Let's Talk Menopause

>> You know, there really should be a mandatory master class for midlife women's health to help prepare women for the physical and emotional changes that will inevitably occur.

I'm Dr. Tara Allmen, author of "Menopause Confidential," and a menopausal woman myself.

That means I'm old and wise enough to give you the talk that every woman should have as she enters the wonderful world of perimenopause and menopause.

>> There are as many ways of going through perimenopause and menopause as there are women who go through it.

>> For a lot of us, it's like as mysterious and as... unsettling as puberty can be.

>> I do believe that it's our fundamental responsibility to open up this conversation.

>> Today, you're going to learn from experts in this highly specialized field, as well as real women sharing their unique stories.

By the end, I have no doubt that you'll be all fired up to get more information and make great decisions about your own midlife journey.

So ladies and gentlemen, crank up your fans and air conditioners, as we get this hot flash party started.

♪ ♪ I always knew I wanted to be a doctor.

I've known since I'm a ten-year- old.

And I trained to be an obstetrician gynecologist.

But somewhere in my 30s, I realized that I had a great passion for taking care of women in their 40s, 50s and beyond because there was so much confusion for this group of women and nobody was teaching them anything about perimenopause and menopause.

>> Can I just ask what this meeting is for?

Is this angry divorcees?

Or... croning?

>> No, menopause, Beau.

>> Oh we don't have that in America.

(laughter) We don't believe in it.

>> Perimenopausal women and menopausal women absolutely express fear.

It's really fear of the unknown.

Am I going to get all wrinkled up and shriveled up?

And is my sex drive ever coming back?

I tell all perimenopausal and menopausal women not to be fearful.

Don't be hopeless.

There are so many great strategies, and treatment options, and things that you can do to have health and wellness from now into your little old ladyhood.

Let's get started.

♪ ♪ >> You start getting hot flashes, you're about 50, a woman, not relevant in men.

>> About the way my mum is now, about 50.

(laughing) >> Get very grumpy.

>> Well, it's known kind of for old age.

It's kind of when you get old and you start to forget things or get really fussy.

>> Menopause is something older women get.

Um, I guess it's a change in their body?

>> Menopause literally means the end of menstrual cycles.

And the formal definition is that you don't have any menstrual cycles for 12 months in a row.

The average age of menopause is 51, but there's an age range anywhere from 40 to 58.

And it never ends.

Menopause goes until death do us part.

And so many women don't realize that.

>> Menopause by definition is a year of not having a period.

So it's actually a retrospective diagnosis made after a woman has stopped having her periods for 12 months.

And surgical menopause is if for any reason somebody's ovaries are removed.

So they would go through menopause immediately upon removal of their ovaries.

♪ ♪ >> Perimenopause is different than menopause.

Perimenopause is the lead-in to menopause.

And it usually starts in our 40s.

And it's marked by changes in menstrual cycles.

Although some women in their 30s can start experiencing changes in their menstrual cycle.

And perimenopausal women will start to not feel well.

They won't know why they don't feel well, but they may start having hot flashes, and night sweats, and moodiness and weight gain.

There is a relationship between when our mothers made that journey through menopause and when we will.

So if your mom is still around, and can remember, and you want to ask her, you know, what went down when it was her turn.

Here's a really important point for the perimenopausal crowd.

You're still ovulating eggs and therefore, you still can get pregnant, so you better not toss out your contraception just yet.

>> Turns out you were right.

You're perimenopausal.

You're also pregnant.

>> What?

♪ ♪ >> Premature menopause is when you stop having menstrual cycles before the age of 40.

There are additional health concerns associated with having menopause so early, such as an increased risk of heart disease and osteoporosis.

>> The difference between post menopause and menopause is specifically that once a... it's just a matter of terminology.

Once a woman has gone 12 months without a menstrual period, she is now in menopause or is post-menopausal, and that's going to stay that way for the rest of her life.

