Dr. Sharon Malone is a nationally known expert in women’s health and the author of Grown Woman Talk. She is the Chief Medical Advisor at Alloy Women’s Health, a telehealth company that focuses on women over 40. Before joining Alloy, Dr. Malone was a partner at one of the oldest and most successful OB/GYN medical practices in Washington, D.C.
Dr. Malone joins Stacy to talk about the current state of menopause legislation and the impact that the Women's Health Initiative (WHI) study had on women’s healthcare. They discuss the disparities that African-American women face in menopause, the need to reorient thinking around women’s health, and why prevention is just as important as treatment. Dr Malone shares practical advice on what women can do to get ahead of aging, and encourages every woman to be a strong advocate for her own health. Listen for the beep at the end of the episode to learn about a musical treat from Dr. Malone!
Dr. Malone's book Grown Woman Talk is available for pre-order.
Follow Dr. Sharon Malone: https://www.drsharonmalone.com/
Follow Stacy London @stacylondonreal
Hello Menopause is a podcast from the national nonprofit Let’s Talk Menopause. Produced in partnership with Studio Kairos. Supervising Producer: Kirsten Cluthe. Edited and mixed by Justin Thomas. Artwork by Stacey Geller.
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Stacy: Hey friends, the views of our guests do not necessarily reflect the views of Let's Talk Menopause. Let's Talk Menopause does not provide medical advice. The content in this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions that you may have.
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Dr. Sharon Malone is a board certified OB GYN and a certified menopause practitioner. She is the Chief Medical Advisor to Alloy Women's Health and is the author of the upcoming book, Grown Woman Talk, due out April 2024. She's also a fierce advocate for women's health and is passionate about empowering women everywhere to get the information they need.
Sharon and I are going to talk about misconceptions about hormone therapy, the systemic changes that need to take place in the healthcare industry, including the menopause research bill that was just presented to Congress, and what women can do to advocate for themselves to get the healthcare they deserve.
Please welcome Dr. Sharon Malone to Hello Menopause.
Dr. Malone, it is so great to talk with you. I know that you have been leading the charge in terms of research and investment around menopause and menopause care policy and changes on the federal level. Can you talk a little bit about legislation and where we are with that? Sure.
Sharon: And thank you for having me, Stacy.
This is a wonderful conversation that I cannot wait to participate in. And let me tell you, I've been out here, talking about menopause for a very long time and, probably over 30 years now. And what is very I guess heartening for me is the fact that the conversation is finally catching fire.
What we are finding is that women are starting to be more engaged in this conversation, and it is this grassroots effort that is fueling the legislation that we have now pending. There's the Menopause Research and Equity Act, which Congresswoman Yvette Clark has introduced. Yay for that.
And it is really aimed at getting the answers to some of the questions that we have been asking for the past 30 years. And it is designed to do a few things. One is to which to examine the record, there is a lot of information that's out there, some of it good, some not so good, to examine and to make sure that we are getting a consistent message out there to women because Yes, we need an impartial arbiter, which should be the NIH, to look at this information and say, you know what, we got some of the stuff wrong.
Let's figure out what the things are that are wrong. Let's correct that record. And that should be corrected on the NIH website, by the way, because there's a lot of still old information out there that's not been corrected. We want to use that as a platform to say, Okay, this is what we have. This is what needs to be corrected.
Where are the areas of deficiency where we can really go back and say, All right, what are these still unanswered or unclear questions that we have to have? And finally, it's also to get NIH to understand that we as women are 51 percent of the population, but in 2022, the NIH budget, which was 45 billion, as best we can tell, about 10 percent of that went to conditions or medic, or medical conditions that affect women.
And that's just unacceptable. So you know, it's a messaging piece of legislation, but it's really to highlight the issues that we really, as women, need to have answered.
Stacy: I was going to say that this is so incredible on so many levels. One, I think, Watching for about five years now this menopause movement, as you've been doing this for so much longer, but to see the way that it's been talked about and the different iterations that it's gone through, this idea that we have no clarity around certain parts of this, I'm curious if you think that started With the WHI study, I we're understudied as women, female physiology.
I think that's a bigger issue. But do you think that, that study, I remember you saying once, like something so incredible, you said: I am not pro-hormones. I'm anti-suffering - and it's stuck with me because now we have been talking about hormones as the gold standard and the WHI study that came out, I think in 2002 or 2001, was telling us that it was so dangerous and everybody was going to get cancer and it was such misinformation that in some ways I think that did more damage to women than we've seen since. Right now, all the work of cutting, chipping away at that myth, or at least correcting that sort of data has been the hard work of people like you.
Sharon: It's been damaging on two fronts, not only in terms of scaring women away from something that is very effective for treating menopausal symptoms, but it is also frozen research in this area because it has become almost established dogma. This association between hormones and breast cancer.
And also lack of benefit from the long term health benefits of hormones, particularly as it relates to cardiovascular disease. And that is really, that's the information that came out of the Women's Health Initiative. And once that took hold, research, not just in the United States, but around the world, basically halted and has been, we've been standing still for 20 years, except for a few researchers out there who are trying to answer some of these questions.
But the funding hasn't been there. No one's interested in hormones anymore. And I think that, it's what really frustrates me, because as a clinician and being out there and being someone who practiced before, for the Women's Health Initiative was announced in 2002, during and after, the narrative about hormones has changed dramatically because the way that we practiced before the Women's Health Initiative was quite different than the way, than what happened afterwards.
