WEBVTT - The Menopause Gold Rush Is Leaving Women Behind 0:00:00.200 --> 0:00:04.560 The menopause gold rush is leaving women behind. While start 0:00:04.600 --> 0:00:08.400 ups and supplements are making billions, the healthcare mainstream hasn't 0:00:08.480 --> 0:00:12.400 kept pace with women's midlife needs. By Kristin V. Brown 0:00:12.960 --> 0:00:17.480 Read aloud by Mark Leedorf. When Yasmin Harris was in 0:00:17.520 --> 0:00:20.040 her early thirties, she began to suffer an array of 0:00:20.079 --> 0:00:24.680 perplexing symptoms. She had chronic urinary tract infections and always 0:00:24.680 --> 0:00:28.920 felt irritated. She was no longer interested in sex. One 0:00:29.040 --> 0:00:33.040 cold Colorado winter's day, she found herself feeling so overheated 0:00:33.080 --> 0:00:35.920 that she went and stood outside on the porch buck naked. 0:00:36.680 --> 0:00:39.000 But when she went to the doctor, all her labs 0:00:39.040 --> 0:00:42.519 came back normal. She received a prescription for antidepressants that 0:00:42.600 --> 0:00:45.400 she says didn't seem to help. I started thinking I 0:00:45.479 --> 0:00:49.199 was just crazy, she recalls. Harris, who works in it. 0:00:49.320 --> 0:00:52.400 Tried to white knuckle these symptoms until one night in 0:00:52.440 --> 0:00:55.720 October twenty twenty two, when while she was making pasta 0:00:55.800 --> 0:00:59.480 for dinner, her heart started pounding. Her father had died 0:00:59.520 --> 0:01:02.000 young of a heart attack. She feared she was having 0:01:02.040 --> 0:01:05.679 won two. At thirty nine, she was diagnosed with congestive 0:01:05.760 --> 0:01:09.600 heart failure, her first indication of any heart condition, prescribed 0:01:09.640 --> 0:01:12.800 a cocktail of drugs, and eventually implanted with a pacemaker. 0:01:13.280 --> 0:01:16.039 She was baffled. In a few years, she'd gone from 0:01:16.040 --> 0:01:19.160 a healthy, happy woman to someone in a perpetual state 0:01:19.200 --> 0:01:23.759 of distress. Then her periods went haywire, lasting for weeks 0:01:23.760 --> 0:01:26.920 at a time. She began to suspect all those disparate 0:01:26.959 --> 0:01:30.319 symptoms weren't random. When she typed them into Google, the 0:01:30.400 --> 0:01:34.360 results suggested she was in perimenopause. It all came together, 0:01:34.600 --> 0:01:39.280 she says. Harris's doctors disagreed she was too young. They said, 0:01:39.760 --> 0:01:42.800 a doctor prescribed birth control to regulate her cycle and 0:01:42.880 --> 0:01:45.840 sent her on her way. So Harris did what many 0:01:45.880 --> 0:01:49.640 frustrated patients do and turned back to the Internet for ideas. 0:01:50.160 --> 0:01:52.960 She sought solace from Reddit and advice from chat gpt. 0:01:53.680 --> 0:01:57.040 She drank more water, ate less sugar, and went for walks. 0:01:57.440 --> 0:02:00.000 She got a prescription for a compound and hormone therapy 0:02:00.080 --> 0:02:02.880 be cream. In the course of about a decade, she 0:02:03.000 --> 0:02:05.800 forught over thousands of dollars, including for all kinds of 0:02:05.800 --> 0:02:08.800 supplements that popped up in ads on Instagram and TikTok, 0:02:09.360 --> 0:02:14.720 black cohosh ashwagandha something called steel libido. If I saw it, 0:02:14.800 --> 0:02:17.600 I tried it, she says, if only any of it 0:02:17.639 --> 0:02:22.040 had worked. Although women around the world live longer than men, 0:02:22.200 --> 0:02:24.880 they spend more of their years in poor health. This 0:02:25.040 --> 0:02:28.240 is partly because of differences in biology, and partly because 0:02:28.320 --> 0:02:30.880 doctors and scientists just don't know enough about how a 0:02:30.919 --> 0:02:35.240 woman's body works, especially as it ages. That includes many 0:02:35.320 --> 0:02:38.800 medical specialists. A twenty twenty three survey found that roughly 0:02:38.880 --> 0:02:42.959 seventy percent of responding OBGYN residency programs in the US 0:02:43.360 --> 0:02:47.520 didn't include any menopause curriculum. Whether or not you're through 0:02:47.520 --> 0:02:51.200 med school, here's a primer. Menopause is a single day 0:02:51.240 --> 0:02:55.080 in a woman's life, marking twelve consecutive months without a period. 0:02:55.600 --> 0:02:58.480 In addition to signaling the end of her child bearing years. 