DR. HEATHER HIRSCH: EPISODE LINK

BOOK: LINK

TRANSCRIPT:

Colleen: Welcome back to Hot Flashes and Cool Topics. We have on today one of our favorite guests, Dr. Heather Hirsch. Welcome back to the show.

Dr. Hirsch: Thank you. Thank you. Just two

of my favorite hosts. I’m so happy to spend the afternoon with you.

Colleen:  Oh, thank you. Yeah, we are so grateful because honestly, it’s funny back from when we

taped in your basement to now it has been such a wonderful experience watching you

explode in your journey and helping so many women and you have a new book coming

out but before we get started with that, I wanted to ask you about when you went and

spoke in front of the FDA about the black box on vaginal estrogen and you were

very eloquent as you always are but can you talk about that experience and do you

think it’s going to make a difference?

Dr. Hirsch: – Thank you for asking about that. It was

actually one of the most nerve -wracking experiences for me and I have been on some

really cool stages and met some really cool people.

I’ve gotten to do so many

amazing things. Met amazing people, been on some amazing stages, but before that clock,

you know, kind of went and it was ticking down, I was really nervous. And it’s

interesting because I think that goes to show for me that the women who are

watching this movement are really so important to me. Like I really wanted to do a

great job. And being on that panel was something I was really proud of. And at the

time, you know, it struck me that this could maybe backfire if people think this is

something that I think is political, which of course I don’t. But you know what, I

didn’t think any of that should hold me back. The chance to really speak my truth

and talk about how important it is to keep women safe by taking that label off was

a wonderful, wonderful experience and opportunity. And I think that unequivocally all

menopause clinicians, specialists, even those who are not saying menopause is their

specialty, really all do believe that the box label warning should be removed from

the local vaginal estrogen. And I think we made that point pretty darn clear. Now,

as to what’s going to happen next, we weren’t given really any clue as to what

might happen next to the point where that was a reason some people didn’t want to

participate in the panel. And that’s up to them because they really wanted to

ensure that their time was going to be meaningful. But we were always told we will

see where this will go. So I am still waiting with bated breath to see where this

will go. But what a wonderful experience. Thank you to the hundreds of thousands of

women who watched that FDA panel, people messaged me, they were in tears, they were

so moved, they had goosebumps, we were changing the world. And so it was just an

honor to be on the panel and to be able to speak for all women.

Bridgett: – Yeah, I mean,

I appreciate so much, all of you that did this. I mean, you’re just, you’re

starting out, stories that were shared, the experiences, it really meant a lot to a

lot of women and it’s just gonna help a lot of women as well.

I just really appreciate everything that all these

doctors did to go up there for women and just say, you know, this is, this is

what is needed for women.

Dr. Hirsch: And it is, it really is. It was really special to get

so many different clinicians in different fields together to agree on how to just go

through that a lot of time that we had. And I think we did such an excellent job.

I think we knocked it out of the park and it seems to be the consensus that most

women thought, you know, who watched it or who men who watched it that, you know,

we really made the points. And I’m excited to see where it’s going to go.

Colleen: Do you find, but now that there seems to be certain, there seems to be a group of doctors that are really moving this conversation forward. Because you were one of the first

ones and you’re kind of doing it on your own, what’s it like now having kind of a

team behind you? With you?

Dr. Hirsch:  Oh, it’s wonderful. I mean, because now you can amplify

your voice

Um, you know, you can, you can really share those messages so you can cross

promote, but also what’s not only just helpful in that is that you can reach more

people is that the women themselves will now hear consistent messages from two,

three, four, five or so clinicians and even up from there on bigger podcasts or on

the news or on big shows. And so that’s really validating for women. And so this

really means that we can go from a small grassroots to making big,

big changes, both from the level of, you know, of course, for me,

it’s a lot of training. I think that’s so important. So having more emphasis on

training, and then upwards through professional societies.

We’re seeing, you know, just skyrocketing numbers of clinicians being certified by the

menopause society. This is all great. And then also when we have societal shifts

from things like, you know, whether it’s celebrities or it’s big media personalities

talking about these as well, these are going to create massive ripple effects that

will change the next generation. And that sounds so like, you know, so aspirational,

But I really think that’s achievable by having so many now voices and clinicians who

become, you know, friends and collaborate and work together. That’s what allows us to

achieve.

Bridgett: Right. And you know, I think back to when we did our first interview with

you back in like 2000 during lockdown.

Dr. Hirsch: Yes.

Bridgett: You were in your basement and look

what’s happened since then. And you’ve done so much since then. I mean, you’ve

written two books since then and your latest is coming out October 14th.

