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As women, we go through many stages in our lives, but perhaps none are as misunderstood as menopause. If you or someone you love is on or about to embark upon the menopausal journey and is looking for approaches to menopause, today’s episode is for you.
My guest today, Dr. Suzanne Gilberg-Lenz, has spent over 20 years as an obstetrician and gynecologist, and during that time she has seen firsthand the lack of information and support available to women experiencing this crucial transition.
In this episode of On Health, Dr. Suzanne shares her insights and advice on how to not only survive menopause but also thrive and embrace this new chapter of life. From the importance of community and self-love to the use of botanicals and so much more, Dr. Suzanne's holistic approach to menopause is a game-changer for women everywhere. So, sit back, relax, and join us as we explore and gain the tools necessary to take on this transformative and empowering stage of life with confidence and ease.
Suzanne and I get into:
- What ultimately inspired her to shift her focus on all things menopause
- The Menopause Bootcamp and the importance of community during this transition
- Taking a closer look at internalized misogyny as women
- Normalizing the grieving process for the loss of who we once were
- The link between the mental health crisis and the menopausal transition
- The common symptoms associated with menopause: sleep, weight gain, brain fog, and more
- Botanicals, cannabis-based products, and other recommendations to minimize the mood shifts associated with menopause
- Mentally and physically navigating weight gain during this hormonal shift
Thank you so much for taking the time to tune in to your body, yourself, and this podcast! Please share the love by sending this to someone in your life who could benefit from the kinds of things we talk about in this space. Make sure to follow me on Instagram @dr.avivaromm to join the conversation. Follow Suzanne at @askdrsuzanne and order her book, The Menopause Bootcamp, here!
This conversation has been edited for clarity and length.
Aviva: Over the course of her 20-year medical career, my guest today, Dr. Suzanne Gilbert-Lenz, noticed a shocking dearth of information and support for women beginning and experiencing menopause. For too long, this crucial stage in women's lives has been given perfunctory notice in medical schools and is often either a hidden secret or the punchline to a joke denying women the information and support we need. This disregard, coupled with the unconscious misogyny and ageism that run rampant in our culture, portrays menopause as something to be afraid of, and worse adds a patina of shame around the blessing of aging and the beginnings of a new normal and enriching phase of our lives.
Dr. Suzanne, as her patients call her believes that women entering menopause each year deserve a thoughtful, candid, modern, holistic information about the physical and psychological issues that arise in this transitional stage, including changes in libido, metabolism, body image, and fears over genetic age-related illnesses. She contends that menopause is a whole life condition and deserves a wide-ranging approach that combines meditation, yoga, therapy, herbal supplements, along with the most up-to-date science and conventional medical solutions – all part of her approach in her Menopause Bootcamp gatherings and her new book of that title. A Diplomat of the American College of Obstetrics and Gynecology, Suzanne Gilbert-Lenz received her medical degree in 1996 from the USC School of Medicine and completed her residency in Obstetrics and Gynecology at UCLA Cedar Sinai Medical Center.
She's also a clinical Ayurvedic specialist, integrating this ancient healing tradition into her work, which she describes as a game changer, allowing her to go deeper into supporting her patient's health and wellbeing. Dr. Gilbert Lenz is frequently a guest and expert in women's health and integrative medicine in print, online and on TV, including appearances on the Drew Barrymore Show. She's the author of Menopause Bootcamp: Optimize Your Health, Empower Yourself, and Flourish as You Age. She’s here today to talk about her 360 degree approach to helping all of us not just survive menopause, but to thrive. And hey, if you're not in menopause yet, stick around because we all need to know about this stuff way ahead of the game to be really prepared for what's coming down the road.
Suzanne: Hi Aviva. It's so nice to talk to you.
Aviva: Nice to talk to you too. We've already established we're sisters from another mother. We chatted for 20 minutes and then finally we're like, we have to do the podcast! We've been everywhere across the landscape of our personal lives, our pet peeves, all the things.
It feels like menopause is having a cultural moment right now. Of course, because 30% of us in this country are in it, we're also the potential cash cow for a lot of companies.
Suzanne: Yes, true.
Aviva: And we're not the keep quiet generation clearly.
Suzanne: I think that's a big part of it..
Aviva: We're not keeping quiet; we're bringing attention to it. We need to talk about this because what WTH is going on. There is a massive influx of hundreds of millions of dollars going into venture capital for continuous glucose monitoring and new supplement lines and all the things. So, I want to kind of drill down with you because we both share this view of all the things have a place.
I think the bigger thing I'm seeing that for the women I'm working with and even for myself – I went into my menstrual years really prepared, and I went into pregnancies and births really prepared. And I've been a midwife for 40 years studying midwifery or practicing midwifery, 40 years now, and a women's health MD. And there are moments where I am, where's my compass? What the hell is going on in my body right now? And for so many of my patients, they're like, okay, where did my sleep go? Right. It ran off to Vegas with my libido.
