WEBVTT - Should you start HRT? With Dr Ceri Cashell 0:00:00.720 --> 0:00:03.160 Why is it so hard to get real answers about 0:00:03.200 --> 0:00:06.560 your health? If you've been told that everything looks fine, 0:00:06.760 --> 0:00:08.800 but you know that something is off, well, you're not 0:00:08.960 --> 0:00:12.800 imagining it. That's why I created Vitality three sixty to 0:00:12.880 --> 0:00:16.080 help you better understand what's going on inside your body 0:00:16.200 --> 0:00:19.040 so that you can take the targeted action needed. With 0:00:19.120 --> 0:00:22.639 a functional health approach plus testing, we go beyond the 0:00:22.720 --> 0:00:26.480 guesswork to uncover the root causes of your symptoms. I've 0:00:26.520 --> 0:00:30.280 teamed up with Dotty Asmina, an incredible integrative GP and 0:00:30.320 --> 0:00:33.479 together we will help you decode your body's signals and 0:00:33.560 --> 0:00:37.640 answer questions like why am I always exhausted? What's really 0:00:37.680 --> 0:00:41.720 causing my stubborn weight? Am I inflamed? Insulin resistant? Or 0:00:41.760 --> 0:00:45.560 maybe missing key nutrients? Because when you understand your body better, 0:00:45.840 --> 0:00:48.920 you can transform your health. Visit v three sixty dot 0:00:49.000 --> 0:00:53.560 health or check out the show notes for more. There 0:00:53.640 --> 0:00:57.440 is no doubt that I am in perimenopause. I'm forty 0:00:57.480 --> 0:01:00.000 seven years old, which puts me in the age bracket, 0:01:00.400 --> 0:01:04.040 and whilst my periods are bang on regular, they have 0:01:04.200 --> 0:01:06.720 started to creep a little shorter, so there now around 0:01:06.720 --> 0:01:10.720 that twenty six days instead of twenty eight days each cycle, 0:01:11.200 --> 0:01:14.720 and the symptoms, the symptoms are starting to come in, 0:01:15.080 --> 0:01:18.080 and some months they are coming thick and fast. For me, 0:01:18.480 --> 0:01:22.560 it's predominantly the night sweats in that week leading up 0:01:22.600 --> 0:01:25.759 to getting my period, and then occasionally I'll get headaches 0:01:25.880 --> 0:01:29.800 also in that same week before my periods. Some months 0:01:29.800 --> 0:01:33.120 I get these really sore boobs right around ovulation that 0:01:33.280 --> 0:01:35.920 just stay sore all the way through to my period. 0:01:36.200 --> 0:01:40.160 Then we've got the rage. The rage so much so 0:01:40.360 --> 0:01:43.360 that sometimes when Tim is sitting next to me on 0:01:43.400 --> 0:01:47.720 the couch chewing an apple so loud, I literally have 0:01:47.800 --> 0:01:50.880 thought multiple times about the different ways that I could 0:01:51.000 --> 0:01:54.880 murder him. But here's the thing. There are some months 0:01:55.000 --> 0:01:58.800 where I have zero symptoms and it's all smooth sailing, 0:01:59.000 --> 0:02:02.920 and my period just arrives, no period pain, couple of 0:02:03.000 --> 0:02:05.960 days of bleeding off and running again. And then there 0:02:06.000 --> 0:02:08.560 are some months where the symptoms appear, but you know, 0:02:08.680 --> 0:02:13.280 quite differently from month to month. So because of these inconsistencies, 0:02:13.440 --> 0:02:16.840 and also because I'm kind of coping. Okay, I haven't 0:02:16.880 --> 0:02:19.640 yet gone down the HRT path, but it got me 0:02:19.720 --> 0:02:23.200 thinking that I bet that there are many women out 0:02:23.200 --> 0:02:26.320 there a little bit like me where you know they've 0:02:26.360 --> 0:02:29.440 got some symptoms, but they're coping okay, and maybe they're 0:02:29.480 --> 0:02:32.960 feeling a little bit confused about when and if they 0:02:32.960 --> 0:02:49.120 should start taking HRT. This is healthy her with Amelia Phillips. 