WEBVTT - Peri-Menopause Anxiety 0:00:08.520 --> 0:00:11.360 This is the Anxiety Bites podcast and I am your host, 0:00:11.520 --> 0:00:17.280 Jen Kirkman. Welcome to another episode of Anxiety Bites. I'm 0:00:17.280 --> 0:00:20.479 your host Jen Kirkman. Today we're talking about menopause and 0:00:20.600 --> 0:00:25.920 perimenopause and how that relates to our levels of anxiety. 0:00:25.960 --> 0:00:29.800 If you are a person who is experiencing either right now, 0:00:30.600 --> 0:00:35.280 I wonder if you know that that absolutely increases any 0:00:35.320 --> 0:00:37.680 anxiety that you are already prone to. It can suddenly 0:00:37.960 --> 0:00:43.320 give you anxiety in the form of panic attacks, obsessive thinking, 0:00:44.159 --> 0:00:47.800 mood swings, depression. You know, it's a lot. Our hormones 0:00:47.880 --> 0:00:51.080 are changing during this very long phase of our life. 0:00:51.120 --> 0:00:53.320 And there is so much more to menopause than what 0:00:53.440 --> 0:00:55.480 you may think, you know, which is just one day 0:00:55.480 --> 0:00:58.160 you stop getting your period and that stuff. It's a 0:00:58.760 --> 0:01:03.160 sometimes seven to any your process of hormones changing before 0:01:03.280 --> 0:01:08.319 that inevitable stop in menstruating happens. And this has not 0:01:08.319 --> 0:01:11.000 talked about in society unfortunately. What you're going to learn 0:01:11.120 --> 0:01:14.600 from my guest today, Dr Stephanie Fabian, is that medical 0:01:14.640 --> 0:01:18.880 doctors are getting less training now in recognizing symptoms of 0:01:18.920 --> 0:01:22.520 perimenopause and menopause. You have to be your own advocate, 0:01:22.560 --> 0:01:26.360 and so I highly recommend starting to learn about this, 0:01:26.400 --> 0:01:29.399 and I'm hoping I'm doing a service for any people 0:01:29.480 --> 0:01:33.520 out there that might be wondering what's going on in 0:01:33.520 --> 0:01:36.240 their forties as they suddenly maybe feel like a teenager again, 0:01:36.280 --> 0:01:40.520 not in the best of ways. And how in our 0:01:40.600 --> 0:01:43.840 ages society where unfortunately, not only do we sort of 0:01:43.840 --> 0:01:46.840 abandon our elders, right, people in their forties and fifties 0:01:46.880 --> 0:01:50.120 now are seen as older in the workplace at least, 0:01:50.160 --> 0:01:53.920 and it can be pretty difficult to want to talk 0:01:53.960 --> 0:01:58.800 about this hormonal change that affects our moods, our anxiety, 0:01:58.800 --> 0:02:03.280 our physical cell that goes on intermittently for seven to 0:02:03.320 --> 0:02:07.400 ten years. And you know, you spend forty weeks in 0:02:07.480 --> 0:02:10.079 your life of your life. That would be great if 0:02:10.080 --> 0:02:11.600 you only had to work forty weeks in your life, 0:02:11.639 --> 0:02:17.240 forty forty hours a week at a job most weeks 0:02:17.240 --> 0:02:20.240 of the year. Well, you're going to run into having 0:02:20.240 --> 0:02:24.639 your perimenopausal symptoms at work and you need special kinds 0:02:24.639 --> 0:02:28.680 of relief. Usually these things might involve time or change 0:02:28.680 --> 0:02:33.120 of environment within the workplace, and it can be pretty 0:02:33.160 --> 0:02:36.680 scary to talk about because we don't want to be 0:02:36.720 --> 0:02:40.360 seen as not being assets to the workplace at our age, 0:02:40.400 --> 0:02:44.960 because obviously we are. So there's that kind of anxiety. 0:02:44.960 --> 0:02:47.680 I mean, even if you don't physically start getting panic 0:02:47.720 --> 0:02:50.680 attacks when you're in perimenopause, there is a lot that 0:02:50.720 --> 0:02:54.480 affects your brain and emotional health when you're going through 0:02:54.600 --> 0:02:58.720 such a big physical change. And serotonin is mildly connected 0:02:58.800 --> 0:03:02.840 to estrogen as well, so when that starts to change, 0:03:02.840 --> 0:03:05.000 it does affect our serotonin, not as much as I 0:03:05.040 --> 0:03:07.520 thought it did actually in Ductor Bobby and will take 0:03:07.600 --> 0:03:11.320 us through