Oct. 9, 2024
Perimenopause! Are you kidding me with these symptoms?
The player is loading ...
It's just a phase, but strap in for a wild ride!
The symptoms of perimenopause are all-incompassing. Insomnia, brain fog, sore joints, itchy skin, weight gain, hot flashes, vaginal dryness, night sweats, low libido, UTIs, mood swings... Perimenopause is the time between regular periods and menopause. It's only a phase, right? Maybe, but this "phase" can last for years. Dr. Amantia Kennedy from WakeMed discusses the litany of symptoms and what we can do about them. Find her and other WakeMed Women's doctors at https://www.wakemed.org/care-and-services/womens.
Send your questions to us at wralfm.com/sarahhasquestions.
DISCLAIMER: The information presented in this podcast is intended to be educational and nothing said by the host or guests should be taken as medical advice. The information presented here is not a substitute for professional medical advice, diagnosis, or treatment. Your health is important, and seeking the advice of your own healthcare provider is always the best course of action.
Transcript
WEBVTT
1
00:00:00.320 --> 00:00:03.860
Hey, guys. Welcome to Sarah has questions. Today, we're talking about perimenopause.
2
00:00:04.400 --> 00:00:08.000
If you're in it, you know it. It has every symptom
3
00:00:08.000 --> 00:00:11.780
under the sun, and yet there's not really a diagnosis for it.
4
00:00:12.000 --> 00:00:15.575
Why is that? What's the deal? Let's talk about perimenopause.
5
00:00:15.875 --> 00:00:19.715
I have a ton of questions. Let's get into it. I'm Sarah
6
00:00:19.715 --> 00:00:23.175
King, and I have a lot of questions. What exactly
7
00:00:23.235 --> 00:00:26.915
happens when you orgasm physically? Will popping a knuckle or a
8
00:00:26.915 --> 00:00:30.730
joint give us arthritis? What can we learn from our poop? The
9
00:00:30.730 --> 00:00:34.489
size of your body doesn't necessarily indicate your measure of health. Yes. And
10
00:00:34.489 --> 00:00:37.949
what are your thoughts on that? Cleansing. Do we need to do anything
11
00:00:38.170 --> 00:00:41.625
special to our nether regions? In this
12
00:00:41.625 --> 00:00:45.085
show, I get to ask all these questions to WakeMed doctors
13
00:00:45.225 --> 00:00:48.905
who happen to know everything about everything. Sarah has
14
00:00:48.905 --> 00:00:52.685
questions is a production of Capital Broadcasting Company and Mix 101.5.
15
00:00:53.545 --> 00:00:57.300
It's presented by WakeMed. Today, I'm so excited for
16
00:00:57.300 --> 00:01:00.980
this episode, because we're talking perimenopause. And
17
00:01:00.980 --> 00:01:04.599
as a 47 year old woman, I know a lot about perimenopause.
18
00:01:05.540 --> 00:01:09.275
Today's doctor is Amantia Kennedy. You are a OBGYN
19
00:01:09.495 --> 00:01:13.015
for WakeMed. Thank you so much for coming in today. Thank you for having me.
20
00:01:13.015 --> 00:01:16.295
And you came in before and talked menopause. I sure did. And so now we're
21
00:01:16.295 --> 00:01:20.055
gonna talk about perimenopause. And the thing about perimenopause that
22
00:01:20.055 --> 00:01:23.770
gets me is you feel like you're making it up. Mhmm. You know? Like,
23
00:01:23.910 --> 00:01:27.430
there and we'll get into the details of this a bit later, but there are
24
00:01:27.430 --> 00:01:30.570
so many symptoms. Mhmm.
25
00:01:30.790 --> 00:01:33.830
And there are days where you wake up and I'm like, oh, did I just
26
00:01:33.830 --> 00:01:37.435
not get enough sleep or is my my brain deceiving me and making me a
27
00:01:37.435 --> 00:01:40.975
forgetful person? Mhmm. You know, am I not sleeping because I drank too much coffee?
28
00:01:41.115 --> 00:01:43.595
Like, you don't know. And then you go to your doctor and they're just like,
29
00:01:43.595 --> 00:01:47.275
oh, it's you get dismissed. Mhmm. So let's just
30
00:01:47.275 --> 00:01:50.335
start from the very beginning. Yes. What the hell is perimenopause?
31
00:01:51.649 --> 00:01:55.170
Perimenopause is the menopausal transition. It's the years
32
00:01:55.170 --> 00:01:59.009
leading up to menopause and it's defined by low
33
00:01:59.009 --> 00:02:02.770
ovarian functions. So during this time, there's a lot of fluctuations in the
34
00:02:02.770 --> 00:02:06.295
hormones that happen. Okay. So that's why we're gonna talk about how these
35
00:02:06.295 --> 00:02:10.134
hormones affect us. How does perimenopause differ
36
00:02:10.134 --> 00:02:13.575
from menopause? The perimenopause is the years leading to
37
00:02:13.575 --> 00:02:17.095
menopause. Okay. It's not it and it's it ends after
38
00:02:17.095 --> 00:02:20.769
12 months of no periods and then you reach the
39
00:02:20.769 --> 00:02:24.530
menopause. So the until the final menstrual period. Okay. That's when it
40
00:02:24.530 --> 00:02:27.670
ends. So what would be a typical age to start perimenopause?
41
00:02:28.450 --> 00:02:31.890
So again, I want to emphasize that perimenopause is not menopause. It's
42
00:02:31.890 --> 00:02:35.695
the the years leading up to menopause. Right. And it ends with the
43
00:02:35.695 --> 00:02:39.375
final menstrual period. So women can enter this
44
00:02:39.375 --> 00:02:42.835
transition phase as early as thirties. Yeah.
45
00:02:42.975 --> 00:02:46.815
And but majority of them will enter it in their forties. Okay. The
46
00:02:46.815 --> 00:02:50.410
median age for a woman entering this stage is
47
00:02:50.410 --> 00:02:54.250
47 in the United States. Okay. And how do you know that you're
48
00:02:54.250 --> 00:02:58.090
entering in? Like, what what are the signs of I'm now in the
49
00:02:58.090 --> 00:03:01.720
perimenopausal state? So because there's fluctuations in the sex hormones, estrogen and progesterone, particularly, which
50
00:03:01.720 --> 00:03:05.485
are the hormones released by the sex hormones, estrogen and progesterone particularly, which are the
51
00:03:05.485 --> 00:03:09.265
hormones released by the ovary, women will
52
00:03:09.485 --> 00:03:12.705
experience abnormalities in their menstrual cycle.
53
00:03:13.245 --> 00:03:16.579
And, we actually have two phases of this menopausal
54
00:03:16.799 --> 00:03:20.239
transition or perimenopause, the early stage and then the late
55
00:03:20.239 --> 00:03:23.760
stage. The early stage during this time, women will start to
56
00:03:23.760 --> 00:03:27.439
experience some irregularities with their periods. Sometimes in the very early
57
00:03:27.439 --> 00:03:30.985
stages, they may have more frequent cycles. Mhmm. And then they're
58
00:03:30.985 --> 00:03:34.825
followed by more sparse, spaced out cycles by more
59
00:03:34.825 --> 00:03:38.505
than 7 days, in length apart. And then that
60
00:03:38.505 --> 00:03:42.345
is followed by maybe you can skip a month or so. And then
61
00:03:42.345 --> 00:03:45.920
the and they enter the late stage when they're starting to skip more than
62
00:03:45.920 --> 00:03:49.519
60 days. Okay. So 2 months. Once you skip 2
63
00:03:49.519 --> 00:03:53.360
months, you're you're getting closer to actually getting to the
64
00:03:53.360 --> 00:03:57.120
land of promise, the Yes. No period land, which
65
00:03:57.120 --> 00:04:00.754
sounds awesome. And we do we can predict that when women enter
66
00:04:00.754 --> 00:04:04.194
this late stage of the perimenopause, they will
67
00:04:04.194 --> 00:04:07.555
achieve their final menstrual period within 2 to 3 years. Oh,
68
00:04:07.555 --> 00:04:11.254
interesting. Okay. Alright. Well and so let me ask you this.
69
00:04:11.490 --> 00:04:15.250
If, when you say skip a period, does that mean no blood at all
70
00:04:15.250 --> 00:04:19.010
or just a very little amount of blood? Skip a
71
00:04:19.010 --> 00:04:22.690
period means no blood. At all. Mhmm. Okay. We'll be right back
72
00:04:22.690 --> 00:04:25.190
because you know I have more questions.
73
00:04:30.975 --> 00:04:34.495
I wanna go through the symptoms or maybe and you can tell me this is
74
00:04:34.495 --> 00:04:37.455
the part that blows my mind. So maybe you can shed some light on why
75
00:04:37.455 --> 00:04:41.190
this is happening. Okay? Yeah. So, and and
76
00:04:41.190 --> 00:04:44.870
please add your own because there's just so many, and I don't understand
77
00:04:44.870 --> 00:04:48.150
why there are so many. But we'll start with number the first one, which is
78
00:04:48.150 --> 00:04:51.990
brain fog. Why is brain fog associated with it? And, honestly, how can
79
00:04:51.990 --> 00:04:55.445
you tell the difference between brain fog and not enough sleep? Like, it's just so
80
00:04:55.445 --> 00:04:58.965
ambiguous. Mhmm. Yeah. Absolutely. Brain fog is
81
00:04:58.965 --> 00:05:02.725
actually a very common symptoms of, perimenopause and up to
82
00:05:02.725 --> 00:05:06.565
40 to 60% of women will experience this. And it's a
83
00:05:06.565 --> 00:05:09.690
collection of cognitive symptoms like forgetfulness,
84
00:05:11.030 --> 00:05:14.330
difficulty focusing or concentrating, losing
85
00:05:14.710 --> 00:05:18.390
objects, difficulty recalling names or verbs, or I can't think
86
00:05:18.390 --> 00:05:22.215
of the the the word. The worst. Yes. So
87
00:05:22.215 --> 00:05:25.195
it happens because, the
88
00:05:25.895 --> 00:05:29.655
fluctuations of the hormones, estrogen and progesterone, we know FX has
89
00:05:29.655 --> 00:05:33.355
receptors in the brain Okay. And there's part of the brains that get affected
90
00:05:33.415 --> 00:05:37.139
by this, including neurotransmitters, and we're gonna talk about that a little bit later.
