WEBVTT - Ep 135 Menopause is whatever you want it to be 0:00:00.240 --> 0:00:02.840 Hi, my name's Marika. Well, this is one of the 0:00:02.880 --> 0:00:06.400 strangest times in my life. In my late twenties to 0:00:06.519 --> 0:00:11.799 early forties, I was hyper productive, high achieving, goal oriented, 0:00:12.560 --> 0:00:14.560 and I was just able to get a lot done. 0:00:15.240 --> 0:00:20.200 I was able to be highly productive with little sleep. However, now, 0:00:20.239 --> 0:00:24.200 with brain fog and high levels of fatigue, some days 0:00:24.239 --> 0:00:28.080 it's difficult to complete a simple list of tasks. It's 0:00:28.120 --> 0:00:31.080 like living with my head in a cloud. Some days 0:00:31.120 --> 0:00:35.120 I'm so tired. The fatigue is really challenging and limits 0:00:35.120 --> 0:00:38.400 my ability to want to do things outside of my 0:00:38.640 --> 0:00:43.640 work and home responsibilities. I have also experienced a substantial 0:00:43.720 --> 0:00:47.360 weight gain of about fifty pounds, which no amount of 0:00:47.360 --> 0:00:52.080 physical activity or calorie restriction seems to address. And oh, 0:00:52.120 --> 0:00:56.080 my gosh, the heat. I used to get cold easily 0:00:56.680 --> 0:01:00.000 Now I long for those days. My first hot flow 0:01:00.560 --> 0:01:03.720 or flesh felt like a wave that started at my 0:01:03.800 --> 0:01:08.480 feet and slowly moved up my body and unfurled and 0:01:08.560 --> 0:01:12.520 unleashed its heat on me. It was wild and almost 0:01:12.640 --> 0:01:17.680 anxiety producing because it felt unlike anything I had experienced previously. 0:01:18.760 --> 0:01:22.360 Since then, I have had many more, but something I've 0:01:22.440 --> 0:01:26.959 really noticed is how hot I am most of the time. Interestingly, 0:01:27.600 --> 0:01:31.520 now I experience fewer hot flashes and instead just feel 0:01:31.560 --> 0:01:36.280 hot most of the time. I've also had really itchy 0:01:36.400 --> 0:01:40.039 in our ears, which I thought was just a strange 0:01:40.200 --> 0:01:43.920 issue I was having, but as I've read more, I 0:01:44.040 --> 0:01:46.920 found that it's a common symptom for women at my 0:01:47.000 --> 0:01:50.559 stage in life. And the darnedest thing is no matter 0:01:50.800 --> 0:01:54.000 the amount of scratching I do, which looks really pretty, 0:01:54.800 --> 0:01:59.880 but it persists what's going on. So men of PAD 0:02:00.240 --> 0:02:05.080 is defined as one year following one's last period. However, 0:02:05.320 --> 0:02:08.519 I had an dmitrial ablation in two thousand and seven 0:02:09.160 --> 0:02:12.320 and haven't had a period since then, so the monitoring 0:02:12.360 --> 0:02:15.840 aspect of where I am in the timeframe of menopause 0:02:15.960 --> 0:02:20.600 or perimenopause is based solely on my symptoms. I found 0:02:20.600 --> 0:02:24.400 it hard to find a practitioner who's truly knowledgeable about 0:02:24.600 --> 0:02:30.919 menopause and perimenopause. My OBGYN is not. My former general 0:02:31.000 --> 0:02:35.440 practitioner and integrative health professional was not, although she claimed 0:02:35.480 --> 0:02:39.040 to be. It took me years to find a North 0:02:39.080 --> 0:02:44.519 American Menopause Society or NAMS certified provider in my rural area, 0:02:45.400 --> 0:02:47.200 and in fact, it took me a long time to 0:02:47.240 --> 0:02:52.120 even find out about NAMS meeting my certified NAMS provider 0:02:52.240 --> 0:02:55.519 was a relief because all the scientific information I had 0:02:55.560 --> 0:02:59.640 read about prior to our meeting was reinforced during the meeting. 