Hormonal Health After Menopause (You’re Not Dead Yet)

Your period is over. Congratulations! But cohosts Erin Stein and Dr. Gillian Goddard have news for you: hormonal health care isn’t over! Let us introduce health during your second act, and life after menopause. We cover what happens to your hormones, why vaginal estrogen may still matter, when to think about bone density, thyroid and blood sugar testing, and why you should keep up with cancer and cardiovascular screening. We also make the case for things that may be just as important as any lab test: using your brain, learning new things, making friends, and staying socially connected. Because menopause is not the end of the road, it’s just a new turn!

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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Visit www.thesavvypatient.com/podcast for episode transcripts.

Watch full podcast episodes @TheSavvyPatient on Youtube.com.

Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.

This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

Erin mentions the novel The Thursday Night Murder Club, and by that she meant The Thursday Murder Club by Richard Osman.

TRANSCRIPT

Erin Stein: Hello everyone and welcome to The Savvy Patient.

Gillian Goddard: Hi.

Erin Stein: What are we talking about today, Gillian?

Gillian Goddard: We are talking about your second act.

Erin Stein: I thought you were going to say your Renaissance.

Gillian Goddard: Your renaissance.

Erin Stein: We mean menopause, people. Menopause. The big M.

Gillian Goddard: We do. We do. Life doesn't end when your period does. In fact, it's just getting started.

Erin Stein: I know. That's our next book. Speaking of books, Gillian wrote this book, The Hormone Loop. You should buy it and read it.

Gillian Goddard: It's so pretty.

Erin Stein: But some older women are very excited for her that she published this book but said, “it's not for me, because I'm past menopause.”

Gillian Goddard: That is right.

Erin Stein: And what do you say to them, Gillian?

Gillian Goddard: Just because you don't have a period anymore doesn't mean that hormones aren't still important and aren't still having effects on your body.

Erin Stein: Yeah. Stuff's still happening. It's not like you hit menopause and you're dead.

Gillian Goddard: Thank goodness.

Erin Stein: Although that might be the popular culture perception.

Gillian Goddard: Perhaps. Menopause is not just about estrogen and progesterone. We've got dozens of hormones.

Erin Stein: Dozens of other hormones and the rest of your body. I mean, this is the other thing. We focus so much on it. And I think if you've listened all the other episodes, a lot of it is actually perimenopause when stuff is happening. The first year when you don't know when you're in menopause yet.

Gillian Goddard: Mm. And the very beginning after your last period. Yeah.

Erin Stein: Right? That's a fun fact that we keep repeating. You don't know because it's one year after you've had a period that you're officially in menopause. So that first year and a half you might still be dealing with some stuff, transitioning your hormone levels. But then after that, it's not like you're done forever.

Gillian Goddard: No.

Erin Stein: You don't stop going to the doctor.

Gillian Goddard: You do not stop going to the doctor. At least I hope you don't.

Erin Stein: I hope you don't 'cause there's a lot of things to keep checking on.

Gillian Goddard: There is!

Erin Stein: Let's start with the estrogen and progesterone piece of it. Once you're done having your periods and whatever symptoms you've been dealing with hopefully are over…

Gillian Goddard: Yeah.

Erin Stein: What, if anything, do you need to deal with regarding those?

Gillian Goddard: This is a big question right now and it's a little bit of an open question. For a long time we said you can stay on hormone therapy for up to five years and then you should stop and you should be symptom free and that should all be fine. It turns out it's probably, like all things, not as clear-cut as that. And so now there is this movement to decide if and when to stop hormone therapy based on women's individual symptoms and risk factors. Oftentimes as women approach 60 or 65, I will think about whether or not we should dial down on estrogen and see how she does. But your body is not gonna be making estrogen and progesterone anymore. The other thing is that your vagina and your vulva do much better when they have a little bit of estrogen around, especially as you get older. And if your body's not making that estrogen, then we need to give it to you. And there is lots and lots of data—I feel like there's more data every single day—about the benefits of vaginal estrogen. So that is estrogen that you apply directly to the vaginal wall and to the vulva, reducing vaginal dryness and discomfort, reducing vaginal acne. Helping maintain the pH of your vagina so that you don't get vaginal infections like yeast infections, and it reduces your risk of getting urinary tract infections. And as women age, urinary tract infections can be quite dangerous. They can spread from your bladder and kidneys into your bloodstream. You can get urosepsis. And that is not an insignificant cause of death among older women. And it turns out that using vaginal estrogen reduces your risk of getting that UTI to begin with. And if you don't get the UTI, you can't get the urosepsis. So there are definitely still things to think about, even if we're going to talk about just estrogen and progesterone.

