- I am an actor and I was going to do like a character who was menopausal.

And I was like, well, let me look up the symptoms and do research.

And as I'm looking it up, I'm like, ha ha, that sounds like me, wait a minute.

- I didn't notice the menopause stuff happening.

I felt like an angry person and I'm not an angry person.

- Menopause certainly changes your brain.

- I was having a problem with words and I couldn't process the word, a word I've known my whole life.

- You don't know that the reason you can't remember what you came into the room for is not your fault.

- Changes in your mood, depressive symptoms and crying spells.

- I started to feel crazy.

- All of a sudden you get like heart fluctuations.

- It's unpredictable and it's frightening.

- Your ovaries are shutting down their production of hormones.

We're simply outliving the lifespan of our ovaries.

- Women come into my office because they thought they were dying.

Something was horribly wrong with them.

- I'm a board certified OB-GYN.

I had four years dedicated to women's healthcare.

I got a month of training of menopause, just think about that.

- It's about bodily autonomy, it's about body sovereignty.

And you can't pick menopause out of that and say you can be free all of your life, except for when you go through menopause.

Like that's not the place where you can be free.

You have to struggle through that.

- Is the last third of my life, not as important as the middle third in my reproductive years?

- It messed with me in ways that I totally was not expecting, totally was not expecting it, so.

- Women are not gonna stand for it anymore.

We don't have to suffer through.

(audience clapping) - Menopause is the one universal female experience.

If you are born with ovaries, you will be menopausal.

You may or may not be pregnant.

You may or may not have fibroids.

You may or may not have a lot of things that primarily affect women.

Menopausal, I guarantee you, you will be.

- We go through puberty and everybody's happy and excited.

And then you go through pregnancy and it's parties and you get celebrated and you get gifts and there's balloons and there's gender reveal parties.

You go through menopause and nobody wants to hear about it.

There's stereotypes, there's stigma, there's ageism, there's sexism.

It undermines your own confidence.

- Menopause is defined by the last menstrual period, no menstrual cycles for one year.

Then a woman knows she's in menopause.

The average age of menopause in the United States is about 52 years.

Anything after the age of 45 is considered normal.

- The most common complaints that I get about menopause are forgetfulness, anxiety, depression.

- You know, hot flashes are the tip of the iceberg.

- Vaginal dryness, bladder dryness, urinary tract infections, urinary incontinence.

- Weight gain, joint pain, dry skin.

- Night sweats, insomnia.

- Depression, anxiety, brain fog.

- Our skin, our blood vessels, dental and gum health.

- Nearly 30% of women in menopause will lose a tooth within the first five years of menopause.

You can't separate the mouth from the rest of the body.

- Women say, I just don't feel like myself anymore.

I'm just a different person, like who is this person?

I've lost myself.

- So every woman has a line drawn at a different place.

This is tolerable.

And now we've crossed over into the intolerable phase.

The option should be, I'm gonna go, I'm gonna get this addressed.

Not I'll just suffer through and it'll be over in a decade.

You know, you are doing far more harm than good by just not addressing what the issues are.

- With the executive order I'm about to sign, I'm directing the most comprehensive set of executive actions ever taken to improve women's health.

- The president of the United States signed an executive order and that will allocate $12 billion to women's midlife research.

So that's a start, that's a start.

That's still not where we need to be.

In 2022, the National Institute for Health Research budget was just over $46 billion.

Of that $46 billion, just around 10% went to women's health.

- A lot of that was breast cancer.

A lot of that is pregnancy related conditions.

How much of that really is dedicated to women over the age of 40?

You know, I mean, we can't even find it.

They don't even keep records on how much research is done on menopausal women.

That's how little has been done.

- I can tell you that even five years ago we had to beg people to talk about menopause.

And I was told by a major news network that that wasn't their demographic.

The generation going through menopause now, it includes the millennials and then we have the Gen Xers.

They're not gonna suffer in silence.

They really want solutions for what's going on with them and in fact they're going to demand them and they're gonna demand them on social media and other venues that we might not have used to talk about menopause in the past.

Women are really driving the conversation now, which is so important.

- Menopause is finally having its moment.

- Some people have called it menopause's Me too moment.

- Menopause explained.

- It had been thought that HRT could increase the risk of breast cancer among other things.

But new data being released now shows that is not the case.

