June 8, 2022 • 56 mins
Jen talks to Dr. Stephanie Faubion, M.D., M.B.A, author of "The Menopause Solution" and Penny and Bill George Director for Mayo Clinic's Center for Women's Health and medical director for The North American Menopause Society - about how anxiety, stress & worry can spike during the 7-10 year perimenopause period and what to do about it.
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Episode Transcript
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Speaker 1 (00:08):
This is the Anxiety Bites podcast and I am your host,
Jen Kirkman. Welcome to another episode of Anxiety Bites. I'm
your host Jen Kirkman. Today we're talking about menopause and
perimenopause and how that relates to our levels of anxiety.
If you are a person who is experiencing either right now,
(00:30):
I wonder if you know that that absolutely increases any
anxiety that you are already prone to. It can suddenly
give you anxiety in the form of panic attacks, obsessive thinking,
mood swings, depression. You know, it's a lot. Our hormones
are changing during this very long phase of our life.
(00:51):
And there is so much more to menopause than what
you may think, you know, which is just one day
you stop getting your period and that stuff. It's a
sometimes seven to any your process of hormones changing before
that inevitable stop in menstruating happens. And this has not
talked about in society unfortunately. What you're going to learn
(01:11):
from my guest today, Dr Stephanie Fabian, is that medical
doctors are getting less training now in recognizing symptoms of
perimenopause and menopause. You have to be your own advocate,
and so I highly recommend starting to learn about this,
and I'm hoping I'm doing a service for any people
out there that might be wondering what's going on in
(01:33):
their forties as they suddenly maybe feel like a teenager again,
not in the best of ways. And how in our
ages society where unfortunately, not only do we sort of
abandon our elders, right, people in their forties and fifties
now are seen as older in the workplace at least,
and it can be pretty difficult to want to talk
(01:53):
about this hormonal change that affects our moods, our anxiety,
our physical cell that goes on intermittently for seven to
ten years. And you know, you spend forty weeks in
your life of your life. That would be great if
you only had to work forty weeks in your life,
forty forty hours a week at a job most weeks
(02:17):
of the year. Well, you're going to run into having
your perimenopausal symptoms at work and you need special kinds
of relief. Usually these things might involve time or change
of environment within the workplace, and it can be pretty
scary to talk about because we don't want to be
seen as not being assets to the workplace at our age,
(02:40):
because obviously we are. So there's that kind of anxiety.
I mean, even if you don't physically start getting panic
attacks when you're in perimenopause, there is a lot that
affects your brain and emotional health when you're going through
such a big physical change. And serotonin is mildly connected
to estrogen as well, so when that starts to change,
(03:02):
it does affect our serotonin, not as much as I
thought it did actually in Ductor Bobby and will take
us through that. But yeah, So this is the second
talk that that people have h a need for in
their life. The first one is you know about getting
your period, and then the second one is about the
years and years it takes for your body to go
(03:22):
through what it needs to go through for your period
to stop. And it's not simple and it's not quick,
And it might be a great episode for you to
listen to, even if this isn't something you're going to
be going through, but it might help you understand the
struggle that maybe people you work with, howe, or people
(03:44):
in your family or friends of yours, or anyone you
know in this age range. So there is hope of course,
But I think what I took most from my talk
with Dr Stephanie is we really have to be our
own advocate, and we cannot think that we are crazy
and that this is in our head. We have to
learn as much as we can about what happens during
(04:06):
paramount of pause, both physically and emotionally and mentally into
our brain. And we can't let doctors tell us that, oh,
it can't possibly be happening because they're not trained in this.
So get yourself. Um, I don't know I was gonna say.
(04:26):
I don't know what I was going to say. To
be honest, get yourself what get yourself this episode so
that you can start to learn something about everything that
you might be going through or will go through someday
if you're lucky enough to hit that age. So again,
my guest today is Dr Stephanie Fabian. She is a
clinician who has practiced in the Women's Health clinic at
Mayo Clinic for over ten years and has evaluated and
(04:49):
treated women with menopausal, hormonal and other health concerns. Relating
to that, she has a broad interest in women's health
and she is the direct dirt for the North American
Menopause Society. Again, the link to that will be in
the show notes. And as the Penny and Bill George
director for the Mayo Clinics Center for Women's Health, today
(05:12):
we're talking about some of the things in her book
called The Menopause Solution, which came out in she said
there is a new version that should be coming out
this year, and you know, will I will say there
is hope. But again, like with any anxiety solution, it
seems as though it's the answers you've heard before, you know,
(05:34):
taking care of your health by making sure you're putting
healthy food into your body, cutting down on alcohol, if
not eliminating it, exercise, meditation, medication as needed, therapy, mindfulness, sleep.
But there are a lot of different stressors that can
affect someone in perimenopause, and an attitude shift is kind
(05:59):
of needed as well, which is that this isn't really
something to dread happening. It's just something to be prepared for.
And unfortunately, it seems like there aren't a lot of
people out there that are helping us prepare. So I'm
hoping I can be a helpful voice in that lack
of voices, and hopefully this episode will give you enough
(06:20):
bread crumbs to find your way to how you want
to handle your paramount of pause. And again, you know,
all of the solutions to this are simple, they're not
necessarily easy. Right, when we take care of our brain
health or mental health or emotional health, whatever you want
to call it, we know what to do, and sometimes
we just don't want to do it. Whether it's our
depression that's making us lack of the motivation, or a
(06:41):
self esteem issue that says, you know, when we're really
not worth taking the time to take care of ourselves,
or the a d h D which affects our executive
brain function. There are so many reasons why people don't
get started on taking care of their brain, emotional, mental health,
and I think there's a lot of times I can
get tricked by is to thinking, Okay, I hope this
(07:02):
episode gives like the definitive number one answer for people,
and it's like, there isn't one, right. It's a combination
of finding out what works best for you, but we're
probably always going to be picking from the same bag
of tricks. And it's not because you know, no one
knows what the solution is. These are the solutions, but Again,
(07:22):
they're simple, but not easy. That's what makes them so
difficult to implement sometimes because again, the mental health that
we're trying to take care of can sometimes get in
our own way from even starting. So again, I hope
you enjoy our conversation about perrymnopause, and I'll see it
on the flip side. We're going to talk about perrymnopause,
(07:45):
menopause and the anxiety, grief moods that accompany it. But
you know, before we get into that, i'd love to
chat with you just what the basics are. What what
is perrymnopause? What is menopause? Yeah, I mean, that's such
a great question. And I've said many times that we
(08:05):
get the talk when we're about to start our periods,
but nobody gives you the talk when you're about to
stop your periods. And there are a number of reasons
for that, UM, including that the timing is variable for
for many women, and so we there's no set time
like your thirty five years of age. You need to
get the talk now. So and UM providers aren't really
(08:27):
comfortable UM giving the talk, which is another major issue
we can talk about. But let's talk about definitions here.
So first of all, starting with the easy one, relatively
easy anyway, menopause is defined as no period for a year,
and that's with it without any manipulation. So you have
a uterus and you would have been menstruating otherwise, and
(08:49):
you haven't had an endometrial ablation, and you don't have
an I U D that would make you stop bleeding,
and you're not on a birth control bill that would
make you stop bleeding. So without all those caveats aside
nature taking its course, it's no period for a year. UM.
The mean age in the United States is around the
age of fifty two UM, but anything after the age
(09:10):
of forty five is considered normal, and about us are
done by the age of fifty five. So when you
back it up, what are the stages they get you
to menopause? And we call that the menopause transition and
the time leading up to the last menstrual period. And
you don't actually know it's the last menstrual period until
it's been a whole year, right, so you're actually we
(09:31):
sort of call it perimenopause until you've been a year
with no period, when in fact you were menopausal when
you had that last period. Right. So that's why this
definition gets a little gray and fuzzy in there. Now
that time leading up to menopause. Perimenopause can last for
several years, and it can be when your periods start
to get a little bit of regular um, And it
(09:53):
can be really subtle at first. It may be you
know it's off by three or four days, or your
periods are getting shorter or longer, or they're getting closer
together for their part, So the variation can be pretty
much anyway. Um. And then you can occasionally miss a
period and you feel like you might be in menopause
then because you could have hot flashes and nights west
(10:14):
and sleep disturbance in your mood is crazy. And then
it all just kicks back in again for a while.
And I had a male colleague once described this time
frame as like a boat motor sputtering, and I went, oh,
dear God, that is like such a classic male description
for a female reproductive stage. And I was going, darn it.
(10:36):
He's kind of right, you know. So people have described
it as kind of like a um, a candle flickering
or fluttering, and I usually just say, look, it's not
like a light switch. You don't just flip it off
in your and your over stopped working one day. They
really do kind of come in and go out for
a little a little bit of time, and you might
(10:57):
blame it on one thing or another, like I got
sick and you know that I didn't have a period
for a couple of months, which can happen um or
you get particularly stressed and you're not sleeping in your
period stopped for a couple of months, and then they
kick back in. So it's a very rocky time frame
for a lot of women because it's so unpredictable in
what your hormones are doing, and until things sort of
(11:18):
settle out post menopause, it can be pretty disruptive. And
so when someone has gone one year without menstruating and
so now they I guess it would say in menopause,
But I guess we don't say in menopause after that year, right,
do we say post menopausele or something or that's a
great question. So some people just say you're in menopause
(11:39):
um or you are post menopausal for the rest of
your life. So so I think either could be accurate.
You are you're technically in menopause or post menopausele either
is fine, and for me, I'm in I'm calling what
I'm in perimenopause, but I am having hot flashes, the
(12:01):
mood swings. If they're not perimenopause, then I, you know,
maybe they should just lock me up and throw away
the key because I've gone insane. But like it has
to be. But I also have a d h D
and I also have depressions, So but I know those
two um bedfellows. This feels different because it's so intermittent,
and it's there's a lot mixed in with it. And
(12:25):
so do I sound like I'm in perimenopause or am I?
Am I experiencing something else? You very likely are in perimenopause,
just from your age alone and your description of your symptoms.
So it just seems like estrogen is a I don't
know how to put it, a beast in terms of
there's too much, there's too little it. How are we
(12:48):
having the same symptoms with different levels of am I
making sense? Like sometimes we have too much, sometimes we
have too little. Why do they produce a similar symptoms?
I think it's the the changes in estrogen levels that
cause the biggest issues. Um, So what happens in perimenopause
is your brain is trying to tell your ovaries, hey,
(13:08):
not here, and from your ovaries, where are you, and
they put out these brain chemicals that stimulate the ovaries
a lot to say, you know, come on, let's hear
from you. And then the ovaries overshoot sometimes and so
you can actually get higher estrogen levels than you've ever
had in the rest of your reproductive lifespan because your
brain is over stimulating your ovaries to get them to work,
(13:32):
and eventually they don't respond, which is why you know,
it kind of dies out eventually. But so so you're right,
you can have these highly variable estrogen levels and and
you know, sometimes when your estrogen levels or high, you
might feel great. Other women might feel breast pain, um
when they're super high. But when they start to fall
is you know, if you're going from super high back
(13:54):
to zero, that's a big shift. And and so that's
a night sweat, hot flash, irritability, can't sleep, you know,
the whole thing. Um when that when that shift is occurring.
