Tamsen Fadal: ''How to Lose Weight, Stop Brain Fog, and Take Back Control During Menopause!''

1. 0:00 – 1:38

   Intro

   1. TFTamsen Fadal0:00

      Over half the population is gonna go through menopause, yet we don't talk about it at home. We haven't learned about it at school. We don't talk about it in the doctor's office. We often feel like our body is betraying us, and we don't know who we are anymore.

   2. SPSpeaker0:12

      She's a powerhouse in women's health. Tamsen Fadal is the Emmy-winning journalist and New York Time best-selling author of How to Menopause, fiercely changing the conversation on women's health.

   3. JSJay Shetty0:21

      Why is menopause still treated as such a taboo topic?

   4. TFTamsen Fadal0:25

      Ageism and sexism. We've just kind of said goodbye to women after the reproductive years. We look at women that are in midlife, and we say, "Wow, their best years are behind them." And that's kind of what the medical system has done as well.

   5. JSJay Shetty0:37

      What are the symptoms? What are women experiencing? What are they going through on a biological and chemical level, but also on an emotional level as well?

   6. TFTamsen Fadal0:44

      Brain fog was the most debilitating of the symptoms. Mood swings, weight changes, joint pain, itchy skin, dryness all over, low libido.

   7. JSJay Shetty0:53

      What happens to a woman's sex drive during perimenopause?

   8. TFTamsen Fadal0:56

      Nearly 60% of women say that menopause has negatively impacted their sex life, and I would say that number is even higher. They experience painful sex. There's dryness that happens all over your body, and it didn't feel good.

   9. JSJay Shetty1:09

      Why is it doctors still dismiss these symptoms and medical research is not investing more?

   10. TFTamsen Fadal1:18

       The number one health and wellness podcast.

   11. SPSpeaker1:21

       Jay Shetty.

   12. SPSpeaker1:22

       Jay Shetty.

   13. SPSpeaker1:22

       The one, the only Jay Shetty.

   14. JSJay Shetty1:25

       [laughs] Hey, everyone. Welcome back to On Purpose, the number one health podcast in the world. Thanks to each and every one of you that come back every week to listen, learn, and grow. Today's guest is going to talk

2. 1:38 – 2:38

   Why Is Talking About Menopause Still So Taboo?

   1. JSJay Shetty1:38

      to us about a subject that I've been fascinated by for a long, long time. It's something that I have a lot of questions about, something that I don't know that much about, and something that every single person we love is going to go through. Today's guest is Tamsen Fadal, an Emmy Award-winning journalist and The New York Times bestselling author of How to Menopause. She's also the producer of the acclaimed documentary, The M Factor, and host of the Tamsen Show podcast. If you haven't subscribed yet, make sure you do. Tamsen has become a leading voice in the global conversation on midlife, menopause, and reinvention, and helping women navigate this transition with knowledge, confidence, and community. Please welcome to On Purpose, Tamsen Fadal. Tamsen, thank you so much for being here. I said this to you off camera. I'm gonna say it again. I'm so excited for this conversation. I feel so much has been lost when it comes to women's health, men's understanding of it, and the ability for women to take charge of

3. 2:38 – 4:20

   What Actually Happens to Your Body in Menopause

   1. JSJay Shetty2:38

      their health, but also for men to be understanding, supportive, and recognizing what a big thing it is, and I'm so grateful that you wrote this book, How to Menopause, that I highly recommend everyone gets. Uh, but thank you so much for being here, truly.

   2. TFTamsen Fadal2:51

      Thank you. I'm so happy to be talking about this because it is so important for men to hear this conversation.

   3. JSJay Shetty2:56

      Yeah, I mean, I wanna start off by... I have a, I have a ton of questions for you, and, like, usually when I interview someone, I have some understanding or some knowledge of the area. I have nothing, which is-

   4. TFTamsen Fadal3:05

      All right. We got you

   5. JSJay Shetty3:06

      ... a really great place for me to be in because I feel like it's gonna give a lot of people the opportunity to learn. And the first question I wanted to ask you is why is menopause still treated as such a taboo topic when it comes to everyday conversation and everyday life?

   6. TFTamsen Fadal3:21

      It's such a great question, and I, I think I have struggled with it for so long myself. Look, I think it's wrapped up in a few things. I think it's wrapped up in ageism and sexism, and I also think this is a time in life where we've just kind of said goodbye to women after the reproductive years. We look at women that are in midlife, and we say, "Wow, their best years are behind them." Society has done that for a very, very long time, especially here in the US, and that's kind of what the medical system has done as well. So we have put the word menopause and taboo together for so long, and my goal is to separate those two things, so we're never saying those two things together.

   7. JSJay Shetty3:55

      It doesn't get the spotlight it deserves when every woman we know is going to experience it at some point in their life. And talk to us about how long it lasts. Like, just, just break down the, break down the taboo of how long is it gonna last, when does it happen, for everyone who's, like, starting from scratch like me. Like, what, what is it like?

   8. TFTamsen Fadal4:14

      Help somewhere, right?

   9. JSJay Shetty4:15

      Yeah.

   10. TFTamsen Fadal4:16

       I, I'll tell you what. It was really shocking to me. I spent 30 years in the news business,

4. 4:20 – 6:09

   There Are Over 100 Symptoms!

   1. TFTamsen Fadal4:20

      and I had never said the word menopause that I remember on television.

   2. JSJay Shetty4:24

      Wow.

   3. TFTamsen Fadal4:24

      And that tells you a lot. We talked about all sorts of studies. We talked about health studies. We talked about diets. We talked about everything. Menopause and women's health were not the things we discussed, and that goes to your first question about how taboo it has been for such a long time. When I actually found out I was in menopause, I got a very simple note from my doctor saying, "In menopause. Any questions?" And no real answers after that. So I started digging into it to figure out what was going on, and I quickly learned one billion women across the world were gonna be in menopause by this year. And I thought, "Okay, well, what is it?" So we'll break it down really simply because I always think it's the best way to do it. Perimenopause is the time leading up to menopause. Four to 10 years of struggle, of hormone changes, of not knowing exactly what's going on with your body, of all different type of symptoms, not just hot flashes. When you hit menopause, that means that you've gone one year without your period, and then everything after that is post-menopause. All the symptoms haven't stopped yet, but that could be a third to half of your life that we're talking about. So when you think about how long a woman is going through this transition, this next season, and the fact that we have such little information about it, it was just shocking to me.

   4. JSJay Shetty5:38

      And talk to me about what are the symptoms. Like, what's someone experiencing at this time? Because-

   5. TFTamsen Fadal5:43

      Yeah

   6. JSJay Shetty5:44

      ... as a man, we're so disconnected from women's health already, and then this is a, like you said, this is a underspoken about-... area, like, what are the symptoms? What are women experiencing? What are they going through on a biological and chemical level, but also on an emotional level as well?

   7. TFTamsen Fadal6:00

      I'm glad you said that, 'cause emotional is the, is the big thing, and I think it gets overlooked quite often. Because we talk about hot flashes, and we talk about irregular periods, and we

5. 6:09 – 8:43

   The Hidden Struggles Women Face

   1. TFTamsen Fadal6:09

      talk about brain fog. And I think for me, brain fog was probably the most debilitating of the symptoms, because it gets wrapped up with a lot of things. I had anxiety, mood swings. A woman can go through weight changes. When you're talking about brain fog, you could be reading a book and not remember the plot of the book. You could be having a conversation like this. I could be sitting here, Jay, across from you. Three years ago, I probably wouldn't be able to have this kind of conversation with you without feeling like, "Hey, can I stop and try to remember what I was talking about?" You go through joint pain. You can go through itchy skin, dryness all over, low libido. So if you think about one day you're going along just fine in life, right? You're in your 30s, you're doing great. You're maybe in the height of your career. You're on your way to wherever you wanna be. You're in a relationship. And you might start to see some of these symptoms crop up. You're not sleeping as well anymore. That's a big one. You're gaining weight around the middle, but you've been eating the same and really working out. So you wake up, and what I heard over and over from women when I was researching this, is that, "I don't feel like myself anymore. I look in the mirror, and I don't recognize myself." And that, to me, was one of the most hurtful things that I could hear, because I understood exactly what they were talking about. One day I woke up, and I was like, "I'm a, I'm a shell of who I am, and I don't know how to find the light switch in this room. I just am in the dark."

   2. JSJay Shetty7:27

      I mean, that sounds like truly one of the most difficult, challenging experiences anyone could go through, and we're saying everyone's gonna go through it for-

   3. TFTamsen Fadal7:35

      Yeah

   4. JSJay Shetty7:35

      ... nearly a decade, potentially.

   5. TFTamsen Fadal7:37

      Mm-hmm.