0:03:00.520 --> 0:03:03.720 This led to complicated discussions and a lot of reading 0:03:03.720 --> 0:03:08.360 about hormone replacement therapy or HRT for short. There are 0:03:08.400 --> 0:03:13.560 so much conflicting information out there. I'm an alternative medicine 0:03:13.600 --> 0:03:16.880 type of girl, and although I'm very pro vaccine, I've 0:03:16.919 --> 0:03:19.960 always prided myself on not taking a lot of meds 0:03:20.560 --> 0:03:25.040 or finding herbal remedies for many ailments. When I was 0:03:25.080 --> 0:03:29.000 in grad school in two thousand and one, the large 0:03:29.040 --> 0:03:32.720 research study called the Women's Health Initiative was grounded and 0:03:32.800 --> 0:03:37.480 halted all recommendations for HRT meds due to the cost 0:03:37.520 --> 0:03:42.240 of treatment outweighing the benefits. One of my statistic professors 0:03:42.360 --> 0:03:45.320 was in the research group for this trial and talk 0:03:45.440 --> 0:03:49.080 to us then about the problems with stopping the trials prematurely, 0:03:49.760 --> 0:03:53.920 including how the data were being misinterpreted, and little did 0:03:53.960 --> 0:03:58.320 I know how this would affect me later. It turns 0:03:58.320 --> 0:04:03.640 out the misinterpretations of the data led to misinformation and 0:04:03.840 --> 0:04:07.440 led me to being really scared to try HRT. As 0:04:07.440 --> 0:04:11.680 a result, I first chose bioidentical hormones, those that mimic 0:04:11.720 --> 0:04:15.360 the ones created by our bodies but derived from plants 0:04:15.480 --> 0:04:19.119 or in this case, sweet potatoes. When I was having 0:04:19.200 --> 0:04:23.880 little or inconsistent results, my provider gently shared the data 0:04:23.960 --> 0:04:28.960 and ideas about taking more traditional HRT. She mentioned that 0:04:29.000 --> 0:04:32.480 the traditional HRT, which has bought at a standard pharmacy, 0:04:33.040 --> 0:04:37.000 meets the standards for consistent dosing, is recommended by NAMS, 0:04:37.560 --> 0:04:41.080 and is effective when started prior to the cessation of symptoms. 0:04:42.680 --> 0:04:45.520 So now I'm six years in and while my symptoms 0:04:45.520 --> 0:04:49.400 are better across the board, they're still present. I look 0:04:49.480 --> 0:04:51.920 forward to the day when they are behind me totally. 0:04:53.000 --> 0:04:58.600 It's been so interesting to find how different people's experiences are. 0:04:58.920 --> 0:05:02.560 Some people have zero symptoms and don't know where they 0:05:02.560 --> 0:05:06.440 are if they've completed menopause or not, and others have 0:05:06.520 --> 0:05:10.040 more extreme symptoms than I do. I'm happy to have 0:05:10.120 --> 0:05:14.400 great physicians to follow, such as doctor Jen Gunter. She's 0:05:14.440 --> 0:05:16.680 an O B G y N who wrote the Menopause 0:05:16.880 --> 0:05:21.440 Manifesto and actively works to debunk myths about menopause as 0:05:21.440 --> 0:05:24.320 well as educate us about what's going on with our bodies. 0:06:09.320 --> 0:06:12.880 Thank you so much, Marika for sharing your story with us. 0:06:13.000 --> 0:06:14.600 We really appreciate it. 0:06:14.960 --> 0:06:18.760 Yeah, thank you. Hi. I'm Aaron Welsh and I'm Aaron 0:06:18.800 --> 0:06:19.880 Oman Updike. 0:06:19.839 --> 0:06:21.920 And this is this podcast will kill you. 0:06:22.279 --> 0:06:25.760 Welcome to the last episode of this season. 0:06:26.600 --> 0:06:28.719 Yeah, I hope that we've been I can't remember have 0:06:28.800 --> 0:06:32.200 we been saying that? Like we're wrapping up this episode. 0:06:32.000 --> 0:06:32.600 Of this season. 0:06:32.680 --> 0:06:41.800 Whoops, not even a little bit, so surprise, but we're 0:06:41.800 --> 0:06:45.880 making it an extra long, extra fun, extra fascinating one. 0:06:46.320 --> 0:06:49.320 Yeah, talking today about menopause. 0:06:50.200 --> 0:06:51.080 We say this a lot. 0:06:52.279 --> 0:06:55.800 This could have been a two parter, a three parter, yeah, 0:06:56.040 --> 0:06:57.200 a four part or a season. 0:06:57.880 --> 0:07:00.520 Maybe it should be maybe you do it. 0:07:01.160 --> 0:07:07.440 Yeah, but I had such a great time researching for 0:07:07.480 --> 0:07:08.200 this episode. 0:07:08.240 --> 0:07:09.600 I am super excited. 0:07:09.680 --> 0:07:12.160 I honestly, I think that I've probably annoyed so many 0:07:12.160 --> 0:07:14.960 people because I cannot stop talking about it. I've lost 0:07:15.040 --> 0:07:17.520 friendships because I will not shut up about menopause. 