WEBVTT - Q&A Gynae/IVF/Menopause with Sam Costa 0:00:05.921 --> 0:00:07.281 Apologie production. 0:00:11.121 --> 0:00:14.481 Hi, my name's beck Woodbine and welcome to Tenderness for Nurses. 0:00:15.081 --> 0:00:18.921 I'm grateful for the person that I have the opportunity 0:00:18.961 --> 0:00:22.521 to be, so I hit it and parked it for 0:00:22.601 --> 0:00:25.801 Nelly four years. We always have free will, We always 0:00:25.801 --> 0:00:26.401 get to choose. 0:00:26.521 --> 0:00:30.241 We are autonomous. Welcome back everyone to Tenus for Nurses. 0:00:30.641 --> 0:00:35.601 We have Sam post back because the questions and the 0:00:35.641 --> 0:00:38.561 information you guys sent back to me was you really 0:00:38.601 --> 0:00:42.720 wanted to get more information out of her. So welcome 0:00:42.760 --> 0:00:43.361 back Sah. 0:00:43.361 --> 0:00:44.761 Thanks for having me back back. 0:00:45.241 --> 0:00:48.641 So I hope you're ready today because we have so 0:00:48.881 --> 0:00:50.921 many questions to go through. 0:00:51.161 --> 0:00:51.560 Love it. 0:00:52.120 --> 0:00:57.441 I love that everyone just embraced it and sent heaps 0:00:57.441 --> 0:00:58.121 of questions. 0:00:58.121 --> 0:01:00.881 There's some juicy ones in there, some really juicy ones. 0:01:01.121 --> 0:01:05.641 The first question is uncontrollable weight gain during peri menopause. 0:01:05.761 --> 0:01:07.721 Why and why in the tummy area. 0:01:07.961 --> 0:01:10.401 Yeah, so this is a really interesting one. And I think, 0:01:10.840 --> 0:01:14.201 like I'll preface with saying that with all of these ants, 0:01:14.200 --> 0:01:16.560 one answer isn't going to be the right answer for everyone. 0:01:16.560 --> 0:01:19.000 And I think when we look at hormones, there are 0:01:19.041 --> 0:01:21.881 so many factors that affect things. But when we look 0:01:21.961 --> 0:01:25.560 at weight gain. In perimenopause, there's a couple of factors 0:01:25.601 --> 0:01:29.360 that affect things. One is estrogen or the reduction of estrogen. 0:01:29.560 --> 0:01:32.200 Estrogen is our feel good hormone, but it's also the 0:01:32.241 --> 0:01:36.641 hormone that controls a lot of things and also interplace 0:01:36.721 --> 0:01:39.881 with our other hormones like insulin. So when we're looking 0:01:39.961 --> 0:01:44.041 at perimenopause, we also see, you know, more insulin resistance 0:01:44.081 --> 0:01:47.520 coming in. We see a reduction in our muscle mass, 0:01:47.521 --> 0:01:50.441 which increases our metabolism and all of that sort of 0:01:50.441 --> 0:01:53.241 stuff as well. So it's really quite multifaceted. 0:01:53.761 --> 0:01:57.041 So really in perimenopause, you start to get a drop 0:01:57.041 --> 0:01:59.321 of estrogen, you do, and do you get a drop 0:01:59.361 --> 0:02:00.001 of progesterone. 0:02:00.041 --> 0:02:02.201 You do get a drop of progesterone as well, but 0:02:02.241 --> 0:02:04.761 it's more the drop in the estrogen that drives a 0:02:04.761 --> 0:02:08.321 lot of these factors. Usually as well, when we look 0:02:08.361 --> 0:02:11.881 at when people tend to go through that perimenopause menopausal 0:02:12.001 --> 0:02:14.841 stage as well, it's usually during a period of time 0:02:14.960 --> 0:02:18.241 where cortosole levels and stress levels are quite high as well, 0:02:18.441 --> 0:02:21.520 because you know where where midlife we're dealing with either 0:02:21.761 --> 0:02:24.321 children that are school age or children that are growing 0:02:25.041 --> 0:02:28.520 and leaving the nest and then aging parents and all 0:02:28.561 --> 0:02:32.441 of these compounding things that increase quartersole levels as well, 0:02:32.441 --> 0:02:36.041 which we know has plays a factor in weight gain. 0:02:36.481 --> 0:02:40.121 When we're looking at estrogen and the reduction in estin 0:02:40.240 --> 0:02:42.561 that's where we get that at a post tissue across 0:02:42.561 --> 0:02:45.921 that midsection as opposed to hips and thighs when we're 0:02:46.001 --> 0:02:46.881 going through puberty. 