Silence Is Not Succession: Why Women’s Health Belongs in Family Conversations

Welcome to Legacy Builders, strategies for building successful family enterprises. Brought to you by Beacon Family Office at Assante Financial Management Limited. I’m your host, Cory Gagnon, Senior Wealth Advisor. And on this show, we explore global ideas, concepts, and models that help family enterprises better navigate the complexities of family wealth.

Today, we welcome Dr. Julia Edelman, founder of Women’s Health and Gynecology of New England. A Yale and Columbia graduate and residency-trained at Harvard, Dr. Edelman is a board-certified gynecologist and nationally recognized menopause expert. For over four decades, she’s combined rigorous clinical practice with mentorship, training physicians and students at both Harvard and Brown. Her work is known for blending evidence-based care with deep compassion. A published author, she was honoured by the North American Menopause Society as “Menopause Practitioner of the Year” following the publication of her book Menopause Matters, and has since written Successful Sleep Strategies for Women for Harvard Health Publications.

My goal is to be the most curious person in today’s conversation with Dr. Julia Edelman, to listen closely for the moments when going off-script leads to something more meaningful. For 57 episodes, Legacy Builders has explored the decisions, dynamics, and disciplines that shape successful family enterprises, and today, we step into a conversation we’ve never had before, and one that is long overdue. We are talking about women’s health, specifically menopause, and how it affects not just individuals, but entire family systems. 

When a matriarch, successor, sibling, or spouse goes through this transition, physically, emotionally, or relationally, it can influence decision-making, communication, and succession readiness in subtle but significant ways. Together, we explore what it takes to challenge institutional norms, how women’s health has evolved from the margins to a more evidence-informed field, and why certain experiences remain unspoken across generations. Dr. Julia offers insights that show how breaking this silence can strengthen trust, improve continuity, and reveal paths that are both personal and powerful.

Now, let’s dive in!

Cory: Alright. Welcome, Dr. Julia. We’re excited to have you here today to share your wealth of knowledge and experiences with us. Let’s dive in, shall we?

Julia: Sure.

Cory: Imagine you’re delivering a commencement speech to the graduating class of 2025, and you have the chance to inspire them with your story. How would you begin your speech to convey the incredible lessons and expertise that you’ve gained along your career?

Julia: It’s a very interesting question, Cory. I think the first thing is, especially when you’re with a cohort in college, and then in high school before that, and then when you come into the work environment, to remember that it’s okay to be an outlier, that you don’t have to succeed by the same parameters as the individuals around you.

Cory: And so in the sense of being an outlier in the work that you’ve done, can you help me understand where that has shown up in your practice and your career journey?

Julia: Sure. So I think every institution has a culture, and it’s helpful whenever possible to be clear on what you want to get out of that culture. For me, I really wanted to be in places where I could learn a lot of different things in different ways, but the trajectory that those institutions offered, the traditional trajectory, didn’t seem to fit that well with my goals. So I think it’s okay to have tangents.

In other words, you go to a place where academically it meets your needs, but it doesn’t mean you’re going to be an academic, or you’re going to get the kind of job that they think you should get at, or that you need to prepare for a graduate degree in the way that they recommend. There are other paths.

Cory: And so your path to women’s health, how did you find that the institutions and the culture were at the beginning? And what made you realize that maybe you needed to to break into a different direction?

Julia: So I had the good fortune to go to Yale University undergrad, which has a tremendous wealth of courses and opportunities and so forth. And at the time, they had a very fixed path to medical school that they thought you should pursue, which, you know, there’s a certain formula. And, not only did I not know that, but I didn’t pursue that. And when it came to apply, they said, well, this is a long time ago. We’re not going to help you, and we didn’t do anything we think you should have done. But I had my own view of what the prep could be. I took the courses and I had different interests in volunteering because I had worked in an office in the medical office when I grew up. My mother was a pediatrician at an office in the house. So I had some idea of the medical field, and I was fortunate to have a role model that loved medicine, always reading and learning, and so forth.

So for me, for example, part of the formula was volunteering in the emergency room or something, and that just didn’t appeal to me. I wanted to do different kinds of things. So I ended up writing a health plan newsletter for the entire university that reached all the students, all the faculty, and all the employees. And for me, that was very educational, and I really enjoyed it. And I learned a lot. And I interviewed different nurse practitioners and physicians about what was going on.