0:07:19.600 --> 0:07:27.560 You're probably not the first one. Arin, Oh, that's exciting. 0:07:27.600 --> 0:07:32.560 I'm really excited to hear your entire section. Like I 0:07:32.600 --> 0:07:34.640 feel like you have given me just enough of a 0:07:34.680 --> 0:07:39.080 glimpse of like the general topics that I'm like, oh. 0:07:38.760 --> 0:07:43.440 I can't wait. I hope I do it justice. 0:07:44.600 --> 0:07:48.040 But before we get to all of that, should. 0:07:47.840 --> 0:07:50.280 We is it? It's quarantine dime? 0:07:50.800 --> 0:07:53.360 Oh yeah, what are we drinking this week? 0:07:53.520 --> 0:07:57.720 We could be drinking nothing other than blood, sweat and beers. 0:08:00.920 --> 0:08:05.040 I love it, and I also I also love the 0:08:05.080 --> 0:08:09.680 recipe because it's more or less Mitchellata. It's something that 0:08:09.720 --> 0:08:12.760 we've done before, but we're spicing it up this time 0:08:12.880 --> 0:08:17.280 by adding cucumber and jalapano and limejuice. 0:08:17.360 --> 0:08:21.000 I don't know how like we know what it's going 0:08:21.080 --> 0:08:21.840 to be delicious. 0:08:22.040 --> 0:08:24.840 It is, it is, and we will post the full 0:08:24.920 --> 0:08:29.480 recipe for the quarantini and the non alcoholic placyburrita on 0:08:29.520 --> 0:08:32.160 our website This Podcast will Kill You dot Com, as. 0:08:32.000 --> 0:08:34.160 Well as on all of our social media channels. 0:08:35.440 --> 0:08:37.560 On our website This Podcast will Kill You dot Com, 0:08:37.600 --> 0:08:40.160 you can find so many things, like our bookshop dot 0:08:40.200 --> 0:08:42.640 org affiliate account. You can find our Goodreads list, you 0:08:42.640 --> 0:08:45.760 can find Bloodmobile, our music and our merch and our 0:08:45.800 --> 0:08:48.880 Patreon and transcripts from all of our episodes and our. 0:08:48.800 --> 0:08:53.199 Sources from every episode. All the list is long, so 0:08:53.200 --> 0:08:54.880 so many things. Check it out. 0:08:55.200 --> 0:08:57.800 I don't think there's any other business besides, you know, 0:08:58.000 --> 0:09:00.640 this is the last episode of the season. Either, we 0:09:00.720 --> 0:09:03.040 will not make you wait very long for the next season. 0:09:03.080 --> 0:09:05.920 Don't worry, and the next season will be jam packed 0:09:05.920 --> 0:09:08.480 full of very many fun, cool things. 0:09:08.840 --> 0:09:14.120 We have so much entirely unplanned, but so many ideas. 0:09:15.280 --> 0:09:17.960 It's gonna be a really great season. 0:09:18.559 --> 0:09:22.040 I you know what I'm I can't wait me neither. 0:09:22.320 --> 0:09:24.800 But first, maybe we should do this episode. 0:09:24.960 --> 0:09:27.600 So we should. Should we take our quick break and 0:09:27.640 --> 0:10:05.720 then get started. Yeah, we should. So. 0:10:05.840 --> 0:10:12.280 The definition of menopause, according to textbooks and doctors and 0:10:12.640 --> 0:10:18.839 all the papers, the definition of menopause is twelve months 0:10:19.280 --> 0:10:24.440 of a menorrhea or twelve months of no period, specifically 0:10:25.240 --> 0:10:30.920 as a result of the cessation of ovarian function. That 0:10:31.080 --> 0:10:37.120 is like the clinical definition, and menopause is like clinically defined. 0:10:37.200 --> 0:10:39.679 There's not like a single test that you can do 0:10:39.760 --> 0:10:44.880 to say menopause or not menopause. So, in a person 0:10:45.360 --> 0:10:49.840 who menstruates after menarc which is like the start of 0:10:49.960 --> 0:10:54.760 getting your periods some number of years later, once you 0:10:54.880 --> 0:10:59.800 then go twelve months without a period, without anything like 0:11:00.200 --> 0:11:05.480 contraceptives or IUD or pregnancy or breastfeeding or even cancer, 0:11:05.720 --> 0:11:10.840 or chemotherapy or something that's altering your hormones temporarily. Once 0:11:10.880 --> 0:11:14.800 you have twelve months with no period, because your ovaries 0:11:14.840 --> 0:11:19.439 are no longer having follicular function, we call that menopause. 