We don’t often talk about the benefits of aging. Karen Adams has a different perspective. From new beginnings to menopausal zest, the director of the Stanford Program in Menopause & Healthy Aging discusses what women can look forward to as they age up.
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- Who do you hope to be like when you are older? Is there someone in your life who has made you excited about getting older?
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The following is a transcript:
Natalie Brennan: Well, I guess I’m thinking about it because I just turned 29. And that’s a—
[Music.]
Yasmin Tayag: A perfect age.
Brennan: A perfect age. My friends keep doing this bit that no matter how old I turn, they keep saying a perfect age for a woman, so it was like 27, the perfect age for a woman, and then I turned 28, the perfect age. Now once again, somehow I’ve turned the perfect age for a woman. But I always remember thinking like, 28, for some reason, really stood out to me as the time that I thought I, like, thought a lot of my life would be together. And now that I’m past that age, it’s so funny to me to think that I thought that everything would magically be figured out at that time. But I find myself now just being like, 34.
Tayag: [Laughs.]
Brennan: It’s gonna work out for me by 34. Which I know, then I’m gonna turn 34 and laugh at that and be like, what I thought was 34 is actually 42.
Tayag: Well, I’m 37, and it’s, it’s funny—when I was a kid, I thought 37, you know, like my parents, I would have it all together. I don’t know what I’m doing.
Brennan: We’re still just us at every single age. It’s just going to be me at every age.
Tayag: Yeah, but there’s something comforting in that. To think that like, Oh, nobody really has it together at any age! They’re all—everyone’s just figuring it out as they go along.
Tayag: I’m Yasmin Tayag, a staff writer with The Atlantic.
Brennan: And I’m Natalie Brennan, producer at The Atlantic.
Tayag: This is How to Age Up.
[Music.]
Brennan: I’m very aware of the fact that 20s, 30s aren’t the typical zone that people think of when they think of aging. [Laughs.] But we are all always aging, right?
Tayag: We’re always aging.
Brennan: And at different life stages, some of us are thinking about it more than others. Like there’s this big cultural hype around turning 30, and you know, I’m a girl who spends a lot of time on the internet. And let me just say: The internet is not usually a space that promotes positive ideas of aging for young women.
Tayag: Really?
Brennan: Yeah, I don’t know if you’ve heard. I’m reporting it live. But I mean, I’m thinking about even last year, the fashion trends revolved around bows; everything leaned very coquette in aesthetic. That in some ways … does promote an infantilization of women.
Tayag: I totally agree, but I do actually think there’s been a recent shift happening in terms of how we think about aging. You know, I wasn’t excited about my 30s when I was growing up. Everyone I admired in pop culture was in their early 20s, max. And now, we’re seeing celebrities who rose to fame in their 20s become even more sexy and powerful as they turn 30 or 40 or 50, like Chloë Sevigny, Alexa Chung, even Beyoncé—they’re just owning their age, and they’re modeling that getting older can still be sexy and powerful.
Brennan: Extremely.
Tayag: When I turned 30, the big thing I noticed was that, like, Oh, I like myself more. I’m more comfortable in my skin.
[Music.]
Brennan: And I’m really grateful that in my personal life, I have so many amazing models of, yeah, people in my life who are in their 30s. Who just, yeah, seem to be more confident and more sure of themselves.
Tayag: I hope I’m one of those people.
Brennan: One thousand percent one of those people.
Tayag: Natalie, you know, as I’m approaching my 40s I’ve been thinking a lot about how I’m about to enter a new stage of life. So I can help you through 20s and 30s—but I’m looking for someone to help me through my 40s, and my 50s, and beyond!
Brennan: And does that feel exciting, or does it feel scary?
Tayag: Well, I’m hoping to go into it with a positive mindset! Especially the perimenopause of it all. And someone, for me, who has really reframed what getting older can look like is Dr. Karen Adams. Dr. Adams is an ob-gyn, and she’s the director of the Stanford Program in Menopause & Healthy Aging.
[Music.]
Tayag: Dr. Adams, tell me how you describe your profession to someone at a cocktail party.
