Breaking Barriers in Women’s Health: Menopause, Screenings, and Advocacy with Dr. Mitzi Krockover

Susan Sly: 00:00

Welcome to The Menopause Health Podcast, where the mission is to help empower women as they navigate perimenopause and menopause. My guest today is an absolute legend in the area of women's health, and I am going to share her credentials and the topics we are discussing.

One of the big takeaways from our interview is the concept of participation by women in research. One reason the data for women's health is lacking is that we haven’t been participating in the research. Why? Because our lives are bananas at times! We are mothers, grandmothers, godmothers, working professionals, and partners juggling countless responsibilities. The last thing we necessarily want to do is participate in research.

Today, we will discuss simple ways for women to get involved and change the narrative. We will also cover the importance of health screenings and, most importantly, the conversations we should be having at home and why they matter.

Before I introduce today’s guest and her incredible accolades, I want to share something with you. If you haven’t downloaded thePause™ App, please go to the Apple App Store and download it today. We are bringing on our early pilot testers, and your feedback is critical. During this phase, we have deeply discounted the price of the app. Participants are actively sharing which features they love and suggesting enhancements, and we are already making a difference.

One subscriber shared with me that this app—and especially our generative AI agent, Harmoni™—has truly helped her. Harmoni™ encourages her to go outside for a walk when she feels like staying in. Harmoni™ has also provided strategies to help her relax enough to fall asleep. These improvements have transformed her outlook on life.

I encourage you to check out thePause™ App today. Find out more at www.thepause.ai.

Now, let me introduce our guest. She is the founder and CEO of Women Centered LLC, a consultancy, media, and investment company focused on women's health. She also serves as a consultant and advisor to several women's health organizations.

In addition, she is the host and producer of the Beyond the Paper Gown Podcast, which inspires and informs women about achieving optimal health. On top of all that, she is a managing director at Golden Seeds, an angel investment organization that funds early-stage companies led by women. She also co-leads their Health Sector Committee.

Previously, she served as the founding Medical Director of the Iris Cantor UCLA Women's Health Center and as Vice President of Women’s Health at Humana. She currently serves on several boards, including the Institute for Mental Health Research, the Black Women’s Health Imperative, and Springboard’s Women’s Health Innovation Council.

She is a board-certified internist, a mother, and somehow manages to squeeze 56 hours into a 24-hour day. Let’s jump into my interview with the one and only Dr. Mitzi Krockover.

Voiceover: 03:36

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.

Voiceover: 04:02

Welcome to The Menopause Health Podcast, your go-to resource for practical advice brought to you by credentialed health professionals and industry experts. Here is your host, Susan Sly.

Susan Sly: 04:18

Well, Mitzi, it is so wonderful to have you on the show. Full confession to everyone listening—Mitzi and I were talking, and I said, “Oh my gosh, we have to do a show.” We were so deep into this conversation.

The burning question that keeps coming up over and over, Mitzi, is: why do you think menopause is having a moment all of a sudden?

Mitzi Krockover, MD: 04:39

You know, I think it’s a perfect storm. We have a lot of women—both high-profile and average-profile—going through this. I think women feel a little bit more empowered.

There is also an increased understanding that our healthcare system was not really created for women. There has been a level of dissatisfaction that has kind of boiled over.

On the positive side, we now have more women in leadership. We have women scientists, women leaders in healthcare systems, and even leaders in venture funding mechanisms and government. A study showed that women scientists are more likely to conduct women’s health research.

Given all of that, I think the awareness is there, the dollars are there, and the level of knowledge and ways to move forward are becoming more evident.

As an angel investor, one reason I started focusing on women’s health was that I met women who couldn’t find the answers to their healthcare issues—either within the system or on the shelves—so they decided to create solutions themselves. For me, that was a lightbulb moment. The way we’re going to advance women’s health is through these women entrepreneurs.

Another part of the storm is technology. We now have so many tools at our disposal: virtual technology, telehealth, asynchronous communication, digital sensors, monitors, wearables, and, of course, burgeoning AI. These advancements only strengthen our ability to address these challenges.

Susan Sly: 06:48

Thinking about that—this inflection point we’re having—I also think it’s generational.

When you look at celebrity culture, women like Halle Berry and Gwyneth Paltrow—these Gen X icons—are boldly talking about menopause. It’s almost like they’re the first generation willing to openly address it.

Let me share a quick story. A woman on our mailing list at thePause™ told me something that really resonated. Her name is Michelle, and she listens to every show. She said, “My mother cried when she read your newsletter.”