- When I first started, people would look at me and say, menopause medicine, that's a thing?

And now, yes, menopause medicine is a thing.

There has been a lot more research.

So we have more evidence-based information and treatment options to share with patient.

- And not every woman is gonna decide to treat her symptoms.

But really every woman needs to understand what menopause means, what it means for health going forward, how they can best manage it, whether it's with medications or not with medications.

- Something is bothering you and someone says is in your head.

It's like, of course it is, everything is in my head.

And hormones affect your brain.

- Women or XX carriers are born with a ton of estrogen receptors, not just in the body, but specifically in the brain.

So our brains run on estrogen starting at puberty, and they keep doing that until the end of their lives.

I think what people are most surprised about from our finding is the extent by which menopause can impact your brain.

- During this transition, that horrible voice that we all carry with us has gotten very loud.

See how your voice has changed?

Can't hit those notes like you used to.

Even two days ago it happened to me and I just was, the voice was loud and especially a perimenopausal ragey voice was very loud in my head and I was like, okay, brain, knock it off.

And then I tried to find something nice to say about myself.

(upbeat music) ♪ There's a place for us ♪ ♪ Some where a place for us ♪ You know, the freakouts you have start to feel like panic attacks coming on because like my heart is pounding too fast where you're like, how come I can't remember anything?

What I never knew is that is a symptom of menopause.

All of a sudden you get like heart fluctuations and I thought, okay, it's just that I'm having a panic attack.

So then that messes with your mental psyche, you know, all of it, all of it.

- Brain fog is a very weird phenomenon that doesn't even actually have a term in medicine, we refer to that as cognitive fatigue or mental fatigue, where you feel like your brain just won't turn on that everything takes a huge effort and you're having trouble accessing information.

Words won't come to mind, really.

What is really concerning I think, is that these changes can be so severe to prompt fears of either going crazy or being developing dementia.

The purpose of the clinical trial is to test the efficacy of a selective estrogen receptor modulator for hot flashes, but also for support of cognitive function and potentially for prevention of Alzheimer's disease.

And the way that we test this is by working with women who are going through menopause.

Menopause has been historically pigeonholed as an issue with the ovaries, which means that you go to your OB-GYN and OB-GYNs don't do brains, right?

It's not their fault, they're just not trained.

Those are neurologists, psychiatrists, neuroendocrinologist, neuropsychologists, anything with the neuro in there.

We do brains.

Obviously we need to change the framework around menopause where it's understood that there's an ovarian component and the brain component.

From a basic science perspective, there is a lot of evidence that supplementing hormones that ovaries no longer make with hormones that come from the outside has potential to support brain health and even possibly lower the risk of some neurological or psychiatric concerns like depression, anxiety, Parkinson's disease, Alzheimer's disease.

Matilda's looking at associations between testosterone in blood and blood flow in the brain.

So here she's comparing men and women in terms of where testosterone has an impact inside the brain.

So the clusters in green are the regions that are impacted in men.

Whereas for women it is more central.

And this bit of red spots are the memory centers of the brain.

So for women it's more memory centric in a way.

And for men it is more association cortex.

Is the female brain different from the male brain?

I'm saying in some ways yes.

And I'm not thinking behavior or intellectual potential.

I'm talking about raw biology because for women, hormonal aging is not linear.

We lose some of the power of estrogen or estradiol as we go through menopause.

And losing the estrogens in a way is a trigger for accelerated cellular aging in the body and in the brain.

This part that used to be there was really, really red before menopause is now more like yellow.

The same thing up here.

Women's brains age differently than men's brains in some ways which are not indicative of differences in behavior or personality or anything psychological, but they're just biological differences that do matter for health.

This was our study, right?

There are women who go through perimenopause who don't show any changes, but in our study they did.

So this is broadly what happened, right?

And then there's a rebound on average where some women go back to premenopausal levels.

Most women do not, but at least they're stable.

And then some women keep deteriorating.

Actually the idea the menopause puts a woman at a disadvantage has nothing to do with biology and everything to do with culture and medical history.

(calm music) The history of medicine that we physicians and scientists were really determined to prove the women's brains were inferior to men's brains.

And menopause was the last blow in a way.

Because at that point, if people think that your only purpose in life is to birth children to men, then once you're no longer able to do that, then you're really, really useless.

And that's what medicine has been saying to us for centuries.