0:02:47.161 --> 0:02:51.081 When people have PCs and they struggle to lose weight, 0:02:51.841 --> 0:02:53.721 like I was led to believe, estrogen sits in the 0:02:53.721 --> 0:02:57.201 fat cells or can do so, is that why people 0:02:57.240 --> 0:03:00.481 with pcos have so many issues with weight? It's because 0:03:00.481 --> 0:03:02.041 they've got so much estrogen. 0:03:02.361 --> 0:03:05.041 No, So when we do bloods on people with pcos 0:03:05.081 --> 0:03:07.921 there anovulagy, we tend to see what we call baseline blood, 0:03:07.960 --> 0:03:11.801 so really low levels of everything except for usually elutinizing 0:03:11.841 --> 0:03:14.281 and FSH hormone because you've got so many follicles there, 0:03:14.601 --> 0:03:18.401 follicles driving follicle stimulating hormone, which has this negative feedback. 0:03:18.921 --> 0:03:22.721 With pcos, it's generally related of the way gain is 0:03:22.761 --> 0:03:24.921 generally related to insulind. 0:03:24.561 --> 0:03:28.041 Okay, okay, that makes sense, and PCOS GUYS is polycystic 0:03:28.081 --> 0:03:30.960 ovarian syndrome. Just in case, you didn't. 0:03:30.680 --> 0:03:33.960 Know, which is very different to PCO, which is polycystic 0:03:34.441 --> 0:03:37.401 ovaries in morphology, which lots of people get. 0:03:37.721 --> 0:03:40.281 I had that, Yeah, but I didn't have the syndrome. Yep, 0:03:40.481 --> 0:03:43.041 So just had a fewfference, you know. Just wasn't that 0:03:43.081 --> 0:03:43.761 easy for imprint? 0:03:43.841 --> 0:03:43.921 Yes? 0:03:44.241 --> 0:03:47.801 Yeah, I still have my period, but have a low 0:03:47.841 --> 0:03:49.921 sex drive is something wrong with me? 0:03:50.401 --> 0:03:53.481 No, nothing is wrong with you. And it doesn't necessarily 0:03:53.561 --> 0:03:56.641 mean that we're going through perimenopause or menopause either. I 0:03:56.681 --> 0:04:01.121 think when we look at sex drive as females, we 0:04:01.161 --> 0:04:05.001 are very cyclical from a monthly perspective for most people. 0:04:05.321 --> 0:04:08.641 But we know that our hormones as females are driven 0:04:08.721 --> 0:04:13.081 by extrimesic factors lack stress. And so just because you've 0:04:13.081 --> 0:04:15.281 got a low sex drive, I can probably guarantee that 0:04:15.321 --> 0:04:17.440 this person is a mother, is running around like a 0:04:17.481 --> 0:04:21.041 crazy person, juggling, you know, multiple things, and that naturally 0:04:21.121 --> 0:04:23.481 drives down that sex drive or. 0:04:23.361 --> 0:04:25.321 That libido because you're just exhausted. 0:04:25.401 --> 0:04:29.640 Correct, Yeah, correct, definitely. You know, with regards to perimenopause, 0:04:29.641 --> 0:04:32.561 if we're looking at it from that perspective again, estrogen 0:04:32.880 --> 0:04:35.200 drives all of those things down as well. For some 0:04:35.241 --> 0:04:38.681 people they find sex less comfortable because estrogen is what 0:04:38.801 --> 0:04:40.841 helps with the lubrication in the vagina and all of 0:04:40.880 --> 0:04:43.281 those sorts of things as well, So there can be 0:04:43.440 --> 0:04:46.440 you know, almost blockers to wanting to have sex, which 0:04:46.481 --> 0:04:49.481 can actually drive down your libido as well. If it's uncomfortable, 0:04:49.481 --> 0:04:50.760 you don't want to do it, and that you know, 0:04:51.201 --> 0:04:53.841 has that whole play. I'd say, we're probably just a 0:04:53.880 --> 0:04:57.561 really busy person and that's completely completely normal. And I 0:04:57.561 --> 0:05:01.121 think it's really important as females to normalize that with 0:05:01.201 --> 0:05:04.241 our partners as well, that sometimes we're just not we're 0:05:04.281 --> 0:05:06.401 just not fiery or in the mood today, and that's 0:05:06.440 --> 0:05:08.921 completely normal with everything else going on in life. I 0:05:08.961 --> 0:05:11.041 think when we look at males, males are like on 0:05:11.081 --> 0:05:14.080 a daily kind of flac or they're just producing stuff left, 0:05:14.121 --> 0:05:17.241 right and center, and you know, females are very very different. 