What’s Really Making Me Angry About Menopause (And Why It Should Make You Angry, Too)
Dr. Betty Murray explains why menopause research is chronically underfunded compared to erectile dysfunction, and how estrogen loss drives Alzheimer's, heart disease, and bone loss. She dismantles HRT myths with imaging data, describes menopause as a chemical castration event, and founded Minerva, a telemedicine platform building a women's health database to push for mandatory menopause education across medicine.
Chapters
Erectile dysfunction has received $2.8 billion worldwide. Menopause, which affects 51% of the population on the effin' planet, and every woman goes through it, nobody gets a pass. It's not some of them, it's every woman goes through it who lives long enough, gets less than $300 million to date worldwide. Temporary inconvenience in the bedroom that affects 19% of men for half of the population, which is roughly 10 times more than the decades-long whole body brain bone thing that happens to the other half of the planet. And we're supposed to call that a rite of passage, right? So menopause is natural. It's, it's a rite of passage. It's what we go through. So it's something we're supposed to embrace. And yeah, I'm going to talk about that today. So today I'm going to be talking about the shit that pisses me off. And this is subject matter number 1. You know, so here's the thing I keep coming back to in midlife. Every woman goes through this and we are lucky enough, you know, in this day and age that we get to live decades past it. Well, we know that aging takes this very sharp arc upward in our forties. Hmm. That's interesting because that's the time of menopause. Men experience it also, but the arc for women is much higher and it goes very stiffly up. So think of it as a very high mountain arc. As you enter into your 50s. Because the reality is, is the diseases of aging, the big ones especially—Alzheimer's disease and dementia, cardiovascular disease, stroke risk, heart attack risk, osteoporosis, sarcopenia—all of those have strong relationships with the loss of estrogen. And testosterone, which is a slower hormone that actually declines over time, but relative to estrogen in menopause is actually high. Got in an argument with somebody about that on, on social media, because they don't understand the difference between associated ratios between hormones. But the reality is we have issues and that's where the concern is. And so what I'm going to talk about today are the things that make me angry. So if you don't want to hear that, you can jump off, but here's the things that are really important to me at the moment that I'm frustrated with. And, you know, it's, I think it's coming from the feral woman energy that we do not care club energy. I don't give a AF at all club energy. That's really what I wanna talk about. It's the freedom to look at what real freedom means in midlife. And it's not apathy. It's the idea that we want a rich life on purpose. And it's instead of a life being spent managing everyone else's comfort for a fear of what if, right? We've lived, many of us, for decades. What if I don't have enough in retirement? What if my kids don't get into a good school? What if my kid doesn't get off my couch? What if my relationship goes to shit and I end up divorced, uh, which is about 55% of the time? What if I did all of this in the name of the company that I work for, and then I get let go because of changes in the marketplace, which is dramatically happening today. So here's, here's the thing. I want to really look at the things that really aren't working and some of the big, big levers, and let's look at it. You know, this isn't medical advice. I'm a PhD. I'm a scientist. I like looking at things and it's not a substitute for any of those things. But these are underlying issues that we come to in America. And it's the disparity between the experiences between the sexes. It's the disparity between the have and the have-nots. And then there's a disparity of the women who are in midlife and then the rest of the planet. So let's talk about what makes me crazy today. So, right. Okay. So it's, so I talked a little bit about erectile dysfunction again, that, really makes me angry that something that only affects 19% of men have— has received that kind of money. And that women all go through menopause and we haven't trained doctors to go through it. We haven't spent any money on research on it relative to the amount of impact it has. And right now our current administration is considering that a DEI just to put the word women in a study because you can't just study women when we didn't do it until 1993 to begin with. And the gap we have now in understanding women's health is because we were never part of that paradigm. But here's the other thing that really pisses me off too, is we have a three-sided war going on in midlife healthcare and treatment. On one side, we have the evidence-based purists. And look, I love evidence. I'm, I'm a researcher and I consistently go out and take what I think is true and go look for things that do not match that. Right. That's what a scientist does. The scientific method requires you to ask questions and hypothesize, to create questions and then create experiments that go out and look for the evidence for or against. And a real scientist goes out and disproves themselves as the intent, not to prove themselves, because cherry-picking research and cherry-picking