0:02:50.040 --> 0:02:52.760 If you're a woman between the ages of thirty nine 0:02:52.800 --> 0:02:57.679 and sixty, chances are you're either perimenopausal, you've reached menopause, 0:02:57.800 --> 0:03:01.760 or you're within that five year when postmenopause. And if 0:03:01.800 --> 0:03:05.920 you're suffering the symptoms of low hormones and spoiler alert, 0:03:05.960 --> 0:03:09.200 these symptoms are so much more than simply hot flushes 0:03:09.200 --> 0:03:13.480 and night sweats, then you've probably considered hormone replacement therapy 0:03:13.760 --> 0:03:16.520 or HRT as you may have heard it called, or 0:03:16.600 --> 0:03:21.160 more recently labeled MHT. Maybe you've been warned off them, 0:03:21.680 --> 0:03:25.440 maybe you've tried them but stopped, or maybe you're on 0:03:25.520 --> 0:03:28.360 them now. Wherever you are on this journey, there are 0:03:28.440 --> 0:03:31.720 often many questions and confusion about the best path forward. 0:03:31.840 --> 0:03:34.960 So to help us navigate this important HRT decision is 0:03:34.960 --> 0:03:39.320 a perimenopause queen herself on a mission to save the fannies. 0:03:39.520 --> 0:03:43.360 As she says in her wonderful Irish accent, Doctor Kerry Kishell, 0:03:43.560 --> 0:03:46.480 doctor Kerry is a Sydney GP and co founder of 0:03:46.560 --> 0:03:51.760 Healthy Hormones, Australia's leading evidence based menopause education platform. She's 0:03:51.800 --> 0:03:54.920 a passionate speaker and advocate for women's health and she's 0:03:55.000 --> 0:03:58.120 on a mission to create true gender equality and healthcare. 0:03:58.240 --> 0:04:02.120 She educates both the public and clinicians on women's health 0:04:02.120 --> 0:04:06.080 and menopause care. Doctor Kerry and her team put menopause 0:04:06.200 --> 0:04:09.000 on the world stage at the Sydney Opera House, which 0:04:09.080 --> 0:04:12.160 really helped bring attention to the inequalities of health care 0:04:12.200 --> 0:04:16.240 for women and the misinformation out there surrounding HRT. I 0:04:16.320 --> 0:04:20.200 really really recommend that you download her Healthy Hormones app, 0:04:20.240 --> 0:04:23.960 which is full of incredible resources, and also follow doctor 0:04:24.000 --> 0:04:26.560 Kerry on Instagram. I'll put both those links in the 0:04:26.600 --> 0:04:30.120 show notes. Doctor Kerry, thank you so much for joining 0:04:30.200 --> 0:04:31.000 us on Healthy her. 0:04:31.320 --> 0:04:33.560 Thank you so much for having me Amelia, delighted to 0:04:33.640 --> 0:04:34.119 be here. 0:04:34.279 --> 0:04:36.960 Well, up until a few years ago, you were a 0:04:37.360 --> 0:04:42.200 regular busy GP minding your own business looking after your 0:04:42.240 --> 0:04:45.560 wonderful patients. What on earth made you pivot down this 0:04:45.760 --> 0:04:49.440 path and become so passionate about menopause care and probably 0:04:49.480 --> 0:04:51.080 now tripled your workload? 0:04:51.360 --> 0:04:55.200 Yeah? So I was looking after one particularly wonderful patient 0:04:56.000 --> 0:04:59.320 no one as my patient Zerial, who came in to 0:04:59.400 --> 0:05:02.280 me one day and said, could you prescribe me some 0:05:02.320 --> 0:05:07.200 of that testosterone stuff? And I said, don't be ridiculous. 0:05:07.279 --> 0:05:11.000 Testosterone is for books and you're a woman, so you 0:05:11.040 --> 0:05:13.400 can't be having any of that. And she said, wow, 0:05:13.560 --> 0:05:16.000 let me tell you something. You know, she's also a 0:05:16.080 --> 0:05:20.159 nurse and great, great crack, and she said, testosterone is 0:05:20.160 --> 0:05:23.800 actually a female hormone, Doctor Kerry, and I think you 0:05:24.000 --> 0:05:25.960 maybe need to go and learn a little bit more 0:05:26.040 --> 0:05:30.320 about female hormones, which includes testosterone and upskill on the 0:05:30.360 --> 0:05:33.559 treatment of perimenopause and menopause. And as you know, where 0:05:34.120 --> 0:05:37.640 I work and live is a village, so there's not 0:05:37.760 --> 0:05:40.920 really anywhere to hide because the people I look after 0:05:41.920 --> 0:05:46.320 teaching the school, they run local businesses, they are local moms, 0:05:46.400 --> 0:05:47.760 they're local politicians. 