Karen Adams: Well, I used to say that I deliver babies, but I don’t do that anymore. And actually people are much more interested when I tell them that I was recruited about two years ago to create and lead a program in menopause and healthy aging. And people’s eyes light up. I mean, everyone wants to age in a healthy way. And of course, you’d have to be living under a rock to not know that menopause is having not even a moment—it’s a movement. People are very interested in perimenopause and menopause.
Before I went to Stanford, I was in charge of training all of the OB-GYN residents at Oregon Health and Science University. And one of the requirements for the training was that they get trained in care of what was called then older women. And they were coming out of training really well, well-versed in delivering babies and operating and contraception and all these different things, but they actually weren’t learning how to take care of women over 40. And so I established this clinic that we called the “Over-40 Clinic”; I’m doing air quotes now. Now we know menopause can happen really at almost any age, through premature ovarian failure or insufficiency or early menopause. So it isn’t really age dependent. It’s been 20–25 years ago that I established that clinic, and it just became more and more my clinical focus.
Tayag: It’s shocking to hear how little focus there was in medical schools on menopause. And, like, if there’s a knowledge deficit in doctors, it must be even greater culturally, just with the general public.
Adams: It’s one of the huge issues right now. That people with ovaries—not everyone identifies as a woman, but I’ll use that term as we’re talking, simply because that’s what the terms are in the research and such have been used—but right, you know, that women are becoming much more educated about this sometimes than their providers are. There was a lot of fear around being on hormones 20 years ago because this big study came out and said, Wow, it increases the risk of heart attack and stroke and blood clots and breast cancer and all these things. And people freaked out, and everybody went off their hormones—and we’re still working to undo those messages. And medical students, residents, people who were in training for about 15 years didn’t get taught about hormones or menopause, so there is some catching up to do.
Tayag: Okay, so I want to come back to the specifics of the Women’s Health Initiative study on hormone therapy. But first I’m hoping to talk to you more about the misconceptions about menopause on the whole that you’re hearing these days?
Adams: Oh, probably most often that it is the end of something. And that people feel mournful about the process, and they feel like it means their best years are behind them. And the reality is, there is a thing called menopausal zest. And it is a real thing. And I’m here to tell you that your mother and your grandmother are pretty much having a good time. It’s the transition that’s hard. You know, perimenopause is hard, because you’re going through a lot of changes, and what is your normal is now different. And so that transition is challenging. But oh my goodness—once you get through it, women rate that they are happier at their work, in their relationships, with their partners, in their overall well-being, their feeling of knowing who they are and being comfortable with that. You know, what’s funny is: Do you know the decade of life when people are the most unhappy? What age would you think that would be?
Tayag: Fifties?
Adams: Twenties.
Tayag: Wow.
Adams: Twenties. Teens and 20s. And then people get happier in their 30s and kind of early 40s, and then there’s kind of a little dip—late 40s to mid-50s, people kind of are struggling a little bit—and then people just get happier and happier. Sixties, people are happier; 70s, people are even happier. So, you know, as long as you’ve made the kind of choices that you want to make to really age in a healthy way. Now certainly, some of it is our genetics. Some of it, we have to play the cards we’re dealt. But our lifestyle choices have so much impact on how healthy we are in our 70s and 80s. And there’s a real correlation between our health with our overall happiness and well-being.
Tayag: I mean, I’m in my late 30s, and I’m starting to come across quite a bit of menopause content on social media. But a lot of it still seems to focus on the negative stuff. Hot flushes and mood swings will happen. Brain fog, sleep challenges, anxiety. And, you know, that’s the stuff people hear, and that gets all the attention. But what I would love to hear from you is: What is good about menopause that we’re missing?
Adams: It’s really, really a part of the story that deserves a little more attention—that it really is so wonderful in so many ways. And menopause literally is one day in your life. It’s that day when you have not had a period for a year. And then, for the whole rest of your life, you are postmenopausal. But that doesn’t happen like flipping a light switch, right? It’s not like you just have your periods every month, and then all of a sudden they stop. So there’s this period of time called the perimenopause, which is where things are changing, and your periods become less predictable and less regular. And then you begin to space them out, and then you start getting some symptoms. And eventually you’ve had no period for a year. When your periods go away, all the symptoms associated with your periods go away. So, buh-bye PMS, buh-bye pelvic pain or cramping; some people get menstrual migraines. Endometriosis is another example of a condition that is very cyclic and very related to your monthly cycles. Once your periods are gone, those tend to go away. So that’s a huge benefit that we don’t talk about very much. You know, because your periods have gone away, you’re not worried about getting pregnant, and people’s sex lives often improve because they’re just—they just enjoy that freedom. Maybe you end up not needing to think about your diaphragm or your cervical cap, counting your cycles if you’re doing natural family planning. It’s just freeing to not be thinking so much about contraception.
