... as Dr. Avery calls it?

You, you're at a steady state, but you're at a steady low state, and that steady low c- low state has long-term health implications for your heart, for your bones, for your skin.

All of that really sort of comes into play.

But the reason why, you know, I want women to be aware of it is you don't have to feel that way, you know? And sometimes, um, the solutions that are given are, again, you're piecemealing the symptoms.

"Oh, my hair is thinning." "Well, here, take this." "Oh, my, my skin is dry," and you go see a dermatologist.

"Oh, I've got, you know, I've got itchy ears," you're at a ENT, and that's sort of how we've been sort of piecemealing, uh, perimenopause.

And I think that also what is an- another problem, which we haven't even gotten to the outer rungs, 'cause you'd think most of the, the responsibility for having these conversations falls to OBGYNs, right? It would be the logical place to have that conversation.

... because of, of that.

Can you define perimenopause, menopause?

I think perimenopause is the most confusing of these stages, because perimenopause just simply means around the menopause, and it is also called the menopausal transition, where you go from your peak fertility years to no fertility, and it's that gap in between.

And for most women, that can last anywhere from four to 10 years.

If you're African American woman, your symptoms and that period lasts more closer to 10 years than four.

Um, it is characterized by a lot of things, but the one thing that it is not characterized by is a lack of periods.

And we think of menopause as being, "Okay, that's when my period stops," right? Well, in perimenopause, you may be getting your period regularly.

It may be different.

Mm-hmm.

Yes.

You know, you are in, you know, you're in the best shape ever at that point.

And to be stricken with things that you don't know, that are bothersome for you, and you know, you need to know what all the symptoms are.

So again, it's not just a hot flash.

Yes.

I mean, many of us have started new careers after menopause.

There is this time where you have the ability to focus on you, which is something that many of us don't have early in our careers or when we're building families or taking care of others.

This is the me time.

[laughs]

Like this.

Mm-hmm.

Mm-hmm.

And leaned in and said, "Light me up." Put it in my mouth and said, "Light me up." Mm-hmm.

Like that.

Mm.

Hear, hear.

[laughs]

But Katie, you and I were both around when that study was released in 2002, and I can't think of another study before nor since that has required, you know, a press conference at the National Press Club to announce the findings of the study.

And I think the good news, and I'll say the good news first, is that Dr. Bernadine Healy was the first female director of NIH, and had she not been there, I am convinced that the study never would have been done, because prior to her recruiting for that study in the early '90s, there had never been, and has still has not been, another large scale, randomized, placebo controlled study on the role of estrogen in post-menopausal women.

And this is despite the fact that estrogen had been in common use for over 50 years.

So this is not a new drug.

We, uh, estrogen w- the Premarin, which was what was used in the study, was approved in 1942.

So we had 50 years of experience using estrogen with no real clear scientific data about what it does and does not do.

[laughs]

Mm-hmm.

Let's just say you start birth control pills when you're 20, and you take them until you're 35 because you're not ready to have a baby until you're 35.

Well, your fertility at 35 when you stop taking the pills is not what it was at 20.

So if you're having difficulty conceiving at 35, it's not the 15 years of birth control pills that did it to you.

It is the fact that you are 35, and that is something that we have to take into account.

Your fertility changes decade by decade, but it's not the pills, and sometimes we blame the pills for things that really we shouldn't.

But let me say, I, I think this is an important point to make, is that some women do react negatively to birth control pills.

What do you want women in their 20s and 30s to understand about how fertility changes as you age?

Mm.

So it wasn't new news, but no one had ever really studied it in a, in a systematic way.

So, um, I don't think that it's an accident that- That w- happened then because we had the first female director of NIH, and we should say her name, Dr. Bernadine Healy.

She conceived of this study, and it was all to sort of codify the things that we kinda knew but no one had ever really rigorously studied.

Um, that was why it came apo- you know, it came about.

A woman spearheaded, spearheaded that study.

And it, and it was a great idea, just implemented not quite the way we wanted, which it should have been, but hindsight is always 20/20.

