December 18, 2024 • 55 mins
Join us for a candid conversation with the esteemed Dr. Nitu Bajekal, a leading OBGYN, as she shares her profound knowledge and personal experiences with perimenopause and menopause. With nearly four decades in women's health, Dr. Bajekal offers invaluable insights into how these life stages can vary widely across different ethnicities. She also opens up about her personal journey, revealing the challenges she faced and the inspiration behind her book, "Finding Me in Menopause." This episode is a must-listen for anyone looking to better understand these significant transitions from perimenopause to menopause and the need for support and understanding for women while they're in this phase.
Discover the truth about menopause symptoms and the solutions available, as we explore the critical role of hormonal changes. Dr. Bajekal addresses common skepticism around hormone therapy, emphasizing its significance in managing symptoms such as hot flashes and mood changes. We offer practical advice on lifestyle adjustments, from improving sleep quality to stress management, that can enhance well-being during menopause. The conversation also highlights the long-term impact of menopause on women's health and the need to embrace this life stage gracefully.
In the realm of exercise and nutrition, learn how strength training can combat osteoporosis and reduce cancer risks, while a plant-based diet can effectively manage menopause symptoms. Dr. Bajekal shares the powerful health benefits of soy and other plant-based foods, along with the importance of workplace support for menopausal women. This episode aims to foster a more inclusive and supportive environment for women experiencing menopause, both in the workplace and beyond. Tune in for guidance, encouragement, and a wealth of knowledge from one of the leading voices in women's health.Her social channels Instagram, TikTok to connect is @drnitubajekal. Be sure to follow @vaipkumar more of these wonderful offerings.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Vai Kumar (00:09):
Welcome to Freshleaf Forever, a podcast that gives
you fascinating insights weekafter week.
Here's your host, vaikumar.
Hey folks, welcome to anotherepisode on podcast Freshleaf
Forever.
Today we have a returning guest, dr.
Nitu Bajekal.
She is a senior OBGYN, multiplebook author, a senior
(00:35):
consultant, obstetrician andgynecologist practicing out of
London, uk, with nearly 40 yearsof clinical experience in
women's health.
Her special interests includelifestyle medicine, menopause,
pcos, endometriosis periodproblems, complex vulval
(00:56):
problems and medical education.
She's a keyhole surgeon withexperience in laproscopic
procedures.
Holds surgeon with experiencein laparoscopic procedures,
including robotics.
She's a fellow of the RoyalCollege and recipient of the
Indian President's Gold Medal.
Dr Bajekal is one of the firstboard-certified lifestyle
(01:18):
medicine physicians in the UK.
She has written the Women'sHealth Module for the first UK
plant-based nutrition course atWinchester University.
It's with great joy that wewelcome back Dr Nitu Bajekal
here to podcast FreshleafForever.
Hey, dr Nitu, how are you doing?
Dr.Nitu Bajekal (01:40):
today I'm very well.
Thank you, Vai, for inviting me.
It's always lovely to come backand chat with you, so looking
forward to our conversation.
Vai Kumar (01:48):
Oh, thank you, Welcome back.
And how about we start bygiving listeners, in fact, first
of all, congratulations on thisfascinating book.
Finding Me in Menopause, it'sjust beautifully written, and
that's the purpose of ourconversation here.
Dr.Nitu Bajekal (02:06):
Yeah, thank you , it was the book I would have
liked to have had.
Vai Kumar (02:10):
Oh, yes, oh yes, it seems like a must read for
anyone in the perimenopause andmenopause phase.
So why don't we get started byquickly telling listeners what
perimenopause is and what ismenopause?
Dr.Nitu Bajekal (02:24):
Right.
Perimenopause, as the worddescribes, is around menopause.
So basically it's a timeleading up to the time when you
completely stop your periods.
So usually that will be aboutfour years around the age of 47.
But we know that life is notnecessarily always a certain
data point, and so between twoto eight years is when
(02:48):
perimenopause can last.
So menopause tends to occuraround the age of 51.
But again, that's all over theworld.
But again, it's not a fixeddata point and the range is
anywhere between 45 to 55.
So menopause is the time whenyou stopped your periods for 12
(03:08):
months completely, and thattends to be between 45 and 55.
It's a retrospective diagnosis.
You don't have periods for 12months and there are no other
obvious reasons, and you saythis person is in menopause and
perimenopause is a time beforeyou completely stop your period.
So if you are destined to stopyour periods at, say, 45 or 46,
(03:30):
perimenopause can be between twoto eight years.
It's a time leading up tomenopause.
And so you may be in your late30s when you're actually going
through perimenopause and you'reat the peak of your career, or
you may not even have startedthinking of having a baby if
that is your plan.
So it's really important tounderstand what perimenopause is
the time leading, or menopausein transition and menopause is
(03:52):
the time when you stop yourperiods completely.
Now important note for maybesome of your listeners who are
from southeast asia indians,pakistanis, bangladeshi origin
and from the black communitymenopause can occur early, so it
can be at 45, 46, 47, dependingon which part of India, for
(04:12):
example, you're from.
It's not, of course again not afix.
There'll be a lot of women whowill say I'm still having my
period and I'm 54.
But there are a lot of women inthat early age group, so they
may be having these symptoms ofmenopause and perimenopause much
earlier, when they are still inthe workplace and nobody is
even thinking about menopause atthat time.
Vai Kumar (04:36):
Okay, and just to get to your own journey and
transition into that menopausestage, I know you had a lot of
challenges and you have outlinedit in the book beautifully
again.
So what prompted you to writethe book and what do you think
were some of the challenges thatyou kind of had to go through
(04:57):
during that phase?
Dr.Nitu Bajekal (04:59):
I think my first challenge was that I
didn't have the confidence toshare with my colleagues.
So I was about 38 when Istarted noticing that my
previously regular periodsalways clockwork didn't really
bother me.
Suddenly I started becomingvery heavy.
They were initially a littlebit crowded, but then they
(05:19):
started hopping and skipping andI thought I was because I was
being bullied at work.
I was also very busy.
I was applying for a consultantjob in London.
I had two young children, a dog,a husband who worked all God
given hours like me, and no realfamily.
We were immigrants from India.
There was a lot of balls in theair and so I really my health.
(05:40):
I was always a healthy personin that I mostly ate plant-based
.
I was never didn't have anyexcess weight.
I was very physically active,but it didn't even cross my mind
.
My mother and my sister werestill.
My mother had a period sinceshe was 52.
My sister, who's who's abouteight years older than me, was
still having her periods.
(06:01):
So it didn't even occur to methat my periods that were
stopping was anything to do withperimenopause and my low mood
and libido issues, all thesethings.
I tried to brush under thecarpet and then realized that
actually my periods hadcompletely stopped and I fell
into that group where I was oneof the specialists in those
areas with premature ovarianinsufficiency, where a woman, or
(06:24):
those who are assigned femaleat birth, basically their period
stopped under the age of 40.
So one in 20 000 girls, youngwomen, may never reach um, you
know, may have the one periodand never have a period again.
So that's very rare but itstill happens.
And then one in hundred and infact in india and all, there may
be as high as four to fivewomen in a hundred will stop
(06:44):
their periods under the age of40.
That is a medical conditioncalled POI, premature ovarian
insufficiency, previously knownas premature ovarian failure or
premature menopause.
We don't like the word failure,we're not very drastic term
right.
Very drastic term.
So basically anybody who hasPOI.
(07:05):
And there are many reasonsgenetics, unknown, there may be
some medical conditions as well,but most of the times we don't
find a reason.
And if anybody who's listeninghasn't had a period for more
than three months because womentake three to four doctors
before they can actually bediagnosed with POI and there may
be other background conditionsit may not be POI.
It may be polycystic ovarysyndrome, for example.
(07:27):
It may be an eating disorder,it may be exercising too much.
Whatever it is, if your periodsare missing for more than three
months, never to be ignored.
It's important to see the rightto see your doctor initially
have the right tests.
So POI is what I diagnosed, knewI had it.
I needed HRT, hormonereplacement therapy or hormone
(07:48):
therapy.
But we are talking I'm almost63 now, so we're talking 24-25
years ago, when the WHI studyand the million women study from
the US and UK had come out andbasically the media got the
information wrong and ran withit and said that HRT is
dangerous, it causes cancer,when actually none of that is,
(08:09):
you know, remotely true andunfortunately my family doctor
refused to prescribe me HRTdespite me going several times.
So I had I been more confidentbecause I had just become a
consultant.
I was a keyhole surgeon.
I was, you know, an immigrant,a woman, a woman of color.
I wanted to be at the top of mygame.
(08:32):
I did not want to appear weak.
But actually, in retrospect,had I shared with my male
colleagues because I was theonly woman, I would have, I
think you know, been able to getheard, think you know, been
able to get heard.
Instead, I managed on my ownfor quite a long time and
luckily for me.
In a way, my younger daughterwas nine.
(08:52):
Around that time she becamevegan and many of my symptoms
improved.
But I didn't, of course, put itdown to diet and lifestyle.
I thought it was just life.
But now I know what it did.
But any woman who's listeningunder the age of 40, I, who
stops their periods, who'sdiagnosed with premature ovarian
insufficiency there's awonderful book by Dr Hannah
(09:13):
Short called the early guy theguide to early menopause and POI
.
But also to seek medical advice.
Please do not let a doctor tellyou it's okay not to have
periods.
So that's my message and Iwrote the book.
I'd always wanted to read abook like what I had written and
it felt right.
We wrote the first book becauseRohini, my older daughter, has
(09:36):
polycystic ovary syndrome andshe wanted me not to write a
general book, and so she saidyou've got all these 35, 40
years of experience.
You need to write about thingsthat you know a lot about
endometriosis or PCOS ormenopause.
So we started off with PCOS andthen, of course, this book was
bubbling inside me, and I hopethere are many more books to
(10:07):
come, but maybe I'm taking a fewmonths off now.
I'm sure I'm sure, this just hasbeen a beautiful transition, I
should say, and it's flourishingin perimenopause and menopause,
and perimenopause because ofall these symptoms that we are
supposed to get, but most womenmay have some symptoms, some
women will have no symptoms andit's not a time for doom and
(10:30):
gloom for everyone so yeah, Ijust want people to realize you
can flourish.
And yes, it's really hard whenyou get a diagnosis when you
haven't even started buildingyour family, for example.
Those are different medicalsituations.
But for the average person, Idon't want you to look at this
time and really that's why Iwrote flourishing in
(10:50):
perimenopause and menopause,because I do believe you can
actually embrace it in differentways and seek the right help.
But also, you know the attitudeis so important, isn't it?
Vai Kumar (11:03):
Exactly, and we all think it's inevitable and that
you know we have to endure thosesymptoms and it's so much of
still, even you know, like weare approaching 2025, and
there's still so much ofsocietal taboo in terms of
discussing all these thingsRight.
And you mentioned about POI,that's premature ovarian
(11:24):
insufficiency, and and copingwith it I guess not just to you
know remain silent but seekmedical help in the form of, say
, hrt, which is hormonereplacement therapy.
And you have highlightedbeautifully how we all tend to,
(11:44):
the number of ovaries we alltend to.
You know it just reduces overtime and that's like a common
process, right yeah?
Dr.Nitu Bajekal (11:52):
Let me explain why POI occurs or menopause
occurs.
So when we are conceived,around 20 weeks, there would be,
say, like a couple of millioneggs in each ovary.
Ovaries are the egg baskets andthey basically are the
powerhouse of the hormonesestrogen producing.
Of course.
Estrogen, progesterone,testosterone are producing the
other parts of your body, butthese are the main sites and
(12:13):
they're regulated by the brain,by the hypothalamus and the
pituitary, which releasehormones which are chemical
messengers which will work andstimulate the ovary, and
there'll be a master switch inthe hypothalamus that starts
everything off and pubertystarts.
So what happens is you havethese couple of million eggs by
the time you're born.
A million have got lost by whatis known as natural attrition.
(12:34):
It just gets, you know,degraded and so you may be born
with a million eggs and thenover time, by the time you reach
puberty and then the time youreach your early 20s and 30s,
the number of eggs keep droppingtill you reach menopause, when
a critical level of below 1000is reached.
