Speaker 1: Apologie production.
Speaker 2: Hi, my name's beck Woodbine and welcome to Tenderness for Nurses.
Speaker 1: I'm grateful for the person that I have the opportunity
Speaker 1: to be, so I hit it and parked it for
Speaker 1: Nelly four years. We always have free will, We always
Speaker 1: get to choose.
Speaker 2: We are autonomous. Welcome back everyone to Tenus for Nurses.
Speaker 2: We have Sam post back because the questions and the
Speaker 2: information you guys sent back to me was you really
Speaker 2: wanted to get more information out of her. So welcome
Speaker 2: back Sah.
Speaker 1: Thanks for having me back back.
Speaker 2: So I hope you're ready today because we have so
Speaker 2: many questions to go through.
Speaker 1: Love it.
Speaker 2: I love that everyone just embraced it and sent heaps
Speaker 2: of questions.
Speaker 1: There's some juicy ones in there, some really juicy ones.
Speaker 2: The first question is uncontrollable weight gain during peri menopause.
Speaker 2: Why and why in the tummy area.
Speaker 1: Yeah, so this is a really interesting one. And I think,
Speaker 1: like I'll preface with saying that with all of these ants,
Speaker 1: one answer isn't going to be the right answer for everyone.
Speaker 1: And I think when we look at hormones, there are
Speaker 1: so many factors that affect things. But when we look
Speaker 1: at weight gain. In perimenopause, there's a couple of factors
Speaker 1: that affect things. One is estrogen or the reduction of estrogen.
Speaker 1: Estrogen is our feel good hormone, but it's also the
Speaker 1: hormone that controls a lot of things and also interplace
Speaker 1: with our other hormones like insulin. So when we're looking
Speaker 1: at perimenopause, we also see, you know, more insulin resistance
Speaker 1: coming in. We see a reduction in our muscle mass,
Speaker 1: which increases our metabolism and all of that sort of
Speaker 1: stuff as well. So it's really quite multifaceted.
Speaker 2: So really in perimenopause, you start to get a drop
Speaker 2: of estrogen, you do, and do you get a drop
Speaker 2: of progesterone.
Speaker 1: You do get a drop of progesterone as well, but
Speaker 1: it's more the drop in the estrogen that drives a
Speaker 1: lot of these factors. Usually as well, when we look
Speaker 1: at when people tend to go through that perimenopause menopausal
Speaker 1: stage as well, it's usually during a period of time
Speaker 1: where cortosole levels and stress levels are quite high as well,
Speaker 1: because you know where where midlife we're dealing with either
Speaker 1: children that are school age or children that are growing
Speaker 1: and leaving the nest and then aging parents and all
Speaker 1: of these compounding things that increase quartersole levels as well,
Speaker 1: which we know has plays a factor in weight gain.
Speaker 1: When we're looking at estrogen and the reduction in estin
Speaker 1: that's where we get that at a post tissue across
Speaker 1: that midsection as opposed to hips and thighs when we're
Speaker 1: going through puberty.
Speaker 2: When people have PCs and they struggle to lose weight,
Speaker 2: like I was led to believe, estrogen sits in the
Speaker 2: fat cells or can do so, is that why people
Speaker 2: with pcos have so many issues with weight? It's because
Speaker 2: they've got so much estrogen.
Speaker 1: No, So when we do bloods on people with pcos
Speaker 1: there anovulagy, we tend to see what we call baseline blood,
Speaker 1: so really low levels of everything except for usually elutinizing
Speaker 1: and FSH hormone because you've got so many follicles there,
Speaker 1: follicles driving follicle stimulating hormone, which has this negative feedback.
Speaker 1: With pcos, it's generally related of the way gain is
Speaker 1: generally related to insulind.
Speaker 2: Okay, okay, that makes sense, and PCOS GUYS is polycystic
Speaker 2: ovarian syndrome. Just in case, you didn't.
Speaker 1: Know, which is very different to PCO, which is polycystic
Speaker 1: ovaries in morphology, which lots of people get.
Speaker 2: I had that, Yeah, but I didn't have the syndrome. Yep,
Speaker 2: So just had a fewfference, you know. Just wasn't that
Speaker 2: easy for imprint?
Speaker 1: Yes?
Speaker 2: Yeah, I still have my period, but have a low
Speaker 2: sex drive is something wrong with me?
Speaker 1: No, nothing is wrong with you. And it doesn't necessarily
Speaker 1: mean that we're going through perimenopause or menopause either. I
Speaker 1: think when we look at sex drive as females, we
Speaker 1: are very cyclical from a monthly perspective for most people.
Speaker 1: But we know that our hormones as females are driven
Speaker 1: by extrimesic factors lack stress. And so just because you've
Speaker 1: got a low sex drive, I can probably guarantee that
Speaker 1: this person is a mother, is running around like a
Speaker 1: crazy person, juggling, you know, multiple things, and that naturally
Speaker 1: drives down that sex drive or.
Speaker 2: That libido because you're just exhausted.