that. But yeah, So this is the second 0:03:11.360 --> 0:03:15.400 talk that that people have h a need for in 0:03:15.440 --> 0:03:17.400 their life. The first one is you know about getting 0:03:17.400 --> 0:03:20.160 your period, and then the second one is about the 0:03:20.280 --> 0:03:22.880 years and years it takes for your body to go 0:03:22.960 --> 0:03:25.400 through what it needs to go through for your period 0:03:25.400 --> 0:03:31.200 to stop. And it's not simple and it's not quick, 0:03:33.360 --> 0:03:36.000 And it might be a great episode for you to 0:03:36.000 --> 0:03:37.760 listen to, even if this isn't something you're going to 0:03:37.800 --> 0:03:41.400 be going through, but it might help you understand the 0:03:41.400 --> 0:03:44.680 struggle that maybe people you work with, howe, or people 0:03:44.680 --> 0:03:46.560 in your family or friends of yours, or anyone you 0:03:46.600 --> 0:03:52.040 know in this age range. So there is hope of course, 0:03:52.320 --> 0:03:55.800 But I think what I took most from my talk 0:03:56.440 --> 0:03:59.400 with Dr Stephanie is we really have to be our 0:03:59.400 --> 0:04:02.040 own advocate, and we cannot think that we are crazy 0:04:02.120 --> 0:04:03.360 and that this is in our head. We have to 0:04:03.440 --> 0:04:06.040 learn as much as we can about what happens during 0:04:06.040 --> 0:04:09.320 paramount of pause, both physically and emotionally and mentally into 0:04:09.320 --> 0:04:14.160 our brain. And we can't let doctors tell us that, oh, 0:04:14.200 --> 0:04:16.560 it can't possibly be happening because they're not trained in this. 0:04:19.600 --> 0:04:26.000 So get yourself. Um, I don't know I was gonna say. 0:04:26.760 --> 0:04:28.200 I don't know what I was going to say. To 0:04:28.240 --> 0:04:32.160 be honest, get yourself what get yourself this episode so 0:04:32.200 --> 0:04:35.120 that you can start to learn something about everything that 0:04:35.160 --> 0:04:37.400 you might be going through or will go through someday 0:04:37.440 --> 0:04:40.599 if you're lucky enough to hit that age. So again, 0:04:40.600 --> 0:04:43.680 my guest today is Dr Stephanie Fabian. She is a 0:04:43.680 --> 0:04:45.920 clinician who has practiced in the Women's Health clinic at 0:04:45.920 --> 0:04:49.080 Mayo Clinic for over ten years and has evaluated and 0:04:49.080 --> 0:04:53.440 treated women with menopausal, hormonal and other health concerns. Relating 0:04:53.480 --> 0:04:56.400 to that, she has a broad interest in women's health 0:04:56.760 --> 0:05:01.560 and she is the direct dirt for the North American 0:05:01.640 --> 0:05:04.560 Menopause Society. Again, the link to that will be in 0:05:04.600 --> 0:05:08.360 the show notes. And as the Penny and Bill George 0:05:08.440 --> 0:05:12.440 director for the Mayo Clinics Center for Women's Health, today 0:05:12.440 --> 0:05:14.559 we're talking about some of the things in her book 0:05:14.600 --> 0:05:18.400 called The Menopause Solution, which came out in she said 0:05:18.440 --> 0:05:21.320 there is a new version that should be coming out 0:05:22.040 --> 0:05:25.480 this year, and you know, will I will say there 0:05:25.560 --> 0:05:29.080 is hope. But again, like with any anxiety solution, it 0:05:29.200 --> 0:05:32.960 seems as though it's the answers you've heard before, you know, 0:05:34.240 --> 0:05:37.440 taking care of your health by making sure you're putting 0:05:37.440 --> 0:05:40.400 healthy food into your body, cutting down on alcohol, if 0:05:40.440 --> 0:05:49.560 not eliminating it, exercise, meditation, medication as needed, therapy, mindfulness, sleep. 