Suzanne: I hope they're having fun.
Aviva: Let's start by talking about what inspired you to begin your focus on menopause?
Suzanne: Well, a lot of it was just me aging with my patients. I mean, I'm very fortunate. I've been in private practice in the same location, in the same town I grew up in, for my entire career. I have patients now that came as teenagers that are now having babies. So, I have this longevity, and as I was aging and my patients were aging, I just noticed that they didn't know what to do and I didn't know what to do. The other backstory, part of this that's pretty interesting, is that a mentor of mine from training is a renowned breast cancer oncologist. And very early in my career, she called me and said, “Look, I have a lot of premenopausal breast cancer patients who don't want to go back to the scene of the crime. Are you willing to see them as a gynecologist?” So, I was like, “Sure.” And basically I had to teach myself breast cancer survivorship medicine.
Now, this may sound tangential, but it's not because a lot of these young women were being put into either temporary menopause because of their treatments for breast cancer, or they were going into menopause early. And so, I had to start teaching myself that.
Aviva: And they can't use hormones all the time the way everyone else can.
Suzanne: They can't use systemic hormones. So, the hormones for the systemic stuff like sleep and hot flashes. They can, and this is where I started really digging in, they can use vaginal hormones for vaginal dryness, sexual dysfunction, what we now call genitourinary syndrome of menopause because it also has a lot of urinary symptoms.
That, and the combination of me having this interest in training in botanical medicine, created an opportunity in a vacuum, which was the Women's Health Initiative. Right as I came into practice, the Women's Health Initiative, the plug was pulled.
Aviva: Some of our listeners don't know what the women's health history trials were and what happened. So yes, this was a pivotal shift in perhaps what had been an overuse and an over-emphasis on hormones as the panacea for everything. And then there was this shift.
Suzanne: It was a one size fits all. Look, the way a clinical trial goes, or the way empiric, big, NIH-funded science goes is you do have to have some structure. So, they were using Prempro, which was apparently the number one prescribed medication in North America at the time. Okay, that's amazing to me.
But it was a one size fits all approach, and they pulled the plug. It's a very political thing how it happened. And literally within days, everybody stopped taking their hormones. Doctors freaked out; patients freaked out. The OB-GYN community understood the data a lot better and was like, wait, wait, wait, wait, wait. Please don't throw the baby out with bathwater. There's good here too. And the study itself wasn't looking at women in transition. It was looking at women who were far from their menopause, who already had big risk factors or medical issues like cardiac disease. So of course these people had more blood clots, more heart attacks, more strokes and more breast cancer because you have more breast cancer in your sixties than you do in your forties. That's just like a statistical effect.
The data has been walked back over the last 20 years, and we understand it in a much more nuanced fashion. I think you and I would agree that hormone replacement therapy is not a silver bullet, but it's also magical and wonderful for the right person.
Aviva: Absolutely.
Suzanne: But it requires a conversation just like botanicals require a conversation. I'm not a really big fan of people going online and randomly getting ‘rando’ chasteberry from the Amazon store. I don't even know what's really in that.
Aviva: Neither does Amazon. They actually published a paper. They actually published their own little white paper saying that we cannot support the veracity of our products claims because we don't even know if they were stored correctly or if they're counterfeits.
But even aside from that, I agree. People are like, oh, I won't take estrogen or progesterone. But we also know that even though Vitex contains estrogen or progesterone, it….
Suzanne: ….increases your endogenous production of progesterone. That's why it works.
Aviva: And I agree too. I have so many patients who resist for a really long time. They don't want to. They've heard about the risks and they're scared, understandably. And in my practice, I always try everything I can that's a little bit lower hanging fruit first. But when somebody's miserable and they're not getting sleep, I mean sleep is so fundamental. And they start a little bit of progesterone and they're like, “I feel like I just got my life back.”
Suzanne: This is actually really, really key. Even the conversation that you and I are having about the process that it requires says everything about your intro and everything about why I ended up getting into this so deeply.
People do not come into it prepared. There is a loss of intergenerational conversations around our health, specifically with women, which is a cultural societal issue. If your toolkit is very small and narrow or you don't think you personally have access to certain tools or you don't know what's in the toolkit, how can you possibly reach in for solutions? There's this idea where “women's health,” I’m air quoting here, has been pathologized. There's something wrong with us innately. Every single thing that we go through, which is physiologic and developmental, is a disease, then you start looking at solutions. It just becomes very complicated in a way that we're not even understanding.
