Speaker 1: Why is it so hard to get real answers about
Speaker 1: your health? If you've been told that everything looks fine,
Speaker 1: but you know that something is off, well, you're not
Speaker 1: imagining it. That's why I created Vitality three sixty to
Speaker 1: help you better understand what's going on inside your body
Speaker 1: so that you can take the targeted action needed. With
Speaker 1: a functional health approach plus testing, we go beyond the
Speaker 1: guesswork to uncover the root causes of your symptoms. I've
Speaker 1: teamed up with Dotty Asmina, an incredible integrative GP and
Speaker 1: together we will help you decode your body's signals and
Speaker 1: answer questions like why am I always exhausted? What's really
Speaker 1: causing my stubborn weight? Am I inflamed? Insulin resistant? Or
Speaker 1: maybe missing key nutrients? Because when you understand your body better,
Speaker 1: you can transform your health. Visit v three sixty dot
Speaker 1: health or check out the show notes for more. There
Speaker 1: is no doubt that I am in perimenopause. I'm forty
Speaker 1: seven years old, which puts me in the age bracket,
Speaker 1: and whilst my periods are bang on regular, they have
Speaker 1: started to creep a little shorter, so there now around
Speaker 1: that twenty six days instead of twenty eight days each cycle,
Speaker 1: and the symptoms, the symptoms are starting to come in,
Speaker 1: and some months they are coming thick and fast. For me,
Speaker 1: it's predominantly the night sweats in that week leading up
Speaker 1: to getting my period, and then occasionally I'll get headaches
Speaker 1: also in that same week before my periods. Some months
Speaker 1: I get these really sore boobs right around ovulation that
Speaker 1: just stay sore all the way through to my period.
Speaker 1: Then we've got the rage. The rage so much so
Speaker 1: that sometimes when Tim is sitting next to me on
Speaker 1: the couch chewing an apple so loud, I literally have
Speaker 1: thought multiple times about the different ways that I could
Speaker 1: murder him. But here's the thing. There are some months
Speaker 1: where I have zero symptoms and it's all smooth sailing,
Speaker 1: and my period just arrives, no period pain, couple of
Speaker 1: days of bleeding off and running again. And then there
Speaker 1: are some months where the symptoms appear, but you know,
Speaker 1: quite differently from month to month. So because of these inconsistencies,
Speaker 1: and also because I'm kind of coping. Okay, I haven't
Speaker 1: yet gone down the HRT path, but it got me
Speaker 1: thinking that I bet that there are many women out
Speaker 1: there a little bit like me where you know they've
Speaker 1: got some symptoms, but they're coping okay, and maybe they're
Speaker 1: feeling a little bit confused about when and if they
Speaker 1: should start taking HRT. This is healthy her with Amelia Phillips.
Speaker 1: If you're a woman between the ages of thirty nine
Speaker 1: and sixty, chances are you're either perimenopausal, you've reached menopause,
Speaker 1: or you're within that five year when postmenopause. And if
Speaker 1: you're suffering the symptoms of low hormones and spoiler alert,
Speaker 1: these symptoms are so much more than simply hot flushes
Speaker 1: and night sweats, then you've probably considered hormone replacement therapy
Speaker 1: or HRT as you may have heard it called, or
Speaker 1: more recently labeled MHT. Maybe you've been warned off them,
Speaker 1: maybe you've tried them but stopped, or maybe you're on
Speaker 1: them now. Wherever you are on this journey, there are
Speaker 1: often many questions and confusion about the best path forward.
Speaker 1: So to help us navigate this important HRT decision is
Speaker 1: a perimenopause queen herself on a mission to save the fannies.
Speaker 1: As she says in her wonderful Irish accent, Doctor Kerry Kishell,
Speaker 1: doctor Kerry is a Sydney GP and co founder of
Speaker 1: Healthy Hormones, Australia's leading evidence based menopause education platform. She's
Speaker 1: a passionate speaker and advocate for women's health and she's
Speaker 1: on a mission to create true gender equality and healthcare.
Speaker 1: She educates both the public and clinicians on women's health
Speaker 1: and menopause care. Doctor Kerry and her team put menopause
Speaker 1: on the world stage at the Sydney Opera House, which
Speaker 1: really helped bring attention to the inequalities of health care
Speaker 1: for women and the misinformation out there surrounding HRT. I
Speaker 1: really really recommend that you download her Healthy Hormones app,
Speaker 1: which is full of incredible resources, and also follow doctor
Speaker 1: Kerry on Instagram. I'll put both those links in the
Speaker 1: show notes. Doctor Kerry, thank you so much for joining
Speaker 1: us on Healthy her.
Speaker 2: Thank you so much for having me Amelia, delighted to
Speaker 2: be here.
Speaker 1: Well, up until a few years ago, you were a
Speaker 1: regular busy GP minding your own business looking after your
Speaker 1: wonderful patients. What on earth made you pivot down this
Speaker 1: path and become so passionate about menopause care and probably
Speaker 1: now tripled your workload?
Speaker 2: Yeah? So I was looking after one particularly wonderful patient
Speaker 2: no one as my patient Zerial, who came in to
Speaker 2: me one day and said, could you prescribe me some
Speaker 2: of that testosterone stuff? And I said, don't be ridiculous.
Speaker 2: Testosterone is for books and you're a woman, so you
Speaker 2: can't be having any of that. And she said, wow,
Speaker 2: let me tell you something. You know, she's also a
Speaker 2: nurse and great, great crack, and she said, testosterone is
Speaker 2: actually a female hormone, Doctor Kerry, and I think you
Speaker 2: maybe need to go and learn a little bit more
Speaker 2: about female hormones, which includes testosterone and upskill on the
Speaker 2: treatment of perimenopause and menopause. And as you know, where
Speaker 2: I work and live is a village, so there's not
Speaker 2: really anywhere to hide because the people I look after
Speaker 2: teaching the school, they run local businesses, they are local moms,
Speaker 2: they're local politicians.
Speaker 1: So we talk, we talk.
Speaker 2: You do not want to be on the wrong side
Speaker 2: of the village gossip as the person that didn't know
Speaker 2: what test austerone was and didn't really know how to
Speaker 2: manage primenopause. And also the response ability of you know,
Speaker 2: the village's economy is on me and you know, the sality.
