The Menopause Knowledge Gap: Why Your Doctor Doesn’t Talk About It, part 2

[00:00:06] Megan Margulies: I’m 41 and I had never once spoken to my gynecologist about perimenopause. I think it’s something that we need to be a lot more prepared for, especially as women who, at least for myself, am constantly doubting what I’m feeling.

[00:00:28] And is this real? Is this just my anxiety acting up? Because of the fluctuating hormones. The dropping of hormones, it can really do a number on your body. and it affects your everyday life. So I wish more women my age and younger were more prepared for what’s to come.

[00:00:54] Ellen Scanlon: Welcome to how to do the pot, the award winning podcast that helps you feel confident about this.[00:01:00]

[00:01:00] I’m your host, Ellen.

[00:01:09] You just heard from Massachusetts based author and journalist, Megan Margulies. Megan wrote an article for InStyle magazine about a 2023 Harvard study that found women are increasingly turning to cannabis for menopause symptoms, promising results. This is the second episode in our menopause series. In part one, we broke down what menopause and perimenopause actually are, explored why menopause symptoms can start much earlier than many people expect.

[00:01:49] Today’s episode is about something that I didn’t understand when I first started learning about menopause. Why don’t more women know about its symptoms? People call it the knowledge [00:02:00] gap. So in today’s episode, I’ll be joined by menopause expert, Dr. Lauren Stryker. She’s going to break down hormone therapy and estrogen.

[00:02:08] Megan will share insights from the Harvard study and we’ll hear what women have learned or haven’t learned about menopause from their moms. Have you signed up for my Substack newsletter yet? I share podcast highlights, women’s stories, brand discounts, and some of the things that inspire me. Last week, I recommended a great Substack newsletter about fragrance called The Dry Down Diaries.

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[00:03:13] Recently, we polled our Instagram followers at DoThePot, and asked how many of you have talked to your mothers or your grandmothers about menopause. More than half of you said you talked about it a tiny bit, and 15 percent have never talked about it at all. Have you asked your mom or an older friend about menopause?

[00:03:36] I created this series because I know women want to learn more about what to expect in this stage of life. I hope these episodes will inspire you to feel more comfortable when you’re ready to bring it up. For California based Patti Pappas, the co founder of cannabis brand Hello Again, talking about women’s health with her family felt pretty taboo, [00:04:00] especially related to menopause.

[00:04:02] Patty Pappas: Sadly, I didn’t even talk to my mom when I got my period, really. I talked to my sister. And so, no, I didn’t have any of those conversations. I think my mom took hormones early on. It was a different generation. We have a saying that your grandmother tolerated it. Your mother medicated it. And, you know, we want to celebrate it.

[00:04:19] So every generation sort of had a different way of dealing with it.

[00:04:22] Ellen Scanlon: Patty’s co founder, Carrie Mapes, never talked to her mom about menopause. Looking back now, she has a different perspective on the health issues her mom was dealing with.

[00:04:34] Carrie Mapes: Sadly, I do remember when I was in junior high, my mom had a hysterectomy.

[00:04:39] And the years leading up to then, she was pretty cranky. And we used to tease her about it, which is so awful now that I think about it, when I realized how she was feeling and what she was going through.

[00:04:52] Ellen Scanlon: Women’s health has long been a taboo topic, even among mothers and daughters. And for [00:05:00] decades, women’s health was underrepresented in medical research, so many doctors didn’t know that much about it.

[00:05:07] It wasn’t until 1993 that the National Institutes of Health, NIH, mandated that women be included in clinical trials for new drugs. Bringing new drugs to market can take 12 to 15 years and cost millions of dollars, largely paid for by big pharmaceutical companies. A result of that is that doctors are still learning about the complexities of women’s health at different stages of life.

[00:05:40] Dr. Lauren Stryker is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine in Illinois. She is an MD, a menopause expert, and the host of an excellent podcast, Dr. Stryker’s Inside Information, all about menopause. [00:06:00] I asked Dr. Stryker why women have been underrepresented in medical research and how that affects research about menopause.

[00:06:09] Dr Lauren Streicher: Women are complicated. They might be pregnant. They can be at different places in their cycle. There’s a difference between a postmenopausal woman and a premenopausal woman. So for that reason, historically, most research has been done, not only in men, but in white men. healthy men in order to complete research as efficiently as possible.

