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Episode 40: Bring On The Heat (1/2)

Sasza
I usually open these conversations asking people, about their background and how they came to be doing the work that they are committed to today. But for this interview, I wanted to open my asking you why and how menopause is stigmatized?

It’s exciting and very positive that this can be something that comes into the spotlight, at the same time the fact that it takes women who are 50 looking like they’re 30, to you know, make something cool, but I’m wondering if this is even something that they are talking about or just the fact that there are women who are public figures in their 50s and we can assume that they are going through some process of menopause or any of them really taking it upon themselves to become spokespeople or even just to destigmatize it in any simple way. 

Jill
You know, I don’t know that there that, you know, actions speak louder than words. and so I think as long as we see examples of women thriving that’s the number one message that has to live but there is a new narrative beginning, you know, just I think a week and a half ago the Hollywood Reporter even did a story on a number of celebrities that have started to or women in the spotlight that have started to address it to talk about it. They even did a list of where certain television shows or films are starting to write it into the scripts through actions not always through dialogue and then even in 2019 we saw a number of new menopause companies pop up or Facebook groups or newsletters or media platforms talking about these topics. So if you and, again, I’m always watching the space in the conversation around menopause so I’m probably a little bit more on it than the average consumer, but it’s beginning and when I started Gennev in 2016, there was nothing, it was crickets except for women on Reddit forums or in private chat rooms or book clubs or wine clubs, and so the conversation definitely is becoming more prominent. 

You’re seeing more organizations start to step up to do something different and to kind of treat and address menopause and empower women to thrive through it in new ways than they ever have before so little by little we’re getting there and it’s naturally not something that’s going to change overnight, anyone’s going to stand up and yell “I’m in menopause” You don’t really see women doing that. If they’re trying to conceive a child and going through fertility treatments they’re not loudly stating that either. So to put that same kind of requirement on menopause in terms of it declaring that it’s out in the public I think that might be a little unfair but from my standpoint we’ve really in the last few years started to see some progress. I have a long ways to go but it’s positive. 

Sasza
And so to put this into context when I was reading before our interview just reading that there are 13 million women in the U.S who are going through menopause and if you use the age of 60 as an average to, you know, assume that a woman has passed through menopause then worldwide there a half of a billion women who have passed through menopause and so just see there’s this huge community it’s not even something that is a quick process per se or that not that many people all can relate to this is an extremely common and I think more difficult than most people realize experience and so to contextualize that in terms of numbers and then also in terms of, you know. treatment realizing in my research leading up to this interview that only 7% of women are getting the help they need to manage menopause symptoms and surveys finding that 48% essentially half of general practitioners, have no training in menopause management and so the sheer numbers and the huge community behind this compared to the resources. This is completely absurd. 

Jill
I agree, we have a lack of care in the medical field, there is little to no education the only petitioner type that receives any education around menopause are obgyns and in the U.S the average age of an obgyn is 55 years old and so we’re retiring them faster than we’re graduating new ones. And so there is a shortage of care and so many women just don’t their doctors don’t understand it primary care gps, they don’t understand or their knowledge and experience working with menopausal symptoms and correlating what’s happening in a woman’s body to the hormonal shifts in her body. A lot of that just isn’t known or they haven’t had time or focus on it or any formal education and so often times a lot of the women that come to Gennev, you know, their number one thing is, you know, “just tell me I’m not going crazy like this is normal” and number two. “I just want someone who gets me where do I find that kind of practitioner that can help me?” and so that’s really what spurred our whole mission to start Gennev and to build this online clinic for women in menopause really based off that notion of the shortage of medical care options that exist for women in this stage of life and your point exactly around the size of the population it is pretty crazy that we don’t have more care because this is half the population that goes through this so it’s not any insignificant or niche number of patients or women and so it’s surprising and I think it goes to show that women are masterful at doing the best they can and or suffering in silence, which is no good for anybody but that is existed for a long time and we’re hoping to change that. 

