EPISODE #988: Menopause Bootcamp: Ditch the BS and Get to Solutions - Dr. Suzanne Gilberg-Lenz

You're listening to the Human Upgrade with Dave Asprey. Today we're going to be talking about something that affects everyone on the planet, whether you thought about it or not. Am I going to talk about the erosion of our soil and what to do about it? No, we're going to be talking about menopause because about a million women every year go through it, and some for way more than one year. And whether it's happening in your household, in your place of work, in your country, on the planet you live on, it affects society. And it's something that seems to be getting worse and something that's always been a problem. So let's go deep on it. In the episode today, there isn't very much taught in medical schools about what happens during that time. It's better now than it used to be, but we just don't have as much research as we would about, oh, I don't know, cholesterol, even though most of that research turns out was sort of maybe a little bit made up and work to sell a lot of drugs. So you're going to learn about how to think about menopause because it's actually not an illness. It's something that happens. And given that I'm building a world full of people who live way past a hundred years old, if you're a follower, you're probably going to spend a meaningful percentage, like maybe more than half of your life postmenopausal, but you're going to go through it at least if you're a woman. Now, our guest is an expert on this who's a doctor for more than two decades. Dr. Suzanne Gilberg Lenz, OBGYN board certified in holistic and integrative medicine. And she focuses on this in her practice. Suzanne, welcome to the show.

Oh, thanks for having me, Dave.

You could have focused on any kind of medicine. You could have been an elbow doctor, you could have been a proctologist. I mean, I don't know why these guys want to look in people's ears like that. Just seems like a weird thing. It's all waxy and hairy in there. Why did you go after menopause and hormones?

Well, I mean, that's a great question. First of all, it evolved. And when I was doing my medical training, I actually started medicine thinking I was going to want to do ob GYN and focus on sort of the lifelong medicine. And I loved the opportunity to both do surgeries, but also practice, like, more medicine. And of course, delivering babies, as hard as it is, is a really Incredible experience. And you know, now in retrospect, with many, many decades behind me, I see that I was. I was much more interested in lifestyle medicine, preventive care, and focusing on health rather than disease. And that's probably ultimately what motivated me to do. To do what I did. So I loved the broad spectrum of opportunities afforded to me by being a gynecologist over time. Really what happened is, I think, two things. I'm always interested in the things that nobody else seemed to be interested in. I'm super curious. And as I aged with my patients, I was following people through their life and wanting to continue to be able to address their needs and, and my own needs selfishly. And as you mentioned, really got almost no formal training in menopause in medical school. I mean, I don't. Granted it was a long time ago that I was in medical school, so I don't remember a lot of things in medical school, but I really don't remember it being discussed very much. Probably it was like one slide. And even in residency focusing on women's health, we got almost no training in it. And there's a lot of data also indicating that people come out of OBGYN residency feeling very, very unprepared to manage and support people through the menopausal transition. So this is not just like my personal experience. It's borne out by the data. And I think the conversation that's now happening culturally around a lot of things, it's a collision of how are we dealing with aging and longevity, how are we dealing with women's bodies? It's such an interesting conversation. So I could go high level for you, I could go micro, but that was where I coming from. And then as I started getting into it and getting my own training and reading and researching and going to places like North American Menopause Society, combining it with my background in herbal medicine and Ayurveda. I have training in Ayurveda, Indian medicine. I just saw the need really opening up. And I saw that people just did not know what to do and then were being falling prey to a lot of bullshit, to be perfectly honest. And I wanted to help people understand and relocate their agency in that process. You said some very interesting things in that intern. Some very important things. This is not a disease. It doesn't need to be bad. Just because something's challenging or hard doesn't mean we can't do it. We just have to have the right tools.

So menopause is like an ice bath?

Yes, yes. We probably need more of ice baths. You know? No, it's really true. Yeah. I mean, I have a very specific perspective based on my own practice and on my own person. Right. I mean, I'm a person who likes challenges. I went to medical school, for God's sake. Like, obviously, I like doing.