0:05:50.920 --> 0:05:53.680 But there are a lot of different stressors that can 0:05:53.720 --> 0:05:59.000 affect someone in perimenopause, and an attitude shift is kind 0:05:59.000 --> 0:06:02.000 of needed as well, which is that this isn't really 0:06:02.040 --> 0:06:04.600 something to dread happening. It's just something to be prepared for. 0:06:05.920 --> 0:06:09.040 And unfortunately, it seems like there aren't a lot of 0:06:09.040 --> 0:06:11.920 people out there that are helping us prepare. So I'm 0:06:11.960 --> 0:06:17.120 hoping I can be a helpful voice in that lack 0:06:17.160 --> 0:06:20.840 of voices, and hopefully this episode will give you enough 0:06:20.839 --> 0:06:23.599 bread crumbs to find your way to how you want 0:06:23.640 --> 0:06:27.600 to handle your paramount of pause. And again, you know, 0:06:27.640 --> 0:06:29.600 all of the solutions to this are simple, they're not 0:06:29.640 --> 0:06:32.640 necessarily easy. Right, when we take care of our brain 0:06:32.680 --> 0:06:34.760 health or mental health or emotional health, whatever you want 0:06:34.760 --> 0:06:37.200 to call it, we know what to do, and sometimes 0:06:37.240 --> 0:06:38.760 we just don't want to do it. Whether it's our 0:06:38.800 --> 0:06:41.400 depression that's making us lack of the motivation, or a 0:06:41.440 --> 0:06:44.200 self esteem issue that says, you know, when we're really 0:06:44.240 --> 0:06:46.479 not worth taking the time to take care of ourselves, 0:06:46.600 --> 0:06:48.760 or the a d h D which affects our executive 0:06:48.760 --> 0:06:52.880 brain function. There are so many reasons why people don't 0:06:52.920 --> 0:06:57.919 get started on taking care of their brain, emotional, mental health, 0:06:58.000 --> 0:06:59.440 and I think there's a lot of times I can 0:06:59.440 --> 0:07:02.360 get tricked by is to thinking, Okay, I hope this 0:07:02.400 --> 0:07:05.440 episode gives like the definitive number one answer for people, 0:07:05.440 --> 0:07:08.120 and it's like, there isn't one, right. It's a combination 0:07:08.520 --> 0:07:10.680 of finding out what works best for you, but we're 0:07:10.720 --> 0:07:13.400 probably always going to be picking from the same bag 0:07:13.520 --> 0:07:20.200 of tricks. And it's not because you know, no one 0:07:20.280 --> 0:07:22.840 knows what the solution is. These are the solutions, but Again, 0:07:22.880 --> 0:07:25.840 they're simple, but not easy. That's what makes them so 0:07:25.920 --> 0:07:29.160 difficult to implement sometimes because again, the mental health that 0:07:29.160 --> 0:07:31.320 we're trying to take care of can sometimes get in 0:07:31.360 --> 0:07:34.440 our own way from even starting. So again, I hope 0:07:34.440 --> 0:07:38.040 you enjoy our conversation about perrymnopause, and I'll see it 0:07:38.080 --> 0:07:44.920 on the flip side. We're going to talk about perrymnopause, 0:07:45.000 --> 0:07:50.440 menopause and the anxiety, grief moods that accompany it. But 0:07:51.560 --> 0:07:54.760 you know, before we get into that, i'd love to 0:07:54.840 --> 0:07:57.880 chat with you just what the basics are. What what 0:07:58.080 --> 0:08:01.880 is perrymnopause? What is menopause? Yeah, I mean, that's such 0:08:01.880 --> 0:08:05.240 a great question. And I've said many times that we 0:08:05.360 --> 0:08:08.640 get the talk when we're about to start our periods, 0:08:08.640 --> 0:08:11.200 but nobody gives you the talk when you're about to 0:08:11.200 --> 0:08:14.120 stop your periods. And there are a number of reasons 0:08:14.160 --> 0:08:18.920 for that, UM, including that the timing is variable for 0:08:18.920 --> 0:08:21.920 for many women, and so we there's no set time 0:08:22.000 --> 0:08:24.040 like your thirty five years of age. You need to 0:08:24.080 --> 0:08:27.880 get the talk now. So and UM providers aren't really 0:08:27.920 --> 0:08:32.240 comfortable UM giving the talk, which is another major issue 0:08:32.240 --> 0:08:34.880 we can talk about. But let's talk about definitions here. 0:08:35.520 --> 0:08:39.200 So first of all, starting with the easy one, relatively 0:08:39.200 --> 0:08:42.840 easy anyway, menopause is defined as no period for a year, 0:08:43.480 --> 0:08:46.400 and that's with it without any manipulation. So you have 0:08:46.480 --> 0:08:49.680 a uterus and you would have been menstruating otherwise, and 0:08:49.760 --> 0:08:52.280 you haven't had an endometrial ablation, and you don't have 0:08:52.280 --> 0:08:54.080 an I U D that would make you stop bleeding, 0:08:54.080 --> 