August 15, 2023 • 29 mins
Gynecologist and women’s health expert Dr. Suzanne Gilberg-Lenz joins Brooke for an information-packed episode about aging, fertility, and menopause. The two discuss why society has normalized women’s pain, and what we can all do to better advocate for our well-being. Plus, the physiological “Now What?” moments you should look for in your lifetime.
Love Dr. Suzanne as much as we do? Check out her latest book “Menopause Bootcamp”
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Episode Transcript
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Speaker 1 (00:04):
What do you do when life doesn't go according to
plan that moment you lose a job, or a loved one,
or even a piece of yourself. I'm Brookshields and this
is now What, a podcast about pivotal moments as told
by people who lived them. Each week, I sit down
with a guest to talk about the times they were
knocked off course and what they did to move forward.
(00:27):
Some stories are funny, others are gut wrenching, but all
are unapologetically human and remind us that every success and
every setback is accompanied by a choice, and that choice
answers one question, now what. I just was looking at
(00:51):
the what to expect when you're expecting books, but I
was looking at the journey of them. Yeah, the drawing,
yeah yeah, yeah yeah, it's unabelievable. I'm writing about all this,
and so it's just it's so fascinating to me because
I was like, look, how miserable this person looks, Yeah,
rocking chair with like sensible shoes. I'm like, what is happening?
(01:14):
But you know they have no concept also of the
mental health struggles and so rough, your nipples hurt, you
can't poop, you haven't slept, you feel disgusting. You're sweaty.
Did you shower this week? I mean, nothing works. You're
so freaking tired, you want to die, and you're supposed
to keep another human alive. I mean that is a
(01:34):
disaster area. And I had everything going for me, so
I don't even know how people do it. My guest
today is doctor Susanne Gilberg Lens. Doctor Suzanne is a gynecologist,
a woman's health expert and advocate, and an authority on
one of the biggest now what moments in many of
(01:57):
our lives, menopause. She literally wrote the book on it
and created a program called Menopause boot Camp to help
women better understand the transition. She worked with women of
all ages for more than two decades, and I reached
out to her because I wanted to talk about what
she's observed during that time and how all of us,
(02:19):
regardless of our age, can be better advocates for our
physical and mental health. I'm thrill that she agreed to
do this show, and I'm grateful to be able to
share her wisdom with you all. Here is doctor Susanne
Gilberg Lenz. Hi, there, it is so nice to meet too. Oh,
(02:42):
thank you so much. It's such an honor for me.
It's so important, and I love having these conversations. Thank you,
Thank you for having me on. I've been wanting to
do an episode just that is focused on women's health
for a while now. I mean, I've talked about my
own health issues and STRUG in my books, but something
that struck me in preparing for this interview was the
(03:04):
general lack of knowledge on women's health. Why do you
think it's remained practically taboo. I'm going to use this
word because the patriarchy and menopause specifically, is I like
to say, is you know, misogyny and agism had a
baby and they called it menopause. You know, I'm full
(03:24):
of these little aphorisms, but I will tell you that
during medical school, I came in thinking I was interested
in women's health, and I really tried to convince myself
otherwise because I felt like obstetrics was probably going to
be hard, and I was right, But I couldn't convince
myself otherwise. So why did I love it? I loved
(03:44):
the opportunity to get to know people over the course
of their lives. I loved development and physiology and normal
stuff and how to help people through these transitions in
these crisis. Yes, I love medicine. I love the operating
room I get to operate, and delivering babies has been magical.
Why do I think we don't know about it? I
think that the way our medical training system grew up,
(04:08):
it grew up in an era where women were like
considered other small men with ovaries. I don't know, like
they just women are not thought of as our own entity.
And you know, we have some magical powers, or appear
to because they are mysterious. They are scary rather than
(04:30):
being seen for what they are, which is like an
amazing gift, just like men have amazing gifts. Human beings
have amazing gifts whatever their gender is. But physiologically we
are able to carry babies and deliver them out into
the world and keep them fed yep, and keep them alive.
And in keeping with what we're talking about, society itself
(04:53):
has normalized female pain. Oh yeah, they don't tell us
that you know IVF will pain or do you know
gynecological procedures could be painful? That all of these things happen?
You know? So how do you how do you with
your patients approach like pain? And discomfort in your own practice.
How do you talk about such a good question? And
(05:14):
I will tell you that it is definitely one of
the questions of the moments right now on social media,
such an interesting and complicated thing, because I will say
that I also feel that there's been sort of this
uh celebration of pain around birth, as if it's some
kind of badge of honor, like as if growing that
fetus and you know, birthing a baby isn't enough. And
(05:35):
I'm not saying that nature isn't a miracle, and I'm
not saying that physiologic, unmedicated birth isn't an option for
a person who wants it. And I support people's desires
to do things the way they want while understanding that
they don't really always know what's going to happen. I mean,
that's part of the beauty of birth, by the way,
is that the surrender into it, right, you don't know
what's going to happen, forget it, and you forget it, well, yes,
(05:57):
if you're lucky. So having said that, I think there's
a weird dichotomy there. I got to tell you to me,
this idea that women don't experience pain when they're having
a biopsy, when they're having an IUD and inter uterine
device placed into their uters. Whatever it is that we're
doing is so cruel and weird. So what I always
discuss with my patients, I do it differently. I've learned
(06:19):
over the years. I learn from my patients. I tell them, Okay,
here's the thing that we need to do, where you
want to do, and here are the options. Pain management
is always an option in my office. We use either nitronox,
which is like nitrosoxide, like old school dentist stuff. We
can do a cervical block, which, by the way, in
and of itself, the injection to the cervix is unpleasant.
(06:40):
We can use sedation, whether they take adavan orally by
mouth and have a ride. I find that when I
talk to the patients in advance, and I always do,
and I advise them here are your options, that right
there makes all the difference because they feel heard and
they feel that they're in a space that is going
to respect what their needs may be. You've given them
(07:00):
a choice, which gives them a certain amount of power.