♪ ♪ >> There are about 65 million perimenopausal and menopausal women in this country and most of them are confused and don't know where to go for information.

>> I believe perimenopause hit me around 44 or 45 years old, and I just figured, "Oh menopause?

I'm kind of looking forward to that.

I won't have to buy feminine hygiene products anymore, won't that be great?"

>> I was a supermodel in the '90s, I've worked for every designer, I've been on the cover of a lot of magazines, I had a great career.

And then I kind of hit a wall when I turned 45, 50, I started to become perimenopausal and going into menopause, and I was like... in the dark.

It's a huge gap in our education.

I wish I had read more, understood more, and been able to get out ahead of it, rather than being surprised by it.

>> I think the most important thing about perimenopause and menopause and women is that we have to band together and support one another, and tell each other that it's going to be okay.

>> I like to think of menopause as ovarian retirement.

Our ovaries have a job to do.

They have to ovulate eggs.

They have to make estrogen, progesterone, and testosterone.

And they have to do that for 30 to 40 years.

Estrogen is so important for the health of women.

I like to think of that expression, you know, women are made of sugar and spice and everything nice.

Well, the everything nice is estrogen.

Estrogen really is in charge of health from basically your head to your toe, from your hair to your toenail, and everything in between is dependent on estrogen.

>> Hormone levels in perimenopause tend to be variable for people.

Generally what happens is if they are having regular menstrual cycles, they are having the same amount of estrogen and progesterone, however if they are missing periods, those months they may have low levels of estrogen.

And some months they may actually have a lot of estrogen, and during those months, sometimes they'll have heavier and prolonged bleeding as well.

So hormone levels in perimenopause are very variable for most women.

>> The fluctuation in estrogen levels appears to be the underlying cause for many of these menopausal symptoms, such as hot flashes, night sweats.

In particular, it's the fluctuating levels.

Many of these symptoms will actually get better after a prolonged period of having low but stable levels.

>> It's important to remember that hot flashes and night sweats can last on average for seven years, and some unlucky women can suffer for more than 20.

That statistic alone is giving me a hot flash!

>> Do you think men should be educated about menopause?

>> Sure, we got to deal with it.

>> They should know because it's like, uh... it's a normal...

I don't know, I don't want to say issue but it's a normal stage for a woman and they have to understand, they've got to understand that it is the stage that it is the end of the fertility of the women.

>> Do you have any menopausal women in your life?

>> I do.

I do.

That's why I drink.

(laughs) You guys have a great day.

>> I like to say that every man needs a gynecologist, and this is why: every man has a grandmother, a mother, a wife, a sister, an aunt, a daughter.

There's some woman in his life.

>> Maybe now is a good time for me to explain a few things to you about menopause.

(laughter) And lucky for you I'm a nurse so I can use the proper terms like epithelial lining and uterine wall.

(men groan, audience laughter) >> In my experience, men really do want to know a little bit about this topic.

>> I think it's really important that men know about menopause.

My husband is a really smart guy, and he's a really caring guy, but he knew a lot less than I did about menopause when I started going through it.

>> I think men know more about almost everything than how their female partners work.

I think they know... ask them about who the second string quarterback of their favorite team is and then ask them to explain perimenopause and watch what happens.

I've tried to educate myself but I think the most important thing is to be there and not, you know, run away and stick your head in a bag.

>> I got to tell you, a lot of the things I was going through inconvenienced him.

And continue to inconvenience him to this day.

I sleep with the window open even when it's 30 degrees out, I mean, just a crack, just a crack.

>> I wear thick socks.

I wear sweatpants.

And I wear a hoodie if necessary because that bedroom is freezing.

I feel like Nanook of Harlem.

♪ ♪ >> So many women struggle with hot flashes, night sweats, mood changes, weight gain, brain fog, poor sleep, fatigue, vaginal dryness, and a decreased interest in sex.

But not all of us are going to experience symptoms the same way.

