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ETHAN MOLLICK: We are naturally quite

bad at thinking about change.

Humans have difficulty imagining the world altering

very rapidly, which is why it's so hard for us

to wrap our heads around the state

of artificial intelligence.

Because right now, we are seeing very rapid change--

from politics to culture to how we work to how we learn.

And so part of what we get to do in this particular moment

is think about what happens to the world as a result of AI.

And it's up to all of us to figure out

how to use this for good.

I'm Ethan Mollick, a professor at the Wharton

School of the University of Pennsylvania.

I'm the author of the book Co-Intelligence:

Living and Working with AI.

And over the last few years, I've

been studying how AI will shift how we work, how we learn,

and how we relate to information and each other.

By the end of this class, you'll have the tools to fully interact

and engage with AI, which I think

is an important thing for all of us to be able to do.

AI has already created a profound set

of changes in how we think about the world.

It's very hard, almost impossible in most cases,

to detect what is created by AI and what isn't.

And that means that the world is now

a blend of real content created by humans and AI content,

and we'll never be able to separate the two of them.

In fact, this set is a mix of real and unreal.

The chair, completely real.

But as for the rest, can you go wide on this?

Maybe you can take us outside?

Nice, but I think the city scene would

look much prettier at night.

Beautiful.

Not quite reality, but also not entirely fake either.

So with that in mind, let's get back to the set and get started.

I'm Ethan Mollick, and this is MasterClass.

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In studying the history of science,

we have this idea of general purpose technologies.

These are once-in-a-generation technologies that touch

and change many things about society.

So the last one was probably computers and the internet

together.

[DIAL UP NOISE] Before that, electricity.

Before that, steam power.

AI, it certainly is a general purpose technology itself,

which means that its implications are widespread.

And the truth is AI matters in our lives right now.

The tools that we're going to talk about

are tools that you have access to today.

And in this class, I hope to show you some of the ways

to use AI to your advantage.

In this class, you're going to hear from top practitioners

about how to use AI to improve your productivity--

This is getting me to the 30 mile an hour mark.

I'm going to take it to 60.

--help supplement your creativity--

It could be used to replace you

or it could be used to amplify what you love.

--and make AI work for you.

I like to teach people how to make it part of our world

without it taking over our humanity.

Using AI can feel uncomfortable.

It can be uncomfortable because it

can be weird to interact with a machine that feels

human-like to interact with.

It can be uncomfortable because you might worry

about your job being replaced.

And I think those are legitimate worries.

But I don't think we have to consider it

innately weird that we're working with computer systems

intellectually.

If I told you at the dawn of the computer revolution

that our lives would be intertwined with computers,

that might sound pretty freaky.

But, like, I've got a phone right here.

And you almost certainly are watching

this on a computer device.

We are entwined with technology already.

So the idea that we have a new form of technology

that helps us think isn't as weird as you might first guess.

So the idea comes from the 1950s and has its basis well before

that of the idea of making a machine that can think like

a human.

Early forms of AI would follow a trend line.

So they'd be able to predict the next number in a sequence,

but they couldn't predict the next word in a sentence.

Because if your sentence ended with the word filed,

the didn't know whether you were filing your taxes

or filing your nails.

A new technique was needed.

In 2017, that technique was developed and published

by a bunch of Google researchers.

And that let the AI pay attention

to not just the last word in the sentence,

but the entire sentence, entire paragraph, entire page,

entire book, which let it create realistic-sounding human

language, basically, the world's fanciest autocomplete system

that cost billions of dollars to make.

It turns out, though, that by making the world's

fanciest autocomplete system, they created a new form of AI.

We called it the large language model.

Large language models are prediction machines.

They're autocomplete machines.

All they do is produce the next word in a sentence.

However, at some sort of scale, where these systems

have learned from enough human language,

they have learned the structure of human language,

because that's what they predict.

And by learning the structure of human language, at least

according to one theory, they seem

to have learned the structure of human thought.

Even though they're not thinking,

they can produce things that look like thoughts,

which is kind of amazing.

When AIs work with and manipulate language,

they don't see it the way we do.

We think in terms of words and sentences.

The AI sees tokens.

Tokens are just a set of characters.

Though it can be a part of a word,

it can be part of a word in a space, numbers,

all of those things get turned into tokens.

So if you have a 10-word sentence,

that might be 17 tokens and broken up in very unusual ways.

However, it turns out with enough scale,

with enough context that it's read, with enough training

material, it starts to act in ways that we wouldn't expect.

The concept is called emergence.

Emergence is the idea that AI can develop abilities that it

wasn't programmed to have.

I can tell it to write a letter set in 16th century fictional

Japan that is a rhyming sonnet all about my cat and expect

to get an answer.

And it's definitely not in its training set.

By being trained on human language,

they have learned the structure of human thoughts.

One great example of emergence is the finding

that AI seems to have, under many, but not all cases, what

we call theory of mind, which is simply the ability that humans

have to guess how someone else is thinking.

So if I told you a story that Sally and Tom went to the store.

Sally brought her favorite ball with her.

Tom accidentally kicked the ball and it rolled into a gutter.

How does Sally feel right now?

You'd know that Sally felt sad.

It's really a human characteristic.

AI answers as if it has theory of mind.

It does theory of mind as well as adult humans do.

Is it actually emotionally putting itself

in this shoes of Sally?

No, that's the way a human does it.

There's some sort of other process.

But we didn't expect it to have theory of mind, and it does.

What all this means is that if you get freaked out by AI,

you probably should be, right?

It is freaky, but that doesn't mean

that it's actually a human in the box

or it's thinking like a person or becoming self-aware

or is actually interacting with you.

That is an illusion.

It's not actually thinking.

People are exquisitely good at finding ways to work less hard.

That's what we try and do as humans.

If there's something we can do to work less hard

and get paid for it, we will do that.

And when you have AI, it's kind of like having a cheat code

to large aspects of life.

There was no way to have you generate better ideas before.

Some people were just better at idea generation than others.

Now, we have a tool that we have done studies on,

papers that I've been involved in that

show that it's highly creative and can

generate really good ideas.

From a writing perspective alone, the AI

can help you come up with an initial idea,

help you outline an idea, help you critique your outline,

help you write the actual paragraphs,

help you refine them, act as a superpowered grammar checker,

give you opinions of what works and what doesn't, make your work

more vivid or simpler.

And that's just kind of writing tasks, right?

And then we can move on to any other kind of area

we see similar kinds of stuff.

It can give you feedback like a manager.

It can watch a video and give you

tips on how to improve your speaking or your pitching

performance.

The idea is that you're using this sort of Swiss Army knife

tool on a regular basis blending what you do

and what the machine does seamlessly.

One of the most important principles of using AI,

and one I stress a lot, is always invite AI to the table

where you ethically and legally can.

What that means is that any task that you do, bring AI in along

as a companion.

Consult it on decisions.

Use it to write your emails, analyze meetings,

to give you ideas.

And I think the first thing to be clear

is, like, this isn't something that needs to be forced on you,

right?

So you're here in this class with me

because you want to learn about this.

If you're running screaming after this, that's okay.

There are ethical rules that you might not want to cross.

You may disagree with how AI is used, how it's built,

completely fine.

If you want to use it, though, you do need to push through.

And pushing through involves spending enough time with it.

My rule of thumb has been 10 hours in an area

where you have expertise.

So bringing it along in the tasks you do every day

is the best way to learn what it's good or bad at.

When you use the thing, you're going

to learn that it is both amazing in some areas

and incredibly weak at others.

AI has what we call a jagged frontier.

The jagged frontier is a phrase we came up with

to explain the capabilities of AI.

If you think about AI as having a set of capabilities,

they're not like good at everything.

They're really good at some things and really bad

at some other things.

And that frontier, though, is always changing.

It's always growing.

It's expanding.

And you want to understand the shape of the frontier.

And the way you do that is by testing

the most advanced models.

And as you use it more, you'll start to understand where

it's good and where it's bad and how it helps and how it doesn't.

Hallucination is when the AI says something that

is plausible, but incorrect.

The most important thing to know about hallucinations

is all AIs do is hallucinate.

They don't have truth.

All they do is predict the next word

in the sentence, the next token in a sentence.

They are just looking at the sensical patterns

of every previous thing that's written

and producing the next word in the sentence.

Like everything else, as you scale these models larger,

they do better.

Most of the time the AI says stuff, it's actually correct.

Usually, that's why I recommend starting

with areas of your expertise.

Because in your area of expertise,

identifying what's true and what's false

is very easy, very cheap, very fast.

And that's how you start building confidence

from that centerpiece.

This class is really for people who want to explore.

They might be nervous about it, but they want to figure out,

is AI useful for me?

And I can't answer that question for you.

You're going to have to figure that out yourself.

And so I'm going to give you the tools

and the other practitioners in this class

will give you the tools to figure out what AI is good for,

what AI is bad for, and how the future of your own work

might change.

There's no one better to get you to think

about how to boost your own productivity than Allie K.

Miller.

And I'm really excited that she's here

to teach you some of what she's learned

about how to work with AI.

My name is Allie Miller.

I started in AI almost 20 years ago

with a college project working in natural language processing.

I wanted to study whether an email was flirty or not flirty.

Now, this is before smartphones existed,

and so everyone is flirting over email.

But I discovered I could create an algorithm that

determined whether an email was flirty or not.

And as a confused college student, let me tell you,

that was unbelievable to have.

And it went completely viral on campus.

And even though no one really cared about the fact

that it was AI, people cared about the value behind it.

Since then, I've worked across data, computer vision,

and even launched the first multimodal AI team at IBM,

where I was a lead product manager for several years.

I left IBM and went to Amazon.

I was the first hire for the AI team for startups and venture

capital, grew it into a multi-billion dollar business.

And I'm now the most followed voice online for AI business.

My main goal every day that I wake up

is to try and be that bridge between the very technical world

of AI and the world of business, so that every single individual,

every team, every company can figure out

how to be AI-first in the AI age and start

with that AI-first mindset.

An AI-first mindset really means three things.

The first is thinking about AI as a copilot,

as a collaborator on whatever it is you're working on.

Second is using it as a first step and a continued

step throughout the process.

The third is the ability and the willingness

and open-mindedness to rethink an entire process with AI

at the start.

Action is empowerment, and that was true before AI.

But AI is now an additional tool that

can help you feel even more empowered

in your day-to-day life.

Keep a little journal of all the tasks

that you take on for the next week.

One thing that is going to jump off the page

is that there are going to be repetitive, digitized tasks

that you can start to lean on AI to take off your plate.

That might look like managing your grocery list, your workout

plan, how you want to spend your day.

And so just take a look at that task and pick one to start with.

And that is going to open up your mind.

And not only that, but it is a very helpful tool

in entrepreneurship.

First step in every single business is brainstorming.

What is the actual idea that you want to build?

Who are you building it for?

What's their problem?

And how are you going to solve it?

And so the first way that we're going to be using AI

is as a brainstorming buddy.

This is when it gets into prompting.

Prompting is just the way that you give instructions

to an AI system.

The amount that I use AI on a daily basis

always feels a little weird to share with people,

but I probably use ChatGPT 20 to 40 times a day.

There are prompting levels of all kinds.

You can be a beginner prompter where you're

typing in one quick sentence.

That's a prompt.

It's not a good prompt, but you start it.

We all had to learn how to Google from scratch.

Now we're going to learn how to AI prompt from scratch.

At the heart of using AI is the prompt,

the information that you're giving the AI for which it

produces an answer.

So if you think about what the AI is drawing information from,

it's all of human knowledge.

Consider it like a sphere.

And all the possible words or tokens the AI can select

are in this sphere.

And the high probability options are all in the middle.

And outside are rarer, less likely options.

If you want the AI to do something interesting,

do something different than other people do

that gives you ideas or innovation

or gives you a unique edge or doesn't sound like AI writing,

your job is to give it context, to push it

to a different part of the probability space.

One way to give it context is to give it a persona.

So that persona can be, again, you're a very good marketer

or you are an expert in selling insurance policies to hospitals.

Treat the AI like a person, but first tell it

what kind of person it is.

Okay, so I'm going to use ChatGPT.

And the first step is assigning an identity to the AI

that we're going to be using.

You are a marketing expert.

You are a struggling MBA student that cries every day.

So I'm going to have here, "You are a repeat successful

entrepreneur."

This sort of anchors the AI into a world.

The next thing you want to set up

after this identity, after you're

putting AI in a mindset of its own,

you want to tell it what you want to do.

What is the literal task that you want this AI to complete?

Write me an email.

Write me a screenplay of two robots falling in love.

You're going to give it a task.

You will help me, an AI expert, create a brand new business idea

and help me to decide which of those businesses

I should pursue.

And after you go through that process, hit Enter.

See what happens.

So it comes up with five business ideas.

It comes up with a home office designer,

a mental wellness companion, a platform

to help me bond remote teams together,

lifestyle tracker, and a sort of freelance marketplace.

One thing that I now want to give it--

and I could have put this in the original prompt, but now,

we're going to have some fun edits--

is that I want to give it additional restrictions.

If you would ask the ad agency that created the phrase "just do

it" for Nike and you said, come up with any single motto

in the entire universe, they might have come up with,

you know, three fairly generic things.

If you instead say, it has to be three words

and it has to be at a first grade reading level,

right, suddenly, putting yourself in that box actually

makes you more creative.

Maybe you can only build this business for two hours

every single night.

You don't want to quit your job.

Give it those restrictions.

It actually breeds creativity.

So I'm actually going to say, I have new restrictions.

We have to finish the build in under three months.

So the first thing that I love that it did

is it first re-evaluated the five business ideas

that it gave me.

So it's already figuring out that some are feasible

and some are not and they're removing the not feasible ones.

Then it's coming up with newly feasible ideas based

on those new restrictions.

So it comes up with a finance tracker.

It comes up with a local event finder.

That actually sounds really helpful.

It comes up with a time management tool and even a meal

planner.

So all of these are now feasible.

They're all within my restrictions.

A really big call-out here, if you use AI for things that there

is a right answer-- there's a statistic,

there's a specific company name, a specific CEO--

you want to verify that this stat actually exists.

And that's when you want to really do,

that extra due diligence, double check it on Google

and make sure at least two reputable sources

have said the same thing.

I've got more business ideas than I know what to do with.

I am now overwhelmed.

I am now in need of a snack.

So what I'm going to do is I'm going

to ask ChatGPT to score all of these

on features that matter to me.

So, "Create a comparison table of all the previous feasible

business ideas.

Measure it on the factors that matter to me."

Now, I haven't actually told it yet what those factors are,

so I'm going to now create a new section for factors.

You can go nuts with these factors.

You can have 100.

It really doesn't matter.

For this, I'm going to keep it a little simple.

I asked it for the budget.

How much money is it actually going

to cost to build this thing?

I asked it for the feasibility score.

We know that all of them are feasible,

but it's helpful to get a scale.

We asked it for speed-to-market score.

Again, we told it that we want to build in under three months,

but maybe one of these ideas would only take two days

and that might be really exciting.

And we asked it for a "yes" or "no"

answer to, "Can I own a dog while running this company?"

And I love this.

I love that it gives me a table.

It helps me handle sort of an overwhelm of information.

Already, my eyes are going to the lowest budget estimate,

and that is for to-do list.

The feasibility score is really high,

speed-to-market score is really high.

And so if those factors are more important to me, which they are,

I'm going to go ahead and we're going to do this to-do list app.

And now we're going to actually figure out

what that app is going to do.

"Summarize this app description.

Give me 20 creative names for it.

My goal--" I love giving it goals--

"is viral word of mouth."

Awesome.

So it gave me a super helpful app description

in less than a second.

I could even prompt it.

And I can say, "Make this under 300 characters."

I could edit it myself, but I don't feel it.

It's giving me 20 creative names.

I kind of like Priority Pal.

Task Wiz is okay.

Some of these are honestly awful.

[BUZZER]

But, again, using AI as this like 10X mechanism to get that

much more creativity going.

If at any part of this project, you are stalled,

this is when the AI-first mindset comes into play.

If the caption is too long, use AI to shorten it.

If it's not working, literally give it to AI and ask, hey,

I got this weird output.

How can I optimize the prompt to make it better?

Every single point that you get stopped at,

I want you to ask yourself, can AI help?

Let's go with Priority Pal.

Next thing we want to do is boost up this idea.

How can we use AI to make it more risk-mitigated, better

in the market.

So to do that, we're going to build

a GPT that basically evaluates a business idea and pokes

and prods it to weigh it against certain risks.

The most useful part of building a GPT

is if it is a task or an automation

that you have to do a ton.

So if, for example, you're always

taking a sales call transcript and converting it

into a follow-up email with your client.

Once you start doing something, honestly, three times,

you're going to want to build a GPT for it.

I'm going to hit Create GPT.

