Dr. Sharon Malone
Appearances
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
You know, it used to be. And let me say, because, you know, I'm in the old group of people. And, you know, the study that really changed everything in 2002, the Women's Health Initiative, really did an about face on the conversation about menopause. Because let me just say, women have been going through menopause for as long as we've been alive. Yes.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
The only thing that's changed historically is that more of us are living long enough to get to this phase of life. But women have complained about menopause forever. But it was thought to be, you know, women just being hysterical with the symptoms or you're losing your mind. Women would go to sanitariums at that point because of the mental illness and the mental distress that it caused women.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But we have known how to treat the symptoms of menopause since 1942. That was when the first estrogen product was introduced. That was Primarin. And so women have been using hormones since 1942, those who had access and the awareness of it. But it really changed everything. In 2002. In 2002. Okay. I was taught about menopause and what to do about it.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And then from 2002 on, doctors who were trained didn't really get that information.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Right. You know, even for the women who are out there who are currently going through menopause, they haven't heard this conversation. And there's another 6,000 women every day going into menopause. And so the backfill is constant because there are people that just haven't had this conversation, not with their doctors, not with their mothers, and not even with their friends.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Exactly. In a nutshell, you know, as I told you, 1942, we've been treating women who were symptomatic during menopause, typically the hot flashes and the mood swings, with an estrogen product. It worked. So as we sort of got more women who were taking hormones, we found that there were some tweaks that need to be made along the way and added the progestin component to it.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Because remember, estrogen and progestin go together.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
So we knew that it treated the symptoms of menopause. That wasn't new news. But what we found was that there was a nurse's study where they just looked at a group of healthy nurses, young women, and watched them through menopause. And what they found is that the women who took estrogen therapy or HRT had half the risk of heart disease than women who didn't, the nurses who didn't take hormones.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
So imagine now the thought was, okay, we're not only relieving the symptoms, but we are actually decreasing the risk of cardiovascular disease by 50%. Well, that would be a blockbuster, right? But you couldn't prove it because it was just an observational study. So the Women's Health Initiative that was really initiated in 1991, the purpose of it was to sort of solidify that finding.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Does hormone therapy really reduce the risk of cardiovascular disease by 50%? That was the central question. So we do a study, largest study ever in the history of NIH, specifically for women. So they recruited women in that study that were anywhere from 50 to 79 years old. The majority of the women, 90% of the women were over age 55.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
So it's not surprising that when they looked at the women, they said, well, there's really no difference here. We don't see any improvement in the cardiovascular. It was like the same whether you took it or not because they were starting it on women who were too old. So that was problem number one with the study design.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
The second part was that when they were looking, they said, well, let's have some safety stops. Let's make sure that women aren't having an increase in breast cancer because of this estrogen, because that was a thought.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
So when they got to about five years in the study and they looked into the data to see how is this coming, there was this dramatic press conference that they held because not only did they not see the expected decrease in cardiovascular disease, but they saw a slight increased risk in breast cancer. From these 60 to 79-year-old women.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
From these women who were on average 63 years old, more than 10 years after menopause. So when you hold a press conference, and it's dramatic, and they stop the study, hold the presses, and they say... Not only does hormone therapy not improve your cardiac profile, it increases the risk of breast cancer. And when they said that, I mean, women who were taking hormones happily... Abandoned them.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
It was a very much misinterpreted study because if you had said, I don't disagree, okay, your data is your data. If you start women on hormone therapy later in life, you're not going to prevent their heart disease. I think that's probably true. The problem is that they generalize that data to everybody. Well, what about a 50-year-old?
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Well, what about if I start it when I'm 45, whenever I'm menopausal? Because that's when we clinically would start it. Yes, yes, yes. That's a very different outcome. And that was the misinterpretation of taking very limited findings and applying it to everyone.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
It has been, when you say the words breast cancer... to women, I think that is their number one fear, is breast cancer, despite the fact that the number one cause of deaths in women is cardiovascular disease. It is more than all cancers combined and all accidental causes of death for women.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
There is everything. When you take that same data, the largest study ever done, and you exclude the women who are older and only apply it to the women who are under 60? Yes. And within 10 years of menopause, guess what they find?