Women have been taught to really just fear their hormones and doubt their brains.

(calm music) There's new science and new research, including some of my own research showing that some of the brain changes that take place during the menopause transition are actually improvements in some ways from a neurological perspective.

- A woman's estrogen level after menopause drops down to less than 20.

Prior to menopause, it could be up to 500.

Think about that, that's like being on six cups of coffee and all of a sudden you're on zero.

Those who drink caffeine, they get that.

They're like, that makes so much sense, right?

And so after menopause, the goal is greater than 20, less than a hundred.

I used to be up to 500, of course this is safe, but that's enough to protect bone, brain, heart and the symptoms.

- You are in menopause forever, let me just say this.

It is not like you're gonna be like, oh well I'm good.

I only had my five years of menopause.

Now I guess we're done, you are in menopause forever.

That's why I don't like the term when someone says, oh, I'm post-menopausal.

I'm like, no you're not, you're still in menopause.

You take medication to relieve your symptoms.

There's nothing that says that you should only take for a certain amount of time.

I'm 65 years old, I've been taking for 15 years.

I think that our quality of life matters.

(calm music) - My appointment with you, honestly, I thought was gonna be a waste of time because everybody else turned me away.

So when you agreed that I could try hormone replacement and after two weeks of being on hormone replacements, it has completely changed my life.

I'm sorry to be upset, but it is just, I felt like it was, I was my old self and that I was thriving in this world again.

And I'm glad I went through with the appointment with you.

- So am I.

- Yes, yeah.

- For the most part, patients who were suffering as much as you were do get good benefits from being on treatment - Again, I thank you.

- Baby boomers a lot are still working and also want to stay active, contribute.

There is a lot more expectation for healthy aging in addition to managing the symptoms of menopause.

- When you are making a menopause plan for patients, you have to take a thorough history and physical, make sure you know what other medications there are, what other medical problems there are.

And then once you know that, you can offer them safe options.

- You said in your workup, you know, it's really affecting how you see the world.

- You bring up perimenopause, the things that are happening to you.

And either you get the, everybody's going through it, it's just a part of life or like kind of a glazed overlook.

I went to my gynecologist and I had a conversation with him and his tone completely changed the moment I mentioned hormone replacement therapy.

I just need to figure this out because I don't feel well.

- You're not your best you.

- No, no.

- So we'll start the hormone therapy, and see how you do.

Menopause society came out in 2022.

Clearly for most women, especially in those first (indistinct) years of menopause, the benefits are to outweigh the risks.

We know that it is protective against cardiovascular disease.

We know it's protective against neuro dementia.

If you start in the window of opportunity, it will always, for your whole life, protect your bones.

It will always for your whole life, protect your genital urinary system.

- Hormone replacement therapy got a bad rap because of a WHI study that was done a long time ago that really scared not only women but scared providers as well.

- They called a press conference and said estrogen causes breast cancer.

- It increases the risk for breast cancer and for blood clots.

- And that's just not what the data supports.

- Women were upset, they called the office, they were like, oh my god, I can't believe you gave me this stuff and it's gonna kill me and gimme breast cancer.

So we were all caught flatfooted.

- Women basically stopped using menopause hormone therapy on mass because of the misinterpretation of the data with regards to heart attacks, cardiovascular events, and breast cancer.

- What we didn't explain to women is who are we seeing these adverse events in?

It was the older patients.

- Women were allowed to participate in this study.

They can be anywhere from 50 to 79 years of age.

More than two thirds of the women already had established cardiovascular disease.

And if you are trying to do a prevention study, it doesn't take a rocket scientist to figure out is that you can't prevent something, in a 75-year-old.

- Women come into my office and ask me if hormone therapy is safe.

For most healthy women, the benefits of hormone therapy are going to outweigh the risks.

And this is very reassuring and a very different message than the message that was first put out after the publication of the WHI trial results.

- Most women now were not around for the Women's health initiative, but it stuck.

Doctors still think that, you know, this is a funny but true story.

I went to see my internist and I've been on hormones since I was 50.

You know, she's, oh, you take medications.

And I said this and she looked at me and she said, you know, I'm not a fan.

And I was like, you know, I didn't ask you.

The point is that if she would say that to me, knowing what I do, knowing then I can only imagine how actively discouraged women are or who will never get prescribed hormones because it just never comes up in the conversation.