0:11:21.120 --> 0:11:22.079 If you think. 0:11:21.880 --> 0:11:26.840 Of it as a reproductive life span. People with ovaries 0:11:26.920 --> 0:11:31.480 and uteruses have the beginning of their reproductive life span 0:11:31.760 --> 0:11:35.360 with menarc that's like your first period anywhere from like 0:11:35.520 --> 0:11:39.719 ten to sixteen years old. And someday we'll do an 0:11:39.720 --> 0:11:44.000 episode about menstruation, we really really need to. Feels like 0:11:44.000 --> 0:11:46.320 a missed opportunity. Could have done that one first, But 0:11:47.920 --> 0:11:51.520 we start where we start, yep. So menarch is the 0:11:51.559 --> 0:11:55.040 beginning of this reproductive life span, as it were, and 0:11:55.080 --> 0:11:58.360 then menopause is like the end of it. And so 0:11:58.559 --> 0:12:03.640 after menopause you are postmenopausal but still alive for a 0:12:03.640 --> 0:12:05.080 really long time hopefully. 0:12:05.840 --> 0:12:06.200 Okay. 0:12:06.280 --> 0:12:10.640 Question I love it already, Okay, already, okay, Like. 0:12:10.800 --> 0:12:15.240 How long do the ovaries take to stop functioning? Is 0:12:15.320 --> 0:12:20.160 menopause a before and after snapshot in time or is 0:12:20.200 --> 0:12:24.120 it a progression? Is something that happens over time? 0:12:24.240 --> 0:12:26.760 Okay, this is such a good question. So it is 0:12:26.880 --> 0:12:30.120 both a process and a single event, and it depends 0:12:30.120 --> 0:12:33.640 on what you're truly talking about, because a lot of 0:12:33.679 --> 0:12:38.600 people call menopause a whole period in which they are 0:12:38.760 --> 0:12:43.440 experiencing symptoms that they're relating to menopause, right, So we're 0:12:43.480 --> 0:12:46.040 going to talk a lot about like what is happening 0:12:46.080 --> 0:12:49.160 in your ovaries, in your brain, in your body during 0:12:49.200 --> 0:12:50.160 this whole transition. 0:12:50.960 --> 0:12:53.120 But because the clinical. 0:12:52.640 --> 0:12:56.160 Definition of menopause is this time point at which you've 0:12:56.200 --> 0:13:00.680 had twelve months with no periods, that's like the clinical 0:13:01.000 --> 0:13:05.160 in the doctor's office definition. Leading up to that period, 0:13:05.640 --> 0:13:09.680 there is a lot of hormonal changes that are happening 0:13:09.960 --> 0:13:13.240 that may or may not result in symptoms. This time 0:13:13.320 --> 0:13:19.200 period is called perimenopause or the menopausal transition, and a 0:13:19.200 --> 0:13:22.320 lot of people just call that period menopause. 0:13:23.000 --> 0:13:26.840 Yeah, I certainly, I think use the two kind of interchangeably, 0:13:26.920 --> 0:13:31.200 like menopause to mean cessation of ovarian function, but also 0:13:31.840 --> 0:13:36.600 going through menopause right as like a term yeah, yeah, yeah. 0:13:36.440 --> 0:13:40.040 And it's kind of like, you know, it's all the 0:13:40.080 --> 0:13:43.280 menopausal transition. I think that's my favorite of the terms 0:13:43.320 --> 0:13:48.439 for it. And so this in theory can happen anytime 0:13:48.640 --> 0:13:52.840 in a person who menstrates, but to be called menopause. 0:13:53.200 --> 0:13:55.800 It generally has to happen towards the end of the 0:13:55.840 --> 0:13:59.680 fortieth or beginning of the fiftieth decade of life. And 0:13:59.760 --> 0:14:03.679 the average age globally is about forty eight to fifty two, 0:14:03.880 --> 0:14:08.400 And there's some variation geographically, but not a ton of 0:14:08.520 --> 0:14:13.240 variation in this. If menopause happens between age forty and 0:14:13.320 --> 0:14:17.200 forty five, we call it early menopause, and if it 0:14:17.240 --> 0:14:21.240 happens before age forty, so if you have cessation of 0:14:21.320 --> 0:14:24.800 periods for twelve months before age forty, we don't call 0:14:24.840 --> 0:14:30.040 it menopause at all. We call it premature ovarian insufficiency, Okay, 0:14:30.520 --> 0:14:32.200 And I'm not going to get into that because it 0:14:32.280 --> 0:14:34.480 is something different. But part of the reason for that 0:14:34.680 --> 0:14:36.800 is that there's a lot of things that can cause 0:14:36.960 --> 0:14:41.720 premature ovarian insufficiency, and they're not all permanent. So sometimes 0:14:41.840 --> 0:14:46.440 ovarian function can return in the case of premature ovarian insufficiency, 0:14:46.520 --> 0:14:50.040 and sometimes it can't. Whereas with menopause, it's happening because 0:14:50.080 --> 0:14:52.560 the ovaries are done ovulating. 