Dr Polly: I probably stayed put for too long 'cause I felt like I was scared. I should deliver babies. I have eight years of postgraduate training. I should do surgery. I stopped doing those things four years after training.

Stephanie: Hi, friend. Welcome to the Big 40. I'm Stephanie McLaughlin. This is the place where we talk about a midlife turning point no one warmed you about. The very normal, often messy, always meaningful experience of transition sometime around age 40. For many of us, it's the first time we realize the life we built in our 20s and 30s doesn't quite fit anymore.

The job, the relationships, even the goals we once chase just start to feel off. I know that feeling well. I fought against it hard and honestly made the whole thing messier than it had to be. On this show, we talk about what happens next, how people navigate change, redefine success, and build lives that actually feel like their own.

I share stories and conversations that help you make sense of what might be shifting in your life and remind you that you're not the only one figuring it out.

And when the conversation wraps, I'll take a few minutes to connect what we've just heard to some of the bigger themes and patterns that show up in this turning 40 transition. So don't rush off when the interview ends.

Today, my guest is Dr. Polly Watson, an OB/GYN who realized in her mid 30s that doing everything right in medicine wasn't the same as practicing medicine right. And she spent the next decade finding a path that felt better.

Stephanie: Hi Polly. Welcome to the show.

Dr Polly: Hi. Nice to be here.

Stephanie: It's so good to have you. We are gonna talk about one of my favorite subjects today. This is something that is very close to my heart, so I'm very excited to jump into your story. I'm not gonna give anything away to begin with. Why don't we just start at the beginning and tell me a little bit about the forces that shaped you into the person you were when our story begins in your mid thirties. How'd you become that person?

Dr Polly: So. I'm an OB-GYN and I really was moved to seek this kind of medicine because my mom went through early menopause, and she really got abysmal medical care.

Stephanie: Yeah.

Dr Polly: And she went through menopause at 38. And so,people were like, this just doesn't happen.gonna

Stephanie: How old were you at the time?

Dr Polly: Oh, I was, let's see, I was born when my mom was 25, so I was like, in middle school.

Stephanie: Oh, wow.

Dr Polly: Yeah, I was in middle school. I had a fortune of going to a small private school called Paideia School in Atlanta. I had a lot. I was surrounded by amazing teachers. I was going to lectures at Emory in science when I was in high school. I was surrounded by people who were like, Hey, cool, you're into this. Let's go figure it out. I think that sounds a little bit weird, but I love  Paideia School. I was grateful, really grateful to go there.

So,when I was 35, so just in case people don't know,18 to 22 is undergrad, 22 to 26 is medical school, 26 to 30 is residency. So you're like starting your career at 30, where the rest of your friends have been working for a decade. So it's a long, arduous, insane process.

And 35, I had been practicing as an OB-GYN for several years and really was struggling with practicing medicine how I wanted to, and also trying to figure out how to be a mom in there. So couldn't get pregnant. Finally got pregnant. Lost a baby. Got pregnant again. That baby was twins, and then one of the babies stuck and one of the babies didn't stick. And then a lot was happening in medicine, right? So I'm 51 now. So I'm one of the doctors

Stephanie: 20 years ago is like Y2K. Right,

Dr Polly: Medicine was on paper. When I started off, used to be able to shout down the hall and say, Hey Carol, I need a urine in room six. And then the electronic health record happened, and then doctors were taking two hours of work home a night clicking boxes for insurance companies. You couldn't yell to Carol, hey I need a urine in room six. You had to click all the boxes to make sure it happened, and then she looked on her computer, and everything became very robotic.

It was a time to start having some kind of, I did all this education, did I do the right thing? Am I really showing up at work how I wanna show up? I remember meeting with someone in coding really early in my career, and she was fussing at me because I didn't list the diagnosis codes in the right order. And I'm like, who am I working for here? I'm working for the insurance company, I'm not working for the patient.

Stephanie: Yeah. Yeah. Wow.

Dr Polly: So that was 35. I was a brand new mom. I had my first baby at 32, almost 33. My second baby at 34, almost 35. That was like, whoa. Being a mom is the hardest job ever, right? It's the greatest job ever, but it's the hardest job ever. It's like showing up every day for a test that you didn't get to study for. That's how I feel about being a parent.

Stephanie: Wow. Well said. Yeah.

Dr Polly: Yeah. So when I was 35, I had two little kids. I was not getting a lot of sleep. I was still kind of figuring out how do I be a physician that I'm proud of being in this climate of clicking the boxes for insurance companies. That's where I was at 35.

Stephanie: Yeah. One of the things I hear so often in these conversations is that, one of the big pieces of this transition is the idea of fulfillment in your professional life. And for you it's a little different, right? 'Cause you spend so much time in school, whereas for a lot of us, we started working in our early twenties, so you're checking boxes and you're following the path and you're climbing the ladders. And I think you were doing the same thing just inside the educational structure, right.

