Women's Health: What If Better Healthcare Started With a Real Conversation? | Emily Paulsen & Dr. Denise Au

We're drowning in health information. Instagram tells us to test our hormones. Friends share what treatments they're trying. TikTok has opinions on everything. And yet, when it comes to understanding what's actually happening in our bodies during midlife, most of us are completely lost.

I sat down with Dr. Denise Au, a fellow of the American College of Physicians with over two decades of experience in women's health, to cut through the noise and have the real conversation about what's happening to our bodies and how to take care of ourselves.

Are We Well-Informed or Just Overwhelmed?

Dr. Au's answer was both: we're well-informed and overwhelmed. There's an overabundance of information from friends, media, and the internet. It's hard for patients and physicians to sort through it all and identify the best course of action for each person.

One day I'm thinking I'm an idiot if I don't know my cortisol levels. The next day I'm focused on something completely different because a friend mentioned a treatment she's trying. The noise is genuinely confusing.

What We Need From Healthcare

Dr. Au wants to see ongoing conversation instead of just annual checkups. Shared decision making where we talk about new therapies, benefits, side effects, and make adjustments in real time.

Women want that relationship. Physicians want to provide it. The barriers are access, appointment length, and frequency of follow-up.

Her recommendations: use telehealth, patient portals for ongoing conversations, schedule regular follow-ups instead of waiting for something to be wrong, and book appointments when you feel well so there's a baseline to compare against when things change.

What's Actually Happening During Perimenopause

I'm 38, about to turn 39, and I feel like my world is consumed by talk of midlife and perimenopause. But I didn't really know what's happening medically.

In your thirties and approaching your forties, you might start seeing early symptoms: hot flashes, night sweats, insomnia, mood swings, changes in exercise ability, pain after exercise, changes in memory and cognition, depression, and anxiety.

Here's what surprised me: hot flashes originate in your brain. Temperature regulation is centered in the hypothalamus. Changes happen there during the menopausal transition. We think of perimenopause as something related to reproductive organs, but so much is actually brain-related.

The Black Box Warning Was Removed

The black box warning on hormone replacement therapy was just removed. This made headlines alongside the ending of the governmental shutdown.

Back in 2002, the Women's Health Initiative studied hormone replacement therapy and found an increased risk of breast cancer. They placed a black box warning on the hormones, which for decades prevented women from asking for it and providers from prescribing it.

The major flaw? The women studied were generally in their sixties and above, well past menopause. Women typically go through menopause in their forties and fifties, and they weren't included.

They've now determined that women closer to menopause can benefit from hormone replacement therapy for relief of hot flashes, night sweats, and quality of life improvement. Women spend 40% of their lifetime in menopause and post-menopause.

As you go through menopause, women stop making estrogen. When you stop making estrogen, you get hot flashes, night sweats, brain fog, depression, anxiety, insomnia, changes in hair and skin, and genital symptoms. Hormone replacement literally replaces what your body no longer makes.

It comes in topical gel, patch, oral tablets, or combined patches. Dr. Au sticks with FDA approved medications. There used to be a hard stop at five years, but that's not necessarily true anymore.

Bonus: it helps protect collagen in the skin, hair growth, and prevention of wrinkles. Not the reason doctors prescribe it, but a nice benefit.

Sleep: The Simplest Thing We're Ignoring

Sleep removes waste from the brain, consolidates memory, restores concentration, helps process emotions, regulates thought and metabolism, improves heart health, decreases risk of obesity and diabetes, improves immune function, and improves fertility.

Most adults need seven to nine hours per night. Many of us aren't getting that.

We chase complicated solutions to lose weight, boost metabolism, or protect brain health. Meanwhile, we're skipping over the simplest thing: just going to bed.

We promote wakefulness with coffee and energy drinks. Then when we try to sleep, we can't.

Those of us who are childfree have fewer barriers to quality sleep than parents with young kids waking them up at night. Maybe we should take advantage of that.

Why We Don't Rest

Women are conditioned to do it all. We have so much responsibility. Sometimes it feels like we're judged based on our output and how much we produce. That makes rest seem weak or lazy.

Dr. Au agreed. Everything we do promotes how ambitious or effective we are. We don't promote the basic need of sleep. We're always connected to the workplace.

I own my own business. I don't have a boss. And yet I set the expectation that if an email comes in late at night, I should respond. It's a psychological craving to always be available. But this data about sleep shows it's actually in our best interest to disconnect.

Let's Stay Curious Together

Here are some ways to put this conversation into practice:

Schedule a follow-up appointment with your doctor just to check in, not because something's wrong.

Use telehealth and patient portals for ongoing conversations about your health instead of waiting for your annual exam.

Ask your doctor about hormone replacement therapy if you're experiencing perimenopause symptoms. The black box warning is gone.

Prioritize sleep like the foundational health intervention it actually is. Seven to nine hours per night.

Follow basic sleep hygiene: no screens two hours before bed, regular bedtime and wake time, cool dark quiet room, write down thoughts before bed.

As childfree women, recognize you have fewer barriers to quality sleep than parents with young kids. Take advantage of that privilege.

Make healthcare a priority before something's wrong, not just when symptoms appear.

Moving Forward

You can listen to Episode 62 of Curious Life of a Childfree Woman wherever you get your podcasts. Dr. Au's expertise and straightforward approach to women's health makes this conversation invaluable for anyone navigating midlife.

Find more reflections on Instagram @curiouslifeofachildfreewoman.

Let's stay curious together.