You're a masochist by nature.

Crazy. It's pathological. And I'm a surgeon too, so, you know.

Oh, you have an ego then. So an egotistical masochist. All right, this is gonna be a fun interview. I got it.

But I've learned humility a lot, so.

An enlightened surgeon whose ego is smaller than mine. I love that. Good job. Yeah, sorry.

You like that? Okay, good. So far so good. Check.

I'm wondering if part of the problem is that OB GYN as a practice, I mean, we're lumping together female care and childbirth.

It's really hard.

It's a lot the same thing. You'd think they'd be maybe different. And I wouldn't hire an endocrinologist unless I had an endocrine cancer, probably. And even then I probably wouldn't because endocrinologists cause more harm than good on average. There's holistic ones and all that, but they look at everything as a silo. When the whole body is a system and you change this hormone, this one changes. So we have this built in problem where maybe looking at women's care is not about childbirth. And when you lump it all into the same specialty, we have a problem.

Yeah. I mean, and I will, to the credit of the people that I work with in the field, I mean, people are coming in with the best of intentions and trying to apply the knowledge they have the best they can. And, you know, I don't know that we want to like spend the entire. We could do another podcast on medical education for sure. Because all of us feel that there are some issues. And as these fields grow and we understand more and we understand what we don't understand, like, how can you do four years and know everything? But I want to remind you something which, you know, it's. It's the practice of medicine. We don't come out of residency, you know, fully baked. We still have some, some. We got to add some spices and we got to just like anything that you do as a profession, if you're not remaining curious and open, you're not. And humble. You're not doing the right thing for the people that you want to serve, no matter what your intentions are. And then I think that is a lot of where I was coming from with the book and in my training, because I got, I knew I came out, I had this is my tr. And now I have to learn and grow with my patients, as I said. And the tools that I got in residency and medical school, I'm grateful for. But that's not everything. You have to continue to be looking at data even as it evolves. Like stuff that I learned in medical school has changed. I graduated Medical School in 1996. I mean, come on, things have changed.

Yeah, we could barely spell Internet back then.

Correct.

And now Dr. Internet, who has by the way replaced Dr. Google because Dr. Google has been neutered by itself. So you can't really search good medical stuff on Google anymore. It's very hard to find it. So it's changed the practice of medicine. And there's something going on too where just more people are taking control of their own biology, which is the definition of biohacking. So all of a sudden I'm seeing women now. And in my, I've run an anti aging nonprofit group with people three times my age for more than a decade. So compared to 10 or 20 years ago, the number of women who are saying, what the hell, I don't like what's going on during menopause, I'm going to change it. And then they're willing to call a functional doctor. And it works. And to my earlier point about endocrinology or dietitians, there's functional endocrinologists and functional dietitians who listen to the show. But dietitians make hospital meals, guys. That practice is fundamentally broken from an educational perspective until people who are licensed free themselves of it and then their own licensing boards go after them for actually caring for people. So those will get fixed. The job of this show is to find people like you who are working at the wow, here's what's possible and shine a light on it. So we move the average expectations more and more in the right direction because everyone knows it's possible. And around menopause it's like the lowest hanging fruit ever because a lot of women just suffer through it and soak their sheets at night with sweat one night and they're cold the next and it's kind of just.

And they're getting dismissed. Even those of us who are not ignoring those, those issues that are really disruptive to not only our activity of daily living, but our, to our long term health. And I have something very specific to say about that there. Some of those people are, a lot of those people are getting dismissed they're coming in to physicians offices and again, you know, I walk a tightrop. I mean, you kind of just named it. Look, I'm a licensed physician. I believe in a lot of what I do from the conventional standpoint, but I have a bigger toolkit. I feel that restricting myself and restricting you in your interaction with me does not make sense for me. But I have to, you know, work within the system sort of. So having said that, people go to the doctor all the time and hear bullshit. They hear there's nothing you can do. They hear you can't do it. The flavor of the week, this week in my office was people coming in and saying, could you please talk to my other doc? Because he or she is telling me I have to come off my hormones. Oh girl, come on. So that's the new, that's the thing now. Wow.

