112 | Menopause, Work & Your Next Chapter with Dr. Arianna Sholes-Douglas

Have you ever found yourself in a meeting, searching for a word that used to come effortlessly, or suddenly losing your train of thought in front of a room full of people? Have you quietly wondered whether you are losing your edge, your confidence, or your ambition — without ever connecting it to what is actually happening in your body?

Menopause does not wait until our careers wind down. It arrives right in the middle of them, when women are leading teams, growing businesses, mentoring others, and stepping into some of the most influential years of their professional lives. And yet it remains one of the most underaddressed issues in both medicine and the workplace.

In this episode of Pleasure in the Pause, Gabriela sits down with Dr. Arianna Sholes-Douglas, board-certified OBGYN, integrative women's health expert, and author of The Menopause Myth, for a wide-ranging and deeply honest conversation about what menopause is actually doing to women at work, what it is costing companies and the broader economy, and why Dr. Arianna refuses to frame this transition as a decline. She calls it an evolution. And once you hear why, you will too.

Are you ready to awaken your sensuality and feel more empowered in your body? Access the FREE Pleasure Upgrade Bundle at https://www.pleasureinthepause.com/gift.

Dr. Arianna Sholes-Douglas is a board-certified OBGYN, integrative women's health expert, nationally recognized speaker, and author of The Menopause Myth: What Your Mother, Doctor, and Friends Never Told You About Life After 35. She is the founder of Tula Wellness and Aesthetics in Tucson, Arizona, and host of the Stay Juicy podcast. After her own perimenopause awakening led her to leave traditional medicine and build an integrative practice focused on the whole woman, she became one of the leading voices helping employers understand that menopause is not just a women's health issue. It is a workplace issue. 

In this episode, we discuss:

• Why even a trained OBGYN missed her own perimenopause — and what that tells us about the gap in menopause education
• The real cost of untreated menopause in the workplace: $1.8 billion lost annually in productivity and $26.6 billion in overall healthcare costs
• How brain fog, ADHD-like symptoms, and loss of executive function show up for high-achieving women at the peak of their careers
• Why Black and Latina women are disproportionately impacted economically by the menopause transition
• What employers can do right now to support women through this transition and stop draining institutional knowledge from the workforce
• Why Dr. Arianna calls menopause an evolution rather than a decline, and what that reframe changes for women in midlife 

Dr. Arianna's advice for women listening right now is simple and radical at the same time. Err on the side of doing too much for yourself. Because even then, you will probably not be close to what you actually deserve.

Menopause is not the end of your most productive, purposeful, and powerful years. For so many women it is where they finally begin. If this episode gave you language for something you have been living without words for, please share it with someone who needs it too.

If you're seeking to reclaim your pleasure and vitality, join Gabriella at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Transcript

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Gabriella Espinosa 0:27

Welcome to Pleasure in the Pause, a podcast dedicated to empowering midlife women to connect with their bodies, pleasure, and power in Perimenopause, Menopause, and beyond. I am your host, Gabriela Espinoza. Each week I sit down with leading medical experts, thought leaders, and trailblazers for bold, thought-provoking conversations that educate, inspire, and challenge the myths we've been taught about our bodies, aging, and sexuality. I also share solo episodes with evidence-based insights and real talk to help you feel informed, supported, and in charge of your health and pleasure in this season of life. Because your pleasure matters in and out of the bedroom. So take a deep breath, settle into your body, and let's begin. Hello, beautiful listeners. Welcome back to Pleasure in the Pause. Have you ever wondered how many women are quietly questioning themselves at work, thinking they're losing their confidence, their focus, or even their ambition, when what they're actually experiencing is menopause. The truth is menopause doesn't happen after our careers are winding down. It happens right in the middle of them, when many women are leading teams, growing businesses, caring for family, mentoring others, and stepping into some of the most influential years of their lives. Maybe you've been in a meeting and suddenly lost your train of thought. Or you found yourself searching for a word that used to come effortlessly. Maybe your body started doing something completely unexpected, and you did everything you could to hold it together, hoping no one would notice. If any of that sounds familiar, here's what I want you to know. You're not losing your edge. You may be moving through one of the most profound transitions of your life. And as you're about to hear from today's guest, this season isn't simply about changing hormones. It can become an invitation to rethink how you want to live, work, and spend the next chapter of your life. Today's guest is someone who's helping change the way we think about menopause. I'm joined by Dr. Ariana Scholes Douglas, board-certified OBGYN, integrative women's health expert, author of the menopause myth, What Your Mother, Doctor, and Friends Never Told You About Life After 38, founder of Tula Wellness and Aesthetics, and host of the Stay Juicy podcast. She's also a nationally recognized speaker on menopause, midlife transformation, and women's health. What makes this conversation especially powerful is that Dr. Ariana isn't speaking only as a physician. She's speaking as a woman whose own experience with perimenopause caught her completely by surprise, even after decades of caring for women as an OBGYN. That awakening changed everything. It led to her leaving traditional medicine, building an integrative practice focused on the whole woman, and become one of the leading voices helping employers understand why menopause isn't just a women's health issue, it's a workplace issue. In this conversation, we explore why so many accomplished women mistake menopause for losing their confidence, what the research tells us about its impact on women and the workplace, why employers should be paying attention, and why Dr. Ariana believes this stage of life isn't about decline. It's an opportunity to reimagine what comes next. So if you've ever questioned yourself during this transition, if you're wondering how you want to spend the next chapter of your working life, or if you've never once heard the word menopause spoken out loud at work, this episode is for you. Let's get into it. Welcome to Pleasure in the Pause, Dr. Ariana. It's such a pleasure to have you here. Great to be here. Thanks for having me. Dr. Ariana, you've spent decades caring for women as an OBGYN, but you've also spoken openly about your own menopause journey. You describe it almost as a menopausal awakening. Can you take us back to that time? What was happening in your life? What symptoms were showing up? And when did you begin to realize that what you were experiencing was actually menopause?

