1 00:00:02,759 --> 00:00:05,920 Speaker 1: Hi. This is Laura Vandercamp. I'm a mother of five, 2 00:00:06,200 --> 00:00:08,039 Speaker 1: an author, journalist, and speaker. 3 00:00:08,920 --> 00:00:11,559 Speaker 2: And this is Sarah Hartunger. I'm a mother of three, 4 00:00:11,720 --> 00:00:14,640 Speaker 2: a practicing physician and blogger. On the side, we are 5 00:00:14,640 --> 00:00:17,440 Speaker 2: two working parents who love our careers and our families. 6 00:00:17,920 --> 00:00:20,440 Speaker 1: Welcome to best of both worlds. Here we talk about 7 00:00:20,440 --> 00:00:23,360 Speaker 1: how real women manage work, family, and time for fun. 8 00:00:23,920 --> 00:00:27,160 Speaker 1: From figuring out childcare to mapping out long term career goals. 9 00:00:27,400 --> 00:00:30,840 Speaker 1: We want you to get the most out of life. 10 00:00:32,600 --> 00:00:35,040 Speaker 1: Welcome to best of both worlds. This is Laura. This 11 00:00:35,159 --> 00:00:37,680 Speaker 1: episode is airing at the very end of January. In 12 00:00:37,720 --> 00:00:40,680 Speaker 1: twenty twenty four, Sarah is going to be interviewing doctor 13 00:00:40,760 --> 00:00:44,080 Speaker 1: Gillian Goddard, who has been a prior guest on the show. 14 00:00:44,159 --> 00:00:47,599 Speaker 1: She was talking about her life as a practicing physician 15 00:00:47,760 --> 00:00:50,760 Speaker 1: in New York and as she's raising four children. She 16 00:00:50,840 --> 00:00:53,360 Speaker 1: particularly talked about having op pars with her family and 17 00:00:53,400 --> 00:00:56,000 Speaker 1: how that had worked as a childcare solution. But she's 18 00:00:56,040 --> 00:00:59,240 Speaker 1: back because she has a new newsletter that is out 19 00:00:59,400 --> 00:01:05,160 Speaker 1: very recently called The Hot Flash, dealing with medical issues 20 00:01:05,240 --> 00:01:10,039 Speaker 1: associated with women who are about our age. Sarah, as 21 00:01:10,080 --> 00:01:13,520 Speaker 1: we hit our mid forties, so looking at issues for 22 00:01:13,640 --> 00:01:15,319 Speaker 1: women in their forties. So why don't you tell us 23 00:01:15,319 --> 00:01:17,760 Speaker 1: a little bit about what you and Jillian cover in this. 24 00:01:18,360 --> 00:01:21,440 Speaker 2: Yeah, so this has been requested many times. We had 25 00:01:21,480 --> 00:01:23,880 Speaker 2: a prior guest shout out to doctor Laura Erdman who 26 00:01:23,920 --> 00:01:26,920 Speaker 2: talked about some of these topics, kind of focusing on 27 00:01:26,959 --> 00:01:30,600 Speaker 2: the obigui in side. But doctor Goddard is an endecnologist, 28 00:01:30,600 --> 00:01:33,319 Speaker 2: so kind of like a different medical field and perspective, 29 00:01:34,200 --> 00:01:37,520 Speaker 2: and great timing since she is starting this amazing newsletter 30 00:01:37,560 --> 00:01:39,920 Speaker 2: which I think came out last week when this episode airs, 31 00:01:40,040 --> 00:01:44,200 Speaker 2: and it's part of Emily Oster's parent Data collection of newsletters, 32 00:01:44,240 --> 00:01:48,400 Speaker 2: so it's going to be awesome. And yeah, I was 33 00:01:48,440 --> 00:01:51,440 Speaker 2: super curious about a lot of things, including whether or 34 00:01:51,480 --> 00:01:55,120 Speaker 2: not I'm in perimenopause spoiler. I think the answer is no. 35 00:01:56,520 --> 00:01:59,440 Speaker 2: But it was a really it was a really, really 36 00:01:59,480 --> 00:02:03,960 Speaker 2: fun conversation. If you are triggered by discussion of cycles 37 00:02:03,960 --> 00:02:06,320 Speaker 2: and fertility and other things like that, this may be 38 00:02:06,440 --> 00:02:09,520 Speaker 2: an episode to skip. We do talk about those kinds 39 00:02:09,560 --> 00:02:13,000 Speaker 2: of things, So yeah, I guess it does make sense 40 00:02:13,000 --> 00:02:14,239 Speaker 2: for me to give that as a little bit of 41 00:02:14,240 --> 00:02:17,040 Speaker 2: a trigger warning. You can check out all of our 42 00:02:17,080 --> 00:02:19,200 Speaker 2: prior episodes if you need something else to listen to 43 00:02:19,360 --> 00:02:19,800 Speaker 2: this week. 44 00:02:20,639 --> 00:02:22,920 Speaker 1: Yeah, but very exciting because this is a topic that 45 00:02:22,960 --> 00:02:25,720 Speaker 1: I know a lot of our listeners are curious about 46 00:02:26,080 --> 00:02:28,400 Speaker 1: as we get a little bit older and watch our 47 00:02:28,440 --> 00:02:32,480 Speaker 1: bodies change again, it's just a constant thing of figuring 48 00:02:32,480 --> 00:02:35,959 Speaker 1: out what's going on, and many of us are helping 49 00:02:35,960 --> 00:02:38,000 Speaker 1: our teen daughters through the first part of that to 50 00:02:38,280 --> 00:02:41,079 Speaker 1: sort of stage, but we are entering into the other 51 00:02:41,120 --> 00:02:43,519 Speaker 1: one of it. So we'll be excited to hear what 52 00:02:44,080 --> 00:02:46,959 Speaker 1: Jillian Goddard has to say and excited that this is 53 00:02:47,000 --> 00:02:51,160 Speaker 1: a topic that more people are talking about and is 54 00:02:51,480 --> 00:02:52,880 Speaker 1: coming into the cultural consciousness. 55 00:02:52,880 --> 00:02:54,360 Speaker 3: So let's hear what she has to say. 56 00:02:54,960 --> 00:02:57,880 Speaker 2: I am so excited to welcome doctor Gillian Goddard to 57 00:02:57,960 --> 00:03:00,760 Speaker 2: Best of Both Worlds for this second time. But Jillian 58 00:03:01,040 --> 00:03:04,440 Speaker 2: was on this podcast previously, not as physician Gillian. She 59 00:03:04,560 --> 00:03:07,040 Speaker 2: was on as parent Gillian, talking all about the O 60 00:03:07,200 --> 00:03:11,000 Speaker 2: pair lifestyle. But we decided we needed to have her back, 61 00:03:11,000 --> 00:03:13,040 Speaker 2: and we beg to have her back because there have 62 00:03:13,040 --> 00:03:16,840 Speaker 2: been so many questions from our audience about perimenopause and hormones, 63 00:03:17,200 --> 00:03:20,600 Speaker 2: and doctor Goddard happens to be an expert in that field. 64 00:03:20,919 --> 00:03:24,040 Speaker 2: She also was an attendee of Bestly Plans Live. Had 65 00:03:24,080 --> 00:03:26,760 Speaker 2: so much fun hanging out with me and Laura in 66 00:03:26,960 --> 00:03:30,960 Speaker 2: Fort Lauderdale last fall. And she's an endocrinologist in private 67 00:03:31,040 --> 00:03:34,440 Speaker 2: practice and the author of hot Flash, which is the 68 00:03:34,440 --> 00:03:38,400 Speaker 2: best name ever. That is a newsletter from Parent Data 69 00:03:38,520 --> 00:03:40,920 Speaker 2: by Emily, auser who we've also had on the podcast. 70 00:03:40,960 --> 00:03:42,840 Speaker 2: So welcome, doctor Gillian Goddard. 71 00:03:44,160 --> 00:03:46,360 Speaker 3: Oh, I thank Sarah. It's so glad to be back 72 00:03:46,400 --> 00:03:47,480 Speaker 3: on Best of Both Worlds. 73 00:03:47,520 --> 00:03:50,240 Speaker 4: I am a very regular listener, so it's great to 74 00:03:50,280 --> 00:03:50,920 Speaker 4: be here again. 75 00:03:51,360 --> 00:03:51,840 Speaker 3: I love it. 76 00:03:51,960 --> 00:03:54,880 Speaker 2: We love having our listeners and Patreon members and just 77 00:03:54,920 --> 00:03:56,520 Speaker 2: people who have kind of gotten to know the show 78 00:03:56,520 --> 00:03:58,920 Speaker 2: really well on It always feels really really smooth, So 79 00:03:59,160 --> 00:04:03,000 Speaker 2: super excited with the conversation. Plus I'm personally excited about 80 00:04:03,040 --> 00:04:05,600 Speaker 2: the topic. So because it's actually funny, I will say, like, 81 00:04:05,640 --> 00:04:07,520 Speaker 2: people think I know adult in new chronology, and I 82 00:04:07,560 --> 00:04:10,760 Speaker 2: know very very little adult in necronology. Someone asked me 83 00:04:10,840 --> 00:04:13,040 Speaker 2: for something about menopause, and I'm like, you realize my 84 00:04:13,080 --> 00:04:15,119 Speaker 2: patients go up to like age twenty. I mean, yes, 85 00:04:15,160 --> 00:04:18,440 Speaker 2: there are some patients that have sort of menopausal scenarios. 86 00:04:18,440 --> 00:04:21,400 Speaker 2: For different reasons, but it's not my forte Okay. So 87 00:04:21,680 --> 00:04:25,159 Speaker 2: with all that said, what is the difference between menopause 88 00:04:25,400 --> 00:04:30,640 Speaker 2: perimenopause and like, is there even like a perimenopause before that, 89 00:04:31,040 --> 00:04:35,040 Speaker 2: like take us through the journey. Sure, So I think 90 00:04:35,080 --> 00:04:36,560 Speaker 2: that this is really. 91 00:04:36,320 --> 00:04:40,719 Speaker 4: Important to make a distinction among all these different phases 92 00:04:40,760 --> 00:04:43,920 Speaker 4: that our bodies go through in our forties and fifties. 93 00:04:44,920 --> 00:04:46,279 Speaker 3: A lot of my patients come. 94 00:04:46,120 --> 00:04:48,320 Speaker 4: In and say they're having all these symptoms and they 95 00:04:48,360 --> 00:04:52,159 Speaker 4: thought they were having perimenopause, but they went to their gynecologists, 96 00:04:52,160 --> 00:04:54,839 Speaker 4: and their gynecologists checked their labs and we're like, no, 97 00:04:55,080 --> 00:04:57,839 Speaker 4: you're not in perimenopause. And then they're like, well, then 98 00:04:57,880 --> 00:05:01,160 Speaker 4: why do I feel so crummy? And so I think 99 00:05:01,200 --> 00:05:03,799 Speaker 4: it is a really important thing to sort of make 100 00:05:04,120 --> 00:05:07,880 Speaker 4: all these distinctions. So let's just talk through them from 101 00:05:07,920 --> 00:05:11,480 Speaker 4: the beginning. So you go from being in your thirties 102 00:05:11,520 --> 00:05:15,120 Speaker 4: and you're having regular periods and you're having your babies 103 00:05:15,200 --> 00:05:18,679 Speaker 4: and your breastfeeding and life is going on as normal. 