You were just following the next step and the next step and the next step. And then often. I hear that people pick their heads up in their mid thirties and say like, wait a minute, is this what I meant to do? This isn't exactly what I thought it would be, and this isn't as fulfilling as I want it to be. And that then becomes important to us. Did you feel some of that same stuff?

Dr Polly: I think you do pick your head up career wise. Hey, medical world is changing. I'm now an insurance clerk, right? I'm an insurance clerk instead of a clinician. And then you throw motherhood into it, right? So then that becomes this really, again, I grew up in the nineties where it was like, you can do it all. Well, guess what? There's only 24 hours in the day.

And, there's a limit to how much sleep we need and all the things we need to take care of ourselves as humans. And so that was a lie. You can't do it all. Where am I with being a physician and serving women and showing up in the way that I would have wanted someone to show up for my mom. And then how do I show up as a parent? I don't know. I just wanna say this. there's this whole like, Cinderella narrative on being a mother and, I wanted so badly to have babies. I love babies. I was so excited about being a mother.

It was so bewildering. It was so unbelievably hard. I still look back on those early years and think, I do not, know, how to breastfeed on demand and have a sleep schedule. I think those two things are incompatible. It was just such an overwhelmingly hard time because at work there was a lot of uncertainty. And then at home, how do you be the parent you wanna be while you're juggling all these other things?

And then all these little creatures, you don't know who you're gonna get. I got somebody who didn't like to sleep very much. It wasn't until the second baby when I had enough courage to say, you know what, I'm just gonna put him in bed with me and we're gonna get some rest. That was a lot easier.

Stephanie: Yeah. So tell me a little bit about the people you were seeing in your practice, the women that you were seeing in your practice, 'cause one of the things that was also happening in this time of huge change in the medical field was that the internet was exploding, and we were all figuring out that the internet was going to become much more central in our lives.

And, many of us started turning to Dr. Google. Talk a little bit about, professionally, the people that were coming in and the things you were hearing.

Dr Polly: Yeah, I think that's a really good thing to bring up because that kind of helps me go to the next chapter, right? The thing that stands out in my mind, if we take a step back, is the pattern that sort of inspired me to go into medicine was that my mom wasn't heard. She wasn't taken seriously. That doesn't exist. What you're telling me, you're experiencing, you're not experiencing, like this complete shutdown. Andwhen women were going to Dr. Google, they would come in and they would say, I think I have adrenal fatigue. Okay. And I'm like, what the hell is that?

What is that? I don't know what that is. No one had taught me what that was. And then I was at Menopause Society sometime around there. This was at least 10 or 12 years ago, where when you had a question you would walk up to a microphone. You didn't use an app.

And so I'm sitting around and I'm like, are your patients asking about this? What is this adrenal? What are they talking about? So one of us stood up and walked up to the microphone and asked, and it was the exact same shutdown. That's not a real thing. That doesn't exist. Go back to your seat, kind of tone.

Stephanie: And can we just pause for a moment and tell me who answered the question?

Dr Polly: Oh,I finally got the question answered when I started learning about integrated and functional medicine.

Stephanie: But what I meant was a man answered that question.

Dr Polly: Right, right, right. Yes.

Stephanie: A man said, that doesn't exist. You are making this up. It's all in your head. Go sit down.

Dr Polly: And we understand now that, if we were gonna use more specific language, we might call it hypothalamic-pituitary-adrenal insufficiency. We might use different words. But I think getting caught up in semantics is not helpful for women who are struggling with energy, focus, sleep disruption, all those things, right?

Women were coming in, the internet was happening. They were saying, Hey, I think I've got these things. The other thing that was happening is they were coming in with garbage bags full of supplements, and they expected me to know what they were taking and how it interacted with their medicine. And I wasn't trained in that at all, in conventional medicine, like zero. Then I would leave and go get on Google as fast as I could and try to figure out if I could find anything. One of the big pushes for me was that I needed to find answers to questions that I was not able to answer for my patients.

I started in some integrated medicine spaces. Eventually I found functional medicine, and I think the big shift was from working with a lot of physicians who are exhausted and burned out, right? They're taking two to three hours of work home a night, that they're not getting paid to do, to click boxes for an insurance company, and they have 12 minutes to see a, patient. We're not shutting these people down. They're working in impossible conditions.

Then I went to a IHM out in California and the meeting, we got to have lunch outside. And you got to sit on bouncy balls. And we had breaks. And the food was really healthy. You would have a yoga as part of the conference, it was just a complete shift and the people were happy. But if you ask a question and someone didn't know the answer, it was met with curiosity and interest, rather than, shutting it down.