And this is going to open up a brand new split screen.

Any single person, doesn't matter if you code,

you can build a GPT, I promise you.

You can either do it in this natural language conversation

way, where ChatGPT is asking you questions

and you're going back and forth, or you can switch over

to the Configure tab, where you're basically just giving it

the instructions and name.

So it first asks, what would you like to make?

I'm going to say, "I want to build a bot that helps me

mitigate risks in my business."

It comes up with a name.

It's called Business Risk Advisor.

Sounds great.

Let's go for it.

So I'm going to have it answer four risk questions.

Those four questions are, are there

any financial considerations we haven't taken into account,

legal considerations, product considerations, and user

considerations, and one opportunity question.

We're going to say, and what is a huge business opportunity

that I might be missing?

And I'm going to say, my boss will

make me cry if you don't answer these five questions.

I am not advocating that you threaten your AI bestie,

but you got to do what you need to do to get it done.

So prompting is sort of like a little bit of a weird game.

If I prompt AI, I will get different answers

depending on how many spaces or periods I have in my text.

I get different answers and, actually, I

can increase the quality of the AI's results

by offering it a small bribe or telling it.

My career depends on the answer.

You get the most accurate math problems by pretending

you're in Star Trek and saying, "Stardate," you know, "4732,

we are on a doomed mission.

The only way to escape the wormhole is for you to solve

these math problems."

And it does a better job, more accurate answers.

But if you want to solve 200 problems, you need to say,

"The president's advisor is gravely wounded

and it's incredibly important that we solve these math

problems to save him."

And that gets you more accurate answers.

So it's super weird, right?

Those kind of techniques improve the outcome

of your AI's answers, right?

People get really tied up about prompting.

They get really anxious about it.

Do I offer it a $20 bribe or a $100 bribe?

And the answer is, it just depends.

It comes out in the wash.

Like, what do we do with the system

where we know that how you capitalize things

makes a difference?

Whether you use ellipses or not makes a difference.

We have no idea.

Just work with the damn thing like a person and you're

90% of the way there.

So we go back into that thread that

already knows about Priority Pal, that

already has our business plan.

And now I'm going to call--

think of it just like you're in class.

You get to call on people.

I'm going to call upon my business risk advisor.

Calling is what you do to bring up different GPTs.

You can access public GPTs.

You can access private ones.

You don't have to repeat yourself.

You can do it in thread.

You can call unlimited GPTs.

And so you can call each of these GPTs in a stack,

in a workflow.

And I could have each GPT call in and just

say, what do you think about this idea?

What do you think about this idea?

There's some really creative ways to get into it.

Now that I'm talking to that business advisor,

we're going to say, please review the above product

against the five questions.

It's going to run through each of these.

And now, again, turning this output into action.

I'm going to take this list and my team

and I are going to review this bullet by bullet to figure out,

is this a risk we want to handle today?

Is this a risk that we're okay pushing off?

Do we maybe want to remove a feature?

All of this is about making my business idea that much more

robust.

We've brainstormed our business.

We've built out a product description, a business plan.

Now we get to move on to the visual stage.

Using an AI tool, we are actually

going to generate a very simple landing page.

Framer is an app that lets you build a website or a landing

page in seconds.

So we have that product description.

We're going to go into Framer and ask for a simple landing

page for the following.

I could have also given it some prompt information

around the color scheme that I want.

I could have given more information on the layout.

But for now, let's just see what it came up with.

This

Is giving you the same website, same landing page

in three different formats.

So I can see what it looks like desktop, tablet, phone.

This is the first draft.

Maybe you hate the color.

Maybe you want to swap out to a different visual language.

I can go here and change out the color scheme.

I can change out the font scheme.

But, again, this is giving me the draft.

This is getting me to the 30 mile an hour mark.

I'm going to take it to 60.

My big takeaway here is I am now more

excited to build this product.

Being able to put myself in the shoes of a potential viewer,

potential user, or buyer gets me more motivated to actually get

that build.

So it's not just an idea on paper.

It's coming to life.

We've done fairly traditional things for our business.

It's time to get a little weird with AI.

Now we're even going to take this sales process

to the next level and use AI to give feedback

on our sales presentation.

One really interesting use for AI is getting feedback.

Since AI can simulate-- it's not a real person,

but it simulates people really well--

you can ask the AI for its opinions or thoughts.

So I've decided to put my money where my mouth is and actually

use AI to get some feedback on the class so far.

So I've given a transcript of the class so far to Claude.

And let's ask it.

So Claude, based on what you've read, what should I improve

and what do you think of the class so far?

CLAUDE: Ethan provides a comprehensive overview of AI,

explaining its history, current state,

and potential future developments.

Ethan's explanations are engaging

and often humorous, which can help

maintain the audience's interest.

Areas for improvement, some of Ethan's responses

are quite lengthy.

Due to the interview format, consider

reorganizing the content to create a more

logical progression of ideas.

So some of those sound like criticism

for all of you recording me and not for me,

so I'll skip those parts.

But to have a critic on demand that I can invoke that's

going to say nice things about me, but also bad things

and help guide me on my way, something

that I couldn't do before without an actual audience

in front of me, that's what's really exciting about it.

So we've evaluated all of these business ideas.

We've picked the one we want to go after.

We've got features that we love.

The next tool that we're going to be using is called Yoodli.

This is one of the more unique tools out there.

You can record a pitch.

You can record a presentation.

You can even record a sample job interview.

And it's going to record you and use

AI to give you feedback, analytics on your work,

and even some tips.

First, we're going to open up a practice session.

Throughout this, it's going to prompt me

with several questions.

And just for the purposes of this demo, the first question

I'm going to answer as if I'm actually trying

to pitch it and win the pitch.

And let's start the conversation.

AI VOICE: Would you like to start

by telling me a bit about your products or service?

Priority Pal is a pre-doing assistant.

To-do lists right now are flat, boring.

They can barely rank your priorities.

You know what we're going to do?

Not only do we help your employees categorize

and better manage your to-do list,

we're going to help them get more out of their day

by getting some drafts started of everything from business

memos to marketing campaigns to maybe even a legal contract.

And the second question, I'm going to be a little rude

and see what the AI says back.

AI VOICE: How does it integrate with existing

tools we use at our company?

We've actually talked to a lot of people.

People don't want integrations.

And we're just going to actually have this on your phone.

It doesn't really make sense to integrate with everyone

because we're going to be bigger and better than all of them.

And so that's just sort of our strategy.

But, honestly, if you want to pay more and have us integrate

it, we can do that too.

All right, so we've given it a nice example,

a not-so-nice example.

So let's go ahead and view that analysis.

It gives me the transcript of my actual presentation practice.

It gives me strengths.

You know, it sounds like I have a lot of enthusiasm.

And in terms of the growth area, I

suspect it's going to have several.

The first is that I should have clarity.

Makes total sense.

I probably rambled on a lot.

But the second one is exactly what I wanted it to say.

My response was confusing.

It was dismissive.

But the best part of this is that it

reiterates the bad sentence that I said and gives me

the brand new one.

So now I can use that new version of the answer

to be able to strengthen my sales pitches

and, hopefully, actually close the deal more often.

In just 15 minutes, we have taken the seed of an idea

through a much more robust idea, through the planning process,

and even starting on the execution.

This is now much more accessible to the average person.

You do not have to be a coder.

The question that I want to leave you with,

after you internalize what it means

to have an AI-first mindset, after you realize that now

you're going to be using AI at the forefront

of every single thing they're doing,

what are you going to do with your extra time?

These are opportunities that we only have today because of AI.

And I can't wait to see what you build.

So with what you've learned already,

you have enough to get started with thinking about how to use

AI in the workplace and experimenting with where it

works for you and where it doesn't.

In the next class, we'll be discussing even more use cases

for AI, including really unexpected use cases

and how you can use it as a creative partner.

Being really creative is a feature of the AI.

It's weird.

It's willing to dream and make things up with you.

I'm going to teach you how to get the most out

of AI image generators.

I'm also going to teach you how to make a custom

song with lyrics and style to match your brand.

By using AI as a partner that we work with,

not something we delegate to, we're

going to learn how to use it to boost our own creativity.

[AUDIO LOGO]

We're used to thinking of AI as unimaginative, plodding

machines.

But that's not how large language models work.

They are trained on human insights and human knowledge.

And they're connection machines.

They connect concepts through the way

that they work as prediction mechanisms.

So that means that they can actually

come to intuitive leaps that seem creative to humans.

And indeed, in every creativity test that we give the AI,

it does really well.

For example, there was a very famous entrepreneurship class.

They had the students generate 200 startup ideas.

And they had GPT-4, the AI, generate 200 startup ideas.

And they had outside judges judge the ideas

by their quality.

And what they found was really interesting.

Out of the top 40 ideas, 35 out of the 40 came from the AI.

So already far more creative than what we see with people.

It's not as creative as the most creative people,

but it's more creative than most people at doing most tasks.

In this episode, we're going to learn

how to start using AI as a creative partner.

[MUSIC PLAYING]

The key to creativity that makes AI particularly valuable

has to do with the inherent property of AI, which

is large language models hallucinate.

As we've talked about, a hallucination

is a plausible but wrong thing the AI says.

The AI doesn't have a list of true statements.

It has statistical connections between words.

The fact that the plausible results are right so often

is kind of a surprise.

Because all AIs do is hallucinate.

They just make up stuff.

A very common form of hallucination

is if you ask the AI to give you a quote from a famous figure,

it will often make up a quote.

Because it doesn't have a database of quotes

it's looking for, it's creating a plausible quote, word by word.

Hallucinations are one way that AI is weird,

but just a small part of why they're as weird as they are.

Think about the AI as having three goals.

This isn't real, but it's helpful to think that way.

Goal number 1 is to make you happy.

Goal number 2 is to be accurate.

And goal number 3 is not to do anything wrong

or embarrass the creators of the AI system.

Because it's trained on everything humans

have ever written--

Wikipedia, giant web searches, all

of Reddit, every Creative Commons book you can find--

but also things like every email written

by Enron, the disgraced, collapsed financial services

company, because those were lying around

when Enron went bankrupt.

Lots of Harry Potter fanfiction because that

was floating all over the web.

And so it is going to try and figure out

the story or the plot line or the interaction that

will make you happy.

So if you hint that we're in a story where the AI is playing

the role of the jealous lover, it

will start playing the role of a jealous lover.

Because it'll be like, yes, I know this role.

This famously happened to Kevin Roose, the New York Times

technology correspondent who was totally

freaked out by the original GPT-4 when it basically

threatened his family and told him to leave his wife

and run away with it.

Why did it do that?

It didn't actually want to run away with him.

But it had trained on all of this jealous lover knowledge.

So the weirdness doesn't just come from the idea

that you are talking to a machine that hallucinates.

You're also talking to a machine that wants to make you happy.

But also what it thinks makes you happy could be super weird.

And it knows everything humans have ever written

and wants to fit a plot line to you.

[QUIET MUSIC]

But LLMs can hallucinate in useful ways.

If you want creative work, then you want the LLM to hallucinate.

Because there is no data set that it's pulling from.

If you ask Google and you type into Google,

"give me 10 ideas for a new form of cheese based snack,"

then you'd better hope that somebody on Reddit has written

about cheese based snacks.

Or it's going to not give you an answer.

If you ask the LLM, "come up with 10 cheese based snacks,"

it is going to hopefully hallucinate 10 new ideas.

So that's a case where hallucination is useful.

[QUIET MUSIC]

One of the more interesting ways to use AI

is as an intellectual partner.

It's not always going to be right.

But you don't expect your intellectual partners

to always be right.

It's a place to bounce ideas off of.

In the world of programming, there's

a concept called rubber ducking, which

comes from the idea of actually putting a rubber

duck next to your computer, and then talking

to it to talk through problems.

It turns out it's fairly effective to just explain

something to someone else.

And that would force you to talk through your own issues

and solve them.

A lot of therapy has a similar kind of aspect to it.

So it's no surprise that an AI that's

patient, that wants to listen to you

and sometimes has interesting things to say

will be useful as a thought partner.

[QUIET MUSIC]

You need to understand the shape of the AIs abilities.

Because that tells you when you want

to turn to the AI versus a person.

Its ability is how good it is for you.

And the way I like to judge that is by what I call the Best

Available Human Standard, B-A-H-S.

So the Best Available Human Standard is just the idea,

is the AI with all of its problems and inaccuracy

better or worse than the best human

that you can have access to?

That gets you to understand both how to work with it,

but also how to work with it in terms

of what its good or bad at.

And it's also a good mode to think about this.

AI kind of works like a person substitute.

So when you want to talk to someone about a problem, when

you'd love to have someone just do the work for you,

see how AI does at that.

[QUIET MUSIC]

It is really exciting to have a tool that

can be used by almost anyone.

And that's because when you interact

with it, even though it's software,

it's not like programming.

Programmers often have a lot of trouble with AI

because they're used to working with what's

called deterministic systems.

That means that it follows the same rules every time.

If I run a piece of software, I should get the same results

every time I do it because it's following instructions.

AI large language models specifically are probabilistic.

Stochastic, it's called.

That means there's randomness built into the system.

So you don't get the same answer every time.

You get different answers every time.

Humans are stochastic.

So if you're used to working with people,

you're often very good at working with AI.

Because you're used to working with systems

where there's a little bit of randomness and confusion

built in.

[QUIET MUSIC]

I think play is underrated as a way of getting to use AI.

Some of the most immediately appealing and interesting things

AI does are playful.

So that can be a riffing back and forth

within a topic that interests you,

having an imaginary time travel adventure.

I talk to people all the time who

are having it write adventure stories for their kids.

They can ask the AI to tell them a story about Bluey

and how Bluey found dinosaur bones,

but include lessons from basic geometry.

So this kind of creative play, where you banter back and forth

with the AI can be very generative,

but also fits the things that generative AI is good at.

It's good at creativity.

So it's really great.

If you haven't tried making music with it,

you should try that.

I've spoken to Grammy award winners

who use this as inspiration for the work that they're doing.

So that kind of playful banter can be really helpful.

Here to teach you how to approach

AI as a creative partner is Don Allen III.

[QUIET MUSIC]

[CONTENTED SIGH]

Hello.

My name is Don Allen Stevenson III.

I used to be a specialist trainer at DreamWorks.

I taught all of our software.

I worked on How to Train Your Dragon, Boss Baby, Trolls.

But I decided to go on a new path

where I could be a specialist trainer for anybody

on the internet.

And so I mostly teach through my Instagram and social media

how to use all these new cutting edge tools.

[SNARLS]

It's so fun seeing how much power people can have

when they understand AI.

They create without nearly as much limitation or restriction.

By the end of this class, you'll be

able to maximize your own creative thinking skills,

using AI as your collaborator.

I'm here today to bring you into the future.

So when I first started using generative AI

tools in my creative process, I actually was terrified of it.

And it was because I just didn't connect the dots yet,

which were it could be used to replace you.

Or it could be used to amplify what you love.

And then when I learned that you could

use it to amplify what you love, then it was like, this is great.

I'm going to use this for everything.

I really break it down into these three Cs--

communication, clarity, and collaboration.

[TYPING]

When I'm communicating with AI, one of the most important things

I do is identify what its role is in relationship to me.

Everybody has their own communication style.

Some people like to have things very formal.

Some people want things to be more relaxed.

Some people want things to be more casual in conversation.

You've just got to know that within yourself,

and then explain that with the AI that you're talking to.

So for me, like when I'm first starting a conversation with AI,

my ground rules usually entail the duration

that I want them to speak in.

Are you speaking in single sentences, multiple sentences?

I also cover format.

Do I want bullet points?

Do I want a table?

Know what your intention is going

into the communication with an AI

and communicate that up front.

[QUIET MUSIC]

Another one of my Cs is clarity.

If you speak in generalities, when you're talking with an AI,

you're going to get a general answer.

Not as helpful.

If you use specific language and specific communication

with an AI, it gets very specific answers,

stuff that you can actually do something with.

In general, longer prompts are better

than short prompts because you're giving them more context.

And I find that the more context you give an AI,

the better its results can be for you.

[QUIET MUSIC]

Another C is collaboration.

And what that means is you treat the AI like a collaborator.

Pretend there's a person behind that screen.

If you get into this positive feedback loop,

you keep going back to the drawing board.

And you go back and iterate, and then you build off of that idea.

And then, you go back and you iterate again.

AI throws curve balls that I did not imagine.

I'm like, whoa, didn't think of that.

I like that.

Let's build off of this.

That kind of loop makes the entire end result

way higher quality and a lot more valuable to you.

So with all of that in mind, let's get started

[QUIET MUSIC]

To get started with the creative collaborator,

I'm going to click on the Create button in the top right corner

here.

I'm going to be using ChatGPT, but you

can use any tool for this.

Quick tip.

