The future of menopause
Dr. Karen Adams, obstetrician/gynecologist and Farwell Family Director of the Stanford Program in Menopause and Healthy Aging, studies menopause and, perhaps more importantly, perimenopause – the critical years preceding it.
During this time, hormone-related symptoms like mood instability, sleep disruption, hot flashes, and joint pain can be severe even though periods continue. Adams explains that perimenopausal symptoms are often misdiagnosed and improperly treated. She says hormonal therapies are safe and effective in perimenopause and menopause, and can even have heart and bone benefits. “Menopause is inevitable, but suffering is not,” Adams tells host Russ Altman on this episode of Stanford Engineering’s The Future of Everything podcast.
Transcript
[00:00:00] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. Since we started this show eight years ago, it's become an archive of amazing and impactful work by my Stanford colleagues. Research is not something that just happens in the lab, and as you'll hear on this show, the research at Stanford can impact areas like health, technology, law, and business, and many other topics that can affect everyday life.
[00:00:23] We hope you'll tune in to learn more about how research has the potential to help your life and to help the lives of people you care about in your family and your community.
[00:00:32] Karen Adams: Women's health is the most under-researched, under-educated, over-legislated area of health in this country, and we only get 10% of NIH funding, and it really has been shameful for a long time.
[00:00:47] And so we really, really have some catching up to do. Women are, are educating themselves, physicians are looking, and, and other providers are looking for education, so it's very exciting to me. I think that for our daughters and our granddaughters, we're gonna know so much more.
[00:01:09] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host Russ Altman. Thanks for listening. If you wanna support the show, telling your friends, neighbors, loved ones, colleagues about the show is a great way to support it and to spread the news about The Future of Everything.
[00:01:23] Today, Karen Adams will tell us that the symptoms that women can get five to seven years before their menopause can be extremely alarming and disabling. So, you need to know about these symptoms ahead of time for you or your loved ones, and you need to get treatment so that you don't have to experience unnecessary symptoms around the time of your menopause. It's the future of menopause.
[00:01:46] Today we're continuing our feature, The Future in a Minute. At the end of our conversation, I will ask Karen a bunch of quick questions. She'll give me a bunch of quick answers, and that'll be The Future in a Minute. Also, before we get started, a reminder to share the show with your friends and loved ones and colleagues and neighbors so that we can spread the news about The Future of Everything
[00:02:11] When we think about menopause, a lot of us have a lot of questions. This is the time when a woman's period stops around the age of 50, 51. But in the five to seven years before then, an alarming set of symptoms, irritability, bone aches, and a bunch of other things can happen that are very disabling and can be of unknown cause, unless the woman has been told to expect these symptoms and seek medical help, because there are treatments.
[00:02:37] In addition, after the menstruation periods stop, then that's the menopausal period, when there are also treatments for the symptoms that can occur, like hot flashes and other things that people have heard about. Karen Adams is a professor of obstetrics and gynecology at Stanford University, and she's an expert on perimenopause and menopause and the management of these physiological changes to optimize women's health and women's life.
[00:03:04] Karen, thanks for being here. Obviously, you're committed to women's health as an OBGYN doctor, but what made you focus on the particular challenges in managing and, and women dealing with, menopause?
[00:03:16] Karen Adams: Well, it's, it's interesting. First of all, thank you so much for having me, Russ. You know, I could talk about this all day, and I have.
[00:03:23] So I, was residency program director for 14 years at a large academic center, and one of the things that our residents were required to learn about was what they called geriatric care, and well, by that, they meant women over 40.
[00:03:43] Russ Altman: Oh my goodness.
[00:03:44] Karen Adams: Right.
[00:03:44] Russ Altman: I would like to register an objection.
[00:03:46] Karen Adams: Oh my goodness. And so, right. And all of our residents were learning everything about contraception and about delivering babies and doing surgery, but we didn't have a clinic focused on the needs of women over 40, and this was a good 20, 25 years ago. And as a good program director would do, I said, "Okay, I'm gonna create that." So, I created it, I staffed it, and that was how I started really digging into this area of medicine, and it's been my career ever since.
[00:04:18] Russ Altman: Great. So, let's, let's start out with a little tutorial about what, everybody should know about menopause. Some people know a lot about it, but some people, especially men, might not even wanna hear about it, but I think it's time for everybody to know the basics.
[00:04:33] So what do we need to know about menopause? Was it... when does it happen? Why does it happen? And what are the health effects?