91
00:05:37.139 --> 00:05:40.979
Okay. But, women have this think
92
00:05:40.979 --> 00:05:44.740
of it as a computer getting a reboot and they they're just not processing the
93
00:05:44.740 --> 00:05:48.435
information as quickly as they used to. Okay. When they when they
94
00:05:48.435 --> 00:05:51.815
were when women were tested with actual formal tests,
95
00:05:52.115 --> 00:05:55.815
they did score a little bit lower on, attentiveness, concentration,
96
00:05:56.515 --> 00:06:00.295
and, verbal recalling Mhmm. But they did not have
97
00:06:00.355 --> 00:06:04.170
a decrease in higher cognitive functions like strategic thinking. So you don't
98
00:06:04.170 --> 00:06:07.930
lose intelligence? You do not lose intelligence. Gotcha. Well, that's
99
00:06:07.930 --> 00:06:11.450
good to know. Yes. And does it ever come back? Does the brain fog
100
00:06:11.450 --> 00:06:15.210
ever, like, go out to sea, basically? Good news. It does.
101
00:06:15.210 --> 00:06:19.050
It reverses. Good. That's awesome. Once we reach menopause, it does reverse for most women.
102
00:06:19.050 --> 00:06:22.305
So we really are kinda getting a reboot. We are. Think of it as a
103
00:06:22.305 --> 00:06:26.145
reboot reboot. And our brains are plastic. They go through different
104
00:06:26.145 --> 00:06:29.605
changes based on our experiences, and they're always changing.
105
00:06:29.825 --> 00:06:33.440
Weight gain is another symptom. Gaining in and of itself is one
106
00:06:33.440 --> 00:06:36.960
symptom, but why is it always in the belly? Yes. That's called
107
00:06:36.960 --> 00:06:40.419
adipose, fat tissue and that is, because
108
00:06:41.039 --> 00:06:44.720
as we transition into this phase and we're having these fluctuations in the
109
00:06:44.720 --> 00:06:48.445
hormones, let's not forget we're also aging. Mhmm. And
110
00:06:48.445 --> 00:06:52.285
that in itself can cause decrease in, muscle mass. And
111
00:06:52.285 --> 00:06:55.805
as I've mentioned before, muscle is the largest organ of energy
112
00:06:55.805 --> 00:06:59.505
expenditure. And so when you have when we're inactive,
113
00:07:00.365 --> 00:07:04.140
like, we don't diet or exercise, or even when we do
114
00:07:04.140 --> 00:07:07.900
diet and exercise because a lot of times women will say, I am doing everything
115
00:07:07.900 --> 00:07:11.420
I did before and I cannot lose weight. I'm actually gaining weight. Oh,
116
00:07:11.420 --> 00:07:15.260
girl. That's me. During this transition phase, though, because of the
117
00:07:15.260 --> 00:07:19.045
lack of estrogen, and estrogen does have receptors in the muscle Mhmm. We
118
00:07:19.045 --> 00:07:22.025
have an acceleration of, this energy
119
00:07:22.645 --> 00:07:26.085
net deficit that we are or actually net gain. So we
120
00:07:26.085 --> 00:07:29.925
are gaining more weight than we're losing the weight because of
121
00:07:29.925 --> 00:07:33.690
the muscle mass is is we're rapidly, decreasing that.
122
00:07:33.850 --> 00:07:37.530
It stabilizes in the menopausal years, but especially during this
123
00:07:37.530 --> 00:07:41.050
transition phase when we're having this hormone, decline Mhmm.
124
00:07:41.210 --> 00:07:44.810
It's a little bit more rapid. So we're starting to get, more more
125
00:07:44.810 --> 00:07:48.504
weight. And so it's super important to keep the muscle then.
126
00:07:48.504 --> 00:07:52.185
Yes? Yes. And that's when we highly recommend strength training
127
00:07:52.185 --> 00:07:55.805
exercises. Okay. Which is not only beneficial for your cardiovascular
128
00:07:56.104 --> 00:07:59.810
function, it's beneficial for maintaining the muscle mass. Yeah. Because
129
00:07:59.810 --> 00:08:03.330
remember, even Arnold Schwarzenegger, he's going to lose some muscle mass as he
130
00:08:03.330 --> 00:08:05.970
ages. But he had a lot to start with. He had a lot to start
131
00:08:05.970 --> 00:08:09.330
with for sure. Which is what you're saying. You know? The more you
132
00:08:09.330 --> 00:08:12.875
have and the more you then you can lose and it won't be as
133
00:08:12.875 --> 00:08:16.635
detrimental. And the goal for, strength training exercises is
134
00:08:16.635 --> 00:08:20.315
to maintain the muscle mass so you don't lose it as rapidly during this phase.
135
00:08:20.315 --> 00:08:23.935
I see. Okay. Next up, we have sore joints.
136
00:08:24.870 --> 00:08:28.470
Yes. So it's real. It is real. I I well, I
137
00:08:28.470 --> 00:08:32.150
find as I'm going through this perimenopausal state that it's only
138
00:08:32.150 --> 00:08:35.770
certain weeks Right. Which is really interesting. Why is that?
139
00:08:35.990 --> 00:08:39.835
It's again, we talk about fluctuations of the hormones. Each cycle will be
140
00:08:39.835 --> 00:08:43.675
different. It's a it's a time of a chaos in our body. So
141
00:08:43.675 --> 00:08:47.355
some months, you may have more estrogen than other months.
142
00:08:47.355 --> 00:08:51.115
And when you have less estrogen in your body and estrogen has
143
00:08:51.115 --> 00:08:54.930
receptors all over our body, including our joints. Yeah. It it
144
00:08:54.930 --> 00:08:58.630
does affect, our joints. So am I feeling inflammation
145
00:08:58.770 --> 00:09:01.830
there or am I feeling lack of fluid? No. It's inflammation.
146
00:09:02.130 --> 00:09:05.750
Okay. So would an anti inflammatory diet help with this?
147
00:09:06.050 --> 00:09:09.824
Absolutely. Okay. Alright. Itchy
148
00:09:09.824 --> 00:09:13.584
skin. Some women complain of itchy skin. Does that I mean,
149
00:09:13.584 --> 00:09:17.345
is this something that is real or are they making it up? They just need
150
00:09:17.345 --> 00:09:20.944
some lotion. No. It's real because as
151
00:09:20.944 --> 00:09:24.650
we do age, our skin, gets thinner. Mhmm. And
152
00:09:24.650 --> 00:09:28.330
actually, we do have estrogen receptors on our skin as well. Estrogen's
153
00:09:28.330 --> 00:09:32.010
everywhere. Everywhere. And so women will have
154
00:09:32.010 --> 00:09:35.850
drier skin and thinner skin. So it can some women can
155
00:09:35.850 --> 00:09:39.690
have a little bit more exacerbation, of the symptoms than others. Mhmm.
156
00:09:39.690 --> 00:09:43.195
And everybody's different. Not everybody's gonna have all the symptoms at
157
00:09:43.195 --> 00:09:46.794
once, but dry skin is one of the Okay.
158
00:09:46.954 --> 00:09:50.795
Complaints. Yeah. For sure. And there's also I'm reading our my producer put
159
00:09:50.795 --> 00:09:53.930
this list together and I'm reading through this and here's one.
160
00:09:55.030 --> 00:09:58.790
Bugs crawling on you. Some people get the sensation of bug is that have you
161
00:09:58.790 --> 00:10:02.070
heard of that before? I have heard of it before and some women have a
162
00:10:02.870 --> 00:10:06.550
like, it's not as common. Yeah. I'll say that. But it goes with the
163
00:10:06.550 --> 00:10:09.885
dry skin. I would think it's got something to do with your nerves as well
164
00:10:09.885 --> 00:10:13.585
because it you know, the the ends. Well, it has to do with, like,
165
00:10:13.725 --> 00:10:17.005
you know, with hot flashes, which is a very common symptom Yes. Has to do
166
00:10:17.005 --> 00:10:20.625
with vasodilation Okay. Of the blood, like, the little capillaries.
167
00:10:21.325 --> 00:10:25.030
So that could be part of of it as well. Feels that way. Mhmm.
168
00:10:25.030 --> 00:10:28.870
Okay. This is one I have, phantom smells. I'll smell
169
00:10:28.870 --> 00:10:31.590
stuff and no one else will smell it, and this has all started in the
170
00:10:31.590 --> 00:10:35.350
past 5 years. Yeah. Have you ever heard of that? I have heard of that.
171
00:10:35.350 --> 00:10:39.035
And, you know, actually, I heard one woman saying that
172
00:10:39.035 --> 00:10:42.795
she heard she smelled like there was smoke in her house and
173
00:10:42.795 --> 00:10:46.475
then she would go to her children's room and her adolescent, like, did you
174
00:10:46.475 --> 00:10:50.075
smoke? And they're like, no. We didn't. We are not smokers. But,
175
00:10:50.235 --> 00:10:53.940
but it it is. Do we understand it all? We don't. We
176
00:10:53.940 --> 00:10:57.540
have so much ongoing research as we speak Oh, I bet.
