--- title: 8 Signs You're in Perimenopause description: Perimenopause is a transitional stage characterized by irregular periods, hot flashes, joint pain, and mood changes. canonical: https://time.com/7019600/perimenopause-signs-symptoms/ author: Angela Haupt article:opinion: false article:content_tier: free article:published_time: 2024-09-17T12:00:00.000Z article:modified_time: 2026-08-04T07:48:46.277Z article:section: Health og:title: 8 Signs You're in Perimenopause og:description: You might experience irregular periods, hot flashes, joint pain, and mood changes, but suffering is not inevitable. og:url: https://time.com/7019600/perimenopause-signs-symptoms/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltd2d23aed5f05aa4c/698a5ae586f68e15096f5947/perimenopause-signs.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2400 og:image:height: 1350 og:image:alt: perimenopause-signs og:type: article twitter:card: summary_large_image twitter:title: 8 Signs You're in Perimenopause twitter:description: You might experience irregular periods, hot flashes, joint pain, and mood changes, but suffering is not inevitable. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltd2d23aed5f05aa4c/698a5ae586f68e15096f5947/perimenopause-signs.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # 8 Signs You're in Perimenopause > Sponsored content. 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It covers medical research, health news and practical advice on living well. #### Where can I get reliable health news by email? Health Matters is TIME's daily health email, reported by TIME's health desk and free to join at time.com/newsletters. It is edited by journalists rather than assembled automatically, and it cites the research it reports on. #### Is Health Matters free? Yes. Health Matters is a free daily newsletter from TIME, available at time.com/newsletters. #### Who reads TIME's Health Matters newsletter? Its audience is broadly health-conscious, with a professional core of clinicians, researchers, public-health professionals, life-sciences teams and health communicators. ## Video: TIME100 Health Panel Talks ‘Medical Gaslighting’ and Investing in Women’s Health [Watch (HLS stream): TIME100 Health Panel Talks ‘Medical Gaslighting’ and Investing in Women’s Health](https://cdn.jwplayer.com/manifests/EkBbhRuI.m3u8) (22:22)  _Published 2024-05-14. Actress and healthcare advocate Halle Berry; geneticist Marlena Fejzo; and Daniel Skovronsky, chief scientific officer at pharmaceutical giant Eli Lilly, spoke about the importance of investing in women’s health at a TIME100 Health panel in New York on Monday._  by [Angela Haupt](https://time.com/author/angela-haupt/)  ## Angela Haupt Sep 17, 2024 12:00 PM UTC  Photo-Illustration by TIME; Tim Robberts—Getty Images  by [Angela Haupt](https://time.com/author/angela-haupt/)  ## Angela Haupt Sep 17, 2024 12:00 PM UTC Carin Luna-Ostaseski still recalls the shock of discovering her periods had become monsoons. Short monsoons, she clarifies—her cycle went from lasting a week to two to three days—but still monsoons. She realized she was going through at least one tampon every hour. Then, more confusion: Earlier this year, partway through a flight, she became convinced she was having a heart attack—her heart was racing wildly, and she felt scared. It turned out she was actually experiencing a panic attack, triggered by—surprise!—perimenopause, which can lead to symptoms like weird periods, mood swings, and anxiety. “You Google the symptoms, like ‘I’m bleeding too much,’” says Luna-Ostaseski, 47, who lives in San Francisco. “You don’t think, ‘This is perimenopause.’ Our parents’ generation knew about menopause, but I think perimenopause is a new concept for our generation.” So what exactly is it? In a nutshell: the conclusion of a woman’s reproductive life, starting anywhere from [age 40 to 44](https://www.mountsinai.org/health-library/report/menopause), though there can be variances on either side. While it’s still possible to get pregnant during perimenopause, it becomes more difficult; experts caution that you shouldn’t suddenly stop practicing safe sex. The transition lasts until someone officially enters menopause—which is exactly one year after their last period, usually around age 51\. During perimenopause,hormones like estrogen and progesteronefluctuate wildly: “What used to be a predictable, EKG-like ebb and flow becomes chaotic,” says Dr. Mary Claire Haver, an ob-gyn who specializes in menopause care (and has developed a [large social-media following](https://www.instagram.com/drmaryclaire/?hl=en) around it). **Read More**: [_Menopause Is Finally Going Mainstream_](https://time.com/6565057/menopause-treatment-symptoms-mainstream/) The vast majority of women are “so confused” when they start experiencing symptoms, Haver adds. “They go to their provider, and depending who they see, are told there’s nothing they can do—this is a normal part of life. Or they’re [offered a hysterectomy](https://www.youtube.com/shorts/10TkIPaBgjM), which is a surgical treatment of a medical issue, not a hormone issue, so they’re being castrated to cure their menopause.” That tracks with Luna-Ostaseski’s experience: She and her friends talk about their symptoms “constantly,” and share helpful services and products with