So it's more the variability. Although high levels and low
levels can cause symptoms, it's more the variability and the
changing that is so disruptive to women. And is there
(14:16):
a tie in I've I thought, I read this that
serotonin is affected by estrogen, and so in that sense,
if the estrogen is being erratic, so goes our serotonin levels. Well, yeah,
it's not that simplistic. So the neurotransmitters are definitely connected,
(14:37):
and and serotonin can be impacted during all of this.
But serotonin levels can be impacted by a lot of things,
including what's going on in your life, you know, and
whether you're getting enough sleep and exercise and everything else.
So so so many things impact those those neurotransmitters, estrogen
being just the one. Anxiety bites will be right back
(15:00):
after a quick little message from one of our sponsors.
What I thought was so interesting, And I'll get to
this chapter in a second chapter five Moods and you.
But there was a mention of grief, and you mentioned
(15:22):
grief in the part of your book where you talk
about maybe going through a premature amount of pause. But
I feel like, even at the right time men of pause,
there must be grief. I never really thought about that
because I don't want to have children, and so I'm
not conflicted about not being able to reproduce anymore. And
but of course people who didn't have children, there may
(15:44):
be some grief and then even grief about getting older.
I mean, it's it's very strange. I mean, I feel young,
I look young, and my body is doing something that
I saw episodes of The Golden Girls about when I
was a kid, you know, so it seems it feels. Um,
I'm not in the part yet where it feels liberating.
(16:05):
I'm I'm in the part where I don't want this
to change. I don't mind getting a period every month.
I don't mind feeling the way I felt since I
was thirteen, you know, I I'm in grief. I think, yeah,
I think that's an interesting concept. And and in talking
with women, it's not a universal experience in my in
(16:26):
my experience, it's it's something that some women have have
to go through, and some women are really just yeah,
let it be gone. I'm really happy to move on.
But I think I think you're right. I think there
is something about leaving that reproductive phase, if you will, Um,
it's somehow sad. You know, you're saying goodbye to something,
(16:47):
even if you don't really care and don't want to
have a baby, right um, but you're you're leaving it behind.
And I think it also is associated with agism too.
You're entering a time where you can't anymore. And I
think more and more women really don't want to be
defined by their reproductive status, like I can or can't
(17:07):
have a baby. I mean, but that still is somehow
a gateway that we all passed through. That that I
think a lot of women struggle with. You know, am
I am I somehow not worth anything to society anymore
because I don't have eggs being produced, you know, and
released every month. And you know, so many people know
so little about menopause that honestly they have no I mean,
(17:32):
I know people that I didn't want to vote for
Hillary Clinton because they were worried what she would be
like on her period. I mean, I'm really just trying
to be funny here, but it is funny. I'm half
serious that we worry about that because most people don't
even know, you know, what it means that nobody would
ever know I'm past my child bearing years if they
wanted to be ages um, because they would they have
(17:53):
no idea what age that is, you know, right? I
know I just read something that I think in Sweden
women are going to have time off for menstrual situations
and they specifically in the article we're talking about period
pain and I'm thinking, God that you know the seven
to nine to ten years of perimenopause through menopause were
(18:14):
these symptoms come in. To be in a workplace is
really hard, and I think that leads to a lot
of anxiety to like you have to hide this thing
you're going through, which actually can show up on your
face when you're sweating. Yeah, that's exactly right. And it's
interesting you bring this up because this conversation about menopause
in the workplace is really taking off, and I think
(18:36):
that's a good thing. Europe's a little bit ahead of
us there and that um they're really pushing workplace policies
for menopause. And I think we are now where we
were with pregnancy and lactation about thirty years ago. We're
starting to say, hey, we should have these conversations about
what this means for women in the workplace. And where
(18:56):
I work at Mayo Clinic, we're in the process of
developing a work place policy um around menopause, because you're right,
it is it can be disruptive. It can go on
for a long time. It can be anything from I'm
in the middle of a business meeting and I break
out in a sweat. I start to have, you know,
pit stains, and people are wondering what's wrong with me?
(19:17):
And I'm having trouble word finding. And some of the
women that I that I see are like, I can't
have this happen. You know, I'm an executive, I'm the CEO,
and and they're like, I can't have this happen. You
have to make this stop, or I'm not sleeping. And
I had one woman that literally said she sweated out
(19:37):
her mattress to the point where it molded. Oh my god,
I'm like, wow, okay, all right, So those are some
serious nights. What's going on? Right? And and she had
to have her husband come pick her up at work
at the end of the day because she couldn't drive
home without falling asleep. So so some of these symptoms
are incredibly disruptive, and it's hard to function during the
(19:58):
day when you're not sleep being at night, or when
you're so irritable you want to rip your spouse's eyes
out um or you know, there's there's there's a lot
going on, UM, and I think we need to have
conversations about one, educating people about what this time is,
and we should be able to talk about it. And
it shouldn't be an age is discussion, right, it should
(20:21):
be UM, a normal conversation. This is a normal phase
of life. This is not a disease. A hundred percent
of women are going to pass through the stage if
they're lucky enough to get that far right, So we
need to be able to have the conversations and and
not have it turn into, UM, a reason for discrimination,
which that's definitely afraid of me too. And I'm getting
(20:44):
anxiety as you're saying it because I'm like, well, you
know what, never mind, No, let's not have the conversation.
I don't want anyone to know because they're going to
think I can't do my job as well. And but
it's true, how do we you know? In one way,
it's nice to talk to other people who get it
and say I really can't find my words right now.
You're having, you know, jokingly, people will say things like that,
(21:04):
I'm having a senior moment where you're trying to say
can you get me that? Oh, go, what's that thing
we write on it, it's um, you know, um paper paper,
give me the you know, we have those moments. But
why wouldn't I mean, I have to be totally honest.
Why wouldn't would discriminate? You know. So I'm very anxious
for us to have this conversation because how is it
not going to backfire? What do we do? I'm very
(21:27):
anxious too, and I have to. I think we have
to be very clear about what we're asking for in
the workplace. And I actually, you know, as as Uh,
a medical director of the North American Menopause Society, we
had this conversation at our last national meeting, and I'm like,
what is it we are asking for? Is it a
cold room at work? So it's amazing. I mean, you know, Frazer,
(21:51):
you have a lactation room, you have a cold room.
I mean, what is it? What is it that we're
asking for? Because I think when you start talking about
workplace accommodation, that gets very sticky. And so you know,
if it's being able to take your jacket off in
a corporate environment for the five minutes when you're having
a hot flash, I get it. But I also think
we need to flip this conversation and look at what's
(22:14):
happened with menopause management in the last twenty years, and
that is, we used to have about us women using
hormone therapy to treat menopause symptoms before two thou two
when the Women's Health Initiative study came out, and since then,
hormone therapy US rates have dropped to orders of magnitude
like four to six percent now, and so we have
(22:35):
a lot of undertreated women out there. And so my
thought is we need to educate women. We need to
educate their healthcare providers. There are treatment options out there
that are available that are safe and effective that we're
not using. And so is it so much that we
need to accommodate someone at work, Yes, maybe, but we
need to offer effective therapy for these symptoms so that
(22:58):
women can keep doing their job and get the promotion
and take the next job if they so choose to do.
Because think about the lost human capital for women not
being fully at their peak form during this time of
their life where they are at their peak form. Right. Well, well,
that's what I wanted to bring up, is that I
(23:19):
honestly would rather have me now in the workforce and
me at and you know, I'm smarter, I'm more capable,
I'm whatever. I'm just much energy. But you know, yeah,
there are moments where I may forget a word and
I may be physically uncomfortable, but it really doesn't affect
my performance. I am not actually experiencing a moment where
(23:41):
my intelligence levels are dropping. And I feel like being
able to watch someone maybe forget a word sometimes or
be a little spacey um, be a little physically uncomfortable
is not indicative of their job performance. You know. I
think a lot of companies started doing this, and then
(24:02):
I think the pandemic disrupted a lot of that um
extra stuff that we bring into the office. Right, maybe
there's a yoga room, a meditation room, you know, for
everybody of all genders and walks of life. Maybe there
are these sort of mental health break rooms things like that.
And you know, this notion of let's make work as
comfortable as home, and then the pandemic hits. I think
(24:23):
it disrupts it and people are like, oh, I'm just
gonna work from home. Right, I think you're right. I
think COVID may have helped us out in many ways
because it's accelerated, um, having us think outside the box
in terms of what work looks like and where work
is and how we're getting it done. And maybe, um,
it's much more flexible now and it can be on
(24:47):
people's own time. So I think we may have moved
ourselves in a positive way just because of the COVID pandemic.
And you know, now we have more access to virtual
care than we ever have before, which is making it
possible for a lot of women to get menopause consultations
virtually with experts that they might not have had access
(25:08):
to before. So I think even for the care aspect,
it's made things a lot easier to Oh, that's great, Right,
you could talk to someone outside of your state. That's right.
But you know, it would be nice if you could
just without being questioned, you know, like a privacy thing.
Just work from home when you feel you need to.
I think that helps a lot too, so you can
sweat and privacy and when you're not needed, take a nap. Um.
(25:32):
But again, every time I say this, I get this
cringe and twinge of anxiety of just like, oh god,
it seems like we're so it seems like we're too much,
you know, but I do think this kind of care
could benefit men as well or people that don't go
through menopause, you know, absolutely, And some women may not
have that option if they're you know, factory workers for example,
you can't opt to work from home, right, So I
(25:55):
think we need to think about different work environments too.
And even those of us who are you know, seeing patients.
Think of the nurses in the emergency room, they don't
have the option to say, Hey, I think I'm gonna
work from home today. So uh so, I think some
jobs are are more amenable to that kind of flexibility,
others are not, and we have to figure out how to. Again,
I think a lot of this is education and a
(26:16):
lot of it is not making it a joke, Like
why is menopause always the joke at the water cooler
um where you get it conjures images of angry, red,
sweaty women, right um. So, so I think we need
to sort of break past that um to where you know,
when women are bringing it up, it's not it's not
(26:37):
automatically going to be a it's a joke. We'll be
right back. You mentioned in your book, uh your chapter
called moods, and you I mean it's so overwhelming to
me to look at all of the things that happened
(27:01):
during menopause. You know, you talk about depression. You know,
someone might be going through depression for the first time.
And again it's not like somebody died and they might
have a year of grief, but this again could be
seven years, ten years. And so we're you know, talking
about people could take antidepressants, cognitive behavior therapy, managing your stress,
(27:22):
and it's like there's so much you can do, which
is great, but it also seems like a lifestyle change,
like how you've got to add in time in your data,
meditate every day and stretch. And that, you know, is
what do you recommend for people that think they're starting
in on perimenopause. Well, I think you bring up a
really good point. One. Let's just back up and get
(27:43):
a bigger picture here, because I think so many women
in this life phase are taking care of everybody else
except for themselves, right, So so many people are you know,
whether it's kids or aging parents, or your next dooring neighbor,
or your dog or your partner. I mean often you
(28:04):
are the last person on the list. And so part
of this I think is, hey, thanks change in perimenopause,
and as you go through the menopause transition, your own
health risk may change. That's a time when whereas women,
our cardiovascular risk goes up as we go through the
menopause transition. And so it's like we should like take
stock of where are we Are we taking care of ourselves?
