Regaining Control: Mastery Over Menopause
S2, E16
April 3, 2024

Dr. Judith Joseph is a board certified Psychiatrist at the forefront of research in anxiety, depression, and mental health. She is Chair of the Women in Medicine Initiative at Columbia University Vagelos College of Physicians & Surgeons and her podcast, The Vault with Dr. Judith is focused on mental health. She has over 1 million followers on social media, using platforms like TikTok and Instagram to raise awareness around issues that affect women during menopause. In this episode, Judith joins Stacy to talk about what happens to women's mental and emotional health during menopause, and she shares some key practices that can help women take control of menopause symptoms to live better, healthier lives.

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Hello Menopause is a podcast from the national nonprofit Let’s Talk Menopause. Produced in partnership with Studio Kairos. Supervising Producer: Kirsten Cluthe. Edited and mixed by Justin Thomas. Artwork by Stacey Geller.

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Stacy: Hey friends, the views of our guests do not necessarily reflect the views of Let's Talk Menopause. Let's Talk Menopause does not provide medical advice. The content in this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions that you may have.

Hello Menopause is changing the conversation around menopause and in every episode we explore the physical, emotional and mental changes that women experience during this transformative stage in life. Menopause has 34 symptoms and we cover all of them, from brain fog to panic attacks to heart palpitations and urinary issues.

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Dr. Judith Joseph is a board certified psychiatrist at the forefront of research in anxiety, depression, and a variety of  other mental health issues. She's conducting the first of its kind study on high functioning depression and will release those results in 2025. She's the chair of the Women in Medicine Initiative at Columbia University, Villegos College of Physicians and Surgeons.

And her podcast, Dr. Judith's Safe Space, is focused on mental health. She has over 1 million followers on social media, using platforms like TikTok and Instagram to raise awareness around issues that affect women during menopause. In this episode, Judith and I talk about what happens to our brains during menopause, depression, anxiety, and why women in midlife need a different kind of support from their doctors.

Please welcome Dr. Judith Joseph to Hello Menopause.

I really want to thank you so much for taking the time to do this interview. Yeah, there's so much, I think, in menopause that is such a big topic. And, even though it's become so popular, what I've found is that, we're really starting to break down the different areas of it, because it's almost overwhelming to say it's just this stage of life.

And I think that a lot of people who are, don't even know that they're in perimenopause or are experiencing it don't realize that we joke around about the fact that feelings are not fact, because I don't think of my feelings as physiological changes in my body, but they are facts, right?

And so when we talk about mental health, I think people get very confused when it is about your sense of self. So I'm curious, first of all, when you focus on mental health in menopause, how do you explain either the feeling of the first thing that I felt was, I don't feel like myself anymore. I look in the mirror and I don't feel like me.

Judith: I treat a lot of women and I think that as women, especially when we're mothers, or we're working or we're entrepreneurs or caretakers for our elderly parents, or we're just the person everyone relies on. After a while, our coping mechanism is not just feelings. I know you said feelings are not facts, but feelings, who has time for that, right?

That's really what I'm dealing with in my office, my busy office on Fifth Avenue, where I see people from all different industries. And I think what happens is that because you don't take the time to really process what you're going through because you're too busy, menopause can hit you like a ton of bricks.

It's like a, it's like a rug is pulled out from under you and now all of a sudden all you think about are your feelings, right? So it's such a strange and extreme dichotomy, right? And I treat children and adults as a psychiatrist, so I do a mixture of therapy and medications. But the beauty of being able to see people from all different developmental stages is that when I have a 50 year old in my office, I'm thinking about what was that 50 year old as a five year old, as a teenager, as a 20 year old, because I see the whole developmental spectrum.

And so when I approach it this way, I educate my patients and say, In preschools, we learn about faces, about feelings, about, if this face means pain, that means your tummy hurts, that means you have to go to the bathroom. We have to re-educate adults. How many times have you and I sat through a meeting and we had to go to the bathroom, but we invalidated ourselves and we're like, this can wait.