[00:04:41] Karen Adams: Okay. And I love that, that you brought in the partners because, you know, I always think this is so important for women and the people who love them.
[00:04:50] Russ Altman: Exactly.
[00:04:50] Karen Adams: And that's basically everyone.
[00:04:52] And I also wanna say that I know a lot of people with ovaries do not identify as women, so I'm gonna be saying women, but what I really mean is people with ovaries. And so that I, and I will try to say persons as much as I can.
[00:05:08] So the definition of menopause is no period for a year. Okay. And on average, that happens around age 51. But that doesn't happen like flipping a light switch, right? It's not like people are having periods every month, and then all of a sudden, they just go away. So that, the... we call this the menopausal transition, and it starts at the beginning of perimenopause. Perimenopause are those years leading up to that final menstrual period, and perimenopause can last four to seven years, and so can be starting kind of in the mid-40s.
[00:05:45] It's the time when women are the most symptomatic. And often they're still having periods. And so it can be very confusing because they're all of a sudden having mood disorders-
[00:05:58] Russ Altman: Oh
[00:05:58] Karen Adams: ... or difficulty sleeping or hot flushes, and they go to their clinician, and the clinician says, "Are you having periods?" And they say, "Yeah." and the clinician says, "Well, I don't know. Then we need to, we need to send you to the sleep center or put you on an antidepressant." And what we're really trying to get the message out there is that sometimes we need to connect those dots and say, "Wow, this could be hormonal."
[00:06:24] Russ Altman: Yes.
[00:06:24] Karen Adams: "This could be perimenopause."
[00:06:26] Russ Altman: So let
[00:06:26] Karen Adams: So one of the, oh ...
[00:06:27] Russ Altman: if I can just interrupt for a second, I'm sorry.
[00:06:28] Karen Adams: Sure.
[00:06:29] Russ Altman: Because I didn't... I, I'm not sure I fully appreciate this. Do, do you mean that, that not only do the periods continue, but they may even continue at the same frequency and regularity as when the woman was in the, in her 30s?
[00:06:42] Karen Adams: It, it can. It can be that way. The symptoms can precede the changes in the cycle.
[00:06:48] Russ Altman: Okay.
[00:06:48] Karen Adams: Eventually the cycles will change because what we know when a woman is having a period every month, what that means is that her brain is sending that signal to her ovary every month, and the brain is talking to the ovary, and the ovary's responding. And the ovary is making estrogen, goes up, comes down. She ovulates, makes an egg. The progesterone goes up, comes down. She has a period. The whole thing starts over again every month. It's cyclic, it's predictable, it's very regular.
[00:07:18] What happens in perimenopause is the brain is still sending that signal to the ovary the way it always has, but the ovary is aging. And as the ovary ages, it responds less and less consistently to the signals that the brain is sending.
[00:07:36] Russ Altman: Okay.
[00:07:36] Karen Adams: So basically it just sits there and goes, "Yeah, no. I'm not doing it."
[00:07:40] Russ Altman: Okay.
[00:07:41] Karen Adams: And then it wakes up, and it makes a, a big surge of hormones, and that, then it's completely unpredictable. You never know, and eventually the periods start changing. But that's what drives those symptoms, is all that crazy dysregulation of the hormone cycling.
[00:07:57] Russ Altman: Gotcha. And, and just to, to, to, to cross our T's and dot our I's, during that period, it is possible to become pregnant. When you are having these periods in the perimo- menopausal period, you can get pregnant?
[00:08:10] Karen Adams: Super important point. Thank you for bringing that up. Absolutely. And until they've gone an entire year without a period, they need to be thinking about contraception.
[00:08:19] Russ Altman: Okay. So now, you, you, you, you hinted at some of the symptoms, but I think it's worth discussing the symptoms 'cause, especially people who are listening, as you said, who are either experiencing this or love somebody who's experiencing this, what are the kinds of subtle changes that might be indications that this is a normal beginning of the perimenopausal period, and that. And, and then what should they do about it, other than go to clueless physicians who, who might not realize what's happening?
[00:08:47] Karen Adams: Right. And that-
[00:08:47] Russ Altman: And I say that with a lot of love for my fellow physicians.
[00:08:51] Karen Adams: And we're working on that. We are really out there trying to educate, clinicians, and we can talk about that.
[00:08:58] And not always so subtle symptoms either.
