The Mel Robbins Podcast#1 Hormone Doctor: The Ultimate Guide to Perimenopause, Fertility, Birth Control, PCOS, & Menopause
EVERY SPOKEN WORD
65 min read · 12,564 words- 0:00 – 2:42
Meet the Guest
- MRMel Robbins
Today, you're gonna get a masterclass with one of the most trusted medical experts in women’s health today. Whether you're 25, 35, 65, heck, 85, this is your guide to understanding what's happening in your body. Dr. Sharon Malone is a board-certified OB-GYN and nationally recognized expert in menopause, perimenopause, reproductive health. I'm getting so many listener questions about PCOS.
- SMDr. Sharon Malone
With polycystic ovarian syndrome, a lot of women will find that they have signs of what we say androgen excess.
- MRMel Robbins
That sounds terrible. What is that?
- SMDr. Sharon Malone
Acne, facial hair, weight gain, higher levels of insulin, irregular cycles. Those are all signs.
- MRMel Robbins
What, uh, Dr. Malone, are surprising reasons for infertility?
- SMDr. Sharon Malone
The thing about, uh, infertility that we don't talk enough about is that it's not just a me problem. Upwards of 50% of infertility cases sometimes is male factor infertility.
- MRMel Robbins
What's the connection between fertility and perimenopause?
- SMDr. Sharon Malone
Suppose you've talked to your mom, and you find out, "Oh, my mom had an early menopause. She was menopausal at 42." Back it up. That means that for you, you might be perimenopausal in your 30s, your early 30s, when you think, relatively speaking, "I should be pretty good on the fertility front."
- MRMel Robbins
Yeah. Let's talk about menopause. What do you want women to really know and take seriously?
- SMDr. Sharon Malone
Well, women who have more severe hot flashes and more frequent hot flashes, sometimes it is a marker for impending cardiac issues. Women need to understand that misery should not be your resting place. The most effective treatment is hormone or estrogen particularly for the symptoms of menopause.
- MRMel Robbins
What the hell was I doing? Why didn't I start this sooner?
- SMDr. Sharon Malone
Why didn't I start this sooner?
- MRMel Robbins
Hey, it's Mel, and before we get into this episode, my team was showing me 57% of you who watch The Mel Robbins Podcast here on YouTube are not subscribed yet. Could you do me a quick favor? Just hit subscribe so that you don't miss any of the episodes that we post here on YouTube. It lets me know you're enjoying the guests and the content that we're bringing you, because I wanna make sure you don't miss a thing, and I'm so glad you're here for this episode, 'cause this is a really good one. All right, let's dive in. Dr. Sharon Malone, welcome to The Mel Robbins Podcast.
- SMDr. Sharon Malone
Thank you so much for having me.
- MRMel Robbins
I am so thrilled that you're here. The team is buzzing, and we have so many questions from our audience, and we're gonna go through
- 2:42 – 6:53
What Every Woman Needs to Know About Hormones
- MRMel Robbins
them one by one. And I think one of the places that I would love to start is I would love to have you speak directly to the person that's here right now and explain a little bit about what might change in their life for the better or their health for the better if they take everything to heart that you're about to share with us.
- SMDr. Sharon Malone
I think the most important thing that women should understand is that we are hormonal beings from the moment we start puberty to the day w- our periods stop forever, and these hormonal changes and, and undulations that happen affect every part of our body, and they're not disconnected. Puberty is not disconnected from your reproductive years. It's not disconnected from perimenopause and menopause. It is one continuous story, and that the sooner you know the story, the better you're able to craft a better ending for you. Whether you're 20-something, 30-something, or 60-something, there will be something in this conversation that will apply to you, whether you're a mother dealing with a daughter with endometriosis or struggling with infertility, or you're a daughter, and you're watching your mother age or worry about fractures as she gets older. There are multiple entry points into this conversation, and I hope that we will hit them all, and there will be something that we can all take away from it, because we're all grown women.
- MRMel Robbins
As I'm sitting here in this chair, you are going to share things that I will likely learn about my body for the first time, and it startles me how much I didn't know about menopause, perimenopause. It startles me as a mom of two daughters in their 20s how much I don't even know how to explain to them about what's going on in their bodies. Why do you think there's so little education when it comes to women really understanding both the beauty and complexity and the very explainable things that are happening?
- SMDr. Sharon Malone
Well, I think that we don't have the conversations. I mean, intergenerationally, we don't have the conversations. You barely got a period talk.
- MRMel Robbins
[laughs]
- SMDr. Sharon Malone
And the period talk is not just about how to put in a tampon or how to use a pad. It is a fundamental change in a girl's body. She is transforming from a girl to a woman, and all the things that sort of happen after that. Do we talk about cramps? Do we talk about PMS? No, we don't. Most of us are left to figure it out.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
And it starts there. Uh, we've gotten a little bit better about having the conversations about birth control and pregnancy, but really, when you get into the phase of life when you need the most advice, you are having that same sort of total body transformation in perimenopause and menopause. No one warns you. You don't even know what the signs and symptoms are, and most women are just caught flat-footed on this. I, I think it has a lot of historical basis for it, in that women are taught that the things that our bodies do are either shameful or disgusting, and so we don't have open conversations, and it starts at the beginning, and it goes all the way to the end.
- MRMel Robbins
Well, what I also love that you just said is that it's this continuum, and it is true. When I think about being 57 or I think about my daughters who are in their mid-20s, it is almost like episode by episode. I'm having problems with my period now, so now I'll go get help, or I am having trouble losing weight or sleeping or brain fog, so then I'm gonna go get help. But we don't th- I've never really kinda thought about it like, what's the whole picture here, and how do the dots connect from the very beginning when you get your period all the way through till the end of your life? And that's why you're here, Dr. Malone, and so I want to go decade by decade and really have you talk about that sort of continuum, medically speaking, related to women, hormones,
- 6:53 – 9:25
Birth Control vs. Natural Birth Control
- MRMel Robbins
health, and let's just start with your 20s, okay? One of the things that I've noticed, Dr. Malone, is there has been a wave of women in their 20s who are going off birth control, who have a lot of fear that birth control is dangerous or that birth control is making them infertile, and they're now using natural methods. And I would love to have you just unpack this for us.
- SMDr. Sharon Malone
I would love to do that because that drives me absolutely insane when I see these posts and they're saying, "Oh my God, birth control pills, they're going to give you, you know, you're gonna be depressed or you're gonna have sexual dysfunction as a result of taking birth control pills." And I would say this to the young women out there, you don't understand. Birth control pills are probably one of the greatest modern inventions in the history of womankind because it is the first time that we have reliably, reliably been able to control when and what time we choose to have our families, and that is something that, you know, historically we've never had. So being able to decide when and where to have your children, major innovation. So anything that really sort of chips away at that notion or takes away options from, for young women about being able to make that decision is problematic for me. And if birth control pills, if the only thing they did was control your fertility, that's enough, but birth control pills are quite helpful whether or not you have cramps or you have heavy periods or for women who even have PMS. Believe it or not, birth control pills help even out some of the hormonal fluctuation-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... with PMS. So, you know, I don't want to give the impression that birth control pills are for everybody. Every medication, it has benefits, it has some risks. The risks are small, particularly for young women, and I don't want them to shy away from the most reliable, accessible birth control option because they're afraid of something or a post that they've seen on social media. And here's the other good news is that now we have other options. If you choose not to do birth control pills, that's fine. We have lots of other contraceptives for young women that are reliable, much more reliable than these natural
- 9:25 – 11:01
The Best Birth Control Options Explained
- SMDr. Sharon Malone
methods.
