September 19, 2025 • 52 mins
Many women are blindsided in their 40s by a sudden return of explosive anger. Clinical neuropsychologist Caroline Gurvich joins Francesca and Louise to explain how hormonal changes can intensify stress, spark mood swings and leave women feeling unrecognisable to themselves. She also shares what helps: lifestyle shifts, medical support and the importance of not simply putting up with it. Plus, a look at brain fog, the overlap with ADHD symptoms and weighing up treatment options for perimenopause symptoms.
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Speaker 1 (00:03):
Hi, I'm Louise Ari and I'm Francesca Brudkin, and this
is season five of our New Zealand Hell podcast, The
Little Things. It's good to have you with us.
Speaker 2 (00:11):
In this podcast, we talk to experts and we find
out all the little things you need to know to
improve all the years of your life and cut through
the confusion and the overload of information out there.
Speaker 1 (00:20):
We've got such good topic today, have looyd Owiz. We're
going to talk about midlife rage, midlife emotions. And I
think at this point my family would quite like to
take over and have their two cents we've maybe contribute
to this conversation. I'll keep them a million miles away
from this. As a child, I was quite explosive, not
(00:41):
all the time, but I could. I was quite unpredictable
and I could definitely let loosen and rage a little bit.
And as an adult, and you've known me as an adult, Louise,
I've worked really really hard to I suppose, calm things
down and challenging moments and you know, I've you know,
(01:03):
as immature, you learn lots of ways of dealing with things.
If you know that your responsive, you know, i'd maybe
just say to people. That's great, I'll have a think
about it and come back to talk about things like.
I just learned all these little ways of remaining calm,
and actually to the point that when I got really angry,
I got quite quiet, and then i'd slow down my
talking to a patronizing kind of spit on the ski
(01:24):
fields and I'd talk very slowly like this, And when
that happens, my kids got, oh shit, she's really angry.
Like like, I learned that. That was when I was
really really angry. But then I hit my forties, probably
my mid forties, and this explosiveness just came back, all
this complete lack of patience for what was going on
around me, and you'd never know what would set me off.
(01:46):
I mean, still not the big stuff. I can still
when all the big stuff happens, I'm still very calm
and but but there'd be just little things that would
happen and I finally could no longer cope, and I
would just verbalize everything going through my head while at
the same time going, you should really just be saying
this in your head. You should not be letting this out.
(02:06):
But I couldn't. I couldn't stop it. I'd be like
I just been like, who is this person? Then discovered
hit and thankfully we've kind of got a middle ground now.
But I'm still I'm still slightly I'm actually slightly embarrassed
about that behavior, and I'm also still slightly shocked at
(02:27):
how it kind of crept up on me over again.
Speaker 2 (02:29):
I think you should not be too hard on yourself
because because certainly not alone for starters. I mean, I'm
impressed that you worked on your explosiveness throughout your life,
and I do think as I got to know you more,
I did put into practice some of your measured sort
of responses to things. Not all the time, but sometimes
I don't think I did it nearly so much, and
(02:51):
I think I could be.
Speaker 3 (02:52):
I was quite a ragy mum.
Speaker 2 (02:53):
I think the kids would say, I mean, there's some stories,
but I mean I even hurt them, But there were
some same we're just thrown into baths. I guess they
don't need them. I believe they got flashed out of
the toilet. But but look, weirdly, my health, Cristi has changed.
I feel deduced with the kids in the mouth of
(03:14):
the time, and you were through the sandwichesn't meet them.
Speaker 1 (03:18):
Yes see, I would have stopped and going, I'm just
going to clean that up. That'd be really annoying.
Speaker 2 (03:22):
Oh, I said they had to eat them, but they
didn't obviously eat them. They got out of the fun the.
Speaker 3 (03:30):
Toilet and dully they ate them. So there you go.
So that was that was I.
Speaker 1 (03:36):
Feel like my kids have missed out. Maybe maybe I
shouldn't let loose a little bit more.
Speaker 2 (03:40):
It's probably the worst one, to be fair, And I
mean we do laugh about it now anyway, but my
health christis changed that that ragey little bit, because I mean,
I don't know, maybe it was the universe talking to me,
but I felt less irritated by every little thing because
something big had happened. But they said, I can get
set off. And and I want to know. I guess
(04:01):
if it's whether you know that thing about getting to
a certain age and not giving two shits anymore? Is
it that or is it realizing life is too short?
Or is it hormonal or is it a big old
mixture of all of them.
Speaker 1 (04:12):
If you didn't give two shits anymore, or if you're
realizing life's too short, then you probably wouldn't react at all,
would you.
Speaker 3 (04:18):
Hmm? Good point.
Speaker 1 (04:19):
I mean, you'd probably go, why am I going to
antagonize you one? Why am I going to put this
out there? If you just roll your eyes and move on.
Speaker 2 (04:25):
Well, that's why I can't the keep all worry stuff
gets to me because I can't understand why if you're
that full of vitriol and hate.
Speaker 3 (04:32):
Yeah, yeah, what's up?
Speaker 1 (04:34):
Judgment and opinion and yeah all the rest of it,
keep it to yourself. Well maybe it's good we let
it out somewhere, but somehow more something more productive.
Speaker 2 (04:44):
Healthy, that's our healthy way. But maybe they're just all
struggling with midlife rage.
Speaker 3 (04:49):
Who knows? They can't just think No.
Speaker 1 (04:53):
I think there's a lot of rage about everything, and
you know, isn't there at the moment in the world.
But look, we hear about women struggle with their mood
and women dealing with mental health issues such as anxiety
and depression, sometimes for the first time in their life
as perimenopause sets, and if they even know about peri
mortive menopause, it can be so destabilizing for your relationships,
(05:13):
your marriage, your job. Does menopause make pre existing anxiety
and depression relapse or intensify? And what can we do
to help ourselves. Joining us today is doctor Caroline Gervich.
Caroline is a clinical neuropsychologist. She is the Deputy director
of her Center Australia, head of the Cognition and Hormones Group,
and an associate professor at Monash University. She has a
(05:35):
research interest in the neuropsychology of women's health and the
role hormones play on cognition. Welcome Caroline, thanks so much
for being with us.
Speaker 4 (05:44):
Hi Francesca, thank you for inviting me to talk to
you today.
Speaker 1 (05:47):
Should we start, maybe at the beginning and talk about
what hormones are the ones that are impacting our mood
and our mental health.
Speaker 5 (05:56):
Yes, So during these life phases where our hormones change,
like menopause, the key hormones we're talking about are estrogen
and progesterone.
Speaker 4 (06:07):
So these are sex hormones and they're the hormones.
Speaker 5 (06:10):
That regulate our reproductive function, and that's often what we
think about when we talk about estrogen and progesterone, but
they actually do a whole lot more than just regulating
our reproductive functions. So they can cross over our blood
brain barrier and enter our brains and have quite potent
effects on different brain areas and particularly brain areas that
(06:31):
regulate our mood and regulate our thinking skills. So that's
why these times of life where our hormones change, we
can also experience changes in mood and thinking skills.
Speaker 1 (06:43):
As well, because we often think of them as the
six hormones, but there's so much more to them than that.
Speaker 4 (06:48):
Yes, yes, so much more so. That's right.
Speaker 5 (06:51):
They are the sex hormones and as I said, regulate
reproductive function. But these hormones, so we know probably a
bit more about estrogen and how that works in the brain,
and we've learned a lot about how estrogen works in
the brain from animal research, and these studies show that
these hormones actually are quite potent sex steroids in the brain,
(07:12):
so that means that they have an impact.
Speaker 4 (07:15):
They actually change the thickness or density of.
Speaker 5 (07:18):
Our connections between our different neurons and the way different
parts of our brains communicate.
Speaker 4 (07:23):
They also have an influence on neurotransmitter systems.
Speaker 5 (07:27):
So these are chemicals in the brain, and you will
have probably heard of things like dopamine and serotonin, So
these are chemicals in the brain or neurotransmitter systems in
the brain that are really important for regulating our mood
and regulating our thinking skills. So at times when our
hormones either fluctuate or gradually decline, our brains react to this.
(07:49):
And some people are sensitive to these hormone changes in
terms of their mood and thinking skills, and.
Speaker 4 (07:53):
Some people aren't.
Speaker 5 (07:54):
So it's not a uniform conclusion that we draw that
when your hormones change, your mood will change, because that's
absolutely not the case. But for some people, they're just
sensitive to hormone changes. But all this animal work that's
been done has really laid that scientific basis for us
to have a really good guess at why some people
might be more sensitive to times of hormonal change.
Speaker 2 (08:16):
So throughout our reproductive lives, we go from puberty through
pregnancy up to perimenopause. Is that the impact we're seeing
is it? Are some of us more sensitive all the
way through or can it vary?
Speaker 5 (08:30):
Yes, it's such a good question. I think there's both scenarios.
So there's certainly some people who are sensitive to hormones always.
Speaker 4 (08:37):
So there's some people who during.
Speaker 5 (08:39):
Their reproductive years when they're experiencing a menstrual cycle for women,
or people assigned female at birth, when they're experiencing a
menstrual cycle. Each menstrual cycle has little fluctuations in estrogen
and progesterone, and the time of the menstrual cycle that
most people who are sensitive to hormone changes experience mood
symptoms is in that pre menstrual so in the few
(09:03):
days before someone gets their period, and at that time,
in terms of our hormones, our progesterone levels are increasing
and our estrogen levels are a bit lower than our
progesterone levels at that point. So the thought is that
it's the progesterone that is some people are sensitive to,
and not even the progesterone itself, but the progesterone has metabolites,
(09:24):
which is kind of when it breaks down and flow
on effects from the progesterone, and so one of them
is called alopregnant alone. But that is what the theory is,
that some people are sensitive to an increase in this
alopregnant alone, and when that increases, some people experience these
mood symptoms. So some people experience that. Then there's some
(09:45):
people who experience quite significant mood changes in the postnatal period,
and there's lots of significant hormone changes that happen both
during pregnancy and in the post natal period. I should
also say that having a baby is a huge life
change as well, so we can't just say, well, it's
all hormones, because there's lots that happens when someone has
(10:06):
a baby, but there's also quite significant hormone changes, and
so it's thought that some people again are sensitive to
those hormone changes.
Speaker 4 (10:13):
And then the next life.
Speaker 5 (10:14):
Phase for females that a lot of people are sensitive
again to hormone changes is in that perimenopause, so the
menopause transitioneers and early postmenopause. So sometimes we see someone
in perimenopause and it's the same person who's been sensitive
at different life phases to hormone changes.
Speaker 4 (10:33):
But then sometimes someone's had none of that. They've not
had any kind.
Speaker 5 (10:37):
Of pre menstrual mood symptoms, they haven't had any postnatal
depression or post natal anxiety, but during menopause they experience
for the very first time a big change in their mood.
Speaker 4 (10:47):
So I think there's both types of people. Some people
are just.
Speaker 5 (10:50):
Sensitive to hormone changes, and some people experience mood changes
for the first time during menopause, and whether that's a
hormone sensitivity or a number of other factors contributing to it.
We're still kind of learning and understanding why those mood
changes come about, but it seems to be related for
(11:10):
a lot of people the hormone changes.
Speaker 1 (11:12):
And have we been able to work out why someone
might be sensitive.
Speaker 5 (11:17):
No, that's a really good question. So there's probably a
number of factors. So there's probably some genetic factors our
genetic makeup. Some people might carry certain combination of genes
that makes them a bit more sensitive to changes in hormones.
There's also a theory that some people who have experienced
trauma throughout their lives and have got a sensitive or
(11:40):
a more sensitive endocrine access that governs our stress response,
that person might also be more sensitive to changes.
Speaker 4 (11:49):
In our reproductive hormones.
Speaker 5 (11:51):
So there's a bit of a crossover between these different
endocrine axes that govern different That are hormones that govern
different responses, so stress response, reproductive hormones, or sex hormones.