It's so easy to like if I take my car in to get it worked on and if the mechanic says he can't fix my flat tire, I don't just drive the car with a flat tire, I fire the mechanic and I get a different one.

Well, but people are doing that increasingly. But this is in a very privileged environment. I'm in Beverly Hills, California where people have access and support sophistication and even people who maybe aren't coming from Beverly Hills but come from West Covina, you know, and they figured it out. These are sophisticated users of the system. I forget sometimes, Dave, because I have these conversations all the time, how few conversations are actually happening out there. How many people don't even know that there is a place that they can go to get better information, that there's a place that they can go to individualize their care, that there's a place they can go to have community and not feel isolated. I mean, that's why I started doing menopause boot camps and that's where the book came from. Because what happened was even in my community, I just didn't have enough time to give people what they needed. And I actually started having these boot camps, like four hour experiences where we would go do a deep dive, answer questions. My life partner is a 35 year fitness pro. He's really knowledgeable about movement and nutrition and we did a whole thing and people really, really needed it. And it was so interesting. I thought people were coming for the information and they were, but they were leaving with community. They were leaving not feeling isolated, stigmatized. People didn't want to say the word menopause.

What did they want to say?

Like that time or something, you know, listen, this you got. What direction do you want to go in here, friend? Because this is like, I tell people all the time, this is the misogyny and ageism. Had a baby and called it menopause. This shit is fraught. So I will just tell you, being a woman in West Los Angeles, okay? And I grew up here, so I have a interesting perspective. And I think being a doctor and being, like, in my brain a lot, I've protected myself in some ways. I'm going to get personal here. But the pressure to look a certain way and be a certain way and hide who you really are and hide your power is immense. And people don't even always understand that that's really what's going on. And it's. It speaks to some of the stuff that we know about control and other things, but that isolates us. And then we don't get the information or we get information. That's. How legit is it? I don't know. Is it legit because you're. You have a business based on this and you're, you know, making a lot of cash money, or is it legit because you're really helping somebody? Remains to be seen. So I'm dealing with all of those things and trying to create an environment where people feel safe, where they can get information, and then they can have more of a conversation with themselves. What are their priorities? And then, yes, they can go out and try to locate people who are going to work with them and guide them through this in a much safer fashion. And I mean safer on all levels, Dave. I mean, safer spiritually also, because how we treat aging as a culture and how we treat ourselves and the wisdom that we gain being on the planet for a longer period of time says a lot about our culture.

It says a ton. And one of the reasons that I am an ardent supporter of longevity is that I think the world will probably die unless we have more wisdom.

Yes.

And wisdom comes with age. And if you know that you're going to have to eat the plastic you threw in the ocean because you have another hundred years on you, maybe you won't throw it in the ocean. So I love that. But why do I have to have gray hair and worse posture and be slower and have a walker and a wheelchair and a diaper? You don't remember my name again. You don't exactly. And that's part of longevity. But when we talk about aging, people.

See that that's exactly right.

Why do we have to say, okay, menopause is A natural part of life. Why don't just say, you know, I decided I'm going to stay fertile and I'm going to set my hormones like I was 35 and I'm just going to do 105. What's stopping us?

That I will tell you philosophically, I not sure that that's really beneficial. And I think that's a philosophical conversation. And I will say this.

It is.

I will say this. Here's where I stand on it. If that's where you're at and that's what you want to do and you understand the options, the risks and benefits and you have been thoroughly counseled and you want to decide to do that. I'm not here to tell you not to do that. That's not exactly what I'm promoting. What I'm promoting is, again, people locating the agency that they actually have, which they can't do fully in a culture and in a health care system. We all know that's not actually a thing, but we're going to call it that because of the language we have available and a healthcare system that doesn't even talk about it or teach about it. How is a person supposed to get all the options? They can't. So I feel like top level, I totally agree with you. If we don't allow for room for people with wisdom, we're just doomed. And if we continue to also commodify absolutely everything, we have some problems as well. The thing that we can do for ourselves is value ourselves, prioritize ourselves enough to avail ourselves of the information that's out there. And a lot of my book is really. And, and the stuff that I've been doing, the work that I've been doing is stuff that anybody can do, like they don't have to have so much access or so much money or, you know, even the best insurance or be able to pay cash money to do it. I want this to be something that, that people are able, have, have access to no matter where they are. You know, otherwise we're. I don't know that this becomes a very elitist endeavor. And that's not. I don't think that's helpful long term.