0:02:58.800 --> 0:03:02.560 It marks a whole body change with sweeping consequences, including 0:03:02.600 --> 0:03:06.640 elevated risks of stroke, heart disease, and osteoporosis. But the 0:03:06.639 --> 0:03:09.520 process of getting there can be a year's long, confusing 0:03:09.600 --> 0:03:13.840 slog as a woman's reproductive system starts to behave more erratically. 0:03:14.600 --> 0:03:19.320 This phase is perimenopause. Menopause's hot cool little sister. As 0:03:19.360 --> 0:03:23.320 comedian Amy Miller has joked the infamous transitional era of 0:03:23.400 --> 0:03:27.840 hot flashes, night sweats, brain fog, and mood swings. Women 0:03:27.919 --> 0:03:32.080 have long been counseled about menopause through whisper networks, instructed 0:03:32.080 --> 0:03:34.960 to tough it out, or told nothing at all. In 0:03:35.000 --> 0:03:38.640 recent years, though, a swath of telehealth companies and influencers 0:03:38.880 --> 0:03:42.560 have begun promoting the power of modern remedies. Now everywhere 0:03:42.600 --> 0:03:46.120 you look, someone is blaming unruly hormones for another middle 0:03:46.120 --> 0:03:52.480 aged ailment. Migraines, You must be approaching menopause, anxiety. That's menopause, too, 0:03:53.040 --> 0:03:57.680 weight gain, dry skin, digestive issues, ding, ding, ding, menopause. 0:03:58.400 --> 0:04:01.320 Earlier this year, after one of her Lawrence, scratched at 0:04:01.320 --> 0:04:04.840 her ears during an appearance on Amy Pohlar's podcast, Polar 0:04:04.880 --> 0:04:09.040 told her that itchy ears are a sign of perimenopause. Congrats, Babe, 0:04:09.080 --> 0:04:12.040 Polar said, as the thirty five year old Lawrence's jaw 0:04:12.160 --> 0:04:15.320 dropped in apparent horror. To be a middle aged woman 0:04:15.400 --> 0:04:19.200 is to live in diagnostic suspense perpetually, one symptom away 0:04:19.240 --> 0:04:24.320 from wrestling with the transition. Generally speaking, the gold standard 0:04:24.320 --> 0:04:27.520 for treating symptoms such as hot flashes and vaginal dryness 0:04:27.560 --> 0:04:32.200 is hormone therapy a boost of estrogen and in some cases, progesterone, 0:04:32.400 --> 0:04:37.000 delivered commonly via pill, patch or cream. Evidence also broadly 0:04:37.040 --> 0:04:41.000 supports hormone therapy to reduce the risk of osteoporosis and 0:04:41.040 --> 0:04:44.640 to treat estrogen decline caused by early loss of ovarian function, 0:04:45.240 --> 0:04:47.599 and as an added bonus, it may reduce the risk 0:04:47.640 --> 0:04:52.120 of cardiovascular disease and diabetes. Many women also report that 0:04:52.160 --> 0:04:55.640 it relieves other symptoms, including anxiety, but a lot of 0:04:55.680 --> 0:05:00.159 things can look like perimenopause, including autoimmune and thyroid disorder. 0:05:00.760 --> 0:05:04.120 Experts continue to debate just how much midlife misery can 0:05:04.160 --> 0:05:07.760 be penned on menopause and when medical intervention is appropriate. 0:05:08.160 --> 0:05:11.000 Menopause is happening in parallel with one of the peak 0:05:11.160 --> 0:05:16.120 accelerated aging moments, says Jill lyss an OBGYN who specializes 0:05:16.160 --> 0:05:19.480 in menopause and an adjunct associate professor at the University 0:05:19.520 --> 0:05:23.480 of Colorado. Hormones are so powerful and important, but they 0:05:23.520 --> 0:05:27.839 do not determine every health outcome. Lys, who has also 0:05:27.920 --> 0:05:31.240 recently signed on as senior medical director for the pharmaceutical 0:05:31.279 --> 0:05:35.080 giant Bear, advises women who suspect their undergoing a menopausal 0:05:35.160 --> 0:05:38.080 transition to seek out an appointment with a doctor who's 0:05:38.120 --> 0:05:42.680 conversant in evidence based treatment options. Here, though, we return 0:05:42.760 --> 0:05:46.719 to the problem of supply. The Menopause Society, an Ohio 0:05:46.839 --> 0:05:51.080 nonprofit that offers education to US doctors, has, through its exams, 0:05:51.160 --> 0:05:55.000 certified roughly fifty three hundred medical professionals across the country 0:05:55.279 --> 0:05:59.320 as experts in midlife women's health. That's not nearly enough 0:05:59.360 --> 0:06:01.880 to serve the world one point three million American women 0:06:02.080 --> 0:06:05.800 who reach menopause every year. Only one point seven percent 0:06:05.880 --> 0:06:09.320 of US women age forty and up used systemic hormone 0:06:09.360 --> 0:06:12.440 therapy in twenty twenty three, according to a Mayo Clinic 0:06:12.480 --> 0:06:15.880 study from June. Liz says her patients wait an average 0:06:15.920 --> 0:06:18.960 of six months to see her. Absent an