And then you get into, really, it requires a lot of help and support with somebody who's knowledgeable, willing to do the work with you, willing to keep reinvestigating, re-looking because it's going to evolve. I tell my patients all the time when they come in, look, this is not going to be a one and done. We're going to keep talking because things are going to change. Your needs are going to change. Your health is going to change, your perspective going to change. And again, I really have been very much involved in emphasizing re-owning yourself, rejecting the narrative that's out there, which is part of the developmental process in my mind of adult aging. You get to own yourself more. You get to say who you are, what you want.
Then you're coming to me as a physician and a healer, frankly. And not all physicians are healers, and not all healers are physicians. I'm here to help you broaden that toolkit and have some support. Sometimes I have people come in who have a lot of complaints, and all I really needed to do was talk about it and have me normalize, oh yeah, your PMS is no longer two days. It's 14 days or it's 37 days because you're skipping periods. You're not insane, this is a thing. Here are some things you could do. And they're like, cool, good. I don't need Lexapro. And then some people come in and they're like, this is ruining my life. I need Lexapro. But they understand what's going on.
It's not about this is good and this is bad. It's about who are you. Is there a space and a container that you can be yourself and have support. We are human beings. We need support. So, it really grew from the story of the premenopausal breast cancer patient – who by the way, then I became one, ironically at 47, I was diagnosed with breast cancer. And then I was like, well, good news, I actually know all about this. And then I started getting frustrated, frankly, Aviva, because I couldn't do what we're doing right now in an insurance-based encounter. People had a lot of questions. And I created an experience called Menopause Bootcamp where people would have four hours with me in community talking about what they were going through, looking at the big picture, doing some fitness that was aimed at longevity and strength and core and flexibility and loving yourself. And it really started taking off. And then the pandemic hit. So I said, “Okay, well, I'll write a book.” I think the book this came out and I woke up and everybody's talking about menopause.
Aviva: I know. It's so funny how that is. It really is everyone's talking about it right now. Hormone intelligence came out and then all of a sudden I was like, wait a minute, I need to now do the sequel. I stopped at perimenopause because I felt like menopause was a whole other book and my publisher couldn’t let me publish a 800-page book. So there you have it.
I think that for me, the biggest changes that have surprised me, I mean I guess I've had some sleep changes. I've had gone through my hot flashes. I've been fortunate around vaginal dryness, libido, I haven't had any of those things like that. But I will say that I have been very taken back by the amount of psycho-emotional realignment with who I am that I've had to do.
Suzanne: Yeah.
Aviva: I think about this with somebody who's like 88 and they wake up and they feel great, and they look in the mirror and they see this 88-year old looking back at them and they're like, wait, wait, what's the disconnect here? And I sometimes feel that way. I'm like, my skin is different, my hair is different, my facial structure's a little different. And with that comes a lot of reckoning with aging.
I want to add to that there are so many women who are our age, and we're in the same year apart age as we discovered before. I think that there's so many women who are embracing menopause and all power to them and blessings on whatever they want to do, but are also doing the filler and the Botox and all the things. And so, I'd love to just hear your thoughts on this integration of our new selves. Look, there's also the freedom to not give a shit what anyone thinks, especially for those of us who are established in our careers. So there's the not give a shit, but then there is the fact that we kind of do give a shit because it is how we appear.
Suzanne: Yeah, it's intense. And I think first of all, we have to give ourselves and each other grace around that. And there are some days where I'm like, I'm hot shit. And some days where I'm like, wow, when did my grandmother show up? What in the hell just happened here? Because I decided to stop coloring my hair actually before the pandemic. And everybody in my family goes prematurely gray. We're gray in our thirties. Now all the dudes in my family are silver foxes. Super hot. And I have had to have a journey on that one too.
So I get it, and I think I kind of live in this place of love. I really try to always bring myself back to a place of love. And I really want to be careful here because I want people to understand what I mean by that. Not a toxic positivity, but I try to focus, and this is my life's journey really – remembering who I am and loving who I am and accepting that which gives me the opportunity to do that for you and create a space for you.
And so if you are a person who wants to keep doing surgeries and fillers and coloring your hair and lipo and all that, that's not what I'm choosing to do. And you get to make a choice. I'm not going to lie. I feel like sometimes there is some self-hatred and some internalized misogyny and internalized ageism going on there. But I can point that out on a larger scale, and also love you and include you and invite you into my community. Because I'll tell you what I learned doing these Menopause Bootcamps. I thought that I was doing them to dispense information and dispel myths. And what I learned was yes, people were coming for that and coming to be taught because they didn’t have a “Are you there, God, it’s me Margaret” and didn’t have any idea what was going on with menopause – but they left with community. And so did I. I left with community. And I'm got to tell you, that is the most healing medicine of anything. Every time I do a book talk, every time I do an event, what I personally am getting out of it and what I'm seeing others getting out of it is that they don't feel isolated and alone. They feel the love. That's the most healing thing that any of us can do.
Aviva: How are you finding women integrating that feeling sexy, that feeling beautiful, that self-love and that come inside of aging at the same time?