0:05:17.681 --> 0:05:20.561 Look. I mean, I know for myself there you know, 0:05:20.561 --> 0:05:22.801 when you're shattered, you just want to get a bed totally. 0:05:22.841 --> 0:05:24.601 And I think you know also too, depending on what 0:05:24.641 --> 0:05:26.961 you do for work, but also when you're a mother 0:05:27.161 --> 0:05:29.521 as well, you know someone's at you all day or 0:05:29.521 --> 0:05:32.321 you've got multiple people and you're having to care and 0:05:32.841 --> 0:05:35.481 be the person that's on for other people, as a 0:05:35.521 --> 0:05:39.280 lot of females do, whether that's in life at home 0:05:39.521 --> 0:05:41.881 or within the workplace. The last thing you want to 0:05:41.921 --> 0:05:44.481 do some things is be touched by someone else, like 0:05:44.681 --> 0:05:46.801 leave me alone. I need more space. I need to 0:05:46.921 --> 0:05:49.640 just you know, calm down and come down. And I 0:05:49.641 --> 0:05:54.001 think that that's a really normal physiological response to just 0:05:54.081 --> 0:05:55.561 being so busy as females. 0:05:55.801 --> 0:06:00.041 Yeah, I couldn't agree more. Okay, the next question, it 0:06:00.121 --> 0:06:04.121 takes me longer to be aroused when once I was 0:06:04.201 --> 0:06:07.801 ready really quick. Why is this? And what can I 0:06:07.880 --> 0:06:09.281 do to help my libido? 0:06:09.641 --> 0:06:13.641 So again I think multifactorial, you know, without knowing the 0:06:13.681 --> 0:06:17.561 person the situation. Maybe it's something to do with menopause 0:06:17.641 --> 0:06:20.201 or perimenopause. I don't know the age, in which case 0:06:20.241 --> 0:06:23.641 we're talking about estrogen. Again, when we're talking about hormones, 0:06:23.681 --> 0:06:25.921 there are things that we can put in place, whether 0:06:25.961 --> 0:06:30.001 that is hormone replacement therapy from a perimenopause menopause al place, 0:06:30.721 --> 0:06:34.841 whether it's lubricant. So naturally, sometimes we're just we might 0:06:34.961 --> 0:06:37.760 feel like we want to have sex, but you know 0:06:37.841 --> 0:06:41.121 the body is not catching up. Again, stress life that 0:06:41.201 --> 0:06:43.921 all plays a factor in it. So talking to a 0:06:44.001 --> 0:06:47.601 GP nurse practitioner, whoever you're seeing from a hormonal perspective, 0:06:47.601 --> 0:06:51.320 if it is in that perimenopause, menopause, or window, because 0:06:51.320 --> 0:06:53.841 we can do things like vaginal estrogen and stuff that 0:06:53.880 --> 0:06:57.281 can help with lubrication, but also too, I think a 0:06:57.320 --> 0:07:00.880 lot of women still utilize lubricant makes it more enjoyable. 0:07:01.241 --> 0:07:06.001 And that's again normalizing that just because you use lubricant 0:07:06.041 --> 0:07:08.041 to have sex doesn't mean that there's anything wrong, doesn't 0:07:08.081 --> 0:07:10.801 mean that you enjoy it any less or you know, 0:07:11.041 --> 0:07:13.241 take longer to be aroused. You can still be aroused 0:07:13.241 --> 0:07:16.201 in your body, just not producing the same amount of 0:07:16.281 --> 0:07:20.001 lubricant as it does in the pollicular phase of your cycle, 0:07:20.041 --> 0:07:23.041 or the beginning of your cycle compared to the lutelle 0:07:23.041 --> 0:07:25.241 phase or the second half of your cycle, where estrogen 0:07:25.281 --> 0:07:27.761 levels have completely dropped off and we're getting ready to 0:07:27.841 --> 0:07:31.001 either maintain a pregnancy if we're pregnant, or getting ready 0:07:31.041 --> 0:07:33.081 to shed the lighting. And so when we look at 0:07:33.081 --> 0:07:37.001 the cycle hormones, our estrogen starts to build at the 0:07:37.001 --> 0:07:39.281 beginning of the cycle, it peaks at population and then 0:07:39.321 --> 0:07:41.721 it drops off. So it is actually really natural and 0:07:41.801 --> 0:07:46.081 normal to