Stephanie: Judgment and arrogance. Oh, sorry. Did that come out? Was that out loud? So the reason that I said at the beginning that this was a subject that was near and dear to my heart is that, for almost the last decade, I have managed a chronic illness, a handful of chronic illnesses that have been, vague and, difficult to get a handle on, and they have proven to be very,resistant to treatments. And, not a single person with an MD behind their name has really been able to help me because my issues are not localized to a single system or a single organ or a single piece of the body. And so that zoom out, more systemic look, more understanding some of the larger forces that affect everything, is something that I have had to go to naturopathic and integrative and functional kind of medical people to even take me seriously. So that's why when you and I first met, I was like, oh yeah, let's talk about this.

Dr Polly: And it's so sad, because you're right, medical training and specialization is putting systems in silos as if they're separate, and we know that they're not separate. We've got, a gut brain connection. We've got a gut immune connection. It's all connected, right?

Stephanie: And then you can't probably do it in seven to 12 minutes either, when you're right, dealing with chronic, long-term, complex illness. Yeah.

So now let's layer on top of all of this, you come into your late thirties and you started experiencing your own hormonal changes.

Dr Polly: Yeah, that was interesting. On one hand, I guess I was 39, and I'm sweating through the sheets. I'm like, okay, mom had menopause at 38. I'm 39. This is what's happening. I went to my gynecologist, who's fabulous, and I said, hey, these are my symptoms. This is my family history. This is what I think's going on. Can I go ahead and get started on some hormones? I'm pretty miserable.

And I just wanna emphasize to all the women that are out there, as a professional woman, the neurocognitive changes with hormone fluctuation are freaking no joke. It's not just hot flashes and night sweats. Like there are a myriad of menopause symptoms, but I remember that I couldn't come up with a name of drugs that I prescribed all the time, to the point that I would literally have to be like, it was back in the day when you were bopping in and out of exam rooms all the time.

And you'd go one little thing and then you'd bop out and then, and I'd bop out and I'd have to go Google, what's the yeast medicine called? And I'm like, it was so bad. It was just so bad. I'm so grateful that my doctor was like, okay, it looks like a duck, quacks, like a duck. I don't even, maybe she did check my hormones.

I think my estrogen was 20. I was also so unbelievably tired and just like pregnancy level, tired, so unbelievably tired.That was helpful. I think there was more to what was going on at that time than just early menopause. But, I'm so grateful that I was able to get adequate medical care because, like starting with hormone deprivation that early, in terms of cardiovascular health, brain health, bone health. Sorry, I'm like switching into doctor mode

Stephanie: Yeah,

Dr Polly: and I'm not supposed to do that, but

Stephanie: that's okay.

Dr Polly: It really matters for your overall health. So I'm so grateful that I was able to get that support, 'cause I also think, as a parent, being that short fused with little kids, I needed some help. So it was really great that I got some.

Stephanie: Do you remember how you first came across the remind me, AIHM is the Academy of Integrated.

Dr Polly: And Holistic Medicine. So it's Mimi Girardi is the head of that organization and they're out in California and they were great.

Stephanie: As a, conventional O-B-G-Y-N MD, and you're starting to feel those sort of grumblings of, this isn't fitting, this isn't quite right. This isn't what I'm intended to be doing.

How did you find the alternative? Where did you come across it? I'm totally projecting here, I'm just gonna admit that right out. I'm guessing that these, alternative medical organizations are really poo-pooed in the rooms, in the buildings that you were in. So where'd you find it? And, how'd you start following that thread?

Dr Polly: I don't remember if my friend Harriet brought it to me or if I brought it to Harriet, so I have no idea. There was another physician in the group that I was working with, and we were both trying to answer some of these questions together.

It first started off as women are bringing in these substances. I didn't know what quercetin was, right? I had no freaking clue. No one taught me about this stuff. It was a conference on supplements. Basically, like how do you pick a supplement? What are these things for? And at that conference, oh dear. Let's see. I'm not gonna be able to pull out all these names in my head, but, there's a nutritionist who wrote a book called Digestive Wellness, and she gave a talk that was amazing.

Oh, Elizabeth

Lipinski is her name. And Elizabeth had, worked with autistic kids and I was blown away.

The other person at that conference, was Scott Shaban, who's a integrative psychologist and, he wrote several books, Don't Label My Child. But I guess those are two people, right off the top of my head where I was just like, whoa. This was just so e xciting.

I was excited to go into medicine. I wanted to help people and then I felt like I got into medicine and everybody is exhausted and burnt out, and not really that joyful anymore. These doctors were happy. They were curious, and they were excited for youngish looking people to be excited about what they were excited about.