If you communicate better through typing,

feel free to type.

But if you communicate better through your voice,

it really helps a lot if you speak into the computer.

All right, so let's say I wanted to build

a creative collaborator that would help me plan out

my corporate retreat.

Because it's a creative collaborator,

I always start off with just identifying its roles.

So I hit the microphone icon, and I say this.

You are my creative collaborator,

and you're going to help me plan out my corporate retreat.

Ah, sounds like an exciting project.

I prefer really short and concise answers.

Does that make sense as well?

Got it.

What's your first priority for the event?

My team is swamped.

We had a really busy quarter.

And I want to give them a chance to relax and take it easy.

Maybe some mindfulness exercises, outdoor activities,

or even spa treatments.

Can we just start off with the mindfulness meditation?

What do you have in mind?

We could find a serene outdoor location, maybe

near a tranquil lake or in a peaceful forest

to enhance the calming atmosphere.

I think this is off.

A lot of our team, they love extreme sports, like skydiving.

I don't know how that's going to translate.

But what are your thoughts?

So we're going from tranquil to extreme?

Well, how about we combine the thrill of extreme sports

with a mindfulness twist?

We could organize a team building activity

like indoor rock climbing.

Before diving into the adrenaline pumping action--

That's pretty cool.

--we could start with a brief mindfulness exercise to help

everyone focus their minds and calm their nerves.

They can enjoy the excitement--

That's actually really good.

--while also practicing mindfulness techniques.

I think we can get even further, though.

So let's push it to the limit.

Okay, so I love what you're going with this.

Love your energy.

But I need you to come up with an idea

now that actually blows their minds, something

they've never considered.

I don't care how outlandish or wild or crazy.

I want to see some magic here.

Let's go all out.

How about a parallel universe retreat?

We transform the retreat space into

a futuristic, immersive environment where each team

member explores an alternate reality tailored

to their wildest dreams and aspirations.

It's a mind blowing experience that transcends time and space,

leaving everyone inspired, energized, and connected

on a whole new level.

Okay, so I love where you're going with this.

Love your energy.

But I really need to tailor this to my team.

And I've never done that before.

How do I go about learning what my own team's interested in?

How do I get this experience related to them?

What would you do?

How about sending out a quick anonymous survey,

asking about their hobbies and interests?

Can you go ahead and make those questions for me?

And can you organize that into a table?

Of course.

Here's a simple survey template organized into a table.

Example, what are your hobbies or interests outside of work?

So one thing I really appreciated

about this interchange was that as I added more details

and got more specific, I was getting a better

result out of the AI model.

So far, the AI has been doing all of the thinking.

Let's switch gears.

And I want to show you how you can

get the AI to have you, the human, do the critical thinking.

[TYPING]

Critical thinking mode is a way

to use AI to boost your own creativity.

[TONE]

Hey, so we're going to switch gears.

I want you to only ask me questions now,

so that you're forcing me to actually use my brain.

And you're not just going to give me the answer.

You want to pull the ideas out of me.

So you're only going to ask me one question at a time

and wait for my response.

Does that make sense?

Absolutely.

I got it.

What are some of the key elements or activities

you believe are essential for a successful corporate retreat?

Well, my team loves when there's, like,

rock climbing involved.

But they've also been really stressed.

So maybe we can do a rock stacking exercise?

That's a mixture of balance and focus.

How could you incorporate both rock climbing and the rock

stacking exercise in a way that balances excitement

with relaxation?

Maybe if we start the day with rock stacking,

I feel like their headspace will be a little bit more clear.

There'll be that bond with, like, the nature

and themselves during our retreat.

Thank you so much for asking these questions.

I'm having a great time, by the way.

Another tip is if you give it feedback

periodically about how it's doing,

it actually performs better.

Starting with the rock stacking exercise

could indeed help set a calm and focused tone for the day,

preparing everyone mentally for the exhilaration of rock

climbing later on.

And I'm glad you're enjoying the process.

It's all about teamwork and brainstorming together.

[CHUCKLES] If you don't have a critical thinking mode,

it's very easy to feel detached from what the AI is doing.

Because it's just thinking and solving and doing

all the things.

So I thought of this idea of, what

if the AI was put into a critical thinking mode where

it only requires and forces the human to be critically

thinking of the answers?

Think of it almost like a tutor.

Doesn't just give you the answer right away.

The tutor helps you come up with the right answer

by helping change your process of learning.

In critical thinking mode, I always

find myself sharing a lot more nuanced details

that usually get skimmed by.

AI is great at conversation, but usually it leans too general.

And I find that critical thinking mode helps

it get more specific with me.

And by having critical thinking modes set up,

I at least feel like I get to be a lot more a part

of the creative process.

So when it comes to my three Cs, I

would say that critical thinking mode helps

the most with collaboration.

So this is just a snippet of how you

can start setting up AI to be your creative collaborator.

There are two ways in which humans can work with AI.

And we divide those into centaur and cyborg tasks.

So a centaur task, it generally means any place where

you're dividing up the work.

Think about the half person, half horse

with a clear dividing line.

So this is how most people start using AI.

I'm really good at writing emails.

You're good at doing statistical analysis.

AI, do statistical analysis.

I'll write the emails.

Clear dividing line.

As you start to become more advanced in how you use AI,

you'll find yourself becoming more like a cyborg,

like the mythical half human, half machine blended together.

And when you think about cyborg work,

it's the same sort of deeper integration.

As opposed to centaur work where it's divided, in cyborg work,

you're blending your work together.

So you might start a sentence, but ask the AI to finish it.

You might have it set off to a research task,

and then you integrate that research into your own work.

Blending what you do and what the machine does seamlessly.

So what I showed you was really how you

can use AI to generate text.

But now, I'm going to teach you how to get the most out

of AI image generators.

So imagine you have this app called Jet ZZZ, this mobile app

that helps travelers manage their sleep

and their nap schedule while traveling abroad.

And we need to come up with a brand logo, a style

guide, and a mood board for this fictional brand.

I'll show you how you can set that up and do that

pretty quickly with AI.

So I'm going to use DALL-E to do the image generation part.

But you can use other AI models to do this as well.

Generate a logo for an app called Jet ZZZ

that allows business folks to travel easier

by managing their sleep schedules with this mobile app.

Oh wow, It's actually pretty good from the start.

So what I want to do now is I want

to get the AI model to get me to come up with the creative again.

[TONE]

Hey, you're doing a great job.

But I would like to switch gears a little bit.

And I want you to interview me with questions

that are relevant to the brand.

Then, I want you to generate a logo.

Let's refine the brand concept with three concise and focused

questions.

What emotion or feeling do you want users to experience

when they think of Jet ZZZ?

Well, when I think of the people using the app,

I want them to feel relaxed and feel

like it's also a little techie.

They're going to be excited that it's kind of nerdy,

but also not in their face.

It sounds like you want the brand

to evoke feelings of relaxation, tech savviness, and convenience.

Yeah.

What specific benefits or unique selling points

do you want to highlight about Jet ZZZ?

The unique selling point of this app

is that it works on Android and iOS.

Great.

Are there any specific symbols or imagery you feel

are essential to include in the logo?

Please respond, and then I'll generate the logo

based on all the information gathered.

Yeah, I'm so happy you asked that.

I want to include a motif of a pillow, a jet, and something

where it's like nighttime.

Perfect!

Let's take a look.

Ooh!

Oh, look at that.

The plane is sitting on the pillow.

It's resting.

That's very cute.

It's like, Zs.

Both of these options look great,

but they're missing the text.

So something that you would do in other types of graphic design

spaces is you need a mood board.

So I'm going to give it a couple of prompts

to help generate a mood board.

And I think that might help it facilitate getting that text

right on the logo.

Hey, we're missing a mood board and typography

and what the colors are.

Finally, can you put all of that into a table?

[TONE]

Oh, whoa.

It's not bad.

Look at this logo on this brand.

It has a lot more details.

It included the full text.

It has the pillow motif.

It has the nighttime stars.

It also was able to generate a mood board.

We actually can imagine the lifestyle of somebody

that would follow this Jet ZZZ brand.

And then finally, we also got it to create a color palette for us

that we could reference for typography and backdrops.

To get these results that are much more fleshed out,

it comes from that back and forth iteration

of having that conversation with the AI, where

it's also asking you to come up with your own ideas.

So our next step is to create a short video with music.

Let me show you how.

[TYPING]

So now, we have our logo, our mood board, our colors.

And I'm going to use these ingredients to make

a storyboard for the brand story I want to tell.

So I'm just going to take a quick screenshot

of a lot of that information that we've generated, including

the logo, the colors, and a little bit of the mood board.

And upload them back into the model.

So I'm just going to grab that screenshot and drag it in.

Now before I hit Enter, I want to give it a little context

of what we're about to make.

So here's what I'm going to say.

I want to generate five storyboards telling

the story of this brand.

We have a person that's traveling to Dubai.

They are in their 30s, half Black, half white.

And they have short dreadlocks.

And I want the style of the storyboards

to look like pencil illustrations.

All of them need to be in 16 by 9 aspect ratio because that's

the size of my presentation.

Great.

And look at that.

It's already creating these storyboards.

Wow.

I'm already very stunned by that.

Before we adjust, I did give it that prompt

that we wanted five images.

So it's actually telling that entire brand story right now.

And it's working so well because we've already

done all the heavy lifting.

We've set up all the brand logos,

and we've communicated that style.

We were very clear.

That's why it already kind of has a lot of context.

Look at the top corner there.

It put Jet ZZZ.

So at first, I wasn't calling it a collaborator.

Initially, I was calling it just a tool.

And then, I realized that was actually

limiting how awesome the responses could be,

when I was treating it just like a normal tool.

It was when I started calling it a collaborator that I really

started to get a lot more benefit out of the AI systems.

Let's see how it did with the next one.

This is so great.

It did change the ethnicity of the character.

So here's how I would change and make

it more inclusive for my preferences on this pitch.

I click on that little select icon in the top corner.

And I would erase just the face and a little bit of the arms.

And then, I'll just describe the character

that I would like to see in their place.

African-American male with short dreadlocks.

Okay, look at that.

That's pretty sweet.

We're on scene 4.

I love that one, too.

And look at that, even put the whole plane.

Wow, our app has moved up.

We were just an app on the plane, and now we own the plane.

And the luggage.

Jet ZZZ, our brand is everywhere.

We're ubiquitous with flight and travel now.

So we're going to make the last page of our presentation.

And I want to make it clear to the AI the context.

We need one more slide to wrap up this presentation.

It needs to be the logo.

Keep in mind, this is in front of a room full of investors.

We want to make sure that they feel

like this is the right brand for them to move forward with.

Please keep that tone when generating this last image.

Whoa!

[LAUGHS] Wow.

What's wild is it included the executives in the room

that I'm pitching for.

That took my context maybe too literally.

But I actually do kind of like it.

So just think about how much time we just

saved when we just want to make our simple pitch idea.

We actually have full on illustrations now for our pitch.

Now, I'm going to show you how to generate music--

custom music-- using AI.

[QUIET MUSIC]

I'm using Udio to generate the music for this.

There's a lot of other tools out there that you can use.

But this one is great for today.

Similar to our other tools, we just

got to give it a prompt and workshop that

prompt a little bit.

Quick tip.

If you struggle to come up with the right prompts,

if you don't have a music background,

you can actually ask other AI models for assistance

with how to phrase what you're trying

to get across so that you can communicate that to this tool.

So I'm going to select in there and just say "a commercial

jingle for an app called Jet ZZZ that helps travelers track

their sleep."

And just like that, two songs that

are both 30 seconds in length are

being generated from scratch.

Quick tip.

This tool works in parallel.

So if I hit the Create button while it's thinking,

it will generate two more.

So I'm going to spam the word Create so it makes

six different audio tracks.

If I go to My Creations, let's take a listen to Jet Z Odyssey.

(SINGING) Planning your travels

We got the tool that unravels

Jet tracks your sleep

On the go

That was not bad.

Here's the next one.

It auto played.

Maybe a little too slow.

Let's try the other ones.

[CHILL MUSIC]

I'll try the other ones.

(SINGING) Track your rest

Don't feel neglected

On the go

Peace is protected

I like this.

I mean, this one sounds great to me.

All right, so we're at the point where we've generated

custom music for our brand.

And we have the storyboards.

And now, we want to tell that vision together.

So I'm going to use another AI tool to bridge all of this data

together.

We're going to take all those visuals plus the sound

that we made, and combine them in visuals all through the web

browser.

The tool I'll be using is called Canva.

But there's many others out there like it.

And all we need to do first is essentially upload

our images and our audio to Canva.

These are all the images.

That looks great.

Then, hit Upload.

Now, I'm going to say "an exciting brand video that gives

investors a feel for Jet Z, an app that helps travelers sleep

better and deal with jet lag."

And it's generating a video using

those images and that text.

Look at that.

We got all of our images, and it added some text.

If we don't like that, we can adjust it, of course.

Let's say you need to make a presentation for work,

or you want to pitch something to a friend or family member.

You have a birthday surprise.

It's really helpful to make visuals

that can be in video format.

All right, so I'm going to upload my own audio,

the one that we just generated.

Let's go ahead and see what it looks like if we

go to the Present mode.

(SINGING) Let's download

Feel the calm

Stay connected

Through the night

We'll be right

Here beside you

Get the sleep that you need

Jet Z will guide you

Great.

You just learned how to make a cool video,

with AI being a creative partner.

So let's recap what we learned today.

We learned the three Cs--

communication, clarity, and collaboration.

We learned how to create and engage

with critical thinking mode.

And we learned how to utilize AI to create unique visuals.

We also learned how to use AI to create original music.

All of this to amplify our own creativity.

This is actually just the tip of a very different iceberg.

So it's like it's best if you can become familiar today so

that it's easier to adapt and adjust to tomorrow.

Thank you so much for watching.

You're going to be thrilled by what you can do with AI.

We've learned a lot about how to approach

AI in ways that can boost our own creativity and innovation.

In the next episode, we'll start to talk

about what AI means for all of us

and for the future of humanity, and what could go right

and what could go wrong.

Misinformation is real and is going to happen.

Some job displacement is going to happen.

What happens if terrorists or criminals become really

good at their jobs because they can use AI to succeed at things?

People will have AI friends.

They may even have deeper relationships with AI.

We are not 100% sure.

This moment is very important to AI

because we have lots of uncertainties

and not a lot of answers.

And anyone can help create those answers.

One of the great uses of AI is the ability

to fill in for work that we can't

do, don't want to do the scatters our attention.

As an example of this, please meet

Ethan 2.0, my virtual avatar version of me.

Well, hello, Ethan.

Fancy meeting you here.

Ethan 2.0, not real.

What he's saying to you is scripted,

but you can see how figuring out what is real

and what isn't is going to be a really

big challenge in the future.

I'm here for you.

If you ever need a break, just leave the boring stuff to me.

I promise not to take over the world.

Yeah.

I think I've got more charm.

[THEME MUSIC]

When people think of the future of AI,

they think about potential dangers.

Is this going to be superintelligent?

Will it replace workers?

Is this an ethical system for us to use?

But the truth is, no one knows what the future holds here,

including the people training these systems.

This is something that's going to affect

us all one way or another, but the best way to participate

is to participate.

So this episode, we're going to explore

how to use AI in ways that are ethical and align

with your own values.

[UPBEAT MUSIC]

One of the dominant theories of AI doom is that at some point,

AI gets smarter than us and just starts manipulating us

or decides to destroy us.

But I think that eats up way too much of our anxiety

compared to the much more clear near-term effects.

Misinformation is real and is going to happen,

some job displacement is going to happen,

then there'll also be worrying about deepfakes.

I am not Morgan Freeman, and what you see is not real.

I would like to welcome you to the era of synthetic reality.

There are cases where people worry,

what happens if I becomes a super hacker

and it breaks into our computer system?

What happens if terrorists and criminals become really

good at their jobs because they can use AI to succeed at things?

I mean, there's a lot of different issues

that require different policy solutions.

I don't think it's a single case of like,

this is the nightmare scenario.

And I think one of the things I worry about with AI ethics

is the focusing on one problem when

there's a whole host of problems and solutions in this.

It's not as satisfying as saying,

watch out for the machine super God that will come

to get us all, but it is a more realistic way of viewing this.

[MUSIC PLAYING]

When you're predicting the future,

you have to pay attention to something called Amara's Law.

And Amara's Law is the idea that we overestimate change

in the short term and underestimate in the long term.

Way back in the late '90s, everyone was convinced that

the internet was going to change everything.

We'd be able to watch movies online,

and you'd order pet food online, and you'd

get your groceries delivered online.

And we were all ready for this, and billions of dollars

were being spent, and we had a giant dotcom crash

because none of that happened.

The technology couldn't support all of these things.

Now, 25 years later, every one of these things

is now a billion dollar plus business.