have a drier vaginal area in that second 0:07:46.081 --> 0:07:47.961 phase of your cycle. Nothing wrong with it. 0:07:48.041 --> 0:07:50.921 And when you look at that, I mean physiologically it 0:07:50.961 --> 0:07:56.481 makes sense because you know, we're designed to procreate, and 0:07:56.561 --> 0:08:00.041 of course you know leading into that phase, you aren't 0:08:00.041 --> 0:08:01.721 going to have more estrogen, which is going to drive 0:08:01.761 --> 0:08:04.041 you know, you're going to have more sex drive to 0:08:04.761 --> 0:08:09.641 try and fertilize that egg. So physiologically that makes sense. 0:08:09.761 --> 0:08:12.721 But also on the other hand, there's so much out 0:08:12.761 --> 0:08:14.841 there that you can just go to the supermarket now 0:08:14.881 --> 0:08:19.641 for lubricants. You know there's flavored ones, smelly ones pretty well, 0:08:20.401 --> 0:08:22.601 but you can actually just go to the supermarket. You 0:08:22.641 --> 0:08:24.481 don't have to go to a sex shop anymore to 0:08:24.481 --> 0:08:27.721 get into that sort of thing. And I think it's 0:08:27.801 --> 0:08:31.241 fantastic that they're meeting a market and I You've just 0:08:31.241 --> 0:08:32.681 got to speak to your partner, don't you. 0:08:32.761 --> 0:08:35.561 Absolutely? And I think that that's, you know, with anything, 0:08:35.561 --> 0:08:40.561 when we talk about hormones and relationships, it's about being 0:08:40.561 --> 0:08:44.881 open and driving that communication. And for some people that 0:08:44.881 --> 0:08:47.881 can actually be really difficult. It's not like everyone's you 0:08:47.921 --> 0:08:50.641 and I and we have no problems in discussing this 0:08:50.761 --> 0:08:53.041 sort of thing. Partly because of nurses and partly because 0:08:53.081 --> 0:08:57.121 you know, we're females and we're advocates for the female body. 0:08:57.401 --> 0:09:00.761 But you know, generationally as well, you know, there's people 0:09:00.801 --> 0:09:03.361 that you know, have grown up in a very very 0:09:03.401 --> 0:09:07.641 conservative household and even though they're young, they haven't been 0:09:07.721 --> 0:09:11.281 exposed to, you know, open conversations about your body and 0:09:11.281 --> 0:09:13.121 sexuality and all that sort of stuff. And then you've 0:09:13.121 --> 0:09:15.321 got the other end of the spectrum, like my nine 0:09:15.361 --> 0:09:18.201 year old, who can tell you about everything that that happens, 0:09:18.321 --> 0:09:20.921 you know, to a woman's body from you know, preteen 0:09:21.001 --> 0:09:24.161 all the way through two menopause, and you know all 0:09:24.201 --> 0:09:26.441 of those sorts of things that go into there as well. 0:09:26.481 --> 0:09:29.761 So I think open communication with your partner is really 0:09:29.801 --> 0:09:33.521 really important. But I think also to within your close 0:09:33.521 --> 0:09:36.401 friends group. You know, you'd be surprised with the number 0:09:36.441 --> 0:09:39.881 of people that are probably experiencing the same thing within 0:09:40.121 --> 0:09:42.521 your close friends group that just don't talk about it. 0:09:42.641 --> 0:09:45.561 I know myself. You know, you get talking to friends 0:09:45.561 --> 0:09:47.681 and they mentioned something, you're like, oh, hang on a second, 0:09:47.681 --> 0:09:50.961 that's not normal, like did you you know? And it's 0:09:51.081 --> 0:09:53.681 just opening up that that conversation. 