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
The same findings that we had from the observational study that the cumulative data says that if you start hormone therapy within 10 years of your last period or before age 60, you decrease the risk of cardiovascular disease by anywhere from 30 to 50%. Wow. Yeah, wow.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
I would love to. The first stage that we're all familiar with is your premenopausal phase, and that really starts at puberty. And that encompasses your reproductive life, the peak reproductive years, which starts somewhere at 12, 13, and it goes to women when they're early 30s. That's premenopause. So when we're talking about that, that's the concern. Yes.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
That is an excellent question because, as I said, that perimenopausal period is the part that is most confusing for women. Yes. But I would say this as a rule of thumb. If you are between the ages of 35 and 45 and you are having any one or any combination of those 34 symptoms that we associate with menopause, hot flashes, mood swings, sleeplessness, painful sex, irregular heavy periods, bloating,
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Brain fog. If you have any of those things in no particular order.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Yes. Then you are perimenopausal. Now, the question then becomes, well, I'm still having my period. And this is the part that really makes my head explode because there are still doctors out there who are saying, well, you're not menopausal yet because it hasn't been 12 months since your last period. Right. That's ridiculous. You should be treated when you are symptomatic.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And no one can tell you when your symptoms are intolerable, but you know. And that's the point at which you should engage and ask someone to please fix this for me. And to be honest with you, we do know what the answer is. It's not like we're waiting to figure out for someone to discover something. It's hormone therapy in some form or fashion.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Then when you become perimenopausal, that is that amorphous phase between being your peak reproductive years and the end of your reproductive years. And the end of reproduction really starts at menopause. So there's this great space in between the perimenopausal years where you start to have some of the symptoms of menopause.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And we may use different types and different dosages for women who are perimenopausal than when they are after when they've had their 12 months of no period. The doses may change, the types may change, but the concept is still the same. You treat a hormonal issue. with hormones. And that's why we say hormone replacement.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Some people don't like that phase, but I'm old, so I still say hormone replacement.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
I've been on hormones for 15 years. And I knew exactly what was happening. And I was like, okay, well, that's enough of that. And just go right on. And I have no intention of stopping unless and until there's a reason, a medical reason why I should stop hormone therapy. But...
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Right. When you are bothered, when you are either you find out that it's either affecting the quality of your life, the quality of your work, the quality of your relationships. When you reach that level, then that is the time that you should seek care. Right.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But here's the reality is, as we said, I say it over and over again, there are not enough doctors who are out there who know how to treat menopause and perimenopause. So what's a woman to do when you have read everything that you need to read and you are clear and you know exactly what's happening to you? And it's not uncommon for you to go to a doctor's office and the doctor will tell you,
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
No, or I don't believe in hormones, which is not an uncommon thing.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And that is really why when I left my private practice that I, you know, joined the women that I work with at Alloy Women's Health. Alloy, yes. Because what it is, is really giving women access who don't have access to doctors who know what they're doing.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Or it's too expensive to go to those doctors because, you know, everyone should have access, in my mind, to the same quality care, whether you live in New York City or whether you live in New Mexico. It shouldn't matter. Or in Dyma. Absolutely. Exactly.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And, you know, and here's the other thing is that for people who are just sort of getting into this hormone therapy game, a lot of them don't have the experience of knowing what to do. So they give you the answer based on, okay, well, this is what it's supposed to do, but every person's different. Yes.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But you're still having your periods, sometimes regularly, sometimes not.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Yes, because sometimes for women, that's the... You're not in menopause until it has stopped. You are not in menopause officially until you have had your last period. And how do you know when you've had your last period? Well, you know you're in menopause when you've gone 12 full months and you've not had another period. Then it's official. You are menopausal.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Thank you.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Thank you. Thank you. Thank you. Thank you. Thank you.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Thank you. Thank you.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But what's confusing for women is that in-between state because it can start as early as your mid-30s. And it can go on until you've had your last period. And that can go on from anywhere from four to 10 years for women. And that's where I think a lot of the confusion comes in.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Because if you're having your period and having hot flashes, well, then you go to your doctor or you're having sleeplessness or... mood disturbances and you go to your doctor and the first question they ask you is, well, when was your last period? And if it was last month, they immediately get off the conversation of perimenopause or menopause.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
,,,,, It's not just annoying and they're not funny. They actually are harbingers sometimes of long-term health implications of menopause, such as increased risk for cardiovascular disease, such as increased risk for weight gain, for hypertension.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
So all of the symptoms that we typically associate with menopause that people are familiar with, like hot flashes, mood swings, sleeplessness, painful sex can start in perimenopause. And women think of menopause as something that happens to old ladies. The average age is 51. But a 35-year-old having these symptoms is very much in that menopausal transition, that in-between state.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
All of these long-term things that we talk about, a hot flash is sometimes the first signal to saying, hey, maybe you're at risk for these things, which again will affect not just the quality of your life in the short term, but in the long term. So that's why I say if you have them, treat them. And you don't get any bonus points for having endured them.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
I think that is very important when we talk about Alzheimer's, what we know and what we think we know. And what we do know is that women are twice as likely to be diagnosed with Alzheimer's in their lifetime than men are. And the women who are more likely are women who have a female relative with Alzheimer's. It's not to mean that you will because it's very much a multifactorial process.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