Also in terms of major, at that time they thought you should be a biology major, biochemistry major, and I wasn’t even, though I like biology and biochemistry, that didn’t interest me. So I was actually a geology major because I had gone to a summer program, and I enjoyed thinking about things that way, how the rocks got there, how the planet got there, and so forth. So I did that, kind of as a combined science major, keeping in mind that I might like to go to medical school, but I also could have gone to forestry school or graduate school. So it gave me a lot of options. I didn’t want to feel like this was lockstep. I was definitely going to do this because I’ve been exposed to it early.

So for me, that was important, to look at other things and see, there was something else I would like to do better? And in fact, there wasn’t, but it was nice to explore that.

Cory: Right. As you mentioned, geology and how the rocks got there, I was thinking about the lunar cycle. And today, when we’re recording, we just had a full moon, and I’m thinking about just the cycles of health that you operate in. So maybe there’s a correlation there, you know, a big rock that has a big influence on many aspects of our lives that we don’t realize. And so, taking that metaphor, Dr. Julia, where have you, along your career, seen the influence and this major component that is often overlooked?

Julia: Well, I think it’s because the cultures are strong in individual institutions, so it’s easy to fall into that culture and think that that’s the only path through.

When I was in medical school, I was in New York City at Columbia, which was a fabulous learning experience. And at that time, OB-GYN was not viewed as a very respectful specialty. They thought if you were very smart, you were an internist. And if you had really good hands, you were a surgeon. And it wasn’t a popular choice, but I really liked surgery. And I like three-dimensional things and figuring things out in the moment. And I also like solving medical problems. And gynecology incorporates both. You have to solve complex endocrinology problems. Patients present different scenarios to you. You have to figure out how to help them. And then the surgeries that you do are very interesting to help people. And mostly they all get better, which is really nice. And you also get to follow people over time, which was important to me, because I had seen that in my childhood exposure. So if you take out someone’s appendix, you may not see them again. You can be a very good, compassionate, qualified surgeon, but you may not see your patients over time. Whereas if you’re a gynecologist, you likely will.

I’ve had the good fortune to practice in the same place for decades, so I have been fortunate to care for women who I met as late-teens and now in their late-forties, early-fifties, and it’s fabulous. I’ve seen them grow up, when they were in high school, when they went to college, and got married or whatever they did. So that’s been really rewarding. It’s another piece of it. So I’ve enjoyed that very much.

Cory: And speaking of the culture from a societal perspective, what have you seen over time in that evolution of maybe what society speaks of, and how some of the influences as it relates to health care and awareness?

Julia: So when I started in gynecology, they didn’t want women in the profession. This was before we were in it. So it was largely all men, and they didn’t think we belonged in there with them. They preferred not to have that, although there were some exceptions.

But now the majority of my colleagues in gynecology are women, but it was not the case at that time. And there wasn’t a lot of research on women’s health. Basically, all the research was on men’s health. So when it came to women, we didn’t really know the differences in dosing for medication. They basically looked at women as small men, and they didn’t really understand things. And at the time, I think the thinking was, if you do research on women, they might get pregnant. They might go through menopause. They might have their period. And there were so many barriers, which is true. Women have very, very complex physiology, biology, and endocrinology. So no one really knew what to do with all that. So it made it seem like it wasn’t a very academic discipline.

But over the decades that I’ve been in it, it’s been fascinating because we’ve had incredible learning in technology. The way we do surgeries for women is much less invasive. We have wonderful inventions through the decades. And also our understanding of menopause, for instance, which I focus on a lot these days, is fascinating. Now we’re learning where the center is in the brain, where the thermostat is in a woman’s brain, what triggers the hot flashes, and how we can block them with other things besides estrogen. So there have been advances every year or two or so. So it’s been a fascinating field to be in, and I feel very fortunate to have been in it over these decades, because you’re learning something every day or two.

You learn from your patients, you learn from your colleagues, and the articles from all over the world now. It’s easy to get research from everywhere. There’s a lot more sharing. And so it’s really blossomed, and we still need more women’s research, because we’re behind, because we didn’t have it all along, but it’s growing. And it’s been really interesting to see.

