Speaker 1: This is the Anxiety Bites podcast and I am your host,
Speaker 1: Jen Kirkman. Welcome to another episode of Anxiety Bites. I'm
Speaker 1: your host Jen Kirkman. Today we're talking about menopause and
Speaker 1: perimenopause and how that relates to our levels of anxiety.
Speaker 1: If you are a person who is experiencing either right now,
Speaker 1: I wonder if you know that that absolutely increases any
Speaker 1: anxiety that you are already prone to. It can suddenly
Speaker 1: give you anxiety in the form of panic attacks, obsessive thinking,
Speaker 1: mood swings, depression. You know, it's a lot. Our hormones
Speaker 1: are changing during this very long phase of our life.
Speaker 1: And there is so much more to menopause than what
Speaker 1: you may think, you know, which is just one day
Speaker 1: you stop getting your period and that stuff. It's a
Speaker 1: sometimes seven to any your process of hormones changing before
Speaker 1: that inevitable stop in menstruating happens. And this has not
Speaker 1: talked about in society unfortunately. What you're going to learn
Speaker 1: from my guest today, Dr Stephanie Fabian, is that medical
Speaker 1: doctors are getting less training now in recognizing symptoms of
Speaker 1: perimenopause and menopause. You have to be your own advocate,
Speaker 1: and so I highly recommend starting to learn about this,
Speaker 1: and I'm hoping I'm doing a service for any people
Speaker 1: out there that might be wondering what's going on in
Speaker 1: their forties as they suddenly maybe feel like a teenager again,
Speaker 1: not in the best of ways. And how in our
Speaker 1: ages society where unfortunately, not only do we sort of
Speaker 1: abandon our elders, right, people in their forties and fifties
Speaker 1: now are seen as older in the workplace at least,
Speaker 1: and it can be pretty difficult to want to talk
Speaker 1: about this hormonal change that affects our moods, our anxiety,
Speaker 1: our physical cell that goes on intermittently for seven to
Speaker 1: ten years. And you know, you spend forty weeks in
Speaker 1: your life of your life. That would be great if
Speaker 1: you only had to work forty weeks in your life,
Speaker 1: forty forty hours a week at a job most weeks
Speaker 1: of the year. Well, you're going to run into having
Speaker 1: your perimenopausal symptoms at work and you need special kinds
Speaker 1: of relief. Usually these things might involve time or change
Speaker 1: of environment within the workplace, and it can be pretty
Speaker 1: scary to talk about because we don't want to be
Speaker 1: seen as not being assets to the workplace at our age,
Speaker 1: because obviously we are. So there's that kind of anxiety.
Speaker 1: I mean, even if you don't physically start getting panic
Speaker 1: attacks when you're in perimenopause, there is a lot that
Speaker 1: affects your brain and emotional health when you're going through
Speaker 1: such a big physical change. And serotonin is mildly connected
Speaker 1: to estrogen as well, so when that starts to change,
Speaker 1: it does affect our serotonin, not as much as I
Speaker 1: thought it did actually in Ductor Bobby and will take
Speaker 1: us through that. But yeah, So this is the second
Speaker 1: talk that that people have h a need for in
Speaker 1: their life. The first one is you know about getting
Speaker 1: your period, and then the second one is about the
Speaker 1: years and years it takes for your body to go
Speaker 1: through what it needs to go through for your period
Speaker 1: to stop. And it's not simple and it's not quick,
Speaker 1: And it might be a great episode for you to
Speaker 1: listen to, even if this isn't something you're going to
Speaker 1: be going through, but it might help you understand the
Speaker 1: struggle that maybe people you work with, howe, or people
Speaker 1: in your family or friends of yours, or anyone you
Speaker 1: know in this age range. So there is hope of course,
Speaker 1: But I think what I took most from my talk
Speaker 1: with Dr Stephanie is we really have to be our
Speaker 1: own advocate, and we cannot think that we are crazy
Speaker 1: and that this is in our head. We have to
Speaker 1: learn as much as we can about what happens during
Speaker 1: paramount of pause, both physically and emotionally and mentally into
Speaker 1: our brain. And we can't let doctors tell us that, oh,
Speaker 1: it can't possibly be happening because they're not trained in this.
Speaker 1: So get yourself. Um, I don't know I was gonna say.
Speaker 1: I don't know what I was going to say. To
Speaker 1: be honest, get yourself what get yourself this episode so
Speaker 1: that you can start to learn something about everything that
Speaker 1: you might be going through or will go through someday
Speaker 1: if you're lucky enough to hit that age. So again,
Speaker 1: my guest today is Dr Stephanie Fabian. She is a
Speaker 1: clinician who has practiced in the Women's Health clinic at
Speaker 1: Mayo Clinic for over ten years and has evaluated and
Speaker 1: treated women with menopausal, hormonal and other health concerns. Relating
Speaker 1: to that, she has a broad interest in women's health
Speaker 1: and she is the direct dirt for the North American
Speaker 1: Menopause Society. Again, the link to that will be in
Speaker 1: the show notes. And as the Penny and Bill George
Speaker 1: director for the Mayo Clinics Center for Women's Health, today
Speaker 1: we're talking about some of the things in her book
Speaker 1: called The Menopause Solution, which came out in she said
Speaker 1: there is a new version that should be coming out
Speaker 1: this year, and you know, will I will say there
Speaker 1: is hope. But again, like with any anxiety solution, it
Speaker 1: seems as though it's the answers you've heard before, you know,
Speaker 1: taking care of your health by making sure you're putting
Speaker 1: healthy food into your body, cutting down on alcohol, if
Speaker 1: not eliminating it, exercise, meditation, medication as needed, therapy, mindfulness, sleep.
Speaker 1: But there are a lot of different stressors that can
Speaker 1: affect someone in perimenopause, and an attitude shift is kind
Speaker 1: of needed as well, which is that this isn't really
Speaker 1: something to dread happening. It's just something to be prepared for.
Speaker 1: And unfortunately, it seems like there aren't a lot of
Speaker 1: people out there that are helping us prepare. So I'm
Speaker 1: hoping I can be a helpful voice in that lack
Speaker 1: of voices, and hopefully this episode will give you enough
Speaker 1: bread crumbs to find your way to how you want
Speaker 1: to handle your paramount of pause. And again, you know,
Speaker 1: all of the solutions to this are simple, they're not
Speaker 1: necessarily easy. Right, when we take care of our brain
Speaker 1: health or mental health or emotional health, whatever you want
Speaker 1: to call it, we know what to do, and sometimes
Speaker 1: we just don't want to do it. Whether it's our
Speaker 1: depression that's making us lack of the motivation, or a
Speaker 1: self esteem issue that says, you know, when we're really
Speaker 1: not worth taking the time to take care of ourselves,
Speaker 1: or the a d h D which affects our executive
Speaker 1: brain function. There are so many reasons why people don't
Speaker 1: get started on taking care of their brain, emotional, mental health,
Speaker 1: and I think there's a lot of times I can
Speaker 1: get tricked by is to thinking, Okay, I hope this
Speaker 1: episode gives like the definitive number one answer for people,
Speaker 1: and it's like, there isn't one, right. It's a combination
Speaker 1: of finding out what works best for you, but we're
Speaker 1: probably always going to be picking from the same bag
Speaker 1: of tricks. And it's not because you know, no one
Speaker 1: knows what the solution is. These are the solutions, but Again,
Speaker 1: they're simple, but not easy. That's what makes them so
Speaker 1: difficult to implement sometimes because again, the mental health that
Speaker 1: we're trying to take care of can sometimes get in
Speaker 1: our own way from even starting. So again, I hope
Speaker 1: you enjoy our conversation about perrymnopause, and I'll see it
Speaker 1: on the flip side. We're going to talk about perrymnopause,
Speaker 1: menopause and the anxiety, grief moods that accompany it. But
Speaker 1: you know, before we get into that, i'd love to
Speaker 1: chat with you just what the basics are. What what
Speaker 1: is perrymnopause? What is menopause? Yeah, I mean, that's such
Speaker 1: a great question. And I've said many times that we
Speaker 1: get the talk when we're about to start our periods,
Speaker 1: but nobody gives you the talk when you're about to
Speaker 1: stop your periods. And there are a number of reasons
Speaker 1: for that, UM, including that the timing is variable for
Speaker 1: for many women, and so we there's no set time
Speaker 1: like your thirty five years of age. You need to
Speaker 1: get the talk now. So and UM providers aren't really
Speaker 1: comfortable UM giving the talk, which is another major issue
Speaker 1: we can talk about. But let's talk about definitions here.