0:05:48.200 --> 0:05:50.599 So we talk, we talk. 0:05:50.720 --> 0:05:52.800 You do not want to be on the wrong side 0:05:52.920 --> 0:05:55.359 of the village gossip as the person that didn't know 0:05:55.400 --> 0:05:57.560 what test austerone was and didn't really know how to 0:05:57.600 --> 0:06:01.080 manage primenopause. And also the response ability of you know, 0:06:01.279 --> 0:06:04.120 the village's economy is on me and you know, the sality. 0:06:04.480 --> 0:06:07.040 So I also went and did did the course and 0:06:07.680 --> 0:06:09.839 did some reading and listened to a ton of podcasts 0:06:10.000 --> 0:06:15.320 and realized that my whole foundation from understanding the female 0:06:15.360 --> 0:06:20.880 model was slightly missing. So in medicine, we're really largely 0:06:20.920 --> 0:06:24.880 trained on the male model, which is quite simple. And 0:06:24.960 --> 0:06:28.080 we come out of our medical training we do, you know, 0:06:28.160 --> 0:06:31.080 and then we all do all these extra these jobs 0:06:31.080 --> 0:06:32.480 that we're supposed to learn more and more, and we're 0:06:32.520 --> 0:06:34.919 still really being trained how to treat the male model. 0:06:34.960 --> 0:06:37.680 And I would say, like women are like ferraris, you know, 0:06:37.720 --> 0:06:42.240 we're a bio engineering feet whereas men haven't chosen the 0:06:42.320 --> 0:06:44.400 right car yet. But I would say somewhere around the 0:06:44.440 --> 0:06:46.600 super you know, kind of reliable and you can pimp 0:06:46.640 --> 0:06:49.200 them up awave it, but really, you know, they're pretty 0:06:49.200 --> 0:06:51.400 easy to service and you can probably do a lot 0:06:51.440 --> 0:06:54.440 of the service in yourself, whereas women like need a 0:06:54.480 --> 0:06:57.640 whole pet crew. You know, we've got different hormones. We've 0:06:57.680 --> 0:07:00.240 got the same hormones but in different amounts, so you know, 0:07:00.520 --> 0:07:03.720 they're changing all the time. We've got connective tissue that's 0:07:03.720 --> 0:07:07.480 more flexible and stretching. We've got an immune system, that's 0:07:07.560 --> 0:07:10.400 much more adaptable, so we have to grow a foreign 0:07:10.400 --> 0:07:12.920 body inside that's fifty percent foreign DNA, you know, when 0:07:12.920 --> 0:07:16.640 we're pregnant, and you know, under our nervous system is 0:07:16.680 --> 0:07:20.360 also more reactive, probably because of all those centuries of oppression, 0:07:20.520 --> 0:07:22.960 or just because you know, we are the smaller, smaller sex, 0:07:23.200 --> 0:07:25.680 so we just are different. And you know, it was 0:07:25.760 --> 0:07:30.720 it's been wonderful to have a framework to understand fifty 0:07:30.760 --> 0:07:32.680 one percent of the population because I think for a 0:07:32.680 --> 0:07:35.080 lot of us, especially female GPS, we're trying to treat 0:07:35.440 --> 0:07:37.760 people that we haven't really been trained to treat. So 0:07:37.800 --> 0:07:40.280 it's been liberating. I would say, I love my job 0:07:40.320 --> 0:07:43.040 more than I could ever have predicted at you know, 0:07:43.080 --> 0:07:45.240 the grand dated fifty one. I've been doing medicine. I've 0:07:45.240 --> 0:07:49.120 been in medicine for thirty three years, you know, for 0:07:49.520 --> 0:07:50.520 you know, twenty seven. 0:07:50.680 --> 0:07:54.600 So well, we certainly are very appreciative of you being 0:07:54.600 --> 0:07:59.200 a real trial blazer and getting perimenopause and women's healthcare 0:07:59.360 --> 0:08:02.280 up in life, even at the opera house, which is wonderful. 