0:09:53.841 --> 0:09:57.081 What causes my period to stop? Hmmm? 0:09:58.121 --> 0:10:04.001 Again, it all comes back down to isugen for a 0:10:04.041 --> 0:10:06.841 start that it it's the drop in your estrogen. But 0:10:07.001 --> 0:10:09.481 what leads to that drop in the estron is we 0:10:09.561 --> 0:10:12.121 have a finite number of eggs within our ovary. So 0:10:12.561 --> 0:10:15.801 when a female baby is in utero at twenty weeks, 0:10:15.801 --> 0:10:17.681 we have the most number of eggs that we will 0:10:17.721 --> 0:10:20.641 ever have. By the time we are born, that halves 0:10:20.761 --> 0:10:23.361 and then yeah, and by the time we actually go 0:10:23.441 --> 0:10:25.721 through puberty, we've only got about four hundred to five 0:10:25.801 --> 0:10:29.881 hundred thousand eggs and they slowly drop off. So biggest 0:10:29.881 --> 0:10:32.881 misconception that I see with patients coming through from a 0:10:32.881 --> 0:10:35.441 fertility perspective is they think that we only lose one 0:10:35.441 --> 0:10:38.201 egg a month. It's actually not true. I like to 0:10:38.361 --> 0:10:41.561 describe because I'm quite a visual person. Ovary is almost 0:10:41.721 --> 0:10:45.081 like a shark's mouth. So anyone that knows sharks knows 0:10:45.161 --> 0:10:47.521 that they have a whole cohort of teeth that come 0:10:47.561 --> 0:10:49.681 through at a different period of time. That's the same 0:10:49.761 --> 0:10:52.721 on the ovary. So within each month we have our 0:10:52.801 --> 0:10:56.361 ovarian reserve or our anthropolical count. When we scan people, 0:10:56.481 --> 0:10:59.801 we can see that. But what naturally happens is your 0:10:59.881 --> 0:11:03.321 fsahal your follicle stimulating hormone is only enough to draw 0:11:03.401 --> 0:11:06.801 one of those little follicles up to become dominant. We 0:11:06.881 --> 0:11:09.321 ovulate and we release it for liticle, but all those 0:11:09.361 --> 0:11:12.401 other cohort of embryos that sit in what we call 0:11:12.441 --> 0:11:16.481 the cortex of the ovary kind of resolve. We lose 0:11:16.521 --> 0:11:19.201 them as well as that one that we've ovulated from, 0:11:19.241 --> 0:11:22.281 and then the next cohort come up. So that happens, yeah, 0:11:22.761 --> 0:11:27.201 month to month to month, and eventually the ovaries lose 0:11:27.241 --> 0:11:31.361 all of their eggs, and that's where the period starts 0:11:30.921 --> 0:11:34.081 to slow down and we start to get irregular cycles. 0:11:34.081 --> 0:11:37.601 And then you know perimenophorse is that that phase where 0:11:37.721 --> 0:11:41.001 your periods become irregular, and they become irregular because we've 0:11:41.001 --> 0:11:44.761 got fewer numbers of eggs pushing through, and that regularity 0:11:44.761 --> 0:11:47.521 of that happening doesn't necessarily occur in that month, in 0:11:47.561 --> 0:11:49.921 that twenty eight day thirty day phase whatever is normal 0:11:50.001 --> 0:11:53.201 for the person, and so eventually there's nothing really there 0:11:53.441 --> 0:11:56.481 and that whole process stops. And so it's like the 0:11:56.561 --> 0:11:59.201 drive of f S, H and hormones, and it actually 0:11:59.201 --> 0:12:02.241 starts in the brain in the petuitary. That's actually where 0:12:02.241 --> 0:12:05.521 all of that, the hormone start and drive over it. 0:12:06.361 --> 0:12:10.081 When I realized I was menopausal, I went and saw 0:12:10.241 --> 0:12:14.001 my gynecologists because I was sort of wanting to kill everybody. 0:12:14.681 --> 0:12:18.841 I was an angry, angry lady. He said, the reason 0:12:18.881 --> 0:12:21.361 why you're feeling like you are is, he said, your 0:12:21.361 --> 0:12:25.281 ovaries have like a last hurrah where they just try 0:12:25.321 --> 0:12:28.881 to kick back in one more time, have one more party. Yeah, 0:12:28.961 --> 0:12:32.521 and then they get totally And he said that can 0:12:33.041 --> 0:12:34.681 be a couple of months, or that can be and 0:12:34.721 --> 0:12:38.561 he said it can be quite horrendous for the woman 0:12:38.641 --> 0:12:40.561 at that time because your body's just sort of. 0:12:40.961 --> 0:12:43.521 Doesn't know what it's doing, like going between the two. 0:12:44.921 --> 0:12:46.521 Am I trying to have a baby? I'm not. Am 0:12:46.561 --> 0:12:50.281 I finishing? And yeah, it can. For some people it 0:12:50.361 --> 0:12:52.641 happens quite quickly, and for other people it drags on 0:12:52.881 --> 0:12:54.281 and that's cruel, but it happens. 