0:08:55.800 and you're not on a birth control bill that would 0:08:55.840 --> 0:08:59.200 make you stop bleeding. So without all those caveats aside 0:09:00.320 --> 0:09:04.240 nature taking its course, it's no period for a year. UM. 0:09:04.280 --> 0:09:06.760 The mean age in the United States is around the 0:09:06.800 --> 0:09:10.040 age of fifty two UM, but anything after the age 0:09:10.040 --> 0:09:13.920 of forty five is considered normal, and about us are 0:09:13.960 --> 0:09:16.240 done by the age of fifty five. So when you 0:09:16.280 --> 0:09:18.760 back it up, what are the stages they get you 0:09:18.840 --> 0:09:22.760 to menopause? And we call that the menopause transition and 0:09:22.840 --> 0:09:25.760 the time leading up to the last menstrual period. And 0:09:25.840 --> 0:09:28.600 you don't actually know it's the last menstrual period until 0:09:28.600 --> 0:09:31.440 it's been a whole year, right, so you're actually we 0:09:31.520 --> 0:09:34.440 sort of call it perimenopause until you've been a year 0:09:34.960 --> 0:09:37.800 with no period, when in fact you were menopausal when 0:09:37.840 --> 0:09:40.360 you had that last period. Right. So that's why this 0:09:40.440 --> 0:09:44.000 definition gets a little gray and fuzzy in there. Now 0:09:44.120 --> 0:09:47.360 that time leading up to menopause. Perimenopause can last for 0:09:47.440 --> 0:09:51.160 several years, and it can be when your periods start 0:09:51.200 --> 0:09:53.360 to get a little bit of regular um, And it 0:09:53.440 --> 0:09:56.480 can be really subtle at first. It may be you 0:09:56.520 --> 0:09:59.559 know it's off by three or four days, or your 0:09:59.600 --> 0:10:03.520 periods are getting shorter or longer, or they're getting closer 0:10:03.520 --> 0:10:06.160 together for their part, So the variation can be pretty 0:10:06.240 --> 0:10:10.240 much anyway. Um. And then you can occasionally miss a 0:10:10.320 --> 0:10:12.840 period and you feel like you might be in menopause 0:10:12.920 --> 0:10:14.839 then because you could have hot flashes and nights west 0:10:14.880 --> 0:10:17.439 and sleep disturbance in your mood is crazy. And then 0:10:17.480 --> 0:10:19.640 it all just kicks back in again for a while. 0:10:19.800 --> 0:10:24.000 And I had a male colleague once described this time 0:10:24.040 --> 0:10:27.400 frame as like a boat motor sputtering, and I went, oh, 0:10:27.559 --> 0:10:31.439 dear God, that is like such a classic male description 0:10:31.600 --> 0:10:36.319 for a female reproductive stage. And I was going, darn it. 0:10:36.400 --> 0:10:39.120 He's kind of right, you know. So people have described 0:10:39.120 --> 0:10:43.080 it as kind of like a um, a candle flickering 0:10:43.160 --> 0:10:46.360 or fluttering, and I usually just say, look, it's not 0:10:46.559 --> 0:10:49.400 like a light switch. You don't just flip it off 0:10:49.400 --> 0:10:52.120 in your and your over stopped working one day. They 0:10:52.280 --> 0:10:55.280 really do kind of come in and go out for 0:10:55.440 --> 0:10:57.679 a little a little bit of time, and you might 0:10:57.720 --> 0:10:59.679 blame it on one thing or another, like I got 0:10:59.760 --> 0:11:01.920 sick and you know that I didn't have a period 0:11:01.920 --> 0:11:04.600 for a couple of months, which can happen um or 0:11:04.679 --> 0:11:07.480 you get particularly stressed and you're not sleeping in your 0:11:07.480 --> 0:11:09.160 period stopped for a couple of months, and then they 0:11:09.240 --> 0:11:13.160 kick back in. So it's a very rocky time frame 0:11:13.640 --> 0:11:16.280 for a lot of women because it's so unpredictable in 0:11:16.320 --> 0:11:18.719 what your hormones are doing, and until things sort of 0:11:18.760 --> 0:11:22.400 settle out post menopause, it can be pretty disruptive. And 0:11:22.480 --> 0:11:25.480 so when someone has gone one year without menstruating and 0:11:25.600 --> 0:11:28.640 so now they I guess it would say in menopause, 0:11:28.720 --> 0:11:32.559 But I guess we don't say in menopause after that year, right, 0:11:32.600 --> 0:11:35.600 do we say post menopausele or something or that's a 0:11:35.600 --> 0:11:38.680 great question. So some people just say you're in menopause 0:11:39.040 --> 0:11:41.600 um or you are post menopausal for the rest of 0:11:41.640 --> 0:11:46.520 your life. So so I think either could be accurate. 