Cory: Right. And thinking of those patients who came in as teenagers, and and now they’re in their forties or or fifties, what sort of information is transferred through families as it relates to to women’s health, menopause that maybe counters, or looking at the pros and cons of of some of the, well, this is the way it was when I went through this?

Julia: That’s a great question. So basically, menopause didn’t used to be mentioned at all. I call it the unmentionables. I have a few categories. That’s one of them. The unmentionables, women didn’t want to talk about menopause because it labeled them as old. And we still have, I think, a very youth-based society, at least in the Western world. My understanding is that in Asia and Africa, those cultures honor the elderly more. So when a woman is menopausal, she’s actually looked up to for her wisdom and her experience. That is not my experience in the Western world. We are a very youth-based culture, and so we don’t have that.

So I’ve had many women say to me, both patients, acquaintances, relatives, and colleagues, and whatnot, say, as I get older, people don’t notice me. I’m almost invisible. Even just walking around, people might not acknowledge me the way they used to. And I think appearance-wise too, people feel pressured to look youthful and slim. And without that, it’s very difficult in our society. So I think we have a lot to learn from other cultures, but we also have a lot of good things here as well.

As far as transmitting information, I think women still feel there’s not enough information available. And I hear it all the time about what’s coming. Doctors aren’t educated about menopause. It’s not part of the training; even in really good OB-GYN residencies, many have no lectures on menopause. Many medical schools have no lectures on menopause, or maybe they have an hour. It’s more of an outpatient thing.

Residencies in OB-GYN, for example, which is women’s health, really, are focused on, you know, make sure you can do a delivery, make sure you can do a c-section if you need to, make sure you can do a hysterectomy if you need to, and that sort of thing. And at the Menopause Society, which is what we used to call it the North American Menopause Society, but I have wonderful Canadian colleagues in that and and, United States colleagues in Mexico. We have quite a few colleagues from all over the world. But we are trying to change that. So we have some very strong educational initiatives.

And part of the goal for me in writing the books that I’ve written is to help patients and interested readers learn more about what information we do have, and also to help colleagues and trainees who would like to understand this better and help their patients more, even if they’re not menopause specialists.

So my books have a dual purpose, even though the publishers don’t usually go for that.

They like it to be in one place on the shelf. So the main focus is for individuals who are looking at the material. But I do have references for all my colleagues who may not be in women’s health in any way. So I feel, in that way, I can honor that. So if a patient were to go to another clinician and say, Hey, Dr. Edelman says this, and they go, who the heck is she? What’s she talking about? They can say, well, here are her peer reviewed references from the New England Journal, or Lancet, or Journal of the American Medical Association, so that they can understand what the information is based on.

And then in the books, there are resources for patients that don’t require a technical background, but are up to date and accurate. I try to include websites, apps, books, and anything I thought would be helpful to a reader, and I do that by chapter.

So if someone wants to read more about hot flashes, or they want to read more about sleep, or about cancer prevention, they can just go to that area and have those resources tailored to that.

And then the other thing is that I have questions to ask your doctor. So if your clinician, your nurse practitioner, physician assistant, if you have someone who isn’t that familiar, you can ask questions that will help you get more out of your visit. So those are by topic as well.

So that’s how I thought I could give individuals, both clinicians and patients, tools to navigate this area, because it’s very complex, but women really need the help.

Cory: Thinking back to your comment about the difference in in Western world versus other parts of the world, and embracing some of the aging as a positive versus always wanting to be youthful. If you think about it, in family systems, and maybe we’re now talking to somebody who’s maybe not experiencing hot flashes or some of those major markers that would say, yes, I’m in a menopausal state, or perimenopause, as I believe it’s called?

And so some of these are okay. We can see by age that maybe this is something coming, or maybe there are other markers where that person hasn’t identified for themselves. But now we’re talking to a family member who’s seeing some changes. What might some of those be, and how can we support that person where maybe they still believe there are stigmas that they’re not ready to acknowledge?

Julia: That’s an excellent question. So basically, that’s the name of the book that just came out a few weeks ago, The Savvy Woman’s Guide to Menopause Before, During, and Beyond. And the beyond was very important to me because a lot of books and other learning formats don’t discuss what happens after the final period. So your point is very well taken.

