The Psychology of Menopause | Tamsen Fadal
Tamsen Fadal, an Emmy-winning journalist and author of 'How to Menopause,' discusses the psychology, biology, and workplace implications of perimenopause and menopause with host Dr. Michael Gervais. She emphasizes that menopause affects 1.2 billion women globally, requires urgent medical education and training, and offers an opportunity for women to build strength, confidence, and wisdom during this life transition.
Summary
Tamsen Fadal shares her personal journey discovering perimenopause at age 46-47 while working as a New York-based evening news anchor. After experiencing unexplained hot flashes, weight gain, brain fog, and mood changes, she was misdiagnosed with depression and put on antidepressants before receiving a dismissive four-word diagnosis: 'in menopause, any questions?' This prompted her to investigate why neither she nor her doctor understood this condition affecting over a billion women globally. She discovered that medical schools stopped teaching menopause education following a 2002 Women's Health Initiative study that created widespread fear about hormone therapy, leading doctors to receive minimal training—sometimes only one hour, occasionally incentivized with free pizza at lunch seminars. Fadal explains that menopause represents a 10-year transition beginning around age 40, characterized by hormone fluctuations causing over 30 symptoms including hot flashes, brain fog, sleep disruption, mood changes, weight gain, joint pain, vaginal dryness, and libido changes. She emphasizes that perimenopause is diagnosed by symptoms rather than hormone panels, as hormones fluctuate chaotically during this period. The condition looks similar to anxiety and depression but has a biological origin rooted in declining estrogen, which has receptors throughout the body. Fadal notes that the 2002 fear-based messaging about estrogen and breast cancer persists today, causing only 5% of eligible women to pursue hormone therapy compared to 40% before 2002, despite updated research showing most women without contraindications can safely use it. She discusses the workplace impact, noting that 20-40% of the U.S. workforce falls within the perimenopause/menopause age range, with studies showing $1.8 billion in lost productivity from missed work days. She advocates for normalized conversations, open workplace policies, accessible healthcare including telehealth services, and third-party education programs rather than internal workplace seminars. Regarding relationships, she notes that partners often feel confused when their spouses become less interested in sex or physical touch, and recommends addressing the issue through understanding outside the bedroom first. On identity and psychology, Fadal describes the loss of confidence she experienced—particularly challenging in her broadcasting career when she couldn't recall words or form coherent thoughts—and emphasizes that understanding what's happening biologically restores agency and confidence. She frames perimenopause as an opportunity to address three critical areas: bone health, heart health, and brain health, with practical strategies including sleep optimization (cool rooms, consistent bedtimes, morning light exposure), strength training, and protein intake. Her approach emphasizes both biological intervention (hormone therapy when appropriate, or alternative medications) and behavioral/psychological work (stress management, self-talk, identity development, reducing shame and guilt). She advocates that women should begin awareness and preventative practices at 40, not wait until 55. Fadal stresses that this is a 'next 30 years' conversation, not just about surviving the transition, and notes that many women report these years become some of their most powerful, describing it as a 'shedding' of what no longer serves them. For male partners and colleagues, she emphasizes that understanding menopause—not making fun of it, recognizing the person hasn't changed but something is changing in them—transforms relationships and workplace dynamics. She highlights that men, whether as partners, fathers, sons, or colleagues, stand to benefit from this education because women comprise significant portions of all professional and personal contexts.