Tayag: So is it just that the symptoms of menstruation suddenly lift, and that’s what leads to the menopausal zest? Or is there something more that’s gained?
Adams: It’s just a time in a woman’s life when there’s some just stepping into your power: that sense of I know who I am. And I really had a lot of the experiences and life learnings that got me to this point. And hey, you know, I’ve got half of my life still ahead of me. What am I gonna do with it now? My kids are almost raised; they’re in college. It’s great. You know, I can have sex in the kitchen if I want to—which is what one of my friends said when I said, “Well, your last kid’s going to college. What are you gonna do?” And she said, “Have sex in the kitchen.”
Tayag: Amazing.
Adams: And that is menopausal zest.
Tayag: Hey, go wild.
Adams: Why not, right? Sex is supposed to be adult play. It’s supposed to be fun. It’s not supposed to be a burden. You’re not supposed to feel guilty that you’re a crummy partner and you wish you wanted it and you don’t. Sex is for us, as our own well-being. You release endorphins. You feel happier. Pain becomes less intense. It’s a great way to manage pain. I talk to my patients about embracing themselves as a sexual being and trying to get back in touch with what I call your erotica menu. Everyone has an erotica menu of things they like, right? Some people like porn. Some people like a back rub. Some people like erotic literature. My point when I talk about that with my patients is: Remember who you are, remember what you like, and stop thinking so much about what you wish you were giving to your partner. Instead, ask for what you want. Think about what works for you.
Now, I’m not at all saying that someone can’t have menopausal zest and have a thrilling, wonderful second half of your life and not be sexually active. That’s fine. Some people are fine not having sex. I’m not worried about anyone’s sex life unless it’s an issue for them. But the majority of my patients over age 70 are sexually active, and they are having sex with no difficulty, no pain, no problems.
Tayag: That’s so incredible.
Adams: Mm-hmm.
[Music.]
Brennan: Yasmin, I’ve been thinking a lot about how our beliefs about aging are often tangled up with our beliefs about appearance.
Tayag: I can say for myself—those two things feel pretty intertwined.
Brennan: And for me, too. And you know, we don’t talk that much culturally about sex in older age maybe because we are just inundated with this problematic idea that, as you age, your sexual importance decreases. Like: I’m even thinking about how beauty products are literally being marketed as “anti-aging,” which perpetuates this false dichotomy between aging and desirability. Like you must not age so you can stay … desirable.
Tayag: Right. I mean, the messaging right now is: How can you freeze your body in place for as long as possible to keep looking the same age forever? It reminds me of this story I wrote for The Atlantic about baby Botox.
Brennan: Which, to clarify, is not babies getting Botox, but refers to the amount of Botox that people are getting, which is a baby dose.
Tayag: Yes. Like, baby Botox is this idea that you start getting small doses of Botox early on, when you’re very young and don’t have any wrinkles, and you can kind of freeze yourself in place. When I was in college, my side gig was working in a doctor’s office who did Botox. And I would see all of these moms come in with their teenage daughters in tow. The idea is that if you never move the muscles that give you wrinkles, you’ll never get the wrinkles.
Brennan: Right.
Tayag: I wrote about this last year, and apparently the number of 20-somethings who got Botox or other injectables jumped 71 percent from 2019 to 2022.
Brennan: That is a huge jump.
Tayag: Yeah. And full stop—if it works for you, amazing. That’s your choice. But this conversation with Dr. Adams has had me thinking that when we try to freeze our bodies or faces or what have you in a particular period of time, what benefits are we missing out on? You know, are there benefits to looking older? I remember being in my 20s starting out in my first job, and, you know, just kind of being dismissed for looking so young and naive. I remember once an older man told me that he, like, looked at me and said, “One day when your face has more gravitas, you’d make an excellent news anchor.”
