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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. You might know this if you're single, maybe not if you're not, dating apps have joined the ranks of Krispy Kreme and Shake Shack, giving premiums to people who show proof of vaccination. That's right. If you're a member of Tinder or Hinge, you can gain access to features like more boosts, super likes, and super swipes that usually cost money if you've had your shots and we expect a lot of you will be swiping this summer, making up for lost time, you might say, and joining a cultural heatwave known as 'hot vax summer'.

With the return of more casual dating and casual sex comes the return of having to think about things like making sure you have the proper birth control and checking for STDs. We know those conversations can be a buzzkill, but they don't have to be, especially when you're doing it with my next guest, internet-famous gynecologist, Dr. Jen Gunter, she's a practicing OB/GYN and host of the new TED podcast Body Stuff.

We'll also talk to her about whether vaccines really affect your period. I can't believe how many calls we get asking that same question, and her latest book which just came out called The Menopause Manifesto. Dr. Jen, welcome back to WNYC.

Dr. Jen Gunter: Hi, thank you for having me.

Brian Lehrer: What do you think of the term 'hot vax summer'? What comes to your mind as a gynecologist when you hear it?

Dr. Jen Gunter: I think it's a great term. I think that we have too much shame in our society about sexual activity related to purity culture. I think it's great. I think we all have had a really difficult year-and-a-half and someone told me they heard a woman on the plane saying she was vaxxed, waxed, and ready to go and I think that's great.

Brian Lehrer: In 2019, the CDC released data that said that reports of STDs, syphilis, gonorrhea, and chlamydia, in particular, had reached an all-time high in the United States. We don't yet have data about STD numbers within the last year I don't think, and I imagine they went down as many people stayed home, but I wonder whether you think the messaging around getting tested during the past year, as it relates to COVID-19, should translate or could translate and be useful for campaigns for these STDs?

Dr. Jen Gunter: I think that's a really great question and I hope it does because getting tested and treated for an STI shouldn't have any more stigma than getting tested for COVID. This is what you do to keep people around you safe. This is what you do to keep yourself safe.

The reasons why that our society, in parts, shame on sex and sexually transmitted infections has nothing to do with the infections themselves. I think that hopefully, this is going to open a new era of openness and discussion.

Brian Lehrer: Listeners, speaking of an era of openness and discussion, it's always that era on this show. Do you have a question about sexual health or development for my guest, Dr. Jen Gunter? It's not every day you get an internet-famous OB/GYN over for dinner, so what do you want to ask? Did you notice changes to your period after getting the vaccine? We'll get into why that might be. 646-435-7280.

We definitely want to hear from you if you started going through menopause in the past year or recently at all, and whether you felt prepared for those changes. Dr. Gunter's latest book is The Menopause Manifesto. What do you wish someone had told you about that process or the process of having a child who's reaching puberty, anything along that entire spectrum? 646-435-7280, 646-435-7280.

As calls are coming in, you can also, listeners, as always, tweet a question @BrianLehrer. Your book, The Menopause Manifesto. You write that the way we learn about menopause is a mirror to how your mother's generation learned about puberty. How so?

Dr. Jen Gunter: Yes. There's really this absence of cultural discourse about menopause. If you think about- my mother didn't know anything about puberty at all, and she woke up one day covered in blood, literally that was her experience. This is the same thing that many women are completely unprepared for. No one tells them that symptoms can start years before their final period.

They're having hot flashes in their mid-40s or vaginal dryness or getting a new-onset depression and everybody's brushing them off as there's nothing wrong, but yet they're having symptoms. If everybody knew that symptoms could start long before your final period and they could be even worse than what you might have later in life, I think that would be valuable. Knowledge is always empowering.

Brian Lehrer: We just had on the news before you came on a story of a vaccination event where one of the people showing up with, I think, Senator Gillibrand and other people was a 12-year-old. The comment was, "You're exactly who we want to see here", because now that 12 to 15-year-olds are also eligible but this, of course, is also right around puberty. Is there any relationship between vaccination that you're aware of and how the onset of puberty takes place?

Dr. Jen Gunter: No. It's important to remember that the fears about fertility and vaccinations and pregnancy is a really long-standing anti-vaccine trope. We've seen it with the tetanus vaccine. We've seen it with the HPV vaccine and there's absolutely no data to link vaccination against COVID with fertility concerns, with pregnancy concerns.

Some women have reported irregular menstruation after receiving the vaccine and we don't quite yet understand why. The lining of the endometrium, the uterus, is part of the immune system so that could be a response to that, a temporary response, just like you get a fever as a temporary response. As we get more data, we will know more, but there's nothing to suggest a concern.