Speaker 1: So first of all, starting with the easy one, relatively
Speaker 1: easy anyway, menopause is defined as no period for a year,
Speaker 1: and that's with it without any manipulation. So you have
Speaker 1: a uterus and you would have been menstruating otherwise, and
Speaker 1: you haven't had an endometrial ablation, and you don't have
Speaker 1: an I U D that would make you stop bleeding,
Speaker 1: and you're not on a birth control bill that would
Speaker 1: make you stop bleeding. So without all those caveats aside
Speaker 1: nature taking its course, it's no period for a year. UM.
Speaker 1: The mean age in the United States is around the
Speaker 1: age of fifty two UM, but anything after the age
Speaker 1: of forty five is considered normal, and about us are
Speaker 1: done by the age of fifty five. So when you
Speaker 1: back it up, what are the stages they get you
Speaker 1: to menopause? And we call that the menopause transition and
Speaker 1: the time leading up to the last menstrual period. And
Speaker 1: you don't actually know it's the last menstrual period until
Speaker 1: it's been a whole year, right, so you're actually we
Speaker 1: sort of call it perimenopause until you've been a year
Speaker 1: with no period, when in fact you were menopausal when
Speaker 1: you had that last period. Right. So that's why this
Speaker 1: definition gets a little gray and fuzzy in there. Now
Speaker 1: that time leading up to menopause. Perimenopause can last for
Speaker 1: several years, and it can be when your periods start
Speaker 1: to get a little bit of regular um, And it
Speaker 1: can be really subtle at first. It may be you
Speaker 1: know it's off by three or four days, or your
Speaker 1: periods are getting shorter or longer, or they're getting closer
Speaker 1: together for their part, So the variation can be pretty
Speaker 1: much anyway. Um. And then you can occasionally miss a
Speaker 1: period and you feel like you might be in menopause
Speaker 1: then because you could have hot flashes and nights west
Speaker 1: and sleep disturbance in your mood is crazy. And then
Speaker 1: it all just kicks back in again for a while.
Speaker 1: And I had a male colleague once described this time
Speaker 1: frame as like a boat motor sputtering, and I went, oh,
Speaker 1: dear God, that is like such a classic male description
Speaker 1: for a female reproductive stage. And I was going, darn it.
Speaker 1: He's kind of right, you know. So people have described
Speaker 1: it as kind of like a um, a candle flickering
Speaker 1: or fluttering, and I usually just say, look, it's not
Speaker 1: like a light switch. You don't just flip it off
Speaker 1: in your and your over stopped working one day. They
Speaker 1: really do kind of come in and go out for
Speaker 1: a little a little bit of time, and you might
Speaker 1: blame it on one thing or another, like I got
Speaker 1: sick and you know that I didn't have a period
Speaker 1: for a couple of months, which can happen um or
Speaker 1: you get particularly stressed and you're not sleeping in your
Speaker 1: period stopped for a couple of months, and then they
Speaker 1: kick back in. So it's a very rocky time frame
Speaker 1: for a lot of women because it's so unpredictable in
Speaker 1: what your hormones are doing, and until things sort of
Speaker 1: settle out post menopause, it can be pretty disruptive. And
Speaker 1: so when someone has gone one year without menstruating and
Speaker 1: so now they I guess it would say in menopause,
Speaker 1: But I guess we don't say in menopause after that year, right,
Speaker 1: do we say post menopausele or something or that's a
Speaker 1: great question. So some people just say you're in menopause
Speaker 1: um or you are post menopausal for the rest of
Speaker 1: your life. So so I think either could be accurate.
Speaker 1: You are you're technically in menopause or post menopausele either
Speaker 1: is fine, and for me, I'm in I'm calling what
Speaker 1: I'm in perimenopause, but I am having hot flashes, the
Speaker 1: mood swings. If they're not perimenopause, then I, you know,
Speaker 1: maybe they should just lock me up and throw away
Speaker 1: the key because I've gone insane. But like it has
Speaker 1: to be. But I also have a d h D
Speaker 1: and I also have depressions, So but I know those
Speaker 1: two um bedfellows. This feels different because it's so intermittent,
Speaker 1: and it's there's a lot mixed in with it. And
Speaker 1: so do I sound like I'm in perimenopause or am I?
Speaker 1: Am I experiencing something else? You very likely are in perimenopause,
Speaker 1: just from your age alone and your description of your symptoms.
Speaker 1: So it just seems like estrogen is a I don't
Speaker 1: know how to put it, a beast in terms of
Speaker 1: there's too much, there's too little it. How are we
Speaker 1: having the same symptoms with different levels of am I
Speaker 1: making sense? Like sometimes we have too much, sometimes we
Speaker 1: have too little. Why do they produce a similar symptoms?
Speaker 1: I think it's the the changes in estrogen levels that
Speaker 1: cause the biggest issues. Um, So what happens in perimenopause
Speaker 1: is your brain is trying to tell your ovaries, hey,
Speaker 1: not here, and from your ovaries, where are you, and
Speaker 1: they put out these brain chemicals that stimulate the ovaries
Speaker 1: a lot to say, you know, come on, let's hear
Speaker 1: from you. And then the ovaries overshoot sometimes and so
Speaker 1: you can actually get higher estrogen levels than you've ever
Speaker 1: had in the rest of your reproductive lifespan because your
Speaker 1: brain is over stimulating your ovaries to get them to work,
Speaker 1: and eventually they don't respond, which is why you know,
Speaker 1: it kind of dies out eventually. But so so you're right,
Speaker 1: you can have these highly variable estrogen levels and and
Speaker 1: you know, sometimes when your estrogen levels or high, you
Speaker 1: might feel great. Other women might feel breast pain, um
Speaker 1: when they're super high. But when they start to fall
Speaker 1: is you know, if you're going from super high back
Speaker 1: to zero, that's a big shift. And and so that's
Speaker 1: a night sweat, hot flash, irritability, can't sleep, you know,
Speaker 1: the whole thing. Um when that when that shift is occurring.
Speaker 1: So it's more the variability. Although high levels and low
Speaker 1: levels can cause symptoms, it's more the variability and the
Speaker 1: changing that is so disruptive to women. And is there
Speaker 1: a tie in I've I thought, I read this that
Speaker 1: serotonin is affected by estrogen, and so in that sense,
Speaker 1: if the estrogen is being erratic, so goes our serotonin levels. Well, yeah,
Speaker 1: it's not that simplistic. So the neurotransmitters are definitely connected,
Speaker 1: and and serotonin can be impacted during all of this.