So there's also a theory that those who have experienced
trauma of some sort, and trauma can be lots of
different things. It's a really personal I mean, somethings are
(12:11):
obviously trauma, and some things are not necessarily considered trauma,
but for an individual that you know, poor attachment when
they were younger, or peer bullying or things like that
can constitute trauma for an individual. And so all sorts
of things might make someone more sensitive to hormones. And
then sometimes we're I mean, it could be a combination
of genetics of trauma for some people, or yeah, I
(12:34):
guess we just don't really know exactly why some people
are more sensitive.
Speaker 2 (12:39):
It makes me very grateful I suppose that we're in
a slightly more enlightened age where we're talking about these
things before they happen. Because freendiscin I both confessed to
not really having any clue about perimidopause for a long time,
and it has sort of come into the social consciousness
a little bit more, particularly for women obviously, and I
just sometimes think about, you know, the jokes around what's
(13:02):
the one before you get your period, premist tension, Yeah, yeah,
foggy brain and in middle life rage and all of
that sort of thing, and you know, we do, we
do laugh things off because we don't understand them.
Speaker 1 (13:17):
M m.
Speaker 5 (13:18):
Yes, And sometimes that's fine, Like for some people the
mood changes the brain fog.
Speaker 4 (13:23):
It's kind of mild and you can laugh it off.
Speaker 5 (13:25):
It's a coping mechanism, and it's absolutely fine to do that,
and it can be.
Speaker 4 (13:29):
Pretty subtle and it's not a big deal.
Speaker 5 (13:31):
But then there are other people where it's it's not
so subtle and it is more of a big deal
and it's a bit more.
Speaker 4 (13:37):
They can't just laugh it off, you know, they're really struggling.
Speaker 5 (13:39):
So I think there's a whole spectrum of experiences that
people have, and yeah, the different sort of coping mechanisms
or help that people need can also be really varied.
Speaker 1 (13:52):
So, Caroline, during perimenopause, in menopause, how are our hormones
impacting our brains and our mental health?
Speaker 5 (14:00):
So as we transition from our reproductive years into menopause,
there's this timeframe, this transition timeframe called perimenopause, and that
can span four to eight ten years for different people.
And during that transition time, we move from having the
reproductive regular menstrual cycle for people who aren't taking any
(14:23):
kind of hormone or contraceptive, and then our sex hormones
estrogen progesterone, instead of fluctuating in a regular cyclical pattern
start to be a bit more erratic, and they can
fluctuate quite rapidly, and at the same time, the estrogen
and progesterone are also gradually declining, So that happens, as
(14:45):
I said, over four to ten years. The things that
we can notice during that time in terms of our
menstrual cycle, that can become irregular, and that's often what
the basis of diagnosis of perimenopause is that your mental
cycle can be come irregular.
Speaker 4 (15:01):
But often just before that happens, people can start to
notice changes to their mood and their thinking skills. So
that's the brain fog of menopause or perimenopause that people
talk about. And the mood changes, the rage, the irritability,
paranoid thinking, anxiety, depression, a whole spectrum of different symptoms
(15:22):
that fall under that umbrella of kind of a perimenopausal
depression that can happen early on in that perimenopausal transition.
They can be some of the first signs that happen,
and it might be that our brains start to become
a bit sensitive to the fluctuations in our estrogen levels
and that gradual decline and progesterone. But if it's happening
(15:44):
early in the perimenopause.
Speaker 5 (15:45):
It's probably our bodies and brains reacting to the fluctuations
in estrogen and progesterone levels that happen during the early
stages of that perimenopause and that transition phase.
Speaker 3 (16:00):
That's fascinating.
Speaker 2 (16:01):
Gosh, that's really making me think back to my late
that is an early forties, to be honest, And so
would you call it a common phenomenon for women and perimenopause.
Speaker 5 (16:10):
So in terms of the mood symptoms, it really varied
depending what literature you look at. It's probably about a
third of women will experience some depression and about two
thirds of women will experience some degree of brain fog.
Speaker 4 (16:25):
But I think there can be kind of secondary depression
secondary brain fog.
Speaker 5 (16:30):
So if people start to experience things like poor sleep,
like anyone knows that if you're not sleeping well, it
can impact your mood, it can impact.
Speaker 4 (16:39):
Your ability to think clearly, So that can happen as well.
Speaker 5 (16:42):
But people can also experience just the mood changes or
just the brain fog on its own. And there's also
a link potentially between the vasomotor symptoms of the hot
flushes there's a theory that if you're experiencing hot flashes
during the night, then that disrupts your sleep, then you
have poor sleep.
Speaker 4 (16:59):
Then you have a flow and effect mood changes and
to brain fog.
Speaker 5 (17:05):
But also, as I said, there's the people who don't
experience any of that but just have the mood changes.
It might be more directly related to the hormone changes
in the brain.
Speaker 3 (17:13):
Can I just ask you a quick question.
Speaker 2 (17:15):
You're talking about contraception, and this is a thing that's
been on my mind, but I haven't known who to
ask and you may not be able to answer. So
does contraception have any impact on perimenopausal symptoms?
Speaker 5 (17:29):
Yeah, so it can, absolutely so, because it flattens out
the natural fluctuations in our hormones across menstrual cycles, but
then adds in synthetic hormones that kind of replicate that.
But if you don't take the sugar pills, so if
you're just taking the active hormonal contraception, then it's kind
(17:51):
of flattened out, and so you lose some of the
effects of a menstrual cycle and you have less fluctuals.
So I think the Australian menopause or Australasian Menopause Society,
which extends to New Zealand, suggests that you can keep
taking hormonal contraceptives in consultation with your doctor until about
the age of fifty And yeah, so that can have
(18:15):
a beneficial impact on mood for some people, but some
people might also need to consider and talk to their
healthcare professional about different options if it's if it's not enough.
Speaker 1 (18:27):
Yeah, and there are there are different options. But I
found it really helpful just for when those when the
metal cycle became really erratic and have to started having
a little bit an impact on life. You know, it
was one way to be able to It was just
another tool to use to try and kind of stabilize
things control. Yea, So how many women who have never
(18:52):
you know, we talked about the sensitivity and things towards
hormone fluctuations and things. I'm sure it must be quite
a surprise for a lot of women to get to
sort of middle age and all of a sudden be
dealing maybe for the first time with anxiety or a
panic attack or this irritability in things.
Speaker 6 (19:13):
Oh.
Speaker 5 (19:13):
Absolutely, And I think you say middle aged, but I
think for some women it's sort of forty, like it's
quite early that some women experience some of the mood
changes because they can be some of.
Speaker 4 (19:23):
The earliest changes.
Speaker 5 (19:25):
So the median age of menopause is fifty one, but
if perimenopause, that transition can go up to ten years,
it can be sort of forty early forties. So some
people don't even have menopause on their radar, so they
don't necessarily know why they're starting to feel a bit anxious,
a bit paranoid, irritable.
Speaker 4 (19:44):
So the connection might not be there.
Speaker 5 (19:47):
And it might come a bit out of the blue,
and it can be really hard to deal with.
Speaker 4 (19:51):
And I think the timing of menopause is now with
our lifestyles, is often at a time of life that
people are really quite particularly women, are quite stretched and
quite busy. So in the middle of your life, you're
often at the prime of your career. You might have
teenage children, perhaps elderly parents who might be managing house,
the household, like you might be doing a whole lot
(20:12):
of things, and so you're just really busy and stretched,
and with that often comes stress, and so I think
that's a huge factor that sometimes we forget to take
into the into consideration. When we think about the impact
of these hormonal changes, it can sometimes be like the
tipping point. You can kind of cope and then you
(20:34):
get to this point where you just can't cope with
all of that pressure and stress anymore.
Speaker 5 (20:39):
And so it might be the hormones that are triggering things.
But then if we look at the whole story and
take a holistic approach, is often a lot going on
for that person at the same time.
Speaker 3 (20:49):
Well, that's that's right.
Speaker 2 (20:51):
So that leads nicely into the you know, that rage
and that irritability, that sort of almost breaking point. Then
you kind of have little all out and then regroup.
Speaker 5 (21:02):
Yes, yes, and I think within that presentation of depression,
we've done a bit of work at her Center, which
is at Monish University where I work, led by Professor j. Shukulcanni,
where we've looked at characterizing that perimenopausal depression, which is
a bit different to a clinical depression at other life
phases because.
Speaker 4 (21:22):
It's a bit more on. It can be for some
women quite on off.
Speaker 5 (21:26):
So suddenly there's that rage or that paranoid thinking, that
irritability kind of out of nowhere, and then you do
bring yourself back together and feel like okay, So it's
kind of got this on off flavor to it that's
a little bit different to that potential, you know, ongoing
sadness or helplessness that might be part of a clinical
depression at other life phases, if.
Speaker 1 (21:47):
I hit an explosive moment at home, Caroline, half the time,
I'd just be going off, saying whatever was going through
my head, and at the same time I'd actually would
have it was like I was looking at myself outside
my body, going who are you? What are you doing what?
It was really strange that two things could be happening
at once. That I could be putting so much effort
(22:08):
into yelling and you know, at my family about something
ridiculous like the fact that no one can put dishes
in the dishwasher, and at the same time I was
sort of going, goodness me, Francesca, what on earth is
going on with you? Who are you? You know?
Speaker 4 (22:20):
It was bizarre, Yeah, And that's not uncommon.
Speaker 5 (22:23):
That's that's a very common description of the feelings and
the emotions and how they play out for a lot
of people.
Speaker 2 (22:30):
And I think it is good to make that distinction that,
like you say about the on off and you're not
saying this is a rule. You're saying this is in general.
But if you are feeling like, gosh, am I clinically
I mean, obviously your first portocoll is your health professional,
But am I clinically depressed?
Speaker 3 (22:46):
Or is can I?
Speaker 2 (22:48):
And this is why they often tell you to do
a diary, don't they to kind of work out when
how often that's happening, what time of the month it's happening,
what time of the even the day it's happening.
Speaker 4 (22:57):
Yeah, exactly.
Speaker 5 (22:58):
And for that reason, we also developed this scale it's
called the MENO D that people can access and it
provides people are capacity to rate their perimenopausal depression to
kind of get an objective score.
Speaker 4 (23:12):
To say where am I at? Is this really I
need to.
Speaker 5 (23:15):
Follow up with a doctor or is this okay? So
there's in the MENOD there's cutoff scores. But I think
if anyone's concerned, intuitively within yourself, just go and speak.
Don't hesitate. Always go and speak to a health care provider.
Because there's so many different options out.
Speaker 4 (23:31):
There to support people.
Speaker 5 (23:32):
People shouldn't just have to bear, you know, put up
with it and bear it and get through. I think
that that thinking is something that's definitely changed that we
now appreciate that it's quite common to experience changes to
mood and to experience brain fog. But you shouldn't just
have to suffer, because you know, four to ten years
is quite a long.
Speaker 3 (23:52):
Quite a long time.
Speaker 1 (23:53):
Yeah, I've pulled up the questionnaire. It's quite extensive. It's good.
It's about four pages, but it's going to cover everything,
which is fantastic. Oh, thanks for pointing us in that direction, Caroline,
that's awesome. Another thing that's almost the opposite of everything
going on in your brain at once and exploding is nothing.
Having moments of blankness and struggling to kind of get
(24:17):
through the brain fog is something that a lot of
people talk about as well.
Speaker 5 (24:20):
Yeah, that's something that's I think gained a lot of
traction and discussion, particularly in the social media space over
the past maybe decade. And it's weird because brain fog
isn't a term like depression. It's not a term that
has a clinical description. It's not a diagnostic or medical
term or psychological term. It's just a term that's emerged
from the community to describe their experiences. And we've asked
(24:45):
them in about what it is for them. You know
what is brain fog, And people talk about memory lapses,
attention lapses, difficulty in making decisions, that word finding difficulty,
you know that when you've got a word on the
tip of your tongue and you just can't find the
right word. So they're the main kind of symptoms that
(25:06):
fall under that umbrella of brain fog for women, and
our understanding of it is a bit similar to the depression,
like we think that some women again when they're sensitive
to the hormone fluctuations. There's estygen receptors in our brain
in the front part of our brain, which is really
important for our higher order executive functions like organizing our thoughts,
(25:28):
as well as in a part of our brain called
the hippocampus, which is really important for our memory. So,
again going back to the science, it makes sense that
when these hormones are fluctuating and declining and they're in
brain areas that are really relevant for our thinking skills,
that there might be a flow on impact to our
thinking skills. And again there's all the other stuff that
(25:49):
can impact life, stress, poor sleep, mood changes, So all
of those things independently can impact your thinking skills. But
then the hormones might have a direct impact for some
people as well on their brains and on their thinking skills.