And I think some of what I've experienced gynecologically, I
was never informed about anything that was happening. So I
didn't know about HPV and I had to have this
extensive cone biopsy. I was never told what that was
(07:21):
going to feel like. A It was a man, a
great doctor, great surgeon, but I don't know if a
female would have done it that aggressively. Yes, he got
all the cancer, but by the same token, it made
it impossible for me to get pregnant. Yeah, naturally, I
think some of that. I want to be careful about
(07:43):
some of this because this is your experience, and I
think the experience you named it, you didn't have information.
I mean, you didn't really have information in a conversation.
And I have to say over the years that I've
seen just as many female physicians perpetrate that as male physicians.
Some of it's generational, some of it's generational. Some of
(08:03):
it is also just how open you are and how
curious you are as a physician. I think you know,
the medical training system is very toxic and very military,
by the way, and so it can breed a lot
of fear based decision making and a lot of what
looks on the outside like egotistical kind of authoritarian behavior
(08:24):
on the part of the physician. You got to understand
that we grow up in a system that rewards that,
and that also asks us not to question. I've been
I've had a reputation, let's say, over the course of
my career, because I want to do the right thing,
and I think nobody could ever point a finger and
say that I don't take great care of my patients
or that my outcomes are not fantastic. But I question things.
(08:45):
So I think if you look at like the generation
of the physician, there's a lot of things I think
if we don't have what's called I just came back.
This is tangential, but not I just came back from
an incredible experience at a place called MEA, the Modern
Elder Academy. It's un believable and one of the things
they talk about it's very similar to the stuff you're
talking about, sort of that new beginning as we get older,
(09:07):
how do we want to be in our in our lives,
in our in the community, in the world. For someone
like me, having a growth mindset has been the key.
It's why I was able to ask these questions. It's
why I was able to change course based on my
training around pain management versus what I do today. It's
why I was able to say menopause, Well, this is
(09:27):
really important. We're not learning about it as physicians. We're
not supporting our patients through the process. How can we
do things different? When is it time to start bringing
the alarm bell like pertaining to pain, what do you
say to your I think again, this is why the
discussion ahead of time is so important. And so I'm
so glad we're having this conversation because one of the
things that people can do at any age is if
(09:49):
their doctor's not bringing it up, come with questions. You
know what, be the annoying person whatever. You're the person
who's receiving care. If they don't like it, maybe that's
not the right environment for you. If I'm doing something
with a patient and they can't tolerate it, I'm not
pushing through. They can come back. We don't have to
do this today. And when people are anxious, by the way,
their pain threshold is much lower. So again, if they
(10:12):
don't feel safe and they don't feel listened to, it's
going to make your job as a physician harder. So
it's I think unfortunately. I want your listeners to know
that their physician may not ask the questions. You come
with questions prepared. I have in my menopause, Balo Camp,
I have like two pages of like advocacy questions, not
(10:33):
to be an a whole and confrontational, but to come
in and be like, hey, I need to take care
of myself. How are we going to work together as
a team. I call this show now What because it's
really about those times in your personal or professional life
that surprise you and shape you. What's a now what
(10:56):
moment that shaped your work as a physician? Oh wow,
Oh well, there's so many, and I think it depends
on the person. I'm going to share a couple of
personal things about myself that really changed the way I
perceived things in the way I practiced medicine. I had
my older child, my son, who will be twenty six
in October, Jaron, while I was the beginning of my
(11:18):
second year of obg Way in residency. That was pretty brutal,
and I was young and thought and I've been, you know,
doing OB and watching this very high pressured environment in
which I was training, and I thought to myself, Wow,
there's a lot of medical interventions going on here. As
is nineteen ninety seven, I don't think I we need
(11:39):
all that, and I like on the down low. Brook
took a Bradley Method natural childbirth course. Okay, nobody in
the class knew I was an OBIE resident. It was
a little extreme, but I was like, I'm going to
take what I like and leave the rest. I came
in and my labor was going super fast. And despite that,
my doctor did all this stuff. She broke my water,
(12:00):
she gave me pitocin, all these things. My husband, I
didn't know till later, was in the corner trying to advocate, like,
do you really need to do that. I know Susanna
doesn't really want you to do that. Do you need
to do that? I didn't need any of that stuff,
And it stole my confidence book, and I said to myself,
I don't think any of that needed to happen, and
I'm never going to do that to another person. I'm
never going to do that to a patient. Nothing quote
(12:22):
bad happened. I was fine, he was fine. You know,
I'm not crying. I'm just saying it changed my life.
Then later one of my mentors, who's an internationally renowned
breast cancer oncologist, she started sending me patients and she
started sending me a lot of her young breast cancer
(12:43):
patients and they were rendered menopausal in their thirties. And
I was like, Filhelmina, I don't know how to treat this.
She's like, well, you'll figure it out. And this is
when I realized I didn't understand menopause and I hadn't learned.
And I taught and taught and taught myself and went
to conferences and read and worked together with them as
a team and really helped understand how to restore their
sense of self, how to feel confident in their body again,
(13:05):
how to regain their sexuality. Some of them ended up
getting pregnant after their chemo was done. It was like,
really miraculous. And I became kind of known as this
pre menopausal breast cancer gynecologist. And then I got breast
cancer in my forties, and I was a pre menopausal
breast cancer patient. So all of these things added up
to reminding me I'm one of you, you're one of me.
(13:30):
I was always very open with my patients about my
own struggles and what I was learning. I had a
deeper and a wider toolkit because I was doing Iraveda
and I was doing herbs, and I was doing holistic medicine,
but also I believed in radiation and surgery, and I
did it. And I also saw acutely how ignored so
(13:51):
many of our quote issues were, and I just it.
Really every step along the way was an AHA for
me because I said to myself, Okay, so I've learned
all these tools, and some of these things actually don't
make sense. Shifting to a more biological now what question,
what are some of the biological timelines that young women
(14:13):
really need to just be cognizant of. And then the
expense of fertility. Yeah, it's costly emotionally, physically, and financially.
I mean, I think the problem with some of this
is that some of the data around fertility changes is
old and it gets get called into question. But the
reality is that we know that there is a pretty
(14:34):
big drop off in live births resulting from pregnancies after
the age of thirty five. So that doesn't mean that
if you're thirty eight you should go into a panic.