Speaker 2: So I also went and did did the course and
Speaker 2: did some reading and listened to a ton of podcasts
Speaker 2: and realized that my whole foundation from understanding the female
Speaker 2: model was slightly missing. So in medicine, we're really largely
Speaker 2: trained on the male model, which is quite simple. And
Speaker 2: we come out of our medical training we do, you know,
Speaker 2: and then we all do all these extra these jobs
Speaker 2: that we're supposed to learn more and more, and we're
Speaker 2: still really being trained how to treat the male model.
Speaker 2: And I would say, like women are like ferraris, you know,
Speaker 2: we're a bio engineering feet whereas men haven't chosen the
Speaker 2: right car yet. But I would say somewhere around the
Speaker 2: super you know, kind of reliable and you can pimp
Speaker 2: them up awave it, but really, you know, they're pretty
Speaker 2: easy to service and you can probably do a lot
Speaker 2: of the service in yourself, whereas women like need a
Speaker 2: whole pet crew. You know, we've got different hormones. We've
Speaker 2: got the same hormones but in different amounts, so you know,
Speaker 2: they're changing all the time. We've got connective tissue that's
Speaker 2: more flexible and stretching. We've got an immune system, that's
Speaker 2: much more adaptable, so we have to grow a foreign
Speaker 2: body inside that's fifty percent foreign DNA, you know, when
Speaker 2: we're pregnant, and you know, under our nervous system is
Speaker 2: also more reactive, probably because of all those centuries of oppression,
Speaker 2: or just because you know, we are the smaller, smaller sex,
Speaker 2: so we just are different. And you know, it was
Speaker 2: it's been wonderful to have a framework to understand fifty
Speaker 2: one percent of the population because I think for a
Speaker 2: lot of us, especially female GPS, we're trying to treat
Speaker 2: people that we haven't really been trained to treat. So
Speaker 2: it's been liberating. I would say, I love my job
Speaker 2: more than I could ever have predicted at you know,
Speaker 2: the grand dated fifty one. I've been doing medicine. I've
Speaker 2: been in medicine for thirty three years, you know, for
Speaker 2: you know, twenty seven.
Speaker 1: So well, we certainly are very appreciative of you being
Speaker 1: a real trial blazer and getting perimenopause and women's healthcare
Speaker 1: up in life, even at the opera house, which is wonderful.
Speaker 1: Let's start with a little bit of a one oho
Speaker 1: one for those of us that are you know, in
Speaker 1: this stage, and I think we're all getting a lot
Speaker 1: more educated, which is fantastic. But starting with the main stages,
Speaker 1: can you please explain the main stages of perry, menopause
Speaker 1: and postmenopause and kind of so we can help to really,
Speaker 1: as we're listening to you today, understand what stage that
Speaker 1: we might be in.
Speaker 2: So if we start right at the beginning, when we're born,
Speaker 2: we're women, and those seven female at birth are born
Speaker 2: with a finite number of eggs or more correctly termed follicles,
Speaker 2: and we've actually already lost millions before we're even born.
Speaker 2: And I didn't even appreciate that. You start to lose
Speaker 2: those follicles. You know from the outset, you're losing them
Speaker 2: before you go through puberty, so you've already lost the
Speaker 2: majority of them by the time you hit forty and
Speaker 2: because there's a finite number, you keep losing them month
Speaker 2: and month, whether you're on the pill, whether you're pregnant,
Speaker 2: you just lose them. So on average, by the time
Speaker 2: a woman hits fifty one in Australia, she's lost almost
Speaker 2: all of her eggs, has maybe left with maybe around
Speaker 2: one thousand. And because you're born with these eggs, they're
Speaker 2: the ones that you've had from birth. They're also the
Speaker 2: quality has gone down, so but the quality and the
Speaker 2: quantity is reduced so much that you're probably not going
Speaker 2: to ovulate anymore on average at fifty one. Some women
Speaker 2: do go later, and for other women it's earlier. And
Speaker 2: at the point that you stop ovulating, you now going
Speaker 2: into what we call menopause. Now, natural menopause is defined
Speaker 2: as twelve months after your last menstrual period. That's natural menopause. Now,
Speaker 2: who chose twelve months?
Speaker 1: Who knows men in cuts in a boardroom some way?
Speaker 2: And I think it's because you don't ever know until
Speaker 2: it's retrospective, you know, until you're looking back when did
Speaker 2: I stop? But probably it's more accurate to say that
Speaker 2: menopause is the end of those periods. To be fair
Speaker 2: for women who have their overrea is removed, that surgical menopause,
Speaker 2: and that is you're in menopause immediately so they don't
Speaker 2: have to wait for another twelve months. And then women
Speaker 2: whose overies are you know, to stop working by medications
Speaker 2: or radiotherapy, that's medical menopause. And again that would be
Speaker 2: considered immediately at that point, and that's that's sometimes temporary
Speaker 2: and the average age of menopause is fifty one, and
Speaker 2: perimenopause is the time running up to that natural menopause.
Speaker 2: It may or may not happen. If you have a
Speaker 2: surgical menopause, you may have been ovulating perfectly and then
Speaker 2: your overraies a removed and that and that is that's
Speaker 2: why surgical menopause for younger women is often a huge
Speaker 2: shock to the system and you know, can really be
Speaker 2: much more devastating in terms of symptoms because there's been
Speaker 2: no gradual shift in those hormones. So perimenopause for some
Speaker 2: woman might only last a few weeks or a few months,
Speaker 2: and for others might last years. And that is really
Speaker 2: best described as a time of stuttering. Overrais so your
Speaker 2: ovaries are desperately trying to push out another egg. The
Speaker 2: brain is recognizing that the hormone levels are starting to change,
Speaker 2: because these eggs are what produced your estrogen and your progesterone.