104 00:05:19,120 --> 00:05:21,400 Speaker 4: And if you're anything like me, you hit forty and 105 00:05:21,440 --> 00:05:21,960 Speaker 4: you are. 106 00:05:21,800 --> 00:05:25,040 Speaker 3: Like, forties are going to be the best. I don't 107 00:05:25,080 --> 00:05:26,160 Speaker 3: have little babies. 108 00:05:26,200 --> 00:05:28,640 Speaker 4: I'm going to sleep at night, I'm going to feel amazing, 109 00:05:29,160 --> 00:05:33,240 Speaker 4: and you know, there's no diapers, there's no breastfeeding, there's 110 00:05:33,279 --> 00:05:36,400 Speaker 4: none of that. And what I found, and what a 111 00:05:36,400 --> 00:05:37,760 Speaker 4: lot of my patients mind. 112 00:05:37,680 --> 00:05:40,679 Speaker 3: Is sure that that works great for. 113 00:05:40,640 --> 00:05:42,800 Speaker 4: A few years, and then all of a sudden, you 114 00:05:42,880 --> 00:05:46,440 Speaker 4: start having like weird headaches and all your periods change, 115 00:05:46,480 --> 00:05:48,359 Speaker 4: and you're not sleeping at night, and none of it 116 00:05:48,400 --> 00:05:53,719 Speaker 4: makes any sense. And what that actually is typically is 117 00:05:53,720 --> 00:05:57,159 Speaker 4: something called the late reproductive phase. So this is a 118 00:05:57,200 --> 00:06:00,760 Speaker 4: phase that typically starts for women in their early forties 119 00:06:01,240 --> 00:06:05,400 Speaker 4: and can go on for five years, maybe even more. 120 00:06:06,360 --> 00:06:10,320 Speaker 4: And what defines the late reproductive phase is that you 121 00:06:10,360 --> 00:06:15,800 Speaker 4: are still having regular periods, but your cycles are changing. 122 00:06:16,440 --> 00:06:18,840 Speaker 3: So even though your period is about the. 123 00:06:18,760 --> 00:06:21,480 Speaker 4: Same length every month, it might go from being thirty 124 00:06:21,560 --> 00:06:25,000 Speaker 4: two days to twenty eight days to twenty six days, 125 00:06:25,640 --> 00:06:30,040 Speaker 4: and along with that you can have heavier periods and 126 00:06:30,080 --> 00:06:34,159 Speaker 4: you can have a lot more symptoms. Some women even 127 00:06:34,600 --> 00:06:39,400 Speaker 4: get more irritable or don't sleep as well. A lot 128 00:06:39,400 --> 00:06:43,560 Speaker 4: of women got hormonal headaches in this time period, and 129 00:06:43,600 --> 00:06:46,200 Speaker 4: some women even get hot flushes, but they only get 130 00:06:46,200 --> 00:06:52,320 Speaker 4: them around their period when our hormones drop and the 131 00:06:52,400 --> 00:06:56,800 Speaker 4: reason all this happens in our forties is because unfortunately, 132 00:06:56,839 --> 00:06:59,760 Speaker 4: as we get into our forties, we still have eggs in. 133 00:06:59,760 --> 00:07:02,640 Speaker 3: Our own but they're not like they're like the last 134 00:07:02,640 --> 00:07:03,279 Speaker 3: guy's picked. 135 00:07:03,279 --> 00:07:06,320 Speaker 4: They're not the most amazing eggs, and it takes a 136 00:07:06,360 --> 00:07:11,400 Speaker 4: lot of stimulus or juice as it were, from our 137 00:07:11,440 --> 00:07:15,440 Speaker 4: pituitary gland to get those eggs to be ready to ovulate. 138 00:07:15,800 --> 00:07:20,520 Speaker 4: So we have this hormone called FSH or follicle stimulating hormone, 139 00:07:20,800 --> 00:07:24,160 Speaker 4: and it goes up higher, and that hormone makes our 140 00:07:24,320 --> 00:07:28,720 Speaker 4: estrogen go up higher, and high estrogen is fine, but 141 00:07:28,760 --> 00:07:31,360 Speaker 4: then that estrogen has to come back down, and it's 142 00:07:31,400 --> 00:07:35,760 Speaker 4: actually the drop that makes us feel really, really grummy. 143 00:07:37,160 --> 00:07:40,560 Speaker 4: And so even though our estrogen levels are rising and 144 00:07:40,640 --> 00:07:42,680 Speaker 4: falling at the same times of the month as they 145 00:07:42,760 --> 00:07:45,840 Speaker 4: used to, they're going higher and they're falling lower, and 146 00:07:45,960 --> 00:07:50,360 Speaker 4: all of that makes us symptomatic. So we trundle along 147 00:07:50,400 --> 00:07:55,040 Speaker 4: with that for five years, and then we typically see 148 00:07:55,120 --> 00:08:01,400 Speaker 4: people transition to perimenopause. Perimenopause is when our cycle length 149 00:08:01,840 --> 00:08:05,600 Speaker 4: starts to vary. So maybe we had gone down to 150 00:08:05,640 --> 00:08:07,760 Speaker 4: having a twenty six day cycle, but it was a 151 00:08:07,760 --> 00:08:13,000 Speaker 4: twenty six day cycle every single month. Perimenopause is a 152 00:08:13,080 --> 00:08:16,960 Speaker 4: twenty two day cycle followed by a forty three day 153 00:08:17,040 --> 00:08:20,320 Speaker 4: cycle followed by a thirty four day cycle, And the 154 00:08:20,400 --> 00:08:24,200 Speaker 4: technical definition is that there's a greater than seven day 155 00:08:24,280 --> 00:08:28,560 Speaker 4: variability from cycle to cycle. And so again, we may 156 00:08:28,560 --> 00:08:33,640 Speaker 4: be ovulating, we may be having periods intermittently. 157 00:08:33,760 --> 00:08:35,199 Speaker 3: They might still feel. 158 00:08:34,960 --> 00:08:38,400 Speaker 4: Kind of regular, but they're much more all over the 159 00:08:38,440 --> 00:08:40,760 Speaker 4: place than they used to be. And we might go 160 00:08:40,840 --> 00:08:45,080 Speaker 4: through times when we feel fine, and we might go 161 00:08:45,120 --> 00:08:48,760 Speaker 4: through times when we're having lots of symptoms like hot flushes, 162 00:08:48,920 --> 00:08:54,920 Speaker 4: night sweats, eared ability, dissleep disruption and all those things. 163 00:08:54,679 --> 00:08:55,760 Speaker 3: Are not so fun. 164 00:08:56,960 --> 00:09:00,880 Speaker 4: And then the cycles tend to space out further and 165 00:09:00,920 --> 00:09:05,800 Speaker 4: further and further, and eventually you will have. 166 00:09:06,080 --> 00:09:09,360 Speaker 3: A last period and enter menopause. 167 00:09:09,640 --> 00:09:12,240 Speaker 4: The funny thing about menopause, though, is you can only 168 00:09:12,280 --> 00:09:16,760 Speaker 4: diagnose it in retrospect, so you have to go twelve 169 00:09:16,880 --> 00:09:20,240 Speaker 4: months without having a period before you can officially say 170 00:09:20,240 --> 00:09:22,480 Speaker 4: you're in menopause. So if you go eleven months and 171 00:09:22,520 --> 00:09:25,360 Speaker 4: then you have a period, you're still in perimenopause. 172 00:09:25,960 --> 00:09:27,800 Speaker 2: The funny thing about that is like the idea that 173 00:09:27,840 --> 00:09:29,640 Speaker 2: you would just never know when it's the last one. 174 00:09:29,679 --> 00:09:32,000 Speaker 2: I never really thought about that, But I don't know 175 00:09:32,000 --> 00:09:34,559 Speaker 2: how I feel about that. 176 00:09:34,559 --> 00:09:37,720 Speaker 5: That has some really important implications too, because there are 177 00:09:37,720 --> 00:09:41,760 Speaker 5: some studies that show that at least twenty five percent 178 00:09:41,840 --> 00:09:44,400 Speaker 5: of cycles that are more than six months long, So 179 00:09:44,400 --> 00:09:46,280 Speaker 5: say you haven't had a period in six months and 180 00:09:46,280 --> 00:09:48,240 Speaker 5: then all of a sudden you have a period, twenty 181 00:09:48,280 --> 00:09:49,920 Speaker 5: five percent of those cycles you. 182 00:09:49,880 --> 00:09:54,439 Speaker 4: Actually ovulate, which I think has really important implications when 183 00:09:54,520 --> 00:09:58,600 Speaker 4: you're thinking about things like contraception. The other thing is, 184 00:09:58,679 --> 00:10:00,360 Speaker 4: we used to think that this was like a very 185 00:10:00,480 --> 00:10:06,920 Speaker 4: orderly progression from the late reproductive phase to perimenopause to menopause, 186 00:10:07,440 --> 00:10:10,120 Speaker 4: and it turns out actually more than half of women 187 00:10:10,360 --> 00:10:16,240 Speaker 4: seesaw between the late reproductive phase and perimenopause, and that 188 00:10:16,280 --> 00:10:18,440 Speaker 4: can go on for quite a while. And so just 189 00:10:18,480 --> 00:10:21,880 Speaker 4: because your cycles start to lengthen out doesn't mean that 190 00:10:21,920 --> 00:10:24,720 Speaker 4: all of a sudden you won't start having regular twenty 191 00:10:24,760 --> 00:10:25,559 Speaker 4: eight day cycles. 192 00:10:25,600 --> 00:10:29,880 Speaker 2: Again, that doesn't seem fair, but good to know. So 193 00:10:30,280 --> 00:10:32,880 Speaker 2: question is there like a I don't know a way 194 00:10:32,880 --> 00:10:35,280 Speaker 2: of predicting when this is going to happen to you 195 00:10:35,360 --> 00:10:38,600 Speaker 2: based on medical history. Do people who start their medicare 196 00:10:38,760 --> 00:10:41,520 Speaker 2: earlier tend to have menopause earlier or is it more 197 00:10:41,559 --> 00:10:44,360 Speaker 2: related to like if your mother had earlier menopause, then 198 00:10:44,400 --> 00:10:45,240 Speaker 2: you will as well. 199 00:10:45,840 --> 00:10:48,079 Speaker 4: So we used to think it was hereditary, but actually 200 00:10:48,160 --> 00:10:51,480 Speaker 4: newer cities suggests that there's not really a hereditary connection. 