So if your genetics aredictating, or your environment
(12:57):
or whatever it is, if yourovarian egg supply has dropped
to less than 1000 and you'reonly 25, then that's POI.
If you're 40, between 40 and 45,that's early menopause, unless
you had it removed.
The ovaries can be removed atsurgery and chemotherapy and all
as well.
And then after 45 and between45 and 55, when those number of
(13:19):
eggs tend to drop below 1000,then the estrogen levels drop,
which is responsible for many ofthe symptoms, and then the
ovaries start telling the braincome on, produce more of the
releasing hormones so we canrelease more estrogen.
So it may work for a bit inperimenopause, your period stop
and start and all that, but thehypothalamus ultimately will
(13:42):
tell the pituitary we, we can'tproduce anymore.
So the FSH, lh levels, fshlevels, the follicle stimulating
hormones, tend to rise to alevel that is menopausal and, as
a result, there's just no more.
There are not enough eggs torelease these ovaries.
And the important thing toremember is that life expectancy
now in most of the westernworld is in the 80s.
(14:05):
So you are going to haveanywhere between 45 to sorry 30
to 35 years in the menopause.
So that's a long period of time.
And so people often say, oh,I've just stopped my periods,
I've had a few hot flushes, orI've had hot flushes terrible
for two, three years and I'mdone with menopause.
No, menopause is from the dayyou completely stop your periods
(14:29):
until the day we die, and thereare long term impacts and there
are some short term impacts,but we are always in menopause
and that's why it's so importantto embrace it, because it's not
going anywhere.
And we are not going anywhere,oh yeah exactly, oh yeah,
exactly.
Vai Kumar (14:42):
and you say in your book you call out like this,
almost like 34 symptoms that can, yes, one, can you know,
possibly all the overall womenpopulation can experience right
and you started, you led usthere, right there, into heart
flushes and night sweats yeahall those they are supposed to
be, some of the more commonsymptoms.
(15:03):
The vasomotor.
Sorry, you were sayingsomething else.
Yeah, the hot flushes the nightsweats, all the vasomotor
symptoms, right Correct, with somuch skepticism and say
reluctance to take hormones?
And with all these symptoms atplay, why don't you just tell
(15:24):
listeners how important it is tonot ignore and what are the
kind of the ramifications whenit comes to, you know, tackling
these symptoms?
Dr.Nitu Bajekal (15:34):
Yeah, If they go unaddressed, there are, you
know.
We say there are 34 symptoms,there are probably 60 symptoms.
Okay, and you know, becausemenopause is a whole body
situation at the end of the day.
So you can imagine thatestrogen receptors in every
tissue, every cell of the bodyand so you can imagine whether
it's from the brain.
(15:55):
You can imagine brain fog,memory issues can be an issue
for some people.
But, as I said, remember allthese symptoms may never occur
for you and some of the symptomsmay occur Rarely will I see.
Remember all these symptoms maynever occur for you and some of
the symptoms may occur Rarelywill I see patients with having
all the symptoms.
But if you go from head to toe,you can imagine there can be
thinning of hair, loss of hair.
You know, depending upon yourgenetics, your family history,
(16:17):
as the estrogen levels drop thenthe hair follicles tend to not
be as healthy.
If you're anemic, that makes iteven worse.
So you need to make sure thatyou have good iron stores.
Again, as I said, going into thebrain memory loss, brain fog,
feeling, you know, having issueswith processing and organizing
those things can be issues forsome people.
(16:39):
Others may notice joint pains.
Others may notice that they mayhave palpitations, night sweats
, hot flashes, and that'sbecause the temper temperature
regulatory zone is set and it'sbecome very sensitive.
So as soon as it falls slightlyoutside, women will notice that
they either have hot flashes orcold sweats or night sweats,
because they're basicallyfinding that they have this
(17:01):
sensation of heat which can lastanywhere from like a few
seconds to up to a minute.
Usually can be just once a day,can be 100 times a day and you
know that's why layering ofclothes can really help in these
situations.
So hot flashes and night sweatsare the most commonly known,
but not everybody will have them.
Low mood, lowered libido, thosefrom brain if you go down to
(17:25):
those are real issues can causerelationship issues as well for
women, because you may be havingdifferent desires at that time
and hard to explain.
You also may be at a situationwhere you have you may have
children who are trying to go touniversity or college, others
may have elderly parents or youmight be just trying to
negotiate.
Do I want a family or not?
(17:46):
So many things can be there.
So perimenopause will have verysimilar symptoms to menopause.
There can be other thingsringing in your ears.
You can have sensations underyour skin called formication,
like as your hands are crawling.
You can have joint pains,tiredness, fatigue.
You can have erratic bleedingin perimenopause because
symptoms such as heavy periods,frequent periods, may become
(18:10):
even more prevalent if you havea background of fibroids or
endometriosis or adenomyosis.
So those things have to be keptin mind and that women may have
pushed them to the back of thebecause they've been so busy and
now they're finding that thesesymptoms are getting worse.
But all the symptoms that yousee in menopause can occur in
perimenopause, but inperimenopause, as women are
(18:31):
still having periods, howeverinfrequently, they may have
period issues as well, and thenof course there are
genitourinary symptoms.
So, for example, women maynotice increased cystitis.
So every time they go to theirdoctor, the the doctor will say,
oh, you have an infection andthey give them antibiotics.
But actually you don't have aninfection.
Your estrogen levels havedropped, and so, while it's
(18:51):
important to check your urine,usually it's because of estrogen
receptors and estrogen levelshave dropped and so that makes
the bladder very sensitive.
The vagina becomes verysensitive, dry, you can have a
sensation of paper cuts,especially after penetrative
intercourse or and so on.
It is important usually tends tooccur in the second half.
(19:12):
So menopausal symptoms tend tobe the early first five, six
years where you'll have thebasomotor symptoms that you were
describing hot flashes, nightsweats, some joint pains, libido
issues and sleep issues Whileafter five, six years women tend
to find more of the morearthritis.
(19:33):
They may have heart healthissues, cholesterol issues,
which can all start inperimenopause as well, but they
may notice cystitis and vaginaldryness, as the estrogen levels
now have really dropped to a lowand local vaginal estrogen is
safe.
It is not even HRT.
You can women almost everybody,including women with cancer
with the okay of the specialist,can use vaginal local topical
(19:57):
estrogen after checking in withyour doctor and you can use it
for the rest of your life,usually twice a week and it
really makes a difference toquality of life.
So there are so many symptomsthat can.
If you take any bowel symptoms,you know, know gut upsets,
constipation, you know change ingut microbiome that can be a
problem.
Bladder increased frequency,you know leaking of urine
(20:20):
urgency.
So literally there's a range ofsymptoms from every organ and
that's why easily they add up to34.
But as I said again please don'tpanic, because there's help for
almost everything and also mostwomen won't have all the
symptoms, and this is where dietand lifestyle.
So not every woman can take HRT, not every woman wants to take
(20:42):
HRT, not every woman can takeHRT.
But even if you're on hormonereplacement therapy, which is
safe, you need to bring inlifestyle changes because all
these symptoms can also behelped when you're doing
lifestyle.
It's not one or the other.
Vai Kumar (20:58):
It's very important.
I think it couldn't have beenunderscored better.
I think it's very importantthat people seek the help of
their OBGYN and go for regularvisits.
The annual visits are much moreimportant.
Getting a mammogram, gettingeverything taken care of and
discussing you also give a nicecheat sheet for people to go
(21:22):
prepare for appointments, right,because this lack of sleep
again say, for example, if wewere to focus on that one
symptom, someone has lack ofsleep that can have a rippling
effect in terms of mood andanxiety and stress and so on.
Dr.Nitu Bajekal (21:38):
Right, because anxiety, depression and, yes,
some women do needantidepressants, but a lot of
women in perimenopause andmenopause may actually all they
need is hormone replacement.
So it's so important to have aob-gyn who understands, who's
willing to acknowledge thesymptoms and accept and their
own limitations and if theydon't have the expertise they
(21:59):
should be able to refer on.
And also, if you as a patientare sitting there thinking I
don't think I've been heard,then do ask for a second opinion
.
It's really important and thereason I've written my book
really important and the reasonI've written my book and because
of my website, which iscompletely free
neethubhajekalcom.
What I try and explain is haveyour questions ready, know your
(22:22):
medical history, know yoursurgical history, know the
medications you're on.
Be careful of taking supplementsthat are not scientifically
validated, because you'll spenda lot of money and they can
actually harm you in the longerrun.
You know collagen supplementsand you know all kinds of these
menopause relief supplements.
They are all not naturalbecause they're in the form of a
(22:43):
tablet, so you're better ofstandardizing it, regulating it
and looking for the right stampsso that they are absolutely,
you know, fda approved or anybig society approved, because I
see every week I see women with10, 15 supplements sitting in
front of them, spending $100,$200.
And I'm thinking you were somuch better spending that money
(23:07):
on buying soybeans and fruitsand vegetables and dals.
I do want to highlight that aswell, because women are very
vulnerable when they're havingsymptoms, so it is whether it's
with the health professionals orwhether it's with the industry
so, and then there's socialmedia, to promote everything.
You know promising all thesecures.
(23:28):
So it's so, so important toactually take those things with
a pinch of salt.
Some supplements, of course,are vital vitamin D and B12 and
possibly algae derived omega-3.
And you know, for sleep, likeyou were talking, there are some
of my patients who findbenefits with magnesium.
Not everybody does.
The studies are not great.
But having a sleep pattern, aregular sleep pattern, sleep
(23:51):
routine, making sure that if youare stressed, learning to do
some de-stress techniques ofbreath work, or going for a walk
, or talking to a friend, makingsure that you don't eat too
late, making sure that you gofor a little walk or do some
little exercise for five minutesto help your insulin levels
settle down after a meal, youknow eating early in the day
(24:14):
these are all simple things.
Having an eye mask, thickcurtains, layering your clothes,
you know.
Just having thin sheets so thatyou can move them away as you
feel hot at night, you know.
Having a fan turning theheating down I have all these
suggestions and different thingswill work for different people
and I know they sound very oh.
(24:35):
Everybody knows that, but you'dbe surprised.
For me, that is my weakestpillar.
Sleep has always been as a whenI was an obstetrician I just
practiced gynecology now but youknow I used to be woken up
several times at night.
Every second or third night Ihave had a very poor sleep.
Then add on top of that theearly menopause.
That was a real issue, and soit is so important to prioritize
(25:00):
that because, as you said, whenyou have sleep issues, you will
tend to wake up stressed.
When you are stressed andanxious, you tend to eat the
donut rather than the apple, andthen when you're eating those
foods, you don't feel likeexercising, you don't feel like
remaining your friends, youdon't want to go out of the
house.
So it's a domino effect for allthe six lifestyle pillars.
So it's so important to try andfind one pillar that you want
(25:23):
to make a little difference,whether it's the food pillar,
whether it's the exercise pillar, whatever it is and then slowly
build it up and that's the samefor any hormonal health
condition to optimize one'shealth, or whether it is
perimenopause or menopause.
Vai Kumar (25:37):
Okay, and you said erratic bleeding.
Even that's not to be ignored,right?
Because sometimes a physicianmay order a pelvic ultrasound,
and that can reveal so much moreinformation.
Is that?
Dr.Nitu Bajekal (25:51):
correct?
Yes, so any woman who hasbleeding after sex.
Even if you had a clear papsmear, if you're bleeding after
sex, is there an area on thecervix that is causing problems?
Is there a polyp?
Whatever it is.
So bleeding after intercourseshould never be ignored.
Bleeding in between your cyclesshould never be ignored.
Bleeding more than seven daysnot be ignored.
(26:15):
If you're passing clots whichis bigger than the size of your
thumbnail, if you're having touse double protection, if you're
having to have painkillers allthe time, if it's affecting the
quality of your life, you shouldnot be ignoring any of these,
because there may be backgroundconditions that have not been
picked up.
So conditions like chronicinflammatory conditions, like
(26:36):
adenomyosis, endometriosis,fibroids, which are benign
growths, but if they are in thecavity, they can cause a lot of
bleeding as well.