So some women do have hot flashes beyond their final period, and they can last different lengths of time, depending on the person, their history, and their lifestyle. But then, after that, it’s the invisible changes. So certain things in perimenopause or before the final period hit women. They may start to get hot flashes or night sweats. They may have trouble sleeping. They may have some brain fog. They may have irregular bleeding, or heavy bleeding, or prolonged bleeding, or they may skip, and that can cause problems if they’re still generating lining that they’re not shedding.

But when all those things have mostly passed, then we’re concerned with bone health.

So bones thin across that perimenopausal transition at a fairly rapid rate, and then it slows down. But unless a woman is maintaining her bone health, one out of every two women 50 suffers a fracture. That’s a huge number. And then when women get a fracture, some of them don’t go back to their pre-fracture level of health. Some of them are debilitated, and there are a lot of sequels to that.

So there are three main areas. So, bone health, you don’t feel it. There’s no pain. It’s not like when you break a bone. Or sometimes people say, I have hip pain. But that’s not osteoporosis. Osteoporosis is the thinning of the structure of the bone. So if you think of a thick sweater that’s knit very closely, healthy bone is like that. It’s got a lot of solid bone material on the inside, and a strong covering of bone on the outside.

So the bones that are most vulnerable to the menopause transition, when the loss of estrogen produces loss of bone, are the vertebrae in the spine and then also the hip. But the vertebrae go first because there are actually estrogen receptors in those vertebrae and in the hip. So a woman could feel just fine and not have any issues with bleeding or hot flashes, which are very common. Eighty percent of women get either bleeding, or eighty percent of women get hot flashes, but almost everybody gets bone thinning. So the stronger your bones are before you get to perimenopause, the more bone you have left when you lose some. So I’ve lost some too, even though I’ve always, I exercise, I get enough calcium in my foods. I do what I tell patients to do. But you’re still going to lose some bone.

So I try with my young patients. I say, look, you’re healthy now. This is when you want to have your peak bone mass. So this is preventive medicine. And I say, this is a time when you want to get really strong bones, because a few decades from now, your bones are going to start to thin. And the stronger your skeleton is, the more strength and health you’re going to have for the rest of your life or your health span.

And then heart health also suffers in perimenopause. So before the final period of menopause, women have less heart disease than men, than their male counterparts with similar health and similar age. So once the estrogen is gone, they lose that protection. So then they become more vulnerable. And unfortunately, women don’t have the same kind of heart symptoms that men have. So men will have crushing chest pain. It feels like an elephant on the chest. It may go down the arm. It may go to the jaw.

And many people will know this man is having a heart attack. Let’s do CPR and help hi,m and call the EMTs. For women, this is not a common pattern. So women commonly suffer from vasospasm, the vessel spasm. They don’t get completely blocked necessarily, and women tend to have smaller blood vessels. So their symptoms can be very idiosyncratic. They might just feel anxious, and when women feel anxious, they go, You’re just anxious. Just calm down. And that doesn’t go well. They could feel panicky or anxious. They may have indigestion. They may have very non-specific, they go home and their heart attack is not treated early.

So women’s survival after heart attacks is much worse than men. So now we have had researchers study this, and we’re getting better at which tests actually diagnose women’s heart conditions, but we’ve been behind for a long time. So heart health is important to address in terms of prevention and maintenance, because it’s harder to diagnose heart disease in women, and women don’t do so well after their heart attacks as men do.

So we have bone health, heart health, and these are all silent when they’re developing. And I would say, also mental health. Women are more vulnerable to depression, even if they’ve never been depressed. So in the perimenopausal period. And one of the theories is that the estrogen is very erratic in perimenopause. So it can go very high.

Actually, people don’t realize, they think perimenopause is low estrogen, but it’s actually erratic. So it can go very high, and very low. And those peaks and valleys are very disruptive, because women are used to gentle hills and valleys. When they ovulate, they have a peak. And then before the period, they have different things happen. And it’s pretty predictable. But in perimenopause, that’s all thrown to the winds for a lot of women. And these volatile estrogen levels have a relationship to serotonin, which is the feel-good neurohormone. So when your serotonin’s all over the place, you’re not going to be very optimistic or feel very good. So some women, even if their lives are very rewarding, and they have a partner that they care about, and their life is going well, they may be depressed because of the physiology of the perimenopause. And the women who are particularly vulnerable are those who have had depression in the past, such as postpartum depression or even severe PMS. But even women who never were depressed can find that they get depressed in perimenopause.

