Samantha Bee and Dr. Jen Gunter dish about menopause

Editor’s note: The podcast Chasing Life With Dr. Sanjay Gupta explores the medical science behind some of life’s mysteries big and small. You can listen to episodes here. Hot flashes and night sweats. Light, heavy or skipped periods. Mood swings and brain fog. Sleepless nights. Changes to hair and skin. These can all be symptoms of the menopause transition, a natural process that a woman goes through as her brain and body wind down and eventually shut off the ability to reproduce. But honest and open discussions about menopause and the years leading up to it — called perimenopause — have, until recently, been nonexistent. Women’s experience have been either ignored or superficially played out in public for laughs, often resulting in a shroud of secrecy and feelings of shame. Treating menopause as taboo even made the process a mystery to the very people going through it. “When I first started to notice changes in my body, I was probably … 46, 47-ish,” Emmy-award winning comedian and writer Samantha Bee told CNN Medical Correspondent Meg Tirrell recently on the podcast Chasing Life With Dr. Sanjay Gupta. “And I was starting to do my own show. ‘Full Frontal’ had just kind of started, and I was under just … immense amounts of stress, no question. “And I really started to feel like I was not coping well,” she said. “My body was changing — I was having physical changes — and I actually, literally didn’t know what was happening.” Bee, who rose to fame first as a correspondent on “The Daily Show With Jon Stewart” and later with her own series, “Full Frontal With Samantha Bee,” said she would stop getting her period for a couple of months here and there. Her hair also started falling out in a way that didn’t feel typical. And she developed frozen shoulder, started sweating at night and was on an emotional roller coaster with her insides “roiling.” Because the majority of her friends are a little younger than she is, Bee said she thought she was “going crazy” because of her job. She finally confided in her gynecologist that she wasn’t sleeping well and “turning into Lady Macbeth.” “And she was like, ‘Oh, you’re in perimenopause.’ And I was like, ‘There’s a word?’” Bee recounted, noting that at the time the topic hadn’t really broken the surface of popular culture. “We’re all talking about it now, and you can read about it, and people are like, ‘Yeah!’ But eight years ago: zip, like zero information,” she recalled. “Nobody in the conversation. Not cool. Very unsexy. Mention it and you are just like a witch-crone who lives in a cave, don’t come out. … I would never in a million years have thought, ‘Oh, I’m in perimenopause.’” You can listen to the full episode here. Bee’s most recent project, “How to Survive Menopause,” was born out of her own bewildering experience. She performed her one-woman show in New York City in October 2024, where it was recorded live and adapted for audio by Audible. Having a word and a framework for what she was going through, Bee said, helped put her “on a path of knowledge.” “You’re de-pubertizing,” Bee said. Her doctor had this helpful guidance: “‘Remember all the torment you felt … when you were 15 and … every zit was an operatic tragedy? She was like, ‘That’s what that is, but just in the other direction.’” The No. 1 thing that helped Bee most, she said, “is that you have to find a community of people that you can talk to, even if it’s just one person.” “Just saying the words out loud and normalizing it. It’s normal. It literally happens to 50% of the population,” she said. “It’s good to make a joke about. It’s good to say it out loud. That’s actually the main thing that has helped me.” What was not helpful, she said, was turning to social media. “I don’t like to take advice from people who are trying to sell me any type of product. Ever.” Whom did Bee trust? For advice and guidance, in addition to her own doctor, she turned to a woman who has been called “the internet’s gynecologist,” Dr. Jen Gunter. Gunter, who authored the best-selling “The Menopause Manifesto: Own Your Health With Facts and Feminism,” is known for debunking myths about this stage of life. “She told me that some of what happens when you are in perimenopause is that your brain is creating new neural pathways because it’s kind of cleaning itself out,” Bee said. “It’s kind of scrubbing out all of the neural pathways related to getting pregnant, feeding a baby, all of those early childhood, maternal pathways in your brain. It clears a little bit of space so it can be a time of tremendous creativity.” Gunter, who said she likes to call it the “menopause experience” or the “menopause continuum,” agreed that we don’t talk enough about perimenopause and menopause. “If you’ve never heard about it, how would you really know what’s going on with your body?” she told Tirrell on a separate episode of the Chasing Life podcast. You can listen to the full episode here. “A lot of women get their symptoms dismissed,” she said. “But also, the symptoms can be really nonspecific.” For example, she said, women can have irregular periods, heavy bleeding, hot flashes and brain fog for other reasons. “So, there’s a combination of reasons that a lot of people don’t realize that’s what it is until they’re in the middle of it.” How menopause is discussed in the wider culture can also be impactful. “How you talk about something actually changes your thoughts about it,” Gunter pointed out. “It means that we have a mind-body experience,” she said. “Everybody around you is telling you that you’re an ugly old hag whose ‘time has come,’ and all you’re seeing are 70-year-old men dating 20-year-old girls. … You could see how someone would feel worse about maybe the changes happening to their body.” Gunter said we speak in euphemisms about men. “They have ‘erectile dysfunction.’ We don’t say ‘penile failure,’” Gunter said. “If we talked about men’s bodies the way we talked about women’s bodies, woof, that would be a whole different ball game.” So, what do women need to know about the menopause experience? Here are Gunter’s top five facts. The ‘what’ of menopause Menopause marks the end of an individual’s reproductive years. The ovaries cease releasing eggs. “This is when ovulation stops,” Gunter said via email. “This means estrogen levels eventually decrease, and production of progesterone stops.” But the progress is not gradual or linear. “Hormones can be chaotic in the time leading up to menopause, which is known as the menopause transition.” Remember the chaos of puberty? “Think of menopause like puberty in reverse,” she said. When does menopause start? The menopause transition typically starts at the average age of 45, according to Gunter. “The average age of menopause 51 and the normal range is 45-55.” “This means for some women symptoms may start in their early 40s, but for others there may be no symptoms until their late forties or even early 50s,” she added via email. In other words, everybody is different, which makes it an unpredictable ride. The diagnosis of menopause Gunter explained that an individual reaches the milestone of menopause when she has not had a period for one year. “Menstrual irregularity is normal in the menopause transition, and when people are reliably skipping a period then menopause is likely 1-3 years away,” she said. No blood or urine tests exist that can indicate whether someone is close to menopause, according to Gunter. Blood work isn’t even needed for the diagnosis. “If you are over age 45 and have gone a year without a period, that makes the diagnosis,” she said. But sometimes more testing is required. “Blood work is indicated if someone is younger than age 45 and going 3 months or more between periods. The reason for the testing is to identify the cause of the irregular bleeding, and one cause may be premature menopause (age 40- 44) or primary ovarian insufficiency (under age 40),” she said. For people who don’t get their periods for other reasons — due to using a hormone IUD or having had a hysterectomy — Gunter said doctors go by symptoms other than bleeding, for example hot flashes. Symptoms and medical concerns Symptoms can vary greatly from person to person, affect many body systems, and start and resolve at different times. “The most common symptom in the menopause transition is irregular periods, but they can also be heavy,” Gunter said. “Everyone is different. Hot flashes and night sweats are common symptoms,” she noted. “Depression, brain fog and joint pain can happen as well. Vaginal dryness, pain with sex and an increased risk of urinary tract infections are also common concerns.” Menopause also ushers in some physical vulnerabilities. “The risk of osteoporosis increases with menopause. Menopause also marks a time when there is a change in the risk of diabetes and heart disease, so it’s important to be checked for diabetes, have your blood pressure checked and also your cholesterol and lipids,” she said. A variety of treatment options The best therapies for you will depend on your symptoms and health risks, Gunter said. “Menopause hormone therapy (also known as hormone replacement therapy) is the gold standard for hot flashes and night sweats, and for women who choose this therapy, it should be an FDA-approved product,” she said via email. “Hormone pellets and compounded hormones are not FDA-approved and not recommended as the dosing is inconsistent and can lead to unnecessary and serious health concerns. “Many women have heard the word bioidentical, but it is a marketing term. That being said, women should know that most hormones approved by the FDA are bioidentical,” she said. Should all women entering menopause be on it? “We do not recommend that every woman take menopause hormone therapy, rather (that) it be prescribed for specific reasons where we have data to show it works or that is biologically plausible that it could help,” Gunter explained. There are several key lifestyle opportunities as well, Gunter said, such as not smoking and eating a balanced, healthy diet. She recommends aiming for 25 grams of fiber every day. “It’s also important to do resistance training and do aerobic exercise, as this improves many health domains,” she said, noting, however, that there is no need to go overboard by, say, running marathons or engaging in competitive weight lifting if you don’t already enjoy these activities. To maintain physical fitness, aging adults can follow the US Centers for Disease Control and Prevention guidelines of 150 minutes of moderate-intensity aerobic activity weekly and two days per week of muscle-strengthening activities of moderate intensity. “There are no menopause-specific supplements that have been shown in rigorous studies to help with symptoms. Considering the menopause gold rush, I recommend people steer clear of those who sell supplements as their content online is almost always geared for sales, not education,” she said. But if a person has a specific health concern, such as low iron or low vitamin D levels, Gunter said in the podcast, a supplement can be of value. Look for one that has been certified by a third party, such as US Pharmacopeia (USP) or the NSF (the National Sanitation Foundation). We hope these five tips help you understand menopause better. Listen to the full episode with Samantha Bee here and with Dr. Jen Gunter here. And join us next week on the Chasing Life podcast when we look at what happens to the brain during pregnancy.