Dr. Rebecca Thurston: Episode Link

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TRANSCRIPT:

Welcome back to Hot Flashes and Cool Topics everybody. Today we have Dr. Rebecca Thurston on the show.

Dr. Thurston is Pittsburgh Foundation Chair of Women’s Health and Dementia.She is the Professor of Psychiatry, Psychology, Epidemiology and Clinical and Transitional Science and the Director of Women’s Biobehavioral Health Program at the University of Pittsburgh. Welcome to the show today. Thanks so much for having me. Yes, so you have done just very thorough research into something that women in this demographic really need to know,
really need to understand, and so many do not understand. So I want to start with your work as the longitudinal study, is it the swan study, then that was the in depth work.

Can you talk a little bit about that and how long this has been going on? Absolutely. So we have a couple different menopause studies going on in our lab and I’m happy to talk about all of them.
But one of them is swan or the study of women’s health across the nation. This is a large longitudinal cohort study of women transitioning through the menopause. It actually began in the big 90s and has been ongoing since then.
We have just completed our 18th follow -up visit with these women. And SWAN was designed to track the natural history of the menopause transition across five different racial ethnic groups at seven sites throughout the United States,
including Pittsburgh being one of the sites where I’m the principal investigator. And the idea for SWAN is to try to discern what is in actual history, the menopause transition, and what does the menopause mean for women’s health?
What do women experience during the menopause? What are its implications later in life? And what’s due to reproductive aging or menopause versus chronologic aging? So that’s SWAN, and SWAN has produced a tremendous amount of information about the menopause transition, really some of our foundational knowledge. of health.

You also work with Ms. Heart and Ms. Brain. So do you mind sharing information about both of those aspects? Absolutely. So those are our really kind of in -depth phenotyping studies where SWAN provides this incredible longitudinal view over many women, thousands of women followed for 20 -some odd years. What you get in breadth, you don’t always get in depth. So what the Ms. Heart and Ms. Brain are designed to do is do kind of more deep phenotyping to really understand,
we use things like wearable technologies, we use vascular imaging, we use neuroimaging, to understand what do these menopausal symptoms mean for women’s health. So things like hot flashes, night sweats, sleep problems, as well as those hormonal changes and various other biological changes that are happening during the menopause transition? What are the implications for heart health? What are the implications for brain health? And really focused on those menopausal symptoms that we used to think were so benign. And now we know that they probably mean more for women’s health than we previously thought.

I’ve read and I’ve watched different videos with you on them. And having symptoms more severe, and correct me Please, if I’m wrong, more severe and earlier, does that tend to lead or your study has found that maybe symptoms in heart health are more severe later in life? Yeah, so actually this began, we kind of have this cross talk between Swan and Miss Heart where we look at these kinds of questions. So in Swan, we were noticing that the women with more vasomotor symptoms or more hot flashes had what we call was poor endothelial function, which is the inner layer lining the vessel, very important to multiple aspects of vascular health. We found that the vascular understanding was not functioning quite as well. We also found that these women with more hot flashes had higher carotid intermediate thickness. So this is an ultrasound measure where we’re measuring the thickness of the inner parts of the vessel,
which it helps us predict who’s going to go on to have heart disease. And then we follow that up with the Ms. Heart Study, where we actually had women wearing wearable measures of hot flashes,
so you don’t need to report them all the time. Where Swan gave women a questionnaire, this time we’re hooking women up to hot flash monitors. We’re giving them a daily diary. We’re seeing what’s happening during the day,
during the night. And what we found in Ms. Heart, again, was that the more hot flashes you had, the poorer your underlying vascular health. So the greater endothelial dysfunction you had, the higher your carotid intramemedia thickness, and these are all indicators of vascular health. Then we toggled back to Swan because women don’t tend to get heart attacks and strokes until they’re 65 plus, typically. So when we’re studying midlife, we use these imaging measures to look at the health of the vascular chart before women have clinical events, such as heart attacks and strokes. Now the Swam women are in their 70s, so we’re able to tie what happened during midlife in the 40s and 50s to what’s happening now to women in their 70s. And what we found is that women with more frequent base motor symptoms at midlife, and particularly if they had these frequent base and motor symptoms over long periods of time, over many years, these women had elevated risks for heart attacks, strokes, cardiovascular disease, mortality when they’re in their late 60s, early to mid 70s. And we found our hazard ratio was about 1 .8. That means an 80 % increased risk.
I mean, that’s amazing. I had no idea, and I’ve been doing this podcast with Colleen for four and a half years, that there was something that you, a wearable that would measure your hot flashes. So yeah, that is amazing to me.

