Puberty + Menopause: How Are We Supposed to Cope?!?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

The following transcript has been automatically generated by an AI system and should be used for informational purposes only. We cannot guarantee the accuracy, completeness, or timeliness of the information provided.

Reena Ninan:
When you combine puberty and menopause, oh boy.

Dr. Lisa Damour:
Your hormones are surging. Mine are downshifting. That’s a combustible combination.

Reena Ninan:
What families have explained this dynamic to anybody?

Dr. Lisa Damour:
They’re dysregulated as all get out. They cannot stand anything we do.

Reena Ninan:
Hot flashes, bad sleep, brain fog, mood swings, unpredictable, irritability.

Dr. Lisa Damour:
So much of what women go through, we don’t think of as symptoms.

Reena Ninan:
All right. This episode, I’ve been waiting for all season. I’ve been talking to you about this all summer.

Dr. Lisa Damour:
I think it’s an important one. I know, I know.

Reena Ninan:
Tell me the top three things about menopause you hate.

Dr. Lisa Damour:
Well, Reena, I actually have some news to share. I went on hormone replacement therapy.

Reena Ninan:
Oh really? That’s huge. What made you decide to do it?

Dr. Lisa Damour:
I was having too many symptoms and I think that that’s something we need to talk and think about is that so much of what women go through, we don’t think of as symptoms, and so I was having trouble sleeping. I was having hot flashes. I could not remember words that I know I knew. I was kind of grumpy all the time. I felt lousy, low energy and I’m an energy person.

Reena Ninan:
Yeah, you are.

Dr. Lisa Damour:
And so I finally wrote all my symptoms down and I went and talked to my doctor and she was like, sure, we can put you on it. In my case, it was just that simple. But what I will say is right now I’m hating nothing about menopause. Cause I feel so much better.

Reena Ninan:
You really feel the difference?

Dr. Lisa Damour:
I really feel the difference. So what I’ll say in terms of what I hate is I think we’ve gone a long way without talking and thinking about these, the symptoms they are and helping people get the care they deserve.

Reena Ninan:
And I think there’s been so much stigma for so long around HRT that people are trying to dispel and the safetiness of it. I feel my mother’s generation, it was still so new, our mother’s generation, they just really didn’t know much and so much has changed in what we know and how wonderful it can be for women.

Dr. Lisa Damour:
It’s true.
Susan Dominus wrote a really excellent article for the New York Times magazine called “Women Have Been Misled about Menopause.” Now Susan’s my friend, I feel like I need to say that in full disclosure. She’s also a super genius writer and it’s a very, very balanced look at exactly what you’re describing, sort of the historical landscape here of women and HRT and menopause treatment and the presentation of studies. So I am not a physician. If a woman is struggling with this, she should talk to her doctor, but I think that talk to your doctor piece has not been happening for a lot of women when it should be happening.

Reena Ninan:
And Lisa, we’ll put Susan Domino’s New York Times article in the show notes linked so people can take a look at it.

Dr. Lisa Damour:
And we’ll do it as a gift link. So if you’re a subscriber, it won’t be a problem and if you’re not a subscriber, you should be able to access it.

Reena Ninan:
I’m so happy you’ve kind of had a handle now on menopause and it’s been transformative for you, but when you combine puberty and menopause, oh boy, I don’t think that is something anybody’s talking about. So we’re going to be talking about that today.
I want to read you the letter: Dear Dr. Lisa and Reena, I’m 49, a single mom and firmly in the throes of perimenopause. The hot flashes, bad sleep and brain fog are bad enough, but the mood swings and unpredictable irritability are what really throw me. Meanwhile, my 13-year-old daughter is hitting puberty full force. She’s moody, weepy and snapping at me even if I breathe wrong to make it more complicated. I also have a 16-year-old son who hardly talks to me these days unless he needs a ride or money. I love my kids and I know what they’re going through is normal, but I feel like I’ve lost my footing. How can I support them when I sometimes feel so off balance myself signed ‘running out of patience and estrogen.’
I like that she’s got a great sense of humor despite going through all of this. First off, what is normal, Lisa?