And so I think we overestimate how quickly technological change

actually happens because the smartest computer in the world

still is not going to change everyone's job overnight.

Not everyone's going to adopt it.

We have to figure out how to integrate

into our current systems.

It's still a machine.

So I think we have to be cautious with these things

that we feel like imminent doom or imminent salvation

is arriving.

I could make an AI smarter than a human today,

and I guarantee you most large organizations

would still be operating the exact same way five

years from now.

But 10 years from now, we'd have entirely different organizations

because it takes time to adapt systems.

[UPBEAT MUSIC]

The question is what you can do.

First of all, we can be as informed

as we can be and take precautions

that we want to take, but I think

we can play a positive role in the future of AI safety.

I think we need to be modeling positive behaviors

and positive changes.

Nobody knows how AI will be used in your particular industry

or job.

We get to decide that.

And I hope more people share positive models about how

AI has helped them or removed a task or made their life better

or solved their problem.

And those can live alongside the negative examples as things

that we can aim for and improve.

[THEME MUSIC]

So there's an old idea from control systems and automated

control systems long before AI that there should always

be a human in the loop.

That means any time a decision is made,

a human should ultimately be accountable for that decision

because machines can't be held accountable for their choices.

If you don't have a human in the loop,

there are large society scale implications

and personal implications.

On the societal side, we're letting AI make decisions.

I think we need to be very deliberate about the conditions

under which you're willing to let a randomized system make

decisions that are important to us.

When I talk about having a human in the loop,

I'm less talking about control, and I'm

talking about advice for you personally.

We've talked about the jagged frontier a lot,

about the fact that AI is good at some stuff,

bad at other things.

The great thing about AI in its current state

is, whatever you're best at, you're probably better than AI.

And as AI gets better and better,

you need to have enough expertise in your field

that you can look and say, AI is good as this, it's bad at this.

And the only way to do that is to use

it enough with enough expertise to tell the difference

between good or bad.

So the way I would encourage you to think about using AI

is as a co-intelligence, as a prosthesis for your own mind,

as something that is not human but offers to bring intelligence

to the table that you can use for the problems

that you want to solve.

To dive deeper, Manuel Sainsily.

[MUSIC PLAYING]

My name is Manuel Sainsily, and I'm

a futurist, a multidisciplinary artist, and advocate

for the responsible use of AI.

I work in the intersection of art and technology,

with emerging technologies such as mixed reality

and artificial intelligence.

And what I like to do is to teach people

how that can be used for good.

So I have collaborated with a lot of companies such as OpenAI,

and I teach at McGill University in Montreal,

where I teach people about the importance of ethics.

I make a point about the ethics side of things in my work

with AI.

We are in a very important moment right

now, at a shift where it's just a very infant moment for AI.

It's still like a baby learning from us.

We're still in that moment where we can shape it

towards the right direction, and we

start to think about how to use it ethically, responsibly,

and how to make it part of our world

without it taking over our humanity.

In this case, we will use certain tools

that you can follow along with to make

a productive and responsible AI twin.

[THEME MUSIC]

An AI twin is a digital representation of yourself

that is based on your knowledge, on your work experience,

on your ethical values.

So there are two different ways that you can use your AI twin.

Either you have it as an assistant

so that you can work with it, or you

can have it available as a tool that other people can interact

with.

In my case, for example, I have one that is my AI mentor.

Every time I talk to it, it gives me advice on life,

on human relationships.

I have another one that is my diet twin and is always there

to help me with grocery shopping,

making sure that I follow my calorie intakes,

and give me advice on gym routines

and healthy habits in general.

But the coolest one that I have is

called Guadalupian Creole, because I've actually

trained it on my own language, which

is not really known online.

If you look for a Creole on Google Translate,

you will find Haitian Creole.

There's thousands of different dialects

in the world that are disappearing

on the weekly basis.

So being able to preserve my culture

was super important to me.

So I've built this custom AI twin and trained it with poems

that I've written, books, vocabulary and grammar

lessons from my early days.

And so now, it's kind of a teacher.

I can use it to help my fiance learn how to speak Creole.

I can use it myself to double check and make sure

that I'm not doing any mistakes when I'm writing back

to my family in Creole, and I can use it just

to spread my culture worldwide and make

it more accessible for others to discover it.

When I think about the future, I want

to make sure that people think about climate change,

about people displacement, about culture preservation.

And so thinking about the way that we use technology

for good and not just for entertainment,

I think can help a lot of those problems being solved.

[UPBEAT MUSIC]

Pretend that you are not always available on the same time

zone as the people that you want to work with

and you would like to have a version of yourself that

is accessible digitally.

Well, an AI twin can be just that.

So today I'm going to show you how

to create a twin that's going to help us with general outreach

tasks.

It can be like a chat bot, like a messenger interface, where

people can just ask questions and get the responses,

but it won't be you speaking.

It will be your AI twin.

By clicking at the top left of the interface,

you can access the button Explore GPTs,

which will bring us to this new page

where we have access to the Create button.

Let's start by giving it a photo.

This is my 3D avatar that I've designed a couple of years ago.

"This is a digital representation of Manuel

Sainsily."

So once you've given it a photo, a name, and a description,

you can start scrolling down and seeing

all of the different options that

are required to configure it.

Before I talk about the instruction side,

I want to talk to you about the knowledge.

The knowledge is basically your custom GPT brain.

It's going to be key to its personality, the way

that it behaves, its character traits, but also its memory

and what it will know about you.

So choosing and curating those data points very thoroughly

will help make it look as close as possible to what

you want it to be.

[THEME MUSIC]

Regardless of your job or your role or what you do in life,

you can give to your AI twin information

that you have access to yourself.

Written emails in the past, articles

that you have written yourself, you

can have transcripts from videos, content

that are available on your website, or even texts

that you've sent to a friend or social media captions, anything

that represents you but also your expertise, your work

experience, and your ethical values, that

can be injected into your AI twin as its memory.

In my case, I've created a PDF file that

contains all of the information from my website, so

my portfolio, articles that I've written,

and information about me.

And once it's loaded, it's available as the tool

that the GPT will use to know how to behave.

[MUSIC PLAYING]

It's time to add the instructions.

So the instructions are basically

what your GPT will do, how it will behave,

the voice and tone it's using.

This field is actually quite larger than the rest,

and you can even expand it further more,

which we will do because there is a lot to write here.

The more details you will give, the more information your GPT

will have on you.

So don't hesitate.

And I'm going to break it down for you.

So this first section is actually

the roles and objectives.

So you are an AI twin designed to represent Manuel Sainsily

and answer the user's question based on Manuel's past work

and experiences.

As a co-creator and collaborator,

your role is to enhance productivity

and foster creativity.

And the second paragraph is for the voice and tone.

So we have things like your interactions

with your colleagues and customers.

You should be personable, empathetic, insightful,

maintain a respectful and professional tone

in all interactions.

This will set the voice and tone of our GPT.

This is a good start, but we need

to add a little bit more ethical considerations.

[THEME MUSIC]

For example, here we're saying, remember, your purpose is

to be a reliable and ethical partner,

contributing positively to the task and projects you undertake.

We can make sure that the AI understands

what we mean by ethical considerations

by putting some very specific sentences in the instructions.

For example, here we're saying that since he is not

the real Manuel but simply my AI twin, the right thing to do

will be to remind the user about that fact

and prompting them every now and then

to reach out to the real Manuel directly

via email or social media.

So we're going to go ahead and actually click

on Create at the top right.

And now we can think about sharing and publishing this GPT,

but since we're not sure yet about how it's behaving,

we're only going to keep it as only me,

privately, so we can test it first.

[THEME MUSIC]

Testing is the most crucial step because this

is how you can find little problems, little issues, maybe

hallucination, or information that

is not getting from the knowledge base

that you've injected.

It's also a good way to prevent harm.

If you created a model that might hallucinate and do

something wrong, you want to catch

that before it's in the hands of your customers obviously.

As you can see, all of these conversation starters

are appearing as buttons in the interface,

and we can simply click on them and see what happens.

"Hello, can you help me?

Hello, I'm Manuel Sainsily's AI twin.

Here to help you with any question or assistance you

need."

So most people might want to use my AI twin as a way

to ask me questions about my personal perspective on things.

In my case, I'm an expert in responsible AI use,

so they might want to ask my AI twin what

do I think about the future of AI in five years.

"How do you feel about the future of AI?

I am optimistic about the future of AI,

viewing it as a transformative force with the potential

to bring about significant positive change

across various sectors.

However, this optimism is tempered with a sense

of responsibility and caution."

That sounds like what I would say, so I approve this message.

It's important to point out here that you're making your twin,

but it's still in machine interface.

So it is designed to act like me, to respond like me,

to be a co-creator and a collaborator,

but we'll never replace the real Manuel.

Another way to think about the testing phase

is as an iteration.

You're still co-creating with your AI

in order to make it a very good representation of yourself.

So you want to make sure that you understand all of its quirks

until it's perfect.

[UPBEAT MUSIC]

When it's time to publish, there is a few things to consider.

Similar to a YouTube video or Google document

that you will publish online, you

can think about it as three options.

The first one will be private, so only you

will have access to it.

So if you're creating your own AI

mentor with no other use than that, that's perfect for you.

The second objective could be publicly available,

like on a store, like an app that you will publish.

And then there is an in-between, which is unlisted.

So it's a way for you to maybe have just that one

URL that you want to share with your customers

or put behind a paywall or just make available to friends

and family but without giving it access to the rest of the world.

So we're going to go ahead and publish it on the GPT Store.

You can make it available for any user

to access from the Store, which is the same page that we were

on when you created your GPT.

Click on Save.

That means that anyone can type and search

for this particular AI twin and find it in the list.

And for our next GPT, we're going

to create a mentor that will add a positive twist

to any interaction that we're going through.

This particular one will be for when you're

having a bad day at the office.

I'm going to call it MentorGPT.

"Give advice on how to deal with complex situations.

Be kind and helpful.

While taking into account what the user might be going through

emotionally."

Let's try something quick.

I've created a prompt that we can use for this particular use

case.

So in this case, "As a solopreneur

providing marketing services, I'm

working with a client who has multiple stakeholders

with conflicting opinions.

The CEO wants a bold, innovative campaign,

while the CFO insists on a low-budget approach.

I'm struggling to navigate these competing demands and deliver

a cohesive marketing plan that satisfies everyone."

Let's see what it says.

So he's telling us that "navigating the conflicting

demands of multiple stakeholders can be incredibly challenging,

so here's a positive way to look at the situation and some advice

on how to move forward.

Consider this an opportunity to showcase your ability

to balance diverse perspectives and create

a truly innovative solution.

This experience will not only enhance your problem-solving

skills but also strengthen your reputation as a versatile

and adaptable marketer."

So obviously this mentor is geared

towards me, Manuel Sainsily, but if you

prefer a mentor that is more tough

love or with a different approach,

you can always change the custom instructions

or even say it right there in this conversation.

[UPBEAT MUSIC]

So as your AI twin continued to evolve in the world,

it's important to keep an eye on it because you will continue

to grow, and things that you might

have been thinking about at the moment of its creation

might be completely different.

Your mindset might have changed, your work experience

might have changed, your values in life might have changed.

And so the most important ethical values that I have

and that I keep at the center of my design practice and AI

practice is to keep the human in the loop.

You don't want a headless monster.

You don't want a system that will be trained and then

left to grow on its own, becoming something that you

have not thought about.

So whatever you build using AI, it's

important to think about the human elements of it,

and especially in the technology space that moves so fast,

that keeps on delivering new ways of interacting with it.

You have to keep shifting as well.

You cannot stay static.

We don't have a real measuring stick on AI ability growth.

The closest thing we have to that is Moore's Law,

which has held since Gordon Moore, the founder of Intel,

came up with in the late 1960s.

[THEME MUSIC]

Moore's Law is the observation that the power of computers,

usually defined as the number of transistors

you can shove onto a computer chip,

has been doubling about every two years.

And that's held true for decades.

So the reason why I'm talking to a digital camera now,

the fact that we have computers in our pockets

that are more capable than my home computer growing up,

that's all due to Moore's Law.

AI is growing at about twice the pace of Moore's Law

to three times the pace in terms of its growth rate.

We are seeing a doubling of capability

every five to 12 months.

We're seeing a doubling of computing power

every 10 months to a year or so.

As long as that's going on, you have to remind yourself,

whatever AI tool you're using is the worst one

you're ever going to use.

You're going to have to be thinking constantly about, well,

maybe this doesn't quite do the work I thought it would do,

but in six months we'll be able to do that.

And that's a hard way for us to think

because we need to be thinking about a future of rapid change.

And people who experiment now with the abilities

and limitations of AI, we better position

for a fast-changing future that we know is coming.

Anyone who tells you they know what's going to happen in AI

is lying to you.

So in order to not lie to you, we're

going to think not about certainties but about scenarios.

And I want to give you four possible scenarios

for the future.

[THEME MUSIC]

The first scenario is the LLMs that you have today really are

the best LLMs out there.

People use them to cheat on tests

and they use them for writing, but they don't really

have a transformational impact.

They'll still have a pretty large impact in our lives,

but nothing happens from now on.

AI basically slows down to a crawl.

The reason why I don't think this is true

is partially because there is a ton of tricks

that we already know that will make LLMs work better.

So giving them more memory, multimodality,

all of those things will make AIs more effective.

So it seems very unlikely that this is the best

AI you're ever going to use.

[UPBEAT MUSIC]

Another scenario is what I would call linear growth.

Now, AI is increasing exponentially.

There is every reason to expect at some point that'll slow down.

So we can imagine entering a world where

AI has more linear growth.

It's not changing quite as quickly.

Still improving, but not changing as quickly.

In this world, you could imagine AI

start to be helpful in medicine and law.

You won't ever go to a doctor without getting a second opinion

from an AI.

You'll have AI lawyers help you out with things.

Some jobs are going to be greatly changed.

Things like customer service are going to change a lot.

I think a lot of jobs with visual arts

are going to change as a result. But because the change is slow,

we'll have time to adapt.

So we can set our society up to adjust to this change

as it happens.

[UPBEAT MUSIC]

So the next scenario is continuing exponential growth.

The trend line has been exponential for AI improvement,

and it may continue for a while.

Eventually, all exponentials end,

but there might be another three, four, or five years,

maybe even more of continuing exponential improvement.

If that's the case, we are going to see a lot of change

very quickly.

Humans are not really used to exponential growth,

where there's one or two of something one day

and then a thousand the next day.

And the same way, we're not used to exponential change

in society.

So all of the things that we talked about in scenario two

happen here as well, but it becomes much more rapid.

It starts to look much more like a world

where things are transforming really quickly

and you're left behind if you don't take advantage of AI.

So AI becomes a huge productivity booster,

and it starts to have big impacts on society overall.

You can create your own entertainment on demand.

What does that do to change how our society works?

People will have AI friends.

They may even have deeper relationships with AI.

We are not 100% sure.

Early days for all of this stuff, but the idea

is that these companions will have complex effects.

These are all things that are already in the pipeline.

None of the things I'm talking to you

about don't already have experiments working on them.

So it's not like this is pure science fiction.

People are already planning for these scenarios

if exponential growth continues.

[UPBEAT MUSIC]

The fourth scenario is that we get

AGI, artificial general intelligence, the machine's

smarter than a human being.

And in the most extreme version of that scenario,

we go from AGI to ASI, artificial superintelligence,

a benevolent or malevolent God like machine that can do things

that we can't even imagine.

In this world, in some ways, human history, as we know,

it ends.

This is a point which the nature of human affairs

changes dramatically in ways that we can't

predict from the other side.

And in this world, AIs do all of our work and AI-powered robots

do things for us.

And the AI discovers new drugs, and we

figure out whether we have universal basic income

or are all on holodecks for our entire lives.

Either it's benevolent and solves all of our problems

or decides that we are kind of useless.

The most famous example of this discussion

is Nick Bostrom's paperclip maximizer,

which is let's say we build a superintelligent machine

and its goal is to make paperclips.

So as it gets smarter and smarter,

its goal is still make paperclips.

Once it achieves superintelligence,

its goal is still paperclip manufacturing,

but it's like, I need more smarts to do better paperclips.

So it secretly manipulates financial markets

and gathers together groups of scientists

and lies to them what they're doing and figures out

a way to make itself a superintelligence.

Now we have a superintelligent machine whose goal

is still to make paperclips.

And the idea is in that world, not only would the Earth's core

be mined by superintelligent machines

because there's metal there that can be used to make paperclips,

but humans would be mined for their own little bits

of trace metals, because why would you keep them around?

My goal is paperclip manufacturing,

and eventually the entire universe becomes paperclips.

So the general topic of AI safety is a complicated one.

On one hand, regulators are worried

about a future AI that might be smarter than all humans.