   6. JSJay Shetty7:38

      And so the fact that every woman we know is gonna go through this, the fact that it's gonna affect them physically, mentally, and emotionally, to the point that it can be debilitating-

   7. TFTamsen Fadal7:48

      Mm-hmm

   8. JSJay Shetty7:49

      ... to how you've just spoken about, what are we seeing a correspondence with when we look at women's health at this age and when they're going through this process? How is that affecting their work, their career, their family, and everything else that comes with it? Like, what's happening when... Because I think sometimes when we talk about health, we kind of talk about it in this silo-

   9. TFTamsen Fadal8:07

      Mm-hmm

   10. JSJay Shetty8:07

       ... of like, "Here's what's happening chemically, here's what's happening with the hormones," but this is having real life impact.

   11. TFTamsen Fadal8:13

       Mm-hmm.

   12. JSJay Shetty8:13

       Is there any correlation between menopause and divorce, break... Like, w- talk to me about the, the real-life impact of it.

   13. TFTamsen Fadal8:21

       It's such a good topic because it doesn't just happen in the doctor's office. You could go to the doctor's office and have the conversation, but once you leave there, you have to think about the whole 360 of it. And it really is what I get excited to talk about, because I think that we feel very lost during this time as women, where we're in our career and maybe we're hit with perimenopause and going into menopause. And we could

6. 8:43 – 10:16

   Busting the Biggest Menopause Myths

   1. TFTamsen Fadal8:43

      be showing up to work, not being able to have a conversation. We don't know how to... How do you go into your boss and say, "Hey, I might be in perimenopause for seven years"? I think that for a lot of women, they're starting to realize that we're normalizing the conversation. We're definitely not having the silence that we had before. But it can really impact you at work. It can show up in a lot of different ways, and what I've been fighting against is making sure that it doesn't penalize women either. We don't want that to hurt women. Women at this point are at the height of their careers. We want companies to retain women, hold onto women. They have some of the greatest wisdom they could ever have during these times and beyond. So I think it's really important for women to be able to get a hold and understand what's going on, so they're not going through this journey just kinda blindly, which is what's been happening. And then I think when it comes to relationships, it has a real impact. You know, we see a lot of divorces happening in the 40s, and I don't think that that's a coincidence. I don't think it's a coincidence that somebody wakes up all of a sudden and feels very differently, or maybe their libido's low, so their partner doesn't understand what's going on. Or all of a sudden, something that didn't bother them a long time ago, they're snapping like this. And that's what's really happening out there. I think we're getting to a place, starting to get to a place, where we're starting to have this conversation more and more, but it's really where we have to bring everybody into it. It can't just be women having this conversation with each other.

   2. JSJay Shetty10:02

      What, what's a myth about menopause that you think's lasted too long, that people are still holding onto, and when you talk about it, that's their first reaction? Because, you know, I, I feel really embarrassed saying this, but I know a lot of men who'd say,

7. 10:16 – 13:45

   The Major Hormonal Shifts Behind It All

   1. JSJay Shetty10:16

      "Oh yeah, there was just this period where my wife was acting out, and she was being a bit crazy, and she was a bit mad," like, language like that.

   2. TFTamsen Fadal10:22

      Yeah.

   3. JSJay Shetty10:23

      And that's one of those myths that I think people are just like, "Oh, just during this phase," like, "Oh, the kids left home, and everything just w-" you know, and it becomes this lifestyle thing. What are some of the myths you're seeing that you're coming up against when you're talking about this?

   4. TFTamsen Fadal10:36

      Yeah, I mean, I've, I've seen so many myths with this. I think the first myth is that your best years are behind you, and that's just not true. I really think that you're coming into a whole new period, and even if you look at some of the data and the, the scientific studies out there, we look at women that are post-menopause, and those are some of the best years that they can have in their lives, so that's exciting. I think another big myth, or something that women feel, and they've said this over and over, "I don't feel like myself, and I feel like I'm going crazy. I feel like something's wrong with me, and I just can't pinpoint what it is. But I know this isn't me anymore." And so, you know, I s- I start the book saying that you are not alone, and you're not crazy. That is not what's going on. You've got something happening to you biologically, and that's affecting you in a whole bunch of different ways. And as soon as you understand that, then you can s- take those steps and deal with those symptoms. And I think it's important also to know that, you know, everyone doesn't have the symptoms that we talked about. Everybody goes about this differently, and I think that's what can make it so confusing to so many women.

   5. JSJay Shetty11:35

      What, what's happeningTo the brain and body during perimenopause and menopause. Like, what's chemically going on?

   6. TFTamsen Fadal11:40

      Yeah, chemically we're losing estrogen, obviously, also losing progesterone. And so when you're going through these hormones, I mean, think about what we went through when we were in puberty. Your hormones were all over the place. I think of perimenopause as kind of this wild ride. It's sort of unexpected. You don't know what's gonna happen, and you definitely feel that in your head when you've lost that estrogen. We have estrogen receptors all over our body, and the brain is no exception. We have them everywhere. And so I remember when I was going through perimenopause, and I didn't know I was even going through it 'cause I didn't have the vocabulary for it, that I would sit there and I'd read something, I couldn't remember it. I would look at a word. I couldn't... I knew the word. I recognized it. I knew I knew how to say it, but it wouldn't come out of my mouth. And those are some scary things that happen because you think, "Is something going on with me? Is this dementia? Is this Alzheimer's? Is this something very serious?" And so I know a lot of women who have gone to the doctor saying, like, "There's really something wrong with my head. I, I don't know what's happening." Or they walk into a room and don't remember why they walked into a room. I, um, I talked to one doctor in the course of, of doing research for the book, and she said, "I forgot my medical number," which is something we say, like our Social Security number. We say it all the time for years, and I sat there and I couldn't remember it, and I actually went to the neurology department and I made them do brain scans on me. That's how serious it can be.

   7. JSJay Shetty12:58

      Wow.

   8. TFTamsen Fadal12:59

      Women have been told, like, if you eat perfectly, if you work out perfectly, if you do all these things perfectly, you're gonna be okay down the line. But the truth is, we hit perimenopause, and there are some real long-term health concerns that you have to pay attention to. Maybe it's not stress. Maybe you don't need to just go home and, you know, and take a walk outside. Maybe it's something more than that, and it's not just you that's going through this. If you're in your 40s or thereabout and you are not able to sleep at night, you have irregular periods, you're feeling anxious or you're feeling a little bit moody, maybe you're gaining some weight around the middle even though you're not doing anything differently, you can pretty much rest assured you're in perimenopause.

   9. JSJay Shetty13:37

      You've probably been hearing about AI everywhere, and we all need to be mindful of the tools we trust in this new chapter of technology.

8. 13:45 – 15:10

   Three Early Warning Signs

   1. JSJay Shetty13:45

      Claude is the if you know, you know AI assistant that just feels different. While other AIs often sound like robots, Claude is being created with special research that informs its character, meaning that Claude just gets it when it comes to empathy and emotional intelligence. That's why millions of people are turning to Claude for parenting tips, dating advice, mindful habits like journaling, budgeting, and so much more. Claude has been thoughtfully crafted by Anthropic and its team of researchers, whose mission is to design the most capable and secure systems that place people at the center. You can try Claude for free at any time, and for a special offer on premium capabilities with Claude Pro, head to claude.ai/purpose. That's C-L-A-U-D-E.AI/purpose. It really hit me when I was at a Time 100 Health event, and I know Halle Berry, who you've collaborated with at your events and multiple other places, I remember her speaking about this, and I know she's been a big advocate from the celebrity side to talk about this topic. And she was talking about how she really believed she was just gonna be too fit, too strong, too, like, yoga-ed out, and, you know, she, she really believed that she had a workout regime that would beat menopause, and that it wouldn't be a reality for her. And when she said that, there was no way you could

9. 15:10 – 17:34

   Perimenopause vs. Menopause

   1. JSJay Shetty15:10

      outwork or-

   2. TFTamsen Fadal15:11

      Yeah

   3. JSJay Shetty15:11

      ... out yoga or whatever it may be, that there wasn't a method to avoiding or just pushing through this.

   4. TFTamsen Fadal15:18

      Yeah.

   5. JSJay Shetty15:18

      What are some of the lies or things women have been told growing up-

   6. TFTamsen Fadal15:22

      Yeah

   7. JSJay Shetty15:22

      ... that you think have tripped them up as it, as they come into perimenopause and menopause?