Speaker 1: Correct, Yeah, correct, definitely. You know, with regards to perimenopause,
Speaker 1: if we're looking at it from that perspective again, estrogen
Speaker 1: drives all of those things down as well. For some
Speaker 1: people they find sex less comfortable because estrogen is what
Speaker 1: helps with the lubrication in the vagina and all of
Speaker 1: those sorts of things as well, So there can be
Speaker 1: you know, almost blockers to wanting to have sex, which
Speaker 1: can actually drive down your libido as well. If it's uncomfortable,
Speaker 1: you don't want to do it, and that you know,
Speaker 1: has that whole play. I'd say, we're probably just a
Speaker 1: really busy person and that's completely completely normal. And I
Speaker 1: think it's really important as females to normalize that with
Speaker 1: our partners as well, that sometimes we're just not we're
Speaker 1: just not fiery or in the mood today, and that's
Speaker 1: completely normal with everything else going on in life. I
Speaker 1: think when we look at males, males are like on
Speaker 1: a daily kind of flac or they're just producing stuff left,
Speaker 1: right and center, and you know, females are very very different.
Speaker 2: Look. I mean, I know for myself there you know,
Speaker 2: when you're shattered, you just want to get a bed totally.
Speaker 1: And I think you know also too, depending on what
Speaker 1: you do for work, but also when you're a mother
Speaker 1: as well, you know someone's at you all day or
Speaker 1: you've got multiple people and you're having to care and
Speaker 1: be the person that's on for other people, as a
Speaker 1: lot of females do, whether that's in life at home
Speaker 1: or within the workplace. The last thing you want to
Speaker 1: do some things is be touched by someone else, like
Speaker 1: leave me alone. I need more space. I need to
Speaker 1: just you know, calm down and come down. And I
Speaker 1: think that that's a really normal physiological response to just
Speaker 1: being so busy as females.
Speaker 2: Yeah, I couldn't agree more. Okay, the next question, it
Speaker 2: takes me longer to be aroused when once I was
Speaker 2: ready really quick. Why is this? And what can I
Speaker 2: do to help my libido?
Speaker 1: So again I think multifactorial, you know, without knowing the
Speaker 1: person the situation. Maybe it's something to do with menopause
Speaker 1: or perimenopause. I don't know the age, in which case
Speaker 1: we're talking about estrogen. Again, when we're talking about hormones,
Speaker 1: there are things that we can put in place, whether
Speaker 1: that is hormone replacement therapy from a perimenopause menopause al place,
Speaker 1: whether it's lubricant. So naturally, sometimes we're just we might
Speaker 1: feel like we want to have sex, but you know
Speaker 1: the body is not catching up. Again, stress life that
Speaker 1: all plays a factor in it. So talking to a
Speaker 1: GP nurse practitioner, whoever you're seeing from a hormonal perspective,
Speaker 1: if it is in that perimenopause, menopause, or window, because
Speaker 1: we can do things like vaginal estrogen and stuff that
Speaker 1: can help with lubrication, but also too, I think a
Speaker 1: lot of women still utilize lubricant makes it more enjoyable.
Speaker 1: And that's again normalizing that just because you use lubricant
Speaker 1: to have sex doesn't mean that there's anything wrong, doesn't
Speaker 1: mean that you enjoy it any less or you know,
Speaker 1: take longer to be aroused. You can still be aroused
Speaker 1: in your body, just not producing the same amount of
Speaker 1: lubricant as it does in the pollicular phase of your cycle,
Speaker 1: or the beginning of your cycle compared to the lutelle
Speaker 1: phase or the second half of your cycle, where estrogen
Speaker 1: levels have completely dropped off and we're getting ready to
Speaker 1: either maintain a pregnancy if we're pregnant, or getting ready
Speaker 1: to shed the lighting. And so when we look at
Speaker 1: the cycle hormones, our estrogen starts to build at the
Speaker 1: beginning of the cycle, it peaks at population and then
Speaker 1: it drops off. So it is actually really natural and
Speaker 1: normal to have a drier vaginal area in that second
Speaker 1: phase of your cycle. Nothing wrong with it.
Speaker 2: And when you look at that, I mean physiologically it
Speaker 2: makes sense because you know, we're designed to procreate, and
Speaker 2: of course you know leading into that phase, you aren't
Speaker 2: going to have more estrogen, which is going to drive
Speaker 2: you know, you're going to have more sex drive to
Speaker 2: try and fertilize that egg. So physiologically that makes sense.
Speaker 2: But also on the other hand, there's so much out
Speaker 2: there that you can just go to the supermarket now
Speaker 2: for lubricants. You know there's flavored ones, smelly ones pretty well,
Speaker 2: but you can actually just go to the supermarket. You
Speaker 2: don't have to go to a sex shop anymore to
Speaker 2: get into that sort of thing. And I think it's
Speaker 2: fantastic that they're meeting a market and I You've just
Speaker 2: got to speak to your partner, don't you.
Speaker 1: Absolutely? And I think that that's, you know, with anything,
Speaker 1: when we talk about hormones and relationships, it's about being
Speaker 1: open and driving that communication. And for some people that
Speaker 1: can actually be really difficult. It's not like everyone's you
Speaker 1: and I and we have no problems in discussing this
Speaker 1: sort of thing. Partly because of nurses and partly because
Speaker 1: you know, we're females and we're advocates for the female body.
Speaker 1: But you know, generationally as well, you know, there's people
Speaker 1: that you know, have grown up in a very very
Speaker 1: conservative household and even though they're young, they haven't been
Speaker 1: exposed to, you know, open conversations about your body and
Speaker 1: sexuality and all that sort of stuff. And then you've
Speaker 1: got the other end of the spectrum, like my nine
Speaker 1: year old, who can tell you about everything that that happens,
Speaker 1: you know, to a woman's body from you know, preteen
Speaker 1: all the way through two menopause, and you know all
Speaker 1: of those sorts of things that go into there as well.