Sasza
Yeah that idea of women being masterful at suffering in silence, which is admirable on one hand but obviously that needs to change both on the side obviously of having resources and support and feeling as though they can you know, since a lot of these other studies mentioned that 47% a.k.a half of women felt they couldn’t discuss their symptoms with their bosses or colleagues. Also, you know, on the part of women as a whole and men to help destigmatize this in, you know, making the effort to overcome those barriers and be somebody who speaks up and shares and helps start these conversations. You guys at Gennev refer to this space as something in which there are few specialists and a lot of myths and so as we touched on the few specialists I’m wondering how much or little do we know about menopause, where there are still gaps in knowledge and what are some of the biggest myths in this space? 

Jill
I think primarily gaps in knowledge, number one, there are 34 different symptoms of menopause that so often go treated individually versus looking holistically at what’s happening in the body and so often times women will be on an antidepressant or something that is not correlated back to the overall hormonal change that’s happening in her body that could be better addressed with an estrogen patch or a localized version of estrogen. And so I think number one, just understanding the correlation and the range of symptoms that hormonal changes can address is point number one, that’s not being met today. A big myth and or fear and lots of doubt exists around estrogen therapy or hrt hormone replacement therapy. I mentioned earlier in back in the early 90s there was the women’s health initiative, which was a big study that really cast a lot of fear and doubt on using hormone replacement therapy because of its potential correlation to cancer, but if you’re using it later in life, which they studied women 65 plus, that correlation is much higher than if you’re using in the early stages of onset menopause symptoms such as hot flashes or anxiety or inability to sleep. And so there’s a lot of fear and myths and uncertainty around hormone therapy that is starting to worry. 

There’s a number of companies now that are trying to start to change that perception because it can be something that is so helpful to women in terms of bringing back their quality of life or improving their quality of life in a safe effective way the means even by which women can be a no acquire it and use it look more localized than systemically like they’ve used in the past have improved, you know, methods have become more effective and innovative and so that’s kind of I’d say the second myth or fear or inadequacy that exists around menopause today. 

And the third one is really just this notion of normalizing it, again, the majority of women that come to Gennev or that talk to think that they’re going crazy or that something is seriously wrong with them when in fact, this is a very much normal part of life and through that we’ve just got to again start to normalize it and you know help people realize that this is this is very normal. It’s very natural, it’s organic and it’s something that women can actually thrive through versus suffering so much by themselves, so kind of those three core things are probably keyed myths or issues in trying to improve this whole part of woman’s life. 

Sasza
And I think as I was reading as well discussing kind of the myths or I’ll say misunderstandings or perhaps misconceptions when I read that menopause technically is just one day. 

Jill
Yes, it is. 

Sasza
You know, the term itself is that specific where it refers to the one year anniversary since your last period so when you have lived one year without having a single period you have an anniversary that is called menopause and then that’s it. And so just these three stages and the perimenopausal stage which is where you’re actually experiencing symptoms and what we associate with being menopause in the term on its own actually has kind of this whole other stage and name for it. 

Jill
Yeah, you know, you’re in that menopause is a single day, perimenopause has this timeframe leading up to that day where a woman has no longer had a menstrual cycle for 12 consecutive months. And so that perimenopausal time of life is probably some of the most disturbing in terms of symptoms because that’s where women are experiencing the most inch in terms of you know, changing menstrual cycle, sometimes it’s unpredictable, sometimes flow is very heavy, sometimes it’s very painful as well as changing anxiety patterns changes in sleep and a woman’s ability to sleep also experiencing hot flashes or night sweats where the body temperature of a woman is just kind of the thermostat is just off and so, you know, she can have kind of a men’s periods of swain that can even lead to heart palpitations and so some women are concerned that they might be having a heart attack. The woman during perimenopause goes through such change that, again, we don’t prepare women for because we don’t talk about it like we prepare young girls for having their first menstrual cycle or their first period we don’t really talk about it with women in menopause. 