Mm

where people should be visiting, I guess the likes of Loophead Lighthouse, come into the picture as well and you know, we'll get to some of the other things that are happening elsewhere that people should be aware of, but maybe we'll start with Loophead Lighthouse.

Okay, yeah I know it's so beautiful around the county this week in particular and Kilrush really is the gateway town to the west of the county, particularly from a tourism point of view, there's so much to do here.

And then, yeah, moving west of here into Kilkee and then further on to the Loophead Peninsula, which is really stunning.

And it is a bit of a drive.

And in my opinion, it's so worth it.

You're getting away from it all and you're driving until you cannot drive anymore and you just come to the lighthouse.

and it's this just gorgeous beacon there, perched out on the Shannon Estuary.

Can you briefly just tell us what's happening at Kilrush and Kilkee libraries for the rest of the summer?

Can you remind people and maybe enlighten some people who mightn't be aware of what the service is, what it offers visitors and how important it is for tourism in the north and west of the county?

Yeah, thanks Alan for having me on.

Yes, so we were very much looking forward to having it back again this year.

There was a brilliant response to it last summer.

So essentially it's a free bus service around North and West Clare.

The general idea of it was, as we know, a lot of visitors coming up to the Cliffs of Moher, which during the summer months can lead to a lot of traffic on the road and a bit of congestion around the area.

And with that, we looked at ways maybe we can reduce that without affecting the visitors' experience to the area and then also spread it out amongst the lovely towns and villages that are around the area.

And I suppose that's good that there is that flexibility to react to big events and provide a more frequent service, that it isn't just a set in stone thing that never changes, no matter what is or isn't happening.

How have you seen the festival grown since it was first launched?

Morning Alan, how are you? It's a wonderful weekend for Kilrush and each year it's grown and grown and there's great excitement this year for it with three very full days planned targeting lots of different interests, music, dance.

Our younger visitors are in for a treat as well with a lovely biology show on Saturday morning.

And this year, too, Kilrush Shamrocks are launching their new publication, The Lord and Master's Book, celebrating the Kilrush Shamrocks' historic five in a row.

They're on Saturday morning launching that.

They also have a family fun day on Sunday up at the cricket field.

We have music during the day as well.

Kids can head along as well.

Could that be perimenopause?

There's actually a newly named syndrome called the musculoskeletal syndrome of menopause.

And that is not only joint pain, muscle pain, bone loss, all of this starts really in the perimenopausal phase.

So yes, that's very common.

Estrogen, we know we have receptors everywhere from your brain all the way down to your skin and everything in between and the joint space in between.

That's a very common complaint for women to have joint pain.

And inflammatory changes in the chest.

Just how you know

That's B-I-O-P-T-I-M-I-Z-E-R-S.com/hyman and use the code HYMAN

HYMANBut what did that mean in real terms? That means for women who did not take estrogen and progestin, 30- the natural incidence is about 30 per 10,000 women per year will be diagnosed with breast cancer, living long enough to get it.

In the estrogen and progestin user group, it went from 30 per 10,000 women per year to 38 per 10,000 per year with no increase in the risk of dying from your breast cancer, even if you were diagnosed on hormone therapy.

So let's make that sound a little better.

All right.

8 per 10,000 additional cases of breast cancer.

Yeah.

If she, if you're having any combination of those symptoms and they are bothersome to you, then that is the time you start treatment.

Uh, um, Sharon, what would, what, what would you add to their experience so that people understand a little bit about what women are going through?

You know, I wish that all women knew that this is a phase of life that will take years long to transition into when you get to menopause, and I think that w- I want them to know that it's normal.

Every woman will go through this, but suffering is not your only option.

You know, this is where I think that we sometimes in the medical community have not, have sort of failed our patients in not preparing them for this because the time to talk about menopause and perimenopause is not when you're in the middle of it.

It's when you're 30, when you're 35, so you're prepared so you don't think that there's something horribly wrong when you start to experience these symptoms.

Menopause and perimenopause, walk us through just some definitional understanding of what those two stages are.