You know, I have patients getting pregnant in their early
forties all the time. I think, if you think you
want to have kids, i'd say in you know, your
early thirties, you should start thinking about what is the
(14:55):
plan there, because maybe you're not ready for a number
of reasons to have kids, But I think that's the
time to start talking to your The issue is that
the testing that we have available is indirect, and it's
I don't want I don't think people should be like
living or dying by the blood tests, like specifically the
anti malarian hormone which has become very popular. That test
has really been developed in order to look at who's
(15:16):
going to be a good responder to in vitro fertilization.
You know, at least have a conversation so that you
know what your options are, whether you have the available
resources to do egg freezing, which by the way, is
not a guarantee at all, or if you say to yourself,
maybe we shouldn't, you know, put this off another five years.
(15:37):
If we really want to have a family, we might
have to pull the trigger or just be okay with
the consequences. The conversation I have with my patients is
that what consequences are you okay with? Including testing? Because
if we're going to do the test and it's just
going to freak you out, but you're not going to act.
I don't know that I want to do this test
on you. What about new parents, Oh my gosh, given
any kind of an instruction manual, you know, they have
(15:59):
no concept. Also of the mental health struggles, it's so rough.
I remember having a moment with my first and I
was thirty thirty thirty one with a really supportive partner
at the time, and I remember having a night where
I was like, I understand why a teenage mom would
leave this baby in a trash gown. Okay, And I
(16:19):
just want you to know that I love that, I
love this baby so much and I could not. I
was done. Your nipples hurt, you can't poop, you haven't slept,
you feel disgusting, you're sweaty. Did you shower this week?
I mean, nothing works. You're so freaking tired, you want
to die, and you're supposed to keep another human alive.
(16:41):
I mean, that is a disaster area. And I had
everything going for me, So I don't even know how
people do it. So do you tell your patients that
without trying to detern them from what I tell them
is Because here's the thing, especially with the first one,
they're in such a cloud and they're so excited. Some
of them are nervous, by the way, and I think
(17:02):
having a pregnancy in twenty twenty three or you know,
versus in nineteen ninety six kind of a little different, right,
Like we were just starting to scratch a service talking
about stuff like barely right, you know, when you and
I were having kids. So they have a little more information,
but in general, they're not in reality. And what I
try to do for them is not burst their bubble,
(17:24):
but make sure that again they have information and they
feel resourced and they know that I'm a safe person
to come to, that our practice is there for them,
and leading up to the post, leading up to the birth,
like as they're starting to get anxious, and reassuring them like, look,
some of it's going to really fucking suck, and who
are your people? Who are the people that you're tapping,
because you need to have that in advance. So my
(17:46):
patients who come into the pregnancy with mood disorders already
in a lot of ways, they are in better shape
because we know they're to increase risk, and so we
have a plan set up. Okay, the psychiatrist is on board.
This is the meds. These are the point people, this
is what the partner's doing. You know, we have a
check in plan that's very different than maybe the rest
(18:07):
of the patients because the reality is you may know
that like for a lot of people who have a baby,
they don't even see anybody again for six weeks, which
is insane. They don't do it like this in other
countries or other cultures. I want to pivot to menopause,
(18:29):
specifically the time leading up to menopause, perimenopause, which you've
gotten on record saying that you what you want to
do away with that term. Tell me why? Well, I mean,
here's the thing. I think initially it was a wonderful
term because it gave people an understanding that it's not
just like boom menopause, but that there is a period
(18:52):
of time that could last up to a decade of
changes in your body, and that they're real. It's not
you're not being crazy, you're not being difficult, you're not
making it up. Because your labs are quote normal and
you still have a regular cycle. There is something going
on in your body. So I think naming it and
again giving information was helpful, but turning it into a
diagnosis that you need to balance, balance your hormones. That
(19:15):
makes me nuts because it's pathologizing something that is not
a pathology. As I mentioned earlier, this is a developmental
physiologic event, puberty of midlife. I would much rather people
understand there's going to be a process. Your whole life
is a process. Your cycle is a process. And what
are the things that they can do to be healthy,
maintain their health, sustain their health and feel their best
(19:37):
self as much as possible. How do you know you're
in menopause? Menopause itself is one day of your life.
Menopause is the cessation of cycles, so in a person
who has a uterus, and this is important. When you
hit twelve months consecutively without a period between the ages
of forty five and fifty five ish, that's menopause. And
the menopause is one day. Perimenopause is the time leading
(20:00):
up to it. It could be three years of noticeable
changes for you. It could be twelve years. Everything from
your period quality changing closer together, heavier skipping, sleep changes,
fatigue changes, intense PMS symptoms. I see a lot of anxiety, yes,
dry vagina, urinary tract infections, anxiety and panic that comes
(20:22):
out of the blue, you know, on and on and on.
How do we not turn this into a death sentence? Though? Like,
how do we sort of not be filled with dread?
There's got to be another way to sort of frame
this or revere it. I don't know. Maybe I'm living
in the clouds. I don't think you are. I think
(20:42):
it's tough because the lead up to it is really
sounds really unpleasant when we list out, you know, the
thirty four symptoms of menopause or whatever the hell is
you know online, and then you compound it with this
cultural narrative, which is that we are used up and
irrelevant and dried up and no longer wanted. But what
I really want people to understand is that the reality
(21:04):
is that for people who go through it in a
community of other women who are sharing advice and support
and have tools that are useful and beneficial and validated,
it's a completely different experience, just like any other experience
we go through with loved ones and with our girlfriends. Honestly,
we get through it. We get through the breakups, we
get through the job losses, we get through the changes
(21:25):
in our lives. We get through the pregnancies, the lack
of pregnancies. And when we get to the other side,
here's the awesome thing. There's this incredible liberation. There's this
unleashing of creativity, of recognition of our own power and agency.
And I will tell you that I feel fucking great. Man.
(21:46):
I'm in a great relationship. My sex life is awesome. Sorry, TMI,
because I do things to make that work. I have
a book that I published in my mid to late fifties.
