Menopause happens to women. And it affects everyone in society. But menopause is not a singular experience for everybody. Every woman has her own journey in this mid-life process. Heather Hirsch, CEO of Health by Heather Hirsch, brings her rare combination of intellect, energy, passion, and creativity to being an advocate and healthcare partner to mid-life women. Whether through social media, panel discussions, or sitting one-on-one with a patient, Heather knows she is making a difference in the lives of so many. As she says, “Women’s health affects everybody.” Let’s have this mid-life conversation today. Tune in to this episode, and let’s make it better for EVERYBODY!

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A Mid-Life Conversation: Unlock Your Menopause Type With Heather Hirsch

Combining

Rachel, it always amazes me when we find an amazing practitioner who suddenly recognizes either their entrepreneurial spirit or their media desire to be out there. Speaking with Dr. Heather Hirsch, we have found that.

I feel like we should give our guests either Superman, Wonder Woman, or some of their appropriate cape when they come on the show because like you, they’re treating patients, running businesses, trying to move the conversation ahead, writing books, and meeting important people who can help them promote the message. She has so much energy. We talked and it felt like a mile a minute keeping up with all the things she’s trying to do with such passion for women’s health, which is like manna from heaven for us.

Let’s talk to Heather.

 

 

We are so excited to have our guest, Dr. Heather Hirsch, who is the CEO of Health by Heather Hirsch, in addition to many other hats she wears, which we’re excited to learn more about. Welcome, Heather. Thanks for being with us.

I’m so excited. Thank you for having me.

I have to start with a part that is personally important to me but may not be as on task as the rest of the questions. You shared a picture where you are standing with Oprah and my best friend, Gayle, who I was on my plane with a few weeks ago. The first article I ever wrote that got published was called How to Find Your Leadership Voice because Oprah is already taken. I’m an Oprah fanatic from back in the day. How did that happen? Was it as great as it seems like it would be? What are you talking to Oprah about?

It was greater than you could think it would be. It was incredible. I got a call in mid-February from the producers of O Daily that if I was available, would I like to meet with Ms. Winfrey for an interview. I was like, “Of course. I can clear everything off.” They wanted to have a panel on menopause and midlife. I knew that it was going to include a lot of the amazing people who were on the panel. It was Drew Barrymore, Maria Shriver, Oprah, Dr. Sharon Malone who’s great and amazing, Dr. Judith Joseph, a psychiatrist, and then Gayle King also. It was this incredible moment of, “Is this real?”

It then got further. She said, “She wants to talk about your book, Unlock Your Menopause Type,” which is landing on June 6th. This is literally a dream come true on my vision board, me talking with Oprah. When I make vision boards, I do them on PowerPoint and put my face on someone else’s face. It was incredible. We talked for a few hours. Finally, the producers were like, “We got to move on because Oprah has other interviews to do here.” It was an amazing energy. You could hear a pin drop the entire time. It was her first live studio audience in the last few years. What my memory is she just glided in, gave me a big hug, and said, “I’m so excited you’re here.” I said, “I’m so excited you’re talking about this.”

If we were to stop at this moment, it looks to the world that menopause is everywhere and it’s all anybody was talking about. Anybody who’s been in this space knows that this is a relatively new phenomenon. Again, you wear so many different hats. You do internal medicine, focus on menopause, and serve a lot of different roles, a speaker, and an author. From your perspective, why is menopause having its day, moment, month, or year now?

This is a good question to discuss amongst the three of us. It is because social media galvanizes women. More women are starting to talk to each other. More women, especially public figures, celebrities, those with large profiles, and YouTubers are starting to talk about menopause and their menopause experience. To me, this seems like this has all happened in the last few years. During the pandemic, enough people were on social media and enough people learned to talk about whatever they wanted to talk about at that time. It is not coming from the medical community. Where else is it coming from now?