data is one of the things that get me going the most, right? So here's one of the things that we hear, right? Because if you're a woman and you're listening to influencers online, you probably get confused because you watch one person and they're like, you know, hormones should be done for everybody all the time, no matter what. Let's say they're all in. And then on the other side, you get somebody that negates that. Oh, it's just a natural transition. Menopause is something we shouldn't raw dog. Menopause is something natural, but yet we would never tell a man castration that occurs because the entire organ stops working. That's what that is. Right. And then we have some in, in the middle that are actually utilizing scare evidence to push an agenda item because it makes them money or promotes their stance. So here's, here's one. Okay. Side one is the evidence-based purist. These are the ones that say, well, if it doesn't have a double-blind placebo-controlled trial with a control group and, and, and the groups that are taking whatever medication, it doesn't exist. Nothing else counts. And here's the problem with that. Women's health has been ignored all the way until 1993. And in 1997, we paid for the Women's Health Initiative, And then that debacle that was actually published in 2002 and ruined 20, 20 years of women's health research and women's health becomes the dedicated line. And so we just haven't spent the money on it. So the truth is, is women's health was ignored for over 20 years because of that study. And we do have studies since then, but the funding basically dried up at that point. So you're demanding a level of proof from a field that was deliberately starved of funding and studies to do it. And we're not flying blind. Here's the thing. We have epidemiological data. We have smaller, smaller research data. We have data coming from other countries. We have decades of clinical experience from people who were actually in the trenches treating women every day on trials that do exist. And I'm not willing to wait another 20 years. I don't want to be 76 and then find out that I didn't understand what was going on before. I want to take what the overwhelming amount of what we do have and the signal it's presenting, and I wanna act on it now. I don't think Gen X and the millennials want to have a sucky senior time and midlife time because we're waiting for somebody to pay for a double-blind placebo-controlled trial. And I'm not willing to wait for that. And I think most women aren't.. And I can tell you from the millennials that I have talked to that are, you know, gonna be knocking on menopausal— menopause's door in a matter of days and weeks. The reality is, is they're not there either. All right. So we have the purists that always talk about evidence only, right? And they love to be contrarian online. Now, side two are the clinicians that took the fear from 20 years ago and never updated it, right? These are the ones who still scaremonger. Women off hormone therapy. They find one little nuanced statement instead of looking even at the totality of the Women's Health Initiative and still say it. You hear this from oncologists, you hear this from, you know, women who haven't— haven't any of the research, and you hear this from conventional physicians who haven't stayed up on the data. Here's what the actual math says. Yes, hormone replacement therapy for menopausal hormone replacement therapy was tested for the reduction of menopausal symptoms like hot flashes, night sweats, vasomotor symptoms. That was the original FDA approval process for quality of life. That's also why we don't get it paid for. Now, do we also have data that hormone replacement therapy reduces the risk of osteoporosis? Yes. Do we also show that it— especially when it started within the first 10 years of menopause— that it actually reduces vascular aging and improves vascular outcomes? Yes. Do we also know from even imaging data done by Mosconi's group that hormone replacement therapy started in that first decade can actually reduce the risk for dementia and Alzheimer's because it halts some of the aging process that accelerates in the human brain? Alzheimer's is 3 out of 4, every patient is a woman. All right. So these scaremongers are always out there just giving a little bit edge of doubt to keep you fearful, to keep you in that. Now, many of them are well-meaning. I don't think it's that they're, they're negatively meaning. They're just not reading the research and staying up to date on what's coming out and what's emerging. And they're not willing to use the scientific method to weigh what they believe to be true. Beliefs are not truths and are not data. Belief is a belief, right? Truth is truth. And in science, we don't prove things. Right? Very, really good scientists never say, we just proved that, right? That is, that is so hard to do in science. But what we can do is look at all of the data presented and have a preponderance of evidence that either leans one way or the other, or helps us make decisions. Right? And so when you get somebody that fearmongers like that, they also cause a lot of concern and they keep women spinning. Now, when they do that online, what does that do? That keeps women in fear, and then they keep going down to try and reengage into that fear narrative that we already spent 22 years doing it. Now, does that say every woman needs hormone replacement therapy? No. Does that say