Erin Stein: Yeah, follow up to you're not dead yet, I hope you are still sexually active in some way. And so gotta keep things healthy down there. You gotta take care of it.

Gillian Goddard: Yeah. Otherwise, you know, sex can become painful and then look, if sex is painful, what's the point? Because once you're in menopause, the only purpose of sex is pleasure. 

Erin Stein: Yes, and there are certain people who might be into that, but I doubt that particular version of pain is attractive to them. And we're not judging them. But I think that you need to keep things moist and plump.

Gillian Goddard: Ha ha ha. Moist and plump.

Erin Stein: Follow up question to that is ,you're still probably going to the gynecologist, I would think, for such reasons?

Gillian Goddard: You should be. And depending on your personal history, potentially also you still need pap smears. There is some disagreement about exactly when and who can stop getting pap smears based on whether you have any history of abnormal cells that have been seen on previous pap smears. Certainly until age 65 and many women need to continue getting pap smears after age 65. So still need that gynecologist.

Erin Stein: Mm, mm. And I was also gonna say, if you are having a good time and many people have switched partners, found a new partner…

Gillian Goddard: Mm-hmm. STIs [sexually transmitted infections], yeah.

Erin Stein: You might need to just get checked out once in a while to make sure.

Gillian Goddard: Yes, especially if you have a new partner. That is very important. One of the places with the biggest growth in STIs is retirement homes. People often move there because of a change in their partner status and then they find a new partner. It's a thing.

Erin Stein: Yup. And they enjoy life, as they should.

Gillian Goddard: Yes, they should, but we just want to keep people healthy.

Erin Stein: Yeah, you're still going to the lady doctor for your lady parts. Yep.

Gillian Goddard: You still gotta go. You do, you do. Also, the gynecologist is often the person who will remember that you need bone density screening. 

Erin Stein: Your bones. So important.

Gillian Goddard: My goodness, so important. And osteoporosis and bone loss is so very common. There's lots of confusion about when you need a bone density and how to think through that. The recommendation is that if you have zero risk factors for osteoporosis, you can have your first bone density at age 65. But if you have risk factors, which includes if you have a mother or sister who've had a fracture, if you yourself have fractured a bone during adulthood and a bunch of other factors, you should actually have a bone density test at menopause. So quite a bit sooner.

Erin Stein: As I've said before, I already got one because my mother does have some of these concerns and I was starting Tamoxifen and I just wanted to get a baseline and I had no problem getting a bone scan just to see where I was starting from so that I can keep an eye on it going forward. So if you feel like it runs in your family, you have other risk factors, or you're going on medication that might affect your bones, get it earlier. you don't have to wait. It's more if you have no reason to be concerned, you can wait a bit.

Gillian Goddard: Sure. Absolutely.

Erin Stein: But even if you're waiting to get a bone density scan, you should be taking care of your bones with some weight-bearing exercise.

Gillian Goddard: I feel like we say this every single episode, but some things do bear repeating.

Erin Stein: I'm saying it to myself, everyone. I'm saying it to myself. I'm in physical therapy so I can get to the point of doing weight bearing exercise. So estrogen, progesterone, still going to the gynecologist, still keeping things healthy down there.

Gillian Goddard: Yes. In a variety of ways.

Erin Stein: In a variety of ways. And then what else are your hormones still doing? Not doing? Need to be checked on?