But one thing I do like to always add is
that while women experience this brain fog in daytay life,
(26:12):
it's very real.
Speaker 4 (26:13):
It happens in about two thirds of women.
Speaker 5 (26:15):
For some people's subtle some people can have quite a
big impact. But when we do a neuropsychological assessment, which
is when we assess someone's cognitive capacity, their actual ability
to reason and to make judgments and to use their
attention and their working memory and to learn, it's normally.
Speaker 4 (26:33):
In the normal range. So people during.
Speaker 5 (26:36):
Menopause, even those women who are experiencing brain fog, their
actual core cognitive skills don't change, so they're still able cognitively.
Speaker 1 (26:45):
That's a really important It's almost more like imposter syndrome
that you've ended up with. You think you can't do it,
but you are still functioning well.
Speaker 4 (26:54):
Yes, but some people just need some support.
Speaker 5 (26:56):
So they might just need a bit more structure or
a little bit more you know, time to do things,
or a little bit less distraction while they're doing tasks.
So it's just the support the scaffolding that people might
need so their brains can continue performing at their best.
Speaker 2 (27:14):
I know, when I can't reach for a word or
a name or so forth, all I really do need
is a little bit of understanding and time, not idea
when you're trying to record a podcast and it happens,
but you know, all I need because I know it's there.
And what I would prefer rather than someone maybe finishing
my sentence or giving up on it, is just that
time is it. Just give me a minute, it will
(27:35):
come to me, you know, because I get more frustrated
when I have to leave it and then go oh,
and then it'll come to me in the middle of
the night when we're awake, because we're awake.
Speaker 4 (27:44):
Through yes exactly. And it's not that helpful then. But
that's the other thing that is.
Speaker 5 (27:49):
I think some people with they get anxious to try
and find the right word or to try and think,
and I think that anxiety can make the brain fog worse.
So I think you said like a bit of time,
I think that's like perfect just to try and you know,
relax and not stress too much about it and just
to back yourself and note like the word is still
(28:09):
somewhere in my mind or I am still able to
make decisions, but I just need a bit more space
in my head to do that.
Speaker 3 (28:15):
And that what was thirty seconds? Maybe I don't know.
Speaker 2 (28:18):
I'd probably give up myself after about thirty seconds.
Speaker 1 (28:20):
I first, yeah, I sort of first mentioned it to
my GP, probably before I even knew there was a
thing called perimenopause. And she would say, she'd sort of
say to me, Okay, tell me what it is that
you can't remember. I go, oh, a name, or does it?
Speaker 3 (28:32):
Then she goes.
Speaker 1 (28:35):
And then I got to one scenario, Caroline, I said
to it, I can't I couldn't remember where the mayonnaise
was in the super market. And she went on, that's
one that we might we might just make a note of.
And she said, but it's never happened again. But I
think that that was the first thing. The first thing
a lot of women probably go to is, oh, my gosh,
am I heading towards dementia, have id early on set dementia,
And it could be very you know, it's easy to
(28:57):
make that assumption.
Speaker 5 (28:59):
Oh, absolutely, because if you think about very superficially the
kinds of experiences you have, like you know, forgetting where
things are, forgetting names, losing your train of thought in
a conversation like those things might sound very superficially like
the early stages of dementia, but I think it's a
few really key differences between menopausal brain fog and dementia are.
(29:22):
One is age, So people aren't diagnosed with dementia generally
of the Alzheimer's type, at least until the age of
sixty five, and even early on. Said, it's sort of
more fifty plus, So just because of someone's age alone,
it's very unlikely that people are experiencing the early stages
of dementia. And if it is early on set or
(29:45):
young ones at dementia, that's quite rare, but it exists.
But the presentation then often has more mood symptoms, more
behavioral changes. It's not the same as that kind of
forgetfulness or not finding the right word or so.
Speaker 4 (30:03):
I think they're some of the key differences.
Speaker 5 (30:05):
And often also with dementia, it's other people around you
who become quite concerned rather than the person the individual themselves.
Speaker 4 (30:13):
Whereas in menopause it's very much the individual.
Speaker 1 (30:16):
Who's ghost So true.
Speaker 5 (30:18):
Yeah, So I think there's a few factors that are
quite different, and certainly clinically and neuropsychologically, the presentations are
really quite different when you drill down.
Speaker 2 (30:29):
So what other issues are you seeing when it comes
to cognitive and mental health issues with women?
Speaker 5 (30:33):
So the other clinical question I have been receiving a
lot in recent years is women who present and they've
got these cognitive changes and their menopausal and they're questioning
where they've got ADHD.
Speaker 4 (30:45):
So this is a new thing that's popped up.
Speaker 5 (30:47):
It wasn't a question that came up, I don't know,
five years ago or so, but.
Speaker 4 (30:52):
It's more and more frequently people are.
Speaker 5 (30:54):
Questioning this, and there's sometimes it's because the peri apause.
A woman has children and they've been diagnosed with ADHD,
and through taking a children through that journey, they've you know,
obviously been made aware of what ADHD is and what
the symptoms look like, and they've identified so many of
the characteristics in themselves, and then they've felt like they're
(31:19):
really experiencing this and they've always been experiencing the symptoms
of ADHD or the characteristics of ADHD, but they've kind
of managed, but they've got to a point where they
can't manage anymore. So that's often the presentation of people.
And in that case, like clinically to tease apart, is
this like a new onset of brain fog.
Speaker 4 (31:40):
That looks a bit like ADHD?
Speaker 5 (31:42):
Or is this a genuine ADHD, like a brain type,
a neurodevelopmental condition that someone's always had. We spend a
lot of time talking to someone and really understanding their
history and understanding what their presentation is. So just for
people who are unaware, so ADHD attention deficit high practicivity disorder.
It can present quite commonly for females as just the
(32:04):
inattentive component, So that's things like forgetting things, losing things,
losing your train of thought, sitting in a conversation and
then realizing you've just missed most of the conversation, haven't
been listening. So that's one presentation of ADHD inattentive. The
other presentation is that hyperactive impulsive where people feel like
(32:26):
they're on the go, they've got a motor inside them,
they sort of talk excessively or butt into conversations.
Speaker 4 (32:32):
And people can also have a combined presentation, but the.
Speaker 5 (32:36):
Undiagnosed woman is often the one who has that inattentive ADHD,
and I think a lot of people look at inattentive
ADAH and it's very easy to tick those bloxes. Like
we all forget things from time to time. We all
sit in a conversation and our brains drift off and
we're not present and we miss things. So a lot
of the characteristics of inattentive ADHD are really common. Sometimes
(33:01):
it means that they can be missed, but I think
in terms of a clinical diagnosis, it has to be
that they're kind of pervasive and that they really are
present in more than one setting, and that they impair functioning.
So it's really separating out, you know, what is normal
degrees of inattention that we all experience from time to
time from something that is someone's neurodevelopmental brain conditional brain
(33:26):
type where it's really causes challenges. And often people have
a history where they've managed or they've been misdiagnosed with
depression and anxiety and all sorts of things, and then
they get to this point and it's quite clear that
they've always had this, but it just hasn't been diagnosed,
and so sometimes that's quite a big journey for people
(33:48):
to go on to get a late diagnosis and to
you know, all the what ifs iphony are known and
so yeah, it can be quite confronting for people, but
also there can be an element of relief for some
people as well when they do have a diagnosis later
in life and a new understanding, a new lens to
understand their world.
Speaker 1 (34:09):
That's a lifetime of what in our family we call
the aha moments. My daughter was diagnosed at thirteen and
we spent a year going oh ah, you know, like
because everything kind of fell into place and things like that,
so that came back. Imagine how that's overwhelming. If that's
a lifetime of those. Yeah, absolutely, yes, I think it's
(34:29):
probably like everything, Caroline. When we have a symptom, it's
really important to, you know, make sure you're talking thoroughly
to your gp about it and not presuming it's just
one thing or the other. It's like, there's such a
massive list, isn't there of menopausal symptoms, And yes, a
lot of the time they do. That's what they are.
It is to do with the hormones. But you've always
got to make sure that you're just double checking that
(34:51):
there's not something else at play and something else going on.
Speaker 5 (34:53):
Yeah, absolutely, yes, definitely always worth having if you're concerned
and it's you know, occupying your mind and in thinking
about it, always worth having a chat to your healthcare provider.
Speaker 1 (35:05):
You're listening to the little things and our guest on
the podcast today is clinical neuropsychologist doctor Caroline Gerbert, talking
about how our hormones impact our brains and our mental health.
Will be back shortly after the break. Welcome back, Carolin.
(35:29):
Maybe we could talk about some tips to help us
through all this, how we can manage it If our
mental health is suffering, is medication the best option? Or
can lifestyle and dietary changes and things help?
Speaker 5 (35:45):
So I think a combination of everything can be most helpful.
So I think you can always start with kind of
behavior change lifestyle change, but if that's not helping, I
think it's definitely recommended that people go and have a
chat to your GP and make sure you've got a
GP who has a really good understanding of menopause because
it's not everyone's area of specialty, and so if someone's
(36:09):
experiencing sort of a new onset depression around menopause, they
might want to be speaking to their GP about different
types of hormone therapies or antidepressants if hormone therapies aren't
appropriate for them, and for the sort of brain foggy
cognitive symptoms as well. Might want to be thinking about
really practical things that people can do just to support
(36:32):
their cognitive health during the menopause transition.
Speaker 4 (36:37):
So that's things like, you know, using.
Speaker 5 (36:39):
Your diary, like feeling comfortable to put everything in your
diary so you don't have to hold it in your head,
and using lists to remember what to do, kind of
doing the brain dumps to get all those thoughts that
are floating around in your head onto a piece of
paper to clear some space so you.
Speaker 4 (36:55):
Can think clearly.
Speaker 5 (36:57):
And you know, in workplaces, making sure people put things
in an email so they don't shout them out in
the corridor. And then you're trying to hold more bits
of information in your head, so put the onus on
other people to structure things for you and email them
through and help with prioritization if need be. So I
think there's kind of practical things. There's medication options, but
(37:20):
I also think midlife and menopause is a really good
opportunity to sit back and reflect on your lifestyle. And
think about healthy lifestyle and what's good for our kind
of brain health. So it's the same things that we
say for heart health, it's exactly the same for brain health.
So it's things like exercise is super important, and exercise
(37:41):
on its own can also help mood. So making sure
people exercise and get moving is very important. Making sure
as much as possible that you get good sleep, and
there's help out there if you're not sleeping well, again,
speak to your doctor about it. It's really sleep is crucial,
you know, Making sure do you have time out so
you're not on the go all the time, making.
Speaker 6 (38:03):
Sure your brain is stimulated, making sure you've got a
good balanced diet like Mediterranean diet, and making sure you're
not using alcohol as a coping strategy because that's not
going to help your brain that I think, you know,
some people kind of turn to alcohol as as a
quick fists and makes them feel better temporarily, but.
Speaker 4 (38:21):
It's not going to help in the long run.
Speaker 5 (38:23):
So there's lots of kind of healthy lifestyle things that
people can do. And I think you know, midlife is
a great time to reflect on your own lifestyle.
Speaker 2 (38:32):
Yes, and we've covered a lot of those points it
was one of the reasons for doing this in the
first place, was how how to help ourselves and sit
I know, for me, exercises a big one and I
really know when I can't the impact it has on me. Yes,
with same with diet and getting that time out can
sometimes be one of the hardest parts.
Speaker 4 (38:53):
Absolutely, but it might not even be.