   8. TFTamsen Fadal15:26

      Yeah, I think it's so important to realize that, and, and Halle Berry has been an incredible voice in normalizing this conversation and getting out there and having real, honest talks about what she went through. And I think that's really helped in so many ways, because I think women see that and go, "Oh my gosh, if she's going through that and she can talk about perimenopause and menopause, then maybe it's okay for me to do the same thing." You know, I think that women have been told, like, if you eat perfectly, if you work out perfectly, if you do all these things perfectly, you're gonna be okay down the line. But the truth is, we hit perimenopause, and there are some real long-term health concerns that you have to pay attention to when it comes to brain health, when it comes to heart health, when it comes to bone health especially. I mean, there are real serious things. I know you've had Dr. Vonda Wright talking to you, and she talks about bone health. It's one of the scariest things. I didn't think about my bones at 20 or 30. Even 40 years old, it wasn't something I was thinking about. So I think that young women have been misled in a lot of different ways to think that this is something that happens to older women, and you don't have to worry about it. We see women coming into perimenopause in their late 30s and beyond, and I don't want them to be afraid. I want them to be really inspired to get ahold of it, know what's happening, and be able to handle it so they don't have these bumps that I think a lot of women have had leading up to this time.

   9. JSJay Shetty16:41

      And let's, let's talk about some of those. What are the early signs of perimenopause that, and I know you said there's lots of different, but, and, and everyone has different experiences, but what would you say are the early signs of perimenopause that you see across women?

   10. TFTamsen Fadal16:53

       Yeah, I would say the three big ones that I've seen across women are irregular periods. You're going along just fine, and then all of a sudden you have your period very heavy, um, or you don't have it at all and you don't know what's happening. A lot of times women will go to the doctor and the doctor will say, "It's just stress. Calm down a little bit. It'll be okay." Instead of, "Hey, you're 41. You know, have, do you have any other of these 30-plus symptoms? Maybe it's perimenopause." The other big one I would say is sleep disruption. That's huge.I was somebody that used to be able to sleep all the time. I've heard women that say, "Oh, my gosh, at 3:00 in the morning, I'm up and I can't go back to sleep," or, "I can't even get to sleep." And that, again, is something else. Try to go to work,

10. 17:34 – 18:30

    Should You Consider Hormone Therapy?

    1. TFTamsen Fadal17:34

       and you'll have five days like that of not being able to sleep, and then you start to understand what's going on, and you start... You just don't feel like yourself. And, um, you know, I think the third one is more of mood changes. There can be anxiety, there can be rage, there can be, uh, depression, and there's a lot of things like that that happen during this time. So I think those are the top three that you see in perimenopause, and the other ones come along. You know, we've all heard of hot flashes. Um, we know a lot about weight gain that starts to happen. But those are three big ones, and I think that those are three very difficult ones as you're coming up against those.

    2. JSJay Shetty18:07

       And what's the difference between perimenopause and menopause?

    3. TFTamsen Fadal18:10

       Yeah, so perimenopause, you're still getting your period. It's all the time leading up to menopause. When you hit menopause, that's that one day after 12 months without your period, and then you're not getting your period any longer. So these are still your reproductive years, but you're in perimenopause, and those can overlap a lot of things. You know, women can get pregnant in perimenopause. Once you hit menopause, you're no longer

11. 18:30 – 22:15

    Lifestyle Shifts That Actually Make a Difference

    1. TFTamsen Fadal18:30

       having a cycle, and then everything after that, you're considered menopause. And some people call it post-menopausal. I just say menopause 'cause it's easier for me to remember when I do have brain fog. Um, but, you know, I think that it's important to know that perimenopause feels very unpredictable. It feels very confusing, because you've been fine up until then. And you could be in your late 30s, and you're thinking, "I'm, I'm too young for this. How could I be dealing with this?" But when those hormonal fluctuations start, you start seeing some of these changes. And I don't think we were really ever taught that. You know, you asked earlier, what are some of the things that young women... You know, they were taught, "You're gonna get your period. You're g- you know, if you decide you wanna have children, you're gonna go through your pregnancy." And then we kind of fall off the map, not only in society, but also in the medical system.

    2. JSJay Shetty19:14

       Yeah, and then what are the symptoms of menopause, then?

    3. TFTamsen Fadal19:16

       So the symptoms of menopause, you can still have a lot of these symptoms that can go right through, and some start to wane off a little bit, and some women can have hot flashes in their 80s, and it just depends. If you decide, you know, how you're going to treat them, what symptoms are important for you to treat, hormone therapy is one of the options that has been named and deemed by the, um, Menopause Society as one of the most effective treatments for hot flashes and vaginal dryness. But I think that, you know, it's important to know what works for you. Not everybody, as we said, is gonna be able to do everything or want to do everything. So I think it's been important first for me to go out there and educate women, because I'll tell you, I was clueless. I had no idea what was happening, and I really felt like I was crazy. And I would wake up in the morning and think, like, "Oh, my gosh, I got two hours of sleep and I've gotta go to work," and I'd get to work and not remember what was going on or remember where I w- what I was supposed to be doing. And I hear so many stories of women in different, you know, places of work, or women that are also raising children at the same time, or taking care of elderly parents, or they're in a relationship, or they're in a new relationship. So it can be a little difficult, and I think it's important to know that menopause is not just for older women. Young women go through menopause. I consider late 30s a young woman.

    4. JSJay Shetty20:31

       To me, it's just mind-boggling how women have been so resilient and strong to move in a world to n-

    5. TFTamsen Fadal20:38

       Yeah

    6. JSJay Shetty20:38

       ... uh, that isn't aware or is not talking about what they're going through on a daily basis, and just how many relationships that touches, and having so many people in your life who don't know what you're going through. Like, we talk about, I feel, in the wellness community around how it feels to be misunderstood.

    7. TFTamsen Fadal20:56

       Mm-hmm.

    8. JSJay Shetty20:57

       I mean, this is the deepest form of feeling misunderstood, because you're going through something physically, mentally, emotionally daily, and everyone you meet has no context of why you're behaving that way. And then you get labeled, "Oh, well, you know, she's just going through something," or-

    9. TFTamsen Fadal21:15

       Yeah

    10. JSJay Shetty21:15

        ... or whatever it may be, that, that, that disassociates you from the exact experience.

    11. TFTamsen Fadal21:21

        The truth is, is that you don't even know you're going through it yourself sometimes. It's not like you went into the doctor and they said, "Hey, at 35, you should start thinking about perimenopause, 'cause you might be going through some of these symptoms." Right now, we're trying to teach women to go to the doctor proactively and say, "Hey, these are my 10 symptoms. Could this be perimenopause?" And that is my hope and dream, that one day there will be this baseline, like we talk about mammograms, like we talk about other kind of tests that people are supposed to get when it comes to, to health and wellness, that we say, "Hey, maybe this is what you're going through. Maybe it's not stress. Maybe you don't need to just go home and, you know, and take a walk outside. Maybe it's something more than that, and it's not just you that's going through this." If we can get to that place, it would be just a really beautiful place, and I think it would end a lot of the suffering, because I don't think women should have to suffer during this time.

    12. JSJay Shetty22:11

        So that's really the first step, and I know in the book you give a list of 34,

12. 22:15 – 26:08

    Finding Strength in Community

    1. JSJay Shetty22:15

       is it, symptoms-

    2. TFTamsen Fadal22:16

       Yeah. [laughs]

    3. JSJay Shetty22:16

       ... that people experience. And so I guess the first step is, if you feel any of those 34 things, go and have the conversation, because chances are your doctor or someone may not have the conversation with you proactively if you don't raise it.

    4. TFTamsen Fadal22:31

       100%. A lot of doctors aren't trained about this, and that was the other thing that was so shocking for me to learn. I think I was somebody who went to the doctor, this is what the doctor said, I went home, and that's what we did. And what I realized over time is that as we looked into menopause and perimenopause, because of the fact that women's health has not been a priority past a certain age, in midlife mostly, after about 40 years old, a lot of doctors weren't trained about this. And to their own admission, OBGYNs, their specialty sometimes got a day of training in medical school to talk about this. If you can imagine, all those years, and they've had to go out and learn for themselves. And so there are a lot of doctors that leave medical school and don't feel comfortable talking about something like this. So about 75% of women go in and are, their symptoms are left untreated as a result of that, and that number is staggering to me.

    5. JSJay Shetty23:20

       That was something I saw as well. I remember at a conference I was at, and you can correct me if I'm wrong, but there was a number that said something like only 2% ofAll medical research goes towards women’s health.

    6. TFTamsen Fadal23:32

       Yep.

    7. JSJay Shetty23:32

       Was it, is that right?

    8. TFTamsen Fadal23:33

       You're right. I would never correct you on that. That's so right.

    9. JSJay Shetty23:35

       That's right, right? It's like-

    10. TFTamsen Fadal23:36

        Yeah, it's unbelievable. And then if you look at that percentage, a tiny, tiny, tiny sliver of that goes to menopause and perimenopause. And I don't know about you, but I'd never heard the word perimenopause until if I started saying it [laughs] a few years, right?

    11. JSJay Shetty23:49

        I, I haven't heard it since I followed you probably, so.

    12. TFTamsen Fadal23:51

        [laughs]

    13. JSJay Shetty23:52

        Yeah. Yeah.

