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Significant life changes, such as perimenopause and menopause, can often be overwhelming. These phases can bring insecurities, misunderstandings, and health challenges that strain relationships. The emotional toll of these changes can be especially difficult when open dialogue and sound advice are scarce. So, how can we foster understanding and support within our relationships during these transformative years?

In this episode, we dive deep into the intricacies of how hormonal changes impact both relationships and individual well-being. We explore the crucial role of exchanging masculine and feminine energies, the importance of proactive medical dialogues, and the benefits of clear communication. Using analogies like the Argentine tango, we highlight the need for both flexibility and defined roles in relationships. Practical advice on hormone therapy and maintaining vaginal health provides actionable steps. Additionally, listeners will discover valuable resources and programs designed to celebrate the wisdom and opportunities that come with aging.

By addressing these topics, this episode aims to empower listeners to navigate midlife changes with confidence and resilience.

Dr. Liz Lyster is an OB/GYN medical doctor, best-selling author and speaker, and an expert in perimenopause and menopause. In her private practice in the San Francisco Bay area, she helps women and men in midlife and beyond lose weight, have more energy, increase their motivation and drive, and generally feel great. She graduated from Cornell University, went to medical school at UC Irvine, and got her Masters degree at UCLA in Community Health Education.

In this episode

03:46 The Importance of education and communication in navigating menopause.

09:47 The balance of masculine and feminine energies in relationships.

14:24 Dr. Lyster emphasizes the need for women to proactively engage in medical discussions, advising preparation, and persistence in addressing sensitive health topics.

18:24 Launching the Miracle of Menopause online community.

22:59 Understanding testosterone’s role in stress and productivity.

35:39 Addressing discomfort during sex with proper estrogen treatment and the importance of openness with partners to enhance intimacy and support.

38:34 How modern environmental stressors and nutrient issues are influencing the onset and experience of menopausal symptoms in women.

41:37 The debate on hormone therapy and bioidentical hormones.

46:09 How hormonal imbalances can affect emotional intimacy and communication within relationships, and the role of different hormones in maintaining well-being.

49:47 Societal perceptions, hormonal symphonies, and aging.

Your Check List of Actions to Take

• Prioritize learning about perimenopause and menopause through reputable sources to better navigate these life stages.
• Openly discuss hormonal changes and their impacts with your partner to enhance mutual support and understanding.
• Prepare and ask questions early during medical consultations to address concerns and avoid dismissive responses.
• Investigate bioidentical hormones and methods like skin patches or topical gels to discuss with your healthcare provider.
• Visit Dr. Liz Lister's website doctorlizmd.com, and explore her book, “Go for Great,” for comprehensive guidance on aging and hormone health.
• Consider participating in the Miracle of Menopause online community for expert workshops, support, and shared experiences.
• Seek appropriate treatments, such as microgram estrogen doses, for issues like vaginal dryness to maintain comfort during intimacy.
• Incorporate balanced sleep, regular exercise, and vital vitamins to manage symptoms and improve overall well-being.

Mentioned

Go For Great!: Dr. Liz's Guide to Thrive at Every Age (*Amazon Affiliate link) (book)

Go For Great (link) (e-book)

Dr. Liz's Easy Guide to Menopause (*Amazon Affiliate link) (book)

Evolve in Love (program)

Connect with Dr. Liz Lyster

Websites: https://drlizmd.com

Facebook: facebook.com/DrLizLyster

YouTube: youtube.com/user/thedrlizlyster

Instagram: instagram.com/drlizlyster

LinkedIn: instagram.com/drlizlyster

Connect with Dr. Jessica Higgins

Facebook: facebook.com/EmpoweredRelationship 

Instagram: instagram.com/drjessicahiggins 

Podcast: drjessicahiggins.com/podcasts/

Pinterest: pinterest.com/EmpowerRelation 

LinkedIn: linkedin.com/in/drjessicahiggins 

Twitter: @DrJessHiggins 

Website: drjessicahiggins.com  

Email: [email protected]

About this episode

Dr. Liz, thank you for joining us today.

My pleasure. Happy to be here, Jessica.