[00:09:01] Russ Altman: Oh.
[00:09:01] Karen Adams: You know, that's the part that can be so distressing for women in their 40s because, and again, on average in their 40s, because they're still having periods and, you know, they're, they're kind of firing on all cylinders. They've got kids, you know, maybe they've got teenagers, maybe their parents are aging. Maybe they're really coming into their own at work, and they're taking on more responsibility, and all of a sudden, they start feeling depressed or irritable, more commonly irritability or anxiousness.
[00:09:32] Russ Altman: Huh.
[00:09:32] Karen Adams: There's a thing called perimenopausal mood instability, PMI, that is more common than PMS, but nobody's ever heard of it. You know? I, I mean, we know about PMS, right?
[00:09:45] Russ Altman: Yes.
[00:09:45] Karen Adams: We all know about it. We talk about it. We know what it is. PMI, perimenopausal mood instability, is more common than PMS, but women don't know that that's what's going on. All of a sudden, they are so irritated with their kids or their boss, and they're just, you know, kind of watching themselves be anxious or having a really short fuse, and they don't know what's going on. They think they maybe need to get divorced or something.
[00:10:11] Russ Altman: Yeah. Yeah, yeah, yeah.
[00:10:12] Karen Adams: And really- it's perimenopause.
[00:10:14] Russ Altman: Do these symptoms tend to co-vary with the period? 'Cause that might give somebody a clue that this is related to, to the menstruation because, oh, during the time that I'm, I'm bleeding, I'm also feeling irritable, or are these disconnected?
[00:10:30] Karen Adams: Such an important point because with PMS, at least you know the week before your period you're gonna feel crummy.
[00:10:37] Russ Altman: Right.
[00:10:37] Karen Adams: And you can predict that and you can prepare for it. With because the cycles and the hormone fluctuations are so erratic and profound in perimenopause and you never know from day to day to day if your hormones are gonna be up or down or whatever, your symptoms are completely unpredictable as well. And that's why it's so distressing because they get up in the morning and, and they have no idea how they're gonna feel.
[00:11:03] Russ Altman: Right.
[00:11:04] Karen Adams: You know, are they gonna feel good or not good? Because it's, there's no cyclicity to it.
[00:11:09] Russ Altman: So, is it the case that we should be treating these women who are starting to have these symptoms, and what are the treatments?
[00:11:17] Karen Adams: We should be. And I will say, you know, when people are going through this, this process, 100% of people have cycle changes. Their periods begin to change. We know that will happen. 80% of people get hot flushes and night sweats. About 70% of people get this perimenopausal mood instability. About 50 to 60% of people start having sleep disturbance, which is hugely bothersome for them because then they have brain fog, you know, during the day and, you know, are irritable and it makes the mood, issues worse. And then about 50% of women begin to get vaginal symptoms.
[00:11:56] So you can get vaginal dryness, you can get pain with sexual activity. So that's kind of the whole gamut. And then there's also joint pain. there's a thing called musculoskeletal syndrome of menopause, and about 50% of women just start having aches and pains when they never have had that before. And then there can be a lot of a gamut of strange symptoms that are less common, like, ringing in the ears or burning mouth or, you know, tingling in your fingers. So there's really a lot
[00:12:29] Russ Altman: That's an amazing list of symptoms. And you can imagine-
[00:12:31] Karen Adams: Right
[00:12:31] Russ Altman: ... somebody who's paying attention saying, "Oh, do I have cancer? Am I, am, am I, am, am I out of shape physically? Am I doing something wrong in my lifestyle? Am I eating the wrong foods?" So I can imagine that being very disruptive. And as you said, this could be at a very challenging and exciting time in their lives.
[00:12:47] Karen Adams: Exactly. So they've just got so much going on, and they think they are losing their minds. You know? It's like, you know, I have gone through puberty and I had my kids and I kinda had it all dialed in, and what in the world is happening to me right now?
[00:13:04] Russ Altman: Yes.
[00:13:04] Karen Adams: So the good news is this is 100% treatable. Nobody needs to suffer. And, it's treatable with hormone therapy. And so we treat the, with hormone therapy, we see what gets better and what doesn't get better.
[00:13:18] So, for example, joint pain. Say I put someone on hormones and the joint pain improves, then I figure, you know, that probably was musculoskeletal syndrome of menopause. If the joint pain doesn't improve, then I need to think, okay, should this person go see a rheumatologist? Maybe they're dealing with arthritis-
[00:13:38] Russ Altman: Right, right
[00:13:38] Karen Adams: Or something else going on.