I'm going to be fifty eight in February. I'm I'm
living my best life. I'm great. Do you have any
tips for helping with the side effects I have just metopause?
Oh my gosh, Yes, I mean I have. And the
(22:08):
book covers not everything, but it covers a lot of
different categories. So all the lifestyle stuff, whether it's really
digging into your sleep, like your sleep honestly is the
most important thing you have to recover your sleep and
protect your sleep. Exercise, movement, fitness. If you're doing it already, fantastic.
If you're not doing it, even better, you have something
you can do. You know, how you eat, when you eat,
(22:29):
stress management, meditation, stillness. Honestly, a lot of that stuff
is the most potent medicine that will sustain you through
not only that process, but the rest of your life.
Making sure you're looking at your overall general health because
we know as women, our hearts and our brains are
going to decline as we get older if we're not
paying attention to not only our exercise and our lifestyle
(22:51):
and our stress. Alcohol use, hormones, are they right for you?
And then specific herbs that have decent data. Never going
to compare it to pharmaceutical data. That's not happening, Let's
be honest. But there is data to support some supplement use.
And then hormone therapy, which can be magical for the
right person and have many many benefits. There's a lot
(23:13):
of talk about hormones, Yes, I mean, what is your
thought on I had a doctor who said, you know what,
why don't we just help you over the edge so
that you're not just plummeting off the off the cliff.
And I got to tell you it's been amazing. I mean,
there's a lot of talk about you, hormone testing and
hormone therapy. Do you have a strong opinion about it?
(23:36):
I have a strong opinion that, like with everything else,
as long as you're educated and you're getting supported, that
might be the right decision for you. I am definitely
in the camp that says hormones should be part of
the toolkit for a lot of people. There are probably
some people that can't use it, people who have already
had a blood clot What about hormone testing for non
(23:58):
menopausal women. One testing is hogwash. There's no data to
support it. And for people. First of all, I just
told you the definition of menopause, so it's a clinical diagnosis.
I will say if you, let's say you've had a
hysterectomy or then that's a person that maybe we do
hormone testing on. But to be honest, we're not treating
(24:19):
those numbers, unlike blood sugar or thyroid, where we know
there's a narrow range you have to be between here
and here. Like I said, menopause is not a disease.
We don't know. Oh, when your estrogen falls below here,
that's when you have a hot flash on your progesterones.
There you feel like you're want to kill your family.
So we're not treating numbers. We're treating you. So doctors
(24:40):
and practitioners who are doing tons and tons of tests
and bringing you back all the time and charging you
for this. That's a business model that's not evidence based.
I'm not saying I never test hormones, because I do,
but I use my brain and I individualize it. So
I'm not against hormone testing, but the idea that you
should be tes leading up. It's not going to do
(25:01):
anything for you. We're going to treat your symptoms. You're
having hot flashes, you can't sleep, estrogen you know more.
It's a little more complicated than this because you need
progesterone as well to protect your users, but also because
progesterone can help with mood, can help with sleep, so
there's so much benefit. And that's just for symptoms. The
(25:22):
reality is that the data is very very clear that
osteoporosis prevention is a thing. We can decrease the risk
of bone loss and fractures if we start hormone therapy
within ten years of menopause before the age of sixty.
The information on dementia risk and heart disease is also
(25:45):
starting to really be more and more robust. I'm a
believer that for the right person, it is appropriate to
start you on hormone therapy early and close to the
time of menopause, even before if you need it for symptoms,
because I think we're going to decrease your risk of
heart disease, which is the number one killer of women,
not breast cancer, even breast cancer survivors. The number one
(26:07):
killer of breast cancer survivors because most of us are
early stage, is heart disease. But also, women haven't really
been taught to know this stuff. Are there any health
conditions that we as women should look for? Oh? Yeah, well,
like I said, and this is where it is so
important for the younger members of the audience to understand
that your health, just like your health going into a
(26:30):
pregnancy is going to really affect the pregnancy and beyond,
your health going into menopause is going to affect your
menopause and beyond. So when we hit menopause, our hormone
levels decline and we start seeing a big bump in
metabolic disorders, so diabetes, pre diabetes, high cholesterol, all of
these inflammatory issues that are all going to contribute to
(26:52):
heart disease and to dimension Alzheimer's. Women are two to
three times more likely to have Alzheimer's than men in
the same age group. So this is why lifestyle, family history,
risk factors are really important to understand and to advocate
for yourself, because if you look at men in the
same age group, they're getting their cardiac evaluations and are
(27:15):
we That's another thing you need to go in and
ask your doctor about. If you're fifty and you haven't
had a deep dive into your cholesterol and other things,
you need to ask your doctor about that. And if
you have a male partner and they've been tested, why
haven't you. I left my doctor because of this. By
the way, so fascinating and this is twenty twenty whatever
(27:35):
when it was, But that's a point. It feels like
we've come a long way, but we have a long time.
We have to take responsibility for ourselves. That's why a
podcast like this is so important. Well, I think you're
bringing it. You're bringing it into a place where we
are a community and can discuss it. And there is
(27:56):
safety in numbers. And I'm adamant in my life about
owning and being so happy about my age. Why do
you think aging is a positive thing? Oh my gosh,
Like I mentioned to me, I know myself so much better.
One of the big grief moments that I see for
(28:18):
women is this loss of the period, Like we feel
so identified with our cycle because we spend so many
decades in it, avoiding it, managing it, whatever. And then
it's like, who are we without a cycle? And guess
what I really like? Who I am without a cycle?
It turns out I was affected by my hormones and
ways that I didn't even really realize. And I feel
just more steady, I feel more like myself. I feel
(28:40):
more calm. I'm like a pretty intense person, so I'm
not as emotional in a way that bothers me. And
I'm just like, like I said, I'm super creative, Like
I'm digging into that creativity in a whole new way.
It has been ah amazing. That was doctor Suzanne Gilberg Lenz.
(29:06):
If you liked our conversation, go pick up a copy
of our book, Menopause boot Camp. That's it for us today.