(28:26):
Are we exercising like we should? Are we sleeping like
we should? Are we managing stress like we should? And
so I think rather than just looking at it is
oh no, all these bad things are going to happen
to me, I think it's take stock and am I
really taking care of myself? And the way that's going
to set me up to be healthy for the rest
of my life is more the way we should be
(28:47):
looking at it. And you know, I really have to
sit some women down and go, you know how when
you're in the airline and they go put the oxygen
mask on yourself before you put it on the person
next to you when the plane is crashing, Well, that's
that's this. I mean, you have got to take care
of yourself first, so you can't take care of all
these other people in your life that need you. So
(29:09):
so I think that's the first message that it's not
selfish to take care of yourself. No, No, it's like
life saving and it can make your quality of life
so so much better. If you take the time and
go exercise like you know you're supposed to but you
just don't. You will feel better, you will sleep better,
you will have better eating habits. I mean, it's all
(29:31):
kind of snowballs in the right direction if you just
start taking care of yourself. So instead of looking at
this like, oh, this is going to be terrible, what
do I do? And you know, how do I manage it? Uh?
The funny thing was when when I wrote that menopause
book back in and by the by the way, the
second version is about to come out. I'm excited and
(29:52):
the Spring of twenty three. But when I was writing that,
my mother said, why are you writing a menopause book?
And I was like, uh, I go, well, I never
asked you, mom, what was your experience like with menopause?
And she said, well, I think I might have had
a hot flash once at a cocktail party when I
had a glass of wine. And I went, wow, okay,
(30:12):
all right, lucky her is she she's she just lying
or she just so I'm like, you know, revisionist memory here.
I don't know if that was really her experience, but
she was like, this is such a non issue. I
don't even understand why you're writing a book about it.
So so some women, I mean, I think that's fair
to put out there, really stop their periods and that
(30:35):
is the end of the story. And they got nothing,
I mean, like no issues, and so God bless them.
That's not the majority of us, um, and most of
us are going to have something. And I think rather
than just dreading the whole thing, you may or you
may not get some issues as as you go through.
And you were talking specifically about mood. I think for
(30:55):
those women that are the ones who need to be
just a little aware about what is happening are the
ones that have had mood issues in the past. So
if you've had a major depression in the past, or
if you've had especially those hormonally related mood issues like
PMS symptoms or like postpartum baby blues or a real
(31:17):
postpartum depression, those are the women that are going to
tend to struggle when their estrogen levels are falling around menopause.
Um are those women who had trouble when their estrogen
levels fell in the past. So if you've had that
happen to you before, just be on the alert that
this could happen again. And so what worked before typically
(31:38):
will work again. So if you were on an antidepressant
before and it was great and it worked for you,
that's where you need to go. Or kindnited behavioral therapy
is always a great adjunct to anything, and sometimes it's
enough on its own, but sometimes needs to be added
to an antidepressant for those women who are also having
hot flashes and night sweats that that time right around
(32:00):
on perimenopause. An early post menopause hormone therapy can actually
be very good for mood too. If you're much past
those first couple of years after menopause, hormones are not
going to help you with your mood, so so we
need to think about something else after that. But sometimes
that combination of hormone therapy for symptoms and an antidepressant
(32:24):
works great too. So so there's a number of things
that women can do, but I think being proactive and
starting with the healthy lifestyle stuff even before you get
there is a great place to start. I think it's
so great because you know, I've had anxiety, depression, a
d H d H in varying degrees my whole life,
(32:45):
and weirdly, it's always been kind of a health conscious person.
And so I feel very lucky that I was starting
to do all of these things since it was my twenties.
So I have a you know, five to seventies a week,
very gentle workout life, you know, bloodies and bloods of walking,
and uh, I have a therapist, and I stretch and
(33:08):
e well, do yoga and meditate and spiritual life like
all the things. And I think what you said just
helped calm me. And I did go back and into
the presence last year because I was anticipating, you know,
maybe something's going on here. It was hard to start
going through this during the lockdown because I was like,
it's this lockdown as this periamoyu. But so what you
(33:28):
were saying is like, instead of dreading it, because I
think that was happening to me, I'm like, I'm already
doing all the things, and so there's nothing i can do,
you know, And it's like, yeah, no, you're doing all
the things that you might have a lesser you might be.
In other words, what I'm experiencing now. It doesn't mean
that it's going to keep getting worse and worse and
worse and worse. This might be how it is. It
might stay here for a few years, but this might
(33:49):
be it, which is it's okay, I can I can
handle this now. My guess is you this is probably
as bad as it's gonna get. Right, let's hope. Um
you're already you said doing the things that you know
will help and that have helped you in the past.
And so I think that's a key for women is
just knowing the tools in your toolbox and making sure
(34:11):
you have those available to you, that you can employ
them when you need them, right, And so I think
not not every woman has a great toolbox, so setting
that up in advance is key. Well, one of the
tools that I think is being taken on of our toolbox,
not that it was ever that helpful anyways, but it
is nice to have a glass of wine. And as
your mom said, she had one after a glass of
(34:32):
wine at a cocktail party. It's I think for women
out there, if your relaxation at night is a glass
of wine, you might really want to find something else
for now that you can do because it does. Alcohol
does affect it. Yeah, you're exactly right. Um. And you know,
one little warning is if you're using that glass of
(34:53):
wine to relax after a hard days of work, it's
probably not a great idea. Men of us are not you.
You're used alcohol to relax, which is a warning sign
right there. Um, And and you're right, um. Alcohol can
make you flash. So can using a hair dryer. So
can drinking a warm beverage. So can eating that. Using
(35:14):
a hair dryer and drinking a warm beverage. Oh wow,
caffeine can make you flash. And so so there's a
number of triggers. And and you know, I have women going,
oh my god, you mean I can't have a morning
cup of coffee, And I'm like, calm down, you can.
It might you might have a hot flasher too, But
it's life, right, I mean, So have your cup of coffee,
(35:34):
have a couple of flashes, go dry your hair. You're
gonna flash again, you know. I mean, it's all right,
it's not the end of the world. And it doesn't
mean you can't have a cup of coffee ever, or
a glass of wine ever. But the glass of wine
can impact your sleep. And let's just talk a little
bit more about that you can impact your sleep. So
you think it's great, it's going to put you to sleep,
but then it makes you have less effective sleep, less
(35:54):
efficient sleep, and so you're not sleeping as well throughout
the night. And also alcohol is a depressant, so if
you're using it to calm down, but you're already having
mood issues too, it's probably not your best bet, right.
UM So I think probably better to go take a
walk around the block after you go have dinner and
kind of you know, settle yourself and maybe do a
little meditative um breathing, etcetera. Is a much better way
(36:17):
to go than the glass of wine. We'll continue the
interview on the flip side of a quick message from
our sponsors. You mentioned in your book too that in
addition to sleeping issues, um one of the stress the
(36:38):
ways that stress can affect women in very menumus menopauses
control issues. And I just wanted you to speak more
and that you may worry that you have no control
or feel the need to exert too much control. I
feel like that's such a huge thing that I never
hear anyone talk about. Well, I think when women feel
out of control. They seek to gain more control, right,
(37:00):
And so I think a lot of women that I
see in my office feel like they can't control or
predict things. Whether it's their mood, whether it's weight gain,
which is so incredibly frustrating to people in midlife um or,
or whether it's what is going on at work. But
they feel a little out of control. And so your
first your first reaction is to try to rain everything
(37:21):
in too where you have it all under control again.
And sometimes you know, I mean that's part of getting
older and letting things go a little bit. Yeah, to
the dishes have to be all done before you go
to bed. What's going to happen if they're not? You know,
what is the worst case scenario of you didn't get
the last thing on the list done before you go
(37:42):
to bed. Right, So you start realizing that that the
world isn't going to fall apart if you don't have
perfect control all the time. And that goes back to
one of your solutions is people doing cognitive behavior therapy,
you know, just learning to reframe their thinking or develop
better mental habits with because I I have that, I
(38:04):
have this you know, list making obsession, and and it's
like irrational, like if things don't get done before bed,
but I know the best thing for me would be
to get full eight hours just to go to bed
and it'll look at well. I've learned that things look
completely different in the morning. And if it starts looking
really black, you know, the night before, I'm like, I
(38:25):
think I just need to go to bed and it'll
it'll be different in the morning, which is almost always true.
So and every time I start looking for more control
and it is now like what is going on in
your life that you feel like you have to have
more control. So so that's when the anxiety level is
higher and you got to pull out the tools in
your toolbox to try to get your anxiety level down.
(38:46):
You know. One of the best things for giving up
control for me was having three daughters. Um, so there
you have no control with three daughters and so uh
so that was probably one of the best sercises and
letting things go um and that has continued throughout their
lives too. If they're now in their early twenties. Well,
(39:08):
it's it's like what you're saying is everything I talked
about on every episode of this podcast. No matter what
the subject is, anxious people want control, and there are
things we have control over, but we don't want to
do those things because they're not as fun. Yeah yeah,
I know I can exercise it and I can sleep,
but we want control everythings were never going to have.
And I think if you're like that anyway, probably does
(39:29):
get exacerbated during this time, especially because as we talked
about at the beginning, it's a little bit like, well,
here you are, you know, entering the second phase of
your life. And I think you're right, it can be
this happy lesson, this gift of a time of really
learning how to let go, especially we haven't had the
(39:51):
opportunity to really do that before, you know, in any
big way. Um is just saying yeah, this is gonna happen.
This is what it looks like. Yep, I am getting older.
Hey maybe I'm wrong about how bad it's going to
be in terms of post menopause whatever, you know, like
this is it's it's like you said earlier, we're lucky
to even be here at this at this point. So well,
(40:14):
I think it also gives you a time to step
back and prioritize what's really important. And I have this
conversation with my patients all the time how to say no,
so and I've struggled with that myself, but I think
this is part of the control thing too. It's really
okay to say no, and it's empowering to say no,
like you don't have to do everything you're asked to
(40:36):
do or invited to do, or even if it's an honor,
should you really do it? And is it in your
best interest to do it? And so I think, um,
figuring out how to have on your plate what you
want on your plate and and get the other stuff
off is just so important and liberating. I love that.
I love that you brought that up, that that's so
(40:57):
important when we're going through a massive change. But I
think it's is so important anyway, especially for people who
have anxiety that people don't say no for many reasons.
One is like they don't even know they have the option.
I think a lot of people with any kind of
self esteem issue just think, who am I did not
do this, like you said, especially if it's something that well,
this is an honor, I should say yes, I'm being
(41:18):
asked to speak at this thing, or you know, um,
I don't know anything like yeah, that's when you said
that I just felt so relaxed. I can say no
to things or say, you know, I'm not gonna do
one thing this week, you know, if it's a social
event or something, but I really can't do it. It
doesn't I love that that That is a great way
(41:38):
to take care of ourselves too. I think for anxiety
at least, well and then and then think about it
this way you I mean, I used the yes no
yes sandwich like yes, that is a really important thing.