- I definitely have patients who come to me and say, I don't want any prescriptions, be it hormones or other medications for my menopause symptoms.

What can I do to help myself?

- Hormones aren't the answer for everything.

And every woman, regardless of what you choose, you should institute the lifestyle modifications between exercise and diet.

- You know, leafy greens, almonds, lots of foods high in calcium content, watching your calories, boring, boring stuff.

- Eating a diet rich in fiber.

- Enough antioxidants.

- Loading your plate up, heavily plant-based with lots of color and lots of variety.

- Lean protein and polyunsaturated fatty acids.

- Don't smoke.

- Limiting obesity and not drinking alcohol.

- Address the bleeding gums.

How to maintain meticulous home care.

- You can take up to 4,000 international units of vitamin D a day.

- Vitamin D is associated with a decrease in fracture risk.

- Control your blood pressure, control your weight.

- Exercise, keeping a more lean body mass.

- Sleep hygiene is important.

- There's also melatonin that can help with sleep.

- But there are also a number of products that have emerged that are what we would refer to as more natural products and supplements.

There is good information in the scientific literature about some of these supplements and the way in which they can support women who are in the menopause transition.

Because it's an OTC product or a supplement, you should still have the conversation with your healthcare practitioner because you wanna be sure that there are no concomitancy issues.

And what I mean by that is the interaction between perhaps a prescription drug and what you may be using with a supplement.

- And you just have to figure out what are the trusted sources that you can go to to weed out, you know, the wheat from the chaff in terms of what's out there in the marketplace.

- It's important to note that while there are some supplements out there, there is nothing that is as effective as menopausal hormone therapy for management of menopause symptoms overall.

- Millions and millions of women are on hormone replacement safely.

And that's where you talk to women about risk benefit analysis.

Now, there are cancers that have estrogen, progesterone receptors that definitely hormone replacement therapy can feed and can cause those cancers and tumors to accelerate in their growth.

But I don't believe that hormone replacement therapy actually causes the inciting event or factor that causes the cancer.

- There are still a lot of misperceptions out there for sure.

And you know, it ranges from hormone therapy as a fountain of youth and it's gonna make me stay young, which is not true, all the way to the other side hormone therapy is going to kill me, it's gonna give me breast cancer, it's gonna make me have a heart attack, which is not true.

And the truth falls somewhere in the middle.

But the reality again is that for most women who are relatively healthy, the benefits are gonna outweigh the risks.

- A stigma of hormones is that we call 'em sex hormones.

So people kind of think, well sex is extra, sex is a luxury, you're not reproducing anymore.

What do you need these sex hormones for?

It's a literal misnaming of what these compounds do.

They are brain hormones, they profoundly affect the brain.

- I ended up having to get a hysterectomy.

Wow, you hear that silence, you could hear a uterus drum.

The sexual side effects or something, I wasn't like I wasn't prepared for how it would make me feel.

You know, there's so much of your like identity that's wrapped up and you're confident that's wrapped up in your sexuality and your ability to feel sexual and to have that just take that away before I've really been able to like fully explore.

I just started to figure out who I am and then I have to figure it out again.

It really, it messed with me in ways that I totally was not expecting.

They removed my uterus and they didn't just remove my uterus, right?

They cleared me the (bleep) out, okay.

They took my uterus, they took my tubes, they took my cervix.

If you put your ear up to my (bleep), you can hear the ocean.

Why haven't I brought up the sexual side effects with my doctor?

Because I think I too consider it mild and extra.

You know what I mean?

Like I almost feel like it's my responsibility to fix that part and not the doctors, I don't know.

Yeah, I don't know.

- When our eyes wear out, we get glasses.

When we need help hearing, we get hearing aids, we're kind of repairing or renewing body parts as we go along.

But when it comes to the ovary, it's like full stop, sorry you outlived your ovary.

But why are we being so unique with one body part when we don't behave that way with all the other body parts?

- Honestly, sitting here right now, I can't tell you the last time we had sex, that's terrible because I love him and I used to like sex, but it physically hurts and the pain that you have after isn't worth it to me.

The lack of intimacy leads you to a lack of connection in your relationship and it's really hard because I love him, he's the best thing ever.

- Tell me kind of what your goals were when you came in to see me in the beginning.

- Well, no libido and I just thought, yeah, I gotta do something.

I can't let this keep going, it's just not sustainable.