    14. TFTamsen Fadal23:52

        So I mean, I, I went, "Wait, what's perimenopause?" And so I think that the more we can say the word, the more we can get it out there, and it doesn't sound like this scary word. When I first started talking about it, I was told, "You're gonna blow up your career talking about menopause. You're gonna age right out of your career," because that is what we thought about when we thought about this word. And so I'm hoping that perimenopause has a little bit of a lighter context, and so that women can say, "Okay, this is the stage I'm in. This is where I'm at. It's gonna be okay, and I know what to do, and I'm not afraid to say the word out loud."

    15. JSJay Shetty24:23

        Yeah. What, what, the... Before we get into some of the solutions and what women can do, what are some of the risks of not managing or not treating these symptoms? So if you just feel the symptoms, but you didn't think about it, you weren't aware, they didn't, no one read your book, you weren't conscious of it, what happens? Like, what's the worst that can happen?

    16. TFTamsen Fadal24:44

        Yeah, you know, I thought when I went into it, "Okay, I don't know." I, I lost my mom to breast cancer, so I was very scared of doing anything. And I think that for me, I never had that conversation with, with a parent, with a mom. I've heard that from a lot of women. But I think one of the big conversations that we miss in all of this are the long-term health ramifications that could come from that. When we talk about osteoporosis, one of the big silent killers of women, and when we talk about heart disease, we talk about so many women dying from heart disease. It's unbelievable when we look at those numbers. And then we talk about brain health. We talk about Alzheimer's. More women are diagnosed with Alzheimer's than men are diagnosed with Alzheimer's. And so we have so much more research to do on all these things, but some of those are long-term health risks that we have to at least pay attention to. There have been studies that... done that say, "Wow, you have more hot flashes. There could be a correlation to your heart health. Pay attention to that." And I don't think those are the conversations we're having enough of, and we're all learning as we go right now and trying to get as much information out there as we can, but those are big risks that I don't wanna take when I'm older. I don't wanna live to be much, much older and be suffering during that time because I didn't know about this time. And it's also, when I think of my 30s, in your 30s, that's the best time to start protecting your bones and paying attention and having great, healthy habits. There's so many things I wish I had done when I was younger now that I understand this is a

13. 26:08 – 27:11

    Why Women’s Health Needs More Research

    1. TFTamsen Fadal26:08

       stage I'm gonna go through.

    2. JSJay Shetty26:09

       Hm. And do, do women of different ethnicities, does perimenopause affect them differently?

    3. TFTamsen Fadal26:15

       You know, there are a lot of studies that are gone on. There's the SWAN study that's, that's gone on for a long time. There is a lot of research that has shown that Black women have more intense symptoms of menopause and often can have longer symptoms and start earlier. And so there's so much more research to done. There has been a lot of research done in different countries to look at things. Um, for example, women in Asia get fewer hot flashes but more joint pain, but the question is why. And so there's a lot that still has to be done to look at that and pull this apart and really say, "Okay, we're looking at menopause, but we've gotta start looking at perimenopause," because these women went through all of these symptoms for seven to 10 years, so what happened during that time, and what was happening differently? What were we talking about when it comes to environment, when it comes to food, when it comes to genetics?

    4. JSJay Shetty27:01

       It's so hard because it's so varied-

    5. TFTamsen Fadal27:04

       Yes, so varied

    6. JSJay Shetty27:05

       ... by ethnicity, by what age it starts, by the symptoms you feel.

    7. TFTamsen Fadal27:09

       Mm-hmm.

    8. JSJay Shetty27:09

       And so no wonder people

14. 27:11 – 31:10

    The Risks of Ignoring Symptoms

    1. JSJay Shetty27:11

       just call it stress and call it a day-

    2. TFTamsen Fadal27:12

       Yes [laughs]

    3. JSJay Shetty27:12

       ... because it, it takes so much. You'd have to be very knowledgeable to actually diagnose it effectively, I imagine-

    4. TFTamsen Fadal27:18

       Mm

    5. JSJay Shetty27:18

       ... and to, to really be able to speak to what someone needs to do.

    6. TFTamsen Fadal27:22

       Well, that's the interesting part is, you know, a lot of people go, "Okay, what's the blood test I can take to figure out if I'm in perimenopause?" But if you think about this, most doctors say you don't really need blood tests. You need to know what your symptoms are, and that's how you can pretty much diagnose. If you're in your 40s or thereabout and you are not able to sleep at night, you have irregular periods, you're feeling anxious or you're feeling a little bit moody, maybe you're gaining some weight around the middle even though you're not doing anything differently, you can pretty much rest assured you're in perimenopause. Now, if you're dealing with heart palpitations, you're dealing with much more intense symptoms, you probably need to make sure it's not something else. But most of the time, that's what you should start looking at there. And the sad thing is, is that what I've learned from women is the Band-Aid that a lot of them are given is antidepressants. A lot of women are given antidepressants right away when they walk into a doctor's office and say, "I'm dealing with stress. I'm gaining some weight. I'm not able to sleep." And the truth is, they might need antidepressants, but they should also be talking about perimenopause or menopause.

    7. JSJay Shetty28:21

       Wow. I mean, I can't imagine... I mean, Halle tells that great story of how-

    8. TFTamsen Fadal28:26

       Yeah

    9. JSJay Shetty28:26

       ... her, you know, her doctor thought she had an STD.

    10. TFTamsen Fadal28:29

        Yeah.

    11. JSJay Shetty28:29

        I think it's just-

    12. TFTamsen Fadal28:30

        Isn't that unbelievable?

    13. JSJay Shetty28:31

        Yeah, which is crazy. Like, I, when I heard that story, I was like, wow. That's one thing, but then to be told, "Oh, it's probably depression, and you should be on-

    14. TFTamsen Fadal28:39

        Mm-hmm

    15. JSJay Shetty28:39

        ... antidepressants," what does that do to menop- So if you were given antidepressants when you had menop- perimenopause, what does that do to your perimenopause?

    16. TFTamsen Fadal28:49

        Well, I was given them. That's how I know.

    17. JSJay Shetty28:50

        Oh, wow.

    18. TFTamsen Fadal28:51

        And that's what was so shocking. So I didn't know I was in perimenopause. I didn't understand all these symptoms. I just knew I was feeling really off. And then I finally landed on the floor of my studio at work in the bathroom with my heart racing out of control, sweating profusely, not able to catch my breath, trying to calm my body down. And I went to the doctor, and I found out I was in menopause. Because once you hit menopause, you can do a blood test because now you've kind of leveled out there.

    19. JSJay Shetty29:19

        How many years were you struggling without knowing?

    20. TFTamsen Fadal29:22

        I was probably struggling about seven years.

    21. JSJay Shetty29:24

        Wow.

    22. TFTamsen Fadal29:24

        You know, I'd gone through a divorce. A lot of the stress I attributed to that. I had hair falling out. I had... I wasn't able to sleep. I went to a doctor, and I went to a doctor a couple of different times. And it's funny, I ran across some of my papers recently that were about four years before I realized I was in menopause, and it said, "Complains of moodiness and weight gain."But no one ever said the word perimenopause to me. I was given Lexapro. That's what I was given. And I was given antidepressants. And so antidepressants, of course, can help with mood, but it's not gonna help your hot flashes, and it's probably not going to help your... Maybe it'll help a little bit on your sleep, but it's probably not gonna help some of the other thi- irregular periods. And so I just think it's so important for all disciplines, not just OBGYNs, to have this conversation and be aware of it. And I'm proud of women, because I think women are, are really... The onus is on women right now to stand up and say, "Hey, I'm tracking myself. I know what's going on. I've written down my symptoms. I'm aware." And I think women are more aware than ever, you know this better than anybody, of their health and what's happening in their lives, to walk in and say, "Maybe this is perimenopause. Can you tell me if it is? And can you tell me if you're comfortable having this conversation with me? And if not, I need to find another doctor."

    23. JSJay Shetty30:33

        Tamsen, what do we do?

    24. TFTamsen Fadal30:34

        [laughs]

    25. JSJay Shetty30:35

        Like, no, it's... I, I'm so glad that we've talked about just, at least to get a basic understanding-

    26. TFTamsen Fadal30:40

        Mm-hmm

    27. JSJay Shetty30:40

        ... of what's going on, the, the types of symptoms to look out for. But I can imagine a lot of women that are listening to this right now who are already there-

    28. TFTamsen Fadal30:48

        Yeah

    29. JSJay Shetty30:48

        ... saying, "Jay, I'm two years into that."

    30. TFTamsen Fadal30:50

        Yeah.
15. 31:10 – 33:21

    Why So Many Miss Perimenopause Signs

    1. JSJay Shetty31:10

       plan? What do, what's the strategy?