I asked, “Why is that, Michelle?”

She explained, “My mother said women of her generation didn’t talk about it. If she’d had resources and tips back then, she wouldn’t have had to suffer in silence.”

This underscores the importance of this willingness to talk about menopause. Mitzi, you’ve been working in women’s health for decades.

Now, we’re finally having these conversations without as much fear of being judged or seen as less than. But there are still a lot of myths surrounding menopause. Can you talk about some of the most common ones and why they’re untrue?

Mitzi Krockover, MD: 08:17

Sure. But before I get into that, let me just say—it’s interesting. Yes, I’ve been doing this for quite some time, but no, I’m not 90 years old, to clarify!

When I was the founding Medical Director of the Iris Cantor UCLA Women’s Health Center, many of our patients were menopausal. At that time, we didn’t have the technology we have now, but we saw a clear need for education. We were giving the same talk repeatedly, so we created menopause groups to provide that information.

Here’s the thing—providers weren’t taught much about menopause. I’m an internist, but even the OB-GYN curriculum historically included very little about menopause. Organizations like The Menopause Society are working to change that, and I’m hopeful we’ll see more knowledgeable providers as a result.

That said, when it came to treating menopause, we approached it matter-of-factly, like, “This is how it is,” instead of exploring innovative ways to address it. Fortunately, we had researchers in the trenches conducting critical studies.

Another issue is that we don’t teach menopause to kids. Reproductive health education should include menopause, but it doesn’t. In England, they’re starting to incorporate this, and I think that’s a great model for us to consider.

Now, let’s talk about myths. The biggest one is, “I’m done. I’ve reached menopause, I’m no longer reproductive, and I have no value to society.”

That couldn’t be farther from the truth. In Japanese culture, for example, menopause is referred to as a “second spring,” which I think is beautiful.

Once you’ve navigated the rough part—the perimenopause transition—you often feel a sense of freedom. You’re having sex without worrying about getting pregnant, though I’ll add: if you’re not in a monogamous relationship, please protect yourself. STIs are on the rise.

Relationships can also deepen during this time. For me, my two daughters are in their 20s, and I’m so proud of them. I also have more time to focus on myself and my passions.

Menopause is not the end. In fact, many women my age—myself included—are diving into third, fourth, or even fifth careers. They’re thriving, innovating, and living vibrantly.

Susan Sly: 11:52

And to your point, it’s a wonderful time to pivot. But I want to step back for a moment because the reason I’m laughing—if you’re watching us on YouTube, you’ll see my face—is related to something Mitzi said.

So, we’re going to do a little PSA because we know that some of you listening to the show are health practitioners, and some are not. Here’s the PSA about getting pregnant in your 40s.

This happened to my girlfriend. She was skipping periods and didn’t think she could get pregnant. She thought she was going into menopause and went to the doctor. She hadn’t had a period for a few months and, poof, she was pregnant at age 48.

So, Mitzi, can we talk about this sidebar? Let’s discuss the fact that if you’re skipping periods, you can still get pregnant.

Mitzi Krockover, MD: 12:43

Yes, exactly. And again, it’s relatively rare compared to when you’re younger because fertility wanes. But yes, it happens.

A lot of women are on birth control for years, and then they stop or transition off of it and aren’t sure what’s happening with their periods. Here’s an important definition that I’m sure many of your listeners already know: menopause is officially diagnosed on the one-year anniversary of your last period.

Until you’ve gone a full year without a period, you’re still in perimenopause, and you can still get pregnant. For example, I was 41 when I had my second child. It was a bit different because I was trying to conceive and was fortunate enough to have Ariana.

But afterward, I experienced terrible night sweats and hormonal changes. Looking back, I now realize I transitioned straight from pregnancy into perimenopause. At the time, I assumed it was all postpartum-related, but it wasn’t.

Susan Sly: 14:09

The same thing happened to me. I had Emery when I was 38, and afterward, I experienced horrible night sweats. I mean, I was soaking the sheets to the point where I could wring them out. It felt like I’d gone to Bikram yoga!

I also couldn’t lose the baby weight as quickly as I did with my other kids, even though I’m very athletic, as you know, Mitzi. I endured 13 years of night sweats and heavy periods. For the first several years, I kept thinking, “Postpartum has to end at some point,” but I didn’t know what was happening.

I want to ask you about this, especially regarding perimenopause. When we had Annina Burns from NIH on, she spent a lot of time discussing the lack of research into perimenopause. Can you talk about that? I think many listeners are either in perimenopause or know someone who is, and there’s so much confusion about this stage.