Some of you are going to be lucky and have mild and manageable symptoms, but the rest of you are going to complain vociferously about this and that-- I can hear you now.

♪ ♪ >> Could I bother you for a glass of water?

I'm burning up.

>> Yes.

>> Hot flashes.

>> Mm!

>> Hot flashes are the most common menopausal symptom and the second most common perimenopausal symptom, and 80% of women will get to enjoy them... (laughs) ...on average for about seven years.

Hot flashes are a sudden, intense feeling of warmth, usually starts in the chest and goes up into your neck, into your face.

Then you can start flushing, and sweating, and then the chills can come.

You may feel anxious.

You might even have some heart palpitations.

>> I'm a skin health expert.

I co-founded a multi-literal organization that supports beauty entrepreneurs around the world.

I do a lot of public speaking and to be on my mental game is of the utmost of importance.

Perimenopause hit me in the summertime.

I was 48, which wasn't that long ago.

And it just came out of nowhere.

And it was really the hot flashes and the night sweats that I couldn't control.

And I was about to go on stage to moderate a panel and I had to tell my team, like, "You have to watch me because I think I'm going to pass out."

And it was so scary not to have any control over these symptoms.

>> What happens when hormones are fluctuating, estrogen is fluctuating and declining, is that the thermostat, which is in the brain, begins to be very, very sensitive to any change in body temperature.

So, if there's a small increase in body temperature, women will feel uncomfortable and begin to have that sensation of warmth.

And the reason you have the flushing and the sweating is that the body's trying to dissipate heat and to cool off.

>> Every hot flashing woman knows that you have to start dressing in layers so that you can remove clothing when you start to have a hot flash.

This is very important.

So there are some strategies.

You want to drink cool liquids.

You want to be in an air conditioned and fanned room.

>> Night sweats are the same hot flashes occurring at night, but sometimes they can be quite severe and awaken a woman from sleep, often, many times a night, where she wakes up in a drenching sweat.

And that can be very disruptive to sleep and can actually lead to fatigue and decreased concentration and focus.

>> All of a sudden you wake up and it's like your hair's wet, and your nightgown's wet, and the sheets are wet.

>> One way to minimize these hot flashes is to understand what the personal triggers are.

Such as alcohol, spicy foods, hot coffee.

It's also been found that there are emotional triggers, and sometimes when a woman is very upset about something that's just happened, that will precipitate a hot flash.

>> So treatment strategies are based on frequency and disturbance and disruption, which is so personal, of course.

We have at the mildest level, you know, lifestyle changes about what people wear and how they cover themselves.

Wearing light clothing, getting air movement in their bedrooms for night time.

There's also some cognitive strategies about how to be mindful about what's happening in a way that doesn't bother them so much.

♪ ♪ >> The mood changes happen and it's like... (sighs) you have to kind of stay conscious of the fact that sometimes your mood will absolutely not match anything that's going on.

Like, you know, it's an okay day and everybody's fine and nobody's insulted you and nobody's on your nerves that much but, you know, you start to go very dark.

And you start to feel really irritable.

And I'm pretty good at saying to, you know, my husband and my kids, uh... "I'm sorry, I can't control my mood.

I don't like the way I feel.

And I don't know why I feel this way and I can't control it."

>> So about once a week I hear a woman say to me, "My husband thinks I'm crazy."

But I always say, "You don't need a husband, your partner, your co-workers, your children.

You yourself feel like you're going crazy."

>> Mood and depression problems are common across the perimenopause transition.

The good news is that most people do not have severe mood problems.

It is very treatable and can be managed with lifestyle changes, with counseling, and when it's more severe, with medication treatments.

>> The mood changes for women in that perimenopausal transition especially can really be, "I feel a little blue.

I'm not really that interested in the activities that used to bring me pleasure.

I feel more anxious for some reason."

If you suffer from PMS symptoms as a younger woman or you had postpartum depression after you had babies, you're actually more at risk for mood symptoms in perimenopause.