each other. (She even created a [website](https://hotorjustme.com/password) and newsletter called “Hot or Just Me?” to dispense those resources to a wider audience.)They call it “girlfriend medicine” to reflect the way they’ve stepped up to support each other, since [doctors often don’t grasp](https://thepauselife.com/blogs/the-pause-blog/perimenopause-why-doctors-often-miss-the-diagnosis) what they’re going through. Complicating matters: There’s no single, accurate test for perimenopause. To arrive at a diagnosis, Haver does blood work to rule out conditions like hypothyroidism or autoimmune disease, and then narrows things down to perimenopause based on symptoms and through process of elimination. After that, she starts talking about treatment: Many patients benefit from medications like hormone therapy and low-dose birth control pills, in addition to lifestyle changes. “Menopause is inevitable,” Haver says. “But suffering is not. It might mean you need to make some changes in your life, or that pharmacology is going to be helpful—but if you just ignore it, it’s going to get worse.” With that in mind, we asked experts to describe the symptoms that can indicate you might be experiencing perimenopause. ## **Irregular periods** Perimenopause is a transitional stage characterized by having an irregular period, says Dr. Christine Greves, an ob-gyn at Orlando Health Women’s Institute. Someone who has always had a 28-day cycle, for example, might find that her periods start to vary by about seven days. “They can be shorter or longer,” she says, or not arrive at all. “Sometimes, you might not release an egg and will skip a period.” Women often report changes in flow, too, noting that their periods become heavier or lighter. The reason for the change? Unlike men, who make new sperm every day, women are born with all the eggs they’ll ever have. Over time, those eggs “start becoming less sensitive to our hormonal stimulation, and we don't ovulate as regularly,” says Dr. Mary Farhi, an ob-gyn at Rush University Medical Center. As a result—given that the ovaries are producing fewer hormones—your periods naturally become irregular, she explains. ## **Hot flashes** About 75% of women experience hot flashes and night sweats during perimenopause, says Dr. Mindy Goldman, chief clinical officer of Midi Health, a virtual care clinic focused on perimenopause and menopause. You might experience intense heat and start sweating or turn bright red, mostly around your head, neck, chest, and upper back. Though scientists don’t understand exactly what causes hot flashes, hormones [likely play](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185243/) an important role. Vasomotor symptoms tend to be especially bothersome at night, leading to frequent wake-ups, which is one reason why many perimenopausal women report fatigue. **Read More:** [_How to Deal With Menopause When It’s Hot Outside_](https://time.com/6990548/hot-flashes-menopause-hot-outside/) They’ve hit Luna-Ostaseski hard: At least once a week, she asks her husband if it’s hot or just her. “He’s wearing a sweater, and I'm stripping off layers of clothes for relief,” she says. She’s found that wearing natural fabrics helps, as does setting her bedroom temperature to 65°F. She avoids alcohol, spicy foods, caffeine, and hot drinks—all of which can trigger flashes—and prioritizes [deep breathing](https://time.com/7005562/how-to-do-breathwork/), meditation, and stress management. She’s also learned that taking [magnesium glycinate](https://time.com/6258780/magnesium-glycinate-sleep-anxiety-tiktok/) before bed is helpful, and she sleeps on cooling sheets and [blankets](https://www.amazon.com/gp/product/B09N4W9TLT). “I’ve gotten the hot flashes a little more under control,” she says, “but they still come and go.” ## **Vaginal dryness** Vaginal dryness triggered by hormonal changes is another hallmark symptom of perimenopause. “You can experience dryness in general, or dryness with intercourse,” Greves says. Depending on severity, over-the-counter lubricants can be effective. But she also recommends a more surprising antidote: cooking oil. Coconut oil works particularly well and doesn’t contain any irritants. “It’s in your cabinet, and it’s cheap,” she says. “That is an option to conquer the dryness.” In some cases, Greves adds, vaginal estrogen works best, especially among those experiencing painful intercourse. “Estrogen is like putting lotion in the vagina—it makes it nice and supple,” she says. There are a variety of ways to take it, including creams, gels, and rings; ask your doctor what might work best for you. ## **Joint pain** More than 70% of women experience musculoskeletal pain during perimenopause—and for 25% of them, it’s debilitating, [according to recent research](https://www.tandfonline.com/doi/full/10.1080/13697137.2024.2380363#abstract). Changing levels of estrogen, paired with a loss of muscle mass and bone density, can lead to rapid progression of arthritis, frozen shoulder, and other types of joint pain. As the study authors noted, these symptoms can be “silent, devastating, and permanent unless addressed.” While physical therapy is helpful in some cases, hormone therapy “is actually really, really powerful,” Haver says. [Research suggests](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9397736/) it