Speaker 2: Estrogen is made from testosterone in the over I should add,
Speaker 2: and as the brain senses those falling hormone levels, its
Speaker 2: sense stronger and stronger signals down to the ovaries going
Speaker 2: come on, lads or lasses just crack out one more
Speaker 2: egg there. Sometimes you'll get these massive surges of estrogen,
Speaker 2: and other months you'll not get anything at all, And
Speaker 2: progesterone is often checking out a lot earlier, because progesterone
Speaker 2: is only made once you actually obviate, whereas the estrogen
Speaker 2: is made by those follicles, those immature eggs maturing. So
Speaker 2: you're tending to be producing estrogen most months, but not
Speaker 2: necessarily progesterone. But the estrogen levels are very erratic, and
Speaker 2: our body, particularly our brain, really dislikes instability. You know,
Speaker 2: it has got used to menstrual cycle. Although for you know,
Speaker 2: most women, you know that you feel a bit different
Speaker 2: for that week before your period or a few days,
Speaker 2: and it might be very subtile. But ninety percent of
Speaker 2: women get PMT pre tension or pre menstal symptoms, and
Speaker 2: ten percent of them get pre menstual dysphoric disorder, which
Speaker 2: is severe PMD, which affects your ability to function. But perimenopause,
Speaker 2: you know, then that just ramps up and eighty percent
Speaker 2: of women will get psychological symptoms, so that perimenopause pay
Speaker 2: phase very different for different people. Average age of menopause
Speaker 2: fifty one, but five percent of women will be in
Speaker 2: menopause by forty one, and a thousand women will be
Speaker 2: in menopause by thirty perhaps more because we're really bad
Speaker 2: at picking it up. I've looked after women who've been
Speaker 2: in menopause since their teenage years and that's you know,
Speaker 2: so it's not that, but it's often not. It's often
Speaker 2: named other things, I think, just to make it more,
Speaker 2: you know, less stigmatized. But the reality is this is,
Speaker 2: you know, a very very very premature in menopause and
Speaker 2: then some women, you know, we won't go into menopause
Speaker 2: until the's sixty after the day of menopause, your postmenopausal
Speaker 2: until you die. So that's the that's the next phase.
Speaker 1: So I guess the confusing thing for a lot of
Speaker 1: us is this perimenopause period, because like you say, it
Speaker 1: can last weeks, months versus a decade, almost stor even longer.
Speaker 1: Is there any telltale signs to say that I'm in
Speaker 1: perimenopause or I'm in early stage perimenopause or late stage perimenopause?
Speaker 1: As a doctor, is there something that is there a
Speaker 1: test that you do or is it more symptom based?
Speaker 1: How do you help a woman navigate where she is
Speaker 1: on that journey.
Speaker 2: So unfortunately, we don't have blood tests that can diagnose
Speaker 2: perimenopause because you've got these really erratic levels of hormones
Speaker 2: that can be different day to day, on different months
Speaker 2: to months. So you might find some months, you know,
Speaker 2: if you check on it, if you manage to choose
Speaker 2: the right day to check a progesterone on, it might
Speaker 2: be low. But the next month, you know, you might
Speaker 2: have ovulated a different day, so you're not going to
Speaker 2: catch that progesterone. So maybe in the future, with continuous
Speaker 2: hormone monitoring, we might be able to diagnose a bit better.
Speaker 1: I've used that before. I've used a product called Mirror
Speaker 1: before and trapped. But again I did three months and
Speaker 1: they were all quite different. But it was interesting to
Speaker 1: see my hormone in real time. It's a lot of work.
Speaker 1: You've got to pay on a stick every morning, so
Speaker 1: you've got to really be interested in it. Didn't tell
Speaker 1: me that much more than what, say, symptoms, So do
Speaker 1: you mostly go off symptoms, for example, the symptoms I
Speaker 1: was talking about at the top of my episode.
Speaker 2: Yeah, absolutely, So this is really what we call a
Speaker 2: clinical diagnosis, and there's lots of things in medicine that
Speaker 2: we don't have good biomarkers for, you know, things like
Speaker 2: migraine doesn't have a blood test. It's very much you know,
Speaker 2: based on what somebody tells us and what we're always
Speaker 2: trying to do as GPS is you know, because which
Speaker 2: I haven't said, you know, every single cell in the
Speaker 2: human body's got estrogen, progesterone and test austrien receptors. Then
Speaker 2: when those hormone levels do change, you can have any
Speaker 2: symptom at all. So there is an infinite number of
Speaker 2: symptoms that can be attributed to perimenopause. But it's really
Speaker 2: important that we don't assume that everything is perimenopausal because
Speaker 2: we don't want to miss you know, more serious things.
Speaker 1: Yeah, night sweats can be linked to serious conditions like cancer.
Speaker 2: That's why you know, don't even if you you know,
Speaker 2: you don't want to have a hormone discussion. If you
Speaker 2: are having symptoms, it is important to go and have
Speaker 2: a chat to you know, your GP to workout is
Speaker 2: this does this seem like perimenopause? Is there something else?
Speaker 2: And also when these estrogen progester and testosterone levels are
Speaker 2: sort of falling and testosterone falls from your late twenties,
Speaker 2: it's not falling off. Particularly at perimenopause, you can start
Speaker 2: to see increasing incidences of other conditions, particularly like autoimmune disease,
Speaker 2: especially thyroid dysfunction. You know, women with heavy periods often
Speaker 2: get iron deficiencies. So you've got all these So you
Speaker 2: may have iron deficiency, you may have thyroid disease, and
Speaker 2: your perimenopausal and you may also have something serious as well.
Speaker 1: It's like the perfect storm, all of this kind of
Speaker 1: urging or car crash.
Speaker 2: Storm, car crash, roller coaster, you know, choose your wild
Speaker 2: ride terminology. So yeah, So looking at symptoms, and we
Speaker 2: would often do a symptoms score. We've got a symptom
Speaker 2: checker on healthy hormones, but there's lots of bonds and
Speaker 2: different platforms, so sort of getting a picture. If you've
Speaker 2: got twenty five symptoms of you know, palpitations and heavy
Speaker 2: periods and irritability, I think that irritation with your partner's
Speaker 2: breathing or chain I think that's the closest to diagnostic sign.
Speaker 1: Yes, I would agree with you because I don't remember
Speaker 1: that apple chewing being nearly as loud or annoying when
Speaker 1: we were first together and you know, ten years ago,
Speaker 1: but it's like, yeah, he's in trouble, man.
Speaker 2: I think if that's new, that's a good sign. So
Speaker 2: people who are in neuro divergent do experience that at
Speaker 2: different times in life. But if that's the first time
Speaker 2: you've experienced that, I think, and this might be perimenopause.