every woman should do hormone replacement therapy? No. Does that mean the woman who sailed through menopause without a bunch of symptoms needs hormone replacement therapy? Maybe, maybe not. But what it does mean is every woman deserves the right to and have an educated medical provider that can have an educated conversation, not just about some shit for 20 years ago. And you know, here's the other one. We also have clinicians and influencers out there that are going online and spreading information that has mechanistic beliefs, right? Mechanistic potential, meaning that the mechanism of this particular medication or this particular hormone has this mechanism in the body However, we don't have any data to say that's what it's doing, or use animal studies and present it as if it's particularly human. Right now, the biggest one that I see this happening in is scaremongering around progesterone therapy. And I have an entire podcast that I put out about 2 months ago about this. By basically taking some animal studies, right, on mice and rats, we use those to figure out if something's toxic and safe for humans, but we are not We are not rats and mice and we don't metabolize hormones the same way. We don't utilize hormones in the exact same way. It's similar, but not exact. And then they perpetuate this story that things like progesterone are unsafe to do on a regular basis, or they try and perpetuate that they're like taking benzodiazepines, which is not true. And it's not mechanistically even accurate. And it's because they grab onto a little shred of information. They may not understand the depth of this knowledge, or they haven't really read every part of it, including things that don't go with what they believe, and then they go perpetuate that online, again seeding fear in women. Now, I'll be the first to say, if you listen to me 10 years ago, I probably had some information at that time that I thought the preponderance of the evidence was this particular angle. And in the last few years, we've got more data, and I now think differently. I'll give you a really good example of this, so how you can sort of look at this thing that, you know, is very, very frustrating and understand it. So it's important to listen to all sides of things. We don't wanna just jump into a belief and wear it like a religion. We want to understand the data and where it goes. But data changes as we have studies, as we have epidemiological data, as we bring in things together. So if you're in this place and you are constantly battling back and forth and saying, I don't, I don't really know how to judge this, right? So I'll give you an example. 10, 15 years ago, if you talked to me, I would've said, you know, high cholesterol is not the problem. LDL is not always a signal because, you know, 50% of people that have heart attacks don't have high LDL. However, we have a preponderance of data that shows LDL, and particularly apolipoprotein B, which is the carrier, and vascular inflammation in particular, when you look at it in population data, not N of 1, but in population data, are concerning. They will increase the likelihood of arterial plaquing. And in women, that doesn't resolve in a big gigantic, you know, plug in the middle of your big plumbing pipes around your heart. What it does do is cause ma— microvascular damage, which is down in your smaller capillaries. So the little tiny blood vessels start to get atherosclerosis and cut off blood supply, which increases our likelihood for dementia, peripheral vascular disease, and a heart attack that doesn't look like a man's, right? So when you're looking at this and you're looking at what I'm saying here, I completely changed my tune over the last 10 to 15 years. As the data changed. So when you see somebody online and they, they're, they're pushing this agenda that's so strongly worded, but they can't point to a bunch of studies, or they look at one that's progesterone in premenopausal women in their 30s, that's probably not gonna apply to you because you're probably a perimenopausal or menopausal woman. So you wanna look at it and, and maybe do a little bit of your own research, but this stuff is making me crazy. Obviously I'm upset. Number 2, funding scandal, right? Again, go back to the numbers with me. $2.8 billion have been spent on erectile dysfunction that affects somewhere between 17 and 19% of men. And under $300,000 worldwide has ever gone into the understanding of the multi-mechanism disease state that menopause drives, right? 51% of the population go through menopause. Every woman who lives long enough will, and the funding gap actually does a lot of things. It's why your doctor doesn't have the trials. So the person that says, well, I need clinical trials. Well, we aren't funding it. So how are you going to get it? And the purists say there's no evidence because we only have epidemiological evidence or clinical judgment, but not a whole bunch of clinical controlled trials. And the reason is we didn't pay for it. Right. Medical schools, if we're lucky, have 2 hours of training and you can take all the OB gynecologists on the planet. And they could not even come close to treating women. Menopause should be required training in every specialty because it affects every system of the body and it affects every woman. But our funding gap and our medical knowledge gap is so enormous. It's, it's not just insulting. It's the mechanism that keeps women undertreated and keeps