But you can't wait in menopause. You really do have to think about how you feel because your feelings give you so much information. And if you process what those feelings mean and what thoughts are tied to those feelings, then you have agency, you have mastery over the way that you behave, over the way that you think respond over the way that you approach life in general.

Stacy: It's interesting to me because I have heard more than once one doctor said to me a lot of times the feelings that we have at the beginning of perimenopause chronologically not talking about surgical or medical, but that it's like some of the biggest life pressures, as you said, having children or dealing with elder care or, all sorts of grown up pressures it comes at a time when we're least physiologically able to manage them.

And I wonder also about what you said about different developmental stages, because I'm, I've read before that the way that we experience perimenopause, particularly emotionally, is not just genetics. It can come from, aCEs, right? Adult adverse childhood experiences and things that actually impact the way that when we get to menopause, we react to that kind of pressure.

And I'm wondering what you see more frequently or if you see all of the same things frequently, but that it's really about anxiety or depression. I had anxiety, depression and rage. It was like the lucky three, but how do you distinguish what somebody is experiencing?

You're not invalidating it by saying, Oh, this is being caused by perimenopause. Because it's still depression, right? So do you manage it in the same way by having that same conversation about Let's talk about your childhood, let's talk about these things, and then treat it as if you would treat depression?

Or is there something specific to the perimenopause experience in the way that you look at [00:06:00] this picture about what's happening physiologically?

Judith: I'm a very holistic provider, and I like to Educate my patients so that they feel armed and ready with information. I can't tell you how many times I had a patient come into the office and say, I don't remember why I got this medicine and I'm not sure what the diagnosis was and I don't know about my family history.

So I really encourage my patients to be the best reporters. of their own life. You should be documenting your life so that by the time you walk into a specialist's office, you know yourself better than anyone. And that's important because when your provider has more information, they spend less time digging for answers, requesting medical records, so really you should have the information and that's why direct to patient information is so important these days because, unfortunately, you can't depend on your providers to know these things because doctors like myself didn't get a lot of education in medical school. I think I got one class on menopause, right? That's not enough. So exactly what I tell my clients is look for the three P's. How do you know if you have depression, which is a major depressive disorder versus. the mood and anxiety changes that can come along with perimenopause. So the three Ps are number one, your period. If you're having period changes, right?

Major depressive disorder doesn't cause that. And there's the DSM five, which is the Bible psychiatry under the diagnosis for major depressive disorder. There's nothing about periods, right? So that's the first P the second P is physical changes. Again, with major depressive disorder, you're not going to have hot flashes, you're not going to have palpitations, you're not going to have skin changes, odor changes, you name it, right? That's just not part of major depressive disorder. And the last P, which is not least, but it's important, if you're someone who's never had a depression, like a true depression in your life, and all of a sudden you're experiencing your first one in midlife, that's a red flag. Or if you're someone who doesn't have a family history of depression, right?

That's a red flag. And so I think that you want to be able to distinguish the two because it's important. The treatments are going to be different for the mood issues and the anxiety issues that come along with, that may come along with perimenopause versus a true major depressive disorder. Very different treatment, very different plan.

Stacy: Just wanted to say one of the things and the focus of this season on the podcast is to give people real life tools and real life information so that when they stop listening to this podcast, they can go out. Get a journal. Start recording the three Ps. This is fantastic. Cause I, nobody ever said this to me.

And so I really had no way to distinguish any of the things that you're talking about. And yet that is very clear information. That idea that really I'm shocked to hear that nobody ever said to me, Hey, when you're thinking about the physical, again, major depression does not cause hot flashes. or night sweats or any, I've never heard that.

I never even made that distinction. So like mind blown and that's also fantastic practical information for somebody in order to go see a provider. As we know, we don't get a lot of time with our providers. It's, I'm listening to you and it's just so unfortunate that the onus is always on us to be the master of our own fate here because we can't rely on the medical system to help us in that way, unless we are really tracking our own information. But if we stay on top of that, the agency that gives us and our provider is so much more, it is exponentially better.