- MRMel Robbins
What are the other methods, other than taking a birth control pill, that as a medical doctor you say these are options that you should consider before you look at the, quote, "natural methods?"
- SMDr. Sharon Malone
Okay. Well, one of the things that's really kind of gone by the wayside are diaphragms and condoms. Those are considered barrier contraception. Now, either one alone is about 80% effective, but together they're actually quite good. That's probably the least used options in young, in young girls today, but let's not forget the sexually transmitted infection issue, where condoms should always be a part of whatever that regimen is, so regardless of your birth control, um, that you choose. But we also have something that has been, that has really taken hold with young women, and that are, that is what we call LARCs. That's long-acting reversible contraception.
- MRMel Robbins
What is that?
- SMDr. Sharon Malone
IUDs.
- MRMel Robbins
Oh, that's what I had.
- SMDr. Sharon Malone
Yeah, that includes IUDs. You have either, um, you know, a hormone-releasing IUD, or you can have a copper IUD that has no hormone in it. Um, there's also injectables. You can use the Depo-Provera, which is shot every three months, and then there are also the implants that young women can use that you put them in three years, change them out. So it takes the user error out of it with the LARCs because, again, birth control pills are only as good as the person-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... the reliability of the person who's taking the pill. But these sort of take the user error out of it, and that's why they're a little bit more effective than the pill. So, yes, we
- 11:01 – 15:53
The Science Behind Birth Control
- SMDr. Sharon Malone
have options.
- MRMel Robbins
Um, what are the medical benefits, Dr. Malone, of taking birth control? Like, what are the positives? Because, you know, I think if you're in your 20s or your 30s, you do not remember a time when this was not something-
- SMDr. Sharon Malone
Right
- MRMel Robbins
... that was accessible to you. And I saw this chart that tracked what happened in society when birth control, safe birth control, became a viable medical option for women to, uh, have so that you could control the most important decision that you may or may not make as a woman, which is when you want to have a family, and I found it incredibly striking. It is a hockey stick. I'm holding up a graph that shows that when birth control was first made widely available, uh, you know, right around 1970, within a decade, there was a statistically significant hockey stick spike in women who were able to enter college, complete college, enter law school, medical school, because they were able to control When they had children. And so I would love for you, Dr. Malone, to just be very scientific about what are the medical benefits of birth control. And then I wanna get into what are the lies that are being spread about this important option for women that we need to know.
- SMDr. Sharon Malone
Okay. Well, I think that the positives of birth control pills, one is that suppose you have really heavy periods, and there are women who have very heavy, debilitating periods, and there's no structural problem, so it's not like it's fibroids or something like that that you could fix. It decreases the amount of bleeding that women have every month. So guess what? Not only is your life and your, you know, and your ability to do the things, you know, not impacted, but anemia is a problem for women-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... who chronically bleed heavy. So you're able to control your periods. They're lighter. They're more predictable. That's a big plus. Also, as I said with PMS, some women have really severe PMS, and it happens, you know, because it happen- happens reliably about a week or a few days before their periods. And what's happening in that case, when you're in a natural cycle, your estrogen level goes up, it peaks around ovulation, and then if you do not conceive, it starts to go down. And we think the trigger for some of the PMS is not the estrogen itself, but the falling estrogen-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... that triggers it. The same is true for migraines, for people who get menstrual migraines. It's the falling hormones. So when you take birth control pills, you can sort of even out that precipitous decline that you get, so that's very helpful. And it's also first line for even when there's suspected endometriosis or cramping, and some people have very, very painful periods, and birth control pills do help with that as well.
- MRMel Robbins
Do birth control pills cause infertility?
- SMDr. Sharon Malone
No, they do not. You're not accelerating the aging. You're not doing anything deleterious to the ovary itself.
- MRMel Robbins
Mm-hmm.
- SMDr. Sharon Malone
Let's just say you start birth control pills when you're 20, and you take them until you're 35 because you're not ready to have a baby until you're 35. Well, your fertility at 35 when you stop taking the pills is not what it was at 20. So if you're having difficulty conceiving at 35, it's not the 15 years of birth control pills that did it to you. It is the fact that you are 35, and that is something that we have to take into account. Your fertility changes decade by decade, but it's not the pills, and sometimes we blame the pills for things that really we shouldn't. But let me say, I- I think this is an important point to make, is that some women do react negatively to birth control pills. I get it. I have two daughters. One it works fine on, the other one not. I believe her. Um, but we find an alternative for, uh, for women who do not tolerate birth control pills. And let's be clear, there are about 20 different birth control pill options out there, and you can play around. Sometimes it's, this is not the science of it, it's the art of it. You may react better to one particular progestin that's in one pill and not to the other. So if you have a little patience, don't say, "I took birth control pills once when I was 20, and I had a bad reaction, so I can't take them ever again." That's not true either. It's just knowing that, you know, we've evolved. We have different pills. They're lower doses. There are a lot of tweaks we can make along the way that will make that option a more
- 15:53 – 24:11
Does Natural Birth Control Work?
- SMDr. Sharon Malone
viable one for you.
- MRMel Robbins
Well, I think a lot of young women are worried about falling fertility rates-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... and are opting to go off this safe medication, right? Because they are reading online or they're being told by an influencer that birth control is responsible for falling fertility rates. And they're opting for, quote, "natural birth control" with the assumption that doing natural birth control somehow preserves your fertility for whenever it is that you think you're gonna get pregnant. Is that what's happening when you use natural birth control, that you're protecting your fertility?
- SMDr. Sharon Malone
You are not. And let me say another thing. I went to Catholic school. This new iteration of natural birth control is really nothing more than modified rhythm method. And having gone to Catholic school, let me tell you, rhythm method doesn't work that well. There were a lot of kids in Catholic school, and they were trying to follow the dictums of the Catholic Church and to be able to say, "Okay, yes, no birth control," and it just is unreliable. And I, I think that, um, when you use catchphrases or words like natural, you automatically assume that it's better.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
And there are a lot of things that are natural. Death and disease are natural, but we don't really wanna go down that path either, do we? So you have to watch what the agenda is, and I think you have to go a little bit deeper into why is there, when we are in a time when we have the most reliable and varied birth control options available in the history of womankind, why are we regressing and going back to something that we know for a fact didn't really work that well to begin with?
- MRMel Robbins
Well, and as a medical doctor, Dr. Malone, you're stating that it's not reliable. And I, I, I guess I'm hovering here because, you know, I really wanna respect somebody's decision-
- SMDr. Sharon Malone
Right
- MRMel Robbins
... to do what they wanna do with their body. And if you are using a method, whether it's called rhythm or it's called pullout or it is tracking your cycle or you're using some app that is marketed to you as, quote, "natural birth control"- Then what that tells me is you don't want a baby right now.