SPEAKER_00 5:05

It was a rude awakening for me. I practiced maternal fetal medicine. I had been practicing that basically high-risk obstetrics. So I wasn't really exposed to a lot of gynecological patients. All my patients were high-risk pregnancy patients. So that wasn't really my world per se, but I still am trained as an OBGYN. And I still know that I received definitely less than an hour's worth of any information on menopause. And so being that wasn't a population of patients that I saw and I had no training on the topic, I pretty much was like the average lay person when it came to the experience. And so I didn't realize as I was in my later 30s, I was having hop flashes at night, night sweats. One time I thought, do I have tuberculosis or something? But I was thinking of all the most random things that why would sweat at night, but it never entered my consciousness that it had anything to do with menopause. And it's just not even on my radar that it's a thing. And then as time goes along, my periods were always kind of regular. So that wasn't really a big thing. I had fairly real PMS, I guess PMDD. And I found that was getting a lot worse. And I was just having worse cycles in general. And then though the irritability, I will say that I think what was the defining moment for me was the irritability and this sense of rage I had. And I realized, I tell this joke all the time, that literally was like, I want to kill my husband. Like I just had contempt for him, even just listening to him chew food or do anything. And I just remember one day, like, oh my God. So I literally went, I was like, I'm gonna poison him. I Googled it and I realized as I was Googling, like, oh, I've watched enough of 2020 and Dateline that I'm already caught. I'm not smart enough to get away with this. And this all lasted a very short period of time. It was a moment, but at that moment I thought, oh my God, like, and I couldn't really point to anything he had done. And I thought, why? Why are you why? And then that's when it started to, I started to connect a lot of the dots. And there were a lot of other symptoms I was having because I also had an autoimmune condition, it affected my thyroid, Hashimoto. So I had the perfect storm of just stress at work and perimenopause and thyroid. And so I was just a hot mess. And it just took years for me to really point my finger to what it was. But that was my awakening. And at that moment, I thought, wow, I'm a gynecologist. And if I don't understand this, I don't know how any woman who has not been trained medically, because at least I could tap into what I had understood and read a few articles or things and catch up really quickly. But I just thought, how did I miss this? And if I miss this, then I know that most women cannot possibly know what's going on. And no one told me that this could start happening to me in my late 30s. That was never a conversation that anyone had. Perimenopause, we didn't even talk about that 30 years ago. The words existed, but no one was talking about it.

Gabriella Espinosa 8:23

Yeah, and I've heard stories, and it's been my experience too. I talk up to this, that some of us who have those pre-existing conditions, Hashimoto's, I also had a thyroid. I had the opposite. I had a grave hyperthyroid, and I feel like it accelerated my journey into menopause where it all got so muddled. I was managing my thyroid, but I was still feeling symptoms and no one knew about menopause then. This was 15 years ago. And so they were all like, fine, you're fine, you're fine. But it was perimenopause. And if a physician like you, who does this work every day, granted, yes, you were looking after prenatal, perinatal women, if a physician who does this work every day can miss menopause in herself, what does this tell us about the gaps in menopause education and awareness in your medical field?

SPEAKER_00 9:17

The gap is real, and it's a huge gap now, I dare say, that thankfully more women, more social media platforms are talking about it. And as you may have witnessed, as I did at the last menopause society meeting, it was like double the attendance. Everybody wanted to talk about perimenopause, like that was the whole topic. And I am convinced that was definitely driven by the consumer. That was driven by women who are frustrated with their providers. It was not driven by the providers themselves, although the women influence the providers, which influence the menopause society. And this is why we're seeing this momentum and why there's so much more interest. And I've always believed that we can't move the needle, unfortunately, through our medical institutions as fast as we can do it through awareness and every woman being informed and educated about this so that they can essentially challenge, unfortunately, is what we have to do oftentimes. But the average medical student is gonna receive less than four hours. The average resident in OBGYN that say they have dedicated programs to menopause, it's still less than four hours. And we're just not trained. And what we were trained, if you are a doctor of a certain age, and around the time when the 2002 study came out that affected everything, we were taught around all of that. So there was in addition to not getting the information, then there was the false information or the inaccurate or the less than complete information that we had. And so we're not getting trained. And then the study comes out that basically says estrogen is terrible. So there's even less interest or idea that we're gonna even address this, especially through hormone therapy. And so I think that just really set us back, I feel like decades in terms of our knowledge and our understanding. But that gap is there, it's closing. And what I am really optimistic in now is that there are even states like California, I think Minnesota or Rhode Island that are now creating programs or legislation around making sure that providers are trained. That's never happened. So that has all been new, and this has all happened within the last, actually, a couple of years, not even five years, but I would say within the last two to three years. There's definitely a lot of work being done looking at how providers are trained. And it's not necessarily coming from the medical institutions, it's coming from outside. So that's why I say I think our medical institutions are just gonna take too long to get there.