201 00:10:52,400 --> 00:10:53,760 Speaker 3: It would make sense if you. 202 00:10:53,760 --> 00:10:58,080 Speaker 4: Started having periods earlier that you would go through menopause earlier, 203 00:10:58,120 --> 00:11:02,600 Speaker 4: but that's not actually true. The late bloomers actually go 204 00:11:02,679 --> 00:11:06,600 Speaker 4: through menopause earlier, and the early bloomers have period typically 205 00:11:06,600 --> 00:11:10,200 Speaker 4: have periods for longer, and so it doesn't make a 206 00:11:10,200 --> 00:11:14,720 Speaker 4: lot of sense a lot of times. But so yeah, 207 00:11:14,760 --> 00:11:17,360 Speaker 4: so there's not a lot of prediction, So you just 208 00:11:17,400 --> 00:11:21,160 Speaker 4: get way you people super interesting gassing it. So okay, 209 00:11:21,200 --> 00:11:23,880 Speaker 4: so what we heard about hot flashes, we heard about 210 00:11:23,960 --> 00:11:28,960 Speaker 4: sleep disruption, irritability, things like pm d D I'm guessing 211 00:11:29,040 --> 00:11:33,040 Speaker 4: become more common in perimenopause. But one thing that women 212 00:11:33,520 --> 00:11:35,960 Speaker 4: tend to talk about a lot is weight gain. Is 213 00:11:36,000 --> 00:11:38,319 Speaker 4: that a myth is that more related to age. Is 214 00:11:38,360 --> 00:11:42,080 Speaker 4: there a hormonal component, what drives that and what can 215 00:11:42,200 --> 00:11:44,640 Speaker 4: counteract it? Since for most people it's probably not the 216 00:11:44,640 --> 00:11:48,559 Speaker 4: most welcome visitor. Yeah, so waking is something that women 217 00:11:48,679 --> 00:11:51,280 Speaker 4: really struggle with I feel like not a day passes 218 00:11:51,320 --> 00:11:53,640 Speaker 4: in my office where someone doesn't come in wanting to 219 00:11:53,679 --> 00:11:56,559 Speaker 4: talk about perimenopausal weight gain. 220 00:11:57,400 --> 00:11:58,040 Speaker 3: It is real. 221 00:11:59,200 --> 00:12:04,320 Speaker 4: There are studies that will follow women longitudinally over time 222 00:12:04,440 --> 00:12:08,559 Speaker 4: and show that women do, on average, gain about four 223 00:12:08,720 --> 00:12:14,040 Speaker 4: pounds over six years in the perimenopausal time period. It 224 00:12:14,120 --> 00:12:19,960 Speaker 4: is interesting largely in the mid section. So if you 225 00:12:20,080 --> 00:12:24,520 Speaker 4: look at something we call waste circumference, where you literally 226 00:12:24,600 --> 00:12:30,720 Speaker 4: just measure around somebody's waste in over and do that serially, 227 00:12:31,160 --> 00:12:35,160 Speaker 4: you see that women do tend to have an increase 228 00:12:35,200 --> 00:12:39,280 Speaker 4: in waste circumference. What's really interesting about it, though, is 229 00:12:39,960 --> 00:12:44,079 Speaker 4: waste circumference seems to be something that increases and then 230 00:12:44,160 --> 00:12:50,000 Speaker 4: levels out, but overall weight continues to creep up over time, 231 00:12:51,440 --> 00:12:55,640 Speaker 4: which means that you're then gaining weight in other places, 232 00:12:55,679 --> 00:12:59,040 Speaker 4: not just in your mid section. The issue though, is 233 00:12:59,080 --> 00:13:04,080 Speaker 4: that when you gain weight in your mid section, it 234 00:13:04,080 --> 00:13:09,920 Speaker 4: has implications for your metabolic health, so blood pressure, diabetes, 235 00:13:10,440 --> 00:13:14,400 Speaker 4: cardiovascular disease, and so that's why we care about it 236 00:13:14,440 --> 00:13:20,600 Speaker 4: beyond just vanity, and there are studies that look at 237 00:13:20,600 --> 00:13:21,960 Speaker 4: how it's tied hormonally. 238 00:13:22,640 --> 00:13:25,640 Speaker 3: Estrogen is a player here for sure. 239 00:13:25,760 --> 00:13:31,040 Speaker 4: The DroPIN estrogen in the perimenopausal and postmenopausal years, does 240 00:13:31,880 --> 00:13:35,560 Speaker 4: it shifts body composition so we are able to gain 241 00:13:35,600 --> 00:13:38,760 Speaker 4: more fat and we lose a small but significant amount 242 00:13:38,800 --> 00:13:43,280 Speaker 4: of muscle mass. And then the other thing that's been 243 00:13:43,280 --> 00:13:47,360 Speaker 4: shown to be have implications as actually the hormone FSH, 244 00:13:47,400 --> 00:13:53,160 Speaker 4: which I mentioned earlier. So FSH, which is follicle stimulating hormone, 245 00:13:53,480 --> 00:13:56,839 Speaker 4: is a hormone made in our pituitary glance to trigger ovulation, 246 00:13:57,440 --> 00:13:59,640 Speaker 4: and after we go through menopause, when we don't have 247 00:13:59,679 --> 00:14:03,200 Speaker 4: any eggs left to ovulate, our pituitary gland doesn't know 248 00:14:03,280 --> 00:14:07,440 Speaker 4: that and so it just keeps making FSH and FSH 249 00:14:07,600 --> 00:14:12,880 Speaker 4: does seem to have implications for perimenopausal we gain as well. 250 00:14:13,360 --> 00:14:15,880 Speaker 2: Oh, that's interesting. It would be a hard study to 251 00:14:15,880 --> 00:14:17,720 Speaker 2: do because it seems like it would be a confounder, 252 00:14:17,760 --> 00:14:20,640 Speaker 2: but I'm sure they figured out ways to control for it. 253 00:14:20,800 --> 00:14:22,880 Speaker 2: And for those listening to this who are like FSH, 254 00:14:22,920 --> 00:14:24,280 Speaker 2: why do I know that that if you go to 255 00:14:24,320 --> 00:14:26,480 Speaker 2: your PCP and want a blood test for menopause, like 256 00:14:26,560 --> 00:14:29,160 Speaker 2: that's typically the one they'll do. I'm not saying that's 257 00:14:29,320 --> 00:14:32,240 Speaker 2: the way to diagnose menopauses. Doctor Goddard said, but for 258 00:14:32,280 --> 00:14:34,680 Speaker 2: those that got that diagnosis or not from their primary, 259 00:14:34,720 --> 00:14:37,880 Speaker 2: that maybe where things started, because it can be a 260 00:14:37,920 --> 00:14:40,960 Speaker 2: marker that at least send you down some path or another. Okay, 261 00:14:41,000 --> 00:14:42,920 Speaker 2: so we're going to talk about what will counteract that 262 00:14:42,960 --> 00:14:44,920 Speaker 2: weight gain. Perhaps in just a moment, we will be 263 00:14:45,160 --> 00:15:01,280 Speaker 2: right back. Okay, we're back. So understanding that both a 264 00:15:01,360 --> 00:15:04,760 Speaker 2: drop and estrogen as well as high FSH levels, plus 265 00:15:04,800 --> 00:15:07,680 Speaker 2: maybe the impact of body composition changes, because that's going 266 00:15:07,720 --> 00:15:12,120 Speaker 2: to then change your basal metabolic rate. I would assume drives. 267 00:15:12,200 --> 00:15:14,160 Speaker 2: The weight gain that is seen doesn't sound like a 268 00:15:14,200 --> 00:15:15,640 Speaker 2: huge amount of weight gain, but kind of like a 269 00:15:15,680 --> 00:15:18,200 Speaker 2: slow and steady weight gain during those menopausal years and 270 00:15:18,200 --> 00:15:21,680 Speaker 2: perimenopausal years. So what do you tell your patients when 271 00:15:21,720 --> 00:15:24,360 Speaker 2: they if and when they are looking for something to 272 00:15:24,400 --> 00:15:24,960 Speaker 2: counteract that? 273 00:15:25,840 --> 00:15:26,160 Speaker 4: Sure? 274 00:15:26,240 --> 00:15:27,760 Speaker 3: I mean, I think it depends on. 275 00:15:27,880 --> 00:15:30,680 Speaker 4: The degree of wegain you're seeing and what your risk 276 00:15:30,760 --> 00:15:35,960 Speaker 4: factors for other diseases are. So if you are someone 277 00:15:36,040 --> 00:15:40,040 Speaker 4: with a with sort of a healthy weight and you're 278 00:15:40,080 --> 00:15:43,240 Speaker 4: seeing a modest wegain, and to me, a modest weaging 279 00:15:43,320 --> 00:15:47,000 Speaker 4: would be you know, five pounds, even ten pounds, Although 280 00:15:47,000 --> 00:15:49,640 Speaker 4: I appreciate that that feels like a lot to people. 281 00:15:50,280 --> 00:15:54,120 Speaker 4: Then really sort of lifestyle factors are the key, and 282 00:15:55,320 --> 00:15:58,320 Speaker 4: I think the biggest key is fighting the loss of 283 00:15:58,400 --> 00:16:02,920 Speaker 4: muscle mass. And this is where being sure that you're 284 00:16:02,920 --> 00:16:07,720 Speaker 4: doing strength training is absolutely key, because if you can 285 00:16:08,080 --> 00:16:11,120 Speaker 4: fight that loss of muscle mass, you can help maintain 286 00:16:11,160 --> 00:16:15,040 Speaker 4: a healthier body composition. And when you maintain a healthier 287 00:16:15,040 --> 00:16:20,320 Speaker 4: body composition, you don't have to the math of calories 288 00:16:20,360 --> 00:16:23,400 Speaker 4: in versus calories outworks much more in your favor because 289 00:16:23,440 --> 00:16:28,520 Speaker 4: your body naturally is burning more calories and it means 290 00:16:28,600 --> 00:16:31,840 Speaker 4: that you can consume a more typical diet and. 291 00:16:31,720 --> 00:16:32,640 Speaker 3: Maintain your weight. 292 00:16:33,560 --> 00:16:34,240 Speaker 2: That makes sense. 