Speaker 2: But the classic symptoms, sorry I should say so, the
Speaker 2: things that we would always classically have said are diagnostic
Speaker 2: of perimenopause would be what's called vasomotor symptoms, which is
Speaker 2: as a result of your brain perceiving changes in temperature
Speaker 2: very you know, as very dramatic changes, so they drive
Speaker 2: the flushing and the sweating or perhaps some people get
Speaker 2: very cold, so that would be vasimotor or hot flushes,
Speaker 2: night sweats, chills would be more classical perimenopause symptoms and
Speaker 2: menopause symptoms, so they are quite a strong marker and
Speaker 2: change in your the frequency of your period, so your
Speaker 2: parents becoming more spaced out, closer together, heavier, lighter. But
Speaker 2: as you've said, you know, women can have regular periods
Speaker 2: and they can be getting psychological symptoms, or they can
Speaker 2: be getting politicians or that they can be getting vaginal
Speaker 2: dryness or sore joints.
Speaker 1: And tell me when these symptoms are non specific symptoms,
Speaker 1: you know, like I'm getting a headache or I'm feeling
Speaker 1: rage or whatever. But then you're noticing because you're tracking
Speaker 1: your period that oh yeah, that every month they're occurring
Speaker 1: in that week before my period. Is that as a
Speaker 1: as a doctor, that's something that you take note of
Speaker 1: and go, well, that very much sounds like it's sicklic cool,
Speaker 1: and its symptoms are coming at this similar time. That's
Speaker 1: a clue.
Speaker 2: Absolutely, So that's definitely a clue that being hormonal. There's
Speaker 2: a bit of discussion in the hormone space as to
Speaker 2: whether we are diagnosing perimenopause too soon and it's actually
Speaker 2: severe PMT or premnstrual dysphoric disorder. So there's a bit
Speaker 2: of argument that this is actually PMDD not perimenopause. When
Speaker 2: it's those real pre menstrual like you're so you're fine
Speaker 2: for two weeks but awful for two weeks, that that
Speaker 2: maybe could be more class hiders PMDD. But the reality
Speaker 2: is if you really treat I find the most effective
Speaker 2: treatment for PMDD is using hormones in some way, and
Speaker 2: that's the same as what you're often doing for perimenopause,
Speaker 2: whether it's a combination of our contraceptive pill, contraceptive valu
Speaker 2: D plus or minus, or just body identical hormones, you know,
Speaker 2: and some woman in either perimenopause or PMDD also need
Speaker 2: an antidepressant as well, and then obviously all your lifestyle stuff.
Speaker 2: So I feel in a way it doesn't really matter
Speaker 2: because different people in those groups will respond to different
Speaker 2: things independent of what we've called them, whether we call
Speaker 2: them PMDD or perimenopause.
Speaker 1: In your clinic, and just anecdotally, I know the research
Speaker 1: might say one thing, but I'm curious for your experience
Speaker 1: in your clinic, what are the most common symptoms that
Speaker 1: are really you know, driving women to come and see you,
Speaker 1: that you know are perimenopause related, and then that you
Speaker 1: see improve really well once you do put them on
Speaker 1: some kind of horn replacement program.
Speaker 2: So definitely, mood symptoms would be at the top, So anxiety,
Speaker 2: not being able to sleep, irritability, wanting to kill everybody
Speaker 2: in your family.
Speaker 1: I'm not alone, You're definitely all alone.
Speaker 2: So definitely, cycle, I would say psychological symptoms are at
Speaker 2: the top.
Speaker 1: Are the biggest ones.
Speaker 2: That's so interesting I think overall the research would sugest
Speaker 2: they are the most common. They're certainly up there at
Speaker 2: the top, and they're what impact women at work, at home,
Speaker 2: you know, in relationships. Next one would be heavy periods
Speaker 2: are really common, I think, are common cause not necessarily
Speaker 2: up high in terms of frequency, in terms of like,
Speaker 2: like some people, the seventy sixty seventy percent of women
Speaker 2: will get hot flushes, but maybe forty five, forty to
Speaker 2: fifty percent will get heavy periods. But a lot of
Speaker 2: women are not overly bothered by their hot flushes. Yeah,
Speaker 2: but their flooding periods are really debilitating. Yeah, because and
Speaker 2: partly because I'm making them aren't efficient, but because they're
Speaker 2: having to live in black clothes. And you know, for
Speaker 2: us in Sydney and Australia, where you.
Speaker 1: Know everyone wears white linen.
Speaker 2: Or go to the beach or go swimming. Yeah, it's
Speaker 2: it's you know, and there's so many women leven black
Speaker 2: for so long. So I would say psychological. And probably
Speaker 2: the second one would be would be struggling with heavy
Speaker 2: periods or a period irregularity would be And then joint
Speaker 2: pen and stiffness and injuries, you know, everything from planta
Speaker 2: fasciadas to you know, penful shoulders, to knee.
Speaker 1: Pen yeah, frozen shoulder yeah.
Speaker 2: And then getting wet around your metal?
Speaker 1: Why is it so hard to get real answers about
Speaker 1: your health? If you've been told that everything looks fine,
Speaker 1: but you know that something is off, well, you're not
Speaker 1: imagining it. That's why I created Vitality three point sixty
Speaker 1: to help you better understand what's going on inside your
Speaker 1: body so that you can take the targeted action needed.
Speaker 1: With a functional health approach plus testing, we go beyond
Speaker 1: the guesswork to uncover the root causes of your symptoms.
Speaker 1: I've teamed up with Doctasmina, an incredible integrative GP, and
Speaker 1: together we will help you decode your body's signals and
Speaker 1: answer questions like why am I always exhausted? What's really
Speaker 1: causing my stubborn weight? Am I inflamed? Insulin resistant? Or
Speaker 1: maybe missing key nutrients? Because when you understand your body better,
Speaker 1: you can transform your health. Visit v three sixty dot
Speaker 1: health or check out the show notes for more and
Speaker 1: of those symptoms. When you do have patients that do
Speaker 1: go on HRT, are there a collection of symptoms that
Speaker 1: you're like I'm usually pretty bang on confident that the
Speaker 1: hormones are really going to help with this, and some
Speaker 1: that you may not be so confident with. Would you
Speaker 1: say that there are some that you're like, I really
Speaker 1: feel confident this is going to help this patient.
Speaker 2: Yeah, so for the uncomplicated woman, and I don't actually
Speaker 2: treat very many of those anymore. For some reason, my
Speaker 2: population or hypermobile neurodivergent, they have a touch of them
Speaker 2: cuss which is a sensitive immune system. But for the
Speaker 2: average whoever you are, Yes, mood symptoms respond really well,
Speaker 2: and even in my bend, in your divergent population. So
Speaker 2: mood symptoms respond well. So the anxiety, the insomnia, the irritability,
Speaker 2: and really response beautifully to hormones.