Speaker 1: But serotonin levels can be impacted by a lot of things,
Speaker 1: including what's going on in your life, you know, and
Speaker 1: whether you're getting enough sleep and exercise and everything else.
Speaker 1: So so so many things impact those those neurotransmitters, estrogen
Speaker 1: being just the one. Anxiety bites will be right back
Speaker 1: after a quick little message from one of our sponsors.
Speaker 1: What I thought was so interesting, And I'll get to
Speaker 1: this chapter in a second chapter five Moods and you.
Speaker 1: But there was a mention of grief, and you mentioned
Speaker 1: grief in the part of your book where you talk
Speaker 1: about maybe going through a premature amount of pause. But
Speaker 1: I feel like, even at the right time men of pause,
Speaker 1: there must be grief. I never really thought about that
Speaker 1: because I don't want to have children, and so I'm
Speaker 1: not conflicted about not being able to reproduce anymore. And
Speaker 1: but of course people who didn't have children, there may
Speaker 1: be some grief and then even grief about getting older.
Speaker 1: I mean, it's it's very strange. I mean, I feel young,
Speaker 1: I look young, and my body is doing something that
Speaker 1: I saw episodes of The Golden Girls about when I
Speaker 1: was a kid, you know, so it seems it feels. Um,
Speaker 1: I'm not in the part yet where it feels liberating.
Speaker 1: I'm I'm in the part where I don't want this
Speaker 1: to change. I don't mind getting a period every month.
Speaker 1: I don't mind feeling the way I felt since I
Speaker 1: was thirteen, you know, I I'm in grief. I think, yeah,
Speaker 1: I think that's an interesting concept. And and in talking
Speaker 1: with women, it's not a universal experience in my in
Speaker 1: my experience, it's it's something that some women have have
Speaker 1: to go through, and some women are really just yeah,
Speaker 1: let it be gone. I'm really happy to move on.
Speaker 1: But I think I think you're right. I think there
Speaker 1: is something about leaving that reproductive phase, if you will, Um,
Speaker 1: it's somehow sad. You know, you're saying goodbye to something,
Speaker 1: even if you don't really care and don't want to
Speaker 1: have a baby, right um, but you're you're leaving it behind.
Speaker 1: And I think it also is associated with agism too.
Speaker 1: You're entering a time where you can't anymore. And I
Speaker 1: think more and more women really don't want to be
Speaker 1: defined by their reproductive status, like I can or can't
Speaker 1: have a baby. I mean, but that still is somehow
Speaker 1: a gateway that we all passed through. That that I
Speaker 1: think a lot of women struggle with. You know, am
Speaker 1: I am I somehow not worth anything to society anymore
Speaker 1: because I don't have eggs being produced, you know, and
Speaker 1: released every month. And you know, so many people know
Speaker 1: so little about menopause that honestly they have no I mean,
Speaker 1: I know people that I didn't want to vote for
Speaker 1: Hillary Clinton because they were worried what she would be
Speaker 1: like on her period. I mean, I'm really just trying
Speaker 1: to be funny here, but it is funny. I'm half
Speaker 1: serious that we worry about that because most people don't
Speaker 1: even know, you know, what it means that nobody would
Speaker 1: ever know I'm past my child bearing years if they
Speaker 1: wanted to be ages um, because they would they have
Speaker 1: no idea what age that is, you know, right? I
Speaker 1: know I just read something that I think in Sweden
Speaker 1: women are going to have time off for menstrual situations
Speaker 1: and they specifically in the article we're talking about period
Speaker 1: pain and I'm thinking, God that you know the seven
Speaker 1: to nine to ten years of perimenopause through menopause were
Speaker 1: these symptoms come in. To be in a workplace is
Speaker 1: really hard, and I think that leads to a lot
Speaker 1: of anxiety to like you have to hide this thing
Speaker 1: you're going through, which actually can show up on your
Speaker 1: face when you're sweating. Yeah, that's exactly right. And it's
Speaker 1: interesting you bring this up because this conversation about menopause
Speaker 1: in the workplace is really taking off, and I think
Speaker 1: that's a good thing. Europe's a little bit ahead of
Speaker 1: us there and that um they're really pushing workplace policies
Speaker 1: for menopause. And I think we are now where we
Speaker 1: were with pregnancy and lactation about thirty years ago. We're
Speaker 1: starting to say, hey, we should have these conversations about
Speaker 1: what this means for women in the workplace. And where
Speaker 1: I work at Mayo Clinic, we're in the process of
Speaker 1: developing a work place policy um around menopause, because you're right,
Speaker 1: it is it can be disruptive. It can go on
Speaker 1: for a long time. It can be anything from I'm
Speaker 1: in the middle of a business meeting and I break
Speaker 1: out in a sweat. I start to have, you know,
Speaker 1: pit stains, and people are wondering what's wrong with me?
Speaker 1: And I'm having trouble word finding. And some of the
Speaker 1: women that I that I see are like, I can't
Speaker 1: have this happen. You know, I'm an executive, I'm the CEO,
Speaker 1: and and they're like, I can't have this happen. You
Speaker 1: have to make this stop, or I'm not sleeping. And
Speaker 1: I had one woman that literally said she sweated out
Speaker 1: her mattress to the point where it molded. Oh my god,
Speaker 1: I'm like, wow, okay, all right, So those are some
Speaker 1: serious nights. What's going on? Right? And and she had
Speaker 1: to have her husband come pick her up at work
Speaker 1: at the end of the day because she couldn't drive
Speaker 1: home without falling asleep. So so some of these symptoms
Speaker 1: are incredibly disruptive, and it's hard to function during the
Speaker 1: day when you're not sleep being at night, or when
Speaker 1: you're so irritable you want to rip your spouse's eyes
Speaker 1: out um or you know, there's there's there's a lot
Speaker 1: going on, UM, and I think we need to have
Speaker 1: conversations about one, educating people about what this time is,
Speaker 1: and we should be able to talk about it. And
Speaker 1: it shouldn't be an age is discussion, right, it should
Speaker 1: be UM, a normal conversation. This is a normal phase
Speaker 1: of life. This is not a disease. A hundred percent
Speaker 1: of women are going to pass through the stage if
Speaker 1: they're lucky enough to get that far right, So we
Speaker 1: need to be able to have the conversations and and
Speaker 1: not have it turn into, UM, a reason for discrimination,
Speaker 1: which that's definitely afraid of me too. And I'm getting
Speaker 1: anxiety as you're saying it because I'm like, well, you
Speaker 1: know what, never mind, No, let's not have the conversation.
Speaker 1: I don't want anyone to know because they're going to
Speaker 1: think I can't do my job as well. And but
Speaker 1: it's true, how do we you know? In one way,
Speaker 1: it's nice to talk to other people who get it
Speaker 1: and say I really can't find my words right now.
Speaker 1: You're having, you know, jokingly, people will say things like that,
Speaker 1: I'm having a senior moment where you're trying to say
Speaker 1: can you get me that? Oh, go, what's that thing
Speaker 1: we write on it, it's um, you know, um paper paper,
Speaker 1: give me the you know, we have those moments. But
Speaker 1: why wouldn't I mean, I have to be totally honest.