army of 0:06:19.000 --> 0:06:22.440 new obgyns, a massive industry of a different sort has 0:06:22.480 --> 0:06:26.920 sprung up to monetize all that midlife dread. Now, instead 0:06:26.960 --> 0:06:30.120 of having no choices, women are confronted with a cacophony 0:06:30.160 --> 0:06:34.279 of products, providers, and promises. The global market for menopause 0:06:34.360 --> 0:06:37.839 treatment was eighteen point seven billion dollars in twenty twenty five, 0:06:38.320 --> 0:06:40.640 and it's expected to reach twenty eight point eight billion 0:06:40.720 --> 0:06:44.159 by twenty thirty three. Women spend more than ten billion 0:06:44.200 --> 0:06:47.360 dollars a year on non medical treatments such as supplements, 0:06:47.480 --> 0:06:51.480 according to an AARP survey, basically the opposite of evidence 0:06:51.520 --> 0:06:56.200 backed therapies. The occasional utilitarian product such as a symptom 0:06:56.279 --> 0:06:59.920 tracking app that uses artificial intelligence to generate reports form 0:07:00.040 --> 0:07:03.039 a woman's doctor to review, is far outnumbered by a 0:07:03.120 --> 0:07:07.719 morass of creatine powders, red light therapy, vibrators, and pricey 0:07:07.760 --> 0:07:11.600 empowerment retreats. You've got everybody trying to get in on it, 0:07:11.600 --> 0:07:15.080 says Monica Christmas, director of the Center for Women's Integrated 0:07:15.120 --> 0:07:18.160 Health at the University of Chicago. Women are left in 0:07:18.200 --> 0:07:21.520 the middle. Although the right kind of care often remains 0:07:21.520 --> 0:07:25.120 out of reach, many false choices are now extremely available. 0:07:25.520 --> 0:07:29.960 Instead of receiving appropriate clinical care, which isn't always hormone therapy, 0:07:30.320 --> 0:07:33.080 women are spending their time and money on Internet approved 0:07:33.080 --> 0:07:37.800 solutions such as testosterone pellets and menopause diets. We are 0:07:37.800 --> 0:07:42.120 modeling female empowerment, but it's really just internalized misogyny of 0:07:42.160 --> 0:07:46.080 being thin and looking youthful, but with a rebrand, Liz says. 0:07:46.840 --> 0:07:50.040 After all the supplements and creams. Harris found answers in 0:07:50.080 --> 0:07:53.680 the doctor's office. In February twenty twenty five, she saw 0:07:53.680 --> 0:07:58.120 a specialist in Liss's department who took her perimenopause suspicions seriously. 0:07:59.040 --> 0:08:03.520 Like Harris, Leslie Appia is black, and Harris recalls her 0:08:03.560 --> 0:08:07.880 explaining that black women often enter perimenopause earlier. They also 0:08:08.000 --> 0:08:12.200 often experience more severe symptoms and have more trouble accessing care. 0:08:13.000 --> 0:08:16.280 She prescribed Harris a low dosed estrogen patch paired with 0:08:16.320 --> 0:08:20.480 an IUD to deliver progestine, a synthetic version of progesterone. 0:08:20.840 --> 0:08:23.280 Within twenty four hours of putting that patch on, I 0:08:23.320 --> 0:08:26.680 felt one hundred percent normal. Harris says, a little more 0:08:26.680 --> 0:08:29.800 than a year after she started hormones, doctors removed the 0:08:29.840 --> 0:08:33.080 pacemaker she'd gotten to regulate her failing heart because she 0:08:33.160 --> 0:08:36.440 no longer needed it. In the nineteen forties, when a 0:08:36.480 --> 0:08:40.880 young doctor named William Masters began studying menopause, hormone therapy 0:08:41.000 --> 0:08:44.360 was viewed mostly as a temporary treatment for hot flashes 0:08:44.400 --> 0:08:47.840 and other symptoms. Menopausal women had long been viewed as 0:08:47.920 --> 0:08:51.760 deficient in the Victorian era. For instance, some were diagnosed 0:08:51.760 --> 0:08:56.880 with climacteric insanity and hidden away in asylums. Masters, who'd 0:08:56.960 --> 0:09:00.319 go on to revolutionize the study of human sexuality alongside 0:09:00.360 --> 0:09:04.040 his colleague and eventual wife and ex wife Virginia Johnson, 0:09:04.400 --> 0:09:10.080 expanded on this idea. Osteoporosis, cardiovascular disease, and senility were 0:09:10.120 --> 0:09:12.800 all ailments of aging that he attributed to a decline 0:09:12.800 --> 0:09:18.400 in estrogen. Ovarian aging, he argued, was every woman's achilles Heel. 0:09:18.600 --> 0:09:21.160 After giving hormone therapy to a small group of women 0:09:21.240 --> 0:09:24.480 at an infirmary in Saint Louis, Masters and his colleagues 0:09:24.520 --> 0:09:27.319 reported in the Journal of Gerontology in