Gabriella Espinosa 12:15

That's so interesting. I've heard of those legislation changes that are happening in those states. It's so sudden to hear that. Is that you think that's being driven at a grassroots level, like women approaching their Congress people and that driving that policy work forward?

SPEAKER_00 12:34

Yeah, I can't say I know what's driving it. I think it's definitely women that are driving it, that are symptomatic, but they are starting to look at menopause in the workplace. And I think where it's actually and why it's potentially becoming more of an interest is because of the economic impact that people are starting to recognize that not managing this normal process that women go through is going to affect the bottom line because now we have data on how that impacts companies, how that has impacted our overall economy and the cost of not treating women. And so I think between understanding the dollars of it and women just making more noise is what's driving it.

Gabriella Espinosa 13:23

And I'd love to talk to you about those numbers and that bottom line in a bit. Going back to your comment about how slow medical institutions are changing with regards to menopause policy and education? I'm curious to hear your thoughts on the recent grant that Melissa French Gates offered the Menopause Society $10 million to be directed to menopause education and training doctors. How much of an impact do you think that will make? Do you really think that will move the needle and move this forward?

SPEAKER_00 14:03

I think it will. I think everything counts, right? And just the awareness, just the fact that somebody now has donated this much money to a cause and an organization, I think that just brings even more awareness to it. The truth is we're still woefully behind in terms of research dollars. So that 10 million is a drop in the bucket in terms of overall research and women's health in general. And those numbers, unfortunately, are even declining just because of other political, legislative things that have affected the ability to do research on certain populations, specifically women, women of color, anybody who is not cis heterosexual male. This is really affecting research in a lot of different areas. But that said, it's a wonderful gesture. I think it allows for the society to just establish themselves even now more as that kind of governing body. And I think that will hopefully bring in other donors that understand the importance of the work. And I think the more that women understand the impact, this isn't complicated at all. It's if you just consider the financial economical impact of not dealing with women going through menopause, then just that alone is enough. But I'm I was excited to hear it. And like I said, I think it just hopefully not only will help, it will move the needle, but it'll also hopefully inspire others to follow along.

Gabriella Espinosa 15:43

Yeah. Yeah, there's definitely other money out there to go around and bringing the attention to women, midlife women's health, and their importance and how they impact the US economy can bring back to their awareness and hopefully direct funds in that direction. I agree with you. So let me just take a couple of steps back. You shared with us your menopausal awakening. Thank you so much. How did you finally understanding what was happening change the way you viewed yourself and the way you cared for your patients? I know that you not only have a traditional OBGYN training, but you also take a very holistic lens, which I appreciated. You've done further study and training and certification and an integrated medical approach to midlife women's health. I'm curious to hear how your own menopause experience has influenced the way you care for women coming to your office.

SPEAKER_00 16:42

The first thing I experienced did was, and this was before I had my office, I was practicing high-risk OB maternal fetal medicine in a hospital setting. So I wasn't in this world at all when this happened. So during all of that, I also was going through what I didn't realize at the time this was all part of menopause because I was ready to blow up my life. And I literally did. That's how I ended up in Tucson. I just quit my job in Baltimore and was just like, yeah, I do this anymore. I moved across the country. And then I got here and I was just like, I hate this. And I was in a not a great place because I was like, I've trained. I trained over 14 years to practice maternal fetal medicine. And now I don't want to do it. I didn't realize that I didn't want to do it. I just thought I didn't want to do it the way that they were doing it here because it was a very different medical model. And it was just too much for me. I couldn't handle it. I couldn't go back from doing consultations to now managing a whole labor and delivery floor and doing emergency C-sections. And it influenced me in the sense that I had to stop working. I was one of those women that I was actually one of those statistics because technically I left that career because of menopause. Like menopause definitely drove me out of there. And then I really have always been interested in integrative medicine. I've always felt like, you know, to just look at a person and just look at their uterus or their breast or whatever body part we're looking at and not understand how it connects to the whole. It just never made any sense to me. So I did the fellowship in integrative medicine here. I still didn't have any idea what I was going to do. And then I just decided a year after I did that fellowship, I'm just going to leave maternal fetal medicine. I'm just going to open up a practice. But I didn't have a vision at that time. I still didn't understand that I was going through menopause. A lot of this was like retrospectively. I'm like, oh, that's why I blew up this and ran out of here. I didn't know what was going on. So I really just kind of stumbled into this because all the patients I started to see and my own experience, I was just like, oh my God, we're going through the thing. And so my practice just ended up being built on that because I had just recently been into it and it made me write the book, The Menopause Myth, um, which your mother, doctor, and friends never shared with you about life after 35, because that was my story. Like nobody told me that by 35 I could potentially be having hot flashes and not remembering things and not being able to sleep. And and I was again another statistical. I was at the peak of my career. I had practiced maternal fetal medicine for over 10 years. And I got to the point where there are things I would be in the middle of a C-section. And one time I remember just forgetting what the next step was. And I had the most ridiculous brain fog. And I was like, I can't operate this way. Number one, I thought I was getting early Alzheimer's. And so my experience was just so traumatic that I had much empathy for patients because I knew that I had experienced so much of what they were starting to experience. And so that's what compelled me to write the book. That's what really compelled me to make sure that was what our foundation was in my practice, even though we do a lot of other things. At the end of the day, our number one mission is to educate women and empower them to help them understand how their bodies are evolving as we age, especially after 40. So that's been my journey. That's how it all was influenced.