>> People who are likely to have significant mood problems, severe mood problems that warrants, you know, more intensive treatment are women who have a history of mood disorders before midlife and menopause.

And it would be very atypical for somebody to go into a very severe depression if she's never had that kind of problem before.

♪ ♪ >> So many perimenopausal and menopausal women will think they're getting Alzheimer's disease because they become a little more forgetful and they're having a hard time with focus and concentration.

So immediately they think they have Alzheimer's disease.

But it is so common during this menopause transition to experience what I call brain fog.

>> It's important to think about whether they're having hot flashes and night sweats, sleep disturbances, anxiety, mood changes, because all of that can affect brain activity or cognitive abilities as well.

>> My husband and I have a duo cabaret act together.

And when I started getting brain fog, when I started not to be able to come up with words, when I started not to be able to remember my own jokes, I was really angry.

Trying to learn new material just became much more of a challenge.

And coming up with jokes off the cuff is a big part of what we do in our act.

>> Are you, a woman, correcting me, a man, in front of all these nice people?

>> Okay, look.

First of all, I know a lot of these people and they are not nice.

(laughter) Especially him.

(laughter) I started to feel dumb, and that's... the kiss of death for what I do, to start to feel dumb or dull.

>> Some of the best things to do when women are experiencing brain fog is just to be physically active, having a healthy diet, avoid alcohol, and try to improve the quality of the sleep.

The good news is that once the hormones stabilize, even at a lower level, it does tend to get better.

>> Are you wondering if you'll ever feel like yourself again, like the you, you knew and loved when you knew and loved you?

The answer is absolutely yes.

♪ ♪ >> Many women in their 40s and 50s show up to the perimenopause and menopause party without a clue as to why they feel so miserable.

But not all of us are going to experience symptoms the same way.

Some of us are going to be lucky and have mild symptoms, and some of us are going to have pretty severe symptoms, and there's really no rhyme or reason about which one of us has which journey.

♪ ♪ There are three lucky women who don't gain weight and then there's all the rest of us.

So what happens when we're not feeling well is we're not making the same healthy choices that we might have otherwise made.

We're not getting good sleep, so we're not eating well the next day.

So, yes, ladies, you are going to gain weight.

You're going to redistribute it to your middle and you're going to be very cranky about it.

>> Hey, how are you?

Can I get a regular coffee with half and half and one Splenda, please?

I have always had trouble with my weight.

When perimenopause hit, all of a sudden I put on, like, 20 pounds.

And I felt so defeated.

And I was working out very hard-- high intensity interval training-- and I was not losing an ounce.

>> Unfortunately, there are some of these unfavorable changes in body composition that have been identified at the time of menopause transition.

>> I think one of the things that happens with a change in estrogen level and in menopause is that we tend to lose our muscle mass.

So it is important for women to do weight-bearing exercises or some sort of resistance training.

If they have more muscle, they're gonna have an increased metabolic rate, which is gonna help them avoid weight gain.

There is actually data that if women are overweight and they lose weight, they tend to have less menopausal symptoms such as hot flashes and night sweats.

♪ ♪ >> Every midlife woman needs to know that it's going to be next to impossible to have the same interest in sex that you did when you were in your 20s and 30s because you're no longer making estrogen, progesterone, and testosterone in the same quantity that you did before.

However, I don't want women to be dismayed about issues with libido.

If you want to have an enjoyable sex life, you can.

There are some changes that occur, especially with vaginal health, as we get older.

So we have to start tending to our vaginas, ladies.

>> There are vaginal changes that do occur for women that can start even before they are... they go through menopause.

Some women may notice that they are having more vaginal dryness and discomfort with intercourse.

The treatment for vaginal dryness is to use a small amount of estrogen, which is available in a cream, a tablet, a ring, or an insert that can be placed in the vagina.

And it is 99% local treatment, just in the vagina.

So it's not absorbed, and there aren't as many systemic health risks associated with it.

