Hi, I'm Wendy Zuckerman, and you're listening to Science Verses. Today on the show, something huge that's coming for 4 billion people on this planet. It could be you, your partner, your mother, your best friend. That thing is menopause. When we asked all of you, our listeners, For questions about menopause, I didn't quite expect so many responses.

Hi, Science Versus. I am so glad you're doing something on menopause.

I'm out of breath because I'm like, I'm going to call them right now. We heard from FOMI numbers, and those just blossoming.

I'm only 27.

I am 37 years old.

55-year-old. Sixty-one.

Some of you hadn't started menopause yet, but were worried about what fresh hell was coming your way.

Is it terrible? Is it going to make me want to murder my family? My mom, my stepmom, my mother-in-law, they're all going through menopause, and all they say about it is that it's the worst.

For a lot of you, it did sound like the worst. People People are getting hot flashes, of course, but also periods were going completely bonkers.

Instead of my periods slowing down, I get it like every two weeks, which just seems obnoxious to me.

I had more periods.

It should be called men are Very short cycle, very heavy period. Heavy. It was just a horror show, basically.

Some of you had this nasty brain fog where you couldn't hold a proper conversation. You were getting mood swings to the point where you didn't recognize yourself.

In advance, I would just be upset for no reason. I never went through any of the things that they talk about, but I will say I gained weight, and the weight that I had completely transformed formed my body and all settled right around my stomach. So it looks like I'm seven months pregnant. I have never struggled with weight in my life, but now that I'm in menopause, I've gained 40 pounds within three months without changing my diet or exercise.

But I have got one symptom that I have not read much about. Every morning when I wake up, there is so much dry skin inside my ears. Unbelievable amounts. I can reach in and peel off, sorry, if this is a bit disgusting, peel off a large amount of dry skin, and it just keeps coming. But symptoms? This is just one of the confusing things going on about menopause. There was also this big question that people had about what on earth they should do about it, and in particular, whether or not you should take hormones. For years, we've been hearing that hormones can be dangerous. But some listeners, going through menopause, thought that they worked almost like a miracle.

Almost within days, I would say all of the symptoms went away. I mean, everything got better. It's amazing.

This tracks with what I'm hearing all over social media, with folks online saying that these drugs are great, and in fact, doctors have been screwing it up for years.

For the vast majority of women, hormone replacement therapy is safe and effective and can give a woman her life back. But that option has been taken off the table.

It's ridiculous to me. What's going on here? Are hormones safe or not? If you don't want to take them, is there anything else you can do? When it comes to menopause, I'm hearing a lot of...

It was just a horror show, basically.

But then there's science. Science versus menopause is coming up just after the break. What does the AI revolution mean for jobs, for getting things done?

Who are the people creating this technology?

And what do they think?

I'm Rana El Khaloubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI with the most human issues at the center.

Join me every Wednesday for Pioneers of AI.

Don't forget to subscribe wherever you tune in. It's season three of The Joy of Why, and I still have a lot of questions like, what is this thing we call time? Why does altruism exist? And where is Jan 11? I'm here, astrophysicist and co-host, ready for anything. That's right. I'm bringing in the A-Team.

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New episodes drop every other Thursday, starting February first.

Welcome back today on the show, Menopause. Our adventure into menopause really starts when the number of eggs in our ovaries dwindles, which can kick this cascade of hormonal changes. This time in our lives is generally called perimenopause. The hormonal changes that we're experiencing during this time are actually not the same for everyone. Studies have found that for some of us, our estrogen levels will actually go up during perimenopause. For others, they will go down. Then there's a group of us where our estrogen levels actually won't change that much during this time. Bottom line, do not believe those posts on social media that say we're all going on the same hormonal journey here, because we're not. But we are all heading for the same destination. At some point, our estrogen levels will drop. We'll also stop getting our period. If your period has disappeared for 12 months, congratulations, you're officially in menopause. One huge Which analysis found that most of us will reach this milestone between our mid-forties and mid-fifties. But it can happen sooner. Our first question is just, what are the real symptoms of menopause and the time leading up to it? Because you go on socials and people say that you can blame basically anything on menopause.