It is the Perimenopausal Survival Guide: Make Sense of Your Symptoms and

Build Your Personalized Treatment Plan. And I said to you earlier before we started

recording how I wish so badly something like this was out there when I was going

through Perimenopause because I was so lost. I didn’t know what was happening.

What made you feel that the importance of right now sharing these stories?

Dr. Hirsch: I jokingly have been referring to perimenopause as menopause’s little sister and some

of my patients called it menopause’s evil little sister and really menopause has

definitely had its moment and it still is to say that it’s not over or that we’ve

exhausted the topic, I don’t even think we’re there yet. Because there are still

millions of women who are just now learning about it. But at the same time, women

who are still having periods have not gotten to that final menstrual period.

This can span an entire decade. This can be a woman’s whole 40s.

This could be from 37 to 47. And a lot of similarities exist,

but enough differences exist that if you were in your 40s, you might have no idea

that this was hormonal. Because it’s easier to think menopause is for your mom or

your grandmother, right? It’s easy when you’re not there yet to think it’s so far

off. Of course, we know it’s not. And time is this mysterious little thing.

But I really wanted to help women, even before they got into the throes of

menopause, understand what could be happening to them. And I know you guys are,

you know, interviewing just incredible experts in menopause. And the sooner women can

start to piece together, how important those little sex hormones are that they do so

much more than just allow us to do breast milk and they were really actually

functioning from head to toe, from the brain, the brain fog, to the cardiovascular

system, the bones, and et cetera. The earlier they can see what hormonal impacts can

really change their health, the better. And so I had so many women read my first

book and kind of say, you know, and I think on this, I think, and I kind of tell

they felt a little lost. And I realized they were in perimenopause. So the menopause

type didn’t make any sense to them because they were not in menopause. They were in

the throes of perimenopause. And so that’s kind of why I really think that it’s

having this moment. It’s adjacent, but it’s still different enough. And it’s now

including women who may have not heard the term menopause. It may not be in the

quote menopause movement to really realize what’s happening. So, you know, we’re

starting to think about the women who are in their 30s and 40s who’ve never heard

these terms before and trying to educate them now.

Colleen: There are so many different

factors that go into perimenopause. And I think, you know, again, your book does it

beautifully like your first book did in really explaining and categorizing what the

different types of symptoms are. But I wanted to start with, I think a really

important thing is that you talk about in the book, you have to understand that

menopause is when your hormones are lower, but it’s kind of stable at that point.

Perry menopause is when you’re on the roller coaster ride of hormones and you don’t

know what day because I think there are women out there that think, “I’m just going

to go get a blood test and whatever my hormones are, I’ll know from there.” So I

love that you really talk about that in the book and could you explain it to our

listeners a little more.

Dr. Hirsch:  – Yes, so this is kind of the hormonal havoc that happens

in this stage. And there’s a couple of things that are happening. So you’re right,

in menopause, they’re low and they’re steady. In perimenopause, your estrogen, it’s

lowering, but it’s also very volatile. So it’s bouncing around. This is why you can

have breast tenderness and cry at the drop of one moment, and then feel like the

Sahara Desert the next moment, like there’s just sort of no rhyme or reason, and it

can really make women feel, you know, like, like you’re going crazy.

And I hate to say that because I do not think that that is what’s happening. But

as someone who has now experienced this herself, I get that feeling of like, what

the heck’s happening to me. And the progesterones also is just beginning to lower. So

this is when anxiety and insomnia can spike. I have had my first experiences of

perimenopause even just the last week. I’ve woken up at the 4 a .m. waking in with

anxiety for no reason, no reason. I think maybe my sleep’s getting a little lighter

because my progestone’s declining and so I’m thinking and I’m waking up and I’m

feeling anxious and I just kind of hold my heart and hold my belly. But, with

perimenopause, because so many women are experiencing this hormonal havoc, they’re

still bleeding and their doctors say you’re too young for menopause, they’re thinking

do I need to go to a psychiatrist, do I need to get on antidepressants, do I need

to, you know, do CBT, do I need to see a sleep medicine specialist,

do I need to see my primary care? And that’s kind of how this whirlwind then

starts to go. And it could be for many women the first time that they’re actually

utilizing the health care system outside of pap smears and babies and it can be

really scary you both probably remember.

That’s what perimenopause can lead to if we don’t know what hormonal havoc is

happening is misdiagnosis and mistreatment or maybe overtreatment or under treatment

or the wrong treatment And it’s such a big deal. But again, menopause can be

crystal clear. Ah, okay, no periods in 16 months. This could be menopause.

Even a doctor who is just learning about menopause, ’cause we’ve been talking about

it, can piece that together. But perimenopause can be such a different beast ’cause

of that hormonal havoc you’re still having periods. And sometimes they’re heavier.