[00:13:39] Russ Altman: It's a really interesting point that you can't just blame everything on the menopause because there might be other underlying diseases and you don't wanna miss those.
[00:13:46] Karen Adams: Correct. That's exactly
[00:13:47] Russ Altman: But it's gonna be hard to, it's, it's hard to know until you treat the, the, the present menopause and then what, as you said, you can triage which symptoms get better and which ones don't. So that, that's really fascinating.
[00:13:58] Now, let's just pause at hormone therapy, 'cause in my career, hormone therapy has had quite a rollercoaster ride. And so, and I'm sure that people who are, who have paid attention are, are aware that there were these trials that like, you know, 30, 40 years ago we were putting all the women on, on hormone replacement therapy. Then there were studies that made things very confusing. We were we were expecting some results and then got different results.
[00:14:24] So, could you take us through what the current understanding, and whatever history you think is important, but the current understanding of how we should use hormones and their safety?
[00:14:32] Karen Adams: Okay. So I do wanna emphasize that the treatment for perimenopause is different from the treatment for post-menopause.
[00:14:41] Russ Altman: Okay.
[00:14:42] Karen Adams: So those are two different things, because in perimenopause people need three things. They need cycle control because their periods are all over the place and their hormones are all over the place. They need contraception, to your point earlier, and, they need symptom management.
[00:15:00] Russ Altman: Okay.
[00:15:00] Karen Adams: So we need to get the symptoms improved, we need to make sure they don't have an unwanted pregnancy, and we need to make sure that their periods are not just erratic and goofy.
[00:15:11] So that requires a certain amount of hormone that post-menopausal women do not need. In post-menopause, we use those traditional hormones that you were just talking about in the big trials. They are about a quarter of the strength of the lowest birth control pill.
[00:15:30] Russ Altman: Okay.
[00:15:30] Karen Adams: So they're a very, very small amount of hormone, and that's really all women need for bone protection, long-term heart health, symptom management, et cetera. And we can talk about that research.
[00:15:41] But in the perimenopause, before we move on and away from perimenopause, it's really important to know that to get those three things, you're not gonna be giving or, or receiving, traditional, what we used to call HRT, we now call it hormone therapy. You're gonna be looking at either a birth control pill, maybe an IUD, or, you know, some other type of stronger hormonal therapy to treat you in that transition.
[00:16:10] Russ Altman: Okay.
[00:16:11] Karen Adams: But once you hit that final menstrual period, age 51 on average, then we're talking HRT, and I'll just use that term because that's what people are familiar with. And yes, HRT has had a long and storied history, right? And if, if you're your age and my age, we have kind of seen that. And it, back in the early, oh, you know, in the '90s and 2000s, a lot of people were on hormone therapy.
[00:16:38] And then the Women's Health Initiative data came out in the early 2000s, and it was an earthquake in menopause medicine. It really surprised us because we had a bunch of observational data up until that point saying that hormone therapy was really beneficial, particularly for women's cardiac risk.
[00:17:00] Russ Altman: Yes.
[00:17:00] Karen Adams: And that's what the Women's Health Initiative was designed to do. It was never designed to assess symptom management or quality of life or anything like that. It was designed to look at the impact of hormone therapy on chronic conditions, primarily heart health, you know, heart attack, stroke, things like that. They also looked at breast cancer risk, other types of cancers.
[00:17:25] So I, I get sad when people criticize it and say that it was a terrible study, it was flawed and all that. It wasn't a terrible study. It was not flawed. It did exactly what it was designed to do, and that was to tell us the long-term risk or benefits of being on hormones. And, surprisingly enough, the people that were on hormones, didn't behave exactly in the way that we thought they would.
[00:17:52] So, the thing that's important to know about the study is that they enrolled women between the ages of 50 and 79 on hormones, people who had never been on hormones before. And we found that the women who were older, over age 65, really responded differently to the younger women.
[00:18:11] So that's really important data that we have now. And we can talk more about it, but you know what, what ultimately happened was that everybody went off their hormones because everybody got scared and, you know, the headlines hit Good Morning America and The New York Times. And hormones cause breast cancer, hormones cause stroke and heart attack.