It was just like the Claritin commercial where someone takes the film off. That was what my life felt like.And then when you go back to the conventional space where I can't unlearn this new stuff. I just learned. How do I put all this in? It was AIHM was the beginning, and then once you start learning about this space. Then I found IFM, which was, a lot of biochemistry, which made me feel really safe. IFM is Institute for Functional Medicine.

And then you just, keep learning, right? I think that's the thing that is exciting to me. Like I'm a gynecologist and I went to integrated medicine and mental health, and I'll probably go to some version of that meeting every year. Because, what happens when your hormones change, right? PMS, perimenopause, postpartum. We have mood symptoms, right? Even though it's like quote unquote outside of my area, it's totally not outside my area.

All those silos start to break down. You can't learn everything and you certainly have to know when to ask for help.

The world got a lot bigger medically, and that was exciting. And then it's also just such a pleasure to work with people that are inspiring and passionate about what they do and not burnt out and exhausted andgrouchy.

Stephanie: I love that. It is a really interesting, I'm almost thinking of, Dorothy, right? For the Kansas to Oz, right? The black and white to full color kind of thing. But I'm guessing, that you had to almost go back to school to learn a new way to practice medicine. Is that right?

Dr Polly: So I did the IFM certification. It took me about two years. And I think that's the tip of the iceberg. So I think that I still do two to three times more CME than I'm required to do because everything is constantly changing, and we're always learning, right?

I'm a nerd. Right? That's, I mean, that, I own that. I enjoy learning. I wanna do the best I can for people. I can't learn everything, so when people come in, we're like 500 page genetic report. I'm like, okay, I'm not a geneticist. I have to get help for this. But I think, the learning never stops. And hopefully we all stay curious. Hopefully we all stay engaged. Hopefully we always wanna get better. We always wanna do better. When I stop doing that, then I should stop practicing medicine.

Stephanie: Sure. Another one of the themes that really is consistent a among these conversations is the concept of should. And for, so many years in our lives, we're doing all of the things that we should be doing and many of us, most of us, a lot of us, are ruled by should, right?

We do more what we should than what we actually want to do. For some people it's, parents,delivering the shoulds, whether implicit or explicit. It could just be society and culture. It could be, any of a number of influences in our lives. I am interested in understanding from you, you are a practicing obGYN MD in a very conventional medical setting and surrounding, were you getting a lot of pushback from people in that world as you started to explore and be attracted to this other world?

Dr Polly: Good question.

Stephanie:

I'll let you think for a minute, 'cause as I was saying it, it's almost to me like the another thing that we hear a lot around midlife is the concept of a spiritual awakening, right? And people opening themselves up to whatever kind of spiritual,practice or theories or whatever is calling or resonates with them. And again, from people who aren'topen to that or awake to that, there's a lot of that kinda like pulling back. Keep me comfortable by keeping you where I know you.

I'm curious professionally if there was any of that as you started to move. It sounds like you actually had a friend, you were exploring this with.

Dr Polly: Yeah, so she left the practice I was at about a year and a half before I did. We were in different financial situations. So I really needed my income. I didn't have a whole lot of flexibility financially to just not make money for a certain amount of time when I was gonna start over again.

I think that helped. I think the group I was working with, they didn't like really scold me. Patients really liked me. My schedule was really full. I wasn't doing anything like crazy and outlandish. And then how much holistic medicine can you practice in 12 minutes? Like not much. You just don't have enough time.

It was just time to go and, I wish I had gone sooner, right? I think about the shoulds for me. I should deliver babies. I have eight years of postgraduate training. I should do surgery. I stopped doing those things four years after training. That was financially not awesome, but for my heart, for my family. Just like anything, like my area of focus is menopause. You can't be amazing at surgery, and amazing, high risk obstetrician, and amazing primary care doc, an amazing endocrinol. Like you can't do it all. It made a lot of sense for me to just really dive into what I felt good about.

I hear you with the shoulds. I probably stayed put for too long 'cause I felt like I was scared. Yeah. I was scared.

Stephanie: When we first chatted, you said it did take you a while to,gin up the courage to make the leap.

Dr Polly: Yeah.

Stephanie: Yeah.

How old were you? Do you remember when you made the leap when you left conventional medicine and kind of

Dr Polly: Yeah,

Stephanie: put up

Stephanie: mid forties.

Okay. All right. So it's interesting because the, this transition, for you is really 35 to 45. It was pretty much the whole decade.It was a slow burn and you had to follow your nose in a bunch of different ways. Some people I talk to have a very sort of discreet and,clearly defined transition. I didn't. Mine was years and years long. And it's interesting to yours was as well. Yours was a long transition.

Dr Polly: Yeah, I had to get a lot more training and then be in a place where I could open a business, but, my only regret is that I didn't do it sooner.

Stephanie: Yeah.

