Gina Kaye (Host): Welcome to the FirstHealth and Wellness podcast. Your host, Gina Kaye, and joining me today is Dr. Lisette Machin, OB-GYN. Our topic today is about the changes in the way women experience menopause, also known as not-your-mother's-menopause. For decades, menopause was something women endured quietly. But today, medicine conversations are reshaping what this stage of life can look like.

So, what's difference, and what should you actually know? Dr. Machin joins the FirstHealth Wellness podcast to discuss the shift in perception about menopause, common misconceptions that still exist, and the key questions you can ask physician to personalize your care. Dr. Machin, thank you so much for joining us today.

Lissette Machin, MD: Thank you for having me.

Host: I'm sure our audience is excited about the topic. So, let's dive into our questions. First of all, how has the understanding of menopause changed over the past 20 to 30 years?

Lissette Machin, MD: Well, it started probably way before the 1990s. There was talk with your provider about menopausal symptoms, very much an afterthought, not a focused visit at times. And women were given hormones.

A concerted study was then conducted in the '90s collecting information for women between 50 to 79 years old. Twenty thousand women were enrolled. This is the big study. The WHI study hosted by NIH, which looked at was hormonal therapy beneficial for cardiovascular health. And so, that study was stopped in 2002, because it showed that there was increased risk for cardiovascular events and possibly some elevation in risk for breast cancer.

And so, at that point, hormones stopped. Like, no one wanted to use it because of this fear that it was detrimental to your health. And that was unfortunate. Because at that point, women who were going through a transition in their life were devoid of maybe benefits. And now that we've looked at the study and had additional studies, we see that the right questions weren't made. Also, medications have evolved to include different delivery systems as well as dosaging of medications. So, it has changed quite a bit because science has advanced. But also, critical thinking went into what was behind that study that caused such a pause and to the benefit of women, now that we've looked at the information.

Host: What are the most common symptoms women experience today, and which ones are often overlooked?

Lissette Machin, MD: Well, I would say what first comes to mind is some of the emotional part of it. And then, the physical manifestations. So, it will range. And that's when you try to tease out with someone, "What are your priorities? What is it you're feeling is the most effective in your life?" So, they will range.

So, women complain about hot flashes, and that can lead to sleep disturbance. not everyone will have the same symptoms, not everyone will have the same group of symptoms. Some will speak of brain fog, and they can't concentrate. Some will say weight gain, "My metabolism just has tanked. I don't know what i'm doing wrong anymore." And everyone is individualized.

And so, I think it's important to give everyone the list of possible symptoms, and she will pick out which ones are affecting her the most and what she's most concerned with. I always say, you know, one symptom may be the result of another sign that maybe she was putting aside. And so, we try to link them all together and try to get a comprehensive idea of what's ailing and what is most important to patient.

Host: You know, any woman of age, including myself can open up our social media feeds and be inundated with all of things about menopause. I'm curious, are women today experiencing it differently, or are we just talking about it more openly? Like I said, seems to be over the news feeds.

Lissette Machin, MD: Yeah. I don't think, and it's hard for me to say, you know, I've been practicing for 20 years, but I think the symptoms are the same. I think our vocabulary around it has changed. I think our exchange and ways we do talk and receive information has changed. And so, the experience itself may not have changed. The process is still very much the same, but how we interpret it, how we engage people around us, and how we engage our community is a lot different than it used to be. These were conversations that were had at the dinner table with older ladies. It wasn't talked about. Certainly, there were no commercials or celebrity advocates out there. So, I think in that way the experience is different. But certainly, biologically it's the same.

Host: It definitely feels more normalized now in conversation, that's for sure. So, let's talk about factors like diet, exercise, sleep, and even stress. How do all of those things affect menopause symptoms?

Lissette Machin, MD: One of the things I think we have to understand is that we're all linked and that it is a systems issue, that, yes, if you're stressed, you're going to have more hot flashes. Your diet definitely regulates your absorption of calories. We want to more protein-driven. We want to have resistance training, that helps with our sleep patterns.

And so, it's really taking a global look at the whole person, and how external factors affect you. Relationships, certainly, you know, job and financial situations. We are organic creatures, and everything around us affects us. And, And how our body receives it and responds to it needs to be understood in order to achieve really effective results.

There's no magic pill to say, "if I give you this hormone, everything's going to be great." That really doesn't serve the patient because she has all these other factors that need to play into it as well.

Host: So, are there things women can start doing in their 30s and even 40s to prepare for a healthier transition?