Hold on. You work in Beverly Hills. Aren't you inherently elitist?

100%, yeah. It's a struggle I have. The struggle is real, friend. I know that sounds so gross. Hello, white lady. I mean, but you know, I'm doing what I can. That's what, you know, I'm trying to reach other people and. Well, the interesting thing about this is that when I was. When I was doing the bootcamps, and then, of course, Covid came and made me have to change everything, which is fine. I pivoted, and it went great, actually. But one of the things that I'm working on right now is creating templates for people to be doing their own boot camps. And it's in the book as well, in their location, because how am I going to Cincinnati or Compton or Cleveland? And I'm telling them what to do. Like, I can give them the basics, and then they can create the template or take the template into their community and tailor it again. That's individualizing. Again.

Okay. It's interesting that you'd write a book called Perimenopause Boot Camp. I mean, it's such a. Such an intriguing title.

Oh, really? Do you think so? Why?

Okay. Your book is really called Menopause Boot Camp, and you mentioned that perimenopause is a word that triggers people. So I was just seeing if you would be triggered by it, and I could see you grit your teeth, but you really handled that triggering really well. Why is perimenopause triggering?

You know, it's really interesting to me. I think early on, it was great to have this name to sort of the longer lead up and transition. And so actually, let me back up here for a second, because part of the issue we have is how do we speak to each other and have a conversation if we are not speaking the same language? And language is the most important communication tool that we have in this media. Right. We got to talk to each other. So I think laying out the terminology is very important. And often people come in to see me or they ask me questions, whether it's online or whatever. They don't understand even what these things are. So here's. Here's the deal. When we're talking from the medical perspective, menopause or post menopause gets confusing. When I say menopause, most of the time, I'm talking about the transition, and I think that's what you're talking about, and I think that's what that is. Where perimenopause falls in. Peri just means the Latin for the time around. Menopause itself is retrospective. You don't know you're there till you're there. 12 months consecutively, no menstrual cycle, for no other medical reason. Hysterectomy, medical cancer, thyroid disease, Under. I mean, excuse me, over the age of 45. That's menopause. And now you are postmenopausal. The transition is really what is so hard for people. I mean, the whole ageism thing is that's a bigger conversation and that's the rest of our lives. But let's talk about menopause, perimenopause. So why is perimenopause triggering? It's almost turned into like a diagnosis, which it's not, or some kind of an accusation. People don't want to be perimenopausal. And I think that that's because they are afraid of the symptoms of the aging, of the invisibility, that they think they're buying into the narrative that they think they're no longer going to be valued or important. And they don't. They also, again, don't have the tools with which to get themselves through that ice cold bath and understand they're going to get out of the ice bath and feel awesome afterwards. We aren't talking about it. So we are anticipating what we don't know. And that causes fear and anxiety, which is never a good way to approach anything. Right. Your frontal lobes closed down, you can't make decisions. Okay. This is just basic stuff. So perimenopause, I think early on, let's say five, 10 years ago, depending on your community and where people are at, was an amazing tool because it was naming something that was going on that people were not talking about. Women in particular were experiencing changes without their period changing mood changes, pmf, breast tenderness, sleeplessness, weight gain, and being told by their doctors, there's nothing wrong. There's nothing wrong. There's nothing wrong. Your labs are fine. Your labs are fine. There's nothing wrong. They didn't feel good. What are you talking about? There's nothing wrong. This human being just sat across the table and told you something is wrong with them. So even if you don't know what it is, or I'm going to own it, I'm the physician, I don't know what it is. Do you know how often I say to people, I don't know, let's figure it out together? I've done that my whole career.