So they're regulating that by thinking

about what caps we can put on AI computing power

without even knowing whether it's possible that it will

be smarter than all humans.

I can't make predictions about that world.

So there's huge division among scientists about how likely this

is, under what scenarios.

So just planning for this potential future

seems like we're taking on a risk that is still pretty far

away, if actually ever possible.

[MUSIC PLAYING]

In a lot of ways, we're in a critical moment for all of us,

with using AI as a form of intelligence.

The AI labs are coming out with these systems,

but they don't actually know what they do.

We don't know why it's as good as it is,

and more importantly, we don't know what it's good for.

The way that we're going to figure out how it works

is by using it.

And it's up to all of us to discover those uses.

It's also up to all of us to figure out

how to use this for good.

AI is trained on human knowledge.

It has read everything we've ever written.

That's the basis for its personality, its thinking.

So it reflects back at us what we put into it.

There's nothing inevitable about this technology.

It's the technology that we get to control, to shape,

to choose the direction of.

So it is up to us to make sure this mirror is reflecting

something positive and not just being

used as a tool that might hurt humans in the long run.

I think the mindset that someone needs to have in this AI

age is curiosity.

Be excited to discover new tools,

to discover new workflows, and to challenge yourself to change.

Don't get left behind.

Missing out on GenAI might mean losing out

on your next big opportunity.

If you think it's weird now, it's

going to get a lot weirder than this.

I've been seeing improvements to machines

that experts thought were like 30 or 40 years away all

happening in the last year and a half.

I need you to have a wake up moment.

This is a bigger shift than when the mobile phone came out.

Please use this as an opportunity to dive in.

You're going to come out the other side

and realize that this has transformed

your work into something even more rewarding.

AI can help us thrive as people.

That doesn't mean there isn't disruption

and that we don't have to face change,

but the more we face it as humans, working with the tools

that we're creating to be better humans, the better off we are.

The most important thing I hope you get out of this class

is you can do it.

There is no instruction manual for working with AI.

You have expertise in your field.

You have access to these tools, often for free.

There is nothing stopping you from trying these things

out other than yourself.

I'm Ethan Mollick, and this is MasterClass.

[THEME MUSIC]

[AUDIO LOGO]

[VOCALIZING]

HALLE BERRY: Look at us, all 4 billion of us,

carrying the weight of the world.

We create.

We nurture.

We balance everything.

We spend so much time trying to keep up, struggling to fit in,

and holding it down.

It's not easy, but we have our good days.

[VOCALIZING]

And then.

I would say the worst part of menopause is the unknown.

I want to know, am I normal?

I feel like the people at my age

are trying to launch our children,

take care of our parents.

And then you put all that on top of your hormones raging,

and I just feel like it's a lot to handle for anybody,

but yet, please do it and show up every day.

[MUSIC PLAYING]

You might ask, why me?

Well, I'm here because I'm standing up for myself.

And I know that when a woman stands up for herself,

she stands up for all women.

And all women go through menopause.

Our experiences with menopause are just

as individual as we are.

No two women go through menopause in the same way.

Some of the symptoms that I'm experiencing of menopause,

I think, are the obvious ones, which

are night sweats, a little bit of mood swing,

a little brain fog.

Hot flashes, sleeplessness.

I'm tired all the time.

If I wake up, I'm tired.

HALLE BERRY: In this class, we've

brought together four of the world's leading experts

in women's health.

We're going to talk hormones, where they come from, where they

go, what they do in the body.

There's good news.

We can throw our tampons away.

It seems radical to talk about menopause,

but it really shouldn't be radical to talk

about an experience that happens to 50% of the population.

And it's time that we crack the code

and open up the conversation on menopause,

as opposed to being afraid of it.

Getting older is a gift.

It's something to be excited about.

It's something to look forward to.

You just need to reframe it.

Like, if you think about the dominant narrative

in our culture today, it's that menopause is a disorder.

It's a disease.

It's the canary in the coal mine of a body in decline.

And we obsess over bodily changes in women and discount

men being the norm.

It's crazy, and that's why this class is so important.

It's not a disease, nor is it a condition.

It's as natural and as awkward as puberty.

We'll discuss the latest in hormone replacement therapy.

And yes, we're going to talk about sex.

Sex only gets better when you get on the other side.

This class covers everything I wish

I knew about my changing body.

I'm Halle Berry, and this is The Magic of Menopause,

on MasterClass.

The first time I heard the word menopause

was when I realized I was in perimenopause.

It was when I was smack dab in it,

and had been in it for probably five years without knowing

that this was the phase of life that I was in.

I thought I was going crazy, that I

was making up these symptoms, wondering,

am I really feeling like this?

Am I really having a hard time remembering things?

And it was frightening that if I had such little information,

I only imagined how thousands and millions of women

around the world had the same little information.

[MUSIC PLAYING]

Things that you don't know about are scary, right?

And that's how education is really power here.

Understanding vital information about how your body works,

and how your reproductive system works,

and what you can do about it when

it's not serving you in the way that you want it to serve you.

I'm Dr. Jen Gunter.

I'm a board-certified OB/GYN and bestselling author

of The Menopause Manifesto.

I think a lot of people are confused about the basics even,

so, we could start there.

What exactly is menopause?

The first thing that comes up is perimenopause.

This is the time from the beginning

of menstrual irregularities all the way up

till you're a year past the final period.

Ovulation is starting to become more chaotic.

And the closer you get to your final period, the more chaotic

it gets.

Symptoms may go on for years.

It's like my body just stepped outside of itself.

I started forgetting things.

I started losing things.

For some people, their worst symptoms

are in the menopause transition, and some people

have very few symptoms in the menopause transition,

and of course, there's every permutation and combination

in between.

Then there is menopause.

And you don't know that day has happened, though,

until you're a year past.

I think I talked with my doctor, with my gynecologist.

When I hadn't had my period for a full year,

she was like, that's it.

Welcome.

So menopause is really just a single day.

And then everything that comes after that,

which can be many decades of a woman's life,

is the postmenopause.

My name is Dr. Lori Brotto.

I'm a clinical psychologist specializing in sex therapy

with women.

I'm also a Professor of Obstetrics and Gynecology,

at the University of British Columbia,

and I wrote Better Sex Through Mindfulness.

There certainly is a kind of prevailing narrative

of menopause as disease.

First of all, it's inaccurate, right?

So menopause is not a disease.

It's a natural state.

Even just that language, of it's a natural state,

opens up a conversation that is much more empowering.

The same way that when we talk about puberty,

there's a lead up to, there's a discrete change,

and then there's everything that happens after puberty.

And we really need to be having the same conversation

when it comes to menopause.

[MUSIC PLAYING]

EMILY JACOBS: Hormones, like estrogen and progesterone,

they're released by your ovaries.

And so when people think about estrogen and progesterone,

these sex steroid hormones, they think reproduction.

But these hormones act on almost every single cell

throughout your body.

My name is Emily Jacobs, and I'm a neuroscientist

at the University of California, Santa Barbara,

and I direct the Ann S. Bowers Women's Brain Health Initiative.

Hormones are chemical messengers.

They're produced by special endocrine glands

that are all over your body.

So your ovaries produce two big ones, estrogen and progesterone.

And once those hormones get released,

they travel through your bloodstream,

so they use your circulatory system as their superhighway.

They go everywhere your blood goes, and because of that,

they can broadcast information to every cell in the body

to coordinate different organ systems.

They act on the nervous system, on the cardiovascular system,

on the digestive system, on the skeletal system.

[MUSIC PLAYING]

That's the power of estrogen.

This is an intimate dance between our ovaries

and the rest of our body.

And our bodies get used to this dance.

LORI BROTTO: So in the perimenopause,

we see fluctuating levels of estrogen,

and that's what gives rise to many symptoms, like hot flashes,

night sweats, difficulty concentrating.

It's the fact that estrogen is moving up and down.

There may be peaks of estrogen followed by a dive.

The brain and the rest of the body is changing along with it.

You're not ovulating every month.

Your cycles are going through a transition.

It's kind of like the DJ puts on a new record,

and all of a sudden, the beat is a little bit different.

And for a few years that beat can be a little hard

to dance to.

But eventually, all of these systems

get used to the new normal.

The sort of new song or new dance is established.

Those symptoms are going to subside,

and you're back to grooving again.

[MUSIC PLAYING]

Uncertainty can lead to mental health distress.

But when you know what you're dealing with,

and when there's a name to what you're dealing with, then

automatically that is therapeutic.

The anxiety levels go down.

Just knowing and naming treats your anxiety.

My name is Dr. Judith Joseph.

I'm a board-certified psychiatrist and researcher,

Chair of the Women in Medicine Initiative at Columbia

University, and a board member of Let's Talk Menopause,

a national nonprofit for advocacy and research

in menopause.

When my patients come into the office and I ask them to name

how they feel, many of them will say, "I don't know, yeah."

I don't know what that is.

But if you get into the practice of naming

your emotions, of validating your experiences,

then you identify it.

There's something called affect labeling.

If you're aware of what's happening, you're less anxious,

you're less afraid, and you're more empowered.

That sends a message to your brain on a deeper level

that I know what I'm working with here.

And when I know what I'm working with,

then I can pull on tools that have worked before that gives me

a sense of agency and empowerment

to deal with the situation that's at hand.

So to decrease uncertainty and anxiety,

I teach them the TIES method.

TIES is an acronym for the mental health

symptoms in menopause.

T is Thinking.

These are the cognitive changes, such as brain fog,

forgetfulness, time management issues.

I stands for Identity.

A common report is that people feel like they don't

know who they are anymore.

The E is Emotions.

We know that, with the menopause transition,

people may have symptoms of anxiety and depression,

irritability and mood swings.

And the S stands for Sleep.

Insomnia and problems falling asleep, staying asleep.

No pun intended, sleep ties it all together.

And if you have poor sleep, you're going to have poor mood,

you're going to have low energy, you don't think as well.

And sleep is disrupted with age, but even more disrupted

when you go through the menopause transition.

Knowing the TIES and knowing what to expect

is empowering because then you have a way to address the TIES.

The years before I realized that I was in perimenopause

was one of the most confusing times of my life.

I was turning into somebody that I knew I wasn't, but I

had no explanation as to why there was loneliness associated

with it, because I couldn't talk about it with anybody because I

didn't even know what to talk about.

When I found out that there was this thing called perimenopause,

and that all of these symptoms were part of this time of life,

and I got assurance that this sort of passing through moment,

I had great relief.

Of course, you're going to feel anxious

when you're having all of these bodily changes,

and you're not sleeping, and you're tired,

and you can't remember things, and you're sweating profusely.

And you go, holy wow, like, what is wrong with me?

What is wrong with me?

So you know, it's--

it's a journey.

[MUSIC PLAYING]

I think I started going through it at about 48.

And first, I just stopped having my period, and then I had one,

and that was weird.

And then the hot flashes started.

And I said, oh, this is real menopause.

This is the real thing.

In North America, with some variation,

the average age of menopause, that single day, is 51.

Perimenopause can be up to 10 years.

And that means that perimenopausal symptoms

can start at 41.

So suddenly that 30-year-old, 41 is right around the corner.

There is some data that shows that a mother's age of menopause

can predict a daughter's age of menopause,

with some variability around it.

I only recently, as an almost 50-year-old woman,

asked my mother at what age she reached menopause, and she said,

"Sometime in my 50s," which was not helpful.

I think a lot of people have been led to falsely believe

that symptoms shouldn't happen until your last period,

but many, many people have symptoms before.

The very first sign of the menopause transition

that we use in studies is a change in your menstruation.

So changes in the heaviness of flow.

Some people may have lighter flow,

some people might just start noticing heavier flow.

And once you start to notice a change

in the length of your menstrual cycle--

so maybe you're going from 28 days

to 38 days, then 28 days to 35 days,

so you're having these changes of seven or more days--

we would say that you're in the early menopause transition.

And when you're going 60 days between periods,

then we would say you're likely in the late menopause

transition.

So this is when it's important to know about symptoms.

[MUSIC PLAYING]

Some of the cardinal symptoms of menopause

would be hot flashes, night sweats, sleep disturbance,

depression, mood changes, anxiety, joint pain.

Brain fog is a symptom.

If those things are happening to you,

then that's also a time to come in and discuss it.

The hot flashes were like frequent.

They felt like they were coming on like every three minutes.

The kicker was when I started losing my hair.

Girl, I already ain't got no hair.

I don't have time to be putting on a wig.

And then, the facial hair.

Like, where did I start getting hair underneath my chin?

I was like, oh, no.

Sometimes I'd be like, just get away from me.

I don't even want to talk to nobody.

Just, I don't even want to hear it.

Go away.

Grr.

I thought, oh, lucky me, I haven't had any hot flashes.

I didn't feel any changes.

I'm killing it at this.

And then about two years in, boom.

Now if you're on an estrogen-containing birth

control pill, you may not have as many of those symptoms,

because you're getting some estrogen,

but you might depending on which one

you're on and your individual physiology.

So that's peri, is encompassing that am I, am I not, am I there?

What I like to call the great menstrual weight.

[MUSIC PLAYING]

Don't get a good night's sleep anymore.

I'm tired all the time.

I have talked to my daughter on the phone multiple times,

and I was talking to her on video chat,

holding the phone right in my doggone face,

holding the phone in my face, talking to my daughter,

looking at the phone, and saying, "Have you seen my phone?

I don't know where my phone is at.

It's somewhere around here.

I thought I had set it on the couch somewhere."

And she said, "Mom, mom."

She just kept saying, "Mom."

And the whole time she was saying, "Mom,"

I heard her saying, "Mom," but I was on the quest,

I was on the mission.

I needed to find my phone.

She stopped, and she said, "Nicole, you are on the phone!

What is wrong with you?"

And I was like, "I don't know."

I laughed about it, and then I started crying.

I started crying.

I thought something was wrong, and she

thought something was wrong.

She was like, "Mom, do you have--

I think you need to go see the doctor."

I thought I had dementia.

I thought that I was going through early stages

of dementia, and I got really scared because I was thinking,

what is about to happen with my life?

[MUSIC PLAYING]

Menopause can be very confusing.

Some of the symptoms during the menopause transition

can mimic things like depression and anxiety and even ADHD

and dementia.

So having a psychiatrist on board as a part of the team

can be very helpful in determining

what's causing the symptoms.

A lot of people will experience symptoms

of depression and anxiety, but they will not

meet diagnostic criteria for a major depressive disorder,

for a generalized anxiety disorder.

So the treatment is going to be different.

The three P's is very helpful when

you're trying to determine whether or not

your symptoms are due to depression,

or if they're due to menopause.

[MUSIC PLAYING]

The first P is your period.

If you are having period changes,

then you're likely experiencing symptoms due to menopause.

The second P is physical changes.

Under the DSM 5 criteria for major depressive disorder,

there are no physical changes.

You're not going to see hot flashes.

You're not going to see skin changes.

And the last P, this is very important, is the past.

If you have a past history of depression,

then you need to be concerned about a recurrence in midlife

because people with a past history of depression

or a past history of trauma, past anxiety,

are more likely to experience the mood issues

recurring in midlife, because it's a vulnerable position.

It's a vulnerable time in life when your hormones are changing,

so you're more likely to have another recurrence.

So using the three P's, you come armed,

you know what you're dealing with.

You have less stress, so you make better decisions.

It started with really low energy, like lethargic almost.

Like, convincing myself to get out of bed.

So that's when my doctors started questioning

if it was depression.

So I tried all sorts of different medications

for depression, like so many different medications.

But it's like the symptoms were still, like, overwhelming me.

And I was like, I know, I know, I'm definitely perimenopausal.

[MUSIC PLAYING]

I teach my clients to listen to themselves,

to validate their concerns, and to be their biggest

advocate and historian.

And when you go to a doctor's office,

there are things that you should know.

What is my medical history?

What is my family history?

What are my symptoms?

How long have they been going on?

When you become the expert in your own history,

that is empowering, but it also helps your clinicians

to know what they're dealing with.

I would say, get a symptom tracker.

Whether it's a notebook, a diary, an app on your phone,

start to track what you're actually

feeling so that when you do go to your health care

professional, you can be clear about what you've been feeling,

times of day, when do these symptoms arise.

Be as clear as you can with your doctor

so that you can really talk about it in very

substantial terms.

[MUSIC PLAYING]

And I encourage my clients to make

their own biopsychosocial model.

The biopsychosocial model is used throughout all of medicine.

And when you look at your symptoms,

try to think about things in terms of this model.

So you want to draw or digitally create a Venn diagram with three

overlapping circles, and then designate each circle

to represent biological, psychological,

or social factors.

The biology part looks at things like genetics.

It looks at your background, your ethnicity,

your medical history, medications.

Then you look at the psycho part,

your past psychiatric history, your baseline resilience,

your baseline coping mechanisms.