So mental health is also important, and social, staying social and engaged with things, and using your brain for things you enjoy and also new things as you age. And then staying active with physical health. So some people, they say, gee, I eat the same and I exercise the same. But you actually have to shift your exercise to maintain a healthier weight and to keep your bones strong.

So I’m a walker. I tell patients I’m a walker, and many of my patients are walkers. So it helps the hips, the heart, and the brain, but it doesn’t help that spine. So if you want bone health, you have to do weight-bearing exercise. And it’s not just any kind. So many of the weight-bearing exercises that we women have access to are bimanformant. You do a bicep curl, you get a nice bicep, you do a tricep, and that’s all very lovely, but it doesn’t help your spine either.

So a woman named Miriam Nelson, who is a PhD at Tufts in Massachusetts, developed these exercises. And the range of motion addresses the bone strength in the spine and in the hip. And she also has some excellent balance exercises, which is another thing to avoid, falling and breaking a bone.

And just as an aside, so for hip fractures, sometimes it’s not that someone is clumsy or they fall. They actually break the hip, and then they fall. So there are a lot of things like that. So fall prevention is an issue, and muscles that get weak and aren’t supporting the bone become issues. So there’s a physical component, a mental component, and then the silent component where you want to prevent heart disease and bone thinning, because they’re going to be very common once the estrogen’s gone.

Cory: Right. And going back to heart health, are there different markers that would be looked at as it relates to the heart health program?

Julia: Yes. And we’re getting new ones all the time. So, depending on where you go and what’s available. But the very basic ones are very important.

So blood pressure. We want the blood pressure under 120 over 80. We want the sugar metabolism to be healthy, the glucose metabolism. We want to avoid diabetes, or if there is diabetes, manage it very well. So the cholesterol panel, we wanna look at that and make sure that’s in line because the higher the cholesterol or the lipids are abnormal, then we want to avoid certain medications and support with other lifestyle measures. So those are the general parameters.

And then, depending on the history and how the person presents, will determine what kind of interventions there are, or what kind of assessment of the risk. Family history is very important. I always ask, did anybody in the family, in the immediate family, or aunts and uncles,or  grandparents have a heart attack? And if so, what age? So that’s helpful too.

And then, of course, you have the personal history of the person you’re talking to. Do they get regular exercise? Do they get aerobic exercise? Some strength training? What about their diet? Things like that.

So we are developing new tests, and they have risk estimators. And there are several of them. But without getting too technical, if you go to a family doctor, or an internist, or some gynecologist, we’ll do that risk profile for you. But it’s still very basic. Make sure that blood pressure is okay, look at that cholesterol, things like that are very important parts of those risk calculators.

Cory: And as you were talking about the peaks and valleys of estrogen and the serotonin relationship, what is it that can be done to help that rollercoaster’s happening?

Julia: So here are different degrees of depression. There’s what they call major depression, and then you have milder depression. So major would be if you’re thinking of killing yourself, or you always want to define how serious it is and how acute. So there’s a variety of medications, but interesting to me is that talk therapy works.

So there’s something called cognitive behavioral therapy or CBT, which has been shown to be extremely effective for perimenopause and menopause and blue mood or poor mood. And it actually helps women rewire their brains, which I find fascinating.

So medication is not the only route. And lifestyle helps too. So researchers have shown that exercise can help. And certain lifestyle measures, getting enough sleep, and getting quality sleep can help. Most of us get more anxious if we don’t have quality sleep or enough sleep. So things like that, managing stress.

A Canadian colleague of mine, Dr. Claudio Soares, who is now the president of the Menopause Society. He and his colleagues did an excellent workbook that’s on Amazon, about a sort of self-paced program on cognitive behavioral therapy for menopause. And also therapists who are trained in cognitive behavioral therapy can be very helpful to women. So it’s not all about medications. Some women do need the medications also, but the cognitive behavioral therapy is a very helpful thing to keep in mind.

Cory: And I would be remiss if I didn’t pick up on the c word that you used briefly, Dr. Julia. What’s the relationship with cancer and menopause?