You also may have conditionslike polycystic ovary syndrome,
so that it's so, so importantthat you don't ignore these
symptoms and have a healthprovider who listens and
arranges the right test.
(26:56):
That is why I have thosechapters in my book to say this
is what you should be asking ifyou have this and there are a
lot of case studies as well soyou empower yourself with the
knowledge from the website, fromgood resources, the NHS website
, the Royal College website,good resources, the nhs website,
the royal college website, theamerican college of lifestyle
(27:18):
medicine and, you know, the mayoclinic sites.
They give you good advice.
You can always go to chat roomsbecause, of course, patients
and people can give you a lot ofgood advice which doctors can't
.
But you do need to make surethat you is individualized.
It's right for you and you'regetting that information because
the number of women I see whywho come with having gone to
(27:39):
these bio-identical hormones,which are, you know, custom
compounded, because they thinkit's better for them but
actually they're not regulatedat all and no expert will
recommend them.
So you always want to choosestandardized, regulated HRT that
is FDA approved and NHSapproved in the UK, in Australia
(28:01):
as well, because you want tomake sure you're getting the
right dose of estrogen, theright dose of progesterone,
rather than hit and miss amounts.
And they are also bioidentical,or we call them body identical,
which basically means that theymimic the same hormones that
our bodies produce, whether itis progesterone and estrogen.
So, again, a lot of womenlistening here will be seeing
(28:23):
people who are giving thembioidentical hormones from
unregulated sources and I wantto call that out yeah, clear.
Vai Kumar (28:30):
And the most important thing with that as
well is when you are under thecare of an OBGYN, who is giving
it.
They have your whole history tokind of go off of and not just
something that you do fromunregulated sources.
Correct.
Back in a moment with our gueston Freshly, forever and weight
(29:02):
gain in menopause yes, I knowyou have a whole chapter on that
you have a whole chapter andyou again, you beautifully bring
out why body neutrality is sosignificant there yes, because
you know it's very well to keepsaying, um, body negativity
women struggle with anyway.
Dr.Nitu Bajekal (29:22):
They're always being told by society you're not
too thin, you're not too,you're too big or whatever you
know it is, you're too thin,you're too fat, whatever it is.
Body positivity can also bequite toxic because, you know,
sometimes you do feel like Idon't want to be positive about
my body.
It's letting me down right now.
But body neutrality is actuallyaccepting that this is the body
(29:44):
that we've been given.
It's so lucky, it works and youknow, even if you have a slight
hangnail, you know that wholeday you'll be thinking about it.
Or if you have an ulcer in yourmouth, but we don't even think
about those parts of our bodywhen they're functioning okay.
So I do want people to be aware.
And weight gain is an issue.
(30:04):
It's an issue for all genders,as after the age of 30 you
steadily put on weight and butit's particularly more prominent
for women in perimenopause andmenopause with the way the
hormones shift and things.
So we know that that can be anissue.
And also there are severalother social factors also that
increase our weight.
For example, you may bestressed, you may have issues
(30:27):
with.
You know, food regulation.
You may be, as I said, havingthese, you know, carer issues,
looking after parents andchildren.
You don't have time to lookafter yourself.
You may be, as I said, havingthese carer issues looking after
parents and children.
You don't have time to lookafter yourself.
You don't have time to care foryourself.
You don't have time to doexercises.
So these things are important.
Plus, we may have more financesand more money to spend, so we
may be eating out more often.
And, of course, if you eat out,what is there?
(30:49):
Oil, fat, sugar, salt, and sowe know that that can slowly
creep up.
Alcohol again.
Not only is the increased riskof alcohol with every glass of
wine you drink in the menopauseand perimenopause significant
increases after the first coupleof units.
So there's no safe limit foralcohol, no safe limit for
smoking, tobacco, vaping allthese things are, you know,
(31:12):
things that you really need tofocus.
Have a celebratory drink, ifyou want, but regular alcohol is
also is quite high in caloriesand, of course, causes seven
different types of cancers,affects sleep and menopause
worsens hot flashes.
So there are so many aspectsthat can affect sleep, can
affect weight, you know, and soI have lots of suggestions there
(31:35):
and of course one of the waysof trying to mitigate that
weight gain is by trying tofocus on a plant forward diet.
So the more large you eat theytend to be light in calories,
very nutrient dense, so you tendnot to put on the weight.
For your same friend who wouldbe having a baked potato with uh
, which is very popular in theuk, so maybe for y'all oh, it's
(31:56):
the same here.
Baked potato is quite potatoesare great source of fiber,
potassium.
You know it's very satiating,it's a delicious dish and it's
actually low in calories.
But your friend may be puttinga dollop of butter or cheese or
tuna mayonnaise, while if youhave it with hummus and a big
salad and baked beans and youknow, or make a curry on your
(32:20):
own and put it on that, you willfind that that is actually a
very satisfying meal which isnot high in calories.
And for every tablespoon of oilthat you consume, which is
about 120 calories, you can eata large salad with some hummus
and things like that.
So it's making these smartswaps, uh, so that you know how
(32:43):
to increase the nutrient qualityof your food but at the same
time reducing the caloriecontent.
So you know I try and talk aboutthis.
I have chapters on variousthings like work, menopause in
the workplace.
You know we talk about thevarious minority communities
that are affected by menopause.
You know very harshly actually.
So I hope that all thesedifferent chapters people can
(33:06):
read, pick and choose whicheverchapters they want.
But for those who don't likereading, then of course, you
know, maybe printing out justthe small sheets from my website
can help.
Vai Kumar (33:16):
Oh yes.
And what about the role ofexercise?
I do want to go into the plantforward diet a little bit more.
The role of exercise.
And Dr Rajiv Bajaykal, yourhusband, an orthopedic surgeon,
has written a beautiful chapterin your book on bone health and
(33:37):
how resistance training and allof that can help.
So, with low estrogen andestrogen deficiency, as we start
from perimenopause going intomenopause and you already said,
we all live the lifespan intoour 80s and about 35 years we
are all in menopause.
(33:58):
So how important, how much canwe just talk about, yeah,
exercise.
Dr.Nitu Bajekal (34:04):
I have dedicated a whole section to
exercise.
First important thing is do notuse exercise to lose weight.
Do not use exercise to loseweight.
You will not lose a gram ofweight unless you're exercising
like Usain Bolt or PaulaRadcliffe or you know one of the
top athletes.
That's not the purpose ofexercise.
The purpose of exercise is toincrease your endorphins, make
(34:25):
you feel better for yourself, soyou make better food choices.
It helps to reduce cancer risksfrom coming Breast cancer, which
is one in seven or one in eightwomen in the US will get a
diagnosis of breast cancer.
So exercising regularly canhelp with that.
And we know that menopausalwomen are at a greater risk.
And especially South Asianwomen and black women tend to
(34:47):
have a much higher risk ofgetting breast cancer earlier on
in age, in their 40s, and oftena more aggressive form.
So it's really important tobring in exercise to reduce the
risk of many cancers, reduce therisk of cancer coming back once
if you have got the diagnosisof cancer.
But it also helps to maintainweight loss.
(35:07):
That's good.
It helps you to tone.
But strength training isparticularly important because
one in three women often willhave a hip fracture because of
osteoporosis.
So it's important to bring infrom the age of 30, our bone
loss starts.
So you want to start doingstrength training from early
childhood.
But it's never too late at allto start making changes at all.
(35:35):
To start making changes so youknow doing weights, either with
the help of a personal trainerif you can afford it or if you
have any health issues, makingsure that you get okay from your
doctor or otherwise.
Looking at youtube and doinginitial five minute exercises
and slowly building up withsmall weights or even like
bottles of water and things likethat, and using your own body
weight.
So strength training is reallyimportant, helps with managing
things like that and using yourown body weight.
So strength training is reallyimportant, helps with managing
(35:55):
things like type 2 diabetes,insulin resistance, but also
helps to strengthen your bonesand then adding that with
certain foods will allow thebones to be even healthier.
So when you drink soy milk,when you eat soybeans, when you
have prunes, these are thingsthat will help your bones and
make it much more healthy.
But at the same time, strengthtraining at least twice a week,
(36:15):
30 minutes minimum, is what youshould be trying to do.
But even if you do five minutes, 10 minutes a day, it doesn't
matter.
Every little bit helps so, andyou're never too old to do them
as well.
So it's so, so important,because one in three women will
have a hip fracture and half ofthose women will be dead by the
first year after a hip fracture.
So we really don't understandthe power.
(36:37):
Like heart disease is anothersituation.
So exercise can really helpimprove heart health and
cholesterol health, because morewomen die of heart disease than
men with a heart attack.
So, um, it's, it's just that wedie a bit later, so nobody
talks about it.
So with exercise, I really wantpeople to think whether it is a
walk, and find an exercise thatyou enjoy and then bring in some
(37:00):
strength training.
So it may be.
You know reformer pilates oryou know doing your own body
weight and planks and thingslike that.
But find things slowly, butdon't try and rush.
I always say, if you'resomebody who's never exercised,
start by maybe getting help andthen slowly doing five minutes.
Even doing 15 minutes reducesdeath rates, we know that.
(37:21):
So slowly do that rather thantrying to run a marathon on day
one.
So always try to slowly buildit up over a period of months,
because it's really shout.
South Asian women are the worldover, tend to be the most
sedentary and our jobs tend tobe quite sedentary.
So if you are I have a desk jobI would suggest standing up
every hour so that you go do awalk, do some burpees, maybe do
(37:45):
some calf raises while you'rewaiting for your tea to be made,
or whatever.
Try and bring in on in a dailyway some ways of acting, uh,
action, so that you're notsitting for long periods of time
.
We sit at desk, then we comehome and we sit in front of the
television or in front of ourphones, you know, and all of us
are guilty of doing that.
So exercise is so, so important, which is why rajiv, who's my
(38:10):
husband he's a back surgeon seesa lot of back aches, and that
again is from sedentary sitting.
So posture is so important.
So I we discuss all that, allthe science behind, why it is so
useful for menopause,perimenopause and actually all
age groups oh yes, and movementis anti-inflammatory, correct?
Vai Kumar (38:28):
absolutely okay okay, and let's delve into workplace
dynamics and accommodation formenopause.
Dr.Nitu Bajekal (38:39):
Yeah.
Vai Kumar (38:39):
What are some factors you think are important?
And in fact, right along this,as a coincidence to this
conversation yesterday here onMorning Show, there was talk
that it's going to be all overlinkedin in 2025, that
accommodation for menopause isimportant and I believe even
(39:01):
insurance companies are likeoffering support forums and
support groups and things likethat, which will be fantastic.
Dr.Nitu Bajekal (39:08):
So I'm really looking forward to 2020 we have
a long go, though we have a verylong way to go.
Studies have shown, evenamongst doctors, that most
female doctors don't get hurt.
They don't get any allowances,and one in four will have severe
symptoms with menopause, andthose women often end up leaving
their job.
And so one in 10 women leavetheir job and they're not meant
(39:31):
to leave their job.
And so one in 10 women leavetheir job and they're not meant
to leave their job.
So you know, it is a real issue, and with 60 to 70 to 75
percent of women in their 50s60s still in the workplace, and
we're talking about, you know,12 women out of 100 having early
menopause between 40 and 45.
We have four in 100 under theage of 40.
And then you have the restbetween 45 and 55, all still at
(39:53):
work.
And work is not only the paidwork, don't forget.
There's also work at home, okay, work at caring.
So we do have to realize womenhave been bottom of the pile for
a very long time, and so makingthese changes that are coming
in through government, in the UKespecially, is very good, but
(40:14):
all employers should be aware,and it is important to have a
person who's a menopause um, youknow?
Spokesperson, if possible inbigger organizations, so that
you can see whether you needleave.
Are you somebody who's hasdisabilities?
Are you somebody who's from aminority community?
Are you somebody who hasdisabilities?
Are you somebody who's from aminority community?
Are you somebody who has gotwho's?
(40:36):
For example, you know trans andso is not able to tell people
that they actually havemenopause issues because that's
not how they're known in theworkplace?
These things are all veryimportant, but for everybody we
need to be able to talk about itopenly.