And so those symptoms are often times not only big changes but their surprises for women and that period of menopause-perimenopause can lead can go anywhere from 2 to 10 years so it can be a freaking chunk of time. When a woman hits that one year anniversary of no periods for 12 consecutive months she’s hit menopause and now from there on out she’s in post menopause and post menopause, you know, essentially is the whole second half of life in some ways, there are symptoms that can continue in that period of life, but we’ll certainly decline over time and oftentimes what we see in the women at Gennev and they complete our, what we call, our menopause assessment and this assessment kind of helps a woman understand where is she at journey between perimenopause, menopause and post menopause. We’ve kind of put out five different types that a woman can be defined in to understand, you know, she’s type 1 she’s in premenopause, type 2 perimenopause, etc. and in that post menopausal phase we’ve seen certain patterns of symptoms that are different than perimenopause a lot more changes around skin and hair, a lot of changes in vaginal health in dryness, in potential sexual pain, libido will go back up during that time of life. But sometimes, you know, the vagina has aged a bit and so just like any other part of our bodies and our skin needs extra care to keep its elasticity in the skin healthy, and so, you know we see and there’s other post menopausal symptoms around heart health, and brain health, and bone health that are incredibly important for a woman to pay attention to and address. 

And so what we’re trying to do at Gennev is really help women understand where they at in this journey, and then how best do they take care of themselves and or put preventive measures in place so that postmenopausal phase of life is good and healthy and we take precautions against any kind of you know postmenopausal challenges specifically around bone health, heart health, and brain health that women can mitigate. 

Sasza
Well, first of all just in terms of the fact that we use these different terms to refer to things that are actually a different phase or outside of that, it reminded me of the fact, you know, when you learn that actually what we refer to as the vagina is the vulva and you know these terms that we just carry on using culturally without reflecting kind of the nuances the extremely important nuances of the body or of these processes and then I couldn’t help but think back to, you know, before menopause had a name and was identified as being something natural and part of the life process. You know, how many women must have just thought considering how many women I know who thought they were dying when they got their first period it I actually can’t imagine, how many women were just so utterly confused and probably convinced that they had some intensely fatal illness with all these mix of symptoms without the information considering that in this day and age it remains a bit murky and confusing, again, it not being openly discussed or the resources being, you know at the hip. 

To clarify in terms of the stages of pre and peri menopausal and it leading up to that year without a period which equals menopause in itself and wondering about how long that process is since at first you might think “okay, so a year” but then obviously there are I’m sure many years that are passed through in which periods cycles change and become, you know less frequent but before a full 12 months is reached about how long can that window be and how early can it start? 

Jill
That period of change can go anywhere from 2 to 10 years. And so you might start seeing some, noticing some changes with your menstrual cycle in terms of its frequency or its timing or periods it, you know between periods “oh, I’m shortening or the flow changing in terms of heaviness”. You could start seeing that in your early 40s and continue through those types of changes into your early to mid 50s and some women, you know, they will go even you know, six to eight months consecutively with no menstrual cycle and then boom it comes back again and they hear they thought they were on their way to that 12-month marker and no it’s interrupted with “oh they got their period” you know, and so that’s very common and that’s what makes that perimenopause time frame frustrating for women because there’s just a little to no certainty and what’s even more women there’s no one-size-fits-all for perimenopause or for women in menopause, every woman is individual. 

Sometimes we can see correlating patterns off of our mothers or sisters or family members, but typically it’s very individual for that woman to further kind of sometimes add mystery or complicate things if a woman is using birth control or an IUD or any kind of you know kind of hormonal based solution for prevention of pregnancy or even to regulate her periods or decrease the pain sometimes that can add further just you don’t get all the signs associated with that menstrual cycle that you typically would if you weren’t on the birth control because some women have an IUD and Mirena IUD to control, you know, discomfort of periods or to not have them at all so we don’t really even know where she’s at in that cycle as a result. 

And so, you know just kind of adds further complication and mystery to this whole, you know cycle of knowing when you hit menopause. So again, that’s why I think this part of women’s health is so complicated because there’s just different variables and every woman leading up to it has addressed not only her pregnancy, but also managed her menstrual cycles up to that period in a way that works for her and so sometimes it can kind of cloud that all the signs of knowing when you hit that 12 month mark.  