Dr Polly: Yeah.

Stephanie: But the reasons that you didn't do it sooner were totally practical and tactical.

Dr Polly: Yeah. We could say that. I think the more honest answer is that, I was also really scared, right?

Stephanie: Okay.

Dr Polly: What if this doesn't work? How are we gonna pay the mortgage? Those are real concerns, right?

Stephanie: Big time.

Yeah. But I'm liking that you're saying and admitting to, it wasn't just how to pay the mortgage, it was also like, actually this is terrifying to,

Dr Polly: Yeah. Yeah.

Stephanie: You never set out to be a business owner. You set out to be a doctor.

Dr Polly: Exactly, and with no formal, like business training. And I think I should say this, I had my own business once before and it did not necessarily go well. When I stopped delivering babies, I had my own business for two and a half years and then had a baby in that time. So I had two kids under two, was trying to run my own business and I had a second job at NC State in student Health to pay the mortgage. It was so hard. I do not recommend that to anyone, ever. Nope.

Stephanie: Yeah.

Dr Polly: So yeah, it was really scary to try it again. I'm really grateful to my husband that he was like, I believe in you. You got this. Because it was.

It was so hard the first time around. This was much easier. Having kids that were older was a lot easier. And then I will just say I have two boys and they're freaking awesome. I was like, okay, mom's gonna do this thing and that means everybody's gonna help out.

I'm really grateful because I'm not a mother who makes their children's lunch. When you're, when they're in the first grade, they learn how to make their own lunch, come on. And they do their own laundry and I wanna raise functional adults, so I'm grateful for them. They've, they really stepped up.

Stephanie: Yeah,I, am also a small business owner and I started my, business, it'll be just about 19 years ago. And my threshold was very low. I felt likethe tightrope I was walking was about six inches off the ground. I owned a condo, so I had a mortgage, butit was little, my nut was really little and all I needed to go into business were a mobile phone and a computer and some internetconnection. And if things were tight and groceries were tight, I would just go to my parents' house for dinner or, accompany my mother to the grocery store and throw some things in the carriage, right? And this is in my mid thirties. But, the bar for me was very low. and then over time, it, it did go, much further from the ground.

But now I feel like I'm a professional tightrope walker and the height doesn't bother me because, I grew with it. My skills grew with my distance from the ground. But for you, I think that it was probably a bit of a bigger commitment to start a business.

Dr Polly: Sure. Absolutely. And then, if you build it, will they come? Will people pay cash out of pocket? They have insurance. I don't take insurance. Will that really land? And it did, and and I'm grateful for that. I'm really grateful that I get to have time with patients and that there's time to explore more complex issues and I'm not working for your insurance company. So if I wanna order some tests, I order the test I wanna order. And if they're not covered by insurance, then we can talk about that. But, I'm working for the patient and that's who I wanna be working for.

Stephanie: I'm very accustomed to that conversation. We're gonna send you for these seven tests. It's only gonna be $1,500. Let's back up a couple steps and talk about that.

Dr Polly: Right.

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Stephanie: So tell me a little bit about, where you are on the other side of this transition, right? You started the business. You're practicing in a way that's more fulfilling to you, that's more joyful for you, that makes you happier, and your business is a few years old now. So tell me a little bit about what life looks like differently now than 15 years ago.

And all that is a privilege. So I don't wanna sound like. And I'm acknowledging that I have privilege that I'm able to do that. But I do think that there are a lot of women that are entertaining, busy for busy sake. And, I think our time and attention is our most precious resource. And so I'm trying to be really deliberate about how I'm using that resource.

And then I think it's also a real privilege that I get to spend time learning about things that I wanna learn about. And then, now I have a podcast. My podcast is called Menopause Rescue. So I can share things that I'm learning and meet interesting people.So life feels pretty good.

This next phase is I'm kind of looking at,empty nest. ,One just went to college and one is a junior. And, I don't know, I'm really diving in. I'm taking a pottery class, and I suck at it.

Stephanie: Yeah.

Dr Polly: That's also really good for me, to try to do things that I'm not good at, and learning new things that have nothing to do with medicine. So it's on Tuesday nights and I spend three hours playing in the dirt, right? And there are no phones in there. And there are a lot of different people that I wouldn't normally hang out with, which awesome.

I don't know, I'm excited for this next chapter 'cause I'm finally, like you see if the forties are like, figure it out, the fifties are like, I don't know about this whole 'I don't care' movement. I think we do really care about what we care about. And because we care about what we care about, the rest can fall away.

Stephanie: Yes.

Dr Polly: Instead of framing it negatively, I would frame it positively. I really do care about what's important to me, and the rest is noise. And I can walk away from that.

