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The Fullness of Midlife

“Somebody has to take up the cause for menopausal women, blow away the shame and silence.”

“Somebody has to take up the cause for menopausal women, blow away the shame and silence.”

by Dr. Barb DePree MD

Ann GarnierAnn Garnier, named among the Top 100 Women in Fem Tech and Health Tech 2019 is the founder and CEO of Lisa Health. A seasoned healthcare leader, she’s helped to create, launch, and scale innovative tech companies and products that have improved patient outcomes and access to care. She graduated from California State University with a degree in communications and business administration and completed programs in strategy and organization and marketing management at Stanford University. When she reached menopause at the classic (and completely average) age of 51, it went off without a hitch. No symptoms. She thought she was one of the few lucky women who sail through perimenopause. A year later, the symptoms started to pile on. After a few frustrating weeks and getting little support from her physicians, she decided to take matters into her own hands. She found a new, ambitious calling to help other women and advance midlife women’s health on a global scale. 

Dr. Barb: I've been intrigued to watch developments in the intersection of healthcare and technology. One that I've been especially interested in is Lisa Health, which is a personalized online resource that coaches women through perimenopause and menopause. Our guest today, Ann Garnier, is the founder and CEO of Lisa Health. Welcome, Ann.

Ann: Thanks, Barb. I'm excited to be on your program.

Dr. Barb: So tell us how it is that you identified that support through this time—this time of perimenopause or menopause—is a problem and it needs to be solved.

Ann: Well, I'm always a little embarrassed to share this story because I am a long-time healthcare executive, and have developed quite a few products for complex conditions including women's health around high-risk pregnancy, complex neonatal care, and even fertility. So when I reached menopause, about a year post-menopause, I started to have all these symptoms. And as you know, typically symptoms start to occur in your 40s, maybe even your 30s; of course you are the expert, but that's generally what the literature tells us. I thought I was one of the lucky 15 percent of women who would just skate through perimenopause without any symptoms. So I was of course happy about that, and because I wasn't experiencing symptoms, I really didn't have any reason to talk to my doctor about menopause. It certainly was not brought up to me in any of my annual well-woman visits.

When I reached menopause, having gone twelve consecutive months without a period, I essentially knew what was happening. But of course, like most women, I asked my doctor and they confirmed that yes, I was officially post-menopausal. But there wasn't any additional discussion about it in the appointment, and since I wasn't having symptoms, I didn't ask any questions or do any of my own research. But one day, a year into post-menopause all these symptoms just piled on. It was so crazy. The hot flashes, the brain fog, headaches that I've always had that seemed to get a bit worse. I just was walking around like this sweaty dazed zombie.

Dr. Barb: Because you had done well for a year and then deteriorated, did you associate it as menopause, or did you wonder if it was something outside of menopause, yourself?

Ann: No, I knew it was menopause. I just thought, okay I haven't really dodged the bullet after all.

Dr. Barb: So did you go back to your provider to have a conversation then?

Ann: Absolutely. And that's what the vast majority of women do; go to their doctor and sadly, like most women, that appointment was pretty disappointing. My doctor didn't really have a lot of information for me. She briefly mentioned hormone replacement therapy. She didn't discuss any of the benefits or risks, just said, "Well, why don't I start you on hormone replacement therapy and we'll see how that goes."

And not having had the benefit of understanding all of the options, the range of options that are available, both hormonal and non-hormonal, I just really wasn't comfortable in that appointment making that decision right then and there. So when I asked her besides hormone replacement therapy or the type she was recommending, what else I could try. For example, lifestyle interventions. She didn't have any information to offer. She just said, "Well you can try that." And I said, "Well try what?"

So, like most women, I left feeling pretty disappointed. And then like most women, straightaway I went onto Dr. Google and found that very confusing and complex. So I think my search for answers was very typical of most women. I've talked to, gosh, hundreds and hundreds of women. So I don't think my experience is atypical. I think it was overall disappointing, and I felt like I was left on my own to figure things out the best I could.

Dr. Barb: So you identified the problem and unlike most women, your answer to the problem, your solution to the problem was to create Lisa Health. Is that correct?

Ann: Well, not initially.

Dr. Barb: Okay.

Ann: As I was sitting there, as I said, being sweaty and in this brain fog and just not feeling myself at all—I'm this very high-achieving, highly active woman, and I just couldn't see myself being this way on a daily basis. So I was sitting there and I thought, “This is stupid. I create health care products for a living around complex conditions, including women's health. There's got to be something in the scientific literature that can help point me in the right direction in terms of relieving my symptoms.” Because I initially thought I'd like to try doing this through lifestyle interventions rather than hormone therapy, which I'm not opposed to. I think it's a decision that is personal for every woman. But I just generally always for anything, try lifestyle interventions first.

Dr. Barb: Sure, and I think as a provider we would like women to make the lifestyle changes that might benefit them.