Sasza
When you mentioned the period coming back all of a sudden it just reminded me of how frequently people make jokes about, you know day 3 or day 5 or whatever of your cycle when you think your periods over and then it just this is the surprise comes back but to a whole other level after months. 

So we’ve kind of discussed a lot of the complications and obviously certain things that forgot to manage and the symptoms, but I’m wondering how you would phrase white the pros of menopause would be or the positive side of it. 

Jill
You know, I think the positivity obviously there’s freedom from having your menstrual cycle, you know, and for menstruating women who are on the other side of it talk about that frequently of also seeing, you know, this notion of increased creativity and confidence women doing new things on the other side of menopause or having gone through it and part of that is just the place in life that we are the older we get the wiser we become because we have more time, and experiences under our belts and so you see, in terms of in the U.S I think alone the highest rate of women starting their own businesses are women 50 plus which I think is interesting because they’ve come to this point in life where they’ve got the social capital, they’ve got maybe the financial capital, they’ve got the confidence, they’ve got the freedom and to actually go do the thing that they want to do. 

And so there is I’d say if you were to say what’s one word that represents women in the second half of life or beyond this menopausal period of life its freedom in so many different ways and you’re seeing it in women really kind of at the top of their game. And so I think that’s where the positivity comes. I also have to say we often talk about menopause as a puberty the second time around but it’s like the anti puberty, it’s like the opposite thing happens. The first time our bodies are flooded with home at hormones and the second time those hormones leave our body and when they leave it sets us up for what’s our health going to look like for truly the second half of life. We’ve got a whole other second half left. And so how best are we going to thrive in terms of feeling great and being healthy and getting to do finally the things we want to now that we have this new found freedom in so many ways and so that’s where the positive message comes out for me and you’re starting to see it, you know, societally and the more that we can help empower women to take control of their health and the changes they’re going through during menopause the more that it sets them up for that positive change down the road. 

Sasza
Yeah, I love that image of liberation of time energy and stress in a way. I can only imagine when women didn’t have to go sit in the red tent for days or a week out of the month, you know, how much more productive they could be and how much more free they felt and so kind of on a much smaller scale just having a bit of that positivity to thread through this narrative of menopause for women I think is really valid and valuable.

And so through all of this and you know looking at Gennev and what you guys are doing to try and help normalize this and provide these much-needed resources to women. I’d love to dive into your story and what events experiences or lesson learned from your past have led you to where you are today in the work you’re doing today. 

Jill
Sure, absolutely. So my background has been in technology. I’ve had 20 years in the tech industry that was working at big tech companies. I started at a software company that we took public Microsoft acquired us and then I worked at Microsoft for 15 years and during that time, you know, obviously, I love tech I love how technology improves people’s lives. So I’ve seen real world applications of that whether that be in developed markets or developing markets. I’ve worked around the world in that capacity, but my personal interests were always in women and girls development philanthropically. That’s where I’ve spent my time. And so when I started Gennev in 2016 it really brought, you know, my passion around women and girls development in this case women’s welfare and development together with my background in business and technology. 

I see a real opportunity to change the way women experience menopause and what really drove me to menopause a- no one was doing anything about it and so that kind of got under my skin like wow, this is something that has been around since life began and yet no one’s really addressed it in terms of helping women thrive through it and number two, I was just seeing women when they’re just starting to hit their stride or get to the top of their game, whether it’s career wise or being more independent from their family or just coming into their own, their confidence was being impacted because of the impacts of menopause in the way that they were feeling and the am I going crazy notion because they just truly didn’t know what was happening and no one would listen to them from a medical standpoint. 