Is there anything that a woman can do to prevent these heart incidents happening, these cardiovascular incidents happening? And if they find out, if they are having more frequent vasomotor symptoms, can they do anything in the meantime to help their cardiovascular health? Absolutely. So yes, we do use these wearable measures of hot flashes, objective measures of hot flashes, which we like because actually people are typically having more hot flashes than they think.
So we tend to kind of learn how to muscle through these to some degree and don’t always report all of them, particularly at night. So We like to use these wearables on now and that becomes important when we talk about brain health,
which we’ll get to. But when it comes to heart health, we don’t know whether the hot flashes are causing heart disease. So we don’t need to quite panic yet. And we don’t yet know whether treating the hot flashes will prevent heart disease. So stay tuned. We want to do that work but we haven’t done it yet. However what we can say is that the women who are having lots of hot flashes that should tell you something that there’s this is a little bit of a wake -up call that now’s the time to be engaging in all of those healthy heart -promoting behaviors that we know are important. So for example if you’re smoking now’s the time to stop smoking. If If you know you have diabetes or you’re teetering on the edge of having diabetes,
now the time to really get that blood sugar of control. Take your blood pressure medications that prescribe. Many people don’t do that. And now is the time to get an exercise routine on board as well.
Midlife is really this great time to intervene to prevent disease later in life because we know that, for example, standard cardiovascular disease risk factors such as blood pressure,
those midlife levels are more predictive of later disease than those later life levels. So midlife is this really, really important time. So I just say, do all of that healthy, heart healthy behavior, we know we should be doing, it’s hard to do, but it’s really important. And partly it’s hard to do because as women we’re not taught to prioritize our health. We’re taught to prioritize everybody else’s health but we have to do it. It’s really really important. It certainly is and a lot of women that we’ve spoken to and a lot of questions that we get we have a private Facebook group are all the sudden I’ve been doing everything in my whole life normal. I’ve been this normal weight. I’ve always had my blood pressure’s always been under control and all of the sudden my blood pressure is elevated. I’m putting on weight at this time of life. And so now this is happening in midlife and during that transition, and I don’t know if there, you know, what to tell them to do to help with the blood pressure.

Like I myself am on a blood pressure medication and it did the same thing. When I hit life my blood pressure was always under control there it went. Is there anything that you know I think you just gave some great advice to is there anything to do to prepare women when they’re transitioning through that phase? First of all I will talk a little bit about what the menopause versus aging effects on cardiovascular disease risk factors so we know women gain weight during menopause and during midlife specifically So that’s a aging, midlife aging thing, and that can be hard to control, but we know that the people who were the most effective at maintaining their weight and swan were the very physically active women. So we’re talking like an hour of cardio a day. It doesn’t need to be going to the gym cardio. It could be a brisk walk, but physical activity is really, really helpful with weight maintenance. But however, we also know that even if you’re weak stable,
there’s a menopause -related effect where some of that lean mass becomes fat mass. So the balance of muscle, bone, and fat kind of changes with menopause. So it does become that much harder to maintain. So really good physical activity, both cardio as well as strength training, is going to be important during this time and work with a trainer or an expert if you haven’t done this kind of stuff before. We don’t want anybody getting hurt, but it’s really helpful and really important. We also know that another menopause related effect are changes in cholesterol or lipids. We see this market increase in LDL cholesterol specifically associated with the menopause transition above and beyond the effects of aging. So if you had your cholesterol checked, when you were pre -menopausal, you’ve let it go for a number of years, you’re now post -menopausal, get it checked again. Let’s make sure that those are under control. Blood pressure, that’s more of an aging effect, is probably driven by some body composition changes as well. And just, you know, be on top of it, make sure that you’re getting your regular checkups,and if you’re prescribed blood pressure your prescription, your prescribed statin, whatever the case may be, take it. Take it as prescribed, it’s really important. – Right, and it certainly is, and it has been helpful. You know, I’m on a statin, and I take it, and it has helped tremendously. – Yeah, and of course diet, physical activity.
Now, in terms of whether things like meditation or stress management help with the blood sure. I don’t know that there’s a huge effect. I think there’s some effect, but nonetheless, really important to managing stress as well.
Many of us are really stressed out, pulled in a lot of different directions, overwhelmed. It’s tough and I totally understand it. It’s easier to say, you know, engage in stress management than actually doing it. But, you know, pay attention to that stress because it does have some biological impacts.