0:11:46.720 --> 0:11:51.800 You are you're technically in menopause or post menopausele either 0:11:51.920 --> 0:11:58.040 is fine, and for me, I'm in I'm calling what 0:11:58.120 --> 0:12:01.760 I'm in perimenopause, but I am having hot flashes, the 0:12:01.800 --> 0:12:05.280 mood swings. If they're not perimenopause, then I, you know, 0:12:05.400 --> 0:12:07.360 maybe they should just lock me up and throw away 0:12:07.360 --> 0:12:10.560 the key because I've gone insane. But like it has 0:12:10.600 --> 0:12:12.400 to be. But I also have a d h D 0:12:13.080 --> 0:12:16.000 and I also have depressions, So but I know those 0:12:16.040 --> 0:12:21.439 two um bedfellows. This feels different because it's so intermittent, 0:12:21.640 --> 0:12:25.280 and it's there's a lot mixed in with it. And 0:12:25.320 --> 0:12:28.679 so do I sound like I'm in perimenopause or am I? 0:12:28.720 --> 0:12:33.960 Am I experiencing something else? You very likely are in perimenopause, 0:12:34.120 --> 0:12:36.840 just from your age alone and your description of your symptoms. 0:12:37.320 --> 0:12:42.120 So it just seems like estrogen is a I don't 0:12:42.120 --> 0:12:44.800 know how to put it, a beast in terms of 0:12:44.840 --> 0:12:48.280 there's too much, there's too little it. How are we 0:12:48.320 --> 0:12:52.360 having the same symptoms with different levels of am I 0:12:52.400 --> 0:12:54.240 making sense? Like sometimes we have too much, sometimes we 0:12:54.280 --> 0:12:56.280 have too little. Why do they produce a similar symptoms? 0:12:57.160 --> 0:13:00.880 I think it's the the changes in estrogen levels that 0:13:01.000 --> 0:13:05.199 cause the biggest issues. Um, So what happens in perimenopause 0:13:05.440 --> 0:13:08.840 is your brain is trying to tell your ovaries, hey, 0:13:08.920 --> 0:13:11.600 not here, and from your ovaries, where are you, and 0:13:11.640 --> 0:13:15.119 they put out these brain chemicals that stimulate the ovaries 0:13:15.240 --> 0:13:17.920 a lot to say, you know, come on, let's hear 0:13:17.920 --> 0:13:21.800 from you. And then the ovaries overshoot sometimes and so 0:13:22.400 --> 0:13:25.440 you can actually get higher estrogen levels than you've ever 0:13:25.480 --> 0:13:28.760 had in the rest of your reproductive lifespan because your 0:13:28.760 --> 0:13:32.080 brain is over stimulating your ovaries to get them to work, 0:13:32.600 --> 0:13:35.280 and eventually they don't respond, which is why you know, 0:13:35.360 --> 0:13:38.800 it kind of dies out eventually. But so so you're right, 0:13:38.840 --> 0:13:42.680 you can have these highly variable estrogen levels and and 0:13:42.760 --> 0:13:44.800 you know, sometimes when your estrogen levels or high, you 0:13:44.880 --> 0:13:48.240 might feel great. Other women might feel breast pain, um 0:13:48.559 --> 0:13:51.160 when they're super high. But when they start to fall 0:13:51.480 --> 0:13:54.400 is you know, if you're going from super high back 0:13:54.440 --> 0:13:58.240 to zero, that's a big shift. And and so that's 0:13:58.280 --> 0:14:02.840 a night sweat, hot flash, irritability, can't sleep, you know, 0:14:02.920 --> 0:14:06.600 the whole thing. Um when that when that shift is occurring. 