nineteen forty eight 0:09:27.679 --> 0:09:31.120 that giving hormone therapy to an aged woman induces a 0:09:31.200 --> 0:09:34.320 reversal of one of the inevitable changes of aging, that 0:09:34.520 --> 0:09:39.360 is menopause. Estrogen, in Master's vision, was an anti aging drug, 0:09:39.679 --> 0:09:42.400 and small studies by his group and others seated the 0:09:42.440 --> 0:09:46.719 idea of long term hormone therapy. A New York gynecologist 0:09:46.840 --> 0:09:49.760 named Robert Wilson helped bring the idea to a larger 0:09:49.800 --> 0:09:53.120 audience when he published the book Feminine Forever in nineteen 0:09:53.160 --> 0:09:56.880 sixty six. Every woman alive today has the option of 0:09:56.960 --> 0:10:00.360 remaining feminine forever, he wrote, no longer In each she 0:10:00.440 --> 0:10:03.679 fret about the cruel irony of women aging faster than men. 0:10:04.400 --> 0:10:07.760 He advocated for pap smears not only to check for cancer, 0:10:08.000 --> 0:10:10.640 but also to examine what percentage of a woman's cells 0:10:10.679 --> 0:10:15.520 were healthy and youthful, what he called the femininity Index. Suddenly, 0:10:15.640 --> 0:10:18.400 women across the country were headed to their doctor and 0:10:18.520 --> 0:10:22.120 clamoring for pills to make them young again. Only later 0:10:22.280 --> 0:10:24.720 was it revealed that Wilson had received funding from the 0:10:24.760 --> 0:10:28.800 makers of the blockbuster hormone therapy Premarin, short for pregnant 0:10:28.880 --> 0:10:32.559 mare urine, which is probably still available at your local pharmacy. 0:10:33.240 --> 0:10:37.360 Widespread adoption of hormone therapy suffered two generational setbacks in 0:10:37.360 --> 0:10:40.880 the years that followed. In the nineteen seventies, research linked 0:10:41.000 --> 0:10:44.640 estrogen therapy to higher risks of uterine cancer, a problem 0:10:44.679 --> 0:10:48.839 eventually mitigated by the addition of progesterone. By centuries end, 0:10:48.840 --> 0:10:51.319 as many as forty two percent of US women from 0:10:51.360 --> 0:10:55.040 age fifty to seventy four were taking prescription hormone drugs, 0:10:55.400 --> 0:10:58.560 but that number plummeted after the US National Institutes of 0:10:58.600 --> 0:11:01.320 Health published a large study d in two thousand and two, 0:11:01.640 --> 0:11:05.360 suggesting the risks of hormone therapy outweighed the benefits. Further 0:11:05.400 --> 0:11:08.000 study found the risks had been blown way out of proportion, 0:11:08.360 --> 0:11:12.200 but the damage was done. Both doctors and patients were spooked, 0:11:12.520 --> 0:11:15.280 and an array of unproven treatments cashed in on this 0:11:15.360 --> 0:11:19.240 distrust in their stead. Only recently has the fear that 0:11:19.360 --> 0:11:23.120 kept generations of women from receiving adequate menopause care begun 0:11:23.160 --> 0:11:27.240 to subside. Concerns about medical risks have eased just as 0:11:27.280 --> 0:11:31.160 extremely online gen xers and millennials have been reaching middle age. 0:11:31.559 --> 0:11:34.440 In November, the Food and Drug Administration announced it would 0:11:34.520 --> 0:11:38.800 drop the black box warning from hormone therapy treatments. Last year, 0:11:38.840 --> 0:11:41.680 about thirty two million prescriptions were written for a form 0:11:41.720 --> 0:11:45.080 of estrogen used to treat menopause, up from eighteen million 0:11:45.120 --> 0:11:48.640 in twenty twenty one, according to Symphony Health data compiled 0:11:48.640 --> 0:11:53.120 by Bloomberg Intelligence. This run on hormone therapy has led 0:11:53.120 --> 0:11:56.599 to a shortage of the estrogen boosting patches known as estradiol. 0:11:57.240 --> 0:12:00.559 People are hormone curious. They want to under stand their 0:12:00.600 --> 0:12:04.440 hormones better, says Joanna Strober, the chief executive officer and 0:12:04.559 --> 0:12:08.000 co founder of Midi Health, a telehealth provider focused on 0:12:08.080 --> 0:12:12.560 menopause treatment, in February. Midi, founded in twenty twenty one 0:12:12.640 --> 0:12:15.760 on the heels of the pandemic telehealth Boom, became the 0:12:15.760 --> 0:12:20.200 first minopause treatment company valued above one billion dollars. I'm 0:12:20.200 --> 0:12:23.320 trying to switch the story here, Strober says, if you 0:12:23.400 --> 0:12:25.480 were a woman coming to me in your forties with 0:12:25.559 --> 0:12:28.960 anxiety and depression, I might start with the