Brian Lehrer: Let's take a phone call from Maria on the Jersey Shore, Maria, you're on WNYC with Dr. Jen Gunter. Hi.

Maria: Hi, thanks for taking my call. My question has to do with bioidentical hormone replacement and what the doctor thinks about that. I had been on it until the pandemic hit, and then I didn't see my doctor for a year-and-a-half, and I have been off of it. I hate my symptoms, which are basically I'm old now, muscle loss, irritability, fatigue, brain fog, everything down south is just different and I'm missing it, but I'm also well-aware of the concerns about stroke and heart. Just wondering what the doctor thinks about going back on it as I contemplate the same.

Brian Lehrer: Thank you, Maria. Does The Menopause Manifesto include anything about bioidentical hormone replacement?

Dr. Jen Gunter: Sure. There's about three chapters that you need to-- It's a lot of information, not something to answer here, but what I could tell you is the term bioidentical is a marketing term. It doesn't actually mean anything really medical. I always tell people the estrogen that's made by your ovaries, which is as bioidentical as it can get, that's the estrogen that can cause breast cancer for some people.

It's whether a treatment has been proven safe and effective. To answer whether or not menopausal hormone therapy is right for any given person, you have to know your age, know your symptoms. Some of these symptoms that were described certainly can be treated by MHT, but some of them may be not like brain fog. Also, vaginal symptoms can be treated with vaginal therapy.

You really need to know your individual risk, your age, the reasons for taking it. The safest treatment for menopausal hormone therapy is transdermal and not made by a compounded pharmacy, a traditional pharmaceutical, like a patch or lotion or cream and there's also a vaginal ring. Those are the safest treatments, and so that's what are recommended as first-line.

Brian Lehrer: I hope that's helpful, Maria, thank you for your call. Erin in Denver. You're on WNYC with Dr. Gunter. Hi, Erin.

Erin: Hi. Thanks for taking my call. Can you hear me?

Brian Lehrer: Yes.

Erin: Great. Before I got my vaccine, I never would have even considered not getting the vaccine. I looked down on people who gave excuses and then after I got it, I had such bad period impacts, and so did so many of my friends, that were really disconcerting. Now I just wonder like why didn't my medical care professional know about those that they were going to happen? Why wasn't I prepared? Why don't they have the information for me now on why those things happened?

Why can't they tell me how long it's going to last, and are there permanent impacts? Is my uterine lining going to be permanently affected? All these questions and I just got such a bland party-line response from my gynecologist about it. It really disconcerted me and it really sent me back and made me question things. I'm wondering if you have any better perspective on any of those issues?

Brian Lehrer: Dr. Gunter, go ahead.

Dr. Jen Gunter: Unfortunately, in the prospective studies, there wasn't any data released about impact on menstruation outside of anything that might take somebody to the emergency department. If people are in such states that they're heading to the emergency department, those kinds of events would be picked up, but there's actually been very little research on the impact of vaccination on the subsequent menstrual cycle.

This is an area of research that clearly needs to be expanded. However, you have to remember the lining of the uterus replaces completely if you're having a regular menstrual cycle every 28 days, and so there's not going to be a permanent change. The lining of the uterus is an active part of the immune system and just like lymph nodes, might swell temporarily after a vaccination.

We may see some temporary changes in the lining of the uterus, but it's also important to remember that we haven't seen prospective studies and lots of things can also affect menstruation. For example, stress, medical conditions. Sometimes we see what's called recall bias. Only the people who are reporting symptoms report that they're having issues than those who don't.

There's definitely a plausible medical link between vaccinations and temporary menstrual irregularity, but we don't really have more information to give on that and that's certainly something that future vaccination studies need to accommodate for, and we need to get that data, but there's absolutely nothing to suggest that there should be anything permanent from this at all. Just in the same way that if you get vaccinated and you have a fever, you're not going to be permanently hot afterwards.

Brian Lehrer: Even without any hint that there could be anything permanent, to part of the caller's question, should there be more explicit talk about this by doctors to their patients or just in the media before women go and get their vaccinations?

Dr. Jen Gunter: Well, I think that since we don't have data, it's hard to tell people exactly what to expect, which is a big fault of the patriarchal nature of how we study medications, so there's that.

We do know that women are definitely reporting this and so I think it's a good idea for physicians to mention that. That these are reports, but we have animal-based reproductive toxicology studies from before the vaccines come out, and looking biologically, there doesn't appear to be any kind of mechanism for a permanent problem.