Suzanne: I think it's probably the same experience that you and I are having. Some days it's liberating. And some days, and when I say liberating, I don't mean I'm just going to be gross. And no, it's like, no, I'm actually liberated from what I think you think about me. The other thing that I have learned over the years is that you're not really thinking about me. You're thinking about yourself.
And as women, it's really weird because the reality is when we walk down the street, we are getting watched, especially in our younger years. I'm going to tell you right now with gray hair, I am not getting catcalled anymore. In a lot of ways it's fantastic because I really do not want to hear that, it's really not a compliment. On the other hand, it hurts my feelings a little bit because I used to get catcalled and I don't anymore.
Aviva: A couple of years ago I went to Jacob's Pillow, the dance theater, which is about 20 minutes from my house. It's epic and incredible. And my oldest daughter, who's now 35, so she was 32, 33 at the time, we went together and you can get a little salad, a drink, whatever at this cafe. And so the server was fully gray-haired, clearly late sixties. And I'm standing there, my daughter and I are both, we're dressed to go out casual Berkshire evening, and she's like, “Mom, I'm just going to go pee.” And I watch him watch her ass as she walks away. And I was invisible.
It was this moment of, okay, the baton has passed. Not that I'm glad he's watching her ass. And I was kind of like, “Dude, that's my daughter.” Because I'm a little bit bold about those things. But it was just this interesting moment of the beauty. Not that we're invisible – I look at women our age and I think wow, we just keep evolving in our gorgeousness. and there are women who are far older than us who are evolving in their gorgeousness. And also looking at it as like, where have I been putting my emphasis in my life and how have I internalized misogyny. Even as a hippie liberated feminist, it's getting me to really reflect on where have I been putting my own value.
Suzanne: Yeah, it's complicated because the thing is that you and I are out in the public eye and we are educating and teaching and supporting women on a really large scale, but we are also individual women that are living in this culture. And we were raised in a very specific way. We raised our daughters very differently than the way we were raised. No disrespect to our parents. It was a different time. But it's just very different. I see how much more bold, not what the word is, comfortable in their skin – my daughter, my son, my son's girlfriend, they're beautiful humans. I know I didn't have the same concept of self-love in my twenties that I do now in my fifties. So I feel proud of that because I think you're right. I think we've raised people a little bit differently, but that doesn't mean the world itself has caught up.
And I think that Gen X is sort of on the battle lines, the front lines of a major cultural shift. So some of it is actually super empowering and so satisfying and gratifying to me. And some of it is scary as hell because it's like, whoa, who am I in all of this?
Some days I feel super psyched about being the Crone. But we are individual humans in this experience trying to make a different and a better way. And while I love the wisdom moment, I also still am an adult human woman with all of those desires and needs and wants. And I've learned to navigate day by day. How do I walk in both of those? Because I get to have an experience also. I think one of the biggest things I notice, because you touched on it, is this grief over the loss of who we thought we were, who we want to be, specifically as hormones change and relationships change, libido, sexuality, intimacy changes. It doesn't have to be gone. It needs to be evolving.
But there has to be a grief over some loss and change. That's a normal process that we have to go through and we get to go through, and again, naming it, giving permission and letting people know that there is something beautiful on the other side. It's like any other change or transition.
Aviva: I think we're not taught that there are phases of our life, that there's one thread of who we are that runs through them that doesn't change. But we spend 30 years, fertile, estrogen-driven, unless we've had a surgical or medical reason for otherwise. But most of us spend our lives bathed in estrogen. And I think it wasn't until I switched over to a different form of estrogen in my body naturally, that I realized actually how much of a companion that hormone had been in shaping who I felt.
Suzanne: Absolutely. And I talk about this all the time. We are identified with that because it's such a large part of our lives. And then again, the emphasis is on that's who you are. You're fertile. You're either trying to have babies, you're trying to not have babies. Your value is your fertility, your sexuality, somehow all these messages that we're getting at every level and when it changes, you're like, oh my God, who am I? I'm sure you hear this all the time from patients who, I don't know who I am and you are anymore. Well, you are. You're a different version of you.
I got to tell you because I'm believe it or effing not, we got to look at my phone, I'm like, day 200. I think this is finally it for me. I am really noticing that not cycling and especially the unpredictable part, which is so hard for us. It's you feel like you don't know who the hell you are. I've been there, I understand the mood and the anxiety and panic. I never had that in my life. But now that it's flattening out, I feel way more steady. And I'm going to tell you, I think that's another point of liberation, which may surprise people. I am no longer subjected to those ebbs and flows of my hormones. I’m not. I get to be who I am.