hormone, see 0:12:28.960 --> 0:12:32.280 if that feels better, and then try the SSRI or 0:12:32.320 --> 0:12:36.920 selective serotonin re uptake inhibitor. The shortage of healthcare professionals 0:12:36.920 --> 0:12:39.640 who are well equipped to treat menopause has left a 0:12:39.679 --> 0:12:43.040 care vacuum that companies such as Midi and rivals including 0:12:43.080 --> 0:12:47.400 Alloy Health have stepped in to fill. Alongside hormone therapy 0:12:47.440 --> 0:12:52.280 products Midi cells, branded supplements, skin creams, GLP ones and 0:12:52.400 --> 0:12:57.760 Sundry longevity prescriptions, other major telehealth companies, including Hymns and 0:12:57.840 --> 0:13:01.360 hers Health, have joined the party, as has maven Clinic, 0:13:01.520 --> 0:13:05.000 a virtual resource for women's health, plus smaller doctor led 0:13:05.040 --> 0:13:09.000 companies like my Menopause RX. The marketplace is a mix 0:13:09.040 --> 0:13:12.000 of companies that offer care covered by insurance or out 0:13:12.000 --> 0:13:15.320 of pocket, as well as those offering therapies approved by 0:13:15.320 --> 0:13:20.319 the FDA or compounded. Doctors who are also minopause influencers 0:13:20.520 --> 0:13:24.840 have authored best selling minopause books, host podcasts, sell serums 0:13:24.840 --> 0:13:27.880 and supplements, and charge as much as two thousand dollars 0:13:27.920 --> 0:13:32.280 for consultations at their boutique clinics. Women have money, women 0:13:32.360 --> 0:13:37.160 want solutions, says Kelly Casperson, a urologist and leading influencer 0:13:37.200 --> 0:13:40.880 in the field, who declined to disclose her fees. Celebrity 0:13:40.920 --> 0:13:44.440 obgyn Mary Claire Haver has amassed more than three point 0:13:44.520 --> 0:13:48.240 five million followers on Instagram, dispensing her own brand of 0:13:48.320 --> 0:13:52.200 no nonsense advice for middle aged women. Naomi Watts has 0:13:52.240 --> 0:13:55.720 a menopause company, Stripe's Beauty, that sells over the counter 0:13:55.800 --> 0:14:00.000 products such as body lotions and vaginal pH balancing probiotics, 0:14:00.360 --> 0:14:04.320 as does Halle Berry Respine. Drew Barrymore signed on as 0:14:04.320 --> 0:14:08.480 a minopause supplement spokesperson, and Middi's investors include Amy Schumer, 0:14:08.679 --> 0:14:12.920 Cheryl Sandberg, and Megan Markel. Weight Watchers and Noom have 0:14:13.040 --> 0:14:16.640 both created weight loss programs targeted at women going through menopause. 0:14:17.080 --> 0:14:20.360 Other entrants include home tracking kits with names like Mira 0:14:20.760 --> 0:14:22.920 that are meant to help show when someone's hormones are 0:14:22.920 --> 0:14:26.360 headed in a generally menopausal direction, as well as in 0:14:26.480 --> 0:14:29.760 person tests from companies ranging from young startups to the 0:14:29.920 --> 0:14:33.640 likes of Lab Corp Holdings. Most experts interviewed for this 0:14:33.760 --> 0:14:37.720 story say such consumer tests offer limited value because of 0:14:37.720 --> 0:14:41.360 women's hormones fluctuate constantly, it's tough to offer more than 0:14:41.360 --> 0:14:44.200 a snapshot of the moment the test was taken. The 0:14:44.280 --> 0:14:48.240 further away from FDA approved prescription therapy, the more dubious 0:14:48.240 --> 0:14:52.200 the claims can become. Meno Mania has blurred the line 0:14:52.240 --> 0:14:55.880 between care and commerce. The doctor in your feed explaining 0:14:55.880 --> 0:14:59.160 how to prevent UTIs or protect bone health could also 0:14:59.200 --> 0:15:02.280 be pushing unpre proven supplements that might be useless or 0:15:02.280 --> 0:15:06.120 even harmful. Black cohosh, for example, has been linked to 0:15:06.160 --> 0:15:09.800 liver damage, and when hormones are the default answer, other 0:15:09.880 --> 0:15:13.400 explanations might be overlooked. Last year, an editorial in the 0:15:13.400 --> 0:15:17.200 British Medical Journal warned that some consumer facing minopause services 0:15:17.200 --> 0:15:21.240 can be counterproductive. This past winter, Wall Street Journal reporter 0:15:21.320 --> 0:15:24.840 Jessica Tunkel wrote about how daughters dismissed her own symptoms 0:15:24.880 --> 0:15:29.160 as perimenopause when in fact she had cancer. As Barbara Hannah, 0:15:29.360 --> 0:15:33.040 an obgyn and founder of Mymenopause RX, puts it, have 0:15:33.160 --> 0:15:36.440 women gone from being dismissed and ignored to being preyed upon. 0:15:37.280 --> 