Speaker 1: Why wouldn't would discriminate? You know. So I'm very anxious
Speaker 1: for us to have this conversation because how is it
Speaker 1: not going to backfire? What do we do? I'm very
Speaker 1: anxious too, and I have to. I think we have
Speaker 1: to be very clear about what we're asking for in
Speaker 1: the workplace. And I actually, you know, as as Uh,
Speaker 1: a medical director of the North American Menopause Society, we
Speaker 1: had this conversation at our last national meeting, and I'm like,
Speaker 1: what is it we are asking for? Is it a
Speaker 1: cold room at work? So it's amazing. I mean, you know, Frazer,
Speaker 1: you have a lactation room, you have a cold room.
Speaker 1: I mean, what is it? What is it that we're
Speaker 1: asking for? Because I think when you start talking about
Speaker 1: workplace accommodation, that gets very sticky. And so you know,
Speaker 1: if it's being able to take your jacket off in
Speaker 1: a corporate environment for the five minutes when you're having
Speaker 1: a hot flash, I get it. But I also think
Speaker 1: we need to flip this conversation and look at what's
Speaker 1: happened with menopause management in the last twenty years, and
Speaker 1: that is, we used to have about us women using
Speaker 1: hormone therapy to treat menopause symptoms before two thou two
Speaker 1: when the Women's Health Initiative study came out, and since then,
Speaker 1: hormone therapy US rates have dropped to orders of magnitude
Speaker 1: like four to six percent now, and so we have
Speaker 1: a lot of undertreated women out there. And so my
Speaker 1: thought is we need to educate women. We need to
Speaker 1: educate their healthcare providers. There are treatment options out there
Speaker 1: that are available that are safe and effective that we're
Speaker 1: not using. And so is it so much that we
Speaker 1: need to accommodate someone at work, Yes, maybe, but we
Speaker 1: need to offer effective therapy for these symptoms so that
Speaker 1: women can keep doing their job and get the promotion
Speaker 1: and take the next job if they so choose to do.
Speaker 1: Because think about the lost human capital for women not
Speaker 1: being fully at their peak form during this time of
Speaker 1: their life where they are at their peak form. Right. Well, well,
Speaker 1: that's what I wanted to bring up, is that I
Speaker 1: honestly would rather have me now in the workforce and
Speaker 1: me at and you know, I'm smarter, I'm more capable,
Speaker 1: I'm whatever. I'm just much energy. But you know, yeah,
Speaker 1: there are moments where I may forget a word and
Speaker 1: I may be physically uncomfortable, but it really doesn't affect
Speaker 1: my performance. I am not actually experiencing a moment where
Speaker 1: my intelligence levels are dropping. And I feel like being
Speaker 1: able to watch someone maybe forget a word sometimes or
Speaker 1: be a little spacey um, be a little physically uncomfortable
Speaker 1: is not indicative of their job performance. You know. I
Speaker 1: think a lot of companies started doing this, and then
Speaker 1: I think the pandemic disrupted a lot of that um
Speaker 1: extra stuff that we bring into the office. Right, maybe
Speaker 1: there's a yoga room, a meditation room, you know, for
Speaker 1: everybody of all genders and walks of life. Maybe there
Speaker 1: are these sort of mental health break rooms things like that.
Speaker 1: And you know, this notion of let's make work as
Speaker 1: comfortable as home, and then the pandemic hits. I think
Speaker 1: it disrupts it and people are like, oh, I'm just
Speaker 1: gonna work from home. Right, I think you're right. I
Speaker 1: think COVID may have helped us out in many ways
Speaker 1: because it's accelerated, um, having us think outside the box
Speaker 1: in terms of what work looks like and where work
Speaker 1: is and how we're getting it done. And maybe, um,
Speaker 1: it's much more flexible now and it can be on
Speaker 1: people's own time. So I think we may have moved
Speaker 1: ourselves in a positive way just because of the COVID pandemic.
Speaker 1: And you know, now we have more access to virtual
Speaker 1: care than we ever have before, which is making it
Speaker 1: possible for a lot of women to get menopause consultations
Speaker 1: virtually with experts that they might not have had access
Speaker 1: to before. So I think even for the care aspect,
Speaker 1: it's made things a lot easier to Oh, that's great, Right,
Speaker 1: you could talk to someone outside of your state. That's right.
Speaker 1: But you know, it would be nice if you could
Speaker 1: just without being questioned, you know, like a privacy thing.
Speaker 1: Just work from home when you feel you need to.
Speaker 1: I think that helps a lot too, so you can
Speaker 1: sweat and privacy and when you're not needed, take a nap. Um.
Speaker 1: But again, every time I say this, I get this
Speaker 1: cringe and twinge of anxiety of just like, oh god,
Speaker 1: it seems like we're so it seems like we're too much,
Speaker 1: you know, but I do think this kind of care
Speaker 1: could benefit men as well or people that don't go
Speaker 1: through menopause, you know, absolutely, And some women may not
Speaker 1: have that option if they're you know, factory workers for example,
Speaker 1: you can't opt to work from home, right, So I
Speaker 1: think we need to think about different work environments too.
Speaker 1: And even those of us who are you know, seeing patients.
Speaker 1: Think of the nurses in the emergency room, they don't
Speaker 1: have the option to say, Hey, I think I'm gonna
Speaker 1: work from home today. So uh so, I think some
Speaker 1: jobs are are more amenable to that kind of flexibility,
Speaker 1: others are not, and we have to figure out how to. Again,
Speaker 1: I think a lot of this is education and a
Speaker 1: lot of it is not making it a joke, Like
Speaker 1: why is menopause always the joke at the water cooler
Speaker 1: um where you get it conjures images of angry, red,
Speaker 1: sweaty women, right um. So, so I think we need
Speaker 1: to sort of break past that um to where you know,
Speaker 1: when women are bringing it up, it's not it's not
Speaker 1: automatically going to be a it's a joke. We'll be
Speaker 1: right back. You mentioned in your book, uh your chapter
Speaker 1: called moods, and you I mean it's so overwhelming to
Speaker 1: me to look at all of the things that happened
Speaker 1: during menopause. You know, you talk about depression. You know,
Speaker 1: someone might be going through depression for the first time.
Speaker 1: And again it's not like somebody died and they might
Speaker 1: have a year of grief, but this again could be
Speaker 1: seven years, ten years. And so we're you know, talking
Speaker 1: about people could take antidepressants, cognitive behavior therapy, managing your stress,
Speaker 1: and it's like there's so much you can do, which
Speaker 1: is great, but it also seems like a lifestyle change,
Speaker 1: like how you've got to add in time in your data,
Speaker 1: meditate every day and stretch. And that, you know, is
Speaker 1: what do you recommend for people that think they're starting
Speaker 1: in on perimenopause. Well, I think you bring up a
Speaker 1: really good point. One. Let's just back up and get
Speaker 1: a bigger picture here, because I think so many women
Speaker 1: in this life phase are taking care of everybody else
Speaker 1: except for themselves, right, So so many people are you know,
Speaker 1: whether it's kids or aging parents, or your next dooring neighbor,
Speaker 1: or your dog or your partner. I mean often you
Speaker 1: are the last person on the list. And so part
Speaker 1: of this I think is, hey, thanks change in perimenopause,
Speaker 1: and as you go through the menopause transition, your own
Speaker 1: health risk may change. That's a time when whereas women,
Speaker 1: our cardiovascular risk goes up as we go through the
Speaker 1: menopause transition. And so it's like we should like take
Speaker 1: stock of where are we Are we taking care of ourselves?