And then we can talk about sleep. Sleep is really important for cardiovascular health as well. Right, you know, and that is a… that gets a little trickier, but we definitely see women reporting trouble falling asleep, women waking up a lot in the middle of the night, women waking up earlier than they wanted to. Hey, it happened to me this morning. I’m the poster child for this stuff, so I get it. However, that the sleep problems, A, they’re really tough on mental health. We know that they increase the risk for depression, for anxiety during the menopause transition, but they also have this link with physical health. So we just published a paper this year actually showing that people who have persistent sleep problems over midlife,
so really kind of that go on and on and on for years. If you’re a bad sleeper and it stays bad or even gets worse during the menopause transition, those women are elevated risk for heart attacks and strokes as well above and beyond the effect of the hot flashes. So again, this is very gloom and doom, I know, but all I’m gonna say about this is sleep problems are treatable. You do not need to suffer, okay? And they’re very important for your health. There’s different kinds of sleep problems. There’s things like sleep disorder, breathing or sleep apnea. The cardinal symptom of that is snoring. And one of the things that increase your risk for sleep apnea is waking. So I see in my, when I see women clinically, I do see that people report waking, sleep disorder and breathing, then increases in tiredness, increases in mood changes, things like that. So get the sleep apnea treated. That’s also a very powerful cardiovascular disease risk factor. If you’re having just garden variety insomnia symptoms, trouble falling asleep, waking up during the night, waking up in the morning, talk to your doctor about that. It is important if it’s driven by the hot flashes, you can treat the hot flashes.
If it’s independent of the hot flashes, there’s very good treatments for insomnia out there, including non -drug treatments. There’s things like cognitive behavioral therapy for insomnia, brief behavioral therapy for insomnia.
These are all really durable, effective, as effective as medication approaches to managing sleep problems. Right and that is we hear from listeners all the time about the sleep issues and you know the the night sweats,
the vasomotor symptoms as well and then you know just the worry, the ruminating when you’re trying to fall asleep and you know we’ve heard about the setting your room at a cooler temperature for women having fans,
electronics. Right, keep all the electronics out of the bedroom. I know it’s hard to do, but really important that bed is just for sleeping sex. You don’t want to be doing, you don’t want to be arguing, you don’t want to be fighting, don’t be on your laptop, don’t be watching TV, all of that. Those are things that we do as part of CBTI. If you find yourself in the middle of the night, laying in bed, ruminating for more than half an hour, get up and get out of bed. We really want to train the body and the mind to see the bed is for sleep and sex and that’s it. We don’t want to be doing other things there. The other thing is when I hear a lot about rumination, so my clinical practice is primarily psychotherapy for menopausal women.
And I hear a lot about sleep problems and I hear a lot about anxiety and a lot about rumination in the middle of the night. And so we do things to help women manage their worries. And that includes scheduled worry time,
that’s not bedtime. And other times we do things like journaling, we do meditation, we do various relaxation exercises.