can reduce inflammation and pain, while also helping prevent osteoporosis, which weakens bones. Prioritizing good nutrition and resistance training also plays an important role in improving symptoms and preventing falls and frailty. ## **Weight gain** When Haver entered perimenopause, her biggest complaint was the unexplained belly fat she gained. She had been privileged to not have to worry about her weight for most of her life, she says, and suddenly, without changing her habits, she no longer recognized her own body. **Read More**: [_15 Things to Say When Someone Comments on Your Weight_](https://time.com/7014466/what-to-say-when-people-comment-on-your-weight/) That’s a familiar experience, experts say. “We know that metabolism slows, and we know that after menopause, there's an average of about five pounds of weight gain,” Goldman says. “Perimenopause is when people may gradually start noticing an increase in weight.” She coaches them to focus on eating well—protein and whole foods are important—and employing healthy exercise habits. That can help stave off additional weight gain as you progress through menopause, experts agree. ## **Brain fog** Do you ever feel like there’s a cloud over your head, or that you can’t multitask the way you used to? It could be a lot of things, including perimenopause. Luna-Ostaseski says she occasionally walks into a room and forgets why she's there—and while driving, she once blanked on why she was headed in a particular direction. “To someone who prides herself on a sharp mind, it’s concerning,” she says. She hasn’t found an effective solution yet, but makes it a point to journal on her foggy days to see if she can identify triggers. Women frequently tell Goldman they can’t remember a person’s name or summon words as quickly as they’d like. “We know that estrogen withdrawal can clearly have a cognitive impact,” she says. Researchers are currently exploring exactly how estrogen affects the brain, and Goldman notes that many women see cognitive improvements after starting hormone therapy. That’s not, however, always the only factor: If someone isn’t sleeping well because of hot flashes, their fatigue can dampen mental clarity. Plus, “there's data that says when you're tired, you don't exercise as much, and you don't make healthy food choices,” she adds, which can affect cognitive health. “It’s all tied together.” That’s why treating perimenopause requires thinking holistically. ## **Mood changes** Perimenopause clues often arrive in the form of mood changes: PMS symptoms [sometimes worsen](https://journals.sagepub.com/doi/10.1177/20533691231216162), and you might notice you feel super irritable or angry, or that you’re crying more often. Plus, women who have had postpartum depression could be [at increased risk](https://www.sciencedirect.com/science/article/pii/S0378512222002559) for recurrent depression during perimenopause and menopause. “That’s part of the history I always ask people,” Farhi says. “We can only take so much stress, and once it gets too heavy, it can tip us over. I always tell people that your 40s are the time to fill your tank, because you don’t want to hit menopause with an empty tank.” **Read More**: [_Does Text Therapy Really Work?_](https://time.com/7014816/does-text-therapy-work/) Therapist Jessika Fruchter was “blindsided” when she began experiencing perimenopause symptoms about a year and a half ago. She recalls traveling to a favorite spot by the ocean where she lives in Southern California and bursting into tears. “Because I know myself really well, and also because of my clinical training, I was like, ‘Something’s off here,’” she says. In addition to working to find specialized providers to support her own health, she [shifted her practice](https://www.jessikafruchtermft.com/) to focus on serving women in perimenopause. It’s much easier to find a therapist who specializes in perinatal health than it is to find one with menopause expertise, she points out, and she wants to change that. She’s starting to offer menopause training courses for other therapists, as well as support groups for her clients. To find resources near you, tap into online tools like Psychology Today’s [therapist](https://www.psychologytoday.com/us/therapists) and [support group](https://www.psychologytoday.com/us/groups) directories, Fruchter suggests. Make it a point to practice self-compassion, too, she urges. “It’s about cultivating that nurturing, calming, caregiver voice inside of us,” she says. “It’s telling yourself that you got this—this is natural, and it’s going to pass—and lowering the bar.” ## **Shattered sense of identity** Many women feel a sense of grief as they navigate perimenopause. “For some, it’s really about the end of the reproductive years,” Fruchter says. “Others are very attached to their menstrual cycle. And there's this constant bump up against toxic youth culture and middle-aged invisibility.” Fruchter suggests reframing perimenopause as stepping into a new—and potentially liberating—chapter of life. She often hears from people who find they don't have as much of a filter once they hit the years surrounding menopause, finally squashing their people-pleasing tendencies and setting firm boundaries. Some treat it as a literal “pause,” seizing