I think that a lot of women have been ill served and have suffered needlessly. And as I said, hormones are not for everyone, but they are for way more women than think they can take them. And that's the part that really distresses me is that, to see all this suffering and to not be able to give them the most effective solution for that discomfort.
Stacy: I suffered from that personally. I was told for seven years that I could not go on hormones when I had pretty much every perimenopausal symptom you can think of, and then some and finally, I was getting about three or four hours of sleep a night. I was losing my mind. And I finally talked to my doctor. I texted her at four o'clock in the morning just to put a really big head on the point on the head there and say, I can't bear this. I'm miserable. Let me talk to a menopause specialist. Let me see what the real risks and benefits are.
Let me weigh them for myself. And I got on hormones. I started sleeping seven to eight hours a night. And possibly because I was sleeping, my mood just completely flattened out. Like I wasn't having these kinds of highs, lows, anxiety, depression, rage. I felt like myself again. And the idea that could be denied somebody for this past 20 years is just, it's infuriating.
And I wonder, why do you think that the scare was so much easier to you know, lodge in people's minds than the newer information that we have, that it is possible to use hormones well and that the risk is much lower than we thought it was. Why is fear mongering so much easier when it comes to medicine?
Sharon: It's fear and it's two sides of a coin. And we have done such an effective job at educating women around breast cancer, that anything that you say that will increase that youth, that even Intimates that it increases your risk of breast cancer has been really the nail in the coffin as far as Hormone therapy goes, you know when you talk about cardiovascular disease people like oh, yeah, whatever, you know that happens to old people but the reality is that cardiovascular disease is the number one killer of women in this country before and still today.
And yet, we don't fear it the way we fear breast cancer. And, and it's good news and bad news because it's really increased awareness. It's made clear for women to get early diagnosis and treatment. And that's the good news. The bad news is that anything associated with that has really driven them away from things that may potentially improve their cardiovascular health.
Stacy: And I guess maybe one of the other questions that I had about it is that there is treatment for breast cancer. I'm not saying I want anybody to get it but there is treatment. There is early detection. There are ways to manage it. Thank you. When, I look at the risk benefits, this idea that cardiovascular health could be helped by hormones, and that we, aside from exercise and diet and sleep and that sort of thing, don't have that many tools to really manage cardiovascular health, you would think that benefit would be of more interest than just the fear of breast cancer. And yet that hasn't taken hold just yet. How do you think that could be improved?
Sharon: You know what? I think that just generally in medicine, we focus so much on treatment and so little on prevention. So there's a lot about cardiovascular disease that we can do without taking the first medication. But we don't preach that gospel to our patients. We wait until someone's got a disease and then try to figure out how many medications are we going to give you to manage it afterwards. So anything that goes on that prevention side, we as physicians have got to do a better job.
Stacy: Could you talk to us a little bit about this? Because one thing for this podcast season that I felt really strongly about was that everybody who listens to this podcast should come away with real time, real information that they can utilize in their own lives. So when you talk about that kind of prevention, three things that are easy for us to do and remember in order to improve our cardiovascular health
Sharon: Exercise. That's number one. And I say that not to say that you need to exercise to lose weight. That's not the point. Exercising in and of itself. Being active not only decreases your risk of cardiovascular disease. Believe it or not, it decreases your risk of heart disease and most cancers, and people don't realize that, just the importance of regular exercise. That's one. Cutting down on alcohol. We used to have this notion that, oh wine is good. You should drink alcohol. It's good for your heart. Turns out, not so much, And again, we're not here instituting that we should reinstate prohibition. We're just saying in moderation.
Stacy: Yes, I know I can't give up a filthy martini.
Sharon: Once in a while, of course, I am all for that, but just understand that alcohol is not the benefit that we thought it was. And the importance, let me just say this again, the importance of sleep. And there is a backdoor reason about why we think that. Hormone therapy helps so much in prevention of cardiovascular disease. Yes, there may be some pathophysiological thing that's going on with the estrogen itself, but just if you did nothing more than decrease the amount of hot flashes that women have that disrupt sleep, that in and of itself would decrease your risk of cardiovascular disease.
And I say this too, for. people that are out there and, I don't, I really don't like to focus a lot on weight. I care more about what your fitness level is. And I care about what your metabolic profile is. If you have high blood pressure, if you have diabetes. If you have high cholesterol or high triglycerides, those are the things that increase your risk. And there are people who weigh more than what we think is an ideal body weight, who have really normal parameters and who exercise and do all those things. And I would say you're good, so we're not trying to, we're not trying to get to a particular number. We're just understanding what the risks are and what you can do to manage them.
If I said, Exercise, get sleep, cut down on alcohol, three simple things that everybody can do that doesn't cost you anything, and then anything you can do over and above that is gravy. So yay for that.
Stacy: That's wonderful. I, going back to what you were talking about in terms of some kind of regulatory official information that would be on the NIH website, which I think would be so incredible, because again, we've seen with this, huge, rage about menopause, there is a lot of conflicting information. And what I've noticed is that the general public still, it's almost like she has decision fatigue before she's made a choice, right? You've got some doctors telling her about hormones. You've got some people selling magic potions. It's still a little bit confusing.
So how far away do you think we are from passing that kind of legislation? And will you be directly involved in what that regulatory information looks like?