So there’s other things that we can do to manage the cognitive, the C component that CBTI, which is the rumination, the worry, the planning in the middle of the night, waking up at 3am, you know, doing your to -do list, right? We all do this, but there’s ways to mitigate even that component of it. That is great because that is such a big issue,sleep, and then that also lends itself those problems to cognitive issues as well. – Absolutely. – Yeah, I would love to hear about the work with Ms.
Brain as well, because that is a big issue too. – Yeah, so when we were doing this work around vasomotor symptoms, sleep problems in women’s cardiovascular health, my dear friend and colleague, Pauline Mackey,was doing work around vasomotor symptoms and neurocognitive or cognitive health and seeing exactly the parallels that we were seeing with the cardiovascular system, she was seeing with cognition and women’s memory performance in particular.
And what she was finding is that women who have more vasomotor symptoms, more hot flashes particularly at night, and those objectively measured hot flashes, those women had poor memory performance just on cognitive testing.
We also know that women, the one cognitive domain that really changes during the menopause transition that we see in multiple studies are changes in verbal memory performance. So that means memory for things like names for words,
right? You know what that word is and you kind of can’t remember it and you are dancing around it with all the words around it, like that’s like a menopause thing. Also memory for lists, nobody’s going to remember their shopping lists anymore, that’s fine, write it down, right? So those are the kind of things that we see with the menopause transition. We think some of that bounces back. We’re not 100 % sure. We think it does. Okay, so independent of the menopause effect, Dr. Mackey was doing work with hot flashes and cognitions similar findings for verbal memory. So we teamed up to say, how are these cardiovascular and brain related things connected? They’re happening in parallel. and what if we imaged the brain? So we took the Ms. Heart ball participants, also recruited some other participants from the community and had them all undergo neuroimaging, as well as their hot flash measurement, their sleep measurement. And what we found was that women with more vasomotor symptoms, more hot flashes, nocturnally, so during sleep at night, these women had more weight matter hyperintensities in the brain. So those are markers of cerebral small vessel disease.
So basically what we were seeing in the periphery in the other vessels of the body with hot flashes we are also seeing in the vessels of the brain. So and again it was those sleep hot flashes objectively measured not driven by sleep itself.
We also measured sleep objectively. we found that these women with more of these motor symptoms nocturnally also had greater circulating amyloid in their blood. So that is a marker for future risk for Alzheimer’s disease.
I know this is a very serious problem. I know, I know. So, so yes, we also saw it with what we call Aveda 4240. Now that’s not a direct one to one, it doesn’t mean you’re going to get Alzheimer’s disease. But it definitely tells us that there’s some brain related changes happening with the menopause, as well as these links with hot flashes. We also saw that the sleep problems and the pin of the hot flashes were also associated with these white matter hyperintensities in the brain.
This was not explained by things like estrogen or other hormones.

When we think about menopause, oftentimes people default to thinking about hormones, hormones are important, they’re not the whole story and then the one optimistic note of all this with the hot flashes is that there is some data to indicate that if you treat the hot flashes the degree of improvement in the hot flashes is directly related to the degree of improvement in memory so we are starting to get closer to be able to provide some recommendations there Now that treatment that was tested was something called Stela ganglion block. That was the novel non -hormonal treatment for hot flashes that was in a clinical trial. It’s not yet FDA approved or anything like that for hot flashes, but it did start to get us a little bit closer to maybe if you do something to treat these things, it can be helpful.

How is hormone replacement is that helpful or just menopause hormone treatment? Is that helpful for this? But it’s you’re saying not necessarily estrogen drug. I mean, I will say this about hormone therapy. I have a story about hormone therapy in my experience in the field. So if you have a minute, I’m going to go through this. Okay. So, you know, when I started this work way back in the 90s, this was, this was when the era when we thought hormone therapy was the panacea for all the algae. So it was good for bone. It was, we thought it was good for cardiovascular health. We thought it was good for the brain. We knew it treated your hot flashes. We thought it was great for skin. We thought it was great for maintaining weight. I mean, we really had, you know, in some ways, in retrospect, the field had a little bit of an over -enthusiasm, right, for this, thinking that anyone medication could do all these things. But nonetheless, that was the thinking. And when we finally did studies called the HER study and the Women’s Health Initiative, these were studies designed for the primary or secondary prevention of cardiovascular disease with hormone therapy to test whether hormone therapy helped prevent a first heart attack or prevent a recurrent heart attack after you’ve already had one. WHI was also designed to test the effects of hormone therapy on the brain, the sub -steady to the WHI called WIMS. It also was to look at whether it prevented fracture. We already knew it treated the vasomotor symptoms or hotlashes. So that was the WHI. both the HR study and the WHO and the big debate actually was whether it was ethical to randomize women placebo for those studies. We were so convinced that this was going to do all these wonderful things. We were not there. Then, lo and behold, in the early 2000s, 1998 was the HR study, around 2003 was WHO We found that lo and behold, it not only did not prevent heart disease or dementia or brain aging, it actually, for some women, the older women in the WHO, it increased your risk of heart attacks, strokes, and the brains did not look better. So it really shocked the field.
And then everybody, the media had a field day and the way the scientists related to the media was probably not optimal in terms of how to translate science for the public. And really what ended up happening is a lot of headlines about hormone therapy not being the panacea, but kind of switching to being the poison. And everybody got terrified. There was also a risk that we found of breast cancer with hormone therapy, the combined estrogen and progesterone formulation formulation that was being tested. Everybody goes off hormone therapy, with all these women without fashions running around, and they’re not being given anything, right? And that’s not okay either. And there was a lot of fear about giving hormone therapy to for midlife women, which the WHO was really designed to look at disease prevention. So it enrolled older women on average, who are gonna go on to have those diseases in the follow -up period of the study. So anyway, the pendulum swung. Now, a recent paper just came out last week, the field has been slowly moving towards a more balanced perspective. That is hormone therapy for vasomotor symptoms. For most women, if you don’t have a lot of contraindications such as clotting disorders, breast, personal history of breast cancer, things like that, you got to do a workup with your provider, your healthcare provider, but for a lot of women this is going to be a reasonable choice for treating hot flashes.