Speaker 1: Oh that's so encouraging.
Speaker 2: Really, confidence comes back, word finding comes back, you know,
Speaker 2: so you're able to speak at work, have an argument,
Speaker 2: which is important whether it work or not. And being
Speaker 2: able to sleep. I think the gift of giving somebody
Speaker 2: their sleep back. And that's something you see in women,
Speaker 2: you know, right up to quite an old age. When
Speaker 2: you start hormones, they're like, wow, I haven't slept like
Speaker 2: that for thirty years. So that periods can be a
Speaker 2: bit more touch and go with body identical hormones that
Speaker 2: can take a lot more work and often heavy periods.
Speaker 2: Do you need other interventions? Wait again, around the middle
Speaker 2: tends to need more interventions. Joint PN responds really well
Speaker 2: to estrogen in general, So that's a nice one on energy.
Speaker 1: And so for someone like me, for example, who has
Speaker 1: some months where no symptoms and then some months where
Speaker 1: I do have symptoms and you know they're uncomfortable, but
Speaker 1: I'm surviving, and I know we're obviously not an adoptive
Speaker 1: patient consult here, So this is all just general advice
Speaker 1: and oh my wonderful listeners know that disclaimer, but just
Speaker 1: curious to know how do you help a woman navigate
Speaker 1: when is the right time to go on your HRT.
Speaker 2: I think it is really so personal and I think
Speaker 2: always well, depending where somebody is, if somebody is really struggling,
Speaker 2: then they usually want to use a medication on which
Speaker 2: hormones would be usually first choice if it's a hormone
Speaker 2: related condition. But for women here are maybe like yeah,
Speaker 2: not sure. Then really looking at your obviously optimized your
Speaker 2: lifestyle because healthy nutrition, getting enough exercise, getting enough daylight,
Speaker 2: getting enough sleep, you know, obviously if you can't sleep,
Speaker 2: then giving yourself all the sleep availability in the world
Speaker 2: isn't going to help. But a lot of women, especially
Speaker 2: in their late thirties and forties, are not giving themselves
Speaker 2: enough opportunity for sleep. We live, and you know, we're
Speaker 2: often even though we're in Australia, we're living inside under
Speaker 2: the led lights. We're not getting enough morning daylight. We're
Speaker 2: caffeinating ourselves up, we don't drink enough fluids, so we're
Speaker 2: often really depleted by the afternoon. Most a lot of
Speaker 2: us are working, you know, and managing a family and
Speaker 2: potentially caring for older parents, so there's a lot of
Speaker 2: juggling going on. So I think really important to just
Speaker 2: maybe take a moment and look and see where you
Speaker 2: can prioritize your own health every day. And it doesn't
Speaker 2: have to be a lot, you know, it can be
Speaker 2: just taking a few minutes outside, you know, getting a
Speaker 2: bit of morning daylight, having a you know, warm water
Speaker 2: or a coffee if that's what you want, and just
Speaker 2: really taking a moment and go like things are not right.
Speaker 2: I need to really spend this bit of time putting
Speaker 2: myself first, because we are the hub beautually of families,
Speaker 2: often of workplace, so investing in you will have a
Speaker 2: reple effect, so that selfishness is actually very selfless.
Speaker 1: One hundred percent agree with you, and I think it
Speaker 1: really is an age when that is no longer an option,
Speaker 1: it actually becomes a necessity for us. And it's funny
Speaker 1: hearing you talking about the sleep so interesting because when
Speaker 1: I was really tracking using mirror and doing some little
Speaker 1: self experiments outside of HRT, just with lifestyle sleep and
Speaker 1: really prioritizing sleep made the biggest difference to my symptoms,
Speaker 1: which is no surprise considering how much hormonal recalibration goes
Speaker 1: on at night. And I had this wonderful sleep expert,
Speaker 1: Dr Lisa Moltman on my podcast and she used this
Speaker 1: great analogy which I refer to quite a lot, and
Speaker 1: she called it can't sleep versus won't sleep, And she said,
Speaker 1: you know, there's a group of you know, poor people
Speaker 1: out there who can't sleep for whatever reason. You know,
Speaker 1: they can't get to sleep or they wake up at
Speaker 1: three am. And that's kind of usually factors outside of
Speaker 1: our control. But then the want sleep group, and that
Speaker 1: was me, who you know, stay up to watch that
Speaker 1: extra episode or just want that may time on the
Speaker 1: catch or doom scroll or you know, burn the candle
Speaker 1: at both ends, and she's like, if you're in the
Speaker 1: won't sleep category, you know what can you do? So
Speaker 1: it is something that I have found really will on
Speaker 1: the months that I prioritize sleep, I find I have
Speaker 1: less symptoms, which it's encouraging to know that there are
Speaker 1: some levers that can make a difference.
Speaker 2: Absolutely, And I do wonder whether because our environments are
Speaker 2: so stressed, well, both the environments that we put on
Speaker 2: ourselves but also the environment we live in have maybe
Speaker 2: made pain menopause that a bit tougher because all of
Speaker 2: those sort of biological things are so protective. So for instance,
Speaker 2: if you do give yourself more safe, you probably can
Speaker 2: produce more hormones. You might obulate a bit more. When
Speaker 2: your body's under stress, you're not going to be able
Speaker 2: to push those we eggs that are still there. So really,
Speaker 2: if you can't, but equally, if you can't manage, it's
Speaker 2: not failure. And I actually think some women do go
Speaker 2: on hormones I see when they're a bit younger and
Speaker 2: sometimes come off to them again because they actually start
Speaker 2: to feel okay. It's almost like it gives them a
Speaker 2: bit of a reset breathing room. Yeah. Yeah, so sometimes
Speaker 2: that can even happen, and that's fine.
Speaker 1: So you spoke about the average woman, wherever she is,
Speaker 1: whoever you are. What is a really stock, standard, average
Speaker 1: hormone replacement therapy, you know, protocol that you would put
Speaker 1: someone on if there is such a thing.