I talked about this with Dr. Monica Christmas, a gynecologist at the University of Chicago.

There's this whole litany of symptoms now, and you can look like, Oh, my God, I have my joint ache. Oh, my goodness. My hair is thinning. My skin is dry. My big toe is throbbing. I mean, I'm being facet, and I don't mean to be facetious because I'm actually in menopause right now, and I I'm having... I'm taping ice packs to my neck and surgery and all kinds of craziness. I actually am not minimizing anyone's menopause. Do you know what I'm talking about?

The most random thing is that last night I woke up at 4:00 AM and my big was throbbing and I was like...

But literally, when people say that to me, I'm like, My big toe is throbbing, too. I don't think that's menopause, but maybe it is.

Okay, but seriously, this idea of, Is this weird thing happening to my body because of menopause or something else? It's actually a huge question for people during this time. Because the thing is, estrogen does a ton of stuff throughout our whole body. So It's easy to blame our hormones. But sometimes something else is going on. For me, I just needed to cut my toenails. To our listener with the dry skin in your ear, well, estrogen acts on cells in our skin, so it could be that. But also doctors told us, maybe check if you have a fungal infection. Monica says, Sometimes things are breaking down in our body just because We're aging.

It's hard to sometimes disentangle what's just you're getting older. I'm grappling with that aspect in my life, too, right now when I put the other side of 50 is real versus what really is due to menopause.

But in the trial of your symptoms versus menopause, there are a few things that menopause is absolutely guilty for. The first thing, I'm so sorry to say, has to do with your Vagina. This was my reaction. Oh, no. As we get older, our vagina's atrophy. Science's word, not mine. I would have chosen downsize. One reason this might happen is because once estrogen levels drop, it makes it harder for blood to reach the tissues in your vagina, which means that your vagina can shrink.

Vaginal tissues become drier, they become thinner. The actual glands make less lubrication.

Because of this, several years after your period has stopped, it might become a bit painful to pee or to have sex. For some, Monica says that's not the problem.

Some people say, I'm not interested in sex. That's not the issue. But I still have a dry, itchy vagina. They just keep thinking they have a yeast infection, and they keep getting treatment. They'll say it works for a little bit, but then I feel itchy again. The reason it works is because the yeast infection cream probably had a moisturizing effect. That's why they felt like they had a little bit of relief because the cream helped. But it's not that they really had a yeast infection.

In fact, research has found that even though changes to your vagina are one of the most common symptoms of menopause, because a lot of people don't know this, they don't get the proper treatment. Okay, so from your vagina to something coming out of it, your period. Estrogen and hormones obviously play a huge role in when you get your period, which is why menstrual cycles can go mental in the time leading up to menopause. We often hear that you'll politely start skipping your period, but it's actually quite common for your menstrual cycles to get heavier and to come more regularly. As a general rule, if your cycle is about a week shorter or longer than it normally is, that's a sign you're in early perimenopause. If you start skipping cycles completely, you're getting close to menopause. Next up, hot flashes. Tons of folks transitioning into menopause are going to get them. While for some, they're not a big deal at all, for others, they are a very big deal. Here's how one of our listeners described it. She said, picture this.

You've got a lasagna in the oven on 450 degrees or something, and you open the oven and get that blast in your face.

This blast in your face, which can last for up to several minutes, can mess with your sleep, which can then really affect other things like your mood. A lot of listeners were asking us, why does this happen? It's weird, right? And amazingly, scientists only discovered the mechanism about a decade ago. So as estrogen levels change, we think that it stimulates these neurons in our brain called candy neurons, and it makes them crazy. So they start sending messages to brain regions that control temperature, telling your brain, You are hot. And so, bam, you feel hot. And some people can experience these flashes of heat on and off for years. In fact, for the unlucky ones, they'll continue even after you've finished menopause. So meet what one paper described as the super flashes. Here's Monica again.