Stephanie: I love that. I would, probably add to that, one of the things about the transition is that we really come into ourselves. And again, as we shed all of those shoulds, and all of the things that other people want us to do, and all of the measurements that other people are putting upon us, the more we are true to ourselves, the more we don't care about what you care about. So,that 'we do not care', movement that's, picking up steam right now. Yeah. It's not about not just giving a shit. It's about really utilizing our attention and our care for the things that are important to us, and not necessarily important to you.

Dr Polly: Yeah, so it's an exciting time.

I think menopause is the second adolescence, right? So the first adolescence, we separate from our parents. And I don't mean to sound negative anyway, but I feel like as an individual we separate a little bit from our families, right? We're no longer wiping noses and wiping bottoms, and we have time to take a pottery class or volunteer at whatever we wanna do.

I don't know. it feels good to have a little bit of space.

Stephanie: Yeah, a little bit of, independence and a little bit of your own identity. That's another thing that gets brought up a lot. So these things are just you. They're not necessarily in the context of other people. These things you're getting to do now.

Dr Polly: Yeah,

Stephanie: Yeah.

Dr Polly: I think it's awesome to do things that are not performative, right? Like I think a lot of us that are like very Type A, we've been very driven. We were judged all the way through to create something and kind of separate from what the end product is. But just to experience the, I get to play in the mud for three hours, who cares if I make anything or not, right?

If at all crashes out at the end, or it blows up in the kiln, whatever. I got to play in the mud for three hours. That was great.

Stephanie: Yeah.

The thing that I have found, I've done a couple of those, different pursuits, over the last, ooh, 15 years. The first one I took up was, aerial circus, which was a blast and absolutely ridiculous because I was like 10 or 15 years older and, 75 pounds more than most of the other, girls in the room. But I didn't care because it was so much fun.

And the thing that I loved about that in particular was it required a hundred percent of my attention, if not more, in order for me to be successful, but also safe in what I was doing. And so as a business owner, it was a wonderful thing to be like, I cannot think of anything else right this minute. Nothing can creep into my head. None of the drama, none of the work stuff, none of the client stuff. None of it can creep into my head or I'll end up on my head on the ground.

So I can imagine with pottery it's similar, right? There's this structural integrity you're trying to figure out. You really have to be present and be there in order to, create what you're hoping to create.

Dr Polly: And there's this surrender, maybe with both of those things, right? So I'll hear myself like, don't force the clay. And I'm like, oh, here I am. Here's Type A Polly. She's showing up, she's trying to push it through. I'm like, Nope, you gotta let that girl go. She's worn out. We're just gonna let the clay spin around what's gonna happen. Like what? It is gonna tell you what it needs to do. Just stop pushing it.

Stephanie: Same. As a 44-year-old woman, looking at the next silks over and seeing a 22-year-old. I love, there's that meme about 22 year olds, working out and some, grizzled lady our age saying, not impressive honey. when I was 22 I was running around in heels eating, french fries and smoking cigarettes and drinking booze like you don't impress me.

Dr Polly: I looked great then too.

Stephanie: Yeah, exactly. Exactly. Yeah, like you, the comparison, you just have to, there is no comparison. You literally have to put it away 'cause otherwise you will lose the joy in the thing that's you're doing to bring yourself joy. Yeah.

You know, one thing I don't normally do, but I feel like I have,a wonderful opportunity with you here. I have a small group of girlfriends that we all staying, in contact via one of these apps. And,they're all a little bit younger than me, but they're starting to talk a little bit about menopause and I think, it's a subject that is becoming more in the forefront in the last, I would say, five or six years, than it was, when you or I were, entering the journey, and certainly when your mom or my mom were entering the journey. So talk a little bit about, from a 30,000 foot view, what do you want women in their, mid to late thirties, early forties, what do you want them to know about menopause? And not necessarily from a like practical, tactical point of view,see your doctor and advocate for yourself. But more like from that 30,000 foot view. Tell me a little bit about menopause.

Dr Polly: I think we could go back to that idea of surrendering, right? What I mean by that is the women that I work with that are the most successful are approaching this transition with interest and curiosity. And they're, they're open-minded, they have a growth mindset and they're willing to try new things.

And so, where I see people get stuck is they're like, I'm doing all the things. I'm going to the gym and it's still not working. And Your body is gonna change. It's puberty in reverse. It kind of sucks, but on the other side, or even like through that process, you do get to this strength that you didn't know that you had, and you have to advocate for yourself in a way that you maybe never have before.

And you can show up in your own life. With so much more intention than you did before because everything now becomes very deliberate. If you can get curious, rather than frustrated.

And then you are doing that aerial yoga or this with the silks and you're suspending your body and all of those things and you're so in your own space, right? Eyes on your own mat kind of thing, that the 22-year-old falls away. Because you have so much wisdom and so much more agency than that 22-year-old, she just falls away. We're not looking at her anymore. That would be my advice to be really open-minded and curious.