Speaker 1: Are we exercising like we should? Are we sleeping like
Speaker 1: we should? Are we managing stress like we should? And
Speaker 1: so I think rather than just looking at it is
Speaker 1: oh no, all these bad things are going to happen
Speaker 1: to me, I think it's take stock and am I
Speaker 1: really taking care of myself? And the way that's going
Speaker 1: to set me up to be healthy for the rest
Speaker 1: of my life is more the way we should be
Speaker 1: looking at it. And you know, I really have to
Speaker 1: sit some women down and go, you know how when
Speaker 1: you're in the airline and they go put the oxygen
Speaker 1: mask on yourself before you put it on the person
Speaker 1: next to you when the plane is crashing, Well, that's
Speaker 1: that's this. I mean, you have got to take care
Speaker 1: of yourself first, so you can't take care of all
Speaker 1: these other people in your life that need you. So
Speaker 1: so I think that's the first message that it's not
Speaker 1: selfish to take care of yourself. No, No, it's like
Speaker 1: life saving and it can make your quality of life
Speaker 1: so so much better. If you take the time and
Speaker 1: go exercise like you know you're supposed to but you
Speaker 1: just don't. You will feel better, you will sleep better,
Speaker 1: you will have better eating habits. I mean, it's all
Speaker 1: kind of snowballs in the right direction if you just
Speaker 1: start taking care of yourself. So instead of looking at
Speaker 1: this like, oh, this is going to be terrible, what
Speaker 1: do I do? And you know, how do I manage it? Uh?
Speaker 1: The funny thing was when when I wrote that menopause
Speaker 1: book back in and by the by the way, the
Speaker 1: second version is about to come out. I'm excited and
Speaker 1: the Spring of twenty three. But when I was writing that,
Speaker 1: my mother said, why are you writing a menopause book?
Speaker 1: And I was like, uh, I go, well, I never
Speaker 1: asked you, mom, what was your experience like with menopause?
Speaker 1: And she said, well, I think I might have had
Speaker 1: a hot flash once at a cocktail party when I
Speaker 1: had a glass of wine. And I went, wow, okay,
Speaker 1: all right, lucky her is she she's she just lying
Speaker 1: or she just so I'm like, you know, revisionist memory here.
Speaker 1: I don't know if that was really her experience, but
Speaker 1: she was like, this is such a non issue. I
Speaker 1: don't even understand why you're writing a book about it.
Speaker 1: So so some women, I mean, I think that's fair
Speaker 1: to put out there, really stop their periods and that
Speaker 1: is the end of the story. And they got nothing,
Speaker 1: I mean, like no issues, and so God bless them.
Speaker 1: That's not the majority of us, um, and most of
Speaker 1: us are going to have something. And I think rather
Speaker 1: than just dreading the whole thing, you may or you
Speaker 1: may not get some issues as as you go through.
Speaker 1: And you were talking specifically about mood. I think for
Speaker 1: those women that are the ones who need to be
Speaker 1: just a little aware about what is happening are the
Speaker 1: ones that have had mood issues in the past. So
Speaker 1: if you've had a major depression in the past, or
Speaker 1: if you've had especially those hormonally related mood issues like
Speaker 1: PMS symptoms or like postpartum baby blues or a real
Speaker 1: postpartum depression, those are the women that are going to
Speaker 1: tend to struggle when their estrogen levels are falling around menopause.
Speaker 1: Um are those women who had trouble when their estrogen
Speaker 1: levels fell in the past. So if you've had that
Speaker 1: happen to you before, just be on the alert that
Speaker 1: this could happen again. And so what worked before typically
Speaker 1: will work again. So if you were on an antidepressant
Speaker 1: before and it was great and it worked for you,
Speaker 1: that's where you need to go. Or kindnited behavioral therapy
Speaker 1: is always a great adjunct to anything, and sometimes it's
Speaker 1: enough on its own, but sometimes needs to be added
Speaker 1: to an antidepressant for those women who are also having
Speaker 1: hot flashes and night sweats that that time right around
Speaker 1: on perimenopause. An early post menopause hormone therapy can actually
Speaker 1: be very good for mood too. If you're much past
Speaker 1: those first couple of years after menopause, hormones are not
Speaker 1: going to help you with your mood, so so we
Speaker 1: need to think about something else after that. But sometimes
Speaker 1: that combination of hormone therapy for symptoms and an antidepressant
Speaker 1: works great too. So so there's a number of things
Speaker 1: that women can do, but I think being proactive and
Speaker 1: starting with the healthy lifestyle stuff even before you get
Speaker 1: there is a great place to start. I think it's
Speaker 1: so great because you know, I've had anxiety, depression, a
Speaker 1: d H d H in varying degrees my whole life,
Speaker 1: and weirdly, it's always been kind of a health conscious person.
Speaker 1: And so I feel very lucky that I was starting
Speaker 1: to do all of these things since it was my twenties.
Speaker 1: So I have a you know, five to seventies a week,
Speaker 1: very gentle workout life, you know, bloodies and bloods of walking,
Speaker 1: and uh, I have a therapist, and I stretch and
Speaker 1: e well, do yoga and meditate and spiritual life like
Speaker 1: all the things. And I think what you said just
Speaker 1: helped calm me. And I did go back and into
Speaker 1: the presence last year because I was anticipating, you know,
Speaker 1: maybe something's going on here. It was hard to start
Speaker 1: going through this during the lockdown because I was like,
Speaker 1: it's this lockdown as this periamoyu. But so what you
Speaker 1: were saying is like, instead of dreading it, because I
Speaker 1: think that was happening to me, I'm like, I'm already
Speaker 1: doing all the things, and so there's nothing i can do,
Speaker 1: you know, And it's like, yeah, no, you're doing all
Speaker 1: the things that you might have a lesser you might be.
Speaker 1: In other words, what I'm experiencing now. It doesn't mean
Speaker 1: that it's going to keep getting worse and worse and
Speaker 1: worse and worse. This might be how it is. It
Speaker 1: might stay here for a few years, but this might
Speaker 1: be it, which is it's okay, I can I can
Speaker 1: handle this now. My guess is you this is probably
Speaker 1: as bad as it's gonna get. Right, let's hope. Um
Speaker 1: you're already you said doing the things that you know
Speaker 1: will help and that have helped you in the past.
Speaker 1: And so I think that's a key for women is
Speaker 1: just knowing the tools in your toolbox and making sure
Speaker 1: you have those available to you, that you can employ
Speaker 1: them when you need them, right, And so I think
Speaker 1: not not every woman has a great toolbox, so setting
Speaker 1: that up in advance is key. Well, one of the
Speaker 1: tools that I think is being taken on of our toolbox,
Speaker 1: not that it was ever that helpful anyways, but it
Speaker 1: is nice to have a glass of wine. And as
Speaker 1: your mom said, she had one after a glass of
Speaker 1: wine at a cocktail party. It's I think for women
Speaker 1: out there, if your relaxation at night is a glass
Speaker 1: of wine, you might really want to find something else
Speaker 1: for now that you can do because it does. Alcohol
Speaker 1: does affect it. Yeah, you're exactly right. Um. And you know,
Speaker 1: one little warning is if you're using that glass of
Speaker 1: wine to relax after a hard days of work, it's
Speaker 1: probably not a great idea. Men of us are not you.
