Prof Petra Stute: Welcome to the EMAS Menopause in the Workplace Podcast, a special series celebrating World Menopause and Work Day, held every year on September 7. This Global Awareness Day was launched by the European Menopause and Andropause Society (EMAS) in 2021, following the publication of our Global Consensus Recommendations on Menopause in the Workplace, to spark conversation and action around an issue that affects millions, yet is still too often overlooked.
I’m Professor Petra Stute, president of EMAS, and here’s what we know: menopause impacts work and work impacts menopause, but too often, no one’s talking about it.
In this episode, Symptoms of perimenopause and menopause and how they may be affecting your productivity and work, we hear from Dr Angela Derosa, a board-certified internist, hormone health specialist, and member of the EMAS Advisory Board. Drawing from both clinical expertise and personal experience, Dr deRosa dives into the often overlooked symptoms of hormonal change and the powerful ways that can affect women’s energy, confidence, and career path. Her message is clear: what many women are feeling is real, treatable, and deserving of attention, especially in the workplace.
Dr Angela deRosa: Hello, my name is Dr Angela deRosa, and I’m a board-certified internist with a specialty background in Women’s Health. And I have really largely spent my career dedicated to the understanding of hormones and the role they play not only in the quality of life, but also how they prevent chronic illness. Of special note, my patients and colleagues call me Dr Hot Flush. Today, I want to talk to you about the symptoms of perimenopause and menopause and how they may be affecting your productivity and work.
Women are often leaving the profession early at the height of their careers due to the hormonal changes that are occurring within their bodies and the subsequent symptoms that are becoming debilitating. Where I really think it would be helpful to start is really to understand the difference between perimenopause and menopause. I know this creates a lot of confusion for my patients and fellow colleagues, for that matter. But it’s important to understand that there are distinctly different. So let’s start with menopause. Menopause is the absolute time that the ovaries fail. It’s a moment in time. The ovaries shut down. Elvis has left the building. They are no longer working. You are going through menopause right at that moment. Perimenopause is the time leading up to that failure of the ovaries, so the perimenopause is a really important transition because it often takes 10 to 15 years for those ovaries to slow down until the point they just said, “I’m tired, I give up. I’m done”. Menopause. They shut down. And then everything from that point forward, we call post-menopausal.
So, reminder that menopause is the absolute time that the ovaries shut down. Perimenopause is the time leading up to that. And as I said, it can take 10 to 15 years on average for women to start experiencing that ovarian hormone secretion decline. And I often see it occur in different stages. So let’s imagine for a second, a woman’s average age of menopause is around 50, which means a woman may start experiencing hormonal decline in the mid-30s on average. But interestingly, a lot of women, when they start to experience those changes in their 30s, get labeled as being depressed or having mood disorders or various other things. And it’s not uncommon for women to be thrown on antidepressants when they actually really need their hormones balanced, and in particular one at that time, which we’re going to talk about. So, again, women can start to experience hormonal decline mid-30s on average, leading up to the menopause at the age of around 50. And the other thing to note is you could be having significant hormonal changes going on, and you could still be having regular cycles. So if someone tells you, “Oh, you can’t be hormonally deficient because you’re having regular periods”, you’re being dismissed and, they’re not fully understanding, and you need to find a different person to help you with your hormones because that is not true. It isn’t up until usually a year or two before the absolute menopause that period start to change, so you could be young, you could be having normal functioning periods and still have hormone deficiencies.
So let’s talk about the decline of the hormones and where they often play. So testosterone. Yes, I said testosterone. Women make a whole bunch of testosterone. It’s actually our most abundant hormone. Yes, I said that. Abundant hormone on a day-to-day secretion of hormones. We make more testosterone than we do estradiol day-to-day during our reproductive years, and it is a vitally important hormone for us. Believe it or not, it’s also the first one to go, so it’s usually the decline of testosterone occurs in our mid to late 30s. So if a patient presents to my office, for instance, with estrogen deficiencies, symptoms like hot flashes and night sweats, she is already testosterone deficient.
So what are those symptoms? Well. They present exactly the same in women as they do in men. We talk about testosterone deficiency causing libido issues and erectile dysfunction in men, but it causes libido issues, desire issues, and clitoral insensitivity in women, so we don’t feel like we want to have sex anymore. But when we attempt to, often our clitoris takes more stimulation in order to achieve orgasm. The orgasms aren’t as wonderful as they were before, and they’re just kind of lackluster. So you see those whole host of responses occurring in women. But testosterone does much, much more than actual libido and sexual health, which is, although a very important thing, it does a whole bunch of other things. Testosterone is essential for energy. It helps with muscle endurance and recovery from workouts. So we get really fatigued. And when we do work out, it just takes forever to recover. It’s just not as effective. Testosterone is Mother Nature’s serotonin, so we become irritable. We don’t cope with stress like we used to. We get new onset anxiety and panic attacks that we never had before. But most commonly, we get apathetic. We just don’t feel anything anymore. It’s just this lackluster way of going through life where he was like, “Oh, everything’s OK”, and it’s like you just expect that that’s where life is at. You’re not gonna have some significant impacts on your relationship because you’re thinking, “Wow, is this all there is?” and it really becomes a pretty sad state of living for women. And we just stoically move through it.