Judith: Yeah, and unfortunately it's reframing, right? You can say, Oh man, it sucks that the onus is on us. On the other hand, I tell my patients, you're part of the treatment team. I can't do this without you. And then that's a reframe. It's wow, I am a part of the treatment team. If I'm active and if I learn and we're all in this together, we're going to all have a really great outcome, right? Or a better outcome than if one person's checked out or one person's Oh, you deal with that, so I like to empower my patients that way and say, be an active part of your treatment team. And the other thing, which I think, all people can do in their time as a part of that third P, the past, draw a little family tree.

A lot of times you'll say I don't know if there was depression in my family. They didn't talk about that stuff. And then with my patient, I'll be like what was your dad? Like when he came home, he came home, knocked back some beers. He's grumpy and he passes out. And that doesn't sound very happy. Or you could say my grandma, she would just talk about worries all the time. She didn't let us go anywhere. Sounds like anxiety, right? So sometimes we can piece it together when we have patchy paths that we don't understand. And that's why I said, it's a part, you're a part of a team. Cause we're literally drawing this tree together and trying to put together the pieces and getting a clearer picture. It's important to understand your past as cheesy as it sounds. They're predictors for the present. And you mentioned ACEs, right? ACEs was a large study done by Kaiser and the CDC and has been coded so many times, but a history of trauma puts you at risk for worse than symptoms of perimenopause and symptoms of menopause. So when I tell that to my patients, they're like, oh my goodness. So let me do my trauma inventory. Oh yeah, this happened to me, this happened to me. I better start getting ready and preparing my body. And I mentioned that I treat a lot of women across different age groups.

I really start to educate black women sooner because they have the studies, the swan studies show that they have they go into perimenopause. menopause sooner, they have worse symptoms, they have worse depression. So I really talked to a woman in their 30s and 40s. And I'm like, you’ve got to start doing some things because you don't start saving for your retirement in your 50s do you? No, that's what they're like, No, who would do that? Why are we? Why aren't we preparing for menopause right early, but we can actually put some really great things in the bank, we could start cutting out toxic habits like smoking cigarettes. We can cut out toxic people because poor human inter connections put us at risk for worse symptoms, right?

We can start taking care of stress and learning how to manage stress and regulate our mood now because that sets us up better off down the line, right? We can start eating healthy foods that nourish our brain and our body. eating things that are high in protein, all these building blocks, getting better bone health, lifting weights, all these things that are really like money in the bank, but in your physical bank, so let's start doing all these things now. And when I approach it that way, when I use that reframe, it doesn't sound daunting Oh my God, cause I find that a lot of people don't want to think about menopause when I, especially when I start talking about it. And my patients in their 30s and 40s, they're like I'll deal with that when it happens. I was like I hate to break it to you, but you’ve got to start thinking about that. But a lot, I could not agree with you more. Yes. But a lot of people approach it and that's, listen, that's human nature.

We all are so busy and we don't want to think about these things. But if we do think about these things now, we are so much better off and actually we start feeling empowered. And I could speak from my personal experience, right? When I started seeing patients in my office who are being referred to me in their fifties for ADHD. Can you believe that? ADHD in your fifties? Not, it can happen, but if you had undiagnosed childhood symptoms, ADHD by definition does not start in your fifties. It starts below the age of 12. And you see a pattern of inattention, time management, planning issues. But I was seeing women in my office being recommended for ADHD, and I'm like, it's brain fog.

Stacy: Or executive function, right? We lose some of our executive dysfunction function in menopause. This is what I was going to ask, you read my mind, because I feel like there has been an epidemic of midlife women being diagnosed with ADHD. I'm like, it can't be this many people. Everybody, every person on social media is suddenly there's All of my, all, I have all the answers to my problems now because I have ADHD and I'm, that, we know that when you talk about brain fog or, loss of executive function, a little bit in, in the brain that comes back post menopause, that's not the same thing and to hear I had no idea that you could diagnose, that ADHD is diagnosed so much earlier in order for it to be ADHD. And I wonder if you have thoughts on that, is it that, again, the same way most people, when they don't know what's going on with them and they don't know how to talk to their provider and they're like, everything sucks. I hate my life. Shoot me. They're like, here's a pill. Here's an SSRI.  