Gabriella Espinosa 20:29

And it makes me think about the women that are sitting in your office across from you. You realize you can empathize with them and the struggles that they're going through in menopause, but that they're also struggling at work. Two, what were you hearing from some of your patients in terms of their struggles at work and some of the same things that you experienced yourself?

SPEAKER_00 20:54

Two things in particular that I noticed. One is brain fog. That was huge. Women who were like, I'm like the CEO, I'm the CFO. Like, I'm they're like doing all the things, and they're like, I'm having a conversation. I don't remember who this person is, even though they worked on my team. I can't recall their name, the brain fog and the idea that am I getting early Alzheimer's? What's going on here? And then the other part was the other side of the same coin was this feeling of having ADHD. So again, the forgetfulness, the just feeling scattered. But I actually really started to notice the ADHD pattern. That's actually what prompted me to do my own research for myself because I was like, I feel like I've been able to manage. And I ultimately, I guess I'm getting at ultimately I was diagnosed with ADHD. But I had no idea. I kind of thought, oh, I probably haven't, but it wasn't impacting my life to the point where I was like, oh no, this is affecting me. But listening to other women, really losing that executive function and being able to multitask, even though they say we're not really multitasking. Yes, we were. I was able to do more. I was able to remember more. I was able to do it. And I am a firm believer that as estrogen levels fall, like I call it the estrogen veil, and it just opens up everything. It opens up our consciousness, it opens up any other diagnoses that may not. Not have been obvious because estrogen allowed it to just kind of simmer below. But with ADHD, like I saw that so many times, and that actually what was what prompted me to do my own research, be like, oh my gosh, I think I have that too. So we don't know if there is a specific phenomenon that it's like an ADHD-like syndrome that women experience, or are these women who were likely undiagnosed with ADHD? I think the majority of them are undiagnosed women. But there are some women that just that sounds like ADHD, talks like it, walks like it, but you don't necessarily have all of it. But it really doesn't matter. It affects us in essentially the same ways. But those are the two things for working women that were really prevalent.

Gabriella Espinosa 23:17

Yeah. I also hear from women that they suddenly feel like they're losing their edge, right? That they're not as sharp and confident and capable as they once were. Some of it can be attributed to rain fog or ADHD.

SPEAKER_00 23:35

That's why I think they feel like they're losing it because they are. They're literally losing the ability to function in the same way. And that does affect competence. And when you are literally at the peak of your career, like by your 40s, you're typically 40, 45 for sure. You're there. You're usually stepping into whatever it is you're going to be doing if you haven't already been there. And so when you're used to functioning at a certain level, and then you clearly cannot function at that level and have to make some pretty serious adjustments to even get close, it can affect your confidence for sure.

Gabriella Espinosa 24:14

Yeah. And this has been something that women have managed quietly and kept out of the workplace conversation entirely. Just I know women who have been undiagnosed with ADHD, in large part is due to the fact that women or young women or girls were very good at masking those symptoms. And as you said, when that estrogen veil lifts, we no longer are able to mask those symptoms. We're no longer able to hide a lot of the perhaps over-functioning, high-functioning patterns that we had that were perhaps due to early childhood adverse experiences or trauma. I know some of that kind of go-go high performance perfectionism is driven by a nervous system regulation. I've talked about it here on the podcast. I feel that was my experience. And so, yes, that estrogen veil lifts and all of that gets exposed, and you can't hide anymore, right? There's nowhere you can hide. And so it is not just a menopausal issue. It's a workplace issue. Why do you think it's taken so long for this to be recognized as a workplace issue and not just a personal issue?

SPEAKER_00 25:37

I think what's mostly has driven this is that there's a been a certain amount of shame and stigma around aging and menopause and anything hormonal, right? Is it PMS? Is it menopause? Like it's there's a stigma that comes with it. And women don't like that stigma, and they don't like the association of being old. At the end of the day, I think it's become less of an idea of you're getting old now that people realize, oh, there's perimenopause at that, that's another 10 years ahead. And if I'm doing this at my 40s and in my 30s, and it's like, okay, that's not old, obviously. So I think there's just more acceptance of when it is. I think so many people were just thinking this is something in their minds that happened to like 60-year-old women. And those aren't really as relevant women in the workplace. But now we're seeing, no, it's actually impacting these women. And now that we understand it more, and again, it goes back to the dollar. Like, why is it a conversation? Because at least $1.8 billion is lost in what we consider just productivity. There are studies in the last few years looking at the economic impact of menopause in the workplace and on the economy. And at the end of the day, $1.8 billion annually is lost in work productivity, and about $26.6 billion is lost annually when we think about just the overall healthcare costs included. So that's a lot of money. And at the end of the day, money talks.