293 00:16:35,240 --> 00:16:39,040 Speaker 4: It's also really important for bone density, which also decreases 294 00:16:39,080 --> 00:16:43,320 Speaker 4: in menopause, and so weight lifting is only going to 295 00:16:43,400 --> 00:16:46,840 Speaker 4: do positive things for you. In women who are looking 296 00:16:47,000 --> 00:16:50,560 Speaker 4: at a more significant weight gain or are looking at 297 00:16:51,440 --> 00:16:55,120 Speaker 4: maybe they've become pre diabetic or even diabetic, there are 298 00:16:55,120 --> 00:16:59,400 Speaker 4: blood pressures going up where there's really health concerns In 299 00:16:59,400 --> 00:17:04,160 Speaker 4: addition to waking. This is where we might think about 300 00:17:04,200 --> 00:17:09,440 Speaker 4: medications depending on the degree of wakaingin. There are several 301 00:17:09,480 --> 00:17:12,359 Speaker 4: medications that have been shown to be really effective, and 302 00:17:12,440 --> 00:17:17,879 Speaker 4: some of the newer medications like wigov or zep bound 303 00:17:17,960 --> 00:17:19,800 Speaker 4: can be really effective. 304 00:17:19,320 --> 00:17:21,400 Speaker 3: For women in the perimenopausal years. 305 00:17:22,760 --> 00:17:24,760 Speaker 4: I know that they've gotten a lot of press lately. 306 00:17:24,880 --> 00:17:29,600 Speaker 4: They're sort of the medications du jure. But for women 307 00:17:29,640 --> 00:17:33,200 Speaker 4: who've had really significant waking in midlife and who are 308 00:17:33,320 --> 00:17:37,879 Speaker 4: seeing their blood sugars creep up and their cholesterol creep up, 309 00:17:37,880 --> 00:17:42,280 Speaker 4: they really are a wonderful tool to help with that 310 00:17:42,480 --> 00:17:43,679 Speaker 4: perimenopausal waking. 311 00:17:44,040 --> 00:17:47,120 Speaker 2: Always nice to have more potential solutions, even if it's 312 00:17:47,160 --> 00:17:50,600 Speaker 2: not always the solution for each person. All right, So 313 00:17:51,040 --> 00:17:54,240 Speaker 2: moving on to contraception. For those who haven't, you mentioned 314 00:17:54,280 --> 00:17:58,240 Speaker 2: that that earlier that sometimes your last period or close 315 00:17:58,280 --> 00:18:00,600 Speaker 2: to your last period can be an ovulatory, which means 316 00:18:00,600 --> 00:18:02,280 Speaker 2: you could get pregnant when you thought you were already 317 00:18:02,320 --> 00:18:06,399 Speaker 2: in menopause, which is super interesting longtime listeners this show, 318 00:18:06,480 --> 00:18:09,920 Speaker 2: I may know I got pregnant like between pregnancies, meaning 319 00:18:10,000 --> 00:18:13,399 Speaker 2: like I had never I'd stopped breastfeeding, never had a 320 00:18:13,440 --> 00:18:16,760 Speaker 2: cycle return, and then got pregnant before my cycle came back. 321 00:18:16,760 --> 00:18:18,919 Speaker 2: So I guess on the very first ovulation between Adabel 322 00:18:18,960 --> 00:18:22,399 Speaker 2: and Cameron, who are twenty two months apart, which for 323 00:18:22,480 --> 00:18:24,800 Speaker 2: me was amazing. I was thrilled because I had had 324 00:18:24,880 --> 00:18:27,560 Speaker 2: such infertility that I'm like, whoo, this is the best 325 00:18:27,600 --> 00:18:30,439 Speaker 2: surprise ever. But I imagine that might not be the 326 00:18:30,440 --> 00:18:33,840 Speaker 2: best surprise if you thought you were in menopause a 327 00:18:33,840 --> 00:18:36,080 Speaker 2: little bit of potentially, I mean maybe it would. 328 00:18:36,080 --> 00:18:37,200 Speaker 3: I don't want to judge. 329 00:18:37,240 --> 00:18:40,520 Speaker 2: Maybe that that was very welcome, but if for some 330 00:18:40,640 --> 00:18:44,600 Speaker 2: that's not the desired outcomes. So talk about contraceptive methods 331 00:18:44,640 --> 00:18:46,680 Speaker 2: for those over the age of forty, And I guess 332 00:18:46,720 --> 00:18:49,919 Speaker 2: one other side is that I personally have found that 333 00:18:50,040 --> 00:18:52,639 Speaker 2: ocps do not agree with me anymore, even though I 334 00:18:52,640 --> 00:18:55,119 Speaker 2: did rely on them for many years in my youth. 335 00:18:55,840 --> 00:18:57,600 Speaker 4: Yeah, so I think you know, when I talked to 336 00:18:57,640 --> 00:19:00,080 Speaker 4: my patients about contraception, I say a few things. The 337 00:19:00,080 --> 00:19:02,400 Speaker 4: one is, because of what we just talked about, if 338 00:19:02,400 --> 00:19:05,000 Speaker 4: you don't want to be pregnant, you should be using 339 00:19:05,119 --> 00:19:10,720 Speaker 4: some form of contraception up until you are in menopause, and. 340 00:19:10,680 --> 00:19:12,120 Speaker 3: Not only if you don't want to be pregnant. 341 00:19:12,880 --> 00:19:15,199 Speaker 4: The eggs that we're ovulating at this point are not 342 00:19:15,400 --> 00:19:18,160 Speaker 4: the again, they're not the champs, and so your risk 343 00:19:18,200 --> 00:19:20,960 Speaker 4: of not just getting pregnant but then having a miscarriage 344 00:19:21,040 --> 00:19:24,600 Speaker 4: is definitely there. And that's a lot to put your 345 00:19:24,600 --> 00:19:28,680 Speaker 4: body through. So I do definitely recommend using a form 346 00:19:28,720 --> 00:19:32,840 Speaker 4: of contraception. When I talk to patients about contraception, I 347 00:19:32,960 --> 00:19:34,960 Speaker 4: like to think about what it can do for you, 348 00:19:35,080 --> 00:19:38,359 Speaker 4: sort of beyond just keeping you from getting pregnant, and 349 00:19:38,400 --> 00:19:41,720 Speaker 4: that can be different for everyone. Some of the forms 350 00:19:41,720 --> 00:19:44,560 Speaker 4: of contraception that we don't think about when we're younger, 351 00:19:44,760 --> 00:19:50,840 Speaker 4: that are irreversible or relatively irreversible, are great options when 352 00:19:50,840 --> 00:19:54,199 Speaker 4: you're in your forties and fifties and you're done having kids. 353 00:19:55,280 --> 00:19:56,640 Speaker 3: So I'm thinking about. 354 00:19:56,359 --> 00:20:03,440 Speaker 4: Things like tubal ligation or sealpingektamy, which is actually removing 355 00:20:03,480 --> 00:20:08,600 Speaker 4: the fallopian tubes completely. The benefit of that procedure is 356 00:20:08,600 --> 00:20:11,400 Speaker 4: that it really reduces your risk of ovarian cancer. 357 00:20:12,600 --> 00:20:13,000 Speaker 5: And so. 358 00:20:14,560 --> 00:20:16,480 Speaker 3: If you're having a c section and you know it's 359 00:20:16,520 --> 00:20:17,360 Speaker 3: your last. 360 00:20:17,040 --> 00:20:19,199 Speaker 4: Baby and they're going to be in there anyway, like 361 00:20:19,280 --> 00:20:22,399 Speaker 4: maybe a sell pingekt tomy would be the right choice 362 00:20:22,440 --> 00:20:26,879 Speaker 4: for you. The other great option that doesn't involve you 363 00:20:26,960 --> 00:20:30,080 Speaker 4: at all if you're the mother of your children is vasectomy. 364 00:20:30,200 --> 00:20:35,960 Speaker 4: That is my favorite form of permanent contraception. Vaseectomy is 365 00:20:36,320 --> 00:20:41,679 Speaker 4: basically you cut and tie off the tubes that carry 366 00:20:41,800 --> 00:20:48,639 Speaker 4: sperm from the testicles. To the semen, and the semen 367 00:20:48,840 --> 00:20:52,720 Speaker 4: doesn't look any different, doesn't seem any different. It just 368 00:20:52,760 --> 00:20:56,160 Speaker 4: doesn't have sperm in it, which is great, and it's 369 00:20:56,520 --> 00:21:00,800 Speaker 4: such a minor procedure. My husband knows that I share 370 00:21:00,840 --> 00:21:05,280 Speaker 4: this information, but he had a sectam and went out 371 00:21:05,280 --> 00:21:09,080 Speaker 4: to dinner that night and coached soccer the next day, 372 00:21:10,200 --> 00:21:13,879 Speaker 4: and so really it was a big non event. The 373 00:21:14,000 --> 00:21:16,439 Speaker 4: key with that sectimy is you do actually have to 374 00:21:16,480 --> 00:21:19,000 Speaker 4: make sure he goes back and has the post procedure 375 00:21:20,320 --> 00:21:23,040 Speaker 4: seem an analysis to make sure that it actually worked 376 00:21:23,080 --> 00:21:23,960 Speaker 4: before you rely. 377 00:21:23,800 --> 00:21:24,840 Speaker 3: On it for contraception. 378 00:21:26,040 --> 00:21:28,440 Speaker 4: But then when we think about other forms of contraception 379 00:21:28,480 --> 00:21:31,919 Speaker 4: that you may have used before, things like iud's and 380 00:21:33,160 --> 00:21:38,160 Speaker 4: oral contraceptive pills, birth control pills are definitely still options. 381 00:21:39,200 --> 00:21:41,920 Speaker 4: I think that there you want to really again think 382 00:21:41,920 --> 00:21:44,200 Speaker 4: about what you're getting from it. So if your periods 383 00:21:44,240 --> 00:21:49,240 Speaker 4: are really heavy and really causing problems from that perspective, 384 00:21:50,240 --> 00:21:54,960 Speaker 4: and a progesterone eluding IUD might be a really like 385 00:21:55,000 --> 00:21:57,680 Speaker 4: a marina or a Kaylina might be a really great 386 00:21:57,720 --> 00:22:01,600 Speaker 4: option for you because they work by thinning the uterine 387 00:22:01,640 --> 00:22:05,119 Speaker 4: lining and really really lighten up your periods. They also 388 00:22:05,280 --> 00:22:08,040 Speaker 4: last you can keep your marina in for seven years now, 389 00:22:08,119 --> 00:22:10,760 Speaker 4: so one or two marinas might get you from your 390 00:22:10,840 --> 00:22:15,240 Speaker 4: last kid to menopause without a lot of fuss. I 391 00:22:15,400 --> 00:22:19,639 Speaker 4: do actually still use a lot of birth control pills 392 00:22:19,640 --> 00:22:22,480 Speaker 4: in women in their forties. We used to think that 393 00:22:22,520 --> 00:22:25,280 Speaker 4: birth control pills were not safe after the age of 394 00:22:25,320 --> 00:22:29,400 Speaker 4: thirty five. Those are like really old studies from the 395 00:22:29,440 --> 00:22:32,040 Speaker 4: original birth control pills, which had pretty high. 396 00:22:31,920 --> 00:22:33,879 Speaker 3: Doses of estrogen in them. 397 00:22:34,440 --> 00:22:39,000 Speaker 4: I typically use the ultra lo doos pills in women 398 00:22:39,040 --> 00:22:41,280 Speaker 4: in their forties, and those have been shown to be 399 00:22:41,400 --> 00:22:45,800 Speaker 4: safe up until the average age of menopause, so early fifties. 