0:14:53.200 --> 0:14:56.040 What if you're taking some form of birth control that 0:14:56.640 --> 0:15:01.160 results in like either really light or non existing periods. 0:15:01.040 --> 0:15:03.920 Aarin, There's so much more to it than just if 0:15:03.960 --> 0:15:09.200 you're taking birth control. I'm so glad you asked though, 0:15:10.360 --> 0:15:13.600 because this criteria that we use to define menopause is 0:15:13.960 --> 0:15:18.480 entirely dependent on bleeding, right, It's dependent on menstrual bleeding. 0:15:19.360 --> 0:15:23.120 By that definition, we can define menopause in a lot 0:15:23.120 --> 0:15:27.240 of people who men straight, but a. 0:15:27.280 --> 0:15:28.760 Lot of people get left out. 0:15:28.880 --> 0:15:32.400 So that includes, yes, people who are taking oral contraceptives, 0:15:32.520 --> 0:15:35.440 or people who have something like a progestin IUD who 0:15:35.480 --> 0:15:38.040 might not have any periods because they have an IUD 0:15:38.160 --> 0:15:42.200 in place. Also people who've had a hysterectomy or an 0:15:42.320 --> 0:15:44.760 endometrial ablation. They're not going to be bleeding at all. 0:15:45.200 --> 0:15:48.040 It also means it's difficult to diagnose in people with 0:15:48.160 --> 0:15:52.680 pcos who might have really variable cycles to begin with, right, 0:15:53.680 --> 0:15:57.640 or for example, trans men who might still have ovaries 0:15:57.680 --> 0:16:01.480 and even a uterus but beyond various hormones so that 0:16:01.480 --> 0:16:05.800 they're not menstruating. There are so many people that are 0:16:05.920 --> 0:16:11.520 left out by this specific definition of menopause. And yet 0:16:12.440 --> 0:16:17.560 if they have ovaries, they're still going to eventually stop 0:16:17.640 --> 0:16:21.560 functioning and therefore have gone quote unquote through menopause or 0:16:21.560 --> 0:16:25.440 through this menopausal transition, whether they realized it or not. 0:16:26.640 --> 0:16:30.640 This is also quote unquote natural menopause, which is different 0:16:30.680 --> 0:16:35.240 than surgical menopause, which is when the ovaries are removed 0:16:35.320 --> 0:16:39.280 surgically for any number of reasons. And as we'll talk about, 0:16:39.320 --> 0:16:42.840 this causes a really rapid decrease in hormones and results 0:16:42.880 --> 0:16:48.560 in menopause. But it's different than quote natural menopause. Okay, 0:16:48.840 --> 0:16:51.360 there's so much here eron, there is so much here. 0:16:52.120 --> 0:16:56.000 So because of that, there are other diagnostic criteria that 0:16:56.040 --> 0:16:59.120 we can use to help diagnose menopause. 0:17:00.200 --> 0:17:01.320 It is if someone. 0:17:01.160 --> 0:17:05.240 Is of the right age, if they are having symptoms 0:17:05.280 --> 0:17:09.280 that we correlate to menopause, then we can also check 0:17:09.359 --> 0:17:12.360 certain hormone levels and we'll get into that, and if 0:17:12.400 --> 0:17:15.240 these hormone levels have risen the way that we expect 0:17:15.320 --> 0:17:17.520 with menopause, then you can use. 0:17:17.400 --> 0:17:19.640 All of this together to say, yes, you. 0:17:20.160 --> 0:17:23.159 Have gone through menopause or maybe are in the midst 0:17:23.160 --> 0:17:24.440 of the menopausal transition. 