Speaker 1: So I think open communication with your partner is really
Speaker 1: really important. But I think also to within your close
Speaker 1: friends group. You know, you'd be surprised with the number
Speaker 1: of people that are probably experiencing the same thing within
Speaker 1: your close friends group that just don't talk about it.
Speaker 1: I know myself. You know, you get talking to friends
Speaker 1: and they mentioned something, you're like, oh, hang on a second,
Speaker 1: that's not normal, like did you you know? And it's
Speaker 1: just opening up that that conversation.
Speaker 2: What causes my period to stop? Hmmm?
Speaker 1: Again, it all comes back down to isugen for a
Speaker 1: start that it it's the drop in your estrogen. But
Speaker 1: what leads to that drop in the estron is we
Speaker 1: have a finite number of eggs within our ovary. So
Speaker 1: when a female baby is in utero at twenty weeks,
Speaker 1: we have the most number of eggs that we will
Speaker 1: ever have. By the time we are born, that halves
Speaker 1: and then yeah, and by the time we actually go
Speaker 1: through puberty, we've only got about four hundred to five
Speaker 1: hundred thousand eggs and they slowly drop off. So biggest
Speaker 1: misconception that I see with patients coming through from a
Speaker 1: fertility perspective is they think that we only lose one
Speaker 1: egg a month. It's actually not true. I like to
Speaker 1: describe because I'm quite a visual person. Ovary is almost
Speaker 1: like a shark's mouth. So anyone that knows sharks knows
Speaker 1: that they have a whole cohort of teeth that come
Speaker 1: through at a different period of time. That's the same
Speaker 1: on the ovary. So within each month we have our
Speaker 1: ovarian reserve or our anthropolical count. When we scan people,
Speaker 1: we can see that. But what naturally happens is your
Speaker 1: fsahal your follicle stimulating hormone is only enough to draw
Speaker 1: one of those little follicles up to become dominant. We
Speaker 1: ovulate and we release it for liticle, but all those
Speaker 1: other cohort of embryos that sit in what we call
Speaker 1: the cortex of the ovary kind of resolve. We lose
Speaker 1: them as well as that one that we've ovulated from,
Speaker 1: and then the next cohort come up. So that happens, yeah,
Speaker 1: month to month to month, and eventually the ovaries lose
Speaker 1: all of their eggs, and that's where the period starts
Speaker 1: to slow down and we start to get irregular cycles.
Speaker 1: And then you know perimenophorse is that that phase where
Speaker 1: your periods become irregular, and they become irregular because we've
Speaker 1: got fewer numbers of eggs pushing through, and that regularity
Speaker 1: of that happening doesn't necessarily occur in that month, in
Speaker 1: that twenty eight day thirty day phase whatever is normal
Speaker 1: for the person, and so eventually there's nothing really there
Speaker 1: and that whole process stops. And so it's like the
Speaker 1: drive of f S, H and hormones, and it actually
Speaker 1: starts in the brain in the petuitary. That's actually where
Speaker 1: all of that, the hormone start and drive over it.
Speaker 2: When I realized I was menopausal, I went and saw
Speaker 2: my gynecologists because I was sort of wanting to kill everybody.
Speaker 2: I was an angry, angry lady. He said, the reason
Speaker 2: why you're feeling like you are is, he said, your
Speaker 2: ovaries have like a last hurrah where they just try
Speaker 2: to kick back in one more time, have one more party. Yeah,
Speaker 2: and then they get totally And he said that can
Speaker 2: be a couple of months, or that can be and
Speaker 2: he said it can be quite horrendous for the woman
Speaker 2: at that time because your body's just sort of.
Speaker 1: Doesn't know what it's doing, like going between the two.
Speaker 1: Am I trying to have a baby? I'm not. Am
Speaker 1: I finishing? And yeah, it can. For some people it
Speaker 1: happens quite quickly, and for other people it drags on
Speaker 1: and that's cruel, but it happens.
Speaker 2: Well, he I was put on HRT and I had
Speaker 2: a mariner in. Yep, my life changed seriously within a
Speaker 2: few days. Within a few days that gel I'm using
Speaker 2: that to the day I die. I'm not joking it.
Speaker 2: It was so notice my head, my fog cleared, you know,
Speaker 2: I could breathe, but the anger subsided and that was
Speaker 2: probably the best thing, because you know, my poor husband was,
Speaker 2: what is happening? You're scary? But so many women say
Speaker 2: the same thing, except so many women they just have
Speaker 2: this just annoyed at everything. And I don't know why.
Speaker 2: I don't know why. I don't know why. I think
Speaker 2: it's I mean, I can look back now, I think
Speaker 2: it's hilarious, but at the time it was not.
Speaker 1: No, absolutely, and I think that that's you know, that's
Speaker 1: quite scary for some women, and particularly you know if
Speaker 1: you're on the younger end of things, when when hormones
Speaker 1: start to change. We know that you know, hormones start
Speaker 1: to change before you even reach that perimenopause. So for
Speaker 1: some people, they get some of the symptoms like the
Speaker 1: brain fog or the agitation or whatever it might be,
Speaker 1: well and truly before their periods start to misbehave and
Speaker 1: become irregular. And it can be really frustrating because you know,
Speaker 1: we don't talk about it enough. Yes, the conversation is
Speaker 1: starting to be out there and we're talking about it more,
Speaker 1: but it is quite a normal phenomenon, but we don't
Speaker 1: talk about it like it is.