Sometimes you’re missing them. I actually hope that like one of the ways you know

you’re in perimenopause is you get a pregnancy test even though you

you know your partner is on the other side of the room you haven’t seen them in two

months. But you’re like why did I not get a period? This is your entry into

perimenopause.

Bridgett:  So there’s so much in this hormonal havoc that’s so different than

menopause and that’s something I love about your book. I mean, you’ve divided it up.

You’ve got three parts. And then each of those parts have different chapters. And I

love that you include, you include myths, you include what could,

what not to use, what to use, and things you can use at home.

I mean, you do every single chapter. I love that. And then the myths are so great,

even though I’ve gone through this already, but when you hear these myths that

people say, and I love that you addressed that there is a lot of misinformation out

there on social media and you really want to help women find the safe,

right path for it. Can you share some of the myths that just drive you bonkers

about this?

Dr. Hirsch: Oh my gosh, there’s a lot of myths, but you know, a lot of the myths

actually come, I think, from the healthcare profession, which for example you touched

on is the lab work, right? So there is a myth that lab work is helpful,

or that it will solidify a diagnosis. Now, both of you have been in this field

getting your MD degree, (jokingly, Bridgett & Colleen are not MD’s) and so you both know, of course,

there’s no lab test that would rule in a rule out perimenopause. But it’s

important to say again, because we’ve got a lot of direct -to -consumer lab tests or

companies that are trying to help women diagnose themselves, but a lab test can’t

diagnose you with perimenopause. Now, I might still check labs for my patients, and

that’s individual, and that might help us kind of get more data. But that’s a big

myth that lab testing can tell you if you’re in perimenopause or not and a lot of

clinicians will actually perseverate that myth. Another big one is that you’re too

young. This myth drives me absolutely bonkers and I see women in their 20s,

30s, 40s, 50s, 60s, 70s. Now there’s lots of reasons I see younger women.

Sometimes I’m seeing them now for PMS, PMDD, which is PMS on steroids, PCOS and

infertility. I mean, most of the time I’m doing perimenopause and menopause, but you

can have perimenopause early if your menopause is early. And so there’s no such

thing as you are too young. You have average ages because we need to know average

ages as physician’s protocols can be helpful. But the more we’re learning about this

topic, the more we realize maybe the average is even not correct. And so you can

never be too young. So, you know, to that point, it’s always like to be actionable.

You know, start journaling and tracking if you’re even either a woman in

perimenopause or you’re in menopause, but you have friends, colleagues, girlfriends who

are in perimenopause. Start journaling and tracking your periods and your symptoms.

What makes them better? What’s making them worse, i .e. red wine and all

the things that we normally like. But that actually gives you ammo to say I’m not

too young. These symptoms are real. These are happening. And so that’s another myth

that really bothers me. And then lastly, you know, that you have to wait until

menopause to start menopausal hormone therapy. Now, the term of course is confusing,

right? It’s menopausal hormone therapy and here’s Dr. Hirsch saying, “You can use it.”

But that’s a big myth. So a lot of women are left to suffer. Their doctors are

told, “Well, we can’t start that until it’s been 12 months of no period.” That

could mean X years of absolute tornado of symptoms.

And that couldn’t be farther from the truth. So I do spend a majority of the book

kind of breaking that down. And how I do prescribe menopausal hormone therapy. I was

very clear on those definitions at the FDA panel for women in perimenopause. So

that’s just the tip of the iceberg. There’s three myths that still really bother me.

Colleen: And I think, you know, again, you also created this collective that you’re doing a

collaborative where you’re educating doctors because so many women will email us and

say, but I don’t have a doctor near me. I don’t, I, you know, the doctors in the,

that are certified are nowhere near my small little town. So can you talk a little

bit just as a side on your collaborative and why it’s so important, why you love

doing that?

Dr. Hirsch: – Yes, you know, I think of myself first and foremost, honestly, as a

teacher. And even my patients, the women that see me, I would say we spend, yes,

I help diagnose and prescribe, but a lot of times I’m teaching what symptoms are

normal? Why do you expect them? Why will this medication help? And that really also

extends into teaching for healthcare professionals and women. So I also started

teaching how to prescribe and manage menopausal hormone therapy because at the time

when I first saw you, there was probably maybe 1,500 clinicians who were certified

by, let’s say, the menopause society. Now, I mean, these numbers have skyrocketed to

over 10,000. And so I really wanted to ensure good treatment with FDA -approved

hormone replacement therapy because so many women were put on pellets or unnecessary

medication. So I’ve now trained probably north of 2,000 healthcare

professionals, whether they’re nurse practitioners, PAs, MDs, DOs, I’ve got

psychiatrists, I’ve got emergency room doctors, surgeons, and really what a gem that

has been. And so if you are looking for a clinician, you can use the Heather

Hirsch Directory. So that’s HeatherHirschDirectory.com that lists everyone who’s taken

my class, which means, of course, we have autonomy to prescribe, but they have sort

of understood the philosophy of how to prescribe and why and the safety of

menopausal hormone therapy in both perimenopause and menopause. And then,

you know, my practice has now increased to have 12 clinicians to take care of

women. And, you know, what a joy to be in this time.