[00:06:29] The problem with that, obviously, is that women are not little men. And you cannot take data that has been found in men and extrapolate that to women. But that’s exactly what’s been done. So that’s just in general, when you look at research, That pertains to women and things like high blood pressure pills or sleeping pills and all of that.

[00:06:52] All of those original studies were done in men. But then specifically when you get to menopause, there hasn’t been an emphasis on [00:07:00] menopause research because. Up until recently, there was really a lack of awareness of the impact that menopause has not just on quality of life, but on length of life. We know that the loss of estrogen has a significant impact on bone health, osteoporosis.

[00:07:20] Brain health, cognitive function, and cardiovascular health. The number one thing that kills women is cardiovascular disease. And we know that menopause has a huge impact. So, there’s been a new emphasis on, Okay, we gotta figure this out. And we really have to circle back. And see what is the impact of menopause long term on women, but a lot of people have this idea that, Oh, there’s no research on menopause.

[00:07:47] There’s a lot of research on menopause. Your doctor may not know it. Your doctor may not be aware of it. It might not be out there in the mainstream, but this idea that there’s been no research on menopause simply isn’t true. [00:08:00]

[00:08:00] Ellen Scanlon: It’s very good news that there is research available. And yet. Most medical schools don’t teach about menopause in their curriculums.

[00:08:11] Doctors, even OBGYNs, are not receiving specialized training in how to treat menopause in their patients. Dr. Stryker explains what’s going on.

[00:08:23] Dr Lauren Streicher: A study came out in the journal Menopause that looked at what do doctors get as far as training during their residency. So we’re not even talking medical school, we’re talking during specialty training, whether it’s OBGYN, family practice, internal medicine, the kinds of specialties that you think people would need to have a knowledge of menopause.

[00:08:46] If you look at OBGYN programs, one third, one third have any kind of menopause curriculum at all. That means two thirds of doctors who are graduating from residency programs in OBGYN get no [00:09:00] training in menopause. If you look at that one third, When you do the deep dive into, okay, what is that curriculum they’re getting?

[00:09:07] It might be some reading material. It might be one or two lectures. It’s really a minimum amount of exposure. I founded a menopause clinic at Northwestern, which is arguably one of the best OBGYN residencies in the country. I mean, these are really stellar doctors who are really going to be outstanding physicians.

[00:09:28] Not one of them has ever rotated through the menopause clinic. Not one, not for one hour, not for one day, and to their defense, it’s not because they’re not interested. It’s because the curriculum doesn’t give them the time. They are so busy doing gynecologic oncology, fertility, obstetrics. Surgery that there’s no time left for menopause.

[00:09:51] It just has not been a priority in training. So, of course your doctor is not going to talk to you about menopause because he or she has had no [00:10:00] training in menopause. I became an expert in menopause and other doctors that are experts in menopause became experts because we chose to do so. Because we did continuing medical education research on our own.

[00:10:14] This was not part of my residency training.

[00:10:17] Ellen Scanlon: I know that is really frustrating to hear. I asked Dr. Stryker if she thinks this will change anytime soon.

[00:10:25] Dr Lauren Streicher: No. If you look at your typical woman who’s in her 40s, early 50s, is she seeing a gynecologist? No, she is not. And a lot of people forget that. That even if, in a perfect world, every OB GYN resident graduated and was very, very knowledgeable about menopause, by the time women get there, they’re no longer seeing an OB.

[00:10:48] Most women see, at best, an OB. At best, one doctor a year, and that doctor’s generally going to be an internist or a family practice doctor. The truth is, most women don’t [00:11:00] even see a doctor for well women care. They go if they have a problem, if they’re sick. And if someone has a diagnosis, whether it’s a heart attack, heart disease, diabetes, cancer, menopause is not going to be at the top of that discussion, even though it’s a very important part of that woman’s experience.

[00:11:19] So honestly, I don’t expect it to change anytime soon with the way medicine is delivered today. What I do expect to change is that there’s going to be other ways for women to get menopause care. There’s a company called midi. That is an online menopause care company so that women can have access to menopause information and care outside of a normal doctor’s appointment.

[00:11:45] So I think it’s initiatives like that that we’re going to be seeing in the future. I do not have an expectation that women are suddenly going to go to their doctor and he or she’s going to say, so tell me. Are you having hot flashes? Are you having vaginal dryness? Are you having an [00:12:00] orgasm? It’s not going to happen.