 

There are certainly a couple of loud obnoxious doctors like myself, but that is not moving the needle. It’s either social media, which has soft-balled this in the sense that it’s given people a lot of different places to go to look at other people, learn about their experiences and hormone therapy, or whatever it might be to be mad and then to advocate and to start nonprofits, podcasts, and many other things. I think that’s why, but if you have other ideas, I’d love to know what you guys think.

Social media helped because there was so much misinformation that was put out there and we needed experts like yourself and us to ride that ship. Social media, in this particular case, being the Wild West did us a favor. My biggest take on the medical community is we’re catching up. Gynecologists used to own this field. That is so no longer the case, which is great because the internal medicine field brings such a different perspective to menopausal health.

The mental health field brings so much to the table, and this is a very big part of the management strategy when it comes to menopausal symptoms as we all know. We are having a moment, and it’s a great thing. Rachel and I have spoken about this and we are wondering where most women are getting their day-to-day care. Is it from their OBGYN or internal medicine doctor? Who is mostly managing women’s health? Can we do it all together and have fun in the sandbox together? Is it going to be more of a piecemeal approach in your opinion?

I do. I have this bias and it could be wrong. I started my career in OBGYN. I did a few years there and realized I was not a surgeon. I got into surgery and I was like, “How long do I have to stand here? What if I’m hungry?”

We don’t eat in our field.

I had so much anxiety about when I would eat again. Now, our gynecologist training is so heavily-focused on obstetrics and surgery because that is so vital. You do not want me taking your uterus out, but internists are so busy learning all the complexities of the human body, but then the pelvic area, that’s gynecology. There is a gray zone. I don’t know how you bridge them, but you can.

I love being able to work hand-in-hand with a gynecologist. For example, when I was at the Center for Women’s Health at Ohio State, people would come to see me because they were interested in menopause. I would realize they were having bleeding that required a biopsy. If they had enough risk factors a D and C, where you have to get put to sleep and you don’t want me in the operating room, I’d realize they needed a myomectomy, or they needed something that the surgeon could do and wanted to do. I’m sitting now and talk until I’m blue in the face because I love helping people make complex decisions in the arena of, “We’ve got plenty of time.”

It’s not like we need to do an emergency C-section. That doesn’t give me plenty of time to make decisions. There is this gray zone where gynecologists know so much about the complexities of females and hormonal swings like pregnancy, infertility, postpartum, peripartum, and some about menopause and perimenopausal because their training is so focused on obstetrics and surgery. Internists are so good at knowing how all these twenty different medications interact with each other in your QT prolongation and this and this but then don’t know how to treat a yeast infection.

There has to be some gray zone where both of our training could work together to create a seamless experience for the patient. That might be teaching things like gynecologists may be teaching basic procedures like an EMB or EndoMyocardial Biopsy rather, which is quite easy. What are all these medications together? What are their interactions there? What does that mean? Interns are used to prescribing hundreds of different medications. For my gynecology colleagues, maybe there’s a set of 10 or 20 that they like to prescribe or whatever. There probably is a good place to interact together, and if we did more fellowship training around this, that could be helpful.

There is a gray zone where both of our training could work together to create a seamless experience for the patient. Click To Tweet

I love this answer. I want to feed off of that one last question. I don’t want to read EKGs or anything like that. That went by the wayside a very long time ago, so I totally get your point of view. My question is these two big limitations in OBGYN training is in sexual health and hormone therapy. We don’t get trained in that at all. It is literally on-the-job training. I wonder if you see similarities in the internal medicine world because I’ve trained in expertise as an already practicing physician.

It’s a funny question because when I go to answer it, at every stage of my training, I would volunteer to teach as much as I could. My thought process evolved. The way women’s health initiative ended in 2002 to 2004 and then prescribing fell off was residents never saw attendings prescribe so they never could watch in that apprenticeship model and learn how to consult and answer those complex questions. It got more complex after it.

Even, I learned in my internal medicine residency. If you have to use hormone therapy, use the tiniest dose for the shortest time. It was when I was on a fellowship at Cleveland Clinic under Dr. Holly Thacker, I realized the safety and the efficacy of hormone therapy, and have been doing as much as I could teach on that.