And again, that doesn't exclude all of the parts of me. Those things are all very important to me still and very much a part of my daily life. However, I don't go up and down in the same way. It's really, really interesting. And I think that is why the Crone, the Wise Woman, the witch in the woods, is such a powerful character in all of our minds and in all of indigenous cultures because that woman is no longer subjected to these ebbs and flows of her hormones. And she can really focus on whatever it is that she wants to, whether it's keeping the tribe going, whether it's working on her medicine, whether it is taking care of herself and disappearing into another realm, whatever it is.
It’s really, really interesting and it's very powerful. And of course that's scary by the way to patriarchal culture because I think they thought, and I can't speak to it because I'm not patriarchal, but I think we're scary because we're no longer in that system and we're not under their control or spell, and we can't and don't want to have their babies. And that's scary when in fact it's just helpful. We have this accrued knowledge that could be supportive of the entire tribe. I think that would be a better way to look at it. That's the way I look at it.
Aviva: I also have found myself inserting a phase between Mother and Crone, which is Queen.
Suzanne: Yes.
Aviva: Or leader.
Suzanne: Yes.
Aviva: We’re at a point in our lives now where our children aren't little and we can fully immerse in the power of our work and what we want to bring to the world. We have time to dedicate to that. We have an enormous amount of accrued life experience. And I think we're looking at the world that our children and our grandchildren in inherit and we're like, “We're not having this shit.” Even if we ever had it before, we're definitely not having it now. And we don't have as much to lose. We're not as vulnerable and dependent on the patriarchy in the same way.
We're not being fed and sheltered in our evolutionary, biological way that we may have been. And so there is an independence and a liberation that I feel allows us to come into this very queenly, empowered, leadership state.
I don't actually love the comparison of menopause and perimenopause to puberty because when I was going into puberty, I had no idea.
So, for your patients and for the people who come into your menopause bootcamp, what do you think are some of the things that women have been most surprised or perturbed about? I would say the three things I hear the most often are sleep problems, weight gain and brain fog. Honestly, low libido. Even though women are experiencing it, they put that lower down.
Suzanne: I hear all of those. I would say for sure sleep, weight, and actually the mood stuff that you had that you had talked about. The mood stuff really sidelines people.
We have a mental health crisis going on for a variety of reasons in this country and in this world. But I think, and I've talked about this a lot, Aviva, the crisis in women's mental health is largely a misunderstanding or a lack of understanding around the lead up, the menopausal transition. I think a ton of women end up with psychiatric diagnoses and mood disorder diagnoses and medications, many of which would, maybe that would be the tool they choose, but they are not being treated by people who understand that this is perimenopause. That is a big problem to me. So I don't want people to suffer, but I want people to also have a much more nuanced conversation around that. That I think is actually the biggest thing I see.
Aviva: Let's talk about some of those. So for example, there's a lot more rage that a lot of women experience.
Suzanne: Yes.
Aviva: Depression, anxiety, but sometimes new onset of things like OCD that they didn't experience before.
Suzanne: A lot of panic, anxiety, OCD, that's a big one that I see, especially in people who had never experienced it before. We also know from the data that anybody who's had a mood disorder at other times in their lives, especially transitions like postpartum or during pregnancy, are at much higher risk for having a recurrence. And by the way, this is side but not, people with a history of eating disorders and addiction disorders who've been in recovery for years, there's a big uptick in these recurring, and this is a big area I want the listeners to understand because what I have also learned here is that you absolutely are going to have to advocate for yourself. You cannot walk in and expect your practitioner to be knowledgeable about this, because a lot of them are not.
Aviva: Let's back up on a few of these things. Because one is that until recently and including now, some of the data still questions whether depression and anxiety have anything to do with menopause. And there's some data that says, well, it's really aging. It's not menopause. But anyone who goes through it, especially if you've never experienced anxiety or depression before, or OCD, knows that, that's bullshit.
Suzanne: I've personally have experienced it, and it's like an out of body experience. You feel like you are not you. I know exactly what people are talking about when they come in to say it.
And here's the thing. I love the data. Science is interesting. Science is not a religion. There are people out there who make it a religion. It's an evolving experience of the world. It's just another way that we look at the world. I love data. I live in a world where I need to acknowledge and understand evidence, but I also am a human being sitting from another human being. And my common sense in my experience count for something.
So, if someone's coming in and telling me this, I'm seeing it in real time. And I know you talk about this a lot too, which is people being the boss of their own body, people understanding their physical experience and their spiritual and emotional experience on the planet better than anybody else. That doesn't mean we don't seek help from somebody who has, again, a toolkit that is larger and deeper than our own, but people know what they're feeling. I agree with you on that.