- SMDr. Sharon Malone
Exactly.
- MRMel Robbins
And if you're doing it because you think it's safer than a, you know, birth control pill because you have been told by people that it will ruin your fertility, you have been told a lie. Is that what you're saying, Dr. Malone?
- SMDr. Sharon Malone
I am saying that. And to give you an idea of, like, is it safer? And I, and I think that safer than what? Okay? Pregnancy is a very complicated and can be a very dangerous time in women's life, just from a health point of view. A lot of what comes up about birth control pills is like, "Yeah, but it increases your risk of blood clots by two to th- two to three times over not being on birth control pills." Pregnancy increases your risk of blood clotting six times over what it would be if you h- if you were not pregnant. So again, you have to look at it in terms of, you know, relatively. Birth control pills are way, uh, uh, safer and, uh-
- MRMel Robbins
Mm-hmm
- SMDr. Sharon Malone
... less deleterious to your health than being pregnant. And that's why it's so important that you choose the timing. And, you know, Mel, just like you said earlier, you gave that graph about what happened to women, you know, and what, uh, professionally and educationally they were able to pursue after birth control. It is, it is a stark line.
- MRMel Robbins
For the person that thinks that, "Okay, I- I've got a journal, I have an app, I can track my cycle, I can take my temperature, um, I've got the smartwatch and the ring," will that prevent me from getting pregnant?
- SMDr. Sharon Malone
No, it won't. The circumstances that it works the best in are people that have extremely regular cycles. So if you say, "28 days, I know where I am, my period's coming, I can feel it. I can feel ovulation," and there are people who feel that, who say that they do that. But what about if your period is 28 days this month, it's 31 the next month, w- or your cycles are very irregular, then all the temperature-taking in the world is not going to help you prevent pregnancy. Because here's the thing about [laughs] taking your temperature, your temperature goes up after you've ovulated, not before. So if you had sex yesterday and your temperature goes up today, oops, you know, that's a little, that's a little too late for that information. So the cycle tracking is helpful in retrospect. You know, you do it and then you say, "Okay, three, six months, I see where it is and when ovulation may happen here." That's when it's helpful. Now we've progressed a little bit. We've got, you know, sticks you can pee on for ovulation. Those are way more helpful when you are trying to conceive than when you're trying to prevent pregnancy.
- MRMel Robbins
Mm.
- SMDr. Sharon Malone
And the amount of time that sperm will survive even before you've ovulated is, like, 72 hours.
- MRMel Robbins
Wait, so if you're practicing the natural method, and let's say your partner pulls out, if a little sneaks in there, it's gonna live in there for three days?
- SMDr. Sharon Malone
Yeah, up to 72 hours. And so you're, you're just like, "I'm good. I didn't ovulate today." Well, what about tomorrow or the next day?
- MRMel Robbins
Or the next day.
- SMDr. Sharon Malone
Or the next day. So that's why I said it's not as reliable. And I, I, I just want women to be able to make good choices.
- MRMel Robbins
Mm-hmm.
- SMDr. Sharon Malone
Make choices based on evidence, science, not fear.
- MRMel Robbins
So Dr. Malone, um, if someone's listening right now-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... and they've been, uh, using the natural, quote, "method," and, uh, they're now thinking, "Wait a minute, I don't wanna get pregnant right now. Wait a minute, uh, the options that have been around for 60 years are medically safe and reliable? Wait a minute, uh, they're not gonna impact fertility?" What are the top three things you would recommend to the person who's now thinking, "Maybe I should consider the IUD. Maybe I should take a..." Like, what would you...?
- SMDr. Sharon Malone
Think about the timeframe that you, you know, that you're trying to not get pregnant in. If you say, "Absolutely, I don't wanna have a baby for five years," then I think the LARCs or the IUDs or the implants are fantastic because, again, the margin error is so small because it's not like, "Well, I forgot to take my pill." But if you say, "I want, I don't wanna get pregnant now, but maybe within the year," then it doesn't make sense to get a long-acting reversible contraceptive because they, you can leave them in place for years.
- MRMel Robbins
Mm-hmm.
- 24:11 – 28:56
PCOS Explained from an OB-GYN
- SMDr. Sharon Malone
you need to do is ovulate.
- MRMel Robbins
PCOS has recently been, uh, renamed to PMOS, and I'm getting so many listener questions about PCOS. Could you explain what this is? I happen to have a daughter that was diagnosed with this in her late teens. Um, but there's a lot of misinformation, and this is a really important thing that impacts a lot of women.
- SMDr. Sharon Malone
I have thoughts on this, Mel, you know?
- MRMel Robbins
Um [laughs]
- SMDr. Sharon Malone
I'm not surprised, Dr. Malone. But PCOS, I'll give you just a little bit of the, the history of PCOS. PCOS is polycystic ovarian syndrome. Um, before it was polycystic ovarian syndrome, it was polycystic ovarian disease.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
So we changed the name from disease to syndrome because disease makes it sound like-
- MRMel Robbins
Sounds terrible.
- SMDr. Sharon Malone
Yeah, sounds terrible. So that was the first name change. And then now we've gone from polycystic ovarian syndrome to polyendocrine metabolic syndrome.
- MRMel Robbins
Okay.
- SMDr. Sharon Malone
Ovarian syndrome. PMOS is what it is. Okay. Well, that's great. We've changed the name. Have we changed the diagnostic criteria for, for PCOS? No, we haven't. It's the exact same things. Uh, the, how I would make the diagnosis today is the same way I would've made the diagnosis 20 years ago. We just changed the name.
- MRMel Robbins
Dr. Malone, what are the symptoms that somebody who has PMOS or PCOS-
- SMDr. Sharon Malone
PCOS. Okay. Generally speaking, the- well, I think what get people derailed is when you say polycystic ovarian syndrome, that means, poly just means many. You've got normally in the course of a, of a menstrual cycle, you know, you'll start recruiting eggs, one will take over, and you'll ovulate from one egg. Well, with polycystic ovarian syndrome, you don't really ovulate regularly. So they get the signal, okay, but no one takes over and it's not just one, uh, egg that ovulates. So you get this sort of chronic overproduction of estrogen. Um, you also, because you don't ovulate, you also don't get that second half hormone, which is your progesterone that you kick in the second half. And so it makes your cycles irregular. They're irregular, maybe once every three months and maybe once a year. So irregularity of cycles is usually the first point. The second point is that there are also other things going on. A lot of women will find that they have signs of what we say androgen excess. That just means that your ovaries are also making testosterone.
- MRMel Robbins
Okay.
- SMDr. Sharon Malone
They make more than just estrogen and progesterone. They make testosterone. And so when you don't ovulate, you get this sort of chronic overproduction of testosterone. And what happens when you get a lot of testosterone?
- MRMel Robbins
You grow hair.
- SMDr. Sharon Malone
Acne. Yeah.
- MRMel Robbins
Oh, acne.