Gillian Goddard: Mm, yes. So one of the good things that happens at this point in life is that a lot of the cognitive symptoms that women experience during perimenopause and the very early days of menopause lift as your hormones stabilize. And all of a sudden you feel like you could start a new career, you know, new wind in your sails. And I think that is one of the greatest things about this stage of life. it really is great. I think so many women worry when they're going through perimenopause and menopause that somehow these cognitive changes that are quite common in perimenopause and menopause are the beginning of dementia and they are not the beginning of dementia. And so oftentimes by the time women hit sixty, sixty-five, they feel like they're clearer than ever. Which is amazing. But then you have to think about your brain going forward. So you get back all this great cognitive function and you have to think about keeping it.

Erin Stein: Mm-hmm.

Gillian Goddard: And this is something that comes up a lot when we talk about hormone therapy because people are interested in whether estrogen may help prevent cognitive decline. The jury is definitely still out on that subject. That doesn't mean we won't find someday that hormone therapy is helpful, but right now we just don't have that data. But we do have a couple of things that we know are helpful, and there's two main things that I think are really worth considering. I always think about my grandma when I think about these things because she lived to be 99, and she dialed into these two things hard. the first of which is if you don't use it, you will lose it.

Erin Stein: Mm-hmm.

Gillian Goddard: So you've got to keep your brain stimulated. My grandmother did that by working until she was in her early eighties, and then she read the newspaper every single day, cover to cover. She got it delivered to her house, good old Arizona Republic.

Erin Stein: Yep. Actual papers.

Gillian Goddard: Actual paper she would sit and read. And you can't just do one thing. There is data that when you use games and that kind of thing, that they are helpful for maintaining that kind of cognition, but they're not necessarily helpful at maintaining global cognition. So what do I mean? Number puzzles will help you retain number sense and word puzzles will help you with things like word recall, vocabulary, conversation, comprehension, those types of things. You do kind of need a little bit of both. There's lots of ways to do that, whether you continue working or not.

Erin Stein: And I would add to that, I think there are studies and some data on this, that it's really about continuing to learn. The best way to use your brain is to be learning something. And so the headline I saw that of course I clicked on was “bird watching is good for your health.” And it wasn't necessarily about bird watching itself. It was more like any hobby that you pick up that you're learning something new. If you're learning the different markings on different birds and how to identify them, you are learning something, right? And so you're engaging your cognition, you're engaging your memory, you're still using all those brain cells. 

Gillian Goddard: Exactly. Yep.

Erin Stein: I make fun of myself and my husband because now that we moved out of the city we have a backyard with some woods and there's a lot of birds and we watch them. Sometimes we do some bird watching.

Gillian Goddard: Yeah. There's a tree that I can see right now actually and in the spring there's always woodpeckers in it. It's hilarious.

Erin Stein: Yeah, we have many woodpeckers. I love the woodpeckers, except when they're hammering on my gutter. I am less fond of that behavior. But we have five different kinds. I mean, that's part of it. We've identified over thirty kinds of birds that have gone in and out of our yard. Yeah.

Gillian Goddard: Wow, that's so cool.

Erin Stein: It is cool, right? So yeah, we all get older and we get interested in birds.

Gillian Goddard: So yes, but it doesn't have to be birds. It could be anything.

Erin Stein: It doesn't have to be birds. It could be the bowling league. It could be learning a new language. Bless you if you're going to attempt that. Or painting or woodworking or yeah, music would be great for your brain.

Gillian Goddard: Music. Yes. Yes. Music as a hobby, playing an instrument or singing. Those are all things that engage your brain in a way that can be so very helpful. And in some cases you can double dip with this next one, and they've done lots of studies about this, which is the importance of social ties for cognition as we age. So close friends and family, people who we engage with socially on a regular basis. My plan for this is that Erin and I are just going to live like down the block from each other once our husbands kick the bucket.

Erin Stein: They can live down the block also. 

Gillian Goddard: I guess they could. I guess they could.

Erin Stein: But, you know, I still think we should just have a giant mansion to ourselves. 

Gillian Goddard: Okay.