And also discernment. I think there's a lot of crap out there, right there. Everybody wants to sell you something on social media for this supplement or that hair growth product, or this thing that's gonna suck away your fat or da da da da. Turn it off. Go outside. Listen to the birds. Exercise. Grow some food. Connect with someone you love. I think my biggest takeaway would be if we could approach this with curiosity and wonder and excitement rather than dread and foreboding, I think we would do real well.

Stephanie: Yeah, That's a great, a great, overview. I love that.

One last question. This one's a personal one for one of my girlfriends. And it's a little, specific, but can you just talk again briefly, 10,000 feet foot view? About the outdated science around hormone replacement.

Dr Polly: Mm, mm-hmm. Yeah. So there's a really great podcast, Rachel Rubin and Peter Attia did, it's two and a half hours. It's on YouTube. And Dr. Rubin did a fantastic job, really debunking the WHI. But very quickly, so the Women's Health Initiative study, the WHI looked at one formulation of hormone replacement therapy.

It was called  medroxyproges.... Oh, Prempro, which was conjugated equine estrogen. So pregnant horse urine estrogen, in an oral form, and a synthetic progestogen called medroxyprogesterone acetate. Those are not modern formulations of hormone replacement therapy.

So in that study, they initially said that there were about three more women out of a thousand over five years that had a slight bump in breast cancer. If we go back and look, the control group probably was underreporting breast cancer, or because they'd been on hormones before, they were actually at lower risk. And so that inflated the risk artificially in the treatment group, and it may actually be statistical noise. Okay, so this whole drama around hormones give you breast cancer.

Okay. That just probably isn't true. Meanwhile, we're dumping poison in our water and in our food, and we're putting endocrine disrupting chemicals all over our bodies every day. But it's the hormone replacement therapy that's the problem. I'm sorry, but this is just one more way to keep women down. Sorry, I'm, it's just garbage.

Typically we are using a transdermal estradiol, so bioidentical body equivalent, however you wanna call it. I think people are kind of moving forward, natural hormone therapy as a term to indicate that we're not using pregnant horse urine. You're not a horse. Great. Transdermal estradiol, oral micronized progesterone, or vaginal micronized progesterone. Fun fact progesterone cream does not absorb through your skin enough to protect your uterus.

You can give yourself uterine lining cancer by taking sufficient estrogen and not balancing it with enough progesterone if you have a uterus. I don't wanna sound disrespectful or unkind to any of the many breast cancer survivors out there. We are not trying to minimize your experience or your disease. We're hoping to look at whole women.

So the rates of death between women who took hormone replacement therapy and the rates of death from breast cancer, of women who didn't, are the same. Okay, so if you have a hip fracture in the United States, your chances of being dead in the next 12 months are 30%. A third of people die who break their hip. Okay. That's huge.

So we're trying to shift the conversation to treating women like boobs on a stick as a whole person. You have a brain, you have a heart, you have a skeleton, you have quality of life, you have a mood, you have a libido, you have energy, you have all these things that hormones can be really helpful for.

And when people say hormones do x, your first step is to say, what hormones were used? How were they delivered? How long were they? How many people ran this study? How old were the people in the study? You need to ask more questions. You should never accept hormones do X. Which hormones, in whom? Okay.

Stephanie: And that can be said, actually that same argument. I was having that same argument with a colleague earlier today who was saying that all of the I won't even say what it was, but it was like, all of these things give you cancer. And I was like, I'm pretty sure that's kind of outdated.

And was your partner looking at an actual study or were they just reading a news story sensationalized that picked a certain piece, you know, cherry picked? So, so, you know, being that,what's the word I'm looking for? Educated consumer.

Dr Polly: Yeah.

Stephanie: Being that educated consumer and thoughtful about what kind of information you are ingesting and what those sources are.

Dr Polly: Yeah. Estrogen Matters is a really good book. I think I would point people in that direction, butwe are living too long, right? When people are like, it's menopause is natural. I'm like, yeah. So is dying of sepsis, right? If it was all natural and we didn't have sanitation and we didn't have antibiotics and we didn't have pasteurization, we didn't have all of these things that have happened to keep us alive so much longer in such a shorter amount of time, naturally we would be dead by now. That's what's natural. And, I wanna live with a strong skeleton and without heart disease. Heart disease kills. The most common cause of death in the United States. And I wanna know who my loved ones are and have my brain working. Yeah, I'm taking hormones. I've been on hormones since I was 40. I will never stop.

Stephanie: I love that.

Thank you so much, Polly. Thanks for being here. Thank you for being so generous with your story. And then thank you for letting me, pick your professional brain about something that a lot of us are either about to head into or are sailing the seas of, or coming out the other side of. So I really appreciate everything you've shared with me today.