Dr. Lisa Damour:
Well, that’s sort of this interesting question. She talks about what her teenagers are going through is normal and she’s right. So here’s what we have. We have a whole bunch of symptoms related to perimenopause and then we have normal adolescents and we have the two together and combustible city. I mean it’s a terrible combination. I think part of what we were starting to think together about at the beginning is people have said, physicians have said for years, well, this is a normal transition. Going through menopause is a normal transition. It’s a natural thing, which it is, but I don’t want to overstate it, but I almost feel like that’s a place where normal or natural has been a little bit weaponized and I think there’s people who are far more strident on this point than I am basically saying this has been used to ignore or deny things that women really are struggling with and deny them care for things that they could get care for.
Sure it’s normal or natural for all of these symptoms to unfold in the course of perimenopause and menopause. But I’m going to keep hammering on the word symptoms because I think we don’t think of them as symptoms.
We think of symptoms as things like you totally can’t control like a cough or a fever or something like that. I think when we get into the universe of perimenopause and menopausal symptoms, we’re like, well, bad sleep. Well if I only exercised more or if I only drank less coffee or word finding. She talks about brain fog. That’s word finding. That’s one of the symptoms of brain fog is like you cannot come up with words and then we can be like, oh, it’s just aging or oh, if I were paying better attention. And so I think there’s this double system going on where physicians have, I think everybody’s agreeing these days not taken menopause nearly seriously enough and not cared for people with the care they deserve. I’m just going to go on record as saying that, but I also think that women who are going through it probably as a function of how the medical system has responded to this second guess
What’s going on with themselves and don’t think of it as a straight up symptom. And if you don’t think of it as a symptom, you’re not going to tell your doctor about it.

Reena Ninan:
Is it happening more often these days when you’ve got a household with menopause and puberty and has that always been the case?

Dr. Lisa Damour:
I think it’s more true as women have babies later or as they become parents later. So I had my second daughter when I was 40, so I’m 55, she’s 15, right? I mean we were like right where this parent is in terms of when she turned 13 and when I was really struggling through this. So I think that as we see these later babies coming along or parents having becoming parents later, my mom was 26 when she had me when I was 13, she was 39. She was still by most measures nowhere near this.

Reena Ninan:
Well that makes a lot of sense too. What do you think women should be doing? I want to address the menopause first. It reminds me of, we talk often about the plane and the oxygen mask. If you don’t help yourself, you can’t help anybody else. And thank you by the way for sharing this because it just helps us understand what you’re navigating and what really worked, which is different for everybody. But what made you decide, alright, HRT is the right thing? I feel like there isn’t enough awareness about symptoms and what you can do.

Dr. Lisa Damour:
So I was reluctant to do it. I think I sort of had this, it’s a phase of life and it’s natural and I was looking at stuff saying it gets better with time that it starts to really improve over time and I’m tough.

Reena Ninan:
Yes you are. Yes you are.

Dr. Lisa Damour:
I can tough this out, right? I’m still managing quite well, but actually my mood just started to become so not me. My mood baseline and my energy baseline. My whole life has been really high. I got juice and I start in a good mood and I would find that sometimes I would achieve that space but that most of the time I was below it struggling to get there as opposed to if I think about me five years ago, I hang out there and every once in a while I take a dip, but I’ll say Reena, it still took me a really long time to get there and I finally had a regular appointment with my physician who I adore, and so I actually did start to write down my symptoms, which for me, even though I know forgetting words is not just spacey, it’s a symptom.
It still took me a long time to get there, but I showed up for my appointment. I’m like, here are my symptoms, and I just walked her through it. I mean my sleep was garbage. I have definitely been struggling with hot flashes, which is connected to sleep. Word finding has been hard, mood has not been great, energy has not been great. She was like, sure, no problem. I was like, are you kidding me? It’s that easy. She was so lovely. She walked me through all the science. She basically said, yeah, we’ve misrepresented the findings that were there. We have not done right by women for years. I mean she was lovely about it. Talking about her own experience and talking about regrets as a physician about all that was not done for women. But then Reena, she gave me the subscription for these patches and I the first pharmacy’s like we’re out, I’m transfer the prescription to another pharmacy and I got to the other pharmacy and they’re like, we don’t have enough for six months. I’m like, what do you have? I was not even messing around and I mean within two weeks, Reena, within two weeks, I just want people to know you need to talk to your physicians. Everything this mom is describing, these are symptoms. This is not her not being tough. This is not her making this up. It feels like you feel a little like is this really real? And people get to decide what they get to decide, but I would never want somebody to be struggling like she’s struggling and not ask for help.

Reena Ninan:
What’s funny is we do so many episodes about here are the symptoms I’m seeing my child, we’ve written them down and when you just mentioned you wrote down your symptoms and everything and put it out on a sheet of paper, I’m like, oh my god, of course. But I would never think to walk into my doctor’s office with that.

Dr. Lisa Damour:
I was surprised that I did and it’s interesting for me, Reena also, and then I want to get to what to do with these teenagers and what the sweet mother should do because they would be cyclical for me. I was finding that I would have better and worse patches. I think that also delayed my request for help.