Erin Stein: And I'll keep the cats on my side of the mansion, but we're gonna hang out all the time is the point.

Gillian Goddard: Yes. And this is something, you know, when I think about my grandmother and the things that she quote unquote did right—other than be born in the correct family, which is genetics do play a significant role here. We were at her house all the time and she had a very wide circle of family and friends. She played bridge with the same group of people for the longest time and so in some ways she was connecting both of these things, right? Pick a hobby that uses your brain and allows for some social engagement. Bridge was hers people do things like playing mahjong certainly playing music with a group of people.

Erin Stein: Well, now the triple threat is pickleball 'cause then you're adding some exercise as well.

Gillian Goddard: Yes, except for that I see so many people who get injured with pickleball. Don't get injured.

Erin Stein: I know, you gotta watch yourselves, okay? I'm speaking to my mother-in-law right now. She knows she needs to wear a knee brace.

Gillian Goddard: Yeah. Yeah. Please don't fall. But it's true, cause you're learning something new, you're socially engaged, and you're moving your body. 

Erin Stein: Yeah. Yes. Maybe swimming would be the least injury prone, perhaps. For your joints anyway.

Gillian Goddard: Yeah, like water aerobics. Yeah, yeah.

Erin Stein: This is something that we kind of know, but we don't really talk about in an important way. Because when you get older, even if you do have a lot of family, maybe they don't live nearby. Maybe they're super busy, they have kids, the kids are in school, there's holidays, or people get divorced, and then the kids are shuttled back and forth. And it's not always possible to spend lots of time around your family anymore, like it used to be. You know, people used to stay living closer together and it used to be easier. So you really have to put some effort into your social circle, finding people, building it, joining groups. Which is gonna be hard for me 'cause I'm not really a joiner, but find someone like Gillian to drag you to these things.

Gillian Goddard: I'll drag you along with me kicking and screaming.

Erin Stein: That's what you need to do. Find one friend who is a joiner and have them make you join. That, actually, I think is a very good solution to this kind of problem. 

Gillian Goddard: It is.

Erin Stein: But a lot of people are lonely. I mean we saw it during the pandemic, but also it already existed and still exists.

Gillian Goddard: Yeah.

Erin Stein: People don't have as much social connection anymore.

Gillian Goddard: And you know what? They've done studies and they show that loneliness literally changes your brain physically and that those changes really do put you at risk for cognitive decline. It seems so trite to be like, you have to have a rich social network, but having that rich social network is keeping all those synapses firing in the best way and so it really is so critically important to have a rich social network.

Erin Stein: Mm-hmm. Get some ladies, do some gossiping, do some hanging out.

Gillian Goddard: Right. Learn something together.

Erin Stein: if the audience has not read The Thursday Murder Club, it's so good. And who doesn't want to be solving murders in their old age as a way to keep your brain functioning?

Gillian Goddard: That would be so fun. This group at my church of older women, decided that they wanted to sponsor a refugee family and they not only learned how to do that themselves and worked with an organization, they got the whole congregation involved. So, you know, the opportunities are limitless and there's so much you can do.

Erin Stein: But you need to put some effort into it.

Gillian Goddard: I mean I think that's the answer, right?

Erin Stein: It is healthcare. It is taking care of yourself and your health. And if you keep working, that's an easy way to stay engaged with people, presumably.

Gillian Goddard: Sure.

Erin Stein: Depending on your work, I suppose.

Gillian Goddard: Yeah.

Erin Stein: But you gotta put some work into it. You gotta make sure you have a social network. It can be easy to let it lag and let other people get busy and move on and you gotta go out and find some other people then.

Gillian Goddard: Midlife tends to be a time when people kind of need to take stock and do a little bit of reflection on their social network? I think for people with kids, a lot of times your social network is very focused around the school community, and then you look up and your kids are in college and some of those communities that started around, all the boys in the fourth grade stick together and some of them don't and you have to kind of reassess and reestablish some ties with some new people. So don't neglect this one.

Erin Stein: Don't neglect it and it's not always easy. 