Gabriella Espinosa 27:16

So that accounts for missed work days due to menopause symptoms, where that $1.8 million a year is a change.

SPEAKER_00 27:23

$1.8 billion annually is lost in work productivity. And a lot of that is driven by sleep and the issues that have through sleep. So they've even broken it down and understood that women who are actually treated and are able to sleep and ultimately not have that fatigue, as much of that fog, and all the things that come with disrupted sleep are able to function better. We know that at the end of the day, ignoring menopause doesn't save money. It actually costs money. And that's what we understand is once we start treating it and having this awareness, everything changes from the economic benefit to just employ satisfaction and in terms of the productivity and people feeling that belonging in the workplace and that there are organizations that actually are going to start making it a thing. And 17% of employers now offer some type of menopause-related support. So that's huge. I don't know where that number was five years ago. And the more work that comes out, the more we understand. And now we're understanding it's not just the impact that it has economically on the business or our economy per se, but also on that individual. Because another study came out of Stanford, and they looked at how that impacted the income of the person affected. And women who were not treated for menopause did not have those resources, basically made around 10% less. And they think that was primarily due to the fact that they had reduced work hours, they had just less participation in the work, and they also exited the workplace more. So women who are not treated are more likely to exit the workplace. This is finding in the UK is way more ahead of us in terms of all of this. I think the United States is just starting to begin to catch up with where the UK's been in the last decade. But what we also know is that women who are impacted by this are also not just physically, but they're economically impacted by it.

Gabriella Espinosa 29:50

Yeah, two-thirds of women say menopause symptoms affect their work performance. And it's one in ten women with symptoms either leave the workplace or actively look for a job with more flexibility. So this impacts their earning potential, but some are choosing to reduce hours, step back from opportunities like promotions, or leaving the workforce all together. What are you seeing actually in the women that are coming to your practice? What are they choosing to do?

SPEAKER_00 30:25

I see different things, and I usually like what I see. I feel like there's almost a certain restlessness, and there's also an awakening that I've seen patients have. They're just like, I don't want to do this anymore. Like I have one patient and she works for Raytheon and she's classic perimenopause. Like she had all the things, and she just had to start looking at her life differently. So what I see women is thinking, what do I really want to do? I hate this job. I don't even like what I'm doing. So what I really want to do. So I see women leaving the workplace to start their own businesses, or just because they're no longer accepting a life of working somewhere, doing something that they don't want to do. I'm not seeing women just pick up and leave as much. There's a few, but I would say more women are just starting to explore what's available to them and other opportunities and wanting to do something that feeds their soul. There maybe also children are leaving the nest. And it's a time when so many things come together. Your children are leaving, your hormones are changing, you're at a certain place in your life, and it's time to make decisions. And so they're making those decisions. And that was my thing. It's like I want to work, I love parts of what I do, and I need to create an environment that supports what I need to do, what I'm here to do. And so I feel again, it's that estrogen veil gets removed, and you're almost naked. You have to decide what am I here really to do? What really does bring me joy and the reality of working somewhere and doing something that you don't love? That's not a sustainable reality anymore.

Gabriella Espinosa 32:09

Some of the stories I hear, because corporate America is invested in the bottom line, that bottom line takes its toll, especially on women who aren't given the flexibility or the benefits of menopause care at work. What can companies do? What can corporate America do to better serve women? Women contribute so much to the American workforce, so much to that bottom line. You would think that these companies want to step in and offer better benefits, more flexible work hours. Do you see that as a possibility?

SPEAKER_00 32:47

I think it's slowly happening. I think that is the question is what do we offer? And what does that look like? In the past, just did our lip and just went and pushed through. But what employers can do obviously is help with schedules, being a little more flexible, maybe working more remotely and having more opportunities to have remote work. But at the end of the day, just the education alone and the awareness and the access to menopause-informed healthcare is really right there. Like, there's not a whole lot that necessarily has to change structurally, but management needs to understand it. And it has to be from the top because I'm even working with the organization now that menopause really would naturally be a good fit for them. And the women in the organization understand that because they're all going through menopause right now, perimenopause. But the leadership doesn't understand it. And so as an organization, it really can't move until that leadership really understands the impact. And so that's what companies can do is really focus on making sure that their leadership understands the true impact of how this affects the bottom line, how this affects employee satisfaction. But at the end of the day, leaders have to understand that if you don't address this, you're basically draining the workforce because what was happening is what we call that institutional knowledge, that understanding that women would have been able to carry throughout however many years she's with that organization, or just because of her experience, that kind of experience to lose those people at the peak of their careers is really not good for a company. So it's somebody having that vision and understanding that they're going to address this. But it's just like climate change. I feel like if people don't understand it until they really start to feel it, and then they're like, oh, maybe this is a thing. But if it doesn't impact you specifically, it's just this kind of esoterical idea. But women being more vocal, that's really been the game changer. And that's always been, in my opinion, only feel gonna move.