Julia: Okay. So it’s actually, I think, more aging than menopause. So men gradually age, and their testosterone gradually goes down, but they don’t have the aging and the abrupt loss of testosterone that women have with estrogen. So women have that unique physiology because they’re set up for childbearing, whether they choose to have a child or not. They have that whole apparatus organized with all the endocrinology and hormones, and things that talk to each other in the body, from the brain to the ovaries to the uterus. So when that dissembles in postmenopause, and the ovaries no longer produce estrogen, then all the physiology changes. And there’s that abrupt, or pretty abrupt withdrawal of estrogen. But at the same time, the aging is continuing right in the background.

So cancer increases with age in general, but it also increases with a lot of the things that happen in peri and postmenopause. Many women gain weight. Many women become insulin-resistant and don’t metabolize their sugar well. Many women become less active. And so these are the types of things that can increase inflammation. They can increase heart disease, and then they can increase many forms of cancer.

So some of them are related to age, and there are more mutations. So the cells, when they replicate themselves, make more mistakes as you go on, and the hair can turn gray because they’re not going to make the same color they made when the person was 20. So those kinds of mutations, you get more spots on your skin, and different things happen. You get wrinkles and so forth. Maybe lose a little height. So the mutations can cause cancer as well. So you do see an increase in cancer, but in the setting of inflammation, in which some of those changes I just described happen, a lot of researchers think that increased inflammation also increases the risk of cancer. So I think it’s a combination of things.

And so in the book, I have a whole chapter on cancer prevention, which I haven’t seen elsewhere. So I have what the female cancers are that women are at risk for, and prevention measures. So there are a lot of lifestyle things that can be chosen, and they will lower the risk of breast cancer.

So, for example, women who have more than one serving of alcohol a day will increase the risk of breast cancer, because the body is busy clearing the alcohol instead of the estrogen through the liver. So the levels of estrogen build up, and the breast tissue is seeing more estrogen than it should. So alcohol is one risk factor, and there’s other ones for breast cancer besides family history. So one out of five women who have breast cancer have a family history, but four out of five don’t. So family history is only one component. But there are lifestyle things such as the alcohol, and I have other ones listed there. And also ones that aren’t true that are missed. 

But there are quite a few things that for cervical cancer too, we have strategies, getting pap smears will allow you to identify it earlier, but our younger patients are getting this HPV vaccine, the human papillomavirus, which causes over ninety-five percent of cervical cancer. And you have a great champion as a colleague and friend of mine, Dr. Vivian Brown in Canada, who’s very active about communicating to patients and clinicians about the HPV vaccine lowering the risk of cervical cancer. So we have strategies for that. Also, women who smoke have a higher risk of cervical cancer.

So I have all these lifestyle, risks, and things that you can choose that lower the risk.

I cover breast cancer, cervical cancer, ovarian cancer, and uterus cancer, and also discuss the more vulnerable populations. So some heritages have more risk factors for getting certain types of cancer. So I review that as well. So there’s a lot in there, and there’s also screening. So there are lots of things to talk about there.

Cory: Right. And as humans, we tend to focus on what hurts the most at that moment. And so some of these topics of cancer prevention, heart disease prevention, and bone health, extremely important. But I want to go back to the hot flashes. The things that make us uncomfortable in that moment, that probably are disturbing sleep and keeping us up. And I’m sure there’s some overlap here, but some of the strategies that you have that maybe can help with that symptom of hot flashes.

Julia: Sure. So caffeine doesn’t cause it, it’s a trigger. So some of the patients, this is not a treatment for high fallages, but I find if patients can taper their caffeine a bit, I’m not talking about eliminating. I like coffee too. But just slow tapers so they don’t get withdrawal headaches, makes a huge difference. Alcohol is another trigger for hot flashes. So I think knowing the triggers, stress is another trigger. That’s a little harder to address. But knowing those triggers is helpful. Then having said that, we have a wide range of things to offer patients.

So for people who want non-hormonal treatments, I go with the lifestyle first, and many women find that works well for them. And then we have some over-the-counter supplements that are well-studied. And then we have medications that are prescription that are used. So one of them is a common antidepressant called paroxetine, and they studied paroxetine and came out in the US. It’s a brand name, BrisDell, 7.5 milligrams is good for hot flashes. But the new thing on the block is to go back to that thermostat, those neurons, they’re called candy neurons.