Sharon: I hope to be. But I think that all I can say, and that what I offer is that, I have 30 years of experience In this field, and I have delved into it more deeply, I would say in the past three or four years than I have even in the past 25 years below, before that and I'm still learning things and to be quite honest with you, I can read a study here and there and it confuses me, and I'm like wait a minute, somebody just said that somebody said this, and it goes back and forth and having clarity on some of these issues is going to require not just reexamining and rehashing old data, because a lot of what we know, benefits about hormone therapy still come from the Women's Health Initiative. That's where we learned, it matters when you take hormones. When you start them in this symptomatic process the earlier in menopause, the more benefit you derive. That's the message that we really got from the Women's Health Initiative. And that didn't really get out there in the world, about timing matters.
Stacy: When you read the WHI, you had already been practicing and you'd already had experience with hormones. What was your personal reaction to it? Were you surprised at the findings? Did you immediately realize this doesn't make sense to me? Because I'm so curious, that it literally stopped research for 20 years.
Sharon: To say I was surprised is an understatement because I remember the day the study came out because we were, we had been out 10 years. I had been taught in training about the cardiovascular benefits and everybody knew that hormone therapy relieved the symptoms of menopause.
That was not even up for debate. Of course, that's why it wasn't one of the endpoints that they even looked at in the study. And as a matter of fact, in the Women's Health Initiative, they recruited women who didn't have symptoms. And the reason why they, that's why these women, there are two reasons why they chose older women predominantly in the study.
One was the study was only slated to last for eight years. Now, if you're trying, if you have a study that you're trying to prove a benefit for cardiovascular disease, which was why the study was started, women don't typically have heart attacks until about 10 years after menopause. There is thought to be a cardio protective effect of estrogen, which is why younger women don't have heart attacks the way men have heart attacks in that 40 to 60 range. But once you get to 60, the heart attack risk goes up and they start approaching the risk of men. So they said why do we need 50 year old women in the study? We're going to take 10 years before we can see a difference in whether it works. If we got older women who were closer to those heart attacks, then we could do something and we could prove that was number one.
And the other reason why they chose women who were older and more, they were less likely to be symptomatic. Because if you're going to do a randomized, double blind, controlled study, placebo controlled study, you have to not know what you're on. Because if the doctor knows what you're taking and you know what you're taking, then, aha, blinding is over. But if you have 10 hot flashes a day, I give you your therapy - it could be a drug or placebo, and your hot flashes go away in two or three days, you know what you're taking, and your doctor knows what you're taking. That's why that population was skewed to older women, to asymptomatic women, who really weren't in, you weren't representative of what, of how we had been, prescribing hormones.
Stacy: I've heard you talk about this before. I just remember that the study wasn't actually about menopause. And I think that is what's so interesting. When I started to learn about this, I thought the whole issue was about hormones and menopause. And the fact that it's about cardiac health. It also makes the conversation even weirder that we stopped for a completely different reason than the test was made for.
Sharon: Oh, absolutely. Bear in mind the women were recruited to be in this study starting in the 1990s, I think it was 1993. That they started enrolling patients in this study. Now, hormones have been around since 1942. So there was considerable evidence about hormones and how they treat symptoms. There was even, and it was such a mindset, not only that it treated symptoms, but for younger women that it decreased the risk of heart disease, that's why they were saying we don't even need younger women in the study. We don't even need them. We know that already. That's how we got to this. But getting back to your original question of what happened on that seismic day in July of 2002. Imagine this. The investigators at NIH, this regulatory board, called a press conference. At the National Press Club, which was the last time anybody reported a study and assembled the press at the National Health Club, unless you were curing cancer or something which you were not curing.
So they assembled the press, and they were determined to say, we've got to clamp down on this. hormone thing. People are just getting a little too carried away about the claims about hormones. So when they stop a study that was supposed to last eight years, they stop it at five years. It makes it look so dramatic because you have found something that's so terrible.
And all they found was that at five years, they didn't see the expected decrease in the risk of cardiovascular disease. Not surprising. These were older women. But they had that slight increase in the risk of breast cancer that they reported. But here's the problem. This is pre internet, pre, we don't have any way, there's no social media such that when they held that press conference, it was 10 days before we even had access to the journal.
So we couldn't even read it. All we had was what they reported in the New York Times and the Washington Post. And you're like where's the study? Can we look at it? In those 10 days, that was pure hell in our office because the phone was ringing off the hook. Oh my God, doctor, I can't believe you're giving me this stuff. It's going to kill me and how dare you and all of that went on and on. And women just stopped taking hormones like overnight. And when I finally got my hands on the journal, Ten days later, in the mail, in the old fashioned snail mail. When I got it, I read it. And to be honest with you, Stacy, at that moment, when I read it, I said this isn't that bad. It was, but we, I knew that in real time. And most people didn't bother to read the story. They read the headline and moved on and everybody said, yes, it causes cancer and it doesn't help with your heart.
But there has always been controversy about that study from the moment it was announced for the next 20 years, there has been debate about this. And that's why you have some experts to say yes, some say no, but the overwhelming preponderance of the evidence says this, hormone therapy is the most effective treatment that we have still to date for menopausal symptoms.