Gabriella Espinosa 35:04

Yeah, yeah. But we saw it with fertility, right? How corporate benefits evolved over the last decade with fertility support, it becoming increasingly mainstream and it's now part of many standard benefits packages. But just because menopause is part of a woman's post-reproductive experience, does it not matter? It should matter equally, if not more, because as you say, we have a group of women who are at the peak who are contributing so much in terms of their institutional knowledge, their skill set, that it should matter to these companies to invest just as much in menopause as in women who are in their reproductive peak years.

SPEAKER_00 35:52

I agree it should matter. A lot of things in women's health should matter. And unfortunately, it won't matter until there's a clear economic line that can be drawn between the two. And the more that line is clear, the more it's gonna be an issue. And I know for sure because it's been an issue. And now that we are getting more data on how it's affecting, now we're seeing that, oh, we're gonna think about this. But I think the bottom line economics and women making noise. That's why we had double the attendance at the menopause society, or I don't know if it's you double the attendance or double the number of people who were getting certified, but something had doubled. And I'm prayerful that it's not just a moment. Because once I think all of this hype goes away, which it will, it'll simmer down a little bit more. The thing is, same women are going to be post-menopausal. And we're not even having that conversation. Like that's a whole nother conversation because it's all about the change and the transition and the tumultuousness of that. But there's a whole life on the other side of that. And there's a still a whole issues around women's health post-menopausally and just her mental, spiritual, there's so much that we just haven't even begun to define. And now we're in this age of we call it longevity or quality of life. But these same women who are going through this, once they finish going through all the changes, now we're going to be asking, how do I live my best? Because now we're living up to a third of our lives post-menopausal. And for some people, it's half of their lives, right? Because if you're menopausal at 45 and you live to 90, then that's half of your life is post-menopausal. There's still not the work or the research or any of the thoughtfulness around how women are aging and what that looks like. What does that look like at 60? What does that look like at 70? I think this gen, what am I? We are Gen XYZ, three X's, right? Yes, Gen X, yeah. Yeah, we're like the first ones to be going through and saying, yeah, no, that's not what we're doing. Now, the millennials, they're not playing at all. Like they, to me, are just they're holding up the banner. And I don't know what the Ziers are doing. But at the end of the day, we don't even have this data because our mothers, they weren't talking about this and they weren't in the workplace. For the majority of them, we're not. We are the first ones to really be a clear generation of women who are as accomplished and in the workplace than any of our predecessors.

Gabriella Espinosa 38:30

Yeah, it really is up to us to really keep raising that flag, keep carrying that torch. I want to go back and just address one very important issue. We know that menopause doesn't affect all women equally, and that black and Latina women often have different experiences and outcomes during this transition, and this is not being talked about. What are some of the unique challenges for black and Latina women? And how do we make sure their voices are actually included in this conversation in the workplace? You address the issue of maybe having to accept less pay, or do they just stick it out and suck it up and suffer through it? I really think about that a lot. And how do we give these women a voice to be included in this conversation?

SPEAKER_00 39:15

Unfortunately, it may impact those women more. It's going to impact women, especially the less education you have, and the more you are working, shipwork or more manual type of labor, then what they found in that study in terms of the economics, those people were more impacted. The more senior you are in whatever field and the more education you have, then the less likely this is going to impact you economically. So indirectly, if that group is overrepresented in any of this, then they're going to be impacted economically. So just by association, we all experience menopause differently, whatever culture and ethnicity. But especially for American women, my observation is that we all experience the same thing. Like if I talk to a black woman and or white woman or Hispanic woman, I don't hear anything different. But we do know that African-American women may have longer perimenopause periods, up to 10 years. And then that's followed by Latino women and white women and then Asian women. So there's a spectrum. We're all having a lot of this, but some of us are having it a little bit more. I think until we deal with the institutional kind of approach of it, it doesn't really matter to separate out our experiences. But we know that indirectly, even in ways that we don't even understand, just through institutional racism, it's baked in, right? Basically, because of socioeconomics and the social determinants of health, like those other things that are affecting our experiences that we don't even consider or sometimes put a label on. So I can't give any broad advice or say it's going to affect them this way or that way, just knowing that we tend to get the worst of the worst. It's economic, we're going to lose the most money. And if it's affecting, you know, ability to stay employed, then we're more likely to be unemployed. So across the board, that's the reality. And we can't separate that out from just the institutional kind of structural racism that exists in the system, right? And we just navigate it the same way we navigate maternal mortality and infant mortality and all the things that the United States and other countries for that matter are not, we're not great at that. We're not great at addressing disparities in healthcare. And we're probably going a little bit backwards right now, but we have to just keep making the advances and educating. And the more I think at the end of the day, education is empowerment. And menopause, perimenopause is not a good place to not be educated in.

Gabriella Espinosa 42:09

Yeah, for sure. And I appreciate your voice in that space of education. You educate through your public speaking in the corporate space, as well as in other spaces, as well as on your social media platform. So thank you for your work in doing that. One of the things that I appreciate most about how you talk about this transition is that you refuse to frame it as a decline. I've heard you describe menopause as an evolution. What do you mean by that?