Speaker 2: Yeah, I mean, is there is kind of their cookie
Speaker 2: cutor what most people get offered. And it's always looking
Speaker 2: at somebody's past medical history and checking that there's no
Speaker 2: serious contra indications, and for the majority of woman there
Speaker 2: really isn't you know, an active breast cancer or a
Speaker 2: history of a hormone receptor positive breast cancer. Takes a
Speaker 2: lot more conversation, but it's still not an absolute no.
Speaker 2: But because we now use estrogen through the skin for
Speaker 2: the majority of woman, that's actually taken out a lot
Speaker 2: of contra indications, so it doesn't increase the risk of
Speaker 2: cloth or stroke or heart attack. So it's really really
Speaker 2: safe for most women. And that comes as a gel
Speaker 2: or a patch. In Australia we don't have the spray
Speaker 2: and that's how you get your estrogen, and so it
Speaker 2: really depends which of those products you're using. I tend
Speaker 2: to start low, so because you never know how women
Speaker 2: are going to absorb it through the skin. There's huge variation.
Speaker 2: You know, you might need one pump of gel and
Speaker 2: I might be able to I might have to sleep
Speaker 2: in the stuff and I still wouldn't absorb it. So
Speaker 2: I tend to start low and see how people go.
Speaker 2: So the estrogen tends to do most of the heavy
Speaker 2: lifting for the symptoms. And then the second hormone that
Speaker 2: we add on is progest a roone and that we
Speaker 2: try to use as body identical progesterone. Progestogens are synthetic.
Speaker 2: That's what's in the contraceptive pills or the IUD, and
Speaker 2: that comes as a little capsule, So you do take
Speaker 2: that usually by mouth, and you take that before you
Speaker 2: go to bed, and that keeps the womb from getting
Speaker 2: too thick from the estrogen. So if you just give
Speaker 2: estrogen on its own to a woman who has a uterus,
Speaker 2: then the women and it will get too thick. So
Speaker 2: you take the progesterone at night before you go to bed.
Speaker 2: If you're in perimenopause, sometimes we give it just for
Speaker 2: half of the month for two capsules. If you're postmenopausal.
Speaker 2: We give it one capsule every night, but we do
Speaker 2: shut chop and change between those for other reasons. So
Speaker 2: progesterone is the second hormone. It doesn't just protect the uterus,
Speaker 2: It actually helps a lot of women's sleep. It also
Speaker 2: reduces anxiety. There's a little bit of evidence for it
Speaker 2: in bone health, immune health, and also reducing cravenks, which
Speaker 2: is good for all the people who've started to self
Speaker 2: medicate with alcohol. And then the third hormone is testosterone,
Speaker 2: which isn't a particularly a hormone that falls off at menopause.
Speaker 2: It's often already low because it's been fallen from your
Speaker 2: late twenties. And in Australia it is only licensed for
Speaker 2: postmenopausal women with low libido. But estrogen and progestone are
Speaker 2: also only licensed for postmenopausal women. So these are all
Speaker 2: off license in perimenopause.
Speaker 1: That's great, Are you serious there? Off label? I knew
Speaker 1: testosterone was, but I did not.
Speaker 2: We have no license drugs to treat peri menopause. Says
Speaker 2: it all, does it not?
Speaker 1: That is mind blowing.
Speaker 2: Yeah, so they're all licensed for postmenopause. Yeah, So when
Speaker 2: people sort of push back about prescribing testosterone to a
Speaker 2: perineanopus a woman. I'm like, well, you're prescribing the estrogen
Speaker 2: and progesterone. It's off license as well, So test astrone
Speaker 2: is licensed for a hyproactive sexual desire disorder, which is
Speaker 2: a long way of said distressing low libido. And it
Speaker 2: works for some woman, works brilliantly for some, does nothing
Speaker 2: for others, but as other women do. Quite a few
Speaker 2: women will say it helps their brain function, helps their energy,
Speaker 2: and some people do for help find it helps their mood.
Speaker 2: It's really variable. It takes a bit longer to work.
Speaker 1: So do you tend to start them on estrogen and
Speaker 1: progesterone on their own first, and then if you need
Speaker 1: to later on brion testosterone so you can get a
Speaker 1: sense of yeah, how the other two are working.
Speaker 2: Yeah, okay, And I have got somebody who's very sensitive,
Speaker 2: you know, Who've got somebody that is who's got a
Speaker 2: history of medication sensitivity, a history of severe PMDD or
Speaker 2: perinatal depression, or sensitivity to the contraceptive pill. I tend
Speaker 2: to start estrogen or progesterone, depends which symptoms are worth
Speaker 2: one at a time, you know, starting them for four weeks,
Speaker 2: so you know if because there are some people who
Speaker 2: will act to body identical hormones and that's not that uncommon,
Speaker 2: so you want to know. So those are your hormones
Speaker 2: that are going to go into your bloodstreain, testostrum, sorry
Speaker 2: as a cream as well, and they'll go around and
Speaker 2: do all the big work. But you can't forget because
Speaker 2: obviously I'm passionate about saving fannies. And irrespective of what
Speaker 2: age you are, whether you're twenty or you're ninety nine,
Speaker 2: if you've got vaginal dryness, urgency frequency getting up at
Speaker 2: night for away your recurrent urn attractive fections, we need
Speaker 2: to think about vaginal hormones and they are pretty much
Speaker 2: safe for everybody, and they reduce the risk of the
Speaker 2: recurrent your attractive fections reduce the risk of women getting
Speaker 2: admitted to hospital, getting sepsis and dying. So they're the
Speaker 2: lowest time in freaking medicine, and we want to prescribe
Speaker 2: them to six percent of post menopozzle woman. But they
Speaker 2: can help women on the pill, They can help women
Speaker 2: who are breastfeeding. Women here on antidepressants, rocky tane drugs
Speaker 2: with skin you know, they are really the bomb.
Speaker 1: Would you prescribe vaginal estrogen at the same time as
Speaker 1: the patch or the gill.
Speaker 2: Yeah, absolutely, and then you might just because of natural attrition,
Speaker 2: you get you know, we're busy, you'd forget to keep
Speaker 2: doing it and then you might be fine. So you know,
Speaker 2: probably about twenty percent of women who are on what
Speaker 2: we call systemic h RT MHT so three the JIT
Speaker 2: skin as a tablet or whatever, will still need to
Speaker 2: use vaginal hormones to get enough into that vaginal involvle tissue.