0:12:54.481 --> 0:12:58.281 Well, he I was put on HRT and I had 0:12:58.281 --> 0:13:02.121 a mariner in. Yep, my life changed seriously within a 0:13:02.121 --> 0:13:06.441 few days. Within a few days that gel I'm using 0:13:06.441 --> 0:13:10.841 that to the day I die. I'm not joking it. 0:13:10.841 --> 0:13:15.441 It was so notice my head, my fog cleared, you know, 0:13:15.521 --> 0:13:20.721 I could breathe, but the anger subsided and that was 0:13:20.761 --> 0:13:23.361 probably the best thing, because you know, my poor husband was, 0:13:24.241 --> 0:13:31.241 what is happening? You're scary? But so many women say 0:13:31.241 --> 0:13:34.561 the same thing, except so many women they just have 0:13:34.681 --> 0:13:38.881 this just annoyed at everything. And I don't know why. 0:13:39.081 --> 0:13:41.641 I don't know why. I don't know why. I think 0:13:41.641 --> 0:13:43.081 it's I mean, I can look back now, I think 0:13:43.081 --> 0:13:44.841 it's hilarious, but at the time it was not. 0:13:45.081 --> 0:13:48.641 No, absolutely, and I think that that's you know, that's 0:13:48.881 --> 0:13:52.481 quite scary for some women, and particularly you know if 0:13:52.481 --> 0:13:56.081 you're on the younger end of things, when when hormones 0:13:56.121 --> 0:13:59.041 start to change. We know that you know, hormones start 0:13:59.081 --> 0:14:02.041 to change before you even reach that perimenopause. So for 0:14:02.121 --> 0:14:05.161 some people, they get some of the symptoms like the 0:14:05.241 --> 0:14:09.161 brain fog or the agitation or whatever it might be, 0:14:09.361 --> 0:14:13.521 well and truly before their periods start to misbehave and 0:14:13.881 --> 0:14:17.281 become irregular. And it can be really frustrating because you know, 0:14:18.121 --> 0:14:21.041 we don't talk about it enough. Yes, the conversation is 0:14:21.121 --> 0:14:23.921 starting to be out there and we're talking about it more, 0:14:24.121 --> 0:14:28.561 but it is quite a normal phenomenon, but we don't 0:14:28.561 --> 0:14:29.641 talk about it like it is. 0:14:30.161 --> 0:14:32.841 So I had a client come in a couple of 0:14:32.841 --> 0:14:36.001 weeks ago and she was so excited she'd had a 0:14:36.081 --> 0:14:41.441 last period. Now, I thought I would go through menopause later. 0:14:42.401 --> 0:14:44.521 And I think I was forty five forty six, so 0:14:44.681 --> 0:14:50.361 that's reasonably young. I this is gonna sound really weird. 0:14:50.761 --> 0:14:52.641 I felt like I was grieving. 0:14:53.641 --> 0:14:54.961 Some people do that. 0:14:55.201 --> 0:14:59.481 I it just happened, yep. And then and I suppose 0:14:59.521 --> 0:15:01.521 having a marina in for so many years didn't help 0:15:01.561 --> 0:15:04.601 because I didn't know when my period was. But I 0:15:04.641 --> 0:15:06.881 sort of a bit sad because that part of my 0:15:06.921 --> 0:15:10.041 life was done. Yeah, and yet other women and I 0:15:10.761 --> 0:15:13.761 sit there and I think, oh, you're amazing because you're 0:15:13.761 --> 0:15:15.681 just celebrating this and you're moving on with the next 0:15:15.681 --> 0:15:18.721 stage of your life. Where I did, I felt sort 0:15:18.761 --> 0:15:19.961 of sad. 0:15:20.241 --> 0:15:23.721 Yeah, you see a mix of a mix of things. 0:15:23.881 --> 0:15:26.601 I think. You know, even when we're looking at women 0:15:26.681 --> 0:15:29.961 that are coming through our clinic and having hysterectomies as well, 0:15:30.001 --> 0:15:31.961 you know, some people are so keen to get that 0:15:32.081 --> 0:15:34.601 uterus out and I don't want anything to do with it. 0:15:34.641 --> 0:15:37.121 And then you have other people that you need to 0:15:37.161 --> 0:15:39.921 have it out for a medical you know, a really 0:15:40.401 --> 0:15:43.321 significant medical problem. They've had bleeding or they've got massive 0:15:43.361 --> 0:15:46.201 fibroads that are causing problems or whatever it may be. 0:15:46.601 --> 0:15:49.921 And even though they know that it's a necessity for 0:15:50.001 --> 