0:14:06.880 --> 0:14:10.959 So it's more the variability. Although high levels and low 0:14:11.040 --> 0:14:13.360 levels can cause symptoms, it's more the variability and the 0:14:13.440 --> 0:14:16.719 changing that is so disruptive to women. And is there 0:14:16.720 --> 0:14:19.320 a tie in I've I thought, I read this that 0:14:20.280 --> 0:14:26.800 serotonin is affected by estrogen, and so in that sense, 0:14:26.920 --> 0:14:32.480 if the estrogen is being erratic, so goes our serotonin levels. Well, yeah, 0:14:32.520 --> 0:14:37.120 it's not that simplistic. So the neurotransmitters are definitely connected, 0:14:37.320 --> 0:14:40.640 and and serotonin can be impacted during all of this. 0:14:40.760 --> 0:14:43.400 But serotonin levels can be impacted by a lot of things, 0:14:43.400 --> 0:14:46.400 including what's going on in your life, you know, and 0:14:46.400 --> 0:14:48.880 whether you're getting enough sleep and exercise and everything else. 0:14:48.920 --> 0:14:53.840 So so so many things impact those those neurotransmitters, estrogen 0:14:53.880 --> 0:14:59.960 being just the one. Anxiety bites will be right back 0:15:00.120 --> 0:15:02.680 after a quick little message from one of our sponsors. 0:15:09.240 --> 0:15:11.320 What I thought was so interesting, And I'll get to 0:15:11.360 --> 0:15:15.040 this chapter in a second chapter five Moods and you. 0:15:15.280 --> 0:15:22.280 But there was a mention of grief, and you mentioned 0:15:22.320 --> 0:15:23.960 grief in the part of your book where you talk 0:15:24.000 --> 0:15:26.600 about maybe going through a premature amount of pause. But 0:15:26.640 --> 0:15:31.160 I feel like, even at the right time men of pause, 0:15:31.520 --> 0:15:34.600 there must be grief. I never really thought about that 0:15:34.680 --> 0:15:37.040 because I don't want to have children, and so I'm 0:15:37.040 --> 0:15:40.040 not conflicted about not being able to reproduce anymore. And 0:15:40.720 --> 0:15:44.640 but of course people who didn't have children, there may 0:15:44.680 --> 0:15:48.880 be some grief and then even grief about getting older. 0:15:48.920 --> 0:15:51.640 I mean, it's it's very strange. I mean, I feel young, 0:15:51.720 --> 0:15:54.760 I look young, and my body is doing something that 0:15:55.720 --> 0:15:58.120 I saw episodes of The Golden Girls about when I 0:15:58.160 --> 0:16:03.440 was a kid, you know, so it seems it feels. Um, 0:16:03.480 --> 0:16:05.520 I'm not in the part yet where it feels liberating. 0:16:05.520 --> 0:16:07.880 I'm I'm in the part where I don't want this 0:16:08.000 --> 0:16:10.600 to change. I don't mind getting a period every month. 0:16:10.640 --> 0:16:13.040 I don't mind feeling the way I felt since I 0:16:13.120 --> 0:16:17.800 was thirteen, you know, I I'm in grief. I think, yeah, 0:16:17.840 --> 0:16:21.680 I think that's an interesting concept. And and in talking 0:16:21.720 --> 0:16:26.000 with women, it's not a universal experience in my in 0:16:26.040 --> 0:16:29.720 my experience, it's it's something that some women have have 0:16:29.880 --> 0:16:32.880 to go through, and some women are really just yeah, 0:16:33.080 --> 0:16:35.000 let it be gone. I'm really happy to move on. 0:16:35.160 --> 0:16:37.960 But I think I think you're right. I think there 0:16:38.080 --> 0:16:43.160 is something about leaving that reproductive phase, if you will, Um, 0:16:44.120 --> 0:16:47.080 it's somehow sad. You know, you're saying goodbye to something, 0:16:47.120 --> 0:16:50.560 even if you don't really care and don't want to 0:16:50.600 --> 0:16:53.720 have a baby, right um, but you're you're leaving it behind. 0:16:53.960 --> 0:16:56.920 And I think it also is associated with agism too. 0:16:57.400 --> 0:17:01.040 You're entering a time where you can't anymore. And I 0:17:01.080 --> 0:17:03.600 think more and more women really don't want to be 0:17:03.720 --> 0:17:07.720 defined by their reproductive status, like I can or can't 0:17:07.720 --> 0:17:11.480 have a baby. I mean, but that still is somehow 0:17:11.880 --> 0:17:14.639 a gateway that we all passed through. That that I 0:17:14.640 --> 0:17:17.520 think a lot of women struggle with. You know, am 0:17:17.520 --> 0:17:21.280 I am I somehow not worth anything to society anymore 0:17:21.320 --> 0:17:23.840 because I don't have eggs being produced, you know, and 0:17:23.920 --> 0:17:26.879 released every month. And you know, so many people know 0:17:27.040 --> 0:17:31.920 so little about menopause that honestly they have no I mean, 0:17:32.040 --> 0:17:34.560 I know people that I didn't want to vote for 0:17:34.640 --> 0:17:36.800 Hillary Clinton because they were worried what she