0:15:40.920 Many Alloy and their competitors have made menopause treatment easier 0:15:40.960 --> 0:15:44.600 to access, and some women have surely benefited, but some 0:15:44.640 --> 0:15:47.840 physicians stressed that there's no one size fits all prescription 0:15:47.960 --> 0:15:51.200 for health and happiness in midlife, no single fix that 0:15:51.240 --> 0:15:54.200 will work for every woman. What it does is it 0:15:54.240 --> 0:15:57.480 gives women a false sense of control, says Pauline Macki, 0:15:57.800 --> 0:16:01.000 a researcher at the University of Illinois Chako who studies 0:16:01.040 --> 0:16:03.880 menopause and the brain. She recalls sitting next to a 0:16:03.920 --> 0:16:06.920 woman on a plane who raved about her testosterone pellet, 0:16:07.320 --> 0:16:10.080 then turned around to reveal a bald patch, a side 0:16:10.080 --> 0:16:14.560 effect of too much testosterone. No testosterone product is approved 0:16:14.560 --> 0:16:17.680 for women in the US, though it sometimes prescribed off 0:16:17.760 --> 0:16:21.760 label for low libido. This hasn't stopped testosterone from becoming 0:16:21.840 --> 0:16:25.360 the hormone du jour. If I wasn't an expert in menopause, 0:16:25.400 --> 0:16:27.960 Maki says, I'm sure I would have gotten one too. 0:16:28.880 --> 0:16:31.760 Without enough access to good care, women can fall down 0:16:31.760 --> 0:16:35.400 the rabbit hole of supplements and compounded hormones which haven't 0:16:35.440 --> 0:16:39.360 gone through the FDA approval process, and expensive menopause retreats. 0:16:39.960 --> 0:16:43.840 Castperson says the problem isn't the marketplace. We need innovation, 0:16:44.000 --> 0:16:48.120 She emphasizes, it's education. She points to a campaign she 0:16:48.200 --> 0:16:51.600 recently saw for toning gummies as an example of the 0:16:51.640 --> 0:16:53.680 sort of thing women should simply know better than to 0:16:53.720 --> 0:16:57.200 fall for. What women really need is less noise and 0:16:57.320 --> 0:17:01.160 more trusted care, says Anne full and White, co founder 0:17:01.160 --> 0:17:05.240 and co CEO of Alloy. Everyone interviewed for this story 0:17:05.280 --> 0:17:08.359 agreed with that the question is how to get there. 0:17:09.320 --> 0:17:11.960 We'll be right back with the menopause gold rush is 0:17:12.080 --> 0:17:18.560 leaving women behind. Welcome back to the menopause gold rush 0:17:18.640 --> 0:17:22.240 is leaving women behind. On the fourth floor of a 0:17:22.280 --> 0:17:26.080 dilapidated shopping mall in Manhattan's Chinatown, a nurse who spoke 0:17:26.200 --> 0:17:29.320 very little English drew my blood. I was here because 0:17:29.320 --> 0:17:31.800 I'd been convinced by social media that I needed to 0:17:31.840 --> 0:17:35.679 interrogate my hormones and brace for the coming wreckage of midlife. 0:17:36.240 --> 0:17:39.200 The content appeared as if triggered by a calendar alert 0:17:39.520 --> 0:17:43.200 about six months before my fortieth birthday. If you're forty 0:17:43.280 --> 0:17:46.720 years old, I have seventeen years of advice for you. Hater, 0:17:47.119 --> 0:17:50.359 the obgyn and influencer said in one of the reels 0:17:50.359 --> 0:17:53.440 that popped up in my Instagram feed, you are most 0:17:53.480 --> 0:17:58.000 likely not prepared for your oncoming menopause. Hater, who declined 0:17:58.040 --> 0:18:00.840 several requests for comment for this article, is one of 0:18:00.880 --> 0:18:03.840 a group of doctors who refer to themselves colloquially as 0:18:04.000 --> 0:18:08.480 the menopause castperson. Is another. To prepare for menopause, I 0:18:08.560 --> 0:18:11.919 gleaned I needed to eat more protein and fiber, Adopt 0:18:11.960 --> 0:18:15.040 a weightlifting regimen by a weighted vest to boost my 0:18:15.119 --> 0:18:19.320 bone health. Start taking vitamin D, magnesium and maybe creatine powder. 