Reena Ninan:
That’s good, to know.

Dr. Lisa Damour:
Because I would think like, oh, I was exercising more and then I slept better and then I felt sharper and more energetic. See this is in my power and then it would sort of degrade again. I went through a lot of rounds of that before I was like, maybe I should bring this up.

Reena Ninan:
Well that’s great. I think that your speaking about it is going to help a lot of people out there who can connect the dots faster. I want to move to the children here because what we do know puberty is normal, just like menopause is normal. And what’s your advice here for the daughter that she’s struggling with?

Dr. Lisa Damour:
I mean this is the most classic possible explanation or description of a 13-year-old and I will tell you Reena, wait, read it again. What did she say the 13 year old’s doing?

Reena Ninan:
Yeah, hitting puberty, full force, moody, weepy, snapping at me even if I breathe wrong.

Dr. Lisa Damour:
So let’s take the moody, weepy, snapping and let’s take the breathe wrong separately. But what I love about this letter, I’m like, this is why 13 is so hard. It is so hard because they’re dysregulated as all get out, especially the girls because they’re a little bit ahead on puberty relative to boys, and then they cannot stand anything we do. Anything we do rubs them the wrong way.

Reena Ninan:
Why is that? Why is that?

Dr. Lisa Damour:
It’s a very real reason, which is at 13 kids are suddenly really starting to think about their own identities. They’re eighth graders for the most part, and I’ve written about this often as they’re trying to articulate their own brand, they’re figuring out their own brand, and so this is a deal Reena and it’s so funny to me. It’s horrible to live through, but it’s so amazing to watch other families have to grapple with this because I just have seen it so many times.
The deal with a 13-year-old is anything that their parent does because they’re still so intertwined with their parent that does not fit with their emerging sense of their brand is annoying to them because the parent reflects on them. I remember when my older daughter was in eighth grade and it was time for back to school night and I just laid out outfits. I was like, what would you like me to wear? Because what I wore to eighth grade reflected so heavily on her as far as she was concerned.

Reena Ninan:
Really?

Dr. Lisa Damour:
Yeah. I think that a lot of eighth graders are like, oh, about their parents, mortified.
There’s this quality of the kid’s brand is still reflected in us. So anything we do that is not matching their emerging brand, it’s not cool enough. It’s not whatever enough is annoying to them. At the same time, anything we do that is like the brand they see themselves starting to adopt is also annoying to them because they’re working to establish their own identity.
So the way this played out at my house with my daughter who’s now 22, okay, when she turned 13, she got really into Beyonce. I had been really into Beyonce for a very long time and I remember one time I had Beyonce on in the kitchen and I was bopping to it in the kitchen and she comes in and she’s like, “Mom, stop!” She was so mad at me.

Reena Ninan:
For your love of Beyonce. Cause she got there first.

Dr. Lisa Damour:
She thought she got there first and I was now on her turf. I was stepping on her brand. Okay, so Reena, here’s what I’ve just articulated. If it is like their emerging brand, they don’t want you doing it. If it is unlike their emerging brand, they don’t want you doing it. Anything you do when they are 13 is buggin them.
That’s normal for that kid. But that plus an adult who has no patience and is exhausted and is hot flashing every five minutes. Yeah, that’s a combustible combination.

Reena Ninan:
Is it different for boys versus girls? Like the son here she talks about who’s 16 by the way, not 13, says hardly talks to me unless he needs a ride or money.

Dr. Lisa Damour:
I think that’s unfortunately, I think a lot of parents would say that their 16-year-old son can feel very, very remote. That kind of withdrawal and quiet, sphinx-like quality. So much good work is coming out now about how to get boys talking. We had our guests, Christopher Pepper and Joanna Schroder about their book, “Talk to Your Boys,” which everybody should read. I think it’s really typical. I don’t think it’s necessarily great. When I think about this from the perspective of the letter writer, I think there’s two things that are really hard. One is, it hurts. We really like our kids.

Reena Ninan:
Especially if they were close to you or were one way and all of a sudden the switch turns off and they’re just cold and distant. It hurts.

Dr. Lisa Damour:
Yeah, you miss ’em, right? So there’s that. This is also a single parent and I will tell you I’ve gotten to work with a lot of single parents over the years. It’s a lot more painful when you don’t have a partner in the house being, who’s getting the same treatment or who can reassure you or who can be sort of sweet with you about the fact that the kid’s being kind of icy from the perspective of this letter writer. I think she’s got the double challenge of it’s not so great when your kid’s acting like this. And on top of that, it’s really hard when you don’t have a partner to support you or make you feel like it’s not you. Right? And I think that that’s a really tough thing. So yeah, she’s got her hands full.