Yes. As we were talking before we got started here, what we're going to be focusing on, perimenopausal phase or menopause, that this will be impacting couples as they approach a particular time in life, particularly heterosexual couples and lesbian couples. Before we get started in this focus, as you're talking with us here today, how did this become of interest of yours to really support people with this journey?

It really evolved over time. In medical school, we rotate through different specialties. Actually, I should go back further. I come from a medical family. My mom is a retired pediatrician. My dad is a retired neurologist. Then in medical school, we get to rotate through different specialties and just check it out, see how we like it, see how we feel. I really enjoyed my OB-GYN rotation. I got to deliver a baby even while I was still a student. It was very exciting.

But also, I had an experience of following one of the residents. So the resident is seeing the patient, I'm just a student tagging along. So I'm standing in the corner and I'm just listening, and this is a patient having menopause symptoms. I'm not even sure what the resident doctor did for her. I just remember realizing how much better she felt after being listened to and just validated. This is a long time ago —we're talking almost 40 years ago. I was in medical school. So I did my OB-GYN training, went into practice, and then I went into menopause when I was only 43, and that definitely influenced. By this time, I was really paying attention. I was always interested in the endocrine system and hormones. That was always something I really, really enjoyed. Then I was writing my first book at the same time. I thought, I should do my own labs. Sure enough, it showed that menopause was upon me. So that really kicked it into really wanting to learn.

Then the last ingredient was a nutritionist friend who needed me to really expand into the area of bioidentical hormones, learning about that. He had a doctor consultant who was retiring. So he said to me, I need you to go to this conference. That was my first conference almost 20 years ago, and then it's just evolved. My favorite thing is talking with women, and it's what I do the vast majority of my work time. So it's really fun. It's a dream job.

Yes, good. I'm so grateful, just how it emerged. It sounds like you come from a lineage of physicians, and just also how the trend of medicine and supporting people in their health, also the medical field has evolved. Just having colleagues to really assist in what they're learning and nudging you in too. Remind us where you are, just for people who are listening. I don't know if you take new patients. But just where are you in the world?

Definitely taking new patients still. My physical office practice is in the San Francisco Bay Area. But most of the time I'm online. I've been doing that for many, many years, doing virtual appointments, even before it was a thing. But of course, during the pandemic, I really put systems in place and solidified it, and now I can really see patients all over the country, really all over the world. Right now I don't have any international patients, I don't think. Most people are in the US. But all over.

Yes, I share that with you. I was working virtually, and with the state licensures, I was also operating as a coach that allowed me to cross state lines. But this is helpful for people to know, as they're listening and perhaps resonating with what you're describing.

So I am curious, I'm sure we could go into what people might look for as far as menopausal symptoms. Even the partner, it's sometimes visible to see changes even before maybe one is really, like you said, it took some lab work to really fully illuminate: Oh, this is what I'm experiencing. As you talk about the endocrine system, and as we look at all the stressors in life, or just diet and various things. I had a huge exposure to toxic mold. It absolutely affected my hormones. Even prior to that, I remember, sometimes I'll experience pre-PMS symptoms, and I wanted to get a t-shirt. Because sometimes my husband—love him, obviously he is amazing, and he's super supportive, very conscious and conscientious—and sometimes, I don't think he fully would grasp the influence of hormones. I wanted to get a t-shirt that says, hormones are real! They're huge, they impact so many aspects.

Sounds good, I think that t-shirt would sell. I think it would definitely sell. I thought you meant to wear once in a while, like when that was applicable.

No, I'm just saying, this is legit. Like, legitimately, let's give this some real acknowledgement. So what would you like us to know just foundationally, as we're looking at approaching this phase? You're saying some people are going to approach this much sooner than expected. Also, do you think there's a change in our cultural place and what we're experiencing as humans, and how that might impact this hormonal endocrine system experience?

Yes, absolutely. You asked me a couple of questions, so you'll help me make sure we cover everything you just asked. Definitely, cultural phenomenon. Two things are happening right now. One is, all the celebrities who are reaching their 50s, and they're super vocal. So we love that. That's really great. Brings it out in the open, brings attention to it. Halle Berry trying to work on bringing more funding on research. So that's all good. That's definitely a cultural shift that's happening. The other thing that's happening is what I refer to as physiologic ambient stress.

So those are both happening.