0:18:19.640 --> 0:18:23.000 Sleep more, expose myself to sunlight first thing in the morning, 0:18:23.320 --> 0:18:26.000 and start tracking my hormones so I'd know the precise 0:18:26.040 --> 0:18:29.159 moment when things started to go south. Every time I 0:18:29.200 --> 0:18:32.080 scrolled through my phone, I stumbled upon a depressing new 0:18:32.119 --> 0:18:36.280 factoid about what lay ahead. My cholesterol would rise, my 0:18:36.400 --> 0:18:40.600 joints would ache, I'd develop fun new food intolerances for 0:18:40.640 --> 0:18:43.879 some reason, Winter would feel harder. The first sign of 0:18:43.920 --> 0:18:47.800 perimenopause I learned from Haver's posts was simply not feeling 0:18:47.880 --> 0:18:51.800 like yourself. What woman hasn't felt that lately? I'd been 0:18:51.840 --> 0:18:55.600 a little anxious, sleeping fitfully and waking up sweaty. I'd 0:18:55.600 --> 0:18:59.320 gained a few pounds, and actually, yeah, my skin was 0:18:59.440 --> 0:19:01.960 kind of dry. I was beginning to wonder if I 0:19:02.000 --> 0:19:05.679 could be in perimenopause already without even knowing it. So 0:19:05.760 --> 0:19:08.480 when an ad from a brand called Joy and Blokes 0:19:08.600 --> 0:19:12.119 offered hormone testing for eighty seven dollars, I thought why not. 0:19:12.920 --> 0:19:15.919 In February, I treked to the Chinatown Lab in the 0:19:15.920 --> 0:19:18.760 interest of being thorough. I also booked appointments with several 0:19:18.760 --> 0:19:23.119 of the biggest menopause telehealth companies, Middi, Alloy, Maven, and 0:19:23.160 --> 0:19:27.119 Electra to learn more about hormone therapy. The internet had 0:19:27.119 --> 0:19:31.720 suggested that with hormones earlier was better. At Alloy, after 0:19:31.800 --> 0:19:34.760 I filled out a form describing my symptoms, I promptly 0:19:34.800 --> 0:19:37.159 received a message from a doctor concluding that I was 0:19:37.200 --> 0:19:41.000 in paramenopause. Weight gain is often one of the first symptoms. 0:19:41.560 --> 0:19:44.879 She prescribed a low dose birth control pill one hundred 0:19:44.920 --> 0:19:48.760 and twenty dollars. Because Alloy doesn't accept insurance and suggested 0:19:48.800 --> 0:19:52.159 six hundred dollars in additional add ons. At MIDI, a 0:19:52.240 --> 0:19:54.480 nurse practitioner told me it can be hard to know 0:19:54.560 --> 0:19:58.719 what's paramenopause and what isn't. But starting hormone therapy earlier, 0:19:58.800 --> 0:20:03.679 she said, could help prevent osteoporosis and dementia. According to Maki, 0:20:03.960 --> 0:20:08.560 the brain researcher, evidence suggests it does not prevent cognitive decline. 0:20:09.080 --> 0:20:12.920 She prescribed a weekly estrogen patch and oral progesterone, which 0:20:12.960 --> 0:20:16.120 my insurance would cover. When my labs came back from 0:20:16.200 --> 0:20:19.560 Joy and Blokes, they suggested my testosterone was low and 0:20:19.640 --> 0:20:25.639 my thyroid stimulating hormone or TSH was high. I spiraled. Menopause, 0:20:25.680 --> 0:20:28.800 of course, also coincides with an age when thyroid dysfunction 0:20:28.880 --> 0:20:32.720 becomes more common. My regular doctor, however, was skeptical that 0:20:32.760 --> 0:20:36.040 these tests meant all that much. Hormone levels swing day 0:20:36.040 --> 0:20:39.840 to day. She reminded me. She retested my TSH it 0:20:39.880 --> 0:20:43.600 was normal. My testosterone levels, meanwhile, had been low for 0:20:43.680 --> 0:20:46.280 a man, but perfectly within range for a thirty nine 0:20:46.359 --> 0:20:50.520 year old woman. Generally speaking, a woman's testosterone levels reveal 0:20:50.600 --> 0:20:53.520 little on their own. There's no agreed upon cutoff that 0:20:53.680 --> 0:20:59.160 by itself requires treatment. In emailed statements to Bloomberg BusinessWeek, MIDI, 0:20:59.320 --> 0:21:02.440 Alloy and d Joy and Blokes all emphasized their commitment 0:21:02.480 --> 0:21:05.720 to helping women access hard to find evidence based care 0:21:05.840 --> 0:21:09.119 in a confusing marketplace. All said that they don't push 0:21:09.200 --> 0:21:12.160 specific courses of action and that they're dedicated to helping 0:21:12.200 --> 0:21:16.639 each patient find appropriate, individualized care. Our goal is not 0:21:16.720 --> 0:21:20.439 to prescribe more treatments. Josh Whalan, the CEO and co 0:21:20.520 --> 0:21:23.679 founder of Blokes, which operates Joy and Blokes, said in 0:21:23.720 --> 0:21:27.400 his statement, it's to ensure each woman receives the right treatment, 0:21:27.520 --> 0:21:31.520 if any. MIDI Chief medical Officer Kathleen Jordan said in 0:21:31.560 --> 0:21:34.320 her statement that trialing hormone therapy to see if it 0:21:34.359 --> 0:21:39.320 improves symptoms is a proactive approach. Addressing paramenopausal symptoms early 0:21:39.400 --> 0:21:43.360 is not aggressive medicine, she said. In Evaluating patients, an 0:21:43.400 --> 0:21:46.560 Alloy spokesperson said their company sees part of its role 0:21:46.640 --> 0:21:50.119 not as persuasion, but as education. Our role isn't to 0:21:50.160 --> 0:21:53.160 