Speaker 5 (38:55):
It's not like you have to go and spend a
day a week in a spa, although that might be nice,
but it might just but you know, having making sure
that you have, you know, five minutes just to go
for a walk by yourself with no phones, no stimulation,
just some actual switch off or just a breather in
the middle of the day, have a cup of tea
or whatever it is.
Speaker 4 (39:13):
But just little bits of switch off where you're not
your brain isn't bombarded with stimulation.
Speaker 3 (39:20):
Any breaks.
Speaker 1 (39:21):
I like that, Yeah, many breaks, Everything's many these days, Caroline.
Conversation ahead with women quite often when they have symptoms
to do with their mood, maybe low mood and things
like that, maybe they're not sleeping as well on things.
Often we're all having the same conversation with our GPS.
Do we need HI or do we need any depressants.
(39:43):
How do we make that decision.
Speaker 5 (39:46):
It's such a good question and we actually don't know
the answer. So we're trying to run a clinical trial
at the moment where we're trying to do this head
on head comparison and antidepressants and hormone therapy because that
hasn't been done, so we don't know that answer at
the moment. Our clinical guidelines say to go with the
(40:06):
antidepressants because they've got a stronger evidence base, but there
just hasn't been as much research with hormone therapy for
mood so I think that's why there's not as much
evidence there. Although the guidelines do say that you can
try hormone therapy for moods as well, it's just not
the first line treatment that's recommended. So I just think
(40:28):
it's really important to go and have a really good
discussion with your GP, and you can look at the
Australasian Menopause Society is a really good place to read
up and they've got literature for anyone who wants to
have a look at what the recommendations are for that
to go to your GP with that see a.
Speaker 4 (40:47):
Bit more equipped to have the conversations.
Speaker 1 (40:49):
And be honest about it. I think if you've never
really suffered from mental health, then it's quite hard to
go in and have that conversation and sort of put
it on the tables. But it's important that we do
how far along is that research. Can we just rush
that along a bit love to.
Speaker 4 (41:06):
Russia.
Speaker 5 (41:07):
We're working through as quick as we can, and.
Speaker 3 (41:11):
How slow research can be.
Speaker 4 (41:13):
It can be really slow. Funding can be really hard
for every research as well.
Speaker 5 (41:17):
So we're doing the best that we can to try
and learn more and get those answers.
Speaker 4 (41:23):
But I think also you know, if you're not.
Speaker 5 (41:27):
Someone who's experienced depression in your life and your hormones
change and your experienced depression for the first time, maybe
trying to replenish those hormones might be a good place
to start. But have that conversation with your GP.
Speaker 2 (41:40):
And I think the good news there is that there
are resources like the Australian Minipause or society. There are
more resources with even in space research that we do
have that women can themselves with or do that research
before they go to see someone. And if you don't
get the answers that you think you need, or if
you feel like you're getting brea off, try try again
(42:02):
with somebody else prehaps.
Speaker 5 (42:03):
Yes, exactly, And I think that's hard, Like often when
you're feeling vulnerable and you build up the courage to
go and speak to a GP. If you do get dismissed,
which can sometimes happen if it's not someone's area of specialty,
it can be hard to try again. But I think
you know, always try and find that new self to
keep trying until you get to a point where you
feel better.
Speaker 1 (42:23):
You mentioned before, you know, will we hit this sort
of period of our lives, it is a good time
to sort of have a little bit of a reset
and think about our cognitive health. But should we always
be looking after it like shou should we be saying
to it? Should we be sort of more aware of
out even our older teenagers and things like that near
cognitive health and putting in good practices.
Speaker 5 (42:43):
Now Absolutely, I think all through our lives we should
do what we can to do the best for ourselves
to optimize our brains and our physical health always, but
I think people probably have other priorities, as you know, teenagers,
and so I think midlife is a great time if
(43:03):
you haven't already implemented some of those things like you know,
a regular exercise routine and a healthy diet. It's not
too late to start to still, you know, there are
things that these they modify our risk of later life
dementia and things like that. We do have some degree
of control and we can try and do our best
(43:24):
to have some of those healthy lifestyle approaches and they
have short term benefits and longer term benefits as well.
Speaker 2 (43:32):
I'm going to ask a really dumb question, and I'm
blaming it on minopause. Okay, our brain is a muscle, right, our.
Speaker 4 (43:39):
Brain, It adapts.
Speaker 5 (43:40):
So our brain they often use the words of being,
you know, plastic, it's malleable.
Speaker 4 (43:46):
So it keeps changing always.
Speaker 5 (43:49):
And so you know, the more we do good things
for our brain, our brain will respond and will adapt.
And that's why people recommend things like you know, learning
a new skill or taking up new hobby or you know,
challenging yourself because that builds new connections in the brain
and strengths and connections in the brain. So, yes, our
brain keeps changing as we as we grow.
Speaker 1 (44:13):
That's what's so cool about it. As we can improve it,
it can grow and get better. That's what's so neat
about it.
Speaker 4 (44:19):
Yeah, yes, yes, always, yes, you know.
Speaker 1 (44:22):
It's interesting. I was gonna ask you, you know, we
really need to support each other a lot more going
through this period of time and how we can do that.
But I wonder whether the best thing that we could
do is get our partners to listen to this podcast. Yeah,
because I think most women, we were all we are
quite understanding of what other women are going through. Yes,
and as Lu said before, we're having a lot more
(44:43):
conversations about it. But I think probably where we struggles
and other environments, like in the workplace.
Speaker 5 (44:49):
Yes, yes, exactly, and I think some workplaces are more
progressive and there's more conversations about menopause and menopause in
the workplace and supporting women through menopause and yeah, but
I think the more conversations that happen, it just becomes,
you know, part of our dialogue and it's not such
a big deal and it's not so taboo and there's
(45:11):
less stigma if there's more conversations. And I think, you know,
at the heart of it, in terms of the workplace,
we want to be able to keep women and all
their talents and that diversity in the workplace, and there's Sadly,
far too many women who get to a point and
for whatever reason, whatever's going on for them, they leave
(45:32):
work during those menopause transition years, and you know that's terrible,
rather than seeking the right supports and then being able
to do their best to thrive during this time. So
I think it's really important that there's support coming from
all different places so everyone can be at their best.
Speaker 2 (45:50):
It's not as if we're using it as an excuse
for any kind of poor behavior or poor work outcomes
or anything like that. So it's a knit win, right
if it's not, and like you say, just giving us
that moment if we need it or I know there's
a lot of talk about uniforms, people who work in
places where they wear uniforms where they're not practical.
Speaker 3 (46:11):
When you have when you have a hot flush.
Speaker 4 (46:15):
Yes, exactly, exactly.
Speaker 3 (46:17):
Sometimes, Yeah, we're not just talking about the corporate workplace.
We're talking about across the board.
Speaker 5 (46:21):
Yes, sometimes people need layers so they can adapt to
however whatever their body temperature is feeling for them.
Speaker 2 (46:29):
I mean, we have arguments all the time about the
airct and in our building.
Speaker 5 (46:34):
Yes, yes, so golden here, yes, yeah, exactly, Yes, it
depends who has the controller.
Speaker 1 (46:42):
When it comes to our cognitive health and the other
things that we've been talking about. Caroline, I suppose if
you do want to reach out and get some help,
the first place you go to is your GP.
Speaker 4 (46:52):
Yes, definitely always yeah, go and have a chat to
your GP.
Speaker 5 (46:56):
And also the other place is good websites like the
Australasia Menopause Society, where there's good resources, evidence based resources.
So I think, you know, looking at those kinds of
websites as well as having a chat to your GP.
Speaker 1 (47:09):
Doctor Caroline Goovich, thank you so much for talking to
us day and normalizing our irritability and our rage and
our you know, our low mood and everything else and
our brain fog, everything else that comes with that.
Speaker 3 (47:21):
We really appreciate it.
Speaker 1 (47:22):
Fantastic tips, yeah yeah, and the men O D questionnaire
that's going to be that's going to be a brilliant
tool for people. So thank you so much.
Speaker 4 (47:31):
Thank you, Francisca and Louise, thank you for having me.
Speaker 1 (47:46):
How good is doctor Caroline Goovitch. I just love the
fact that it's all evidence based, science based. There is
a reason that you have this irritability and this rage
and that everything that the world is. You know, it
seems to be changing around you.
Speaker 2 (48:00):
I hang on every word, and I only wish that
perhaps I did have more of an understanding of that.
I'm not even kidding. In my late thirties and early forties,
which is when I would say, I was at my
lowest EBB mental health wives and it wasn't related to
the birth of a baby or anything else. Like, there's
nothing else to put my finger on except for a
lot of probably a lot of.
Speaker 1 (48:22):
But there was also a lot going on in your
life at that point.
Speaker 2 (48:24):
Yes, well, as she explained it as often, it offers
that horrible kind of convergence of everything of everything.
Speaker 3 (48:30):
Yeah, but I think you're right.
Speaker 2 (48:32):
I think this one is for the boys too, and
actually was just reflecting and maybe for my kids just
I'll just take some snippets out and send it to them,
because that might.
Speaker 3 (48:42):
Just explain those Raigie drives to school. Did you ever
have those? You just screamed at the children all the
way to school?
Speaker 1 (48:50):
No, once I put the horn on. Oh yes, I
feel like that was that was I just we were
driving through the lights and I were arguing, and I
just put the horn on. But we were quite close
to school, so of course they were mortified because everyone
was staring at us and until when they stopped off
the wall. So we had it, had a good day.
Speaker 2 (49:08):
There was the mother of five that winteresso and I'm
not gonna I got it. And literally I remember walking
the kids to school and you're driving past what she
got the horn on.
Speaker 3 (49:18):
The minivan for? And then she explained it.
Speaker 1 (49:21):
Yeah, no, I think I think I got it off her.
And I remember using what's going That was actually pretty effective.
Hey really quickly though, Caroline mentioned a questionnaire you can
do if you're just trying to work out sort of
what level your symptoms are at your perimenopausal symptoms. It's
called meno dno slash D. If you google that, you'll
(49:45):
take you through to the questionnaire and it's from the
mon Nash University and it's great for you to maybe
use as a tool. But if you're struggling to maybe
you know, explained and listened to by your GP, you
could always sort of maybe print out and take it
in and go, look, here we go. I've done a
bit of a this is where I'm at, this is
what we need to do something with, So that could
(50:05):
be potentially a really great tool. Just just want to
touch on one other thing. I found that really interesting,
the sensitivity and how they've worked out how some people
are more sensitive to hormone fluctuations in it, but we
can't quite work out why.
Speaker 3 (50:18):
Yeah, a little bit probably to do on that. I'm
sure they'll get to it.
Speaker 2 (50:21):
The Australasian and menopause Al Society is also really good,
a really good point of reference for and more information
and I'm pretty sure that's their name of their website
as well, so and that will keep you up to
date with research as well. It's it's a full time,
it's a frull time. And I think we've touched on
lots of elements of menopause, but not done a specific
(50:44):
one about.
Speaker 1 (50:45):
This, about that age, mood and the things like that.
I think I think we often talk about other things
a little bit more than we open up about that
hemnopause maybe, or we try and we do. We do
try and laugh it off because what else gotta do?
Cry and ray and put your horn on and just
(51:06):
leave your hand on that horn for as long as
you're lining. Maybe that's my joy of the week, just
exprussing yourself, just you know, put your hand on the
horn and just let it blair and let everyone look
at you and just let it out.
Speaker 3 (51:20):
Then just give them the evidence.
Speaker 5 (51:21):
Yeah.
Speaker 3 (51:22):
Yeah, well that's a good joy.
Speaker 6 (51:23):
I like that.
Speaker 5 (51:24):
Do you have one.
Speaker 3 (51:26):
I'm full of a cold, so I my joy is coming.
Speaker 2 (51:31):
I'm feeling very grateful for good health when you have it.
So yeah, it's just a cold, but my god, it's
really it's kind of doing a number on me.
Speaker 1 (51:40):
Well, we know what happens to Louise, which you can't exercise.
You know, I get a bit range, you get a
bit rangy. There we go. Thanks for joining us on
our new zealanderial podcast, Serious Little Things. We hope you
share this podcast with the women in your life. We
can all live with a little less rage.