Judith: I have a lot of thoughts on ADHD. A lot. I tell you, I treat children and adults. And with the Children, the bulk of the work is with ADHD and stimulants because it's the most common condition, right? That we create in Children. And during the pandemic, we were all on our computers. We're all working from home. We were all in places of massive distraction and. People were self diagnosing because they were on their TikTok. And you have all these creators, it's great that they're bringing about awareness, but a lot of creators were saying, I have this, I have organization issues, I have focusing issues, and people were self diagnosing with ADHD. That created a huge problem for my practice and other people's practices. Why? Because that caused a stimulant shortage that is still ongoing. So the people who actually had ADHD, they're not able to get their medications because people were self diagnosing. And they were getting information on TikTok and they were asking their providers for stimulants. So that put us in a position where we had to be creative. I'd be calling up my friends like, okay, which pharmacy has this? Which pharmacy? It was a conundrum. So then what did we do as child psychiatrists? We pulled out the organizational skills therapy. So organizational skills therapy is a type of behavioral therapy that is heavily used in pediatric populations who have ADHD.

So we focus on behavioral modifications to help with time management, with planning, with focusing, and using these skills, children can figure out tools that are non medicinal because not all kids can tolerate medication to help and support their executive functioning issues related to ADHD. But guess what? These skills are helpful in people with executive functioning issues in other fields. So in a way, I'm grateful for the stimulant shortage because I was like, I gotta start, using more organizational skills.

Stacy: And be creative, right? How are you going to serve your patients?

Judith: It's amazing. And then it was actually very helpful in the woman I was treating with brain fog. And Stacy, you and I have talked about this before, but I use an acronym called TIES because I work with medical students and acronyms are how we learn and remember things. But the T is the thinking and the thinking. Thought issues. A lot of times you have things like the tip of the tongue. Like, I'm about to say something, I can't remember it, or I can't find my keys. Like I used to have everything. And a lot of time management issues that you didn't have before. That can be caused by some of the hormonal fluctuations. That's the thing, the tie, the T and ties and organizational skills therapy is a behavioral therapy that can support you in this area. Because many of us are so accustomed to multitasking that if something is thrown into the mix like a hormonal fluctuation, we don't know what to do when we can't multitask anymore. But using organizational skills, you can simplify your routine. You can use some of these tools to support you so that you don't feel as disorganized. And then the second I is what you started with identity issues. So if you're someone who's been on the go all your life, everyone depended on you. You are used to doing XYZ and all of a sudden you're forgetful or you're moody. You feel like you don't know who you are anymore. But with my patients, I remind them that you are not your role. You were a person before you had all of these accolades and all of these things that you were doing for your mom. So try and use mindfulness practices. which is derived from something called dialectical behavioral therapy, which helps with mood regulation and interpersonal skills. Drawing from those practices, we're able to pick and choose the thoughts and feelings we want to give a priority. And isn't it amazing if you can pick and choose how you want it to feel and what you want to think, but we can do it with practice. And that helps people to feel mastery again. So they feel as if I'm still the same person. Two things can be true. My body's going through changes. I am still the same me.

Stacy: It's why I wear my necklace. Two things can be true.

Judith: Two things can be true. And is so important. That simple reason is so important. And then the E is the emotions and ties. So emotional regulation, dysregulation and anxiety. These are the problematic symptoms that people experience. And then they get sent to a psychiatrist and they're put on all these antidepressants. And I'm like let's pull that away because we know that if it's due to the mood issues are due to perimenopausal. issues, then hormones may help, and also therapy can help. Let's try those first, right? Not to say that antidepressants will help down the line, because sometimes you do eventually develop a major depressive episode, so everyone's different, but there is a therapy called cognitive behavioral therapy that allows you to challenge those negative thoughts.

so that you have more agency and mastery over your behaviors. And that is very powerful for women when they feel like they developed a skill that they can use over a lifespan. And CBT cognitive behavioral therapy is also helpful for sleep, which is the S and ties, right? And sleep ties it all together.