[00:18:33] But what got lost in the messaging was that that was in those women over 65 who, who were really having the heart attacks and strokes. And if you start on hormone therapy under the age of 60 or within 10 years of the final menstrual period, those women actually got benefits. So the, the data is nuanced, and we have to have that discussion, with people so that they understand, you know, it's not, it's not one size fits all medicine.
[00:19:03] Russ Altman: This is The Future of Everything. I'm Russ Altman, and I'm speaking with Karen Adams. We've been discussing perimenopause, getting into menopause, and some of the treatments.
[00:19:11] We ended our last part of our discussion with the Women's Health Initiative, and it, it, it was a confusing time for many people because a, a treatment that was universal and was really seemed to be doing well all of a sudden came into question. So, to kind of put a bow a little bit on, on those issues, what do you tell women, both perimenopausal and post-menopausal, about the risk and benefits of a hormone replacement or hormone therapy these days?
[00:19:37] Karen Adams: Yes. I, I first talk about the benefits. I say, "You know, I can take your hot flushes away in about three weeks. You'll get a decent night's sleep. it's gonna be very stabilizing for your mood. Your joint pain's gonna get better. Over time, probably your brain fog will lift, and your vagina will get happier because the vagina loves estrogen." So, those are all the benefits.
[00:20:00] Russ Altman: And that all sounds quite good, right? That's quite a sales pitch.
[00:20:03] Karen Adams: Right. Well, yeah, if you wanna call it a sales pitch. I, I'm just laying it out there.
[00:20:09] Russ Altman: Yeah, my words, not yours. Not yours.
[00:20:11] Karen Adams: Right. I'm just laying it out there. And, and so all of those things, not only that, 15 years from now you'll have better bones. You'll have fewer bone fractures, better bone density. We know that. Estrogen increases bone density by about 5 to 6%. So of course, we talk about strength training, we talk about other things that people need to do for healthy bones, but estrogen really is good for the bones.
[00:20:35] Also, if you're under 60 or less than 10 years out from your final menstrual period, you will get cardiac benefits as well. So we're all depositing calcium in the coronary arteries in our hearts, but that process slows down in younger women who take hormones. Younger women-
[00:20:55] Russ Altman: And the calcium is bad, just to state the obvious.
[00:20:57] Karen Adams: Exactly
[00:20:57] Russ Altman: ... the calcium deposition in your coronary arteries is not good.
[00:21:00] Karen Adams: Right. We don't want that. And so if you're under age 60 or within 10 years of your final period, you're gonna get that benefit in the heart.
[00:21:09] In women over that timeframe, it doesn't harm them, but they don't have any benefit over and above placebo. So, it didn't seem to have that same benefit in the older women. So, that's part of the reason why we think it's best to start in that window of opportunity under age 60 or within 10 years of the final period. So those are all good things. What are the downsides?
[00:21:33] The downsides are, that in the Women's Health Initiative, we saw an increased risk of breast cancer in the women who were taking both estrogen and progesterone. and it was only about eight extra cases per 10,000 women per year, which is not much.
[00:21:51] Russ Altman: Yeah.
[00:21:51] Karen Adams: It's greater with a sedentary lifestyle or if you drink one glass of wine a night. Obesity increases the risk of breast cancer by ninefold. So, there are many other things that increase the risk of breast cancer more than hormone therapy.
[00:22:06] We also think that that was an overestimate because those were done, that data came from synthetic hormone use, and we are now using bioidentical, meaning your body recognizes it. We think those hormones are much less inflammatory and much more breast neutral. So, we don't worry too much about the breast cancer risk, but that's an individual discussion that we talk about with, an individual patient. People do...
[00:22:35] Russ Altman: Would family, would a family history, if a woman has a mom or an aunt or a sister who has a history of breast cancer, does that come into the calculation?
[00:22:43] Karen Adams: It does, but it's not a contraindication to being-
[00:22:46] Russ Altman: Okay
[00:22:46] Karen Adams: ... on hormones. Even if a woman has a BRCA gene, even if she's BRCA positive, she can still consider being on hormones, and that's a discussion that we have. The only people who really should not take hormone therapy are people who have breast cancer themselves, and even that's a little nuanced because it depends on the type and how long it's been and all that. People who have had a heart attack or a stroke, or people who've had a blood clot in their leg or their lung or their brain, again, with some nuance there. So we talk about all of those things.