Speaker 2 (51:54):
You can follow this podcast on iHeartRadio or where ether
you get your podcasts, and for more episodes from us
on other topics, head to zid Herald dot co dot
ZT and we'll catch you next time on the Little
Thanks
Hi, I'm Louise Ari and I'm Francesca Brudkin, and this
is season five of our New Zealand Hell podcast, The
Little Things. It's good to have you with us.
Speaker 2 (00:11):
In this podcast, we talk to experts and we find
out all the little things you need to know to
improve all the years of your life and cut through
the confusion and the overload of information out there.
Speaker 1 (00:20):
We've got such good topic today, have looyd Owiz. We're
going to talk about midlife rage, midlife emotions. And I
think at this point my family would quite like to
take over and have their two cents we've maybe contribute
to this conversation. I'll keep them a million miles away
from this. As a child, I was quite explosive, not
(00:41):
all the time, but I could. I was quite unpredictable
and I could definitely let loosen and rage a little bit.
And as an adult, and you've known me as an adult, Louise,
I've worked really really hard to I suppose, calm things
down and challenging moments and you know, I've you know,
(01:03):
as immature, you learn lots of ways of dealing with things.
If you know that your responsive, you know, i'd maybe
just say to people. That's great, I'll have a think
about it and come back to talk about things like.
I just learned all these little ways of remaining calm,
and actually to the point that when I got really angry,
I got quite quiet, and then i'd slow down my
talking to a patronizing kind of spit on the ski
(01:24):
fields and I'd talk very slowly like this, And when
that happens, my kids got, oh shit, she's really angry.
Like like, I learned that. That was when I was
really really angry. But then I hit my forties, probably
my mid forties, and this explosiveness just came back, all
this complete lack of patience for what was going on
around me, and you'd never know what would set me off.
(01:46):
I mean, still not the big stuff. I can still
when all the big stuff happens, I'm still very calm
and but but there'd be just little things that would
happen and I finally could no longer cope, and I
would just verbalize everything going through my head while at
the same time going, you should really just be saying
this in your head. You should not be letting this out.
(02:06):
But I couldn't. I couldn't stop it. I'd be like
I just been like, who is this person? Then discovered
hit and thankfully we've kind of got a middle ground now.
But I'm still I'm still slightly I'm actually slightly embarrassed
about that behavior, and I'm also still slightly shocked at
(02:27):
how it kind of crept up on me over again.
Speaker 2 (02:29):
I think you should not be too hard on yourself
because because certainly not alone for starters. I mean, I'm
impressed that you worked on your explosiveness throughout your life,
and I do think as I got to know you more,
I did put into practice some of your measured sort
of responses to things. Not all the time, but sometimes
I don't think I did it nearly so much, and
(02:51):
I think I could be.
Speaker 3 (02:52):
I was quite a ragy mum.
Speaker 2 (02:53):
I think the kids would say, I mean, there's some stories,
but I mean I even hurt them, But there were
some same we're just thrown into baths. I guess they
don't need them. I believe they got flashed out of
the toilet. But but look, weirdly, my health, Cristi has changed.
I feel deduced with the kids in the mouth of
(03:14):
the time, and you were through the sandwichesn't meet them.
Speaker 1 (03:18):
Yes see, I would have stopped and going, I'm just
going to clean that up. That'd be really annoying.
Speaker 2 (03:22):
Oh, I said they had to eat them, but they
didn't obviously eat them. They got out of the fun the.
Speaker 3 (03:30):
Toilet and dully they ate them. So there you go.
So that was that was I.
Speaker 1 (03:36):
Feel like my kids have missed out. Maybe maybe I
shouldn't let loose a little bit more.
Speaker 2 (03:40):
It's probably the worst one, to be fair, And I
mean we do laugh about it now anyway, but my
health christis changed that that ragey little bit, because I mean,
I don't know, maybe it was the universe talking to me,
but I felt less irritated by every little thing because
something big had happened. But they said, I can get
set off. And and I want to know. I guess
(04:01):
if it's whether you know that thing about getting to
a certain age and not giving two shits anymore? Is
it that or is it realizing life is too short?
Or is it hormonal or is it a big old
mixture of all of them.
Speaker 1 (04:12):
If you didn't give two shits anymore, or if you're
realizing life's too short, then you probably wouldn't react at all,
would you.
Speaker 3 (04:18):
Hmm? Good point.
Speaker 1 (04:19):
I mean, you'd probably go, why am I going to
antagonize you one? Why am I going to put this
out there? If you just roll your eyes and move on.
Speaker 2 (04:25):
Well, that's why I can't the keep all worry stuff
gets to me because I can't understand why if you're
that full of vitriol and hate.
Speaker 3 (04:32):
Yeah, yeah, what's up?
Speaker 1 (04:34):
Judgment and opinion and yeah all the rest of it,
keep it to yourself. Well maybe it's good we let
it out somewhere, but somehow more something more productive.
Speaker 2 (04:44):
Healthy, that's our healthy way. But maybe they're just all
struggling with midlife rage.
Speaker 3 (04:49):
Who knows? They can't just think No.
Speaker 1 (04:53):
I think there's a lot of rage about everything, and
you know, isn't there at the moment in the world.
But look, we hear about women struggle with their mood
and women dealing with mental health issues such as anxiety
and depression, sometimes for the first time in their life
as perimenopause sets, and if they even know about peri
mortive menopause, it can be so destabilizing for your relationships,
(05:13):
your marriage, your job. Does menopause make pre existing anxiety
and depression relapse or intensify? And what can we do
to help ourselves. Joining us today is doctor Caroline Gervich.
Caroline is a clinical neuropsychologist. She is the Deputy director
of her Center Australia, head of the Cognition and Hormones Group,
and an associate professor at Monash University. She has a
(05:35):
research interest in the neuropsychology of women's health and the
role hormones play on cognition. Welcome Caroline, thanks so much
for being with us.
Speaker 4 (05:44):
Hi Francesca, thank you for inviting me to talk to
you today.
Speaker 1 (05:47):
Should we start, maybe at the beginning and talk about
what hormones are the ones that are impacting our mood
and our mental health.
Speaker 5 (05:56):
Yes, So during these life phases where our hormones change,
like menopause, the key hormones we're talking about are estrogen
and progesterone.
Speaker 4 (06:07):
So these are sex hormones and they're the hormones.
Speaker 5 (06:10):
That regulate our reproductive function, and that's often what we
think about when we talk about estrogen and progesterone, but
they actually do a whole lot more than just regulating
our reproductive functions. So they can cross over our blood
brain barrier and enter our brains and have quite potent
effects on different brain areas and particularly brain areas that
(06:31):
regulate our mood and regulate our thinking skills. So that's
why these times of life where our hormones change, we
can also experience changes in mood and thinking skills.
Speaker 1 (06:43):
As well, because we often think of them as the
six hormones, but there's so much more to them than that.
Speaker 4 (06:48):
Yes, yes, so much more so. That's right.
Speaker 5 (06:51):
They are the sex hormones and as I said, regulate
reproductive function. But these hormones, so we know probably a
bit more about estrogen and how that works in the brain,
and we've learned a lot about how estrogen works in
the brain from animal research, and these studies show that
these hormones actually are quite potent sex steroids in the brain,
(07:12):
so that means that they have an impact.
Speaker 4 (07:15):
They actually change the thickness or density of.
Speaker 5 (07:18):
Our connections between our different neurons and the way different
parts of our brains communicate.
Speaker 4 (07:23):
They also have an influence on neurotransmitter systems.
Speaker 5 (07:27):
So these are chemicals in the brain, and you will
have probably heard of things like dopamine and serotonin, So
these are chemicals in the brain or neurotransmitter systems in
the brain that are really important for regulating our mood
and regulating our thinking skills. So at times when our
hormones either fluctuate or gradually decline, our brains react to this.
(07:49):
And some people are sensitive to these hormone changes in
terms of their mood and thinking skills, and.
Speaker 4 (07:53):
Some people aren't.
Speaker 5 (07:54):
So it's not a uniform conclusion that we draw that
when your hormones change, your mood will change, because that's
absolutely not the case. But for some people, they're just
sensitive to hormone changes. But all this animal work that's
been done has really laid that scientific basis for us
to have a really good guess at why some people
might be more sensitive to times of hormonal change.
Speaker 2 (08:16):
So throughout our reproductive lives, we go from puberty through
pregnancy up to perimenopause. Is that the impact we're seeing
is it? Are some of us more sensitive all the
way through or can it vary?
Speaker 5 (08:30):
Yes, it's such a good question. I think there's both scenarios.
So there's certainly some people who are sensitive to hormones always.
Speaker 4 (08:37):
So there's some people who during.
Speaker 5 (08:39):
Their reproductive years when they're experiencing a menstrual cycle for women,
or people assigned female at birth, when they're experiencing a
menstrual cycle. Each menstrual cycle has little fluctuations in estrogen
and progesterone, and the time of the menstrual cycle that
most people who are sensitive to hormone changes experience mood
symptoms is in that pre menstrual so in the few
(09:03):
days before someone gets their period, and at that time,
in terms of our hormones, our progesterone levels are increasing
and our estrogen levels are a bit lower than our
progesterone levels at that point. So the thought is that
it's the progesterone that is some people are sensitive to,
and not even the progesterone itself, but the progesterone has metabolites,
(09:24):
which is kind of when it breaks down and flow
on effects from the progesterone, and so one of them
is called alopregnant alone. But that is what the theory is,
that some people are sensitive to an increase in this
alopregnant alone, and when that increases, some people experience these
mood symptoms. So some people experience that. Then there's some
(09:45):
people who experience quite significant mood changes in the postnatal period,
and there's lots of significant hormone changes that happen both
during pregnancy and in the post natal period. I should
also say that having a baby is a huge life
change as well, so we can't just say, well, it's
all hormones, because there's lots that happens when someone has
(10:06):
a baby, but there's also quite significant hormone changes, and
so it's thought that some people again are sensitive to
those hormone changes.
Speaker 4 (10:13):
And then the next life.
Speaker 5 (10:14):
Phase for females that a lot of people are sensitive
again to hormone changes is in that perimenopause, so the
menopause transitioneers and early postmenopause. So sometimes we see someone
in perimenopause and it's the same person who's been sensitive
at different life phases to hormone changes.
Speaker 4 (10:33):
But then sometimes someone's had none of that. They've not
had any kind.
Speaker 5 (10:37):
Of pre menstrual mood symptoms, they haven't had any postnatal
depression or post natal anxiety, but during menopause they experience
for the very first time a big change in their mood.
Speaker 4 (10:47):
So I think there's both types of people. Some people
are just.
Speaker 5 (10:50):
Sensitive to hormone changes, and some people experience mood changes
for the first time during menopause, and whether that's a
hormone sensitivity or a number of other factors contributing to it.
We're still kind of learning and understanding why those mood
changes come about, but it seems to be related for
(11:10):
a lot of people the hormone changes.
Speaker 1 (11:12):
And have we been able to work out why someone
might be sensitive.
Speaker 5 (11:17):
No, that's a really good question. So there's probably a
number of factors. So there's probably some genetic factors our
genetic makeup. Some people might carry certain combination of genes
that makes them a bit more sensitive to changes in hormones.
There's also a theory that some people who have experienced
trauma throughout their lives and have got a sensitive or
(11:40):
a more sensitive endocrine access that governs our stress response,
that person might also be more sensitive to changes.
Speaker 4 (11:49):
In our reproductive hormones.
Speaker 5 (11:51):
So there's a bit of a crossover between these different
endocrine axes that govern different That are hormones that govern
different responses, so stress response, reproductive hormones, or sex hormones.
So there's also a theory that those who have experienced
trauma of some sort, and trauma can be lots of
different things. It's a really personal I mean, somethings are
(12:11):
obviously trauma, and some things are not necessarily considered trauma,
but for an individual that you know, poor attachment when
they were younger, or peer bullying or things like that
can constitute trauma for an individual. And so all sorts
of things might make someone more sensitive to hormones. And
then sometimes we're I mean, it could be a combination
of genetics of trauma for some people, or yeah, I
(12:34):
guess we just don't really know exactly why some people
are more sensitive.