0:08:02.560 --> 0:08:04.400 Let's start with a little bit of a one oho 0:08:04.400 --> 0:08:08.080 one for those of us that are you know, in 0:08:08.120 --> 0:08:09.960 this stage, and I think we're all getting a lot 0:08:10.000 --> 0:08:14.320 more educated, which is fantastic. But starting with the main stages, 0:08:14.360 --> 0:08:17.520 can you please explain the main stages of perry, menopause 0:08:17.600 --> 0:08:20.960 and postmenopause and kind of so we can help to really, 0:08:21.000 --> 0:08:24.560 as we're listening to you today, understand what stage that 0:08:24.680 --> 0:08:25.640 we might be in. 0:08:26.000 --> 0:08:29.160 So if we start right at the beginning, when we're born, 0:08:29.240 --> 0:08:31.720 we're women, and those seven female at birth are born 0:08:31.800 --> 0:08:35.880 with a finite number of eggs or more correctly termed follicles, 0:08:35.880 --> 0:08:38.480 and we've actually already lost millions before we're even born. 0:08:38.880 --> 0:08:41.040 And I didn't even appreciate that. You start to lose 0:08:41.080 --> 0:08:43.720 those follicles. You know from the outset, you're losing them 0:08:43.720 --> 0:08:46.760 before you go through puberty, so you've already lost the 0:08:46.800 --> 0:08:49.040 majority of them by the time you hit forty and 0:08:49.120 --> 0:08:51.560 because there's a finite number, you keep losing them month 0:08:51.559 --> 0:08:53.959 and month, whether you're on the pill, whether you're pregnant, 0:08:54.160 --> 0:08:57.439 you just lose them. So on average, by the time 0:08:57.480 --> 0:09:01.079 a woman hits fifty one in Australia, she's lost almost 0:09:01.120 --> 0:09:03.280 all of her eggs, has maybe left with maybe around 0:09:03.280 --> 0:09:06.080 one thousand. And because you're born with these eggs, they're 0:09:06.080 --> 0:09:07.920 the ones that you've had from birth. They're also the 0:09:08.000 --> 0:09:09.760 quality has gone down, so but the quality and the 0:09:09.800 --> 0:09:13.439 quantity is reduced so much that you're probably not going 0:09:13.480 --> 0:09:16.320 to ovulate anymore on average at fifty one. Some women 0:09:16.400 --> 0:09:18.840 do go later, and for other women it's earlier. And 0:09:18.960 --> 0:09:22.560 at the point that you stop ovulating, you now going 0:09:22.600 --> 0:09:26.560 into what we call menopause. Now, natural menopause is defined 0:09:26.760 --> 0:09:31.960 as twelve months after your last menstrual period. That's natural menopause. Now, 0:09:32.000 --> 0:09:33.120 who chose twelve months? 0:09:33.360 --> 0:09:37.720 Who knows men in cuts in a boardroom some way? 0:09:38.120 --> 0:09:40.440 And I think it's because you don't ever know until 0:09:40.480 --> 0:09:43.040 it's retrospective, you know, until you're looking back when did 0:09:43.080 --> 0:09:45.800 I stop? But probably it's more accurate to say that 0:09:45.840 --> 0:09:48.960 menopause is the end of those periods. To be fair 0:09:49.679 --> 0:09:52.839 for women who have their overrea is removed, that surgical menopause, 0:09:53.200 --> 0:09:56.160 and that is you're in menopause immediately so they don't 0:09:56.200 --> 0:09:58.640 have to wait for another twelve months. And then women 0:09:58.679 --> 0:10:02.040 whose overies are you know, to stop working by medications 0:10:02.160 --> 0:10:04.760 or radiotherapy, that's medical menopause. And again that would be 0:10:04.840 --> 0:10:08.240 considered immediately at that point, and that's that's sometimes temporary 0:10:08.280 --> 0:10:10.720 and the average age of menopause is fifty one, and 0:10:10.880 --> 0:10:16.280 perimenopause is the time running up to that natural menopause. 0:10:16.440 --> 0:10:17.880 It may or may not happen. If you have a 0:10:17.880 --> 0:10:21.720 surgical menopause, you may have been ovulating perfectly and then 0:10:21.720 --> 0:10:23.679 your overraies a removed and that and that is that's 0:10:23.679 --> 0:10:26.280 why surgical menopause for younger women is often a huge 0:10:26.320 --> 0:10:28.640 shock to the system and you know, can really be 0:10:28.720 --> 0:10:31.040 much more devastating in terms of symptoms because there's been 0:10:31.080 --> 0:10:35.200 no gradual shift in those hormones. So perimenopause for some 0:10:35.280 --> 0:10:37.840 woman might only last a few weeks or a few months, 0:10:37.880 --> 0:10:41.520 and for others might last years. And that is really 0:10:41.679 --> 0:10:45.160 best described as a time of stuttering. Overrais so your 0:10:45.720 --> 0:10:48.960 ovaries are desperately trying to push out another egg. The 0:10:49.040 --> 0:10:52.720 brain is recognizing that the hormone levels are starting to change, 0:10:52.760 --> 0:10:56.559 because these eggs are what produced your estrogen and your progesterone. 