Gillian Goddard: It isn't. It isn't.

Erin Stein: It can be hard. I forced myself to do this just before the pandemic, and then I was glad I really did it because then I used it during the pandemic. But a woman had started a network, a group of women over the age of thirty-five. It was a great organization and I joined it just in time. And we had Zooms and all kinds of things online during the pandemic. It was supposed to originally be more in person stuff, but we ended up doing lots of gatherings online. I met people and made friends that way. And I kinda had to force myself to do it and to go to the Zooms and participate. But it was totally worth it. And I would send you there, but the group doesn't exist anymore. It was great but I did very consciously have to force myself to do it and tell myself that it was good for me.

Gillian Goddard: Yes. Yeah. Absolutely. Absolutely. There's lots of books about how to make friends as an adult. it's not always easy, but it can be done. People want to be friends. Usually people are happy to meet someone new.

Erin Stein: I think in person is best, but connecting with people online or in Zoom. Like, you can also take a class online and interact with people in your class that you're taking, even if it's over the internet. We used to have the AOL chatrooms. I met all kinds of people in those things and made some friends and then we would mail each other episodes of The X-Files.

Gillian Goddard: I love it. It was a certain time. Yeah.

Erin Stein: It was a certain time. Yeah. Anyway, okay, what else?

Gillian Goddard: What about all your other hormones?

Erin Stein: What about them? You have to tell me.

Gillian Goddard: Yeah. okay, so estrogen, progesterone, fine. But you have all these other hormones that need attention or may need attention. This is important. Just because your reproductive hormones are done doesn't mean that the rest of your hormones are done. In fact, hopefully they're not. Menopause is a common time for people to develop thyroid issues. So that is something that you always want to be asking people about. Menopause is a common time for people to develop blood sugar issues. That is a hormonal issue that we need to be thinking about. And so really, with the exception of your reproductive loop, your other hormones hopefully are chugging along normally because otherwise you're gonna be in trouble. And understanding how all those other hormones are working and why they're important to you is as an endocrinologist I think it's pretty important.

Erin Stein: You would. We talked about this in our Hormones 101 episode and Gillian talks about it in her book a lot. All of these loops work together. There is no functioning without all the loops functioning, you know?

Gillian Goddard: Yeah. Yeah.

Erin Stein: Let's talk about the thyroid issues for a minute because if you're in menopause, what are some things you might be experiencing that might send you to the doctor? hopefully you're getting your physical once a year and getting some levels checked, but what might you notice or experience that might be a thyroid issue or a sign of a thyroid issue?

Gillian Goddard: This is really tricky because thyroid symptoms are super vague and when I list them you'll be like, huh, that sounds like it could just be normal aging. So thyroid symptoms include dry skin, brittle nails, brittle hair, hair loss, constipation…

Erin Stein: Ooh, fun.

Gillian Goddard: …weight gain, brain fog and then mood changes like depression and anxiety. Think about that. All of those things, you could be like, well I'm getting older. But you might not just be getting older. 

Erin Stein: Or you could think it's still menopause / perimenopause and menopause and just never ended.

Gillian Goddard: Yes, yes, yes, yes. absolutely. I think one important distinction here is when did the symptoms start? Are they new? Are you, a few years past your last menstrual period and now you're starting to have new symptoms? Those are less likely to be menopause symptoms as opposed to something else and so they warrant some investigation. The other thing is, are you on hormone therapy and your symptoms aren't well managed? That would also suggest maybe those symptoms aren't menopause symptoms and that you should investigate them further. When we are talking about these sort of very broad symptoms, which are often thyroid symptoms, but are often symptoms of lots of other things, the key is not to just chalk them up without any investigation to aging or to menopause, especially if they're not managed by hormone therapy or they're new a couple of years or more past menopause.

Erin Stein: Is your blood work a pretty easy way to catch that at your annual exam, or are there things that might be missed just doing a standard workup?

