Four Days in Costa Rica: The Conflict, the Breakthrough, and Why This Story Matters

Written by Dr. Betsy Greenleaf for Ravoke.com

When I boarded the plane to Costa Rica to film Four Days, my stomach was in knots.

This wasn’t a casual media appearance. It wasn’t a controlled interview. It wasn’t a conference stage where I knew exactly what I was walking into.

I was about to fly to another country to film a menopause docuseries. I’d be surrounded by strangers, the format was a mystery, and cameras would be on me from dawn till dusk, capturing every unscripted moment. There was no script in my hand.

No guarantee of how it would unfold.
No clear sense of what — or who — would be waiting on the other side.

And if I’m honest, there was a flicker of fear. To be honest, the skeptical New Jerseyan in me half-expected to be kidnapped.

Fear of the unknown.
Fear of conflict.
Fear of stepping into something that could either elevate the conversation around menopause — or explode into chaos.

I remember thinking: This is either going to be powerful… or it’s going to be a disaster.

What unfolded was intense.

But it was also transformative.

This Wasn’t a Documentary. It Was a Pressure Cooker.

If you’re picturing a traditional medical documentary — think again.

There was no quiet chair under bright lights. No carefully rehearsed talking points. Charles Mattocks films like a reality series. Cameras were rolling from early morning until late at night. You didn’t know when you would be called into a scene. You didn’t know when a casual conversation would ignite into something pivotal.

It was immersive. Emotional. Unfiltered.

Five women arrived navigating perimenopause and menopause. They carried exhaustion, frustration, confusion, and in some cases, deep hopelessness. You could feel it immediately.

The way they held themselves. The tone in their voices. The quiet fear behind their questions.

But the emotional intensity wasn’t limited to the women.

It was also among the experts.

When Experts Collide

When you place multiple strong, passionate medical professionals in one room — all used to being the authority — tension is inevitable.

And tension there was.

One of the most defining conflicts for me was with Dr. Diana Bitner.

Dr. Bitner represents the traditionally trained physician — grounded in strict evidence-based medicine, deeply committed to published data and formal guidelines. Her position is clear: if there isn’t large-scale, evidence based research supporting it, it doesn’t belong in mainstream care.

Our philosophies clashed almost immediately.

Much of the friction centered around bioidentical hormones. The argument from her side was straightforward: there isn’t sufficient large-scale evidence to support them.

And on paper, she’s correct.

But here’s the part that gets lost in translation.

Bioidentical hormones are naturally occurring. You cannot patent what nature already created. If you can’t patent it, there’s no pharmaceutical incentive. No incentive means no massive research funding. No massive funding means limited large-scale trials. Limited trials mean limited “evidence.”

So how do you debate within a system that only validates what is financially backed?

You can’t win that argument. I immediately felt what many women feel….unheard, quieted and dismissed.

That was the frustration.

Because medicine is not just science.

Medicine is also art.

It is pattern recognition.
It is clinical experience.
It is listening deeply to the woman sitting in front of you.

You cannot always prove what is right in a randomized controlled trial. But you can observe patterns. You can witness transformation. You can individualize care.

Initially, I pulled back. I didn’t want to escalate the conflict. I didn’t want ego to overshadow the women’s experience. But shrinking has consequences.

And that realization hit me hard.

The Sentence That Changed Me

Dr. Sangeeta Pati became one of the most impactful voices for me that week.

Her wisdom is expansive. Her knowledge is vast. But it’s her heart — her freedom of thought — that truly moved me.

In a quiet moment, when I had reached my wits end of frustration of trying to navigate some of the aggressive outspoken practitioners on set, she told me:

“When you stay quiet, you’re not the only one who suffers. Women suffer.”

That sentence shifted everything.

Silence in rooms where women’s care is being defined is not neutral. It protects the status quo. It limits options. It keeps conversations small.

You can actually see the shift happen during filming. The polite restraint begins to crack. The conversations deepen. The tension becomes productive instead of suppressed.