Speaker 2: But it's just so important that people realize that that
Speaker 2: vaginas are not just for sex. They're protecting your bladder
Speaker 2: and that is so important for health, you know, because
Speaker 2: the current UTIs I don't want to be sitting in
Speaker 2: a nursing home smelling away because I had a year
Speaker 2: and retrapped infection, fell over and broke my hip and
Speaker 2: you know, couldn't live at home anymore. So vaginal hormones
Speaker 2: are a total win and you can start them at
Speaker 2: any age. So if you've got a mum or granny doctor,
Speaker 2: because about ninety percent of women over seventy have symptoms.
Speaker 1: Yeah, I know in speaking and working with some all
Speaker 1: the ladies, how much recurrent UTIs are an issue and
Speaker 1: no one likes to talk about them because who wants
Speaker 1: to talk about having a ut?
Speaker 2: Well, doctor should, but we don't. We seem to have
Speaker 2: a week.
Speaker 1: Let's talk about mental health for a moment, because you
Speaker 1: know you mentioned earlier how impactful hit can be. For
Speaker 1: that now, research shows that women in perimenopause have a
Speaker 1: forty percent higher risk of developing mood orders such as
Speaker 1: depression than any other life stage. Like, that's almost half
Speaker 1: forty percent than any other life stage, you know. Researchers
Speaker 1: also believe that this makes perimenopause an extremely vulnerable time
Speaker 1: for women for mental health, for emotional resilience, and also
Speaker 1: for overall well being. These falling hormone levels, they seem
Speaker 1: to coincide with the highest statistical window for female suicide,
Speaker 1: which I was shocked to find out that the highest
Speaker 1: window for suicide in a woman's lifespan is forty five
Speaker 1: to forty nine years old. Is it true, then, with
Speaker 1: all of that in mind, that SSRIs are still the
Speaker 1: first line tree, even though research suggests that they are
Speaker 1: largely ineffective when the mental health disorder is triggered by
Speaker 1: low hormones.
Speaker 2: Yeah, that's all very true. Sone, no, no, I mean
Speaker 2: so much of when you sort of start to dive
Speaker 2: and keep going into this, I mean each thing is
Speaker 2: I mean, everything you read is just mind blowing. So estrogen, progesterone, testosterone,
Speaker 2: as I say, every cell has got receptors for them,
Speaker 2: but they're probably their most potent in the brain. So
Speaker 2: they work themselves as neurotransmitters. And they also influence your serotonin,
Speaker 2: your dopamine, your gabba, your acetal cooling, your histamine, your glutamate.
Speaker 2: So they affect how you feel, how you think, how
Speaker 2: you behave, even how you learn. So they're so potent,
Speaker 2: and women know this. You know that you're sharper and
Speaker 2: your different moods at different times of the month. You
Speaker 2: know when you're having a regular cycle, so of course
Speaker 2: it's going to go away a bit upside down in primenopause.
Speaker 2: They also affect the blood flow of your brain, how
Speaker 2: your blood flows around your brain, the effect the immune
Speaker 2: function of your brain. So there's all these things going on,
Speaker 2: and yet because we weren't trained, we will still when
Speaker 2: we see the average doctor will see a woman who
Speaker 2: comes in who's anxious who's not sleeping. We will talk
Speaker 2: about the stress and the social stuff that's happening. We're
Speaker 2: good at that, but we're not thinking hormones. We're still
Speaker 2: going this is an anxiety disorder, this is a depressive disorder,
Speaker 2: And twenty five percent of women in midlife are on
Speaker 2: an SSRI. And you're right. Big meta analysis suggests that
Speaker 2: overall antidepressants are not that effective even at trading major
Speaker 2: anxiety depression. They do have they absolutely have a role,
Speaker 2: but not as much of a role as a hormone
Speaker 2: does in trading a hormonal issue. And the worst thing
Speaker 2: I think is not just that they're not the right treatment.
Speaker 2: They often can make that loss of joy failing worse.
Speaker 2: So you come in, you're feeling rubbish, You get given
Speaker 2: a drug and then you feel a bit worse, and
Speaker 2: then you might get tried on a second or a
Speaker 2: third antidepressant, and each time you feel a bit worse,
Speaker 2: but you also don't get better. So now you're hopeless.
Speaker 2: And I think all the those things we have no data,
Speaker 2: but I based on sort of how humans behave. You're
Speaker 2: already feel rubbish and each time the treatment fails, So
Speaker 2: you can just see how that conspiral and women. There
Speaker 2: is a real difference when women have this primen apostal depression.
Speaker 2: They are different. They're often still very well dressed, they're
Speaker 2: often masking really well. And I think it definitely there's
Speaker 2: an overlap with all of the undiagnosed neurodiversions in women,
Speaker 2: because you know, we've been crap at picking that up
Speaker 2: as well, and that really drives that burnout in the forties.
Speaker 2: But I think it's like that's we wrote the first
Speaker 2: guidance for primen apostal depression for GPS in Australia got
Speaker 2: published this year, and you know, even then, they're still pushback,
Speaker 2: people saying perimenopostal depression isn't a thing, you know, so
Speaker 2: and that's from the establishment. Yeah, it's crazy. And I'm like,
Speaker 2: come in, sit in my surgery and see these poor
Speaker 2: women and then see them come back two to three
Speaker 2: months later going you know what, I feel a lot better, Yes,
Speaker 2: And I'm starting to dad a bit better and I'm
Speaker 2: going to the gym and so, you know, it's just
Speaker 2: there isn't anything that you see that transformation with me
Speaker 2: certainly don't see it on an anti present.
Speaker 1: That is just so remarkable and I almost fell off
Speaker 1: my chair when I saw that actually the SSRIs can
Speaker 1: be treatment resistant when the low mood is caused by
Speaker 1: low hormones. I had doctor Luise Newsome on my podcast
Speaker 1: a little while ago who echoed the same sentiment as you,
Speaker 1: and just the sheer frustration of it. I will ask you,
Speaker 1: though HRT doesn't work, and I say that in inverted
Speaker 1: commas for everyone, what would you say to ladies who
Speaker 1: are like, oh, I tried it and it didn't work.
Speaker 1: It didn't do anything for me. Is there a dosage
Speaker 1: conversation to be had here or a timing thing stage
Speaker 1: of perimenopause.