0:10:57.440 --> 0:11:00.720 Estrogen is made from testosterone in the over I should add, 0:11:00.800 --> 0:11:03.880 and as the brain senses those falling hormone levels, its 0:11:03.920 --> 0:11:06.920 sense stronger and stronger signals down to the ovaries going 0:11:06.960 --> 0:11:10.080 come on, lads or lasses just crack out one more 0:11:10.080 --> 0:11:13.440 egg there. Sometimes you'll get these massive surges of estrogen, 0:11:13.720 --> 0:11:16.280 and other months you'll not get anything at all, And 0:11:16.360 --> 0:11:20.160 progesterone is often checking out a lot earlier, because progesterone 0:11:20.240 --> 0:11:23.800 is only made once you actually obviate, whereas the estrogen 0:11:23.840 --> 0:11:26.720 is made by those follicles, those immature eggs maturing. So 0:11:26.760 --> 0:11:30.000 you're tending to be producing estrogen most months, but not 0:11:30.080 --> 0:11:34.280 necessarily progesterone. But the estrogen levels are very erratic, and 0:11:35.240 --> 0:11:40.840 our body, particularly our brain, really dislikes instability. You know, 0:11:41.080 --> 0:11:44.360 it has got used to menstrual cycle. Although for you know, 0:11:44.840 --> 0:11:46.600 most women, you know that you feel a bit different 0:11:46.600 --> 0:11:48.840 for that week before your period or a few days, 0:11:48.920 --> 0:11:50.839 and it might be very subtile. But ninety percent of 0:11:50.880 --> 0:11:54.679 women get PMT pre tension or pre menstal symptoms, and 0:11:54.800 --> 0:11:57.440 ten percent of them get pre menstual dysphoric disorder, which 0:11:57.440 --> 0:12:02.200 is severe PMD, which affects your ability to function. But perimenopause, 0:12:02.640 --> 0:12:05.800 you know, then that just ramps up and eighty percent 0:12:05.840 --> 0:12:08.480 of women will get psychological symptoms, so that perimenopause pay 0:12:08.720 --> 0:12:12.200 phase very different for different people. Average age of menopause 0:12:12.280 --> 0:12:15.440 fifty one, but five percent of women will be in 0:12:15.480 --> 0:12:18.400 menopause by forty one, and a thousand women will be 0:12:18.480 --> 0:12:22.640 in menopause by thirty perhaps more because we're really bad 0:12:22.760 --> 0:12:25.160 at picking it up. I've looked after women who've been 0:12:25.160 --> 0:12:28.080 in menopause since their teenage years and that's you know, 0:12:28.240 --> 0:12:32.480 so it's not that, but it's often not. It's often 0:12:32.559 --> 0:12:34.720 named other things, I think, just to make it more, 0:12:34.840 --> 0:12:37.640 you know, less stigmatized. But the reality is this is, 0:12:38.000 --> 0:12:41.120 you know, a very very very premature in menopause and 0:12:41.160 --> 0:12:42.840 then some women, you know, we won't go into menopause 0:12:42.880 --> 0:12:46.880 until the's sixty after the day of menopause, your postmenopausal 0:12:46.960 --> 0:12:49.960 until you die. So that's the that's the next phase. 0:12:50.200 --> 0:12:52.560 So I guess the confusing thing for a lot of 0:12:52.640 --> 0:12:56.120 us is this perimenopause period, because like you say, it 0:12:56.120 --> 0:13:01.000 can last weeks, months versus a decade, almost stor even longer. 0:13:01.480 --> 0:13:05.480 Is there any telltale signs to say that I'm in 0:13:05.600 --> 0:13:11.079 perimenopause or I'm in early stage perimenopause or late stage perimenopause? 0:13:11.360 --> 0:13:13.160 As a doctor, is there something that is there a 0:13:13.240 --> 0:13:15.880 test that you do or is it more symptom based? 0:13:15.920 --> 0:13:18.679 How do you help a woman navigate where she is 0:13:18.960 --> 0:13:19.960 on that journey. 