Jennie Brooks, host of the Unstoppable Together Podcast chats with Dr. Andrea Jones, an OBGYN, attorney, and advocate for women's health. Tune in as they discuss the experience of menopause in the workplace, what employers and colleagues can do to provide support, and more. Part 2 to follow.
Jennie Brooks:
Welcome to Booz Allen Hamilton's Unstoppable Together podcast, a series of stories that unite us and empower each of us to change the world. I'm Jennie Brooks with Booz Allen Hamilton, and I'm passionate about diversity, equity, and inclusion. Please join me in conversation with the diverse group of thought leaders to explore what makes them and all of us unstoppable.
Hello everyone, and welcome to the Unstoppable Together podcast. I'm your host, Jennie Brooks, and today I'm excited to be joined by Dr. Andrea Jones, OB/GYN attorney, an advocate for women's health. We're here to talk about menopause at work. We are really stretching my comfort level today, folks, and radical candor and courage to share stories. Dr. Jones, welcome to the podcast.
Dr. Andrea Jones:
Oh, thank you so much, Jennie. And you can call me Andrea. We're going to have a pretty frank conversation today.
Jennie Brooks:
We certainly are. Thank you, Andrea. It's nice to meet you. To get us started, let's just talk about menopause 101. Can you give us the ins and outs of menopause?
Dr. Andrea Jones:
Sure. So I just wanted to thank you again for inviting me to do this, because I think the focus has been on an individual's reproductive phase of life and not the menopausal phase of life. And because of that, many have suffered in silence. And I think it's important for women to know their bodies function during both phases of life, but especially how to manage symptoms of perimenopause and menopause, since these phases are not always widely discussed. So to answer your question, the simple answer is that menopause means ceasing or stopping menstruation. So you're considered menopausal once you've stopped menstruating for one year, and this stopping of periods also correlates with a decrease in the ovarian hormones estrogen and progesterone that your body also makes on a monthly basis. I consider myself an educator, so I like to go back to the beginning, and we're going to go back very far and just talk a little bit about how this all works. So, and I know this sounds very scary, it's scary when I bring this up to my patients too, but your body's intent is to get pregnant monthly.
If you do happen to get pregnant, then that pregnancy lasts for nine months, but there's a monthly opportunity for your body to get pregnant. So the pituitary gland in your brain pumps out what we call follicle stimulating hormone, and what that does is it stimulates her ovaries to make an egg and ovulate. At that time, the ovaries then start to communicate with the uterus by pumping out the hormones estrogen and progesterone, and that stimulates the lining of the uterus. It allows it to thicken up in anticipation of a potential embryo implantation. So if a pregnancy doesn't occur, then that thickened lining is shed, and this is what we call your period. If a pregnancy does occur, then that embryo implants in that thickened lining and the pregnancy hopefully progresses. So the first day of your period is considered day one of your cycle, and then this process starts again on a monthly basis. It's a continual loop in the women's reproductive health cycle.
So menarche, or the start of your period, begins on average age 12 or 13 in the United States. It's highly dependent on diet, so you'll notice that it may change from country to country, or from continent to continent. So basically women are born with the amount of eggs that we have. We don't make more through our lifespan, and that's anywhere from one to one and a half million follicles or pre-eggs. And then at the start of puberty, when we start to get our periods, we lose about half of those eggs. And every month, several follicles or pre-eggs will compete to be the dominant egg, so we're losing pre-eggs or follicles on a monthly basis so that by the time we're 37, we're exponentially losing more eggs per month. And then by age 51, which is the median age of menopause in North America, once again it varies from region to region, continent to continent, we only have approximately 1000 eggs left. So that's a significant decline from one million to 1000.
And then this menopausal transition is known for fluctuations in hormonal levels as our ovaries start to slow down as well. Levels of estrogen and progesterone decrease, and other hormones, that follicle stimulating hormone I was telling you that gets this process started, starts to increase. Because, if you can imagine, if your ovaries aren't wanting to create that dominant egg, the hormone in the brain has to increase in order to get that ovary to work. And so because of these fluctuations, women have various types of symptoms. Top symptoms include irregular periods, which are variable. Periods can become shortened or prolonged, and then everything in between. Hot flashes, or what we officially call vasomotor symptoms, which I've been having now that I'm going through menopause. I just turned 51 last month.
But the hot flashes that I'm going through and that my patients describe are the sudden sensation of extreme heat in the face, neck, chest, and they last anywhere from one to five minutes. Some women will get what we call prodromal symptoms. Your body warns you that a hot flash is about to occur. For me, believe it or not, that's a tingling sensation that starts in my feet almost like a-
Jennie Brooks:
Oh, interesting.