Even Dr. Bitner, by the end of the week, began to soften. Hearing lived clinical experiences. Hearing perspectives beyond rigid frameworks. Growth happened — not because there was no conflict, but because there was.

And that’s powerful.

Michelle: Smiling Through a Fracture

Then there was Dr. Michelle Hannah.

Michelle embodies the woman who keeps going no matter what.

During filming, she slipped in her room and fell. She came back to set. She smiled. She engaged. She pushed through.

Later, after we returned home, we discovered she had fractured her clavicle.

A broken clavicle.

And she kept showing up.

That moment was heartbreaking.

How many women smile through pain?

How much power through insomnia, mood shifts, intimacy struggles, anxiety, weight gain, and fatigue without asking for help?

How many say “I’m fine” because they don’t want to be a burden?

Michelle represents the woman who looks polished on the outside while suffering quietly inside.

And here’s the uncomfortable truth: sometimes medicine misses her. We all missed her. I missed her. Because she looked good on the outside. How many women does this happen to?

Because her labs are “normal.” Because she’s functioning. Because she’s successful.

But underneath?

That’s where the real story lives.

Robert: The Man Standing Alone

And then there was Robert Higgs.

Seeing him there alone deeply affected me.

He came without his wife. A man trying to understand how to reconnect. Trying to regain closeness. Trying to repair a relationship that felt strained.

He represents countless men who are navigating menopause alongside their partners — confused, uncertain, afraid of saying the wrong thing.

Men are often left out of this conversation.

When a woman’s hormones shift, emotional dynamics shift. Communication shifts. Physical intimacy shifts. Household rhythms shift.

Men feel helpless. Rejected. Isolated.

Robert standing there alone symbolized the silent side of menopause.

This isn’t just a women’s issue.

When a woman suffers, everyone feels it.

Why You’ll Want to Watch

Four Days is not polished and predictable.

It is layered.
It is emotional.
It is tense.
It is real.

You will see friction between experts.
You will see raw vulnerability from women.
You will see a man quietly fighting for his marriage.
You will see transformation that feels earned, not scripted.

If you’ve ever been told “your labs are normal” while you feel anything but normal…
If you’ve ever felt unseen or dismissed…
If your relationship has shifted and you don’t know why…
If you’re tired of suffering quietly…

This series will resonate.

Those four days in Costa Rica were daunting.

But sometimes stepping into something daunting is exactly how change begins.

I know I learned to listen beyond what is being said (Michelle). I learned that menopause doesn’t just affect women but it affects all those around them (Robert). I learned compassion for my fellow colleagues who are only following what they have been taught (Dr. Diana Bitner), and it is my mission for women and humanity not to stay quiet to avoid conflict but to speak out, to teach, and to empower (Dr. Sangeeta Pati).

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FAQ’s on Menopause and Perimenopause

What is perimenopause?

Perimenopause is the transitional time leading up to menopause when hormone levels begin to fluctuate. Women may experience irregular cycles, mood changes, sleep disruption, hot flashes, and other symptoms even while still having periods.

What is menopause?

Menopause is diagnosed after 12 consecutive months without a menstrual period. It marks the end of ovarian hormone production and reproductive years.

Are “normal labs” enough to rule out menopause symptoms?

No. Many women are told their labs are “normal” while they continue to struggle with symptoms. Hormone levels fluctuate significantly during perimenopause, and clinical symptoms matter.

What are bioidentical hormones?

Bioidentical hormones are compounds that are chemically identical to hormones naturally produced by the body. Debate exists around research, regulation, and large-scale evidence, but many clinicians use individualized approaches based on patient response and clinical experience.

Does menopause affect relationships?

Yes. Hormonal changes can impact mood, libido, sleep, and communication. Partners may feel confused or disconnected. Open conversation and education are key.

Why is menopause often dismissed?

Historically, menopause has been under-researched and under-discussed. Many treatment models rely heavily on large-scale funded trials, which may not always capture individualized patient experience.

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