Jay Shetty & Tamsen Fadal ON Navigating Menopause Changes

Why is menopause still a taboo topic in 2025, and how can we make sure that people understand the changes that all women eventually go through at some point in their lives?

In this On Purpose episode, Jay Shetty had an open discussion with Tamsel Fadal, Emmy award-winning journalist and the New York Times best-selling author of How to Menopause. She is also the producer of the documentary The M Factor and hosts The Tamsen Show podcast. Tamsen Fadal has established herself as a leading global voice in discussions concerning midlife, menopause, and reinvention, dedicating her efforts to empowering women to navigate this life transition with essential knowledge, confidence, and strong community support.

We Don't Talk About Menopause

Although modern medicine has made considerable progress in the past century, menopause remains a taboo topic. Tamsel Fadal considers sexism and ageism to be the top reasons for this phenomenon. She told Jay Shetty that women have often been dismissed after their reproductive years, being constantly told that their best years were behind them.

Unfortunately, the medical system treats menopause the same way. Fadal recalls that, in her 30-year journalism career, she never mentioned the word "menopause." She explained that a phenomenon that all women go through is still deeply entrenched in silence and doesn't receive the spotlight it deserves.

When Fadal started experiencing menopausal symptoms, her doctor only told her that it had started, but he didn't provide any further explanations. Intrigued, she researched the topic, and she learned that 1 billion women are expected to be in menopause by the end of the year.

Perimenopause, Menopause, and Postmenopause

Tamsen Fadal told Jay Shetty that menopause is divided into three distinct stages: perimenopause, menopause, and postmenopause.

Perimenopause is the crucial time leading up to menopause, and it can start as early as your 30s. This challenging stage often lasts between four and ten years, characterized by hormonal changes, fluctuations, and a lack of clear understanding about what is happening in the body. Hot flashes are the most common perimenopausal symptom, but not the only one. A woman may still experience her period, although it can start to become more irregular during this time. It's important to note that women can still get pregnant during this time.

The transition to menopause itself occurs on the specific day a woman has gone one full year (12 months) without her period, after which she no longer has a menstrual cycle.

Postmenopause refers to everything after menopause. The symptoms do not automatically stop once menopause is reached; this phase can encompass anywhere from a third to half of a woman’s life.

A Symphony of Symptoms

Fadal shared with Jay Shetty the wide range of symptoms that impact women on biological, chemical, and emotional levels. She explained that these can range from 30 to potentially hundreds, as research advances and new data are uncovered.

In her personal experience, Fadal found brain fog to be the most debilitating symptom. She described it to Jay Shetty as reading a book and not remembering the plot, or struggling mid-conversation to recall the topic. Key symptoms also include significant mood and emotional changes, such as anxiety, mood swings, rage, and depression.

Physical discomforts range from joint pain, itchy skin, and dryness throughout the body to unexplained weight gain around the middle, often despite maintaining the same diet and workout routine. Sleep disruption is real, frequently characterized by waking up at 3:00 AM and being unable to fall back asleep, or struggling to fall asleep in the first place. Another significant symptom is low libido, or complete loss of sex drive. The culmination of these issues leads women to not feel like themselves anymore, unable to recognize themselves in the mirror.

Menopause or Dementia?

The biological process behind menopause involves the loss of estrogen and progesterone. Fadal told Jay Shetty that perimenopause feels like a wild hormonal ride, affecting the mind.

The cognitive symptoms can be terrifying, and many women experiencing them tend to believe they are developing Alzheimer's or dementia. Tamsel Fadal had some of these symptoms herself and witnessed other high-profile women acting confused because of the hormonal imbalance. Menopause and its manifestations are not a choice or something that we can influence, and therefore, it's important to spread this information more widely.

Careers and Relationships May Suffer

The transition through perimenopause and menopause has major, real-life impacts on careers, family, and relationships. It's not limited to a woman's body, but it influences everything around her. At work, she may struggle to function, despite being at the height of her career, potentially unable to sustain a conversation due to debilitating brain fog.

Tamsel Fadal stressed to Jay Shetty the importance of normalizing conversations around perimenopause, so that women don't get penalized for something out of their control. Yet the lack of information lets many women cross this period blindly, without real support.

The surge in divorces among women in their 40s is no coincidence, Fadal told Jay Shetty. Hormonal changes can lead women to feel very differently, and even lose libido. Another symptom may be increased irritability, quickly snapping at things that didn't used to bother them before.

Seen from the outside, it's difficult to picture the changes that happen inside the perimenopausal woman's body. This is why partners are more likely to call them "crazy" or accuse them of acting out, without understanding the hormonal changes and how they affect women's lives.

Misdiagnosis and Untreated Suffering

The lack of awareness surrounding menopause led to widespread suffering and misdiagnosis. Unfortunately, not many doctors are trained on the subject, including OB-GYN. As a result, around 75% of women's menopause symptoms are left untreated, Fadal told Jay Shetty. Moreover, only 2% of medical research is dedicated to women's health, and only a fraction of that revolves around perimenopause and menopause.¹‍

When addressing their symptoms, many women are told it's just stress, and no further investigation takes place. Fadal complained to her doctor about moodiness and weight gain and was given antidepressants, which only improved her mood but didn't alleviate other physical symptoms like hot flashes or irregular periods. She believes that proactive self-advocacy is necessary; women must track their symptoms themselves and come to the doctor's office prepared with relevant questions.