It appears that there is a window of time that it is important to start hormones. Don't start hormones at 70 and expect you're going to decrease your risk of heart disease because you probably already got it. And the other thing that we found is that the risk of breast cancer was also overblown. And to put that in perspective for you, even the women who took the estrogen and progestin therapy, and those are for women who had a uterus, they found that the risk associated and not causal associated with hormone therapy use was less than one percent. in a thousand additional cases per year, less than one in a thousand.And you would have thought, oh my God, women are just falling out and dying. And even that's debatable. That's the part about it. Because 26% sounds like a lot, but 26%t means your risk goes from being 30 in 10, 000 to 38 per 10,000, which is less than one in a thousand additional cases for women who took hormones balanced by all the other benefits that you get from hormone therapy, which, seemingly disappeared from public conversation and knowledge.
Stacy: Certainly all these patients who were calling you and saying, you're killing me on this stuff. How, how could they, how could everybody not realize one, one study is one thing, but I realize now. Particularly because we're in this age of social media, it's so much worse because everybody has an opinion about everything, and it's opinion, and that is not medical fact. And so now, you hear something, it's terrifying to me that we don't actually know the truth. This idea of something being regulatory and certainly, there are things that you said before that we don't know because we haven't been able to have that research, we don't have that data. How are we going to get more funding for that? Is that a legislative issue as well?
Sharon: You know what I think is really going to happen? I hate to say this, but I don't really have a whole lot of faith in our Congress to be able to do anything, to be honest with you. They certainly don't represent constituents, that's for sure. But I think what's really moving the dial on this, Stacy, is the conversations like this that we're having, women have to get mad and demand it because a lot of what we were trying to do to even get support for this bill was really building grassroots support. It will happen. If we write our congressperson, if we say, Hey, NIH, why can't, why don't you fund things that primarily affect women? And just as an aside, it was only until 1993 that women were even mandated to be included in studies by NIH. And and these are things that we've got to say, most people are unaware of this, and once you're aware of it, yeah, we want you to be indignant, we want you to be righteously outraged, the fact that we are still using men as the measuring stick. Our physiology is different. We're finding out that it's not just about hormones. It is across the board. Statins don't work the same in women as they work in men. Aspirin, this whole thing about taking aspirin a day. Guess what? It's different for women than it is for men.
And no one has actually taken into account the fact that Our physiology is different and it's been said time and time again, women are not little men.
Stacy: It's so interesting to me that you say that because when I think about it, all the things that I've read about medical history and even the way that we practice medicine today.
Even if you are a woman, you've still been taught medicine through this sort of patriarchal lens. The idea that women have only been studied for 30 years isn't even necessarily with this lens of what is it about female physiology that has nothing to do with male physiology. What are we looking at specifically? What's that plumbing? What are those systems? And I imagine as a doctor, I know you're no longer practicing as an OBGYN, but I imagine that is very frustrating to you because there's only so many people that you can talk to, right? There's only so many people that you can reach. And I do, I feel very strongly that my interest in menopause obviously was my experience with menopause.
And that sort of led me to the conclusions that you are talking about, that we are just understudied and we are so under. When we also bear the brunt of carrying children, we're getting the short end of the stick, both in research and in life. The pay gap, all of those things, seems to lead to so many different issues.
Sharon: One of the things that we've got to do and one of the mindsets that we have to change is really to reorient women's thinking and the medical community's thinking about what the expectations are for women. And I think that our language is important. And we have incorporated the language of suffering. We suffer from migraines. We suffer from cramps. We suffer with this. We suffer from depression and it, we say it so nonchalantly as if, yeah that just goes along with being a woman, you women suffer from things. But no one has really taken the next step and says, okay what are we going to do about that?
Or what do we have to alleviate that suffering and I hate to see people suffer. That's why I went into medicine, to figure out a way to make that not be the case and for People to tacitly accept that as their lot in life. To me that's tragic. Like I said I'm not, I'm in this game not to sway you one way or the other. But what I do want you to have is the facts. And I think that women, when they're given facts, they're more than capable of making decisions for themselves. They have agency. Yeah, of course. Don't let fear be the motivator about why you do or don't do something. And my job is also to make sure that this next generation of physicians does not grow up in this 20 years, this 20 year vacuum that we've had post-WHI.
Because they are now coming around to the fact that, “Oh I didn't learn anything about that”. Let me get educated because it's going to take too long for that pipeline. We're going to change that. Medical education is going to change. People like Mary Claire Haver are out there volunteering her time to teach residents about menopause. But that's going to take a minute. In the meantime, we've got to get people to realize that this is something that we need to fix today, not 10 years from now, because we're already 20 years behind.
Stacy: I love this idea of changing language around female experience, this idea that we do use the term “suffer” or “battle” or things that just make it sound like we are fearful of what's going to happen to us.
And again, I just want to reiterate, because I think it's so important for people to hear, you should never have to make these decisions out of fear. You should make them out of knowledge and out of getting facts that allow you to make choices. And as you said before, hormones aren't the only choice, but if you don't know what they are, how do you make an informed decision?
I wanted to talk to you a little bit about health and equality. Because this is not just an issue of we're not little men, right? This is about economic disparity. This is about race. This is about rural communities. It's one thing to say, oh, look, if hormones aren't covered by your insurance, that's fine.
Privileged people can pay for that. And in some ways, I think, we say we're healthier, but that's for the wealthier. How does this become something where the information and the access becomes available to more people?
Sharon: Again, there is the short term and long term, about how we're going to do this. And the short term solution, which is really why I joined Alloy Women's Health, which is a telehealth company, because I realized that most women, even with the knowledge, And the money still don't have the access because they go to their doctors and their doctors are gatekeeping because they don't know what the answer is.