400 00:22:46,920 --> 00:22:47,880 Speaker 3: The key there. 401 00:22:47,840 --> 00:22:50,600 Speaker 4: Though, is making sure that it's the right one for you, 402 00:22:50,800 --> 00:22:53,480 Speaker 4: and the nice thing about it is if you are 403 00:22:53,560 --> 00:22:57,440 Speaker 4: having a lot of symptoms like hot flushes or sleep disruption, 404 00:22:58,840 --> 00:23:02,399 Speaker 4: they essentially act like hormone replacement therapy. They're the same 405 00:23:02,480 --> 00:23:05,479 Speaker 4: hormones that are in hormone replacement therapy, just in a 406 00:23:05,480 --> 00:23:07,840 Speaker 4: slightly higher dose, and. 407 00:23:07,800 --> 00:23:09,080 Speaker 3: So you can get a lot of benefit there. 408 00:23:09,119 --> 00:23:12,200 Speaker 4: You can also skip periods with the low dose birth 409 00:23:12,200 --> 00:23:16,280 Speaker 4: control pills, which a lot of women find really really beneficial. 410 00:23:16,840 --> 00:23:17,880 Speaker 3: The key though, is. 411 00:23:17,800 --> 00:23:21,200 Speaker 4: Just to make sure that whatever you are using it's 412 00:23:21,280 --> 00:23:23,479 Speaker 4: working for you, and that you're not just sticking with 413 00:23:23,640 --> 00:23:27,720 Speaker 4: something because it's what you've always used when it maybe 414 00:23:27,840 --> 00:23:31,439 Speaker 4: isn't working for you anymore. So reassessing like, well, I 415 00:23:31,520 --> 00:23:33,959 Speaker 4: used to be on this pill, but maybe now a 416 00:23:33,960 --> 00:23:36,800 Speaker 4: different pill would be the right choice because of the dose. 417 00:23:38,000 --> 00:23:39,679 Speaker 4: Or I used to use a birth control pill, but 418 00:23:39,840 --> 00:23:43,280 Speaker 4: now maybe a moreno would be the right choice. And 419 00:23:43,320 --> 00:23:46,680 Speaker 4: so I think just being ready to kind of reassess 420 00:23:46,760 --> 00:23:49,640 Speaker 4: and reconsider is key. The one thing I would say 421 00:23:49,680 --> 00:23:55,320 Speaker 4: is while barrier methods can be great and are super reversible, 422 00:23:55,920 --> 00:23:59,280 Speaker 4: they might not be the right choice if a pregnancy 423 00:23:59,320 --> 00:24:02,840 Speaker 4: in your family would be catastrophic, because they do have 424 00:24:02,880 --> 00:24:06,879 Speaker 4: a much higher failure rate. The beauty of things like 425 00:24:07,000 --> 00:24:13,080 Speaker 4: IUDs and even sterilization procedures is they don't involve you 426 00:24:13,160 --> 00:24:16,840 Speaker 4: doing anything. You go to the doctor, have something done, 427 00:24:16,840 --> 00:24:18,720 Speaker 4: and you don't think about it, and so there's no 428 00:24:19,880 --> 00:24:22,959 Speaker 4: there's not a lot of dependency on your sort of 429 00:24:23,560 --> 00:24:25,520 Speaker 4: operating them appropriately. 430 00:24:26,119 --> 00:24:28,159 Speaker 2: I mean you say barrier methods, I assume you mean, 431 00:24:28,280 --> 00:24:30,479 Speaker 2: like you know, traditional condoms, but then there's also some 432 00:24:30,600 --> 00:24:34,640 Speaker 2: newer there's also some newer medications that can be basically 433 00:24:34,760 --> 00:24:37,480 Speaker 2: placed up there that kind of serve the barrier method 434 00:24:37,520 --> 00:24:42,679 Speaker 2: that have gained popularity recently. Yeah, yeah, all right, so 435 00:24:43,160 --> 00:24:45,119 Speaker 2: that is all about contraception, and yeah, I didn't mean 436 00:24:45,119 --> 00:24:47,359 Speaker 2: to diss OCPS. I just tried two different ones and 437 00:24:47,760 --> 00:24:50,560 Speaker 2: cured my migraines by stopping them all. And so the 438 00:24:50,600 --> 00:24:52,679 Speaker 2: migraines were so bad and first went on for so 439 00:24:52,800 --> 00:24:55,840 Speaker 2: long on two different medications that I'm personally not willing 440 00:24:55,880 --> 00:24:59,679 Speaker 2: to revisit it. But to each their own. And I 441 00:25:00,160 --> 00:25:02,480 Speaker 2: not have ever had migraines if I didn't have a 442 00:25:02,560 --> 00:25:06,359 Speaker 2: probably predisposition to them. So all of that said, great 443 00:25:06,400 --> 00:25:09,080 Speaker 2: to have again, so many different options to think about, 444 00:25:09,600 --> 00:25:12,639 Speaker 2: So how about HRT in those like when do you 445 00:25:12,720 --> 00:25:16,280 Speaker 2: start thinking about hormone replacement therapy? And I feel like 446 00:25:17,720 --> 00:25:20,920 Speaker 2: I trained in medical school during the Women's Health Initiative 447 00:25:21,000 --> 00:25:23,840 Speaker 2: years and we were like HRT is charitable and nobody 448 00:25:23,880 --> 00:25:26,240 Speaker 2: should ever use it and it's just killing people. And 449 00:25:27,680 --> 00:25:31,119 Speaker 2: then it seems like finally the pendulum has really swung 450 00:25:31,119 --> 00:25:34,159 Speaker 2: in the other direction. And I would love you to 451 00:25:34,200 --> 00:25:36,840 Speaker 2: talk about how that has shifted and what kinds of 452 00:25:36,920 --> 00:25:38,919 Speaker 2: options are out there for people who might find themselves 453 00:25:39,000 --> 00:25:41,440 Speaker 2: in perimenopause and having symptoms. 454 00:25:42,119 --> 00:25:45,200 Speaker 4: Sure, So I think the decision about whether to use 455 00:25:46,040 --> 00:25:49,760 Speaker 4: hormone replacement therapy versus something like a birth control pill 456 00:25:50,240 --> 00:25:55,440 Speaker 4: really depends on how regular your periods are and kind 457 00:25:55,480 --> 00:26:00,359 Speaker 4: of where you are in your life cycle. Having a 458 00:26:00,440 --> 00:26:04,879 Speaker 4: period every six months and you're having tons of hot flushes, 459 00:26:05,040 --> 00:26:10,240 Speaker 4: hormone replacement therapy is probably the better choice. If you're 460 00:26:10,520 --> 00:26:14,960 Speaker 4: forty five and you're still having super regular periods, probably 461 00:26:14,960 --> 00:26:18,800 Speaker 4: a birth control pill is the better option. The key 462 00:26:18,880 --> 00:26:21,840 Speaker 4: with hormone replacement therapy, though, is if you're having symptoms, 463 00:26:21,960 --> 00:26:25,399 Speaker 4: talk to your doctor about them, because there's just really 464 00:26:25,480 --> 00:26:28,560 Speaker 4: no reason to be miserable through menopause. 465 00:26:28,600 --> 00:26:29,920 Speaker 3: I think a lot of women. 466 00:26:31,119 --> 00:26:34,240 Speaker 4: Also came of age during the Women's Health Initiative, and 467 00:26:34,280 --> 00:26:36,480 Speaker 4: maybe they weren't in medical school like you and I were, 468 00:26:36,560 --> 00:26:40,480 Speaker 4: but they were seeing news articles and hearing their moms 469 00:26:40,520 --> 00:26:44,280 Speaker 4: talk about menopause and sort of getting the same message 470 00:26:44,320 --> 00:26:47,159 Speaker 4: that we were getting. And unfortunately, it's taken in twenty 471 00:26:47,240 --> 00:26:52,560 Speaker 4: years of a lot of women suffering unnecessarily to really 472 00:26:52,640 --> 00:26:56,399 Speaker 4: get the pendulum swinging back in the right direction. And 473 00:26:56,480 --> 00:27:00,280 Speaker 4: I think that if you are having hot flushes with. 474 00:27:01,280 --> 00:27:05,159 Speaker 3: Sleep disruption, mood changes. 475 00:27:06,280 --> 00:27:10,520 Speaker 4: It's all fodder for discussion with your GYN or primary 476 00:27:10,560 --> 00:27:14,440 Speaker 4: care doctor because all those things can be managed with 477 00:27:15,160 --> 00:27:18,520 Speaker 4: hormone replacement therapy. And actually part of the reason the 478 00:27:18,560 --> 00:27:23,280 Speaker 4: pendulum is swung back is because, well, we can talk 479 00:27:23,320 --> 00:27:26,560 Speaker 4: about the Women's Health Initiative study all day, and I 480 00:27:26,560 --> 00:27:28,440 Speaker 4: think everyone might be bored except for you and me. 481 00:27:28,640 --> 00:27:31,080 Speaker 3: But there's been a. 482 00:27:31,040 --> 00:27:34,680 Speaker 4: Lot of new data that's come out showing that there 483 00:27:34,680 --> 00:27:38,080 Speaker 4: may be significant benefits to hormone replacement therapy. There's some 484 00:27:38,200 --> 00:27:42,520 Speaker 4: new studies about dementia risk, especially in people at high 485 00:27:42,600 --> 00:27:48,240 Speaker 4: risk for dementia, and hormone replacement therapy. There's certainly positive 486 00:27:48,240 --> 00:27:53,040 Speaker 4: effects with hormone replacement therapy and bone and using hormone 487 00:27:53,080 --> 00:27:57,160 Speaker 4: replacement therapy in your fifties may actually be beneficial from 488 00:27:57,200 --> 00:28:00,399 Speaker 4: a cardiovascular point of view, which is directly as to 489 00:28:00,440 --> 00:28:03,320 Speaker 4: what came out in the Women's Health Initiative, and that 490 00:28:03,440 --> 00:28:08,119 Speaker 4: was probably because of their patient population. So I think 491 00:28:08,160 --> 00:28:12,360 Speaker 4: that we're really rethinking hormone replacement therapy. We also use 492 00:28:12,400 --> 00:28:15,400 Speaker 4: it really differently now, so we don't do a lot 493 00:28:15,400 --> 00:28:18,719 Speaker 4: of oral hormone replacement therapy anymore, although those options are 494 00:28:18,760 --> 00:28:22,520 Speaker 4: still out there. We do a lot with transdermal estrogen, 495 00:28:22,560 --> 00:28:25,560 Speaker 4: which means you put the estrogen on your skin and 496 00:28:25,600 --> 00:28:29,360 Speaker 4: it goes in through your skin. And there are patches 497 00:28:29,400 --> 00:28:33,560 Speaker 4: and gels and all kinds of different options for getting 498 00:28:33,640 --> 00:28:36,959 Speaker 4: the hormones into you in a way that seems to 499 00:28:37,000 --> 00:28:41,680 Speaker 4: be more beneficial in the perimenopausal years. 