us underfoot. And it actually leads to a longer lifespan with poorer health. And here's the thing. I, it's not a rite of passage problem. I get it. It's a priorities problem. And the priorities are somebody else's choice that has made it a problem for us. Right. And here's my other one. So again, I'm going to kind of drive back to that. Well, it's natural. Yeah. Yeah. Okay. So menopause is natural, right? Living long afterwards isn't. So if you aren't clear on that one, we weren't designed to live, you know, 30 to 40 years after menopause. We just weren't. But menopause is, I would say, a celebration. Like, there's a whole bunch that I love about it. Not giving any fucks. I love that. Being able to look at my dreams and say, this is time for me to have my dreams. Right. Being able to say, I'm not gonna put up with other people's crap and I'm gonna put myself on the agenda. All those things seem to be easier to do in menopause. Right. If there's some natural things like that, but here's the thing. Men at the same age as a 50-something-year-old woman in menopause have more estrogen than you do. Menopause is equivalent to castration, right? So I promise you, any man experienced castration, especially not by choice, cuz again, we can't control whether we go through menopause, we would be up in arms. $2.8 billion wouldn't even be close to the amount of money that the medical system would pay to figure out how to reverse that. So men don't go through castration. And guess what? We already know what happens in men in castration. Depression, anxiety, hot flashes, loss of bone mass, loss of muscle mass, cognition problems, no sexual activity, on and on and on and on. Right? So menopause is a castration event. Yes. It's a castration event that happens to us naturally because our ovaries run outta eggs because of the oxidative stress. And we burn through lots and lots of eggs each month. It's not like just one gets utilized. Thousands get, get basically used up every month until we're out. So menopause is like a chemical castration, right? And if we should look at it as natural, it's a sleight of hand. You know, it's, it's before anyone comes at me and says, you know, hey, some women sail through it. Yeah, I totally get that. Minimal symptoms. I've never had a hot flash or night sweat. I had a lot of other ones, but that doesn't mean that we're not seeing acceleration of bone loss. Maybe you have really great bones and you'll never experience osteopenia, osteoporosis. Maybe you have, you know, no real symptoms. Maybe your periods were great. Maybe you feel great. Or maybe you're on the other side of that and your periods were so bad, you're like, I don't even want to know. But that doesn't mean that aging isn't accelerating underneath, right? It doesn't mean that the vascular system is changing. The brain system is changing. The bones are changing. They are. And what else probably contributes to that is how you're wired genetically. So some of us may be losing or or gaining different parts at a different rate. But the reality is, is it's quiet symptoms don't necessarily mean a perfectly clean bill of health. And it's all, it's acquired aversion of the same clock. Right. And so ultimately, yes, menopause is natural, but women deserve the right to explore if hormones can be beneficial for them regardless of age. Right. Regardless of age. And obviously, you know, I'm not supposed to talk, so, so So the other thing that chaps me today is the rage I'm not supposed to say or have, right? Here's the thing. The rage that I feel, right, is very, very harnessed. Like, I'm not just angry and just spouting. My anger has been directed towards changing women's health. It's how Minerva, the telemedicine and technology company that I founded with my co-founder, got started, is to harness the frustration and the anger that I see and use the skillset I have as a scientist to advance women's health regardless of what the government does. And that's the— that's not just about being hormones, right? That's not being just hormonal. And I believe certain things would simply be available to me, right? So I feel very empowered by this time period. I feel very empowered by where I am in my life, and I feel very positive about it, but only if I'm moving things forwards and staying active. There are some things that I thought we would always have access to as women that are in question. Right? We have the right to vote. We have some of our government in the United States are actively discussing whether they should repeal the 19th Amendment, which allowed women to vote. And we have women that are backing that up, which is mind-boggling to me. Mind-boggling to me. I am equal to a man and therefore should have equal rights to a man, period, full stop. And if you don't like that and you're a man listening, get off my podcast. But the reality is, is I assumed incorrectly that those things were settled. Long before I got here. And that's not true. And I'm watching things like that slip. The funding for women's research, which we had just pushed right before the administration change, lots of money into that arena when they— and then they turn around and say that we— they won't approve grants that have the word women in it, right? Again, thinking that we were moving the things forward. You know, I think about the article that Melinda Gates wrote about we deserve better. Hell no, we don't just deserve better, we demand better. And so