    2. TFTamsen Fadal31:12

       First of all, I don't want women to be afraid, and I want younger women to come into this thinking, "Oh, my gosh, for a third of my life I'm gonna deal with that?" There are some incredible things that happen during this time. I think menopause gave me purpose. I can't even believe I say that, but that is really the truth. I had no idea what was going on in my life, and I had no idea what was gonna happen after, but I found something really different in myself. So I want women to not feel afraid. When it comes to what to do, as we know, everybody goes through it differently, but I think the most important thing is to be able to have that conversation with a doctor or somebody who specializes in menopause and can give you some of the options. And there are some different options. Some women opt for lifestyle changes. Solely lifestyle changes. That's what they wanna do. Other women say, "You know what? I need something more. I'm dealing with brain fog. The hot flashes, I'm having 15 of them a day. I can't deal with this anymore." Hormone therapy is a very viable option for a lot of women. There was a study that was done in 2002 that scared a lot of women. The Women's Health Initiative headlines came out that said estrogen causes breast cancer. That's essentially what the headlines were. That's what the media took away from it, and it scared women to death. About 44% of women in this country were on hormone therapy at the time. Literally, after those headlines came out, it dropped to about 4%, and we're right around 5% right now. That was 20-plus years ago. So that's why it's so important to get this message out. So hormone therapy is one of those options if you are eligible for hormone therapy. There are certain women, certain risk groups that are not. That's one option. It was very helpful for me. It was also something I wasn't sure about. I went back and forth and struggled for a long time whether or not that was gonna be something I did, and at one point, my symptoms got so bad that that was what I opted to do.

    3. JSJay Shetty32:53

       Before we go to the others, what is hormone therapy-

    4. TFTamsen Fadal32:55

       Sure

    5. JSJay Shetty32:55

       ... and what does it include?

    6. TFTamsen Fadal32:57

       Hormone therapy is estrogen and progesterone, and both of those things have been extremely helpful for me with regard to mood, with regard to sleep, with regard to hot flashes. And, you know, we lose so much estrogen. Our estrogen doesn't go like this. It just kinda goes all over the place, and then goes down. And so that has been very helpful, estrogen and progesterone. There's also testosterone, if a

16. 33:21 – 35:41

    When to See a Menopause Specialist

    1. TFTamsen Fadal33:21

       woman decides to do that, if she's dealing with a low libido. And for me, that was something that came about a year later. I wanted to start on the two. I was, I was a little nervous, honestly, because I didn't know what was going on, and I'd never done anything like that before. And then there's also vaginal estrogen, which is a fourth component, which is helpful for painful sex or for low libido. So those are, those are hormone therapy, menopausal hormone therapy, you can see it referred to as, or hormone replacement therapy.

    2. JSJay Shetty33:49

       Are there any side effects to hormone therapy?

    3. TFTamsen Fadal33:51

       It's been great for me. There's different women that have different things that, you know, they, they... Some women feel like they've been more emotional on it. There's some women that feel like the patch, if they're on a patch, it has the glue, can be irritating to them. Look, there's always risk that comes with everything, but according to the Menopause Society, this is the most effective way to treat these symptoms. And for some women, these symptoms are debilitating, life-changing, and not things that we can say, "Oh, get through these years and then you'll be okay."

    4. JSJay Shetty34:20

       Mm.

    5. TFTamsen Fadal34:20

       And I think that's what's happened for a long time. You know, women in perimenopause don't think that hormone therapy is an option for them, and it can very well be an option.

    6. JSJay Shetty34:28

       And then what were the other solutions? There was lifestyle choices.

    7. TFTamsen Fadal34:31

       Yeah. So lifestyle is so important, I think, to talk about, because, as we see, only 4% of the, of women really are, uh, on hormone therapy. So we look at the rest and we're saying, "What are they doing? Are they struggling every day?" So I look at couple of things. I look at sleep as the number one priority, no matter what. I don't think you can do any of the other things if you don't get sleep, if you don't figure out how to prioritize that. And that became something really important to me. You know, I had to figure out a bedtime. I hadn't done that since I was young, but I really had to figure that out. I had to figure out a wake-up time. I had to figure out what not to do before going to bed. I started, uh, taking magnesium as a supplement, because that was helpful to me before I was doing hormone therapy. Progesterone eventually really helped me get a good night's sleep. So sleep was my number one priority, and that took precedent over everything. And then after that, I looked at some of the other things. The second thing I really paid attention to was the protein I was putting in my body. I grew up as one of the ones that was like, "I'll stay on the treadmill all day long and do my cardio, and I guess I'll lift some weights, but I don't really wanna do that." Strength training now has risen to the top of my list. It's really, really important to protect your bone health. Like, I had no idea, and I don't think a lot of women did

17. 35:41 – 38:26

    What Men Need to Know

    1. TFTamsen Fadal35:41

       know that for a very long time. So that's important, to figure out some type of routine. There's a lot of women that say, like, "All right, I've been working out for a long time," but I think if you flip it a little bit and put strength training up there first to protect your bones, that's really critical. And then I think the third thing, if we look at some of the lifestyle changes that you would take, obviously we look at food, and we look at inflammation, and we look at trying to get control of that, because that is very, very real. And I didn't know how important that was. You know, in my 20s and 30s, I'm like, "I'll eat what I want, I'll do what I want, I'll play how I wanna play, and I'll worry about-Being older when I'm older. And so I get excited for women who are in their 30s right now that can say, "All right, I'm gonna look at inflammatory foods. I'm gonna try to increase my fiber. I'm gonna try to pay attention to what is causing bloating," because bloating is a big problem during this time. And I, I think also making sure that you're balanced too. Like, I don't get everything right all the time. You know, I try to establish as many healthy habits as I can, but I know it's not always gonna be perfect, so you gotta give yourself a little grace. And then I think the final thing would be stress management, which I know is easier said than done, but I think it's really, really important, and I think part of that comes with having somebody to talk to. I think it's having community, having loved ones understand. I feel very sad when I look at the decades of women who felt they didn't have anybody to share this with. They didn't share it with partners. They didn't share it with families. Maybe they whispered about it with other women. We went to DC at the end of last year, and we sat there with, um, one of the lawmakers who said, "This is the first time that we've uttered the word menopause out loud in this building." That's unbelievable to me.

    2. JSJay Shetty37:18

       So, wait, so that's hormone therapy, lifestyle choices?

    3. TFTamsen Fadal37:21

       Lifestyle changes, yes.

    4. JSJay Shetty37:22

       And those are the two.

    5. TFTamsen Fadal37:22

       And then I would say lifestyle choices, and I would say stress management-

    6. JSJay Shetty37:25

       Right

    7. TFTamsen Fadal37:25

       ... and community.

    8. JSJay Shetty37:26

       Right.

    9. TFTamsen Fadal37:26

       I think community is really important. I don't know that I really ever understood community. I understood friends for a very long time. I understood friendship groups. I didn't understand the importance of having people that were going through something I was going through, and when I realized that, it changed everything for me. I have a core group of women right now where I can pick up the phone and say, "Hey," like, "I am not myself," or, "Wow, I feel terrible," or, you know, "This weight is just making me feel different," or, "I can't sleep anymore." And so I think that that's a really important part of this process, and I, I'm excited to see how groups are coming together. One of my friends told me she started the Hottie Hotline with all these women that are going through perimenopause right now from college, and they're sharing their symptoms and going back and forth and, and having a conversation about it, and I think that's important.

    10. JSJay Shetty38:13

        That's such a great distinction between friends and community. I love that. I don't think anyone's ever put it that way before. It's your friends may or may not be going through the same things as you, but your community is that chosen group of people that are going through the same thing,

18. 38:26 – 42:39

    It’s Normal For Your Sex Drive to Change

    1. JSJay Shetty38:26

       and therefore, you can share notes, share your heart. I mean, I think one of the biggest challenges that I can say as a man is I just feel like part of that community or your friend needs to be a partner.

    2. TFTamsen Fadal38:39

       Yes.

    3. JSJay Shetty38:39

       And it's really hard as a man when you're completely unaware about this subject. I wanna be educated because the woman I love most in the world, my wife, is gonna go through this. The other woman that I love most in the world, my mom, has already been through this, and I probably wasn't... I was maybe too young to be helpful or supportive, but I wish I was more understanding. And then I have a younger sister who's gonna go through this. So when I look at it through the lens of my life, I'm thinking, wow, there are three women in my life that I love so much, and they're all going to experience this. One of them's already gone through it, and I probably have no clue what-

    4. TFTamsen Fadal39:13

       Right

    5. JSJay Shetty39:13

       ... she struggled with at the time, and, you know, in one sense, it's quite hard to reflect on that.

    6. TFTamsen Fadal39:18

       Mm-hmm.

    7. JSJay Shetty39:18

       What do men need to know about menopause?