[00:12:02] It’s just not.

[00:12:03] Ellen Scanlon: If you’re starting to feel overwhelmed, please wait. There is good news. There are doctors out there with a lot of expertise in menopause. You just might have to look harder to find them. In the first episode in the series, Dr. Stryker guided us to menopause. org and the Find a Physician tab on their website.

[00:12:27] You can put in your zip code and find a doctor, either who’s in your area or who offers telemedicine appointments.

[00:12:39] When I talk to women about menopause, the first thing I ask is how are you sleeping? Because for so many women, trouble sleeping is a first sign that your hormones are shifting. And as you’ve heard and will hear throughout the series, not sleeping can set off a cascade of negative effects. [00:13:00] mood swings, weight changes, low libido.

[00:13:03] The list unfortunately goes on. I am very protective of my sleep and I’m grateful to have tools that help me. CBD is an essential part of my nighttime routine. I think of it like a sleep vitamin. If sleep has been elusive for you, I want to share what works best for me. Before bed, I take one Lazarus Natural CBD plus CBN sleep capsule, which helps me stay asleep all night.

[00:13:32] If I wake up, I have a Lazarus Natural sleep oil tincture ready on my nightstand. You just put a dropper under your tongue and hold it for about 30 seconds. One of the reasons I’ve been waking up recently is because of my 10 year old Maine coon cat. He is vocalizing in the middle of the night. It’s brutal.

[00:13:56] When he wakes me up, I take a dropper of CBD sleep oil [00:14:00] and I give him one too. We both fall back to restful sleep in about 10 or 15 minutes. Sometimes women tell me that CBD doesn’t work for them. Its effects can be subtle at first. It takes consistency. You’ll need to take it for at least two weeks before you’ll feel the full benefits.

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[00:14:47] One of the first things that may come up when you think about menopause is hormone therapy and estrogen. There are a lot of misconceptions about these treatments dating [00:15:00] back to the 1990s. Dr. Stryker shares what physicians and researchers know today.

[00:15:07] Dr Lauren Streicher: We use the term hormone therapy or menopause hormone therapy, and the reason is because we’re actually not replacing your hormones.

[00:15:16] We’re supplementing, we’re giving some hormones, but we are not reproducing the amounts that you had when you were 20, and hormone therapy Maybe estrogen. It may be estrogen and a progesterone. It may include a testosterone. So it means a lot of different things. But for the sake of this discussion, let’s just start with estrogen because that’s really what women are talking about is that should they be taking estrogen?

[00:15:41] And when we talk about bad information and misconceptions, estrogen is at the top of the list. If you ask most women, is estrogen dangerous? They’ll say, Oh yes, it causes breast cancer. And they’re shocked when they learn that estrogen actually decreases the risk of breast cancer. And this is not my [00:16:00] opinion.

[00:16:00] This is facts. This is what has been demonstrated in the medical literature, that if you give women between the ages of 50 and 60 estrogen, that they will have an 18 percent decreased risk of developing breast cancer. breast cancer. So that when we think in terms of side effects, they’re really very, very minimal, particularly if we’re looking at transdermal estrogen.

[00:16:26] When you take estrogen, you can either take it by mouth, which is oral, or you can take it through the skin in the form of a patch, a spray, a gel. And we know that if you take estrogen through the skin, skin that it doesn’t get metabolized by the liver and when it avoids that trip through the liver, what it means is that you avoid the number one side effect of estrogen and that’s blood clots.

[00:16:50] It’s not cancer. It’s blood clots. And even those numbers are very, very low in most women. So that’s the number one misconception is [00:17:00] What is the side effects of estrogen? Is not only the most effective thing, but is it the safest thing? And the answer is yes, it is.

[00:17:09] Ellen Scanlon: If you’d like to learn more about hormone therapy and menopause, Dr.

[00:17:13] Stryker introduced me to a great resource. It’s called the SWAN Study.

[00:17:19] Dr Lauren Streicher: There’s a study that’s been going on now for almost 20 years called the SWAN study, the study of women across the nation. And, and this study is an extraordinary study, not only in that it looked at women prospectively, meaning it started studying women when they were in their 40s and then followed them through, but also because unlike other studies, they didn’t just look at one population.