SPEAKER_00 42:42

It's the time where we literally get to figure out who we are and why we came here. And going back to the veil of estrogen, that same veil is what keeps us more silent, what subdues us, which doesn't allow us to hear our voice, see our voice, speak our voice. Once the veil's gone, everyone understands I'm a different person. I'm just not the same person. And that's going to show up in a lot of different ways. It might show up like I don't care. It may show up like I'm leaving this relationship. It may show up as I'm leaving this job. It may show up as just a breakdown and understanding spiritual awakening as well of what did I come here to do? I went to school, I raised these kids, I did all the things. And now what am I doing? I have all this time left. What else is here to define me? There's no other social constraints that are put on us the same way. And we get to decide. I decided that I'm not going out like that. And I didn't come here to do all this work and just go to school and work hard and raise kids. I came here to be a beautiful expression of whatever I'm here to do. And so this is that time, I think, why I would call it my evolution. And the only time in a woman's life when she really does honestly have that option is unless she clearly is not attached. But we know that marriage at the end of the day, won't get me going, but marriage isn't healthy for women in a lot of ways, and whether it's through their work or through their health, there is a cost. There's a price that's paid being a spouse, being a mother. There's a cost that we have to pay for that. And not saying it's a bad cost, but at the end of the day, if we're not involved in some of those things and we have more, it's not maybe as much of that evolution. If women who are single and have always been afforded this opportunity to do whatever they want and travel and do that, then by the time they get to 50, they're not like, oh, I need to do this, because that was their lives. And that's becoming more and more prevalent. But for the rest of us who decided to drink the Kool-Aid, read the script, and do all things. And again, no regrets, it's all good, but it's an evolution for us because now we get to play.

Gabriella Espinosa 45:14

I love it. I think, and then I appreciate your frankness about it because I think many of us accepted the script and didn't know that there were other options. Or now that we know that there are other options outside of that script, we want to take advantage of them. And so how do we do that? I feel like a lot of women are stepping into this, like, hey, I am worthy of this. I don't know if that veil of estrogen balling has anything to do with it, but hey, I'm tired of putting myself at the bottom of the to-do list. I want to put myself at the top of the to-do list. I am worthy of love. I am worthy of pleasure. I am worthy of joy. I'm worthy of abundance. Women want that. If it means leaving a marriage, leaving a job, ending relationships or friendships or moving across the country, women are willing to do that. And I think our generation, Generation X, we're like waking up and thinking, hey, there is a different way. And so I am seeing it a lot. I read this article the other day in the New York Times about how women in their 50s, there's this myth or notion out there that women in their 50s become invisible. And the writer of this article said, I'm 53, stop telling me I'm invisible. And I'm seeing it too. I'm seeing women who are me who are like, no, I'm not gonna buy that script. Starting businesses, starting podcasts, traveling, doing all sorts of things. So we have to, like, as you said before, it's up to us to push back against these narratives, push back against these inherited scripts, and push back against these policies that don't serve us in the workplace and in medical institutions. And I think we're pretty well equipped, Dr. Ariana. I think we're forces to be reckoned with, we can do it. What do you think?

SPEAKER_00 47:09

Yeah. No, I think there are definitely some voices in our generation, but I think again, I'm definitely seeing it in these millennials. They are not playing with their menopause. And then when I think about Gen Z, when I think about my kid, they're just some of these girls are, they're just so opposite of anything that we would have even ever considered at age 20, some of the things that they're doing and the successes that they're having. I love it. I just, I'm like, I don't even think they realize, even though we probably could have done a lot of those things, you just didn't do that. And now it's just from their sexuality to what they want to do career-wise, and like you said, travel and their decisions around having children and getting married, they don't even have that narrative. I mean, they still get there's still a lot of it there, but it's very different. And it's I love it. I love that women now get choices. And at the end of the day, for me, I would have loved to see more role models of women who are just like not doing that. But I drank the Kool-Aid, and I can't say I regret drinking it, but these girls have opportunities, and I'm seeing things that I never thought I just never even imagined that I'd see women doing.

Gabriella Espinosa 48:28

Yeah. I think there's plenty of space and time for us to be those role models than to show women who uh are coming behind us that 60, we both just entered our 60th decade, that it can be done differently. 60 doesn't look like what it used to, or it doesn't have to be that way. And it's still 60, but it can look and feel differently. So it really is up to us to change that perception and be those role models. And I know that you're doing it, and I intend to do it too. I'm so grateful to be on this journey with you, Dr. Ariana. You know, for women listening right now, someone who may be recognizing herself in this conversation, maybe for the first time, putting language to what she's experiencing, because we've been pretty bold in our conversation here today. What are the first steps you would encourage her to take? To really have agency over her life, have agency over her health, especially in the second half of her life?