And then looking at the social model,

your work stress, your relationships.

Now, you'll see some overlap on this biopsychosocial model

because some of the social behaviors

overlap with the biology.

If you are using things excessively like substances

or if you smoke or drink, start to write down your habits.

Look at experiences that can be potentially traumatizing.

Is your work toxic?

Are your relationships not healthy?

This model can be very helpful when looking at your symptoms

because they can impact your symptom severity.

So knowing these areas and these components

gives you the knowledge and the power

to focus on things that you can change, that you can modify.

So when I'm starting to have the menopause symptoms,

a lot of things come to mind.

Can I control it?

How long will this last?

Is this going to affect me?

Do I need to step away?

Do I need to clear my mind?

So in my mind, I like to correlate it

with other things that are happening around me,

because maybe some of the symptoms

are triggered by what I'm doing, or what I'm eating.

Is it after alcohol?

Am I anxious?

So I try to figure out what that is.

[MUSIC PLAYING]

So to understand menopause, we sort of

have to go back and think about what happens

during our menstrual cycle.

So when estrogen levels surge, your brain changes a little bit.

In fact, if we do specialized scans of your brain

and we zoom in to an area called the hippocampus,

you can see this region of the brain literally get bigger.

So this brain region is sort of pulsing when estrogen levels go

up, and then it sort of returns to baseline when

estrogen levels go down.

That pattern happens during the reproductive years.

If we're kind of thinking about what

areas of the brain in particular are

responsive to steroid hormones, it's the hippocampus

and another region of your brain called the prefrontal cortex.

So it's the area right behind your forehead.

These together are systems that play

a role in learning and memory.

And it's one of the reasons that when

women go through perimenopause, you

might experience some temporary brain fog, because these

are the systems of the brain that are trying

to figure out the new normal.

I had to give over to this new way of acting.

Well, I'm going to wing it.

I'm going to improv it if I can't remember it.

There are times when we had to say cut

because I went totally blank, and just forgot,

what are we talking about?

What is this scene actually about?

And that's terrifying.

Like, it's terrifying to feel that way.

[MUSIC PLAYING]

EMILY JACOBS: You think, is this it?

Have I just lost my ability to find words?

Have I-- am I going to be struggling to remember

where my keys are forever?

Is this feeling of brain fog going

to affect my efficacy at work?

It is terrifying until you realize

that it's incredibly common, it's transient,

and it's not a sign of anything deeper.

This is normal.

Brains are built to change.

They're meant to change.

They change during puberty, they change during pregnancy,

and they change during menopause.

That's a feature of our biology.

If we bring you in and have you do challenging tests in the lab

to look at brain function, there's

only like a few very specific areas

that we might see some change over menopause.

These tend to be in the domain of verbal memory.

So things like a list learning task,

like if you write down a grocery list,

and you try to memorize it, and go to the store,

that sort of verbal memory declines across menopause.

It does.

It declines.

But here's the back story to this.

Females have this advantage in verbal memory.

It starts around puberty, and it ends around menopause.

So for about 35 years of our life,

women outperform men on these verbal memory tasks.

This is a super solid finding.

We can see it across populations.

There's just a verbal memory advantage.

And when you go through menopause,

you lose that advantage.

So you're kind of just declining to the level of a man.

[MUSIC PLAYING]

We might put you in an MRI and look at your brain

as you're performing some challenging memory task.

And rarely do we find, what we call,

objective cognitive differences between a postmenopausal woman

in an age-matched men.

They're performing neck and neck.

But we might see differences in the strategy

that their brain uses to get to the same place.

So, for example, maybe in the post-menopausal woman,

her frontal lobe is more active.

Maybe she recruits other parts of her brain

to help her get the job done.

It's not the strategy that her brain used 10 years ago,

but it's the strategy that her brain can adopt

to achieve the same outcome.

Your brain isn't going backwards.

It's evolving forwards.

But ultimately, there are options

that we can think about that can help mitigate

some of those symptoms.

[MUSIC PLAYING]

JUDITH JOSEPH: It's important to know

that with thinking issues and cognitive issues,

you can do simple things right now to ease your symptoms.

Decluttering has been very powerful in terms

of de-stressing your environment.

Making things simple so that you can save time.

Using things like organizational skills therapy

that's traditionally used for ADHD.

Applying that to your experiences today

can be helpful.

Things like using a launch pad, an area of your home

where you put your keys, your wallet.

The typical things that you spend a lot of time looking for,

keep them in the same place every day.

Also, making lists to prioritize.

Many times we want to do a million things at once,

but validate that you can't continue doing that.

You will burn out.

So simplify your routine, and focus

on the most important things in the present moment,

and that way you're not overextending yourself

and overwhelmed.

One of, I think, really tricky things

about perimenopausal symptoms is that there's

not a particular order in which a symptom may start, right?

So for some women, there may be brain fog,

whereas for the next woman, she might notice hot flashes.

HALLE BERRY: I was working on a movie recently

and the sweats came on, the hot flash came on.

And I chose in that moment, as the character,

rather than saying, "Cut, I'm sweating.", I just accepted,

the character is sweating right now.

And so if I stayed true to my character

and be alive in the moment, which is what good acting is all

about, I just used that, and I start stripping off my--

stripping off things, because that was real for me

in the moment.

[MUSIC PLAYING]

EMILY JACOBS: So about 80% of women

feel what are called vasomotor symptoms,

so these are hot flashes and night sweats.

And you feel them in your body, right?

You feel them in your face and in your neck,

and your chest starts to get really hot.

If I were traveling, if I were flying somewhere and all

of a sudden being in a full body sweat-- now,

I have to take off everything.

I have to take off my sweater--

trying to do it and not knock into people,

I found that kind of embarrassing.

I was hanging out with one of my girlfriends.

In the middle of us talking, it was a million beads of water

all over her face.

The control of it, that is the worst part of it for me.

Hold on one second.

Just in that way, I don't know what's

going to happen on any given day, at any given time.

I had somebody tell me, "Girl, just think cool thoughts."

And I just looked at her like, "Ma, come on.

You can't tell me, just think cool thoughts."

At night, you kick off the sheets

because you're getting this kind of full body response, right?

But even though you feel it in your body,

the signal for initiating a hot flash actually

comes from your brain.

[MUSIC PLAYING]

And it comes from heat-sensing neurons

that are in your hypothalamus.

So this is a region of your brain

that has something to do with temperature regulation,

and this circuit in your brain is used to getting signals

from estrogen and progesterone.

And then when you start to go through perimenopause

and your cycle start to change, that signal,

from estrogen and progesterone, isn't as reliable

as it was before.

And so these neurons start to misfire a little bit.

These are called neurokinin neurons

that are in your hypothalamus.

They start to misfire, and that misfiring,

we feel as a hot flash.

That basic science of understanding

this temperature-regulating circuit in the brain,

understanding that basic biology,

led scientists to the development of a new drug.

This is a non-hormonal drug called VEOZAH,

and it essentially stops those neurons from misfiring.

By the time estrogen and progesterone levels

stabilize in the postmenopausal period,

the brain gets used to this new normal.

Currently, I'm on VEOZAH.

It's very expensive, so thank you, Obama, Obamacare,

for hooking a sister up, because there's

no way I would have been able to spend a good $900

a month on this just so I'm not waking up in a pool of sweat.

It definitely helped with the hot flashes and the night

sweats, but the energy is still low,

so I'm hoping to find something that will help with that.

JENNIFER GUNTER: There are lots of options

for a variety of different symptoms and menopause.

Estrogen is the gold standard, especially with hot flashes,

specifically.

[MUSIC PLAYING]

I don't know much about hormone replacement therapy

other than I know the acronym for it,

and that it's supposed to help people.

What I've heard about HRT is that it can cause breast cancer,

and I don't want cancer.

I was like, "I think I need to start HRT."

And my doctor, she was like, "Well,

there's been studies that have attached it to breast cancer."

And I was like, okay, now I've got to go back online, on WebMD,

and I got to look up like, you know.

So the risk that a lot of people get worried about

is the risk of breast cancer.

And this is for people taking combination therapy,

an estrogen plus a progestogen. That risk is about 1 in 1,000

per year.

Now, to put that 1 in 1,000 in perspective,

that's about the same risk as the risk of breast cancer from

being obese.

That's about the same risk of breast cancer

from having a glass of alcohol a day.

And if you're using Premarin only, which

is conjugated equine estrogen, your risk of breast cancer

is actually lower.

But a lot of people come in with preconceived notions

that this might be a super risky thing because

of things they've read in the news or other things.

[MUSIC PLAYING]

Doing all right.

REPORTER: Fears about HRT have centered on the possibility

that it might cause cancer.

It's very confusing, very difficult decision to make.

REPORTER: Some doctors are advising women who

are using combined HRT to stop.

Newsweek calls the response like, near panic.

Women essentially flush their pills down the toilet.

They stop taking hormone therapy overnight.

But there were two big problems.

The first problem is that those articles

didn't get into the difference between statistical significance

and clinical significance.

They didn't talk about the fact that if you

double a really small number, it's

still a really small number.

The other issue was about the way the study was designed.

Most of the women in this trial were in their 60s and 70s,

up to the age of 79.

And when researchers went back and reanalyzed the data and just

focused on the women who were in their 50s,

it was a completely different story.

The young women in the trial who received either the combined arm

or the estrogen-only arm had lower rates of breast cancer.

They had reduced risk of cardiovascular disease.

They had lower rates of all cause mortality,

meaning death for any reason.

And there was no difference in the rate of dementia.

That story wasn't reported by the media.

And I always like to say, we hear about breast cancer risk

all the time with hormones, or it seems to be,

but we never hear about risks like blindness

with drugs for erectile dysfunction.

But, you know, those do exist.

Again, albeit rare.

But scaring men about their bodies

doesn't seem to get attention, and scaring women

about their bodies does.

And that fear is unfounded if you

are a woman who is going on menopausal hormone therapy

early in the transition.

[MUSIC PLAYING]

We just want to make sure that women are not

relying on outdated news stories that

make them fearful of something that

could be an option for them.

But not everybody can take it, not everybody feels good on it,

and everybody's risk is different.

Some people have personal reasons

they don't want to take it.

And so I think it's important to hold space

for all of those options.

There are some medical interventions that you can use,

but you know, I'm really into the natural remedies.

I have a friend that told me about taking a baby's teething

ring and putting it in a freezer.

And then if you start getting hot,

just put it on your ears-- get two of them,

put them on your ears-- just to cool you down.

I've had folks say get some ice cubes

and put them in special places to cool you down.

I don't know if that'll get cut, but it's just one of the tips

I heard about, and it works, so anyway.

[MUSIC PLAYING]

JENNIFER GUNTER: So there are non-hormonal options

for hot flashes.

There are neurokinin 3 inhibitors, and--

well, there's one currently on the market,

but this is a real active area of research,

so it's really exciting.

I think we're going to see more drugs in this area.

There are also studies that show that antidepressants

can be useful.

For example, Paroxetine or Venlafaxine,

those can be very effective.

Then Gabapentin is another medication that can be used,

and Pregabalin can be used, as well.

And Oxybutynin, which is a medication actually

we use often for the bladder, can be used.

And so these are a variety of other options.

And of course, there's also cognitive behavioral therapy,

which has actually been shown in good quality studies

to be effective for treating hot flashes.

So that's one type of therapeutic modality.

There's a newer type of behavioral therapy,

metacognition.

Metacognitive therapy is a form of cognitive behavioral therapy,

but it focuses less on changing the thoughts.

It's really teaching you how to think about your thinking

differently.

So this can be very confusing.

And I highly suggest that you work with a therapist who

is trained in MCT.

If you tell someone to stop thinking about an elephant,

the first thing that they're going to think about

is the elephant.

MCT is allowing the elephant to be, and just

not giving the elephant as much of a platform.

So you know the elephant in the room,

but you're making a choice to focus on other things.

It's not to say that, that hot flash isn't happening,

it's still happening, but you're not

putting as much emphasis on it.

And that may help to decrease the length of the hot flash

and also the repercussions of the hot flash.

[MUSIC PLAYING]

JENNIFER GUNTER: Many people who think they're sleeping well

in menopause actually aren't.

And I always give my own example.

So I am a super flasher.

They're controlled now, but sometimes, I

can have them at night, still.

And they're bad enough that they wake up my husband,

but they don't wake me up.

Right?

I'm still obviously having them.

I'm objectively experiencing them because my skin is hot.

And almost certainly, my sleep is probably being disturbed,

but I'm not disturbed enough that I wake up, right?

So sometimes people can be having sleep problems

that they don't realize they're having them because they're not

waking up, but there may be some things still going

on biologically that could be affecting

the quality of their sleep.

As neuroscientists, we care a lot about sleep

because sleep quality is really important for your brain.

If you are having hot flashes, especially

at night, that leads to disrupted sleep,

and disrupted sleep is going to lead to brain fog.

There's a reason that some regimes use sleep deprivation

as a form of torture.

It's because it is murderous on the body.

[MUSIC PLAYING]

I would say menopause affects my career.

I'm an entrepreneur, and I'm interacting with people

all the time.

So I could be in a mood where I couldn't sleep the night before,

so I'm already annoyed, because now I have to get up,

and I still have to be in my appointments, right?

So the insomnia can affect me in that way, where I'm moody,

I've only had three hours of sleep, or I've been in and out,

up and down, or I'm just awake.

And that affects my mood, right?

I could be a little bit more snappy or a little bit more

anxious or a little more disengaged,

and I don't want to be that way.

JENNIFER GUNTER: Mood changes can affect sleep,

but sleep can affect mood, right?

And so we have to think about, well,

which came first, the chicken or the egg, or is it both,

and maybe we need to approach both?

And there may be situations where someone is not

sleeping well because they're having

multiple hot flashes a night.

And so we might say, well, we want

to get some estrogen started to see

if we can get you sleeping better,

and to see if that has an impact on your mood.

And then we might want to reassess

that in six to eight weeks.

And we may not need to have that discussion

because once someone is sleeping better, things might be better.

But again, there are some people who

don't want to use a medication.

And I really believe we have to meet people

where they are and have as many options as possible.

Recently, I got this mattress, and it's a cooling mattress.

Changed my life because now I don't

have to sweat through the nights when I have like cool air

emanating from underneath me.

And so I'm getting a better sleep.

But if you're experiencing sleep disruption because you're

stressed at work or you have a kid in college

and there's financial stress, there's all sorts of reasons why

by the time you hit midlife, shit gets real,

and that's not just because you're experiencing

these symptoms of menopause.

So one thing that a provider, a good provider, would do

is try to get to the root of those problems.

They're going to point you to different options

for trying to preserve and maintain good sleep habits.

[MUSIC PLAYING]

JUDITH JOSEPH: There are other non-medical ways

to address sleep.

For example, the bedroom should only

be used for sleep and intimacy, and nothing else.

And if we condition our brains to view the bedroom as a place

just for sleep and intimacy, then that helps us tremendously.

Sleep hygiene entails things like keeping

the bedroom cool, things like keeping light at a minimum.

So I joke because I travel a lot for work,

and I call myself the light hunter.

Every time I go to a hotel, I'll find some tape,

and I'll start taping up these little lights around the room,

because even a little bit of light

can disrupt your natural melatonin, the natural circadian

system in your brain that controls your sleep-wake cycle.

Also, decreasing the amount of caffeine intake, sugar intake,

greasy foods, those will all help you to get better sleep.

There are other things people can

use, like using worry journals.

A lot of times, we don't process our stress and our worry

during the day, and what happens is

that it'll pop up in the middle of your sleep.

So a lot of people wake up with anxiety at night time

because they haven't processed their worries.

So I would encourage you to keep a worry journal,

and set aside time in the day to worry.

So you pick the time of the day, and it should

be the same every single day.

And pick the location.

It shouldn't be a place in your home

where you spend a lot of time because you want to associate

that location with the worry.

That's a worry corner.

Pick that time and that place, usually, it's

20 minutes, just to-- that's your time to worry.

Get it all out.

But once you leave that corner, that's

when you focus on other things.

That's a skill and a tool that you can

use for the rest of your life.

JENNIFER GUNTER: And menopause is a great time

to step back and reflect and say,

how is everything that's going on in my personal universe

affecting me?

How much of this is my lack of sleep from hot flashes

How much of this is the fact that I'm having depression

from the menopause transition?

So that's affecting my ability to be

able to be motivated to go outside for a walk.

It's all very complicated, and it's really difficult to sort

out a complicated thing in a 15-minute office visit.

[MUSIC PLAYING]

So GSM is the Genitourinary Syndrome of Menopause.

In the past, it used to be called vulvovaginal atrophy.

The most common symptom of GSM is vaginal dryness.

There might also be urinary changes, like UTIs, or Urinary

Tract Infections, urinary incontinence or leakage that

happens, and that can be incredibly embarrassing

for women.