What we also know is that the same things that we tell you to do that decrease your risk of cardiovascular disease decrease your risk of Alzheimer's. So regular exercise, good night's sleep, cutting back on alcohol, don't smoke. And for goodness sake, watch your diet. Weight is important.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
All of these things, just lifestyle, whether we're talking about heart disease prevention or Alzheimer's prevention, or whether we're talking about just the rules that you need to observe for healthy living and aging. So all of that.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But what we do know, and I'll tell you what we know and what I think, there's a brilliant neuroscientist by the name of Dr. Lisa Moscone who has written a book called The Menopause Brain.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And what we know is that for women who have an early menopause, and early means you have had your last period before age 45, or it's a premature menopause if you've had your last period before 40, those women who do not get hormone replacement, because they are so young, are at increased risk for cardiovascular disease and Alzheimer's.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
That could go on for another 10, 15 years. It can go on for another 10 years. And I think what is also confusing is that when women say, all right, so we've got premenopause, perimenopause, menopause, and postmenopause. And I don't really like the term postmenopause because it implies that at some point you're over it.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Now, do we know for a fact that estrogen therapy is a preventative measure for Alzheimer's? Maybe. That's where we need a lot more data on that.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
It certainly does.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
No, ma'am. No, ma'am. That is not a contraindication to HRT. It is not. And as a matter of fact, not only is it not a contraindication to HRT, to estrogen therapy, I should say, because you've had a hysterectomy. Remember I said you don't need the progestin. All you need is the estrogen. So, yes, you can have estrogen.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
The only reasons, the only contraindications that we have for HRT are if you personally have breast cancer or an estrogen-dependent cancer such as endometrial cancer, if you have undiagnosed vaginal bleeding, if you currently have a heart attack, you, not a family history of a heart attack or stroke. or you have active liver disease.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And the issue about blood clots is debatable, but we'll leave that aside for now. But that's it. Those are the only contraindications. So you might go back to your doctor and say, well... Or go to another doctor.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
I honestly don't think that doctors are trying to do a bad job. I really don't, because I worked for... I don't think that they're trying to do a bad job.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
They don't know and they don't even know what they don't know. And they don't know what they don't know. And that's the problem is that you've got to keep current. And that's why I really would advocate that menopausal care and care of women in midlife should be separate and apart. from all the other things that OBGYNs have to do. It's a lot to keep up with.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
You know, you've got to do surgery and you've got to deliver babies and you've got to, you know, get birth control. But this phase of our life that we will spend anywhere from 30 to 40% of the rest of our lives in this menopausal phase deserves its own area of inquiry. We need more research. We meet more doctors who are knowledgeable about it because that's what they do. We deserve...
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
As women in midlife.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
We deserve better and we deserve to have the attention paid to the issues that have historically not been paid attention to.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Because it is a celebration of a time of life where I think we should all look forward to. And I do say this in my book, Oprah. I said when people have a different vision of what that time of life is like, people think of it as, oh, I'm getting old or dread. But I mean this sincerely.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
I mean, for people like Michelle Obama, Naomi Watts, you, Halle Berry, all the people, Gayle, who are out here showing young women what this phase of life looks like, it should be something that we look forward to because I don't know about you, but I am happier now At 66. For sure. Then I was at 46. So I look at people sometimes like, oh, don't feel sorry for me.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
You're not over it.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
You're never over it. And people think that because your hot flashes stopped or you didn't have hot flashes that you didn't have menopause. And I'm saying, yes, you did.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
We deserve a celebration.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Yes, you did.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But there are other ways that women can go through menopause other than just the natural process that happens.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Absolutely no longer fertile. And sometimes it's not just the complete loss of eggs, it's the loss of function of your eggs. Because the other thing that happens that people don't talk enough about during perimenopause is that there's a change in your fertility.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Because when you're perimenopausal, when you're 40, you still have eggs, you're still having your period, but your fertility is not what it was at 20. It's not what it was at 25. Because you've already lost eggs. It's not because you've lost them. It's because they are less responsive. Oh, they're less functional. They're less functional. And I'll give you an example.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
I like to say, you're born with all the eggs you're ever going to have. You don't get any more, you don't make any more. And then over time, you ovulate some, but you're not losing them because you've run out of them. You only ovulate about 500 times in your lifetime, but you had a million when you were born. Those eggs become less functional.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
And every woman has a different expiration date stamped on your eggs. So you don't know, are my eggs going to last until I'm 45? Or are they going to expire when I'm 35? And that's why we start to see the fertility changes. And for each individual, when you reach the end of that road, it's going to be different from person to person.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Yes, hormone replacement therapy, typically it is comprised of estrogen, which is the secret sauce in hormone replacement therapy, and a progestin, which is the second hormone that you take when you have an intact uterus. Now, for women who've had hysterectomies and don't need to have the progestin, you can just take estrogen alone.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
But most of what we associate with the symptomatic relief really comes from the estrogen component.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Yes, they are. But all of the studies that have been done really basically are with estrogen and progestin. We are sort of behind the curve. We're finding out a lot more about testosterone because women make testosterone too. And I think that that's sort of the misconception is that, well... Estrogen is a female hormone and testosterone is a male hormone. And that is not true.
The Oprah Podcast
Oprah and Dr. Sharon Malone on Everything You Need to Know About Menopause
Women make almost as much testosterone in the course of our reproductive lives as we make estrogen. That's really responsible for that sex drive that you get right around mid-cycle. So we're coming back around to understanding that maybe there should be more to hormone replacement therapy than just estrogen and progestin. But we need a lot more studies about that.