My poor mom is one of them, that they always have them. They might not be as severe as they were when they first went through menopause transition, but they will always have them.

How's your mom now?

She is better, but she will still have a hot flush. If I say her age, she would kill me, so I won't say her age. I'll just say I'm in my 50s, and she did not have me when she was 16.

She's still having hot flushes.

Yeah. All the grandkids are like, How old is Grandma? And I'm like, Who the heck knows? She used to tell everybody that she was 45. And when I turned 45, I'm like, Mom, you at least need to be older than your oldest child. And she looked me straight in my face and said, That sounds like a you problem. Well, not a me problem.

Research has found that Black women, like Monica's mom, are more likely to be super flashes compared to White and Asian women. We're not sure why. Okay, so if You are getting hot flashes. Your menstrual cycle is being weird. Chances are you are on the train to menopause. There's other stuff too, like joint pain and stiffness. But then there's two symptoms that I hear about a in the context of menopause, where things aren't so simple. Now, let's look at memory and brain fog. This was a really big issue for a lot of you out there. In an email, someone told us, The brain fog was absolutely awful. I lost confidence in even carrying on a conversation because I couldn't find the words to use. To find out what's going on here, we need Professor Samar El Koudari at the University of Pittsburgh. She's been studying menopause for almost 20 years.

I see how I used to study it without fear, but now I could see that I'm living it. You know what I mean? Yes. If that's what- Study it without fear.

Even when I'm building this episode, I completely understand where you're coming from. Yeah. A lot of people in perimenopause, around 60%, say they're having attention and memory problems.

Sometimes you are talking and you want to remember name of someone. You feel like it's there. You want to say the name, and you are not able to remember.

It makes sense that changes to your hormones could affect how you think because we know that estrogen does really important stuff to our brains, like it helps memories to form. But for the average person going through menopause, how bad is this? Let me tell you about this amazing study that Samaa works on. It's tracked more than 3,000 women for decades, and it's measured their hormones and all kinds of things. But it's also given the memory tests over and over again, over many years. Here's what it's found.

You expect as you repeat the test, you should get better on the test, right? Right. However, what we found is during the perimenopause, women actually are not getting better. They're learning is not as you would expect for someone younger.

Yeah. Their test scores didn't drop. They just didn't go up. It's not like going through menopause trashed their memory. Other research finds this thing, too. For example, one study gave women a list of words to remember and found that during perimenopause, they weren't so good at this. But When it was subtle, the women had trouble remembering one or two words out of 16. The good news is that in some of these kinds of studies, including SMARS, it shows that this so-called menopause brain, it doesn't last forever.

It's really temporary, and it will go away once they become postmenopausal.

Interesting. I think bottom line, this is real. While some of us might be hit harder by it than others, thankfully, on average, our brains will fare better than our vaginas. Okay, just quickly, the last symptom we need to dive into is weight gain. People have this story that I went through menopause and I put on 50 pounds overnight.

It's not because of menopause. You are not gaining weight because of menopause. You are gaining weight because you are getting older.

Generally speaking, as we get older, we tend to put on weight. In the study Samaa works on, women tended to put on around 2 kilos or 4.5 pounds over three years. But when researchers followed the women to see who Who's perimenopausal? Who's postmenopausal? They can see that the weight gain isn't linked to where they are in that menopause journey, but rather how old they are. Other studies have found the same thing. So one big review paper wrote, quote, Weight gain per se does not appear to be affected by the hormonal changes of the menopause. But then what about all those people at the start of the show? Talking about how They had all this belly fat all of a sudden. Well, if that's you, you're not imagining it because menopause is doing something here.

Menopause and the hormone would affect where this fat go in your body. You see women start to accumulate more fat in their abdomen.