You bring up our project you're talking about or opportunity.
Um no, Unfortunately I can't do it this time, but
(41:59):
think of me next time, which is the second yes,
or I have somebody else in mind for you. So
it's a good way to actually mentor other people because
you can give them opportunities and be the sponsor for
somebody else to open a door. So so I think
now is that time to embrace what you know. You
are in the senior position and you can help other
people and you don't have to take it all on yourself.
(42:21):
And I still exercising that every day. Well, thank you
for saying yes to me today. I really appreciate you
breaking down for us what's really going on inside of
our our bodies and how how we can look at
this phase of our lives, and and and do you
have anything else that I haven't asked you that you'd
like to let everybody know. Well, I think one of
(42:44):
the important things is that, um, there are things that
you can do so so women don't have to suffer
through this. And I see this again and again and again.
I didn't know there was anything I could do. You know,
whether it's the hot flushes and the nights wests, or
the horrible moods stuff, or not sleeping, well we're vaginal
dryness or pain with sex, whatever it is, they're suffering
(43:05):
and they don't really know that there are options out there.
And so I think the important thing to note is
there are a lot of options out there, and whether
you do or don't want to use hormone therapy or
any other treatment, we've got lots of options. And so,
you know, just putting in a plug for the North
American Menopause Society, it's menopause dot org. But there's a
located provider tab there, so you can actually put in
(43:26):
your zip code and find somebody who's certified and menopause
it's in your area. So I think if you're not
getting answers from your from your local healthcare provider. A
lot of providers aren't even educated menopause anymore. And we
actually did a study on this in where we surveyed
graduating residents across the country from A B G y
N Family medicine and intral medicine, and none of them
(43:50):
are receiving more than an hour or so of education
about menopause during their training programs now and so we
have a whole bunch of uneducated providers UM with regard
to menopause management. So I think it's important to when
you're asking those questions, I understand if you have the
provider who knows something about it, or if they don't
feel comfortable with it or don't have that skill set,
(44:13):
then there are other resources available. That's brilliant. And I
will tell you I just thought of this. I was having, uh,
about a year and a half ago, heart palpitations, and
I know myself very well, and I thought, I think
this is anxiety. I think this is related to UM,
you know, having been so isolated during the lockdown. But
(44:33):
you know, let me just get it checked out, because
it was it was happening a lot and I went
to a cardiologist and they were incredible and they really
found nothing wrong. And once I found nothing wrong, they
sort of went away. And I thought it might be
a symptom of paramenopause. I had heard that could be
and so when I was in the office, I said
to the cardiologist was a young man. I said, I'm
(44:54):
really not worried about this. Is want to let you
know I have a feeling this is paramenopause. And he goes,
oh yeah, because I said I I'm in parma. Oh
no you're not, as though I had said I'm a big,
ugly monster, and he was like cheering me up. And
I was like, oh no, no no, no, it's not a
like it's I am like, it's you know, and it's okay, yeah,
and it's okay. I'm not calling myself old, and it
(45:17):
was I I changed doctors after that because I was
just appalled, you know, and yeah, I don't even want
to say I know. He meant, well, it's it, there's
no no, he just sends exploding. He thought he thought
it was a a derogatory statement, right, Yeah, so interesting.
(45:37):
One more quick point on a study that was recently
published that I think is so important that I think
the implications are important. A study that came out in
menopause last year, and it showed that women even before
they start to have significant cycle length and regularity, so
their periods really haven't changed. They have the same symptoms
(45:58):
as women who are in menopause to the same degree
and with the same degree of bother and and out
of the you know, it was like fifty different symptoms.
Only hot flashes were a little bit less. Everything else
was about the same. So the sleep disturbance, the mood disturbance,
the all of the other symptoms of menopause, we're pretty
much as bothersome before any changes in menstrual cycle length
(46:21):
occurred as they were in menopuzzle women. And that to
me was just a big aha moment that that is
like for all those women that come into their doctor's
offices and are still having periods and they're saying, I
have all these symptoms that are going well, you couldn't
because you still have periods, so you're not there. Um,
it's so validating to all those women who are reporting
(46:43):
having these symptoms when they're forty five or forty six
or forty seven years of age and still having regular periods.
So I think that just speaks to yes, it's for real. Yes,
you are experiencing it, You're not making it up, You're
not crazy. Um. Are there things that we can do
about it? Absolutely? And you need to you need to
see somebody if they bother something after you. Hi. I
(47:07):
hope you enjoyed learning all about what happens to our
emotional and mood health during Perry menopause. Hopefully you're a
little better educated and not too scared about when it's
going to happen to you. But let's look at some
of the takeaways. So, first of all, just starting relatively easy.
(47:29):
Menopause is defined as no period for one year, and
that's without any manipulation such as an I U D
or a birth control pill. The mean age in the
United States for hitting menopause is around fifty two, but
anything after the age of forty five is considered normal.
The stages that get us to menopause is called Perry menopause,
(47:54):
and it can last for several years, from seven to
ten years. Some of the symptoms of Perry men pause
are hot flashes, night sweats, sleep disturbance, and a crazy mood.
After you have stopped menstruating for one year and you're
able to say that you went through menopause, you are
now considered post menopausal. It is changes in our estrogen
(48:19):
levels that cause the biggest issues in perimenopause. So sometimes
our levels can spike, which is because our brain is
desperately contacting our ovaries and saying where are you, and
the brain chemicals can over stimulate the ovaries, and that
leads to higher estrogen levels than you've ever had in
(48:39):
the rest of your reproductive lifespan. And then eventually, when
the ovaries don't respond, the brain stops pushing them to respond,
and the estrogen just kind of dies out. Eventually. What
causes breast pain or trouble sleeping or mood changes is
(49:00):
not just because the estrogen is too high or too low,
but it is the swings of it going super high
and then back to zero. That's when you get your nights.
What's hot flash, irritability, can't sleep, it's the very ability.
Serotonin levels can be impacted by a lot of things,
including what's going on in your life and whether you're
(49:22):
getting enough sleep and exercise. So many things impact neurotransmitters
in your brain that develop serotonin estrogen is just one
of them. Let it be note that perimenopause and menopause
is a normal phase of life. This is not a disease.
(49:42):
We need to have conversations about perimenopause and how to
care for people going through it in the workplace without
it meaning to discrimination. One positive is that after the pandemic,
we now have more access to virtual care than we
ever did before, which is making it possible for a
lot of women to get menopause consultations virtually with experts
(50:05):
that they may not have had access to before due
to their locations. When we are thinking about going through
these changes in our life, there are other health risks involved.
During the menopause transition. A woman's cardiovascular risk goes up
as well. So in taking stock of where you are,
(50:28):
are you taking care of yourselves? Are you exercising like
you should? Are you sleeping like you should? Are you
managing stress like you should? Looking at a menopause transition
is oh my god, all these bad things are going
to happen to me. Maybe think about it as taking
stock and really looking at it is are you taking
care of yourself in the way that's going to set
(50:49):
you up to be healthy for the rest of your life.
You have to take care of yourself first or you
cannot take care of all the other people in life
that you need to. If you've had major depression in
the past, or anxiety, or any kind of hormonially related
mood issues like PMS symptoms or postpartum depression, these are
(51:12):
the people that will tend to struggle when their estrogen
levels are falling around menopause, and so it's important to
take care of your mental and emotional health. If you
were on antidepressant before and it was great and it
worked for you, consider staying on it during perimenopause because
it can help with hot flashes. Cognitive behavioral therapy is
(51:34):
always great to add in with that as well. Some
women who are having hot flashes and night sweats, hormone
therapy can actually be very good for mood as well.
If you are much past the first couple of years
after menopause and you are no longer getting a period,
hormones may not help you with your mood, so you
may think of something else for that, like an antidepressant
(51:56):
or more lifestyle changes. A lot of things can cause
hot flashes, like having some alcohol to relax so alcohol
can stimulate a hot flash. A hair dryer con stimulate
a hot flash. Drinking a warm beverage, eating salsa caffeine
can make you hot flash. There are a number of triggers,
(52:17):
but again, pick your poison. If you need your coffee,
just know that you might have a hot flash. But
in terms of wine and alcohol, it can impact your sleep.
So you might think alcohol is helping to put you
to sleep, but it makes your sleep less effective and
less efficient, so you're actually not sleeping as well throughout
the night. Many women going through paramount of pause feel
(52:42):
out of control and they want to seek to gain
more control. They feel like they can't predict things, whether
it's their mood or their weight gain, which is incredibly frustrating.
But it's important to look at how we handle feeling
out of control. Our first reaction is to try to
rain everything in and have control over it, but we
might want to look to what we know works for anxiety,
(53:05):
which is acceptance. What is the worst case scenario if
you didn't get the last thing on your to do
list done before you go to bed? I am I'm
bad with that one. Don't ask me to give up
my to do list. One way to take care of
yourself that we may not think of is it's okay
(53:26):
to say no, and it's almost empowering to say no.
You don't have to do everything you're being asked or
invited to do, even if it's an honor or even
if you think you really should do it. One way
to practice saying no is to use a yes sandwich,
such as, wow, I thank you so much for the opportunity.
Unfortunately I can't do it, but think of me next time,
(53:48):
or I have somebody else in mind for you, which
would be a good way for you to mentor the
person who you are passing this opportunity onto. If you
need any help with anything. If you want to find
out anything more about menopause or perimenopause, going to the
North American Menopause Society website. It's menopause dot org. Again,
the link will be in the show notes. There's a
(54:10):
located provider tab you can put in your zip code
and find somebody who is certified in menopause in your area. Unfortunately,
due to a study that was done at the Mayo
Clinic in they surveyed graduating residents from across the country
from O B. G y N to family medicine, internal medicine.
(54:33):
None of them are receiving more than one hour of
education about menopause during their training programs right now. So
we have a whole bunch of uneducated providers headed out
into the world with regard to menopause management. So it's
important to understand if you have a provider who knows
something about it or who doesn't, and if they don't
(54:56):
feel comfortable or have that skill set, you need to
know that they're our other resources available, and of course
you need to be your own best advocate. Again, if
you want to read any of these takeaways, you can
go to my website Jen Kirkman dot com click on
anxiety Bites. That link is also in the show notes.
As we are winding down here and almost in our
last ten or so episodes of the season one, which
(55:19):
ends in August, I would beg you, I'm now begging
if you could leave a five star review on Spotify
or Apple Podcast. Those are the two places that have
podcast reviews and just say you love the show. Whatever
you want to say about those five star reviews do
help keep it climbing in the algorithm. I actually saw
(55:39):
a huge jump in the charts um last week when
a bunch of you did heed my call to write
some reviews. So it really helps. And I want to
keep being able to help people with anxiety. And the
more people that find out about this podcast, the more
people will be getting help with their anxiety. And you know,
doesn't that make a better or society less people out
(56:01):
there annoying you with their anxiety while you're trying to
live with yours. Okay, and just remember anxiety bites, but
you're in control. For more podcasts for my heart Radio,
visit the I Heart Radio app, Apple podcast, or wherever
you listen to your favorite shows.