I didn't know if I was a candidate for hormones because I'd had a blood clot before with a broken bone and my mom had breast cancer.

- And those are really great to bring up because I think common misperceptions about systemic estrogen, everybody can be on vaginal estrogen.

The misperceptions about systemic is family history of breast cancer does not disqualify a woman.

A provoked blood clot does not disqualify a woman.

We started you on the systemic estrogen, how did that go?

- Oh my god, that was like a lifesaver.

- I always worry when we tell women how they should feel about midlife.

And one thing I see a lot is that you're no longer a woman 'cause you either can't reproduce or you're not having periods, you're still a woman.

It doesn't take it away.

That's not, we don't have a limited definition like that.

So I really, you know, want women to know, this gets to be whatever you want it to be.

In my urology training we deal with male sexual dysfunction all the time.

You know, we invented Viagra, it's been around since 1998.

I went to a conference as a resident and they said, we'll never figure out women.

They're too complicated.

- I asked my primary care doctor when I was in for an annual, hey, can you check my testosterone level?

And it was practically nothing like there was none.

And then when I looked at what the symptoms of being low testosterone looked like I ticked every box.

- What did you notice the most about being on the testosterone?

- I got my brain back, I had an energy and a focus that I hadn't felt since my thirties probably.

And that felt amazing.

- I love the topic of testosterone.

I'm a urologist, which gives me a very unique training coming into women's health and menopause.

And the reason for that is I give people 10 times the dose of testosterone every day.

They're called men, but I can't just come in and say, I wanna start you on testosterone because women don't know that they even have testosterone in their bodies.

So I really have to do the education before a woman will accept testosterone, which is fair.

The other unique thing about testosterone is it's really kind of been heralded as the hormone for libido.

I would argue estrogen is also a very good libido drug.

But testosterone's profoundly important for muscle, recovery after workouts, our bone health, our mental health, mood and depression.

So we're starting to research the effects, but all you have to do is start giving women physiologic, female dose testosterone and they come back and they say, I feel like myself again.

And you can't measure that, how do you measure I feel more like myself?

So how does a woman get testosterone in the United States of America today?

The most common option is to use a male product, just dose it for women's physiology.

And that on average is about one 10th the dose.

The tough part about that is it's very hard to dose a small packet of testosterone gel.

So for women you have to say take one packet, which is like a ketchup packet and you have to open it up and then you dose it over 10 days.

How do you dose this appropriately over 10 days?

The other problem, you take it to Rite Aid, Walgreens, whatever your conventional pharmacy is, your insurance won't cover it 'cause it's non FDA approved.

So men get it covered.

People who are transitioning to men get it covered.

Only the women don't get it covered by insurance.

- When you gave me the testosterone, you said it could take two to three months, but at about two months it was very, very noticeable.

- What'd you notice?

- Well I had a friend just tell me, you are so different.

And I said, well how am I different?

And she said, you're just not negative anymore.

I wasn't happy, and yeah, that's what my husband said too is you're just happier.

I said, yeah, I am.

- I think one of those most damaging things we did to women is that we made them afraid of something their body naturally makes.

I think it's devastating.

- You can't lump menopause into one basket for all races, ethnicities.

There is more research coming out that is showing that women of color experience menopause very differently.

- We did have a paper that looked at some of the differences or disparities in our black and white women because that's where some of the greatest differences exist.

Our black women as well as our Hispanic women, are more likely to have frequent or bothersome hot flashes versus our white women or Chinese and Japanese women are less likely to have hot flashes.

And the reason for the difference is something that is still an area of exploration.

- With regards to Asian women, there's a lot of genetic differences.

And so for Asian women, menopause tends to be a lot of bone pain, joint pain, headaches and less of the hot flashes and night sweats.

But for Asian women, obviously with menopause comes the risk of osteoporosis.

So a lot of care needs to be taken for Asian women going through menopause to preserve bone health.

So there are many different ways of going through menopause and there needs to be individualized treatments.

(woman speaks Spanish) - Latinas show positive attitudes towards menopause because it's, oh I don't have my monthly period anymore.

But then in the conversations when you begin to discuss the actual experience and symptoms and when they begin to associate menopause with aging because they'll view menopause positively, Latinas, but aging negatively.

I think that that's also why there's an opportunity to kind of empower people to change the perception of menopause and what positive aspects they can kind of take out of this time period.