Yeah, so the hormonal changes during menopause tell your body to change where it stores fat. For some mad reason, it's redirecting that fat to your belly. In one study, postmenopausal women had around 50% more fat inside their abdomen compared to premenopausal women. For those really feeling this menopausal belly fat, it could be this one-two punch. We tend to gain weight as we get older, and then our body shoves it in our thumb. Here's where we're at. The adventure into menopause can be a real drag. I mean, for one, it can dry out your vag, it can give you hot flashes that for some of us will hang around for years. It can affect our memory, although for most of us, that won't be too bad, and it can affect our body shape. Our next question is, what can we do about all this? Because on Instagram and podcasts and news reports, it feels like there is one message screaming from the rooftops. Just take hormones. So should you do it? That's coming up. Welcome back today on the show, Menopause. It doesn't sound like a barrel of laughs, but now we're asking, what can we do to make it funner?

The treatment getting a lot of buzz right now is hormone therapy. The idea is that you take a synthetic version of the hormones that your ovaries are no longer pumping out. What's confusing here is that for years, we've been hearing that these hormones can be dangerous and can cause things like breast cancer. But now, the pendulum is swinging in the other direction, with folks online saying that these drugs are safe and can work wonders for your menopausal symptoms. And yet, doctors have been withholding these drugs from us. Why? Well, apparently, it's all because of one study.

Scared off, say advocates by an NIH-funded study called the Women's Health Initiative, or WHI, from two decades ago that they say dramatically overstated the risk of hormones. The thought that estrogen causes breast cancer is the worst thing that came out of that study because it's not true.

What we know, and this is not controversial, women that take estrogen alone have a decrease in getting breast cancer. And this is the message that is not getting out.

It's hands down the biggest grew up of the entire medical field in the last 25 years, that I won't be able to think of a bigger act of incompetence than what happened with the Women's Health Initiative.

I've been involved with the WHI since the study inception.

That last voice, that's Professor Joanne E. Manson at Harvard Medical School. She's been working on the Women's Health Initiative for more than 30 years. She does not think that it is the biggest act of incompetence. But let's get into it. Because this study might be the single most influential study out there that's affected our perception of these hormones and whether or not they're going to help us or hurt us during menopause. Let's start our story in the '80s and '90s. Some early research had suggested that if you're an older woman and you took these hormones, it could prevent heart disease. Doctors were given out these drugs like jelly beans. But at that time, Joanne and a huge team of researchers wanted to find out if this was really true. Did taking hormones like estrogen and progestin, which is the synthetic version of progesterone, did that really prevent heart disease? So they launched this huge study. And because heart attacks are such a big killer in the US, women were lining up to be involved.

We had a slogan, be part of the answer. And so many women in the study would talk about they just want to be part of the answer, not only for themselves, but for women of future generations, for their daughters, granddaughters. And it was very exciting.

It sure was exciting. More than 27,000 women over 50 signed up. Some were given hormones, others were just given a placebo. And this study was trucking along for five years. But then Then, the researchers started analyzing the data, and they found something that they really didn't expect. Instead of hormone therapy preventing heart disease and saving lives, they saw the opposite.

An increased risk of heart attack, stroke, blood clots in the legs and lungs, and breast cancer.

Yeah. So not only did hormones not to prevent heart disease, but they also increased a woman's risk of breast cancer. A press conference was set up. They announced the results and said that the trial would be stopped early. And suddenly, people were freaking out about these hormones. Here's an interviewer on the Today Show talking to a researcher at the time.

You actually found heart disease, the risk increased by 29%, the risk of strokes increased by 41%, invasive breast cancer risk increased by 26%, What are we telling women, the 6 million women in America today who are taking HRT?

Well, it was a shocking finding. It was seismic. Women were calling their doctors frantically. They were tossing their pills and patches.

Were you getting calls from people who were in the trial from your patients? Yes.

I received calls from my own patients as well. It was very stressful. And led to a sea change in clinical practice. Many clinicians were telling their patients to stop. So it was a big...