Okay.

Well, menopause is, is a little bit easier to divine, define because it does have a bright line, and that is the time at which either your ovaries stop functioning naturally as a result of age, or you may have had surgery.

Uh, um, Sharon, what would, what, what would you add to their experience so that people understand a little bit about what women are going through?

You know, I wish that all women knew that this is a phase of life that will take years long to transition into when you get to menopause, and I think that w- I want them to know that it's normal, every woman will go through this, but suffering is not your only option.

You know, this is where I think that we sometimes in the medical community have not, have sort of failed our patients in not preparing them for this because the time to talk about menopause and perimenopause is not when you're in the middle of it.

It's when you're 30, when you're 35, so you're prepared so you don't think that there's something horribly wrong when you start to experience these symptoms.

Walk us through just some definitional understanding of what those two stages are.

Okay.

Well, menopause is, is a little bit easier to divine, define because it does have a bright line, and that is the time at which either your ovaries stop functioning naturally as a result of age, or you may have had surgery, you may have had chemotherapy, things that prematurely c- plunge you into menopause.

So that's easy.

[laughs]

I don't think that was her thought process, but lo and behold, I'm here.

And I was born at home.

And again, I was born at home by choice, not because it was just baby number eight and she couldn't get to the hospital.

We lived a block away from the hospital.

And I don't have my mother here to ask her, but you know how sometimes you put together, you're like, "Well, what could she have been thinking?" 'Cause my sister who's seven years older than me, my mother had that baby at the hospital.

It was the Mobile General Hospital, the City Hospital, and it was segregated.

What would you say to someone who does have that disconnect about how to rebuild trust with their own bodies?

It's part of life, just like puberty is right.

That's exactly right.

And let me just say lifestyle matters.

Yeah.

Because it's helpful in a lot of things as far as disease prevention and longevity.

So yes, but you can't outrun your ovaries.

When they stop working and your estrogen levels plummet, about 80% of people will be symptomatic during the menopausal transition and beyond.

cancer.

I have.

It is not.

And that's the message that I think should be very hopeful, and I think that we should always give women the, the same basic lifestyle advice that we give all the time.

It's not rocket science.

It's exercise and eat right and get a good night's sleep, and all the things that you need to do.

Cut down on alcohol, don't smoke, manage your blood pressure.

But there's so many things that we just accept as normal, and they shouldn't be.

What do you tell a woman who's been dismissed or ignored by her doctors?

Mm-hmm.

And being able to communicate that effectively is everything.

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(instrumental music) Well, you know, I am not gonna lie.

It was really hard.

... who is, you know, pointing you in the right direction.

So can you talk, Dr. Sharon, about an essential thing that we can do for our health as we get older? Why is screening for colon cancer so important?

Colon cancer is one of the most common types of cancer in the United States.

And as a physician, I've unfortunately seen firsthand how common it is.

In my clinical practice, I have seen patients getting diagnosed with stage three or stage four colon cancer because they waited too long to get screened.

And these are young, healthy people.

There are even patients in their early to mid-40s with no family history of colon cancer.

What people don't realize is that there is no such thing as being low risk.

Can you talk a little bit about colon cancer screening and options people have?

Yes.

One of the things that I always tell, uh, young women, particularly when they're concerned about what does this mean in terms of childbearing and will I be able to have a baby or not...... first thing is know your family history, because I think you should talk to your mother.

Because at 35, if you talk to your m- you say, "Mom, when did you go through menopause?" If she remembers and she shares that information, if she tells you, you were menopausal s- she was menopausal at 42, well then that has some bearing for you.

Because at 35, you are more likely to be perimenopausal and to maybe have some fertility cha- challenges more than someone whose mother had menopause at 55.

Do you see what I mean? So yes, it has a direct, uh, implication on when your symptoms start, um, but what to do about it...

And let me say, e- e- we have more options now than we have ever had, because this is a situation if you say, "I'm not really, I'm not ready to have a baby right now at 35.

I may not have even identified a partner at 35." Then this is where we can use-

(laughs)