0:13:20.320 --> 0:13:23.559 So unfortunately, we don't have blood tests that can diagnose 0:13:23.600 --> 0:13:27.880 perimenopause because you've got these really erratic levels of hormones 0:13:27.920 --> 0:13:31.000 that can be different day to day, on different months 0:13:31.000 --> 0:13:33.280 to months. So you might find some months, you know, 0:13:33.320 --> 0:13:35.160 if you check on it, if you manage to choose 0:13:35.160 --> 0:13:37.439 the right day to check a progesterone on, it might 0:13:37.480 --> 0:13:39.480 be low. But the next month, you know, you might 0:13:39.520 --> 0:13:41.440 have ovulated a different day, so you're not going to 0:13:41.480 --> 0:13:43.880 catch that progesterone. So maybe in the future, with continuous 0:13:43.920 --> 0:13:46.200 hormone monitoring, we might be able to diagnose a bit better. 0:13:46.600 --> 0:13:50.320 I've used that before. I've used a product called Mirror 0:13:50.400 --> 0:13:55.000 before and trapped. But again I did three months and 0:13:55.080 --> 0:13:58.360 they were all quite different. But it was interesting to 0:13:58.440 --> 0:14:01.480 see my hormone in real time. It's a lot of work. 0:14:01.480 --> 0:14:03.280 You've got to pay on a stick every morning, so 0:14:03.320 --> 0:14:05.720 you've got to really be interested in it. Didn't tell 0:14:05.760 --> 0:14:09.680 me that much more than what, say, symptoms, So do 0:14:09.760 --> 0:14:12.840 you mostly go off symptoms, for example, the symptoms I 0:14:12.920 --> 0:14:14.960 was talking about at the top of my episode. 0:14:15.080 --> 0:14:17.360 Yeah, absolutely, So this is really what we call a 0:14:17.360 --> 0:14:19.720 clinical diagnosis, and there's lots of things in medicine that 0:14:19.720 --> 0:14:22.120 we don't have good biomarkers for, you know, things like 0:14:22.200 --> 0:14:24.840 migraine doesn't have a blood test. It's very much you know, 0:14:24.880 --> 0:14:27.720 based on what somebody tells us and what we're always 0:14:27.720 --> 0:14:31.000 trying to do as GPS is you know, because which 0:14:31.000 --> 0:14:32.800 I haven't said, you know, every single cell in the 0:14:32.880 --> 0:14:35.760 human body's got estrogen, progesterone and test austrien receptors. Then 0:14:35.760 --> 0:14:38.240 when those hormone levels do change, you can have any 0:14:38.320 --> 0:14:40.520 symptom at all. So there is an infinite number of 0:14:40.560 --> 0:14:43.200 symptoms that can be attributed to perimenopause. But it's really 0:14:43.200 --> 0:14:46.480 important that we don't assume that everything is perimenopausal because 0:14:46.480 --> 0:14:48.480 we don't want to miss you know, more serious things. 0:14:48.720 --> 0:14:53.240 Yeah, night sweats can be linked to serious conditions like cancer. 0:14:53.560 --> 0:14:55.600 That's why you know, don't even if you you know, 0:14:55.680 --> 0:14:57.760 you don't want to have a hormone discussion. If you 0:14:57.800 --> 0:14:59.520 are having symptoms, it is important to go and have 0:14:59.560 --> 0:15:02.800 a chat to you know, your GP to workout is 0:15:02.840 --> 0:15:05.720 this does this seem like perimenopause? Is there something else? 0:15:05.760 --> 0:15:08.520 And also when these estrogen progester and testosterone levels are 0:15:08.600 --> 0:15:11.320 sort of falling and testosterone falls from your late twenties, 0:15:11.320 --> 0:15:14.440 it's not falling off. Particularly at perimenopause, you can start 0:15:14.480 --> 0:15:18.080 to see increasing incidences of other conditions, particularly like autoimmune disease, 0:15:18.920 --> 0:15:22.760 especially thyroid dysfunction. You know, women with heavy periods often 0:15:22.800 --> 0:15:25.360 get iron deficiencies. So you've got all these So you 0:15:25.400 --> 0:15:28.280 may have iron deficiency, you may have thyroid disease, and 0:15:28.360 --> 0:15:32.080 your perimenopausal and you may also have something serious as well. 0:15:32.240 --> 0:15:34.800 It's like the perfect storm, all of this kind of 0:15:34.880 --> 0:15:36.440 urging or car crash. 