Speaker 2: So I had a client come in a couple of
Speaker 2: weeks ago and she was so excited she'd had a
Speaker 2: last period. Now, I thought I would go through menopause later.
Speaker 2: And I think I was forty five forty six, so
Speaker 2: that's reasonably young. I this is gonna sound really weird.
Speaker 2: I felt like I was grieving.
Speaker 1: Some people do that.
Speaker 2: I it just happened, yep. And then and I suppose
Speaker 2: having a marina in for so many years didn't help
Speaker 2: because I didn't know when my period was. But I
Speaker 2: sort of a bit sad because that part of my
Speaker 2: life was done. Yeah, and yet other women and I
Speaker 2: sit there and I think, oh, you're amazing because you're
Speaker 2: just celebrating this and you're moving on with the next
Speaker 2: stage of your life. Where I did, I felt sort
Speaker 2: of sad.
Speaker 1: Yeah, you see a mix of a mix of things.
Speaker 1: I think. You know, even when we're looking at women
Speaker 1: that are coming through our clinic and having hysterectomies as well,
Speaker 1: you know, some people are so keen to get that
Speaker 1: uterus out and I don't want anything to do with it.
Speaker 1: And then you have other people that you need to
Speaker 1: have it out for a medical you know, a really
Speaker 1: significant medical problem. They've had bleeding or they've got massive
Speaker 1: fibroads that are causing problems or whatever it may be.
Speaker 1: And even though they know that it's a necessity for
Speaker 1: their own health, it's a really hard concept to grapple with.
Speaker 1: And I think, you know, menopause and that transition, it
Speaker 1: is a transition to a different phase of your life,
Speaker 1: and it does sneak up on you all of a
Speaker 1: sudden you're there, and if you know, you have that
Speaker 1: preconceived idea that oh, well, you know what happens in
Speaker 1: my fifties, and you know it's age is a way
Speaker 1: I don't have to worry about it. And then all
Speaker 1: of a sudden you're forty five and you're there. You're like,
Speaker 1: hay in a second, oh, ten years until this is happening,
Speaker 1: Like what is what is going on? And so I
Speaker 1: think it is a big shift for us to kind
Speaker 1: of go as women, Okay, well that part of my childbearing,
Speaker 1: all my reproductive time is over, and that was an
Speaker 1: amazing journey, whatever that looks like. Because for everyone, not
Speaker 1: everyone's you know, decides to have children or is fortunate
Speaker 1: enough to be able to have children, but it is
Speaker 1: you know that you move on to that next phase,
Speaker 1: and I think there's some merit in celebrating it, but
Speaker 1: also I think allowing yourself to grieve if they're the
Speaker 1: feelings and the emotions that come up during that period
Speaker 1: of time as well. And I think that's that's the thing.
Speaker 1: What happens for one person isn't going to be the
Speaker 1: same for you, And just normalizing that in itself, is
Speaker 1: that the way that your friend experience is very menopause,
Speaker 1: and menopause isn't going to be how you experience it.
Speaker 1: I think when we're looking at all of the information
Speaker 1: out there, and certainly one of the things that I
Speaker 1: noticed with the questions that came through was there is
Speaker 1: no one size fits all approach, and what one person
Speaker 1: experiences from a symptom perspective may beeause or perimenopause, but
Speaker 1: for another person it may just be that you're really
Speaker 1: stressed at work and your hormones are just doing something
Speaker 1: funky and then you know, in two months time when
Speaker 1: life comes down, things you know, kick back into to
Speaker 1: normal gear.
Speaker 2: So can stress impact estrogen, Absolutely, it.
Speaker 1: Can affect your whole entire hormonal system, because again, hormones
Speaker 1: are drived predominantly from your hypothalmus and everything like that.
Speaker 1: And so once we're stressed, our body goes, you know what,
Speaker 1: We're not ready to have a baby, We're not ready
Speaker 1: to potentially be responsible for creating life. We're just going
Speaker 1: to shut down. And so you see that all the time,
Speaker 1: particularly in like athletes, young women with eating disorders, or
Speaker 1: corporates that are really really stressed kind of in that
Speaker 1: right or flight mode for long periods of time. Our
Speaker 1: body is unalthy. It is unhealthy, but it's also you know,
Speaker 1: in the body's way of going, you know what, it's
Speaker 1: actually not the right time to bring something else into
Speaker 1: the world or to put your body under any more
Speaker 1: stress than what it's already under. We shut things down.
Speaker 2: I have spoken about this before on the podcast, but
Speaker 2: I'm a big believer in box breadth. You know, one
Speaker 2: two three four one two three four. The evidence is
Speaker 2: overwhelming that just two cycles of that reduces your quartersol
Speaker 2: dramatically in an emergency. So for example, you know, and
Speaker 2: there was an emergency situation in the emergency department and
Speaker 2: someone was coming in and you know, fight or flight,
Speaker 2: and you take the time and you can do it well,
Speaker 2: you know, you can think about it in your head.
Speaker 2: The change in your demeanor and how you cope and
Speaker 2: then how you analyze the situation changes dramatically, and I
Speaker 2: find I do I definitely do box breathing because you
Speaker 2: can sit on the toilet and do it totally. You know,
Speaker 2: and you know, and it sounds weird, but it actually
Speaker 2: makes a difference.