We need to make sure that youhave a toilet.
Because you have increasedfrequency, you know you
(40:58):
shouldn't have to trek todifferent floors to go to the
bathroom.
If you need to have a fan, ifyou need to sit near a window
simple things they can bebrought in.
And If you are somebody who'sstruggling with symptoms and you
need to go see your healthprovider, it is important for
the employer to give you timeoff rather than you having to
(41:19):
take annual leave or leavewithout people knowing.
So I think there are a lot ofthings people can do, including
educating your seniors andhaving you know people come in,
like I often do talks forcorporate organizations or, you
know, for nhs organizations.
It's important that you dothese things because a lot of
(41:41):
men and women who have gonethrough all that have women will
say you know people women of myage will say, oh, that happened
a long time ago, let's move on.
I didn't have all that support,but that's not.
If we have to move forward, wehave to make sure that we're
bringing all the right changesin.
So changing the legislation,changing the paperwork, but also
bringing these small workplacechanges having bowls of fruit
(42:04):
rather than biscuits lyingaround these are all little
things that people can do.
Ensure that there's healthylifestyle promoted, people are
allowed to take their lunchbreak and go for a walk without
being made to feel guilty.
Little things like that canmake a huge difference to
experience of perimenopause andmenopause.
Vai Kumar (42:22):
Yeah, and including, you know, the simplest thing
right, Providing access to someclean water drinking water right
alongside you know your deskarea.
Yeah, so lifestyle and menopause.
You call it age-proofing yourmenopause.
In this beautiful book, wetalked a little bit about the
(42:44):
influence of plant-based diet,so specifically talking more
about it and the role ofproteins in terms of, know, bone
health, and not just protein,carbs, fats everything good fats
and a lot of vitamins andminerals that are inherent in
food.
Why don't you talk more aboutthat?
(43:06):
Because there's so much.
I think, yeah, we touched uponit when you were referencing
weight gain and how we can sortof combat it yeah, I mean, I
personally follow a plantexclusive diet, a fully
plant-based diet, and have donefor 22, 23 years.
Dr.Nitu Bajekal (43:24):
But it would be great if people can do that,
but not everybody can.
So I want to encourage peopleto have a plant predominant or
plant forward diet.
So if you're somebody who'seating no fruits because you're
scared of sugar in the fruits,let me reassure you that the
fiber is there in the fruits youwant to be eating to reduce the
risk of type 2 diabetes.
If you have type 2 diabetes,that will get improved if you
(43:46):
want to make sure that you getall the right nutrients and
vitamins and calcium in youroranges, so I would suggest
starting, if you're not eatingany fruits, maybe having one
fruit and then a fruit that youlike, maybe some satsumas or
clementines, and then bringingin some grapes and mango and
papaya and watermelon.
Watermelon is supposed to helpwith vaginal lubrication, so you
(44:06):
know, eat more of these fruits.
So fruits is a very importantpart of one's diet, especially
in perimenopause and menopause.
The second group that you wantto bring in are lots of
vegetables.
Find vegetables that you like.
Again, if you're somebody whodoesn't eat vegetables, maybe
start with a small handful of avegetable that you like and
slowly build it up.
(44:26):
Some cooked, some raw Greenleafy vegetables really help
with, you know, heart health andopening up blood vessels.
So it's really important thatyou try and bring in the
vegetables Now.
The particular foods that arevery helpful for menopause and
perimenopause are herbs andspices.
They can help in a number ofways, whether it is turmeric for
joint pains, whether it iscinnamon for blood sugar
(44:48):
regulation.
So you want to bring in hugeamounts of fresh herbs, dried
herbs and spices in your diet.
You also want to make sure thatyou're focusing on whole grains
, tubers, so whole grains likebrown rice and quinoa, millet,
amaranth doesn't matter Findingfoods like that because they
keep you full.
They have lots of fiber andfiber helps you lose weight.
(45:11):
Fiber helps you your gut health.
Fiber helps to preventconstipation.
Fiber helps to reduce the riskof cancers and things like that.
So you want to bring in wholegrains as well.
You want to bring in legumes,which are the star of menopause
and perimenopause.
What are legumes?
They are basically lentils andpulses which you want to start
with if you're not used toeating beans.
(45:32):
Start with the soft dals andlentils.
Cook them really soft.
Rohini has written a fullchapter.
My daughter, who's anutritionist, she's written a
chapter on bloating and things.
It's important that you bringin these lentils and pulses.
Don't be scared.
Start with a small amount andslowly increase it.
Then move on to the beans.
Beans are again very rich infiber and the king all beans.
(45:54):
You want to eat chickpeas andburlotti beans and kidney beans
and all kinds of beans and tryto eat two or three times a day
over time as you slowly get usedto it.
We know that those communitiesthat eat a lot of beans tend to
live the longest and thehealthiest.
But soybean is particularlyimportant for menopause.
It has a very good proteinprofile.
(46:15):
So it is.
You know, all the people who goto the gym are always talking
about egg white.
Egg white has got so many um,non good health issues with it.
So you want to be focusing onthe soybean because it has got
the same plant, same proteinprofile, same amino acid profile
, without any of the nasties.
It helps reduce cancer risk ofyour liver cancer, bowel cancer,
(46:38):
ovarian cancer, you know whatelse Breast cancer, prostate
cancer.
So really you want to befocusing on the protein profile
of the soybean.
How do you eat soy?
You want to have it in the formof edamame beans, mature
soybeans, you want to have it inthe form of tofu and tempeh and
soy milk and soy yogurt.
(46:59):
You don't have to gospecifically for the organic or
the gmo, non-gmo version.
But if people are anxious andthey can access that, that's
fine.
I'm not fussed about it becausethat is not a real risk as such
.
But soy itself has been aroundfor 5000 years In China.
Huge populations have alreadyalways eaten it with huge
(47:21):
benefits for overall healthheart health, cholesterol health
, brain health, weight loss aswell as menopausal symptoms.
Neil Bernard did a wonderfulstudy where people ate about 50
milligrams of isoflavones, whichare the plant estrogens that
you know kidney beans have,blueberries have, pistachios
have.
But soy has it particularlyhealthy and so men and women who
(47:45):
eat it and the earlier youstart eating, lower is the risk
of prostate cancer and breastcancer.
So we know that will help.
But having half a cup of maturesoybeans or having a handful of
edamame beans, a cup of soymilk, maybe a handful of tofu,
will give you the 55 milligramsof isoflavones, which are the
plant estrogens, and that willhelp to reduce the risk of your
(48:09):
hot flashes by 84 percent.
So that's a huge benefit, youknow, other than for women who
can't take HRT, who don't wantto take HRT.
I personally tend to takebetween three to four portions
of soy every single day, becauseI do a lot of strength training
, so I will have some plantprotein in the form of soy
protein, a tablespoon of it,some days.
(48:30):
Some days I'll have pea protein, brown rice protein.
I mix all my different proteinsto get the, because, you know,
as you get older, you want 1.4to 1.6 grams of protein,
sometimes a little bit higher,but this is a good amount.
So you want to get it from uh,you know the soybean, which has
got a very good source ofprotein.
Also all your lentils andlegumes, and very rarely are
(48:53):
people allergic to soy, so it'sreally a very good way of
getting tofu.
Tempeh, seitan is another one,which is wheat protein and, of
course, protein powder.
So we have a whole chapterfocusing on protein, because, as
you get older, as you becomemenopausal, focusing on protein.
But plant protein is moreimportant than animal protein
(49:14):
and so you want to focus on that.
So we've talked about fruits,vegetables, whole grains, we've
talked about green leafyvegetables, herbs and spices.
We've talked about legumes,including soy, and I really want
people to take away nothingelse you remember from this chat
.
Remember that soy is safe foryou.
I have a whole fact sheet on mywebsite.
I have a whole chapter on mybook, but I don't get paid by
(49:38):
anybody, it's just.
I see the benefits of soy, soit's really important, and, of
course, things like potatoes,sweet potatoes, yam these are
all very important foods.
They keep you full, they havelow calorie, they're very rich
in fiber, but you don't want tochip your potatoes and you don't
want to fry your potatoes.
You want to have them, you know, baked, or have them, you know,
(50:00):
boiled and mashed and thingslike that.
And when you eat this kind ofway, your inflammation levels
reduce.
So we know the chronicinflammatory conditions like
adenomyosis and endometriosisand type 2 diabetes and heart
health and all can improvebecause you're reducing the
advanced glycation end products,which are called AGEs.
(50:22):
Ages are found in meats and inhighly fried foods and things
that tend to damage yourarteries, your ovaries, your
heart.
So it's so important to try andeat as much as possible.
Start your day with a bigporridge with lots of berries,
flaxseed powder to increase youromega-3s, and your soy has that
as well, so have it in soy milk.
(50:43):
Lunch can be a big salad or asoup, you know, with lots of
tofu on the side, or as croutons.
Evening can be you know, bigstir fry with, you know, soy
noodles, or you know big stirfry with you know, soy noodles,
or you know peanut sauces anddifferent things.
So it's really important tohave lots of recipes in my book
and on my website as well.
So it's a very joyful way ofeating and people often think,
(51:05):
oh, I can't have this and Ican't have that, so slowly start
eating this way, and when youlook down on your plate, there
should be color.
Vai Kumar (51:12):
Yeah, very well said.
And oil, sugar, salt everything.
Dr.Nitu Bajekal (51:20):
You know, like it's they should be.
Yeah, they should be condiments.
They should not be centralfocus.
As I said, one tablespoon of oilextra virgin olive oil can be
really good for you, but ifyou're somebody who's trying to
lose weight which is 70 of thepopulation think about do you
want to have that, or would yourather have your salad with some
olives and hummus and thingslike that?
(51:41):
So you know, it's just findingthings, but for people who need
to put on weight, who don't havea weight issue, children, all
these people extra virgin oliveoil has got a lot of benefits as
well as well, but by and large,the use sugar and salt, as you
(52:01):
know, little additions ratherthan having huge quantities of
these free sugars, rather thanfocus on fruits and, you know,
have a couple of dates with somenuts that will usually satisfy
most people's sweet tooth overtime yeah, and if there is one
thing you would love to seechange, I know with all your
advocacy efforts with your bookand everything, and you're also
very conscious of how we areprogressing on the climate front
(52:24):
and you also advocate thateating plant forward is so good
and I I eat a plant-based dietand I know for a fact I did a
whole season on sustainabilityon this show.
Vai Kumar (52:36):
So if there's one thing you would love to see
change, what would that be interms of everything that you
have written and in terms ofwhat you see out there from your
practice?
Dr.Nitu Bajekal (52:47):
I think I would like women to acknowledge
themselves and realize thatthey're very valued members of
the world and community and weare the force for change, and
that change happens withinourselves first.
So don't worry about yourpartner, don't worry about your
community.
You, yes, you do need to changethem, but first, when you make
those changes, you will feel somuch better for yourself.
(53:09):
Don't be harsh on yourself ifyou slip up.
I think that's important andreally, if I had to make one
change, I would say start eatingmore soy, eat less animal foods
.
If you can achieve those twothings, you will help climate
change, you will help therainforest, because most of the
(53:29):
soy that's produced is foranimals.
You will help your health, youwill help, uh, animal suffering
and you will also help you knowyour um the climate.
So that's what I would sayeating plant forward every time
you eat.
Think about what you're puttingin your mouth, think about the
future generations that you'regoing to leave this beautiful
(53:50):
earth to which we are rapidlydestroying.
Vai Kumar (53:52):
Well, fascinating conversation, and my takeaway is
knowledge is power and allunpleasant symptoms are not to
be endured.
So those are the biggesttakeaways.
And neethubhajekalcom, that's awebsite, right.
I'll be sure to include it inthe show notes.
Dr.Nitu Bajekal (54:09):
I have about 15 different fact sheets all free
and lots of recipes and podcastlinks and things, so I hope
people will access that.
Vai Kumar (54:17):
Wonderful, so I'll be sure to include the link to the
book.
And is it available on Amazonand where else?
Would you like to add anythingelse?
Dr.Nitu Bajekal (54:27):
Yeah, no, not at all.