convince women they need treatment. It's to help them understand 0:21:53.200 --> 0:21:57.200 what's happening in their bodies. With some distance, my symptoms 0:21:57.200 --> 0:22:03.160 had more obvious explanations frequently stress baking macarones then eating them. 0:22:03.480 --> 0:22:05.880 My husband had piled blankets on the bed to ward 0:22:05.920 --> 0:22:08.840 off the winter chill. Once I removed them, my night 0:22:08.920 --> 0:22:13.000 sweats vanished. A nurse practitioner at Maven calmly suggested I 0:22:13.040 --> 0:22:16.520 revisit hormone testing with my regular ob before getting too 0:22:16.640 --> 0:22:20.919 riled up about perimenopause. At Electra, a gynecologist told me 0:22:20.960 --> 0:22:23.600 that every symptom of middle age, such as weight gain, 0:22:24.000 --> 0:22:28.760 wasn't necessarily as signed of peramenopause. I wasn't in perimenopause. 0:22:29.160 --> 0:22:31.400 I was just hot and whipped into a frenzy about 0:22:31.440 --> 0:22:36.280 an inevitability that women generally survive just fine. I wasn't 0:22:36.320 --> 0:22:39.280 alone texting with some girlfriends about the grip of the 0:22:39.320 --> 0:22:43.000 menopause algorithm. Another confessed she'd started to wonder whether she 0:22:43.080 --> 0:22:46.880 was in perimenopause herself. Olga, a forty year old software 0:22:46.880 --> 0:22:50.280 engineer in Brooklyn, says she viewed the transition as a betrayal. 0:22:50.880 --> 0:22:54.760 Your body just stops functioning, she says. People's hair falls out, 0:22:54.800 --> 0:22:57.800 they get fat, their skin gets bad. Who wants that? 0:22:58.520 --> 0:23:00.880 Three years ago, she'd begun or uttering a drug called 0:23:00.920 --> 0:23:05.159 rapamycin from India, inspired by early stage clinical trials that 0:23:05.240 --> 0:23:07.760 aim to show it can help in delaying the ovarian 0:23:07.840 --> 0:23:11.800 aging that leads to a decline in fertility and ultimately menopause. 0:23:12.480 --> 0:23:15.280 I plan on taking birth control until I can't anymore, 0:23:15.520 --> 0:23:19.040 and then switching to hormone therapy until I die, says Olga, 0:23:19.200 --> 0:23:21.680 who prefer not to use her full name when discussing 0:23:21.720 --> 0:23:26.160 the legally dubious practice of importing prescription drugs. I can 0:23:26.200 --> 0:23:30.040 mitigate the downsides of having a female body. In some 0:23:30.080 --> 0:23:33.560 parts of Asia, where menopause may carry fewer negative cultural 0:23:33.600 --> 0:23:38.040 associations and older women often hold greater social status, studies 0:23:38.080 --> 0:23:42.240 have sometimes found that women report fewer classic symptoms. Studies 0:23:42.240 --> 0:23:45.280 of modern Maya women and HUDs of women in Tanzania 0:23:45.480 --> 0:23:49.119 have found similarly low rates of some typical menopause symptoms. 0:23:49.760 --> 0:23:53.520 In ancient Greece, where the Hippocratics believed women's constitutions grew 0:23:53.560 --> 0:23:56.280 stronger late in life, there was much ado about the 0:23:56.359 --> 0:24:01.439 dangers of puberty, menstruation, and childbirth, but virtual nothing about menopause. 0:24:02.080 --> 0:24:04.400 The ancient Greeks didn't even have a word for it. 0:24:05.200 --> 0:24:09.280 Women in today's industrialized societies may genuinely be experiencing a 0:24:09.359 --> 0:24:12.040 rougher go of it for a variety of reasons, but 0:24:12.160 --> 0:24:17.640 medicalization deeply influences experiences of menopause in modern societies. As 0:24:17.680 --> 0:24:20.720 the historian Susan Mattern writes in her book The Slow 0:24:20.800 --> 0:24:24.240 Moon Climbs and freaking out doesn't seem to help either. 0:24:25.000 --> 0:24:28.600 This is where the MENO marketing blitz might well be counterproductive. 0:24:29.119 --> 0:24:33.080 Although menopause is emphatically not a disease, the AD's flooding 0:24:33.080 --> 0:24:36.359 women's social media accounts often make it seem otherwise, says 0:24:36.440 --> 0:24:40.199 Dina Emera, an evolutionary biologist who studies menopause at the 0:24:40.200 --> 0:24:44.880 Independent Buck Institute for Research on Aging in California. When 0:24:44.880 --> 0:24:47.520 I go on Instagram, like half the stuff I see 0:24:47.640 --> 0:24:50.920 is on menopause, Emera says, it's hard to get away 0:24:50.960 --> 0:24:53.960 from the messages that your body is messed up. The 0:24:54.040 --> 0:24:57.000 truth is there's no magic salve for the many indignities 0:24:57.000 --> 0:25:01.080