Gillian Goddard: It really depends on your primary care doctor and sort of asking your primary care doctor what their standard bloodwork is. Some primary care doctors are literally checking your electrolytes, cholesterol, fasting blood sugar and not a whole lot else. Some doctors will do an average blood sugar called your hemoglobin A1C, and that can get you some blood sugar information. Some doctors will routinely check one thyroid test called your TSH or your thyroid stimulating hormone. But some will only do that if they know that you are at risk. And if you haven't told your doctor that you have family members with thyroid disease or that you had a weird thyroid thing that happened after pregnancy, your doctor might not check your TSH unless, you know, unless you say something. And so I think the things to be checking for is do they check an average blood sugar, a hemoglobin A1C? I would advocate if insulin level but sometimes that's hard to get them to do but a fasting insulin level might be appropriate and at least a TSH as a as a starting point. The other thing that happens a lot in primary care is that a number will be off but it will be near the cutoff and so they'll mention it and they'll be like “well we'll just recheck it next year” and I think it's important to try and be a little more proactive than that, to push back on that a little bit and be like, “well, I'd like to recheck it sooner,” or, in a month or two instead of in a year, just to kind of keep the momentum going.

Erin Stein: I just had my physical (yay me!) and they did check all of those things, but also when I was in with the doctor before I had blood drawn, I said, I wanna check all the things. I wanna check the thyroid, I wanna check my vitamin levels, do it all.

Gillian Goddard: Yep.

Erin Stein: I'm a woman of a certain age and it's been a while since we did it all, check the cholesterol. Just do it, all the things. I think at this place they tend to do it all anyway. You should ask, say, I want to make sure we're checking everything at this point to make sure that my cholesterol is okay, that my TSH is okay, that my iron levels are okay. especially if it hasn't been done in a while.

Gillian Goddard: Yep.

Erin Stein: Especially then. But even so, I mean, your body has just gone through a big change and it keeps changing. Our bodies don't  stop doing things. 

Gillian Goddard: Yeah, they're not static. And it is really common to have new problems with these hormonal shifts that come along with menopause. This is definitely not a time to ignore your hormones. It's a time to be particularly aware of them.

Erin Stein: Any other hormonal test things? Any adrenal loop things?

Gillian Goddard: You know, the adrenal loop is the one loop that tends to really behave itself quite nicely. The biggest issue that comes up with the adrenal loop is that a lot of people have nodules in their adrenal glands and those nodules are most often benign and don't make anything. And usually we call them incidental lomas because often they're incidental findings from another test. You go in to the ER because you're having really bad belly pain and they do a CT scan. Or, your doctor notices something about your kidney numbers, so you get a sonogram of your kidneys, and your adrenal glands sit right on top of your kidneys so they happen to see one. But the adrenal glands and the function of the adrenal glands is so important that it is rare to have problems with them because their function is very well regulated and preserved.

Erin Stein: When you are past menopause, you're an older lady, a wise woman, what are the most common health issues or health risks? We talked about UTIs I would say also activity in bones, because if you fall and break stuff, it's not good.

Gillian Goddard: Yes, osteoporosis. Heart disease is a huge one. And then your routine cancer screenings, of course. Your colon, your boobs.

Erin Stein: Check that colon. Check your boobs.

Gillian Goddard: Check your boobs, check your colon.

Erin Stein: The point is there are some hormonal things still going on. You're not totally done with the gynecologist or with your lady parts. 

Gillian Goddard: You never are.

Erin Stein: You never are. Yeah, unfortunately, you never are. I kind of would like to be done with them to a certain extent.

Gillian Goddard: I would say you have to think about them less often. How's that?

Erin Stein: Okay, sure. Less vigilant, but still vigilant. But still, ultimately if you're in menopause, you should go back and listen to our You Turned 40. Now What episode because all of the health things that we talked about are basically the health things you need to be checking, still. Still.

Gillian Goddard: Still, still.

Erin Stein: Sorry not sorry.