Me and Bridgett were talking about that, you know, what a wonderful time to see so

much energy and focus and support for midlife women’s health. And I wake up every

day and I think how cool is it that I get to talk to you today, do podcasts,

teach, work with the best minds and help move women’s health forward. So teaching

has always been my favorite thing and I just love being a part of building the

next generation of not just clinicians, but really I hope I’m helping create thought

leaders in this field.

Bridgett: Absolutely. And we need that. I can remember that first

podcast. I remember you saying that because you had just opened the women’s

clinic, Brigham Clinic in Boston. And I think I remember you saying there were maybe

30 at the time. I remember that. Yes, that really stuck out.

I remember thinking, this is, oh my gosh, something’s got to happen and it’s

happening. And I also really liked in your book that you talked about just all the

different types of menopause hormone replacement for perimenopause. Things

about IUDs. You talk about the different types of IUDs and what has

progesterone and what doesn’t have it. And then also people are very concerned about

pain. Can you address a pain involved with inserting an IUD but you talked about

something else that helps, yes, so, yeah.

Dr. Hirsch: – I’m glad we’re talking about this.  You know, we’ve seen this be

published in big media as well as, you know, this procedure of an IUD placement and

ignoring women’s pain, which historically doesn’t bode well, because we have ignored

women’s pain and suffering, i .e., the menopause movement, right? It’s been for far

too long. And one of the barriers I see for a lot of women for IUD insertions is

the fear and the pain, and that’s completely valid.

Why I like to break down what we’re doing and how we can reduce that pain is

because for many women, not all, and again, I always like to present women with

lots of different options, but in perimenopause. When you’re dealing with a lot of

heavy bleeding, which can lead to its own set of symptoms, but you also have

symptoms of the hormonal havoc, sometimes being able to stop or slow the bleeding

can really help overall the quality of life. Sometimes if there’s progesterone

intolerance, an intrauterine device can be helpful because the progesterone is not

going to the whole body, it’s just going to the uterus. So removing pain as a

barrier is huge. Now when the procedure is done,

you can numb the cervix. The cervix is what has the nerve endings, but the IUD

sits in the uterus. The uterus actually doesn’t have a lot of nerve endings. That’s

why you could be pregnant if you’ve ever been pregnant as a woman. It’s not

comfortable every day, but it’s not a burning pain all the time because you actually

don’t have a lot of nerve endings in your uterus. The cervix, on the other hand,

is very sensitive and does not like to be touched. You could do a cervical block

where you numb the cervix to be able to place the IUD. Now, interestingly,

the historical, because I was an OB /GYN intern, and this was 15 or so years ago,

and I had learned, well, the numbing of the cervix is painful, so just skip that

and place the IUD. Now, I’m not sort of kind of putting anyone under the bus here,

but that was sort of the thought process. Now, I equate that to a cavity is

painful, but so is the numbing. So just skip the numbing and go straight to

drilling the cavity. Would you want that?  Even though, now these

might not be perfect examples, but if you’ve ever had a cavity, you know that that

needle, it’s a little painful, but you’ll sit through that because then the rest of

the procedure is less painful. And so you can numb the cervix as well, which is

the organ that really feels the sort of more of that acute pain of the IUD

placement. The other thing is you want to make sure it’s placed correctly and that

has to do with experience, which now we’ve gotten a lot more time placing IUDs.

And so if we can remove a barrier like the fear of the pain of the insertion,

that’s something that healthcare professionals can do and it’s something patients can

ask their doctor if they want to have an IUD placement say, you know, will you be

able to ease the pain by either numbing my cervix or a cervical block?

Colleen: I think the second part of your book, when you’re kind of choose your own adventure, it’s really

important that a lot of women don’t know which symptom is the worst. Like, you

know, they’re having three or four symptoms. It goes into different categories Can

you talk about the 75 % rule, which was helpful in reading it, but can you talk

because women are going in with these, sometimes they think unrelated symptoms,

but they’re actually very important to know.