[00:17:39] They included Included women, white, black, Hispanic, Asian, to see what kinds of differences there are in terms of their menopause experience. And so what we know from SWAN and some other studies that have emerged as well, is that the experience of a black woman is dramatically, dramatically different than it is for an Asian woman.[00:18:00]

[00:18:00] Or Hispanic women, black women tend to go through menopause sometimes earlier, they tend to have much more severe hot flashes and those hot flashes last longer. And the reason why that’s so important isn’t just about again, quality of life, but the fact that when we look at rates of cardiovascular disease, cognitive function issues, et cetera, that we see in black women, one of those reasons may well be because of their hot flash experience.

[00:18:29] Transcribed

[00:18:30] Ellen Scanlon: We’ll talk more about hot flashes later in the series. While the SWAN study is the gold standard for menopause, the small Harvard study about menopause and cannabis is a big step forward. It’s so challenging to get any medical studies about cannabis. Journalist Megan Margulies, who you heard at the beginning of the show, explains why she wanted to write about it.

[00:18:55] Megan Margulies: This study really caught my eye because a lot of women [00:19:00] I knew were using cannabis, mostly gummies, for menopausal symptoms, perimenopause, the stress of motherhood, anything that created these really uncomfortable and often disruptive symptoms. Like sleep disturbances, insomnia, night sweats, anxiety, stress, depression.

[00:19:26] You know, there’s so many things that a woman’s body with the hormones fluctuating or diminishing or whatever stage you’re in, it can really ruin your life. So I was really struck by the study because it enabled women to feel like, okay. I’m doing something that’s okay and possibly right, and I shouldn’t feel guilty about it.

[00:19:50] The study itself was pretty small. So the study had 258 women participate, and they found that [00:20:00] almost 80 percent of these women found relief with cannabis for the menopause related symptoms. The majority of those people, it was for sleep disturbance, and then the rest was for mood and anxiety. So, even in the study itself, at the end it says, what this study accomplishes is not that this is the way to go for relieving symptoms with menopause.

[00:20:26] This isn’t the gold standard, but what it means is that it’s absolutely worth looking deeper into and researching more,

[00:20:35] Ellen Scanlon: which is a big deal. Dr. Stryker is also conducting an anonymous study about cannabis and menopause. Here’s what she’s learned so far.

[00:20:45] Dr Lauren Streicher: The other thing that is really interesting about the survey is the scope of symptoms that women are treating with cannabis.

[00:20:54] I thought that most women would say I’m using cannabis just to help me sleep or [00:21:00] maybe with my hot flashes, but that’s not the case. People are using cannabis also for sexual function, specifically libido. to decrease vaginal dryness to help with orgasm. So the scope of what they’re using it for is really way beyond quite frankly, what most menopause experts are treating.

[00:21:21] And quite frankly, what most products that we use right now are treating. Many, many women turn to cannabis. So even when I’m out there talking about cannabis and when it might be useful and what it might do for a post menopause woman, I’m always very clear to say that the gold standard is estrogen. We know that estrogen works the best.

[00:21:43] We know that estrogen is the safest, and that we’re not just looking at getting rid of bothersome symptoms. But also looking at long term issues such as the effect on the brain and bones for cognitive function and osteoporosis. The other thing also that’s interesting [00:22:00] is to understand that when a woman is using cannabis and estrogen, then she may experience the entourage effect.

[00:22:08] And the entourage effect is means that the sum total of estrogen and cannabis is greater than either one of them individually. And that’s because we know that estrogen is involved in the metabolic pathway of cannabis.

[00:22:25] Ellen Scanlon: Jackie Cahan, the Illinois based managing partner of Paragray Adventures, shares how she found cannabis for her menopause symptoms.

[00:22:33] Jackie Cahan: I’m actually closer to being out of menopause than being in the thick of it or certainly perimenopausal. I wish I was not so scared about menopause, to be honest with you. I was terrified of weight gain, hair loss, certainly terrified of decreased libido, all the things that traditional doctors will prescribe pharmaceuticals for, and things that I have actually decided to manage with cannabis.

[00:22:56] I wish I knew it was okay to treat common symptoms of menopause with [00:23:00] cannabis. I’m so very grateful that I found cannabis two and a half years ago. I was drinking heavily experiencing insomnia, weight gain, and the loss of libido, and of course those really dreaded hot flashes, these are all typical menopausal mayhem.

