Jancee Dunn's New Book on What No One Tells You About Menopause
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Alison Stewart: This is All Of It on WNYC. I'm Alison Stewart. 1.3 million women transition into menopause each year, according to research in a new book titled Hot and Bothered. Now, think about this. If women make up half of the population, nearly half of the US workforce and 44% of women in the workforce are over 44 years old, it's likely that Beth from accounting may be experiencing one of the 34 symptoms of menopause, but you didn't know that there were that many symptoms of this perfectly natural occurrence that can affect someone in your life. The reason you didn't know it is that there isn't a huge amount of medical research on menopause and it can even be tough to find a provider to spearhead the care.
In addition, until very recently, menopause really hasn't been talked about openly in the media with regard to healthcare policy or even within families, so many women suffer silently with hot flashes, lack of sleep, foggy memories, and a host of physical and emotional symptoms for years. Many do so while they are balancing work, caregiving to kids or elderly parents.
Journalist Jancee Dunn, a health reporter, columnist for the New York Times, and author of more than five books became a member of, as she calls it, the flash mob three years ago. Having hot flashes, night sweats, and not knowing where to turn. Her search for answers and a way to stop sweating led her to write her latest book, Hot and Bothered: What No One Tells You About Menopause and How to Feel Like Yourself Again. Jancee joins us today. Hi, Jancee. I'm very excited to see you. That's why I was stumbling a little bit through my [chuckles] introduction. I'm just so happy to talk to you in real life, over Zoom.
Jancee Dunn: Likewise. I'm so glad to be here. Thank you.
Alison Stewart: Listeners, are you experiencing or have you experienced menopause? What were some things that helped you? What were your challenges? What do you wish you knew or wish was talked about more? Give us a call. 212-433-WNYC, 212-433-9692, or reach out on social media at @AllOfItWNYC or maybe you want to ask Jancee a question. She's done a whole ton of research. Wrote a whole book about it. 212-433-WNYC, 212-433-9692. Just so we can set the table, what is menopause? What is perimenopause?
Jancee Dunn: Perimenopause, peri means around, is the years leading up to menopause. It can be four to eight years you can start getting symptoms. They most often occur, which I didn't know even though I'm a health writer, in your 40s. I had always assumed, oh, that's something that happens later in life. Oh, that's Golden Girls era or something, but it's not. It most commonly occurs in your 40s. If you don't know what the symptoms are, you don't know what to look for, you don't recognize a pattern.
Then menopause, the average age of menopause is 51, and that means that you haven't had your period for 12 straight months, even if you have your period again at month 10, then you go back to the beginning and you count for another 12 months. On average, that happens at age 51.
Alison Stewart: How long does menopause last on average?
Jancee Dunn: It varies from woman to woman, but the entire process from perimenopause to menopause can be roughly seven years, eight years even, just depending on how severe your perimenopause symptoms are. Many experts that I talked to said, "Be sure and tell your readers that not everybody gets symptoms." I have yet to meet this mythical person that doesn't have symptoms, but they say that many women sail, not many, but a good amount of women sail through menopause with no symptoms. It doesn't always happen, but it sure did with me.
Alison Stewart: Who did you write this book for?
Jancee Dunn: [chuckles] You know what? There's a great book, The Menopause Manifesto, Jen Gunter, and there's some other good ones, but it was mostly because I realized I am in the health world, I write about this stuff all day, and I didn't have the information that I wanted. I wrote it for myself. I did this little experiment where I went to my library-- I live in New Jersey, and I thought, "Well, what's out there?" I went to the library and there are-- It's like medicine falls off a cliff after women have babies if they choose to have babies. There was acres of pregnancy books. If you want to know what to expect when you're expecting, you're covered, but when you're not expecting, there's nothing. I remember looking because I was thinking, "Should I read a book about menopause?"
There was one book on menopause at my library, which has a lot of books, and it was from the '90s. It was very dusty. The pages were yellow. I just thought, "That's what's out there. What's going on?" Pregnancy lasts what? Nine months, and this transition-- You enter menopause, you don't leave it. Once you're in it, you're in it. You can be menopausal for decades. You're post-menopausal, yet there was just nothing. That was my incredibly long answer to your question. I wrote it for me and just for other people because, certainly, I love that there's more attention focused on menopause now. People need information.