Mitzi Krockover, MD: 15:14

Absolutely. The big picture is this: historically, women have been excluded from medical research.

It wasn’t until: 1993

Part of the reason women were excluded was protective. Since women can have babies, researchers wanted to avoid any risk to unborn children. Also, women’s hormones fluctuate, which adds complexity and cost to research. So, researchers assumed that what was true for men would also apply to women.

tten smarter. That mandate in: 1993

However, when it comes to women’s health, we still face significant funding gaps. I don’t have the exact numbers on hand, but we’re lacking data on outcomes for conditions like autoimmune diseases, lung cancer (which is rising in women), and Alzheimer’s—66% of people with Alzheimer’s are women.

Cardiovascular disease is another critical area. It’s the number one killer of women, yet their outcomes are worse than men’s. Women are misdiagnosed more often, diagnosed later, and treated less effectively.

And then there’s menopause, which has received minimal funding. I remember my physiology textbook in medical school—the last chapter was on women’s physiology. You never get to the last chapter in any course, and this one was a fraction of the size of the rest of the book.

Here’s another point to consider. It’s not just that women haven’t been represented in clinical trials. We also know relatively little about the female body overall. This creates challenges for scientists trying to develop solutions based on inadequate data.

That said, I’m optimistic. There’s growing momentum in women’s health research, and it feels like a snowball effect. I don’t think we’ll go backward from here.

But for now, it’s important for women to understand that when you go to the doctor and feel frustrated, it’s not necessarily because your doctor doesn’t care. It’s often because they weren’t trained in these areas. Doctors can’t be trained unless the research exists, and that’s where we’re still playing catch-up.

Susan Sly: 18:54

Well, to your point as well, one of the things I learned from you during the FemTech and Women’s Health Summit was that most clinical trial volunteers are men. It’s critical to emphasize this point—it’s almost like death by a thousand cuts.

It’s not just that there wasn’t an interest in researching women; it’s more complex than that. We knew women’s biology was complex, and then we also weren’t volunteering for trials.

One of the beautiful things that came out of our summit, Mitzi, was hearing so many women say, “I’m now going to volunteer. I’m now going to volunteer.”

Our friend Joan from AZBio said, “Do you know how many trials I’ve signed up for, just because I learned this?”

For women listening who are now thinking, “Okay, that makes sense, and I want to get involved,” here’s my question: where can women start? Not all clinical trials are pharmacological, right? Could you talk about the different types of trials and where women can find more information?

Mitzi Krockover, MD: 20:07

Excellent question. As you know, I have a podcast as well, and I recently interviewed Dr. Jane Morgan, a Black cardiologist. She made an excellent point—women, especially women of color, need to ask, “Where can I volunteer for a clinical trial?”

Representation is so important. Women of color are even less represented in research than women overall.

Many people may know about ClinicalTrials.gov. People with cancer often look there to find trials that might help them.

Another fantastic initiative is The WISDOM Study. It’s working to recruit 100,000 women to help personalize breast cancer screening. Breast cancer screening, as you know, is a whole conundrum. Depending on the week, it seems like recommendations keep changing.

With The WISDOM Study, women simply need to share their medical history, mammogram results, and screening information. If they choose, they can also complete a genetic test. It’s easy, and you’re contributing to important science.

This is critical because breast cancer screening has not been the panacea we’d hoped for in identifying cancer early. The study is at www.wisdomstudy.org.

Susan Sly: 21:58

To your point about breast cancer, more research is emerging, especially around lifestyle factors like alcohol use and its increased risk for breast cancer.

Breast health is incredibly complex. Take 10 women, and you’ll find that no two have the same breasts. And then, there’s the additional complexity of implants. I’ve shared openly about my explant surgery and how my breasts changed dramatically afterward.

Let’s talk about screening. As women, we wear so many hats—the mom hat, the partner hat, the grandmother hat, the working professional hat. And let’s face it: screening often falls to the bottom of the list.

Okay, confession time—I don’t enjoy mammograms. It’s one of the least enjoyable things ever! I’d rather do a host of other activities.

Because of that, we tend to deprioritize screening. Mitzi, could you talk about screening—not just breast screening, but other types of screenings women in this age group should prioritize?

Mitzi Krockover, MD: 23:20

Right. Well, you know, here’s the bad news—I just fell off my chair! The bad news is that, as we age, our risk for certain diseases increases.

We’ve talked about cardiovascular disease, which includes heart disease. What contributes to heart disease? High blood pressure, diabetes, increased stress (because our cortisol levels go up), and smoking—all of which we can manage or eliminate.