0:17:26.160 --> 0:17:29.040 I have another question, but I'm worried that, like I'm 0:17:29.200 --> 0:17:32.600 just I've stalled us out at the very beginning of 0:17:32.640 --> 0:17:36.200 the biology. There's so much though, areas so so much 0:17:36.600 --> 0:17:38.560 so if it's like getting ahead of things, we can 0:17:38.680 --> 0:17:42.199 just wait and answer it later. Okay, why is it 0:17:42.240 --> 0:17:45.200 important to know whether someone has or has not yet 0:17:45.240 --> 0:17:50.080 gone through menopause besides something like you know, fertility. 0:17:51.840 --> 0:17:53.840 So fertility is a big one if people want to 0:17:53.880 --> 0:17:57.360 know either whether they could still have children or make 0:17:57.400 --> 0:17:59.960 sure that they can no longer have children, if they're, 0:18:00.040 --> 0:18:02.240 for example, wanting to come off of birth control or 0:18:02.280 --> 0:18:07.120 something like that. It also, as we'll talk about, risks 0:18:07.160 --> 0:18:11.720 of certain diseases do change after menopause because of these 0:18:11.840 --> 0:18:17.040 changes in hormone balance, so perhaps it would be worth 0:18:17.119 --> 0:18:21.080 knowing for that reason. But really, if someone is not 0:18:21.359 --> 0:18:27.199 experiencing symptoms related to this menopausal transition, there is not 0:18:27.760 --> 0:18:32.159 a need to do any testing necessarily to say you 0:18:32.320 --> 0:18:37.480 are or you are not menopausal or postmenopausal. It really 0:18:37.480 --> 0:18:41.119 comes down to what somebody is experiencing and what their 0:18:41.520 --> 0:18:44.720 desires are in terms of knowing what's going on or 0:18:44.760 --> 0:18:48.080 what has or hasn't happened kind of a thing. So 0:18:48.240 --> 0:18:50.359 let's talk about that, shall we Let's talk about like 0:18:50.720 --> 0:18:54.440 what is we defined menopause And now we're like, well, 0:18:54.440 --> 0:18:55.280 what the heck is that? 0:18:57.320 --> 0:18:58.280 Forty questions? 0:18:58.520 --> 0:19:03.800 Right, So let's talk about what is happening physiologically during 0:19:03.840 --> 0:19:07.880 this time, and then I will talk about the quote 0:19:08.040 --> 0:19:13.360 symptoms that can occur during this menopausal transition. But first, 0:19:13.520 --> 0:19:18.159 let's just talk about what the hormones are happening doing. 0:19:18.359 --> 0:19:25.720 Okay, yeah, to do that, let's remind ourselves briefly of 0:19:25.760 --> 0:19:29.520 what is going on hormonally in people who menstruate prior 0:19:29.680 --> 0:19:33.119 to menopause, Like, what is menstruation exactly? 0:19:33.280 --> 0:19:35.520 Okay, just the basin, just the basic. 0:19:36.800 --> 0:19:42.280 So the menstrual cycle itself, which again starts with menarch 0:19:42.440 --> 0:19:46.000 like in the teenage years, the menstrual cycle has two 0:19:46.320 --> 0:19:49.720 main phases, the follicular phase at the beginning, and the 0:19:49.800 --> 0:19:54.639 luteal phase. The follicular phase starts when you start your 0:19:54.680 --> 0:19:56.919 first day of bleeding. That's how we like define the 0:19:56.960 --> 0:20:01.879 start of a menstrual cycle. And every month ish during 0:20:01.920 --> 0:20:07.560 this follicular phase, follicles in the ovary are recruited and. 0:20:07.480 --> 0:20:11.320 Start to mature. These are basically baby eggs. Okay yeah. 0:20:11.560 --> 0:20:16.000 After a period of maturation and in response to hormone 0:20:16.240 --> 0:20:23.520 surges specifically estrogen and lutinizing hormone, one mature follicle aka 0:20:23.680 --> 0:20:29.119 one egg is released, and that is ovulation. Following ovulation, 0:20:29.440 --> 0:20:33.440 we then enter the luteal phase, which lasts about fourteen days, 0:20:34.400 --> 0:20:36.560 and at the end of that phase, if there's no 0:20:36.720 --> 0:20:40.879 embryo that gets implanted, then menstruation occurs. That is the 0:20:40.880 --> 0:20:44.720 shedding of uterine lining and vaginal bleeding cool and you've 0:20:44.760 --> 0:20:49.440 started your next cycle. During this menstrual cycle, there are 0:20:49.920 --> 0:20:54.639 a lot of hormonal fluctuations that are happening, and these 0:20:54.680 --> 0:21:00.800 hormonal fluctuations are a very complex interplay of positive and 0:21:01.080 --> 0:21:05.880 negative feedback cycles that are