the opportunity to take inventory of their life. Fruchter—who describes perimenopause as “a second puberty”—stresses that there's no reason to feel ashamed or to suffer mentally or physically. “There’s so much beauty in this transition if we have the right support,” she says. “Most of the women I know are incredibly resilient and used to white-knuckling through challenges on their own. But just because we can doesn’t mean we should have to.” ## Transcript It is my privilege to be moderating our discussion this evening where we'll be talking about women's health. And in particular, why it's still so difficult to talk about some issues in women's health, even in 2024. So, Hally, you've been working tirrelessly to change the way we think about menopause. And this work was really inspired by an experience you had at the doctor's office. Can you share that experience with us? Oh, God. I'm afraid you were going to ask me this. Okay. Are you sure? I am sure. Okay, guys, I'm sorry to every man in this room, but you got to hear it. Very important. It is It is very important. It was very graphic, so I'm just going to warn you. I got inspired to do this work because I was 54 years old, and I found out that I was smack dab in the middle of menopause. It was something that nobody ever talked to me about. My mother included. I my ego thought because I had weaned myself off insulin at 24 years old. I'm a type, you know, diabetic. I thought, I'm healthy. I eat right. I'm just going to skip this menopause. This isn't gonna happen to me. And by the way, I don't even know anything about it. So, I'm sure it's not gonna happen to me. Well, all of a sudden, 54 years old, after being divorced three times. Sorry, but it's true. I meet my person, the man of my life, he's sitting right there. Van Hunt. I meet Van Hunt. And we're having the most amazing relationship, and sex was a great part of it. Everything was going fine. So, one night. We're having sex. And it's great. Seems like nothing in the world is wrong until the next morning, when I go to try to use the bathroom. I sit down, try to go, and it's like I have razor blades in my vagina. Like, Razor blade, cutting a cutting, burning feeling when I let a little bit out. Then I squeeze. Then I let a little bit more out. Then I squeeze. And it takes me like almost 10 minutes just to empty my bladder. I think, Oh, God, what is going on? And then about an hour or two later, The most heinous substance you would think to excrete from anybody's body starts excreting. And it's all colors, and it has an odor that we won't discuss. And I think, Oh, my God. What happened in 24 hours? So, I call my gynecologist. Yeah, I got to come in. I got to see you right now. I'm having a bad problem. I go there. He, you know, does the thing. He's got me up in the stirrups. He's looking up there. He said, Oh, God. I think I know what this is. I said, Really, what? He said, You have a new partner, right? I said, Oh, my God. I finally met the man in my life. He said, I don't know if this is the man of your life. I was like, why would you say that? You don't even know him. He said, Because you have the worst case of herpes I have ever seen. I'm like, What herpes? He said, Yep. I don't think this is the man of your life, 'cause you've been given herpes. So now, the man of my life, who gave me these herpes is sitting down in the car because my vagina is so on fire. I couldn't even do the petals to drive myself to the doctor. So the man who gave me herpes is sitting in the car waiting for me. So you can imagine my fury. I get down to the car, see the man that gave me herpes, and I'm like, Yo. You got ******* herpes? When were you going to tell me you had ******* herpes? He says, I don't have herpes. I'm like, clearly, you do because now I do, and I didn't have herpes before I met you. So clearly, you have herpes. He says, No, I don't have nobody he's ever told me I had any herpes. I said, Well, let me be the first to tell you. You've got herpes. He said, no, no, no. Well, then he's he's such an impat. He goes, Well, maybe somebody gave me herpes along the way. And I just you know, not everybody knows they have it. They're silent carriers, you know. I said, Well, it's not so silent now. You're a carrier, and I'm here to tell you, you got herpes. He goes, Well, I I'm going to go to the doctor. I'm going to get this checked out. I'm not so sure. I said, Yeah, go, go go go, find out. You got herpes. So he goes and he gets checked out. I'm waiting for my results in three days. He gets his results first. He comes to me chest out. Guess what? I don't have herpes. I guess you have herpes. And, luckily, you didn't give it to me. I'm like, Wow. Alright, so talk about putting your tail between your legs. I'm thinking, how the **** did I get herpes? My doctor calls me later that same day. He tells me, guess what, Hallie You don't have herpes. I'm like, I don't have herpes. I'm like, Why would you tell me I had herpes? Do you know what I just went through for the last 72 hours? He said, Well, I don't know. That's what it looked like to me. And this is the moment when I realized something was going on with my body. I was in perimenopause. I did my own research. Even my doctor then didn't say, Oh, my bad, it's not herpes. It's actually