Brennan: What?
Tayag: Looking back, it was a weird thing to say. I wasn’t offended at the time—I had taken it as a compliment, he was saying that I was pretty enough to be in front of the camera someday. But now I can see how he also suggested I didn’t look serious enough to deliver news, because I was pretty and young.
Brennan: I … hate that. And unfortunately—I think so many of us can relate to that, right? This sense that if you’re young and attractive, you can’t be a serious person. But once you become older and serious-looking, there’s a flip side, that you aren’t seen as attractive. And, of course, it can be very gendered—young men aren’t dismissed as easily.
Tayag: Nope.
Brennan: And I think it comes from women largely being seen as sexual objects, until they’re not.
Tayag: Right. On some level, I imagine it would be liberating to reach an age where we aren’t being evaluated primarily for our looks.
Brennan: But I don’t know. It feels like you’re either too sexualized, or you’re not seen as a sexual being. I think both can feel really loaded.
Tayag: Totally. And that tension is something that Dr. Adams and I spoke a lot about.
[Music.]
Adams: It’s so funny, right? We’re either too young, or we’re too old. If we have been valued for our appearance and our external attributes, it can be really challenging to age and to find that part of ourselves changing. And I think we have to avoid internalizing those messages; it’s the work of a lifetime. And I remember being a young OB-GYN surgeon, and I went into the holding area to meet my patient that morning to see her, because we were getting ready to do her hysterectomy. And I met her husband for the first time, and we talked. And I said, “Okay, this is what’s going to happen. Do you have any more questions before we go back?” And he said, “Yes. When are we going to meet the surgeon?” And I said, “That would be me.” And he said, “You, you’re going to do the surgery?” And I said, “Yes.” And his wife was so embarrassed. She was like, “Oh, my gosh, I told you.” Now, I like looking older because people think I know more, right? ’Cause I’m a doctor. So it’s like, you want your doctor to be experienced, and all of that. But boy, if I were an actress or if I were something where it’s all about your physical appearance, that would be tough. But, I think all of the messages that we get have to be shifted a little bit. We should be working out to be strong, not to be thin. And focus on how the choices that you make will promote your physical and emotional well-being. And if we’re lucky, we have parents that teach us to listen to ourselves and trust ourselves. And we learned that from an early age. I think we’re teaching people more to trust themselves. And it’ll be interesting to see how that changes the experience of aging for your kids, you know, because I think people are much more aware of the importance of that than we used to be.
Tayag: After the break: Menopausal zest sounds awesome, but what about the symptoms so many women struggle with during the transition?
[Music.]
Tayag: Dr. Adams, we’ve talked a lot about the benefits of menopausal zest, but I’m curious about the transition through. It is a transition, right?
Adams: Oh, absolutely. It’s really unmistakable, because it’s physical. You know, there are physical changes happening. And so sometimes we go through emotional changes and transitions, but boy, menopause is a physical one. It is something that ushers in this new era of your life. But I think that one of the keys for menopausal quality of life is having good health care, so that you’re not suffering with hot flushes, night sweats, sleep disturbance, mood disturbance, joint pain, brain fog, vaginal dryness. And that’s one of my huge missions at Stanford, in our Program in Menopause & Healthy Aging, is teaching other providers how to take care of these folks, because a lot of people were not trained. Women deserve high-quality health care, and the state of the current situation is shameful. We can’t blame people for not knowing things they were not taught. But it behooves those of us who do have that expertise to share it. And one of the best resources is through an organization called the Menopause Society, which is an organization that certifies menopause experts. So you can go on their website and put in your zip code, and a whole bunch of providers who have been certified in menopause will come up. And you can find someone in your area who can help you get through this, because this is not something you want to do without a road map. You need a road map.
Tayag: Okay, so what does that road map actually look like? What are some practical things people can do to manage what they are going through?