happening between our ovaries, which 0:21:05.920 --> 0:21:11.160 are making hormones like that you've heard of, like estrogen, progesterone, testosterone, 0:21:11.600 --> 0:21:14.800 but also a lot of lesser known but not less 0:21:14.800 --> 0:21:19.080 important hormones like anti mularian hormone and in hibben b. 0:21:20.080 --> 0:21:23.760 And these hormones travel through our bloodstream and interact with 0:21:24.400 --> 0:21:28.600 and are then affected by hormones released in our brain, 0:21:29.240 --> 0:21:32.560 specifically by this axis in our brain called the hypothalamic 0:21:32.720 --> 0:21:36.160 pituitary axis, so like two different areas in our brain, 0:21:36.720 --> 0:21:42.040 and these are hormones like gnatotropin releasing hormone, follicle stimulating 0:21:42.080 --> 0:21:47.280 hormone FSH, and lutinizing hormone or LH. We don't have 0:21:47.359 --> 0:21:50.520 to understand all of the nitty gritty of this cycle, 0:21:50.800 --> 0:21:55.439 in part because that's another episode, but also because what 0:21:55.480 --> 0:21:58.840 we just need to understand to understand menopause is. 0:21:58.800 --> 0:22:02.120 That there are are these cyclic ups. 0:22:01.760 --> 0:22:06.120 And downs of all of these hormones that are happening 0:22:06.680 --> 0:22:12.040 in communication between our ovaries and our brain, and as 0:22:12.160 --> 0:22:17.879 our ovaries start to deplete these follicles, big shifts start 0:22:17.920 --> 0:22:22.000 to happen. So, because we are born, if you're born 0:22:22.040 --> 0:22:24.840 with ovaries, you have a set number of ovarian follicles 0:22:24.840 --> 0:22:27.240 that you're born with. We don't make any more. Unlike 0:22:27.400 --> 0:22:30.160 people born with testes who are constantly just making more 0:22:30.200 --> 0:22:33.600 sperms like all the time, the ovary has a certain 0:22:33.680 --> 0:22:36.160 number of follicles and they don't make any more. 0:22:36.800 --> 0:22:37.800 So as these. 0:22:37.640 --> 0:22:41.119 Follicles are literally depleted because they are used up and 0:22:41.200 --> 0:22:45.360 either ovulated out or just half matured but then never 0:22:45.440 --> 0:22:49.960 quite ovulated, this ovary loses a number of follicles. And 0:22:50.040 --> 0:22:55.000 as this happens, hormone levels start to shift, specifically anti 0:22:55.080 --> 0:22:59.080 Mularian hormone or AMH and in hibben B, which are 0:22:59.080 --> 0:23:03.119 two hormones the ovary produces slowly starts to fall As 0:23:03.200 --> 0:23:05.840 we age, they peak at like around age twenty five, 0:23:06.359 --> 0:23:06.879 and then. 0:23:06.880 --> 0:23:10.760 Slowly, slowly, slowly start to go down over time. 0:23:11.440 --> 0:23:16.280 This has an effect on our brain of slowly increasing 0:23:16.520 --> 0:23:20.639 hormones like FSH, which is what stimulates our follicles to 0:23:20.880 --> 0:23:23.840 make an egg for ovulation, to make like a ripe 0:23:23.920 --> 0:23:29.280 egg for ovulation. And as we see these declines in 0:23:29.400 --> 0:23:32.960 the number of follicles and these hormones like AMH and 0:23:33.040 --> 0:23:36.760 in hibbin, what we see is an ovary and follicles 0:23:36.880 --> 0:23:42.520 that are less responsive, so they need higher and higher 0:23:42.560 --> 0:23:47.080 amounts of FSH to be able to respond appropriately. 0:23:47.119 --> 0:23:47.800 If that makes sense. 0:23:48.080 --> 0:23:50.960 Yeah, kind of like in our diabetes episode when we 0:23:51.040 --> 0:23:54.760 talked about like your pancreas needs, like your pancreas is 0:23:54.760 --> 0:23:59.240 making more and more insulin because your tissues just aren't responding. 