Ann: Right, right. So I just did a deep dive into the scientific literature and read, I can't tell you how many studies, around a range of topics—both the efficacy of hormone therapies and non-hormonal therapies—lifestyle interventions. But as I said, I really decided initially to focus on lifestyle. So with an “n” [sample size] of one and a very detailed Excel spreadsheet, I started to undertake a variety of activities. And sort of my bar was that there was some evidence that women found a particular lifestyle intervention helpful for improving their menopause symptoms, and it was safe. So I certainly wasn't trying to do anything that was really, I don't know how to put it, but something that was kind of out of bounds from a safety perspective.

Dr. Barb: Sure.

Callout: I got my old self back, which is what a lot of women are looking for.Ann: What I found is after four to six weeks, my symptoms started to measurably improve, some went away altogether, others were diminished to such an extent that they weren't interfering with my life on a day-to-day basis. So I felt like I got my old self back which is, I think, what a lot of women are looking for. I think even more than that, I benefited from probably improving my health, because I was very focused on making certain changes in terms of exercise and diet and self-care, mental health. But also it was an opportunity for me to connect with my husband around what was going on at this stage of my life, and I think it brought us closer together and really deepened our relationship. So for me, initially thinking menopause is a drag, I have all these bothersome symptoms, but I was able to really turn it around and reframe it in a very positive, celebratory way.

Dr. Barb: Yeah, I was talking with a colleague recently, and she suggested it's a second spring. That was her term, and it sounds exactly like that—your description. So it was, I guess then I understand it was kind of your success around this journey of discovery that led you to think about a platform that you could share this and help other women journey. Is that correct?

Callout: Things happen for a reason.Ann: Yes. Well, things happen for a reason, and I was already planning to start a company. I had helped many other entrepreneurs start and grow venture backed startups in the healthcare arena. And I felt it was more than time that I did my own thing. So I was already evaluating a number of different areas of interest, and I kept going back to women's health because that's one of the areas I'm most passionate about. Because the pregnancy and fertility space was already pretty crowded, I was looking at other opportunities, and certainly menopause popped up, but it didn't grab my attention straight away. So it was through this personal journey that the light bulb went off. Entrepreneurs talk about that all the time, right?

Callout: Somebody has to... blow away the shame and silence.So I literally thought, “Wow, this experience was hard for me, and I'm a really savvy healthcare consumer who knows how to advocate for myself as to sort of work in women's health. What is this like for the average woman? This must be really, really difficult if it was hard for me.” So it was just right then and there I thought, this is what I'm going to focus on. Somebody has to take up the cause for women going through this stage of their life and help to kind of blow away the shame and silence, but also bring science and trust. Because they think it's important that women be able to source products and services that have science and evidence behind them and that they can trust.

Dr. Barb: And I applaud you for that because I think it is a much needed focus for women seeking solutions. And I think we're grateful that women like you recognize the importance of that quality of safety.

Ann: Mm-hmm [affirmative]. Well, part of my exploration around the products and services available in the menopause space really enlightened me to what really women have available to them. So, it's not an area, as you well know, that historically has had a lot of innovation or even attention paid to it. There's been some great research, but it's not one of the most well-researched areas of women's health.

I found that while there were some very good products and services, there were quite a few that have dubious medical claims, and are unsafe. So I think when women are going through this period of their life, there's a certain amount of desperation to try to relieve yourself of the symptoms, particularly if you're wanting to do that in a more holistic way. So I felt it was really important to bring a heavy educational component, but also to ground our product in evidence-based medicine.

Dr. Barb: So what exactly are you offering through Lisa Health?

Callout: Oftentimes women really aren't clear about where they're at.Ann: Sure. So Lisa Health is the first digital platform to use technology and evidence-based medicine to give women insights into their menopause transition because oftentimes we find that women really aren't clear about where they're at. We also offer personalized non-hormonal plans to help them manage their symptoms. And those—we call them journeys—those journeys include a science and expert-backed recommendations, specifically designed for managing the physical and emotional symptoms of menopause. We also support our users with high-quality education, tips and reminders, a wealth of resources and symptom tracking. So we've really consolidated—on one platform—all of the tools that you need to manage your menopause journey in a non-hormonal, holistic way.

Dr. Barb: So you're engaging with women really over a continuum?

Callout: We should be talking about menopause much, much earlier in a woman's life.Ann: Yes, absolutely. I mean, you know, Barb, this is a journey for women. It's not like you go in to the doctor, and you are cured in one visit. I mean this is a very long period of time that women can be experiencing symptoms, and those symptoms can change in terms of the type as well as intensity. And just during midlife, women have a lot that they're dealing with. So you combine that with the menopause transition, and it makes for a very complex period of our lives, but one that can be the most amazing period as well if you approach it and manage it in the right way.