Adams: Right, right, right. Well, I can take people’s hot flushes and night sweats away in about three weeks with some estrogen. So if that, if it’s related to menopause, it’s highly, highly, highly treatable. And the only people who shouldn’t take estrogen are people who themselves have had a heart attack or a stroke, people who’ve had breast cancer with certain types of hormone receptors, possibly people who’ve had a blood clot in their leg or their lung or their brain, some types of hormone-sensitive cancers. But most people can be on hormone therapy, and that’s estrogen—and if you have a uterus, you’re on progesterone as well. Night sweats are part of the reason that people have difficulty with sleeping, but some of it is because of anxieties. And so we talk to our patients about some techniques for mindfulness, for mindful breathing, some different things to help you get out of your head and be able to get back to sleep. There’s a thing called cognitive behavior therapy that is the most beneficial for sleep disturbance and mood disturbance in menopause. And it can also decrease the bother of hot flushes. Everyone should do it. It is such a powerful tool for dealing with all the stresses of life. And so that’s something I talk to all my menopausal patients about—is find some cognitive behavior therapy resources. It will really, really help.
Tayag: Okay, so I want to go back to hormone therapy, because there’s still a lot of misunderstanding about what it can do and the risks involved. So what happened with the Women’s Health Initiative study, and what does it mean for the number of women on hormone treatment today?
Adams: So less than 2 percent of people who are candidates for hormone therapy are actually on hormone therapy. Which is so awful. The Women’s Health Initiative was the biggest trial in women’s health, at that time, and I believe to date it was 165,000 women. And it’s not that it was a bad study or that it was harmful. What the Women’s Health Initiative did was, they enrolled people between the ages of 50 and 79 and started them all on hormones. They had not been on hormones before. And lo and behold, what we found is the people over 70 were the ones who had heart attacks, strokes, blood clots, etc. And the people between the ages of 50 and 60 actually had benefits. And now we have 20 years of follow-up data, and we found that those people have not died of heart disease more than people who were not on hormones, nor have we had increased numbers of deaths of breast cancer. So that is the part of the message that we really have to be clear on. When you’re under 60 and you don’t have any of those absolute contraindications, it’s really a window of opportunity. And the risk of breast cancer with it is like eight extra cases per 10,000 women; the risk of breast cancer is greater with a sedentary lifestyle or alcohol intake more than one glass of wine a night, or being obese. And people worry so much about hormones when they don’t even think about the fact that they’re sedentary and they’re overweight. Those are much bigger risks for breast cancer. So we do talk to folks now if they’re under age 60 or less than 10 years out from menopause: They’re going to get tremendous benefits being on hormones. And we’re working hard to get that message out.
Tayag: Are you worried at all that as people realize hormone therapy could be safe for them that there’s a risk that it starts to be seen as a cure-all? We see that so often in the wellness space.
Adams: We recognize we have so much control over our health, and that rather than looking for the answer in a supplement or some pill that you take—although there are certainly value, values to taking pills, and I’m not saying there isn’t value to that—but when people come to me, and they say, “If I go on hormones, will I prevent dementia? My mother had dementia. I don’t want it. If I go on hormones, will it prevent me from getting dementia?” I say, “We don’t really know.” We know there’s some benefit in the brain when people are on hormones. But we do know what decreases the risk of dementia. And it is: Don’t smoke, minimize your alcohol intake, exercise, eat mostly plants. Manage any chronic health conditions you have, like high blood pressure, diabetes, things like that. And stay connected to your family and friends and your community.
Brennan: Yas, you know, it’s really amazing to hear this conversation about women embracing rather than defying aging, because so much of what we hear about right now in the longevity space is focused on trying to eradicate aging all together. And I do wonder if there is something about a very physical transition like menopause that almost forces women to reckon with aging—like, you can’t ignore what’s happening to your body when it hits you all at once. It’s not something you can compartmentalize or ration yourself out of. It’s a part of your everyday. And maybe people who don’t go through such a sudden shift miss out on that.
Tayag: Yeah, I mean, men go through changes too, as they age. They experience things like a lack of energy, weight gain, sleep problems, sexual issues. And there’s been some effort to classify these changes as menopause. The male version of menopause. But there’s a lot of pushback on this idea, because it’s just not the same thing. What men go through isn’t caused by a sudden shift in hormone levels that leads to huge transformations in their bodies. It’s not like their testosterone suddenly nose-dives the way estrogen does. It decreases a little, but very gradually over a long period of time. So, there may not be a moment or a life period that marks or reinforces aging in the same visceral way.