I love the term ambient. It's just perhaps like the air, the elements that we're exposed to. But it's not super, maybe, acute that it's taking our attention, but it's just with us.

Exactly, it's like water to the fish.

Yes, thank you. I started to say the analogy and I didn't finish it. Do you think people are approaching or experiencing symptoms more sooner?

I do, I'm definitely observing that. It has a lot to do with some of the things you just mentioned. It's very difficult with nutrients, what they put in our food. People are exposed to lots of different things in their environment. You had an experience with mold. There's just a lot that our bodies are having to cope with. So I do see that.

Also, stressors. Just plain stressors. We're not going to start debating screen time and online activity. But we do know that it's bringing a lot of anxiety to younger people, so we'll see how that unfolds. Right now, that generation still, I'm not talking about teens, my kids are in their twenties, I'm really talking more about them. That's the generation I have more experience with. But that'll remain to be seen. So I do see things younger and younger. So shifts that normally happen in the 30s, I'm seeing younger women having those issues.

You mentioned celebrities bringing awareness, thus promoting more research. Typically, maybe you could speak to this a little bit, there's perhaps been a lack or not as much medical research to guide us.

That's a mixed bag, and I'll tell you why I'm saying that. So on the one hand, generally speaking across the board, women have been studied less than men. A lot of reasons for that, including the idea. Well, it's true that women are not small men, so we really do need to be studied on our own. So that part is true. But we've been excluded from studies because of different kind of excuses—the potential of getting pregnant, the potential of harming a possible pregnancy. All these possibilities were rationale for excluding women from research. So that's definitely true, no question.

Also, there is abundant research that confirms the safety and efficacy of the correct types of hormones to use to replenish, as our hormone levels go down as we get older, and we have various symptoms, which I think we'll get more into. But even as that's happening, for example, I'm going to say the majority of doctors are still operating under the dark shadow of the Women's Health Initiative that came out more than 20 years ago. That was one study. It was a very large study, but it was one study that had these suggestions that people took from that that hormones lead to breast cancer. Even those authors are now, finally all these years later, acknowledging the flaws in the study, and they are fatal flaws. 

So those are three rights that have been wronged.

It's not without risk, there are things to consider. I have some physician friends and they're saying, depending on various variables, you want to continue to get tested or be tracking. So it's not to be totally discarded. But that there's some nuances to this so you can't just use it in a binary. These hormones, bioidentical particularly, are not to be completely discarded.

I would take it further than that. I really would. I would say that the concerns related to hormones really stem from understandings that came from that study. That study studied the wrong women, used the wrong hormones, and gave the hormones to those women by the wrong route of administration. There are abundant studies with tens of thousands of women—for example, European studies, and also other studies in the US—that really confirm that honestly the vast majority of women are good candidates to replenish hormones in some way, shape, or form, that would be of benefit to them, way more than even doctors think.

Okay, and remind us the three things that you're really underscoring. That it's not just taking hormones, it's the type of hormone, it's when you administer it, how you're administering. Tell me, I think I'm getting it wrong.

You're getting it right. So the right hormones. So bioidentical hormones definitely are lower risk, we know this. In that study, they used estrogen that came from horses. The estrogen they used is completely unlike the estrogen that our women's ovaries make. They also used progestin. Our ovaries don't make progestins. Our ovaries make progesterone. So that's the first. It's the right hormones, and that they be bioidentical. The second is the route of administration. So we learned, in that study, women were given estrogen orally. That does what we call the first pass effect through the liver, and stimulates the formation of clotting factors. So that's where you hear about blood clotting issues, cardiovascular issues. So we know that estrogen through the skin—a topical gel, a patch, even hormone pellets that don't go through the mouth and past the liver—that's the right route of administration.

Then third, of these three, are the right women. Really, we've come a very long way on this. So at the time, in that study, over 20 years old—this study is now old—what they did is it was a randomized study. So that's a good form of a study, but it's hard to do. So if you have women who are having perimenopause or menopause related symptoms, they can't be in that study because they'll know if you gave them a sugar pill or hormones. Because if you gave them hormones, they'll feel better. So therefore, they studied women with an average age in their 60s, which was 10 or more years into menopause without hormones. At that point, stuff had gone down. Inflammation had set in. Other things had happened. All the things that we know hormones are beneficial for—reducing cancer risk, reducing heart disease risk, we can get more into that later if we want—but that's really actually true, that estrogen in particular really lowers the risk of colon cancer, lowers the risk of breast cancer. That's not the understanding that's out there, but that's actually what the data showed.