- SMDr. Sharon Malone
Acne, facial hair. You know, you'll get, uh, women will find that they start to get chin hair or hair around the nipples. So there's a sort of a m- more of a, a male pattern hair-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... growth. It can also lead, because you've got that, it can also lead to hair loss. But the, the endocrine part of it is that we've also realized that it's not just, again, it's never just the ovaries. There are other organ systems that are affected, and the endocrine part is there's an overproduction of insulin. So there's a degree of insulin resistance because you're not responding to the insulin, so you're, you overshoot it and you're making too much insulin. You know, so acne, weight gain, higher levels of insulin, irregular cycles, those are all signs. Tha- those criteria are basically the same. And I think that when you get caught up on the polycystic part of it-
- MRMel Robbins
Yes
- SMDr. Sharon Malone
... you think you're gonna do an ultrasound and see, instead of seeing one follicle, you're gonna see 20 little ones. Well, you don't see it, and, uh, you don't always, that's not an integral part of making the diagnosis. So we've made a lot of pr- progress in terms of changing the name.
- MRMel Robbins
Mm-hmm.
- SMDr. Sharon Malone
But you know where we haven't made a lot of progress? Finding out why it happens and having new treatments for how to, how to deal with it. That's where the attention needs to be focused. So when I say, "I have thoughts," it's like, yeah, great, I'm glad you changed the name, but we need to focus on, okay, now what are we going to do about it? We need more research.
- MRMel Robbins
It almost sounds like it's a hormone bala- imbalance that j- is just wreaking havoc on your body, your menstrual cycle, your ovaries, other organs, insulin. Sort
- 28:56 – 33:33
How to Know If You Have Endometriosis
- MRMel Robbins
of like menopause does.
- SMDr. Sharon Malone
Yeah.
- MRMel Robbins
You know, you write about e- uh, endometriosis in your best-selling book, and I was really surprised to hear that it affects one in 10 women, and it's also one of the leading causes of painful periods and infertility. Can you explain what endometriosis is and what are the symptoms?
- SMDr. Sharon Malone
Yes. Endometriosis is simply that same tissue that lines the uterine cavity.
- MRMel Robbins
Mm-hmm.
- SMDr. Sharon Malone
This, the tissue that gets stimulated every month with estrogen before you ovulate and sloughs every month if you don't conceive during that cycle. That's endometrial tissue, which is why it's called endometriosis. Well, it belongs in the lining of your uterus, but for reasons that we don't really know why, it can migrate or spontaneously generate in places where it doesn't belong. So it can be in your, it can be on your ovaries, it can be the lining of your abdominal cavity.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
It can be on your bladder, it can be on your bowel, anywhere. But it's just not supposed to be there. We don't know how it got there. There are a lot of theories, but it's there. And so those same hormonal, um, triggers that you are getting every month to tell the lining of your uterus to grow and shed is happening... Remember, it's talking to the, that endometrial implant that's on your bladder, and it's doing the same thing. And chronically, it can lead to scarring. Because remember, when you get your period, you're sloughing that tissue out. Well, what happens? It has nowhere to go. So it's there, and that chronic inflammation- Really can cause pain-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... scarring, and in the worst cases, infertility. And as I said, a lot of, a lot of women walk around. I think it is probably, uh, more under-diagnosed than PCOS because when you say one of the signs is painful periods, well, do you know how many women walk around with painful periods and they just figure, "Well, I'll just take, you know, I'll take more Motrin," or, "I'll do something else," or, "I'll just assume that that's normal"? Now, the, the other thing about endometriosis is that it's called really the great masquerader because suppose you have it, it's on your bowel, and your symptoms may be, "Oh, I have, you know, really bad diarrhea or bowel issues," or sometimes even on your bladder. So it is causing the problems where it lands. Uh, if you have really bad endometriosis, the scarring can make sex unbearable-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... for women. So, you know, again, you need to have someone to talk to who says, "You know, yeah, I kinda see the pattern here." But women are often treated individually for their symptoms. So you've got bowel symptoms, you go see a GI doctor. Oh, you have a bladder thing, you go see, you know, a urologist, and not really understanding that it all goes together, and that's why it's a delay in diagnosis for most women. The delay in diagnosis is seven to nine years-
- MRMel Robbins
What?
- SMDr. Sharon Malone
... before they are adequately diagnosed and treated for their endometriosis. Yeah, it's a long time. Women with endometriosis have had multiple, multiple trips to the doctor. It's not like they were not complaining about it, it's just that being able to make the diagnosis. And, and as physicians, we like objective data. We like to be able to do some lab work and see it, or do an ultrasound and see it, or a CT.
- MRMel Robbins
Yeah.
- SMDr. Sharon Malone
And the problem with endometriosis, the reason why a lot of times it's not visualized on a scan, is because the little p- spots of endometriosis will be so small-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... that they're below the resolution of whatever you're trying to do to, to look at it. So you don't s- you can't see it on a scan. Well, then how do you diagnose it? Well, you can... You have the clinical, uh, presentation, but sometimes if you're really concerned, you need to do a laparoscopy, which is, that's where you just take a look, go through a scope and look in there, and you see it.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
And that's how you can definitively make the diagnosis. The one thing that the laparoscopy will allow you to do is that if you see it, in addition to being able to treat it medically, if I see endometriosis, I can go in with my laser and I can zap it and, and correct the things that I see, then do the medical treatment afterward.
- MRMel Robbins
That is so
- 33:33 – 35:46
The Best Age to Have Children
- MRMel Robbins
helpful. Um, since you also said that endometriosis is one of the big causes of infertility, um, let's just talk more about fertility.
- SMDr. Sharon Malone
Mm-hmm.
- MRMel Robbins
What do you want women in their 20s and 30s to understand about how fertility changes as you age?
- SMDr. Sharon Malone
Well, your peak fertility years are really in your 20s, probably in your late teens to through your 20s. And then when you get into your early 30s, it's a little different, but it's not markedly different. You know, the, what's the difference between 32 and 28? Probably not that much. But once you get to about 35, 36, then we start to see some of the more of the age-related fertility decline. Um, our fertility is declining, but it's more rapid once you get to your mid-30s, to the point where by the time you get to your early 40s, then it's even lower. I mean, you know, the likelihood that you'll conceive at 40 is way less than what it would be if you try to conceive at 20. So we have two things. We have number of eggs, and that's more of an issue when you're 50. But when you're in that window of declining fertility, like between 35 and your 40s, there's also, uh, another component that we don't think of, that some of it's genetic, some of it's environmental, and that is your eggs have an expiration date stamped on them. So you don't know when yours is. It is helpful to know your family history. That's why I encourage young women, I said, "Please talk to your mother." Ask your mother, "Mom, did you have trouble conceiving? How old were you when you had your last baby? When did you stop using birth control?" That tells you a lot of things. It tells you, you know, knowing your family history about endometriosis, about fibroids, about infertility is important. It helps you be proactive going forward. It helps you perhaps make a decision. Maybe I won't have my first baby at 37, maybe I'll have it at 34. It's kind of, I say it's data, and you do with that data what you,
- 35:46 – 39:32
Should You Freeze Your Eggs?
- SMDr. Sharon Malone
what you will.
- MRMel Robbins
Does freezing your eggs impact the expiration date?
- SMDr. Sharon Malone
No, it does not. Remember I told you your peak fertility years are in your 20s.
- MRMel Robbins
Uh-huh.