Talk to you next week now. What with Burke Shields
is a production of iHeartRadio. Our lead producer and wonderful
showrunner is Julia Weaver. Additional research and editing by Darby
(29:27):
Masters and Abu Zafar. Our executive producer is Christina Everett.
The show is mixed by Vahid Fraser
What do you do when life doesn't go according to
plan that moment you lose a job, or a loved one,
or even a piece of yourself. I'm Brookshields and this
is now What, a podcast about pivotal moments as told
by people who lived them. Each week, I sit down
with a guest to talk about the times they were
knocked off course and what they did to move forward.
(00:27):
Some stories are funny, others are gut wrenching, but all
are unapologetically human and remind us that every success and
every setback is accompanied by a choice, and that choice
answers one question, now what. I just was looking at
(00:51):
the what to expect when you're expecting books, but I
was looking at the journey of them. Yeah, the drawing,
yeah yeah, yeah yeah, it's unabelievable. I'm writing about all this,
and so it's just it's so fascinating to me because
I was like, look, how miserable this person looks, Yeah,
rocking chair with like sensible shoes. I'm like, what is happening?
(01:14):
But you know they have no concept also of the
mental health struggles and so rough, your nipples hurt, you
can't poop, you haven't slept, you feel disgusting. You're sweaty.
Did you shower this week? I mean, nothing works. You're
so freaking tired, you want to die, and you're supposed
to keep another human alive. I mean that is a
(01:34):
disaster area. And I had everything going for me, so
I don't even know how people do it. My guest
today is doctor Susanne Gilberg Lens. Doctor Suzanne is a gynecologist,
a woman's health expert and advocate, and an authority on
one of the biggest now what moments in many of
(01:57):
our lives, menopause. She literally wrote the book on it
and created a program called Menopause boot Camp to help
women better understand the transition. She worked with women of
all ages for more than two decades, and I reached
out to her because I wanted to talk about what
she's observed during that time and how all of us,
(02:19):
regardless of our age, can be better advocates for our
physical and mental health. I'm thrill that she agreed to
do this show, and I'm grateful to be able to
share her wisdom with you all. Here is doctor Susanne
Gilberg Lenz. Hi, there, it is so nice to meet too. Oh,
(02:42):
thank you so much. It's such an honor for me.
It's so important, and I love having these conversations. Thank you,
Thank you for having me on. I've been wanting to
do an episode just that is focused on women's health
for a while now. I mean, I've talked about my
own health issues and STRUG in my books, but something
that struck me in preparing for this interview was the
(03:04):
general lack of knowledge on women's health. Why do you
think it's remained practically taboo. I'm going to use this
word because the patriarchy and menopause specifically, is I like
to say, is you know, misogyny and agism had a
baby and they called it menopause. You know, I'm full
(03:24):
of these little aphorisms, but I will tell you that
during medical school, I came in thinking I was interested
in women's health, and I really tried to convince myself
otherwise because I felt like obstetrics was probably going to
be hard, and I was right, But I couldn't convince
myself otherwise. So why did I love it? I loved
(03:44):
the opportunity to get to know people over the course
of their lives. I loved development and physiology and normal
stuff and how to help people through these transitions in
these crisis. Yes, I love medicine. I love the operating
room I get to operate, and delivering babies has been magical.
Why do I think we don't know about it? I
think that the way our medical training system grew up,
(04:08):
it grew up in an era where women were like
considered other small men with ovaries. I don't know, like
they just women are not thought of as our own entity.
And you know, we have some magical powers, or appear
to because they are mysterious. They are scary rather than
(04:30):
being seen for what they are, which is like an
amazing gift, just like men have amazing gifts. Human beings
have amazing gifts whatever their gender is. But physiologically we
are able to carry babies and deliver them out into
the world and keep them fed yep, and keep them alive.
And in keeping with what we're talking about, society itself
(04:53):
has normalized female pain. Oh yeah, they don't tell us
that you know IVF will pain or do you know
gynecological procedures could be painful? That all of these things happen?
You know? So how do you how do you with
your patients approach like pain? And discomfort in your own practice.
How do you talk about such a good question? And
(05:14):
I will tell you that it is definitely one of
the questions of the moments right now on social media,
such an interesting and complicated thing, because I will say
that I also feel that there's been sort of this
uh celebration of pain around birth, as if it's some
kind of badge of honor, like as if growing that
fetus and you know, birthing a baby isn't enough. And
(05:35):
I'm not saying that nature isn't a miracle, and I'm
not saying that physiologic, unmedicated birth isn't an option for
a person who wants it. And I support people's desires
to do things the way they want while understanding that
they don't really always know what's going to happen. I mean,
that's part of the beauty of birth, by the way,
is that the surrender into it, right, you don't know
what's going to happen, forget it, and you forget it, well, yes,
(05:57):
if you're lucky. So having said that, I think there's
a weird dichotomy there. I got to tell you to me,
this idea that women don't experience pain when they're having
a biopsy, when they're having an IUD and inter uterine
device placed into their uters. Whatever it is that we're
doing is so cruel and weird. So what I always
discuss with my patients, I do it differently. I've learned
(06:19):
over the years. I learn from my patients. I tell them, Okay,
here's the thing that we need to do, where you
want to do, and here are the options. Pain management
is always an option in my office. We use either nitronox,
which is like nitrosoxide, like old school dentist stuff. We
can do a cervical block, which, by the way, in
and of itself, the injection to the cervix is unpleasant.
(06:40):
We can use sedation, whether they take adavan orally by
mouth and have a ride. I find that when I
talk to the patients in advance, and I always do,
and I advise them here are your options, that right
there makes all the difference because they feel heard and
they feel that they're in a space that is going
to respect what their needs may be. You've given them
(07:00):
a choice, which gives them a certain amount of power.
And I think some of what I've experienced gynecologically, I
was never informed about anything that was happening. So I
didn't know about HPV and I had to have this
extensive cone biopsy. I was never told what that was
(07:21):
going to feel like. A It was a man, a
great doctor, great surgeon, but I don't know if a
female would have done it that aggressively. Yes, he got
all the cancer, but by the same token, it made
it impossible for me to get pregnant. Yeah, naturally, I
think some of that. I want to be careful about
(07:43):
some of this because this is your experience, and I
think the experience you named it, you didn't have information.