Aviva: I think if you go to your doctor and say, I'm in menopause. I'm having this, but the data that they're being fed is, oh, that doesn't have to do with menopause. Then you do get “sickified” and treated as a psychiatric patient. The other thing I think is that sometimes we can be so in it that we don't see it's happening. An example for me is I'm a high achieving person and I definitely have some perfectionist tendencies, but I've never had OCD. And when I was working on Hormone Intelligence, so for those of you listening, when you get a book contract, it specifies how many words are in that book contract. So mine was a 90,000 word book contract. It took me about an extra year to write the book, and I ended up submitting 300,000 words. Granted, it was a big book – there was a need to talk about a lot of things, but part of what was happening, and my publisher called me out on it, he said, ‘Aviva, you don't have to read every research paper all the way through.’ And I was like, ‘no, Gideon, I actually do.’
And I realized that I was being a little OCD about it actually. And then I came across a paper that talked about new onset OCD tendencies in menopause. And I was like, holy shit, that’s what's happening to me. Roll it back. But if I hadn't seen that, I think I was so in it that I wasn't noticing it.
You know what, for me what helped me the most, I think going through perimenopause and menopause is that I'm still friends with my bestie from when I was 12.
Suzanne: So she really knows you.
Aviva: And she really knows me. We're three months apart in age. We went through our first periods together and we were having a chat and she's like, my period is all over the place. And then three months later, my period was all over the place. And then three months later she was going through something and then three months later I was. And just having that person that I was kind of like, okay, even though I knew as a physician and intellectually and help countless women through it, when we go through it ourselves…
Suzanne: …it's very different.
Aviva: It’s the knowledge of it versus the experience of it. So let's talk about some more of these mood and feeling changes and how you work with women who experiencing anxiety, depression. What are some of your things that you just feel like really make a difference?
Suzanne: Well, it's a multi-pronged approach. First of all, if we don't get the sleep under control, I tell them, if we don't deal with your sleep, none of this is going to get better. I mean, the brain fog, the mood stuff, the weight stuff. And I will tell you that the sleep is the single most difficult thing to deal with. I have issues with it too. So, getting sleep under control. A lot of that is just sleep hygiene. Everybody knows what it is and most of us don't do it. So really putting the screens away, getting early morning sunlight, making the room cool. There are botanicals that can be helpful – everything from Ashwagandha and rhodiola or melatonin on a regular basis. I think this is the other thing, people reach for botanicals like their pharma. And it's not Ambien – you have to taking it on a regular basis.
I'm actually a fan of some of the cannabis-based products. for some people, I think they can be very helpful. I think understanding the difference between how it's being administered – tincture is going to be immediate. That's not really what you want. Most of my people are not having trouble falling asleep. They need a gummy or a tablet because it's going to take three or four hours to digest in your system and hit you at two in the morning when you wake up. Just understanding the processes, making sure people are not over exercising, dealing with stress and cortisol in their lives. Maybe you're not a meditator and meditation sounds scary and overwhelming, but understanding how to do box breathing for two minutes in the morning. There's a lot of stuff people can do that are reachable, free, but they have to commit to plugging in. And there's chill pads and all sorts of other things.
Aviva: And can I add too, and this is back to what you talked about earlier about addiction and sobriety and that shift in menopause. I did a two-part series on alcohol back in January of this year,2023. And a big piece that I emphasized was when we're in perimenopause and menopause, as our hormones shift and as our neurotransmitters shift, we actually want alcohol more – even if we've never had a problem with drinking. Its pleasure activity is increased so that even gives us a greater sense of reward. But its impact is harder on our bodies, and we are much more prone to addiction or re-addiction. But I tell my perimenopausal and menopausal women, if sleep is a problem, the first thing is just 86 the evening alcoholic.
Suzanne: A hundred percent. I'm so glad you're bringing it up. I say the same thing like I say to you, look, you want to have that cocktail at dinner. Just know you're going to be paying for it and it's not just about like, oh, partying hangover. Although you could have a hangover from one martini, by the way, where you never would've before. Your blood sugar's going to go crazy. You're a hundred percent going to wake up in the middle of the night. You're going to have hot flashes. It's going to happen. Just know it's going to happen. Glass of wine, this whole wine thing that's going on out there, I think it's being unraveled now. Thank God. I love wine. I'm not anti-wine,, as long as you're not sober. You know what I'm saying? But wine is the worst thing a middle-aged woman could ever drink. Ever, ever. It is messing you up.
And this is the thing, you never, there's never one answer Aviva, I'm going off. If you're having hot flashes and you don't get those night sweats under control, you're not going to sleep.
So, having said that mood earlier in perimenopause, you're getting unpredictable cycles. This is a really a direct result of ovarian aging. This is a good place to insert some basic knowledge here. Your ovary is creating, in concert with your brain, the opportunity to ovulate. Creating a home for a fertilized egg, if that's what's going to happen. The first half of the cycle is that – that's estrogen. The second half you ovulate and then you're making progesterone. Progesterone's being created in the ovary as we age. It's scheduled that you're going to be making not just less estrogen. People focus a lot on estrogen. We're making less progesterone. And so those ratios change. And by the way, this is not a disease. It's not fun, it's not comfortable, but it's not a disease. The loss of progesterone early on is really what I see driving a lot of the mood issues that people have. Vitex is just my favorite, favorite for all of that.