- SMDr. Sharon Malone
So if you were gonna freeze eggs, if I were just saying theoretically, "When, when would I get the best yield from egg, egg freezing and retrieval?" It'd be in your 20s. But the flip side of that is, well, what's the likelihood that I would ever come back for those eggs? Because if you're in your 20s, you've got a whole life in front of you.
- MRMel Robbins
Yeah.
- SMDr. Sharon Malone
You know? So you meet someone at 30 and you get married, and you get pregnant. If you get pregnant on your own, are you ever coming back for those eggs that you've spent tens of thousand dollars for? So even though the sh- the yield is better, the likelihood that you will ever need them goes down.
- MRMel Robbins
Got it.
- SMDr. Sharon Malone
So I think the sweet spot is somewhere probably late 20s, early th- 30s for freezing. But let me be clear about egg freezing. Egg freezing gives you the possibility of pregnancy. It does not guarantee anything.
- MRMel Robbins
That makes a lot of sense.
- SMDr. Sharon Malone
Yeah.
- MRMel Robbins
What, uh, Dr. Malone, are surprising reasons for infertility?
- SMDr. Sharon Malone
I think the most surprising and frustrating one is unexplained infertility. Now, we do a whole workup. You know, we've done ultrasound and we looked at the lining of the uterus, and we know your tubes are open, all of that, and sometimes every single thing checks off on the list. You're good, your spouse or your partner's good, and you're still not pregnant. That, I think, is, is probably more frustrating to people than saying, "Oh, I have fibroids," or, "I had a polyp," or, "My tubes were blocked," because everybody likes to have a reason, and I think that's frustrating. I think the other thing about infertility that we don't talk enough about is that it's not just a me problem, it's a us problem, and upwards of 50% of, um, uh, infertility cases sometimes is male factor infertility.
- MRMel Robbins
50%?
- SMDr. Sharon Malone
Yeah. Women get blamed, but, you know, it's like, "It may not be me. It may be you." Um, and but again, but their answer's even-
- MRMel Robbins
For how did that-
- SMDr. Sharon Malone
That's what, you know, IVF is for. That's what, what's something called ICSI. When you have male factor infertility, then that's just intracytoplasmic sperm injection, ICSI. You see why we say ICSI?
- MRMel Robbins
Yes, I do. [laughs]
- SMDr. Sharon Malone
Yeah. But the, all you're doing is now you're just giving that sperm some... You're like, "I know you're not gonna get there on your own, so I'll just directly put it into the egg." That's helpful.
- MRMel Robbins
You're giving it pre-workout, basically.
- SMDr. Sharon Malone
Oh, you're just going ahead, giving it a whole head start.
- MRMel Robbins
[laughs]
- SMDr. Sharon Malone
Um, but that's helpful.
- MRMel Robbins
Yeah.
- SMDr. Sharon Malone
And that has helped a lot of couples, so it's not just like, "Oh, poor me." You know, the more you know, the better choices you're able to make. And I would also say to young women who are thinking about, you know, where they are in their careers, and should I do it now, should I do it two years from now, the other important point to make here is that freezing embryos, which is what we do in IVF, where you've already got a known egg and a known sperm, and then we freeze them and come back for them later, that's more successful than egg freezing.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
The procedure is the same. We still have to, you have to take all the same medications for IVF that you would for an egg retrieval. You're retrieving eggs. That part of the procedure is the same. The only thing is, like, what are you doing after you've retrieved the eggs? Are we fertilizing them now or are we freezing the eggs? And fertilizing them now with a known partner is always the better option if you have a known
- 39:32 – 42:51
Questions Every Daughter Should Ask Her Mom
- SMDr. Sharon Malone
partner.
- MRMel Robbins
Dr. Malone, what's the connection between fertility and perimenopause?
- SMDr. Sharon Malone
Oh, well, they go together, and it's a age-related thing. Now, here's the connection that I think a lot of people don't understand. Remember I told you there's a natural age decline in your fertility, right? Associated with age. Well, suppose I tell you, we'll do a little thought experiment here. Uh, we say the average age is 51 for having gone through menopause, completed, end, end of discussion, shop is closed. Oh, nothing's happening there, right? No ovaries.
- MRMel Robbins
Yep.
- SMDr. Sharon Malone
No, no estrogen from those ovaries. 51. Well, perimenopause, that window, that long span between your peak reproductive years and the end of your reproductive years, okay, it can be four to 10 years. So if I tell you you're menopausal at 50, all right, then perimenopause can start as early as 40, and then it takes you 10 years to go through that process, and there is also diminished, um, ability to conceive because, again, now you're 40-something-
- MRMel Robbins
Right
- SMDr. Sharon Malone
... in addition to these hormones are changing. But suppose you're menopausal. You've talked to your mom and you find out, "Oh, my mom had an early menopause. She was menopausal at 42." Back it up four to 10 years. That means that for you, you might be perimenopausal in your 30s, your early 30s, when you think, relatively speaking, "I should be pretty good on the fertility front."
- MRMel Robbins
Yeah.
- SMDr. Sharon Malone
But you don't, you can't predict where you are in that spectrum necessarily, so that's why I say it's important to know your family history so you can say, "All right, Mom. Well, I did not know, Mom, that you were menopausal at 40." And that, you know, it's not a one-to-one, but it is a very important data point if you're the daughter.
- MRMel Robbins
If you're listening and you have not talked to your mom or your grandmother if she's still here, what are the questions you want every daughter to ask their mother?
- SMDr. Sharon Malone
You want to know all about their, um, their medical history, but particularly you want to know about things, "Mom, did you have cramps?" That's a sign. Did you have these painful, awful periods that could be indicative endom- of endometriosis? Because we know that daughters of women with endometriosis have a higher incidence of endometriosis. You want to know about whether or not your mom had fibroids. You want to know, because again, that increases your risk-
- MRMel Robbins
Hmm
- SMDr. Sharon Malone
... of having fibroids at some point in your reproductive life. You want to know what age she was when she conceived. Was it difficult? And you also want to know what was your pregnancy like? Because again, these are very, very important points that may affect your history. Whether they do or do not, it n- it makes you aware such that if any of those things come up for you, you don't wait two or three years to go get that diagnosed.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
You mention that to your doctor, by the way. "Oh, yes, my mother had endometriosis." Well, guess what? That's gonna help me make, get to the diagnosis point with you sooner than if you don't know that.
- MRMel Robbins
So even just knowing makes you recognize that, "Okay, this is something I need to pay attention to,"
- 42:51 – 43:44
Can You Get Pregnant With PCOS?
- MRMel Robbins
which is really important. If you've gotten a diagnosis of PCOS or PMOS earlier in your life, will that potentially impact your fertility as well?
- SMDr. Sharon Malone
It may. Because in PCOS, as I told you, the, the treatment depends on what your, what your goal.
- MRMel Robbins
Yep.
- SMDr. Sharon Malone
And if you have PCOS and you're trying to get pregnant, you may ovulate irregularly, and you don't know when that is. So you may are gonna ovulate three months from now. So when you're trying to get pregnant, and that's a very different situation than for someone who has a period once a year, your opportunities for pregnancy are less.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
You know, for someone who has a monthly cycle, well, at least you have the op- opportunity every month. For someone who has PCOS, maybe you ovulate three times a year. So yes, that affects your fertility. But we do have medications that we can induce ovulation
- 43:44 – 49:58
Why Do Women Have Hot Flashes?