Reena Ninan:
What do you think families need to step back and think about if you’re in this situation?

Dr. Lisa Damour:
So I think she should talk to her doctor if she hasn’t already. I’m not saying that that’s going to be the solution and there are a lot of solutions that are non-medical, cognitive behavioral therapy has been found to help with sleep, which can help with overall mood and everything. There are non-hormonal, I’m not a physician again, but I’ve looked into this quite a bit. There are non-hormonal options that can reduce hot flashes if that’s a real problem. There’s a range of interventions available. She should be looking into them. I don’t want her to feel like she just got to tough this out. So I think that piece is really important. Just to be honest though, getting to the doctor sometimes getting an appointment, making that happen, I don’t want to be casual about that. She could just go check in and it would be no big deal.
That might be hard, but I think putting wheels in motion on that is an important thing.
Okay, let’s take the kids separately. These are two very different ways of being a teenager. Hopefully it feels better to hear how natural and normal it is that her 13 year old’s acting like a 13-year-old and that they are very challenging. I will tell you, Reena, the most urgent calls I get from people are often I’m like, “13-year-old, yup.” It just is so hard on families. I think we should talk for a minute about why the kid is so dysregulated that actually is also a hormonal effect, but it’s one that’s, well, there’s no treatment for it actually how it’s supposed to be. I think that that’s a way to think about it.

Reena Ninan:
The moodiness you’re talking about with a 13-year-old weepy, moody, snappy, you’re just saying that’s hormonal and there isn’t really much you can do. It’s a phase.

Dr. Lisa Damour:
It’s a phase and what’s actually happening, it’s actually pretty interesting stuff. So this kid’s going through puberty, which is where her hormones are making all of this, eventually very good stuff happen and a lot of it’s driving brain development, but the way this works is that the brain remodels in the order that it developed, which is from emotion centers, which are right over the back of the neck up to the perspective, maintaining systems behind your forehead. And so 13-year-olds, they’re in this juncture where we start talk about them sometimes as having a gawky brain where their emotion systems have been upgraded, but their perspective maintaining systems haven’t, and so they dysregulate really easily. When they’re calm, they’re fine, but if they get upset it’s volcanic for them and they can’t tame it. One thing I think it opens up is a little bit of conversation and it’s kind of neat to think about the two ends of the hormonal spectrum conversation that could be happening.
I could see this parent saying, “Listen, your hormones are surging, mine are down-shifting, your hormones are causing you to have this neurological impact.” Usually I don’t pull back the veil for teens and here’s what’s happening developmentally, and this is why you’re acting like this on the brain stuff and the mood stuff. They like to hear it. They feel like in their words, kids have said to me, I feel crazy and it is actually hormonally driven mood stuff or hormones driving brain development, which drives mood. It’s sort of a three step process. To say to them, “This is natural. It won’t last forever and your brain will keep maturing and then you’ll have more control,” I think is often very reassuring. And then to say, “And now I’m on the down slope with the hormones and that’s why I can be so grumpy.”

Reena Ninan:
I love that.

Dr. Lisa Damour:
The parent could say, “I’m working on it, but sometimes we have a hard time with each other. That may be what’s going on.”

Reena Ninan:
Because what families have explained this dynamic to anybody. This is new to me and I’m 46.

Dr. Lisa Damour:
It’s sort of funny too, Reena, because I love the way this letter writer signed off of running out of estrogen. Right? It’s such a funny thing too because I think also, I’m just going to name it underneath all of this, okay, the kids being bananas, you feel bananas. That’s a terrible combination. But there’s also this sense of, I would almost say envy, where you’re like, oh, my tank is emptying and your tank is filling and you are full of juice and full of energy. And I’m like, oh, where did I leave my coffee?

Reena Ninan:
Yes. No, amen. I think a lot of women out there will identify with what you just said, Lisa. So tell me a little bit more about the 16-year-old son. What else can the parent think about here?

Dr. Lisa Damour:
Okay, so number one, it’s not personal. When a kid ices you out, it hurts. And I think just to really recognize it’s not personal. Number two, I hope she has loving co-parent type support maybe from an ex, maybe from a dear friend, maybe from a sibling. Just somebody who can be like, yeah, that hurts or that stinks. I mean, I’ll tell you Reena, the other thing that I’ve seen be so hard on single parents is when they have to go head to head with a kid. When a kid is misbehaved and they need to discipline the kid and the kid is really angry at them and nobody wants to do that when there’s no other adult in the house. And so when I watched single parents do this, I’m like, you are the most incredible person on the planet that you are holding the line even though you’re basically the only other person on the other side of that line. I also just think not giving up on talking to this boy, not giving up on this idea that you could have a good connected relationship with a 16-year-old. I think you totally can.