Then there came this thing about, well, you have to start the hormones earlier. So that luckily has been worked on over these years, these intervening years. Even the North American Menopause Society, in their most recent position statement, where they do a super detailed review of all the literature, even they acknowledged that there really isn't a cutoff date by which you have to have started hormones, otherwise you can't. So that was huge for them to acknowledge that, because they're really the most mainstream medical world in terms of the menopause information that's out there. So I was very excited when I read that.

Yeah, it's a little bit more of an authoritative voice in this aspect. So as we look, for people listening, I feel my inclination to want to go deep into what you're describing around the research and the science, and I know people can get in touch with you and your books and get a consult or actually start to work with you if they want to get deeper into this. I mean, you're also saying it's unique to someone's system, but also there's so much opportunity here, is what really what I'm hearing you speak to.

For people that are living life and perhaps going through something stressful, what might a woman who's menstruating, I know irregular menstrual cycles is a sign, but what are some other basic signs?

Sleep disruption, weight gain despite doing everything else the same, changes in some blood markers, cholesterol panel, blood sugar, that tends to change, and mood. I would put those way at the top. I'm really glad you asked that. Because what those women tend to receive are what I call band-aid medications—a sleeping pill, an antidepressant. Those are okay. I'm not against band-aids, sometimes you need them. But that's often what happens. Women who are still having their period are very often told by their doctors: Well, you're still having your period, so it can't be your hormones. That's not true. That's absolutely not true. I saw a patient recently, just this week, a patient, she's right there. She is 50, still having her period, and her numbers are just all menopause. The hormones are really low, the FSH is really high. So she's my most recent example in my mind.

This is where perimenopausal, it's when one is still menstruating, and yet there's still a lot of symptoms that are indicating. Because I think, at one point, I had thought menopause was like maybe a year or something. Actually, the average is like 10 years, right?

Yes. So the technical definition of being in menopause is going one whole year without your period. Or of course, if a woman has her ovaries removed, then she's immediately put into what we call surgical menopause. The average age of naturally going into menopause is age 51. So what you're saying is perimenopause, and that is definitely 10 or more years, and then there's a transition. There is a transition. So the hormone levels are declining, they're declining, and then especially estrogen, it starts to do up and down, up and down, and then it comes out on the other end really low. I call that the stock market phase, because it reminds me of the stock market. Because that's what it looks like. They feel terrible, then they make an appointment, and by few weeks later, they're at the appointment and then they're feeling better. Well, that's because things are going to transition into menopause. I use the words menopause and post-menopause totally interchangeably, by the way. That's how I use those words.

Great. So just as we're getting our scope of what we're talking about, when one is taking the bioidentical hormones, likely that will prolong menstruation. Is that right?

That's a wonderful question. The answer is maybe. Because there's still a natural life span of the ovaries. They do go completely into retirement. So for women who are having symptoms—things are irregular, the symptoms are coming and going, the period might be irregular—balancing the hormones often gets things back on a regular track. So that definitely can happen. It does not speed up or slow down whatever the natural course was going be of that person's ovaries.

Gotcha. So much more to say on that, and I do want to pivot towards just what people are experiencing in relationship. I mean, we're talking an average of 10 years, it might be 15 years, and this is a huge contributor to someone's wellbeing. Talk to us, I know we're getting some indicators and there's ways that people can support, and you used the word replenish. Also, what can you speak to as far as lifestyle and relationship? Talk to us a little bit about this, if you will.

Oh, I love talking about all this sort of thing. So first of all, I like to say that I cannot out-hormone your lifestyle. It's very important to do the things. Get good sleep. Move your body in ways that you enjoy, whether it's exercise, dancing, whatever it may be. Some just very basic vitamins, Vitamin D, that type of thing. Communication with your beloveds, that's essential, as you know, as you talk about. 

First, usually the one to appear is the sleep disruption and not enough progesterone, and then estrogen can go up or down. It can cause problems either way. It can cause the period to act up, get heavier, get more irregular, and then it can also affect mood. But then, of course, the two of them together are impacting metabolism and weight.