And they go, Oh no, you can't have that. You'll have a family history of breast cancer. You can't have that. ridiculous. So you have to give women a way to access information. What is going to happen? And here's an interesting statistic, the group of doctors that is probably most well equipped to treat menopause would be OBGYNs, right?
We've got a huge OBGYN shortage in this country. And with all that's going on post Dobbs, there are going to be states where the gap is going to be even wider because who's going to want to move to states where everything you do is watched and maybe you'll be prosecuted for something? So we have to have a way where women who live in Yazoo City, Mississippi can get access to the same care - and I won't even say better care, because just because you live in New York City there's a lot of nonsense in New York City too.
Stacy: And again that's why I talk about this. This is not a coastal problem. It really is that lack of knowledge leads to a lack of access for everybody. So yeah, so I know you're the chief medical advisor to Alloy and they are a telehealth platform and big telehealth has become much more popular. Do you see that as being part of the answer in the short term?
Sharon: That's part of the solution for now. You know, it really is. Because, we have short term, long term goals. And I think that, but particularly, there are going to be a lot of things, and menopause is probably the prototype for the type of care that really can be done in a telehealth environment. You go to your doctor for the things you need to go to your doctor for. But there are certain conversations and information that is really best delivered in telehealth because guess what? You can go to a website and read about this. You can have all that you can have curated information, vetted information for you. And then now you can educate yourself and go do this and interact with a doctor in a way that you don't have 45 minutes to talk to a doctor in real life.
Stacy: We've talked about that before, right? It's 11 minutes and five minutes to get dressed.
Sharon: Exactly. That amount of time is getting shorter and shorter. I think that it's uniquely suited for this, but you'll find that telehealth is here and it is not going away. It gives women access who otherwise have doctors who are gatekeeping or uninformed or you don't have a doctor that's also a problem.It's also a great solution for women. What about people who are between jobs? You lose your insurance. And now what are you supposed to do? You're sitting here and now you're miserable until whenever it is. We tried it. One of the things that was very important to me, and one of the things that we were able to do is that we kept our solutions affordable because again, it should not be a reason that we price this out.
And this is only for people who are wealthy. No, that was why we chose the solutions that we have because we use generics. We keep them at a price point that most people can afford. people can afford. So that was number one. And two, when you're talking about the equity piece and not only are women who live in, rural areas who [00:34:00] have no doctors that's not just a problem for them.
When you're talking about African American women. Now here's another little statistic that was jarring because it came from the studies of women across the nation, which is just this long term study that NIH has going that's just saying we just want to know what menopause looks like. So we're not doing anything.
We're not giving any drugs. We're just enrolling women and watching you as you go through this menopausal transition. What are your symptoms? What are you doing? What? How much
Stacy: money is put towards something like that? I'm just curious. If this is like an ongoing, NIH is not really doing anything except recording information.
Sharon: All they're doing is collecting data. I'm so curious to
Stacy: see how much money goes into something like that.
Sharon: That would be a very good question because the thing about The funding at NIH is because you can't really track how much money they have. I told you there's only about 10.8 percent that goes to women. How much of that 10. 8 goes to menopause? Not much - 0005. Yeah, exactly. Because they don't even track it that way. Where are the studies that are on perimenopause? Duh, I don't know. But, because they don't even I don't think that it is worthy of being a trackable item.
Stacy: And how money is allocated, that I find fascinating. So NIH is just tracking women, symptoms, things like that. We were talking about African American women.
Sharon: And what they have found just from the study, just so you know, and they're saying, okay how long, this is how we get this information of how long does perimenopause last, and it lasts way longer than women think it lasts, it's anywhere from four to seven years.
African American women average 10 years. 10 years to be sleepless, brain fog, hot flashes, vaginal, all those things that we associate with menopause start happening to women in the menopausal transition, can be as early as 40. And what we also found out about African American women experience during menopause is that their symptoms start earlier, the menopause transition takes longer, And the symptoms are more severe.
So all of those bad things, and, again, think about that. And to make it worse, they are least likely to get a prescription for hormone therapy. They're only about half as likely to get a prescription, even when they go to their doctor and ask for it. And another drop off after that, because even after they get the prescription, they're less likely to take it.
So we are treating a fraction of the women who have the most severe symptoms. And to me, that is unconscionable. That we don't do a better job. Because remember I told you, hot flashes in and of themselves are an independent risk factor for cardiovascular disease. So you've got women who have the most symptoms, who are more at risk for cardiovascular disease, who are getting the least amount of therapy and treatment.
Stacy: And, there, there's so much, there's bias, right? Obviously I think that it's been documented. And then there are so many women that I have met of different races who have said to me, I get my nails done and my hair done before I go in for any procedure because I want my doctor to think I can sue them.
That, which I was like, oh my God. And then I met women. who said to me that their uterus was taken out without their permission. And that happened so much more than it does to Caucasian women. And I found that astounding. And then I'm like why do you expect other races to trust the medical system?
When you say that African American women don't usually don't take that medicine, that makes perfect sense to me. They have no reason to trust the medical system. And that feels like another thing we have to Correct.
Sharon: But it gets back into this whole notion about accepting suffering, and I don't think anyone is suffering more than African American women in this country. Let's be real. And so this notion that that's just how it is, girl, just, I have literally been out and I'm not in my, I don't have my doctor hat on. I'm just out and people are talking and I will see. Women just break out into a giant sweat, and they're sitting there and and they're fanning and I don't sometimes I don't, I'm like, and I'll go over.