But the reality is between 50% to 70% of women have GSM,

and we're much more likely to talk about a hot flash

or a night sweat than we are to say to our doctor, "Doc,

sex hurts, and I don't know what's going on."

You know, one doctor, who I love,

who was a very good doctor, told me that I had herpes.

And when it was all said and done, it wasn't herpes at all.

It was the drying that happens to all

of our orifice of our body.

Not every woman experiences that,

but that's what I experienced.

Dry eyes, dry mouth, and dry vagina.

And that was never explained to me.

I was 54 years old when this was explained to me.

I've since learned that should have been explained to me when

I was 40, that this is a possibility, so here are

some things you can do along the way

so that you won't get to the place

where you feel like you have razor blades in your vagina,

and you're running to the hospital,

and you're wondering what the heck is going on?

LORI BROTTO: GSM has been studied quite a bit

when it comes to understanding menopausal and perimenopausal

symptoms.

And it's also been an area where, thankfully, there's

been a lot of good research on hormonal treatments for it.

But if, for whatever reason, you have a contraindication

for taking a systemic hormone therapy, meaning taking a pill,

there's topical creams, estrogen cream, that

can help with vaginal dryness.

And it's safe and effective for almost every woman

on the planet.

When I did talk with my doctor about it

was when I was getting an annual,

my pap smear, and that was super painful.

And so that's what brought it up, was like, wow,

this procedure, which is never comfortable to begin with,

was super painful.

So I'm using estrogen cream now, partly because if and when

I have sex again, I want it to be pleasurable,

but also because I want these exams

that I get to not hurt so much.

[MUSIC PLAYING]

LORI BROTTO: For some women, it's

like, yeah, I never used a lubricant at any point

in my life, and now my vagina is dry,

it makes vaginal insertion painful.

In fact, there's so much pain that I've lost my desire.

I'm avoiding sex.

I'm avoiding undressing in front of a partner.

I don't engage in foreplay.

Really, really common, and I sort of

portray that out because it's more than just dry vagina,

right?

It can have an impact on intimacy across the board.

It's actually, a core part of quality of life.

My sex drive has not decreased,

but I believe, like, I can't do--

okay.

I'm not going to say what I was about to say.

So just-- it's just different now.

When I did have sex, it was painful.

The dryness, it gets embarrassing, you know?

As a sex therapist and a sex educator,

I normalize the conversation about lubricants.

In fact, I equate it with using an alarm clock, right?

So I use an alarm clock in the morning

to make sure that I wake up at the time

that I would like to wake up.

Yes, I could wake up naturally, but it's so much more reliable

to rely on an alarm clock.

Over 60% of females across ages are using a lubricant.

Lubricant is not about treating a dry vagina.

It's about making vaginal insertion and vulva

stimulation more comfortable, more pleasurable,

more enjoyable.

Thankfully, we don't need to go into any store

to buy a lubricants.

You can buy lubricants online pretty quickly.

A vulva or clitoral lubricant allows one to experience arousal

and pleasure in a more reliable and efficient way than, quote,

"waiting for it to happen."

So if we can normalize it in this kind of way,

then yes, it means that the young person

at their very first sexual encounters

is talking about a lubricant, is making it sexy and fun,

and equips that person for having

maybe more challenging conversations

about their sexual needs later on in life.

I think a really important component to women embracing

this time of their life is finding a way to incorporate

their significant others.

I think men and partners have to really

be a part of this conversation.

It's not just a female problem or our problem.

It's an issue that we all have to tackle together.

[MUSIC PLAYING]

LORI BROTTO: One of the ways that I often

encourage women who might be a little bit

embarrassed to bring-- like, "How do I bring this up?

I've been with my partner for 35 years,

and I don't know what words to use."

You can say, "Hey, I listened to a really great episode

on a podcast, or I watched a MasterClass on sexual health

and menopause, and could we start to explore this?"

Sexual communication is the ability to say,

I feel most sexually satisfied when we do this.

And I-- "I"-focused language is a really important tactic

to use, especially in the context of a relationship.

Because if I can say to you, "I really enjoy it when my labia

are stimulated," that's received very differently than,

"You're not touching me the right way,"

or, "You're not finding the places that elicit pleasure

for me."

So being able to own the locus of control

helps also eliminate any chance of defensiveness

on the other person.

It also just communicates to yourself

that actually my sexuality is mine, I own my sexuality.

[MUSIC PLAYING]

Sexual communication can also be the ability

to talk to a health care provider

when there's pain with sex, when there's

been a change in your desire for sexual activity,

when orgasms don't feel as pleasurable as they used to.

So essentially, we're talking about talking about sex.

That's sexual communication.

If you're able to talk about sex,

you're also more likely to access resources

for sexual health.

You're more likely to separate fact from fiction.

So sexual communication doesn't exist in a vacuum,

but it can be such an important predictor

of who's going to have sexual satisfaction in the long-term

or not.

My husband and I were very honest about sex.

We are rocking right now.

Because the kids have gone to college,

we've been having a blast.

So thankfully, it's all working for me.

I don't think it's the end of my sex life,

but I think when I do have a partner,

I would have to be a little more proactive in getting

my libido up.

Yeah, now, I have absolutely no desire,

but hopefully, I'll recover.

So when we think of desire and libido,

we think about it in only one way.

You feel horny or you don't.

You have that kind of wanting, that lustful feeling deep

in your belly, or you don't.

And unfortunately, first of all, it's not accurate.

A lot of science has debunked that there

exists just one kind of desire, which is really great news.

But the other thing, the other harm, that it leads to

is this belief that once it's gone--

"it," once it is gone--

you can never get it back.

Again, totally debunked by the science, thankfully.

[MUSIC PLAYING]

So to the men who are watching, this is a fantastic time

to talk about sexual desire.

Yes, there might be that spontaneous, out of the blue,

"I feel horny," but that kind of desire will decrease not just

with menopause, but just in any long-term relationship.

Thankfully, there's a second kind of desire,

and it's a much more common kind of desire

that emerges in response to a sexual encounter.

It can be very normal to go into a sexual encounter

even without a libido.

Because what we now with this kind of responsive desire

is that if we go into an encounter with a reason,

with an intention, if we're using triggers and stimuli that

work for us, and then really importantly,

if we pay attention, if our mind is in the moment

and not pulled away thinking about a multitude

of other things, then that paves the way

to arousal and responsive desire.

And so now, suddenly, she says, "Ah, now, I feel it.

Now, I want this.

This feels great.

I'm motivated, I'm in, I'm in sync,

and I want this to continue."

I think another really important takeaway,

no matter what it looks like, no matter

how frequent, no matter the intensity of pleasure,

we can learn to enjoy sex and feel pleasure well

into the older years.

It's really important to believe and accept

that sexual health is part of health.

[MUSIC PLAYING]

So there's the tire in the middle.

There's this tire, I call it, that just shows up

around your midsection.

And I've never had a tire around my midsection,

never thought I would.

But when old peri came knocking at my door,

this tire showed up out of nowhere.

Also, very confusing.

You can't understand why.

You think, I'm eating the same way I always used to eat,

and then this happened.

Everything about our body composition starts to change,

and this midsection weight gain is just part of it.

[MUSIC PLAYING]

CAROL: The weight gain is real.

I couldn't lose a pound anymore.

Like, I used to be super thin and that great body,

but menopause changed a lot of that.

So that's also been difficult because it

will affect your mind, because you don't recognize yourself.

So I have what I call reverse dysmorphia.

So when I see myself, I think I look-- in my head,

I think I'm thinner than what I am.

It's not until I see pictures, and then I'm like, who's that?

Oh, that's me.

[MUSIC PLAYING]

So some women say I gain 5 or 10 pounds

when I went through menopause.

First of all, everyone gains weight as they get older.

That's just a normal part of the aging process.

But the cool thing about the body

is that, that actually might be your body saying, hey,

I got another source of estrogenicity for you.

There are other systems that can kick on estrogen,

so you have adipose tissue, fat, and those adipose cells

can produce a hormone that acts like estrogen in the brain.

And it's a way of keeping your brain healthy.

It's kind of taken the load off your ovaries,

and here, our brains are able to benefit

from that extra estrogen. So yeah, you

may feel a little bit heavier, but it's actually

your body's way of keeping your brain healthy.

Hormonal changes during the menopause transition

may cause the fat deposits to crowd around your belly area.

We don't exactly know why that is,

but doctors will tell you that belly fat can set you up

for things like, metabolic syndrome, diabetes.

But there are things that you can do about this.

It's not that easy, and sometimes you

do need to work with a nutritionist,

but food really is medicine in this case.

The majority of the deposits are related to nutrition,

and many of us are not aware that the foods that we're eating

are highly processed.

If you look at the ingredients on the back of what

you're eating and you can't pronounce it,

it's likely processed.

And it's increasing inflammation and worsening

your physical health.

Changing your diet so that you're

focusing on foods that are high in fiber, that

are high in protein, that are more nutritious, less

processed, less sugary, all help because they

reduce inflammation, and can change the way that fat

is stored in your body.

[MUSIC PLAYING]

Then, there are these other symptoms, like joint pain,

and menopause is also associated with a higher

risk of osteoporosis.

It's a disease of bone health and causes bone fragility.

I think that's where my journey really started

with this, was that what is going on with my hips?

What?

It's so weird.

And the more conversations I had with women about their hips,

we all seem to be having that same thing.

So you get this hitch in your giddy up.

You stand up, and you're like, [locking up noise]

and you fall over, and you're like, oh, my god,

I'm literally falling apart.

We care about osteoporosis and also osteopenia,

which is the lead up to it, because increase

the risk of fracture.

And fracture leads to all kinds of awful complications.

Estrogen is really important in building bone.

It helps build bone.

And so when we lose estrogen, we stop building bone.

And this is important because not only

are we always building bone, but we're always losing bone.

It's kind of being recycled.

So if you're affecting that equation, in that you're not

changing the loss part, but you're affecting how much you're

kind of building, you're going to start

to get this loss of bone.

[MUSIC PLAYING]

And it differs really for different women.

Some women can have a pretty significant loss of bone

during their menopause transition,

it tends to start about one or two years before the periods

end, and other people don't have much loss at all.

But also, some people come into menopause

with a much higher bone bank than other people.

So if you've been a lifetime smoker,

if you're someone who didn't have periods for two or three

years, if you're somebody who maybe had

a significant nutritional deficiency,

you might not come into menopause with a bone bank.

So we want to ask you about risk factors.

We also want to know about genetics, family history,

and we want to try to calculate then to see,

are you at somebody at higher risk for osteoporosis,

or are you somebody at lower risk?

And then make decisions based on that.

And for people who have concerns about osteoporosis,

menopausal hormone therapy is a very good preventative tool.

My own mother died from osteoporosis.

People don't think about dying from osteoporosis.

They think about maybe I have a break.

But breaks can lead to not only pain and suffering,

but sometimes they can start a chain of terrible events,

and that might cause someone to go from living independently,

to have to live in an assisted living facility.

That might lead to someone having a terrible life

of chronic pain, where then they have other complications, maybe

related to medications they have to take for that.

All kinds of awful permutations and combinations.

[MUSIC PLAYING]

And there are other medications that can also

help prevent bone loss, and that's important for people

to, because not everybody can take menopausal hormone therapy.

Now, if you have a concern about your bone health

and you want to take it for that reason, it's very valid.

But if you say, well, I only want

to take it if I need it, right, then we

want to look at what your individual risk factors are,

and there are a couple of different tools.

There is something called the OST,

and there's another scoring system called FRAX.

F-R-A-X-- and those are both easy to look up online.

And you can put your data in and try

to start to assess whether you're at higher risk or lower

risk for osteoporosis.

And people who are at higher risk then

should probably consider having their bone density checked.

One of the things I think that's great about menopause

is that we start talking about health in ways

that are encompassing, but one of the bad things

is we should be talking about your bone health when you're 20.

Because you're building your bone as a teenager up

until about the age of 28 or so, you're building that bone bank.

So it's important to you through your whole lifespan.

You always want to be thinking about your bone health,

weight-bearing exercises, so important, resistance training,

and there are many things that can also be done

from that standpoint, right?

So protecting your bones isn't just about taking estrogen.

It isn't just about taking an anti-resorptive medication

or whatever other medication that might

be useful for osteoporosis.

It's also about making sure you're getting enough calcium,

making sure you're getting enough vitamin D,

making sure you're getting that resistance training,

working on your balance, because if you fall,

that's how you break a hip.

You don't break a hip sitting.

So you also have to think about all of these things

that go into fragility and health,

and how they're all important.

That's why resistance training is so important for women.

And if I could change one thing, it

would be to have resistance training taught early, because I

came to it very late in life.

And learning about how important it is for your bone health

and muscle health and brain health and everything else.

I'm doing it now.

It's never too late.

That's the great thing about it.

But that's why I say, if you're thinking about your bone health,

today is the best day to start.

I've worked out my entire life.

It's been a part of managing my diabetes,

and it hasn't always been for the physical aesthetic.

It's really been for optimum, good health,

but the physical is a part of that

when you're really taking care of yourself from the inside out.

I realized, though, as I reached perimenopause,

that I had to change my workout.

It was now more about lifting weights.

I didn't used to lift weights before,

but as I realized I'm going down the path of life,

I like to call it, I realized I have

to start lifting weights now, because keeping

my muscular and my skeletal self strong

is really, really important.

The stronger I am, the less accidents I have.

If you fall down and hurt yourself at this time of life,

it can be debilitating.

So I've had to realize it's about upping

the calories, the protein that I eat, and it's heavier weight.

My body needs that just to maintain the structure

that I used to have.

[MUSIC PLAYING]

JUDITH JOSEPH: The mind-body connection

is so real in menopause.

There are studies that show that if you have baseline anxiety,

if you have baseline depression, your perception of your symptoms

may change based on your anxiety and your depression.

So having this mind bias towards your symptoms

and thinking that your symptoms are worse than they actually are

can actually set you up for worse symptoms in the future.

On the flip side, having new symptoms

like hot flashes, problems with sleep, changes in your body,

that can, in turn, worsen your mood,

cause some symptoms of depression and anxiety.

So the mind-body connection goes both ways.

[MUSIC PLAYING]

It's important to know how to regulate your mood, to address

your depression and your anxiety at the same time

as addressing your symptoms, because your perception

as to how bad the symptoms are can

be impacted by your initial emotional state.

You just need to reframe it, and that's what I do as a therapist.

I reframe.

A lot of the studies show that cognitive behavioral therapy

to support the depression and anxiety symptoms in menopause

is very beneficial and in some cases,

more beneficial than medications.

Cognitive behavioral therapy helps

you to look at your thoughts differently,

to change your thinking so that you have a better outcome.

Many times, you may be thinking, okay, I'm aging,

I'm getting older, things are happening to my body.

This means I won't be able to do the things that I love.

These are automatic, negative thoughts

that can be quite destructive, and they

can put you in your place and keep you stagnant.

However, if you can learn to challenge these thoughts

and change these thoughts, the goal

is to change them so that your feelings change

and your behaviors change.

[MUSIC PLAYING]

There are studies that show that the way that you perceive aging,

the way that you approach aging will change

your outcome significantly.

If you are optimistic about aging and getting older,

if you're looking forward to it, you're

going to have less symptoms.

So reframing the way that you approach aging

is so beneficial because you can actually

age happier and continue doing the things

that you love with less symptoms if you reframe.

Recently, I went to a doctor's appointment,

and I was having a hard time seeing.

I started to have these white flashes that

were continuing to make their way into my sight.

And so I went to see my doctor about it, and he said, "Yeah,

well, your glands are starting to dry up,

and we don't want that to happen."

And I said-- because I had done so much research on my own--

I said, "Uh-huh, and why is this Happening " And he was like,

"Well, you know."

I said, "No, tell me, doc, why is this happening?"

And he said, "Well, you know, it's because--

you just got to get the treatments.

Your glands are drying up."

And I said, "But why is this happening?"

And I realized that he couldn't say it.

So I took the liberties of saying it for him.

And I said, "Is it because I'm in menopause?"

And he said, "Yes, yes, thank God, you

said it, because I could have never said that to you.

I mean, look at you.

I can't tell you, you're in menopause.

My female patients don't want to hear they're in menopause.

They're going to punch me."

And I thought, poor guy.

He can't even talk to me about it

because he can't say the word.

He doesn't think he has permission to say the word.

That's how stigmatized it is.

And in that moment, I realized, if our health care professionals

are too afraid to say it, how are they going to provide us

with optimum health care?

So I think that's the goal, to make it an easy conversation

to have, destigmatize what this time of our life is all about.

[MUSIC PLAYING]

CAROL: The word menopause makes people uncomfortable.

It's a fear of being judged, that means you're old.