0:15:36.760 --> 0:15:39.880 Storm, car crash, roller coaster, you know, choose your wild 0:15:40.120 --> 0:15:42.760 ride terminology. So yeah, So looking at symptoms, and we 0:15:42.800 --> 0:15:44.760 would often do a symptoms score. We've got a symptom 0:15:44.840 --> 0:15:46.600 checker on healthy hormones, but there's lots of bonds and 0:15:46.640 --> 0:15:49.200 different platforms, so sort of getting a picture. If you've 0:15:49.240 --> 0:15:52.960 got twenty five symptoms of you know, palpitations and heavy 0:15:53.000 --> 0:15:57.760 periods and irritability, I think that irritation with your partner's 0:15:57.800 --> 0:16:02.120 breathing or chain I think that's the closest to diagnostic sign. 0:16:02.280 --> 0:16:04.960 Yes, I would agree with you because I don't remember 0:16:05.040 --> 0:16:08.440 that apple chewing being nearly as loud or annoying when 0:16:08.440 --> 0:16:10.800 we were first together and you know, ten years ago, 0:16:10.920 --> 0:16:13.520 but it's like, yeah, he's in trouble, man. 0:16:13.720 --> 0:16:15.400 I think if that's new, that's a good sign. So 0:16:15.400 --> 0:16:17.280 people who are in neuro divergent do experience that at 0:16:17.280 --> 0:16:19.320 different times in life. But if that's the first time 0:16:19.360 --> 0:16:22.160 you've experienced that, I think, and this might be perimenopause. 0:16:22.280 --> 0:16:24.040 But the classic symptoms, sorry I should say so, the 0:16:24.040 --> 0:16:27.080 things that we would always classically have said are diagnostic 0:16:27.160 --> 0:16:31.000 of perimenopause would be what's called vasomotor symptoms, which is 0:16:31.320 --> 0:16:35.520 as a result of your brain perceiving changes in temperature 0:16:35.840 --> 0:16:38.520 very you know, as very dramatic changes, so they drive 0:16:38.600 --> 0:16:41.440 the flushing and the sweating or perhaps some people get 0:16:41.520 --> 0:16:44.400 very cold, so that would be vasimotor or hot flushes, 0:16:44.480 --> 0:16:48.880 night sweats, chills would be more classical perimenopause symptoms and 0:16:49.000 --> 0:16:51.760 menopause symptoms, so they are quite a strong marker and 0:16:52.400 --> 0:16:55.160 change in your the frequency of your period, so your 0:16:55.200 --> 0:16:59.160 parents becoming more spaced out, closer together, heavier, lighter. But 0:16:59.240 --> 0:17:03.000 as you've said, you know, women can have regular periods 0:17:03.080 --> 0:17:06.240 and they can be getting psychological symptoms, or they can 0:17:06.359 --> 0:17:09.280 be getting politicians or that they can be getting vaginal 0:17:09.320 --> 0:17:11.240 dryness or sore joints. 0:17:11.359 --> 0:17:15.040 And tell me when these symptoms are non specific symptoms, 0:17:15.080 --> 0:17:17.240 you know, like I'm getting a headache or I'm feeling 0:17:17.359 --> 0:17:20.600 rage or whatever. But then you're noticing because you're tracking 0:17:20.640 --> 0:17:23.280 your period that oh yeah, that every month they're occurring 0:17:23.320 --> 0:17:25.439 in that week before my period. Is that as a 0:17:25.440 --> 0:17:27.560 as a doctor, that's something that you take note of 0:17:27.600 --> 0:17:30.360 and go, well, that very much sounds like it's sicklic cool, 0:17:30.400 --> 0:17:33.240 and its symptoms are coming at this similar time. That's 0:17:33.280 --> 0:17:33.800 a clue. 0:17:33.880 --> 0:17:36.760 Absolutely, So that's definitely a clue that being hormonal. There's 0:17:36.800 --> 0:17:39.879 a bit of discussion in the hormone space as to 0:17:39.920 --> 0:17:46.119 whether we are diagnosing perimenopause too soon and it's actually 0:17:46.200 --> 0:17:49.719 severe PMT or premnstrual dysphoric disorder. So there's a bit 0:17:49.760 --> 0:17:52.960 of argument that this is actually PMDD not perimenopause. When 0:17:52.960 --> 0:17:55.720 it's those real pre menstrual like you're so you're fine 0:17:55.800 --> 0:17:58.000 for two weeks but awful for two weeks, that that 0:17:58.480 --> 0:18:02.680 maybe could be more class hiders PMDD. But the reality 0:18:02.880 --> 0:18:06.200 is if you really treat I find the most effective 0:18:06.200 --> 0:18:10.040 treatment for PMDD is using hormones in some way, and 0:18:10.080 --> 0:18:12.879 that's the same as what you're often doing for perimenopause, 0:18:12.920 --> 0:18:16.760 whether it's a combination of our contraceptive pill, contraceptive valu 0:18:16.880 --> 0:18:21.520 D plus or minus, or just body identical hormones, you know, 0:18:21.960 --> 0:18:25.000 and some woman in either perimenopause or PMDD also need 0:18:25.040 --> 0:18:28.080 an antidepressant as well, and then obviously all your lifestyle stuff. 