[00:23:19] But you know, Russ, what people come to me and they say, "I'm not having a ton of symptoms," that sometimes happens, "but I want it for my brain," or, "I want it, you know, I want it for, you know, my mom had dementia, and I don't wanna have that." so that's a kind of a, a more nuanced discussion. We know that there are estrogen receptors in the brain, and they light up as people get older. It seems like the brain is trying to sop up estrogen more and more, as a woman ages, but we don't have good data to say that it prevents dementia. In fact, if you start hormone therapy after age 65, it increases the risk of dementia.
[00:24:00] Russ Altman: So a lot of these, of the advice that you're giving is very dependent on the age of onset. Is there any downside? So let's say a woman who perhaps listening to this podcast gets excited, she has symptoms, and she goes on, the initial perimenopausal hormone therapies, and then she has her, her menopause, and then continues with the postmenopausal.
[00:24:20] Is there any downside to being on those, those treatments like early and then throughout your life? Or do you feel like there's a, some sort of lifetime limit of how much hormone exposure you should have?
[00:24:33] Karen Adams: Great question. There's no age at which we automatically stop-
[00:24:37] Russ Altman: Okay
[00:24:37] Karen Adams: ... hormone therapy. And I will tell you, I'm 67 and I'm going to die with my hormones in my hand. And so, you know, I believe in it, and I think that if you start at the right time and you don't have the contraindications and you don't develop any contraindications, there's no age at which we automatically should stop.
[00:24:59] Russ Altman: Great. So I, I wanted to also hit. You made, you made a, a mention of a happy vagina, and I wanted to go back to that 'cause I know in your writings and in your research you talk a lot about lifestyle and sexual health, and, and, and these are intimately related to some of the symptoms and some of the physiology associated with both perimenopause and menopause.
[00:25:17] So, what do you have to say about the, options that women have and what, what, how they should be thinking about this? Like, my sense is that all is not a lost cause and people shouldn't give up.
[00:25:27] Karen Adams: Absolutely. Now, 50% of women do not have pain with sex when they go through menopause. I have a patient who is 80 years old and she's having sex with two different men, no pain at all.
[00:25:39] And so that can be true for some women. But some women will start to experience pain in their 40s, pain with penetration, inserting something into the vagina, and that is treatable. And the way we treat that is, with local estrogen. So when we're talking hormone therapy, we're talking, you know, a patch, a skin patch, or gel on the arm or gel on the thigh.
[00:26:03] Those create circulating blood levels of estrogen. But the vaginal types of estrogen that are creams or a ring in the vagina or a tablet that goes in the vagina, those do not circulate estrogen levels in the bloodstream, so they are local effects only, and there is literally no contraindication for a woman to use that.
[00:26:26] Even if she's got breast cancer, even if she's had two heart attacks or something, she can still use local estrogen, and that's gonna make the vagina happier and the bladder happier. Because this thing called genitourinary syndrome of menopause is not just vaginal, it's also frequent UTIs, feeling like you have a UTI and you don't, that sort of thing. So those options are available to women, and it's important that they know that those are effective and safe.
[00:26:56] Russ Altman: So two questions about that. Would the, would those creams and topical, ointments, would they be used in addition to systemic, like pills for hormone therapy, or are they a alternative to taking the pill?
[00:27:08] Karen Adams: Right. That, they can be used in addition. When people are on systemic hormone therapy, the patch or the gel on the skin that give you the circulating blood levels, you get about 70% improvement in the vagina with that. So, a lot of people won't need it, but some people still need it, need the additional vaginal treatments.
[00:27:30] Russ Altman: And the, and the other question I had, as the, from a perspective of a man is, is there any risk to a man, having sex with a woman, who's using the ointments in terms of absorption of the estrogens- during sex?
[00:27:45] Karen Adams: Right. Important because women, the vagina is mucosa. It's like the inside of your mouth, so it's gonna absorb a lot more, whereas men are covered with skin, and that is much more of a barrier to absorption of anything.
[00:28:00] So I tell my patients, "If you've applied some cream that night and then you happen to have sex, you don't need to worry about it. You know, it's not, it's not gonna impact your partner at all." You know, and even oral sex, you know. most of the time with the, with the cream, we have them rub it in really well so you don't get a glob of cream in the mouth or anything like that. But it's not harmful for men.
[00:28:23] Russ Altman: Great. Great. So in the last minute or so, I did wanna ask you about the, the your general view of the landscape of women's health. You've written about this. You care about this deeply. We've talked about some aspects of it, just now. but how is things looking in terms of understanding, you know, what makes men and women different? What are the, what are the different health challenges? What are the different physiologies that are relevant? What's the state of our knowledge, and are, and are you pleased with our current, state, or do you think there's a too much work to be done?