Speaker 1: You're used alcohol to relax, which is a warning sign
Speaker 1: right there. Um, And and you're right, um. Alcohol can
Speaker 1: make you flash. So can using a hair dryer. So
Speaker 1: can drinking a warm beverage. So can eating that. Using
Speaker 1: a hair dryer and drinking a warm beverage. Oh wow,
Speaker 1: caffeine can make you flash. And so so there's a
Speaker 1: number of triggers. And and you know, I have women going,
Speaker 1: oh my god, you mean I can't have a morning
Speaker 1: cup of coffee, And I'm like, calm down, you can.
Speaker 1: It might you might have a hot flasher too, But
Speaker 1: it's life, right, I mean, So have your cup of coffee,
Speaker 1: have a couple of flashes, go dry your hair. You're
Speaker 1: gonna flash again, you know. I mean, it's all right,
Speaker 1: it's not the end of the world. And it doesn't
Speaker 1: mean you can't have a cup of coffee ever, or
Speaker 1: a glass of wine ever. But the glass of wine
Speaker 1: can impact your sleep. And let's just talk a little
Speaker 1: bit more about that you can impact your sleep. So
Speaker 1: you think it's great, it's going to put you to sleep,
Speaker 1: but then it makes you have less effective sleep, less
Speaker 1: efficient sleep, and so you're not sleeping as well throughout
Speaker 1: the night. And also alcohol is a depressant, so if
Speaker 1: you're using it to calm down, but you're already having
Speaker 1: mood issues too, it's probably not your best bet, right.
Speaker 1: UM So I think probably better to go take a
Speaker 1: walk around the block after you go have dinner and
Speaker 1: kind of you know, settle yourself and maybe do a
Speaker 1: little meditative um breathing, etcetera. Is a much better way
Speaker 1: to go than the glass of wine. We'll continue the
Speaker 1: interview on the flip side of a quick message from
Speaker 1: our sponsors. You mentioned in your book too that in
Speaker 1: addition to sleeping issues, um one of the stress the
Speaker 1: ways that stress can affect women in very menumus menopauses
Speaker 1: control issues. And I just wanted you to speak more
Speaker 1: and that you may worry that you have no control
Speaker 1: or feel the need to exert too much control. I
Speaker 1: feel like that's such a huge thing that I never
Speaker 1: hear anyone talk about. Well, I think when women feel
Speaker 1: out of control. They seek to gain more control, right,
Speaker 1: And so I think a lot of women that I
Speaker 1: see in my office feel like they can't control or
Speaker 1: predict things. Whether it's their mood, whether it's weight gain,
Speaker 1: which is so incredibly frustrating to people in midlife um or,
Speaker 1: or whether it's what is going on at work. But
Speaker 1: they feel a little out of control. And so your
Speaker 1: first your first reaction is to try to rain everything
Speaker 1: in too where you have it all under control again.
Speaker 1: And sometimes you know, I mean that's part of getting
Speaker 1: older and letting things go a little bit. Yeah, to
Speaker 1: the dishes have to be all done before you go
Speaker 1: to bed. What's going to happen if they're not? You know,
Speaker 1: what is the worst case scenario of you didn't get
Speaker 1: the last thing on the list done before you go
Speaker 1: to bed. Right, So you start realizing that that the
Speaker 1: world isn't going to fall apart if you don't have
Speaker 1: perfect control all the time. And that goes back to
Speaker 1: one of your solutions is people doing cognitive behavior therapy,
Speaker 1: you know, just learning to reframe their thinking or develop
Speaker 1: better mental habits with because I I have that, I
Speaker 1: have this you know, list making obsession, and and it's
Speaker 1: like irrational, like if things don't get done before bed,
Speaker 1: but I know the best thing for me would be
Speaker 1: to get full eight hours just to go to bed
Speaker 1: and it'll look at well. I've learned that things look
Speaker 1: completely different in the morning. And if it starts looking
Speaker 1: really black, you know, the night before, I'm like, I
Speaker 1: think I just need to go to bed and it'll
Speaker 1: it'll be different in the morning, which is almost always true.
Speaker 1: So and every time I start looking for more control
Speaker 1: and it is now like what is going on in
Speaker 1: your life that you feel like you have to have
Speaker 1: more control. So so that's when the anxiety level is
Speaker 1: higher and you got to pull out the tools in
Speaker 1: your toolbox to try to get your anxiety level down.
Speaker 1: You know. One of the best things for giving up
Speaker 1: control for me was having three daughters. Um, so there
Speaker 1: you have no control with three daughters and so uh
Speaker 1: so that was probably one of the best sercises and
Speaker 1: letting things go um and that has continued throughout their
Speaker 1: lives too. If they're now in their early twenties. Well,
Speaker 1: it's it's like what you're saying is everything I talked
Speaker 1: about on every episode of this podcast. No matter what
Speaker 1: the subject is, anxious people want control, and there are
Speaker 1: things we have control over, but we don't want to
Speaker 1: do those things because they're not as fun. Yeah yeah,
Speaker 1: I know I can exercise it and I can sleep,
Speaker 1: but we want control everythings were never going to have.
Speaker 1: And I think if you're like that anyway, probably does
Speaker 1: get exacerbated during this time, especially because as we talked
Speaker 1: about at the beginning, it's a little bit like, well,
Speaker 1: here you are, you know, entering the second phase of
Speaker 1: your life. And I think you're right, it can be
Speaker 1: this happy lesson, this gift of a time of really
Speaker 1: learning how to let go, especially we haven't had the
Speaker 1: opportunity to really do that before, you know, in any
Speaker 1: big way. Um is just saying yeah, this is gonna happen.
Speaker 1: This is what it looks like. Yep, I am getting older.
Speaker 1: Hey maybe I'm wrong about how bad it's going to
Speaker 1: be in terms of post menopause whatever, you know, like
Speaker 1: this is it's it's like you said earlier, we're lucky
Speaker 1: to even be here at this at this point. So well,
Speaker 1: I think it also gives you a time to step
Speaker 1: back and prioritize what's really important. And I have this
Speaker 1: conversation with my patients all the time how to say no,
Speaker 1: so and I've struggled with that myself, but I think
Speaker 1: this is part of the control thing too. It's really
Speaker 1: okay to say no, and it's empowering to say no,
Speaker 1: like you don't have to do everything you're asked to
Speaker 1: do or invited to do, or even if it's an honor,
Speaker 1: should you really do it? And is it in your
Speaker 1: best interest to do it? And so I think, um,
Speaker 1: figuring out how to have on your plate what you
Speaker 1: want on your plate and and get the other stuff
Speaker 1: off is just so important and liberating. I love that.
Speaker 1: I love that you brought that up, that that's so
Speaker 1: important when we're going through a massive change. But I
Speaker 1: think it's is so important anyway, especially for people who
Speaker 1: have anxiety that people don't say no for many reasons.
Speaker 1: One is like they don't even know they have the option.
Speaker 1: I think a lot of people with any kind of
Speaker 1: self esteem issue just think, who am I did not
Speaker 1: do this, like you said, especially if it's something that well,
Speaker 1: this is an honor, I should say yes, I'm being
Speaker 1: asked to speak at this thing, or you know, um,
Speaker 1: I don't know anything like yeah, that's when you said
Speaker 1: that I just felt so relaxed. I can say no
Speaker 1: to things or say, you know, I'm not gonna do
Speaker 1: one thing this week, you know, if it's a social
Speaker 1: event or something, but I really can't do it. It
Speaker 1: doesn't I love that that That is a great way
Speaker 1: to take care of ourselves too. I think for anxiety
Speaker 1: at least, well and then and then think about it
Speaker 1: this way you I mean, I used the yes no
Speaker 1: yes sandwich like yes, that is a really important thing.