We also know that hormone therapy helps protect the bone loss that we do see during the menopause transition, there’s other ways to do that as well. And that was something we learned from the DHI, we actually already probably knew that before the WHI, but that was one of the other things we learned. So, okay, so hormone therapy, effective for hot flashes, not gonna cure everything, it’s not gonna prevent heart disease and dementia. Okay, so I think that’s what we have learned, but we shouldn’t be denying women treatment of their symptoms. It’s really, suffering is overrated. Women deserve treatments. Okay, do we know whether treating the hot flashes with the hormone therapy is going to prevent these adverse outcomes that we’re seeing with the hot flashes? We do not know that. And if anything, in the WHOI, the reason why we started asking this question is that there was what we call post hoc analyses, so ancillary analyses after the main trial results that came out that showed that women who were the older women who were randomized to the hormone therapy arm who had vasomotor symptoms, those were the women at highest rates for cardiovascular disease events. That’s why we started to ask what’s going on with the underlying task structure of these women hot flashes. So that’s all to say, I wouldn’t jump to saying that treating hot flashes with hormone therapy is going to be the answer for all this.
We don’t know. We also, however, do have non -hormonal approaches to treating hot flashes. There’s two other FDA -approved treatments for hot flashes. One is Paxol or Paroxetine, not as effective as hormone therapy, but for many women it can really help. Also a new drug called Veozah was just FDA -approved last year. So there’s options, and I hope that we’re going to have more options as well, all from a new class of drugs called neurocontinue three receptor antagonists. They’re in clinical trials right now, other drugs beyond just Veozah, so just stay tuned.

Right, and you know, that’s something we hear from so many women too is just the, well, first of all, they go to their physician that probably hasn’t been updated or knows everything that’s going on in the world of hormone treatment and menopause, because they’re so busy. I mean, there’s, yeah, they’re so busy. – All the things, and this is a fairly fast moving field. Also, there’s different, a lot of different formulations of hormone therapy right now. We’re not using, all using premarine like we did way back in the day. So there’s a lot of different options, a lot of different routes of delivery. It’s not just pills, it’s patches, it’s, you know, suppositories, it’s a lot of things like that. So, yeah, I mean, one of the ways that you can find somebody who’s trained in this kind of stuff is to go on the Menopause Society’s website. This is a scientific society. It’s not a profit -driven thing. It’s nonprofit. There’s a directory of providers that have been trained and undergo certification from the Menopause Society in menopause care. And those folks should know how to do hormone therapy, the nuances of hormone therapy, as well as how to do a really good risk assessment,
which you need to do. You need to know if you have contraindications for hormone therapy. And I’m talking about systemic hormone therapy, which is a different thing than topical. When you’re using,
for example, for your genital symptoms, things like vaginal dryness, your doctor may have given you the vaginal estrogen, that’s a different thing altogether, much less systemic absorption there.