500 00:28:42,480 --> 00:28:44,160 Speaker 3: That is awesome, all right. 501 00:28:44,240 --> 00:28:47,200 Speaker 2: Now on to a question I get from patients as well, 502 00:28:47,240 --> 00:28:50,640 Speaker 2: and I'm sure it's not uncommon the adult population, but 503 00:28:51,040 --> 00:28:53,920 Speaker 2: what are the natural things one can do to combat 504 00:28:54,160 --> 00:28:58,719 Speaker 2: perimenopausal symptoms or menopausal symptoms? Are there supplements that are recommended? 505 00:28:58,800 --> 00:29:01,120 Speaker 2: I feel like, remember what it was? There was one 506 00:29:01,200 --> 00:29:02,920 Speaker 2: I heard about for a while, but now I feel 507 00:29:02,960 --> 00:29:05,360 Speaker 2: like I haven't heard about it. And then not to 508 00:29:05,520 --> 00:29:08,560 Speaker 2: like open Pandora's box, but kind of similar lines. What 509 00:29:08,600 --> 00:29:12,680 Speaker 2: about bioidentical hormones as well? As I feel like I've 510 00:29:12,680 --> 00:29:16,800 Speaker 2: heard a lot of women taking small doses of topical testosterone, 511 00:29:16,880 --> 00:29:19,160 Speaker 2: So I would love comments on all of that supplements, 512 00:29:19,440 --> 00:29:22,080 Speaker 2: natural hormones, bioidenticals, and testosterone. 513 00:29:22,400 --> 00:29:23,640 Speaker 3: So let's start with supplements. 514 00:29:23,960 --> 00:29:27,960 Speaker 4: The main supplements that people talk about are soy phido 515 00:29:28,160 --> 00:29:32,560 Speaker 4: estrogens and supplements like black cohosh. There's zero data that 516 00:29:32,600 --> 00:29:36,720 Speaker 4: they actually do anything. I wish they did because people 517 00:29:36,800 --> 00:29:39,800 Speaker 4: really would like an option like that, But there's really 518 00:29:39,800 --> 00:29:42,920 Speaker 4: when you drill down into the studies, there's not a 519 00:29:42,960 --> 00:29:46,200 Speaker 4: lot of there there, So I would skip it. If 520 00:29:46,200 --> 00:29:49,760 Speaker 4: you're looking for a non hormonal treatment, those do exist 521 00:29:49,840 --> 00:29:53,720 Speaker 4: at this point, and so I would go there before 522 00:29:53,760 --> 00:29:57,640 Speaker 4: I went with one of the sort of supplement options. 523 00:29:57,880 --> 00:30:00,280 Speaker 4: The one supplement I do recommend my page it's a 524 00:30:00,280 --> 00:30:07,200 Speaker 4: lot though, for sleep disruption and hormonal headaches is magnesium. 525 00:30:07,640 --> 00:30:12,120 Speaker 4: Magnesium is a great option for women. You take it 526 00:30:12,160 --> 00:30:14,400 Speaker 4: at bedtime, it actually helps you with sleep and it 527 00:30:14,480 --> 00:30:18,320 Speaker 4: reduces hormonal headaches as well. And there is actual data 528 00:30:18,400 --> 00:30:25,400 Speaker 4: supporting that the bioidenticals are really funny product because what 529 00:30:25,480 --> 00:30:29,600 Speaker 4: they are essentially is the same estrogen and progestins that 530 00:30:29,640 --> 00:30:35,360 Speaker 4: you can get in a commercially available hormone replacement patch, 531 00:30:35,920 --> 00:30:40,959 Speaker 4: but made in a compounding pharmacy, usually in a lotion 532 00:30:41,640 --> 00:30:46,560 Speaker 4: or cream that you put on topically. The issue there 533 00:30:47,040 --> 00:30:50,680 Speaker 4: is that pharmaceutical companies are required to go through all 534 00:30:50,720 --> 00:30:54,680 Speaker 4: of these checks with the FDA to quality assurance to 535 00:30:54,720 --> 00:30:57,200 Speaker 4: make sure that what you're getting in your estrogen patch 536 00:30:57,280 --> 00:30:59,560 Speaker 4: or in your there's a product called divvy jail, which 537 00:30:59,600 --> 00:31:04,640 Speaker 4: is in gel that those products have in them exactly 538 00:31:04,720 --> 00:31:06,560 Speaker 4: what they say they have in them, and nothing else 539 00:31:07,720 --> 00:31:13,320 Speaker 4: and nothing else. Compounding pharmacies really vary in their quality, 540 00:31:14,520 --> 00:31:18,600 Speaker 4: and it really varies even from batch to batch whether 541 00:31:18,640 --> 00:31:22,960 Speaker 4: you're getting exactly what you think you're getting. Add to 542 00:31:23,000 --> 00:31:28,320 Speaker 4: that that compounding pharmacies typically are not covered by insurance, 543 00:31:28,360 --> 00:31:30,320 Speaker 4: so bioidenticals are typically. 544 00:31:30,040 --> 00:31:31,280 Speaker 3: An out of pocket purchase. 545 00:31:32,400 --> 00:31:34,760 Speaker 4: And I've had patients come in and they've been spending 546 00:31:35,080 --> 00:31:38,600 Speaker 4: hundreds of dollars a month on bioidentical hormones, and it 547 00:31:38,680 --> 00:31:44,880 Speaker 4: turns out that if they used a pharmaceutical product approved 548 00:31:44,920 --> 00:31:47,320 Speaker 4: by the FDA, that it would be covered by their 549 00:31:47,360 --> 00:31:49,440 Speaker 4: insurance and they'd be paying like ten dollars a month. 550 00:31:49,920 --> 00:31:52,640 Speaker 3: So I really caution people to. 551 00:31:52,680 --> 00:31:57,200 Speaker 4: Think long and hard about bioidenticals because I'm not sure 552 00:31:57,400 --> 00:32:00,520 Speaker 4: that you really get a lot of value for the 553 00:32:00,560 --> 00:32:02,400 Speaker 4: money that you're spending, and you may not even be 554 00:32:02,440 --> 00:32:03,760 Speaker 4: getting what you think you're getting. 555 00:32:04,240 --> 00:32:05,800 Speaker 2: Okay. 556 00:32:06,000 --> 00:32:10,040 Speaker 4: Testosterone is a really fun new addition to. 557 00:32:11,600 --> 00:32:13,320 Speaker 3: Hormone replacement therapy. 558 00:32:13,520 --> 00:32:19,040 Speaker 4: So women have testosterone, they just have it in much 559 00:32:19,080 --> 00:32:23,400 Speaker 4: smaller amounts than men do orders of magnitude smaller, so 560 00:32:23,520 --> 00:32:27,760 Speaker 4: men have testosterone in the hundreds. Women during their reproductive 561 00:32:27,800 --> 00:32:34,840 Speaker 4: lives typically of testosterones around twenty and some women after 562 00:32:35,200 --> 00:32:39,720 Speaker 4: menopause their testosterone or in perimenopause their testosterone drops quite low. 563 00:32:40,760 --> 00:32:42,440 Speaker 3: Other women have the opposite problem. 564 00:32:42,440 --> 00:32:45,160 Speaker 4: Their testosterone levels get high and they get all scient. 565 00:32:45,000 --> 00:32:47,160 Speaker 3: Types of symptoms that they don't like from that. 566 00:32:47,640 --> 00:32:53,040 Speaker 4: For the women who get low testosterones, they can have fatigue, 567 00:32:53,600 --> 00:32:57,360 Speaker 4: low libido. A lot of times they can't even describe it. 568 00:32:57,360 --> 00:33:01,120 Speaker 4: They just don't feel good. There can be a lot 569 00:33:01,120 --> 00:33:06,600 Speaker 4: of mood effects that women have, and if testosterone is low. 570 00:33:06,560 --> 00:33:09,160 Speaker 3: Then giving a little baby. 571 00:33:08,760 --> 00:33:14,560 Speaker 4: Dose of a testosterone gel can actually be life changing 572 00:33:14,680 --> 00:33:18,880 Speaker 4: for some women. So if we think about sort of 573 00:33:18,960 --> 00:33:23,840 Speaker 4: again orders of magnitude, testosterone is manufactured for men and 574 00:33:23,920 --> 00:33:27,400 Speaker 4: it comes in little packets that a man uses one 575 00:33:27,480 --> 00:33:32,760 Speaker 4: packet each day. My patients, I typically start them on 576 00:33:33,480 --> 00:33:37,160 Speaker 4: a fifth of a packet, so a one packet lasts 577 00:33:37,160 --> 00:33:40,640 Speaker 4: them five applications, and they do it every other day 578 00:33:40,760 --> 00:33:44,160 Speaker 4: or three days a week, and so that tiny, tiny 579 00:33:44,200 --> 00:33:49,120 Speaker 4: bit of testosterone is enough to make them feel much better. 580 00:33:50,400 --> 00:33:53,040 Speaker 4: It is not typically covered by insurance for women, even 581 00:33:53,040 --> 00:33:55,840 Speaker 4: though there's lots of studies looking at off label use 582 00:33:55,880 --> 00:33:59,160 Speaker 4: of testosterone and women and it does seem to show benefit. 