Alison Stewart: They do. I'm going to be cynical for just a minute.
Jancee Dunn: Please.
Alison Stewart: When you talked about all of the books about babies and expecting, I remember I was pregnant in 2008 during the crash, the economic crash, but the one place that was packed where people were buying things was, I called it the baby barn, that baby buy [chuckles] giant warehouse store of baby stuff, and I thought, "Wow, this industry is incredible." I'm wondering if it's just people aren't making money off of menopause.
Jancee Dunn: Well, right, there's not a lot of procedures. That's where the money is. It's procedures like for pregnancies or for various diseases. With menopause, it's mostly about counseling and coordinating care. You are absolutely 100% right. Even just from a commercial standpoint, the rituals that women have throughout their lives, they get baby showers or wedding showers or even getting the talk for their period. There's no ritualized behavior for getting the talk for your last period. Nothing. Maybe we could put together an idea for a menopause shower.
Alison Stewart: [laughs] It's a shower. It's a cold shower is what it is. [laughs]
Jancee Dunn: It's actually a cold shower. Exactly right. [laughs]
Alison Stewart: Is this an American thing that we don't talk about menopause? Did you get into cultural differences?
Jancee Dunn: There seems to be a stigma worldwide pretty much. Definitely, the symptoms seem to vary depending on you're hot flashes in certain Asian countries, things like that. It may be because of a soy diet. We don't know because, again, there's not a ton of research out there from any country. The most interesting country that I studied about this was England. They have various menopause practices and policies in place. They learn about menopause in school. Kids learn in health class. It's part of the curriculum that you learn about menopause. Quiz any kid in the US. [laughs] Ask 'em if they know what menopause is. A lot of people don't know what it is. I'm sure if you stopped someone on the street and said, "What is perimenopause?" a kid, a woman, a man, any gender might not know. My mother didn't know.
Alison Stewart: This is a great part of your book, is that it is very personal. It's conversations you have with your mom, you've got your friend Julie is your ride along, you're going through this experience together. [laughs] Was that helpful for you to have-
Jancee Dunn: It was.
Alison Stewart: -[unintelligible 00:08:39] ?
Jancee Dunn: One message that I have in the book is just to talk about it. I don't want to be glib about-- It's not easy to talk about it in the workplace because I come across some pieces of advice that will say, "Oh, just mention when you're having a hot flash." Well, that's easier said than done. There is a lot of stigma. If your conference room is filled with 25-year-old guys, that can be difficult. At a grassroots level, if you can talk about it with your friends-- My mom is still around and I had never had a single conversation with her about menopause until I started writing this book. I said, "Oh, how was that experience anyway?" I remember saving my diaries. Did you used to keep a diary or else? I've saved mine to give to my kids.
Alison Stewart: Aw.
Jancee Dunn: Did you save yours or keep yours?
Alison Stewart: No.
Jancee Dunn: I threw mine away after I looked at them recently because I had saved them. I have a daughter who's now 14 and I thought, "Oh, maybe she'll want to read them." I went through them recently and I realized how often I was saying that my mom was crabby or I used other New Jersey language about how she was acting. I realized now she was going through menopause and her generation, they never said a word. It is helpful. I've talked with my friends about the most personal things you can imagine and we even didn't talk about menopause with my sisters. Now I talk about it nonstop. It's also helpful if your mom is not living to even talk about it with older relatives that are like an aunt or somebody, that you can at least get the medical information that may then inform your care. Start slowly. I realized I didn't even talk about it with my husband. I was keeping some of the symptoms from him because urinary incontinence is not the sexiest thing in the world.