0:23:59.240 --> 0:24:04.040 It's kind of like that, h But eventually you get 0:24:04.040 --> 0:24:06.239 to a point where there are so few follicles that 0:24:06.280 --> 0:24:09.479 ovulation just isn't going to happen, but you're still going 0:24:09.560 --> 0:24:12.160 to get this increase in FSH because of all these 0:24:12.200 --> 0:24:16.639 complex feedback loops. And at the same time that all 0:24:16.680 --> 0:24:22.440 of this is happening, estrogen declines pretty drastically, so by 0:24:22.520 --> 0:24:25.199 the end of menopause. What has happened is that we 0:24:25.280 --> 0:24:28.439 have depleted all of those follicles. There's no more eggs 0:24:28.640 --> 0:24:32.959 left in your ovaries to ovulate, and our hormone levels 0:24:32.960 --> 0:24:37.760 have shifted from estrogen being high, which is what it 0:24:37.800 --> 0:24:42.719 looks like during the reproductive years, and FSH being low 0:24:42.960 --> 0:24:47.119 on average, to a reverse where FSH is high and 0:24:47.359 --> 0:24:52.040 estrogen is now low. And that is the big change 0:24:52.280 --> 0:24:55.919 that occurs. By the point that you've gotten to menopause, 0:24:55.960 --> 0:24:59.080 that is twelve months without a period. 0:25:00.520 --> 0:25:04.439 If there are no more f's for FSH to act 0:25:04.520 --> 0:25:08.600 on or stimulate, then what is FSH doing? 0:25:09.560 --> 0:25:11.280 Oh great question? 0:25:13.880 --> 0:25:18.359 Not much, but it's still going to be there, right 0:25:18.400 --> 0:25:22.639 because our brain doesn't necessarily know like, hey, FSH, like 0:25:22.680 --> 0:25:24.360 you're not doing much, Like we can just. 0:25:24.359 --> 0:25:25.000 Chill out with you. 0:25:25.640 --> 0:25:28.840 It's more like we have lost the negative feedback and 0:25:28.960 --> 0:25:32.560 hibben has decreased, and so now there's no negative feedback 0:25:32.600 --> 0:25:34.560 to say, hey, we don't need this anymore. 0:25:35.080 --> 0:25:38.560 And so that's how it remains for like after menopause. 0:25:38.680 --> 0:25:39.919 Uh huh. 0:25:40.040 --> 0:25:44.240 The whole time, we're just still making yep FSH. 0:25:44.320 --> 0:25:44.960 Yeah. 0:25:45.000 --> 0:25:46.840 And it's possible that there's a point at which it 0:25:46.880 --> 0:25:49.119 like slowly starts to kind of go down from like 0:25:49.200 --> 0:25:52.199 a peak or something like that. But realistically, for the 0:25:52.200 --> 0:25:55.960 rest of your postmenopausal life, estrogen is low and FSH 0:25:56.080 --> 0:25:56.560 is high. 0:25:57.640 --> 0:26:01.160 I am okay, I don't know why that, like, I'm 0:26:01.200 --> 0:26:04.160 so hung up on Yeah, well, it's interesting, right because 0:26:04.200 --> 0:26:07.240 it's basically you've lost this what used to be cycles. 0:26:07.359 --> 0:26:08.080 You've lost it. 0:26:08.320 --> 0:26:13.480 Yeah, you've lost that cycling now during the menopausal transition. 0:26:13.680 --> 0:26:19.679 Right during this timeframe when your ovaries are still making eggs, 0:26:19.680 --> 0:26:24.040 they're still ovulating, but the number of follicles has started 0:26:24.080 --> 0:26:29.040 to decline. What we see is a lot more erratic 0:26:29.800 --> 0:26:35.320 hormone changes because your ovaries still have enough to sometimes 0:26:35.359 --> 0:26:39.720 ovulate and they're still making enough estrogen that they might 0:26:39.840 --> 0:26:43.480 sometimes cause a cycle to happen, even if it's not 0:26:43.600 --> 0:26:44.720 an ovulatory cycle. 0:26:44.800 --> 0:26:45.960 So it gets really. 0:26:45.800 --> 0:26:49.760 Complicated in that timeframe that we call perimenopause, or the 0:26:49.800 --> 0:26:53.520 time leading up to menopause, and that is a timeframe 0:26:53.560 --> 0:26:56.919 in which sometimes people might have symptoms, But it's also 0:26:57.320 --> 0:27:00.919 after that menopause transition and the years they're after, where 0:27:01.320 --> 0:27:04.000 your body is getting used to this new normal of 0:27:04.080 --> 0:27:10.280 low estrogen and high FSH and it's not just FSH 0:27:10.320 --> 0:27:15.240 and estrogen, because this alteration in hormone production, remember, is 0:27:15.520 --> 0:27:20.760 affecting our brains, our hypothalamic pituitary axis, and the hormone 0:27:20.760 --> 0:27:25.600 production alterations that happen in our hypothalamus also have direct 0:27:25.600 --> 0:27:31.120 effects on other pathways like our neurogenergic pathway, our serotonergic pathway. 0:27:31.520 --> 0:27:36.280