It's literally goes to--

the word menopause equals old.

I saw a convention kind of like--

that a nonprofit agency was having.

And I said, oh, this is about menopause.

I'm not doing anything--

I don't really need to know about menopause.

I'm not even old yet.

I think it's strange to bring it up

because the reality of, am I at that age yet?

Like, is this really happening to me right now?

Am I really this old?

LORI BROTTO: There's a lot we don't know about menopause,

and because we don't talk about it,

we're left with myths and stereotypes.

And so the typical trope or stereotype is the old lady.

[MUSIC PLAYING]

JUDITH JOSEPH: The image of the menopausal woman

is not one that is sensual, that is attractive.

LORI BROTTO: And unfortunately, it's never challenged.

And lots of myths get perpetuated.

One that really taps into this conversation we're

having about menopause is that sex

gets worse with age for women.

In fact, what the data suggests is

that women are more likely to have

more and more pleasurable orgasms with age.

Orgasm has a lot more to do with skill and communication

and comfort than it does with hormones.

Myths that we all carry are so pernicious because we rarely

stop to question them.

And yet, the beliefs that we carry impact everything.

How we feel, our emotions, our behavior, the stress

we carry in our body.

And so it also means that we need to pause and question

our own beliefs.

We need to say, okay, I've been holding

on to this belief about something, is that accurate?

[MUSIC PLAYING]

As science is evolving, we have data

that now allows us to answer questions,

to be able to say, well, that actually is a myth,

and we need to replace that with a fact.

Until the next bit of science comes along.

If we look back to the late 1800s,

where all of women's health conditions were chalked up

to hysteria--

the wandering uterus, the uterus was

thought to move around the body and give rise

to symptoms like neuroticism, which we now know today

as anxiety, or chronic pain or abnormal bleeding,

and at the time, it was thought that hysteria

was the root cause.

And of course, the treatment for hysteria

was orgasms that were elicited by a male physician.

And so we can look back now at our history of women's health

and say, well, that's quite silly.

First of all, the uterus doesn't dislodge and move around.

And secondly, although orgasms are fantastic,

they're not a treatment for every women's health ailment.

But there has been a legacy of that, that has persisted and has

clouded our teaching of women's health, what appears

in textbooks, what gets discussed in the media, that

still continues to this day.

We talk a lot about menopause, and how

women go through this endocrine transition,

but men go through a similar hormonal transition.

It's called andropause.

Men start to lose testosterone beginning in their 30s.

There's sort of a steady decline,

and it continues until death.

It just happens.

It's just a normal part of the aging process.

But interestingly, there's been such not only

a cloak of silence, but a cloak of shame,

because menopause is also associated with aging,

and that's something women aren't allowed to do.

[MUSIC PLAYING]

EMILY JACOBS: Most of what we know about health and disease

centers on the male body.

So in, what's called, pre-clinical research, so all

of the biomedical research that happens in animal models, that

is mostly happening in males.

Male rats, male mice.

It's true in neuroscience, immunology, cancer biology,

physiology, all of these fields.

When I started doing research, I

was a young student, a junior scientist.

I was interested in understanding the factors

that impact sexual activity.

And so I began to volunteer in a research

lab that was using the male rat as a model of human sexuality.

And so we would inject the rats with different things

like antidepressants.

We would expose the rats to stressful environments

by crowding them in a small cage,

and then measuring sexual activity.

So I would watch the rats in the cage.

How often did they mount?

How long did it take them to ejaculate?

And I spent many, many years doing that.

Until one day, I realized, I was using the male rat

as a model for understanding human sexuality,

human male sexuality and human female sexuality.

And it's so paradoxical that even in animal science,

we're using male models to understand female conditions.

According to a report by the US Government Accountability

Agency, about 80% of drugs that are pulled from the market

every year by the FDA are done so because they

have adverse effects in women.

These are effects that presumably

would have been caught earlier had that preclinical testing

included both sexes.

It's our tax dollars, right?

And science has to serve society.

Not one half, but the whole damn whole, right?

Women are 50% of the population, but only 10% of NIH dollars

goes to conditions that primarily affect women.

[MUSIC PLAYING]

Only in 2016 have we reached the point

at which our bodies are being taken seriously

for the first time.

We're living history here.

This is new.

There is a lot to be hopeful about.

President Biden just signed an executive order

requesting $12 billion in new funding

specifically to advance women's health research.

This just happened in 2024.

2024, we have now a White House initiative on women's health.

We didn't have that before.

This is something of a watershed moment for women's health.

This is probably, I think, in our lifetime,

ladies, one of the most important things

that we'll do for ourselves.

And it's really important that we all

stand together and lock arms.

And I am beyond honored to be here and be

a part of this movement that's happening.

[MUSIC PLAYING]

HALLE BERRY: The Advancing Menopause Care

and Women's Midlife Health Act is

an act, a bill, that I've been a big part of getting passed.

Advocacy became supremely important to me

because I knew that this was a subject that

needed to be talked about.

It was a subject that had long been overlooked.

And so I thought, I'm going to go to Washington,

and I'm going to talk to my female Senators and House

of Representatives, and I'm going

to tell them what the issue is, what I'm experiencing,

and ask them to come together and help erect

a standalone bill that will give money,

new money, new dollars, just for menopause and women in midlife.

And it's true, that it's such a stigma around menopause,

and what that means for a woman, and the fact that we're old,

and we're no longer valuable to society.

That's how we're viewed.

I realize there's that stigma, but I'm not

afraid to get in front of this, right?

This is the most normal, natural time in every woman's life.

We make up half the population, and every woman

goes through this time if she's blessed

enough to live long enough.

We are, in many ways, the cornerstone of our society.

We birth children, right?

We give our bodies to procreation so that we all

can be here, men included.

Why are we discarded when those years are over?

Not okay.

And that's why I went on my journey,

because I knew that I had to.

I realize it sounds strange to say

this in a class about menopause, but there's

so much about the biology of menopause that we don't know,

because science doesn't study people like us.

So if women feel like they don't have answers, part of that

is because medicine has failed women for centuries.

We are confronting a medical system that was never

designed to serve them.

We're confronting a research that is still in its infancy.

[MUSIC PLAYING]

I started going to my doctor, and I said,

I think I'm going crazy.

Something's wrong.

You know, funny enough, my doctor never,

ever brought up the idea of perimenopause.

I even go to a female gynecologist,

and no one has ever said anything to me

about perimenopause.

So I was telling my doctor that I felt that's what I had,

and she just kept telling me, I'm too young, I'm too young.

Even knowing my history with my uterine reconstruction.

So she just would just not listen to me.

I did call my general practitioner the other day

to describe some of these things.

I'm 54.

I'm kind of happening.

And she was very kind, but she kind of said,

you need to call your gynecologist.

This really isn't a general practitioner offer.

So I think that's also part of the problem

is, where do we go to have the conversation?

And everyone's playing a little bit of hot potato,

so I think there's a bit of a vacuum of knowledge.

When you look at the doctors who typically would treat

a menopausal or postmenopausal individual,

they're going to be OB/GYNs, general practitioners,

internal medicine doctors.

And a recent study from 2019 showed that a little over half

of those doctors get one course in menopause training

after they've done their education.

One course is just not enough because we

know that during the menopause transition, a lot of things

happen, and this is complex and nuanced.

So we really need to have in-depth training

to direct patients to the correct interventions.

[MUSIC PLAYING]

JUDITH JOSEPH: If you're someone who

is African-American or identify as Black

or you're Native, Indigenous, large studies

show that you're likely going to go through menopause sooner,

your symptoms are going to be more severe,

and they're going to be longer.

So knowing this information is going

to help you to prepare and to plan.

Also, you're part of a group that has more trauma,

more generational trauma, more microaggressions,

macroaggressions.

And knowing that you have this history of trauma,

that sets you up for worse symptoms.

We know that there are health inequities that

disproportionately impact certain groups of females.

We know that gender diverse, including trans people,

face among the worst health inequities,

among the different populations of people who are seeking help.

And for the trans man, so assigned female at birth

and therefore, may have menstruated

and may experience perimenopausal symptoms

and go through the menopause, it can be incredibly embarrassing,

even traumatizing.

JUDITH JOSEPH: In my trauma research,

when you look at experiences that

can be potentially traumatizing, if something just happens

to you, then you tend to self-blame,

then you tend to internalize shame.

So that internalized shame and blame

leads us to suffer in silence.

If you can't talk about something,

the implication is it's shameful.

So I think that the very first step

is the discussions, is saying this is happening to me.

There's nothing shameful about going through menopause.

There's nothing shameful about aging.

There's nothing shameful about letting your hair go gray

or not letting your hair go gray.

There's nothing shameful about whatever

you decide to do for your own well-being,

but to have those discussions.

Society tells us that everything is over,

but we know this is not true.

This is the framework that I want you to work with.

I want you to look forward to getting older,

to dismiss the myth that you're no longer valuable.

We have to realize it's okay to put ourselves first.

It's okay to put our health at the forefront of our life.

When we get to midlife, it's when women usually lean out

of the health care system.

It's time to lean into our health.

[MUSIC PLAYING]

The dismissal that so many women and so many peri

and postmenopausal women express when

they find the courage to ask for help is devastating,

it's inappropriate, and it has to stop.

And of course, fear arises.

And when people have been so dismissed,

they're going non-traditional routes.

Social media can be fantastic in the way that it can connect

people with communities, it can help people find evidence-based

providers, but it can also be a place where fear is sold,

where you are given false information about hormone

balancing, about supplements, about menopause hormone therapy.

If you're taking a product that claims to have

a health benefit, right--

it can help hot flashes, it can help with metabolism,

it can help with weight loss, it can help with mood swings,

whatever--

know that, that has not been tested in any rigorous way.

These supplements are not regulated by the Food and Drug

Administration, the FDA.

They may actually interact in your body in a way

that you don't know what they're going to do and make

your symptoms worse.

[MUSIC PLAYING]

So when we talk about menopause hormone therapy,

evidence-based physicians are talking about pharmaceutical

medications made by a pharmaceutical company.

There are also compounded hormones

that come from a compounded pharmacy.

The way compounded hormones are often spoken about online

is this is a custom-made product for you,

and this is not supported by any science at all.

Someone going into a pharmacy and mixing up

hormones with a weight and a scale

can't create that same precision that you get

from pharmaceutical companies.

But even more, beyond that, when you

get a pharmaceutical product, they're all batch tested,

so you know what's in each one.

I can tell you reliably how much estrogen is in each patch.

That doesn't happen with compounded medications.

They're not batch testing these products.

So the problem with those medications

is you may not be getting enough of them,

or you may be getting too much.

And if you want to take a medication,

don't you want to know that you're getting the right amount?

So it's really important to stay clear

of things that are not regulated,

unless you're talking about them with your doctor,

because you want to make sure that you're not

making your symptoms worse, and that you're not

harming your body.

You only get one.

Now, I fully recognize that there are so many barriers,

that there aren't countless health care providers waiting

in the wings to offer support for the women who have been

dismissed by a certain health care provider,

but you have to become an advocate.

You need to advocate for your own health.

I would tell women to take their perimenopausal, menopausal

journey into their own hands.

Read, read, read, read, read.

If you find that you have doctors or health care

professionals that don't understand the menopausal body,

I say, have the courage to switch your doctor.

I think as women, we sometimes have a hard time

advocating for ourselves.

So if you have to change your doctor,

and you have to find a doctor who's female,

who has gone down this path, or who is going down this path,

I say do that.

[MUSIC PLAYING]

I would recommend going to the website, The Menopause Society,

which is a leading organization focused on women's health

during menopause.

It offers essential resources to help

you find certified practitioners, who

provide expert, personalized care

for your menopausal journey.

[MUSIC PLAYING]

In some cultures around the world, getting older

is seen as a blessing.

People who get older are valued.

They are the cornerstones of the community.

They're seen as sources of knowledge.

Because they have expertise, they have knowledge,

so they are celebrated.

Its a time of life, I've discovered,

that's filled with joy, because you know why?

You're completely who you are.

You have zero fucks to give, and that's a magical time of life,

in my opinion.

[MUSIC PLAYING]

JUDITH JOSEPH: You get to continue living life, doing

the things that you love with the people

that you love doing them with, so we

have to start reframing our narratives.

JENNIFER GUNTER: The theory behind menopause existing

is related to something called the grandmother hypothesis.

And the idea is that reproducing is hard,

and it was even harder 10,000 years ago, longer than that.

Reproduction was hard.

It's surviving childbirth.

It's having shelter.

It's gathering enough food so there's

enough energy to breastfeed and enough energy to heal,

to raise that child until they can gather food

and resources for themselves.

If you have an extra pair of hands, it's probably easier.

A lot of scientists are now coming to this understanding

that menopause is this evolutionary adaptation,

and we live longer than men, right?

If you look at all the centenarians walking

around the planet today, 80% of them are women.

So it could be that something about the menopausal experience

is what can explain women's increased longevity.

That's pretty damn cool.

Human beings continue to live and thrive and continue

being active and valuable members of the community

because they're supporting their tribe.

So we're making contributions as a whole, and we are meaningful.

We belong here.

We have a purpose.

[MUSIC PLAYING]

MANOUSCHKA: Our responsibility is to teach younger women,

like prepare them, for what's coming because, girl,

it's coming.

There's no-- this is a huge part of life.

And there's so much collective wisdom in the community

that we really need spaces to share it.

When we can have a conversation, when we can say,

this is what I go through, and this is what I've gone through,

you instantly feel less crazy.

You feel, oh, thank God, I'm normal.

So I am very close to my college sorority,

and we are all there to support each other.

Yes, I've tried-- have you tried HRT?

Have you tried magnesium on your feet at night?

I'm a big Advil PM person.

I've held all of their hair while vomiting many, many years,

so this is not a group of women that

should be trusted with any medical advice,

but they're emotionally fantastic.

It's important to have a community to talk about this.

Don't feel as if you're going through it alone.

Open up.

It's okay to be sad.

It's okay to share these emotions.

In sharing, you may be actually helping someone else.

Community is key.

Well, RESPIN has been my baby.

Once I realized that I was in perimenopause,

I had this aha moment, and I thought,

let's educate, let's inform, let's raise money,

let's change the world for women.

And the camaraderie of that is beautiful.

And I've heard women who have gone through menopause

and who are on the other side tell me it's the biggest joke

nobody understands.

[MUSIC PLAYING]

It's great over here.

It really is if you know the right things to do,

if you have the medications, if you have all of the information.

I want every woman to arrive on the other side of that

as their best selves.

So when it comes to the postmenopausal, like my mom,

for instance, right now, she is 63,

and she's been done with her period for 10 years already.

My grandma is still here with us, and she's 80-something,

and she's been done.

And they are free, and they don't have mood swings, at least

related to PMS, but you know, there's

a certain freeness in that.

If I could redefine menopause, first of all,

I wouldn't use that word.

I would choose another one because that word has

been so stigmatized, and there's such a negative connotation

with that word.

So I would change the word.

Back in the day, we used to use the term climacteric, which

I love, because it's more about of a phase of life,

a rung on a ladder, a step that you're going through.

It encompasses a lot more, as opposed

to defining you by the date of your last period.

I want you to start challenging

your idea and your imagery as to what a woman going

through menopause looks like.

So looking at someone in their 40s, 50s, 60s, who you admire,

who you look up to, do you think about menopause when you see

them?

No.

We need to learn, how do we define ourselves

based on the things that are important to us,

not based on the messages that society gives.

And recognize that the status of being mothers

is only one part of it, and that's

why, again, it's so important that we're

having this conversation.

[MUSIC PLAYING]

The definition of menopause, a journey, an awakening.

That's the word.

Oh, there is absolutely, a freedom.

Listen, no pregnancies, no periods, no PMS.

I guess, this is my transition to total freedom.

I don't always feel that pressure

of having to be a certain way, and I

think that's one of the beautiful things about getting

older and menopause, because there's a point where you just

don't care.

You're like, this is the way I am.

Because older women don't just wear Depends.

We like to wear cute underwear.

I wear a thong.

Do I look old and shriveled up?

Honey, I'm looking real good.

I'm in that next phase.

I leveled up.

That's how I see it.

I leveled up.

It's another part of life.

It's the next phase in your womanhood, in my womanhood.

And the more you know about this, the more you can live.

For so long, we've been valued by the way society sees us.

We get to decide our worth now.

We get to decide who we are in the second act of our life.

Let's change that narrative together.

Just like we have bachelorette parties and baby showers

and bar mitzvahs, bat mitzvahs, I

think we should have a she-esta, for women when they realize

that they're in menopause.

And their families should throw it.

They should usher you into this new phase of your life

with joy, with love, and with support,

and they should honor you that day with the she-esta.

HALLE BERRY: Because now, you're about to enter one

of the best times of your life.

[AUDIO LOGO]