Wow, you're unusual. Because the I don't know is a very hard thing for doctors to say because it makes patients feel unsafe sometimes. Because you're trained to know.

My experience has been. It doesn't. It validates them. Because when I say to them, I don't know this, we're going to work on this together. Like, this is what I know, this is what I don't know. What I do know is you Came to me. You're having an issue. Something is not okay for you. So we're going to figure it out. I've learned that's how I got to Ayurveda. I didn't. Do you think I didn't walk into Ayurveda on the street, for God's sake? Somebody brought it to me and I was like, I don't know what that is. Let me check it out. Oh my God. I'm very interested. That's really what happened. So perimenopause early on, I think was empowering. Now people come in and they're like, oh my God, I'm in perimenopause. It's a disaster. Like someone told them they have cancer. So it's just words. I mean, again, if that word works for you, cool. To me, it's starting the conversation so that we can get the toolkit going.

So is it your view that as soon as things start to get wonky with your hormones on a monthly basis and you're sometime around that age, is that the beginning of menopause or what's the name for that? If perimenopause is the wrong name, we.

Can call it what we want. I mean, I refer to all of it as the menopausal transition, which also scares people because if you're 37, you don't want to hear that. But you don't want to hear that because of all the things we just talked about. And I think we have to destigmatize this word. Like, lord have mercy, this is great. That means you're still alive, for God's sake. It's the puberty of midlife. If people feel better with that, we can call it that.

I'm going to have to be a little skeptical on that one. So I was the only 27 year old in this anti aging group full of people 60, 70 and 80. Because when you are in your 20s, you do not care about aging.

No, you don't.

It's number 17 on your list. What you care about is building a career and getting laid. Like that's what mother Nature programs us to do. And we care about those things before we even think about them. We just know them to be true. Right.

So I don't think that this book is. I mean, if it reaches the 27 year old, great, but that's not who it's for.

They're the ones who you have to destigmatize. Everyone who's already been through menopause or transitioned into it, they already Know it. Right? People who reach their 40s and have some friends who have started it, it's a different thing. The problem with ageism.

No, Dave, I'm gonna tell you something. I do this all day, every day. I do this all day, every day. And partly because I, you know, look, my patients know what I'm up to and they follow me and all this other stuff. But no, women get to their 40s and they really don't know what is going on. It's shocking. Or they get to my cohort. So I'm 56 and a half, and my cohort is sort of, you know, Gen X, how we are. We're like. We're a little bit pissed about some stuff, but so. And we're like, why did nobody tell us, you know, that kind of thing happening? And then the people older than me are like, ah, fuck it. It happen. But I will say it's very interesting. This was a really. This is pretty funny. I had something in the office and I was talking to one of my patients who was like 30, and she's. She was really into it. They are so. They are very curious about what's coming next, and they are very much interested in advocating for themselves. And she said to me, she's right. Taking notes. So what's the book called? Menopause for Millennials. And I was like, oh, no, but okay, of course everything's about you guys. But that was amazing. That was amazing. She was like, so into it. So you might be surprised, there are.

A percentage of people who are into it. The point about telling younger people that they should listen to older people has been a theme, I think, since the first Greek tragedies were written. And it hasn't worked yet. And I think it's biological. Right. So we either have to put it in their language and I'll be straight up.

Yeah.

The anti aging nonprofit work that I did, I could get no one from Google and we're four minutes from their headquarters. No one would show up for the meetings. Which is why I stopped talking about aging. I started talking about biohacking, and now I've got teenagers biohacking because it's a performance and longevity thing. So how do we talk about menopause for people who really aren't that interested in it, so that they become interested in it? That's how you destigmatize, I think.

I think just saying the word and I. Again, I think maybe. And I don't want to be too. I don't want to journalize too much because I can speak only for the people that I have had experiences with. But I think in general, the red tent situation, communal conversations amongst women, that actually is ancient and it is innate in a lot of indigenous communities and a lot of ethnic communities.