the reality is, is we're watching stuff slip away. We're watching our available opportunities to get better health, to get better financial stability, to get independence so we can choose to be with a partner of our choosing, not required to be the partner with the partner we have to have, right? That's a very different And so the women coming up behind us, the next generations, the grandchildren, the children, the great-great-grandchildren are likely to inherit less autonomy over their own body, own their— over their own checkbook, over their own ability to be independent and then choose who they want to spend their time with. Not because they're required. Let's be real. If you can't vote and you can't have your own finances, or you can't make decisions without a head of household that happens to have a pair of testicles, you are no longer free. Right. And I look at that now and I go, it's not just a— it's a math thing. We have to do something today. Even if you believe in head of household, you need to look at what's that— what is that going to open the door for later on down the road? Most of us don't think about that. And the truth is, the funding gap that we have, the research gap that we have, the healthcare gap that we have, will widen at the rate, if not faster, as the changes in our ability to have autonomy over everything in our lives as women. And it will erode faster in the healthcare environment because it hasn't even caught up to the independence that we really had. Right? So obviously that's frustrating me post Independence Day, 250-year anniversary. I don't feel as free as I feel like we should. And You know, here's the other thing I want to talk about too, is the sandwich. I've talked a lot about this kind of off and on. And, and the truth is, is midlife women, if you haven't already experienced this, you will. Statistically, we are the sandwich generation. We are the ones that are going to raise children and also care for ailing parents, at least one, if not multiples. I've met women who literally had to take care of four. And I spent almost 3 years caring for my mom who went from fully living on her own, making her own financial decisions, to a full assist in an assisted living center. So what does that mean? She couldn't feed herself. She couldn't go to the bathroom. She couldn't walk. She couldn't speak and actually tell her truth all in a 24-hour period. And the truth is, is that costs a lot. It's, it's, it's energetically draining. It's financially draining. It's emotionally draining. And it's often happening when everything else is changing underneath. And it's also the unpaid labor that women experience and caregiving is one of the biggest. But it's one of the things that is some of the most emotionally draining times. And, and the truth is, is as women, when our body's changing underneath it, we, we end up, we are the load-bearing walls of our household, right? You can't knock a hole in it. You can't rearrange it. Women in the family unit are the load-bearing walls and nowhere else is this more true than the midlife woman. And when you're stuck in a situation where you're caring for other family members, that's usually not a, hey, I could choose differently. We are in it. And careers are often subs, you know, sent to the side. Our relationships with our partners are often off to the side because we don't have the bandwidth. Our relationship to ourselves, our sense of self-worth, all of that becomes difficult. And so the reality is, is also that sandwich generation is a lot. And I think the acknowledgement that we see online is also not being seen in the world, right? We have a lot of women just talking about the unpaid labor, but we don't necessarily see society joining in the bandwagon. And if anything, we're seeing that, you know, coming back to the idea of tradwife. I don't know who a tradwife is because there's never been a tradwife. And I can tell you, unless that man is earning 3 times what he's earning today and the woman can stay home and have a lifestyle that they could normally have with 2 incomes, We don't have trad husbands either, right? And so that whole movement is mistakenly whittling away and leaving women in a position where they don't have independence. And we're also going to have a situation where we're all likely caregiving for people, especially our parents and even our partner's parents, where we feel trapped by it. And because we're the load-bearing walls, we can't actually get out from underneath it., you know, and so what do, you know, what do you do with all this? Cuz obviously I like to be highly passionate. If you follow me, you know, I'm highly passionate. Otherwise known as frustrated, you know, what do we do? So when it comes to the three-sided science war, right? The purist with the research, the speculative that doesn't really have enough to actually say it's true or not, or the data supported or not. And then the person that's in between, what does this mean for you? So what it means for you is if you are online, whether it's social media, Substack, an article or whatever, and if you read something that is so far left of what you have already read, your goal is then to go out and do what a scientist would do. Play a mini scientist, go out and type in something contrary to that. Like, I'll give you an example. You know, long-term use of progesterone increases the risk for dementia and/or cognitive decline. Go look for research that