177
00:10:57.620 --> 00:11:01.139
Regarding, a lot of the symptoms because, you know, as
178
00:11:01.139 --> 00:11:04.899
women, we we do demand more research and we do demand some answers
179
00:11:04.899 --> 00:11:08.735
to to better, help our lives for sure. I have just
180
00:11:08.735 --> 00:11:12.415
recently heard that even in rat studies, they didn't study
181
00:11:12.415 --> 00:11:14.835
female rats. Can you
182
00:11:15.935 --> 00:11:19.555
what? You know, it was in 1987 that FDA
183
00:11:19.870 --> 00:11:23.150
required researchers to actually study drugs in women
184
00:11:23.390 --> 00:11:27.070
Yikes. Only. Everything was based on male studies as
185
00:11:27.070 --> 00:11:30.550
well. Chihuahua. So and it that was we were alive, both of us. Yes. So
186
00:11:30.670 --> 00:11:34.305
yeah. I was in elementary school that I it
187
00:11:34.305 --> 00:11:37.824
makes my blood boil. If I mean, were they curious? Were we that
188
00:11:37.824 --> 00:11:41.105
confusing to them that they thought they just couldn't figure it out? Like, that says
189
00:11:41.105 --> 00:11:44.865
a lot. Well, either confusing or not important. I don't know. Or they they
190
00:11:44.865 --> 00:11:48.064
do those things. I don't know. Does it make your blood boil? It does a
191
00:11:48.064 --> 00:11:51.320
little bit. Oh, it makes mine really. I mean No. It does a lot. Okay.
192
00:11:51.320 --> 00:11:55.160
Thank you. Let's be real. You're mad. We're all mad. Oh, yeah. But
193
00:11:55.160 --> 00:11:59.000
but the good news is that there's so much ongoing research. More is
194
00:11:59.000 --> 00:12:02.675
coming. That's what makes me excited for our daughters. Yes.
195
00:12:02.895 --> 00:12:06.654
Because when they enter into menopause, it's going to be a different world. Because
196
00:12:06.654 --> 00:12:10.175
by that time, we'll have another decade or so. I well, actually,
197
00:12:10.175 --> 00:12:13.775
numerous decades of research, and they'll be the beneficiaries of
198
00:12:13.775 --> 00:12:17.295
it. And then that's exciting. And I think what our
199
00:12:17.295 --> 00:12:20.889
generation's big thing is is we need to just bring awareness
200
00:12:21.509 --> 00:12:25.129
to them that they don't let yourself be dismissed.
201
00:12:25.670 --> 00:12:29.430
Absolutely. That's so important. That's an important message. And we were talking about this
202
00:12:29.430 --> 00:12:33.014
next symptom. We I've got 2 more, that
203
00:12:33.014 --> 00:12:35.975
you've mentioned that you have issues with. I don't because I would do a morning
204
00:12:35.975 --> 00:12:39.735
show at 4 AM every day. So it's sleeping issues. I never have a problem
205
00:12:39.735 --> 00:12:43.435
falling asleep, but I know a lot of women experience, insomnia.
206
00:12:44.375 --> 00:12:48.140
Absolute. This is actually when they studied the 4
207
00:12:48.140 --> 00:12:51.900
most common symptoms of the menopausal transitions. Yeah. Half
208
00:12:51.900 --> 00:12:55.580
flashes, night sweats, difficulty sleeping Uh-huh. Which
209
00:12:55.580 --> 00:12:59.195
include insomnia Uh-huh. Genital urinary
210
00:12:59.195 --> 00:13:02.714
symptoms. Oh, like a leaking. Not only leaking, but,
211
00:13:02.875 --> 00:13:06.255
vaginal itching, dryness, painful sex, etcetera.
212
00:13:06.555 --> 00:13:10.394
Okay. Urinary tract infections, etcetera, but also
213
00:13:10.394 --> 00:13:14.150
mood changes, irritability, anxiety, depression. So those were the
214
00:13:14.150 --> 00:13:17.690
4 most common symptoms. So let's talk about insomnia.
215
00:13:17.910 --> 00:13:21.510
Yeah. It's a very common complaint and actually can be quite,
216
00:13:21.830 --> 00:13:25.615
distressing for a lot of women because lack of sleep can
217
00:13:25.615 --> 00:13:29.214
cause, irritability the next day, can cause decreased
218
00:13:29.214 --> 00:13:32.654
focusing and concentration, so your your coping
219
00:13:32.654 --> 00:13:36.095
mechanisms are diminished as well. But, we know that
220
00:13:36.095 --> 00:13:39.920
estrogen has, receptors in the brain. We know that it it affects
221
00:13:39.920 --> 00:13:43.620
parts of the brain that control, some of these circadian
222
00:13:43.680 --> 00:13:47.220
rhythms. Okay. So a lot of times, women will suffer from insomnia.
223
00:13:48.560 --> 00:13:51.940
You were saying that, off off air,
224
00:13:52.575 --> 00:13:56.415
you were saying that that the they're trying to pull estrogen from places. What
225
00:13:56.415 --> 00:14:00.175
were you saying with that? So what what our brain does when
226
00:14:00.175 --> 00:14:04.015
we're kinda going into this decline of ovarian function, because that's what
227
00:14:04.015 --> 00:14:07.580
perimenopause is, our brain, in order to compensate for
228
00:14:07.580 --> 00:14:11.420
it, starts to express some more receptors for estrogen so that it tries to catch
229
00:14:11.420 --> 00:14:14.500
as much as it can. So it creates more receptors. It creates more receptors. Oh,
230
00:14:14.500 --> 00:14:18.045
it's kinda like an alcoholic. Whenever they have too much alcohol, they they
231
00:14:18.045 --> 00:14:21.885
create more receptors. And then when they don't get it, they get crazy. Right. So
232
00:14:21.885 --> 00:14:25.005
they do. They it is trying. Our brain is trying to compensate for it, but
233
00:14:25.005 --> 00:14:28.845
there is always decline, decline, decline. Right. So a lot of times, women
234
00:14:28.845 --> 00:14:32.065
will suffer from insomnia, and it's a very common distressing
235
00:14:32.205 --> 00:14:32.919
symptom. Yeah. It's miserable. I mean, not being able to sleep has to be miserable.
236
00:14:32.919 --> 00:14:36.337
Yes. So would So would is the
237
00:14:36.351 --> 00:14:37.380
same thing at play here when it comes to mood and the mood swings? Absolutely.
238
00:14:37.380 --> 00:14:39.400
We, know that estrogen also affects the neurotransmitters like serotonin and dopamine. Mhmm.
239
00:14:48.605 --> 00:14:51.985
And when you have less serotonin production in our symptoms
240
00:14:52.445 --> 00:14:56.285
I mean, in our system Mhmm. Then we feel more depressed. We're in
241
00:14:56.285 --> 00:14:59.885
more depressed mood. Oh, that honestly, like, I I'm
242
00:14:59.885 --> 00:15:02.685
reading through this and it seems like a long list, but I have a lot
243
00:15:02.685 --> 00:15:05.779
of these. A lot of women have them. Yeah. Yeah. And it's not, like, every
244
00:15:05.779 --> 00:15:09.620
day. Mhmm. And that's what makes it so frustrating. It's like it's
245
00:15:09.620 --> 00:15:12.580
some days you feel normal, and then some days you don't. And you're like, where
246
00:15:12.580 --> 00:15:16.339
is this coming from? Right. And a lot of women feel alone in this.
247
00:15:16.339 --> 00:15:20.135
Like, is it is it me? Am I going through What's going on?
248
00:15:20.195 --> 00:15:23.735
Exactly. Exactly. Last symptom is decreased
249
00:15:23.875 --> 00:15:27.715
libido. Yes. Remember, estrogen and
250
00:15:27.715 --> 00:15:31.555
progesterone are sex hormones. So naturally, when
251
00:15:31.555 --> 00:15:35.300
we have a decline in our sex hormones, we also have
252
00:15:35.300 --> 00:15:38.660
a decline in our libido. But, as we talk to
253
00:15:38.660 --> 00:15:42.420
women, libido is very complex for us women. It's not just physical,
254
00:15:42.420 --> 00:15:46.260
it's also psychological. So it's important to address how
255
00:15:46.260 --> 00:15:50.035
they're feeling, how they're doing. What we know now is that,
256
00:15:50.035 --> 00:15:53.635
you know, as women, we take on our lives as adults and we
257
00:15:53.635 --> 00:15:56.615
compensate and kinda suppress some of of the
258
00:15:57.315 --> 00:16:00.675
things that are a nuisance to us. But as we're going through this
259
00:16:00.675 --> 00:16:04.150
transition and we're having this depletion of our sex
260
00:16:04.150 --> 00:16:07.690
hormones, we don't have those coping mechanisms that we used to
261
00:16:07.990 --> 00:16:11.830
and all of a sudden, we can't we we don't feel like taking
262
00:16:11.830 --> 00:16:15.510
on any more emotional, burden for us and we don't feel like
263
00:16:15.510 --> 00:16:19.065
taking on the slack, of our partners, for instance. Oh, yeah. Picking up
264
00:16:19.065 --> 00:16:22.905
socks. So exactly. Things that didn't bother us
265
00:16:22.905 --> 00:16:25.865
before. Yeah. But all of a sudden, it puts you in a rage state. It
266
00:16:25.865 --> 00:16:29.639
does. And and the thing is it can be very confusing for the partner as
267
00:16:29.639 --> 00:16:33.399
well because, you know, they also feel rejected or
268
00:16:33.399 --> 00:16:37.160
they feel that they I don't know this person anymore. Like, who are
269
00:16:37.160 --> 00:16:40.440
you? Right. But I think that during this time, it's very important to have an
270
00:16:40.440 --> 00:16:43.579
open communication with your partner so that you can have the support.