And do follow me on socialmedia because I'm quite active
generally, although I'm taking alittle break over Christmas,
but TikTok and Instagram, I tendto be sharing quite a lot of
information.
Vai Kumar (54:41):
Excellent.
I'll be sure to includeeverything in the show notes and
thank you, Dr Neetu, for afascinating conversation on how
best we can help women equipthemselves and empower
themselves into their transitionfrom perimenopause to menopause
Listeners as always follow thepodcast.
(55:02):
Rate the podcast.
Leave a review from yourpodcast app of choice.
Follow me on Instagram andYouTube at YP Kumar.
That's V-A-I-P-K-U-M-A-R forall things digital media and
lifestyle.
Until next time with yetanother interesting guest and
yet another interesting topic.
It's me, mai, along with DrNeetu, saying so long Bye-bye.
Welcome to Freshleaf Forever, a podcast that gives
you fascinating insights weekafter week.
Here's your host, vaikumar.
Hey folks, welcome to anotherepisode on podcast Freshleaf
Forever.
Today we have a returning guest, dr.
Nitu Bajekal.
She is a senior OBGYN, multiplebook author, a senior
(00:35):
consultant, obstetrician andgynecologist practicing out of
London, uk, with nearly 40 yearsof clinical experience in
women's health.
Her special interests includelifestyle medicine, menopause,
pcos, endometriosis periodproblems, complex vulval
(00:56):
problems and medical education.
She's a keyhole surgeon withexperience in laproscopic
procedures.
Holds surgeon with experiencein laparoscopic procedures,
including robotics.
She's a fellow of the RoyalCollege and recipient of the
Indian President's Gold Medal.
Dr Bajekal is one of the firstboard-certified lifestyle
(01:18):
medicine physicians in the UK.
She has written the Women'sHealth Module for the first UK
plant-based nutrition course atWinchester University.
It's with great joy that wewelcome back Dr Nitu Bajekal
here to podcast FreshleafForever.
Hey, dr Nitu, how are you doing?
Dr.Nitu Bajekal (01:40):
today I'm very well.
Thank you, Vai, for inviting me.
It's always lovely to come backand chat with you, so looking
forward to our conversation.
Vai Kumar (01:48):
Oh, thank you, Welcome back.
And how about we start bygiving listeners, in fact, first
of all, congratulations on thisfascinating book.
Finding Me in Menopause, it'sjust beautifully written, and
that's the purpose of ourconversation here.
Dr.Nitu Bajekal (02:06):
Yeah, thank you , it was the book I would have
liked to have had.
Vai Kumar (02:10):
Oh, yes, oh yes, it seems like a must read for
anyone in the perimenopause andmenopause phase.
So why don't we get started byquickly telling listeners what
perimenopause is and what ismenopause?
Dr.Nitu Bajekal (02:24):
Right.
Perimenopause, as the worddescribes, is around menopause.
So basically it's a timeleading up to the time when you
completely stop your periods.
So usually that will be aboutfour years around the age of 47.
But we know that life is notnecessarily always a certain
data point, and so between twoto eight years is when
(02:48):
perimenopause can last.
So menopause tends to occuraround the age of 51.
But again, that's all over theworld.
But again, it's not a fixeddata point and the range is
anywhere between 45 to 55.
So menopause is the time whenyou stopped your periods for 12
(03:08):
months completely, and thattends to be between 45 and 55.
It's a retrospective diagnosis.
You don't have periods for 12months and there are no other
obvious reasons, and you saythis person is in menopause and
perimenopause is a time beforeyou completely stop your period.
So if you are destined to stopyour periods at, say, 45 or 46,
(03:30):
perimenopause can be between twoto eight years.
It's a time leading up tomenopause.
And so you may be in your late30s when you're actually going
through perimenopause and you'reat the peak of your career, or
you may not even have startedthinking of having a baby if
that is your plan.
So it's really important tounderstand what perimenopause is
the time leading, or menopausein transition and menopause is
(03:52):
the time when you stop yourperiods completely.
Now important note for maybesome of your listeners who are
from southeast asia indians,pakistanis, bangladeshi origin
and from the black communitymenopause can occur early, so it
can be at 45, 46, 47, dependingon which part of India, for
(04:12):
example, you're from.
It's not, of course again not afix.
There'll be a lot of women whowill say I'm still having my
period and I'm 54.
But there are a lot of women inthat early age group, so they
may be having these symptoms ofmenopause and perimenopause much
earlier, when they are still inthe workplace and nobody is
even thinking about menopause atthat time.
Vai Kumar (04:36):
Okay, and just to get to your own journey and
transition into that menopausestage, I know you had a lot of
challenges and you have outlinedit in the book beautifully
again.
So what prompted you to writethe book and what do you think
were some of the challenges thatyou kind of had to go through
(04:57):
during that phase?
Dr.Nitu Bajekal (04:59):
I think my first challenge was that I
didn't have the confidence toshare with my colleagues.
So I was about 38 when Istarted noticing that my
previously regular periodsalways clockwork didn't really
bother me.
Suddenly I started becomingvery heavy.
They were initially a littlebit crowded, but then they
(05:19):
started hopping and skipping andI thought I was because I was
being bullied at work.
I was also very busy.
I was applying for a consultantjob in London.
I had two young children, a dog,a husband who worked all God
given hours like me, and no realfamily.
We were immigrants from India.
There was a lot of balls in theair and so I really my health.
(05:40):
I was always a healthy personin that I mostly ate plant-based
.
I was never didn't have anyexcess weight.
I was very physically active,but it didn't even cross my mind
.
My mother and my sister werestill.
My mother had a period sinceshe was 52.
My sister, who's who's abouteight years older than me, was
still having her periods.
(06:01):
So it didn't even occur to methat my periods that were
stopping was anything to do withperimenopause and my low mood
and libido issues, all thesethings.
I tried to brush under thecarpet and then realized that
actually my periods hadcompletely stopped and I fell
into that group where I was oneof the specialists in those
areas with premature ovarianinsufficiency, where a woman, or
(06:24):
those who are assigned femaleat birth, basically their period
stopped under the age of 40.
So one in 20 000 girls, youngwomen, may never reach um, you
know, may have the one periodand never have a period again.
So that's very rare but itstill happens.
And then one in hundred and infact in india and all, there may
be as high as four to fivewomen in a hundred will stop
(06:44):
their periods under the age of40.
That is a medical conditioncalled POI, premature ovarian
insufficiency, previously knownas premature ovarian failure or
premature menopause.
We don't like the word failure,we're not very drastic term
right.
Very drastic term.
So basically anybody who hasPOI.
(07:05):
And there are many reasonsgenetics, unknown, there may be
some medical conditions as well,but most of the times we don't
find a reason.
And if anybody who's listeninghasn't had a period for more
than three months because womentake three to four doctors
before they can actually bediagnosed with POI and there may
be other background conditionsit may not be POI.
It may be polycystic ovarysyndrome, for example.
(07:27):
It may be an eating disorder,it may be exercising too much.
Whatever it is, if your periodsare missing for more than three
months, never to be ignored.
It's important to see the rightto see your doctor initially
have the right tests.
So POI is what I diagnosed, knewI had it.
I needed HRT, hormonereplacement therapy or hormone
(07:48):
therapy.
But we are talking I'm almost63 now, so we're talking 24-25
years ago, when the WHI studyand the million women study from
the US and UK had come out andbasically the media got the
information wrong and ran withit and said that HRT is
dangerous, it causes cancer,when actually none of that is,
(08:09):
you know, remotely true andunfortunately my family doctor
refused to prescribe me HRTdespite me going several times.
So I had I been more confidentbecause I had just become a
consultant.
I was a keyhole surgeon.
I was, you know, an immigrant,a woman, a woman of color.
I wanted to be at the top of mygame.
(08:32):
I did not want to appear weak.
But actually, in retrospect,had I shared with my male
colleagues because I was theonly woman, I would have, I
think you know, been able to getheard, think you know, been
able to get heard.
Instead, I managed on my ownfor quite a long time and
luckily for me.
In a way, my younger daughterwas nine.
(08:52):
Around that time she becamevegan and many of my symptoms
improved.
But I didn't, of course, put itdown to diet and lifestyle.
I thought it was just life.
But now I know what it did.
But any woman who's listeningunder the age of 40, I, who
stops their periods, who'sdiagnosed with premature ovarian
insufficiency there's awonderful book by Dr Hannah
(09:13):
Short called the early guy theguide to early menopause and POI
.
But also to seek medical advice.
Please do not let a doctor tellyou it's okay not to have
periods.
So that's my message and Iwrote the book.
I'd always wanted to read abook like what I had written and
it felt right.
We wrote the first book becauseRohini, my older daughter, has
(09:36):
polycystic ovary syndrome andshe wanted me not to write a
general book, and so she saidyou've got all these 35, 40
years of experience.
You need to write about thingsthat you know a lot about
endometriosis or PCOS ormenopause.
So we started off with PCOS andthen, of course, this book was
bubbling inside me, and I hopethere are many more books to
(10:07):
come, but maybe I'm taking a fewmonths off now.
I'm sure I'm sure, this just hasbeen a beautiful transition, I
should say, and it's flourishingin perimenopause and menopause,
and perimenopause because ofall these symptoms that we are
supposed to get, but most womenmay have some symptoms, some
women will have no symptoms andit's not a time for doom and
(10:30):
gloom for everyone so yeah, Ijust want people to realize you
can flourish.
And yes, it's really hard whenyou get a diagnosis when you
haven't even started buildingyour family, for example.
Those are different medicalsituations.
But for the average person, Idon't want you to look at this
time and really that's why Iwrote flourishing in
(10:50):
perimenopause and menopause,because I do believe you can
actually embrace it in differentways and seek the right help.
But also, you know the attitudeis so important, isn't it?
Vai Kumar (11:03):
Exactly, and we all think it's inevitable and that
you know we have to endure thosesymptoms and it's so much of
still, even you know, like weare approaching 2025, and
there's still so much ofsocietal taboo in terms of
discussing all these thingsRight.
And you mentioned about POI,that's premature ovarian
(11:24):
insufficiency, and and copingwith it I guess not just to you
know remain silent but seekmedical help in the form of, say
, hrt, which is hormonereplacement therapy.
And you have highlightedbeautifully how we all tend to,
(11:44):
the number of ovaries we alltend to.
You know it just reduces overtime and that's like a common
process, right yeah?
Dr.Nitu Bajekal (11:52):
Let me explain why POI occurs or menopause
occurs.
So when we are conceived,around 20 weeks, there would be,
say, like a couple of millioneggs in each ovary.
Ovaries are the egg baskets andthey basically are the
powerhouse of the hormonesestrogen producing.
Of course.
Estrogen, progesterone,testosterone are producing the
other parts of your body, butthese are the main sites and
(12:13):
they're regulated by the brain,by the hypothalamus and the
pituitary, which releasehormones which are chemical
messengers which will work andstimulate the ovary, and
there'll be a master switch inthe hypothalamus that starts
everything off and pubertystarts.
So what happens is you havethese couple of million eggs by
the time you're born.
A million have got lost by whatis known as natural attrition.
(12:34):
It just gets, you know,degraded and so you may be born
with a million eggs and thenover time, by the time you reach
puberty and then the time youreach your early 20s and 30s,
the number of eggs keep droppingtill you reach menopause, when
a critical level of below 1000is reached.
So if your genetics aredictating, or your environment
(12:57):
or whatever it is, if yourovarian egg supply has dropped
to less than 1000 and you'reonly 25, then that's POI.
If you're 40, between 40 and 45,that's early menopause, unless
you had it removed.
The ovaries can be removed atsurgery and chemotherapy and all
as well.
And then after 45 and between45 and 55, when those number of
(13:19):
eggs tend to drop below 1000,then the estrogen levels drop,
which is responsible for many ofthe symptoms, and then the
ovaries start telling the braincome on, produce more of the
releasing hormones so we canrelease more estrogen.
So it may work for a bit inperimenopause, your period stop
and start and all that, but thehypothalamus ultimately will
(13:42):
tell the pituitary we, we can'tproduce anymore.