In terms of screening, everyone should know their cholesterol levels, including the different components. You should know your blood pressure, your glucose levels, and those are the basics.

Another major risk for women as we enter menopause and beyond is osteoporosis, or thinning of the bones. Medicare pays for bone densitometry at age 65, which is the recommended screening age. However, I would argue that screening should probably happen earlier. By the time you’re 65, you may have already lost significant bone density, and you can’t regain that.

The good news is there are things you can do to mitigate bone loss—strength training, weight-bearing exercises, and proper nutrition can help.

Cancer screenings are also critical. Cervical cancer screening guidelines have changed, so they’re not necessarily annual anymore, which is great. But it’s still important to get a Pap smear or an HPV test.

Now, let’s talk about breast cancer screening, which has been all over the place and is often confusing. Only about 5% of people have a genetic predisposition to breast cancer, so family history is important, but it’s not the whole story.

Here’s the other piece: 40–50% of women have dense breasts, and we don’t always know this. The FDA recently mandated that radiologists must notify patients if their mammogram reveals dense breast tissue.

Why does this matter? Dense breast tissue appears white on a mammogram, and so do lesions. It’s like trying to find a snowflake in a snowstorm. You can’t see it. Women with dense breasts often need supplemental screening, such as an ultrasound or MRI, but these aren’t always covered by insurance.

There’s legislation being proposed to address this. In the meantime, let me share a personal story to illustrate the point.

I’ve been getting mammograms since I was 40. I’ve always been told my results were normal or negative. My most recent mammogram was the same—I got a text saying, “Everything’s normal.”

Then, I received the follow-up letter, which started with, “Your mammogram results are normal.” I almost stopped reading, but something told me to keep going. In the next paragraph, it said, “You have dense breasts.”

I had never been told this before. If I hadn’t read the entire letter, I wouldn’t have known. Now, I’ve had to pursue supplemental screening. My ultrasound came back negative, but I’m considering whether I should get an MRI because some women’s cancers aren’t detected until that stage.

The problem is, we don’t yet have the tools or data to truly personalize breast cancer screening. There are risk algorithms that can help, but they’re not perfect.

Here’s my “bully pulpit” moment: we need better ways to screen for breast cancer. We need biomarkers—things we can test for in blood, tears, or other bodily fluids. Imaging can only do so much, though AI-enhanced imaging is promising. Ultimately, we need more research to effectively prevent late-stage breast cancer.

Susan Sly: 28:12

Absolutely. And to your point about AI, I think there are incredible opportunities ahead. Many years ago, I taught nutrition at the college level in a nursing school, and I can tell you—the average person, even in healthcare, doesn’t always know the lifestyle risks.

Research is constantly changing. For example, we can say smoking increases your risk. We can say not exercising increases your risk. But what about over-exercising? What about the exact amount of sleep you need?

Where I think we’ll get to with AI is being able to assess these risks much faster, with precision recommendations tailored to different lifestyles and cultures.

This is something you and I are working on together. I’m excited about using AI to make personalized health insights accessible, especially for underserved populations.

I want to circle back to a critical area of research—women in the Black community. When Mia Chorney, my co-founder of thePause™, joined the show, we talked about how Black women experience increased vasomotor symptoms during menopause.

You’re deeply involved with Black women’s health initiatives. Can we talk about the unique challenges faced by women of color—not just Black women but other underserved communities? They’re under-researched and may experience different symptoms. That’s a real problem because it’s not a one-size-fits-all situation. You can’t apply the same intervention to everyone and expect it to work.

Mitzi Krockover, MD: 30:06

Absolutely. And we also have to consider people in the context of their environment—what’s available to them, their resources, and everything else.

I serve on the board of the Black Women’s Health Imperative (BWHI), the largest national organization dedicated to Black women’s health. Within any population, there are differences. As you mentioned, Black women tend to experience vasomotor symptoms more intensely and potentially reach menopause earlier. These factors can increase the risk of other medical conditions.

Take breast cancer, for example. Linda Goler Blount, the CEO of BWHI, has said that when Black women are diagnosed and treated adequately, their chance of survival is no different than that of white women. The issue is access—getting to that mammogram and understanding the screening guidelines.

For instance, screening guidelines have historically been based on averages that don’t always account for higher-risk groups. At one point, the recommendation was for women to begin mammograms at age 50. But Black women as a group tend to face higher risks earlier, and many cancers were missed as a result.