    8. TFTamsen Fadal39:21

       I love, first of all, that you understand all those touchpoints in your life, and it's pretty amazing when you think about it. So I think it's so important for men to understand what menopause is. I really think it can be that simple. And I think it's also really important to understand what to do during this time, and I never wanna say to a guy, "You've gotta solve all the problems," but you, I think awareness is a huge part of it. I think, "Hey, what's going on right now? Is everything okay?" You know, "What's the hardest part of this for you? Is there something I can help with?" What kind of habits is your partner or your sister or your mom trying to take on to help that you can be a part of, that you can jump into? Is it walking in the morning? Is it trying to go to bed a little bit earlier? Is it just simply understanding? You know, I, I think that we've laughed in society about hot flashes so long. We've always made it seem this hysterical woman that's trying to cool off or can't fall asleep, or she's rage-y and upset about everything. That's not the picture of menopause or perimenopause anymore. Halle Berry, Naomi Watts, you know, those are the pictures of, of perimenopause and menopause, so this is happening to all of us. If we're lucky enough as women, we're gonna go through this stage of life. So I think it's important for a man to know what it is, what perimenopause is, understanding how long that could last, and understanding some of these symptoms. Because I think sometimes the person outside of you can see those better than you can see them yourself.

    9. JSJay Shetty40:45

       Yeah, I think awareness is definitely the starting point. If you know your partner is gonna go through this between early 40s or late 30s-

    10. TFTamsen Fadal40:52

        Mm-hmm

    11. JSJay Shetty40:52

        ... onward, to be mindful of it, to be present for it, be patient for it. I, I think the challenge is we assume that if everyone's going through it, then it can't be that bad, right? There's a human trait of just like-

    12. TFTamsen Fadal41:05

        Right

    13. JSJay Shetty41:05

        ... well, everyone's going through it.

    14. TFTamsen Fadal41:06

        Yeah.

    15. JSJay Shetty41:06

        Like, what's the big deal? That's why I was asking, like, what, what's the worst that it can get to? Like, what have you, what have you seen the worst-case scenario of?

    16. TFTamsen Fadal41:14

        I've seen couples going through divorce, you know, not knowing what's going on. I've seen men not understanding what's happening because perhaps his partner doesn't wanna have sex and has not wanted to for a long time, and he doesn't understand it. I have seen women that get osteoporosis as a result of this, women who are not treating their heart, women who have heart issues as a result of this. You know, I, I think that we have to pay attention to our health, and I don't think that knowing that you're in perimenopause doesn't mean that you're going to prevent heart disease. But you'll start paying attention to those things. I had never had heart palpitations before. As a result of that, and it turned out that it was menopause, I wound up seeing a cardiologist to just understand where my baseline was, and I think that's really, really important. Because the last thing that I want women to do is suffer, one, and two, not be aware of what's happening in their lives during this time.

    17. JSJay Shetty42:02

        What happens to a woman's sex drive during perimenopause?

    18. TFTamsen Fadal42:06

        Yeah, let's talk about that because, listen, you're still getting your period during perimenopause, and so your hormones can be all over the place, and sometimes you can really wanna have sex, and sometimes you might not wanna have sex at all. And I think that some of it's emotional, too. You know, I lost my sex drive completely toward the end of perimenopause. Like, I had nothing, and I got remarried at the age of 50. So imagine I went into this brand-new relationship and was likeYeah, I've, I've no interest in it anymore. And I think that my partner, my husband, was like, "What happened? Is it me? What, what happened?" And so I think that that can really cause some problems, and I think that can cause

19. 42:39 – 46:28

    Am I Too Young for Menopause?

    1. TFTamsen Fadal42:39

       unspoken problems, and that's the big issue with a partner not understanding what's happening.

    2. JSJay Shetty42:44

       And it just disappears.

    3. TFTamsen Fadal42:45

       It disappeared. Like, I was going along, we were dating, everything was great, and then it disappeared. And that was really why I turned to-

    4. JSJay Shetty42:54

       You feel attraction, you want intimacy, and then-

    5. TFTamsen Fadal42:56

       I love it. I wanna kiss you. I wanna be with you. You know, you're amazing. I wanna be close to you. But I didn't wanna have sex, because it was painful, quite frankly. And that's what a lot of women experience. They experience painful sex. There's dryness that happens all over your body, and it didn't feel good, quite frankly. And I hear women talk about it now openly, but it wasn't something we were ever told to talk about or to express or to sit with somebody. I mean, I couldn't imagine sitting here talking to you about this three years ago-

    6. JSJay Shetty43:23

       Oh, yeah

    7. TFTamsen Fadal43:23

       ... five years ago, right? But I think it's what we have to do so young women understand it, and so that men understand that something might be going on with their partner, and it might not just be that she's lost interest.

    8. JSJay Shetty43:36

       And I think that's the take from a man's perspective. It's like, oh, well, maybe this relationship doesn't exist anymore.

    9. TFTamsen Fadal43:40

       Mm-hmm.

    10. JSJay Shetty43:40

        Like, there isn't attraction. There isn't a desire for intimacy. And then if you don't understand that there could be this hormonal shift that's causing this desire... I thi- I think it's so interesting, isn't it? Like, we, we grow up thinking a lot of this is purely mental-

    11. TFTamsen Fadal43:57

        Mm-hmm. We do

    12. JSJay Shetty43:59

        ... and not biological-

    13. TFTamsen Fadal44:00

        We do

    14. JSJay Shetty44:01

        ... and, and not hormonal and not chemical in that sense. It feels like, oh, it's a choice or-

    15. TFTamsen Fadal44:06

        Yeah

    16. JSJay Shetty44:06

        ... an attitude, and some of this is not a choice. You didn't make a choice to not want to have sex anymore. Like, it was just, it was almost like there was an off switch.

    17. TFTamsen Fadal44:15

        It was an off switch, and it w-

    18. JSJay Shetty44:16

        Yeah

    19. TFTamsen Fadal44:16

        ... it scared me to death. It scared me to death, 'cause I thought, "Wow, is this, like, is this it? Do I..." And it made me question, do I, do I not have desire for him anymore? What, what's going on?

    20. JSJay Shetty44:27

        Yeah. Yeah, yeah. Do I l- Like-

    21. TFTamsen Fadal44:27

        It scared me.

    22. JSJay Shetty44:28

        Yeah, that's a really interesting to... Yeah, right.

    23. TFTamsen Fadal44:29

        Yeah, it scared me, and I, and that's really why I turned and I, you know, I, I started to treat these symptoms, but I really thought it was something that was going on with me, and I, and I was scared to say it, because I didn't even know how to say it. How do you say, like, "Hey, I just, I don't wanna have sex anymore, and I don't know why. And all of a sudden it doesn't feel good anymore"? And so I think that those are really tough things to contend with as a woman, and I think it's really hard when a partner doesn't know what's happening, and they feel in the dark. And so that's why I love when men want to h- understand this conversation, they wanna hear about this conversation, and they wanna know what they can do. I wanna tell you a quick story. You know, I was, I was doing a book signing, and I... It's always m- women in the room, you know? And so, 'cause I don't know very many men that are gonna be like, "I'm gonna go to the How to Menopause book signing."

    24. JSJay Shetty45:14

        [laughs]

    25. TFTamsen Fadal45:15

        "I can't wait." And so this one man was sitting there next to who I assumed was his wife, and he was just watching me, and he didn't really have a reaction. He wasn't nodding to where you feel like, "Hey, is, is this okay that I'm talking about all these things?" And, uh, he came up afterwards and he said, "Hi, I need to ask you a question." And I said, "Yes." And he said, "How old is too old to be learning about this, or how old is too young to be learning about this?" And I said, "Women at all ages should be learning about this. This should be being taught in school. People should understand this at all ages. Doctors should be talking about this when women going into the doctor's office. There's no question." And he said, "How important is it for men to understand this?" He said, "Because I've never even heard any of this, and I think it, it's really important." And I said, "It is." He came back to me and he said, "I'm going to take two of these books and I'm gonna give them to my daughters and their husbands, because I'm going to insist that their husbands read these books." And I was blown away and I thought, wow, like, one man has now shared this message with two other men, and that's how the conversation starts to happen.

    26. JSJay Shetty46:15

        Yeah, absolutely. I mean, I've, I've been thinking about it. I've been having a lot of conversations about it with my male friends who are older than me, whose partners are probably in that space right now, and just helping

20. 46:28 – 47:08

    The Truth About Hormone Therapy Side Effects

    1. JSJay Shetty46:28

       them become conscious of how it could affect them. Because it's a human trait, again, that when you haven't experienced something, you have no idea how it impacts someone. And that applies to anything, whether it's your parents getting divorced, whether it's visiting certain countries when you were young, whatever it may have been. Like, as humans, we're bad at knowing how something can affect someone else, and, you know, even, even to the point of, you know, me and my friend were just talking the other day. We have three friends in our generation who have cancer right now.

    2. TFTamsen Fadal46:57

       Mm-hmm. Sorry.