Aviva: Can I just tell you, if I ever need a day off, are you ever need a day off, we should just swap places. Cause we literally are twins in everything we say. I mean, I'm learning from you as I'm listening, but I'm also like, I'm looking in the mirror hearing myself. It's amazing. I'm loving it.
Suzanne: Oh, that's the best compliment. It's so fun when you meet someone that you really vibe with. And it’s also really important for us to support each other because it can be hard out there being the salmon swimming upstream.
Aviva: So we're talking about botanicals for hormones. We're talking about botanicals for sleep and for hot flashes. And vitex, actually, chasteberry is one that can work across all those.
Suzanne: It really can. And it can work in younger people too. I mean, there are a lot of other reasons I use it, but I plug it in there. The other thing I do – some of my patients look at DIM+I3C, things that are going to, I hate this term but I'm going to use it. But things that are going to deal with estrogen dominance, because as I just noted, it's not really a disease. It's just that you are making more estrogen than progesterone. It's all declining. But somehow, sometimes evening these things out can help. The data on that is not the best. And it's theoretical. But I find it helps a lot of people get to sort of reestablish some sense of normalcy.
And then all the ones that I noted earlier, the passionflower and ashwagandha and rhodiola, that will help sort of with cortisol and stress management because that starts to rise as a result.
And then honestly, sometimes I just give people progesterone. I cycle them on progesterone, 10 to 14 days of the month at the end of the month as you're leading up to the bleed, just to even that out.
So there are a lot of different ways this can be done, but I that find that helps with the mood a lot more. I mean, there's St. John's wort and valerian and a lot of other things that can be helpful for sleep and mood. Honestly don't tend to reach for those that much because what I find is it's more process oriented. And so reestablishing some kind of normalcy will help and then mindfulness around it. And listen, do I prescribe Lexapro? I sure do. Some people are just like, they can't get on top of it.
I'm very fortunate. I live in a large city where I've been in practice a long time. I have a really close relationships with excellent practitioners of Chinese medicine. I send a lot of patients to them because I can't do what they can do. I find that helps a lot for a lot of the transitional issues in my patients who either are not ready for hormones, don't want hormones, can't use hormones.
Aviva: You mentioned earlier that medicine is not a religion, that it's just a story. And when I say medicine, conventional western medicine, the way I see conventional western medicine and all medicine is that how medicine is practiced in a culture just reflects the values of that culture. Our medicine is the story of a technocratic, patriarchal, western industrialized society. When we look at menopause only through the lens of a western technocratic industrialized society, those are the only solutions we get.
When it comes to the issue of weight, I have a theory.
Suzanne: Let me hear it.
Aviva: For so many women, one of the things I'm seeing a lot on the internet now is women writing about how they're dreading menopause. It really saddens me because I feel like it really does portray menopause as this disease or horrible thing. And yes, we can go through big changes in our bodies, and I do want to emphasize that in other cultures, not all women go through the same big changes. They go through the big hormonal changes, but they don't have all the symptoms in every other culture.
Suzanne: That is very, very true and very interesting.
Aviva: It is. Right. And so that also reflects partly, not to blame the person going through it, but how we're primed to experience it.
Suzanne: Exactly.
Aviva: One of the things I see women really afraid about is, am I going to gain weight? Is it inevitable? Am I going to gain weight? And here's my take. As our ovarian function starts to become more dormant and decline, our ovaries are not producing that estrogen anymore. And so where are we producing it – in our fat cells.
Suzanne: Yeah, exactly. I think that there's some developmental biology and evolutionary biology evidence to support this.
Aviva: And so if we do gain the weight, even if it's five or seven or eight or 10 pounds, if we have been underweight particularly, or on the slim side most of our lives, then we now have a place in our body that we can make the estrone that our brains and our bones depend on.
Suzanne: Yes.
Aviva: So, I want to support women in being in the bodies they want to be in, and being fit and healthy. But I'm concerned about some of the menopausal emphasis on weight loss when it's really, I think, part of what our body is trying to do is gain a little bit.
Suzanne: A hundred percent. I support you and the way the tack I took in looking at this, because I am not an expert in everything, I talked to a lot of different experts in the field and interviewed them and included them and attributed them in the book, because I'm not an expert in nutritional medicine, I am not an expert in queer menopause. I am not an expert in black menopause. And I really reached out into my community to ask for help in this.
And the woman who co-wrote with me with is very knowledgeable about this stuff too, and introduced me to Lindo Bacon and other people who are really important in not just body positivity, but in the science of nutrition. In general I've always been sort of anti-diet culture. I don't like to frame myself as anti anything, but I think we all understand how damaging this stuff can be because you're focusing on the way something looks on the outside, not how it's functioning on the inside.