It was a royal pain in the ass.

Susan Reid, a professor of obstetrics and gynecology, at the University of Washington, was in the middle of a different clinical trial using hormones. She told me she had to stop because of all this.

We had to stop.

Oh.

Yeah, I remember it very well because my OPI was in England singing with a choir, and I was left holding the bag. It was horrible. So I remember it.

Was it literally singing with a choir or metaphorically?

No, literally.

This WHI study It really set the stage for hormone therapy not to be given to loads of folks suffering through menopause because doctors thought it was too dangerous. But now you fast forward 20 years and you have people saying that this was a huge mistake. Why? Well, some say that the study was flawed, and it's 20 years old. It's irrelevant. I asked Susan about this. There is this feeling that the Women's Health Initiative was this old study done using hormones that we don't even prescribe anymore, and this is punk science, and we shouldn't trust it at all. What do you think of that? Is this still a useful study?

It's totally a useful study. And so that mantra is coming from people who want to sell hormones sometimes. People shouldn't say this study was horrible because it was incredibly well done and it answered questions that it was set out to answer. But unfortunately, it showed there were risks for those people in that study. It's good data. Use it, right? Use it. But don't Don't twist the message. Don't twist it.

Without twisting the message, the second complaint that people have is that the press conference overstated the risks here. Let's look at what happened with breast cancer. In that press conference all those years ago, they said that for the women who took the hormones, estrogen and progestin, they had a 26% higher incidence of breast cancer compared to those who got a placebo, which could sound pretty scary, right? A 26% increase. But if you tell people the stats in a different way, it can feel pretty different. For example, if you look at it like this, out of 10,000 people who take these hormones, how many extra folks are going to get breast cancer? A recent Lancet paper calculated that it was six. Six more cases compared to what would have happened naturally. Six out of 10,000. Here's Susan.

How big is the risk? If you look mathematically, it's small. Super small. Less than one in a thousand per year attributed to the hormones. They are small, but you need to know about them. Any risk might be scary to someone. If they had three family members die of breast cancer, they don't want it.

But then, what's up with these people on social media getting loads of views for claiming that these hormones lower your risk of breast cancer? Well, I think what they're doing is cherry-picking the facts in a way that actually could be quite dangerous. They're telling you about a particular group of women in that study, and it was women who didn't have their uteruses. They'd been removed. This is important because the thing is, if you don't have a Susan says.

You're my favorite patient to give hormones to.

Yeah, that's because you can just take estrogen. You don't have to take this other hormone called progestin as well. If you have a uterus, you can't do that because just taking estrogen increases your risk of uterine cancer, something you don't have to worry about if you don't have a uterus. It really increases my risk.

Oh, yeah. You can only take estrogen alone if you don't have a uterus. Uterus.

The thing is, in that WHI trial, if you just zoomed in on the women without uteruses who just took estrogen, they actually did have a lower risk of breast cancer. Not all, but some smaller studies have since come along and found this, too.

It's real. It's science.

In a nutshell or a boob-shell, if you have a uterus taking hormones, estrogen and progestin, that will slightly increase your risk of breast cancer. If you don't have a uterus, you're good here. Then just quickly, remember how early in the WHI study, they saw that hormones up your risk of heart disease?

You actually found heart disease, the risk increased by 29%, the risk of strokes increased by 41%.

The latest science marches to the beat of a slightly different drum. Okay, so if you are over 60, it's still bad news. Here's Susan.

If you start hormones at age 60, you have an increased risk for a heart attack, increased risk for a stroke, increased risk for leg clots and lung clots. Those are real risks.

But if you're in your 50s, Taking hormones actually lowers your risk of heart disease, which is interesting, right? The reason this might be happening is because if you take hormones like estrogen when you're older, you might already have dangerous plaques in your arteries. We think that estrogen can help to rupture those plaques, increasing your risk of a nasty blood clot forming. But if you take estrogen before those plaques form, we think it might be protective. Okay, so that is basically the tea on that big study that people like to crap on. But now, let's look at which menopausal symptoms hormones can actually help with. Because Monica hears over and over again these stories about the magical powers of these drugs.