And so that kind of is really what drove me to start Gennev because I was like, there’s a better way to figure this out and I bet we can leverage some notion of technology to try to bring more support to millions of women around the world. Our mission at Gennev is to empower women to take control of their health and the second half of life “dot dot dot” starting with menopause because that’s where the change begins and so the more that we can do that the more we help women feel in that place of confidence and in control of their lives and to me that’s the mission of our business that’s what keeps me excited about this. I’m also a business person, I see a huge market and a huge opportunity and so that’s certainly part of what motivates me but we even more so technology has a great role to play and be applied to this part of women’s health. And so I hope to just bring a little bit of that value to millions of women around the world because I think the bar to me, because no one’s done, anything is low so even if we can start to address it in terms of education or bringing women together in a community or getting them access to tools and resources and services that they wouldn’t typically have without Gennev that’s kind of mission accomplished in my mind. 

Sasza
As you said, you know, this is something that’s been around since life began. I couldn’t help but think how it also ironically and beautifully is the result of the process of reproduction that is what allows for the beginning of life in itself and so as we’re here and we’re talking about women and menopause I’d love to and I’m not sure if this is something kind of within your forte, but talk about men and what role they can play in this process, but before even getting there on a practical level talk about what processes men go through and what some of the equivalent processes might be. 

Jill
Yeah, you know, certainly men are aging too and their bodies are changing and their hormone levels are changing too, sometimes people have affectionately called it manna pause, but, you know men certainly, you know with testosterone changes are going through their own set of changes. I think that from what I understand and know it doesn’t probably impact them in 34 symptomatic different ways like menopause does for women because you know are estrogen and progesterone in our bodies control so much they control the gray matter in our brains that cushions our brain it controls our moods it controls our ability to sleep it helps our skin and hair stay you know, moisturized our vagina stay moisturized and so just the impacts of those hormones on our bodies is just more extreme than some of what men go through. Men also go through some of these changes a little bit later so there so sometimes the cycle of change is starting to happen in women faster than it is in men at an earlier age. So I think that’s why sometimes hours are heightened over men’s a number of men come to us at Gennev and ask us “how do I support my partner? “How better can I help her through this period?” like help me help her which is fantastic that we’re seeing more and more of that. We surveyed women in 2019, we published the menopause zeitgeist. It’s the 2019 menopause zeitgeist and it’s just helping people in general understand who is today’s menopausal woman and we published that based on over 6,000 women completing the menopause assessment, that’s a free assessment on our site, as well as doing some more social based research amongst women and one in five women said they wished they had better support from their partner and many of them, said my partner it’s not that they don’t want to support me, they just don’t know how or I don’t feel comfortable bringing this up with them or I don’t even know how to ask for their support or how they could support me. And so it even shows that between men and women we have a long ways to go in terms of just understanding one another and then being able to talk about it. give each other some space, being patient, knowing that it’s not the other, you know, and when one might have a short fuse and so there’s a relationship dynamic that we tend to see in women of this change or this age going through often times where relationships degrade because they don’t have that language or don’t know how to talk about it or don’t even know that it’s a thing to understand and give the other some space on rather they think it’s more of a relationship or a change in the person that they don’t like. 

So men go through their own changes in addition to women physically going through ours, but then as well how we engage and interact in that relationship dynamic is also something to pay huge attention to.

Sasza
I love that you guys, publish that menopause zeitgeist and helping people especially men but not only men, you know, other women who haven’t gone through this phase of life and are not very familiar with it either to help recognize and understand how they can be better supporters better allies as you mentioned, you know, some of those big changes. I love how in some of the research and interviews that we’ve done at BBXX on aging how people can have a very healthy sexual life, sexual connection later on and that yes, there are certain bodily changes that happen, especially, in association with these hormone changes, but that when navigated and you know, you have the resources or the tools or the lubricant to assist you that a lot of people as they get older actually have even more fulfilling and very satisfying sexual lives with their partners if only given the chance to be able to move through these processes in a healthy and informed way. 

In this week’s episode we talk with Jill Angelo, the Co-founder & CEO of genneve, an online clinic, resource center, and community whose mission is to empower all women in menopause to take control of their symptoms. In our hour-long conversation, we cover the stigmas and myths of menopause, the lack of resources and support for women going through the phases of menopause and the ways in which we can normalize and create greater visibility surrounding this natural life stage. 