I mean, you didn't really have information in a conversation.
And I have to say over the years that I've
seen just as many female physicians perpetrate that as male physicians.
Some of it's generational, some of it's generational. Some of
(08:03):
it is also just how open you are and how
curious you are as a physician. I think you know,
the medical training system is very toxic and very military,
by the way, and so it can breed a lot
of fear based decision making and a lot of what
looks on the outside like egotistical kind of authoritarian behavior
(08:24):
on the part of the physician. You got to understand
that we grow up in a system that rewards that,
and that also asks us not to question. I've been
I've had a reputation, let's say, over the course of
my career, because I want to do the right thing,
and I think nobody could ever point a finger and
say that I don't take great care of my patients
or that my outcomes are not fantastic. But I question things.
(08:45):
So I think if you look at like the generation
of the physician, there's a lot of things I think
if we don't have what's called I just came back.
This is tangential, but not I just came back from
an incredible experience at a place called MEA, the Modern
Elder Academy. It's un believable and one of the things
they talk about it's very similar to the stuff you're
talking about, sort of that new beginning as we get older,
(09:07):
how do we want to be in our in our lives,
in our in the community, in the world. For someone
like me, having a growth mindset has been the key.
It's why I was able to ask these questions. It's
why I was able to change course based on my
training around pain management versus what I do today. It's
why I was able to say menopause, Well, this is
(09:27):
really important. We're not learning about it as physicians. We're
not supporting our patients through the process. How can we
do things different? When is it time to start bringing
the alarm bell like pertaining to pain, what do you
say to your I think again, this is why the
discussion ahead of time is so important. And so I'm
so glad we're having this conversation because one of the
things that people can do at any age is if
(09:49):
their doctor's not bringing it up, come with questions. You
know what, be the annoying person whatever. You're the person
who's receiving care. If they don't like it, maybe that's
not the right environment for you. If I'm doing something
with a patient and they can't tolerate it, I'm not
pushing through. They can come back. We don't have to
do this today. And when people are anxious, by the way,
their pain threshold is much lower. So again, if they
(10:12):
don't feel safe and they don't feel listened to, it's
going to make your job as a physician harder. So
it's I think unfortunately. I want your listeners to know
that their physician may not ask the questions. You come
with questions prepared. I have in my menopause, Balo Camp,
I have like two pages of like advocacy questions, not
(10:33):
to be an a whole and confrontational, but to come
in and be like, hey, I need to take care
of myself. How are we going to work together as
a team. I call this show now What because it's
really about those times in your personal or professional life
that surprise you and shape you. What's a now what
(10:56):
moment that shaped your work as a physician? Oh wow,
Oh well, there's so many, and I think it depends
on the person. I'm going to share a couple of
personal things about myself that really changed the way I
perceived things in the way I practiced medicine. I had
my older child, my son, who will be twenty six
in October, Jaron, while I was the beginning of my
(11:18):
second year of obg Way in residency. That was pretty brutal,
and I was young and thought and I've been, you know,
doing OB and watching this very high pressured environment in
which I was training, and I thought to myself, Wow,
there's a lot of medical interventions going on here. As
is nineteen ninety seven, I don't think I we need
(11:39):
all that, and I like on the down low. Brook
took a Bradley Method natural childbirth course. Okay, nobody in
the class knew I was an OBIE resident. It was
a little extreme, but I was like, I'm going to
take what I like and leave the rest. I came
in and my labor was going super fast. And despite that,
my doctor did all this stuff. She broke my water,
(12:00):
she gave me pitocin, all these things. My husband, I
didn't know till later, was in the corner trying to advocate, like,
do you really need to do that. I know Susanna
doesn't really want you to do that. Do you need
to do that? I didn't need any of that stuff,
And it stole my confidence book, and I said to myself,
I don't think any of that needed to happen, and
I'm never going to do that to another person. I'm
never going to do that to a patient. Nothing quote
(12:22):
bad happened. I was fine, he was fine. You know,
I'm not crying. I'm just saying it changed my life.
Then later one of my mentors, who's an internationally renowned
breast cancer oncologist, she started sending me patients and she
started sending me a lot of her young breast cancer
(12:43):
patients and they were rendered menopausal in their thirties. And
I was like, Filhelmina, I don't know how to treat this.
She's like, well, you'll figure it out. And this is
when I realized I didn't understand menopause and I hadn't learned.
And I taught and taught and taught myself and went
to conferences and read and worked together with them as
a team and really helped understand how to restore their
sense of self, how to feel confident in their body again,
(13:05):
how to regain their sexuality. Some of them ended up
getting pregnant after their chemo was done. It was like,
really miraculous. And I became kind of known as this
pre menopausal breast cancer gynecologist. And then I got breast
cancer in my forties, and I was a pre menopausal
breast cancer patient. So all of these things added up
to reminding me I'm one of you, you're one of me.
(13:30):
I was always very open with my patients about my
own struggles and what I was learning. I had a
deeper and a wider toolkit because I was doing Iraveda
and I was doing herbs, and I was doing holistic medicine,
but also I believed in radiation and surgery, and I
did it. And I also saw acutely how ignored so
(13:51):
many of our quote issues were, and I just it.
Really every step along the way was an AHA for
me because I said to myself, Okay, so I've learned
all these tools, and some of these things actually don't
make sense. Shifting to a more biological now what question,
what are some of the biological timelines that young women
(14:13):
really need to just be cognizant of. And then the
expense of fertility. Yeah, it's costly emotionally, physically, and financially.
I mean, I think the problem with some of this
is that some of the data around fertility changes is
old and it gets get called into question. But the
reality is that we know that there is a pretty
(14:34):
big drop off in live births resulting from pregnancies after
the age of thirty five. So that doesn't mean that
if you're thirty eight you should go into a panic.