Over time, if it's used regularly, it increases the collagen content and the health of the vagina.

Libido is complicated for women.

The highest levels of libido are in younger people, in their 20s.

And there is a decline for most people throughout their lives.

>> The first things you want to think about when women complain about low libido is to think about whether there is pain or discomfort with intercourse.

Other things that we always think about is a woman's physical health, her psychological health, relationship issues.

There are two medications that are currently approved by the FDA specifically for low libido in premenopausal women.

One of them is an oral pill, which can be used on a daily basis.

And the other one is an injection that is used as needed, which can be taken 45 minutes or longer prior to intercourse.

♪ ♪ >> Sometimes I would only sleep five hours, but even if I slept a lot I always felt like I needed more sleep, I just didn't want to do anything but sleep.

And fatigue would hit me in the afternoon at, you know, 3:00.

Oh, you know, we all have a little bit of a crash at 3:00, but I mean like so much fatigue that I wanted to cry.

>> For women across the menopause transition, sleep is one of the most common symptoms that is quite distressing.

The nature of the sleep problem in menopause and perimenopause transition is a waking up problem.

And the most common reason why women are waking up in the middle of the night is that they experience night sweats.

Even when they're not having a hot flash, the rest of their sleep is rather disrupted.

Part of it is the amount of time that they're sleeping, but a big part of it is that it's not a smooth flow between all the sleep stages that it's that they... they're very interrupted.

A short light sleep, a short deep sleep, a short light sleep, a brief awakening, so it's not, it's not a consolidated pattern, which is really what you want to feel refreshed.

>> It was to the point where I was only getting maybe one really good night's sleep where every single other night was riddled with anxiety and then insomnia.

So they went hand in hand.

>> We know that when women are sleeping poorly with hot flashes, which is usually not just, you know, one night, or one week or one month, it happens over many years, they accumulate a sleep deficit.

It also in terms of brain function can really contribute to mood changes.

So low mood, you know, negative mind set, feeling kind of blah or down or very sad can... are really linked to this unrefreshing sleep and this sleep interruption.

>> The most important thing that women can do to help preserve cognitive function, in my opinion, is to get a proper night's sleep.

And that means that we have to go to bed about the same time every single night of the week.

And no, you can't binge watch your favorite shows.

And no, you can't check your last email.

You really have to be respectful and protective of your sleep habits.

>> When you think about a menopausal woman what kind of images come to mind?

(laughing) >> Angry face.

Uh... >> Getting old.

>> Yeah.

>> Are there any women in your life who have gone through menopause?

>> Uh, I guess, maybe my mom?

I guess she's in her like 60s.

Maybe her menopause has started?

>> When you think about a menopausal woman, what kind of images come to mind?

>> Myself.

♪ ♪ >> Once we hit menopause and our ovaries are no longer making estrogen, we're going to really see a lot of changes, and not for the better, in terms of overall health and wellness, in terms of heart health, bone health, brain health, the health of your hair and your skin and your nails, and all your bits and pieces in between.

♪ ♪ >> Osteoporosis and related fractures are an enormous health problem for women, and women are at four to five times the risk of osteoporotic fracture compared to men.

Women who are at the highest risk of osteoporosis are those who have a low body weight.

Women who smoke have an increased risk of osteoporosis, and there are genetic factors as well.

A mother with a hip fracture and a history of osteoporosis may be a sign that you are at increased risk.

One of the most important ways to reduce the risk of osteoporosis is to be physically active, and strength training, resistance training, will go a long way in improving bone strength.

Diet may play a role, there's some evidence that having adequate calcium, vitamin D, and avoiding very high intake of alcohol or carbonated beverages also would be important for maintaining optimal bone health.

>> The real key, the real secret here to not having an osteoporotic fracture or bone fracture-- a bone attack, you should think about it that way-- is to start introducing balance training.

Nobody tells women that.

So you can start with a nice tai chi class, or you can do something as simple as standing on one leg and balancing for a period of time and then switch your legs.