I realized when I was racing from the grocery store into my house as fast as I could and getting annoyed with him if he was in my way, he just thought I was uptight for some reason because I didn't want to tell him, "No, I'm afraid that I might not make it to the bathroom in time." Or, sex starts to hurt. It often starts to hurt because as the estrogen leaves all the tissues in your body, including your pelvic floor, it's painful. Grimacing is not an aphrodisiac necessarily. I wasn't telling him what was up, even though he's getting older, too. Why was I keeping it a big secret? I started talking to him about it, too.
Alison Stewart: I also want to say the book, while it's very funny and there are the personal stories, it is jam-packed with information, with medical information. You did a really thorough job researching. I just want to say that out loud because you're very fun and fun to talk to, but I want to say that this is a serious book as well and has a lot of really good information for people. Let's talk to Cheryl from Toms River, New Jersey. Hi, Cheryl. Thanks for calling All Of It.
Cheryl: Oh, hi. How are you?
Alison Stewart: Doing great. You're on the air.
Cheryl: Oh, great. I want to know what you can do to prevent the weight gain. I gained a lot of weight around my stomach and the hot flashes. I get a lot of hot flashes. I'm 59. I've been going through this year, so I can't seem to lose any weight.
Alison Stewart: Thank you for calling Cheryl. Those are two topics you go deep on. Let's start with the weight gain, why it happens, and what people can do about it if anything.
Jancee: Well, researchers aren't still entirely sure why it happens. The average weight gain is about 5 to 7 pounds. Cheryl, just like you, I gained it in my stomach. That's where you commonly get it. In fact, one researcher told me that you sometimes can lose a little weight in your behind, but then it collects around your middle. I can remember yelling at my pants because I couldn't do them up anymore. I eventually had to donate most of my pants and get new ones. Sometimes it collects there, and it stays, and you can stay active and as healthy as you can, and there's not much that you can do about it.
However, if you are having severe hot flashes, I would urge you to see if you can get them treated. There's a new hot flash medication, it's non-hormonal. It's called fezolinetant. I'm trying to remember what the-- I can't even blame brain fog anymore because that went away. It's called fezolinetant, and it just came out recently. It's supposed to clear up hot flashes quickly, almost at 90%. If your weight gain is tied to sleep loss, if you're having a ton of hot flashes, and they are messing with your sleep severely, and you're deranged from lack of sleep, that's all tied to the weight gain, too. Get a handle on your hot flashes, and you can sometimes get a bit more of a handle on your weight. That's what all the experts tell me. I'm not a doctor myself, but I talk to tons of them. That was the consensus.
Alison Stewart: What is a hot flash in scientific terms? What do doctors tell you?
Jancee: It's tied up with your hypothalamus. The interesting thing about hot flashes is that they start with perimenopause, which you think is going to be smooth sailing. It's really not. They call it reverse puberty, which isn't entirely correct, but your hormones can-- It's not some smooth glide into menopause. It can just be all over the place. That includes hot flashes. They still don't know exactly what causes that, either. It's something about your temperature regulation that's just off-filter in your hypothalamus. It occurs in your brain. Because there isn't still a ton of research on menopausal women, we're just not entirely sure what it is at this point. There are treatments. There are treatments to be had.
Alison Stewart: We'll talk about treatments after the break. Jancee will read a little bit from her book, and we'll hear about the 34 symptoms and which one blew her mind. The name of the book is What No One Tells You About Menopause and How to Feel Like Yourself Again. If you want to get in on this conversation, if you've gone through menopause, if you want to offer how you got through it, 212-433-WNYC, 212-433-9692. We'll have more with Jancee and take more calls after a quick break. This is All Of It.
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This is All Of It on WNYC. I'm Allison Stewart. My guest is Jancee Dunn. The name of the book is Hot and Bothered: What No One Tells You About Menopause, and How to Feel Like Yourself Again. 34 symptoms possible with many-- [laughs] I think we know hot flashes, sleeplessness, weight gain. What is one that just blew your mind?
