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Women’s sexuality, especially older women’s, is often overlooked or dismissed by the medical system. When men get procedures that may impact their erections, they’re informed. When women get treatments that may affect their ability to have an orgasm? Crickets. Too few women’s doctors talk about women’s sexual satisfaction, including how well their clitoris is responding or if they’re having orgasms. That’s got to change. It’s normal to want to be sexual and experience sexual pleasure throughout your life. We don’t question it for men. We shouldn’t for women either. This week we dig into all of that and more (including how it’s high time to change how menopause itself is defined) with sexual medicine and menopause expert Dr. Lauren Streicher. 

Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, and the current Medical Advisor at Midi Health Care. She is a certified menopause practitioner of The Menopause Society (formerly NAMS), the host of Dr. Streicher’s Inside Information: THE Menopause Podcast, and the author of four best-selling books on women’s health, as well as the upcoming title, Put the O Back in Mojo, available for pre-order now. You can learn more about her and her work at www.drstreicher.com

Resources

Dr. Streicher’s Inside Information: THE Menopause Podcast here

Hit Play Not Pause: Sex Solutions with Dr. Lauren Streicher here

Menopause editorial: Is it time to rethink how menopause is defined? here

The State of the Union on Sex after 60 Kinsey Institute Survey with Cosmopolitan here

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From being burned as witches to being barred from attending medical school, from being dismissed as hysterical to well, just being dismissed, from being shamed to being sexualized, the medical system has a long, sordid history in how it treats women and women’s health. And those toxic roots still poison the waters we have to navigate to this day. If you’ve ever wondered why we’re so far off the back with regards to our understanding of women’s health and wellness and treatment, this week’s guest Dr. Elizabeth Comen, author of All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today has some answers. Prepare to have your head explode as we dig into it in this episode.

Elizabeth Comen, MD, has dedicated her medical career to saving the lives of women. An award-winning, internationally sought-after clinician and physician-scientist, Dr. Comen works as a medical oncologist with a specialty in breast cancer at Memorial Sloan Kettering Cancer Center and is an assistant professor of medicine at Weill Cornell Medical College. She earned her BA in the history of science from Harvard College and her MD from Harvard Medical School, then completed her residency in Internal Medicine at Mount Sinai Hospital and her fellowship in oncology at Memorial Sloan Kettering Cancer Center. She lives in New York City with her family. You can learn more about her and her work and buy her book at www.drelizabethcomen.com

Resources

All in Her Head at Amazon

Cover photo credit: Deborah Feingold Photography

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We wrap up heart health awareness month with one topic that comes up a whole lot in our community–cholesterol. We hear from scores of athletic, active women who have had perfectly fine lipid levels their whole lives only to see them shoot up, often dramatically, at menopause. If you’re one, you’re not alone. This week we take a deep dive into all things lipids, including what they are, what influences them, and what to do about them, with cardiologist and lipid and women’s health specialist Dr. Samia Mora. 

Samia Mora, MD, MHS, is a cardiologist and molecular epidemiologist conducting translational research in the prevention of cardiometabolic disease, with a focus on lipid and inflammatory mechanisms of cardiovascular disease. She is the Director of the Center for Lipid Metabolomics and Director of the Biorepository, Divisions of Preventive and Cardiovascular Medicine at the Brigham and Women's Hospital. Dr. Mora is also a Professor of Medicine at Harvard Medical School. You can learn more about her and her work at Brigham and Women’s Hospital. 

Resources

Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? here

NAMS 2022 Hormone Therapy Position Statement here

7 Countries Study here

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For years, hot flashes and night sweats (aka vasomotor symptoms) were considered just a “bothersome” part of being a menopausal woman: we were to wear layers, buy a fan, and soldier on. Then researchers started making some troubling connections between vasomotor symptoms and chronic disease. This week’s guest, Dr. Rebecca Thurston, is one of those investigators whose work shows that women with severe and/or persistent vasomotor symptoms have an increased risk for cardiovascular disease and changes in the brain that are linked to dementia. We dig into those findings and many more during this week’s episode.