When I say the term Latinas, it's not a homogenous group.

Latinas come from different countries, nationalities, languages, cultural influences, either you were born in the US or not.

And these all impact the menopause experience and Latinas in particular have high levels of perceived stress and depressive symptoms and sleep disturbances during the menopause transition.

These are all things that are related to cardiovascular health later on.

In Latinas we also see additional stressors in that there isn't in the family discussions about menopause.

You also then sometimes have in terms of gender roles, that there are certain roles that you think you should fulfill that the symptoms are bothering and interfering with these roles such as cooking or cleaning or being the caregiver for others and you being unable to discuss it leads to stress.

(woman speaks Spanish) - Women of color, particularly African-American women tend to experience menopause early on average about a year earlier than white women do.

They have symptoms that are more severe and their symptoms last longer and that can go on for 10 years and that is a very long time to be that miserable.

- There's a lot of research still going on, but a lot of it is felt to be due to weathering, an accumulated lifetime experiences of illnesses of stress that makes menopause more challenging for black women.

- Every black person I know has a story of mistrust with a doctor and every black person I know keeps in the back of their mind the Tuskegee experiment.

So we have a history that we need to remember.

- They're least likely to get a conversation about menopause.

They're least likely to get a prescription and less likely to take that prescription even when it is offered.

- So we take our first breath.

All right, so y'all know this deck that we created a couple of years ago was created to kind of help facilitate the conversation, right?

So for tonight I pulled out questions that are specific to menopause.

- What tools, resources, or provisions do you think people need to navigate their midlife awakening and journey through menopause?

I think patience is the biggest thing that I needed with myself.

Is not the same thing as patience for others.

- We don't come from a place of problematizing or pathologizing menopause.

The work that we do is to illuminate the uniqueness of your experience and to say that it's on a spectrum.

There are some people who don't have any issues whatsoever.

There are some people who are really struggling.

When we say that black women and other women of color experience menopause differently than their white counterparts.

It's not because there's something physiologically different from us.

There is something different culturally from us.

If you think about the impact of growing up in a racist society on your body, the trauma, it makes sense to me like as you get older, that trauma impacts your hormones.

And I think that the medical field needs to catch up and taking into consideration this holistic experience of a person.

And let's also think about the systems that are impacting your menopause experience and what we want to do together to disrupt that.

- What has been rampant, you know, in the past and even now is this sense that women don't know what they're talking about, that men know better.

I am in the perimenopause stage and it is interesting that I'm having to go through these informal kinds of networks, talking to other women my age, you know, where we're kind of comparing notes about the things that we're going through.

It's almost reminiscent of me being in the archives and looking at those 18th and 19th century books and women's concerns have been written off as either superstitious or that they don't quite know what they're talking about.

- Any person who studies medical history or has gone to medical school when they had their gynecological rotation, they learned about J. Marion Sims because he's been deemed and also was a self-proclaimed father of gynecology.

Who they don't talk about are the mothers of gynecology, the enslaved women that he practiced on.

(dramatic music) - That doesn't mean that gynecology or obstetrics didn't exist, but in the United States in particular, it was the Atlantic slave trade that made the advancement and the development happen even sooner because of the access to bodies that one essentially had free reign on.

The mothers of gynecology are Anarcha, Betsey and Lucy.

And these were young women from their late teens to their early twenties living in Montgomery, Alabama.

In the 1840s, Dr. James Marion Sims enters their world because of a condition that these women all share.

Vesicovaginal fistula, the condition that was created after a very prolonged child birthing session.

The end result is incontinence and if there's tearing in the back, there's also incontinence there as well.

He is experimenting on them by trying to create a surgical reparative technique that is innovative and new and advanced.

Most doctors in the 1840s are not using anesthesia because anesthesiology as a medical branch has not been created.

There are different kinds of interventions that doctors rely upon.

Alcohol, Laudanum.

Anarcha, Betsey and Lucy unfortunately do not receive any kind of pain relief through medication during the years that they spend as experimental patients.

Dr. James Marion Sims is carrying on these surgeries for almost four years and one of the enslaved women, Anarcha, is operated on 30 times and that is considered excessive even for the Antebellum era.

After a few years he continues to fail.

The two white male surgical assistants, they walk away.

Sims has to train his enslaved labor force how to perform the work.