Dr. Hirsch:  You know, and the way I kind of do

this and the way I was really encouraged to write it, is what do you actually, what

do you do with your patients? Since I still see my patients every week, in fact, I

saw two patients today. And so what I really kind of help them do is first think

about, is there one symptom where if you think that’s better, it could potentially

help ease up the other symptoms. So for a lot of women, it’s sleep, they’ll say,

you know what, if my sleep gets better, I bet maybe my mood would get better,

maybe the less brain fog, maybe less snacking, maybe the weight. And we’re like,

okay, Let’s hone in on that symptom. I like to kind of ask them what symptom,

if we got better, would help all the other things. Or another way I’ll say this

is, I’ll say, if I had a magic wand, ’cause now

most people know I don’t, and I could, you know, alleviate one symptom, the most

bothersome one, what would it be? And for everyone, it’s different. Sometimes they’ll

say it’s honestly the libido and the pain because my intimacy and then the marriage

and then the fighting and then the kids. So everyone’s really different. So I have

them help pick out the one symptom. Then a lot of women who come to me, we’re

thinking about using menopausal hormone therapy or it may not be MHT. That is not

the one and only thing I prescribe. But let’s use that because we’re still kind of

on this wavelength. And lots of times we’re using this as a diagnostic tool as well

as therapeutic. What do I mean by that? Well, let’s say they’re like, maybe it’s

the joint aches and pains. And they say, if the joint aches and pains would go

away, I wouldn’t wake up as much in the middle of the night. I would sleep the

night, I would get up earlier, I would go on my morning run, I would see my

friends, I would be social, I’d be more productive, and we’re thinking, okay, great.

But she’s thinking, I’m, I, I don’t know if this is hormonal. So okay, that’s the

first thing. hormone therapy and see if it’s both diagnostic, it

rules it in or rules it out. And if it does, then Colleen, I want my patients who

are using hormone therapy to be at least 70 to 80 % better. That’s always my

benchmark as a clinician. And you know, doing this for the last 10, 12 years, it’s

definitely achievable, particularly once we’ve rolled in. Ah, yes, it is hormonal. I

had one patient who was going to go to Mayo Clinic if it wasn’t hormonal.

And for her, the menopausal hormone therapy didn’t help. Now, while she was like,

“Darn, I wish it would,” she felt a lot better doing that extra trip to see that

specialist, because common things happen commonly, perimenopausal will happen to

everyone. But for just as though I have her, my one patient who did go see a

specialist, eight out of 10 actually found that the menopausal hormone therapy was

really effective. They canceled their other specialists and that one thing then helped

the joint pains, then the sleep and then on and on, you can see how it goes from

there. And so that’s kind of how I actually write it and teach it in the book and

help you with some journal prompts and write things down. So each journey is so

individualized, but with just a couple of reframing and prompting and then working

with a knowledgeable clinician, you can gain so much valuable information before,

you know, a whole decade’s gone by.

Bridgett: Right. I mean, that second section was,

you know, just the different chapters, things that I never thought about when I was

going through perimenopause and the bleeding

till you drop. I thought, oh my goodness. I know that when I went to just my

regular primary care physician, I didn’t know that my periods were going to get this

heavy. I have nine sisters. Eight of them are older than me and they did not tell

me that they were going to be like this. Like you’ve described a woman that was a

teacher in your book and I was a teacher and I I’ve said this before on our

podcast, I was on a bus, on a field trip, just bleeding through everything. You

know, luckily I had dark jeans, but I mean, it was terrible. It was absolutely

terrible. And then I thought, well, my goodness, I might have been anemic. After reading your book, I’m thinking, “Oh, my

goodness, these are things that could be happening to you.” And you also talked

about the four pillars of health and how all of this kind of ties into the four

pillars of health. Do you mind sharing what those pillars are and how that is so helpful in this

time?

Dr. Hirsch: – Yes, and I hear you on the bleeding and again, this is a topic that’s not

in most menopause books because mostly menopause is characterized by your

bleeding being done. Now, there is some touching on, you know, bleeding after

menopause, but this heavy, heavy bleeding really impacts our health,

just like you said in so many ways. And, you know, one of the other things I’m

also realizing as I’m going through perimenopause is it’s not just about, you know,

treating the, it’s not just about hormone therapy in a way, or it’s not just about

what’s the one medication. I mean, as a clinician, yes, I definitely think about

that a lot. And patients often need that before they can start thinking about their

mental health and their nutrition, just because you got to feel at least a little

bit better before you start, you know, meal prepping. But it is really about the

whole picture. And even at the collaborative, which is the telemedicine practice,

we’ve included wellness partners because my four pillars of health is so important.