This is the Anxiety Bites podcast and I am your host,
Jen Kirkman. Welcome to another episode of Anxiety Bites. I'm
your host Jen Kirkman. Today we're talking about menopause and
perimenopause and how that relates to our levels of anxiety.
If you are a person who is experiencing either right now,
(00:30):
I wonder if you know that that absolutely increases any
anxiety that you are already prone to. It can suddenly
give you anxiety in the form of panic attacks, obsessive thinking,
mood swings, depression. You know, it's a lot. Our hormones
are changing during this very long phase of our life.
(00:51):
And there is so much more to menopause than what
you may think, you know, which is just one day
you stop getting your period and that stuff. It's a
sometimes seven to any your process of hormones changing before
that inevitable stop in menstruating happens. And this has not
talked about in society unfortunately. What you're going to learn
(01:11):
from my guest today, Dr Stephanie Fabian, is that medical
doctors are getting less training now in recognizing symptoms of
perimenopause and menopause. You have to be your own advocate,
and so I highly recommend starting to learn about this,
and I'm hoping I'm doing a service for any people
out there that might be wondering what's going on in
(01:33):
their forties as they suddenly maybe feel like a teenager again,
not in the best of ways. And how in our
ages society where unfortunately, not only do we sort of
abandon our elders, right, people in their forties and fifties
now are seen as older in the workplace at least,
and it can be pretty difficult to want to talk
(01:53):
about this hormonal change that affects our moods, our anxiety,
our physical cell that goes on intermittently for seven to
ten years. And you know, you spend forty weeks in
your life of your life. That would be great if
you only had to work forty weeks in your life,
forty forty hours a week at a job most weeks
(02:17):
of the year. Well, you're going to run into having
your perimenopausal symptoms at work and you need special kinds
of relief. Usually these things might involve time or change
of environment within the workplace, and it can be pretty
scary to talk about because we don't want to be
seen as not being assets to the workplace at our age,
(02:40):
because obviously we are. So there's that kind of anxiety.
I mean, even if you don't physically start getting panic
attacks when you're in perimenopause, there is a lot that
affects your brain and emotional health when you're going through
such a big physical change. And serotonin is mildly connected
to estrogen as well, so when that starts to change,
(03:02):
it does affect our serotonin, not as much as I
thought it did actually in Ductor Bobby and will take
us through that. But yeah, So this is the second
talk that that people have h a need for in
their life. The first one is you know about getting
your period, and then the second one is about the
years and years it takes for your body to go
(03:22):
through what it needs to go through for your period
to stop. And it's not simple and it's not quick,
And it might be a great episode for you to
listen to, even if this isn't something you're going to
be going through, but it might help you understand the
struggle that maybe people you work with, howe, or people
(03:44):
in your family or friends of yours, or anyone you
know in this age range. So there is hope of course,
But I think what I took most from my talk
with Dr Stephanie is we really have to be our
own advocate, and we cannot think that we are crazy
and that this is in our head. We have to
learn as much as we can about what happens during
(04:06):
paramount of pause, both physically and emotionally and mentally into
our brain. And we can't let doctors tell us that, oh,
it can't possibly be happening because they're not trained in this.
So get yourself. Um, I don't know I was gonna say.
(04:26):
I don't know what I was going to say. To
be honest, get yourself what get yourself this episode so
that you can start to learn something about everything that
you might be going through or will go through someday
if you're lucky enough to hit that age. So again,
my guest today is Dr Stephanie Fabian. She is a
clinician who has practiced in the Women's Health clinic at
Mayo Clinic for over ten years and has evaluated and
(04:49):
treated women with menopausal, hormonal and other health concerns. Relating
to that, she has a broad interest in women's health
and she is the direct dirt for the North American
Menopause Society. Again, the link to that will be in
the show notes. And as the Penny and Bill George
director for the Mayo Clinics Center for Women's Health, today
(05:12):
we're talking about some of the things in her book
called The Menopause Solution, which came out in she said
there is a new version that should be coming out
this year, and you know, will I will say there
is hope. But again, like with any anxiety solution, it
seems as though it's the answers you've heard before, you know,
(05:34):
taking care of your health by making sure you're putting
healthy food into your body, cutting down on alcohol, if
not eliminating it, exercise, meditation, medication as needed, therapy, mindfulness, sleep.
But there are a lot of different stressors that can
affect someone in perimenopause, and an attitude shift is kind
(05:59):
of needed as well, which is that this isn't really
something to dread happening. It's just something to be prepared for.
And unfortunately, it seems like there aren't a lot of
people out there that are helping us prepare. So I'm
hoping I can be a helpful voice in that lack
of voices, and hopefully this episode will give you enough
(06:20):
bread crumbs to find your way to how you want
to handle your paramount of pause. And again, you know,
all of the solutions to this are simple, they're not
necessarily easy. Right, when we take care of our brain
health or mental health or emotional health, whatever you want
to call it, we know what to do, and sometimes
we just don't want to do it. Whether it's our
depression that's making us lack of the motivation, or a
(06:41):
self esteem issue that says, you know, when we're really
not worth taking the time to take care of ourselves,
or the a d h D which affects our executive
brain function. There are so many reasons why people don't
get started on taking care of their brain, emotional, mental health,
and I think there's a lot of times I can
get tricked by is to thinking, Okay, I hope this
(07:02):
episode gives like the definitive number one answer for people,
and it's like, there isn't one, right. It's a combination
of finding out what works best for you, but we're
probably always going to be picking from the same bag
of tricks. And it's not because you know, no one
knows what the solution is. These are the solutions, but Again,
(07:22):
they're simple, but not easy. That's what makes them so
difficult to implement sometimes because again, the mental health that
we're trying to take care of can sometimes get in
our own way from even starting. So again, I hope
you enjoy our conversation about perrymnopause, and I'll see it
on the flip side. We're going to talk about perrymnopause,
(07:45):
menopause and the anxiety, grief moods that accompany it. But
you know, before we get into that, i'd love to
chat with you just what the basics are. What what
is perrymnopause? What is menopause? Yeah, I mean, that's such
a great question. And I've said many times that we
(08:05):
get the talk when we're about to start our periods,
but nobody gives you the talk when you're about to
stop your periods. And there are a number of reasons
for that, UM, including that the timing is variable for
for many women, and so we there's no set time
like your thirty five years of age. You need to
get the talk now. So and UM providers aren't really
(08:27):
comfortable UM giving the talk, which is another major issue
we can talk about. But let's talk about definitions here.
So first of all, starting with the easy one, relatively
easy anyway, menopause is defined as no period for a year,
and that's with it without any manipulation. So you have
a uterus and you would have been menstruating otherwise, and
(08:49):
you haven't had an endometrial ablation, and you don't have
an I U D that would make you stop bleeding,
and you're not on a birth control bill that would
make you stop bleeding. So without all those caveats aside
nature taking its course, it's no period for a year. UM.
The mean age in the United States is around the
age of fifty two UM, but anything after the age
(09:10):
of forty five is considered normal, and about us are
done by the age of fifty five. So when you
back it up, what are the stages they get you
to menopause? And we call that the menopause transition and
the time leading up to the last menstrual period. And
you don't actually know it's the last menstrual period until
it's been a whole year, right, so you're actually we
(09:31):
sort of call it perimenopause until you've been a year
with no period, when in fact you were menopausal when
you had that last period. Right. So that's why this
definition gets a little gray and fuzzy in there. Now
that time leading up to menopause. Perimenopause can last for
several years, and it can be when your periods start
to get a little bit of regular um, And it
(09:53):
can be really subtle at first. It may be you
know it's off by three or four days, or your
periods are getting shorter or longer, or they're getting closer
together for their part, So the variation can be pretty
much anyway. Um. And then you can occasionally miss a
period and you feel like you might be in menopause
then because you could have hot flashes and nights west
(10:14):
and sleep disturbance in your mood is crazy. And then
it all just kicks back in again for a while.
And I had a male colleague once described this time
frame as like a boat motor sputtering, and I went, oh,
dear God, that is like such a classic male description
for a female reproductive stage. And I was going, darn it.
(10:36):
He's kind of right, you know. So people have described
it as kind of like a um, a candle flickering
or fluttering, and I usually just say, look, it's not
like a light switch. You don't just flip it off
in your and your over stopped working one day. They
really do kind of come in and go out for
a little a little bit of time, and you might
(10:57):
blame it on one thing or another, like I got
sick and you know that I didn't have a period
for a couple of months, which can happen um or
you get particularly stressed and you're not sleeping in your
period stopped for a couple of months, and then they
kick back in. So it's a very rocky time frame
for a lot of women because it's so unpredictable in
what your hormones are doing, and until things sort of
(11:18):
settle out post menopause, it can be pretty disruptive. And
so when someone has gone one year without menstruating and
so now they I guess it would say in menopause,
But I guess we don't say in menopause after that year, right,
do we say post menopausele or something or that's a
great question. So some people just say you're in menopause
(11:39):
um or you are post menopausal for the rest of
your life. So so I think either could be accurate.
You are you're technically in menopause or post menopausele either
is fine, and for me, I'm in I'm calling what
I'm in perimenopause, but I am having hot flashes, the
(12:01):
mood swings. If they're not perimenopause, then I, you know,
maybe they should just lock me up and throw away
the key because I've gone insane. But like it has
to be. But I also have a d h D
and I also have depressions, So but I know those
two um bedfellows. This feels different because it's so intermittent,
and it's there's a lot mixed in with it. And
(12:25):
so do I sound like I'm in perimenopause or am I?
Am I experiencing something else? You very likely are in perimenopause,
just from your age alone and your description of your symptoms.
So it just seems like estrogen is a I don't
know how to put it, a beast in terms of
there's too much, there's too little it. How are we
(12:48):
having the same symptoms with different levels of am I
making sense? Like sometimes we have too much, sometimes we
have too little. Why do they produce a similar symptoms?
I think it's the the changes in estrogen levels that
cause the biggest issues. Um, So what happens in perimenopause
is your brain is trying to tell your ovaries, hey,
(13:08):
not here, and from your ovaries, where are you, and
they put out these brain chemicals that stimulate the ovaries
a lot to say, you know, come on, let's hear
from you. And then the ovaries overshoot sometimes and so
you can actually get higher estrogen levels than you've ever
had in the rest of your reproductive lifespan because your
brain is over stimulating your ovaries to get them to work,
(13:32):
and eventually they don't respond, which is why you know,
it kind of dies out eventually. But so so you're right,
you can have these highly variable estrogen levels and and
you know, sometimes when your estrogen levels or high, you
might feel great. Other women might feel breast pain, um
when they're super high. But when they start to fall
is you know, if you're going from super high back
(13:54):
to zero, that's a big shift. And and so that's
a night sweat, hot flash, irritability, can't sleep, you know,
the whole thing. Um when that when that shift is occurring.