    3. JSJay Shetty46:59

       And, you know, and it's, and, and you're having this conversation, you're thinking about it, and you have so many friends who don't understand how hard it is for that person, because you're like, "Oh, it's stage

21. 47:08 – 49:20

    Menopause, Fertility, and the Overlap

    1. JSJay Shetty47:08

       two. Oh, it's stage one."

    2. TFTamsen Fadal47:09

       Yeah.

    3. JSJay Shetty47:09

       Like, you'll be okay. But then when you really think about it, that word is so loaded, it's so heavy, it's so hard. Whatever stage it's at, it's, it's tragic to go through, and I think that's partly the challenge here as well, that when it comes to menopause, I'm talking to my male friends about it a lot, because I think looking at it as the source of some of the struggles in a relationship and the challenges that they're going through, communication challenges with their partner, is helpful to both of them. Because otherwise, like you said, you were thinking it was all your fault, that there was something wrong with you, and that person, if they're not understanding, could feel the same way. "Oh, it's all your fault." How did your husband help you? Like, how did, what did that process look like? Because I'm assuming you weren't this well-versed at the time either.

    4. TFTamsen Fadal47:54

       When you talk about that, you talk about, um, cancer, that's life altering, whatever stage it's in, just to hear those words. My husband helped me in a lot of ways, and it was really interesting when I got the first, you know, was told I was in menopause. We were boarding a plane and I said, uh, "Oh my gosh, I just got a note in my patient portal that says I'm, I'm in menopause. I'm too young for menopause." I was 48. The average age is 51. I wasn't too young for menopause, I was just clueless. I just had no idea, and I couldn't believe it. And to me, I associated that word with old age, and, like, somebody whose best years were behind them, and I realized it was anything but. And as I continued to learn, I would talk to him about it, and I'd say, "Hey, listen, I found out that, like, I-There's not just three symptoms, there's 30-plus symptoms of menopause, and now they're in the hundreds. You know, we're counting more and more. As we learn more, we're learning more and more symptoms of menopause. And then eventually, when it came to sex, I had a r- I have a real conversation, you know, because I went on my honeymoon to Hawaii, and I had no sex drive. It was really awful. It was real- it felt, it felt emotionally awful for me, but also, I felt for him. And then you know that feeling where you're going, "Oh, my gosh, what's he thinking? What's she thinking?" I had to have the conversation, though, with him through the process, and I was really grateful that he was open to listening to it, and it wasn't like, "Hey, you get that taken care of, and-

    5. JSJay Shetty49:09

       Yeah

    6. TFTamsen Fadal49:09

       ... you know, then let's talk," because, uh, what's going on? Um, and I talked about it w- with him through everything. I, with weight gain, with not being able to sleep at night, with sleeping on the couch, you know, for almost a

22. 49:20 – 51:30

    How to Prepare for Perimenopause

    1. TFTamsen Fadal49:20

       month at one point because I couldn't fall back to sleep, and I was tossing and turning and tossing and turning. And then eventually decided that hormone therapy was gonna be the, the choice for me, and it, and it really changed everything, and my lights kind of came back on, and it felt very, very different. But we go back, and we look at that time now, and I said, "Gosh, I, I was a shell of myself, wasn't I?" And he said, "You were really different from the girl I met."

    2. JSJay Shetty49:41

       Wow.

    3. TFTamsen Fadal49:41

       "You were totally different." And I felt so sad because I, I didn't know what to do, and I didn't know what I had done.

    4. JSJay Shetty49:46

       Mm.

    5. TFTamsen Fadal49:47

       And that's really what I, I want... I wish that every couples counselor, anybody, any coach, anybody that people are going to for help or advice would educate themselves about the changes that happen during this time in a woman's life because I think it would solve so many problems.

    6. JSJay Shetty50:03

       It really would. I feel like there's a lot of trends in society that are changing, like women are having children at an older age.

    7. TFTamsen Fadal50:11

       Mm-hmm.

    8. JSJay Shetty50:12

       What happens when perimenopause and fertility kind of, you know, overlap, those periods that you're experiencing it? What does that look like?

    9. TFTamsen Fadal50:21

       We're starting to have that conversation a little bit more, and I'm, I'm excited about it because I think it's important. I don't think that any of us, or I certainly didn't, uh, as a, as just a regular woman, you know, I d- I'm not a doctor. I'm a journalist. I didn't understand that it started in these early years. I didn't understand in your 40s you would be dealing with any type of symptoms of perimenopause because I didn't know the word. But there have been some women that said, like, "I didn't know the difference between having my child, and then all of a sudden, I was postpartum. And then the crossover between perimenopause, like, what, w- what was it? What was going on in my life? I didn't even know what was happening." And then obviously, in perimenopause, you can still get pregnant. So, you know, some women think that their period's gone away for six months, then all of a sudden, you know, they realize that they can still have children. And so then we have children, you know, they're having children later in life. So there is definitely, I think, more of that crossover than we've ever seen before because we're having, seeing women having children later in life.

    10. JSJay Shetty51:17

        Are there any implications? What should people be aware of if, if that's what they're going through?

    11. TFTamsen Fadal51:21

        I think to be aware of the symptoms of both because I know there's a lot of women that are like, "I didn't know what was happening. I didn't know if it was after I had a child that I wasn't able to, to get the weight

23. 51:30 – 53:03

    Do Birth Control Pills Help?

    1. TFTamsen Fadal51:30

       off, or I was feeling this, like, very, a lot of emotions going on and not going back to sleep." And some of those same things that I was dealing with when I was, uh, pregnant in my reproductive years are the same symptoms of perimenopause, so which is which? And I think that that's where you really have to have that relationship with your doctor. I really believe that we've done a disservice to women because we've kinda said, like, "Here, when you're in your pri- reproductive years, here's what your OBG- OBGYN looks like. And then after that, you can go to the doctor and have your appointments and everything." But there's a real crossover in those years from 35, 38 years old to, to when you hit menopause, and I think you have to be having both of those conversations at the same time. You could get pregnant. Some of those symptoms could also be perimenopause.

    2. JSJay Shetty52:17

       If there are younger women listening right now, how would you best recommend that they plan for perimenopause? Is there a way you can plan or prepare?

    3. TFTamsen Fadal52:25

       If I were a young woman right now, best thing could be to pay attention to some of those health habits. You don't have to be perfect. I'd pay attention to the strength training. I'd pay attention of how to get habits to sleep well now. You can go have a good time. I promise it's great. Go have a great time. But pay attention to some of these things that I think you need to put into place. Protein, adding that to part of you, what you have going on, and figure out a way to manage stress. I think all those are so important. And I would also do this. I'd also get a bone density test, which was nothing I'd ever heard of before or anything I thought I should get. Most women wait till they're 60 years old to get something like this, but I'd wanna know what my baseline

24. 53:03 – 55:19

    Inspiring Stories of Women Thriving

    1. TFTamsen Fadal53:03

       is for my bones.

    2. JSJay Shetty53:04

       Mm.

    3. TFTamsen Fadal53:04

       Because that's really important, and the last thing you wanna do is break one.

    4. JSJay Shetty53:07

       Yeah. So it's, it's amazing to me how the habits do help. Like, getting good sleep-

    5. TFTamsen Fadal53:14

       So much

    6. JSJay Shetty53:14

       ... your nutrition, these things do matter.

    7. TFTamsen Fadal53:16

       They do matter.

    8. JSJay Shetty53:16

       It's just that it's not gonna, it's not gonna stop this from happening, right? It's, it's-

    9. TFTamsen Fadal53:21

       It's not gonna cure it. [laughs]

    10. JSJay Shetty53:22

        It's not gonna cure it, right. Yeah, you can't avoid it. It won't cure it, but it will help you-

    11. TFTamsen Fadal53:28

        Yeah

    12. JSJay Shetty53:28

        ... it will help you move through it.

    13. TFTamsen Fadal53:30

        I think it'll help you manage your symptoms, and that's the most important. You know, perimenopause and menopause, this isn't a disease. This is a, a transition that we're going through, and I think it's really important to know... You know, I, I wish that when I were younger, I was thinking a little bit older. I wish that I was thinking that, oh, I have time to do all those things. If I had established some of those habits when I was in my 20s or my 30s, then it wouldn't have been so hard in my 40s and 50s to try to figure it all out so quickly, and I think that's the advantage that younger women have today, and I feel really inspired by that. I feel really motivated for them, that they're gonna get ahold of this, and I don't think that perimenopause and menopause is gonna look like this in five or 10 years.

    14. JSJay Shetty54:12

        Yeah. I, I definitely think that, especially all of our listeners, but there's such a culture now of trying to get into those healthy habits earlier, and, and it's good to know that that will fare people well as, as they move through this transition. What, what's the impact of the pill, uh, and birth control drugs on perimenopause?