I even want my patients to experience this. It’s not just for my books, it’s really

how I treat patients, which is just such a beautiful thing. So, you know, the four

pillars is your mental health, your nutrition, your movement or exercise,

but I like the word movement better and your sleep. And we really address these

holistically and I address some in the book because once you get to 70 % better on

your treatment, or that’s my goal, you need to also then start including these

pillars and forming these good habits now, and that is going to set you up for

just wonderful next chapter. This is really this crucial moment where we can reform

habits. We have a lot of neuroplasticity. As you know, you’ve talked with Lisa

Mosconi. There’s lots of neuroplasticity around this time as well. And so it’s like

a wonderful time to form new habits, get rid of the ones that don’t serve us and

add the new ones in. And I’m just so excited that I, you know, bring this to

life, write it in my book and I can’t wait for people to read it and sort of see

how I really get to help women navigate all of these things.

Colleen: And again, it is so comprehensive. Just like your other book, you really, you talk about the

history behind why women are afraid to take menopausal hormone therapy. And it’s so

important for women to understand that because we’re now getting into a generation,

what do they call it, millennial pause or what are they going to do? They’re not

even going to know about what happened in the early 2000s. So it’s really important

that they remember and they learn about what is happening now and also adding the

element of fertility, which is not something that we had to deal with because

usually we were done by then. But you talk about that in the book. Can you go a

little bit into detail about the fact that some women are just starting their

journey on having kids and perimenopause is right at the door?

Dr. Hirsch: Yes. Oh, my goodness.

You know, you guys are remembering some of the best parts of my books. And I’ve

seen, as the years have gone on women who have children later in life. I’ve had

three geriatric pregnancies. So I understand that. And some women are utilizing,

you know, assisted reproductive technology, so IUI or IVF to have their miracle

babies. And, you know, when you’re later in life, what is the stressor that might

put on your ovarian reserve?

‘Cause I see a lot of women go from IVF to postpartum to perimenopause overnight

and so I address a lot of that. Could it be that? How do you know if it’s

postpartum versus perimenopause? I have been actually talking about this over on my

Instagram or I’m going to start talking about this topic as well and even the fact

that for women in perimenopause who had their sight on their miracle baby,

menopausal hormone therapy is only helpful. It might not be the full treatment by

any means, but it actually can help to kickstart some of that ovarian reserve as

well. If you’re already in perimenopause or you’ve already been told, gosh, your

chances are low ’cause you’re in your 40s or whatever the story might be. And so I

wanna clear up some of these new questions that are coming, that I’m seeing online

in my DMs for my patients about this time. And so I get to clarify some of those

things in my book and some of them are still left to be researched ’cause no

surprise to you two, we don’t have enough research, but it is something I am seeing

a lot. Now, I do wanna say that could be like the biased that those patients come

to see me. So there could be many women who do IVF and then have a baby and

they’re great and they don’t have these symptoms for a while. But for the women

that do, I do wanna help them. And I am wondering, is this more of what’s really

happening or is this just what I am seeing? And so opening this dialogue will be

helpful as well. It’s almost like, we’re starting to peel the layers off. It’s like

menopause became the focal point and now we’re going younger and older, right? And

it’s really interesting to see how we can use menopause instead of maybe what used

to be like pregnancy. In a way, pregnancy was kind of like the end of the story.

And now we’re saying, you know what, the focal point might be menopause, and what

comes after that, and then what comes before that, and sort of using that as sort

of a grounding place. Isn’t that cool? I mean, I’m just kind of saying that as I’m

talking about, as we’re thinking about all these complex topics, all the hormonal

changes that women go through. You know, I call perimenopause hormonal havoc. So was

IVF. And so, you know, there’s a lot of similarities and I want to help women

really differentiate so that they can be the best so that they can thrive, you

know, all of those things.

Bridgett: Right. And you also include that, hey, if you’re still

having your period and you’re cycles are slowing down, you could still get

pregnant. I mean, that is a very big point.

Colleen: you know, I didn’t go through menopause until I was 55.

That would have been my worst nightmare. Honestly, I used to kid my daughters that

they would have to raise the child.

You’d be raising the baby because that time has passed.

Dr. Hirsch: Yeah. You know,

you know, that is a funny thing to mention right after we talked about, you

know, um, wanting to conceive and being an older mom, the exact opposite could

happen. You could have your 3 .5 kids or 2 .5 kids, you know, and there’s many oops

babies. And that’s also a myth that you can’t get pregnant in perimenopause either.