For us women, I really think this is different than it is for men. Of course it impacts men, and we love men. Men are about 10% of my practice, by the way. I love helping the guys. They are simpler than we are, from a hormonal standpoint. So it's really fun for me, it's very gratifying. I can get them feeling better pretty quickly. So that's really good.

Like you said, hormones are real. Of course they're real, they're the chemistry of our emotions. That's the lens that I see things through. So they impact everything, absolutely everything. Thyroid, I want to be sure to mention thyroid and adrenals. The adrenals are what keep us going when we're tired, and we women have a bad habit of taking care of everybody else before we attend to ourselves.

Yeah. You mentioned even the cultural aspect and the level of pressure or stress, and I think this is important to consider. I think there's a lot of women, myself included at times, that will run masculine energy to get an outcome or achieve a goal, and that can sometimes compromise my system. I think this is where, I'm not on social media a ton, but I have seen different people really emphasizing women over a certain age, if they're attending to their weight or their appearance, that driving hard isn't necessarily the right approach. That it's actually counterintuitive, if one's wanting to lean out. As you're speaking to, the calming and helping really soothe the nervous system and helping activate the parasympathetic. The system wants to be in homeostasis. But I think when we get to this chronic stress level, it's really difficult. It sounds like you agree.

That's right, 100%. You also are prompting me to mention another one of my very favorite hormones for women, which is testosterone. A lot of people out there, especially doctors, there's no pharmaceutical way to help women with their testosterone. It only comes from compounding pharmacies. So a lot of doctors just aren't aware of that avenue, they're not familiar with that avenue. So testosterone, I call testosterone the confidence hormone, and it's also a stress resilience hormone. I think that's the first time I've actually said it that way, but I like that. So stress resilience hormone.

So for women, before menopause, half of our testosterone comes from our ovaries and half from the adrenals. As we go into menopause and ovarian function declines, then we're relying more and more on our adrenals for that testosterone. I also call testosterone the hormone of productivity. Exactly what you're saying, the masculine mode—the produce, the be at work. I'm in the San Francisco Bay Area, it's very intense. Silicon Valley, you can feel it when you go there. You're like, whoa! So that's definitely the case. Men have 20 times or more as much testosterone as we do, so they have vastly less reliance on their adrenals than women. That's really, really important.

So I'm giving you the hormonal underpinnings of what you're talking about, which is balancing the feminine and masculine, but the receiving and the giving, and also the sympathetic and parasympathetic. That's so important. A lot of people are talking about that, and I love that. The vagus nerve, how to stimulate it and calm down.

Oh my gosh, yes. I actually have a friend who does deep studying, and she's not in any particular industry. She's just pretty well-informed. I remember her referencing, if one is going into this phase of perimenopausal or menopause with a level of heightened chronic stress, they're far worse. This kind of explains from a science perspective, if one's adrenals are already so taxed, and then the ovaries are winding down and the testosterone, it just seems like that much more complicated.

So help us here relationally, what tips or what things would you invite? Because part of this is education, just recognizing a change or a process that's occurring. There are ways to support it hormonally and replenish. Also, people sometimes feel a little ill-equipped or don't know what to expect, and then in relationship, how to negotiate this. Because I think if one person is experiencing something, whether or not it's a mental health issue or an addiction issue, the couple as a system is dealing with it. So to think that it's just one person's problem or one person's experience, I think the whole system is impacted.

Absolutely. You are reminding me also to mention what happens in men, because men also go through a decline in their hormone levels. The difference is that it's very smooth and gradual. Men start losing 1-2% of their testosterone every year, starting at age 30. This is also part of the ecology of the relationship. Because when men don't have enough testosterone, they feel crabby, short-tempered—they're gaining weight, they're not getting the results they're used to at the gym, potentially sexual function.