Stigmatization of Menopause

If you dig into the historical accounts and treatment of menopause, you’ll quickly realize that women going through this stage of life have been stigmatized since time immemorial across various cultures. In the book Hot Flushes, Cold Science: A History Of The Modern Menopause, author Louise Foxcroft recounts how many doctors in 19th century England claimed their menopausal patients were suffering from “hysteria.” While we’ve come a long way from this perception, our modern society still struggles to view menopause as a natural and liberating start to the second half of a woman’s life.

In cultures or societies where value is placed on women in their ability to be reproductive or to be beautiful and young, menopause has a stigma associated with it because it doesn’t represent those things.

The Power of Language

As always, it’s important to note the ways in which words and language as a whole shape our overall perception of ideas and topics, in both discreet and more not-so-discreet ways. To this day, menopause is still a victim to the language used to discuss its characteristics and symptoms. In the Western world, the medical language used to discuss menopausal biological processes is largely dominated by “negative imagery such as ‘reproductive failure or ovarian failure,’” implying that menopause is a malfunction of the body or a disease to be treated, rather than a natural life stage.  

The Main Myths & Misunderstandings of Menopause

  1. Treating Individual Symptoms — There are 34 different symptoms of menopause, but so often these symptoms get treated individually instead of looking at the body holistically and understanding the correlation between symptoms.
  2. Fear surrounding HRT — After the Women’s Health Initiative published the report showing the increased risk of breast cancer and other life-threatening conditions related to HRT, women feared this treatment. In reality, there are now safe and healthy HRT options that alleviate many of the challenging symptoms.
  3. Viewing it as a Dysfunction — So often women think something is seriously wrong them, either mentally or physically, when they begin to experience menopausal symptoms. More work needs to be done to normalize this chapter in a woman’s life.

The Beginning of HRT

In the 1930s, the medical community began referring to menopause as a deficiency disease and by the 1970s estrogen hormone replacement therapy (HRT) was being touted as a “liberation” for middle-aged women. But HRT’s moment in the sun was shattered after the Women’s Health Initiative published a report showing that HRT had more detrimental than beneficial effects, namely increasing the risk of breast cancer, heart disease, stroke, and blood clots. To this day, HRT remains misunderstood even though studies have shown ways to safely manage menopause with various HRT options.

The Upside of Menopause

All emphasizes the freedom of menopause — not only the physical liberation of no longer menstruating, but the emotional liberation of feeling wiser, more confident, and more powerful as a woman in the second half of her life. 

We’ve also seen this notion of increased creativity and confidence — women doing new things on the other side of menopause…In the U.S., the highest rate of women starting their own businesses are women 50-plus.

The Upside of Menopause Cont’d

The Menopause Zeitgeist, a survey of more than 6,000 women in menopause, found that 72% claimed to be happier, 57% reported feeling physically stronger, 69% reported feeling more confident, and 54% felt more in control of their careers compared to 10 years prior. 

The Need for Partner Support

The Menopause Zeitgeist also found that 94% of the women surveyed felt that they didn’t have enough support from their partner during the menopausal journey. Women reported three main ways for partners to be more supportive:

            1. Not taking mood swings or other symptoms personally

            2. Becoming more educated about menopause and its symptoms

            3. Cultivating patience

There’s a relationship dynamic that we tend to see in women of this age where relationships degrade because they don’t have that language or don’t know how to talk about it or don’t even know that it’s a thing to understand.

Other Resources and Research

About the Expert

Jill Angelo

Jill Angelo

Jill is the CEO and founder of Gennev, whose mission is empower women to take control of their health. Gennev is the first-ever online clinic for women in menopause and offers telemedicine access to OBGYNs, menopause health coaches, wellness products and free education. Prior to running Gennev, Jill had a 20-year career in tech, with 15 of those years spent at Microsoft in executive roles such as Chief of Staff to the CMO, Director of Global Media, and Product Management for Emerging Markets. Jill recently joined the Board of Directors for Special Olympics of Washington. Named as one of Inc. Magazine’s 2016 Most Impressive Women Entrepreneurs, Jill is a driving force for bringing effective health solutions, information and resources to women in the most vibrant years of their lives.

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