271
00:16:45.195 --> 00:16:49.035
Also, with the low libido, and as I mentioned before, during
272
00:16:49.035 --> 00:16:52.875
this transition times, we also have genitourinary symptoms, and that
273
00:16:52.875 --> 00:16:56.415
includes vaginal itching, vaginal dryness. And sometimes
274
00:16:56.635 --> 00:17:00.090
sex feels like a sandpaper. A lot of times, women will describe it
275
00:17:00.090 --> 00:17:03.850
as. And so when you're not when you're not feeling good and then physically
276
00:17:03.850 --> 00:17:06.650
you're also not feeling good, then you're not feeling like you need to be an
277
00:17:06.650 --> 00:17:10.329
intimate. Yeah. But what I do want to encourage women that are
278
00:17:10.329 --> 00:17:13.865
listening right now is that there is help. You know? Being
279
00:17:13.865 --> 00:17:17.404
miserable is optional at this point. There are many options
280
00:17:17.625 --> 00:17:20.845
that treat the symptoms. And also,
281
00:17:21.464 --> 00:17:24.904
there's not just one medication can help at all. It can be a
282
00:17:24.904 --> 00:17:28.440
multi, system treatment. It may involve more than
283
00:17:28.660 --> 00:17:32.420
just one physician. Okay. I've this you made me think of
284
00:17:32.420 --> 00:17:36.260
2 further questions. 1, your partner, yes. Mhmm. You know, talk to
285
00:17:36.260 --> 00:17:39.700
your partner and let them know where you are and all those things. What about
286
00:17:39.700 --> 00:17:43.515
colleagues at work? Like, this is gonna affect your work. And that's
287
00:17:43.515 --> 00:17:46.675
the for me, that's that's the hard part because you're like, I don't know why
288
00:17:46.675 --> 00:17:50.435
I can't remember anything today. You know? So do you have any suggestions for
289
00:17:50.435 --> 00:17:54.275
those moments? Well, I think that the more we talk
290
00:17:54.275 --> 00:17:58.035
about this and the more awareness there is, I think the more grace it will
291
00:17:58.035 --> 00:18:01.480
be in the work place as well. And I think that the more women talk
292
00:18:01.480 --> 00:18:04.200
about it, you know, I I bet you if you talk to one of your
293
00:18:04.200 --> 00:18:07.820
colleagues that is the same age as you are, they will completely
294
00:18:07.880 --> 00:18:11.605
understand. My female colleagues get it. Female colleagues will get it.
295
00:18:11.605 --> 00:18:15.445
But, you know, as we're bringing our partners during this discussion That's a
296
00:18:15.445 --> 00:18:18.804
good point. And educating them as well. That is a good point. Partners, they will
297
00:18:18.804 --> 00:18:22.645
be more understanding because they have that at home. Yeah. They it's the old adage,
298
00:18:22.645 --> 00:18:26.110
you, educate women, you educate the world. Exactly. Because we
299
00:18:26.110 --> 00:18:29.890
educate everybody. Agreed. And then you're saying there's treatments.
300
00:18:30.110 --> 00:18:33.730
Hormone replacement therapy got a real bad rap in the nineties.
301
00:18:34.030 --> 00:18:37.230
And I know there's politics and all kinds of stuff behind. I think, in fact,
302
00:18:37.230 --> 00:18:40.875
PBS is coming out with a special on menopause
303
00:18:41.015 --> 00:18:44.775
and the whole hormone replacement therapy. So is it good
304
00:18:44.775 --> 00:18:48.455
or bad? So in the nineties, you're right. They did
305
00:18:48.455 --> 00:18:52.295
do women's health initiative. They did do a large study where they included
306
00:18:52.295 --> 00:18:56.100
a lot of women and they thought if we give them hormone replacement therapy,
307
00:18:56.399 --> 00:19:00.080
it will help their cardiovascular function. What they found, and
308
00:19:00.080 --> 00:19:03.600
they stopped the study early, is that actually they increased the rates for
309
00:19:03.600 --> 00:19:07.440
stroke, so they stopped the studies. So as
310
00:19:07.440 --> 00:19:10.445
soon as media got a hold of that, then everybody,
311
00:19:11.145 --> 00:19:14.765
took it off the market, and nobody wanted to prescribe it anymore.
312
00:19:14.825 --> 00:19:18.665
Right. And, actually, we had a a generation of physicians, a
313
00:19:18.665 --> 00:19:22.440
gap in the training during this time. Okay. But what
314
00:19:22.440 --> 00:19:25.880
what they found is that women were continuing to have these symptoms and they were
315
00:19:25.880 --> 00:19:29.399
not being treated, and nobody was listening. Yeah. So they said,
316
00:19:29.399 --> 00:19:33.159
well, you know, as as more women entered the workforce as well and we
317
00:19:33.159 --> 00:19:36.934
wanted better care for ourselves, then we looked and they said, let's look
318
00:19:36.934 --> 00:19:40.775
at this study. What was about that study that caused this abnormality that
319
00:19:40.775 --> 00:19:44.375
we did not predict? Right. Well, what they found is that the average woman
320
00:19:44.375 --> 00:19:48.140
entering that study was age 65. Oh, Oh, they didn't even bother
321
00:19:48.140 --> 00:19:51.020
with the thirties and the forties and the fifties. So what they found is that
322
00:19:51.020 --> 00:19:54.539
we know that once you reach a certain age, age alone will make your
323
00:19:54.539 --> 00:19:58.140
vessels rigid and if you have, risk for cardiovascular disease and you're
324
00:19:58.140 --> 00:20:01.945
forming plaques, adding estrogen to that Yeah. Is going to make those
325
00:20:01.945 --> 00:20:05.565
unstable and increase the stroke. But when they looked at younger women,
326
00:20:05.705 --> 00:20:09.325
women in their fifties, like within the 1st 10 years of reaching menopause,
327
00:20:09.785 --> 00:20:12.845
they actually found lower mortality
328
00:20:13.385 --> 00:20:16.090
rates for all across the board.
329
00:20:17.030 --> 00:20:20.790
So then more studies came along to actually look at,
330
00:20:21.030 --> 00:20:24.630
the benefits of hormone replacement therapy. So the more we
331
00:20:24.630 --> 00:20:28.470
learn about it, the more we are willing to prescribe it and educate the newer
332
00:20:28.470 --> 00:20:32.184
generation of physicians. That is what's so frustrating about the medical industry is the
333
00:20:32.184 --> 00:20:35.565
fact that these studies, they depend so much on the design.
334
00:20:36.025 --> 00:20:39.784
And we, as laypeople Mhmm. Can't really dig into that. And we don't know. And
335
00:20:39.784 --> 00:20:42.845
so we're at the mercy of everyone doing their homework. Absolutely.
336
00:20:44.810 --> 00:20:48.190
Are there any so, well, let me go back to treatments before I move on.
337
00:20:48.410 --> 00:20:51.950
So talk briefly on the types of treatments and hormone
338
00:20:52.010 --> 00:20:55.770
therapy. Like, what do these look like? Yeah. The hormone replacement therapy is
339
00:20:55.770 --> 00:20:59.525
very beneficial. And again, as I mentioned that the estrogen and progesterone
340
00:20:59.665 --> 00:21:03.184
effects not only biologically as the symptoms, but also
341
00:21:03.184 --> 00:21:06.885
psychologically. So for women that are having issues like
342
00:21:07.184 --> 00:21:09.684
increased anxiety, premature dysphoric syndrome,
343
00:21:10.750 --> 00:21:14.590
ADHD, they can actually benefit from being
344
00:21:14.590 --> 00:21:17.809
on hormone replacement therapy. Right. That may be another
345
00:21:18.270 --> 00:21:21.870
adjunct to whatever is their treatment currently, and that may be
346
00:21:21.870 --> 00:21:24.850
beneficial for them as they're going through these transition years.
347
00:21:25.544 --> 00:21:29.384
There are multiple combination of hormone replacement therapy, but when I
348
00:21:29.384 --> 00:21:33.225
explain it to my patient, I said there's systemic hormone replacement therapy, and
349
00:21:33.225 --> 00:21:36.904
then there's a local, hormone therapy. The
350
00:21:36.904 --> 00:21:40.000
systemic therapy is your whole body sees it. So it's like a pill or something?
351
00:21:40.080 --> 00:21:43.840
A pill. It's a patch. It's gels. And if you
352
00:21:43.840 --> 00:21:47.200
have a uterus, you need progesterone for, to help
353
00:21:47.200 --> 00:21:50.900
with maintaining the lining of the uterus to decrease the risk for
354
00:21:50.960 --> 00:21:54.575
endometrial cancer. Oh, yeah. But if for women that do not have a uterus,
355
00:21:54.795 --> 00:21:58.395
then you can just use estrogen alone. Got it. There are some women that have
356
00:21:58.395 --> 00:22:02.235
contraindications, and they should discuss with their providers whether they're
357
00:22:02.235 --> 00:22:06.075
candidates for that. With the local therapy, it can help with,
358
00:22:06.075 --> 00:22:09.670
like, those genital urinary symptoms. Yeah. And that's local
359
00:22:09.670 --> 00:22:13.050
estrogen. It can be given effectively without progesterone
360
00:22:13.510 --> 00:22:17.270
because it's not systemically absorbed. I see. There are other hormone
361
00:22:17.270 --> 00:22:21.110
therapy in the market that are local, like DHEA is one of
362
00:22:21.110 --> 00:22:24.625
them that, is a steroid that converts into estrogen and
363
00:22:24.625 --> 00:22:28.465
testosterone locally in the vaginal tissue. Okay. So are you putting this in like
364
00:22:28.465 --> 00:22:32.145
a gel inside your vagina? It's like a little bullet. Yeah. It's like a little
365
00:22:32.304 --> 00:22:35.745
Like a suppository. Yeah. It's suppository. Yes. And then there's a
366
00:22:35.745 --> 00:22:39.490
ring. There's gels. There's different combinations. Okay. But
367
00:22:39.490 --> 00:22:43.010
talking about non hormonal therapy because there's other women that
368
00:22:43.010 --> 00:22:46.630
cannot have hormones or do not want to have hormones,
369
00:22:47.090 --> 00:22:50.929
and there's other options as well. There's non hormonal options to manage
370
00:22:50.929 --> 00:22:54.605
depending on what their symptoms are. Yeah. There is a newer
371
00:22:54.605 --> 00:22:57.664
medication that helps with hot flashes and is non hormonal,
372
00:22:58.365 --> 00:23:01.885
specifically targets the part of the brain that is responsible for
373
00:23:01.885 --> 00:23:04.784
thermoregulation. Yeah. And there is other
374
00:23:05.530 --> 00:23:08.750
non hormonal medications like antiepileptic medications.