would be 0:17:36.840 --> 0:17:39.160 like on her period. I mean, I'm really just trying 0:17:39.200 --> 0:17:41.080 to be funny here, but it is funny. I'm half 0:17:41.119 --> 0:17:43.720 serious that we worry about that because most people don't 0:17:43.720 --> 0:17:46.880 even know, you know, what it means that nobody would 0:17:46.920 --> 0:17:49.840 ever know I'm past my child bearing years if they 0:17:49.880 --> 0:17:52.960 wanted to be ages um, because they would they have 0:17:53.000 --> 0:17:55.720 no idea what age that is, you know, right? I 0:17:55.840 --> 0:17:58.120 know I just read something that I think in Sweden 0:17:58.200 --> 0:18:03.120 women are going to have time off for menstrual situations 0:18:03.200 --> 0:18:06.159 and they specifically in the article we're talking about period 0:18:06.200 --> 0:18:10.960 pain and I'm thinking, God that you know the seven 0:18:11.000 --> 0:18:14.320 to nine to ten years of perimenopause through menopause were 0:18:14.359 --> 0:18:18.159 these symptoms come in. To be in a workplace is 0:18:18.359 --> 0:18:21.440 really hard, and I think that leads to a lot 0:18:21.440 --> 0:18:23.760 of anxiety to like you have to hide this thing 0:18:23.760 --> 0:18:26.000 you're going through, which actually can show up on your 0:18:26.040 --> 0:18:30.040 face when you're sweating. Yeah, that's exactly right. And it's 0:18:30.080 --> 0:18:33.800 interesting you bring this up because this conversation about menopause 0:18:33.840 --> 0:18:36.480 in the workplace is really taking off, and I think 0:18:36.720 --> 0:18:39.320 that's a good thing. Europe's a little bit ahead of 0:18:39.400 --> 0:18:43.440 us there and that um they're really pushing workplace policies 0:18:43.480 --> 0:18:47.360 for menopause. And I think we are now where we 0:18:47.359 --> 0:18:51.200 were with pregnancy and lactation about thirty years ago. We're 0:18:51.200 --> 0:18:53.840 starting to say, hey, we should have these conversations about 0:18:53.840 --> 0:18:56.920 what this means for women in the workplace. And where 0:18:56.960 --> 0:18:58.919 I work at Mayo Clinic, we're in the process of 0:18:58.960 --> 0:19:03.400 developing a work place policy um around menopause, because you're right, 0:19:03.560 --> 0:19:06.439 it is it can be disruptive. It can go on 0:19:06.560 --> 0:19:09.160 for a long time. It can be anything from I'm 0:19:09.200 --> 0:19:11.560 in the middle of a business meeting and I break 0:19:11.560 --> 0:19:13.840 out in a sweat. I start to have, you know, 0:19:13.960 --> 0:19:17.200 pit stains, and people are wondering what's wrong with me? 0:19:17.359 --> 0:19:21.720 And I'm having trouble word finding. And some of the 0:19:21.760 --> 0:19:24.080 women that I that I see are like, I can't 0:19:24.119 --> 0:19:27.359 have this happen. You know, I'm an executive, I'm the CEO, 0:19:27.560 --> 0:19:30.040 and and they're like, I can't have this happen. You 0:19:30.119 --> 0:19:33.040 have to make this stop, or I'm not sleeping. And 0:19:33.080 --> 0:19:37.600 I had one woman that literally said she sweated out 0:19:37.640 --> 0:19:41.080 her mattress to the point where it molded. Oh my god, 0:19:41.880 --> 0:19:45.119 I'm like, wow, okay, all right, So those are some 0:19:45.240 --> 0:19:48.119 serious nights. What's going on? Right? And and she had 0:19:48.160 --> 0:19:49.840 to have her husband come pick her up at work 0:19:49.880 --> 0:19:51.760 at the end of the day because she couldn't drive 0:19:51.800 --> 0:19:55.440 home without falling asleep. So so some of these symptoms 0:19:55.440 --> 0:19:58.800 are incredibly disruptive, and it's hard to function during the 0:19:58.880 --> 0:20:01.560 day when you're not sleep being at night, or when 0:20:01.600 --> 0:20:04.640 you're so irritable you want to rip your spouse's eyes 0:20:04.680 --> 0:20:08.640 out um or you know, there's there's there's a lot 0:20:08.720 --> 0:20:11.080 going on, UM, and I think we need to have 0:20:11.160 --> 0:20:15.280 conversations about one, educating people about what this time is, 0:20:15.359 --> 0:20:17.119 and we