So the FSH, lh levels, fshlevels, the follicle stimulating
hormones, tend to rise to alevel that is menopausal and, as
a result, there's just no more.
There are not enough eggs torelease these ovaries.
And the important thing toremember is that life expectancy
now in most of the westernworld is in the 80s.
(14:05):
So you are going to haveanywhere between 45 to sorry 30
to 35 years in the menopause.
So that's a long period of time.
And so people often say, oh,I've just stopped my periods,
I've had a few hot flushes, orI've had hot flushes terrible
for two, three years and I'mdone with menopause.
No, menopause is from the dayyou completely stop your periods
(14:29):
until the day we die, and thereare long term impacts and there
are some short term impacts,but we are always in menopause
and that's why it's so importantto embrace it, because it's not
going anywhere.
And we are not going anywhere,oh yeah exactly, oh yeah,
exactly.
Vai Kumar (14:42):
and you say in your book you call out like this,
almost like 34 symptoms that can, yes, one, can you know,
possibly all the overall womenpopulation can experience right
and you started, you led usthere, right there, into heart
flushes and night sweats yeahall those they are supposed to
be, some of the more commonsymptoms.
(15:03):
The vasomotor.
Sorry, you were sayingsomething else.
Yeah, the hot flushes the nightsweats, all the vasomotor
symptoms, right Correct, with somuch skepticism and say
reluctance to take hormones?
And with all these symptoms atplay, why don't you just tell
(15:24):
listeners how important it is tonot ignore and what are the
kind of the ramifications whenit comes to, you know, tackling
these symptoms?
Dr.Nitu Bajekal (15:34):
Yeah, If they go unaddressed, there are, you
know.
We say there are 34 symptoms,there are probably 60 symptoms.
Okay, and you know, becausemenopause is a whole body
situation at the end of the day.
So you can imagine thatestrogen receptors in every
tissue, every cell of the bodyand so you can imagine whether
it's from the brain.
(15:55):
You can imagine brain fog,memory issues can be an issue
for some people.
But, as I said, remember allthese symptoms may never occur
for you and some of the symptomsmay occur Rarely will I see.
Remember all these symptoms maynever occur for you and some of
the symptoms may occur Rarelywill I see patients with having
all the symptoms.
But if you go from head to toe,you can imagine there can be
thinning of hair, loss of hair.
You know, depending upon yourgenetics, your family history,
(16:17):
as the estrogen levels drop thenthe hair follicles tend to not
be as healthy.
If you're anemic, that makes iteven worse.
So you need to make sure thatyou have good iron stores.
Again, as I said, going into thebrain memory loss, brain fog,
feeling, you know, having issueswith processing and organizing
those things can be issues forsome people.
(16:39):
Others may notice joint pains.
Others may notice that they mayhave palpitations, night sweats
, hot flashes, and that'sbecause the temper temperature
regulatory zone is set and it'sbecome very sensitive.
So as soon as it falls slightlyoutside, women will notice that
they either have hot flashes orcold sweats or night sweats,
because they're basicallyfinding that they have this
(17:01):
sensation of heat which can lastanywhere from like a few
seconds to up to a minute.
Usually can be just once a day,can be 100 times a day and you
know that's why layering ofclothes can really help in these
situations.
So hot flashes and night sweatsare the most commonly known,
but not everybody will have them.
Low mood, lowered libido, thosefrom brain if you go down to
(17:25):
those are real issues can causerelationship issues as well for
women, because you may be havingdifferent desires at that time
and hard to explain.
You also may be at a situationwhere you have you may have
children who are trying to go touniversity or college, others
may have elderly parents or youmight be just trying to
negotiate.
Do I want a family or not?
(17:46):
So many things can be there.
So perimenopause will have verysimilar symptoms to menopause.
There can be other thingsringing in your ears.
You can have sensations underyour skin called formication,
like as your hands are crawling.
You can have joint pains,tiredness, fatigue.
You can have erratic bleedingin perimenopause because
symptoms such as heavy periods,frequent periods, may become
(18:10):
even more prevalent if you havea background of fibroids or
endometriosis or adenomyosis.
So those things have to be keptin mind and that women may have
pushed them to the back of thebecause they've been so busy and
now they're finding that thesesymptoms are getting worse.
But all the symptoms that yousee in menopause can occur in
perimenopause, but inperimenopause, as women are
(18:31):
still having periods, howeverinfrequently, they may have
period issues as well, and thenof course there are
genitourinary symptoms.
So, for example, women maynotice increased cystitis.
So every time they go to theirdoctor, the the doctor will say,
oh, you have an infection andthey give them antibiotics.
But actually you don't have aninfection.
Your estrogen levels havedropped, and so, while it's
(18:51):
important to check your urine,usually it's because of estrogen
receptors and estrogen levelshave dropped and so that makes
the bladder very sensitive.
The vagina becomes verysensitive, dry, you can have a
sensation of paper cuts,especially after penetrative
intercourse or and so on.
It is important usually tends tooccur in the second half.
(19:12):
So menopausal symptoms tend tobe the early first five, six
years where you'll have thebasomotor symptoms that you were
describing hot flashes, nightsweats, some joint pains, libido
issues and sleep issues Whileafter five, six years women tend
to find more of the morearthritis.
(19:33):
They may have heart healthissues, cholesterol issues,
which can all start inperimenopause as well, but they
may notice cystitis and vaginaldryness, as the estrogen levels
now have really dropped to a lowand local vaginal estrogen is
safe.
It is not even HRT.
You can women almost everybody,including women with cancer
with the okay of the specialist,can use vaginal local topical
(19:57):
estrogen after checking in withyour doctor and you can use it
for the rest of your life,usually twice a week and it
really makes a difference toquality of life.
So there are so many symptomsthat can.
If you take any bowel symptoms,you know, know gut upsets,
constipation, you know change ingut microbiome that can be a
problem.
Bladder increased frequency,you know leaking of urine
(20:20):
urgency.
So literally there's a range ofsymptoms from every organ and
that's why easily they add up to34.
But as I said again please don'tpanic, because there's help for
almost everything and also mostwomen won't have all the
symptoms, and this is where dietand lifestyle.
So not every woman can take HRT, not every woman wants to take
(20:42):
HRT, not every woman can takeHRT.
But even if you're on hormonereplacement therapy, which is
safe, you need to bring inlifestyle changes because all
these symptoms can also behelped when you're doing
lifestyle.
It's not one or the other.
Vai Kumar (20:58):
It's very important.
I think it couldn't have beenunderscored better.
I think it's very importantthat people seek the help of
their OBGYN and go for regularvisits.
The annual visits are much moreimportant.
Getting a mammogram, gettingeverything taken care of and
discussing you also give a nicecheat sheet for people to go
(21:22):
prepare for appointments, right,because this lack of sleep
again say, for example, if wewere to focus on that one
symptom, someone has lack ofsleep that can have a rippling
effect in terms of mood andanxiety and stress and so on.
Dr.Nitu Bajekal (21:38):
Right, because anxiety, depression and, yes,
some women do needantidepressants, but a lot of
women in perimenopause andmenopause may actually all they
need is hormone replacement.
So it's so important to have aob-gyn who understands, who's
willing to acknowledge thesymptoms and accept and their
own limitations and if theydon't have the expertise they
(21:59):
should be able to refer on.
And also, if you as a patientare sitting there thinking I
don't think I've been heard,then do ask for a second opinion
.
It's really important and thereason I've written my book
really important and the reasonI've written my book and because
of my website, which iscompletely free
neethubhajekalcom.
What I try and explain is haveyour questions ready, know your
(22:22):
medical history, know yoursurgical history, know the
medications you're on.
Be careful of taking supplementsthat are not scientifically
validated, because you'll spenda lot of money and they can
actually harm you in the longerrun.
You know collagen supplementsand you know all kinds of these
menopause relief supplements.
They are all not naturalbecause they're in the form of a
(22:43):
tablet, so you're better ofstandardizing it, regulating it
and looking for the right stampsso that they are absolutely,
you know, fda approved or anybig society approved, because I
see every week I see women with10, 15 supplements sitting in
front of them, spending $100,$200.
And I'm thinking you were somuch better spending that money
(23:07):
on buying soybeans and fruitsand vegetables and dals.
I do want to highlight that aswell, because women are very
vulnerable when they're havingsymptoms, so it is whether it's
with the health professionals orwhether it's with the industry
so, and then there's socialmedia, to promote everything.
You know promising all thesecures.
(23:28):
So it's so, so important toactually take those things with
a pinch of salt.
Some supplements, of course,are vital vitamin D and B12 and
possibly algae derived omega-3.
And you know, for sleep, likeyou were talking, there are some
of my patients who findbenefits with magnesium.
Not everybody does.
The studies are not great.
But having a sleep pattern, aregular sleep pattern, sleep
(23:51):
routine, making sure that if youare stressed, learning to do
some de-stress techniques ofbreath work, or going for a walk
, or talking to a friend, makingsure that you don't eat too
late, making sure that you gofor a little walk or do some
little exercise for five minutesto help your insulin levels
settle down after a meal, youknow eating early in the day
(24:14):
these are all simple things.
Having an eye mask, thickcurtains, layering your clothes,
you know.
Just having thin sheets so thatyou can move them away as you
feel hot at night, you know.
Having a fan turning theheating down I have all these
suggestions and different thingswill work for different people
and I know they sound very oh.
(24:35):
Everybody knows that, but you'dbe surprised.
For me, that is my weakestpillar.
Sleep has always been as a whenI was an obstetrician I just
practiced gynecology now but youknow I used to be woken up
several times at night.
Every second or third night Ihave had a very poor sleep.
Then add on top of that theearly menopause.
That was a real issue, and soit is so important to prioritize
(25:00):
that because, as you said, whenyou have sleep issues, you will
tend to wake up stressed.
When you are stressed andanxious, you tend to eat the
donut rather than the apple, andthen when you're eating those
foods, you don't feel likeexercising, you don't feel like
remaining your friends, youdon't want to go out of the
house.
So it's a domino effect for allthe six lifestyle pillars.
So it's so important to try andfind one pillar that you want
(25:23):
to make a little difference,whether it's the food pillar,
whether it's the exercise pillar, whatever it is and then slowly
build it up and that's the samefor any hormonal health
condition to optimize one'shealth, or whether it is
perimenopause or menopause.
Vai Kumar (25:37):
Okay, and you said erratic bleeding.
Even that's not to be ignored,right?
Because sometimes a physicianmay order a pelvic ultrasound,
and that can reveal so much moreinformation.
Is that?
Dr.Nitu Bajekal (25:51):
correct?
Yes, so any woman who hasbleeding after sex.
Even if you had a clear papsmear, if you're bleeding after
sex, is there an area on thecervix that is causing problems?
Is there a polyp?
Whatever it is.
So bleeding after intercourseshould never be ignored.
Bleeding in between your cyclesshould never be ignored.
Bleeding more than seven daysnot be ignored.
(26:15):
If you're passing clots whichis bigger than the size of your
thumbnail, if you're having touse double protection, if you're
having to have painkillers allthe time, if it's affecting the
quality of your life, you shouldnot be ignoring any of these,
because there may be backgroundconditions that have not been
picked up.
So conditions like chronicinflammatory conditions, like
(26:36):
adenomyosis, endometriosis,fibroids, which are benign
growths, but if they are in thecavity, they can cause a lot of
bleeding as well.
You also may have conditionslike polycystic ovary syndrome,
so that it's so, so importantthat you don't ignore these
symptoms and have a healthprovider who listens and
arranges the right test.
(26:56):
That is why I have thosechapters in my book to say this
is what you should be asking ifyou have this and there are a
lot of case studies as well soyou empower yourself with the
knowledge from the website, fromgood resources, the NHS website
, the Royal College website,good resources, the nhs website,
the royal college website, theamerican college of lifestyle
(27:18):
medicine and, you know, the mayoclinic sites.
They give you good advice.
You can always go to chat roomsbecause, of course, patients
and people can give you a lot ofgood advice which doctors can't
.
But you do need to make surethat you is individualized.