Speaker 1: No. There are some articles about, you know, first responders
Speaker 1: and before they hit a trauma or before a trauma
Speaker 1: comes in or whatever that looks like that they do
Speaker 1: some form of box breathing or some of those other
Speaker 1: breathing techniques to kind of just center themselves. There is
Speaker 1: an organization over in America that helps support I think
Speaker 1: it's the police over there, and they talk about doing
Speaker 1: that sort of breathing before you're entering into whatever scenario
Speaker 1: that you may be entering into, because there is a
Speaker 1: huge amount of research with regards to it. But I
Speaker 1: know myself, I do the same thing. I am under
Speaker 1: a lot of stress at the moment, and I find
Speaker 1: just you know, I can start to feel quite anxious
Speaker 1: and heightened and just slowing down and doing a couple
Speaker 1: of breaths of back.
Speaker 2: It's quite remarkable.
Speaker 1: It's amazing. I remember reading it and being like okay, whatever,
Speaker 1: and then doing.
Speaker 2: It and I was like, oh, it actually works.
Speaker 1: Okay, this is this is the thing, and it's interesting.
Speaker 1: Like my my little girl when she was in prep,
Speaker 1: they taught them five finger breathing, which is very similar,
Speaker 1: so you trace your fingers and inhale and exhale five times.
Speaker 1: And the the prep teachers taught them that in their
Speaker 1: first week of how prepulous like for if they were
Speaker 1: feeling overwhelmed and whatnot. And so to this day, Ivy
Speaker 1: will still if she starts to get a bit things
Speaker 1: because it's got to do my five finger breathing mommy,
Speaker 1: and she takes a moment and she does the.
Speaker 2: Right They so seriously are why is IVF so expensive.
Speaker 1: IVF is expensive. It's not because of the doctor, which
Speaker 1: I think is the biggest misconception. So the doctor gets
Speaker 1: a tiny tiny amount of the amount that you pay
Speaker 1: to the IVF unit wherever that is. The where that
Speaker 1: money goes is all of the science that goes behind
Speaker 1: making embryos from the eggs and sperm that we collect
Speaker 1: for like, it's quite an involved process, from the microscopes
Speaker 1: that we need to use and the tools that we
Speaker 1: need to use if we're microinjecting sperm into eggs, to
Speaker 1: the embryoscopes and the areas that we keep our little
Speaker 1: embryos and watch our little embryos into. Plus, you know
Speaker 1: that the time of all the staff and everything that
Speaker 1: are constantly going through, you know, the lab doesn't stop it.
Speaker 1: It's a continual thing, and so it's the science behind
Speaker 1: everything that continues to run and build create these little
Speaker 1: embryos in our little petri dishes. That IVF is so
Speaker 1: so expensive, and the more for want of a better term,
Speaker 1: intervention that we need to have with regards to IVF,
Speaker 1: the more expensive it gets. So when we start to
Speaker 1: look at IVF versus IXY, which is where we microinject
Speaker 1: sperm into the egg rather than allowing the sperm to
Speaker 1: penetrate the egg as if it would within the fallopian tubes,
Speaker 1: that's an additional cost. But for some people that's nesseette
Speaker 1: because that's the only way that the sperm is going
Speaker 1: to get into the egg. When we look at genetic
Speaker 1: testing of our embryos, that's another additional cost because again
Speaker 1: for some people they don't require it, but for other
Speaker 1: people they do. And then when you look at the
Speaker 1: types of testing there are. You know, there's more involved
Speaker 1: testing if we're looking for specific gene related conditions, and
Speaker 1: so that expands that cost further as well.
Speaker 2: Don't you think it's remarkable that, you know, an egg
Speaker 2: is so tiny east or an embryo, even embryo is tiny,
Speaker 2: and they can take.
Speaker 1: It's fascinating and send it off.
Speaker 2: I mean when I went to QFG, I used to
Speaker 2: love looking down that microscope and seeing the embryos and
Speaker 2: they're multiplying and growing.
Speaker 1: It now remarkable embryoscope. It's like a time lapse cameras,
Speaker 1: so every couple of minutes you get a new picture
Speaker 1: of the embryo. So like watching that in succession, it's
Speaker 1: just incredible.
Speaker 2: Yeah, Okay, my daughter is only eleven but already has
Speaker 2: pimples and black heads. Why is this when she is clean,
Speaker 2: washes the face, and doesn't have a period.
Speaker 1: So this is probably both of our questions, but I could.
Speaker 1: I'm going to preface by saying that girls' bodies start
Speaker 1: to change from a hormonal perspective at least two years
Speaker 1: before we actually have a period. For some people it's
Speaker 1: only twelve months, and for other people it's two years,
Speaker 1: two and a half years, So that's the first and
Speaker 1: foremost thing. Also, secondly, I watched my nine year old
Speaker 1: wash her face and it's not done very well. But yeah,
Speaker 1: the hormonal changes are happening internally long before we're having
Speaker 1: a period. So it's the same with you know, what
Speaker 1: we call budding, so starting to get breasts and hair
Speaker 1: and all of that sort of stuff that happens well
Speaker 1: and truly before periods. When we're looking at budding and
Speaker 1: hair development, it's usually six to twelve months before girls
Speaker 1: get there first period, but we know that some of
Speaker 1: those skin changes happen long before that.