Reena Ninan:
So don’t beat isolation with isolation. Make a point to ask questions. Be involved.

Dr. Lisa Damour:
That’s a beautiful way, beautiful way to say it. I think that’s right. Not don’t sort of just collapse, give up. I think that there’s a lot to be said for quiet time together. A friend of mine was telling me about her other friend who goes fishing with her son. They just go fishing. I know that that’s a very specific to where I live and what’s available to us kind of option. But I just, the kid loves it and I don’t know how much they’re talking or not, but they’re together. So I think anything that can be offered that might be interesting to the boy of ways of just being together, talking or not, I wouldn’t devalue that. I think sometimes we feel like connecting is having the intense, intimate conversation. No, connecting is like you drive in he DJs and you listen to what he’s listening to and you find out what music he’s interested in. When I talk to teenagers for them, that’s very powerful connection with the adults in their lives.

Reena Ninan:
Interesting. I’ve always only thought about connection with my child as communicating and talking. I never thought just being present, sitting next to them doing an activity that they love to do can be enough too.

Dr. Lisa Damour:
Yeah. It can be. You come and do your email while they’re doing their homework. If we really look at it, we have such a specific script in mind for what connecting is. Connecting is your kid walks in the door and you’re like, how was school? And they’re like, oh, this thing happened. And then we say something really smart and they’re like, oh my gosh, that’s so helpful. That never happens. That’s so not family life. But connecting is like, let’s go do something together or let’s listen to something together or let me sit by you. You’re doing homework you don’t want to do. I’m doing emails, I don’t want to do, we’ll keep each other company and every five minutes we’ll have an m and m together. There’s something like that. There’s lots of ways to just meet them where they are. That’s what I would say about the boy.

Reena Ninan:
I can’t wait to call my girlfriend whose son is 13 and ask, why do you have to say, how was your day every time I come home from school? It was an angry conversation about that.

Dr. Lisa Damour:
Is that what he said to her?

Reena Ninan:
Yes. Yes.

Dr. Lisa Damour:
He was mad at her for asking.

Reena Ninan:
He was mad at her for every day after school asking, how was your day?

Dr. Lisa Damour:
Isn’t that interesting?

Reena Ninan:
Yeah.

Dr. Lisa Damour:
Isn’t that interesting?

Reena Ninan:
But it kind of makes sense now to what you’re saying.

Dr. Lisa Damour:
It does, but it does if you live in teen world, right? I think that’s the thing, right? If you’re like, oh, that they’re trying to be independent, they’re trying to be separate, they’re highly reactive. So hence it would make sense that a 13-year-old would be somehow badly offended by the question, how was your day? But you have to live in teen world for that to make sense because in every other developmental moment you’re like, what’s wrong with kid? What’s the matter here?

Reena Ninan:
Or you feel offended, right? I want to make connection, but that’s not how they want to connect.

Dr. Lisa Damour:
Yeah.

Reena Ninan:
I am so grateful for this conversation. I got to say, I feel like we’ve just scratched the surface, so maybe we need to do another one. So send us on Instagram, DM us, let us know what you think and what your thoughts are on this episode because we’d love to know what questions you still have. I think this isn’t enough. I mean, I think it’s just a curtain-raiser to this, but I’m so grateful that you shared your personal journey because not enough people are talking about menopause, let alone puberty and menopause under one roof.
So what do you have for us, Lisa, for Parenting to Go?

Dr. Lisa Damour:
It’s funny, Reena. I think if I had to put a headline on every last bit of my work on adolescent development, I would call it, “It’s Not Personal,” right? I think this 13 year old’s being really snappy, this 16 year old’s being really icy, it hurts, it feels lousy. Step number one, it’s not personal. This is typical development. I think as soon as you can take that position, your friend, whose kid is like, why are you asking me about my day? As soon as you can tell yourself it’s not personal, you can handle it better. And then I would just say, it’s what you said. Put on our own oxygen mask before we try to help our kids. I want this woman to take good care of herself. I want her to ask for the help she deserves. Doing that and not taking the rest of it personally should ease this substantially.

Reena Ninan:
Great advice all around, Lisa, thank you for sharing your personal journey, but also helping us connect the dots with our teens and understand what it all means. I’ll see you next week.

Dr. Lisa Damour:
I’ll see you next week.