You know, I have patients getting pregnant in their early
forties all the time. I think, if you think you
want to have kids, i'd say in you know, your
early thirties, you should start thinking about what is the
(14:55):
plan there, because maybe you're not ready for a number
of reasons to have kids, But I think that's the
time to start talking to your The issue is that
the testing that we have available is indirect, and it's
I don't want I don't think people should be like
living or dying by the blood tests, like specifically the
anti malarian hormone which has become very popular. That test
has really been developed in order to look at who's
(15:16):
going to be a good responder to in vitro fertilization.
You know, at least have a conversation so that you
know what your options are, whether you have the available
resources to do egg freezing, which by the way, is
not a guarantee at all, or if you say to yourself,
maybe we shouldn't, you know, put this off another five years.
(15:37):
If we really want to have a family, we might
have to pull the trigger or just be okay with
the consequences. The conversation I have with my patients is
that what consequences are you okay with? Including testing? Because
if we're going to do the test and it's just
going to freak you out, but you're not going to act.
I don't know that I want to do this test
on you. What about new parents, Oh my gosh, given
any kind of an instruction manual, you know, they have
(15:59):
no concept. Also of the mental health struggles, it's so rough.
I remember having a moment with my first and I
was thirty thirty thirty one with a really supportive partner
at the time, and I remember having a night where
I was like, I understand why a teenage mom would
leave this baby in a trash gown. Okay, And I
(16:19):
just want you to know that I love that, I
love this baby so much and I could not. I
was done. Your nipples hurt, you can't poop, you haven't slept,
you feel disgusting, you're sweaty. Did you shower this week?
I mean, nothing works. You're so freaking tired, you want
to die, and you're supposed to keep another human alive.
(16:41):
I mean, that is a disaster area. And I had
everything going for me, So I don't even know how
people do it. So do you tell your patients that
without trying to detern them from what I tell them
is Because here's the thing, especially with the first one,
they're in such a cloud and they're so excited. Some
of them are nervous, by the way, and I think
(17:02):
having a pregnancy in twenty twenty three or you know,
versus in nineteen ninety six kind of a little different, right,
Like we were just starting to scratch a service talking
about stuff like barely right, you know, when you and
I were having kids. So they have a little more information,
but in general, they're not in reality. And what I
try to do for them is not burst their bubble,
(17:24):
but make sure that again they have information and they
feel resourced and they know that I'm a safe person
to come to, that our practice is there for them,
and leading up to the post, leading up to the birth,
like as they're starting to get anxious, and reassuring them like, look,
some of it's going to really fucking suck, and who
are your people? Who are the people that you're tapping,
because you need to have that in advance. So my
(17:46):
patients who come into the pregnancy with mood disorders already
in a lot of ways, they are in better shape
because we know they're to increase risk, and so we
have a plan set up. Okay, the psychiatrist is on board.
This is the meds. These are the point people, this
is what the partner's doing. You know, we have a
check in plan that's very different than maybe the rest
(18:07):
of the patients because the reality is you may know
that like for a lot of people who have a baby,
they don't even see anybody again for six weeks, which
is insane. They don't do it like this in other
countries or other cultures. I want to pivot to menopause,
(18:29):
specifically the time leading up to menopause, perimenopause, which you've
gotten on record saying that you what you want to
do away with that term. Tell me why? Well, I mean,
here's the thing. I think initially it was a wonderful
term because it gave people an understanding that it's not
just like boom menopause, but that there is a period
(18:52):
of time that could last up to a decade of
changes in your body, and that they're real. It's not
you're not being crazy, you're not being difficult, you're not
making it up. Because your labs are quote normal and
you still have a regular cycle. There is something going
on in your body. So I think naming it and
again giving information was helpful, but turning it into a
diagnosis that you need to balance, balance your hormones. That
(19:15):
makes me nuts because it's pathologizing something that is not
a pathology. As I mentioned earlier, this is a developmental
physiologic event, puberty of midlife. I would much rather people
understand there's going to be a process. Your whole life
is a process. Your cycle is a process. And what
are the things that they can do to be healthy,
maintain their health, sustain their health and feel their best
(19:37):
self as much as possible. How do you know you're
in menopause? Menopause itself is one day of your life.
Menopause is the cessation of cycles, so in a person
who has a uterus, and this is important. When you
hit twelve months consecutively without a period between the ages
of forty five and fifty five ish, that's menopause. And
the menopause is one day. Perimenopause is the time leading
(20:00):
up to it. It could be three years of noticeable
changes for you. It could be twelve years. Everything from
your period quality changing closer together, heavier skipping, sleep changes,
fatigue changes, intense PMS symptoms. I see a lot of anxiety, yes,
dry vagina, urinary tract infections, anxiety and panic that comes
(20:22):
out of the blue, you know, on and on and on.
How do we not turn this into a death sentence? Though? Like,
how do we sort of not be filled with dread?
There's got to be another way to sort of frame
this or revere it. I don't know. Maybe I'm living
in the clouds. I don't think you are. I think
(20:42):
it's tough because the lead up to it is really
sounds really unpleasant when we list out, you know, the
thirty four symptoms of menopause or whatever the hell is
you know online, and then you compound it with this
cultural narrative, which is that we are used up and
irrelevant and dried up and no longer wanted. But what
I really want people to understand is that the reality
(21:04):
is that for people who go through it in a
community of other women who are sharing advice and support
and have tools that are useful and beneficial and validated,
it's a completely different experience, just like any other experience
we go through with loved ones and with our girlfriends. Honestly,
we get through it. We get through the breakups, we
get through the job losses, we get through the changes
(21:25):
in our lives. We get through the pregnancies, the lack
of pregnancies. And when we get to the other side,
here's the awesome thing. There's this incredible liberation. There's this
unleashing of creativity, of recognition of our own power and agency.
And I will tell you that I feel fucking great. Man.
(21:46):
I'm in a great relationship. My sex life is awesome. Sorry, TMI,
because I do things to make that work. I have
a book that I published in my mid to late fifties.
I'm going to be fifty eight in February. I'm I'm
living my best life. I'm great. Do you have any
tips for helping with the side effects I have just metopause?