And we spent the whole first half of this podcast talking about the transition that you and I are making currently into an inward focus that allows us to shine outward as a beacon. So I felt very strongly about that. I mean, I've had my own struggles with disordered eating and body dysmorphia my whole life. And so this has been a challenge for me. It's been really important and interesting to dig into what is the meaning for me in terms of my mental health, my spiritual health, and my physical health. I am a fairly small person who had gestational diabetes and now has some blood sugar issues and now has some high cholesterol. These are all genetic, and I am fit. I try to balance and just be real about all that. And I do the same thing with my patients. I want them to be supported, have tools, understand that yes, visceral fat is dangerous, but having a little chub on your belly…
Aviva: …or your hips or your thighs.
Suzanne: Or wherever it is you're gaining it. But the waist is where I think most people are like, yeah, what happened. That’s not necessarily going to kill you. Make sure you're advocating for yourself and looking at your lipids and demanding your doctors do not ignore your cardiac health because that happens with women. The number one killer of women is heart disease. But not getting so obsessed that you're punishing yourself and getting into this crazy thing that is actually really damaging you. I'm so glad you brought that up.
Aviva: Thank you for sharing about your own personal struggles around this. I think of two of the things you said earlier – one, when we spend time in community with other women we are reminded that we are all shapes and sizes. We're not just what we're seeing on Instagram or a magazine or on TV. And I think that's shifting we are seeing more shapes and sizes. The other thing is we can get really focused on the immediacy of our symptoms and forget that this time in our life is a portal into the next 35, 40 years of a being in a hopefully very long life where our functionality, our brain function, our bone function, our heart function is so important. And I also wanted, that reminded me when you said earlier about the power of being in community and women coming away from community with the menopause boot camps. I don't know, are you familiar with the INTERHEART study? The INTERHEART study was a multi-center study – it’s been a while since I've looked at the study, it's either like 12,500 or 17,500 women were looked at. What they found was that loneliness was more a predictor of heart disease for women, of actually having a heart attack than diabetes, being overweight, and smoking combined.
Suzanne: Wow. Not shocking. Not shocking.
Aviva: It’s not shocking. And especially for those of us who have gone through menopause in the last few years during COVID with isolation, feeling like we lost a couple of years because so many people feel that way. That added loneliness is something I really want to emphasize that being in groups where you're online, wherever you find great groups, being with other women and talking about anything, but talking about these things is really important. And another recent study found that even just talking with people online on Zoom is protective of our brain health compared to loneliness, which is another big factor for our brain health.
Suzanne: We're social beings, we're social beings. And I think if we didn't learn in the last couple years how important it is for us to care for each other and be in community in some form, I don't know how we would ever learn it. I think that actually what's gone on in the last couple years has contributed, frankly, to the rise of the discussion around menopause. I think that it's a response in combination with #metoo, and understanding how the patriarchy is so problematic, understanding colonialism and our complicity in capitalism and all sorts of other things. But I do think us being separated and having to find each other had some big impact. I think we'll understand it as we move forward, but I think you're a thousand percent right. And if that's the only message people come away from, don't isolate yourself., don't be alone in it.
I'm surprised every day by women who are super smart, educated, sophisticated, have access, who come in and say their friends won't talk about it. If they say the word at lunch, everybody shuts down. It's really interesting to me. People are still very afraid to have the conversation, and just having the conversation is medicine. That is medicine. And I think just kind of reframing what medicine is, right, which I think you and I have been doing our whole career.
Aviva: Suzanne, I have a question to ask you before you go. I love to ask this question of my guests. If you could tell your younger self anything, how old would she be and what would you tell her?
Suzanne: Ooh, oh my God. I think probably I would tell, let's see, maybe six- or seven-year old Suzanne, like you are such a shining star and you actually know it right now. And do not forget it. No matter what happens, things are going to come your way that you don't expect, that you don't like, but you are a shining star.
Aviva: Why am I imagining a little hula hooping, roller skating, Suzanne telling herself that at six?
Suzanne: I wasn't much of a roller skater but definitely loved the hula hoop.
Aviva: That's a beautiful, powerful reminder. Thank you. Thank you for all you are doing for women. Thank you for this wonderful conversation. It's really exciting. I mean, kind of that just seems even trite. Thank you for being a new sister in my life. I'm really excited about this excited connection.
Suzanne: Me too.
Aviva: And everyone you can find, Suzanne, is all the links over in the show notes. And Suzanne, I hope we get to have a conversation online again. I know we'll have lots of them off and I'll wish you a wonderful patient day. Thank you.
Suzanne: Thank you, honey. You, too.
Aviva: Thank you everyone for joining us.