583 00:33:59,560 --> 00:34:02,520 Speaker 4: It is something that women typically have to pay out 584 00:34:02,520 --> 00:34:05,920 Speaker 4: of pocket for, but a thirty day supply for a 585 00:34:06,000 --> 00:34:08,799 Speaker 4: man lests the woman the way I described it for 586 00:34:08,880 --> 00:34:13,480 Speaker 4: almost a year, and testosterone gel is generic at this point, 587 00:34:13,520 --> 00:34:15,440 Speaker 4: so it tends out to be a big investment when 588 00:34:15,480 --> 00:34:18,359 Speaker 4: you think about amateurizing it over the course of the year. 589 00:34:19,040 --> 00:34:19,640 Speaker 3: Totally cool. 590 00:34:19,680 --> 00:34:22,000 Speaker 2: And I feel like that's one that definitely, like ten 591 00:34:22,080 --> 00:34:24,920 Speaker 2: years ago, nobody was talking about and now it's out there, 592 00:34:24,960 --> 00:34:27,080 Speaker 2: so who knows what else will be coming down the pike, 593 00:34:27,200 --> 00:34:30,400 Speaker 2: probably even more exciting options, because I feel like this 594 00:34:30,520 --> 00:34:33,200 Speaker 2: is an area that just was kind of ignor well, 595 00:34:33,200 --> 00:34:35,160 Speaker 2: I guess I wasn't ignored. I mean they were trying, 596 00:34:35,280 --> 00:34:36,759 Speaker 2: but I just don't feel like there was a lot 597 00:34:36,800 --> 00:34:38,680 Speaker 2: of new knowledge coming out for a while. 598 00:34:39,480 --> 00:34:39,719 Speaker 5: Yeah. 599 00:34:39,880 --> 00:34:41,960 Speaker 4: No, And I think there's a lot of really interesting 600 00:34:42,000 --> 00:34:43,080 Speaker 4: things going on now. 601 00:34:43,600 --> 00:34:44,440 Speaker 3: There's a new. 602 00:34:45,760 --> 00:34:51,400 Speaker 4: Non hormonal treatment for hot flushes called Veoza, which is great. 603 00:34:52,480 --> 00:34:57,120 Speaker 4: That's wonderful if you really have contraindications to using hormones 604 00:34:57,160 --> 00:35:01,480 Speaker 4: and you're having lots of hot flushes, so I think there's. 605 00:35:01,320 --> 00:35:02,760 Speaker 3: Lots of interesting things happening. 606 00:35:03,080 --> 00:35:05,040 Speaker 4: It's a much better time to be a woman in 607 00:35:05,080 --> 00:35:07,759 Speaker 4: your forties or fifties than it was twenty years ago. 608 00:35:07,880 --> 00:35:11,600 Speaker 2: I think, yay, good timing for us. Well, Doctor Gillian, 609 00:35:11,719 --> 00:35:15,000 Speaker 2: thank you so much for coming on. Tell our listeners 610 00:35:15,000 --> 00:35:18,040 Speaker 2: a little bit about hot Flash before you head off, 611 00:35:18,040 --> 00:35:19,400 Speaker 2: because I have a feeling it's going to be of 612 00:35:19,440 --> 00:35:22,720 Speaker 2: interest to at least some of them in our wonderful 613 00:35:22,719 --> 00:35:24,280 Speaker 2: age range. 614 00:35:24,440 --> 00:35:24,720 Speaker 3: Yeah. 615 00:35:25,480 --> 00:35:31,360 Speaker 4: So, Hot Flash is a weekly newsletter that is under 616 00:35:31,400 --> 00:35:34,120 Speaker 4: the Parent Data by Emily Oster Umbrella. 617 00:35:34,600 --> 00:35:37,520 Speaker 3: So Parent Data is Emily Auster's. 618 00:35:37,960 --> 00:35:43,560 Speaker 4: Newsletter that she puts out regularly about data for pregnancy 619 00:35:43,719 --> 00:35:47,319 Speaker 4: and early childhood. Hot Flash is an extension of that 620 00:35:48,400 --> 00:35:53,040 Speaker 4: really focused on the years after you're done having your kids, 621 00:35:53,120 --> 00:35:56,959 Speaker 4: your forties and fifties, just exactly what we've been talking 622 00:35:57,000 --> 00:36:01,239 Speaker 4: about today, and our goal there is really to provide 623 00:36:01,640 --> 00:36:08,960 Speaker 4: evidence based analysis of different topics just like those we've 624 00:36:09,000 --> 00:36:12,680 Speaker 4: been talking about today, where the focus is really making 625 00:36:12,760 --> 00:36:19,239 Speaker 4: sure that we're breaking down the data and helping you 626 00:36:19,560 --> 00:36:22,400 Speaker 4: to make better decisions and helping you to have a 627 00:36:22,400 --> 00:36:27,200 Speaker 4: better conversation with your doctor about your symptoms and what 628 00:36:27,239 --> 00:36:30,320 Speaker 4: you're experiencing as a woman in your forties or fifties. 629 00:36:30,920 --> 00:36:33,400 Speaker 2: Awesome, Well, thank you so much for coming on. This 630 00:36:33,480 --> 00:36:37,480 Speaker 2: has been a very instructive conversation. I'll I'll have to 631 00:36:37,600 --> 00:36:40,040 Speaker 2: kind of bookmarkt and remember to re listen as symptoms 632 00:36:40,080 --> 00:36:42,120 Speaker 2: crop up as they as I'm sure they will. 633 00:36:42,239 --> 00:36:46,000 Speaker 3: So thank you again, my pleasure. So we are back. 634 00:36:46,080 --> 00:36:49,520 Speaker 1: That was awesome listening to doctor Gillian Goddard talk about 635 00:36:49,560 --> 00:36:54,480 Speaker 1: perimenopause and other hormonal related topics. So exciting to get 636 00:36:54,480 --> 00:36:58,600 Speaker 1: more information on that. So today's question comes from a 637 00:36:58,680 --> 00:37:01,920 Speaker 1: listener who is interested in financial topic. She says, you've 638 00:37:01,920 --> 00:37:04,520 Speaker 1: both mentioned your family upbringing with regards to money. I mean, 639 00:37:04,600 --> 00:37:07,360 Speaker 1: just spoiler alert, both very middle class sort of upbringing. 640 00:37:08,680 --> 00:37:11,279 Speaker 1: She finds the conversations about how you've learned to use 641 00:37:11,320 --> 00:37:15,279 Speaker 1: money some of the most interested. I'm specifically interested in 642 00:37:15,320 --> 00:37:19,960 Speaker 1: your philanthropy plans as you are talking about leveling up 643 00:37:20,000 --> 00:37:23,359 Speaker 1: and doing more with that, and also any resources for 644 00:37:23,400 --> 00:37:27,600 Speaker 1: getting into angel investing, because she has no idea where 645 00:37:27,640 --> 00:37:29,799 Speaker 1: to start. So Sarah, maybe you can talk a little 646 00:37:29,800 --> 00:37:31,440 Speaker 1: bit about the giving side of this, because I know 647 00:37:31,440 --> 00:37:33,600 Speaker 1: you guys have been a little bit more organized in 648 00:37:33,640 --> 00:37:35,839 Speaker 1: terms of your budgeting categories and stuff like that. 649 00:37:36,440 --> 00:37:38,920 Speaker 2: Yeah, so we use the software. You need a budget, 650 00:37:39,120 --> 00:37:41,600 Speaker 2: and giving is just one of the categories, just like 651 00:37:41,640 --> 00:37:44,000 Speaker 2: anything else. So the way you need a budget works 652 00:37:44,040 --> 00:37:46,800 Speaker 2: is every single month you create your budget. So I'll say, okay, 653 00:37:46,840 --> 00:37:48,600 Speaker 2: I want to give. I need to put two hundred 654 00:37:48,600 --> 00:37:51,239 Speaker 2: in my electric bill budget or whatever. And then you know, 655 00:37:51,360 --> 00:37:53,640 Speaker 2: I have a category for gifts, which is like birthday gifts, 656 00:37:53,680 --> 00:37:56,520 Speaker 2: and then all kinds of other things including giving, and 657 00:37:56,960 --> 00:37:59,280 Speaker 2: I just dump a standard amount in there every month, 658 00:37:59,560 --> 00:38:02,799 Speaker 2: but it accumulates, so I don't necessarily need to say like, oh, 659 00:38:02,880 --> 00:38:05,160 Speaker 2: I'm gonna give X dollars every single month, and I'm 660 00:38:05,160 --> 00:38:06,839 Speaker 2: gonna give you know, to a different cause. We don't 661 00:38:06,840 --> 00:38:08,640 Speaker 2: do it that way. Instead, we just kind of like 662 00:38:08,760 --> 00:38:11,600 Speaker 2: put the same amount in every month, and then when 663 00:38:11,640 --> 00:38:14,399 Speaker 2: something comes up that seems worthwhile, we can just be like, ooh, 664 00:38:14,480 --> 00:38:17,000 Speaker 2: let's like give a bigger contribution and empty out this 665 00:38:17,080 --> 00:38:20,759 Speaker 2: category to whatever. So like, for an example, recently, I 666 00:38:20,880 --> 00:38:24,600 Speaker 2: just got some like email, as one does, from a 667 00:38:24,640 --> 00:38:28,080 Speaker 2: cause that was like, oh, I'm gonna triple donations. It 668 00:38:28,120 --> 00:38:30,440 Speaker 2: was like an anti gun violence type of thing, and 669 00:38:30,480 --> 00:38:32,480 Speaker 2: it was it was Bloomberg who said he would triple 670 00:38:32,520 --> 00:38:34,719 Speaker 2: all the donations. I was like, you know what, our 671 00:38:34,760 --> 00:38:36,799 Speaker 2: donation will go three times as far if I do 672 00:38:36,840 --> 00:38:39,319 Speaker 2: it now. So let's just empty the category out. I 673 00:38:39,400 --> 00:38:41,160 Speaker 2: you know, wanted to donate to that, and so we 674 00:38:41,239 --> 00:38:43,800 Speaker 2: did it. Sometimes it'll be like, you know, a disaster 675 00:38:43,880 --> 00:38:46,160 Speaker 2: happens and we'll be like, oh, let's let's give to 676 00:38:46,200 --> 00:38:49,520 Speaker 2: this to help these victims of whatever just happen, et cetera. 677 00:38:50,400 --> 00:38:53,680 Speaker 2: And so you know, we're not like huge philanthropists. It's 678 00:38:53,680 --> 00:38:58,840 Speaker 2: not some giant chunk of our income. I see it 679 00:38:58,920 --> 00:39:01,279 Speaker 2: kind of as twofold, like we give some now, and 680 00:39:01,320 --> 00:39:04,040 Speaker 2: then I also hope too, as we accumulate more money 681 00:39:04,080 --> 00:39:06,040 Speaker 2: at have it invested money and our secure in our 682 00:39:06,040 --> 00:39:09,480 Speaker 2: future to give even more later out of what we've invested. 