No pun intended. It's really important. Solid sleep affects your mood. It affects your thinking. It affects how you feel about yourself. It even affects your belly fat, right? There are studies that show that if you don't get good deep sleep, your metabolism is impacted. And women in midlife tend to have higher rates of sleep apnea. So sometimes I send my patients for a sleep study. Cognitive behavioral therapy for insomnia is as effective or in some times more effective than some sleep medication. So if women know that these are tools at their disposal, and they know that there are options, then they feel empowered and they know what they're doing.

What questions to ask, who, which specialists to go see, where to spend their time and resources. But if you're just running after random things and you're not sure, you're going to get deflated. You're going to be, feel demoralized and you're going to give up.

Stacy: I know. I wish I'd met you when I was 47.

It was, I would have felt so much better about myself. And I, this is why, again doing this kind of Podcast is so important to me. I don't think that people, because of the way our medical system is set up. It's what I was saying before. Of course, there's a shortage of stimulants for ADHD because it's throw a pill at it. If somebody comes to you and says, I, I can't function. I can't, I can't multitask. I can't do these things. We don't know about ties and most doctors  don't take that time in order to not only explain it the way that you're explaining it, which again, to break it down makes it so much easier for us to take control of this. And I think the way that you use the word control is so perfect here. Because I felt completely helpless during perimenopause. I felt helpless and hopeless. And it never, I kept saying to myself, if somebody had told me I was going to get hit by a Mack truck, I would have gotten out of the way instead of getting hit.

So training people earlier to know that, hey, there's a continuum here. Things are going to happen as you age. And then giving them these kinds of resources makes such a huge difference. And also the dependence that we have on drugs becomes so much less, right? This is, and again, nobody is saying that SSRIs aren't important or that stimulants aren't important for ADHD, but particularly when you're able to pinpoint it around the perimenopause experience rather than depression. Or anxiety or ADHD, it makes such a huge difference. And I'm wondering if you see a difference in your patients as they work with you over time, if they are able to do dialectical behavioral therapy, cognitive behavioral therapy, which I've heard amazing things about.

Judith: I do. And I think what you're saying is so important because it's validating. Not everyone wants a pill. Not everyone wants medication, and it's an unpopular opinion, but I say it, like we talk about hormones, but you know what? Not everyone wants hormones. And my patients will say to me, I feel bad. Cause I'm still afraid of hormones. Don't feel bad. Like you’ve got to do it in your own time. If patients are not, really buying into. Treatment plan. They'll tell you that they're doing it, but they won't be doing it. And who's benefiting from that, right? So like in my office, it's a safe space and I say when you're ready for medicine, you let me know.

But if you're ready to do other things besides medicine, let's do that. There are tons of things you can do. You can Pick and choose one of those modalities that I just said, one of those type of therapy modalities. You can work with someone who is a breathing expert or a movement and yoga expert. There are other things you can do to support yourself so that you feel grounded, so that you're starting to become more in touch with yourself because you lost sight of that along the years, right?

So you don't want to discourage people and say Oh, you don't understand them. the medical literature. You don't realize that the study that was antiquated was wrong. No, but it takes a while, right? We were scared until believing that hormones are bad. And now all of a sudden we know they're good, but many of us are still not okay with that. And also some of us will never want to take medicine. That's why the rates of medical illnesses is so high because patients will get prescriptions and never take them. Okay, so we don't want to pretend that something that is happening is not happening. We want to be very real and we want patients to be honest with us because they are part of the treatment plan and we have to treat them as such or else we're not helping them.