That hormone therapy is going to fix everything. It's going to make me sunny. It's going to make me happy again. I'm going to have all this energy.

The truth is that hormone therapy can be great for a few different things. Like, it can help your poor, downsized vagina. Researchers found that estrogen put straight into your vagina, which is quite safe even if you have a uterus, can even increase the number of blood vessels in your genital area, which is exciting.

Treatment with local vaginal estrogen can be extremely helpful.

Hormones are also great for hot flashes and night sweats. One review found that hormones reduce hot flashes in peri and postmenopausal women by around 75% compared to a placebo. Monica says that this means other stuff can get better, too.

If I give you hormone therapy and your hot flashes and night sweats resolve or get better and you're sleeping If you're keeping better, then you probably will have more energy. You will have more clarity, right? But if that's not actually the trigger, just taking hormone therapy isn't going to make your brain fog go away.

Which takes us to the stuff that hormones don't really help with. Studies find that they don't seem to improve memory problems. Research on depression isn't great either, but it might help if you're in perimenopause. Hormones are also not particularly great at helping you shed that belly fat. Should you take them or not? Well, over and over again, I heard basically the same advice from academics and doctors. You look at what your symptoms are, ask yourself, how bad are they? Can hormones actually help with them? Then you balance that against the small but real risks here. And generally speaking, take the lowest dose that helps with your symptoms, and don't stay on these hormones any longer than you need to. Here's Monica again.

We don't want to mislead people by saying, This is safe. It's like jelly beans. Everybody should be on it. It's still a low risk. It's not zero, but it's still a pretty low risk. I don't think that that's in a really symptomatic individual that's really having problems, their quality of life is just terrible. Those people should not be afraid, or doctors should not be withholding hormone therapy from them because vast majority of people will be fine. I think that's the key point there.

Okay, so our last question on this menopause, Dananza, is what if you want to try something more natural? You don't want to take the hormones. Well, Susan Reid has studied a bunch of options out there.

We like to take herbs, right? We like vitamins. We like herbs. We think it's going to be natural. We think it's going to be good. How's the data on that? Not so hot. It's just not so That's really a bummer. It's really a bummer.

Susan did a big clinical trial to see if one of the most popular supplements for menopausal stuff, Black Cohosh, could help with heart flashes or vaginal symptoms against a placebo.

It did Bupkis.

What do your patients tell you after you did this study and you're like, I don't see it helping?

They hated us. They hated us. They wanted their Black co-host. In fact, our naturopathic physician who was part of our team who really helped us with all this, she sobbed. She sobbed. She was so sad because this was what she told all her patients. I mean, it was really sad.

Susan has also looked into phytoestrogens. Sometimes people take them as a supplement or eat foods high in them, most famously soy or tofu. This might work. It's actually cool because special bacteria in the gut can take that soy and then transform it into a molecule that acts a bit like estrogen in your body. The thing is, though, it only works if you have those special gut bugs, and a lot of us don't. Plus, you need to eat a lot of phytoestrogens.

You can't just drink soy lattes. It's not going to do it.

Instead of supplements, try exercise, including It can help with loads of things like your sleep, your mood, your bones, and maybe even it might help you to maintain your weight. But it doesn't look like you can outrun your hot flashes. When it comes to hot flashes, there is actually a new drug that doesn't muck about with hormones, but instead tweaks that candy neuron system that we talked about at the start of the show. Just quickly, Susan has found something recently that she thinks is really awesome and just might help you with your trouble sleeping and your hot flashes. It's perfectly safe, and it is your mind. Susan and other teams have found that cognitive behavioral therapy, so just using your brain to reframe your hot flashes as not being so bad can help.