I don't think everyone listening knows what the red tent is.

I'm going to explain it.

Yeah. Would you please?

It is a place that, in ancient times, many, many cultures, my own included Judaism, it was actually a tent where people went to menstruate. Right. But what was going on and to take care of themselves during that time, not running and doing, but being there, being cared for and attended. And the other thing that happened was that. So you had intergenerational conversation going on throughout women's lifespan, and you weren't. So you knew through when you were a girl, this is coming next and this is how you're going to be cared for. And you're participating. And you knew as an older person, you're done with this time. You have the wisdom, you went through it. You're going to assist people through that time. Same thing with childbirth. The fact that we have to take classes now to have a human come out of our bodies is, you know, okay, thank God we have them. But obviously in the way past. And I don't want to romanticize the way past because women also died largely during childbirth. So that wasn't good. But you would have never gotten pregnant and had a baby without having had some contact with that. It wasn't the first time you ever had contact. You saw it on a farm or you had family members. People had births at home. Again, I'm not saying all that was great in every way, but the loss of wisdom and the loss of the intergenerational conversation is profound. And I do think that using the word and talking about it and reconnecting and I will tell you, Dave, it's been really gratifying how many groups have been coming to me to want to specifically have an intergenerational conversation to reestablish those lines of communication. Women are very tied to our bodies in a very specific way. Way. I'm not saying men are not. I'm talking about my experience and women's experience.

Why don't you just say that women are more that way than men? It's okay, because it's true.

We are. We live by cycles. We live by cycles.

Sure.

We are identified.

Women are better biohackers than men on average because you notice changes in your bodies. And we only notice if, like, there's a bone Sticking out totally or you're bleeding to death.

But stereotypes are based in reality totally.

I'm fine with it.

So it's. It's really, really interesting to me. In fact, the actual, like, the big inspiration for all of this I shared with you. But the actual aha. Moment came when my dear friend Erica Chitty asked me to come to the wing, you know, like in 2017 or 2018. And she wanted. She's 20 years my junior. She wanted to interview me about menopause. And I was like, really? Okay. And during that conversation, this is where this aha. About intergenerational conversation loss happened. And it all rolled from there. So even though initially this has been focused on people who are more immediately concerned with it, I do have a bigger picture in mind, which is for people to feel less uncomfortable with it. And I'm comfortable struggling against the tide of humanity. I'm comfortable with the fact that we have been trying to get people to listen to. To elders for millennia. That's cool with me. I'm happy to be a part of the conversation, just in general. And I do see things shifting and changing. It's really, really interesting.

I think they are changing. And some of this goes back a couple generations. There's a researcher named Chris Masterjohn who was on my show like 900 episodes ago, probably one of the first 50. He just posted something the other day about how the American Medical association, back, I think in the 20s or 30s, came after someone who'd written a guide on women's care and specifically on birth and on infant and childcare. And they basically said, this is the doctor's job, not the mother's job. You're not a doctor. You're not allowed to do it. So they put a panel of physicians in place to muzzle the woman who had done this. It's been going on for more than 100 years by the trade union for doctors like AMA. We've got your number. You're not serving healing anymore. You're serving the profession, and you got to back off a bit.

Oh, I. I would. I would. I would beg to differ. I'm not sure they're serving the profession. A lot of doctors. I'm not. I've never been an AMA member, and I'm not. But I'm not such a weirdo outlier. I just told you. I have, like, a totally conventional. Sure, like, practice in Beverly Hills. So a lot of us are not AMA members. But that organizational medicine and a lot of the regulatory bodies that we deal with are complicated. Let's say I'm going to call it complicated today.

That's my complicated works. All right. Well, let's talk. In your book, you talk about menopausal hormone therapy versus hormone replacement therapy. Why is it controversial and what is the controversy itself doing?

And I don't think again, it's so interesting to me how words like affect people. I don't think there needs to be a controversy, but this is just a matter of shifting the language.