Rebecca C. Thurston, PhD, FABMR, FAPS, is recognized nationally as a leader in the field of women’s health, particularly in the areas of menopause, trauma, cardiovascular disease, and brain aging in women. Her innovative research focuses on menopause, cardiovascular disease, and dementia risk in women, three prevalent and inter-related health issues that can have a profound impact on women's lives. She is Pittsburgh Foundation Chair in Women's Health and Dementia and Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science, at the University of Pittsburgh. She also serves as Director of Women's Biobehavioral Health Program at the University of Pittsburgh as well as Cardiovascular Behavioral Medicine Research Training Program at the University of Pittsburgh. You can learn more about her and her work at UPMC.com 

Resources:

Trajectories of Sleep Over Midlife and Incident Cardiovascular Disease Events in the Study of Women’s Health Across the Nation here

Trauma and its implications for women's cardiovascular health during the menopause transition: Lessons from MsHeart/MsBrain and SWAN studies here

Menopausal Vasomotor Symptoms and White Matter Hyperintensities in Midlife Women here

Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN here

Cognitive behavioral therapy for insomnia here

Brief behavioral treatment for insomnia here

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Whether you run, lift, or ride (and especially if you ride), an otherwise great workout can be wrecked by a painful vulva. And lots of issues can crop up during and beyond the menopause transition that can cause pain, discomfort, and even damage to your vulva and vaginal tissues. We address them all this week with Rochelle Bernstein, MD, of Purely Menopause, who focuses her OB/GYN practice on women’s sexual health and menopausal medicine.

Dr. Rochelle Bernstein is an expert in menopausal medicine and women's sexual health, as well as an avid skier, hiker, and mountain biker. She is a member of The Menopause Society and the International Society for the Study of Women's Sexual Health (ISSWSH). She is board certified and is a fellow of the American Congress of OB/Gyn (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL). She established Purely Menopause to empower women with the knowledge, tools, and confidence necessary to lead healthy, happy lives. You can learn more about her and her work at www.purelymenopause.com

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Mirna Valerio, aka the Mirnavator, has never shied away from adversity. As a Black woman in a larger body who is also an ultrarunner, she’s endured her share of harassment and ridicule, both online and in real life. But despite some people trying to put her down, she’s devoted her life to lifting others up, showing those like herself what’s possible, which, for her, includes 11 marathons, 15 50K+ ultras, and a best-selling memoir, A Beautiful Work in Progress. Now, Mirna is facing another challenge we’re all familiar with, perimenopause. This week we talk all about what she’s experiencing, how it’s impacting her running, and what she’s doing to take care of herself through this chapter of her journey.

Mirna Valerio is an ultramarathoner, cyclist, skier, DEI professional, and author of the memoir, A Beautiful Work in Progress. She began running in high school, recommitted to the sport after a health scare in 2008 and started her blog Fatgirlrunning—about her experiences as a plus-sized woman in a world of thinner endurance athletes— while training for her first marathon. Mirna has been featured in the Wall Street Journal, Runner’s World, on NBC Nightly News, CNN, and in the viral documentary short, REI Presents The Mirnavator. She’s written for Women’s Running, Self, Outside, and Runner's World. In 2018 she was chosen as a National Geographic Adventurer of the Year, and since then has appeared on the Kelly Clarkson Show, Access Daily, The Today Show, and Good Morning America. Mirna is one of the Lululemon ambassadors participating in FURTHER, an initiative to show how far women can go when they’re supported with resources and product innovations typically reserved for men. The initiative will culminate in the six-day FURTHER ultramarathon that begins on International Women’s Day, March 8, 2024. You can learn more about her and her work at themirnavator.com

Resources

Learn more about Lululemon’s FURTHER initiative here

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As women who’ve grown up steeped in diet culture, we often give away our agency to books, apps, and strict food rules rather than trusting ourselves to know what to eat and what our bodies need. During menopause, when our bodies are changing, we can doubledown on those rules, making life harder. This week we talk about ditching diets and restrictive rules and using our knowledge and intuition to find food freedom and a whole lot more joy with Intuitive Eating Coach Pam Moore. 

Pam Moore is a journalist and an occupational therapist-turned-award-winning intuitive eating coach. Her writing has appeared in outlets including The Washington Post, Runner's World, SELF, and many others. Also a certified personal trainer, six-time marathoner, and two-time Ironman finisher, Pam is the creator of the Real Nourished newsletter, where she shares evidence-based tips to help women detach their weight from their worth, and the Real Fit podcast, featuring conversations with women athletes about body image, "enoughness", and more. Learn more about her and her work at pam-moore.com.