Oh my gosh, Yes, I mean I have. And the
(22:08):
book covers not everything, but it covers a lot of
different categories. So all the lifestyle stuff, whether it's really
digging into your sleep, like your sleep honestly is the
most important thing you have to recover your sleep and
protect your sleep. Exercise, movement, fitness. If you're doing it already, fantastic.
If you're not doing it, even better, you have something
you can do. You know, how you eat, when you eat,
(22:29):
stress management, meditation, stillness. Honestly, a lot of that stuff
is the most potent medicine that will sustain you through
not only that process, but the rest of your life.
Making sure you're looking at your overall general health because
we know as women, our hearts and our brains are
going to decline as we get older if we're not
paying attention to not only our exercise and our lifestyle
(22:51):
and our stress. Alcohol use, hormones, are they right for you?
And then specific herbs that have decent data. Never going
to compare it to pharmaceutical data. That's not happening, Let's
be honest. But there is data to support some supplement use.
And then hormone therapy, which can be magical for the
right person and have many many benefits. There's a lot
(23:13):
of talk about hormones, Yes, I mean, what is your
thought on I had a doctor who said, you know what,
why don't we just help you over the edge so
that you're not just plummeting off the off the cliff.
And I got to tell you it's been amazing. I mean,
there's a lot of talk about you, hormone testing and
hormone therapy. Do you have a strong opinion about it?
(23:36):
I have a strong opinion that, like with everything else,
as long as you're educated and you're getting supported, that
might be the right decision for you. I am definitely
in the camp that says hormones should be part of
the toolkit for a lot of people. There are probably
some people that can't use it, people who have already
had a blood clot What about hormone testing for non
(23:58):
menopausal women. One testing is hogwash. There's no data to
support it. And for people. First of all, I just
told you the definition of menopause, so it's a clinical diagnosis.
I will say if you, let's say you've had a
hysterectomy or then that's a person that maybe we do
hormone testing on. But to be honest, we're not treating
(24:19):
those numbers, unlike blood sugar or thyroid, where we know
there's a narrow range you have to be between here
and here. Like I said, menopause is not a disease.
We don't know. Oh, when your estrogen falls below here,
that's when you have a hot flash on your progesterones.
There you feel like you're want to kill your family.
So we're not treating numbers. We're treating you. So doctors
(24:40):
and practitioners who are doing tons and tons of tests
and bringing you back all the time and charging you
for this. That's a business model that's not evidence based.
I'm not saying I never test hormones, because I do,
but I use my brain and I individualize it. So
I'm not against hormone testing, but the idea that you
should be tes leading up. It's not going to do
(25:01):
anything for you. We're going to treat your symptoms. You're
having hot flashes, you can't sleep, estrogen you know more.
It's a little more complicated than this because you need
progesterone as well to protect your users, but also because
progesterone can help with mood, can help with sleep, so
there's so much benefit. And that's just for symptoms. The
(25:22):
reality is that the data is very very clear that
osteoporosis prevention is a thing. We can decrease the risk
of bone loss and fractures if we start hormone therapy
within ten years of menopause before the age of sixty.
The information on dementia risk and heart disease is also
(25:45):
starting to really be more and more robust. I'm a
believer that for the right person, it is appropriate to
start you on hormone therapy early and close to the
time of menopause, even before if you need it for symptoms,
because I think we're going to decrease your risk of
heart disease, which is the number one killer of women,
not breast cancer, even breast cancer survivors. The number one
(26:07):
killer of breast cancer survivors because most of us are
early stage, is heart disease. But also, women haven't really
been taught to know this stuff. Are there any health
conditions that we as women should look for? Oh? Yeah, well,
like I said, and this is where it is so
important for the younger members of the audience to understand
that your health, just like your health going into a
(26:30):
pregnancy is going to really affect the pregnancy and beyond,
your health going into menopause is going to affect your
menopause and beyond. So when we hit menopause, our hormone
levels decline and we start seeing a big bump in
metabolic disorders, so diabetes, pre diabetes, high cholesterol, all of
these inflammatory issues that are all going to contribute to
(26:52):
heart disease and to dimension Alzheimer's. Women are two to
three times more likely to have Alzheimer's than men in
the same age group. So this is why lifestyle, family history,
risk factors are really important to understand and to advocate
for yourself, because if you look at men in the
same age group, they're getting their cardiac evaluations and are
(27:15):
we That's another thing you need to go in and
ask your doctor about. If you're fifty and you haven't
had a deep dive into your cholesterol and other things,
you need to ask your doctor about that. And if
you have a male partner and they've been tested, why
haven't you. I left my doctor because of this. By
the way, so fascinating and this is twenty twenty whatever
(27:35):
when it was, But that's a point. It feels like
we've come a long way, but we have a long time.
We have to take responsibility for ourselves. That's why a
podcast like this is so important. Well, I think you're
bringing it. You're bringing it into a place where we
are a community and can discuss it. And there is
(27:56):
safety in numbers. And I'm adamant in my life about
owning and being so happy about my age. Why do
you think aging is a positive thing? Oh my gosh,
Like I mentioned to me, I know myself so much better.
One of the big grief moments that I see for
(28:18):
women is this loss of the period, Like we feel
so identified with our cycle because we spend so many
decades in it, avoiding it, managing it, whatever. And then
it's like, who are we without a cycle? And guess
what I really like? Who I am without a cycle?
It turns out I was affected by my hormones and
ways that I didn't even really realize. And I feel
just more steady, I feel more like myself. I feel
(28:40):
more calm. I'm like a pretty intense person, so I'm
not as emotional in a way that bothers me. And
I'm just like, like I said, I'm super creative, Like
I'm digging into that creativity in a whole new way.
It has been ah amazing. That was doctor Suzanne Gilberg Lenz.
(29:06):
If you liked our conversation, go pick up a copy
of our book, Menopause boot Camp. That's it for us today.
Talk to you next week now. What with Burke Shields
is a production of iHeartRadio. Our lead producer and wonderful
showrunner is Julia Weaver. Additional research and editing by Darby
(29:27):
Masters and Abu Zafar. Our executive producer is Christina Everett.
The show is mixed by Vahid Fraser
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