Speaker 1: You bring up our project you're talking about or opportunity.
Speaker 1: Um no, Unfortunately I can't do it this time, but
Speaker 1: think of me next time, which is the second yes,
Speaker 1: or I have somebody else in mind for you. So
Speaker 1: it's a good way to actually mentor other people because
Speaker 1: you can give them opportunities and be the sponsor for
Speaker 1: somebody else to open a door. So so I think
Speaker 1: now is that time to embrace what you know. You
Speaker 1: are in the senior position and you can help other
Speaker 1: people and you don't have to take it all on yourself.
Speaker 1: And I still exercising that every day. Well, thank you
Speaker 1: for saying yes to me today. I really appreciate you
Speaker 1: breaking down for us what's really going on inside of
Speaker 1: our our bodies and how how we can look at
Speaker 1: this phase of our lives, and and and do you
Speaker 1: have anything else that I haven't asked you that you'd
Speaker 1: like to let everybody know. Well, I think one of
Speaker 1: the important things is that, um, there are things that
Speaker 1: you can do so so women don't have to suffer
Speaker 1: through this. And I see this again and again and again.
Speaker 1: I didn't know there was anything I could do. You know,
Speaker 1: whether it's the hot flushes and the nights wests, or
Speaker 1: the horrible moods stuff, or not sleeping, well we're vaginal
Speaker 1: dryness or pain with sex, whatever it is, they're suffering
Speaker 1: and they don't really know that there are options out there.
Speaker 1: And so I think the important thing to note is
Speaker 1: there are a lot of options out there, and whether
Speaker 1: you do or don't want to use hormone therapy or
Speaker 1: any other treatment, we've got lots of options. And so,
Speaker 1: you know, just putting in a plug for the North
Speaker 1: American Menopause Society, it's menopause dot org. But there's a
Speaker 1: located provider tab there, so you can actually put in
Speaker 1: your zip code and find somebody who's certified and menopause
Speaker 1: it's in your area. So I think if you're not
Speaker 1: getting answers from your from your local healthcare provider. A
Speaker 1: lot of providers aren't even educated menopause anymore. And we
Speaker 1: actually did a study on this in where we surveyed
Speaker 1: graduating residents across the country from A B G y
Speaker 1: N Family medicine and intral medicine, and none of them
Speaker 1: are receiving more than an hour or so of education
Speaker 1: about menopause during their training programs now and so we
Speaker 1: have a whole bunch of uneducated providers UM with regard
Speaker 1: to menopause management. So I think it's important to when
Speaker 1: you're asking those questions, I understand if you have the
Speaker 1: provider who knows something about it, or if they don't
Speaker 1: feel comfortable with it or don't have that skill set,
Speaker 1: then there are other resources available. That's brilliant. And I
Speaker 1: will tell you I just thought of this. I was having, uh,
Speaker 1: about a year and a half ago, heart palpitations, and
Speaker 1: I know myself very well, and I thought, I think
Speaker 1: this is anxiety. I think this is related to UM,
Speaker 1: you know, having been so isolated during the lockdown. But
Speaker 1: you know, let me just get it checked out, because
Speaker 1: it was it was happening a lot and I went
Speaker 1: to a cardiologist and they were incredible and they really
Speaker 1: found nothing wrong. And once I found nothing wrong, they
Speaker 1: sort of went away. And I thought it might be
Speaker 1: a symptom of paramenopause. I had heard that could be
Speaker 1: and so when I was in the office, I said
Speaker 1: to the cardiologist was a young man. I said, I'm
Speaker 1: really not worried about this. Is want to let you
Speaker 1: know I have a feeling this is paramenopause. And he goes,
Speaker 1: oh yeah, because I said I I'm in parma. Oh
Speaker 1: no you're not, as though I had said I'm a big,
Speaker 1: ugly monster, and he was like cheering me up. And
Speaker 1: I was like, oh no, no no, no, it's not a
Speaker 1: like it's I am like, it's you know, and it's okay, yeah,
Speaker 1: and it's okay. I'm not calling myself old, and it
Speaker 1: was I I changed doctors after that because I was
Speaker 1: just appalled, you know, and yeah, I don't even want
Speaker 1: to say I know. He meant, well, it's it, there's
Speaker 1: no no, he just sends exploding. He thought he thought
Speaker 1: it was a a derogatory statement, right, Yeah, so interesting.
Speaker 1: One more quick point on a study that was recently
Speaker 1: published that I think is so important that I think
Speaker 1: the implications are important. A study that came out in
Speaker 1: menopause last year, and it showed that women even before
Speaker 1: they start to have significant cycle length and regularity, so
Speaker 1: their periods really haven't changed. They have the same symptoms
Speaker 1: as women who are in menopause to the same degree
Speaker 1: and with the same degree of bother and and out
Speaker 1: of the you know, it was like fifty different symptoms.
Speaker 1: Only hot flashes were a little bit less. Everything else
Speaker 1: was about the same. So the sleep disturbance, the mood disturbance,
Speaker 1: the all of the other symptoms of menopause, we're pretty
Speaker 1: much as bothersome before any changes in menstrual cycle length
Speaker 1: occurred as they were in menopuzzle women. And that to
Speaker 1: me was just a big aha moment that that is
Speaker 1: like for all those women that come into their doctor's
Speaker 1: offices and are still having periods and they're saying, I
Speaker 1: have all these symptoms that are going well, you couldn't
Speaker 1: because you still have periods, so you're not there. Um,
Speaker 1: it's so validating to all those women who are reporting
Speaker 1: having these symptoms when they're forty five or forty six
Speaker 1: or forty seven years of age and still having regular periods.
Speaker 1: So I think that just speaks to yes, it's for real. Yes,
Speaker 1: you are experiencing it, You're not making it up, You're
Speaker 1: not crazy. Um. Are there things that we can do
Speaker 1: about it? Absolutely? And you need to you need to
Speaker 1: see somebody if they bother something after you. Hi. I
Speaker 1: hope you enjoyed learning all about what happens to our
Speaker 1: emotional and mood health during Perry menopause. Hopefully you're a
Speaker 1: little better educated and not too scared about when it's
Speaker 1: going to happen to you. But let's look at some
Speaker 1: of the takeaways. So, first of all, just starting relatively easy.
Speaker 1: Menopause is defined as no period for one year, and
Speaker 1: that's without any manipulation such as an I U D
Speaker 1: or a birth control pill. The mean age in the
Speaker 1: United States for hitting menopause is around fifty two, but
Speaker 1: anything after the age of forty five is considered normal.
Speaker 1: The stages that get us to menopause is called Perry menopause,
Speaker 1: and it can last for several years, from seven to
Speaker 1: ten years. Some of the symptoms of Perry men pause
Speaker 1: are hot flashes, night sweats, sleep disturbance, and a crazy mood.
Speaker 1: After you have stopped menstruating for one year and you're
Speaker 1: able to say that you went through menopause, you are
Speaker 1: now considered post menopausal. It is changes in our estrogen
Speaker 1: levels that cause the biggest issues in perimenopause. So sometimes
Speaker 1: our levels can spike, which is because our brain is
Speaker 1: desperately contacting our ovaries and saying where are you, and
Speaker 1: the brain chemicals can over stimulate the ovaries, and that
Speaker 1: leads to higher estrogen levels than you've ever had in
Speaker 1: the rest of your reproductive lifespan. And then eventually, when
Speaker 1: the ovaries don't respond, the brain stops pushing them to respond,
Speaker 1: and the estrogen just kind of dies out. Eventually. What
Speaker 1: causes breast pain or trouble sleeping or mood changes is
Speaker 1: not just because the estrogen is too high or too low,
Speaker 1: but it is the swings of it going super high
Speaker 1: and then back to zero. That's when you get your nights.