SPEAKER_00 49:30

It's so important to really take that time to figure out who you are and who you are when you're not somebody's mother, not their wife, not this employee, what really brings you joy and just taking that time is so important because we just don't think about it. And we're so conditioned to not think about it and to think about everybody else first, almost to the point where, like, even now, I was telling somebody about all the trips I'm going on this year and what I'm doing. And I won't say I feel guilty, but there's a part of me that I could tell, like that when I was sharing, there was like, oh, okay. Because they could tell you were just doing everything. You're going everywhere, you're doing it. I'm like, You're doing you, you're doing you, Dr. I and it was like abundantly clear to this person. And I wouldn't say it was pushback, but it wasn't received as much as not that they were unhappy or anything, but it just was more of a they were taken aback. Like, really, you're gonna do that much for yourself? Like, you're gonna do that much. And I have to like constantly push myself and say, because like unconsciously, I do think, oh, that's a lot. Am I doing too much? And I think about how much I've done, and I'm just like, no, no, no, no. So I'm gonna err on the side of doing too much for me. That's just what so that would be my advice. Err on the side of doing too much for yourself, and you'll still probably not even be close to what we deserve in terms of our self-care and self-love and all the things, but it really does, it is a journey, and there's so much work. And I tell people, you can do the work, you can not do the work. Either way, there will be suffering. And so the more you can just do that personal work and really understand what your traumas, your triggers, and how you got to where you are, and really do that assessment and figure things out, like the sooner you can do that work, it doesn't happen overnight, but the closer you get, it's that journey. And the only way we can really explore it is through knowing who we are.

Gabriella Espinosa 51:40

Yeah. And going back to this conversation, just if there are any employers, managers, HR leaders who might be listening, thinking, what in the world? What's one thing they could start doing tomorrow that would make a meaningful difference for the women on their teams?

SPEAKER_00 51:57

Number one is educate yourself. Information is empowerment, and you have to understand this. So I would say having an understanding and not necessarily just a TikTok understanding, but look at the research, look at the data, and open your mind up to how this really could be potentially affecting you. And I've said this even to female business owners because you would think that we might be more thoughtful around this. And I don't know, I don't have any statistics around that, but it to me, sometimes it's the female leadership that is not getting it. There's actually male leadership there that is starting to understand it better. So also understand that your male counterparts can be your allies because sometimes we're indoctrinated under the same confusion that the doctors are. Just like some women don't have Mitchell cramps. So they're like, oh, whatever, you're fine. If you don't experience it, you don't really understand how this impacts you, but understand that there's a price that we're all paying and it's higher than what we think it is. And I think these numbers are probably maybe not even as accurate. I think they're underestimating the impact. Because when I think about it, I wouldn't have even defined myself as someone who left the workforce per se. But I did technically leave one workforce. I left corporate medicine and started a practice. So I left something. I retired from doing what I had been trained by life work to be. But I would not have necessarily shown up on that statistic. So I know it's affecting all of us. And then educating yourself, educating your leaders in the group and educating the women, having open conversation, just that acknowledgement that something exists and having a conversation around it, that's just a start. Doesn't mean you have to create a whole workplace protocol, but just start having the conversation.

Gabriella Espinosa 53:58

Yeah, thank you for that. Dr. Ariana, this has been such a rich and insightful conversation. Thank you so much for lending your voice to the space around menopause and menopause in the workplace and female empowerment. Please share with our listeners where they can find your incredible body of work.

SPEAKER_00 54:20

Oh, thank you. It was my pleasure. We're tag teaming each other, so I'm excited that we've been able to share on each other's podcast. But speaking of that, I have a podcast called Stay Juicy. Juicy Lives, Juicy Experiences, Juicy Vaginas, and we just talk about all things women, especially post-menopause and what happens next. And I'm on Instagram and TikTok and all the handles at Dr. Ariana. And then, of course, my book is the menopause myth, what your mother, doctor, and friends never shared with you about life after 35. And you can get that on the website or Amazon at drariana.com.

Gabriella Espinosa 54:58

Thank you so much. I'll make sure to share those links. And where is your practice based if someone wants to come and see you?

SPEAKER_00 55:05

We are in Tucson, Arizona. Your practice is called Tula. Sorry, it's called Tula Wellness and Aesthetics. So Tula means balance in Sanskrit. And we are about balancing women through all life phases and stages. So that is what Tula is about. We offer not only the medical aspect, but all the things that happen as a result of us aging. So our skin loses collagen and we gain weight and we get the little love handles. And so we have aesthetics and weight loss and even intimate wellness to help address women that are dealing with vaginal dryness and issues around menopause that have affected them in their sex life. So we have a whole kind of holistic view of the woman as she goes through this transition and try to address all of those pain points.

Gabriella Espinosa 55:59

Thank you for everything that you do for women. It has been a pleasure speaking to you. I'm so glad we got to meet in person earlier this year. And I hope that we meet again, that our paths cross again. And I'm so grateful for your work. Thank you again for being here.

SPEAKER_00 56:16

Thank you for having me, and thank you for your work in this space. You inspired me. Aw thank you.

Gabriella Espinosa 56:22

We're in this together, Dr. Ariana. Yes, we are. Thank you for joining me for this episode of Pleasure in the Pause. Want to help me spread more pleasure in the world? Please hit subscribe to the podcast and share this episode with a friend, a sister, or any woman you care about. Because when we share these conversations, we remind each other we are not alone. Together, we create ripples of empowerment and support that reach far beyond ourselves. Your support means the world to me. Thank you. Remember, your pleasure matters. The information shared on this podcast is for educational and informational purposes only, and it's not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or pleasure in the pause.