So it's more the variability. Although high levels and low
levels can cause symptoms, it's more the variability and the
changing that is so disruptive to women. And is there
(14:16):
a tie in I've I thought, I read this that
serotonin is affected by estrogen, and so in that sense,
if the estrogen is being erratic, so goes our serotonin levels. Well, yeah,
it's not that simplistic. So the neurotransmitters are definitely connected,
(14:37):
and and serotonin can be impacted during all of this.
But serotonin levels can be impacted by a lot of things,
including what's going on in your life, you know, and
whether you're getting enough sleep and exercise and everything else.
So so so many things impact those those neurotransmitters, estrogen
being just the one. Anxiety bites will be right back
(15:00):
after a quick little message from one of our sponsors.
What I thought was so interesting, And I'll get to
this chapter in a second chapter five Moods and you.
But there was a mention of grief, and you mentioned
(15:22):
grief in the part of your book where you talk
about maybe going through a premature amount of pause. But
I feel like, even at the right time men of pause,
there must be grief. I never really thought about that
because I don't want to have children, and so I'm
not conflicted about not being able to reproduce anymore. And
but of course people who didn't have children, there may
(15:44):
be some grief and then even grief about getting older.
I mean, it's it's very strange. I mean, I feel young,
I look young, and my body is doing something that
I saw episodes of The Golden Girls about when I
was a kid, you know, so it seems it feels. Um,
I'm not in the part yet where it feels liberating.
(16:05):
I'm I'm in the part where I don't want this
to change. I don't mind getting a period every month.
I don't mind feeling the way I felt since I
was thirteen, you know, I I'm in grief. I think, yeah,
I think that's an interesting concept. And and in talking
with women, it's not a universal experience in my in
(16:26):
my experience, it's it's something that some women have have
to go through, and some women are really just yeah,
let it be gone. I'm really happy to move on.
But I think I think you're right. I think there
is something about leaving that reproductive phase, if you will, Um,
it's somehow sad. You know, you're saying goodbye to something,
(16:47):
even if you don't really care and don't want to
have a baby, right um, but you're you're leaving it behind.
And I think it also is associated with agism too.
You're entering a time where you can't anymore. And I
think more and more women really don't want to be
defined by their reproductive status, like I can or can't
(17:07):
have a baby. I mean, but that still is somehow
a gateway that we all passed through. That that I
think a lot of women struggle with. You know, am
I am I somehow not worth anything to society anymore
because I don't have eggs being produced, you know, and
released every month. And you know, so many people know
so little about menopause that honestly they have no I mean,
(17:32):
I know people that I didn't want to vote for
Hillary Clinton because they were worried what she would be
like on her period. I mean, I'm really just trying
to be funny here, but it is funny. I'm half
serious that we worry about that because most people don't
even know, you know, what it means that nobody would
ever know I'm past my child bearing years if they
wanted to be ages um, because they would they have
(17:53):
no idea what age that is, you know, right? I
know I just read something that I think in Sweden
women are going to have time off for menstrual situations
and they specifically in the article we're talking about period
pain and I'm thinking, God that you know the seven
to nine to ten years of perimenopause through menopause were
(18:14):
these symptoms come in. To be in a workplace is
really hard, and I think that leads to a lot
of anxiety to like you have to hide this thing
you're going through, which actually can show up on your
face when you're sweating. Yeah, that's exactly right. And it's
interesting you bring this up because this conversation about menopause
in the workplace is really taking off, and I think
(18:36):
that's a good thing. Europe's a little bit ahead of
us there and that um they're really pushing workplace policies
for menopause. And I think we are now where we
were with pregnancy and lactation about thirty years ago. We're
starting to say, hey, we should have these conversations about
what this means for women in the workplace. And where
(18:56):
I work at Mayo Clinic, we're in the process of
developing a work place policy um around menopause, because you're right,
it is it can be disruptive. It can go on
for a long time. It can be anything from I'm
in the middle of a business meeting and I break
out in a sweat. I start to have, you know,
pit stains, and people are wondering what's wrong with me?
(19:17):
And I'm having trouble word finding. And some of the
women that I that I see are like, I can't
have this happen. You know, I'm an executive, I'm the CEO,
and and they're like, I can't have this happen. You
have to make this stop, or I'm not sleeping. And
I had one woman that literally said she sweated out
(19:37):
her mattress to the point where it molded. Oh my god,
I'm like, wow, okay, all right, So those are some
serious nights. What's going on? Right? And and she had
to have her husband come pick her up at work
at the end of the day because she couldn't drive
home without falling asleep. So so some of these symptoms
are incredibly disruptive, and it's hard to function during the
(19:58):
day when you're not sleep being at night, or when
you're so irritable you want to rip your spouse's eyes
out um or you know, there's there's there's a lot
going on, UM, and I think we need to have
conversations about one, educating people about what this time is,
and we should be able to talk about it. And
it shouldn't be an age is discussion, right, it should
(20:21):
be UM, a normal conversation. This is a normal phase
of life. This is not a disease. A hundred percent
of women are going to pass through the stage if
they're lucky enough to get that far right, So we
need to be able to have the conversations and and
not have it turn into, UM, a reason for discrimination,
which that's definitely afraid of me too. And I'm getting
(20:44):
anxiety as you're saying it because I'm like, well, you
know what, never mind, No, let's not have the conversation.
I don't want anyone to know because they're going to
think I can't do my job as well. And but
it's true, how do we you know? In one way,
it's nice to talk to other people who get it
and say I really can't find my words right now.
You're having, you know, jokingly, people will say things like that,
(21:04):
I'm having a senior moment where you're trying to say
can you get me that? Oh, go, what's that thing
we write on it, it's um, you know, um paper paper,
give me the you know, we have those moments. But
why wouldn't I mean, I have to be totally honest.
Why wouldn't would discriminate? You know. So I'm very anxious
for us to have this conversation because how is it
not going to backfire? What do we do? I'm very
(21:27):
anxious too, and I have to. I think we have
to be very clear about what we're asking for in
the workplace. And I actually, you know, as as Uh,
a medical director of the North American Menopause Society, we
had this conversation at our last national meeting, and I'm like,
what is it we are asking for? Is it a
cold room at work? So it's amazing. I mean, you know, Frazer,
(21:51):
you have a lactation room, you have a cold room.
I mean, what is it? What is it that we're
asking for? Because I think when you start talking about
workplace accommodation, that gets very sticky. And so you know,
if it's being able to take your jacket off in
a corporate environment for the five minutes when you're having
a hot flash, I get it. But I also think
we need to flip this conversation and look at what's
(22:14):
happened with menopause management in the last twenty years, and
that is, we used to have about us women using
hormone therapy to treat menopause symptoms before two thou two
when the Women's Health Initiative study came out, and since then,
hormone therapy US rates have dropped to orders of magnitude
like four to six percent now, and so we have
(22:35):
a lot of undertreated women out there. And so my
thought is we need to educate women. We need to
educate their healthcare providers. There are treatment options out there
that are available that are safe and effective that we're
not using. And so is it so much that we
need to accommodate someone at work, Yes, maybe, but we
need to offer effective therapy for these symptoms so that
(22:58):
women can keep doing their job and get the promotion
and take the next job if they so choose to do.
Because think about the lost human capital for women not
being fully at their peak form during this time of
their life where they are at their peak form. Right. Well, well,
that's what I wanted to bring up, is that I
(23:19):
honestly would rather have me now in the workforce and
me at and you know, I'm smarter, I'm more capable,
I'm whatever. I'm just much energy. But you know, yeah,
there are moments where I may forget a word and
I may be physically uncomfortable, but it really doesn't affect
my performance. I am not actually experiencing a moment where
(23:41):
my intelligence levels are dropping. And I feel like being
able to watch someone maybe forget a word sometimes or
be a little spacey um, be a little physically uncomfortable
is not indicative of their job performance. You know. I
think a lot of companies started doing this, and then
(24:02):
I think the pandemic disrupted a lot of that um
extra stuff that we bring into the office. Right, maybe
there's a yoga room, a meditation room, you know, for
everybody of all genders and walks of life. Maybe there
are these sort of mental health break rooms things like that.
And you know, this notion of let's make work as
comfortable as home, and then the pandemic hits. I think
(24:23):
it disrupts it and people are like, oh, I'm just
gonna work from home. Right, I think you're right. I
think COVID may have helped us out in many ways
because it's accelerated, um, having us think outside the box
in terms of what work looks like and where work
is and how we're getting it done. And maybe, um,
it's much more flexible now and it can be on
(24:47):
people's own time. So I think we may have moved
ourselves in a positive way just because of the COVID pandemic.
And you know, now we have more access to virtual
care than we ever have before, which is making it
possible for a lot of women to get menopause consultations
virtually with experts that they might not have had access
(25:08):
to before. So I think even for the care aspect,
it's made things a lot easier to Oh, that's great, Right,
you could talk to someone outside of your state. That's right.
But you know, it would be nice if you could
just without being questioned, you know, like a privacy thing.
Just work from home when you feel you need to.
I think that helps a lot too, so you can
sweat and privacy and when you're not needed, take a nap. Um.
(25:32):
But again, every time I say this, I get this
cringe and twinge of anxiety of just like, oh god,
it seems like we're so it seems like we're too much,
you know, but I do think this kind of care
could benefit men as well or people that don't go
through menopause, you know, absolutely, And some women may not
have that option if they're you know, factory workers for example,
you can't opt to work from home, right, So I
(25:55):
think we need to think about different work environments too.
And even those of us who are you know, seeing patients.
Think of the nurses in the emergency room, they don't
have the option to say, Hey, I think I'm gonna
work from home today. So uh so, I think some
jobs are are more amenable to that kind of flexibility,
others are not, and we have to figure out how to. Again,
I think a lot of this is education and a
(26:16):
lot of it is not making it a joke, Like
why is menopause always the joke at the water cooler
um where you get it conjures images of angry, red,
sweaty women, right um. So, so I think we need
to sort of break past that um to where you know,
when women are bringing it up, it's not it's not
(26:37):
automatically going to be a it's a joke. We'll be
right back. You mentioned in your book, uh your chapter
called moods, and you I mean it's so overwhelming to
me to look at all of the things that happened
(27:01):
during menopause. You know, you talk about depression. You know,
someone might be going through depression for the first time.
And again it's not like somebody died and they might
have a year of grief, but this again could be
seven years, ten years. And so we're you know, talking
about people could take antidepressants, cognitive behavior therapy, managing your stress,
(27:22):
and it's like there's so much you can do, which
is great, but it also seems like a lifestyle change,
like how you've got to add in time in your data,
meditate every day and stretch. And that, you know, is
what do you recommend for people that think they're starting
in on perimenopause. Well, I think you bring up a
really good point. One. Let's just back up and get
(27:43):
a bigger picture here, because I think so many women
in this life phase are taking care of everybody else
except for themselves, right, So so many people are you know,
whether it's kids or aging parents, or your next dooring neighbor,
or your dog or your partner. I mean often you
(28:04):
are the last person on the list. And so part
of this I think is, hey, thanks change in perimenopause,
and as you go through the menopause transition, your own
health risk may change. That's a time when whereas women,
our cardiovascular risk goes up as we go through the
menopause transition. And so it's like we should like take
stock of where are we Are we taking care of ourselves?