And so he teaches these enslaved women to assist him as nurses and also surgical assistants.

And this is the incredible thing.

Here you have a group of five to six women who are assisting him at any given moment who are illiterate.

And yet this is a surgical team that helps Sims come up with a successful surgical reparative treatment.

Sims did not give anyone credit except himself in his writings about the curing of vesicovaginal fistula.

So Anarcha, Betsey and Lucy are ultimately returned to their owners.

They are, at least from his writings, cured.

We're not quite sure what happened.

Based on my research of other enslaved women, they might have gone on to work as healers in their community.

The campaign to usher in a reckoning where we honor the work and the lives of Anarcha, Betsey and Lucy and the other unnamed women that Sims worked on is afoot.

It is not about saying Sims didn't create this particular kind of surgical development, but he didn't do so in isolation and that this is happening because he has access to enslaved bodies to be able to do this kind of work.

- Just because you're post reproductive, you're not done contributing to society.

At this point, we have a lot of life experience, a lot of spunk and a lot of great ideas to contribute to the workplace.

- We need support and having a flexible workplace I think would be a great place to start.

I'm sure that as I go through menopause, I'm gonna be like, I'm having hot flash, just shut up.

And I'm fortunate that I can do it because I'm in charge, but I know that so many women cannot do the same.

- I was hosting a meeting of 40 of our senior leaders in the room and I came in that morning, you know, I had a terrible migraine.

I was, you know, very nauseous.

I felt really awful, from perimenopause and I had to make a decision, do I go home or what do I do?

And we have conference rooms everywhere with little sofas in them.

And I thought, well I'm gonna go lay on the sofa, not because that's a comfortable thing for me to do.

You know, who wants to see their president laying on a sofa in a conference room?

What are people gonna think?

But again, I had this incredible opportunity to make it okay to take a break, you know, take whatever pause I needed to feel better.

And therein is the opportunity to then be transparent.

I hope it gives women permission to at least say I'm not having the best day today.

- We have the cost of lost work productivity, women with lost wages, women who maybe didn't take a promotion because of their symptoms or who might step out of the workplace early altogether, which could jeopardize their ability to retire.

This is an enormous loss of human capital.

- We don't wanna pathologize someone getting older.

We don't wanna pathologize someone experiencing menopause.

- We initially started talking about this a few years ago.

It scared me to death, the last thing we wanna do is handicap women in the workplace to where they're thought of as a liability to their employers.

- I go back to my 35-year-old self.

I was the mother of three and people I worked with, I didn't openly share that.

I didn't want anybody to think that I was gonna be distracted from doing a great job because my child was sick.

- We have a women's group and they get together regularly and talk about various topics.

Some brave soul mentioned that she was having some menopause symptoms that were affecting her at work.

And lo and behold, other members of the group started speaking up.

- There was like a floodgate of women just sharing how this had impacted their lives.

- And no one wants to go to their manager and say, I'm not feeling well and apparently I won't for the next five to seven years, women have really just suffered in silence not knowing what was going on with them in their bodies.

- Someone stood up and said, have you ever thought about having some sort of support or company benefit for people going through menopause?

No we hadn't, but what a great idea.

- And this was the first time we'd ever been asked.

So I was like, okay, where do we start?

Not companies had put in menopause benefits at that time.

- At the same time we ran our numbers on our employee demographics.

What we found is that at Genentech, over 55% of our employees are women with an average age of 45.

- At this age, many women are at the peak of their careers.

Women are critical to the organization.

And so I think the better it is for women of course and the better it is for the company.

- And so the benefit that we provide provides 24/7 access to educational materials, webinars, provider led sessions and same day access to appointments with specialists.

- So from my perspective, this is an improved way for us to ensure that all women have access to the care that they need and that they deserve.

- So the irony of the fact that we have this benefit now is when it first came up, you know, I was part of the whole discussion, but I have to say it wasn't as real for me because I wasn't going through menopause at that time.

And then fast forward nine months and I'm in the heat of it.

I was just saying to my primary care physician who honestly wasn't as sympathetic when I would go talk to her about my issues, oh it's just aging.

Finally got connected through our benefit to an OB-GYN who then said, hey, I want you to try estrogen.

Literally my mood changed, my body wasn't as sore and aching.

My husband was happy 'cause my libido was better.

But that's what thriving looks like, right?