When I went to Ohio State and then later when I went to Brigham back in my academic days, I tried to push to get them a couple of hours of education, but a couple of hours of education out of three years is a drop in the bucket. I don’t know how much our OBGYN colleagues are learning in residencies since I myself did not make it past the first year. Maybe you can fill me in on how much training they get, but I assume it’s pretty similar-ish.

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Here’s the Hot Flash for women to have the optimal healthcare they deserve. They should be seeing both an internal medicine doctor who has a different perspective on heart, lungs, kidney, liver disease, and all kinds of medical issues, and a gynecologist who focuses on care, fertility, reproductive health, sexually transmitted issues, and also hormone therapy. The best is to glean the best from both worlds to complete women’s healthcare each year.

 

 

You both have said so many different things, and I want to bring it back to the first question. Why is the moment now? Part of it is social media. It’s conversations like these and more investments going into women’s health. It’s women, especially famous women talking about their menopause, which I consider a combination of social media platforms and also having the money to invest and attract other people to invest.

With COVID, we started having these conversations. One of my favorite examples of this is the City of New York had as their guidance from the New York City Department of Health, “You are your safest sex partner.” That was during COVID. Never before in the history of New York City education and probably in the history of US sexual health education has someone said, “Masturbating is the way to go so you don’t catch anything.”

It’s a combination of these things and having positions with a platform like you have and Alyssa has to make those connections are important. If we’ve learned nothing about women’s health, one thing we’ve learned is how the pieces are put together. It’s not just physiological. It’s physiological and that doesn’t mean it is just female parts. It’s all the things that are in the gray area. It’s financial, psychological, and the whole mental health craze in the most positive way. The awareness of mental health that has invaded society and now is part of women’s health has helped us make huge leaps.

You can’t think about women’s health without thinking about mental health. It’s not possible. I do think that the progress happens in connecting people across those gray areas where Alyssa might not want to do an EKG, and you might not want to do surgery, but finding a way to figure out who’s going to get that done for the benefit of a woman.

 

 

You’re so right. I also think it’s crazy to ignore the elephant in the room.

There are so many.

I was going to say the financial elephant. We know that this is the value added to be a $50 billion, $80 billion, or $250 billion industry. It keeps going up and up, but it is not just companies that are delivering healthcare, companies delivering products, digitals, and other things that I’m missing. There is interest among entrepreneurs and venture capitalists to start thinking about this space. Let’s say you’re a 29-year-old venture capitalist guy and your mom started telling you about hot flashes. You start thinking about it because you’re thinking about it. It’s on your mind.

That’s one of the challenges. It’s a downside and an upside. If we need the male venture capitalist to be able to relate to the problem, we’re going to miss a lot of investment opportunities. The example I give is if I were to present to a male venture capitalist, “I’m selling this software as a service to help cybersecurity and global military organizations,” they can say, “That’s a good business. I’m never going to be the buyer, but I get that people need that service.”

With women’s health, we’re adding that extra hurdle. If it’s not personal to the VC, you can’t get over that hurdle. It all makes it even harder. Alyssa and I have both had this conversation. Alyssa as an entrepreneur and as a practitioner says, “Forty-three percent of women have sexual concerns and difficulties.” We’ll be like, “Not me. I’ve never heard of it,” but if you talk about fertility or their mom has hot flashes, which she decides to share with her VC son, then all of a sudden it becomes a real thing. We have to get away from, “This is women’s health,” and we’re making great progress because we’re talking about it in a much greater context. There are big problems. People can make a ton of money by providing better solutions. All those things are true.

I love how you package it all together. You’re absolutely right. My friend Lyndsey Harper has an app called Rosy. This is an exact quote from Rosy, and this applies to a lot of these things. When asked, “Who are your customers?” she was like, “Everyone is my customer because women have sex with either other women or with men. You’re all my customers.” That’s so true.