[00:23:16] After finding low doses of cannabis via the edible format, my symptoms subsided greatly and eventually faded. I’ve experienced incredible sleep, weight loss. I actually have hair gain and I have overall sexual vitality due to cannabis.

[00:23:31] Ellen Scanlon: Here’s a stat that always gets people’s attention. A woman’s tolerance to cannabis can change by up to 30 percent depending on where you are in your menstrual cycle.

[00:23:42] We talk more about why in episode 123, Cannabis for Better Sex. For today, I asked Dr. Stryker what changes in tolerance women in menopause may experience. The data so far says that women might need less weed, a lower [00:24:00] dose than they think, to feel better.

[00:24:02] Dr Lauren Streicher: The message for women out there is that a post menopause woman, as best as we can tell from our available research, will metabolize cannabis significantly slower than she did pre menopause.

[00:24:17] And this is problematic, because not only can this lead to people overdosing, and having significant negative effects to cannabis, but it really impacts on other potential problems that we see in an older population. Things like arrhythmias, things like interaction with other medications. So, when I’m talking to a post menopause population about the use of cannabis, it’s not just about what should you use and how it may help you, but how to use it safely.

[00:24:48] Ellen Scanlon: We’ll continue the conversation about how to safely consume cannabis during menopause later in the series. Dr. Stryker’s advice for trying cannabis is in line with what I say [00:25:00] a lot. Start with a low dose, two or three milligrams of THC, maybe with an equal amount of CBD. She recommends cannabis infused water.

[00:25:10] Oil tinctures, which you put under your tongue for 30 to 60 seconds, and you’ll feel the effects in about 15 minutes. Edibles are also very popular with her patients, especially for sleep. We have a whole series about cannabis and sleep, so check it out to learn more. Megan Margulies has been writing about women’s health for several years.

[00:25:32] She started to notice a positive change in the conversation around menopause and women’s health in general.

[00:25:39] Megan Margulies: We’re in a really interesting time with women’s health in terms of just being more outspoken and demanding more attention to menopause and any other issues that were, I mean, there’s been so many books about invisible diseases that affect mostly women, autoimmune diseases affect [00:26:00] mostly women.

[00:26:00] So. This study about women using cannabis might not feel so important to that endeavor, but I think it absolutely is because it’s just allowing women to see that you can take things in your own hands and Be an advocate for yourself. And I’m really excited about this time because I feel like more women are speaking out, more women journalists are speaking out about it and writing about it.

[00:26:29] Ellen Scanlon: Stay tuned for more in our series, all about cannabis and menopause. We’ll take on some of the most common symptoms of menopause, issues with sleep, sex, hot flashes, and weight gain. We’ll hear more from Dr. Stryker and from women all across the country about how cannabis is helping to relieve their symptoms.

[00:26:54] If you’d like to share your story, please reach out to Hi at DoThePot. com or [00:27:00] DM us at DoThePot. We have been getting such great feedback about the first episode, and I hope you’ll share the series with women that you love. In episode 275, we had a fun date night giveaway from Potley and the independent film, You, Me, and Her.

[00:27:21] Thank you to everyone who entered to win. I’m excited to announce that our winner is Madeline Kemeny. Congratulations, and thank you to everyone who entered.

[00:27:34] For lots more information and past episodes, visit do the pot. com. And that’s also where you can sign up for my sub stack newsletter. If you like how to do the pot, please rate and review us on the podcast platform that you use for listening. It really helps more people find the show. Thank you to writer Joanna Sokoloski and producers Maddy Fair and Nick Patry.

[00:27:59] [00:28:00] I’m Ellen Scanlon and stay tuned for more of How to Do the Pot. Support for How to Do the Pot comes from Lazarus Naturals. Are you struggling with sleep issues? I take Lazarus Naturals sleep capsules. For me, it’s like a sleep vitamin. I also keep a CBD oil tincture on my nightstand for those middle of the night wake ups.

[00:28:24] It works. Lazarus naturals makes potent, effective CBD. So you actually feel the benefits. Please prioritize your sleep. It really affects everything. And I have a promo code for you. Visit Lazarus naturals. com and use the code do the pot for 20 percent off. I’ll add a link in the show notes with all the details.