 It’s an acronym for kisspeptin, neurokinin b, and dynorphin. And they’re neurons in the brain, in the hypothalamus, that are responsible for temperature control. So in the past, we hadn’t identified those things. And so when women lost estrogen and they got horrible hot flashes or night sweats, the mainstay was estrogen therapy. And many of us still use that. But for women who can’t take estrogen or don’t want to, we now have blockers that just go to those receptors, and it’s not estrogen.

So if you have someone with breast cancer, they can take this medication. So the first one that came out was Fezzelenetan, and that’s the generic name. I don’t know how they come up with these names. And, there’s a new one, Elizanetan, that just came out a couple of weeks ago, that blocks two sites on the receptor, and they’re very effective for blocking hot flashes and night sweats. And you can take them indefinitely as long as you don’t have any problem with them. 

And, the second one may help with sleep as well. So that’s a huge thing for women. So we’re constantly adding to the tool chest, what things we can offer women, so they don’t have to suffer. And we have quite a few more things to help them with. And there’s cooling pillows and all kinds of things that I have listed in the book that people can look at.

Cory: Fantastic! Dr. Julia, as we near the end of our conversation today, there are a few questions that I ask each guest before we wrap up. Are you ready for the tough ones?

Julia: Sure.

Cory: Alright. What is one key strategy that you believe is essential for building a successful family enterprise?

Julia: So I think it’s really important to hear everyone involved in the enterprise. So everyone will have a unique perspective that might be helpful, and everyone might have different ideas about how the enterprise should be run, and they may have different requests or preferences. But I think it’s really important for everyone to be acknowledged. 

And I think you can learn a lot from your colleagues or family members when you hear what their perspective is. And so I think that’s really important, not to just have a hierarchy and things get passed down because someone has more experience, because their experience is different, even though it’s a very rich experience. Other people have important experience to share as well.

Cory: Right. I think that builds nicely on it’s okay to to be an outlier as we started with that. Going back to “we also need to acknowledge those outliers and bring those into the fold.”

Julia: Yes. I think that does dovetail well.

Cory: And what is the most common challenge that you see family enterprises encountering when it comes to the transition of wealth, and continuity in the family unit?

Julia: So I don’t work in family enterprise. My husband does, so I’ve learned a lot from him, and he’s been on your podcast, Paul. I think work-life balance is a challenge, because each generation has their own notion of what work-life balance is, and they have different priorities and goals. So I think it’s important to incorporate different views of work-life balance in whether it’s a business, or practice, or an organization, or a family enterprise, so that everybody feels that it’s a place they can thrive, and they don’t just have to conform to the leader’s vision of work-life balance.

Cory: Right. I didn’t state this at the beginning, but, as a practitioner, I think that you mentioned stress, and stress is a very difficult thing to manage. But I think that you get to hear such a different perspective as you work with patients. And as much as you might not work in that system, as it relates to the family enterprise itself, I think some of those conversations that you’ve had, one-on-one, with patients, probably does give you quite a bit of insight.

Julia: It’s fascinating. You learn so much from the patients. I learned medicine from the patients because everybody reads different things and has different clinicians helping them, and there’s always more information. I learn all day long. It’s very, very interesting.

Cory: Absolutely! And in your experience, what are the top three key qualities that a successful family enterprise or just a successful leader possesses?

Julia: I think you have to be a good listener. I think you have to welcome new ideas, and you have to be able to integrate diverse kinds of input and strategies so that you have people who want to work there and bring their best contributions. So on a smaller scale, I have a wonderful staff at the moment, one of the best teams I’ve had. And we were redesigning the lab area and let them redesign it because they work there. They sit there all day long. I mean, I had input, and I covered the cost of it. But they said, gee, we think the counter should be this high, and we want to sit here and there. Said, let’s do it.

So I think honoring how people feel about their workflow and their input is really important, because they see pieces I don’t see. And the medical administrative assistants are upfront, they’re answering the phone all day. They hear things I don’t hear. So what the patients are asking for, what they’re saying. And so it’s very valuable to hear what they say and what they think about how the workflow should go, and what things we need to serve patients better. And I think that’s true in families too. None of us have the perspective of every person in the family. It’s true with kids, spouses, parents, or whatever. You know, it’s just everybody has a different perspective. So integrating that, I think, is really key, and not insisting that a leader’s perspective is the only one.