says that, right? We have animal studies and we have a short-term premenopausal women's study that showed short-term memory was a little bit impaired on the second half of a woman's cycle when they added additional progesterone, right? None of which is true for perimenopause and menopause. None of that data is true. Right? So when you see these kind of arguments and we're like, wait a minute, everybody else is saying something different. It doesn't mean follow blindly. What it means is that you can take the opportunity to look at both and you have to ask those questions and say, show me the research that shows this, show me the research that shows this, and then start to educate yourself. You know, we're lucky enough to have the ability to do that today. So when you get to that science war and you're stuck spinning because you don't know who to trust, don't trust me any more than you can trust the data, right? Don't trust anybody else that far either, right? And take the opportunity to just look beyond what's being said online. Because the algorithm and the people who are really successful online know how to keep you spinning, cuz that keeps you on the platform. Right? The funding gap. The funding gap is probably the biggest driver to why we have healthcare that completely ignores women and particularly midwife women. And so what do we need to do? This is where private industry needs to step in and actually support women because the truth is, is women need funding. We're not gonna get it from NIH. We're not gonna get it from our government. This is where private industry can step in, and that's actually what Minerva is here for. We're building the technology platform to become the research database that we deserve, right? So we can actually look at lots of different markers all at once and understand clinically individuals so we can be proactive and predictive for each woman, and also at larger quantities so we can under— actually understand why do some women get, I don't know, osteoarthritis and others don't. We don't know. And it's not just aging. It's not just aging. It's not right. So the reality is, is we have to fill that funding gap, and that's gonna come from private industry and private individuals, right? So when we go out and look at, you know, I wanna do philanthropy and things like that, funding a women-owned business or women-owned science or women-owned or women-directed things is a philanthropic activity because what you do is you lift up all women by providing those organizations that are actually catering to women. And then I would say the last thing is we have to look at the research and say, it's no longer okay that my cardiologist doesn't know anything about women's hormones. It's no longer okay that my internal medicine doctor hasn't read a women's study in 20 years. It is not okay that my, you know, whether it's hepatologist or my gastroenterologist doesn't understand women's health. Hormones affect all of those systems. They must. And we can pressure organizations like medical schools and other organizations, continuing education credits, to require that of our specialists. It is not the purview of OB-GYNs. They are surgeons. They don't get much more training than anybody else. But the reality is, is every doctor should be able to have this conversation cuz menopause is a full body castration event. We have less estrogen in our body at menopause than the average man of the same age. Progesterone is also down in the toilet. Testosterone is elevated to it, but is also generally lower than what it was in our 20s. Not for every woman, but it's generally lower. And all of those hormones have a place, but we have to have a medical system that can provide for that. And then the other part of it, you are the load-bearing walls for the people in your world, right? And it's high time that we recognize that and that we have an opportunity for women to be heard about how hard it is to be the sandwich generation. And the three-legged stool and the load-bearing walls and the unpaid labor across the board for families and the emotional laborer, right? And it's time for all of our constituents, men, women, children, to start to understand that the world has changed and women are in a position today that we can be on our own, but we need to defend that, right? And that we can make decisions about the world that we live in, but we need to defend that. Because it's very easily taken away. And so those are the things that are frustrating me today on Menopause Mastery. And, you know, hopefully I listened, you know, one of my friends said, really, you're just gonna get on there and complain? I was like, I'm not complaining. I'm pointing out errors, right? It's complaining. Let's be real. But my hope is that you listen to this and not only feel that I see you and understand you and, and know exactly where you're coming from, but that you also feel that that frustration, the rage, the anger, the sort of feral woman energy. Can be harnessed. And maybe these 3 or 4 things that I talked about are the area you want to harness them in. Right. So thank you for listening to Menopause Mastery. If you're as frustrated as I am, you know, give me 5 stars, 5 stars on my podcast, on any platform that you're on, or if you're watching this on YouTube, give me a subscribe and then talk to me about it in the comments. Tell me how frustrated you are, because I think, I think we all are at about our wit's end.