375
00:23:09.690 --> 00:23:13.130
There are the medication in the the SSRI or SNRI, the
376
00:23:13.130 --> 00:23:16.809
antidepressant medication group. Okay. So you have a lot of choices. We have choices,
377
00:23:16.809 --> 00:23:20.410
and it tailors to what the most bothersome symptoms are to
378
00:23:20.410 --> 00:23:23.237
you. And our grandmothers would love to hear this. They would love to be have
379
00:23:23.237 --> 00:23:24.677
been a part of it today. Today. Yes. Just like we're gonna wanna be a
380
00:23:24.677 --> 00:23:28.265
part of our our daughter's future. I wanna talk about diet. Mhmm. Is,
381
00:23:29.285 --> 00:23:31.545
is there any diet recommendations you can make for
382
00:23:34.820 --> 00:23:38.580
someone going through perimenopause? Yes. What is proven scientifically to
383
00:23:38.580 --> 00:23:42.340
be most beneficial is Mediterranean diet and diet that
384
00:23:42.340 --> 00:23:45.860
focuses on lean and plant based proteins. Okay. Okay.
385
00:23:45.860 --> 00:23:49.575
Great. This is probably my last question. When it comes to determining whether or
386
00:23:49.575 --> 00:23:53.355
not you are in perimenopause, is there a blood test
387
00:23:53.495 --> 00:23:56.875
that you can use? That's a good question. So we typically
388
00:23:57.015 --> 00:24:00.475
clinically diagnose somebody based on age and their menstrual
389
00:24:00.615 --> 00:24:04.060
history. However, there is a group of women that,
390
00:24:04.380 --> 00:24:08.220
either have a hysterectomy or they have an endometrial ablation or they have an
391
00:24:08.220 --> 00:24:11.820
IUD and they've not had a period. Mhmm. There are a couple of hormones that
392
00:24:11.820 --> 00:24:15.420
we can check, the antimalirian hormone, which is the hormone that, is
393
00:24:15.420 --> 00:24:18.934
released by the early growth of the follicles. Mhmm.
394
00:24:19.315 --> 00:24:23.075
And when it reaches undetectable levels, we know that a woman is
395
00:24:23.075 --> 00:24:26.915
in menopause Okay. Or the follicle stimulating hormone. But again, those are
396
00:24:26.915 --> 00:24:30.355
more helpful in women that are 48 years old or
397
00:24:30.355 --> 00:24:33.940
older. Right. But you're saying that you can detect menopause. Can you detect
398
00:24:33.940 --> 00:24:37.320
perimenopause? Not accurately.
399
00:24:39.059 --> 00:24:42.660
Great. There's not a particular test that says But it's all it's
400
00:24:42.660 --> 00:24:46.495
mostly you have to sit with your doctor and to go through your symptoms. Mhmm.
401
00:24:46.495 --> 00:24:50.014
And how can you get, like, how do you get your doctor to talk about
402
00:24:50.014 --> 00:24:53.215
these things? Because I know when I went to my doctor the last time, she
403
00:24:53.615 --> 00:24:56.815
first time ever, do you still get your period? And that was all that was
404
00:24:56.815 --> 00:25:00.150
mentioned. It was the nurse. They never gave me any real, like, do you wanna
405
00:25:00.150 --> 00:25:03.510
talk about what's going on? Have you noticed any of these types of things? Like,
406
00:25:03.510 --> 00:25:07.270
is there any kind of work going towards doctors just to be better
407
00:25:07.270 --> 00:25:10.950
doctors when it comes to women in perimenopause? There is
408
00:25:10.950 --> 00:25:14.435
more awareness amongst us and a lot of us are trying to reeducate
409
00:25:14.495 --> 00:25:17.955
ourselves about all of this, new research that's ongoing.
410
00:25:18.175 --> 00:25:21.555
But another thing that I do want to mention to patients,
411
00:25:21.935 --> 00:25:25.375
and and women in general is that, you know, empower
412
00:25:25.375 --> 00:25:29.130
yourself. If you have symptoms, don't just mention
413
00:25:29.130 --> 00:25:32.970
them at the end of the visit. That's very important because
414
00:25:32.970 --> 00:25:36.750
a lot of times women are too shy or I don't know why they don't,
415
00:25:37.370 --> 00:25:41.210
you know, talk about their symptoms and some of them might feel like it's
416
00:25:41.210 --> 00:25:44.245
in their head or they're made to feel like it's in their head. Well, the
417
00:25:44.245 --> 00:25:48.005
doctor comes in and is typically, like, getting to business. You know, you
418
00:25:48.005 --> 00:25:51.445
come in, and it's pretty quick. And so you feel like they gotta get their
419
00:25:51.445 --> 00:25:55.049
job done first before they get you can get to your questions. You're saying when
420
00:25:55.049 --> 00:25:58.409
you get when the doctor walks in and say, let's talk before anything starts. Yeah.
421
00:25:58.409 --> 00:26:01.769
Absolutely. Allowed to tell them what to do. You're paying them. You are allowed to.
422
00:26:01.769 --> 00:26:05.529
You're that's why you're there. They're there to educate you. But, also, do
423
00:26:05.529 --> 00:26:09.225
not have other problems and then all of a sudden at the end of
424
00:26:09.225 --> 00:26:12.505
the visit, you mention, oh, but I have this and this and this. You don't
425
00:26:12.505 --> 00:26:16.265
make it an a point to actually discuss your symptoms,
426
00:26:16.265 --> 00:26:19.945
only your symptoms. Like, just go for it. Oh, just go make an appointment just
427
00:26:19.945 --> 00:26:23.179
to talk about that. Right. I have a lot of patients. Now that there's more
428
00:26:23.179 --> 00:26:26.779
awareness, a lot of my patients come in for menopausal symptoms or
429
00:26:26.779 --> 00:26:30.460
perimenopausal symptoms. Lots of that. Yeah. Just about that. And I think that's
430
00:26:30.460 --> 00:26:33.899
what it needs to be. There needs to be advertising for that. I'm sorry.
431
00:26:33.899 --> 00:26:37.065
Marketing needs to go into the fact that you know, you can just go to
432
00:26:37.065 --> 00:26:40.525
your doctor and you can just talk to them and ask them questions. Absolutely.
433
00:26:40.985 --> 00:26:44.825
And and your gynecologist will pick up on based on,
434
00:26:44.825 --> 00:26:48.640
as I mentioned clinically, part of the vital signs for
435
00:26:48.640 --> 00:26:52.080
a woman in a gynecologist's office is your menstrual
436
00:26:52.080 --> 00:26:55.760
cycle. Okay. And that will tell us quite a bit Okay. Of where you are
437
00:26:55.760 --> 00:26:58.880
in that space. Your calendar, and don't forget, like I do every time, when was
438
00:26:58.880 --> 00:27:01.765
your last period? Darn it. I knew I was supposed to look that up. Thank
439
00:27:01.765 --> 00:27:05.044
you so much. This has been you. Last time you came with menopause, I learned
440
00:27:05.044 --> 00:27:08.245
a ton. Didn't think I could learn anymore. And what was I thinking? Of course,
441
00:27:08.245 --> 00:27:12.085
I could. Thank you so much. Thank you for having me. Isn't
442
00:27:12.085 --> 00:27:15.470
doctor Kennedy just the best? She was also our guest on the
443
00:27:15.470 --> 00:27:19.149
menopause episode at the end of season 1. Check it out. It's
444
00:27:19.149 --> 00:27:22.450
an awesome episode. You can find out about her and WakeMed
445
00:27:22.510 --> 00:27:26.190
Women's at wakemed.org. Please share this episode with
446
00:27:26.190 --> 00:27:29.565
someone who needs to hear it. If you or your friends are in the
447
00:27:29.565 --> 00:27:33.405
perimenopause zone with me, you're probably already talking
448
00:27:33.405 --> 00:27:37.245
about it. Hit the share button on your podcast player and pass it on.
449
00:27:37.245 --> 00:27:38.305
See you next time.
1
00:00:00.320 --> 00:00:03.860
Hey, guys. Welcome to Sarah has questions. Today, we're talking about perimenopause.
2
00:00:04.400 --> 00:00:08.000
If you're in it, you know it. It has every symptom
3
00:00:08.000 --> 00:00:11.780
under the sun, and yet there's not really a diagnosis for it.
4
00:00:12.000 --> 00:00:15.575
Why is that? What's the deal? Let's talk about perimenopause.
5
00:00:15.875 --> 00:00:19.715
I have a ton of questions. Let's get into it. I'm Sarah
6
00:00:19.715 --> 00:00:23.175
King, and I have a lot of questions. What exactly
7
00:00:23.235 --> 00:00:26.915
happens when you orgasm physically? Will popping a knuckle or a
8
00:00:26.915 --> 00:00:30.730
joint give us arthritis? What can we learn from our poop? The
9
00:00:30.730 --> 00:00:34.489
size of your body doesn't necessarily indicate your measure of health. Yes. And
10
00:00:34.489 --> 00:00:37.949
what are your thoughts on that? Cleansing. Do we need to do anything
11
00:00:38.170 --> 00:00:41.625
special to our nether regions? In this
12
00:00:41.625 --> 00:00:45.085
show, I get to ask all these questions to WakeMed doctors
13
00:00:45.225 --> 00:00:48.905
who happen to know everything about everything. Sarah has
14
00:00:48.905 --> 00:00:52.685
questions is a production of Capital Broadcasting Company and Mix 101.5.
15
00:00:53.545 --> 00:00:57.300
It's presented by WakeMed. Today, I'm so excited for
16
00:00:57.300 --> 00:01:00.980
this episode, because we're talking perimenopause. And
17
00:01:00.980 --> 00:01:04.599
as a 47 year old woman, I know a lot about perimenopause.
18
00:01:05.540 --> 00:01:09.275
Today's doctor is Amantia Kennedy. You are a OBGYN
19
00:01:09.495 --> 00:01:13.015
for WakeMed. Thank you so much for coming in today. Thank you for having me.