(28:26):
Are we exercising like we should? Are we sleeping like
we should? Are we managing stress like we should? And
so I think rather than just looking at it is
oh no, all these bad things are going to happen
to me, I think it's take stock and am I
really taking care of myself? And the way that's going
to set me up to be healthy for the rest
of my life is more the way we should be
(28:47):
looking at it. And you know, I really have to
sit some women down and go, you know how when
you're in the airline and they go put the oxygen
mask on yourself before you put it on the person
next to you when the plane is crashing, Well, that's
that's this. I mean, you have got to take care
of yourself first, so you can't take care of all
these other people in your life that need you. So
(29:09):
so I think that's the first message that it's not
selfish to take care of yourself. No, No, it's like
life saving and it can make your quality of life
so so much better. If you take the time and
go exercise like you know you're supposed to but you
just don't. You will feel better, you will sleep better,
you will have better eating habits. I mean, it's all
(29:31):
kind of snowballs in the right direction if you just
start taking care of yourself. So instead of looking at
this like, oh, this is going to be terrible, what
do I do? And you know, how do I manage it? Uh?
The funny thing was when when I wrote that menopause
book back in and by the by the way, the
second version is about to come out. I'm excited and
(29:52):
the Spring of twenty three. But when I was writing that,
my mother said, why are you writing a menopause book?
And I was like, uh, I go, well, I never
asked you, mom, what was your experience like with menopause?
And she said, well, I think I might have had
a hot flash once at a cocktail party when I
had a glass of wine. And I went, wow, okay,
(30:12):
all right, lucky her is she she's she just lying
or she just so I'm like, you know, revisionist memory here.
I don't know if that was really her experience, but
she was like, this is such a non issue. I
don't even understand why you're writing a book about it.
So so some women, I mean, I think that's fair
to put out there, really stop their periods and that
(30:35):
is the end of the story. And they got nothing,
I mean, like no issues, and so God bless them.
That's not the majority of us, um, and most of
us are going to have something. And I think rather
than just dreading the whole thing, you may or you
may not get some issues as as you go through.
And you were talking specifically about mood. I think for
(30:55):
those women that are the ones who need to be
just a little aware about what is happening are the
ones that have had mood issues in the past. So
if you've had a major depression in the past, or
if you've had especially those hormonally related mood issues like
PMS symptoms or like postpartum baby blues or a real
(31:17):
postpartum depression, those are the women that are going to
tend to struggle when their estrogen levels are falling around menopause.
Um are those women who had trouble when their estrogen
levels fell in the past. So if you've had that
happen to you before, just be on the alert that
this could happen again. And so what worked before typically
(31:38):
will work again. So if you were on an antidepressant
before and it was great and it worked for you,
that's where you need to go. Or kindnited behavioral therapy
is always a great adjunct to anything, and sometimes it's
enough on its own, but sometimes needs to be added
to an antidepressant for those women who are also having
hot flashes and night sweats that that time right around
(32:00):
on perimenopause. An early post menopause hormone therapy can actually
be very good for mood too. If you're much past
those first couple of years after menopause, hormones are not
going to help you with your mood, so so we
need to think about something else after that. But sometimes
that combination of hormone therapy for symptoms and an antidepressant
(32:24):
works great too. So so there's a number of things
that women can do, but I think being proactive and
starting with the healthy lifestyle stuff even before you get
there is a great place to start. I think it's
so great because you know, I've had anxiety, depression, a
d H d H in varying degrees my whole life,
(32:45):
and weirdly, it's always been kind of a health conscious person.
And so I feel very lucky that I was starting
to do all of these things since it was my twenties.
So I have a you know, five to seventies a week,
very gentle workout life, you know, bloodies and bloods of walking,
and uh, I have a therapist, and I stretch and
(33:08):
e well, do yoga and meditate and spiritual life like
all the things. And I think what you said just
helped calm me. And I did go back and into
the presence last year because I was anticipating, you know,
maybe something's going on here. It was hard to start
going through this during the lockdown because I was like,
it's this lockdown as this periamoyu. But so what you
(33:28):
were saying is like, instead of dreading it, because I
think that was happening to me, I'm like, I'm already
doing all the things, and so there's nothing i can do,
you know, And it's like, yeah, no, you're doing all
the things that you might have a lesser you might be.
In other words, what I'm experiencing now. It doesn't mean
that it's going to keep getting worse and worse and
worse and worse. This might be how it is. It
might stay here for a few years, but this might
(33:49):
be it, which is it's okay, I can I can
handle this now. My guess is you this is probably
as bad as it's gonna get. Right, let's hope. Um
you're already you said doing the things that you know
will help and that have helped you in the past.
And so I think that's a key for women is
just knowing the tools in your toolbox and making sure
(34:11):
you have those available to you, that you can employ
them when you need them, right, And so I think
not not every woman has a great toolbox, so setting
that up in advance is key. Well, one of the
tools that I think is being taken on of our toolbox,
not that it was ever that helpful anyways, but it
is nice to have a glass of wine. And as
your mom said, she had one after a glass of
(34:32):
wine at a cocktail party. It's I think for women
out there, if your relaxation at night is a glass
of wine, you might really want to find something else
for now that you can do because it does. Alcohol
does affect it. Yeah, you're exactly right. Um. And you know,
one little warning is if you're using that glass of
(34:53):
wine to relax after a hard days of work, it's
probably not a great idea. Men of us are not you.
You're used alcohol to relax, which is a warning sign
right there. Um, And and you're right, um. Alcohol can
make you flash. So can using a hair dryer. So
can drinking a warm beverage. So can eating that. Using
(35:14):
a hair dryer and drinking a warm beverage. Oh wow,
caffeine can make you flash. And so so there's a
number of triggers. And and you know, I have women going,
oh my god, you mean I can't have a morning
cup of coffee, And I'm like, calm down, you can.
It might you might have a hot flasher too, But
it's life, right, I mean, So have your cup of coffee,
(35:34):
have a couple of flashes, go dry your hair. You're
gonna flash again, you know. I mean, it's all right,
it's not the end of the world. And it doesn't
mean you can't have a cup of coffee ever, or
a glass of wine ever. But the glass of wine
can impact your sleep. And let's just talk a little
bit more about that you can impact your sleep. So
you think it's great, it's going to put you to sleep,
but then it makes you have less effective sleep, less
(35:54):
efficient sleep, and so you're not sleeping as well throughout
the night. And also alcohol is a depressant, so if
you're using it to calm down, but you're already having
mood issues too, it's probably not your best bet, right.
UM So I think probably better to go take a
walk around the block after you go have dinner and
kind of you know, settle yourself and maybe do a
little meditative um breathing, etcetera. Is a much better way
(36:17):
to go than the glass of wine. We'll continue the
interview on the flip side of a quick message from
our sponsors. You mentioned in your book too that in
addition to sleeping issues, um one of the stress the
(36:38):
ways that stress can affect women in very menumus menopauses
control issues. And I just wanted you to speak more
and that you may worry that you have no control
or feel the need to exert too much control. I
feel like that's such a huge thing that I never
hear anyone talk about. Well, I think when women feel
out of control. They seek to gain more control, right,
(37:00):
And so I think a lot of women that I
see in my office feel like they can't control or
predict things. Whether it's their mood, whether it's weight gain,
which is so incredibly frustrating to people in midlife um or,
or whether it's what is going on at work. But
they feel a little out of control. And so your
first your first reaction is to try to rain everything
(37:21):
in too where you have it all under control again.
And sometimes you know, I mean that's part of getting
older and letting things go a little bit. Yeah, to
the dishes have to be all done before you go
to bed. What's going to happen if they're not? You know,
what is the worst case scenario of you didn't get
the last thing on the list done before you go
(37:42):
to bed. Right, So you start realizing that that the
world isn't going to fall apart if you don't have
perfect control all the time. And that goes back to
one of your solutions is people doing cognitive behavior therapy,
you know, just learning to reframe their thinking or develop
better mental habits with because I I have that, I
(38:04):
have this you know, list making obsession, and and it's
like irrational, like if things don't get done before bed,
but I know the best thing for me would be
to get full eight hours just to go to bed
and it'll look at well. I've learned that things look
completely different in the morning. And if it starts looking
really black, you know, the night before, I'm like, I
(38:25):
think I just need to go to bed and it'll
it'll be different in the morning, which is almost always true.
So and every time I start looking for more control
and it is now like what is going on in
your life that you feel like you have to have
more control. So so that's when the anxiety level is
higher and you got to pull out the tools in
your toolbox to try to get your anxiety level down.
(38:46):
You know. One of the best things for giving up
control for me was having three daughters. Um, so there
you have no control with three daughters and so uh
so that was probably one of the best sercises and
letting things go um and that has continued throughout their
lives too. If they're now in their early twenties. Well,
(39:08):
it's it's like what you're saying is everything I talked
about on every episode of this podcast. No matter what
the subject is, anxious people want control, and there are
things we have control over, but we don't want to
do those things because they're not as fun. Yeah yeah,
I know I can exercise it and I can sleep,
but we want control everythings were never going to have.
And I think if you're like that anyway, probably does
(39:29):
get exacerbated during this time, especially because as we talked
about at the beginning, it's a little bit like, well,
here you are, you know, entering the second phase of
your life. And I think you're right, it can be
this happy lesson, this gift of a time of really
learning how to let go, especially we haven't had the
(39:51):
opportunity to really do that before, you know, in any
big way. Um is just saying yeah, this is gonna happen.
This is what it looks like. Yep, I am getting older.
Hey maybe I'm wrong about how bad it's going to
be in terms of post menopause whatever, you know, like
this is it's it's like you said earlier, we're lucky
to even be here at this at this point. So well,
(40:14):
I think it also gives you a time to step
back and prioritize what's really important. And I have this
conversation with my patients all the time how to say no,
so and I've struggled with that myself, but I think
this is part of the control thing too. It's really
okay to say no, and it's empowering to say no,
like you don't have to do everything you're asked to
(40:36):
do or invited to do, or even if it's an honor,
should you really do it? And is it in your
best interest to do it? And so I think, um,
figuring out how to have on your plate what you
want on your plate and and get the other stuff
off is just so important and liberating. I love that.
I love that you brought that up, that that's so
(40:57):
important when we're going through a massive change. But I
think it's is so important anyway, especially for people who
have anxiety that people don't say no for many reasons.
One is like they don't even know they have the option.
I think a lot of people with any kind of
self esteem issue just think, who am I did not
do this, like you said, especially if it's something that well,
this is an honor, I should say yes, I'm being
(41:18):
asked to speak at this thing, or you know, um,
I don't know anything like yeah, that's when you said
that I just felt so relaxed. I can say no
to things or say, you know, I'm not gonna do
one thing this week, you know, if it's a social
event or something, but I really can't do it. It
doesn't I love that that That is a great way
(41:38):
to take care of ourselves too. I think for anxiety
at least, well and then and then think about it
this way you I mean, I used the yes no
yes sandwich like yes, that is a really important thing.