Jancee: I didn't expect-- your skin dries out, all of your skin. My ears dried out. They looked like Trader Joe's dried mango slices. They were even a little orangey. I don't know what that was about, but I really did not realize how thoroughly your skin can dry out, all of your skin. Also, my nails became flaky to the point of baklava. You asked me for one, but there's so many wacky ones. Tingling in my hands and feet. Again, some of these symptoms, I can go over, [chuckles] we can sit here for a while and I can go over all 34, but if you don't-- again, if you can't connect them up, they can just scare people so much. I also had a racing heart and I thought, "Oh, boy, here comes the big one. Goodbye." I went to a cardiologist and there were a couple of times women can be gaslighted as well. I got, "Have you tried yoga?" "How about a glass of wine?" A glass of wine comes up a fair amount if you have painful sex, which really isn't the best prescription. Yes, dizziness, anxiety, all kinds of things. Another problem with that is that if they're occurring in your 40s when all this stuff, as you mentioned, is going on in a person's life, it can be hard to tease out if it's perimenopause or just life stuff. Who isn't having difficulty sleeping? That's why it's helpful to know the symptoms.
Alison Stewart: Let's talk to April from the Upper West Side on line 7. April will be with us now. Hi, April, you're on the air.
April: Hi, thanks. In the years since I had my last period, my symptoms haven't been terrible, except the one that gets me down. The one I don't hear a lot of people talking about is hair loss.
Jancee: Oh, my God. I had it too. I called someone, this hair specialist at the Mayo Clinic, and she said, "Oh, yes, hair loss. It's fairly common, and often your hair, you lose it in a Christmas tree pattern." I said, "Come again? What now?" It's that your part gets wider, [chuckles] and then you get a Charlie Brown Christmas tree pattern on top while there's a little bit missing. Yes, it is common. It is one of the 34 symptoms.
I talked to several experts about it. Minoxidil is really the best solution. You can get about 15% hair growth back. Often the men's Minoxidil is a little bit [unintelligible 00:18:53], as it's called, is a little bit cheaper because the pink tax. That's great. If you have more money, you can do other treatments, but they can be costly. Yes, when I did an author photo for the book, I had my husband take, I don't know, 200 photos, and I started crying because I had to eventually get hair in a can, which some people remember from the '90s where you put it on your head, and I filled in the little blanks. Then Minoxidil, which I still take, has helped me. I'm not getting any--
Alison Stewart: kickbacks.
Jancee: Kickback from Minoxidil. Yes, thank you for filling that in. Another symptom is brain fog. By and large, a really great thing about brain fog is that it does-- That wasn't demonstrated just now, but by and large, it does go away. You'll have it for a couple of years. Then several neuroscientists told me your marbles will roll back into your head. How often does that happen when you lose some sort of function, and it is returned to you? That's one of the good things about symptoms. I don't want to make it all gloomy.
Alison Stewart: Yes. Let's talk to Patricia from Chatham, New Jersey. Hi, Patricia. Thanks for calling All Of It.
Patricia: Hi, there. I finally hit menopause about a year ago, and the one thing that really surprised me was the loss of muscle strength. It was just really unbelievable how quickly, if you really don't, aren't in a, I would say resistance type of program, how quickly you lose that muscle strength.
Alison Stewart: Patricia, thanks for calling in. You addressed that in the book as well.
Jancee Dunn: Yes. It's always good too. The second you get symptoms, it's especially great if you're in perimenopause. That's the time when you can still build capillaries. I know it's really hard and I'm loathed to give people advice to, oh, get out there and work out when they're already so busy. If you can do weight-bearing exercises, and that can even include gardening or that can include brisk walking. That helps so much with at least maintaining your muscle and also maintaining the strength of your bones, which is yet another symptom that can change.
Alison Stewart: Let's talk to Eileen, who's calling in from the East Village. Hey, Eileen, thanks for calling All Of It.
Eileen: Hi. I went through it, I don't know, 10 years ago. I was working with a herbal. He was saying, "It's just a stressor whenever you're going through stress stuff, you're just using up minerals faster than you would otherwise, like altitude or any of those kinds of things." She just had me on alfalfa, kelp, and [unintelligible 00:21:53]. I didn't end up having any hot flashes or gain any weight or any of that. She just said, "It's just that most people are really low on those things and then their bodies just don't have enough resources to deal with it." Anyway, that was my experience.