Speaker 2: Yeah, so it's absolutely not for everybody. But I think
Speaker 2: that a lot of the people who've said who say
Speaker 2: it didn't work, probably weren't absorbing it. So I am
Speaker 2: quite tenacious and I work. We work and try and
Speaker 2: find the right dose, and for ninety nine percent of
Speaker 2: my patients we find a dose that actually does make
Speaker 2: them feel better, and they do so. And I think
Speaker 2: a big part of that is the patch gel thing,
Speaker 2: where you know, there's huge variation how well women absorb
Speaker 2: it through the skin. The second group of people who
Speaker 2: there's also a group of women and they're that's much
Speaker 2: smaller group of women who react to hormones, and I
Speaker 2: think they're very much in this hypermobile and you're divergent
Speaker 2: overactive immune system because fluctuating, particularly the fluctiating hormones can
Speaker 2: really activate the immune system and cause you know, relations
Speaker 2: of hastorine, but load loads of other chemicals that sometimes
Speaker 2: that can be a bit more tricky. But even then
Speaker 2: for those women still managed, I've got I think about
Speaker 2: three patients who I've not managed to find.
Speaker 1: Works out of all of them.
Speaker 2: Out of all of them, well, look.
Speaker 1: Doctor Kerry, for those that are not lucky enough to
Speaker 1: live close enough to have you as the doctor, and
Speaker 1: I know your books are pretty close to being full anyway,
Speaker 1: closed close, Okay, shopp ish shit, guys, How can we
Speaker 1: go about finding a GP that we feel confident has
Speaker 1: had some extra training in women's health and that can
Speaker 1: hopefully give some of the sound guidance that you can give.
Speaker 2: Yeah, So this has been our passion project. So myself,
Speaker 2: I'm my co founder, doctor Emma Harvey, who's a GP
Speaker 2: up in Balina. She runs a national telehealth service called
Speaker 2: remy r Emi. But we set up Healthy Hormones together
Speaker 2: because we realized we've never been trained and we wanted
Speaker 2: to just create a group where we could share knowledge,
Speaker 2: and so it started off really very much as a
Speaker 2: community forum. We've now got about six thousand clinicians in
Speaker 2: there from all walks of life. You know, we've got
Speaker 2: about a nearly two thousand GPS, but we've got specialists,
Speaker 2: we've got Allied Health and a lot of women's health
Speaker 2: knowledge lives in clinicians' brains. Still it's not in you know, publications,
Speaker 2: not in books, not in guidelines. So we've got this
Speaker 2: wonderful mind high there. But we've also created a Menopause
Speaker 2: Essentials course and it's about nine of training on menopause
Speaker 2: and everybody that completes that then gets listed in our
Speaker 2: Menopause Informed Practitioner list. We've now got practitioners throughout Australia.
Speaker 2: So these are people they're not they're independent of Healthy Hormones,
Speaker 2: but they've done our course so they're there. So on
Speaker 2: the other half of Healthy Hormones is for the general public,
Speaker 2: so you can sign up as anybody can sign up
Speaker 2: and you can see the list of menopause informed doctors
Speaker 2: and nurse practitioners and psychologists and all of those people
Speaker 2: have spent an extra nine hours and there's nowhere else
Speaker 2: that you can find a list like that in Australia.
Speaker 2: It is the only menopause comprehensive menopause training.
Speaker 1: Course I've been on there. I highly recommend if for
Speaker 1: my beautiful listeners who we have got some clinicians, but
Speaker 1: predominantly everyday ladies jump on there and it's such a
Speaker 1: useful resource to be able to jump in and to
Speaker 1: search for the doctor or the allied health professional that
Speaker 1: you're looking for, and to know that they've had that
Speaker 1: extra training. So yeah, thank you for putting that together.
Speaker 1: It's so so helpful and useful.
Speaker 2: Yeah, it's not fair women are spending a fortune going
Speaker 2: from you know. I hear so many stories of people
Speaker 2: who've said, you know, I've seen three GPS and I've
Speaker 2: been to two specialists and this was the advice I got.
Speaker 2: And it's not fair because it's costly. So we really
Speaker 2: wanted to create a network that was good to work
Speaker 2: for the whole of Australia, you know. And that's also
Speaker 2: about people find in conditions that are right for them
Speaker 2: as well. But our public communities there, which also mentioned
Speaker 2: go and say, hey, I live in x y Z.
Speaker 2: Do you know anybody that's local that's good and that
Speaker 2: personal recommendation is so valuable. And then because we do
Speaker 2: the you know, the fortnightly webinars, you know we do,
Speaker 2: we interview sort of experts from all around the world
Speaker 2: from different things. You know, we're really covering a lot
Speaker 2: of really fascinating topics in women's.
Speaker 1: Health, so relevant for the age and stage that we're at.
Speaker 2: Two.
Speaker 1: Well, look, doctor Kerry, I could talk to you all day,
Speaker 1: but just to wrap up, I would love a parting
Speaker 1: piece of advice from you for my beautiful listeners who
Speaker 1: might be thinking about starting HRT but feeling a bit
Speaker 1: apprehensive or not sure about starting. What some padding woods
Speaker 1: be from you?
Speaker 2: I think lean into what your body's telling you. I
Speaker 2: think one of our most our greatest powers as females
Speaker 2: is that we have a great part of intuition. We
Speaker 2: know really what's going on. Get yourself informed. People like
Speaker 2: to learn from different resources. Healthy hormones obviously, I'm bass
Speaker 2: I think it's got it all there. We link out
Speaker 2: to lots of other experts as well, so get informed
Speaker 2: so that you can make a decision that's right for you,
Speaker 2: because everybody's health journey is going to be different, so
Speaker 2: don't be influenced by what your friend says or what
Speaker 2: your mum says. Just work out what's right for you,
Speaker 2: and you don't need to share what you're doing with
Speaker 2: everybody because everybody will have an opinion and everybody's journey
Speaker 2: is so individual, So just do what's right for you,
Speaker 2: and whether that's going natural, taking hormones, throwing it all
Speaker 2: at it, you know, just work out what's right for you,
Speaker 2: and whatever you decide today, you can change next week
Speaker 2: or next year, because.
Speaker 1: You can just stop taking the homemones if they don't
Speaker 1: agree with you. You just don't put stup jail tomorrow.
Speaker 1: Doctor Kerry Keshell, thank you so much for your time.
Speaker 2: Thank you so much for ralvoan it.
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