- SMDr. Sharon Malone
with.
- MRMel Robbins
Let's talk about menopause. Um, what is it really? And Dr. Malone, what do you want women to really know and take seriously when this change starts to happen in your body?
- SMDr. Sharon Malone
What I want women to understand is this, is that menopause is not an event, it is a life stage. You will spend 30 to 40% of your life after you have completed menopause. You will spend more time in menopause than you did in your reproductive years. It is probably, if you're lucky enough and you don't get hit by a car, that will be the longest, uh, of your reproductive phases that you were in. That's why I don't like the term post-menopause, because when you say post-menopausal, and I get it why we say it that way, but I don't want you to think of it that way, is because that gives the impression that you're over menopause-
- MRMel Robbins
Yes
- SMDr. Sharon Malone
... and you're not. You're never over menopause. The effects of the lack of estrogen and hormones in your body will affect you from that point forward. Your bones, your brain, your skin, your hair, all of it. So I- that's why I said I don't want people to go, "Oh, I'm over it." And you know what they mean when they say, "I'm over menopause?" They're usually, they're saying that their hot flashes went away, and menopause is so much more than a hot flash. I mean, that's the least of the things. But hot flashes are often harbingers of things to come.
- MRMel Robbins
Wait, hold on a second, because I l- uh, harbingers of things to come sound like the orcs are rattling-
- SMDr. Sharon Malone
[laughs]
- MRMel Robbins
... over the mountain. And I do have a question here.
- SMDr. Sharon Malone
Yes.
- MRMel Robbins
"Why do I still have hot flashes at 58? I haven't had my period in over two years." So w- if you're still having hot flashes, what is this a signal of things to come, Dr. Malone?
- SMDr. Sharon Malone
Well, women who have more severe hot flashes and more frequent hot flashes, sometimes it is a marker for impending cardiac issues, because what happens to women who have a lot of hot flashes? And who has the most hot flashes? Black women do. They have hot flashes that are more severe, they last longer, and they start earlier.
- MRMel Robbins
Hmm.
- SMDr. Sharon Malone
So, you know, when I told you perimenopause is four to 10 years, if you're an African American woman in this country, it's closer to 10 years. So you are most symptomatic during perimenopause, so all the time. You may be still getting your period. That's the worst. I'm getting my period and hot flashes. But it can happen. And then there's also about 20% of women whose hot flashes will continue into their 60s, 70s, and beyond.
- MRMel Robbins
Dr. Malone, don't be telling me this. Really?
- SMDr. Sharon Malone
I'm, I'm... Yes.
- MRMel Robbins
Why?
- SMDr. Sharon Malone
See, who knows why? Th- th- th- wait
- MRMel Robbins
Do you think there's a connection with stress? Like, if, w- like when I hear the stat that you said about Black women having, uh, more severe hot flashes-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... it starting earlier, lasting longer, what came into my mind was the statistic that, um, Dr. Gabor Maté shared on this episode about autoimmune diseases and the 4X rise of them in the last 20 years, and it was his theory, and I know there's a lot of research around this, that chronic stress and chronic caregiving and microtraumas and aggression-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... and bias-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... um, that Black women deal with, that, you know, I don't have to deal with-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... because I'm not being discriminated against-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... in microaggressions every day-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... that that chronic stress creates conditions in your body that impact your immune system. Do you think that that is contributing to these symptoms?
- 49:58 – 56:11
When to Start HRT
- SMDr. Sharon Malone
Mm-hmm.
- MRMel Robbins
What would you say, Dr. Malone, are the thing, like, the top three things you want someone to be aware of that you should be checking out to mitigate this?
- SMDr. Sharon Malone
One, I would say this: know that hot flashes are not benign. That's what we've been socialized to believe, that suffering, pain, misery, they're just part of womanhood, so we should just grin and bear it and s- don't worry, close your eyes, it'll be over in a decade or so. That's ridiculous to me. And I do this all the time, because, you know, now people have these little portable fans that they walk around with.
- MRMel Robbins
[laughs] Yes, I have one. [laughs]
- SMDr. Sharon Malone
And I will see a portable fan, and I will just walk up to somebody and say, "Girl, you know we have something for that, don't you?"
- MRMel Robbins
[laughs]
- SMDr. Sharon Malone
"We don't, we don't have to walk around with a fan. Fix it. Do it." I mean, and, and-
- MRMel Robbins
What do I do?
- SMDr. Sharon Malone
I- it's hormone therapy. I mean, the most effective treatment, FDA-approved, f- is, is hormone or estrogen particularly for the symptoms of menopause, vasomotor symptoms or hot flashes. It works. But it's the fear factor that keeps women away from the most effective treatment for the symptoms of menopause.
- MRMel Robbins
You know what's interesting, is it's happening to women in their 20s, because there's so much misinformation and lies being spread about birth control-
- SMDr. Sharon Malone
Right
- MRMel Robbins
... which in many cases is low doses of estrogen.
- SMDr. Sharon Malone
Yes.
- MRMel Robbins
And the same thing is happening to women in our 40s and 50s when it comes to the misinformation and lies related to hormone replacement therapy, which is not only safe for the vast majority of women, but it is shockingly effective. Like, I remember this, when I started hormone replacement therapy, it took about five weeks, and all of a sudden I thought, "Oh my God, I, I, like, my, I, I feel like myself."
- SMDr. Sharon Malone
Yeah.
- MRMel Robbins
I, w- what the hell was I doing? Why didn't I start this sooner?
- SMDr. Sharon Malone
Why didn't I start this sooner? And, and there's a, there's really even more of a medical benefit for starting sooner, because the sooner you start and treat those symptoms, the more benefit you get in the long term.
- MRMel Robbins
What do you mean?
- SMDr. Sharon Malone
I mean, in terms of your cardiovascular risk, in terms of weight gain, in terms of being able to sleep, all of those things. Perimenopause does not have a bright line that defines it the way menopause has a bright line that says when you're done.
- MRMel Robbins
Mm.
- SMDr. Sharon Malone
Okay? But when to start treatment, when to use hormone therapy in some form or fashion in perimenopause, again, depends on what your treatment goals are, and it depends on how bothered you are by your symptoms, and that is what I want women to understand. If you're between the ages of 35 and 45, which is usually about the time that perimenopause or the menopausal transition starts, you seek treatment when you are bothered by your symptoms.
- MRMel Robbins
Like, I wish I had known you, like, five years ago.
- SMDr. Sharon Malone
Yeah.
- MRMel Robbins
Because when I think about how revelatory it is to me that I didn't even consider the age range of 35 to 45, and that there's no benefit to waiting until you're suffering, and if you just don't feel like yourself, the world is hard enough.
- SMDr. Sharon Malone
Right.
- MRMel Robbins
And if this is something that can help you feel like yourself again, it's gonna make you feel better equipped to handle what's going on in your life instead of... Like, 'cause what ends up happening is you describe any of those symptoms, "I can't really sleep. Like, something's wrong. I'm gaining weight. I don't know what's going on." "Oh, here's a, here's an SSRI."