Speaker 2 (12:39):
It makes me very grateful I suppose that we're in
a slightly more enlightened age where we're talking about these
things before they happen. Because freendiscin I both confessed to
not really having any clue about perimidopause for a long time,
and it has sort of come into the social consciousness
a little bit more, particularly for women obviously, and I
just sometimes think about, you know, the jokes around what's
(13:02):
the one before you get your period, premist tension, Yeah, yeah,
foggy brain and in middle life rage and all of
that sort of thing, and you know, we do, we
do laugh things off because we don't understand them.
Speaker 1 (13:17):
M m.
Speaker 5 (13:18):
Yes, And sometimes that's fine, Like for some people the
mood changes the brain fog.
Speaker 4 (13:23):
It's kind of mild and you can laugh it off.
Speaker 5 (13:25):
It's a coping mechanism, and it's absolutely fine to do that,
and it can be.
Speaker 4 (13:29):
Pretty subtle and it's not a big deal.
Speaker 5 (13:31):
But then there are other people where it's it's not
so subtle and it is more of a big deal
and it's a bit more.
Speaker 4 (13:37):
They can't just laugh it off, you know, they're really struggling.
Speaker 5 (13:39):
So I think there's a whole spectrum of experiences that
people have, and yeah, the different sort of coping mechanisms
or help that people need can also be really varied.
Speaker 1 (13:52):
So, Caroline, during perimenopause, in menopause, how are our hormones
impacting our brains and our mental health?
Speaker 5 (14:00):
So as we transition from our reproductive years into menopause,
there's this timeframe, this transition timeframe called perimenopause, and that
can span four to eight ten years for different people.
And during that transition time, we move from having the
reproductive regular menstrual cycle for people who aren't taking any
(14:23):
kind of hormone or contraceptive, and then our sex hormones
estrogen progesterone, instead of fluctuating in a regular cyclical pattern
start to be a bit more erratic, and they can
fluctuate quite rapidly, and at the same time, the estrogen
and progesterone are also gradually declining, So that happens, as
(14:45):
I said, over four to ten years. The things that
we can notice during that time in terms of our
menstrual cycle, that can become irregular, and that's often what
the basis of diagnosis of perimenopause is that your mental
cycle can be come irregular.
Speaker 4 (15:01):
But often just before that happens, people can start to
notice changes to their mood and their thinking skills. So
that's the brain fog of menopause or perimenopause that people
talk about. And the mood changes, the rage, the irritability,
paranoid thinking, anxiety, depression, a whole spectrum of different symptoms
(15:22):
that fall under that umbrella of kind of a perimenopausal
depression that can happen early on in that perimenopausal transition.
They can be some of the first signs that happen,
and it might be that our brains start to become
a bit sensitive to the fluctuations in our estrogen levels
and that gradual decline and progesterone. But if it's happening
(15:44):
early in the perimenopause.
Speaker 5 (15:45):
It's probably our bodies and brains reacting to the fluctuations
in estrogen and progesterone levels that happen during the early
stages of that perimenopause and that transition phase.
Speaker 3 (16:00):
That's fascinating.
Speaker 2 (16:01):
Gosh, that's really making me think back to my late
that is an early forties, to be honest, And so
would you call it a common phenomenon for women and perimenopause.
Speaker 5 (16:10):
So in terms of the mood symptoms, it really varied
depending what literature you look at. It's probably about a
third of women will experience some depression and about two
thirds of women will experience some degree of brain fog.
Speaker 4 (16:25):
But I think there can be kind of secondary depression
secondary brain fog.
Speaker 5 (16:30):
So if people start to experience things like poor sleep,
like anyone knows that if you're not sleeping well, it
can impact your mood, it can impact.
Speaker 4 (16:39):
Your ability to think clearly, So that can happen as well.
Speaker 5 (16:42):
But people can also experience just the mood changes or
just the brain fog on its own. And there's also
a link potentially between the vasomotor symptoms of the hot
flushes there's a theory that if you're experiencing hot flashes
during the night, then that disrupts your sleep, then you
have poor sleep.
Speaker 4 (16:59):
Then you have a flow and effect mood changes and
to brain fog.
Speaker 5 (17:05):
But also, as I said, there's the people who don't
experience any of that but just have the mood changes.
It might be more directly related to the hormone changes
in the brain.
Speaker 3 (17:13):
Can I just ask you a quick question.
Speaker 2 (17:15):
You're talking about contraception, and this is a thing that's
been on my mind, but I haven't known who to
ask and you may not be able to answer. So
does contraception have any impact on perimenopausal symptoms?
Speaker 5 (17:29):
Yeah, so it can, absolutely so, because it flattens out
the natural fluctuations in our hormones across menstrual cycles, but
then adds in synthetic hormones that kind of replicate that.
But if you don't take the sugar pills, so if
you're just taking the active hormonal contraception, then it's kind
(17:51):
of flattened out, and so you lose some of the
effects of a menstrual cycle and you have less fluctuals.
So I think the Australian menopause or Australasian Menopause Society,
which extends to New Zealand, suggests that you can keep
taking hormonal contraceptives in consultation with your doctor until about
the age of fifty And yeah, so that can have
(18:15):
a beneficial impact on mood for some people, but some
people might also need to consider and talk to their
healthcare professional about different options if it's if it's not enough.
Speaker 1 (18:27):
Yeah, and there are there are different options. But I
found it really helpful just for when those when the
metal cycle became really erratic and have to started having
a little bit an impact on life. You know, it
was one way to be able to It was just
another tool to use to try and kind of stabilize
things control. Yea, So how many women who have never
(18:52):
you know, we talked about the sensitivity and things towards
hormone fluctuations and things. I'm sure it must be quite
a surprise for a lot of women to get to
sort of middle age and all of a sudden be
dealing maybe for the first time with anxiety or a
panic attack or this irritability in things.
Speaker 6 (19:13):
Oh.
Speaker 5 (19:13):
Absolutely, And I think you say middle aged, but I
think for some women it's sort of forty, like it's
quite early that some women experience some of the mood
changes because they can be some of.
Speaker 4 (19:23):
The earliest changes.
Speaker 5 (19:25):
So the median age of menopause is fifty one, but
if perimenopause, that transition can go up to ten years,
it can be sort of forty early forties. So some
people don't even have menopause on their radar, so they
don't necessarily know why they're starting to feel a bit anxious,
a bit paranoid, irritable.
Speaker 4 (19:44):
So the connection might not be there.
Speaker 5 (19:47):
And it might come a bit out of the blue,
and it can be really hard to deal with.
Speaker 4 (19:51):
And I think the timing of menopause is now with
our lifestyles, is often at a time of life that
people are really quite particularly women, are quite stretched and
quite busy. So in the middle of your life, you're
often at the prime of your career. You might have
teenage children, perhaps elderly parents who might be managing house,
the household, like you might be doing a whole lot
(20:12):
of things, and so you're just really busy and stretched,
and with that often comes stress, and so I think
that's a huge factor that sometimes we forget to take
into the into consideration. When we think about the impact
of these hormonal changes, it can sometimes be like the
tipping point. You can kind of cope and then you
(20:34):
get to this point where you just can't cope with
all of that pressure and stress anymore.
Speaker 5 (20:39):
And so it might be the hormones that are triggering things.
But then if we look at the whole story and
take a holistic approach, is often a lot going on
for that person at the same time.
Speaker 3 (20:49):
Well, that's that's right.
Speaker 2 (20:51):
So that leads nicely into the you know, that rage
and that irritability, that sort of almost breaking point. Then
you kind of have little all out and then regroup.
Speaker 5 (21:02):
Yes, yes, and I think within that presentation of depression,
we've done a bit of work at her Center, which
is at Monish University where I work, led by Professor j. Shukulcanni,
where we've looked at characterizing that perimenopausal depression, which is
a bit different to a clinical depression at other life
phases because.
Speaker 4 (21:22):
It's a bit more on. It can be for some
women quite on off.
Speaker 5 (21:26):
So suddenly there's that rage or that paranoid thinking, that
irritability kind of out of nowhere, and then you do
bring yourself back together and feel like okay, So it's
kind of got this on off flavor to it that's
a little bit different to that potential, you know, ongoing
sadness or helplessness that might be part of a clinical
depression at other life phases, if.
Speaker 1 (21:47):
I hit an explosive moment at home, Caroline, half the time,
I'd just be going off, saying whatever was going through
my head, and at the same time I'd actually would
have it was like I was looking at myself outside
my body, going who are you? What are you doing what?
It was really strange that two things could be happening
at once. That I could be putting so much effort
(22:08):
into yelling and you know, at my family about something
ridiculous like the fact that no one can put dishes
in the dishwasher, and at the same time I was
sort of going, goodness me, Francesca, what on earth is
going on with you? Who are you? You know?
Speaker 4 (22:20):
It was bizarre, Yeah, And that's not uncommon.
Speaker 5 (22:23):
That's that's a very common description of the feelings and
the emotions and how they play out for a lot
of people.
Speaker 2 (22:30):
And I think it is good to make that distinction that,
like you say about the on off and you're not
saying this is a rule. You're saying this is in general.
But if you are feeling like, gosh, am I clinically
I mean, obviously your first portocoll is your health professional,
But am I clinically depressed?
Speaker 3 (22:46):
Or is can I?
Speaker 2 (22:48):
And this is why they often tell you to do
a diary, don't they to kind of work out when
how often that's happening, what time of the month it's happening,
what time of the even the day it's happening.
Speaker 4 (22:57):
Yeah, exactly.
Speaker 5 (22:58):
And for that reason, we also developed this scale it's
called the MENO D that people can access and it
provides people are capacity to rate their perimenopausal depression to
kind of get an objective score.
Speaker 4 (23:12):
To say where am I at? Is this really I
need to.
Speaker 5 (23:15):
Follow up with a doctor or is this okay? So
there's in the MENOD there's cutoff scores. But I think
if anyone's concerned, intuitively within yourself, just go and speak.
Don't hesitate. Always go and speak to a health care provider.
Because there's so many different options out.
Speaker 4 (23:31):
There to support people.
Speaker 5 (23:32):
People shouldn't just have to bear, you know, put up
with it and bear it and get through. I think
that that thinking is something that's definitely changed that we
now appreciate that it's quite common to experience changes to
mood and to experience brain fog. But you shouldn't just
have to suffer, because you know, four to ten years
is quite a long.
Speaker 3 (23:52):
Quite a long time.
Speaker 1 (23:53):
Yeah, I've pulled up the questionnaire. It's quite extensive. It's good.
It's about four pages, but it's going to cover everything,
which is fantastic. Oh, thanks for pointing us in that direction, Caroline,
that's awesome. Another thing that's almost the opposite of everything
going on in your brain at once and exploding is nothing.
Having moments of blankness and struggling to kind of get
(24:17):
through the brain fog is something that a lot of
people talk about as well.
Speaker 5 (24:20):
Yeah, that's something that's I think gained a lot of
traction and discussion, particularly in the social media space over
the past maybe decade. And it's weird because brain fog
isn't a term like depression. It's not a term that
has a clinical description. It's not a diagnostic or medical
term or psychological term. It's just a term that's emerged
from the community to describe their experiences. And we've asked
(24:45):
them in about what it is for them. You know
what is brain fog, And people talk about memory lapses,
attention lapses, difficulty in making decisions, that word finding difficulty,
you know that when you've got a word on the
tip of your tongue and you just can't find the
right word. So they're the main kind of symptoms that
(25:06):
fall under that umbrella of brain fog for women, and
our understanding of it is a bit similar to the depression,
like we think that some women again when they're sensitive
to the hormone fluctuations. There's estygen receptors in our brain
in the front part of our brain, which is really
important for our higher order executive functions like organizing our thoughts,
(25:28):
as well as in a part of our brain called
the hippocampus, which is really important for our memory. So,
again going back to the science, it makes sense that
when these hormones are fluctuating and declining and they're in
brain areas that are really relevant for our thinking skills,
that there might be a flow on impact to our
thinking skills. And again there's all the other stuff that
(25:49):
can impact life, stress, poor sleep, mood changes, So all
of those things independently can impact your thinking skills. But
then the hormones might have a direct impact for some
people as well on their brains and on their thinking skills.
