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Navigating Perimenopause and Menopause | Alicia Jackson

Over 50% of the population experiences perimenopause and menopause. Yet, like with most women's health issues, there's not enough data and information. Thus stumping clinicians and women alike. Dr. Alicia Jackson is the founder of Evernow, a telehealth platform, supporting women in this stage of life. Evernow conducted a survey of over 70,000 women to better understand this stage and is using that data to more effectively help the staff at ever now support the women coming through its doors. Dr Jackson and I sat down to discuss Evernow’s survey findings and how women can apply this information into their own care.


Dr. Alicia Jackson is the CEO and founder of Evernow - a next-gen telemedicine company focused on menopause. Dr. Jackson has a long track record of bringing to life technological advances to solve pressing challenges facing people across the globe. She is a PhD graduate of MIT, served as a policy staffer for the US Senate Energy Committee, and was the Deputy Director of the Biological Technologies Office at DARPA, the Pentagon’s principal engine for disruptive innovation.

In this episode, Dr Jackson shares results from the survey of 70,000 women in peri/menopause and discusses how Evernow is leveraging this data to support women in peri/menopause through telehealth. We discuss:

  • Why it is often challenging to get answers from your doctor

  • Predictors for how severe your experience of symptoms (e.g., hot flashes) will be

  • Why hormonal blood work may not be as helpful as you would think

  • The one thing you should be prepared for if you need a hysterectomy

  • Medications vs. supplements


Georgie Kovacs: How did you come up with the concept of Evernow?

Dr Alicia Jackson: This is not at all the company I thought I'd be starting right now. I have a deep science background from my life at MIT, investing in biotech through DARPA, I thought I'd be starting in a fertility company right now. I took six months off to do nothing but to study that space and really understand what the opportunities were. During this time period, I came across this really interesting piece of research talking about how to reverse menopause in young women who had gone through chemotherapy. It brought up all these questions, and I knew right then that there was something interesting there and started to research menopause further.

The Women

This is the first generation who may live longer post menopause than in menopause. And seeing how tightly correlated when you go through menopause, and how that's managed, whether you're on hormonal therapies or not, can make a big impact on your risk of things like cardiovascular disease, osteoporosis, neurodegenerative diseases, diabetes, and more.

I had thought this was an experience of women much older than in their 40s. Women start going through perimenopause, that period of time when your estrogen starts fluctuating and decreasing in your 40s, and then the average woman in the US hits menopause at 51. That's right in the smack in the middle of your life when you're going full steam.

I read stories of women struggling to find a physician who really is up to date on the latest science and research, who understands how to treat and recognize the symptoms of not only perimenopause and menopause, and who understands the greater health impacts not right, not just right then in the moment, but for the longer term.

Their Doctors

I also spoke to physicians who reinforced that they had had very little training in menopause and many who had had very little training since their residency, which might be 20 years ago, and our understanding of menopause and the role of estrogen and women's bodies and its role in protecting us against a lot of these diseases of aging, like osteoporosis, neurodegenerative disease, and diabetes, that many doctors just had knowledge that was out of date.

There is great data showing that if you have a family history of challenging menopausal symptoms, you are much more likely to have those challenging menopausal symptoms.

The Healthcare System

This is compounded by the fact that a lot of the medical system is not situated around, around being able to provide the care that's necessary during menopause.

I concluded that women need access to treatments and great care. Let's build a company to do that, and it's going to leverage telemedicine. We're going to create world class menopause care and medical care and deliver it to women 40+, and that was the creation of Evernow.

Georgie Kovacs: We’ve covered the dynamics of the healthcare system and its impact on women’s care. Tell us about the findings which surprised you most in your 70,000 person survey.

Dr Alicia Jackson: When women are going through that period of perimenopause, their symptoms are going to differ from what they might experience when they're in the thick of the menopausal transition, when they're going through a year without a period. When they're in perimenopause, they still may be cycling. A lot of women are going to have an abnormal period, though, and that's a really good signal.

We are also seeing a lot of symptoms manifesting in the brain. This is because estrogen is a key driver of energy metabolism in the brain, which is full of estrogen receptors. Yet this is the time when your estrogen levels are just fluctuating wildly, which is why we see high incidences of brain fog, anxiety, and depression. Over 70% of women report having these symptoms, and two thirds of those report these to be severe or very severe.

This is such an incredibly busy time in women's life. They're taking care of their kids, they're taking care of their aging parents, they're in the middle of their career, there's a pandemic going on. And so many women are like, "Well, of course, I'm stressed out of course, I'm suddenly having panic attacks, or I feel depressed because my life is so busy and so stressful dealing with all these things." But what they may not realize is that these are also the canonical symptoms of perimenopause and that they can do something about them to help treat those symptoms.

The good news is, those symptoms do tend to dampen down as you get into the menopausal transition. Now other symptoms pop up like hot flashes and night sweats that you have to deal with, but it is good that a lot of the ones that really have to deal with the mood will start to level out over time.

Georgie Kovacs: What helped women experiencing these symptoms?

Dr Alicia Jackson: We found that women who decided to take hormonal therapy found over a 72% reduction in those symptoms within two months. So hormonal therapy, if that is if it is perimenopause that is really driving those symptoms, a little bit of hormonal therapy and we're talking like a sixth of what you might have in birth control can really help to level those out. It's not going to get rid of the stress, but it's going to help in terms of how you can deal with that stress.

Georgie Kovacs: Tell us about the data related to hysterectomies.

Dr. Alicia Jackson: There was a strong correlation between women who had had hysterectomy in weight gain. We found that women who have had a hysterectomy were 27% more likely to have a BMI over 30 compared to women who had not had a hysterectomy. And this is something that we had heard a lot anecdotally, but I think is really powerful when you see it borne out in the data, and when you go and look at the scientific literature as to why this might be happening.

What we've definitely seen in, for example, animal studies, such as mice or different forms of monkeys is that if you take out their ovaries, which is one form of hysterectomy, you do see a huge decrease in energy metabolism nearly overnight. So it shouldn't be shocking that when women have a hysterectomy, and over 25% of women end up undergoing a hysterectomy, it is one of the most common gynecological surgeries.

Shockingly, many women are not counseled about the health effects. Essentially overnight, your estrogen levels drop rapidly. One health effect that you can have includes very rapid weight gain. It's important for women to be counseled on this, and it doesn't mean they shouldn't have a hysterectomy, but they should probably be counseled that you should definitely be on hormonal therapy immediately after hysterectomy to really help to buffer out that very rapid transition.

We've had so many women come through Evernow telling us they really felt, in their words, "Bamboozled" after they got a hysterectomy. They were told, “You'll have a hysterectomy. This will solve whatever gynecological issue you're having right now.” But they weren't really told about the after effects. And it's more than just weight gain. It's also symptoms like brain fog, hot flashes, vaginal dryness, painful sex, inability to sleep, and it's all due to this very rapid, essentially deprivation, of estrogen for your body overnight.

Georgie Kovacs: Tell us what else you learned about BMI.