Not having-- I think this is a situation where, and is a great example when people don't have the information how disempowering that can be, and how frightening and how upsetting it can be. I think what we need to do going forward is to try to collect this data so we can give people a better understanding of what to expect. It's one of these things that's worrying, but not worrisome.

Brian Lehrer: Erin, thank you very much for your call. Christine in Manhattan, you're on WNYC with Dr. Jen Gunter, author of The Menopause Manifesto. Hi, Christine.

Christine: Hi, Brian. Thank you so much for featuring the doctor today and this important subject. I'm happy to call in. I was triggered to call in because honestly, I have had-- I'm 52 and have had periods that are lasting like- they're worse than when I was 15 and my doctors have zero ideas. They're all women. I was shocked at how much lack of information there is on women going through menopause. It's just shocking.

Dr. Jen Gunter: I can speak to that. Your doctors should know that menstruation can get much heavier during the menopause transition. There's a variety of reasons for that. I have a whole chapter on it actually in on The Menopause Manifesto. Sometimes it's because people accumulate medical conditions with age and it can be from something called uterine fibroids, which are benign growths in the uterus.

That's something easily diagnosed with an ultrasound, but the hormonal changes that happen at the level of the oocytes, the eggs, result in a lower level often of progesterone for some people. What that means is the lining of the uterus gets thicker and a thicker uterine lining is heavier bleeding, and so it's not unexpected at all. It's something that can often be managed with hormone therapy, menopausal hormone therapy, but also there should be an investigation just to rule out any concerns about cancer as well.

Brian Lehrer: I hope that's helpful, Christine. Thank you. Use the term in the book, 'a feminist menopause'. What does that look like?

Dr. Jen Gunter: Well, a feminist menopause is one where women are diminished with age that we don't use a language that's pejorative when we talk about it. As men age, they get distinguished, they get euphemisms, they get erectile dysfunction. When we talk about what happens to the ovaries, people talk about loss, but the end of ovulation is a planned event. It's not a loss, it's not something that we shouldn't be having. This is actually how we evolved.

I think it's really important to be super careful about the language that we use and not couch menopause in any way as if it's pejorative or negative or undesirable. There's a very long history in both medicine and society of treating women as less because they've lost estrogen and it's not a loss of estrogen, it's just a change. It's a different phase of life, and we need to start speaking about it accurately with information so people aren't unaware of what's happening to their bodies.

Brian Lehrer: Maya in Gravesend, Brooklyn, you're on WNYC with Dr. Jen Gunter. Hi, Maya.

Maya: Hi, Brian. Hi, Doctor. I have a 12-year-old and she got her first period just a few days before the COVID vaccine was available to her. We had been planning on having it administered that Thursday, but we decided to delay a couple of days because her symptoms for having her first period were low-grade fever, lethargy just like the same symptoms that arise from the COVID vaccine, so we delayed.

Just a couple of days ago, she finished the cycle. She got the vaccine and now this month is time for her second shot and she, of course, is going to have her cycle again. I am wondering how I should re-schedule the second vaccine. I should let her experience her periods first, just go ahead and get all the low-grade fever and lethargy over with at the same day. What would you recommend?

Dr. Jen Gunter: Well, first of all, for a 12-year-old, it's entirely possible that her next period isn't going to be at 28 days. It's really common for the first few periods to be irregular. I think that planning specifically around that is going to be difficult, anyway.

I think that staying on track-- It's obviously something to discuss with her pediatrician, but since her period is likely going to be unpredictable, then you take away that in the whole scheme of things and talk it over with her, she may have opinions on it as well.

Maya: Thank you. She wanted to get it right away, but I was like, "Can we just wait a couple of days and see what happens?" How long will it be for a 12-year-old who develops irregular cycle? How long is that exact, like--? [crosstalk]

Dr. Jen Gunter: Yes. Some people are like regular right off the bat, and other people, it can be two or three years. It's not uncommon to have your first period and then not get another one for three to four months. They can just be a really wide range, so I wouldn't plan on it being a 28-day thing. If it is, it is, and if it isn't, it isn't and that's not a sign of concern if it isn't, but she sounds like she's pretty empowered if she's like, "Yes, I don't want to delay the vaccine," then you know what? I think I'd trust her.

Brian Lehrer: Maya, thank you very much. Maryanne in Hackettstown, you're on WNYC with Dr. Jen Gunter. Hi, Maryanne.

Maryanne: Hi, thank you so much for having this conversation. Honestly, I almost started crying. It's so comforting to finally feel seen. I'm 51 and when I started having some symptoms and not really sure what it had to do with, but I would go to my OB/GYN and my general practitioner and complaining, "I'm exhausted, I've got brain fog. I can't keep straight what I'm doing. I'm depressed."