It's right for you and you'regetting that information because
the number of women I see whywho come with having gone to
(27:39):
these bio-identical hormones,which are, you know, custom
compounded, because they thinkit's better for them but
actually they're not regulatedat all and no expert will
recommend them.
So you always want to choosestandardized, regulated HRT that
is FDA approved and NHSapproved in the UK, in Australia
(28:01):
as well, because you want tomake sure you're getting the
right dose of estrogen, theright dose of progesterone,
rather than hit and miss amounts.
And they are also bioidentical,or we call them body identical,
which basically means that theymimic the same hormones that
our bodies produce, whether itis progesterone and estrogen.
So, again, a lot of womenlistening here will be seeing
(28:23):
people who are giving thembioidentical hormones from
unregulated sources and I wantto call that out yeah, clear.
Vai Kumar (28:30):
And the most important thing with that as
well is when you are under thecare of an OBGYN, who is giving
it.
They have your whole history tokind of go off of and not just
something that you do fromunregulated sources.
Correct.
Back in a moment with our gueston Freshly, forever and weight
(29:02):
gain in menopause yes, I knowyou have a whole chapter on that
you have a whole chapter andyou again, you beautifully bring
out why body neutrality is sosignificant there yes, because
you know it's very well to keepsaying, um, body negativity
women struggle with anyway.
Dr.Nitu Bajekal (29:22):
They're always being told by society you're not
too thin, you're not too,you're too big or whatever you
know it is, you're too thin,you're too fat, whatever it is.
Body positivity can also bequite toxic because, you know,
sometimes you do feel like Idon't want to be positive about
my body.
It's letting me down right now.
But body neutrality is actuallyaccepting that this is the body
(29:44):
that we've been given.
It's so lucky, it works and youknow, even if you have a slight
hangnail, you know that wholeday you'll be thinking about it.
Or if you have an ulcer in yourmouth, but we don't even think
about those parts of our bodywhen they're functioning okay.
So I do want people to be aware.
And weight gain is an issue.
(30:04):
It's an issue for all genders,as after the age of 30 you
steadily put on weight and butit's particularly more prominent
for women in perimenopause andmenopause with the way the
hormones shift and things.
So we know that that can be anissue.
And also there are severalother social factors also that
increase our weight.
For example, you may bestressed, you may have issues
(30:27):
with.
You know, food regulation.
You may be, as I said, havingthese, you know, carer issues,
looking after parents andchildren.
You don't have time to lookafter yourself.
You may be, as I said, havingthese carer issues looking after
parents and children.
You don't have time to lookafter yourself.
You don't have time to care foryourself.
You don't have time to doexercises.
So these things are important.
Plus, we may have more financesand more money to spend, so we
may be eating out more often.
And, of course, if you eat out,what is there?
(30:49):
Oil, fat, sugar, salt, and sowe know that that can slowly
creep up.
Alcohol again.
Not only is the increased riskof alcohol with every glass of
wine you drink in the menopauseand perimenopause significant
increases after the first coupleof units.
So there's no safe limit foralcohol, no safe limit for
smoking, tobacco, vaping allthese things are, you know,
(31:12):
things that you really need tofocus.
Have a celebratory drink, ifyou want, but regular alcohol is
also is quite high in caloriesand, of course, causes seven
different types of cancers,affects sleep and menopause
worsens hot flashes.
So there are so many aspectsthat can affect sleep, can
affect weight, you know, and soI have lots of suggestions there
(31:35):
and of course one of the waysof trying to mitigate that
weight gain is by trying tofocus on a plant forward diet.
So the more large you eat theytend to be light in calories,
very nutrient dense, so you tendnot to put on the weight.
For your same friend who wouldbe having a baked potato with uh
, which is very popular in theuk, so maybe for y'all oh, it's
(31:56):
the same here.
Baked potato is quite potatoesare great source of fiber,
potassium.
You know it's very satiating,it's a delicious dish and it's
actually low in calories.
But your friend may be puttinga dollop of butter or cheese or
tuna mayonnaise, while if youhave it with hummus and a big
salad and baked beans and youknow, or make a curry on your
(32:20):
own and put it on that, you willfind that that is actually a
very satisfying meal which isnot high in calories.
And for every tablespoon of oilthat you consume, which is
about 120 calories, you can eata large salad with some hummus
and things like that.
So it's making these smartswaps, uh, so that you know how
(32:43):
to increase the nutrient qualityof your food but at the same
time reducing the caloriecontent.
So you know I try and talk aboutthis.
I have chapters on variousthings like work, menopause in
the workplace.
You know we talk about thevarious minority communities
that are affected by menopause.
You know very harshly actually.
So I hope that all thesedifferent chapters people can
(33:06):
read, pick and choose whicheverchapters they want.
But for those who don't likereading, then of course, you
know, maybe printing out justthe small sheets from my website
can help.
Vai Kumar (33:16):
Oh yes.
And what about the role ofexercise?
I do want to go into the plantforward diet a little bit more.
The role of exercise.
And Dr Rajiv Bajaykal, yourhusband, an orthopedic surgeon,
has written a beautiful chapterin your book on bone health and
(33:37):
how resistance training and allof that can help.
So, with low estrogen andestrogen deficiency, as we start
from perimenopause going intomenopause and you already said,
we all live the lifespan intoour 80s and about 35 years we
are all in menopause.
(33:58):
So how important, how much canwe just talk about, yeah,
exercise.
Dr.Nitu Bajekal (34:04):
I have dedicated a whole section to
exercise.
First important thing is do notuse exercise to lose weight.
Do not use exercise to loseweight.
You will not lose a gram ofweight unless you're exercising
like Usain Bolt or PaulaRadcliffe or you know one of the
top athletes.
That's not the purpose ofexercise.
The purpose of exercise is toincrease your endorphins, make
(34:25):
you feel better for yourself, soyou make better food choices.
It helps to reduce cancer risksfrom coming Breast cancer, which
is one in seven or one in eightwomen in the US will get a
diagnosis of breast cancer.
So exercising regularly canhelp with that.
And we know that menopausalwomen are at a greater risk.
And especially South Asianwomen and black women tend to
(34:47):
have a much higher risk ofgetting breast cancer earlier on
in age, in their 40s, and oftena more aggressive form.
So it's really important tobring in exercise to reduce the
risk of many cancers, reduce therisk of cancer coming back once
if you have got the diagnosisof cancer.
But it also helps to maintainweight loss.
(35:07):
That's good.
It helps you to tone.
But strength training isparticularly important because
one in three women often willhave a hip fracture because of
osteoporosis.
So it's important to bring infrom the age of 30, our bone
loss starts.
So you want to start doingstrength training from early
childhood.
But it's never too late at allto start making changes at all.
(35:35):
To start making changes so youknow doing weights, either with
the help of a personal trainerif you can afford it or if you
have any health issues, makingsure that you get okay from your
doctor or otherwise.
Looking at youtube and doinginitial five minute exercises
and slowly building up withsmall weights or even like
bottles of water and things likethat, and using your own body
weight.
So strength training is reallyimportant, helps with managing
things like that and using yourown body weight.
So strength training is reallyimportant, helps with managing
(35:55):
things like type 2 diabetes,insulin resistance, but also
helps to strengthen your bonesand then adding that with
certain foods will allow thebones to be even healthier.
So when you drink soy milk,when you eat soybeans, when you
have prunes, these are thingsthat will help your bones and
make it much more healthy.
But at the same time, strengthtraining at least twice a week,
(36:15):
30 minutes minimum, is what youshould be trying to do.
But even if you do five minutes, 10 minutes a day, it doesn't
matter.
Every little bit helps so, andyou're never too old to do them
as well.
So it's so, so important,because one in three women will
have a hip fracture and half ofthose women will be dead by the
first year after a hip fracture.
So we really don't understandthe power.
(36:37):
Like heart disease is anothersituation.
So exercise can really helpimprove heart health and
cholesterol health, because morewomen die of heart disease than
men with a heart attack.
So, um, it's, it's just that wedie a bit later, so nobody
talks about it.
So with exercise, I really wantpeople to think whether it is a
walk, and find an exercise thatyou enjoy and then bring in some
(37:00):
strength training.
So it may be.
You know reformer pilates oryou know doing your own body
weight and planks and thingslike that.
But find things slowly, butdon't try and rush.
I always say, if you'resomebody who's never exercised,
start by maybe getting help andthen slowly doing five minutes.
Even doing 15 minutes reducesdeath rates, we know that.
(37:21):
So slowly do that rather thantrying to run a marathon on day
one.
So always try to slowly buildit up over a period of months,
because it's really shout.
South Asian women are the worldover, tend to be the most
sedentary and our jobs tend tobe quite sedentary.
So if you are I have a desk jobI would suggest standing up
every hour so that you go do awalk, do some burpees, maybe do
(37:45):
some calf raises while you'rewaiting for your tea to be made,
or whatever.
Try and bring in on in a dailyway some ways of acting, uh,
action, so that you're notsitting for long periods of time
.
We sit at desk, then we comehome and we sit in front of the
television or in front of ourphones, you know, and all of us
are guilty of doing that.
So exercise is so, so important, which is why rajiv, who's my
(38:10):
husband he's a back surgeon seesa lot of back aches, and that
again is from sedentary sitting.
So posture is so important.
So I we discuss all that, allthe science behind, why it is so
useful for menopause,perimenopause and actually all
age groups oh yes, and movementis anti-inflammatory, correct?
Vai Kumar (38:28):
absolutely okay okay, and let's delve into workplace
dynamics and accommodation formenopause.
Dr.Nitu Bajekal (38:39):
Yeah.
Vai Kumar (38:39):
What are some factors you think are important?
And in fact, right along this,as a coincidence to this
conversation yesterday here onMorning Show, there was talk
that it's going to be all overlinkedin in 2025, that
accommodation for menopause isimportant and I believe even
(39:01):
insurance companies are likeoffering support forums and
support groups and things likethat, which will be fantastic.
Dr.Nitu Bajekal (39:08):
So I'm really looking forward to 2020 we have
a long go, though we have a verylong way to go.
Studies have shown, evenamongst doctors, that most
female doctors don't get hurt.
They don't get any allowances,and one in four will have severe
symptoms with menopause, andthose women often end up leaving
their job.
And so one in 10 women leavetheir job and they're not meant
(39:31):
to leave their job.
And so one in 10 women leavetheir job and they're not meant
to leave their job.
So you know, it is a real issue, and with 60 to 70 to 75
percent of women in their 50s60s still in the workplace, and
we're talking about, you know,12 women out of 100 having early
menopause between 40 and 45.
We have four in 100 under theage of 40.
And then you have the restbetween 45 and 55, all still at
(39:53):
work.
And work is not only the paidwork, don't forget.
There's also work at home, okay, work at caring.
So we do have to realize womenhave been bottom of the pile for
a very long time, and so makingthese changes that are coming
in through government, in the UKespecially, is very good, but
(40:14):
all employers should be aware,and it is important to have a
person who's a menopause um, youknow?
Spokesperson, if possible inbigger organizations, so that
you can see whether you needleave.
Are you somebody who's hasdisabilities?
Are you somebody who's from aminority community?
Are you somebody who hasdisabilities?
Are you somebody who's from aminority community?
Are you somebody who has gotwho's?
(40:36):
For example, you know trans andso is not able to tell people
that they actually havemenopause issues because that's
not how they're known in theworkplace?
These things are all veryimportant, but for everybody we
need to be able to talk about itopenly.
We need to make sure that youhave a toilet.
Because you have increasedfrequency, you know you
(40:58):
shouldn't have to trek todifferent floors to go to the
bathroom.
If you need to have a fan, ifyou need to sit near a window
simple things they can bebrought in.
And If you are somebody who'sstruggling with symptoms and you
need to go see your healthprovider, it is important for
the employer to give you timeoff rather than you having to
(41:19):
take annual leave or leavewithout people knowing.
So I think there are a lot ofthings people can do, including
educating your seniors andhaving you know people come in,
like I often do talks forcorporate organizations or, you
know, for nhs organizations.
It's important that you dothese things because a lot of
(41:41):
men and women who have gonethrough all that have women will
say you know people women of myage will say, oh, that happened
a long time ago, let's move on.
I didn't have all that support,but that's not.