The secret to not getting a bone fracture really is not to fall down.

And how do you do that?

You start practicing balance training.

♪ ♪ I don't think women realize that the number one killer of women in this country is heart disease.

And we're protected when we're younger, reproductive-aged women with estrogen.

But once we stop making estrogen, all of a sudden we have the same risk as the men do.

And our risk of heart attack goes up.

>> We have a great deal of control over our risk of heart disease.

Heredity is not destiny.

There are some genetic factors that will increase our risk, but there's so much that we can do.

80% of heart disease is preventable by lifestyle modifications.

The highest risk of heart disease are those who are smoking, sedentary lifestyle, not being regularly physically active, not having a healthy diet.

♪ ♪ I mean, when you have a lot to do, you know, and you love the life you lead, you know, you love your partner, you love your kids, you love your job, feeling good, feeling back to normal, feeling yourself, that's everything.

>> Menopausal women, perimenopausal women, we're all different.

We have many times multiple symptoms.

So you really have to take the whole big picture into consideration when you make your choices for which strategies.

>> Not all women will need prescription medication, so we also can be reassuring that most women do not have symptoms that are so severe that they require prescription medication.

♪ ♪ >> So if you're a menopausal woman with hot flashes and night sweats, or you're an increased risk for osteoporosis, the gold standard treatment is FDA-approved hormone therapy.

And that means estrogen for the treatment of your symptoms and the protection of your bones and progesterone if you also have a uterus to protect the uterine lining from getting overstimulated by the estrogen, which has to do all the work.

>> Hormone therapy does have risks and benefits for women.

So it's important to talk to the patients about the risks.

The main risk it has if somebody is around the age of menopause or less than 60 years old is there is a slight increase in breast cancer, which is fairly minimal and it's particularly not as worrisome if patients are on hormone therapy for just three to five years after they stop their periods.

In terms of blood clots, there's also a slight increased risk for blood clots, but again, it's fairly rare.

So I think that talking to patients and explaining that the risks are fairly small, and especially presenting numbers, a lot of people might be reassured and may elect to choose hormone therapy.

♪ ♪ The use of hormone therapy has fluctuated a lot over the past many decades.

We were prescribing a lot of hormone therapy for women in the past.

Uh, in fact, up to half of all women who were in menopause were on hormone therapy at one point in the 1980s and 1990s.

♪ ♪ >> What was so surprising was that the women's health initiative, the largest randomized trial of hormone therapy, suggested that overall the risks of hormone therapy were outweighing the benefits.

With estrogen plus progestin, there was an increased risk of breast cancer that began to emerge after about three to four years of treatment.

There was tremendous confusion and fear surrounding those findings.

But after delving more deeply into the results, we now have really clear evidence that the women who were younger and closer to the onset of menopause at the time did better on hormone therapy than the women who were older and very distant from menopause.

>> The women who should consider hormone therapy are the symptomatic women.

So if you're hot flashing and you're sweating all over the place, you're absolutely a candidate.

If you're less than ten years from your final menstrual period, you're generally healthy.

You are a candidate to consider hormone therapy.

There are some women who are not candidates to consider hormone therapy.

So for instance, if you have breast cancer or active heart disease, if you've had a history of heart attack or stroke, if you're having bleeding that's unexplained, there's a group that really cannot use hormone therapy, but the vast majority of younger, healthier symptomatic menopausal women can consider it.

>> Some of the newer treatments that are available include transdermal, the patches, the gels, the sprays which are less likely to increase the risk of blood clots in the legs and lungs.

And also there are lower doses that are now available.

>> For me, I just needed...

I needed an estrogen therapy.

So it's as simple as you put a patch on twice a week.

And it works really well.

It works really well.

The brain fog has lifted, energy better, sleeping better, hot flashes are almost non-existent.

This is just me.

So, you know, I'm not saying that there's a one and done cure all for everybody, but there is help if you go to a doctor and you get an individualized treatment.