It's just so overwhelming and nobody's saying, "Oh, this is menopause, you can do A, B, or C," instead I just get prescribed Lexapro. I just did not put those pieces together and felt very, I don't know, ignored.

The other thing that I wanted to mention to you is I have four boys and they range in age from pre-puberty to 16 years old. I take every opportunity that I can. I mean, they see me walking around the house with like a little mini fan, and sometimes I got to catch a nap on the couch. I always say to them, like, "I'm going through menopause. Just the way that you go through changes because you're going from being a little boy to being a man, I'm going through changes going from being a young woman to an older woman."

We use the word all the time. I don't want it to be foreign or scary to them. I just want to change it for them because I was raised with a lot of shame. You're never allowed to talk about anything like this with anybody, God forbid, anybody of the other sex.

Dr. Jen Gunter: Well, I'm so sorry to hear that you were suffering and that you were dismissed and there's a whole host of things that should happen when someone has the symptoms that you were presenting with. Certainly, one of them is to be screened for depression but there are-- To also look at menopause as being a cause for some of the symptoms and there are a wide variety of treatment options, and I'm so sad that didn't happen.

I am thrilled to hear that you talk about it with your boys. I do with mine. I have 17-year-old twin boys and obviously, I was writing a book about menopause the last year and a half and there's menopause stuff all over the house. I've done interviews about menopause and they're probably two of the most informed 17-year-olds on menopause.

I think it's great. The more people know the better and your boys are not going to treat it as something shameful. They're going to treat it as something normal, so you're doing a wonderful thing.

Brian Lehrer: Maryanne, I hope that's helpful. A listener called in anonymously, didn't want to go on the air but wanted us to ask you for them. Would like to know how to have a conversation with a new partner if you have an STD.

Dr. Jen Gunter: It would depend on the sexually transmitted infection as to the conversation that you're going to have. If you've had something like chlamydia or gonorrhea and you've been treated, and you're three weeks out from being treated, then transmission is not a concern but still, you want to protect yourself and protect your partner. It's always a good idea with new partners to use condoms, whether you're using an internal condom that can go inside the vagina, inside the rectum, or an external condom that goes on a penis or a sex toy.

If you're talking about other infections, it really depends on what the infection is. It's a hard discussion to have. We obviously recommend disclosure, and telling your partner allows you to use protection, have your partner use protection. It's going to be individual whether people should disclose that they've had an abnormal Pap smear, for example, in the past.

So at the age of 20s, you had an abnormal Pap smear which should be related to the human papillomavirus, and now, 4 years later, your Pap smear is cleared, those are things that we just don't really have good guidance for. Otherwise, disclosure is always the best. Somebody should care that you care enough to talk to them about this, and if they don't, then maybe they're not really the right person, anyway.

Brian Lehrer: We're just about out of time. I actually want to rotate for our last question from the personal advice that you've been giving and people are appreciating this so much. You can tell even just from the way people are framing their questions.

To the political realm, you recently retweeted the story of the Dallas High School valedictorian who scrapped her approved graduation speech and took aim at Texas's new abortion law. She called the new law, which bans abortion after 6 weeks of pregnancy, a war on my body and a war on my rights. I wonder if you want to reflect here on that speech and what's happening in Texas and in other conservative legislatures. I read something like, as of last month, bills proposing 549 separate abortion restrictions have been introduced recently in 47 states.

Dr. Jen Gunter: I think it's amazing what she did. That took a lot of courage to do that in front of the audience like that and to have it go viral and get all that attention. I absolutely commend her for doing that. It's amazing.

I think that the number of laws tells it. We know that this is nothing about life. This is about-- These laws usually are specifically crafted to control women. That's usually the point but they're really to control anyone who can get pregnant, and punishing people who can get pregnant gets votes. That's really what it does. When you combine that with gerrymandering in a lot of different districts, this is a way to just stay in power and fundraise.

I think that claiming that you're the most punitive about abortion seems to be a very effective fundraiser for politicians. The same politicians who vote for legislation about restricting abortion are also many of the same politicians who refuse to wear masks, who are anti-vaccine. Obviously, they are forced birth. They have nothing to do with life. Sadly, that's an effective way to fundraise and an effective way to stay in office. I think there's a big fight ahead and we need to dig in because this is a really important human rights issue.

Brian Lehrer: There we leave it for today with Dr. Jen Gunter, practicing OB/GYN, host of the new Ted podcast, Body Stuff. Her latest book is called The Menopause Manifesto. Dr. Gunter, thank you so much.

Dr. Jen Gunter: Thank you so much for having me.

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