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As active, athletic women, we know ourselves better than anyone. We know our pace, our power, and our mindset for training and competing. Perimenopause can make all of that change out of the blue. It can rob us of our confidence and knock us off our game, just when we feel like we’re really hitting our stride. Elite cyclist and coach Jill Patterson, 42, lived that reality for months, wondering if she had just “aged out” of her sport before discovering that the muscle and power loss, low motivation, mood swings, fatigue, and sudden aches and pains were in fact perimenopause. This week, we talk about her experience going into the menopause transition and how she got her power, mojo, and competitive edge back.

After graduating college, Jill Patterson moved to Japan to teach English. She ended up staying 10 years, picked up road cycling, and was recruited to race on a Japanese women’s road racing team. After returning to the US 8 years ago, she continued to explore cycling in all forms, including Gran Fondo, criteriums, gravel, mountain bike, and cyclocross. Today she is a full time cycling coach for athletes from all over the world. Jill continues to race and has achieved many notable wins including the 2018 GFNY World Championship, the 2021 Wedu Segment Challenge, and the 2022 and 2023 USA Cycling Gran Fondo National Championship titles. You can learn more about her at @jillpattersoncycling on Instagram and at jillpattersoncycling.com.

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The New York Times recently called Ozempic a “new match for menopausal weight gain”. But is it? These drugs can be a godsend for those who need them. But there's a lot we need to understand. How do they work? How well do they work? Who benefits from them? What are their risks? What impact do they have on muscle, bone, and performance? How do they affect training and racing? We dig into all of that and more this week with endocrinologist and Ironman triathlete Dr. Jody Dushay who has been researching these drugs for more than a decade. 

Jody Dushay, M.D., MMSc, is an endocrinologist at the Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School. She is also the founder and director of Well Powered, a comprehensive wellness and weight management program. Dr Dushay has studied the effect of pharmacotherapies and dietary interventions on body weight for years, including a large single-site study examining the effects of a glucagon-like peptide receptor agonist on body weight in obese women without diabetes. As a triathlete, she has qualified for Kona 3 times and came in 2nd in her age group at the 2020 Ironman World Championship in St George. You can learn more about her and her work at wellpowered.org.

Resources:

Dr. Jody Dushay’s research:

Short-term exenatide treatment leads to significant weight loss in a subset of obese women without diabetes

Weight Loss Outcomes Among Early High Responders to Exenatide Treatment: A Randomized, Placebo Controlled Study in Overweight and Obese Women

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Most women don’t expect menopause symptoms to start until age 50. Neither do many of their healthcare providers. That’s a problem because, as this week’s guest Nina Coslov’s research shows, women can actually start experiencing symptoms associated with menopause during their late reproductive years before their periods become noticeably irregular and they’re officially in perimenopause. Yet when they seek care, they’re often told they’re “too young for menopause” because they still have regular cycles. This week, Coslov talks about her research on the late reproductive stage in a woman’s life as well as womenlivingbetter.org, the organization she started to help women get the menopausal information they need before they’re suffering and not knowing where to turn.

Nina Coslov created Women Living Better (womenlivingbetter.org) to provide anticipatory guidance about perimenopause. Intent on better characterizing the path to menopause, she focuses on education and research, and along with her partners, has published six papers in peer-reviewed journals. Nina was the lead author on “Symptom experience during the late reproductive stage and the menopause transition: observations from the Women Living Better survey,” published in the journal Menopause. She authored the chapter “Women’s Voices: The Lived Experience of the Path to Menopause” in Each Women’s Menopause: An evidenced Based Resource. Nina received the 2021 Media Award from the North American Menopause Society. Prior to Women Living Better, Nina worked in the biotech industry and before that was a management consultant. Nina has an MBA from the Tuck School of Business at Dartmouth and a BA from Williams College. 

Resources

Menopause Journal study https://pubmed.ncbi.nlm.nih.gov/34313615/

Women Living Better Instagram https://www.instagram.com/womenlivingbetter/

Perimenopause care resources: https://womenlivingbetter.org/published-research-health-care-for-perimenopause/

https://womenlivingbetter.org/hormonal-changes/

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Previnex: Get 15% off your order with code HITPLAY at https://www.previnex.com/

Wahoo: Use the code FEISTY2026 to get a free Headwind Smart Fan (value $300) with the purchase of a Wahoo KICKR RUN at https://shorturl.at/WVhdr