Cory: Fantastic! And before we conclude our discussion today, I’d like to highlight where our listeners can engage in more of the conversations that you’re having. Throughout our discussion, you dropped some great names. So we’ll make sure to find those resources and link them in the show notes. But can you kindly provide us with any additional resources?

Julia: Sure. I can help you with those links. The cognitive behavioral therapy book is listed in the book I mentioned, the set that I just wrote, The Savvy Woman’s Guide to Menopause Before, During, and Beyond. So that’s on Amazon, and Barnes and Noble.

The sleep book is also on there, the Successful Sleep Strategies for Women, which, and it’s also for men too, but they asked me to write it for women. So it has some particular risks for women. So that’s for women 18 and over.

And then the website for the practice that I started is womenshealthne.com for New England, that I’m going to be posting some blogs with information along the lines of what you and I discussed that people might find helpful.

And then there’s some newer technical therapies that individuals might find helpful, both men and women, for urine control that many people find challenging as they age. And that’s on juliaedelmanmd.com. There’s some new technologies from Europe and from The US that have a lot of benefits for people, helping with bone mass and muscle mass, and just helping. Sometimes people are taking GLP ones to lose weight, and they lose a lot of muscle mass, so we can restore the muscle mass and give them a boost. So there’s information on that on the julieedelmanmd.com website as well.

Cory: Fantastic! And I wanted to make sure that we covered everything today. Is there anything else there you’d like to share with our audience that maybe we just didn’t get a chance to touch on?

Julia: I think you did a great job. I think we covered a lot. I mean, there’s basically the silent changes that it’s good to be aware of. And then as you pointed out very well, there’s the physical things that bother you that make it difficult to get through the day, and it’s important to address all of them. And it’s good to have a clinician, whether it’s a nurse practitioner, physician assistant, or a doctor that’s in tune with these preventive measures.

If someone is looking for a menopause clinician, they can look on menopause.org. That’s the Menopause Society site, and there are a lot of good educational materials there that are all evidence-based. And they have a lot for patients and for clinicians as well. So you can also use that to identify a practitioner, whether it’s a nurse practitioner, physician assistant, or doctor that has some training in menopause, you get a lot of these points addressed if you’re not able to address them elsewhere.

Cory: Fantastic! Well, thank you so much, Dr. Julia, for taking the time to share your expertise and experiences with us today. I’ve sure learned a lot, and your insights have been incredibly valuable to me, and I’m sure that our guests will be very grateful for your contribution as well.

Julia: Thank you, Cory. It was a pleasure to talk with you. Thanks for inviting me.

As we wrap up this episode, we invite you to take a moment to reflect on Dr. Julia’s invitation to rethink the paths we follow and how listening to our own instincts can lead to care that feels more grounded, authentic, and responsive to what really matters.

Whether you’re part of a family enterprise or work alongside enterprising families, her perspective reminds us that overlooked topics like menopause, aging, or health equity deserve our attention, and that lasting change often starts with deeper awareness.

Throughout our conversation, Julia offered a grounded, candid view into how health, identity, and aging intersect. She reminded us that many vital topics like menopause, mental health, bone strength, and heart health in women often go unnamed, even though they shape our lives in lasting ways. From the science behind hormonal shifts to the silence around aging, her reflections invite us to stay curious, speak openly, and create space where overlooked experiences are acknowledged and supported.

If you’re thinking about how to align decisions with values that matter for yourself, your clients, or your family, Dr. Julia Edelman brings deep clinical insight and decades of experience to that work. Her writing, including Menopause Matters, Successful Sleep Strategies for Women, and her latest book, The Savvy Woman’s Guide to Menopause: Before, During, and Beyond, reflects a commitment to making complex health topics accessible and actionable. You’ll find links to her books and contact details in the show notes.

Disclaimer: 

This program was prepared by Cory Gagnon, who is a Senior Wealth Advisor with Beacon Family Office at Assante Financial Management Ltd. This not an official program how Assante Financial Management and the statements and opinions expressed during this podcast are not necessarily those how Assante Financial Management. This show is intended for general information only and may not apply to all listeners or investors; please obtain professional financial advice or contact us at BeaconFamilyOffice@Assante.com or visit BeaconFamilyOffice.com to discuss your particular circumstances before acting on the information presented.