683 00:39:09,560 --> 00:39:11,239 Speaker 2: So that's kind of how we do it. It's not 684 00:39:11,360 --> 00:39:13,160 Speaker 2: super super systematic. 685 00:39:12,760 --> 00:39:13,560 Speaker 3: But it works. 686 00:39:13,640 --> 00:39:16,160 Speaker 2: And I like having a category that's just dedicated to that. 687 00:39:16,400 --> 00:39:19,000 Speaker 2: It's kind of similar to holiday, Like I like to 688 00:39:19,120 --> 00:39:21,000 Speaker 2: collect the money throughout the year and then use it. 689 00:39:21,040 --> 00:39:23,480 Speaker 2: And I liked for their whenever a cause comes up, 690 00:39:23,520 --> 00:39:25,840 Speaker 2: like we have money in there, we can give it 691 00:39:25,880 --> 00:39:27,640 Speaker 2: and feel really good about that, but also know we've 692 00:39:27,640 --> 00:39:28,319 Speaker 2: budgeted for it. 693 00:39:29,280 --> 00:39:30,759 Speaker 1: Yeah, I think this is the kind of thing that 694 00:39:31,120 --> 00:39:34,239 Speaker 1: it just pays to put some thought into it. So 695 00:39:35,200 --> 00:39:38,120 Speaker 1: especially as you're in kind of the wealth accumulation, although 696 00:39:38,120 --> 00:39:40,080 Speaker 1: maybe you're not, maybe you're totally into the giving it 697 00:39:40,120 --> 00:39:43,160 Speaker 1: away stage at this point of your life, but you know, 698 00:39:43,320 --> 00:39:47,239 Speaker 1: be thinking about what causes really inspire you. And I mean, 699 00:39:47,239 --> 00:39:49,319 Speaker 1: I know there's a sort of utilitarian argument of like, 700 00:39:49,320 --> 00:39:50,640 Speaker 1: give it to the thing where it can go the 701 00:39:50,640 --> 00:39:53,000 Speaker 1: furthest and there's something to that, but there's also so 702 00:39:53,200 --> 00:39:57,400 Speaker 1: many problems in the world that you want a cause 703 00:39:57,440 --> 00:40:00,720 Speaker 1: that inspires you and so because then you'll keep giving 704 00:40:00,880 --> 00:40:03,000 Speaker 1: to it and you'll get involved with it personally and 705 00:40:03,080 --> 00:40:07,399 Speaker 1: use whatever social capital you have as well to make 706 00:40:07,440 --> 00:40:10,680 Speaker 1: a difference in that. So really be thinking about what 707 00:40:10,719 --> 00:40:12,920 Speaker 1: inspires you, like, what causes make you think like this 708 00:40:12,960 --> 00:40:14,640 Speaker 1: is a change I'd like to see in the world 709 00:40:15,040 --> 00:40:18,480 Speaker 1: beyond the lookout for ones where again most of us 710 00:40:18,520 --> 00:40:20,359 Speaker 1: are not going to be giving billions away, so we're 711 00:40:20,360 --> 00:40:22,480 Speaker 1: looking for ones where maybe a smaller amount of money 712 00:40:22,520 --> 00:40:25,680 Speaker 1: could make a significant difference. So maybe that's because it's 713 00:40:25,680 --> 00:40:27,759 Speaker 1: something local, right, you can make a big difference in 714 00:40:27,760 --> 00:40:30,359 Speaker 1: your own local community. But start really thinking about these things, 715 00:40:30,400 --> 00:40:33,200 Speaker 1: having a conversation with your partner if you have one, 716 00:40:34,000 --> 00:40:36,160 Speaker 1: and then thinking about like what amount of money would 717 00:40:36,160 --> 00:40:38,759 Speaker 1: we be interested in giving to make a difference in this. 718 00:40:38,840 --> 00:40:40,440 Speaker 1: And I'm with Sarah that I think you're better off 719 00:40:40,480 --> 00:40:43,960 Speaker 1: giving a bigger amount to a smaller number of things 720 00:40:44,080 --> 00:40:47,560 Speaker 1: versus a small amount to a lot of things, partly 721 00:40:47,640 --> 00:40:50,080 Speaker 1: just because it keeps you very invested in that small 722 00:40:50,160 --> 00:40:54,360 Speaker 1: number of things. So you then follow the topics and 723 00:40:55,000 --> 00:40:57,000 Speaker 1: if you're working with a nonprofit, you might get involved, 724 00:40:57,000 --> 00:40:58,839 Speaker 1: you might get on their board or whatever else like that. 725 00:41:00,160 --> 00:41:02,560 Speaker 1: Not an investing podcast, so I don't think you want 726 00:41:02,560 --> 00:41:05,040 Speaker 1: to get all your invested you know, angel investing information 727 00:41:05,120 --> 00:41:07,920 Speaker 1: from here, but I will just do a quick discussion 728 00:41:07,920 --> 00:41:10,880 Speaker 1: of it for anyone who is looking into this. So 729 00:41:11,719 --> 00:41:14,440 Speaker 1: to invest in private companies, so ones that are not 730 00:41:14,480 --> 00:41:17,480 Speaker 1: publicly traded, and in startups and things like that, you 731 00:41:17,520 --> 00:41:19,839 Speaker 1: basically either need to know the founder or you need 732 00:41:19,880 --> 00:41:21,840 Speaker 1: to be what they call here in the US and 733 00:41:21,880 --> 00:41:25,720 Speaker 1: a credited investor, which means that you are well off 734 00:41:25,880 --> 00:41:29,560 Speaker 1: enough that the financial authorities assume you are a big 735 00:41:29,600 --> 00:41:32,239 Speaker 1: girl and can look it into it on your own 736 00:41:32,360 --> 00:41:34,560 Speaker 1: right that you're not going to be devastated if you 737 00:41:34,640 --> 00:41:39,520 Speaker 1: lose your investment. So there's a certain income requirement or 738 00:41:39,560 --> 00:41:44,680 Speaker 1: a certain net worth requirement minus your primary residence. It's high, 739 00:41:44,719 --> 00:41:47,520 Speaker 1: but it's not billionaire high. Again, so there's probably a 740 00:41:47,560 --> 00:41:51,360 Speaker 1: reasonable number of people listening to this whose households income 741 00:41:51,360 --> 00:41:54,239 Speaker 1: wise or net worth would fit into it. As for 742 00:41:54,360 --> 00:41:57,200 Speaker 1: finding companies to invest in, I mean, this is networking 743 00:41:57,400 --> 00:42:00,640 Speaker 1: like anything else. It's probably going to be former colleagues 744 00:42:00,680 --> 00:42:03,880 Speaker 1: of yours, for instance, who have gone the startup route, 745 00:42:03,920 --> 00:42:06,520 Speaker 1: and you get a business plan from them and think 746 00:42:06,520 --> 00:42:08,239 Speaker 1: it looks good, and you put a small amount of 747 00:42:08,280 --> 00:42:09,080 Speaker 1: money into. 748 00:42:08,880 --> 00:42:11,359 Speaker 3: It, maybe people you went to school with. 749 00:42:11,960 --> 00:42:14,680 Speaker 1: If you are in a reasonable sized city or near 750 00:42:14,719 --> 00:42:19,759 Speaker 1: a university, there might be you know, investing organizations that 751 00:42:20,120 --> 00:42:23,360 Speaker 1: various entrepreneurs can come pitch their idea too, and people 752 00:42:23,400 --> 00:42:27,080 Speaker 1: ask questions and then you can see what looks good 753 00:42:27,160 --> 00:42:29,960 Speaker 1: and all that. But as you start doing it, as 754 00:42:29,960 --> 00:42:34,080 Speaker 1: you make small investments in small companies, founders will hear 755 00:42:34,120 --> 00:42:37,000 Speaker 1: about you too, and so they will come and you know, 756 00:42:37,040 --> 00:42:39,440 Speaker 1: you'll start getting pitches and then you can evaluate what 757 00:42:39,480 --> 00:42:41,040 Speaker 1: do I think will grow? What do I think has 758 00:42:41,040 --> 00:42:44,120 Speaker 1: a reasonable exit strategy so that I, you know, would 759 00:42:44,120 --> 00:42:47,160 Speaker 1: hopefully make my money back, although again with this you're 760 00:42:47,160 --> 00:42:48,480 Speaker 1: probably not going to make your money back on the 761 00:42:48,520 --> 00:42:50,480 Speaker 1: vast majority of them. The ideas that maybe you know, 762 00:42:50,600 --> 00:42:54,400 Speaker 1: one in twenty might return twenty x and then you're 763 00:42:54,440 --> 00:42:56,319 Speaker 1: even or something are slightly ahead. So it's just more 764 00:42:56,320 --> 00:43:00,520 Speaker 1: of a fun way to get involved in investing, and 765 00:43:00,600 --> 00:43:03,600 Speaker 1: so again not an investing podcast, but there are plenty 766 00:43:03,640 --> 00:43:06,120 Speaker 1: of ones out there that are, so you know, recommend 767 00:43:06,160 --> 00:43:09,520 Speaker 1: you kind of google that and get the basics if 768 00:43:09,560 --> 00:43:12,920 Speaker 1: you are interested. Well, this has been best of both worlds. 769 00:43:13,040 --> 00:43:17,640 Speaker 1: Sarah was interviewing doctor Gillian Goddard about perimenopause and related topics. 770 00:43:17,920 --> 00:43:19,880 Speaker 1: We will be back next week with more on making 771 00:43:19,920 --> 00:43:21,200 Speaker 1: work and life fit together. 772 00:43:23,280 --> 00:43:26,040 Speaker 2: Thanks for listening. You can find me Sarah at the 773 00:43:26,080 --> 00:43:30,480 Speaker 2: shoebox dot com or at the Underscore Shoebox on Instagram, 774 00:43:30,880 --> 00:43:31,279 Speaker 2: and you. 775 00:43:31,160 --> 00:43:35,440 Speaker 1: Can find me Laura at Laura vandercam dot com. This 776 00:43:35,480 --> 00:43:38,759 Speaker 1: has been the best of both worlds podcasts. Please join 777 00:43:38,840 --> 00:43:41,640 Speaker 1: us next time for more on making work and life 778 00:43:41,680 --> 00:43:42,360 Speaker 1: work together.