We're just a part of the problem. And the other thing I think is, I mentioned that medical students and doctors don't get a lot of training. So there's a psychological a concept called projection. So if you're feeling a certain way, you may on an unconscious or subconscious level behave in a way that puts that feeling onto someone else, right? So because I do that with my dog all the time, the same thing, exactly. But I'm always like, I'm sad. She's sad. You mentioned you said helpless, you said you felt helpless at times and hopeless in your process. If a doctor doesn't feel like they have mastery and they have confidence in his topic, they're going to project that onto you. And then you're going to feel like what are we doing here? So you're both like, I have no idea what to do. Go see your OBGYN and then you go to your OBGYN and your OBGYN is on the menopause train. Then you're going to, they're going to be sending you everywhere, so that's why I think it's so important to educate yourselves as in the podcast, from Join groups because when you meet other women who've been through situations, you don't have to reinvent the wheel.

You learn from their experiences. And if you experience something that they didn't, you can teach them and there's power in helping each other and that community. And that's how this movement began, right? Because [00:24:00] people started opening up and talking to each other and sharing. And then there's strength in numbers.

There's less shame when you share. Because you're not alone, and there's less guilt because some people feel guilty that they're not the same. When you're sharing this information and you're learning together, you're actually helping the greater good, not just yourself.

Stacy: Yeah, it makes so much sense to me, and, I realize that, obviously, This is probably something that you have been noticing and treating for much longer than it's been, a popular topic.

But, we do talk about the fact that like in the last five to 10 years, it really, menopause as a topic has really taken off. And, one of my theories is that Gen X got to perimenopause and was like what the hell is that? I thought menopause happened in my seventies. I thought Edith Bunker was in her 70s when she yelled at Archie, and it turns out she was 47. Gene Stapleton was 47 on All In The Family. I was like five years old and watching this. And so I thought menopause happened when you were much older. And, again, to speak to that idea that got to this stage of life and we were like, Oh, hell no, we are not taking no for an answer and one of the things that you talk about in terms of building this community, I think has been so beautiful to watch because if I had known that there were going to be 1 billion people in menopause in 2025, I would have felt a whole lot better if I could have randomly pointed at somebody and been like, Hey, are you going through this too?

So the idea that there are communities that are popping up, I think is so positive. And one other thing that you said before that I think is difficult to dislodge, and I wonder on a psychological level, how we do this. Because you said, the SWAN study, the WHI study, really did scare the bejesus out of most people into taking hormones at all. It stopped doctors from prescribing them. It stopped medical schools from teaching anything about menopause. How do we dislodge the fear, especially when there was so much wrong about that study? And, I spoke with Dr. Sharon Malone. And we talked a little bit about the fact that there was good that came out of that study that was helpful.

How do you dislodge fear when that was like the overriding kind of message of the study itself? How do you get people, maybe they're not ready to take hormones, but how do you reassure them that there are ways in which you can manage? Now we talk about hormones being the gold standard. That's a big leap from where we were. How do you dislodge fear? How do you keep people open and curious?

Judith: You know how we mentioned projection? I think a lot of it has to do with starting when the doctors are the baby doctors, right? I work with, I am a chair of women in medicine at Columbia at the Vagelos College of Physicians and Surgeons, and I work with medical students. And I also work with the alum who graduated who are women. So they're all over the world and they're doing great things and they're leaders in their fields. Many of them are like a chair of departments and award winning entrepreneurs and researchers and so forth, but there's this community that I mentioned and it starts there, like there are huge pushes to revamp medical education so that doctors feel mastery in this topic so that they're learning about a woman's development from midlife and beyond and not just, up until reproductive ages. We're more than just a uterus, right?

We have to start with the doctors, with the people in training. And then, that's where they create change with their patients. Many of the patients get their information directly from the source, from the doctors. So I think we do need to focus on that. And also social media. I use my platform a lot to educate and to spread awareness.

And I recently went to a talk in DC where a woman she's an economic researcher. She said a statement that I thought was very profound. She said, the UK is really leading the menopause movement. And she said that she studied it and she looked at the rates of women leaving the workplace. And then the rates of people replacing those women leaving the workplace in [00:28:00] midlife.