Dr. Andrea Jones:
Yeah, very interesting. Almost like the pins and needle sensation we get if we [inaudible 00:06:26] on our elbow too long. So I get that first, and then I know that a hot flash is coming. So hot flashes unfortunately can be very uncomfortable. They include sweating, chills, and the chills can follow a hot flash, especially if you're sweating and then your body's starting to cool down. Clamminess, anxiety can go along with this, and then some women actually have heart palpitations. Studies show that about 87% of women who report hot flashes have them daily, and about 33% of those women report having a minimum of approximately 10 per day, which is a lot. And this affects how a woman presents at work. Other symptoms include night sweats, and both night sweats and hot flashes can interfere with sleep and lead to sleep deprivation. Mood changes are some of the menopausal symptoms that women experience. Weight gain and slow metabolism, thinning hair and dry skin.
And then vaginal dryness tends to be a huge issue, and this is a result of decreased estrogen levels, which leads to atrophy of the vaginal tissue and dryness. And approximately 10 to 40% of women will experience vaginal dryness in menopause. This includes decreased vaginal discharge. I think a lot of women think that vaginal discharge is abnormal, but actually normal discharge is actually your body's normal natural lubrication. And once you go through perimenopause or menopause, that starts to decrease, and then that leads to vaginal dryness, which affects a woman's a woman's quality of life because this also affects her sexual intimacy, and that's a big thing. So vaginal dryness is one of the top three things, including hot flashes and irregular periods, that patients will complain of when they first start to see these symptoms. Now, I just want to stress that it's important that women realize that menopause is normal. We know that menopausal women are the fastest growing demographic in the workforce, so it's important now more than ever to be able to speak openly about menopause at work.
Jennie Brooks:
Right, and that's absolutely why we're here today. I know that we typically hear about hot flashes. I'm stunned to hear that some people experience as many as 10 a day. Oh my gosh. The other thing you mentioned was anxiety, and I would assume, maybe I shouldn't assume, does depression go along with that as well?
Dr. Andrea Jones:
Depression can be indirectly linked to menopause, and we think it's because... It's not a direct link, meaning that your estrogen, progesterone levels drop and then you're at increased risk of being depressed. What happens is that with all of the symptoms going on in your life, that will indirectly lead to feelings of depression because you're so impacted on a daily basis by these menopausal symptoms.
Jennie Brooks:
Right. And I said tongue in cheek at this top of the discussion around having the courage to talk about it and leaning into it, but that's absolutely why we're here, because when you talk about those supports at work, we really want to be able to understand how we can encourage the dialogue. So when I started going through perimenopause, the symptom I started to see early was sleep disruption. So I wouldn't have really recognized it to be perimenopause at the time. I just carried on as if I just had a pattern of bad sleep. What are some of the challenges that you see with early symptoms, and just how to have that conversation with your provider, or the diagnosing it, if you will, or understanding what it is as a woman who's entering the phase?
Dr. Andrea Jones:
So yeah, Jennie, I appreciate that. Those are really good questions. I believe that one of the biggest challenges in getting women to the healthcare providers when they're first having these symptoms is often multifactorial, right? So some of it is pride. I am woman, hear me roar. I don't need a healthcare provider. I can handle this.
Jennie Brooks:
I can handle a little sleep disruption. Right.
Dr. Andrea Jones:
Exactly. Some of it is provider availability. So I always tell women that perimenopause, menopause are diagnoses of exclusion. Meaning if everything else has been ruled out, then you're likely going through normal expected changes. However, if your periods are irregular or you're losing sleep, there could be some underlying issues that need to be evaluated before assuming that you're going through these changes. So let's say, for instance, if your periods are irregular, there could be some underlying thyroid dysfunction issues. You could have some changes inside the uterus, including polyps or fibroids. If your period disappears, let's say, this could be a sign of pregnancy. I can't tell you how many women I've diagnosed after the age of 45 with a pregnancy, and they assumed they were in menopause.
Jennie Brooks:
Wow.
Dr. Andrea Jones:
Yeah. So definitely important to go to a healthcare provider if you're having symptoms. Vaginal dryness can be a sign of precancerous changes of the vagina. So these are things that need to be ruled out before assuming that one is going through menopause. So when symptomatic, being evaluated, of course, is most important. In the same vein, however, another obstacle is getting providers to listen to their patients and not automatically defaulting to perimenopause and menopause. So if you feel like you're not being heard by your provider, then maybe the provider is not right for you, and it's okay to find someone who is right for you. Listen to family and friends on how they rate their relationships with their providers. That's important. I can tell you that when I was practicing full time, the majority of my patients came to me by word of mouth.
Jennie Brooks:
Thanks Andrea. We had such a rich conversation with Andrea that we decided to split this conversation into two episodes. Stay tuned for part two of Menopause at Work. Thanks for listening. Visit careers.boozallen.com to learn how you can be unstoppable with Booz Allen. Be the future. Work with us. The world can't wait.