    15. TFTamsen Fadal54:32

        It's interesting. Uh, some women have said to me, "Oh, gosh, I went to the doctor. I, they said it was in perimenopause according to my symptoms, and I was given a birth control pill."Well, the birth control pill oftentimes is given because you had irregular periods. If you went in there saying like, "My periods are irregular," then the birth control pill is there to kind of regulate those. And so some women will be on that for quite some time. They'll be eventually weaned off of that if they're in perimenopause, and then they can start hormone therapy. And any of the doctors I've talked to say that, you know, both of those things are possible options depending on what, what your symptoms are. If you go into the doctor and you're saying, "Hey, I've got hot flashes, and, uh, I can't sleep, and my, my joints hurt right now, and I'm just feeling a little bit of brain fog," they're probably not gonna give you birth control. They will start you on a low-dose hormone therapy most likely

25. 55:19 – 1:05:03

    Why It’s More Than “Just Aging”

    1. TFTamsen Fadal55:19

       and tell you to add in those lifestyle practices to be able to help you. But birth control pill with regard to doing anything to perimenopause, I think more often will help regulate your period.

    2. JSJay Shetty55:30

       You're saying there's not a negative impact between younger women being on birth control and then how they experience perimenopause?

    3. TFTamsen Fadal55:36

       Not that I know of, except that some women say, "Oh, wow, I don't know if my period has stopped or started. I don't know where I am." So a lot of times, if a woman is a little bit older, a doctor will oftentimes wean them off of that, so they can figure out kind of where they are in their, in their cycle. 'Cause again, if you've gone 12 months without your period, now you're menopausal, and then you would be doing hormone therapy. You wouldn't be doing birth control 'cause you wouldn't need it any longer.

    4. JSJay Shetty55:59

       What else... There was, there was a funny video I saw on TikTok. It was, it was funny. It was comedic, but it was making a really big point, and it was showing how men's hormones-

    5. TFTamsen Fadal56:08

       [laughs]

    6. JSJay Shetty56:08

       ... how they stay steady and how women's hormones go, you know.

    7. TFTamsen Fadal56:12

       Yeah.

    8. JSJay Shetty56:12

       And, and just the amount of cycles that women have to go through and the experience of it all and... What have you heard from your community that's given you strength, hope, encouragement? What, what have you noticed about people who have transitioned effectively? What, what are the success stories almost?

    9. TFTamsen Fadal56:30

       The success stories of women who have gone into this stage successfully are, "I feel like myself again. I feel really bold, and I can't wait for this next chapter. I'm feeling good about my body." And I think what they feel more than anything else is knowledgeable, and they feel like, "Wow, I know what journey I'm on. I understand what's happening to me now, and now I can tackle these different things as they come along." I never understood that knowledge and community were so important to something like this, and I think it means everything. When a woman hears, "Hey, this is what you're going through," versus, "Oh, my gosh, could I be dealing with dementia? Could I be dealing with Alzheimer's? Why is my heart racing out of control? Why am I gaining weight?" When you are in the dark, and you don't understand what is going on, I think that can be the scariest thing happening, and I think that's what so many women have been dealing with for so long, which makes me really sad. I, I go back, and I think about my mother. I lost my mother to breast cancer when she was 51 years old, and she had a surgical menopause, meaning that as a result of her surgery and chemotherapy, she went through menopause early. She was 44 years old when she was diagnosed, so it was pretty early. And we used to go into restaurants, and we'd have to leave the restaurants because sweat would be literally pouring down her face. Like, she just, she couldn't stay there, and her heart was racing out of control, and she'd be throwing water on herself. And she'd laugh along with the rest of the family, and we'd be like, "Oh, Mom's hot again. Ha ha." And it wasn't... This was years ago. My mom died in 1990, and it wasn't until maybe three, four years ago when I really started research, and I was doing this, I realized that that was my mo- what was my mother was going through. It made me so sad to go back and say, "Oh, my gosh, she was laughing with all of us, trying to play it off, and she was really suffering on the inside."

    10. JSJay Shetty58:14

        That's the hardest part for me-

    11. TFTamsen Fadal58:16

        Yeah

    12. JSJay Shetty58:16

        ... is knowing that there are so many women that I care about and that I love-

    13. TFTamsen Fadal58:19

        Yeah

    14. JSJay Shetty58:19

        ... that I would've been, it would've been useful if I had this context, that I could've shared that with them. They would've found better support and help in their journey, whether it's lifestyle changes or hormonal support or stress management, as you rightly said, and, and I would've been, you know, understanding and empathetic-

    15. TFTamsen Fadal58:37

        Yeah

    16. JSJay Shetty58:37

        ... to, to the change that they were going through. I think it would, it would change so much. Why is it that despite everything we've talked about, doctors still dismiss these symptoms, and medical research is not investing more? I just can't wrap my head around that.

    17. TFTamsen Fadal58:53

        I can't either. Honestly, I think part of it is societal. I think part of it is that we think women in midlife are kind of best years are behind them. I think that sadly, when it comes to research, you know, we did a lot of research. We do a lot of research about reproductive years, about what happens when you're older, even what happens when you're, you know, younger, all ends of the spectrum, and then there's this kind of chunk of women in, in a time in our lives that we're just sort of, we've kind of fall off the radar. We're just not there. And so that happens when it comes to research. And then I think with doctors not being educated about it, you know, it's not the doctor's fault. They're there to help. That's what they wanna do. Doctors have good intention, but unfortunately, if they didn't learn about it, if you've got a woman coming in there, and you've got a woman saying like, "Oh, I'm, I'm tired. I'm not able to sleep. I'm gaining weight," you know, a doctor will often be like, "Okay, it's a part of aging," or it's, you know, "Take this, and call me. Take an antidepressant or try to get some more sleep or practice winding down." And so sadly, you know, we've got doctors that are dismissing women, women feeling they leave a doctor's office and don't know what to do, and I've heard from so many women. Every single day, Jay, I get messages saying, you know, "My doctor told me it was because of my age," or, "My doctor said I couldn't possibly be in perimenopause yet," or, "If your symptoms aren't bad enough, you don't really need to do anything." And I think that's the one that bothers me the most. I really get upset when I hear, "Your symptoms have to be so much worse for you-"

    18. JSJay Shetty1:00:23

        Yeah

    19. TFTamsen Fadal1:00:23

        ... "to do something about it," 'cause that's not true. It's just not true. And is that there's so much that can be done about this, and there's so many different ways to help women. And so my hope is that we start getting this training, and we start making sure it's mandatory, and we start making sure that all disciplines, not just OBGYNs, learn about perimenopause and menopause. If you go to your cardiologistThey should be talking to you about perimenopause and menopause. We know doctors can't know everything, but that's where it comes upon the woman to be educated about this, too, and right now I think it's the best thing we can do. We're not gonna be able to get a whole bunch more studies right now in a short amount of time. We're not gonna be able to get tons of money poured into women's health all the time, specifically perimenopause and menopause, and we're not gonna be able to get all doctors trained so quickly. But what we can do is get this message out to all women, young women, older women, daughters, mothers, sisters, aunts, anybody that could be going through it or has somebody that they know going through it, and now especially men.

    20. JSJay Shetty1:01:23

        Yeah. Well said. Well, I'm happy to be a part of that and, and, and have this conversation because it's what you said also just about if you're, if you care about someone, you know, it's so important to be aware of what they're gonna go through.

    21. TFTamsen Fadal1:01:37

        Yeah.

    22. JSJay Shetty1:01:37

        And, and to me, that's especially something that is something they can't control, you know? Something that they don't have that influence over.

    23. TFTamsen Fadal1:01:45

        I have to say, I'm so grateful to you for this, because I know it's not an easy conversation, because it's like, w- I don't know. Where do we even start?

    24. JSJay Shetty1:01:51

        It's easy talking to you about it, so [laughs]

    25. TFTamsen Fadal1:01:53

        [laughs] Thank you.

    26. JSJay Shetty1:01:53

        Yeah. You have, you, you've like just given us a masterclass on it.

    27. TFTamsen Fadal1:01:56

        [laughs]

    28. JSJay Shetty1:01:57

        I feel so much more well-versed-

    29. TFTamsen Fadal1:01:59

        I'm so glad

    30. JSJay Shetty1:02:00

        ... just from speaking to you, because you make it so simple. You make it so understandable. I'm glad that people have the book so they can check the 34 symptoms. I'm glad that people have the book so that they can actually figure out where in the course they are so that they can turn to the doctor or turn to their partner, find their community. I mean, the way you laid out the three really simple steps people can take, whether it's lifestyle changes, stress management, or hormonal therapy, it's, it makes it feel manageable. It doesn't make it feel like this is something insurmountable. It feels like something that we can at least grasp and know what we need to do to take the next step. So thank you, uh, for being such a great messenger for it, and, and having the courage to do it. I'm sure it's hard being you to, as you heard, your career was-

Episode duration: 1:05:03