20
00:01:13.015 --> 00:01:16.295
And you came in before and talked menopause. I sure did. And so now we're
21
00:01:16.295 --> 00:01:20.055
gonna talk about perimenopause. And the thing about perimenopause that
22
00:01:20.055 --> 00:01:23.770
gets me is you feel like you're making it up. Mhmm. You know? Like,
23
00:01:23.910 --> 00:01:27.430
there and we'll get into the details of this a bit later, but there are
24
00:01:27.430 --> 00:01:30.570
so many symptoms. Mhmm.
25
00:01:30.790 --> 00:01:33.830
And there are days where you wake up and I'm like, oh, did I just
26
00:01:33.830 --> 00:01:37.435
not get enough sleep or is my my brain deceiving me and making me a
27
00:01:37.435 --> 00:01:40.975
forgetful person? Mhmm. You know, am I not sleeping because I drank too much coffee?
28
00:01:41.115 --> 00:01:43.595
Like, you don't know. And then you go to your doctor and they're just like,
29
00:01:43.595 --> 00:01:47.275
oh, it's you get dismissed. Mhmm. So let's just
30
00:01:47.275 --> 00:01:50.335
start from the very beginning. Yes. What the hell is perimenopause?
31
00:01:51.649 --> 00:01:55.170
Perimenopause is the menopausal transition. It's the years
32
00:01:55.170 --> 00:01:59.009
leading up to menopause and it's defined by low
33
00:01:59.009 --> 00:02:02.770
ovarian functions. So during this time, there's a lot of fluctuations in the
34
00:02:02.770 --> 00:02:06.295
hormones that happen. Okay. So that's why we're gonna talk about how these
35
00:02:06.295 --> 00:02:10.134
hormones affect us. How does perimenopause differ
36
00:02:10.134 --> 00:02:13.575
from menopause? The perimenopause is the years leading to
37
00:02:13.575 --> 00:02:17.095
menopause. Okay. It's not it and it's it ends after
38
00:02:17.095 --> 00:02:20.769
12 months of no periods and then you reach the
39
00:02:20.769 --> 00:02:24.530
menopause. So the until the final menstrual period. Okay. That's when it
40
00:02:24.530 --> 00:02:27.670
ends. So what would be a typical age to start perimenopause?
41
00:02:28.450 --> 00:02:31.890
So again, I want to emphasize that perimenopause is not menopause. It's
42
00:02:31.890 --> 00:02:35.695
the the years leading up to menopause. Right. And it ends with the
43
00:02:35.695 --> 00:02:39.375
final menstrual period. So women can enter this
44
00:02:39.375 --> 00:02:42.835
transition phase as early as thirties. Yeah.
45
00:02:42.975 --> 00:02:46.815
And but majority of them will enter it in their forties. Okay. The
46
00:02:46.815 --> 00:02:50.410
median age for a woman entering this stage is
47
00:02:50.410 --> 00:02:54.250
47 in the United States. Okay. And how do you know that you're
48
00:02:54.250 --> 00:02:58.090
entering in? Like, what what are the signs of I'm now in the
49
00:02:58.090 --> 00:03:01.720
perimenopausal state? So because there's fluctuations in the sex hormones, estrogen and progesterone, particularly, which
50
00:03:01.720 --> 00:03:05.485
are the hormones released by the sex hormones, estrogen and progesterone particularly, which are the
51
00:03:05.485 --> 00:03:09.265
hormones released by the ovary, women will
52
00:03:09.485 --> 00:03:12.705
experience abnormalities in their menstrual cycle.
53
00:03:13.245 --> 00:03:16.579
And, we actually have two phases of this menopausal
54
00:03:16.799 --> 00:03:20.239
transition or perimenopause, the early stage and then the late
55
00:03:20.239 --> 00:03:23.760
stage. The early stage during this time, women will start to
56
00:03:23.760 --> 00:03:27.439
experience some irregularities with their periods. Sometimes in the very early
57
00:03:27.439 --> 00:03:30.985
stages, they may have more frequent cycles. Mhmm. And then they're
58
00:03:30.985 --> 00:03:34.825
followed by more sparse, spaced out cycles by more
59
00:03:34.825 --> 00:03:38.505
than 7 days, in length apart. And then that
60
00:03:38.505 --> 00:03:42.345
is followed by maybe you can skip a month or so. And then
61
00:03:42.345 --> 00:03:45.920
the and they enter the late stage when they're starting to skip more than
62
00:03:45.920 --> 00:03:49.519
60 days. Okay. So 2 months. Once you skip 2
63
00:03:49.519 --> 00:03:53.360
months, you're you're getting closer to actually getting to the
64
00:03:53.360 --> 00:03:57.120
land of promise, the Yes. No period land, which
65
00:03:57.120 --> 00:04:00.754
sounds awesome. And we do we can predict that when women enter
66
00:04:00.754 --> 00:04:04.194
this late stage of the perimenopause, they will
67
00:04:04.194 --> 00:04:07.555
achieve their final menstrual period within 2 to 3 years. Oh,
68
00:04:07.555 --> 00:04:11.254
interesting. Okay. Alright. Well and so let me ask you this.
69
00:04:11.490 --> 00:04:15.250
If, when you say skip a period, does that mean no blood at all
70
00:04:15.250 --> 00:04:19.010
or just a very little amount of blood? Skip a
71
00:04:19.010 --> 00:04:22.690
period means no blood. At all. Mhmm. Okay. We'll be right back
72
00:04:22.690 --> 00:04:25.190
because you know I have more questions.
73
00:04:30.975 --> 00:04:34.495
I wanna go through the symptoms or maybe and you can tell me this is
74
00:04:34.495 --> 00:04:37.455
the part that blows my mind. So maybe you can shed some light on why
75
00:04:37.455 --> 00:04:41.190
this is happening. Okay? Yeah. So, and and
76
00:04:41.190 --> 00:04:44.870
please add your own because there's just so many, and I don't understand
77
00:04:44.870 --> 00:04:48.150
why there are so many. But we'll start with number the first one, which is
78
00:04:48.150 --> 00:04:51.990
brain fog. Why is brain fog associated with it? And, honestly, how can
79
00:04:51.990 --> 00:04:55.445
you tell the difference between brain fog and not enough sleep? Like, it's just so
80
00:04:55.445 --> 00:04:58.965
ambiguous. Mhmm. Yeah. Absolutely. Brain fog is
81
00:04:58.965 --> 00:05:02.725
actually a very common symptoms of, perimenopause and up to
82
00:05:02.725 --> 00:05:06.565
40 to 60% of women will experience this. And it's a
83
00:05:06.565 --> 00:05:09.690
collection of cognitive symptoms like forgetfulness,
84
00:05:11.030 --> 00:05:14.330
difficulty focusing or concentrating, losing
85
00:05:14.710 --> 00:05:18.390
objects, difficulty recalling names or verbs, or I can't think
86
00:05:18.390 --> 00:05:22.215
of the the the word. The worst. Yes. So
87
00:05:22.215 --> 00:05:25.195
it happens because, the
88
00:05:25.895 --> 00:05:29.655
fluctuations of the hormones, estrogen and progesterone, we know FX has
89
00:05:29.655 --> 00:05:33.355
receptors in the brain Okay. And there's part of the brains that get affected
90
00:05:33.415 --> 00:05:37.139
by this, including neurotransmitters, and we're gonna talk about that a little bit later.
91
00:05:37.139 --> 00:05:40.979
Okay. But, women have this think
92
00:05:40.979 --> 00:05:44.740
of it as a computer getting a reboot and they they're just not processing the
93
00:05:44.740 --> 00:05:48.435
information as quickly as they used to. Okay. When they when they
94
00:05:48.435 --> 00:05:51.815
were when women were tested with actual formal tests,
95
00:05:52.115 --> 00:05:55.815
they did score a little bit lower on, attentiveness, concentration,
96
00:05:56.515 --> 00:06:00.295
and, verbal recalling Mhmm. But they did not have
97
00:06:00.355 --> 00:06:04.170
a decrease in higher cognitive functions like strategic thinking. So you don't
98
00:06:04.170 --> 00:06:07.930
lose intelligence? You do not lose intelligence. Gotcha. Well, that's
99
00:06:07.930 --> 00:06:11.450
good to know. Yes. And does it ever come back? Does the brain fog
100
00:06:11.450 --> 00:06:15.210
ever, like, go out to sea, basically? Good news. It does.
101
00:06:15.210 --> 00:06:19.050
It reverses. Good. That's awesome. Once we reach menopause, it does reverse for most women.
102
00:06:19.050 --> 00:06:22.305
So we really are kinda getting a reboot. We are. Think of it as a
103
00:06:22.305 --> 00:06:26.145
reboot reboot. And our brains are plastic. They go through different
104
00:06:26.145 --> 00:06:29.605
changes based on our experiences, and they're always changing.
105
00:06:29.825 --> 00:06:33.440
Weight gain is another symptom. Gaining in and of itself is one
106
00:06:33.440 --> 00:06:36.960
symptom, but why is it always in the belly? Yes. That's called
107
00:06:36.960 --> 00:06:40.419
adipose, fat tissue and that is, because
108
00:06:41.039 --> 00:06:44.720
as we transition into this phase and we're having these fluctuations in the
109
00:06:44.720 --> 00:06:48.445
hormones, let's not forget we're also aging. Mhmm. And
110
00:06:48.445 --> 00:06:52.285
that in itself can cause decrease in, muscle mass. And
111
00:06:52.285 --> 00:06:55.805
as I've mentioned before, muscle is the largest organ of energy
112
00:06:55.805 --> 00:06:59.505
expenditure. And so when you have when we're inactive,
113
00:07:00.365 --> 00:07:04.140
like, we don't diet or exercise, or even when we do
114
00:07:04.140 --> 00:07:07.900
diet and exercise because a lot of times women will say, I am doing everything
115
00:07:07.900 --> 00:07:11.420
I did before and I cannot lose weight. I'm actually gaining weight. Oh,
116
00:07:11.420 --> 00:07:15.260
girl. That's me. During this transition phase, though, because of the
117
00:07:15.260 --> 00:07:19.045
lack of estrogen, and estrogen does have receptors in the muscle Mhmm. We
118
00:07:19.045 --> 00:07:22.025
have an acceleration of, this energy
119
00:07:22.645 --> 00:07:26.085
net deficit that we are or actually net gain. So we
120
00:07:26.085 --> 00:07:29.925
are gaining more weight than we're losing the weight because of
121
00:07:29.925 --> 00:07:33.690
the muscle mass is is we're rapidly, decreasing that.