0:15:53.721 their own health, it's a really hard concept to grapple with. 0:15:53.801 --> 0:15:56.321 And I think, you know, menopause and that transition, it 0:15:56.401 --> 0:15:58.961 is a transition to a different phase of your life, 0:15:59.001 --> 0:16:01.641 and it does sneak up on you all of a 0:16:01.681 --> 0:16:05.921 sudden you're there, and if you know, you have that 0:16:06.081 --> 0:16:08.841 preconceived idea that oh, well, you know what happens in 0:16:08.561 --> 0:16:11.081 my fifties, and you know it's age is a way 0:16:11.081 --> 0:16:12.361 I don't have to worry about it. And then all 0:16:12.401 --> 0:16:14.961 of a sudden you're forty five and you're there. You're like, 0:16:15.001 --> 0:16:17.561 hay in a second, oh, ten years until this is happening, 0:16:17.601 --> 0:16:19.321 Like what is what is going on? And so I 0:16:19.361 --> 0:16:22.321 think it is a big shift for us to kind 0:16:22.321 --> 0:16:25.441 of go as women, Okay, well that part of my childbearing, 0:16:25.521 --> 0:16:29.041 all my reproductive time is over, and that was an 0:16:29.081 --> 0:16:31.921 amazing journey, whatever that looks like. Because for everyone, not 0:16:32.001 --> 0:16:35.361 everyone's you know, decides to have children or is fortunate 0:16:35.481 --> 0:16:38.761 enough to be able to have children, but it is 0:16:38.801 --> 0:16:41.161 you know that you move on to that next phase, 0:16:41.201 --> 0:16:43.881 and I think there's some merit in celebrating it, but 0:16:43.921 --> 0:16:46.401 also I think allowing yourself to grieve if they're the 0:16:46.601 --> 0:16:49.961 feelings and the emotions that come up during that period 0:16:50.001 --> 0:16:52.681 of time as well. And I think that's that's the thing. 0:16:52.921 --> 0:16:55.361 What happens for one person isn't going to be the 0:16:55.361 --> 0:16:59.681 same for you, And just normalizing that in itself, is 0:16:59.721 --> 0:17:02.281 that the way that your friend experience is very menopause, 0:17:02.321 --> 0:17:04.641 and menopause isn't going to be how you experience it. 0:17:05.041 --> 0:17:07.121 I think when we're looking at all of the information 0:17:07.241 --> 0:17:09.360 out there, and certainly one of the things that I 0:17:09.441 --> 0:17:12.801 noticed with the questions that came through was there is 0:17:12.880 --> 0:17:16.201 no one size fits all approach, and what one person 0:17:16.441 --> 0:17:20.920 experiences from a symptom perspective may beeause or perimenopause, but 0:17:21.001 --> 0:17:23.360 for another person it may just be that you're really 0:17:23.360 --> 0:17:26.241 stressed at work and your hormones are just doing something 0:17:26.241 --> 0:17:30.080 funky and then you know, in two months time when 0:17:30.160 --> 0:17:32.721 life comes down, things you know, kick back into to 0:17:32.840 --> 0:17:33.481 normal gear. 0:17:33.801 --> 0:17:37.681 So can stress impact estrogen, Absolutely, it. 0:17:37.640 --> 0:17:42.321 Can affect your whole entire hormonal system, because again, hormones 0:17:42.360 --> 0:17:46.481 are drived predominantly from your hypothalmus and everything like that. 0:17:46.521 --> 0:17:49.081 And so once we're stressed, our body goes, you know what, 0:17:49.561 --> 0:17:51.481 We're not ready to have a baby, We're not ready 0:17:51.521 --> 0:17:55.160 to potentially be responsible for creating life. We're just going 0:17:55.201 --> 0:17:57.961 to shut down. And so you see that all the time, 0:17:58.080 --> 0:18:02.801 particularly in like athletes, young women with eating disorders, or 0:18:03.201 --> 0:18:05.760 corporates that are really really stressed kind of in that 0:18:05.840 --> 0:18:09.840 right or flight mode for long periods of time. Our 0:18:10.160 --> 0:18:13.080 body is unalthy. It is unhealthy, but it's also you know, 0:18:13.120 --> 0:18:14.641 in the body's way of going, you know what, it's 0:18:14.640 --> 0:18:18.001 actually not the right time to bring something else into 0:18:18.080 --> 