- SMDr. Sharon Malone
Right.
- MRMel Robbins
"You might be depressed."
- SMDr. Sharon Malone
Right. "Here's a sleeping pill. Good night."
- MRMel Robbins
Yes.
- 56:11 – 58:28
Estrogen Patch Alternatives
- MRMel Robbins
a difference. And in fact, you know, it has been on the headlines-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... that there's a shortage-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... of estrogen patches. What is going on, Dr. Malone, and what should you do if that's affecting you?
- SMDr. Sharon Malone
Women are waking up.
- MRMel Robbins
I know.
- SMDr. Sharon Malone
[laughs]
- MRMel Robbins
I mean, I'm, I'm delighted because it means that there's more demand for it, and I think what is distressing to me is that you didn't see this coming. I mean, when I tell you I have personally been out here in this space talking about menopause publicly for over five years. I've been talking about it privately for 35 years. So the notion that now that women are aware, that's the only difference, that more women are aware, we've knocked down a lot of the misconceptions about breast cancer and all the bad, negative press about HRT. Could you not have seen... D- can you not read the room here that there was gonna be more demand for hormone therapy? Well, you know. Again, I, I think that there's not a lot of attention being paid to women's health, but that's another issue. But the point is, is that the estrogen patch is not your only option. Systemic estrogen falls into two categories. S- um, there's transdermal, of which the patch is transdermal, just means it just goes through the skin. So if you're out of patches, if you wanna say, "Oh, but I really wanna stay with the transdermal," you can use a spray, you can use a gel. Those are readily available. And even different dochas- doses of the patch are available. So I don't think anyone needs to panic because you can't find a patch. We have options. Then there's also oral. You know, um, and again, oral, um, hormone therapy gets maligned as if that's something terrible. It's like, you can use oral. Most of the information, the data that we have on the benefits, all the things about hormone therapy really comes from the data that we have on oral. I really just appreciate that you are explaining this in a way that's easy to understand with a level of depth that doesn't make me feel like an idiot for really going either-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... I've never heard it that way-
- SMDr. Sharon Malone
Yeah, yeah
- MRMel Robbins
... or I actually understand it at a
- 58:28 – 1:01:45
HRT vs. Vaginal Estrogen
- MRMel Robbins
deeper level.
- SMDr. Sharon Malone
Mm.
- MRMel Robbins
And one of the topics that I recently feel like, oh, wait, I never really understood that there's a difference [laughs] between HRT and what vaginal estrogen-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... might do.
- SMDr. Sharon Malone
Mm-hmm.
- MRMel Robbins
And it was after learning about the benefits of vaginal estrogen for UTIs, for overall health in your sexual health, that I started taking vaginal estrogen as a supplement.
- SMDr. Sharon Malone
Mm-hmm.
- MRMel Robbins
I can't believe the difference. And so could you explain, Dr. Malone, what the vaginal estrogen supplement is for, how it relates to HRT, and how you want women to think about this, especially as we get older?
- SMDr. Sharon Malone
Right. That's, that's an excellent point because a, you know, sometimes it gets all mushed in together. But when I'm talking about HRT, generally we're talking about systemic, which means that you are using estrogen and a progestogen of some type at a level that, again, controls the symptoms, hot flashes, the mood swings, all the, the brain fog that we typically associate with perimenopause and menopause. So we're taking estrogen at a level that will take care of those symptoms.
- MRMel Robbins
Okay.
- SMDr. Sharon Malone
Okay? So you can do it orally, you can do it transdermally as a patch, but it is going, it's a systemic because it is going throughout your body, your blood.
- MRMel Robbins
Got it.
- SMDr. Sharon Malone
Okay. Topical or vaginal estrogen is used just locally. You put it in your vagina, and it, and you can use it even on the outside, on the, on the vulva, on the labia, on the labia ma- basically because it is addressing the genital urinary syndrome of menopause, or GSM. That's vaginal dryness, painful sex, urinary frequency urgency, infrequent urinary tract infections. You can treat that using local, topical, vaginal estrogen, and it will take care of those symptoms, but it basically stays where you put it.
- MRMel Robbins
Okay.
- SMDr. Sharon Malone
It's not going anywhere. And so you don't, it's not enough in vaginal estrogen. If you have hot flashes and you're using vaginal estrogen, you'll still have hot flashes.
- MRMel Robbins
Mm.
- SMDr. Sharon Malone
You'll still have sleepless-
- MRMel Robbins
'Cause it's not systemic.
- SMDr. Sharon Malone
It's not systemic.
- MRMel Robbins
It's not going through your whole body.
- SMDr. Sharon Malone
No, it is not.
- MRMel Robbins
It's like a pimple patch.
- SMDr. Sharon Malone
It-
- MRMel Robbins
You're, like, putting it here-
- SMDr. Sharon Malone
You-
- MRMel Robbins
... but it's not in your whole body
- SMDr. Sharon Malone
... you put it where you want it to work.
- MRMel Robbins
Got it.
- SMDr. Sharon Malone
Okay? And the same is true of, like, topical estrogen that you use for your face. Remember, one of the things that happens in menopause with estrogen Depletion.
- 1:01:45 – 1:10:30
The #1 Exercise for Strong Bones
- MRMel Robbins
Wow. Uh, Dr. Malone, talk to us about the importance of muscle loss and, uh, bone health and strength.
- SMDr. Sharon Malone
That is so important, because one of the things that happens in menopause is is you start this cycle of bone loss. 'Cause remember, estrogen affects everything; your skin, your muscles, your bones.
- MRMel Robbins
So that starts in menopause?
- SMDr. Sharon Malone
That, that start, really starts in, in late perimenopause, and certainly continues through menopause-
- MRMel Robbins
Okay
- SMDr. Sharon Malone
... at a more rapid clip once you are finally done with menopause. You tend to lose muscle, you lose bone, and you gain fat. So that even when you are weight neutral in menopause, you are still changing your body composition, which mean that's why it's, it's like, "Wait a minute, why do I all of a sudden have this weight around the middle? Why do, why do I have this spare tire?" It is because the l- the lack of estrogen causes this sort of redistribution of body fat and loss of muscle. So now if you go through the next 20 years and you're losing muscle and you're losing bone, well, now you're more susceptible to osteoporosis. Why is that important? Because then you're more likely to fracture a bone, be it your spine, be it your hip or wrist. Your bones are thinner and more fragile. Now, this is where it's a, it's a dangerous combo. If you are not careful and mindful of your muscle mass, now you're weaker.
- MRMel Robbins
Mm.
- SMDr. Sharon Malone
So now you've got less muscle, less bone. What happens if you trip and fall? You're weak. You've got no cushioning, you do, whatever. So when you go down, you go down like a tree and you break things. And that is really why I think our goals as we age, yes, we do hormone replacement therapy, because hormone replacement therapy or the estrogen component is the only medication that we have that prevents osteoporosis.
- MRMel Robbins
Wait, estrogen is the only thing that we have that can prevent osteoporosis?