0:18:28.160 --> 0:18:31.040 So I feel in a way it doesn't really matter 0:18:31.119 --> 0:18:34.359 because different people in those groups will respond to different 0:18:34.359 --> 0:18:36.639 things independent of what we've called them, whether we call 0:18:36.680 --> 0:18:39.119 them PMDD or perimenopause. 0:18:38.640 --> 0:18:42.640 In your clinic, and just anecdotally, I know the research 0:18:42.760 --> 0:18:45.359 might say one thing, but I'm curious for your experience 0:18:45.400 --> 0:18:48.320 in your clinic, what are the most common symptoms that 0:18:48.400 --> 0:18:51.480 are really you know, driving women to come and see you, 0:18:51.960 --> 0:18:55.040 that you know are perimenopause related, and then that you 0:18:55.160 --> 0:18:58.239 see improve really well once you do put them on 0:18:58.560 --> 0:19:01.840 some kind of horn replacement program. 0:19:02.160 --> 0:19:06.080 So definitely, mood symptoms would be at the top, So anxiety, 0:19:06.320 --> 0:19:09.919 not being able to sleep, irritability, wanting to kill everybody 0:19:10.000 --> 0:19:10.680 in your family. 0:19:11.119 --> 0:19:14.240 I'm not alone, You're definitely all alone. 0:19:14.240 --> 0:19:17.000 So definitely, cycle, I would say psychological symptoms are at 0:19:17.000 --> 0:19:17.560 the top. 0:19:17.560 --> 0:19:18.639 Are the biggest ones. 0:19:18.720 --> 0:19:21.679 That's so interesting I think overall the research would sugest 0:19:21.680 --> 0:19:23.639 they are the most common. They're certainly up there at 0:19:23.680 --> 0:19:26.439 the top, and they're what impact women at work, at home, 0:19:26.840 --> 0:19:29.760 you know, in relationships. Next one would be heavy periods 0:19:29.760 --> 0:19:32.720 are really common, I think, are common cause not necessarily 0:19:32.800 --> 0:19:36.040 up high in terms of frequency, in terms of like, 0:19:36.040 --> 0:19:38.040 like some people, the seventy sixty seventy percent of women 0:19:38.040 --> 0:19:40.159 will get hot flushes, but maybe forty five, forty to 0:19:40.160 --> 0:19:42.280 fifty percent will get heavy periods. But a lot of 0:19:42.280 --> 0:19:45.080 women are not overly bothered by their hot flushes. Yeah, 0:19:45.080 --> 0:19:49.359 but their flooding periods are really debilitating. Yeah, because and 0:19:49.359 --> 0:19:51.360 partly because I'm making them aren't efficient, but because they're 0:19:51.359 --> 0:19:53.199 having to live in black clothes. And you know, for 0:19:53.280 --> 0:19:55.800 us in Sydney and Australia, where you. 0:19:55.720 --> 0:19:58.200 Know everyone wears white linen. 0:19:57.960 --> 0:20:00.479 Or go to the beach or go swimming. Yeah, it's 0:20:00.520 --> 0:20:02.640 it's you know, and there's so many women leven black 0:20:02.720 --> 0:20:05.000 for so long. So I would say psychological. And probably 0:20:05.000 --> 0:20:07.800 the second one would be would be struggling with heavy 0:20:07.840 --> 0:20:11.919 periods or a period irregularity would be And then joint 0:20:12.040 --> 0:20:15.720 pen and stiffness and injuries, you know, everything from planta 0:20:15.800 --> 0:20:19.320 fasciadas to you know, penful shoulders, to knee. 0:20:19.040 --> 0:20:21.520 Pen yeah, frozen shoulder yeah. 0:20:21.359 --> 0:20:23.120 And then getting wet around your metal? 0:20:35.560 --> 0:20:38.000 Why is it so hard to get real answers about 0:20:38.000 --> 0:20:41.359 your health? 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