About this episode
<p><strong>Tamsen Fadal was 47 and anchoring the evening news when the first hot flash hit.</strong></p><p>She got off the set and laid down on the bathroom floor. She had never heard the word perimenopause. A few weeks later, a note landed in her patient portal with four words: “In menopause, any questions?”</p><p>Tamsen Fadal is an Emmy Award-winning journalist, executive producer of the documentary The M Factor, and New York Times bestselling author of How to Menopause. She spent thirty years in television news before turning to the thing nobody had explained to her.</p><p>Tamsen and Mike get into what menopause actually is, why the symptoms are read as anxiety or depression, what changed after the 2002 hormone study, and how partners and teammates can be useful instead of awkward.</p><p>Mike talks about watching his wife go through it, and what the two of them missed.</p><p>Tamsen calls what comes next “the next 30.” Her point is that these are the years to decide what you want them to look like, and to start now.</p><p>Enjoy the conversation.</p><p>___________________________________________________</p><p><strong>Links & Resources:</strong></p><p><strong>Tamsen Fadal’s Website: </strong><a href="https://www.tamsenfadal.com" rel="noopener noreferrer" target="_blank">tamsenfadal.com</a></p><p><strong>Tamsen Fadal’s Books: </strong><em>How to Menopause: Take Charge of Your Health, Reclaim Your Life, and Feel Even Better than Before, The New Single, Why Hasn’t He Proposed?, Why Hasn’t He Called?</em></p><p><strong>Tamsen Fadal’s Documentaries: </strong><em>The M Factor: Shredding the Silence on Menopause</em> and <em>The (M) Factor 2: Before the Pause</em>, both on PBS</p><p><strong>Tamsen Fadal’s Podcast: </strong><em>The Tamsen Show</em></p><p><strong>Subscribe</strong> to our Youtube Channel for more conversations at the intersection of high performance, leadership, and wellbeing: <a href="https://www.youtube.com/c/FindingMastery" rel="noopener noreferrer" target="_blank">https://www.youtube.com/c/FindingMastery</a></p><p><strong>Get exclusive</strong> discounts and support our amazing sponsors!</p><p><strong>Go to: </strong><a href="https://findingmastery.com/sponsors/" rel="noopener noreferrer" target="_blank">https://findingmastery.com/sponsors/</a></p><p><strong>Subscribe</strong> to the Finding Mastery newsletter for weekly high performance insights: <a href="https://www.findingmastery.com/newsletter" rel="noopener noreferrer" target="_blank">https://www.findingmastery.com/newsletter</a></p><p><strong>Download</strong> Dr. Mike’s Morning Mindset Routine: <a href="https://www.findingmastery.com/morningmindset" rel="noopener noreferrer" target="_blank">findingmastery.com/morningmindset</a></p><p><strong>Follow</strong> on <a href="https://www.youtube.com/findingmastery" rel="noopener noreferrer" target="_blank">YouTube</a>, <a href="https://www.instagram.com/findingmastery/?hl=en" rel="noopener noreferrer" target="_blank">Instagram</a>, <a href="https://www.linkedin.com/in/drmichaelgervais/" rel="noopener noreferrer" target="_blank">LinkedIn</a>, and <a href="https://x.com/michaelgervais" rel="noopener noreferrer" target="_blank">X</a></p><p>See Privacy Policy at <a href="https://art19.com/privacy" rel="noopener noreferrer" target="_blank">https://art19.com/privacy</a> and California Privacy Notice at <a href="https://art19.com/privacy#do-not-sell-my-info" rel="noopener noreferrer" target="_blank">https://art19.com/privacy#do-not-sell-my-info</a>.</p>
Key Insights
- Fadal argues that the 2002 Women's Health Initiative study's fear-based headlines about estrogen causing breast cancer created widespread distrust of hormone therapy that persists today, dropping usage from 40% to 5% of eligible women, despite updated research clarifying the original interpretation was misleading.
- She claims most physicians received minimal menopause training—sometimes only one hour during medical school, with some gynecologists receiving just a week of education, and some being offered only free pizza at lunch seminars to attend talks on the topic.
- Fadal contends that perimenopause is diagnosed by symptoms rather than hormone panels because hormones fluctuate so chaotically during the transition that testing on different days produces different results, yet many doctors still rely on blood work.
- She argues that the loss of cognitive function and word-finding ability during perimenopause resembles anxiety or depression but is fundamentally biological rather than psychological, yet most patients get misdiagnosed with mental health conditions without considering menopause as a differential diagnosis.
- Fadal identifies that 20-40% of the U.S. workforce falls within the perimenopause/menopause age range, with documented studies showing $1.8 billion in lost productivity annually from women missing work due to symptoms, yet many employers remain unaware of this business impact.
- She contends that understanding what is biologically happening during perimenopause restores a woman's sense of agency and confidence, not because menopause is solved but because she knows she's on a track to address the underlying causes rather than blaming herself or external circumstances.
- Fadal argues that men often interpret their partners' decreased interest in sex and physical touch during menopause as personal rejection or attraction loss, when in fact it stems from hormonal changes, vaginal dryness, and sleep deprivation—a misunderstanding that damages relationships unnecessarily.
- She claims that building strength in bone health, heart health, and brain health during the perimenopause years (starting around age 40) prevents long-term consequences like osteopenia that can develop even in women who experience minimal menopause symptoms.
Topics
Transcript
I'm on the set one night and we're on a commercial break and I felt something that I'd never felt before. I had this heat come up through my body and just sweat break out everywhere, my heart racing like pumping and I was like, I'm gonna pass out. She's a New York Times best-selling author of How to Menopause. She's a powerhouse in women's health. Emmy-winning journalist and health advocate Tamsen Fadal. I was told not to bring it up on television and I did. And they said, could you please stop talking about this over and over again just please stop nobody wants to hear about this all the time and i said 1.2 billion women globally are…
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