Menopause is a little bit different. They’re retiring earlier, don’t feel well, or are not treated. They’re leaving the workforce, changing jobs, and divorces happen because of menopause. Lawyers are making money off of it. It affects everyone. To say that it affects only women is silly, but that’s still the narrative that menopause happens just to women. It happens to society because women aged 45 to 55, and even broader, 35 to 65, are running the country. They should be running the world.

I hear Beyoncé coming on in the background.

They’re so skilled, emotionally smart, and intellectual. To have that taken away from you because menopause happens to women affects everyone in society.

 

 

I wanted to hone in a little on your personal journey. I wondered if you took the traditional path where you were seeing patients or in academia, which it sounds like you were. How did you springboard to these other endeavors which are so exciting and so useful?

I fell in love with midlife women’s healthcare during my fellowship training at Cleveland Clinic, which is in 2014. I was a Women’s Studies major in college. I dual majored in Women’s Studies. Never in a million years that I think I was going to become a menopause doctor, but looking back now, it all makes sense, retrospectively. I love taking care of women in midlife. It’s so satisfying. Women are so fascinating. I learned so much from my patients. Each patient is so unique and different, has different biases, and preferences, and comes in with different stories.

I always say I like to fix the Rubik’s cube for each person. The thing with that is it takes a lot of time. One thing that I don’t have is time. My time is my most valuable resource, so there was always a limit on how many women I could see in a day in the clinic. In 2016 and 2017, with my second maternity leave, I started my own podcast. I used to upload episodes to SoundCloud. In fact, it wasn’t even a podcast, it was audio bits for my patients because they’d come in and they would say, “Dr. Hirsch, I’m having hot flashes, but my mom had breast cancer so I can’t use hormone therapy.” I’m answering these same questions every day.

 

 

Going back to something either we had said which is that there were so many misconceptions, I was like, “That’s not a reason you can’t use hormone therapy.” That was so much to unpack. I said, “What can I do to lessen this burden?” Also, I’m going to burn out. If I burn out, then instead of helping my measly ten people a day, I help zero people a day. I trying to be a little innovative and think outside the box. I was like, “Here’s my SoundCloud link,” like I’m Billie Eilish or something. “Go listen to myths about hormone therapy.” They would say, “I heard that vaginal estrogen isn’t safe for breast cancer survivors.” “No, it is.” I then uploaded that to SoundCloud.

I thought, “I’ll just make it a podcast.” I thought I was the most innovative doctor. Lots of doctors had podcasts even in 2017 and 2018. I then started making courses for people because so many people would ask me questions on Instagram. You can’t give direct medical advice. Women were curious. I was like, “I’ll make a YouTube channel and answer more questions.” This innovative process kept going. I kept trying to think, “How can I whittle down the time it takes or how can I give women hours of information but only have 30 minutes with them?” I kept going on this innovative spree.

It’s not that innovative to make YouTube videos, but for academic medical centers, this is pretty wild stuff. Sending people links to YouTube is pretty mind-blowing, especially for my patients. It started to grow this brand of just me. Along the way, one of my most valuable lessons is the same old cliché thing we all hopefully learn at some point, which is to embrace who you are. It’s easy to say. All along the way, I’m trying to do research and do IRBs. I was like, “I should get this K Award. I should get NIH funding, make YouTube videos, be a mom, and write a book.”

I then finally realized what I like is sitting in front of a microphone and speaking the way I speak where I speak this way to patients and my kids. It’s great because I can be the same person in different scenarios. I can move it around a little bit. I can speak to clinicians versus lay women versus knowing when not to swear and when to swear, but it’s so nice to embrace your authentic self, which ultimately meant I wanted to leave academics so that I could remove a lot of the red tape and the steps to do the things that I wanted to help my patients and help more women.

 

 

It’s opposed to having every sentence you said to go through a regulatory approval process or that comms in the academic center. What’s so interesting when you talk about your authentic self and your energy literally is palpable and jumps through the screen is the joy that you have. There are folks that we’re meeting in the course of this journey, and Alyssa and you are clearly one of them who is reconnecting with the joy of taking care of people.