So you know, I do talk about when should you think about contraception or how could

you treat your perimenopausal symptoms menopausal symptoms, or Dr. Hirsch is always

talking about menopausal hormone therapy. How do we do that? And also prevent

pregnancies. We already talked about one, the IUD. And so, isn’t it, I mean, I

think this topic is never ending and fascinating, and you can see how they all kind

of can come back to the same focal point of knowing what’s happening to a woman’s

body is something we haven’t historically done a very good job at. And we’re in

this wonderful place and wonderful atmosphere with these, you know, beautiful resources

and books. And like you mentioned, Colleen, so many people coming together,

forming, you know, friendships and connections across social media et cetera,

that it’s really helping to push women’s health forward.

Bridgett: Yeah, and I do love too that you include the appendixes in the book as well, like

things to take and what to ask, and that’s always so helpful because also I like

how you say, make a special appointment, don’t, yes, don’t include it in you’re yearly checkup, try to make a special appointment, tell

them this is what what I wanna talk about.

Colleen: – Right, ’cause most women don’t even

know they can do that.

Dr. Hirsch: Yeah, yeah. – Exactly, you know, I was just in Boston too.

And I said, you know, to this group of lovely executive women, yep, call the

doctors and say, “I wanna make a perimenopause appointment,” you know, or menopause,

or sexual health. And, you know, I really think this point is really key.

that women still, if possible, start with your OB /GYN or your primary care or your

family medicine doctor because that is doing something massively important. Just like

Colleen had asked me, if enough women do talk to their primary care, after eight to

15 women ask them about perimenopause or make perimenopause appointments, and they’re

thinking to themselves, “I need to get retrained in this. There’s that cycle of

love, then they’re getting the training that they need. And so we’re actually, as

the women who are laying the groundwork, really pushing the medical profession to do

better for women. So I love that. Make an acute visit,

just like you would call for pneumonia or sinus infection. You call and say, “It’s

perimenopause or menopause,” and you’ve got that 30 minutes where you’ve tracked your

symptoms, you bring them in, and that’s how you avoid those myths of you’re too

young, bring some resources with you, bring some of the incredible books, bring this

podcast, and you know, resources, you can always get a second opinion. There’s lots

and lots of options now, luckily for us. But something special happens when you

start with your clinician is we’re all just moving the collective forward. And again,

bring the book. Read the book, highlight the book, put little stickies where it

applies to you and be prepared. The best thing you can do is go in prepared

for that time slot so you have your questions. And now that we have the

information, we can ask the questions.

Colleen: I do also like in the book and I appreciated

that you talk about what you don’t recommend. Because I think of, you know, there’s

good and bad in in any conversation, and Bridgett and I have been on the end of

people saying, “Why are you saying this?” But there’s a lot of social media out

there that are pushing quick fixes for perimenopause and menopause,

and some people smell money, and they’re like, “I’m gonna go in.” So it’s so

important that women listen to podcasts like this to follow you on Instagram to read

the books. Does it concern you that there’s some information out there that just is

inaccurate?

Dr. Hirsch: Yes. Um, yes, yes. You know, it’s funny because I think for so many years it

frustrated me. I would lose sleep over things like pellets or, and some of the more

harmful stuff on the spectrum. Sometimes it harms you because you’re just throwing

money away, in which case, of course, that still bothers me. And actually, all sorts

of women then can really be hit by this, or all the way down to who is actually

harmful. So a lot of those things, I actually kind of unfollowed because I would

lose so much sleep over these conversations. So I think if it sounds too good to

be true, often it is. And I think, you know, I’m glad that you will notice how

important that is because knowing just what not to spend your time and money on is

just as helpful as what to.

Bridgett: – Right. And I love too that you also put for each

section that you put contraindications, things that could be. I really appreciate that

And it’s going to be good for another symptom or another issue, but something may

not be so good. So there, there’s just so many great things that are addressed in

here and things that women feel like the weight gain, the, yeah,

everything, they’re dragging yourself through life. I mean, just all of those things

in there, women have so many questions about and then they may not realize it has

anything to do with perimenopausal.

Dr. Hirsch: you know, I think that there’s a chance the three of us live in a bubble and I know

I do ’cause my patients tell me, oh no, I still hear this out in the wild

Dr. Hirsch. But, you know, for me, it’s probably even more insulated.

But to remember that there are millions of women who’ve never in their 41 years

old, they’re waking up in the middle of the night, like me with the anxiety. They

have no idea why this is happening. They’ve still never heard of perimenopause. Like

I really want to create a movement and really hope that the book is easy to read and

fun to read, something you can share and talk about amongst your friends so that

these women who are currently in their 40s don’t have to experience some of the

devastating years of neglect that women in their 50s or 60s have had.

And I’m just so, so excited to be podcasting with you to get the information out

there to be, you know, such a part of what you’ve grown as well. This whole

conversation’s really been just so wonderful. I have the biggest smile on my face

just talking about this topic with you both who care about it so much. And thank

you for helping be a part of really spreading this information to women who need

it.