♪ ♪ >> Perimenopausal women, remember, are different than menopausal women.

They are still making hormones.

So they are not candidates for hormone therapy.

Instead, perimenopausal women who are symptomatic do great on a low dose birth control pill.

>> My solution?

Should I tell you my solution?

Was the pill.

I got the pill and within five days, every single symptom went away.

I got my life back 100%.

♪ ♪ >> Not everyone gets to consider hormone therapy for the treatment of their menopause symptoms, but don't worry, there are other strategies.

For instance, they can consider selective serotonin re-uptake inhibitors.

Those are SSRIs or serotonin norepinephrine reuptake inhibitors.

Say that three times fast.

These are antidepressants that we have used very successfully for symptomatic menopausal women.

And, in fact, there is an FDA approved low dose antidepressant specifically for the treatment of menopause symptoms.

Now here comes a really important point: you really have to partner with an expert in midlife women's health in order to know what is the right strategy for you.

♪ ♪ I would say most symptomatic women really reach for non- prescription strategies first.

Whatever your best friend tried, you're more inclined to want to try.

But there are very few scientifically studied strategies that have been shown to be helpful.

>> A large percentage of women do use alternative or over-the-counter products for menopausal symptoms.

There's many available on the market.

A lot of products that are over the counter are not FDA approved, and there's really very little data for whether they work or not.

One of the most common is black cohosh, which is a plant-based estrogen product that has a weak binding to the estrogen receptors.

And it will be helpful in some women; however, the data suggests that it's not necessarily any better than using a placebo.

>> There's a lot of talk about whether midlife women should eat more soy foods.

Will that help relieve menopause symptoms?

And soy foods are delicious.

You can get them in the form of tempeh, or soy milk, edamame.

They're all very healthy, but they really won't help reduce hot flashes.

What I always say to women is you can try any natural strategy that you want.

Give it about three months.

If it's not going to work for you by that point, it's probably not going to work for you ever.

♪ ♪ >> There is a few studies that have looked at acupuncture for treatment of hot flashes and night sweats.

And there is some data that it seems to be a little bit better than placebo for some patients.

>> I went to acupuncture really looking for help with my menopause symptoms, with the hot flashes and the brain fog.

And I always felt better after an acupuncture session.

I was having a lot less anxiety.

>> Some of the triggers for menopausal symptoms like hot flashes can be related to anxiety and stress.

So if we can do anything to help patients reduce their stress and anxiety, such as meditation and yoga, as well as cognitive behavioral therapy, that's something that patients can also try.

>> I ended up finding a meditation app that spoke to me, and something so simple has changed my levels of anxiety.

And now I have more sleepful nights than I do sleepless nights because of that one simple act of meditating before I go to bed.

Finding this meditation app was perfect, was perfect.

Coupled with the pill...

I am just like in heaven.

(chuckles) ♪ ♪ >> All perimenopausal and menopausal women need to start making really great lifestyle choices, that we've put off because we've been so busy taking care of everyone else, but I like to think of perimenopause and menopause as the chance to finally get yourself on your own to-do list.

All menopausal women should be out loud and proud... (laughs) ...and announce to everyone, "I'm a menopausal woman and I'm really fabulous, thank you very much."

>> My best advice is to speak up and don't be afraid.

>> Don't la-di-da your way through it.

Forewarned is forearmed.

>> Own your age, own your beauty, own your power, and understanding your body is a beautiful thing, and growing old with a lot of wisdom, that's really powerful.

>> I really want all of you to know that menopause is the best time of your life.

And I mean that sincerely.

In my opinion, there's all upside.

Now, you get to be the woman you've always wanted to be, but you've been putting it off.

Yes, there are some health challenges.

Yes, you're going to have to make some important decisions.

And, yes, you're going to be in charge finally of your destiny and now you know it.

So get started... (laughs) ..on this really exciting time.

♪ ♪ ♪ ♪