Brennan: Right. I mean, I cannot see “manopause” going over very well right now in the current cultural zeitgeist. But, regardless, I think one thing that might be important to remember right now is all of these internalized ideas that Dr. Adams has been talking about in regards to aging: They affect all of us. People of all genders. So recognizing them, unpacking them, working through them—that’s more of a call to everyone.
[Music.]
Tayag: You know, throughout this conversation, I couldn’t help but notice you’ve said “we know now” so many times—which is amazing, because it means “Yes, we know now, menopause can be awesome.” So why are we so stuck on this narrative?
Adams: Why are we? And I have to tell you, I would rather be 66 as I am now than pregnant. No question. No question. I wouldn’t be 35 again for anything. You’re trying to figure out your career. You’re trying to figure out your partner. You’re trying to figure out where you’re going to live. You’re trying to figure out—are you going to have kids? Where are you going to raise them? What are you going to do? There’s so much going on in our 20s and 30s that is challenging and hard, and physically we’re not getting much sleep, and we’re trying to progress in our careers and all of that. It’s challenging. And so much of that is resolved when you’re in your 50s and 60s. It’s so great. It’s so great.
Tayag: Dr. Adams, thank you for the absolutely enlightening conversation. I am excited to enter my next decade in a way that I wasn’t before we talked. So thank you.
Adams: I’m so glad. I’m so glad. Come on in. The water is fine.
[Music.]
Tayag: Natalie, as you know, I just adored this conversation with Dr. Adams.
Brennan: We are two huge fans.
Tayag: And, you know, a thing I’ve been thinking a lot about is that, intellectually, I understand the benefits of aging. I get that it can be great in all these ways. But emotionally, it’s hard to undo all those assumptions. And I find it hard to trust that I, too, am going to feel as awesome as she does at that age.
Brennan: Yeah; I really can relate to that. But we can’t know how we are going to feel in this life stage that we’re not in yet. What we do know is that we have this testimony and affirmation from older women who do know, and I do find that really comforting.
Tayag: Right.
Brennan: You know, there’s this poem by Mary Ruefle that this conversation really reminds me of in this way of acknowledging from where you and I are at right now. We can’t even yet really understand where we’re gonna land, because we haven’t gone through it yet. And maybe that persists throughout your life. I remember sending the poem to my mom around the time she was going through menopause, and we both really love it and keep coming back to it.
Tayag: Hmm, that’s really sweet.
Brennan: And, you know, maybe it could be another point of reference for you too. I’m going to read you the end of this poem.
Tayag: I’m going to cry. [Laughs.]
Brennan:
If you are young and you are reading this, perhaps you will understand the gleam in the eye of any woman who is sixty, seventy, eighty, or ninety: they cannot take you seriously (sorry) for you are just a girl to them, despite your babies and shoes and lovemaking and all of that. You are just a girl playing at life.
You’re just a girl on the edge of a great forest. You should be frightened but instead you are eating a lovely meal, you are cooking one, or you are running to the florist, or you are opening a box of flowers that has just arrived at your door, and none of these things are done in the great spirit that they will later be done in.
You haven’t even begun. You must pause first, the way one must pause before a great endeavor, if only to take a good breath.
Happy old age is coming on bare feet. Bringing with it grace and gentle words and ways which grim youth have never known.
[Music.]
Tayag: That’s all for this episode of How to Age Up. This episode was hosted by me, Yasmin Tayag, and co-hosted and produced by Natalie Brennan. Our editors are Claudine Ebeid and Jocelyn Frank. Fact-check by Ena Alvarado. Our engineer is Rob Smierciak. Rob also composed some of the music for this show. The executive producer of audio is Claudine Ebeid, and the managing editor of audio is Andrea Valdez.
Brennan: Next time on How to Age Up:
Kera Nyemb-Diop: So I would say yes, protein is essential, but also it’s a trend, and trends come with noise.
Tayag: How to make sense of fueling our bodies and what to tune out. We’ll be back with you on Monday.
The post How to Wish You Were 66 Instead of 35 appeared first on The Atlantic.