Right, and so we’re not at work for things like that. And from what I’ve heard from different physicians, that is typically safe for people who are breast cancer survivors,
is that correct, topical for like urinary tract infections and things like that. Is that correct? – It can be. I mean, that’s something you wanna talk to your doctor about,
your gynecologist, your oncologist, depends on the dosing, it depends on, you know, the type of breast cancer you had, et cetera, et cetera. But many physicians are comfortable prescribing topical estrogen,
but again, that’s something to really talk to your doctor Right, right. And that is something that is very confusing to a lot of women, but we love the menopause society and you were president of that is that.
Yes, and yeah, formerly known as NAMS and something that I wasn’t even aware of when I was transitioning through menopause and until we started doing this podcast.
I found out about it and anytime we get a and I immediately just do a link to Menopause Society’s website because, yeah, I mean, you just, you can find them in every state, a provider in pretty much every state in the United States. So it’s a great resource to have. And we are very thankful for the Menopause Society.

I wanted to talk about mental health, especially during this time of life. And, you know, your and really covers so much. So can we talk about mental health during this time of life?
– Absolutely. Yeah, so I am a licensed practicing clinical psychologist. So I do see women for menopause, midlife women essentially, for mood anxiety issues during the menopause transition and life transitions, right? ‘Cause this is not only a hormonal reproductive transition, this is also a life transition, it’s midlife, and there’s a lot of things going on in women’s lives. But when speaking specifically to menopause, what our science has shown, so here in the Pittsburgh site of SWAN, we also had an ancillary study called the Mental Health Study,  and what that study did was interviewed women every year with a diagnostic interview to be able to diagnose depression every time that women came in for their swan visit.
And what that allowed us to do was address this question of is the menopause transition associated with increased risk for major depressive disorder? Because we have a sense that there’s mood -related changes with the menopause transition, but there was a lot of debate in the field about this. And there still continues to be some debate, but there was a lot of debate. So this really helped us clarify, is the menopause associated with risk for depression?
And the answer is yes. So we saw about a 2 .5 increase odds of having a major depressive episode during the peering menopause and the early post -menopause.
So that’s, you’ve had 12 months of no menstrual cycles, so it’s first year or two, that’s a really big window of risk as well. So we saw about a fourfold risk there. So So, or odds, which is sorry,
deepen the weeds with the stats here. But basically, there is an increased risk. The women who are most at risk are those who have had an episode in the past. With depression, we know that the typical course is that you first have an onset of a depressed episode if you’re at risk during late adolescence and early adulthood.So that’s usually in your late teens, early 20s. That’s when you usually see your first episode and then women go on to have recurrent episodes throughout their life and mid -life of the menopause transition is really a time of vulnerability to a recurrent episode. However, there was a subset of women, 25 % of the women or so, in the study who had a new onset depressive episode during the menopause transition. That surprised us because that’s a less typical course,but we now know that that can really happen. And it’s the people who are having lots of sleep problems, lots of hot flashes, having major life stress are going on. I see clinically a lot of divorce happening during this time.So it’s things like that or a major health event that happens. So those are the things that really put women at risk for one of these new onset depressive episodes. I also see clinically we have less strong data on this research -wise, but clinically I see a lot of anxiety, a lot of anxiety.