And in the UK, they ran into an issue. They didn't have enough employees to fill those shoes. So it was out of necessity capitalism. They had to do something about menopause specifically in the workplace to keep women in midlife in the workplace because you're at the top of your game then, right? You are, you've made networks. You just have the skill set that is so seasoned. And then. menopause hits you and then you're out, right? So the UK led that charge. So that's forcing the rest of the world to follow, right? We may not have the same force crisis here, but information spreads because we have the internet because we have social media.

Whereas 40 years ago, we didn't. And one of the studies in in from McKinsey, which is a consulting firm. I love to read and I read this study about different generations and how different generations consume information and how they purchase and so forth. But the interesting thing about this McKinsey study, and they looked at Brazil, because Brazil has one of the largest populations of consumer Gen Zs, and they looked at the values of the different generations. So the boomers, the Gen X, the Gen Y millennials. and then the Gen Z. And what they found was that the Gen Zs, they really don't feel happy unless their peer is happy. For example, if there's injustice happening in their peer group, they can't be happy. They want the whole world to get happy with them. They want the whole world to get rich as they get richer. So I do think that there is a beauty in this generation because they don't want people left behind. So I think that there's a combination of factors. We have younger generations that are more, I think, socially active and responsible. We have a spread of information because of the internet and social media we have more women in the workplace and we have the UK movement. So I think that's why we're all like, okay, it seems like all of a sudden menopause is a thing, but it was always there. But these factors, I think, made it a priority and that's what we're talking about.

Stacy: Yeah. And I agree with you. I think that the same issues about losing women in midlife apply here, right? There's been I don't know, I'm forgetting his name, but there was a Harvard Business Review article that Thames and Fidel just did with Brian, and I forget his last name, about, about this very issue is that, we can't afford, companies cannot afford to lose people. And really it's just by the numbers, instead of talking about it in the billions and trillions, now people are really starting to look at. What is the value of this person?

What is the amount of support that they need? What's the price differential to keep them and still make money? And give people what they need in the workplace the same way we had to do maternity leave or pumping rooms or things like that. So I'm very encouraged by that. But I'm also curious, social media we've just been talking about the good information that's spread like people, like experts like you. But then there's the bad, there's a, there's, what we've seen also with the rise of popularity and menopause conversation and all kinds of health conversations is that there are a lot of charlatans and there's a lot of misinformation and disinformation out there.

And just what you were saying before about the fact that during COVID. We all became scatterbrained from, constantly scrolling or constantly being on Zoom calls. And it's almost like some of the things that have helped us, with this movement are all, also hinder us and also get in the way of us being able to focus or being able to take the time to get that control that you're talking about and to value ourselves. Somebody once told me that we see in a 24 hour news cycle more images today than our grandparents saw in their entire lifetime. And I don't know how your brain … we're still working with prehistoric software here, right? We don't have any chips or anything for extra storage. So I imagine that also plays a real role in terms of anxiety. Or, feeling distracted or things like that.

Judith: Absolutely. There's a whole center at Stanford, the Zoom fatigue center. And when I give corporate talks, I encourage people to go on that website and take the test because a lot of times what people think is ADHD, it's Zoom fatigue, right? We're not designed. to stare at a screen all day. We're not even designed to look at ourselves on a zoom call. That's harmful for our mental health. And I treat children, adolescents and adults. So I think about it developmentally, a child looking at two dimensional images, you're depriving that child of sensory input. If you put a two year old on the floor with a box, they're gonna have a field day. They're gonna put that box in their mouth, they're gonna tear it apart with their hands, they're gonna be rolling around with that box, right? But you put a two year old in front of an iPad, and they're just like, swipe, swipe.

That's not helping that brain, they're supposed to be in the world. stimulating their senses, and there are studies that are showing that's causing Children, Children to have poor attention, irritability, poor social reciprocity, poor language development. And you look at Children, they're experiencing a lot of social rejection and anxiety because again, they're not supposed to have never ending images that they compare and contrast themselves to.