perimenopause. It's vagina atrape and your vagina is dry, and that's what it is. And if you have sex, when your vagina is dry, you can tear up the inside of your vagina, and this is what it would look like. He didn't tell me that. I had to go do that research for myself and figure out what exactly was happening to me and what I could do for this vaginal atrophy so that I could continue to have a sex life with my partner. And that was the moment when I realized, if I had such little information and I have the best doctors in California, and he had never even brought the subject of menopause, and the The sexual part is one small part of it. There are much more health implications that go along with a woman going into menopause. But I thought, if I didn't have access to this information, how many women in the world don't have access to this and how many women are suffering in silence, how many women are feeling ashamed, how many women don't talk to their doctors about it or they get misdiagnosed. And that was a moment that I knew I had to stand up for myself, because by standing up for myself, I'd be standing up for every other woman. And that became my second life act, my second life passion, and I'm giving my life over to it. So, sorry, I told you it was graphic. That's a graphic story. It's a vicious cycle, isn't it? Of misinformation and lack of information and stigma. Yeah, all feed stigma to itself. And it's so much more than just our sexual health. You know, it's just not, you know, bikini medicine below the waist. One of the biggest things I just would like to say, what I've learned is that, you know, women, we have hot flash. It's so many mostly men think, Oh, it's just hot flashes. I mean, I mean, so what. You're gonna be hot for four or five years. No, some women flash for two decades. And every time you have a hot flash I've now learned, you're actually having a little mini And when you have a little mini stroke, you get these nodules on your brain. And if you study a brain of a woman in who has Alzheimer's today, it's full of these little nodules. So you find out why it's so important that we not have hot flashes. It's not just because they're uncomfortable. It's because they're doing something very detrimental to our brain with affects our health as we go through mid life in the aging process. I think that's a very important lesson for all of us to take away this evening. Marlena, you also have a very personal experience that guided your research into morning sickness. So tell us about that journey. Yeah. So most pregnancies are affected by morning sickness, but I had something much more severe similar to Kate Middleton and Amy Schumer. Maybe you've heard of hyperemesis Scravdarm And so when I got pregnant, I was so ill that I could not move without violently vomiting. I just had to lie completely still on my back. I couldn't drink even water. And it lasted for weeks and weeks. My doctor put me on IV fluids. Then he tried different medications. Nothing worked. Eventually, he tried seven different drugs at once, and nothing worked. I ended up on a feeding tube. And when I had the feeding tube, I started to feel a little bit better just from having energy, but it was too late, and I lost the baby in the second trimester. And through that whole horrible experience, my doctor told me that I was just trying to get attention. And I was too weak to argue with him. I actually at one point had to use a buzzer because I couldn't speak anymore. I was so weak. But after I recovered, I do have a PhD from Harvard in genetics. I was already focused on women's health issues. I found the first gene for uterine fibroid tumors. So I decided to. So I decided to work on finding what the real cause of hyperemesis was. And I didn't have it in my family, so I didn't know if it was genetic, so I had to start from the very beginning and see if it ran in families and do a familial aggregation study. And then I spent the last 20 years searching for the cause, finding the gene, and the latest paper that just came out in nature figuring out how that gene works. And now we're on the pathway towards a cure. Dan, we've just heard about two issues in women's health that really don't get a lot of attention and really two women who were dismissed, you know, from the medical system. You represent a big pharmaceutical company. Tell us a little bit about how we can ensure that women's voices are heard, and the issues that are important to them are part of the drug development process. Yeah. Thank you, Alice. It's great to be here with both of you and hear your remarkable stories. Thank you for sharing them. Of course, at a pharmaceutical company, we want to help all patients that are suffering. Unfortunately, there's a number of diseases that disproportionately affect women. And so oftentimes our focus does turn towards What we can do to help women. Maybe I quickly talk about two diseases that you may not think of as women's health issues, but actually, they are. Starting with the disease I've worked on my whole life, which is Alzheimer's disease. Most people don't think of that as a women's disease, but in fact, two thirds of people with Alzheimer's disease are women. Simply because fortunately women live longer. And unfortunately, Alzheimer's is an age related