At the end of the day, we don’t have enough data. And when we talk about clinical trials, there’s also a trust issue. Some groups are understandably hesitant because of historical injustices in medical research.

It’s also a logistical challenge. If you’re juggling kids, caring for elders, working full-time, and managing everything else, when are you supposed to hop on a bus or drive to an academic institution—and find parking—to participate in a trial?

As a healthcare community, we must make participation more accessible. If we want people to show up, we can’t impose on their already packed lives.

Susan Sly: 32:55

It all comes back to accessibility. That’s why a project we’re working on together with thePause™ is so exciting. We aim to enable research through people’s mobile devices—capturing biometrics and lifestyle data.

It’s research in your pocket, which I think will revolutionize participation rates.

Mitzi Krockover, MD: 33:23

Exactly. Two key things come to mind. First, because we don’t have enough data on women, one of the challenges with AI is ensuring it doesn’t hallucinate. When AI lacks information, it can generate incorrect or fabricated outputs. That’s why robust data is so crucial.

Second, apps like thePause™ and other women’s health technologies are creating an incredible opportunity to gather real-world evidence. The volume and diversity of this data often exceed what we’ve seen in traditional research.

Analyzing and segmenting this data will lead to meaningful, personalized solutions for women.

Susan Sly: 34:29

Absolutely. Let’s pivot for a moment to something more personal. Mitzi, you’re a wife, a mother, an investor, a board member, a health practitioner, a speaker, and a volunteer.

When it comes to your screenings, do you tackle everything in one week, or do you spread them out? What’s your approach?

Mitzi Krockover, MD: 35:04

Well, you’re probably not going to like my answer. One thing I’ve noticed during menopause is that my ADHD has worsened. I’m like a squirrel—“Oh, I want to do this! I want to do that!”

Over time, I’ve started saying no to things that don’t align with my goals. Even if something seems fun or worthwhile, there’s always a cost to saying yes. If it doesn’t truly serve a purpose, I let it go.

So yes, I’m a work in progress—like all of us. On the surface, I might look like a swan gliding across the water, but underneath, my legs are paddling like crazy!

Susan Sly: 36:19

The ADHD part is so real. Personally, I take a completely focused approach. I block off two or three days and get all my screenings done at once.

That way, all my data comes in at the same time, and I don’t have to deal with scattered results throughout the year. And if I’m going to get poked and prodded, let’s just rip the band-aid off—pelvic ultrasound, mammogram, everything—just get it done!

Mitzi Krockover, MD: 37:13

That’s the dream—to be that planful! You’re my role model for this.

Susan Sly: 37:19

Thank you! I learned it from Kathy Coover, who’s on our advisory board. She taught me to be intentional about managing my time.

Final question: people are familiar with “Blue Zones,” regions where people live exceptionally long, healthy lives. In the U.S., we also have “Bio Zones”—areas known for biosciences.

You and I are on a mission to make Arizona a leader in FemTech and women’s health. What’s your take on this?

Mitzi Krockover, MD: 37:57

Absolutely. Arizona is a hidden gem for innovation in women’s health.

Entrepreneurs need a few key things: a place to pilot or conduct clinical trials, an understanding of reimbursement and how the healthcare system pays for solutions, and access to scientists generating intellectual property (IP). They also need a supportive government and policymakers.

We have all of that here. It’s also a collaborative community, which is invaluable.

Susan Sly: 38:17

Exactly. For everyone listening, we don’t know the exact date yet, but the FemTech summit will happen in 2025, and you’re all invited.

Thanks to Arizona’s leadership, we’re creating the infrastructure to support innovation so researchers and entrepreneurs can focus on their work without worrying about resources.

Mitzi Krockover, MD: 40:07

Absolutely. And I should mention Arizona’s growing investor community. It’s a critical part of the ecosystem.

Susan Sly: 40:22

And we’re fun!

Mitzi Krockover, MD: 41:03

Absolutely!

Susan Sly: 41:11

If you come to Arizona, we promise you’ll have fun. Mitzi, thank you for everything you do to advocate for women globally.

For everyone listening, check out the resources Mitzi mentioned, including The WISDOM Study and ClinicalTrials.gov. We’ll link them in the show notes.

Visit thePause™ YouTube channel for more content, and don’t forget to subscribe!

Voiceover: 42:43

This episode of The Menopause Health Podcast is brought to you by thePause™. Learn more at www.thepause.ai, and follow us on social media. Subscribe, share, and join us for the next episode.

This transcript has been generated using AI technology. There may be minor errors or discrepancies in the text.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.