should be able to talk about it. And 0:20:17.160 --> 0:20:21.520 it shouldn't be an age is discussion, right, it should 0:20:21.600 --> 0:20:25.320 be UM, a normal conversation. This is a normal phase 0:20:25.359 --> 0:20:27.800 of life. This is not a disease. A hundred percent 0:20:27.880 --> 0:20:30.080 of women are going to pass through the stage if 0:20:30.119 --> 0:20:33.760 they're lucky enough to get that far right, So we 0:20:33.800 --> 0:20:36.000 need to be able to have the conversations and and 0:20:36.080 --> 0:20:40.240 not have it turn into, UM, a reason for discrimination, 0:20:40.359 --> 0:20:44.480 which that's definitely afraid of me too. And I'm getting 0:20:44.480 --> 0:20:46.159 anxiety as you're saying it because I'm like, well, you 0:20:46.200 --> 0:20:47.920 know what, never mind, No, let's not have the conversation. 0:20:47.960 --> 0:20:49.840 I don't want anyone to know because they're going to 0:20:49.920 --> 0:20:53.080 think I can't do my job as well. And but 0:20:53.200 --> 0:20:56.440 it's true, how do we you know? In one way, 0:20:56.640 --> 0:20:58.840 it's nice to talk to other people who get it 0:20:58.880 --> 0:21:02.000 and say I really can't find my words right now. 0:21:02.040 --> 0:21:04.560 You're having, you know, jokingly, people will say things like that, 0:21:04.600 --> 0:21:07.720 I'm having a senior moment where you're trying to say 0:21:07.720 --> 0:21:09.480 can you get me that? Oh, go, what's that thing 0:21:09.520 --> 0:21:12.280 we write on it, it's um, you know, um paper paper, 0:21:12.320 --> 0:21:14.919 give me the you know, we have those moments. But 0:21:15.080 --> 0:21:17.280 why wouldn't I mean, I have to be totally honest. 0:21:17.320 --> 0:21:22.360 Why wouldn't would discriminate? You know. So I'm very anxious 0:21:22.400 --> 0:21:24.520 for us to have this conversation because how is it 0:21:24.560 --> 0:21:27.800 not going to backfire? What do we do? I'm very 0:21:27.840 --> 0:21:30.560 anxious too, and I have to. I think we have 0:21:30.680 --> 0:21:33.320 to be very clear about what we're asking for in 0:21:33.320 --> 0:21:37.680 the workplace. And I actually, you know, as as Uh, 0:21:37.880 --> 0:21:40.439 a medical director of the North American Menopause Society, we 0:21:40.480 --> 0:21:43.520 had this conversation at our last national meeting, and I'm like, 0:21:44.480 --> 0:21:46.560 what is it we are asking for? Is it a 0:21:46.560 --> 0:21:51.160 cold room at work? So it's amazing. I mean, you know, Frazer, 0:21:51.480 --> 0:21:53.720 you have a lactation room, you have a cold room. 0:21:53.760 --> 0:21:55.920 I mean, what is it? What is it that we're 0:21:55.960 --> 0:21:58.680 asking for? Because I think when you start talking about 0:21:58.720 --> 0:22:03.520 workplace accommodation, that gets very sticky. And so you know, 0:22:03.560 --> 0:22:05.879 if it's being able to take your jacket off in 0:22:05.920 --> 0:22:08.320 a corporate environment for the five minutes when you're having 0:22:08.359 --> 0:22:10.800 a hot flash, I get it. But I also think 0:22:10.800 --> 0:22:14.320 we need to flip this conversation and look at what's 0:22:14.400 --> 0:22:17.479 happened with menopause management in the last twenty years, and 0:22:17.520 --> 0:22:21.639 that is, we used to have about us women using 0:22:21.720 --> 0:22:25.640 hormone therapy to treat menopause symptoms before two thou two 0:22:25.680 --> 0:22:28.200 when the Women's Health Initiative study came out, and since then, 0:22:28.359 --> 0:22:31.920 hormone therapy US rates have dropped to orders of magnitude 0:22:31.960 --> 0:22:35.000 like four to six percent now, and so we have 0:22:35.200 --> 0:22:38.720 a lot of undertreated women out there. And so my 0:22:39.200 --> 0:22:41.520 thought is we need to educate women. We need to 0:22:41.600 --> 0:22:45.880 educate their healthcare providers. There are treatment options out there 0:22:45.960 --> 0:22:48.160 that are available that are safe and effective that we're 0:22:48.200 --> 0:22:51.280 not using. And so is it so much that we 0:22:51.359 --> 0:22:54.719