Sexual function, we can definitely spend more time on that, but it's really the least of it. I think, especially for us as women, we've learned over the decades, the old masters and Johnson model of sexual function. It's linear. First you think about sex, then you get aroused, then you have sex, then resolution. It's very linear. That's not how it works for us. That's why when you help us do the dishes, we are like: Okay, all right, start the bonding. Feeling safe in the relationship, so many factors. It's more of a circular effect. Some of the questions that I ask women when they talk about lower libido, that's on all the lists. Everything you've asked me up to now that I haven't said low libido, that goes on too. It's not only about sex. Libido is life, energy, it's motivation. Definitely, men are very aware of that. But women also, they're just like: I used to love to exercise, and now I don't feel like I can even be bothered. So that becomes part of the snowball effect of the gaining weight and that sort of thing.

One thing I want to really be sure to remember for our audience for this, is that really, I cannot think of one single reason why any woman should tolerate discomfort with sex. This is really important. That can happen. A woman, she's still having her period, she's in her 40s, and already can start to have vaginal dryness and vaginal irritation. We're talking microgram doses of estrogen, it can be helpful and really make a difference. So when women talk to me about low libido, low sex drive, and then we uncover that they're actually having discomfort with sex, then I say: Look, we're going to address that, because it's normal to not want to do something that hurts. So we're talking breast cancer survivors, family history of breast cancer, all the things that make women worry about using any estrogen.

We really know that the vast majority are absolutely fine and completely safe, from a health risk standpoint, to use estrogen externally or vaginally—so on the vulva, in the vagina, treat those tissues. It also affects the bladder. The base of the bladder is made of the same type of cells as the lining of the vagina. So we're really doing ourselves a big favor by addressing that. It's not just a surface dryness, it's the elasticity underneath that gets decreased. So it's not just nice in terms of how we feel, but it can really benefit our health. Fewer bladder infections, that type of thing.

One of my friends, not a patient, who was going through menopause and saying: I feel like I'm back to teenage, or early in her sex life, where every time she had sex, she'd get a bladder infection. So that started to happen again as she was approaching menopause. Luckily, she was able to work with somebody and get that addressed. So there's really no reason. Using estrogen vaginally does not affect the rest of the body. You don't get the benefits of estrogen—you don't get the bone health, the heart health, the skin glow, the good things that we get from systemic estrogen. You don't get that with local estrogen. But I also like to say that by way of reassuring women who have any concern about it, there is zero reason to be afraid to treat that area and get it feeling good, get the elasticity of the tissues, so you can enjoy the intimacy with your partner in whatever way that occurs.

Absolutely, this is just so all interconnected. If a woman is experiencing a lot of stress, isn't having as much opportunity to slow down and restore, isn't having as much space to feel the emotional intimacy with their partner, then, as you said, maybe having some discomfort or pain during sexual intimacy. I'm also thinking, how much are you seeing your patients having open communication about this with their significant other? You're laughing. Tell me.

I'll tell you why I'm laughing. Go ahead.

No, that's my question. It seems like it's really important. Because not only is the emotional intimacy and the support helpful for the whole system, and also, that kind of soothing. But also, a sense of not feeling alone, or feeling that belonging, feeling that connectedness. It can be quite an elixir for the body to be in a place of more healing and restorative. All of this works in concert, so it's hard to pull on any one aspect and not talk about the others. But I'm curious what you would say about communication. Because so often the female, whether or not it's feminine hygiene or menstruating or PMS or perimenopause or menopause, these things aren't necessarily always traditionally discussed.

Absolutely. That's where love comes from, is communication. Again, I'm always giving the hormonal underlying of what's happening in there. So I wrote a blog a while ago called Estrogen is the Family Glue. That's why it's actually part of a really great arc of life, as we have less estrogen than when we were 20, is when women look up and look around and say: Wow, I want to go out in the world, I want to make a difference. Maybe they've been focused on family or partners or other people up until then. So as we have less estrogen, it allows us to do that. But if we don't have enough, that's when we have short fuse, crabby. My patients say things like, I'm not being very nice to my kids, that type of thing.

Like, I don't care. They don't give a bleep.

Yeah, a little too distant from that. So there's that. There's the hormonal balance that we have in ourselves, and also progesterone, feeling calm, and also having good sleep. It's really hard to have a good, healthy conversation with our beloved when we are tired, not feeling well. That's really a challenge. So my message is always: do not tolerate those things. Do everything you can do to feel your best, and then you can really be your best in your relationship in the communication. Then there's lots of fun things between women and men, which I love talking about. My joke between my husband and I is, the data that has confirmed things that we know, which is women talk more than men. We do. We literally use more words in a day than they do. So then sometimes, my husband is being quiet, and I'll say, is everything okay? And he'll say, I'm just saving my words for tomorrow. So that's funny between us.