If we have to move forward, wehave to make sure that we're
bringing all the right changesin.
So changing the legislation,changing the paperwork, but also
bringing these small workplacechanges having bowls of fruit
(42:04):
rather than biscuits lyingaround these are all little
things that people can do.
Ensure that there's healthylifestyle promoted, people are
allowed to take their lunchbreak and go for a walk without
being made to feel guilty.
Little things like that canmake a huge difference to
experience of perimenopause andmenopause.
Vai Kumar (42:22):
Yeah, and including, you know, the simplest thing
right, Providing access to someclean water drinking water right
alongside you know your deskarea.
Yeah, so lifestyle and menopause.
You call it age-proofing yourmenopause.
In this beautiful book, wetalked a little bit about the
(42:44):
influence of plant-based diet,so specifically talking more
about it and the role ofproteins in terms of, know, bone
health, and not just protein,carbs, fats everything good fats
and a lot of vitamins andminerals that are inherent in
food.
Why don't you talk more aboutthat?
(43:06):
Because there's so much.
I think, yeah, we touched uponit when you were referencing
weight gain and how we can sortof combat it yeah, I mean, I
personally follow a plantexclusive diet, a fully
plant-based diet, and have donefor 22, 23 years.
Dr.Nitu Bajekal (43:24):
But it would be great if people can do that,
but not everybody can.
So I want to encourage peopleto have a plant predominant or
plant forward diet.
So if you're somebody who'seating no fruits because you're
scared of sugar in the fruits,let me reassure you that the
fiber is there in the fruits youwant to be eating to reduce the
risk of type 2 diabetes.
If you have type 2 diabetes,that will get improved if you
(43:46):
want to make sure that you getall the right nutrients and
vitamins and calcium in youroranges, so I would suggest
starting, if you're not eatingany fruits, maybe having one
fruit and then a fruit that youlike, maybe some satsumas or
clementines, and then bringingin some grapes and mango and
papaya and watermelon.
Watermelon is supposed to helpwith vaginal lubrication, so you
(44:06):
know, eat more of these fruits.
So fruits is a very importantpart of one's diet, especially
in perimenopause and menopause.
The second group that you wantto bring in are lots of
vegetables.
Find vegetables that you like.
Again, if you're somebody whodoesn't eat vegetables, maybe
start with a small handful of avegetable that you like and
slowly build it up.
(44:26):
Some cooked, some raw Greenleafy vegetables really help
with, you know, heart health andopening up blood vessels.
So it's really important thatyou try and bring in the
vegetables Now.
The particular foods that arevery helpful for menopause and
perimenopause are herbs andspices.
They can help in a number ofways, whether it is turmeric for
joint pains, whether it iscinnamon for blood sugar
(44:48):
regulation.
So you want to bring in hugeamounts of fresh herbs, dried
herbs and spices in your diet.
You also want to make sure thatyou're focusing on whole grains
, tubers, so whole grains likebrown rice and quinoa, millet,
amaranth doesn't matter Findingfoods like that because they
keep you full.
They have lots of fiber andfiber helps you lose weight.
(45:11):
Fiber helps you your gut health.
Fiber helps to preventconstipation.
Fiber helps to reduce the riskof cancers and things like that.
So you want to bring in wholegrains as well.
You want to bring in legumes,which are the star of menopause
and perimenopause.
What are legumes?
They are basically lentils andpulses which you want to start
with if you're not used toeating beans.
(45:32):
Start with the soft dals andlentils.
Cook them really soft.
Rohini has written a fullchapter.
My daughter, who's anutritionist, she's written a
chapter on bloating and things.
It's important that you bringin these lentils and pulses.
Don't be scared.
Start with a small amount andslowly increase it.
Then move on to the beans.
Beans are again very rich infiber and the king all beans.
(45:54):
You want to eat chickpeas andburlotti beans and kidney beans
and all kinds of beans and tryto eat two or three times a day
over time as you slowly get usedto it.
We know that those communitiesthat eat a lot of beans tend to
live the longest and thehealthiest.
But soybean is particularlyimportant for menopause.
It has a very good proteinprofile.
(46:15):
So it is.
You know, all the people who goto the gym are always talking
about egg white.
Egg white has got so many um,non good health issues with it.
So you want to be focusing onthe soybean because it has got
the same plant, same proteinprofile, same amino acid profile
, without any of the nasties.
It helps reduce cancer risk ofyour liver cancer, bowel cancer,
(46:38):
ovarian cancer, you know whatelse Breast cancer, prostate
cancer.
So really you want to befocusing on the protein profile
of the soybean.
How do you eat soy?
You want to have it in the formof edamame beans, mature
soybeans, you want to have it inthe form of tofu and tempeh and
soy milk and soy yogurt.
(46:59):
You don't have to gospecifically for the organic or
the gmo, non-gmo version.
But if people are anxious andthey can access that, that's
fine.
I'm not fussed about it becausethat is not a real risk as such
.
But soy itself has been aroundfor 5000 years In China.
Huge populations have alreadyalways eaten it with huge
(47:21):
benefits for overall healthheart health, cholesterol health
, brain health, weight loss aswell as menopausal symptoms.
Neil Bernard did a wonderfulstudy where people ate about 50
milligrams of isoflavones, whichare the plant estrogens that
you know kidney beans have,blueberries have, pistachios
have.
But soy has it particularlyhealthy and so men and women who
(47:45):
eat it and the earlier youstart eating, lower is the risk
of prostate cancer and breastcancer.
So we know that will help.
But having half a cup of maturesoybeans or having a handful of
edamame beans, a cup of soymilk, maybe a handful of tofu,
will give you the 55 milligramsof isoflavones, which are the
plant estrogens, and that willhelp to reduce the risk of your
(48:09):
hot flashes by 84 percent.
So that's a huge benefit, youknow, other than for women who
can't take HRT, who don't wantto take HRT.
I personally tend to takebetween three to four portions
of soy every single day, becauseI do a lot of strength training
, so I will have some plantprotein in the form of soy
protein, a tablespoon of it,some days.
(48:30):
Some days I'll have pea protein, brown rice protein.
I mix all my different proteinsto get the, because, you know,
as you get older, you want 1.4to 1.6 grams of protein,
sometimes a little bit higher,but this is a good amount.
So you want to get it from uh,you know the soybean, which has
got a very good source ofprotein.
Also all your lentils andlegumes, and very rarely are
(48:53):
people allergic to soy, so it'sreally a very good way of
getting tofu.
Tempeh, seitan is another one,which is wheat protein and, of
course, protein powder.
So we have a whole chapterfocusing on protein, because, as
you get older, as you becomemenopausal, focusing on protein.
But plant protein is moreimportant than animal protein
(49:14):
and so you want to focus on that.
So we've talked about fruits,vegetables, whole grains, we've
talked about green leafyvegetables, herbs and spices.
We've talked about legumes,including soy, and I really want
people to take away nothingelse you remember from this chat
.
Remember that soy is safe foryou.
I have a whole fact sheet on mywebsite.
I have a whole chapter on mybook, but I don't get paid by
(49:38):
anybody, it's just.
I see the benefits of soy, soit's really important, and, of
course, things like potatoes,sweet potatoes, yam these are
all very important foods.
They keep you full, they havelow calorie, they're very rich
in fiber, but you don't want tochip your potatoes and you don't
want to fry your potatoes.
You want to have them, you know, baked, or have them, you know,
(50:00):
boiled and mashed and thingslike that.
And when you eat this kind ofway, your inflammation levels
reduce.
So we know the chronicinflammatory conditions like
adenomyosis and endometriosisand type 2 diabetes and heart
health and all can improvebecause you're reducing the
advanced glycation end products,which are called AGEs.
(50:22):
Ages are found in meats and inhighly fried foods and things
that tend to damage yourarteries, your ovaries, your
heart.
So it's so important to try andeat as much as possible.
Start your day with a bigporridge with lots of berries,
flaxseed powder to increase youromega-3s, and your soy has that
as well, so have it in soy milk.
(50:43):
Lunch can be a big salad or asoup, you know, with lots of
tofu on the side, or as croutons.
Evening can be you know, bigstir fry with, you know, soy
noodles, or you know big stirfry with you know, soy noodles,
or you know peanut sauces anddifferent things.
So it's really important tohave lots of recipes in my book
and on my website as well.
So it's a very joyful way ofeating and people often think,
(51:05):
oh, I can't have this and Ican't have that, so slowly start
eating this way, and when youlook down on your plate, there
should be color.
Vai Kumar (51:12):
Yeah, very well said.
And oil, sugar, salt everything.
Dr.Nitu Bajekal (51:20):
You know, like it's they should be.
Yeah, they should be condiments.
They should not be centralfocus.
As I said, one tablespoon of oilextra virgin olive oil can be
really good for you, but ifyou're somebody who's trying to
lose weight which is 70 of thepopulation think about do you
want to have that, or would yourather have your salad with some
olives and hummus and thingslike that?
(51:41):
So you know, it's just findingthings, but for people who need
to put on weight, who don't havea weight issue, children, all
these people extra virgin oliveoil has got a lot of benefits as
well as well, but by and large,the use sugar and salt, as you
(52:01):
know, little additions ratherthan having huge quantities of
these free sugars, rather thanfocus on fruits and, you know,
have a couple of dates with somenuts that will usually satisfy
most people's sweet tooth overtime yeah, and if there is one
thing you would love to seechange, I know with all your
advocacy efforts with your bookand everything, and you're also
very conscious of how we areprogressing on the climate front
(52:24):
and you also advocate thateating plant forward is so good
and I I eat a plant-based dietand I know for a fact I did a
whole season on sustainabilityon this show.
Vai Kumar (52:36):
So if there's one thing you would love to see
change, what would that be interms of everything that you
have written and in terms ofwhat you see out there from your
practice?
Dr.Nitu Bajekal (52:47):
I think I would like women to acknowledge
themselves and realize thatthey're very valued members of
the world and community and weare the force for change, and
that change happens withinourselves first.
So don't worry about yourpartner, don't worry about your
community.
You, yes, you do need to changethem, but first, when you make
those changes, you will feel somuch better for yourself.
(53:09):
Don't be harsh on yourself ifyou slip up.
I think that's important andreally, if I had to make one
change, I would say start eatingmore soy, eat less animal foods
.
If you can achieve those twothings, you will help climate
change, you will help therainforest, because most of the
(53:29):
soy that's produced is foranimals.
You will help your health, youwill help, uh, animal suffering
and you will also help you knowyour um the climate.
So that's what I would sayeating plant forward every time
you eat.
Think about what you're puttingin your mouth, think about the
future generations that you'regoing to leave this beautiful
(53:50):
earth to which we are rapidlydestroying.
Vai Kumar (53:52):
Well, fascinating conversation, and my takeaway is
knowledge is power and allunpleasant symptoms are not to
be endured.
So those are the biggesttakeaways.
And neethubhajekalcom, that's awebsite, right.
I'll be sure to include it inthe show notes.
Dr.Nitu Bajekal (54:09):
I have about 15 different fact sheets all free
and lots of recipes and podcastlinks and things, so I hope
people will access that.
Vai Kumar (54:17):
Wonderful, so I'll be sure to include the link to the
book.
And is it available on Amazonand where else?
Would you like to add anythingelse?
Dr.Nitu Bajekal (54:27):
Yeah, no, not at all.
And do follow me on socialmedia because I'm quite active
generally, although I'm taking alittle break over Christmas,
but TikTok and Instagram, I tendto be sharing quite a lot of
information.
Vai Kumar (54:41):
Excellent.
I'll be sure to includeeverything in the show notes and
thank you, Dr Neetu, for afascinating conversation on how
best we can help women equipthemselves and empower
themselves into their transitionfrom perimenopause to menopause
Listeners as always follow thepodcast.
(55:02):
Rate the podcast.
Leave a review from yourpodcast app of choice.
Follow me on Instagram andYouTube at YP Kumar.
That's V-A-I-P-K-U-M-A-R forall things digital media and
lifestyle.
Until next time with yetanother interesting guest and
yet another interesting topic.
It's me, mai, along with DrNeetu, saying so long Bye-bye.
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