But one thing I do like to always add is
that while women experience this brain fog in daytay life,
(26:12):
it's very real.
Speaker 4 (26:13):
It happens in about two thirds of women.
Speaker 5 (26:15):
For some people's subtle some people can have quite a
big impact. But when we do a neuropsychological assessment, which
is when we assess someone's cognitive capacity, their actual ability
to reason and to make judgments and to use their
attention and their working memory and to learn, it's normally.
Speaker 4 (26:33):
In the normal range. So people during.
Speaker 5 (26:36):
Menopause, even those women who are experiencing brain fog, their
actual core cognitive skills don't change, so they're still able cognitively.
Speaker 1 (26:45):
That's a really important It's almost more like imposter syndrome
that you've ended up with. You think you can't do it,
but you are still functioning well.
Speaker 4 (26:54):
Yes, but some people just need some support.
Speaker 5 (26:56):
So they might just need a bit more structure or
a little bit more you know, time to do things,
or a little bit less distraction while they're doing tasks.
So it's just the support the scaffolding that people might
need so their brains can continue performing at their best.
Speaker 2 (27:14):
I know, when I can't reach for a word or
a name or so forth, all I really do need
is a little bit of understanding and time, not idea
when you're trying to record a podcast and it happens,
but you know, all I need because I know it's there.
And what I would prefer rather than someone maybe finishing
my sentence or giving up on it, is just that
time is it. Just give me a minute, it will
(27:35):
come to me, you know, because I get more frustrated
when I have to leave it and then go oh,
and then it'll come to me in the middle of
the night when we're awake, because we're awake.
Speaker 4 (27:44):
Through yes exactly. And it's not that helpful then. But
that's the other thing that is.
Speaker 5 (27:49):
I think some people with they get anxious to try
and find the right word or to try and think,
and I think that anxiety can make the brain fog worse.
So I think you said like a bit of time,
I think that's like perfect just to try and you know,
relax and not stress too much about it and just
to back yourself and note like the word is still
(28:09):
somewhere in my mind or I am still able to
make decisions, but I just need a bit more space
in my head to do that.
Speaker 3 (28:15):
And that what was thirty seconds? Maybe I don't know.
Speaker 2 (28:18):
I'd probably give up myself after about thirty seconds.
Speaker 1 (28:20):
I first, yeah, I sort of first mentioned it to
my GP, probably before I even knew there was a
thing called perimenopause. And she would say, she'd sort of
say to me, Okay, tell me what it is that
you can't remember. I go, oh, a name, or does it?
Speaker 3 (28:32):
Then she goes.
Speaker 1 (28:35):
And then I got to one scenario, Caroline, I said
to it, I can't I couldn't remember where the mayonnaise
was in the super market. And she went on, that's
one that we might we might just make a note of.
And she said, but it's never happened again. But I
think that that was the first thing. The first thing
a lot of women probably go to is, oh, my gosh,
am I heading towards dementia, have id early on set dementia,
And it could be very you know, it's easy to
(28:57):
make that assumption.
Speaker 5 (28:59):
Oh, absolutely, because if you think about very superficially the
kinds of experiences you have, like you know, forgetting where
things are, forgetting names, losing your train of thought in
a conversation like those things might sound very superficially like
the early stages of dementia, but I think it's a
few really key differences between menopausal brain fog and dementia are.
(29:22):
One is age, So people aren't diagnosed with dementia generally
of the Alzheimer's type, at least until the age of
sixty five, and even early on. Said, it's sort of
more fifty plus, So just because of someone's age alone,
it's very unlikely that people are experiencing the early stages
of dementia. And if it is early on set or
(29:45):
young ones at dementia, that's quite rare, but it exists.
But the presentation then often has more mood symptoms, more
behavioral changes. It's not the same as that kind of
forgetfulness or not finding the right word or so.
Speaker 4 (30:03):
I think they're some of the key differences.
Speaker 5 (30:05):
And often also with dementia, it's other people around you
who become quite concerned rather than the person the individual themselves.
Speaker 4 (30:13):
Whereas in menopause it's very much the individual.
Speaker 1 (30:16):
Who's ghost So true.
Speaker 5 (30:18):
Yeah, So I think there's a few factors that are
quite different, and certainly clinically and neuropsychologically, the presentations are
really quite different when you drill down.
Speaker 2 (30:29):
So what other issues are you seeing when it comes
to cognitive and mental health issues with women?
Speaker 5 (30:33):
So the other clinical question I have been receiving a
lot in recent years is women who present and they've
got these cognitive changes and their menopausal and they're questioning
where they've got ADHD.
Speaker 4 (30:45):
So this is a new thing that's popped up.
Speaker 5 (30:47):
It wasn't a question that came up, I don't know,
five years ago or so, but.
Speaker 4 (30:52):
It's more and more frequently people are.
Speaker 5 (30:54):
Questioning this, and there's sometimes it's because the peri apause.
A woman has children and they've been diagnosed with ADHD,
and through taking a children through that journey, they've you know,
obviously been made aware of what ADHD is and what
the symptoms look like, and they've identified so many of
the characteristics in themselves, and then they've felt like they're
(31:19):
really experiencing this and they've always been experiencing the symptoms
of ADHD or the characteristics of ADHD, but they've kind
of managed, but they've got to a point where they
can't manage anymore. So that's often the presentation of people.
And in that case, like clinically to tease apart, is
this like a new onset of brain fog.
Speaker 4 (31:40):
That looks a bit like ADHD?
Speaker 5 (31:42):
Or is this a genuine ADHD, like a brain type,
a neurodevelopmental condition that someone's always had. We spend a
lot of time talking to someone and really understanding their
history and understanding what their presentation is. So just for
people who are unaware, so ADHD attention deficit high practicivity disorder.
It can present quite commonly for females as just the
(32:04):
inattentive component, So that's things like forgetting things, losing things,
losing your train of thought, sitting in a conversation and
then realizing you've just missed most of the conversation, haven't
been listening. So that's one presentation of ADHD inattentive. The
other presentation is that hyperactive impulsive where people feel like
(32:26):
they're on the go, they've got a motor inside them,
they sort of talk excessively or butt into conversations.
Speaker 4 (32:32):
And people can also have a combined presentation, but the.
Speaker 5 (32:36):
Undiagnosed woman is often the one who has that inattentive ADHD,
and I think a lot of people look at inattentive
ADAH and it's very easy to tick those bloxes. Like
we all forget things from time to time. We all
sit in a conversation and our brains drift off and
we're not present and we miss things. So a lot
of the characteristics of inattentive ADHD are really common. Sometimes
(33:01):
it means that they can be missed, but I think
in terms of a clinical diagnosis, it has to be
that they're kind of pervasive and that they really are
present in more than one setting, and that they impair functioning.
So it's really separating out, you know, what is normal
degrees of inattention that we all experience from time to
time from something that is someone's neurodevelopmental brain conditional brain
(33:26):
type where it's really causes challenges. And often people have
a history where they've managed or they've been misdiagnosed with
depression and anxiety and all sorts of things, and then
they get to this point and it's quite clear that
they've always had this, but it just hasn't been diagnosed,
and so sometimes that's quite a big journey for people
(33:48):
to go on to get a late diagnosis and to
you know, all the what ifs iphony are known and
so yeah, it can be quite confronting for people, but
also there can be an element of relief for some
people as well when they do have a diagnosis later
in life and a new understanding, a new lens to
understand their world.
Speaker 1 (34:09):
That's a lifetime of what in our family we call
the aha moments. My daughter was diagnosed at thirteen and
we spent a year going oh ah, you know, like
because everything kind of fell into place and things like that,
so that came back. Imagine how that's overwhelming. If that's
a lifetime of those. Yeah, absolutely, yes, I think it's
(34:29):
probably like everything, Caroline. When we have a symptom, it's
really important to, you know, make sure you're talking thoroughly
to your gp about it and not presuming it's just
one thing or the other. It's like, there's such a
massive list, isn't there of menopausal symptoms, And yes, a
lot of the time they do. That's what they are.
It is to do with the hormones. But you've always
got to make sure that you're just double checking that
(34:51):
there's not something else at play and something else going on.
Speaker 5 (34:53):
Yeah, absolutely, yes, definitely always worth having if you're concerned
and it's you know, occupying your mind and in thinking
about it, always worth having a chat to your healthcare provider.
Speaker 1 (35:05):
You're listening to the little things and our guest on
the podcast today is clinical neuropsychologist doctor Caroline Gerbert, talking
about how our hormones impact our brains and our mental health.
Will be back shortly after the break. Welcome back, Carolin.
(35:29):
Maybe we could talk about some tips to help us
through all this, how we can manage it If our
mental health is suffering, is medication the best option? Or
can lifestyle and dietary changes and things help?
Speaker 5 (35:45):
So I think a combination of everything can be most helpful.
So I think you can always start with kind of
behavior change lifestyle change, but if that's not helping, I
think it's definitely recommended that people go and have a
chat to your GP and make sure you've got a
GP who has a really good understanding of menopause because
it's not everyone's area of specialty, and so if someone's
(36:09):
experiencing sort of a new onset depression around menopause, they
might want to be speaking to their GP about different
types of hormone therapies or antidepressants if hormone therapies aren't
appropriate for them, and for the sort of brain foggy
cognitive symptoms as well. Might want to be thinking about
really practical things that people can do just to support
(36:32):
their cognitive health during the menopause transition.
Speaker 4 (36:37):
So that's things like, you know, using.
Speaker 5 (36:39):
Your diary, like feeling comfortable to put everything in your
diary so you don't have to hold it in your head,
and using lists to remember what to do, kind of
doing the brain dumps to get all those thoughts that
are floating around in your head onto a piece of
paper to clear some space so you.
Speaker 4 (36:55):
Can think clearly.
Speaker 5 (36:57):
And you know, in workplaces, making sure people put things
in an email so they don't shout them out in
the corridor. And then you're trying to hold more bits
of information in your head, so put the onus on
other people to structure things for you and email them
through and help with prioritization if need be. So I
think there's kind of practical things. There's medication options, but
(37:20):
I also think midlife and menopause is a really good
opportunity to sit back and reflect on your lifestyle. And
think about healthy lifestyle and what's good for our kind
of brain health. So it's the same things that we
say for heart health, it's exactly the same for brain health.
So it's things like exercise is super important, and exercise
(37:41):
on its own can also help mood. So making sure
people exercise and get moving is very important. Making sure
as much as possible that you get good sleep, and
there's help out there if you're not sleeping well, again,
speak to your doctor about it. It's really sleep is crucial,
you know, Making sure do you have time out so
you're not on the go all the time, making.
Speaker 6 (38:03):
Sure your brain is stimulated, making sure you've got a
good balanced diet like Mediterranean diet, and making sure you're
not using alcohol as a coping strategy because that's not
going to help your brain that I think, you know,
some people kind of turn to alcohol as as a
quick fists and makes them feel better temporarily, but.
Speaker 4 (38:21):
It's not going to help in the long run.
Speaker 5 (38:23):
So there's lots of kind of healthy lifestyle things that
people can do. And I think you know, midlife is
a great time to reflect on your own lifestyle.
Speaker 2 (38:32):
Yes, and we've covered a lot of those points it
was one of the reasons for doing this in the
first place, was how how to help ourselves and sit
I know, for me, exercises a big one and I
really know when I can't the impact it has on me. Yes,
with same with diet and getting that time out can
sometimes be one of the hardest parts.
Speaker 4 (38:53):
Absolutely, but it might not even be.
Speaker 5 (38:55):
It's not like you have to go and spend a
day a week in a spa, although that might be nice,
but it might just but you know, having making sure
that you have, you know, five minutes just to go
for a walk by yourself with no phones, no stimulation,
just some actual switch off or just a breather in
the middle of the day, have a cup of tea
or whatever it is.