Gillian Goddard: We used to say once you get to a certain age and it would vary from test to test, there was just no point in checking you anymore. Because the likelihood that you were gonna get whatever thing we were screening you for and it was gonna kill you before something else was gonna kill you was low. Well, it turns out as we're focused on people living longer and medication and medicine is getting better, that becomes less and less true. If you aren't dropping dead from a heart attack at 75, then the colon cancer you didn't diagnose at 70 could be the thing that is the problem. And so there is an effort now to re

focus screening efforts not based on your age but on your health span or your projected health span. So based on how healthy are you right now, and how long do we think you're gonna live, well, then we're going to keep doing these screening tests. My grandma, who lived to be 99, was diagnosed with endometrial cancer when she was 90. She had a hysterectomy and some radiation treatment and was right as rain in a couple of months. If they had said, well, you know, you're 90, you're gonna die at some point…first of all, she would have gone and found a different doctor, because that was definitely not her speed; but also, it could have been endometrial cancer that was the thing that shortened her life. And she lived another nine years after that, cancer free. It really depends on who you are.

Erin Stein: Such a good example for so many things, that grandma. Yeah, your grandma.

Gillian Goddard: Yeah she was a character. When she passed away, my sister and I drove to the funeral home together and so she passed away in June and we were in Arizona.  So my sister turns off the car and I think, you know, we're gonna get out and go into the funeral home. And I looked at her and she wasn't moving. And I'm like, “Are you ready?” And she was like, “No.” And I'm thinking, we're gonna die in this car. 

Erin Stein: 'Cause it's hot.

Gillian Goddard: Cause it was a hundred and ten degrees and then we sit for a few more minutes, and I'm like, “Well, are you ready now?” And she was like, No. And we sit for a few more minutes, and she goes, “you know, Grandma was born before childhood vaccines, before antibiotics. She never smoked herself, but she lived with grandpa and he smoked two packs of camels a day and she lived with him for 45 years.” And she never exercised, although she did clean her own house until she was 97. So I would argue that's exercise.

Erin Stein: That's exercise.

Gillian Goddard: And she never really worried about like dieting and that kind of stuff. And she lived to be ninety-nine. And my sister looked at me and she said, “I think we're gonna live to be like a hundred and twenty.” So yeah, you got a long way to go and if you wanna be like my grandma, now's the time to do the stuff to stay.

Erin Stein: Yep and we have a whole episode about your heart health and cardiovascular; that is a big one because that's the one most likely to shorten things drastically. 

Gillian Goddard: A hundred percent that's the number one killer of women: Heart disease.

Erin Stein: But to your point, we are all living longer. We're all working longer, for better or worse. We're all hanging in there and looking better, I would say, longer into our lives.

Gillian Goddard: Go back and look at pictures of Abraham Lincoln right before he died and then look at how old he was. Yeah. Yeah. We look better now.

Erin Stein: And that's all great and it might all go fine as long as you're keeping on top of stuff.

Gillian Goddard: Yeah.

Erin Stein: And catching it and treating it and moving on.

Gillian Goddard: And maintaining all those lovely social relationships.

Erin Stein: You gotta eat well and exercise and have friends. Do all the things.

Gillian Goddard: Yeah. And use your brain.

Erin Stein: Please use your brain. In a variety of meanings.

Gillian Goddard: [laughs]

Erin Stein: I do worry that some people, and probably not listeners of this podcast, but some people get older and they're like, Well, I'm old, who cares? Like what does it matter? And it actually does really matter. 

Gillian Goddard: It really does. It really does.

Erin Stein: You can make a real difference, ladies. Just because you hit menopause doesn't mean it's over. There's so much more for you to do.

Gillian Goddard: I couldn't have said it better myself.

Erin Stein: You gotta keep looking after your health.

Gillian Goddard: You do. It's so important.

Erin Stein: I know it sucks.

Gillian Goddard: You just gotta find yourself a doctor that you like to go and see.

Erin Stein: Interesting tactic. Sure, go find an attractive doctor you want to say hi to.

Gillian Goddard: I didn't mean like that!

Erin Stein: Well that's how I heard it! [laughter]

Gillian Goddard: And on that note

Erin Stein: And I think that's where we end.