I was like, girl, you know we have something for that, right? I'm just trying to help you. Why do you think that this is okay? And they are clearly miserable. And if you tell someone, Oh, if you told me I had to be miserable for a day, that would be a problem for me. But if you tell me this goes on for 10 years and this is also putting my health at risk by doing so.
Here's the other piece of it, the other part of the Women's Health Initiative that never got any pickup in the press. I told you, stop the presses. All right, that was only the actual press conference when they stopped the arm of the study that had women who had intact uteruses.
So these are women who had to take estrogen and progesterone, right? Stop that after 5. 2 years, bam, and then all the bad press. The women who were on estrogen only, because if you've had a hysterectomy, you don't have to take the progestin. All those bad things that they said about the estrogen, it didn't, they didn't see it in the group of women who were just taking estrogen alone.
If estrogen causes breast cancer then why are you letting this other part of the study go on for another two and a half years? so it went on for Seven and a half years and guess what they found and have continued to find in the group of women who took Estrogen only who had a higher percentage of african american women because african american women have more hysterectomies They found A decrease in the risk of breast cancer, a 23 percent decrease in the risk of breast cancer, a 40 percent decrease in the risk of dying from breast cancer, even if you got breast cancer having headache.
Did anyone say anything about that? No. Where was that from? Where was that from? And that is, and that has persisted, they followed up year after year, they did a 13 year, a 15 year, a 20 year follow up on these women who took estrogen only, still decreasing the risk of breast cancer, decreasing the risk of dying from breast cancer.
And that to me is huge, because you can't blame estrogen. If whatever you're saying is the reason for your rationale, it makes no sense. And that this has persisted for 20 years. It should be something that we should be shouting from the mountaintops because there are still a lot of women out here who've had hysterectomies who are again at risk and not being given hormones.
And to me, that's malpractice. That's not right.
Stacy: Yes, I want to shift a little bit and I know we probably need a little primer just for people who are listening who are getting educated maybe for the first time about hormones, that there is estrogen, progestin, progesterone I know testosterone is one of those things that I don't know, I don't know where you fall on that spectrum of people who approve or don't approve but those are the sort of four four biggest hormones that we're talking about in terms of M.
H. T., menopause hormone therapy? Is that correct? And you don't take progesterone or progestin if you don't have a uterus?
Sharon: Exactly. Exactly. You only need the only, and that, again, that's something we learned in those 40 years of hormone therapy because when estrogen was originally prescribed, they should just give [00:42:00] estrogen by itself.
And they found out, oh. Oh, that increases your risk of uterine cancer if you take it alone, figure it out, adjust it, add the progestin, and now we're back, we're back on track. What we have found is that you need estrogen, you need progesterone if you have a uterus. We find that testosterone also decreases at menopause.
But it doesn't drop off as precipitously as estrogen and progestin do. It starts declining and it continues. There's a whole other argument piece about whether or not testosterone should be added to the regimen, more studies, but everything that we have says that, look, yes, it's not that it's not.
Bad either. It's not a male hormone. Women make testosterone too and there are some benefits, but the studies are lacking. And not only that, testosterone is regulated as if it is regulated by the D. A. As if it were an illicit drug. And so you can't even get it.
Stacy: And this I was told by Dr. Kelly Casperson that she was saying that it's on class with oxycontin and all of these things. And I'm like we did studies for that. Why aren't we doing the studies for testosterone? It makes no sense.
Sharon: It came up and, all right, I am not a huge conspiracy theorist.
I am not, but this is something I find particularly interesting, let's just say. Whenever it comes to things that involve women's sexuality, their reproductive organs, everybody's got a say in that. Men, not so much. Oh, you look at Viagra and you say it could give you, you could go blind, have an erection lasting for two days will make your penis fall off. You could have a stroke. You could have the list of side effects and not 10 years from now. Today, taking Viagra is quite long and men are able to say, okay, that's good. I'll take it. I'll take that risk. Men get to make decisions for themselves because they have agency. Women get told what they can and cannot have and what they can and cannot do with their bodies.
And this is, that gets into the whole, if it's anything that's involving sex or our reproductive organs, Then someone's got to say, and if you said testosterone, because it actually came up in front of the FDA for approval because they wanted to use it for sexual dysfunction and issues in women.
And they turned it down, said no, because who wants to treat women's sexual function? Women aren't, that's not what you're supposed to be doing anyway.
Stacy: It's so interesting, it feels so puritanical to me because if it's about sex, just about sex, like sex for pleasure, then nobody wants to hear about it.
If it's about reproduction, then you are almost, what's the word I'm looking for, you're reduced to your reproductive function. How are you going to make a baby? Not whether or not you're the person with a uterus. Which seems so backward to me. And I, it's shocking to hear that the FDA turned it down.
But I guess if I, if we were, if we, this was a play, let's say, and we had the character estrogen, progestin, progesterone, and testosterone. Who plays what function?
Sharon: Okay. For most of the benefits. Estrogen is the key player, because estrogen is gonna, if you had to say what is going to relieve my high flashes, help me sleep, all the things that we associate with menopause, it's the estrogen.
And progestin is there as a support role, it's a supporting actress. Supporting, yes, it's best supporting. Because it's there to really ward off the bad things that just unopposed, which means estrogen by itself can do to the uterus. That's the only bad thing that estrogen does. So it's, that's its purpose.