Speaker 2: And it's funny because they will come into the clinic
Speaker 2: and the hair is like a grease gray hit. Particularly
Speaker 2: the boys. You know, they've got oily skin, oily faces,
Speaker 2: and you know, those hormonal changes are happening, and it's
Speaker 2: just a matter of teaching them how to cleanse their
Speaker 2: face correctly and not like they do on TikTok. And
Speaker 2: the other thing I found I found with these younger
Speaker 2: patients of mind that come in and look after their
Speaker 2: skin is they're on TikTok and they're trying out fifty
Speaker 2: different things and their skin turns into this absolute mess,
Speaker 2: strips it within an inch of its life. But when
Speaker 2: the young boys come in and they're sitting there and
Speaker 2: they're sort of embarrassed at first, and then we do
Speaker 2: what we do and they they love it, and not
Speaker 2: just love it. They do what I say to do,
Speaker 2: down to the let like down to the full stop.
Speaker 2: They are remarkable, these young boys, and have no problem
Speaker 2: cleansing their face. And I said, indeed, you got to
Speaker 2: wash your hair. It's like you could ski off that.
Speaker 2: It's disgusting. And they go but they like it because
Speaker 2: they put product in or something. It's just disgusting. But
Speaker 2: you talk to them and you say, you know, you
Speaker 2: just got to change a bellow case. You've got to
Speaker 2: just wetch your face after sport, just wash it down.
Speaker 2: You've got to wash your face when you get home,
Speaker 2: and when you think you've washed it, give it another wash,
Speaker 2: just like your pits. When you've washed them, then go
Speaker 2: back in and wash them again. But I just they're
Speaker 2: you know, they're coming in. The hormones are just going rampant.
Speaker 1: And definitely and you know when we look at little girls,
Speaker 1: you know, I like I said, my daughter's night and
Speaker 1: starting to look at some of her little friends and
Speaker 1: the change in body shape, and you know at a
Speaker 1: post tissue starting to go on the eyes and stuff,
Speaker 1: and you can go, okay, well, you know little people
Speaker 1: that you know are going to start going through through
Speaker 1: changes sooner rather than later. Yeah, and then you've got
Speaker 1: my little string bean who's like, do you think away,
Speaker 1: I have my period soon?
Speaker 2: I'm like, nah, enjoy it, enjoy it. Do men have
Speaker 2: a type of menopause.
Speaker 1: It's not called menopause, it's andropause, and it tends to
Speaker 1: happen much later in life than what it does with women,
Speaker 1: and it's where they're androgen so their testosterone and stuff
Speaker 1: starts to drop. Some people it drops significant enough that
Speaker 1: they fatigue, they have sexual dysfunction, libido drops off, and
Speaker 1: for other people there's a natural decline but not anything
Speaker 1: to impact life. But there is definitely a change that happens,
Speaker 1: but it's much much later. And that's why you know,
Speaker 1: you see, you know, men in their seventies and eighties
Speaker 1: still fast.
Speaker 2: Yeah, yeah, yeah, good to think of anything worse. Can
Speaker 2: I use testosterone to improve my libido? Or is weight
Speaker 2: lifting and building must is good? Yeah?
Speaker 1: So that's a question that really you need to sit
Speaker 1: down with your practitioner whoever that is, and look at
Speaker 1: what is happening. So would really require blood test monitoring,
Speaker 1: seeing what's happening. Weight bearing exercise to increase muscle mass
Speaker 1: helps when we're looking at perimenopause and menopause because we
Speaker 1: know that obviously with more muscle we increase our metabolism.
Speaker 1: We know that with muscle growth we do get a
Speaker 1: little bit of testosterone that comes or androgens that come
Speaker 1: with that. But at the same time, we're female, we're
Speaker 1: not going to have the same testosterone drive from future
Speaker 1: amounts of muscle like boys do because we can't develop
Speaker 1: huge amount of muscle that's what boys do. So depending
Speaker 1: on the symptoms that people are experiencing and why they
Speaker 1: feel they need testosterone is probably the first question, but
Speaker 1: also looking at that whole Pomona profile, because again for
Speaker 1: a lot of people, once we start supplementing the estrogen
Speaker 1: and the project stone, we tend to find that things
Speaker 1: kind of balance off nicely. It's very rare that we
Speaker 1: need to add in testosterone, and if we do, it's
Speaker 1: a very small amount and very personalized.
Speaker 2: If I use testosterone, will I get hairy?
Speaker 1: So testosterone is an androgen, and so for some people, yeah,
Speaker 1: they can have a little bit more facial hair and
Speaker 1: stuff as well. I know, we use a tablet. It's
Speaker 1: not testosterone, it's another male androgen to help convert some
Speaker 1: of our IVF medications. And for short periods of time
Speaker 1: that doesn't change things. But with things like PCOS and
Speaker 1: stuff as well, higher androgens in the body will naturally,
Speaker 1: over a course of time cause the body to produce
Speaker 1: excess hair. That's what androgens do, and that's.
Speaker 2: One of the when you've got the syndrome for PCOS. Purseudism.
Speaker 2: Hair is one of the side effects of having multiple follicles. Yeah,
Speaker 2: and it's something we treat a lot, but it's ongoing
Speaker 2: with those ladies unfortunately.
Speaker 1: Yep.
Speaker 2: You know you can treat, but at the end of
Speaker 2: the day, did you know that, like eggs or like follicles,
Speaker 2: we have a finite number of hair follicles. Yeah, so
Speaker 2: there you go. So you if you treat and treat
Speaker 2: and eventually it will go.
Speaker 1: Yeah.