- SMDr. Sharon Malone
Estrogen in the hormone replacement therapy that you take has an FDA indication for the prevention of osteoporosis. So if you are at risk for osteoporosis-
- MRMel Robbins
Aren't we all?
- SMDr. Sharon Malone
Well, not everybody. Not everybody's gonna break something. I mean, it just depends, and see, there's a genetic component that you bring to it. I have, you know, bone density bec- great bone density because I'm a bigger person and I have... But it's dependent on your exercise level that you have growing up. How did you f- how much bone did you form in the first place? Some of it's genetic, some of it's-
- MRMel Robbins
Mm
- SMDr. Sharon Malone
... y- from your activity. How much calcium? Were you a milk drinker as a kid? That's why your mom always says, "Drink your milk." Um, whether or not you've had enough calcium and vitamin D to actually create that bone, and then whether you've been able to maintain it. And exercise matters. Not just cardiovascular exercise, but w- that's where the weight training comes in, because your bones will respond to whatever load you give it. So the more stress you put on it, the better your muscles are, the more weight-bearing you can do, you tend to preserve more of your bone mass. So that's where you enter menopause. But w- regardless of where you start, you're gonna start to lose it after menopause, and if your bone density is really high, it may take me 35 or 40 years-
- MRMel Robbins
Mm
- SMDr. Sharon Malone
... to get to the fracture point. But if you start really low, you're gonna get there sooner.
- MRMel Robbins
If you're already losing bone density, maybe you have a diagnosis or not, maybe you just feel frail or, like, nervous about it, will weight training pause what's happening? Will it help you regrow?
- SMDr. Sharon Malone
Here's the thing about most bone loss. Most of it, uh, when it happens-
- MRMel Robbins
Mm-hmm
- SMDr. Sharon Malone
... you very rarely get back to where you started.
- MRMel Robbins
Okay.
- SMDr. Sharon Malone
So once you're coming in 10 years after the fact, you may be able to sort of slow the train down a little bit. But for the most part, what's lost is lost. You can maintain your bone density.
- MRMel Robbins
Okay.
- SMDr. Sharon Malone
Okay?
- MRMel Robbins
And H- and estrogen and resistance training, building muscle helps you?
- SMDr. Sharon Malone
Yes. Uh, the estrogen, I'll give you an example where I think it will be helpful-
- MRMel Robbins
Please
- SMDr. Sharon Malone
... for women to know. Right now, the current recommendation for, um, getting a bone density is they said recommendation is do it at 65.
- MRMel Robbins
Why would you do it that late?
- SMDr. Sharon Malone
Isn't that a good question? Why would you wait? Remember I told you, the most rapid phase of bone loss happens in the first five years after menopause. By the time you get it at 65, you've already lo- that's 15 years of bone loss that you're not gonna be able to recoup. It makes more sense to me, and what I would advise my patients to do is that once you get to menopause, you don't need to do a bone density when you're 30, you know? But once you get to menopause, say, "Let's do a snapshot right now and see what my bone density is." It's gonna be good, not so good, or maybe it's fantastic. If it's not so good, that doesn't necessarily mean, that also doesn't mean that you're going to fracture. But I would be more aggressive in terms of saying, "All right, well, what we can do to prevent you losing further bone-
- 1:10:30 – 1:13:36
The Two Questions to Ask Your Doctor
- MRMel Robbins
a question that I'm curious about. If there was one question, Dr. Malone, that you, uh, believe every woman could be asking her doctor-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... after listening to this episode, what would that ques- like, that important question be?
- SMDr. Sharon Malone
I think you should come in to your doctor, um, w- and you should actually ax- ask them two questions. When you are even contemplating having the discussion about hormone therapy and aging, just aging in general, which God willing, we will all do. When you are having a discussion about hormone therapy and whether or not it's right for you, it's not right for everybody, but it's, you know, it is the most effective treatment for most women. W- the conversation that you really need to have is what are the benefits of taking hormone replacement therapy, and what are the negative things will happen if I don't?
- MRMel Robbins
Ooh, I love that, if I don't, 'cause most of us go, "What's negative I do?"
- SMDr. Sharon Malone
Right.
- MRMel Robbins
What if I don't?
- SMDr. Sharon Malone
What if I don't? What am I, what am I at risk for, and what, what are the things that will happen if I don't? And I think we don't have two sides of that conversation.
- MRMel Robbins
Well, Dr. Malone, thank you for not only educating us. Thank you for not only being a voice that has been both privately in practice over 40 years and very publicly sharing this information for free-
- SMDr. Sharon Malone
Mm-hmm
- MRMel Robbins
... and advocating for women. Thank you for writing this remarkable guide, Grown Woman Talk, that gives you the f- medical and scientific facts that every woman needs to understand and know so you can make informed choices and understand the ramifications of doing them or not. And thank you for also putting your effort into solving the access problem, because one of the things that I think a lot about is that I know with the global reach of this podcast, that step one is giving somebody access to a world-renowned expert like you in a way that makes you feel empowered, that makes you understand what's happening, that makes you understand, uh, the various options that you can, and levers you can pull that can help you take control of your life, your health.
- SMDr. Sharon Malone
You know, the message that I really want women to have is that you deserve to feel better. You deserve the, with every tool available, to be able to age healthfully and gracefully. That should be the new goal, not the, all the negativity that's associated with aging. Some of that is gonna come, but the reality is, is that you have way more control over how you navigate this final phase of your life than you think.
- MRMel Robbins
That's why I'm grateful that you're here. Dr. Malone, what are your parting words?
- 1:13:36 – 1:15:39
How to Thrive After Menopause
- SMDr. Sharon Malone
My parting words would be this: Menopause is inevitable It is the one universal female experience. So know what that is. Know it’s coming. Don’t be afraid, because I will guarantee you this, I’ll tell any 47-year-old out there now, and I’m 67, I’m having way more fun at 67 than I was at 47, really. But you gotta feel well enough to be able to do it.
- MRMel Robbins
Well, Dr. Malone, uh, thank you for giving us the no BS, science-backed medical truth that we needed to hear so we can make informed decisions and understand what’s going on. And I cannot wait to see how this impacts the lives of women and the people who love them around the world. Thank you, thank you, thank you.
- SMDr. Sharon Malone
You are so welcome, and thank you for having me. I, I really enjoyed this conversation.
- MRMel Robbins
I did, too, and I also wanna thank you. Thank you for taking the time and making the time to listen to something that will improve your health. I know you wanna feel better. I know you wanna do better, and what you learned today from Dr. Malone is gonna give you the tools that you need to understand what’s happening in your body and to make informed decisions so that you can feel better. And in case no one else tells you this today, as your friend, I wanted to tell you that I love you and I believe in you and your ability to create a better life. And as Dr. Malone just said, holy cow, you can create a better life. But you have to take responsibility for advocating for yourself and getting the support that you deserve. And I promise you, if you do that, you will have a better life, ’cause you’re gonna feel a lot better. All righty. I’ll see you in the next episode. I welcome you in the moment you hit play. And thank you for watching all the way to the end, and you’re gonna love this next video, and I’ll be waiting to welcome you in the moment you hit play.
Episode duration: 1:15:43
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Transcript of episode 9tKZ3w-Gku8