Lissette Machin, MD: Yes. So ideally, you know, we want to be the best we can be the moment we are right now. It definitely sets you up for a better transition in whatever you do, whatever phase of life you're going into. So even in their teenage years, establishing good health habits, in our reproductive life. We want to know what our family history is so that we're proper screening. And you're preparing like an athlete does when we get ready for menopause. So, there's training and habit developing that we need to start understanding, but also know what our risk factors are, and understanding what am I bringing to the table genetically? What am I predisposed of? What I need to be working on.

So yes, absolutely, healthy habits. Great mental health, self-care. Check on yourself regularly. You know, we tend to be very caring and giving ourselves to the people around us. But we need to check on our own self-awareness, so that we can prepare ourselves for the next .

Host: I agree wholeheartedly with that. And we talk a lot about the physical symptoms. Why is it important to address emotional and psychological side of menopause and not just the physical symptoms?

Lissette Machin, MD: Yes. So, again, it feeds into it. I joke with my patients, it's like, "Do you like around you, and do the people around you like you?" Because that feeds us. And so, they say, you know, "I have this relationship with my children or my partner," and we have to address it because they reinforce us, right? They make us feel good about who we are, what we're doing. So, the emotional part of it is as important as the hot flash you're having.

And so, that's where I say that self-inventory, self-care is really important. And it can be talked about. I mean, certainly, you want to be in a safe environment, pick a good provider team, because sometimes it does take a team. But also, those supportive people around you and home to say, "You know what? This is not me. This is not who I want to be, but I'm working through this."

Host: If you could identify one major myth about menopause that wish would disappear, what would that be?

Lissette Machin, MD: That it's an accepted burden that we have to endure. I feel we chalk it up as this part of aging. Yes, it is, and I think we can age gracefully and in the most healthy capacity possible and embracing the things around us. But we don't have to accept being sad. We don't have to jeopardize our cardiovascular health, our bone health, well, because it was something that perhaps our older ladies in our family experienced like osteoporosis. "Well, that's what I inherited." I'm like, "Well, perhaps you are at risk for it, but we can change the course for you."

Sexual health, you know, is not something that we just put on the shelf anymore. It can be very much a vital part of your life. Staying fit, you know, wanting to maintain activity, that it shouldn't be accepted that it's just part of aging. Yes, we will age. Thankfully, we will. But we want to be healthy and vibrant and good for ourselves and the people around us that matter.

Host: Very good. Where are women often getting misinformed today? Like social media, outdated advice, et cetera?

Lissette Machin, MD: I think it comes from everywhere. I mean, it comes from your peers, it comes from social media. And I have a balance I try to maintain because I think it has opened up pathways of conversation. And I think it has normalized the conversation in a lot of ways. But you have to remain critical of the information you're getting.

And I want women to advocate for themselves and understand that there is no secret formula. There really isn't. It's going to take a lot of input. Being critical of the information you're getting. be wary of someone who gives you the best scenario with the least amount of work or investigation. So, you know, we're desperate to know and be better. And so, sometimes the quick fix is the most attractive. But probably if it's too good to be true, it really isn't good for us.

But like I said, I think it has opened up a lot of communication. So, it's a balancing act. You know, patients come in with information. And we as providers of women's care, we have to be receptive to that and say, you know, that is a vital pathway for her to get information. I don't want to discredit it. I want to understand it and help her be that critical thinker for herself and know what's good information, what's bad information. Ask me questions. Challenge me. I learn from my patients every day.

Host: If listeners could take away just one message from today's conversation, what would it be?

Lissette Machin, MD: I would say pick your team, and be critical and open to all sources of information. Keep the conversation going. And I remarked on it before, it is not one thing that's going to help, it's going to be the whole picture. And talk to those that matter to you about it, it can be wonderful.

I say perimenopause and menopause is now unveiling who you are and who you will become. So, there's a lot of freedom in that. And we should know that aging is a privilege. With it comes a lot of knowledge and experience. And I hope we grow as a society and a community, and embrace these knowledgeable, wise women that we are becoming. And don't fear it. Like I said, it could be liberating, and then you grow into your own. and you can live very happy, full lives and be better than you were where you might have expected to be.

fhc028_Gina: Dr. Machin, thank you so much for your time today. I'm sure your information has truly made a difference.

Lissette Machin, MD: Oh. Well, thank you for having me, Gina. Thank you so much.

Host: For more information more information about today's episode, please visit firsthealth.org/GYN. If you enjoyed podcast, please share it on your own social media channels. This has been the FirstHealth and Wellness Podcast. Thanks for listening.