Testosterone is also essential for cognitive function, so we start to get mentally foggy or very forgetful, and we lose that killer instinct to want to go out and do things in the world, in particular, professionally, we may lose that drive to start new projects or take on new things. It is also essential for executive function thinking, so we it takes us forever to read a paragraph and retain the information. We just aren’t sharp anymore, and it’s testosterone’s role to keep us that way. It also kills our confidence, and if we think women have imposter syndrome now, wait till the testosterone deficiency symptoms kick in, because it’s going to exacerbate that and it can lead to also headaches. It puts us at risk for bone loss, which can lead to fractures and, most importantly, since I’m an internal medicine physician, the one thing I often think about is, “What is the most important physiologic role of testosterone?” Well, here it is: It helps us manage glucose. So when we eat a meal, everything converts to glucose, and it is testosterone’s job to move it from the bloodstream into the muscle so the muscle can use it cleanly for energy. If you lose your testosterone, that doesn’t happen anymore. So where does that sugar go? Well, now, the pancreas has to pump out a whole lot more of insulin in order to deal with that, and it then takes that glucose and converts it to fat, and it puts it right in the midsection. So women will often see their weight shift from their thighs and their buttocks into their midsection, and it’s almost impossible to get rid of, so those weight changes are occurring because of testosterone deficiency. And to make matters worse, when you start taxing that pancreas to make more and more insulin, it’s going to burn it out. It gets tired. So then we start to see creeping a blood level called hemoglobin A1C that doctors look at to see if you’re pre-diabetic or diabetic, so we start seeing those values go to the pre-diabetic levels. But instead of people being treated with testosterone to reverse that, they often get put on drugs like the GLP agonists, or metformin, or, horribly, if they keep going down that path to insulin eventually. But it’s all rooted in that testosterone deficiency. So you start to see marked changes of it, so I’m hoping you’re that there’s one thing you get out of this, this little series here, is understanding that testosterone is vitally important to women, and we need to be addressing its deficiencies in women because it’s impacting our health in a great manner.
So that starts first ladies in their 30s and that’s where we usually get labeled depressed. You’re not depressed. Well, some of you might be, and you may be depressed by the symptoms you’re having, but you need your testosterone to help you balance that out. Then, usually in the 40s, we get to the symptoms of the estrogen deficiency. Now those are more commonly known. That’s the hot flashes, night sweats. You just don’t sleep like you used to. Your skin and hair start to change. Your skin gets saggy, more yellow, instead of that pink hue that we like to see. You also start to see your hair is thinning out. Also impactfully, we get significant vaginal dryness, which can lead to painful intercourse, and I’ve even had some women say just the act of sitting down was so painful because of the vaginal dryness. And then that can lead to urinary symptoms like urinary incontinence, a lot more urinary tract infections. So estrogen deficiency is also really important in the aspect that when you become estrogen-deficient, your cardiovascular risk goes up. So with testosterone, the cardiovascular risk goes up because of the insulin resistance and diabetes you can develop. But with estrogen, it hardens our arteries and we’re deficient, so we get high blood pressure. It negatively impacts our cholesterol panels when we’re deficient in estrogen. Which leads to hyperlipidemias or hypercholesterolemia and those cardiovascular problems of high blood pressure and lipid disorders, and you guessed it, if you throw in things like poor diet, smoking, lack of exercise, all just becomes this huge problem toward events of heart attack and stroke. So it’s women who are on estrogen have lower risks of cardiovascular disease than those who are not, and it’s important to catch those women early as they’re moving through perimenopause and menopause to make sure that that’s balanced so that we keep that risk nice and low.
So you can imagine if you’re feeling all of these different symptoms that you’re not only being affected in your personal life, but in your professional life. I hear this all the time. Women leaving their professions or going part-time, or end up having to take more time off, and their productivity drops because of these problems they’re experiencing at work, and unfortunately, the workplace is not necessarily very sympathetic, often to women, and we’re very self-critical and self-conscious about this. So really, it’s important as a society that we start to educate more workplace personnel who can help us make changes to advocate for women in the workplace, so that we can understand what’s happening to them, build systems and priorities to take care of those women, so that they can get their mojo back. So it’s really hormonal education resources to get proper hormone balancing and understand the time to do so.
So hopefully this information will give you some food for thought and help you maybe figure out ways you can advocate for yourself and others in the workplace, because it’s going to make some significant changes if we can make the workplace and our professional lives obviously much better. So I hope you find this information helpful. I hope you find it empowering and really just go out there and know that you’re not crazy. This isn’t all in your head, and what you could be experiencing is very, very real. And there are ways to help it with proper bioidentical hormone replacement therapies. Have a great day.
Prof Petra Stute: Thanks for listening. If you enjoyed this episode, don’t keep it to yourself. Share it with a colleague, a friend, or someone in your workplace who might need to hear it. To discover more about menopause at work and how to take action, visit emas-online.org and explore our resources, events, and educational tools. Let’s keep the conversation going.
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