122
00:07:33.850 --> 00:07:37.530
It stabilizes in the menopausal years, but especially during this
123
00:07:37.530 --> 00:07:41.050
transition phase when we're having this hormone, decline Mhmm.
124
00:07:41.210 --> 00:07:44.810
It's a little bit more rapid. So we're starting to get, more more
125
00:07:44.810 --> 00:07:48.504
weight. And so it's super important to keep the muscle then.
126
00:07:48.504 --> 00:07:52.185
Yes? Yes. And that's when we highly recommend strength training
127
00:07:52.185 --> 00:07:55.805
exercises. Okay. Which is not only beneficial for your cardiovascular
128
00:07:56.104 --> 00:07:59.810
function, it's beneficial for maintaining the muscle mass. Yeah. Because
129
00:07:59.810 --> 00:08:03.330
remember, even Arnold Schwarzenegger, he's going to lose some muscle mass as he
130
00:08:03.330 --> 00:08:05.970
ages. But he had a lot to start with. He had a lot to start
131
00:08:05.970 --> 00:08:09.330
with for sure. Which is what you're saying. You know? The more you
132
00:08:09.330 --> 00:08:12.875
have and the more you then you can lose and it won't be as
133
00:08:12.875 --> 00:08:16.635
detrimental. And the goal for, strength training exercises is
134
00:08:16.635 --> 00:08:20.315
to maintain the muscle mass so you don't lose it as rapidly during this phase.
135
00:08:20.315 --> 00:08:23.935
I see. Okay. Next up, we have sore joints.
136
00:08:24.870 --> 00:08:28.470
Yes. So it's real. It is real. I I well, I
137
00:08:28.470 --> 00:08:32.150
find as I'm going through this perimenopausal state that it's only
138
00:08:32.150 --> 00:08:35.770
certain weeks Right. Which is really interesting. Why is that?
139
00:08:35.990 --> 00:08:39.835
It's again, we talk about fluctuations of the hormones. Each cycle will be
140
00:08:39.835 --> 00:08:43.675
different. It's a it's a time of a chaos in our body. So
141
00:08:43.675 --> 00:08:47.355
some months, you may have more estrogen than other months.
142
00:08:47.355 --> 00:08:51.115
And when you have less estrogen in your body and estrogen has
143
00:08:51.115 --> 00:08:54.930
receptors all over our body, including our joints. Yeah. It it
144
00:08:54.930 --> 00:08:58.630
does affect, our joints. So am I feeling inflammation
145
00:08:58.770 --> 00:09:01.830
there or am I feeling lack of fluid? No. It's inflammation.
146
00:09:02.130 --> 00:09:05.750
Okay. So would an anti inflammatory diet help with this?
147
00:09:06.050 --> 00:09:09.824
Absolutely. Okay. Alright. Itchy
148
00:09:09.824 --> 00:09:13.584
skin. Some women complain of itchy skin. Does that I mean,
149
00:09:13.584 --> 00:09:17.345
is this something that is real or are they making it up? They just need
150
00:09:17.345 --> 00:09:20.944
some lotion. No. It's real because as
151
00:09:20.944 --> 00:09:24.650
we do age, our skin, gets thinner. Mhmm. And
152
00:09:24.650 --> 00:09:28.330
actually, we do have estrogen receptors on our skin as well. Estrogen's
153
00:09:28.330 --> 00:09:32.010
everywhere. Everywhere. And so women will have
154
00:09:32.010 --> 00:09:35.850
drier skin and thinner skin. So it can some women can
155
00:09:35.850 --> 00:09:39.690
have a little bit more exacerbation, of the symptoms than others. Mhmm.
156
00:09:39.690 --> 00:09:43.195
And everybody's different. Not everybody's gonna have all the symptoms at
157
00:09:43.195 --> 00:09:46.794
once, but dry skin is one of the Okay.
158
00:09:46.954 --> 00:09:50.795
Complaints. Yeah. For sure. And there's also I'm reading our my producer put
159
00:09:50.795 --> 00:09:53.930
this list together and I'm reading through this and here's one.
160
00:09:55.030 --> 00:09:58.790
Bugs crawling on you. Some people get the sensation of bug is that have you
161
00:09:58.790 --> 00:10:02.070
heard of that before? I have heard of it before and some women have a
162
00:10:02.870 --> 00:10:06.550
like, it's not as common. Yeah. I'll say that. But it goes with the
163
00:10:06.550 --> 00:10:09.885
dry skin. I would think it's got something to do with your nerves as well
164
00:10:09.885 --> 00:10:13.585
because it you know, the the ends. Well, it has to do with, like,
165
00:10:13.725 --> 00:10:17.005
you know, with hot flashes, which is a very common symptom Yes. Has to do
166
00:10:17.005 --> 00:10:20.625
with vasodilation Okay. Of the blood, like, the little capillaries.
167
00:10:21.325 --> 00:10:25.030
So that could be part of of it as well. Feels that way. Mhmm.
168
00:10:25.030 --> 00:10:28.870
Okay. This is one I have, phantom smells. I'll smell
169
00:10:28.870 --> 00:10:31.590
stuff and no one else will smell it, and this has all started in the
170
00:10:31.590 --> 00:10:35.350
past 5 years. Yeah. Have you ever heard of that? I have heard of that.
171
00:10:35.350 --> 00:10:39.035
And, you know, actually, I heard one woman saying that
172
00:10:39.035 --> 00:10:42.795
she heard she smelled like there was smoke in her house and
173
00:10:42.795 --> 00:10:46.475
then she would go to her children's room and her adolescent, like, did you
174
00:10:46.475 --> 00:10:50.075
smoke? And they're like, no. We didn't. We are not smokers. But,
175
00:10:50.235 --> 00:10:53.940
but it it is. Do we understand it all? We don't. We
176
00:10:53.940 --> 00:10:57.540
have so much ongoing research as we speak Oh, I bet.
177
00:10:57.620 --> 00:11:01.139
Regarding, a lot of the symptoms because, you know, as
178
00:11:01.139 --> 00:11:04.899
women, we we do demand more research and we do demand some answers
179
00:11:04.899 --> 00:11:08.735
to to better, help our lives for sure. I have just
180
00:11:08.735 --> 00:11:12.415
recently heard that even in rat studies, they didn't study
181
00:11:12.415 --> 00:11:14.835
female rats. Can you
182
00:11:15.935 --> 00:11:19.555
what? You know, it was in 1987 that FDA
183
00:11:19.870 --> 00:11:23.150
required researchers to actually study drugs in women
184
00:11:23.390 --> 00:11:27.070
Yikes. Only. Everything was based on male studies as
185
00:11:27.070 --> 00:11:30.550
well. Chihuahua. So and it that was we were alive, both of us. Yes. So
186
00:11:30.670 --> 00:11:34.305
yeah. I was in elementary school that I it
187
00:11:34.305 --> 00:11:37.824
makes my blood boil. If I mean, were they curious? Were we that
188
00:11:37.824 --> 00:11:41.105
confusing to them that they thought they just couldn't figure it out? Like, that says
189
00:11:41.105 --> 00:11:44.865
a lot. Well, either confusing or not important. I don't know. Or they they
190
00:11:44.865 --> 00:11:48.064
do those things. I don't know. Does it make your blood boil? It does a
191
00:11:48.064 --> 00:11:51.320
little bit. Oh, it makes mine really. I mean No. It does a lot. Okay.
192
00:11:51.320 --> 00:11:55.160
Thank you. Let's be real. You're mad. We're all mad. Oh, yeah. But
193
00:11:55.160 --> 00:11:59.000
but the good news is that there's so much ongoing research. More is
194
00:11:59.000 --> 00:12:02.675
coming. That's what makes me excited for our daughters. Yes.
195
00:12:02.895 --> 00:12:06.654
Because when they enter into menopause, it's going to be a different world. Because
196
00:12:06.654 --> 00:12:10.175
by that time, we'll have another decade or so. I well, actually,
197
00:12:10.175 --> 00:12:13.775
numerous decades of research, and they'll be the beneficiaries of
198
00:12:13.775 --> 00:12:17.295
it. And then that's exciting. And I think what our
199
00:12:17.295 --> 00:12:20.889
generation's big thing is is we need to just bring awareness
200
00:12:21.509 --> 00:12:25.129
to them that they don't let yourself be dismissed.
201
00:12:25.670 --> 00:12:29.430
Absolutely. That's so important. That's an important message. And we were talking about this
202
00:12:29.430 --> 00:12:33.014
next symptom. We I've got 2 more, that
203
00:12:33.014 --> 00:12:35.975
you've mentioned that you have issues with. I don't because I would do a morning
204
00:12:35.975 --> 00:12:39.735
show at 4 AM every day. So it's sleeping issues. I never have a problem
205
00:12:39.735 --> 00:12:43.435
falling asleep, but I know a lot of women experience, insomnia.
206
00:12:44.375 --> 00:12:48.140
Absolute. This is actually when they studied the 4
207
00:12:48.140 --> 00:12:51.900
most common symptoms of the menopausal transitions. Yeah. Half
208
00:12:51.900 --> 00:12:55.580
flashes, night sweats, difficulty sleeping Uh-huh. Which
209
00:12:55.580 --> 00:12:59.195
include insomnia Uh-huh. Genital urinary
210
00:12:59.195 --> 00:13:02.714
symptoms. Oh, like a leaking. Not only leaking, but,
211
00:13:02.875 --> 00:13:06.255
vaginal itching, dryness, painful sex, etcetera.
212
00:13:06.555 --> 00:13:10.394
Okay. Urinary tract infections, etcetera, but also
213
00:13:10.394 --> 00:13:14.150
mood changes, irritability, anxiety, depression. So those were the
214
00:13:14.150 --> 00:13:17.690
4 most common symptoms. So let's talk about insomnia.