Long-Term Health Consequences

Tamsel Fadal told Jay Shetty that women must become aware of the changes their bodies undergo and their health implications. There are major risks associated with declining hormones, and it's essential to address them under the care of your healthcare provider. Some of the risks include osteoporosis, which is one of the biggest silent killers of women.² Ideally, you should start caring for your bones already in your 30s, Fadal explained.

Research has confirmed a correlation between hot flashes and heart health risks.³ Additionally, Alzheimer's is more prevalent in women and is sometimes linked to hormonal shifts.⁴ Fadal stressed the importance of educating the public about women's health, and especially around menopause and perimenopause, because it can save lives.

Managing the Symptoms

As menopause is a natural occurrence, there is nothing we can do to prevent it. However, Tamsen Fadal suggests building a strategy for navigating this period smoothly, consisting of three pillars:

1. Hormonal therapy.
2. Lifestyle changes.
3. Stress management/ community.

She discussed with Jay Shetty the available hormonal therapy, such as Menopausal Hormone Therapy (MHT) or Hormone Replacement Therapy (HRT). Tamsen Fadal considers it essential for women experiencing debilitating symptoms such as severe brain fog or a high number of hot flashes per day. Hormonal therapy usually includes a combination of estrogen and progesterone, which has helped Fadal with her mood, sleep, and hot flashes. Other hormonal options include testosterone for low libido and vaginal estrogen for painful sex or dryness.

When it comes to lifestyle changes, Tamsel Fadal listed three main priorities:Sleep.

1. Strength training and protein intake.
2. Diet and keeping inflammation under control.

Lastly, stress management and community are one crucial component. Tamsel Fadal told Jay Shetty that it's essential to find people going through the same experiences. You need someone to exchange experiences with who understands exactly what you are going through, as this gives women a sense of belonging and makes them feel less isolated.

Educate Your Partner

Jay Shetty firmly believes that women's partners need to be educated on this topic, as well. Women are going through many changes, and it's sometimes impossible for them to even realize what's happening. Therefore, those around you must know how to support you during this tumultuous period.

Fadal explained that low libido during perimenopause or menopause is common; hormones fluctuate widely, so the sex drive may come and go. As the estrogen levels drop, some women may experience a complete loss of libido, because intercourse becomes painful due to dryness. Tamsel Fadal openly shared her experience of getting remarried at age 50 and realizing her sex drive had completely disappeared, despite her desire for intimacy and closeness with her partner.

If the partner doesn't understand the cause, they may mistakenly believe that a relationship is over and that the attraction is gone. Tamsel Fadal told Jay Shetty how incredibly grateful she is for her husband's understanding, who supported her through weight gain, poor sleep, and the search for an appropriate hormone therapy. She believes that many relationships could be saved during this phase if more counselors were educated on this topic.

As a final piece of advice for younger women in their 30s, Fadal suggests proactive planning to manage symptoms. Her list includes:

• Good sleep and nutrition habits.
• Strength training.
• Protein consumption.
• Stress management.
• Get a bone density test.

Tamsel Fadal told Jay Shetty that women should be empowered with knowledge, ensuring they are no longer suffering alone or feeling crazy, and realize that it is never too late to make the changes needed to help them feel even better than before. She remains optimistic that with increasing awareness and community support, menopause will look vastly different in the next five to ten years.

More From Jay Shetty

Listen to the entire On Purpose with Jay Shetty podcast episode “Tamsen Fadal: You Are Not Going Crazy… Your Hormones Are Changing! (THIS is the GUIDE to Navigate Menopause & Take Back Control of Your Mind, Body & Life)” now in the iTunes store or on Spotify. For more inspirational stories and messages like this, check out Jay’s website at jayshetty.me.

¹Smith, Kerri. (2023). Women’s health research lacks funding — these charts show how. Nature. 617. 28-29. 10.1038/d41586-023-01475-2. 

²Szamatowicz M. How can gynaecologists cope with the silent killer - osteoporosis? Prz Menopauzalny. 2016 Dec;15(4):189-192. doi: 10.5114/pm.2016.65682. Epub 2017 Feb 8. PMID: 28250721; PMCID: PMC5327627. 

³Thurston RC, Sutton-Tyrrell K, Everson-Rose SA, Hess R, Matthews KA. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women's Health Across the Nation Heart Study. Circulation. 2008 Sep 16;118(12):1234-40. doi: 10.1161/CIRCULATIONAHA.108.776823. Epub 2008 Sep 2. PMID: 18765392; PMCID: PMC2728044. 

⁴Budson, Andrew E., M.D. “Why Are Women More Likely to Develop Alzheimer’s Disease?” Harvard Health Blog, January 20, 2022. https://www.health.harvard.edu/blog/why-are-women-more-likely-to-develop-alzheimers-disease-202201202672