They're not supposed to know their friends are out doing things without them. We didn't have that as kids and we're fortunate, but we can't say the same for this generation. And then adults, there are even studies, the data is really coming out and it's showing that that's not healthy for us to be in front of these screens to be looking at these new cycles. There was recently a study on on, on doom scrolling. Doom scrolling is not something that is not, that is recognized in the Bible of psychiatry, the DSM, but that doesn't mean it doesn't, right? If I do scrolling really, you're not going to say, Oh, it's not in the DSM. So it can't be real. No. But there are all these phenomenon that are happening that are part of our world. But the science hasn't caught up yet, but they're impacting us. What I say to my clients is that we don't know the implications of social media and technology. Treat it like a drug.

A drug should be taken with caution. If you're experimenting And moderation. If you're experimenting with a drug, you're not going to do eight hours of that drug, right? So take it in small doses and then see how you feel. And if you're finding that it's impacting you negatively, then it's time for a reset. And I love my acronym. So I say the reset is R is realization. How is this? How do you, how are you feeling after you're interacting with this? Are your family members saying that you're online too much? For example, doom scrolling with menopause, I had a client who came to me and was like, there are 50 symptoms. And I went through it and I was like, okay, that's not really helpful. Like you got to limit it sometimes. So realize how it's impacting you. The E is educated, right? So try to listen to podcasts, read articles about how all this information is impacting you. And then the S is strategy.

What's your strategy? Are you going to limit the amount of time on it? Are you going to only follow certain accounts? Are you going to only follow reputable accounts? The E is really examining Okay, so how did this actually impact my family? What are, what am I hoping to get out of this?

Am I hoping to feel better about myself? Or am I hoping to have better relationships with others? Have less anxiety and the T is thoughtfulness. Like at the end of the process when you have limited exposure to social media and all of these technologies. How are you feeling? Did it help with your goals? Do you need to shift things? Was it too rigid? Was it too loose? Do you have to rethink this whole method? So there are ways that you can, try and do this little experiment with yourself. But again, it's a drug that many of us don't know the long term applications of, so we have to treat it carefully. So when you're online and you're doom scrolling about menopause, Don't watch a hundred videos on it. Yeah, it's important to learn about it from reputable sources. But just because one woman in the middle of the country has a hundred symptoms and lost her job in her home, that's not helpful for you, right?

Stacy: And, it's so funny that you say that. I, there's an I remember, I know that there was the study that came out about sort of 10 year old girls being more depressed because it's not even that they're doom scrolling, they're just comparing themselves and feeling less self esteem because, they don't feel as, worthy as their peers. And I said, why are we doing that study on middle aged women? Because I, I'm pretty sure it's the same thing, right? It's not that it's about a particular age group, but this idea that I didn't know all of my friends had houses in the Caribbean or that they were, I don't need to see that all the time. There's just things that I really understand. Again, this is such great information and you make it sound so easy, which to me is the best part about it. I think that when anybody thinks anything is too hard, they don't attempt to do it. But this idea of the TISE acronym and the RESET acronym, these are things that actually just take a little bit of self awareness, a little bit of quiet. And if you use both of them, then I think that you really have so much, so many more options than you think you do. And again, at the end of the day, the most important thing that I think that you've really shown us is that we can have agency and as you said, be part of our own treatment team.

I don't, I have never heard it put that way before and I can't think of anything more empowering. I can't thank you enough for this interview. Thank you so much. Thank you for having me. It was my pleasure.


Let's Talk Menopause, a national non profit organization, is changing the conversation around menopause to make sure women get the information they need and the healthcare they deserve. Please visit for a wealth of menopause information, including a symptoms checklist, information about long term health risks, how to navigate menopause at work, interviews with health experts, and so much more.

This episode of Hello Menopause is sponsored by Always Discreet, makers of liners, pads, and underwear for bladder leaks. Always Discreet because we deserve better and you can find Always Discreet at Target, in store and online. Hello Menopause is a production from Let's Talk Menopause. Produced in partnership with Studio Kairos, I'm your host Stacy London. Kirsten Cluthe is our supervising producer, editing and mixing by Revoice Media. Hello Menopause is available on Spotify, Apple, Google, and wherever you get your podcasts.