Speaker 2: Sometimes the laser agitates a hair follicle beside it, so
Speaker 2: you can treat. Actually, waxing was the worst for agitating
Speaker 2: hair and then another hair would come up beside it
Speaker 2: shaving that it makes your hair worse is the biggest
Speaker 2: fallacy there ever was it doesn't change your hair because
Speaker 2: your hair is already the way it is at a
Speaker 2: cellular level. But yeah, it's finite finite. I know there's
Speaker 2: a bit of trivia for the trivia arts excellent. If
Speaker 2: I use HRT, will it reduce my risk of Alzheimer's
Speaker 2: as my mum has it?
Speaker 1: So the juries out on this one. I think when
Speaker 1: we look at Alzheimer's as a whole, it can be
Speaker 1: a hereditary based condition. We do know that in there
Speaker 1: are some studies to show that starting HRT earlier in
Speaker 1: that verimenopausal journey can be a protective factor compared to
Speaker 1: studying it later in the journey. But again it is
Speaker 1: very very individualized as to that whole genetic history as well.
Speaker 2: Yeah, can I use HRT forever?
Speaker 1: The I guess when we're looking at the research that's
Speaker 1: out there at the moment, most research is up to
Speaker 1: about ten years. But again we need to be looking
Speaker 1: at why we're wanting to use it. The theory for
Speaker 1: a long period of time has been shorter period possible
Speaker 1: that is starting to draw out. Most people tend to
Speaker 1: be on HRT for about that four to five gear
Speaker 1: mark and then they start to slowly wean it off.
Speaker 1: But again it's very individualized and personalized as to why
Speaker 1: we're using it and in what modality as well. Yeah,
Speaker 1: whether it's you know, I HRT, whether it's low, whether
Speaker 1: it's a bit of you know, estrogen cream to help
Speaker 1: with liubrifcation in the vagina, a little bit of transdermal
Speaker 1: estrogen that there's a whole array of HRT when we're
Speaker 1: looking at what that looks like. And so, yeah, it
Speaker 1: again very very individualized.
Speaker 2: Why do I have to use progesterone with estrogen when
Speaker 2: I have a uterus?
Speaker 1: Yes, when you've got a uterus, you need both estrogen
Speaker 1: and progesterone. Progesterone is our hormone that sheds outlining. Our
Speaker 1: estrogen is the hormone that thickens the lining. So if
Speaker 1: we continue to take estrogen without having progesterone in there
Speaker 1: to have what we call a withdrawal bleed or in
Speaker 1: the case of having a marina in where you've got
Speaker 1: that constant, steady state of gesterone, what happens is the
Speaker 1: lining continues to thicken and then we're at risk of
Speaker 1: individual hyperplasia or an endometrial cancer. So it's to reduce
Speaker 1: the risk of having an indivitrial ypoplasia.
Speaker 2: And is it a tablet or is it a cream?
Speaker 1: Usually usually a tablet, usually micronized tablet.
Speaker 2: Does using HIT increase the risk of breast cancer? And
Speaker 2: that has been proven, guys. It is a fallacy that
Speaker 2: estrogen or HRT causes cancer that has been debunked.
Speaker 1: It has most definitely. The big study we touched on
Speaker 1: her before was the Women's Health Initiative back in the
Speaker 1: seventies that came out with all of these scare factor tactics,
Speaker 1: and that included also you know, the likes of or
Speaker 1: contraceptive feelain and all.
Speaker 2: Of those sorts of terrible as well.
Speaker 1: It was really really quite terrible. That's well and truly
Speaker 1: been debunked. I think when we look at cancer, and
Speaker 1: particularly breast cancer and ovarian cancer, when we're looking at hormones,
Speaker 1: there are some types of cancers that are estrogen or
Speaker 1: progesterone receptive, and so you know, being on something may
Speaker 1: slightly increase the chance of that, but for most people
Speaker 1: they were going to end up having that sort of
Speaker 1: cancer anyway. You know what I mean, it's not taking
Speaker 1: the HRT hasn't caused you to.
Speaker 2: Get develop that cancer. It takes a long time to
Speaker 2: get aroused, and sometimes I spot during sex. Is this normal?
Speaker 2: Sex can be quite painful and I just don't enjoy
Speaker 2: it anymore. What can I do?
Speaker 1: So this again, without knowing the situation or the person,
Speaker 1: sounds like we're probably in our perimenopause menopausal journey. I'd
Speaker 1: say we're probably estrogen depleted for want of a better term,
Speaker 1: where you know, where we don't have the nice levels
Speaker 1: of estrogen to keep the vagina juicy. And so with
Speaker 1: that we get vaginal atrophy, which is just where the
Speaker 1: vagina becomes less plump for want of a better word.
Speaker 1: And with that we get tend to get micro tares
Speaker 1: within that vagina war which is where we tend to
Speaker 1: see like that spotting side of things. I think with
Speaker 1: any post coital bleeding it's really important to go and
Speaker 1: see someone to make sure that it's not something more sinister.
Speaker 1: We do see postcode or bleeding with cervical problems as well,
Speaker 1: and what we call sin so stages before you're like
Speaker 1: civical cancers, which is always really important Obviously our csts
Speaker 1: or our regular pap smears should pick up some of
Speaker 1: those cells, but for some people it doesn't. I think
Speaker 1: also when we're looking at that generation of women that
Speaker 1: are sitting in that perimenopause menopausal state at the moment,
Speaker 1: they weren't the women that had the HPV vaccination like
Speaker 1: my generation. So there is still a higher proportion of
Speaker 1: people that have HPV related cervical changes, whether that's a
Speaker 1: cancer or whether that's just changes in general that cause
Speaker 1: some people to have that instrumental or post quote or bleeding.