And whether you use that progestin as a synthetic progestin or a natural progesterone it it's a matter of personal preference, and to be honest with you, and that's my next soapbox that I'll get on, but I'll save that for another day, is that, progestin, progesterone, is, we've, we stopped blaming the estrogen for the breast cancer, and now we say, oh, but it's that bad old synthetic progestin, probably not so bad.
Stacy: Exactly. So just to be clear, progestin and progesterone, one is synthetic, but they play the same role. They're in competition for best support. And then I, I am unclear as to one, if testosterone is about sexual function in women, that, that makes sense to me.
Obviously, but does it play a bigger role in terms of women's health?
Sharon: It probably does. And that's, again, that's one of those areas where we need more research. But let me just say that what we have says that testosterone does play a part in maintaining your muscle mass. as you age, it might maintain your bone.
So it has some other benefits other than just increasing libido, which it does. And so we have got to do a little bit more research about, again, long term health benefits of testosterone. Are they there? Evidence suggests that it does have more of a benefit than just in sexual function. So yes.
Stacy: And to me, it's so interesting, medicine has to be revised every time you learn something new, right? That's the way it works. And if you have no research, you have no way of progressing and making things better for everybody. I want to talk a little bit, just one last question about your book, which is coming out and it's called Grown Woman Talk, Your Guide to Getting and Staying Healthy. So one, when can we expect that? And two, tell us a little bit about how you organized the book and why now? Sure.
Sharon: The book will be available on April 9th. It’s available for pre-order now, wherever you get your books. I wrote this book because I think that there needs to be a combination of two things, common sense and medical knowledge. And I think that the nature of our relationships with medicine and the medical community has changed dramatically and will continue to change.
And I wanted to give women a guide. About all these things have changed. No one told you. So let me tell you what you need to do to be a better advocate for yourself. So it starts with how to pick a doctor. And it's told from the perspective. I use a lot of storytelling. I use a lot of family stories. I use some patient scenarios Because I want you to understand that i'm not just a doctor lecturing to you about what you know, do this, do that. No, I want to tell you that it's personal. I'm a woman. I'm a sister. I talk about what happened with my mother. So these are things that I can relate to, not just from the medical side of it but from the person side of it and what that means. So it's very practical advice and I tried to make it fun and engaging such that you wouldn't feel like, Oh my God, this is like reading a textbook.
I did it such that it's all the things you need to, grown women need to know how to pick a doctor, what's important about your history and your family history. What are the common things that you will encounter during the midlife heart disease, cancer, and the as we little chapters on perimenopause and menopause, the importance of community.
And it ends with How to get your proverbial house in order, which one of the things you need to know for the end of life, be it for your parents or even for you things that you haven't thought about that you need to know. And in essence, it's like everything every grown woman needs to know either for you right now or for you'll need to know it in 10 years from now.
Stacy: Essentially, it's the book that I've been waiting to have fall out of the sky, because there is no roadmap, right? And I think that this idea of a practical guide that gives you exactly what we want to do on this podcast, practical information that you can actually utilize in your real life.
It gets really boring when people just lecture you about whether or not hormones are good for you. Yes. Like we've talked about that, but that idea. I will tell you, perimenopause was when I lost my father, and it changed my relationship to mortality instantly. And I also think that our generation is probably going to be the generation that doesn't wind up retiring and moving to Florida and dying and just waiting to die.
I think that we want better for ourselves than what we saw for our grandparents. We're going to have much longer health spans. If we do all of these things and take care of ourselves post menopause, we will have better outcomes to live longer. You strain, train, hopefully you don't fall, do stability training, things like that.
I'm curious when you talk about this housekeeping. I also love the fact let me get to that one second, that this housekeeping was that end of life. For me, it really did change my perspective. Not to be at all morbid, but I have more days behind me than in front of me.
One, that makes them more valuable and how am I going to use them? And two, how do I become not just organized, but more accepting, psychologically just accepting of the fact that this is going to happen. And I don't think we talk about death enough. at all.
Sharon: And that's why, I, that's why it was really important for me to add that chapter because I lost my mother very, when I was very young my mother was 57 when she died.
I've lost, I've lost three siblings at this point in my life. And so there, I want people to learn from my experience. And this isn't from doctor hood. This is just from saying, Hey, did you think about, who's got your medical power of attorney? Where's your will? Who's got it?
Who's gonna be the first person in your house? These kinds of things, because most of us, whether you have children or you don't, I have children. I have a one on one coast, one on the other. There's not the expectation that they will be the caretakers for me. And that, the message that I keep going through in and, from the beginning of this book to the end of this book, is that you have to take care of you.
Stacy: That's a unique perspective. I think a lot of people as they age assume that children will take that responsibility. So that to me is very interesting. And I also think it's incredible because you have been so out front and center really talking about the menopause experience and fighting for us that you wrote a book about it for grown women, that this is not just about the menopause experience, that do you feel like all the work that you've been doing informed the fact that you couldn't just talk about menopause, that it needed to be bigger, a bigger topic?
Sharon: Because that's what interested me. When I say I can talk about menopause from now until next year, and I probably will, but there's so much of this experience. And, Stacy, I'm 65 years old. And when you say, yes, do I have way more days behind me than in front of me. And so one of the things that when, and I'm the youngest, I'm the youngest of eight kids. So my experience has been informed by watching the people. ahead of me. Oh, what's worked? What didn't work? I don't want to do that, and watching these things. And these are things that people don't really think about. I wanted that to be equally valuable to me telling you to go exercise and take a multivitamin.