0:18:20.361 the world or to put your body under any more 0:18:20.360 --> 0:18:23.360 stress than what it's already under. We shut things down. 0:18:23.801 --> 0:18:28.041 I have spoken about this before on the podcast, but 0:18:28.080 --> 0:18:31.241 I'm a big believer in box breadth. You know, one 0:18:31.281 --> 0:18:34.720 two three four one two three four. The evidence is 0:18:34.801 --> 0:18:39.521 overwhelming that just two cycles of that reduces your quartersol 0:18:39.681 --> 0:18:45.280 dramatically in an emergency. So for example, you know, and 0:18:45.360 --> 0:18:49.240 there was an emergency situation in the emergency department and 0:18:49.281 --> 0:18:51.521 someone was coming in and you know, fight or flight, 0:18:51.681 --> 0:18:56.360 and you take the time and you can do it well, 0:18:56.561 --> 0:18:58.120 you know, you can think about it in your head. 0:18:59.201 --> 0:19:02.080 The change in your demeanor and how you cope and 0:19:02.120 --> 0:19:08.321 then how you analyze the situation changes dramatically, and I 0:19:08.561 --> 0:19:12.880 find I do I definitely do box breathing because you 0:19:12.921 --> 0:19:15.160 can sit on the toilet and do it totally. You know, 0:19:15.360 --> 0:19:19.201 and you know, and it sounds weird, but it actually 0:19:19.201 --> 0:19:19.921 makes a difference. 0:19:20.001 --> 0:19:22.960 No. There are some articles about, you know, first responders 0:19:23.041 --> 0:19:25.080 and before they hit a trauma or before a trauma 0:19:25.120 --> 0:19:26.960 comes in or whatever that looks like that they do 0:19:27.080 --> 0:19:30.361 some form of box breathing or some of those other 0:19:30.441 --> 0:19:33.640 breathing techniques to kind of just center themselves. There is 0:19:33.681 --> 0:19:37.721 an organization over in America that helps support I think 0:19:37.761 --> 0:19:41.041 it's the police over there, and they talk about doing 0:19:41.080 --> 0:19:45.600 that sort of breathing before you're entering into whatever scenario 0:19:46.080 --> 0:19:49.321 that you may be entering into, because there is a 0:19:49.441 --> 0:19:51.240 huge amount of research with regards to it. But I 0:19:51.281 --> 0:19:53.961 know myself, I do the same thing. I am under 0:19:54.001 --> 0:19:56.920 a lot of stress at the moment, and I find 0:19:57.001 --> 0:19:59.201 just you know, I can start to feel quite anxious 0:19:59.400 --> 0:20:01.721 and heightened and just slowing down and doing a couple 0:20:01.721 --> 0:20:03.961 of breaths of back. 0:20:04.041 --> 0:20:05.041 It's quite remarkable. 0:20:05.041 --> 0:20:08.360 It's amazing. I remember reading it and being like okay, whatever, 0:20:08.721 --> 0:20:09.321 and then doing. 0:20:09.120 --> 0:20:11.201 It and I was like, oh, it actually works. 0:20:11.281 --> 0:20:14.001 Okay, this is this is the thing, and it's interesting. 0:20:14.120 --> 0:20:17.281 Like my my little girl when she was in prep, 0:20:17.400 --> 0:20:20.721 they taught them five finger breathing, which is very similar, 0:20:20.761 --> 0:20:25.360 so you trace your fingers and inhale and exhale five times. 0:20:25.840 --> 0:20:28.281 And the the prep teachers taught them that in their 0:20:28.321 --> 0:20:31.521 first week of how prepulous like for if they were 0:20:31.521 --> 0:20:35.080 feeling overwhelmed and whatnot. And so to this day, Ivy 0:20:35.120 --> 0:20:37.041 will still if she starts to get a bit things 0:20:37.080 --> 0:20:39.161 because it's got to do my five finger breathing mommy, 0:20:39.201 --> 0:20:41.440 and she takes a moment and she does the. 0:20:43.160 --> 0:20:47.761 Right They so seriously are why is IVF so expensive. 0:20:48.880 --> 0:20:52.880 IVF is expensive. It's not because of the doctor, which 0:20:52.921 --> 0:20:56.321 I think is the biggest misconception. So the doctor gets 0:20:56.321 --> 0:20:59.241 a tiny tiny amount of the amount that you pay 0:20:59.321 --> 0:21:02.920 to the IVF unit wherever that is. The where that 0:21:03.001 --> 0:21:05.761