Colleen: – Well, it’s been our joy to watch just your success because you really are

giving back by creating an environment for the next generation of doctors that women

are going to be able to, you know, take for granted that the conversation around

perimenopause exists that that word exists even because like Bridgett said, she didn’t

even know the word

Bridgett: I didn’t know what it was when I was going through it didn’t

know what it was hadn’t heard of it and I have eight older sisters

and they did that I’ve talked to some of them they did that on purpose

Colleen: what’s funny is I was when I was stuck on my plane today the gentleman who was sitting

in the aisle was like, I need to get this for my wife. So I was like, I’m going to interview Dr. Hirsch. She wrote a book. He’s like, I need to

get this book for my wife.

Dr. Hirsch: – Yes. – You know, that’s a great point, Colleen. Men

are problem solvers. They wanna solve a problem. They wanna help to solve a problem.

And they see this in their partners or their wives or their girlfriends or their

sisters. And they’re thinking like, okay, we’ve got a solution. And men can be the

gateway as well into helping us spread this information. They are excited because

then they’re like, “Okay.” Just like they’re, you know, now I always say, you know,

now they’re putting cribs together because they’re like, “Okay, I can do that, I can

put the cribs together,” you know? They’re like, “I can give you this book, I can

read it too, I can help with some of the language, I can come to the doctor’s

appointment with you so I can remember some things if you’ve got brain fog.” And

They’re really, really excited to help support their partners. And so I love that

you shared that story because they’re such advocates too. You know, we forget.

Colleen: And

they’re going through it.

Dr. Hirsch: They are. They have to live with the partner that’s losing

it, sometimes thinks they’re losing their mind and they can say, “No, remember this

is brain fog or remember this is your hormones.”

Colleen: And so I think it’s a great thing

for men to, much better than a vacuum

Dr. Hirsch:  You know, like, yeah,

like, you know, don’t respond to my rage, my short fuse, I guess. And then in a

few hours, just stay nice and calm. That’s better than anything you could ever do,

and then just hand them the book.

Colleen: And I have to say, I think your next book should be post

menopause talking, about that. Yeah, Bridgett and I are

finally post menopause. I didn’t think it was ever going to happen,

but, um, wow, what a difference when, and it really becomes a conversation on

longevity at that point.

Dr. Hirsch: Yes, exactly. Can you keep your health?

Colleen:  So I think,

you know, if we could suggest anything, we would say,

Bridgett: because you’re not busy

enough, you know,

Dr. Hirsch: you’re absolutely right.

I love thinking about this focal point of menopause instead of maybe women’s health,

the focal points, a gestation, it’s menopause. And what’s up here, what’s above,

what’s below? Because really, to me, now that we’re living into our 80s and 90s,

menopause is technically the middle of the focal point, right? That’s where you can

kind of actually use as a much better timeline than other things. And women, I love

this, I’ve always kind of always called myself, instead of being an

internist, I always want to be a quality of lifeist. You know, a quality of life

is so crucial to me.

And, you know, it’s easy to forget that in the thick of things or if we’re in

survival or if something, you know, dangerous or scary happens. But this is

absolutely now that we’re getting through menopause more knowledgeable and with less

sort of, hopefully less years of okay,

well, now I want to do this. I want to get an A plus. I want to

do this amazing. I want to live life to the fullest. I mean, this is the point

where in women’s lives, they get to, I mean,  I’m hoping and you guys can tell

me, we get to really enjoy the fruits of our labor. And to be able to feel

healthy and feel good and look good and feel sharp. I love that idea, Colleen.

Colleen: – Yes, and you don’t care anymore. Estrogen leaves and it takes all of the,

I care about what you think of me.

Bridgett: – And the patches don’t bring it back 100%.

They bring back what you need, but just don’t care. ‘Cause I have my patch on and

I still don’t care.

Dr. Hirsch: – I cannot

wait, I cannot wait for that.

Colleen: – It really is, that’s what we’ve been exploring

because it’s just, we’ve been talking to a lot of women who are post 60 and we’re

like, we’re kind of jealous. It’s like, I can’t wait to turn 60.

Dr. Hirsch: – Oh yeah,

60 is like the new 20 basically. – Yes, yeah. – So you’re free again, right?

Colleen: – Loving life and they don’t want to go back to before, so but, well, we are so excited

to have talked to you about The Perimenopause Survival Guide, Make Sense of Your

Symptoms and Build Your Personal Treatment Plan. Thank you so much, Dr. Hirsch. We

love, love having you on and we wish we could do it all the time.

Dr. Hirsch: Thank you so

much for having me on. It’s my pleasure. Can’t wait to see you guys for the next

round. Thanks.