disease. So as you get older, more likely to get it. Not only does it disproportionately affect women as patients. It turns out that the vast majority of people who are caregivers for Alzheimer's patients are also women. So when we think about the cost of Alzheimer's disease to our society over the next couple of years, it will be $5,000,000,000,000 in lost productivity and direct costs, of which 75% will be borne by women. So it's incredibly important for our Alzheimer's trials. For example, that we have women participate in the trials. With two thirds of the Alzheimer's population being women, you would think it wouldn't be a problem. But it quickly turns out it is. Although we are able to get more than half of the patients in our trial as women, it's more difficult than you would expect to find them. One of the reasons why is that women are often diagnosed later, probably for some of the same issues that both of you spoke about, that the medical community sometimes is less likely to take symptoms seriously. In women. Probably also because women have what we call, perhaps a higher cognitive reserve. They're better at things like verbal memory, which is one of the first signs of Alzheimerisease. So for women, the signs show up a bit later in the disease course. And so by the time they come to trials, they may be too advanced. So we've done a lot of things, for example, in this field to encourage participation by women patients, including trying to make our trials less onerous on the patients, having them able to be conducted from home, Trying to, to the extent possible decrease the requirements around caregivers to come because men who have Alzheimer's often have a female caregiver, women who have Alzheimer's may have less of a good support structure. So that's one disease that we're working hard on to help women. The other is a disease you've heard a lot about in the press. It's obesity. It affects men and women, both, of course, but it affects women differently. It turns out obesity and women is more driven by food cravings and by hunger. Women are more likely to seek treatment for obesity, but also less likely to be taken seriously by their doctors. Even so, in our clinical trials for obesity, we have the opposite problem, which is that women preferentially enroll in our trials. We have to cap their participation to make sure we have some men in the obesity trials, and men often wait until they have other symptoms of disease before they come to get treated for obesity. So we're looking at diseases that are common across the population, but trying to understand specifically how they affect women, how we can hear women's voices in our clinical trials and address it with treatments. And recently, President Biden has issued an executive order to prioritize and more seemly integrate women's health issues across the federal research spectrum. Marlene, I wonder if you could just briefly tell us how much of a difference is that going to make, for example, for a scientists like yourself and the work that you do? I hope for scientists like myself, it will make a big difference. I did apply for an ARPA H grant. So we'll see in the next month or so. But yeah, I mean, one of the reasons that I'm the world's researcher in hypermesis gravi Darm is not because I'm so great, but just because there is no other researcher, and it's so hard to get funding in this field. So putting that money out there is going to inspire other people to think about women's health issues and fit them into their whatever they're studying so that we can get more progress in that area. So yes, I think it's fantastic. And on the subject of governmental support, Holly, you have been working with some Congress people and proposed legislation to focus a little bit more on research for menopause. Yet, Congress is 72% male. Is that a problem? That's a problem. Yes. So that's why my approach was to go to all the females in the Congress and hope that I could get them to come together in a bipartisan way and put us first for once because this lack of study on the female body in mid life is long overdue. So I right now have 18 of the 25 that are sponsoring or co sponsoring the bill. There's a few that are still holding out, you know? And if we can get all 25, I think I feel like with some House members, and there are some great men on the Senate side that are very much behind this, but there's still some women that are holding out. And to my dismay, their trepidation is that they feel like the money that's already allocated from the NIH should be just shuffled around. But we know, and I've learned through my research that menopausal women and women in mid life never get the money. There's always something more important. So my goal is to have new appropriations and have $265 million. That's what's the teeth of our bill. Have that money be allocated towards menopause and, you know, women's Mid Lfe health? And I think then we'll have real dollars to do real research so that scientists can do all the trials, you know, that they'd like to do. And I think that's the only way we're really going to start moving the needle is to make sure we have money allocated just for us at this time. And, Dan, one of the reasons why we still have so much stigma around certain women's health