Dr Polly: Well, this was so fun, Stephanie. I hope you have a great day and thanks for having me.

Stephanie: Thanks so much for listening today. Don't you love it when people don't let themselves off the hook, even when you give them a perfectly good out?

When Polly and I were talking about the reason it took her so long to start her medical practice, I suggested that there were practical and tactical reasons, like paying a mortgage that held her back, but she didn't take the bait and I love it.

She womaned up and owned the hard truth. She was scared. And that may be one of the most important things she said in this entire episode. And it would be easy to sort of shase beyond it because the practical and tactical reasons were not a cop out. The mortgage was real. The financial pressure she faced was real. But also, she was intellectually ready to leave for years before she actually did it. And the gap between knowing and going was fear and not logistics.

So maybe, now that I've pointed that out, this could be something that you recognize in your own life. And I'm sure you have some absolutely, 100% valid reasons for not making a change or taking a chance, but if you were being honest like Polly, it's not the whole reason, is it?

And it's hard to be honest enough with yourself to admit that kind of fear. Most people don't name the fear at all. They just keep reworking that practical excuse until it's airtight and they are fully convinced. But Polly's story is a wonderful illustration of a theme that keeps coming up, when doing everything right stops working.

And Polly did everything right by every available measure. She got her degrees. She did extensive training. She followed a career path. She worked within the system. And then she arrived at age 35, feeling like she was an insurance clerk more than a physician. This is a textbook case of the doing everything right framework, not producing what it promised.

So once she realized she wasn't on the path she intended or expected to be on, and she acknowledged that it really wasn't feeling fulfilling to her, she started exploring adjacent paths to see if any of those could be a better fit, and she found one, but it was scary.

Learning to distinguish between a genuine obstacle and a comfortable reason to stay put is the nuance. Again, she had perfectly defensible reasons to stay put, and it's easy to hide behind those, which draws in another one of our recurring themes, the lure of pretty good.

Pretty good is seductive precisely because it's defensible. Polly talked about how she stopped doing surgeries and delivering babies only four years after she finished training, even though she had spent eight years of postgraduate education telling her that she should be doing those things.

And this is kind of a deeper insight into that same problem. It's not just the fear of the leap. It's the difficulty of leaving something you've worked so hard to build, something that looks completely fine, maybe even, um, enviable from the outside. And nobody is telling you to leave it, but the should is internal. And it's loud.

And the longer you've invested in a path, the harder it is to admit that the path has run out for you specifically, even if it's still working for everyone else around you or looks good to the audience in your life.

And the danger of a life that looks fine, but does not feel right is arguably the backbone of her entire story.

Polly's schedule was full. Her patients liked her. Nobody was scolding her, telling her to do something else. From the outside, everything looked like it was working. But that's precisely what it made, what made it so hard to leave and, so easy to rationalize staying. Because how do you explain leaving something that looks completely fine to everyone else?

But Polly at least acknowledged that there was something more, and that she was scared, and that's a tough thing to do in our society. How often is it okay for us to be scared or unsure?

But admitting that fear opens up another path for exploration, should we be so bold. The opportunity to identify what it is that fear might be protecting. Because that, that fear that hides behind mortgages and very, very good reasons not to do something is almost never just about the thing that it says that it's about. It's often protecting something deeper, could be an identity, could be a self-image, could be a story you've been telling yourself about who you are and what your life means.

For Polly, she just did, she didn't just have a job. She had eight years of postgraduate training. She was a doctor, specifically the kind of doctor that delivers babies and does surgery. So leaving that wasn't just a career change. It was a renegotiation of who she was.

So the fear might have been, "What if this new business fails?" Or, "What if I can't help pay the mortgage?" But it wasn't only that. The fear was also, "What if I'm not who I thought I was? " Or even, "What if all of that work I did didn't mean what I thought it was, what I thought it did.

Polly's transition took a full decade, and although she said her only regret was not doing it sooner, I think it is important to point out that she didn't do nothing during that decade. She was following the thread. The decade wasn't a delay. It was the actual process of figuring out what was next. She went to the supplements conference. She found, uh, AIHM. She did the two-year IFM certification. She stayed in the conventional practice while she was becoming someone who could eventually leave it.

That was actually the transition happening, even if it didn't look like much of a transition from the outside. Because I hate to say it, but the messy middle is often the work, not just the waiting room for what's next.

All right. Next time, you'll meet MJ, who always wanted to be an investigator and never got the chance until her 40s handed her the most personal cold case you could imagine.

Can't wait to share that one with you. I'll see you next time.

The Big Four Oh Podcast is produced and presented by Savoir Faire Marketing Communications.