A lot of my husband’s family are physicians, and it’s gotten so hard to be a physician. There are so many demands on you and you have to learn skills that you never thought of, run a business, and deal with insurance, and you don’t have enough time. To your point, you have to take care of yourself because you’re an important asset also. I love that you are building a business and a platform based on loving what you intended to do, which was to help people get answers to questions.

Maybe it’s because of the age at which you graduated from medical school. This was the time to use these channels to communicate in a very efficient way in ways that COVID accelerated. We couldn’t see doctors, so we had to talk to them on the phone. We got used to it. Maybe we couldn’t even get a telehealth appointment. We have to watch videos. It’s a lot of necessity as the mother of invention to find new solutions.

I talked to Alyssa a lot about how time-starved physicians are and how crushing it is not to be able to give your patients the care that you went into this field to do. That’s what I’m so enjoying about doing this with Alyssa, hearing about the many things she’s working on now, and the way you talk about it, “I like sitting in front of a microphone and talking about women’s health, and I don’t want to do any surgery, so here’s my business.”

Other than hanging out with Oprah, what comes down the pipe for you? Not that hanging out with Oprah is not enough.

I would consider that the pinnacle and retire the next day.

I would love to manifest like a series thinking how incredibly immersive this two-hour panel was, and we just scratched the surface. When Oprah talks, it’s business. I don’t know what level you get past Oprah wanting to sit down and talk about a topic.

I don’t know. God is after that.

I think so. It’s amazing. I knew we had questions that we had from patients in the audience on vaginal dryness and sexual health. Two hours in, we didn’t even get there. We took questions that were not planted but planned. I have a book coming out on June 6th, I am potentially working on another book, which is about perimenopause. I am starting my own business and I have lots and lots of ideas. I never stop with ideas. This entrepreneurial spirit of mine has always been deep down there and now letting her loose. It’s incredibly fun. It feels so good to finally say, “I’m going to work for me and I believe in me.”

Those are all the things. You can find me on my social media platforms. I’m at @HeatherHirschMD everywhere. My website is HeatherHirschMD.com. It was so boring, but that’s where I am if you want to find me. There’s so much we could talk about for hours on the topic of midlife women’s health and business and how interesting, intricate, complex, and intertwine all these things are. I would also love to be back sometime if you want. Thank you for having me.

The book, “Unlock Your Menopause Type,” talks about the six different phenotypes. Click To Tweet

What’s the name of your book?

My book is called Unlock Your Menopause Type. I talk about six different phenotypes that I see. I told you I love Rubik’s Cube and solving each person. I couldn’t do that in a book so I used the six most common things that I see.

Keep up the amazing work. We love watching all the things that you’re doing and the passion, energy, and progress that you’re bringing to the space. Thank you for spending time with us.

Thanks for having me.

 

Important Links

• Health by Heather Hirsch
• How to Find Your Leadership Voice
• Unlock Your Menopause Type
• Podcast – Health By Heather Hirsch
• Rosy
• @HeatherHirschMD – Instagram

 

About Heather Hirsch, M.D. MS, NCMP

HEATHER HIRSCH, M.D. MS, NCMP, is the Chief Medical Innovation officer at Midi Health, the first virtual clinic designed to meet the needs of women in midlife. Dr. Hirsch founded the Menopause & Midlife clinic at the Brigham and Women’s Hospital and also served on the faculty at Harvard Medical School. Dr. Hirsch is board certified in Internal Medicine and completed advanced fellowship training in Women’s Health at the Cleveland Clinic.

She is also an author, podcaster, and content creator! Her specialty practice focuses on menopausal hormone therapy, perimenopause, breast cancer survivorship, sexual dysfunction, bone health, and other conditions common to women in midlife. She is an active member and contributing member of the North American Menopause Society, and the International Society for the Study of Women’s Sexual Health.