Alison Stewart: Eileen, thanks for calling in. When someone's going through menopause, what is being depleted?
Jancee Dunn: It's interesting because you can if you have very erratic periods when you have perimenopause. I had crime scene periods, it was really, really bad. Again, that goes back to what I was saying earlier that it's not some slow thing. Often it's very chaotic, so you can lose a ton of blood and in which case you can get your iron stores depleted. That's something to look for. Also, be sure and get your vitamin D levels tested because that can help with your bones and that can also be depleted. There's not a lot of good scientific evidence about herbal remedies, but if they work for you, great. The important thing is if they make you feel better, wonderful.
Alison Stewart: In the book you offer a lot of different, not procedures, but ways that you can take back sort of control a little bit. That you can have some agency, even if maybe the medical establishment won't or you're not able to get your doctor on board. What're one or two things you'd like people to do their own research on that you think could be helpful if someone's going through menopause? One or two things they could consider.
Jancee Dunn: I don't think women feel comfortable enough with talking about quality-of-life issues when they absolutely should. If something is ruining the quality of your life, you absolutely should go to a doctor. Again, if you have hot flashes that you're not able to function in the daytime because they're keeping you up at night, then you don't know when they're going to end. They could go on for years. It would behoove you to go to a doctor and just see if there is a medication that can help you. I know that it's an out-of-pocket expense, but if you are able to go see a menopause specialist, it can save you a lot of time, a lot of copays, a lot of running around to this doctor or that doctor.
You go to the North American Menopause Society type in your zip code and some incredibly informed expert who has to get re-certified every three years can coordinate your care. It's incredible. Like department heads at Yale will be in charge of, who have done like 300 scientific papers on menopause will be in charge of your care. It can be one or two times, it doesn't have to be forever. They will then kick back the care to your primary care physician and they know what they're talking about. That is a resource that I also didn't know about until I started writing the book.
Alison Stewart: Let's talk to-- Oh my goodness. Megan on line seven calling in. I think we've got Megan. Hi, Megan. Thanks for calling All Of It.
Megan: Hi. Thanks for taking my call.
Alison Stewart: You're on the air.
Megan: Hi. I just wanted to say, I'm so glad you're talking about this because more women need to be talking about this with each other and also like our doctors need to be discussing this with us because my symptoms were really life-changing, and we don't know what it is that's affecting us. It was like the pandemic was happening. I was homeschooling my kid and I had all this anxiety and didn't know if it was just attributing it to the pandemic and homeschooling and everything.
Then I realized a couple of years later it was all due to perimenopause and menopause and I wish I had found treatment for it earlier either herbally or now I started hormone replacement therapy that has made me get back to feeling myself. Many of these symptoms are really challenging and doctors are not so informed and don't discuss it with us.
Alison Stewart: Yes. Megan, I'm going to jump in here. We only have about a minute and a half left. When someone hears hormone replacement therapy, if you're sort of our generation, there's ugh, that. [laughs] A lot of the opinion has changed about that. There was this one study that was somewhat flawed that made a lot of people afraid of hormone replacement therapy. What's one reason people should at least investigate it?
Jancee Dunn: That study has been reanalyzed many times and it was the Women's Health Initiative and it was in the early aughts and it scared a lot of people. There were a couple of reasons why that was-- The evidence was not ideal. One is that a lot of the women were in their 70s. In this study they were smokers. If you're in good health and you're within 10 years of going through menopause, it's worth having a conversation with your doctor about it to see if the benefits outweigh the risks. I'm not advocating one way or another, but it is worth a conversation because it can be life-changing.
Alison Stewart: The name of the book is Hot and Bothered: What No One Tells You About Menopause and How to Feel Like Yourself Again. It is full of really great information and resources and some very good and funny writing from Jancee Dunn. Jancee, thank you so much for taking listeners' calls and sharing your book with us.
Jancee Dunn: Thank you for covering this subject. Thank you so much.
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Alison Stewart: That is All Of It for today. I'm Alison Stewart, I appreciate you listening and I appreciate you. I will meet you back here next time.
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