Dr. Barb: I think what I've observed is that knowledge is power as has been said over and over again. But as you started out earlier, there hasn't been a lot of discussion around perimenopause and menopause and so my focus has been, if we can equip women before they're in the journey and find themselves stuck in a bad place if they recognize what might be coming. 

Obviously the menopausal experience varies so broadly. Many women transition and you know, wonder what in the world all the fuss is about because they've exp,erienced nothing, and other women who literally are nearly disabled by it. But I think the goal would be in my mind, to bring in younger women so they can again have the knowledge in advance, but also some of the interventions you may have to offer. So my question here really is, how are you reaching younger women or how are you bringing those women into the Lisa Health journey?

Callout: The earlier you adopt a healthy lifestyle, the better your health is going to be...

Ann: Well, I completely agree with you Barb. Menopause is something that we should be talking about much, much earlier in a woman's life because, as you know, not just around menopause, but health in general, the earlier you adopt a healthy lifestyle, generally the better your health is going to be down the road.

I certainly think that there's some truth to that when it comes to the menopause symptoms and the severity of those symptoms. We do know for example, from the research, that women who smoke are more likely to start menopause earlier and have more intense hot flashes. So I think if women understand that some of the lifestyle choices that they've made, then they may want to start making those adjustments early, that that will really help them down the road in terms of the menopause transition.

So we do invite women who are younger to join Lisa Health and to engage in a journey to start to prepare themselves for menopause. But we also do a lot of education around the risks of early and premature menopause because as you know, that can increase their risk of conditions like cardiovascular disease and osteoporosis.

Dr. Barb: Yes. Right. So being deep in the technology industry, what do you think is possible? And on the flip side, what might be unrealistic regarding what technology will be able to do for us and women's health?

Ann: Sure. Well, technology has pervaded virtually every aspect of healthcare. I mean, there are apps for everything from pregnancy and fertility to diabetes, to depression. So from my perspective, why should menopause be overlooked when there's so much that technology can do to fill the gap in menopausal care?

With technology, we can address the shortage of trained physicians, and reach underserved populations, not just in the U.S. but worldwide. With technology, we can empower women to take control of their menopause journey and give them the tools they need. We can also help facilitate meaningful conversations between women and their physicians. So if a woman is tracking her symptoms and engaging in these evidence-based activities, that can facilitate a really strong conversation about treatment options.

Then there's incredible potential for technology to address everything from symptom management to understanding how menopause may be affecting your mood on a day-to-day basis. So I've been in healthcare technology my entire career, and from my perspective this is the most exciting period of innovation that I've ever witnessed, and I think women's health can benefit tremendously.

Dr. Barb: Yeah, I'm thinking as you're talking about this. I have patients fill out an eight-page questionnaire that they bring in, and we review it together. But I'm thinking if they had an app where they had been tracking the specifics—so I'm going through and asking, so how often are you experiencing this, and what time of the day, and what are your triggers, and when do you find this interferes as much, and is it as much in your work days as your weekend days?

But boy, if I could just look at the data that they had tracked, how much more efficiently their ability to communicate it because it's their memory when they're sitting in the room with me. It's really their actual symptoms that have happened over time—understanding the pattern, and the intensity, and frequency, and so on. What an efficient way to communicate that to the provider.

Ann: Right, I think you've hit on one key aspect of technology that can help is in pattern recognition—not only for the woman, which I think would be very insightful to understand triggers as an example, but also for you as a physician—and then really help to facilitate that dialogue about what the next steps are. I've had quite a number of physicians tell me that they would love to “prescribe” the Lisa Health platform to their patients, and I put prescribing in quotation marks. But in the sense that many of them don't have the time unfortunately, or the training in lifestyle medicine that they would ideally like to spend talking to patients. But we've done the legwork, and we've created this platform. So physicians really have responded very positively, and see it as a complement to the relationship, and helping to fill that unfortunate gap that we've created in medicine.

Dr. Barb: Well this is really exciting, and I guess I would like to just applaud you for your success in the fem-tech arena because it's necessary. It feels like a latecomer for some of the applications of technology and, obviously the Baby Boomers are smack dab in the middle of it in there. I think the statistic is 5,000 American women become menopausal every day. So the need is great, but the experience of the providers is limited and so access, like you said, providing access is wonderful. So tell listeners specifically how they can find you.

Ann: Sure. They can go to

Dr. Barb: Good. Well, thank you. So as we conclude our time together today, Ann, I would just like to ask, where do you find fullness at this stage of your life?

Ann: Fullness for me is in travel. Learning about and experiencing other cultures, exchanging points of view, and finding common ground with people around the world. I feel full when I make a connection with someone in a distant land that reminds me that we all want the same things: peace and love and not war and hate. That's what gives me fullness in my life.

Dr. Barb: Well, that was well said and a great way to conclude our time together. Thanks again for your time today, Ann.

Ann: Well, thank you, Barb. This was a pleasure. I enjoyed sharing more about Lisa Health with you and your audience.


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