- You know, if I were to say one piece of advice to companies is start the conversation.

Again, it is a normal part of life.

- We are pioneering the acceptance of these conversations, these behaviors and on occasion we're gonna have to push through a few barriers and invite others to come into awareness on this topic that we feel so passionate about.

- My goal is to make menopause medicine a public health issue.

Just like smoking cessation.

Just like prevention of heart disease.

When you look at how much Alzheimer's, dementia, osteoporosis, all of these medical morbidities cost the government so much money every year, we're talking about billions of dollars.

- You know, I think the role of government is to make sure that the citizenry is able to live and thrive inside of the country that they live in.

And part of that is health and healthcare.

To be able to offer healthcare that supports their community, you need to do intersectional research.

You need to understand what your community needs.

- We will build a healthcare system that puts women and their lived experience at its center.

Where no woman or girl has to hear that, oh it's all in your head, or it's all just stress.

You know where women aren't an afterthought but a first thought.

- First lady Joe Biden is making this investment and she's been really diligent about bringing people to the table as we move into this new place of intersectional research and government funding, that needs to be front and center.

It needs to live on the table.

- If you have somebody who's graduated from a residency program within the last 20 years, it is not their fault in a sense 'cause they were not taught much menopause education.

- You know, I had to go outside of my own training to learn about menopause care and I thought I was a good provider.

Turns out I was a terrible menopause provider until I went through menopause.

Started reading, realized there was a huge gap in my own education.

- In my dental school training, we learned about how fluctuating estrogen levels can affect the gums and the impact on the mouth.

But never once were we taught about the impact during menopause.

- I have 23 years of formal education.

Not once did someone mention menopause to me.

- I was like a deer in the headlights.

And after the patient would leave, I would hurry up and pull out all my books 'cause back then we still used books.

There will be maybe one paragraph in an entire book about menopause.

- In medical school we really did not get any formal training at all on menopause as part of our women's health curriculum.

A lot of it's focused on the reproductive age years, on pregnancy, on different like benign gynecology issues.

But as part of our second year residency here, we get to rotate with Dr. Shen, who is our menopause expert, if you will, in a clinic just dedicated to menopause, which is really special.

- Here I could possibly effect a change, at least train the next generation and have more opportunity to learn and to do research around menopause.

- So what does it take for menopause to be part of medical textbooks and scientific textbooks?

It takes women in power.

- I try to trick my medical students into going into OB-GYN and going into particularly menopause research because I guarantee you there's a Nobel Prize for the person that can figure this out.

- I think the most important thing that we are doing in this space right now is really educating women so they know how to go to their doctor.

And have this conversation, do not wait until the doctor brings it up.

- I have two daughters and we talk about gynecologic health.

We talk about what's going on with their bodies.

So this is my biggest passion is education.

And I think the earlier the better.

I tell my patients all the time, no one knows your body better than you do.

- I do want to empower people to feel like when I go to my doctor, you are the expert of your body.

If you don't know the right question to ask, you often don't get the right answer.

- Now if your doctor brushes you off in that conversation.

- Then you need a new doctor.

What perimenopause and menopause is, and I say it's a profound hormone shift, but we've done this before.

We do this every month with periods.

We do this with pregnancy, we do this with puberty and kind of normalize it is this is another event in our life.

This is not so unique and devastating that we've never dealt with something like this before.

- I'm optimistic.

I think that we're headed in the right direction with regards to improving healthcare for women, after the menopause.

- I hopefully have another 50 years left.

Am I gonna sit here and be at home and miserable and yelling at everybody or am I gonna go out and do something?

And you know, I'm just as valuable now as I was in my twenties and I have a lot more to give and I have a lot more wisdom.

- Menopause can actually be viewed as freedom.

Freedom from having menstrual cycles, the freedom from fear of getting pregnant.

Women should celebrate the wisdom and the knowledge that is gained from the decades lived and carry herself with pride that she is someone who has made it through and she has a lot to give.

- The postmenopausal women are generally happier than they themselves were before menopause.

You are more resilient at that point and maybe you figured out your priorities and you're just happier with yourself.

You're proud of Yourself.

- I am in some ways more valuable now than I have ever been.

And that's what lays on the other side of this and all the way through it, and power.

Empowerment lays on the other side as well.

♪ Some time ♪ ♪ Some where ♪ (calm music)