So all of that is important. Also, it's hard to talk about sexual intimacy in particular, and we just have to do it. We just have to be willing to have the difficult conversations. There's a book I read a long time ago called Fierce Conversations, where she talks about that. She's not talking about this in particular, but I'm applying it to this because there's just no value in putting it off. A lot of people, myself included, really experience an intimacy, a bringing together, when one of the two people is willing to be brave and start talking about if it's embarrassing, or if something is happening or something has changed, or new desires. 

Totally, absolutely. There's two things I'm thinking as you're describing this. One of which is, we haven't really addressed identity as you're describing and going through this, and we're talking about it very neutrally, which I love. And people tend to associate menopause with aging. Like, I'm no longer this or that. So there can be a sense of anxiety or shame or worry or fear, and so to have a space to be able to communicate about that. Especially when we look at current age, where I do think, stereotypically, in media, for men, there's a little more space for aging, and that's still to be very attractive. My husband watches a lot of sports, and I love sports, but I don't always allocate as much time to watch it.

Speaking of, I don't know if you could actually endorse this, on a total aside. I heard someone say that when men are watching something, that it actually supports their testosterone, and to not see that as a lazy thing. That actually, if we look at it evolutionarily, that's actually something that needed to happen was just watching surroundings. I don't know if that's true or false, but do you want to comment on that?

I would love to. I can't quote studies for you right now, but I will go look for that after we're done. I think that's true. It's actually a tough conversation. There's really a role for men bonding with each other, as we know there's an important role for women bonding with each other. One thing I have seen data on is that men's testosterone lowers when there's a new baby in the house. It makes sense. We want him to tone it down, the masculine inclination to go do things. No, more nesting, more staying home, more helping. So that does make sense, and I have seen that data. So we know that these types of things affect us.

Also, I want to remember to mention, I'm going to insert it here, is oxytocin—fabulous hormone. That wonderful release during orgasm, it's released during breastfeeding. It's a bonding hormone. It's released during hugging. We were really deprived of oxytocin with the pandemic shutdown. That was really a big part of the problem. Oxytocin works better, at least for women, in the presence of estrogen. It really does make sense. So there's a doctor who I did some training with for hormone pellet therapy nine years ago. I started doing that with my practice, and also for myself, for my own hormones. He had a quote, which was: Women who don't have enough testosterone don't like their husbands, and women who don't have enough estrogen don't like anybody. So that was one of his quotes. He was from Texas, so you have to add the Texas twang to it. So it was pretty funny. But it just speaks to the interaction.

You also said everything working in concert, and I'm going to add that, because I talk about the hormone symphony. So I'm going to start to use the word concert, because the concert does sound really good. All of the hormones need to be in a nice place, not back to when we were 20. That's a little further down the spectrum. I'm definitely in the anti-aging world, no question. Just using that term for convenience. I like to say I'm not against aging, I'm in favor of it. But everybody knows what I mean, where we want to feel as vital and energetic as possible.

Enhancement, as people use.

Okay, that's good.

Well, speaking of which, I was just on a thread of when I see women in the public sphere being very visible. So my husband was watching women's basketball, I think it was WNBA. Granted, I'm sure the head coaches have a certain level of stress. I don't know, I'm just imagining.

I would imagine.

I appreciate, but I don't experience or it doesn't seem visible that there's a lot of enhancement happening, and I'm just like: Ah, it's so refreshing. Yet, also, I guess I just see a quite a bit of an imbalance. All that to say, in couplehood, I can appreciate that might spawn insecurities of am I still gonna be attractive or all these things.

So one of the things that just strikes me, I know we're winding down here, that for a male partner of a female going through this change, likely wants to help, wants to be supportive. And without education, without these conversations, or even the person going through, the female going through perimenopause or menopause may not even know what she needs. So it does occur to me that getting educated, also having conversations. Through conversations, we learn. Sometimes, awareness gets built that we weren't even thinking about or acknowledging, or questions get posed that then offer more opportunity to deepen and learn. So I think, in partnership, that we're much more able to support each other when we can be educated, we can get curious, and we can start having more of these conversations.