[00:28:53] Karen Adams: Oh, my goodness. Oh, my goodness. I am pleased with our current state, and I'm also hungry for more because women's health is the most under-researched, under-educated, over-legislated area of health in this country, and we only get 10% of NIH funding. And it really has been shameful for a long time. Women were not even enrolled in clinical trials until 1993.
[00:29:20] Russ Altman: Yeah.
[00:29:21] Karen Adams: And so we really, really have some catching up to do, but the good news is there is a spotlight being shown on this now. We have Melinda Gates writing an op-ed in The New York Times. We have the Menopause Society that just has been given $10 million to focus on menopause education for clinicians around the country and around the world.
[00:29:42] We have a wonderful new documentary that's coming out that Katie Couric has done that's called Hormonal, that I actually was honored to be interviewed for.
[00:29:50] Russ Altman: Oh, great.
[00:29:51] Karen Adams: I'm super excited for that. Hopefully we'll see you at the Oscars.
[00:29:54] Russ Altman: Yes. Yes.
[00:29:54] Karen Adams: And, and, and so I do. And, you know, Halle Berry was on the steps of the Capitol screaming that she... about menopause. So there is a lot more attention being paid to it now. Women are, are educating themselves. Physicians are looking and, and other providers are looking for education, so it's very exciting to me. I think that for our daughters and our granddaughters, we're gonna know so much more.
[00:30:18] Russ Altman: That is great to hear, and so, and, and a great way to finish most of our conversation.
[00:30:23] But before we finish our total conversation, I wanted to ask you if you're ready for our, segment that we call, The Future in a Minute, where I'll ask you some rapid-fire questions, and we'll get your, kind of quick responses.
[00:30:35] Karen Adams: Love it. Great.
[00:30:36] Russ Altman: Okay. Here we go. What is one thing that gives you the most hope about the future?
[00:30:41] Karen Adams: That spotlight that is on women's health right now, I am so optimistic that things are, are gonna improve. So I'm very hopeful about that.
[00:30:51] Russ Altman: What's one thing you want people to walk away from this episode remembering?
[00:30:57] Karen Adams: If you have ovaries and you live long enough, you will go through menopause. so menopause is inevitable, but suffering through it is not inevitable, and you should not stop until you find expert treatment, and you can find that.
[00:31:15] Russ Altman: Aside from money, what is the one thing you need to succeed in your research?
[00:31:20] Karen Adams: Money. I need money. But actually, I'm not a researcher, really. I'm a clinician and an educator. We have wonderful people at Stanford doing work in menopause in all kinds of realms, and what I'm actually recruiting for right now is a research director. I need someone to come in and pull those people together and help them with their collaboration and creativity.
[00:31:47] I've brought them together for education and for clinical care, but we are actually recruiting for a research director. And if there's anybody out there who's a professor or associate professor and does menopause research and is interested in coming to Stanford, call me, because, we are actively recruiting.
[00:32:05] Russ Altman: Awesome. If all goes well, what does the future look like?
[00:32:09] Karen Adams: If all goes well, every 35-year-old woman will get anticipatory guidance, every perimenopausal woman will have her symptoms treated, and every post-menopausal woman will have, counseling around chronic health concerns to improve and maximize her lifespan and health span.
[00:32:33] Russ Altman: If you were starting over again and you needed to get your certification or your degree in a different discipline, what would it be?
[00:32:41] Karen Adams: I would either be a financial advisor, because I love the financial markets, I think it's super interesting, or a pastry chef, and I would make baguettes and croissants all day.
[00:32:54] Russ Altman: Thanks to Karen Adams. That was the future of menopause. Thank you for listening to this episode of The Future of Everything. Don't forget, we have a back catalog with more than 300 episodes that you can listen to forever on a wide variety of topics. We wanna thank you for listening, and if you have a moment, we'd be really grateful if you would rate and review the show.
[00:33:11] We'd like a 5.0 if we deserve it. In the comments, we read every one of them, and it helps us think about new ways to improve the show. You can find me on many social media platforms, including LinkedIn, Threads, Mastodon, and Bluesky. You can also follow the Stanford School of Engineering @StanfordSchoolofEngineering, or more briefly, @StanfordENG.
