the kindest to my body.
I felt betrayed. I was like: Why are you doing this? How could you be doing this? Why can't you be, quote unquote, normal? And I never had the desire around having children, and so I didn't have to deal with any of those feelings, which I'm glad because I can only imagine that would be really difficult because with my diagnosis — which gives me the symptoms of premenopause, or early menopause — [I] have a very low ovary reserve. Basically, my ovaries don't produce eggs, so if I wanted to have a child, I'd have to use a donor egg. I mean, that's really expensive, so it was a challenging time. And I am 42, now, so I've had this diagnosis for a while. Prescriptions that I use, every now and then, I think: Oh, let me try to do this other thing. I'm like: No, no, no. Stick to what you know because I cannot suffer like I suffered before.
Omisade Burney-Scott
I'm wondering — you talked about so many people when they hear ovarian failure there are a lot of assumptions we make about how people are going to respond to that as it relates to reproduction and their ability to have children — if they desire children or not. And so, I appreciate you letting us know that wasn't necessarily something that impacted you, but I do wonder how it might have impacted your relationship with sex and intimacy and your libido.
Paris Hatcher
That's a huge one. I mean, that's the thing that was, and continues to be, challenging. I've had some great medical care. I really feel excited about that. I feel like I've been empowered, but I will say that the libido — the doctors were never as interested in my libido as I have been. I was like: Listen, my sex drive is down. I need something to get it up, so I've come up, actually with some natural remedies that are helpful, or some herbs that I take that are helpful for me - but when it seems like doctors are kind of like: You can live with a low libido, if your other symptoms are managed.
Omisade Burney-Scott
Were your doctors curious at all about your identity? And like, as you were navigating this from 19 all the way until the end of your 20s, did your identity as a queer person come up as a part of the conversation? Were they curious about how this was affecting you?
Paris Hatcher
I would say that my doctor that diagnosed me — I was very clear. Like, this is who I am. I'm a Black lesbian. You can see the Black part, maybe not the lesbian part. Like this is what's important to me, and I think she really heard me , and when I — over the course of the year, she would always ask me during my annual or she would say: If anything changes around you wanting to have children, just let me know because there's technologies and I have experience working with queer couples as being couples to build their families.
So, I actually felt affirmed and didn't feel that she was withholding any information, but I do take my desire and my libido, as just as a human being taken seriously, I will say: No - but I think in general, women's libidos and gender expansive people's libidos are not taken seriously, right. Because it's definitely like it should be controlled, but this is actually a really great reminder for myself to - again, on this journey to be like: Huh, have I deprioritized my desire on this journey to which I'm loved? I love thinking about this, and thank you for prompting it.
Omisade Burney-Scott
Absolutely. I think about if we could time travel back to the beginning of your journey. What would you offer to any other person who's under 40 and might be having a similar experience? What would you want to offer to them as some words of support or encouragement for their journey?
Paris Hatcher
Well, number one: I would tell you to listen to all these podcasts to let you know that you're not by yourself. I think that's really important. Having a community is really important. Secondly, you do not have to suffer. I suffered way too long, and I would suggest, if you are like: Something's going on with my cycle, my cycle's not regular, I'm having these hot flashes — If you're able to see a doctor, yes — but have your doctor get you to an endocrinologist or reproductive endocrinologist. That to me is really important.
On this journey of us being best friends and so good to our bodies is to listen to them and get the care that we need, and I do know that navigating the medical industrial complex can be really terrifying, but there are some caregivers that are helpful. There are community. There are groups on Facebook. There's more groups on different social media channels, so find your people and get your buddy some help.
Anita Rao
Paris Hatcher and Omisade Burney-Scott. You can hear more from Omi on her podcast, the Black Girls Guide to Surviving Menopause. No two bodies will experience menopause the same. Even within families, experiences can be wildly different, but hearing these stories and really bearing witness to the range of experiences can only make us better prepared to advocate for our present and future selves. My mom hopes for as much for me and my sister.
Sheila Rao (Anita's Mom)
What I want for you is that you have all the tools and information, which I think you already have, and have support. Friends, sisters, you know, people who you can talk to, and I think that that really is very helpful, and I would want you just to know all these things are normal and be in tune with your body. Menopause is like PMS plus. You're emotional, and I think it's a good time just to, at this stage in life, is to focus on yourself, try to exercise, try to eat well. We all know the right things to do. It's just doing it in the moment. It's a normal process, so we should just make the best of it.
Anita Rao
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I'm Anita Rao — taking on the taboo with you.