Speaker 1: And so anything that's abnormal from that perspective. With regards
Speaker 1: to bleeding, always go and get it checked out. But
Speaker 1: I'd say that it's probably more related to estrogen depletion,
Speaker 1: in which case something like an estrogen vaginal green.
Speaker 2: It can help, and that will help sick it and
Speaker 2: lubricate that won't. Definitely, that just made me think perhaps
Speaker 2: near for everybody now, the therapeutic guidelines say every five years.
Speaker 1: CST every five years if it's normal and if there's
Speaker 1: no known history of a HPV.
Speaker 2: Okay, So for women my age, it's just a matter
Speaker 2: of doing it every five years unless there's something comes back,
Speaker 2: something comes back up normal. But in five years a
Speaker 2: lot can.
Speaker 1: Happen, ok which is why again regular screening is recommended.
Speaker 1: So five years, we know that the changes within a
Speaker 1: cervix don't tend to happen rapidly rapidly Okay, But again
Speaker 1: if you're we're having changes at it, I guess when
Speaker 1: we look at the guidelines and the recommendations around that
Speaker 1: five years, it's five years if you don't have any concerns.
Speaker 1: If you've got concerns, if you've noticed a change in
Speaker 1: you know, discharge, discharge or bleeding, post sex or anything
Speaker 1: that go in and get its seen to. It's really
Speaker 1: simple to run another screening test. It's really simple for
Speaker 1: someone to have a look at the cervix and see
Speaker 1: what it looks like on the exit, you know, the
Speaker 1: external part of the cervix, and to do another CST.
Speaker 1: It's yeah, recommendations are five years if you don't have interns.
Speaker 2: Now, someone said to me in the clinic that there
Speaker 2: are self tests. There are and where do you get
Speaker 2: them from?
Speaker 1: So they are given out by practitioners. So you can
Speaker 1: request a self test and form is done up the
Speaker 1: same way and you've just given the little swap with
Speaker 1: a little tube and you do it yourself.
Speaker 2: But I think that's going to be a bit hit
Speaker 2: and missed, don't you think?
Speaker 1: No, Because the way that the testing has changed allows
Speaker 1: for those vical cells within the back of the vagina
Speaker 1: or the power to Douglas to be collected. So the
Speaker 1: change from the peraps smear to the CST is what
Speaker 1: has allowed that change over to be able to do
Speaker 1: a self collect We tend to see the self collects
Speaker 1: more in our trans people and our non binary people,
Speaker 1: and also our sexual assault patients as well.
Speaker 2: Finally, the last question, ringing in my ears started after menopause.
Speaker 2: I haven't been around loud noises. Could it be related
Speaker 2: to menopause?
Speaker 1: So this one I had actually not heard of, So
Speaker 1: I did have to do a little bit of deep diving. Again.
Speaker 1: My exposure to menopause or postmenopause is limited just with
Speaker 1: regards to I guess the patient population that I tend
Speaker 1: to see. It did find that it can be due
Speaker 1: to some hormonal changes. It's not common, but more likely
Speaker 1: to do with stress and blood pressure changes. So when
Speaker 1: we look at changes that occur in menopause, one of
Speaker 1: the changes is our cardiovascular change, and so we do
Speaker 1: see a change and fluctuation in blood pressures, carting of
Speaker 1: vascular risk as we get older. It's probably more linked
Speaker 1: to that. And again like we like I mentioned before,
Speaker 1: when we're looking at people that are going through menopause,
Speaker 1: generally there's a lot of stuff happening in life, Like
Speaker 1: you're not slowing down. Your body is trying to tell
Speaker 1: you to take a break. But there is a lot happening.
Speaker 1: You know, we're looking after children or they're leaving. You
Speaker 1: have elderly parents, there's usually a shift in your relationship
Speaker 1: as well as you you know, going from having children
Speaker 1: around to being empty nesters. Changes that that happen within
Speaker 1: you know, a sexual relationship when you know, going through
Speaker 1: menopause and perimenopause, and so I think there's a lot
Speaker 1: of compounding factors. But yeah, interesting, maybe more linked to
Speaker 1: cudiovascular changes.
Speaker 2: Well, thank you so much. Our time is up and
Speaker 2: I've gone. It has gone so quickly. I really appreciate
Speaker 2: you coming in and sharing your knowing again, and thanks
Speaker 2: everyone for all the questions. Yeah, that's great. There was questions.
Speaker 1: I was like, oh, I can talk for hours, and
Speaker 1: then there was someone I was like, oh, I've not
Speaker 1: come across that. I really like. I think, you know,
Speaker 1: as a nurse practitioner candidate and someone that works in
Speaker 1: the field, I think it's really important. And I know
Speaker 1: you feel the same way back that we don't know everything,
Speaker 1: and I actually really enjoy getting a question. I'm like,
Speaker 1: you know what, I don't know the answer to that.
Speaker 1: I love it, you know, deep dive into the research
Speaker 1: and the literatureancy what's there. So I actually really enjoy it.
Speaker 2: Well, thank you, and who knows you could be back
Speaker 2: keep sending the questions in guys. Thanks Tom, Thanks