Speaker 4 (39:13):
But just little bits of switch off where you're not
your brain isn't bombarded with stimulation.
Speaker 3 (39:20):
Any breaks.
Speaker 1 (39:21):
I like that, Yeah, many breaks, Everything's many these days, Caroline.
Conversation ahead with women quite often when they have symptoms
to do with their mood, maybe low mood and things
like that, maybe they're not sleeping as well on things.
Often we're all having the same conversation with our GPS.
Do we need HI or do we need any depressants.
(39:43):
How do we make that decision.
Speaker 5 (39:46):
It's such a good question and we actually don't know
the answer. So we're trying to run a clinical trial
at the moment where we're trying to do this head
on head comparison and antidepressants and hormone therapy because that
hasn't been done, so we don't know that answer at
the moment. Our clinical guidelines say to go with the
(40:06):
antidepressants because they've got a stronger evidence base, but there
just hasn't been as much research with hormone therapy for
mood so I think that's why there's not as much
evidence there. Although the guidelines do say that you can
try hormone therapy for moods as well, it's just not
the first line treatment that's recommended. So I just think
(40:28):
it's really important to go and have a really good
discussion with your GP, and you can look at the
Australasian Menopause Society is a really good place to read
up and they've got literature for anyone who wants to
have a look at what the recommendations are for that
to go to your GP with that see a.
Speaker 4 (40:47):
Bit more equipped to have the conversations.
Speaker 1 (40:49):
And be honest about it. I think if you've never
really suffered from mental health, then it's quite hard to
go in and have that conversation and sort of put
it on the tables. But it's important that we do
how far along is that research. Can we just rush
that along a bit love to.
Speaker 4 (41:06):
Russia.
Speaker 5 (41:07):
We're working through as quick as we can, and.
Speaker 3 (41:11):
How slow research can be.
Speaker 4 (41:13):
It can be really slow. Funding can be really hard
for every research as well.
Speaker 5 (41:17):
So we're doing the best that we can to try
and learn more and get those answers.
Speaker 4 (41:23):
But I think also you know, if you're not.
Speaker 5 (41:27):
Someone who's experienced depression in your life and your hormones
change and your experienced depression for the first time, maybe
trying to replenish those hormones might be a good place
to start. But have that conversation with your GP.
Speaker 2 (41:40):
And I think the good news there is that there
are resources like the Australian Minipause or society. There are
more resources with even in space research that we do
have that women can themselves with or do that research
before they go to see someone. And if you don't
get the answers that you think you need, or if
you feel like you're getting brea off, try try again
(42:02):
with somebody else prehaps.
Speaker 5 (42:03):
Yes, exactly, And I think that's hard, Like often when
you're feeling vulnerable and you build up the courage to
go and speak to a GP. If you do get dismissed,
which can sometimes happen if it's not someone's area of specialty,
it can be hard to try again. But I think
you know, always try and find that new self to
keep trying until you get to a point where you
feel better.
Speaker 1 (42:23):
You mentioned before, you know, will we hit this sort
of period of our lives, it is a good time
to sort of have a little bit of a reset
and think about our cognitive health. But should we always
be looking after it like shou should we be saying
to it? Should we be sort of more aware of
out even our older teenagers and things like that near
cognitive health and putting in good practices.
Speaker 5 (42:43):
Now Absolutely, I think all through our lives we should
do what we can to do the best for ourselves
to optimize our brains and our physical health always, but
I think people probably have other priorities, as you know, teenagers,
and so I think midlife is a great time if
(43:03):
you haven't already implemented some of those things like you know,
a regular exercise routine and a healthy diet. It's not
too late to start to still, you know, there are
things that these they modify our risk of later life
dementia and things like that. We do have some degree
of control and we can try and do our best
(43:24):
to have some of those healthy lifestyle approaches and they
have short term benefits and longer term benefits as well.
Speaker 2 (43:32):
I'm going to ask a really dumb question, and I'm
blaming it on minopause. Okay, our brain is a muscle, right, our.
Speaker 4 (43:39):
Brain, It adapts.
Speaker 5 (43:40):
So our brain they often use the words of being,
you know, plastic, it's malleable.
Speaker 4 (43:46):
So it keeps changing always.
Speaker 5 (43:49):
And so you know, the more we do good things
for our brain, our brain will respond and will adapt.
And that's why people recommend things like you know, learning
a new skill or taking up new hobby or you know,
challenging yourself because that builds new connections in the brain
and strengths and connections in the brain. So, yes, our
brain keeps changing as we as we grow.
Speaker 1 (44:13):
That's what's so cool about it. As we can improve it,
it can grow and get better. That's what's so neat
about it.
Speaker 4 (44:19):
Yeah, yes, yes, always, yes, you know.
Speaker 1 (44:22):
It's interesting. I was gonna ask you, you know, we
really need to support each other a lot more going
through this period of time and how we can do that.
But I wonder whether the best thing that we could
do is get our partners to listen to this podcast. Yeah,
because I think most women, we were all we are
quite understanding of what other women are going through. Yes,
and as Lu said before, we're having a lot more
(44:43):
conversations about it. But I think probably where we struggles
and other environments, like in the workplace.
Speaker 5 (44:49):
Yes, yes, exactly, and I think some workplaces are more
progressive and there's more conversations about menopause and menopause in
the workplace and supporting women through menopause and yeah, but
I think the more conversations that happen, it just becomes,
you know, part of our dialogue and it's not such
a big deal and it's not so taboo and there's
(45:11):
less stigma if there's more conversations. And I think, you know,
at the heart of it, in terms of the workplace,
we want to be able to keep women and all
their talents and that diversity in the workplace, and there's Sadly,
far too many women who get to a point and
for whatever reason, whatever's going on for them, they leave
(45:32):
work during those menopause transition years, and you know that's terrible,
rather than seeking the right supports and then being able
to do their best to thrive during this time. So
I think it's really important that there's support coming from
all different places so everyone can be at their best.
Speaker 2 (45:50):
It's not as if we're using it as an excuse
for any kind of poor behavior or poor work outcomes
or anything like that. So it's a knit win, right
if it's not, and like you say, just giving us
that moment if we need it or I know there's
a lot of talk about uniforms, people who work in
places where they wear uniforms where they're not practical.
Speaker 3 (46:11):
When you have when you have a hot flush.
Speaker 4 (46:15):
Yes, exactly, exactly.
Speaker 3 (46:17):
Sometimes, Yeah, we're not just talking about the corporate workplace.
We're talking about across the board.
Speaker 5 (46:21):
Yes, sometimes people need layers so they can adapt to
however whatever their body temperature is feeling for them.
Speaker 2 (46:29):
I mean, we have arguments all the time about the
airct and in our building.
Speaker 5 (46:34):
Yes, yes, so golden here, yes, yeah, exactly, Yes, it
depends who has the controller.
Speaker 1 (46:42):
When it comes to our cognitive health and the other
things that we've been talking about. Caroline, I suppose if
you do want to reach out and get some help,
the first place you go to is your GP.
Speaker 4 (46:52):
Yes, definitely always yeah, go and have a chat to
your GP.
Speaker 5 (46:56):
And also the other place is good websites like the
Australasia Menopause Society, where there's good resources, evidence based resources.
So I think, you know, looking at those kinds of
websites as well as having a chat to your GP.
Speaker 1 (47:09):
Doctor Caroline Goovich, thank you so much for talking to
us day and normalizing our irritability and our rage and
our you know, our low mood and everything else and
our brain fog, everything else that comes with that.
Speaker 3 (47:21):
We really appreciate it.
Speaker 1 (47:22):
Fantastic tips, yeah yeah, and the men O D questionnaire
that's going to be that's going to be a brilliant
tool for people. So thank you so much.
Speaker 4 (47:31):
Thank you, Francisca and Louise, thank you for having me.
Speaker 1 (47:46):
How good is doctor Caroline Goovitch. I just love the
fact that it's all evidence based, science based. There is
a reason that you have this irritability and this rage
and that everything that the world is. You know, it
seems to be changing around you.
Speaker 2 (48:00):
I hang on every word, and I only wish that
perhaps I did have more of an understanding of that.
I'm not even kidding. In my late thirties and early forties,
which is when I would say, I was at my
lowest EBB mental health wives and it wasn't related to
the birth of a baby or anything else. Like, there's
nothing else to put my finger on except for a
lot of probably a lot of.
Speaker 1 (48:22):
But there was also a lot going on in your
life at that point.
Speaker 2 (48:24):
Yes, well, as she explained it as often, it offers
that horrible kind of convergence of everything of everything.
Speaker 3 (48:30):
Yeah, but I think you're right.
Speaker 2 (48:32):
I think this one is for the boys too, and
actually was just reflecting and maybe for my kids just
I'll just take some snippets out and send it to them,
because that might.
Speaker 3 (48:42):
Just explain those Raigie drives to school. Did you ever
have those? You just screamed at the children all the
way to school?
Speaker 1 (48:50):
No, once I put the horn on. Oh yes, I
feel like that was that was I just we were
driving through the lights and I were arguing, and I
just put the horn on. But we were quite close
to school, so of course they were mortified because everyone
was staring at us and until when they stopped off
the wall. So we had it, had a good day.
Speaker 2 (49:08):
There was the mother of five that winteresso and I'm
not gonna I got it. And literally I remember walking
the kids to school and you're driving past what she
got the horn on.
Speaker 3 (49:18):
The minivan for? And then she explained it.
Speaker 1 (49:21):
Yeah, no, I think I think I got it off her.
And I remember using what's going That was actually pretty effective.
Hey really quickly though, Caroline mentioned a questionnaire you can
do if you're just trying to work out sort of
what level your symptoms are at your perimenopausal symptoms. It's
called meno dno slash D. If you google that, you'll
(49:45):
take you through to the questionnaire and it's from the
mon Nash University and it's great for you to maybe
use as a tool. But if you're struggling to maybe
you know, explained and listened to by your GP, you
could always sort of maybe print out and take it
in and go, look, here we go. I've done a
bit of a this is where I'm at, this is
what we need to do something with, So that could
(50:05):
be potentially a really great tool. Just just want to
touch on one other thing. I found that really interesting,
the sensitivity and how they've worked out how some people
are more sensitive to hormone fluctuations in it, but we
can't quite work out why.
Speaker 3 (50:18):
Yeah, a little bit probably to do on that. I'm
sure they'll get to it.
Speaker 2 (50:21):
The Australasian and menopause Al Society is also really good,
a really good point of reference for and more information
and I'm pretty sure that's their name of their website
as well, so and that will keep you up to
date with research as well. It's it's a full time,
it's a frull time. And I think we've touched on
lots of elements of menopause, but not done a specific
(50:44):
one about.
Speaker 1 (50:45):
This, about that age, mood and the things like that.
I think I think we often talk about other things
a little bit more than we open up about that
hemnopause maybe, or we try and we do. We do
try and laugh it off because what else gotta do?
Cry and ray and put your horn on and just
(51:06):
leave your hand on that horn for as long as
you're lining. Maybe that's my joy of the week, just
exprussing yourself, just you know, put your hand on the
horn and just let it blair and let everyone look
at you and just let it out.
Speaker 3 (51:20):
Then just give them the evidence.
Speaker 5 (51:21):
Yeah.
Speaker 3 (51:22):
Yeah, well that's a good joy.
Speaker 6 (51:23):
I like that.
Speaker 5 (51:24):
Do you have one.
Speaker 3 (51:26):
I'm full of a cold, so I my joy is coming.
Speaker 2 (51:31):
I'm feeling very grateful for good health when you have it.
So yeah, it's just a cold, but my god, it's
really it's kind of doing a number on me.
Speaker 1 (51:40):
Well, we know what happens to Louise, which you can't exercise.
You know, I get a bit range, you get a
bit rangy. There we go. Thanks for joining us on
our new zealanderial podcast, Serious Little Things. We hope you
share this podcast with the women in your life. We
can all live with a little less rage.
Speaker 2 (51:54):
You can follow this podcast on iHeartRadio or where ether
you get your podcasts, and for more episodes from us
on other topics, head to zid Herald dot co dot
ZT and we'll catch you next time on the Little
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