Our minds are powerful. It's exciting. You literally can change your perception of that and how bothersome it is for you. We saw a benefit that was better than you might have seen with a pill.

Have you had any pushback of getting women to do therapy for menopause is telling them it's all in their head once more.

Oh, no. I flip that. I don't say it's in their head at all. It is real. But I flip it to say, your mind is powerful and look what you can do with it. You can do with your mind more than you could do with a pill.

Well, so when it comes to science versus menopause, what is going on? Well, the most common symptoms are hot flashes, bonkers periods, and vaginal troubles. And while it might not make you pour on the pounds, it can put those pounds on your belly. As for a cure, hormone therapy is far from the panacea that people might claim, but it can be really helpful for some things, including hot flashes and itchy vaginas. But you know what? Because everyone's estrogen journey is different, it's possible that it could be really helpful for your symptoms. There are just a few risks you need to know about, particularly breast cancer, and if you're over 60, heart disease. Meanwhile, there are other things you can try, like CBT. Here's how Monica, who, if you'll remember, is currently ice-packing her way through menopause, thinks about this whole wild ride.

It is unavoidable. If we're lucky to live long enough, you're going to go through menopause. Menopause isn't a disease. It's a natural process. And I think with this whole monetization of menopause right now, it makes it seem like there's a fix for it. And yes, by and large, there's treatment to help certain symptoms, but there's no magic pill to stop the aging process.

So I hope you feel a bit better and more prepared for what's going on with menopause. If you are still feeling very freaked out about all this, Susan told me, You know, menopause, it's not all bad. If you are someone that gets moody around your period, if you feel bloated, if you get painful cramps, for a lot of us?

It all stops. Life is one nice smooth ride. There's none of that and down. Oh, yeah. Some people love it. Some people are totally like, You don't have to think about contraception anymore. It's liberating. It's very liberating.

Great. One listener told us that she can wear white jeans again, and she looks really cute in white jeans. Yeah.

You don't have to buy new sheets.

That's science versus. This episode on Menopause has a 158 citations. 158. Oh, my gosh. If you want to see these citations, if you want to read more about anything I've said on this show, then just go to the show notes and there's a link to the transcript. I really hope that this helps you understand what's going on because there is so much garbage on social media about this. I just really want to thank all of our listeners who got in touch, whether it was on email or voicemail. I listened to all of those voicemails and my heart went out to every one of you. I cried a couple of times. I just really appreciate you getting in touch and trusting us with your story. We always love hearing from you. If you want to get in touch, I'm on TikTok at Wendy Zuckerman, and we are on Instagram, science_vs. This episode was produced by me, Wendy Zuckerman, with help from Rose Rimla, Meryl Horne, Aketi Foster-Kees, and Michelle Dang. We're edited by Blight Terrell. Fact-checking by Diane Kelly. Mix and sound design by Sam Baer. Music written by Bobby Lord, Peter Leonard, So Wiley, Emma Munga, and Bumi Hidaka.

Thanks to all of the researchers that we spoke to for this episode, including Dr. Caroleyn Gurvich, Professor Martha Hickey, Professor Nancy Woods, Professor Cindy Farkwa, Professor Jayashri Kulkhani, Dr. Rebecca Thurston, Dr. Siobhán Hálo, Dr. Susan Diem, and Dr Yana Zina Gradova. An extra special thanks to Sirene Jayamana, Penny Greenhalte, and Imogen Hayes for our brainstorming session about a better word for vaginal atrophy. We threw a bunch out there, but went with downsized in the end. Thanks, guys. Also, thanks to the Zuckerman family and Joseph LaVelle Wilson. Science Versus is a Spotify Studio's original. Listen to us for free on Spotify or wherever you get your podcasts. But if you are listening on Spotify, you can follow us and tap the bell icon so you get notifications when new episodes come out. And wherever you are listening to us, please rate and review us. Give us a five-star review. One for every million citations we have on the show. I'm Wendy Zuckerman. Back to you next time.