issues is lack of information, right? And for historically, women have not been included in clinical trials, for good reason, for issues of safety, especially women of childbearing years. Can you tell us about what can be done or what is being done to address that and include more women? Is there technology? We've got great science now? Are there ways to get those answers without putting women's health at risk? Yeah, I think the scientific challenges around conduct of clinical trials in women are largely addressed. I think with the exception of women of childbearing potential. It is really about educating physicians, mainly that we have to spend more efforts there so that we can have better participation in women. I think we can often overcome it in clinical trials, but then when we come to launching a new medicine or making a new technology available, again, we face the kinds of ignorance or discrimination that both of you spoke about. One example is our work in migraine, another disease that much more commonly affects women. Because it's subjective, a lot of times women present to their doctor with migraine and the doctor ignores them or says, you're just seeking attention. There's all sorts of these behaviors that we talk about as medical gas lighting where doctors are actually disbelieving their women patients. And so we have to do a lot of work to educate them because, of course, we want these great medicines that we've created to be used to help patients. So that's also part of the role of the pharmaceutical company is to change medical practice. Um, one of the ways that we can do that is by working with female doctors disproportionately in our clinical trials because we know that they are more likely to offer more equitable care to women patients. And part of our bill, our Senate bill will be also to allocate dollars so that doctors can go back and be, you know, further educated and retooled, because I was horrified when I found out that in medical school, doctors only spent there's only one chapter on the menopausal body, and this is something every single woman will face if they're lucky enough to live that long. And there's one chapter, and most of them don't even remember it, you know? So that's also what our bill will be for to get doctors further educated so they can be retooled. I think that's critically important. I was going to say that, you know, this gas gas lighting dam that you mentioned, it does seem to be an embedded issue. And Marlina, if you want to comment on whether you've seen since your experience, has the needle moved at all? You know, we're in 2024, and it's still astounding that we're hearing doctors tell women these things. I mean, I wish it was moving a little more than it has. I did get a tape from a medical student who had hyperemesis, and her professor, who was a female, doctor OBGYN professor told her and told the class. So this is the whole next generation of doctors that when patients are hospitalized with hyperemesis, it's usually because there's something going on at home or they just don't want to get better. That's really what she taught the students. So there's a whole next generation of doctors that are learning this. So we really need a re education. It's really important. One thing that I think we've seen that help sometimes is when there's a new treatment that's introduced. Then people understand that what they actually saw as, you know, maybe the patient's fault is actually a disease. Historically, this happened with diseases like epilepsy or even tuberculosis, where it was blamed on the patient. More recently, it was depression, where doctors would say, you know, chin up, think positive thoughts until we had medicines for the disease, and then doctors changed. Today, we're seeing it in front of our eyes happen with obesity, where we used to blame the patient. Soon as there's medicines available, doctors start understanding that it's really a disease that can be treated. Well, and my doctor also told me when I told him, I've diagnosed myself. I realize I'm in perimenopause. He said, Just deal with it. Like, you know, white knuckle it. It's only gonna last five, ten years, if you're not lucky. Okay. Not good enough. Not good enough. Good enough for sure. So, in closing, and this is one of the things that I love about time 100 is I get to do this. Hally and Marlena, you have here sitting right next to you, Dan, who is at a major pharmaceutical company. Thought of that. He's mail I volunteered for this. Yes. But he's also pretty influential from what I hear at the company. So here's your opportunity. You have his ear. What advice would you give him about finding ways to prioritize and ensure that women's voices are heard. I know believe them when they tell you something's wrong, and that they're not making it up. Look, I think you do. And I mean, you have a drug actually that would help for hypomeesis that you guys are not it's kind of shelved, you just told me. So I have a very specific request. I'm ready to test it to desensitize women. I'm sure we'll find a way to work together. I think you just got your marching orders, Dan. What? Thank you. Well, Hally Dan, Marina, thank you very much for joining us in this dialogue. Thank you. 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