Absolutely, I'm enjoying listening to you describe it. Because that's what we want, that's why we're in relationships with people. Even if we're single, we're still in relationships with people. Single people are not all by themselves—they're in their communities, they have their connections. Then, in partnership, I really like talking about masculine and feminine. Because it's not only male and female. It doesn't matter if it's two women, two men, a man and a woman. It doesn't matter. There's still masculine and feminine energy that's being exchanged. My husband and I do Argentine tango dancing, and that's a very clear leader and follower. You cannot do the other person's job, or feet will be hurt. I actually had an instructor who told me that therapists would send women, in particular, to the tango classes, in order to have the physical experience of receiving. It's really great. Then of course, San Francisco area is totally awesome. All of these, there aren't strict binary definitions, which is so fun and exciting. There's entire tango events where they call it switch tango, where leaders and followers will switch in the middle of a dance. Like, you've got to be ready! So that's like a relationship. There's just any given moment, somebody has to know where we're going, and the other person has to say okay.

Yeah, I love the creativity there and the playfulness with the traditional way. Well, wonderful. I'm just curious, before we wrap up, is there anything you want to speak to that we haven't gotten to?

Couple of things just to add, goes right along with what you were talking about, that we need to do. We need to be proactive. We need to be savvy patients. So I want women to, in particular—men also, but for sure women—be ready. 

I really like it if people bring a list of questions. I say: Great, lay it on me, give me the whole list. That way, I'll make sure that during our time together. I don't work in the insurance world, so I have lots of time with my patients. I'm not restricted. But going to a regular doctor, they're going to have 10-15 minutes, and you've got to be ready with your priorities. I recommend bringing them up very early in that time together, so that you can really be sure to get your questions answered.

One more very important thing. Usually, when I'm giving talks and presentations, I usually end on the note of: don't be gaslit. Don't be gaslit. The doctor saying, like what we said earlier: Oh, you're still having your periods, so it can't be your hormones. Or the ones that are my favorites on the bad list, which is: You're just getting older, you just have to accept feeling worse or more tired or whatever it is. So I call that the J word, and I want people to draw a circle around that and put a line right through it. Yes, we're getting older. You said that at the very beginning, we're blessed to be able to live life and get older. Yes, it brings physical changes, and it also brings wonderful opportunities.

Yeah, wonderful! Well, I'm aware that we are very grateful, as I mentioned, education, and you are doing so much to guide people in this journey and have awareness, have research, have data, and be very conscientious, and have agency, as they move through in this proactive way. So tell us how people can get connected with you and your work and what you're offering.

A few things. First of all, the very best way to find me is always my website, which is DrLizMD.com. Everything is on there. The programs, there's one I want to share in particular in a second. But my blogs are there. There's video, there's just all kinds of content. There's a newsletter. I do not bombard people with tons of emails, but there's also just a way to be engaged. All the social media links are on there. It's like the central hub. Also, the free gift for your listeners, which is the more recent book that I wrote, called Go for Great: Dr. Liz's Guide to Thrive at Every Age. GREAT is actually an acronym. It stands for: Gain knowledge; Realize the truth about hormones; Explore expectations; Advocate for yourself; and Thrive. So I did that on purpose so I could remember, because that's really all the things I love to talk about. So there's that gift.

Then last, but definitely not least, is a program that we are introducing hopefully in the new year, that is called The Miracle of Menopause Online Community. This will be a fully virtual program that does all the things that we love, brings us together to interact with each other, guest experts, monthly workshops. We're really putting a lot of content in there. Because yes, we have to deal with these hormonal changes, we have to address problems that may arise. But it's also a huge opportunity. 

Lovely! I will make sure to have those links on today's show notes. Just to echo the last sentiment there, I have a friend who does a lot to support women, and she was talking about this phase of perimenopausal menopause, just talking about the opportunity to be in a place of wisdom. It seems as though, as you're supporting someone to thrive, that their vehicle, their body, their whole system is functioning in a more optimal way, that allows them to be in the world in a more expansive way rather than this shrinking. So I really appreciate what you're doing. Thank you for sharing all that you've shared with us today.

My pleasure. Thank you for having me.

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