And we also see the anxiety and depression together. These things tend to travel together. So this is all to say this can be a time of anxiety, depression for women, also things like brain fog. I see a lot of that. And I would say the message here is to, again, suffering is overrated, do not try to suffer. We know that the people who did not get treated for depression in some of these, in our studies, they go on to have other recurrent episodes during midlife, so we want to treat the depression. And this can be psychotherapy or pharmacotherapy or for some people both. Psychotherapy, meaning talk therapy, finding a good clinical psychologist or therapist, ideally who knows something about menopause. There’s not a lot of us, but ideally who knows something about menopause. And then for pharmacotherapy, that’s things like antidepressants. And that you’ll talk to your physician about your PCP, your psychiatrist, your gynecologist, people like that will be able to prescribe those antidepressants and if there’s something that’s worked for you in the past that you know um a specific antidepressant it’s that’s usually what they’ll try first but don’t be surprised if you need something different.
Our biology has changed during the menopause transition and sometimes we need to do something a little different. Right and to not give up you know that is some people right they try once and they said that didn’t work and they don’t try to find another solution because everybody’s different and what works for one person may not work for another person. Be careful, however, if you’re experiencing anxiety and you start taking things like Xanax or a class or Valium, the class of drugs called benzodiazepines, those are kind of addictive, so we don’t want to get people on habit -forming kind of drugs. Your standard antidepressants like Axel, Prozac, from SSRIs or SNRIs as class,
those are not habit forming. So just be aware that, you know, we don’t want to be starting to get into a habit forming loop with these anti -anxiety drugs. Also with therapy, if you don’t meet somebody you like right away, try again. Sometimes it really has to click and it’s okay if you meet your therapist once or twice and you’re just like, you know, I’m not feeling it with this person. It’s fine. Move on to somebody else. You want a good, strong therapeutic relationship to really be able to make progress. And then tell your therapist the truth. Don’t try to hide things from your therapist. It doesn’t work in terms of the therapy, right? So you got to be honest. It doesn’t matter even if it’s stuff you’re ashamed of.
Let me tell you, as therapists, we have likely heard it before. It’s very hard to shock us. So be honest about everything that’s going on. Other things to think about, like I said, the sleep problems I find, if we can head off for people who’ve had history of depression in the past, they’ll start to get early warning signs of another depressive episode. Pay attention to those warning signs. And for some people, it’s persistent sleep problems. So we want to go after those to head off a depressive episode if we can. Other things,if you find yourself using substances, like you’re drinking a lot more wine to help you maybe fall asleep, which tends to backfire in the long run, you’re starting to use a lot of cannabis, whatever the case may be, be really honest with your therapist about that as well. We do see that during the life particularly with women. Yeah that’s so important too because so many women are so embarrassed about things like you said or ashamed but that’s why you’re there and they’re there to help.

That is so important just to get that message from someone in the field to hear that and I just I can’t thank you enough for the work that you’ve done and the work that you continue to do for women’s health. It is so important and has been so pushed aside, but things like the swan study and just the depth that it’s done into and the subsets and all of the different backgrounds of women that have been studied in this field. It’s amazing.
It needs to continue. I’m so thrilled to see it’s getting attention. Women’s health is getting more attention and there’s still so much that needs to be done.

There’s one more thing I want to leave us on a down note because I will say this is both from my personal experience, from my clinical experience, I’m trying to do a little bit,get our research studies to address the positive side of midlife aging for women. It sounds like this is all blue and blue and that the menopause is terrible. I will tell you, I think midlife is an incredible time for women. This is a time that I hear people telling me about feeling more self -confident, feeling more authentically themselves, not worrying as much about what other people think about them. And I think that, and just feeling, even though people are having symptoms, they may be having life stressors, there’s also an increased kind of self -awareness and resilience that’s there. And we want to, as providers, help support that, help celebrate that, so decreasing the negative and increasing the positives to really help women make it through this midlife transition and really harness what’s great about it. So I just wanna leave us with a little highly cleanser that this can be an incredible time. And for those of you, maybe who are not there yet, who are looking at this with trepidation. It’s every woman I talk to in the 40s and 50s says, I love being this. I would don’t want to go back to my right. Absolutely. Yes. Yeah. This is an incredible time of life. I think for women that we can celebrate.

Well, we agree. Colleen and I agree 100%. You know, we always say who wants to be on their period again. I don’t but Also, just the great, you know, this time of life, you’ve got 40, 30, 40 more years or more, hopefully left. And you know, it’s great, it is a great time. You know, right now, empty nesting has actually getting ready to go places. It is a wonderful time of life. And I’m so glad that you brought up that point. Yes, it is not all doom and gloom.
And you know, you always hear about the happiness curve and it’s like going back up. So it is, it is great. So that’s so important. But thank you so much for coming on the show today,
Dr. Rebecca Thurston. And guys, she has done the work, the background, the work, everything there all across the board. And it’s so important. Remember, Menopause Society is a great menopause .org.
Is that, I think that’s what it is. Menopause .org, just go to that. And thank you so much for being on the show today. I really appreciate it. –

My pleasure. And thank you for paying attention to this really important topic.
– Thank you.