Speaker 1: What's hot flash, irritability, can't sleep, it's the very ability.
Speaker 1: Serotonin levels can be impacted by a lot of things,
Speaker 1: including what's going on in your life and whether you're
Speaker 1: getting enough sleep and exercise. So many things impact neurotransmitters
Speaker 1: in your brain that develop serotonin estrogen is just one
Speaker 1: of them. Let it be note that perimenopause and menopause
Speaker 1: is a normal phase of life. This is not a disease.
Speaker 1: We need to have conversations about perimenopause and how to
Speaker 1: care for people going through it in the workplace without
Speaker 1: it meaning to discrimination. One positive is that after the pandemic,
Speaker 1: we now have more access to virtual care than we
Speaker 1: ever did before, which is making it possible for a
Speaker 1: lot of women to get menopause consultations virtually with experts
Speaker 1: that they may not have had access to before due
Speaker 1: to their locations. When we are thinking about going through
Speaker 1: these changes in our life, there are other health risks involved.
Speaker 1: During the menopause transition. A woman's cardiovascular risk goes up
Speaker 1: as well. So in taking stock of where you are,
Speaker 1: are you taking care of yourselves? Are you exercising like
Speaker 1: you should? Are you sleeping like you should? Are you
Speaker 1: managing stress like you should? Looking at a menopause transition
Speaker 1: is oh my god, all these bad things are going
Speaker 1: to happen to me. Maybe think about it as taking
Speaker 1: stock and really looking at it is are you taking
Speaker 1: care of yourself in the way that's going to set
Speaker 1: you up to be healthy for the rest of your life.
Speaker 1: You have to take care of yourself first or you
Speaker 1: cannot take care of all the other people in life
Speaker 1: that you need to. If you've had major depression in
Speaker 1: the past, or anxiety, or any kind of hormonially related
Speaker 1: mood issues like PMS symptoms or postpartum depression, these are
Speaker 1: the people that will tend to struggle when their estrogen
Speaker 1: levels are falling around menopause, and so it's important to
Speaker 1: take care of your mental and emotional health. If you
Speaker 1: were on antidepressant before and it was great and it
Speaker 1: worked for you, consider staying on it during perimenopause because
Speaker 1: it can help with hot flashes. Cognitive behavioral therapy is
Speaker 1: always great to add in with that as well. Some
Speaker 1: women who are having hot flashes and night sweats, hormone
Speaker 1: therapy can actually be very good for mood as well.
Speaker 1: If you are much past the first couple of years
Speaker 1: after menopause and you are no longer getting a period,
Speaker 1: hormones may not help you with your mood, so you
Speaker 1: may think of something else for that, like an antidepressant
Speaker 1: or more lifestyle changes. A lot of things can cause
Speaker 1: hot flashes, like having some alcohol to relax so alcohol
Speaker 1: can stimulate a hot flash. A hair dryer con stimulate
Speaker 1: a hot flash. Drinking a warm beverage, eating salsa caffeine
Speaker 1: can make you hot flash. There are a number of triggers,
Speaker 1: but again, pick your poison. If you need your coffee,
Speaker 1: just know that you might have a hot flash. But
Speaker 1: in terms of wine and alcohol, it can impact your sleep.
Speaker 1: So you might think alcohol is helping to put you
Speaker 1: to sleep, but it makes your sleep less effective and
Speaker 1: less efficient, so you're actually not sleeping as well throughout
Speaker 1: the night. Many women going through paramount of pause feel
Speaker 1: out of control and they want to seek to gain
Speaker 1: more control. They feel like they can't predict things, whether
Speaker 1: it's their mood or their weight gain, which is incredibly frustrating.
Speaker 1: But it's important to look at how we handle feeling
Speaker 1: out of control. Our first reaction is to try to
Speaker 1: rain everything in and have control over it, but we
Speaker 1: might want to look to what we know works for anxiety,
Speaker 1: which is acceptance. What is the worst case scenario if
Speaker 1: you didn't get the last thing on your to do
Speaker 1: list done before you go to bed? I am I'm
Speaker 1: bad with that one. Don't ask me to give up
Speaker 1: my to do list. One way to take care of
Speaker 1: yourself that we may not think of is it's okay
Speaker 1: to say no, and it's almost empowering to say no.
Speaker 1: You don't have to do everything you're being asked or
Speaker 1: invited to do, even if it's an honor or even
Speaker 1: if you think you really should do it. One way
Speaker 1: to practice saying no is to use a yes sandwich,
Speaker 1: such as, wow, I thank you so much for the opportunity.
Speaker 1: Unfortunately I can't do it, but think of me next time,
Speaker 1: or I have somebody else in mind for you, which
Speaker 1: would be a good way for you to mentor the
Speaker 1: person who you are passing this opportunity onto. If you
Speaker 1: need any help with anything. If you want to find
Speaker 1: out anything more about menopause or perimenopause, going to the
Speaker 1: North American Menopause Society website. It's menopause dot org. Again,
Speaker 1: the link will be in the show notes. There's a
Speaker 1: located provider tab you can put in your zip code
Speaker 1: and find somebody who is certified in menopause in your area. Unfortunately,
Speaker 1: due to a study that was done at the Mayo
Speaker 1: Clinic in they surveyed graduating residents from across the country
Speaker 1: from O B. G y N to family medicine, internal medicine.
Speaker 1: None of them are receiving more than one hour of
Speaker 1: education about menopause during their training programs right now. So
Speaker 1: we have a whole bunch of uneducated providers headed out
Speaker 1: into the world with regard to menopause management. So it's
Speaker 1: important to understand if you have a provider who knows
Speaker 1: something about it or who doesn't, and if they don't
Speaker 1: feel comfortable or have that skill set, you need to
Speaker 1: know that they're our other resources available, and of course
Speaker 1: you need to be your own best advocate. Again, if
Speaker 1: you want to read any of these takeaways, you can
Speaker 1: go to my website Jen Kirkman dot com click on
Speaker 1: anxiety Bites. That link is also in the show notes.
Speaker 1: As we are winding down here and almost in our
Speaker 1: last ten or so episodes of the season one, which
Speaker 1: ends in August, I would beg you, I'm now begging
Speaker 1: if you could leave a five star review on Spotify
Speaker 1: or Apple Podcast. Those are the two places that have
Speaker 1: podcast reviews and just say you love the show. Whatever
Speaker 1: you want to say about those five star reviews do
Speaker 1: help keep it climbing in the algorithm. I actually saw
Speaker 1: a huge jump in the charts um last week when
Speaker 1: a bunch of you did heed my call to write
Speaker 1: some reviews. So it really helps. And I want to
Speaker 1: keep being able to help people with anxiety. And the
Speaker 1: more people that find out about this podcast, the more
Speaker 1: people will be getting help with their anxiety. And you know,
Speaker 1: doesn't that make a better or society less people out
Speaker 1: there annoying you with their anxiety while you're trying to
Speaker 1: live with yours. Okay, and just remember anxiety bites, but
Speaker 1: you're in control. For more podcasts for my heart Radio,
Speaker 1: visit the I Heart Radio app, Apple podcast, or wherever
Speaker 1: you listen to your favorite shows.