Stacy: No question. I think that's a gift. It's a gift that you're giving your family. It's one of the things that my father taught me because my grandmother did it for him. There was a box with all the papers. Everything was taken care of. The lot was paid for. The stone was paid for. All of the things. It was a gift because it really, truly allowed me to not worry about the paperwork and just grieve. And I don't think we recognize how important that is. I'm so excited to read the book.
Sharon: You know what one of my mantras is about when I said, when I die, you want to have things in order. And I said, when I leave this earth, I would like for the people that I leave behind to just be sad, not mad.
Stacy: Yes. Don't be mad. Oh my God. These are aphorisms that I feel like we need to put on pillows, because this is the type of stuff. “I'm not pro hormone, I'm anti suffering”. These are things that I really do believe that people need to know. So the book is coming out April 9th, Dr. Malone, thank you so much for your time. This was such an unbelievable interview I can't thank you enough.
Sharon: You are so welcome. And you know what? If you think of anything else you need, like I said, as I said, I'll be talking about hormones from now until, whenever.
Stacy: Exactly. And it's great that you've been doing work with Let's Talk Menopause. It's wonderful because, look, there are a lot of companies, obviously, Maybe, maybe this is worth asking, that we have seen this uptick. I think a lot of people saw an economic opportunity. In some ways, obviously I think in telehealth, that made a lot of sense. I learned very quickly from acquiring a company that like, we don't need cosmetics.
Because we had millions of hits to the site and very little conversion. And then the more I learned about menopause as a stage and all of it's like physical, emotional, all of the well being. You're, if you are feeling suicidal, what is face oil going to do for you? This idea that we can't minimize, I think, what is happening here.
And so we've really seen that in the last five to ten years. Do you feel like, was there another reason other than this sort of economic opportunity for this to catch fire right now? Because you've been talking about it forever. What was the impetus for somebody that, for all of us, because it does feel like all of a sudden there were just all these wonderful women starting to talk about it.
I wonder if you have a theory about that.
Sharon: I do. And I'm going to give credit where credit is due. And I think we're going, I think we owe a great debt to. Social media and social media, people who are out there who are giving good information, Mary Claire Haver, Judith Joseph Kelly Casperson and Rachel Rubin, because this young, this younger generation behind us certainly, they're out there saying what happened here? And they have the voice, the, and the megaphone to get out there and start talking about it. And I'm also going to give credit to my friend, Michelle Obama, which is how the people in LA found me because. Because she and I did a podcast that was three and a half years ago, and she talked about her menopause, her menopause journey and her experience.
And we had this conversation about it, and it all of a sudden made it okay to, for women to admit. Yeah, I'm having hot flashes. This is nonsense. She started it and the more women started to open up and realize that this is not something to be embarrassed about. This is not shameful. I don't have to hide this.
Let's talk about it. And why didn't somebody tell me, by the way? So it's that combination. I think there's this, we're living in a moment where, you know, Okay. Awareness and people willing to step out there and say this is where they are. And then the younger people who were able to take that message and amplify it and get it out there.
And so I, I am just happy to be living at the intersection of these two pieces because, I have to admit, I've been talking about this for 30 years and I'm just talking to one person at a time and I can convince about half of them, maybe, and so to have this opportunity to be out here and educate women is really important to me, which is why I want to do the advocacy piece of it too.
Because again, I don't want you to do what I say. I want you to know what the. facts are, where to get them, and what to do about it. Because again, we do have to hold our government and our tax paying dollars, we have to make sure that they are channeled in a way that works for us.
Stacy: Yes. And this whole idea, you were saying before about just talking about this, the idea that anything to do with female physiology is so stigmatized.The idea that we're de-stigmatizing any part of it. Menopause, menstruation, pregnancy, postpartum, all of it. I, it makes me so happy and it makes me laugh when you say your friend, Michelle Obama talked about this with you three and a half years ago and started to normalize this conversation.The woman normalized wearing a sleeveless dress to the state of the union, she normalizes a lot for people. So it's a wonderful way to really see that this is something, again, we've seen a lot of hope. I'm going to go ahead and start talking about this now. And again, the higher the profile the louder the reach in some ways. And that's not the same thing as being a medical professional, but it certainly helps the advocacy part of it.
Sharon: And it normalizes the conversation because as I say, Menopause is inevitable. Suffering is not.
Stacy: Yes. Okay. Another pillow. This is what I'm going to do for Christmas. I'm just going to listen to the transcript. I'm going to transcribe this and then I'm just going to make pillows for everybody.
Sharon: I really appreciate it. You're so wonderful and so clear and it's so helpful.
Bonus:
Sharon: One of the things I really wanted to do with my book is to make it accessible and fun and not have. people's eyes glaze over. So one of the things that I did is I have a musical playlist at the end of each chapter. So you'll be able to, as you're reading along, then you'll, I have little musical notes.
And at the end, you'll get to the end and play the song. I'll post them on Spotify and Apple music and wherever you get your music. So you'll have a little something to look forward to at the end of each chapter.
Stacy: I love that there is an auditory sensory piece to this book. Again, this is such a great way to use technology.
Sharon: I wanted to be a DJ in my other life and it didn't work out. I went to med school instead.