You bring up our project you're talking about or opportunity.
Um no, Unfortunately I can't do it this time, but
(41:59):
think of me next time, which is the second yes,
or I have somebody else in mind for you. So
it's a good way to actually mentor other people because
you can give them opportunities and be the sponsor for
somebody else to open a door. So so I think
now is that time to embrace what you know. You
are in the senior position and you can help other
people and you don't have to take it all on yourself.
(42:21):
And I still exercising that every day. Well, thank you
for saying yes to me today. I really appreciate you
breaking down for us what's really going on inside of
our our bodies and how how we can look at
this phase of our lives, and and and do you
have anything else that I haven't asked you that you'd
like to let everybody know. Well, I think one of
(42:44):
the important things is that, um, there are things that
you can do so so women don't have to suffer
through this. And I see this again and again and again.
I didn't know there was anything I could do. You know,
whether it's the hot flushes and the nights wests, or
the horrible moods stuff, or not sleeping, well we're vaginal
dryness or pain with sex, whatever it is, they're suffering
(43:05):
and they don't really know that there are options out there.
And so I think the important thing to note is
there are a lot of options out there, and whether
you do or don't want to use hormone therapy or
any other treatment, we've got lots of options. And so,
you know, just putting in a plug for the North
American Menopause Society, it's menopause dot org. But there's a
located provider tab there, so you can actually put in
(43:26):
your zip code and find somebody who's certified and menopause
it's in your area. So I think if you're not
getting answers from your from your local healthcare provider. A
lot of providers aren't even educated menopause anymore. And we
actually did a study on this in where we surveyed
graduating residents across the country from A B G y
N Family medicine and intral medicine, and none of them
(43:50):
are receiving more than an hour or so of education
about menopause during their training programs now and so we
have a whole bunch of uneducated providers UM with regard
to menopause management. So I think it's important to when
you're asking those questions, I understand if you have the
provider who knows something about it, or if they don't
feel comfortable with it or don't have that skill set,
(44:13):
then there are other resources available. That's brilliant. And I
will tell you I just thought of this. I was having, uh,
about a year and a half ago, heart palpitations, and
I know myself very well, and I thought, I think
this is anxiety. I think this is related to UM,
you know, having been so isolated during the lockdown. But
(44:33):
you know, let me just get it checked out, because
it was it was happening a lot and I went
to a cardiologist and they were incredible and they really
found nothing wrong. And once I found nothing wrong, they
sort of went away. And I thought it might be
a symptom of paramenopause. I had heard that could be
and so when I was in the office, I said
to the cardiologist was a young man. I said, I'm
(44:54):
really not worried about this. Is want to let you
know I have a feeling this is paramenopause. And he goes,
oh yeah, because I said I I'm in parma. Oh
no you're not, as though I had said I'm a big,
ugly monster, and he was like cheering me up. And
I was like, oh no, no no, no, it's not a
like it's I am like, it's you know, and it's okay, yeah,
and it's okay. I'm not calling myself old, and it
(45:17):
was I I changed doctors after that because I was
just appalled, you know, and yeah, I don't even want
to say I know. He meant, well, it's it, there's
no no, he just sends exploding. He thought he thought
it was a a derogatory statement, right, Yeah, so interesting.
(45:37):
One more quick point on a study that was recently
published that I think is so important that I think
the implications are important. A study that came out in
menopause last year, and it showed that women even before
they start to have significant cycle length and regularity, so
their periods really haven't changed. They have the same symptoms
(45:58):
as women who are in menopause to the same degree
and with the same degree of bother and and out
of the you know, it was like fifty different symptoms.
Only hot flashes were a little bit less. Everything else
was about the same. So the sleep disturbance, the mood disturbance,
the all of the other symptoms of menopause, we're pretty
much as bothersome before any changes in menstrual cycle length
(46:21):
occurred as they were in menopuzzle women. And that to
me was just a big aha moment that that is
like for all those women that come into their doctor's
offices and are still having periods and they're saying, I
have all these symptoms that are going well, you couldn't
because you still have periods, so you're not there. Um,
it's so validating to all those women who are reporting
(46:43):
having these symptoms when they're forty five or forty six
or forty seven years of age and still having regular periods.
So I think that just speaks to yes, it's for real. Yes,
you are experiencing it, You're not making it up, You're
not crazy. Um. Are there things that we can do
about it? Absolutely? And you need to you need to
see somebody if they bother something after you. Hi. I
(47:07):
hope you enjoyed learning all about what happens to our
emotional and mood health during Perry menopause. Hopefully you're a
little better educated and not too scared about when it's
going to happen to you. But let's look at some
of the takeaways. So, first of all, just starting relatively easy.
(47:29):
Menopause is defined as no period for one year, and
that's without any manipulation such as an I U D
or a birth control pill. The mean age in the
United States for hitting menopause is around fifty two, but
anything after the age of forty five is considered normal.
The stages that get us to menopause is called Perry menopause,
(47:54):
and it can last for several years, from seven to
ten years. Some of the symptoms of Perry men pause
are hot flashes, night sweats, sleep disturbance, and a crazy mood.
After you have stopped menstruating for one year and you're
able to say that you went through menopause, you are
now considered post menopausal. It is changes in our estrogen
(48:19):
levels that cause the biggest issues in perimenopause. So sometimes
our levels can spike, which is because our brain is
desperately contacting our ovaries and saying where are you, and
the brain chemicals can over stimulate the ovaries, and that
leads to higher estrogen levels than you've ever had in
(48:39):
the rest of your reproductive lifespan. And then eventually, when
the ovaries don't respond, the brain stops pushing them to respond,
and the estrogen just kind of dies out. Eventually. What
causes breast pain or trouble sleeping or mood changes is
(49:00):
not just because the estrogen is too high or too low,
but it is the swings of it going super high
and then back to zero. That's when you get your nights.
What's hot flash, irritability, can't sleep, it's the very ability.
Serotonin levels can be impacted by a lot of things,
including what's going on in your life and whether you're
(49:22):
getting enough sleep and exercise. So many things impact neurotransmitters
in your brain that develop serotonin estrogen is just one
of them. Let it be note that perimenopause and menopause
is a normal phase of life. This is not a disease.
(49:42):
We need to have conversations about perimenopause and how to
care for people going through it in the workplace without
it meaning to discrimination. One positive is that after the pandemic,
we now have more access to virtual care than we
ever did before, which is making it possible for a
lot of women to get menopause consultations virtually with experts
(50:05):
that they may not have had access to before due
to their locations. When we are thinking about going through
these changes in our life, there are other health risks involved.
During the menopause transition. A woman's cardiovascular risk goes up
as well. So in taking stock of where you are,
(50:28):
are you taking care of yourselves? Are you exercising like
you should? Are you sleeping like you should? Are you
managing stress like you should? Looking at a menopause transition
is oh my god, all these bad things are going
to happen to me. Maybe think about it as taking
stock and really looking at it is are you taking
care of yourself in the way that's going to set
(50:49):
you up to be healthy for the rest of your life.
You have to take care of yourself first or you
cannot take care of all the other people in life
that you need to. If you've had major depression in
the past, or anxiety, or any kind of hormonially related
mood issues like PMS symptoms or postpartum depression, these are
(51:12):
the people that will tend to struggle when their estrogen
levels are falling around menopause, and so it's important to
take care of your mental and emotional health. If you
were on antidepressant before and it was great and it
worked for you, consider staying on it during perimenopause because
it can help with hot flashes. Cognitive behavioral therapy is
(51:34):
always great to add in with that as well. Some
women who are having hot flashes and night sweats, hormone
therapy can actually be very good for mood as well.
If you are much past the first couple of years
after menopause and you are no longer getting a period,
hormones may not help you with your mood, so you
may think of something else for that, like an antidepressant
(51:56):
or more lifestyle changes. A lot of things can cause
hot flashes, like having some alcohol to relax so alcohol
can stimulate a hot flash. A hair dryer con stimulate
a hot flash. Drinking a warm beverage, eating salsa caffeine
can make you hot flash. There are a number of triggers,
(52:17):
but again, pick your poison. If you need your coffee,
just know that you might have a hot flash. But
in terms of wine and alcohol, it can impact your sleep.
So you might think alcohol is helping to put you
to sleep, but it makes your sleep less effective and
less efficient, so you're actually not sleeping as well throughout
the night. Many women going through paramount of pause feel
(52:42):
out of control and they want to seek to gain
more control. They feel like they can't predict things, whether
it's their mood or their weight gain, which is incredibly frustrating.
But it's important to look at how we handle feeling
out of control. Our first reaction is to try to
rain everything in and have control over it, but we
might want to look to what we know works for anxiety,
(53:05):
which is acceptance. What is the worst case scenario if
you didn't get the last thing on your to do
list done before you go to bed? I am I'm
bad with that one. Don't ask me to give up
my to do list. One way to take care of
yourself that we may not think of is it's okay
(53:26):
to say no, and it's almost empowering to say no.
You don't have to do everything you're being asked or
invited to do, even if it's an honor or even
if you think you really should do it. One way
to practice saying no is to use a yes sandwich,
such as, wow, I thank you so much for the opportunity.
Unfortunately I can't do it, but think of me next time,
(53:48):
or I have somebody else in mind for you, which
would be a good way for you to mentor the
person who you are passing this opportunity onto. If you
need any help with anything. If you want to find
out anything more about menopause or perimenopause, going to the
North American Menopause Society website. It's menopause dot org. Again,
the link will be in the show notes. There's a
(54:10):
located provider tab you can put in your zip code
and find somebody who is certified in menopause in your area. Unfortunately,
due to a study that was done at the Mayo
Clinic in they surveyed graduating residents from across the country
from O B. G y N to family medicine, internal medicine.
(54:33):
None of them are receiving more than one hour of
education about menopause during their training programs right now. So
we have a whole bunch of uneducated providers headed out
into the world with regard to menopause management. So it's
important to understand if you have a provider who knows
something about it or who doesn't, and if they don't
(54:56):
feel comfortable or have that skill set, you need to
know that they're our other resources available, and of course
you need to be your own best advocate. Again, if
you want to read any of these takeaways, you can
go to my website Jen Kirkman dot com click on
anxiety Bites. That link is also in the show notes.
As we are winding down here and almost in our
last ten or so episodes of the season one, which
(55:19):
ends in August, I would beg you, I'm now begging
if you could leave a five star review on Spotify
or Apple Podcast. Those are the two places that have
podcast reviews and just say you love the show. Whatever
you want to say about those five star reviews do
help keep it climbing in the algorithm. I actually saw
(55:39):
a huge jump in the charts um last week when
a bunch of you did heed my call to write
some reviews. So it really helps. And I want to
keep being able to help people with anxiety. And the
more people that find out about this podcast, the more
people will be getting help with their anxiety. And you know,
doesn't that make a better or society less people out
(56:01):
there annoying you with their anxiety while you're trying to
live with yours. Okay, and just remember anxiety bites, but
you're in control. For more podcasts for my heart Radio,
visit the I Heart Radio app, Apple podcast, or wherever
you listen to your favorite shows.
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