215
00:13:17.910 --> 00:13:21.510
Yeah. It's a very common complaint and actually can be quite,
216
00:13:21.830 --> 00:13:25.615
distressing for a lot of women because lack of sleep can
217
00:13:25.615 --> 00:13:29.214
cause, irritability the next day, can cause decreased
218
00:13:29.214 --> 00:13:32.654
focusing and concentration, so your your coping
219
00:13:32.654 --> 00:13:36.095
mechanisms are diminished as well. But, we know that
220
00:13:36.095 --> 00:13:39.920
estrogen has, receptors in the brain. We know that it it affects
221
00:13:39.920 --> 00:13:43.620
parts of the brain that control, some of these circadian
222
00:13:43.680 --> 00:13:47.220
rhythms. Okay. So a lot of times, women will suffer from insomnia.
223
00:13:48.560 --> 00:13:51.940
You were saying that, off off air,
224
00:13:52.575 --> 00:13:56.415
you were saying that that the they're trying to pull estrogen from places. What
225
00:13:56.415 --> 00:14:00.175
were you saying with that? So what what our brain does when
226
00:14:00.175 --> 00:14:04.015
we're kinda going into this decline of ovarian function, because that's what
227
00:14:04.015 --> 00:14:07.580
perimenopause is, our brain, in order to compensate for
228
00:14:07.580 --> 00:14:11.420
it, starts to express some more receptors for estrogen so that it tries to catch
229
00:14:11.420 --> 00:14:14.500
as much as it can. So it creates more receptors. It creates more receptors. Oh,
230
00:14:14.500 --> 00:14:18.045
it's kinda like an alcoholic. Whenever they have too much alcohol, they they
231
00:14:18.045 --> 00:14:21.885
create more receptors. And then when they don't get it, they get crazy. Right. So
232
00:14:21.885 --> 00:14:25.005
they do. They it is trying. Our brain is trying to compensate for it, but
233
00:14:25.005 --> 00:14:28.845
there is always decline, decline, decline. Right. So a lot of times, women
234
00:14:28.845 --> 00:14:32.065
will suffer from insomnia, and it's a very common distressing
235
00:14:32.205 --> 00:14:32.919
symptom. Yeah. It's miserable. I mean, not being able to sleep has to be miserable.
236
00:14:32.919 --> 00:14:36.337
Yes. So would So would is the
237
00:14:36.351 --> 00:14:37.380
same thing at play here when it comes to mood and the mood swings? Absolutely.
238
00:14:37.380 --> 00:14:39.400
We, know that estrogen also affects the neurotransmitters like serotonin and dopamine. Mhmm.
239
00:14:48.605 --> 00:14:51.985
And when you have less serotonin production in our symptoms
240
00:14:52.445 --> 00:14:56.285
I mean, in our system Mhmm. Then we feel more depressed. We're in
241
00:14:56.285 --> 00:14:59.885
more depressed mood. Oh, that honestly, like, I I'm
242
00:14:59.885 --> 00:15:02.685
reading through this and it seems like a long list, but I have a lot
243
00:15:02.685 --> 00:15:05.779
of these. A lot of women have them. Yeah. Yeah. And it's not, like, every
244
00:15:05.779 --> 00:15:09.620
day. Mhmm. And that's what makes it so frustrating. It's like it's
245
00:15:09.620 --> 00:15:12.580
some days you feel normal, and then some days you don't. And you're like, where
246
00:15:12.580 --> 00:15:16.339
is this coming from? Right. And a lot of women feel alone in this.
247
00:15:16.339 --> 00:15:20.135
Like, is it is it me? Am I going through What's going on?
248
00:15:20.195 --> 00:15:23.735
Exactly. Exactly. Last symptom is decreased
249
00:15:23.875 --> 00:15:27.715
libido. Yes. Remember, estrogen and
250
00:15:27.715 --> 00:15:31.555
progesterone are sex hormones. So naturally, when
251
00:15:31.555 --> 00:15:35.300
we have a decline in our sex hormones, we also have
252
00:15:35.300 --> 00:15:38.660
a decline in our libido. But, as we talk to
253
00:15:38.660 --> 00:15:42.420
women, libido is very complex for us women. It's not just physical,
254
00:15:42.420 --> 00:15:46.260
it's also psychological. So it's important to address how
255
00:15:46.260 --> 00:15:50.035
they're feeling, how they're doing. What we know now is that,
256
00:15:50.035 --> 00:15:53.635
you know, as women, we take on our lives as adults and we
257
00:15:53.635 --> 00:15:56.615
compensate and kinda suppress some of of the
258
00:15:57.315 --> 00:16:00.675
things that are a nuisance to us. But as we're going through this
259
00:16:00.675 --> 00:16:04.150
transition and we're having this depletion of our sex
260
00:16:04.150 --> 00:16:07.690
hormones, we don't have those coping mechanisms that we used to
261
00:16:07.990 --> 00:16:11.830
and all of a sudden, we can't we we don't feel like taking
262
00:16:11.830 --> 00:16:15.510
on any more emotional, burden for us and we don't feel like
263
00:16:15.510 --> 00:16:19.065
taking on the slack, of our partners, for instance. Oh, yeah. Picking up
264
00:16:19.065 --> 00:16:22.905
socks. So exactly. Things that didn't bother us
265
00:16:22.905 --> 00:16:25.865
before. Yeah. But all of a sudden, it puts you in a rage state. It
266
00:16:25.865 --> 00:16:29.639
does. And and the thing is it can be very confusing for the partner as
267
00:16:29.639 --> 00:16:33.399
well because, you know, they also feel rejected or
268
00:16:33.399 --> 00:16:37.160
they feel that they I don't know this person anymore. Like, who are
269
00:16:37.160 --> 00:16:40.440
you? Right. But I think that during this time, it's very important to have an
270
00:16:40.440 --> 00:16:43.579
open communication with your partner so that you can have the support.
271
00:16:45.195 --> 00:16:49.035
Also, with the low libido, and as I mentioned before, during
272
00:16:49.035 --> 00:16:52.875
this transition times, we also have genitourinary symptoms, and that
273
00:16:52.875 --> 00:16:56.415
includes vaginal itching, vaginal dryness. And sometimes
274
00:16:56.635 --> 00:17:00.090
sex feels like a sandpaper. A lot of times, women will describe it
275
00:17:00.090 --> 00:17:03.850
as. And so when you're not when you're not feeling good and then physically
276
00:17:03.850 --> 00:17:06.650
you're also not feeling good, then you're not feeling like you need to be an
277
00:17:06.650 --> 00:17:10.329
intimate. Yeah. But what I do want to encourage women that are
278
00:17:10.329 --> 00:17:13.865
listening right now is that there is help. You know? Being
279
00:17:13.865 --> 00:17:17.404
miserable is optional at this point. There are many options
280
00:17:17.625 --> 00:17:20.845
that treat the symptoms. And also,
281
00:17:21.464 --> 00:17:24.904
there's not just one medication can help at all. It can be a
282
00:17:24.904 --> 00:17:28.440
multi, system treatment. It may involve more than
283
00:17:28.660 --> 00:17:32.420
just one physician. Okay. I've this you made me think of
284
00:17:32.420 --> 00:17:36.260
2 further questions. 1, your partner, yes. Mhmm. You know, talk to
285
00:17:36.260 --> 00:17:39.700
your partner and let them know where you are and all those things. What about
286
00:17:39.700 --> 00:17:43.515
colleagues at work? Like, this is gonna affect your work. And that's
287
00:17:43.515 --> 00:17:46.675
the for me, that's that's the hard part because you're like, I don't know why
288
00:17:46.675 --> 00:17:50.435
I can't remember anything today. You know? So do you have any suggestions for
289
00:17:50.435 --> 00:17:54.275
those moments? Well, I think that the more we talk
290
00:17:54.275 --> 00:17:58.035
about this and the more awareness there is, I think the more grace it will
291
00:17:58.035 --> 00:18:01.480
be in the work place as well. And I think that the more women talk
292
00:18:01.480 --> 00:18:04.200
about it, you know, I I bet you if you talk to one of your
293
00:18:04.200 --> 00:18:07.820
colleagues that is the same age as you are, they will completely
294
00:18:07.880 --> 00:18:11.605
understand. My female colleagues get it. Female colleagues will get it.
295
00:18:11.605 --> 00:18:15.445
But, you know, as we're bringing our partners during this discussion That's a
296
00:18:15.445 --> 00:18:18.804
good point. And educating them as well. That is a good point. Partners, they will
297
00:18:18.804 --> 00:18:22.645
be more understanding because they have that at home. Yeah. They it's the old adage,
298
00:18:22.645 --> 00:18:26.110
you, educate women, you educate the world. Exactly. Because we
299
00:18:26.110 --> 00:18:29.890
educate everybody. Agreed. And then you're saying there's treatments.
300
00:18:30.110 --> 00:18:33.730
Hormone replacement therapy got a real bad rap in the nineties.
301
00:18:34.030 --> 00:18:37.230
And I know there's politics and all kinds of stuff behind. I think, in fact,
302
00:18:37.230 --> 00:18:40.875
PBS is coming out with a special on menopause
303
00:18:41.015 --> 00:18:44.775
and the whole hormone replacement therapy. So is it good
304
00:18:44.775 --> 00:18:48.455
or bad? So in the nineties, you're right. They did
305
00:18:48.455 --> 00:18:52.295
do women's health initiative. They did do a large study where they included
306
00:18:52.295 --> 00:18:56.100
a lot of women and they thought if we give them hormone replacement therapy,
307
00:18:56.399 --> 00:19:00.080
it will help their cardiovascular function. What they found, and
308
00:19:00.080 --> 00:19:03.600
they stopped the study early, is that actually they increased the rates for
309
00:19:03.600 --> 00:19:07.440
stroke, so they stopped the studies. So as
310
00:19:07.440 --> 00:19:10.445
soon as media got a hold of that, then everybody,
311
00:19:11.145 --> 00:19:14.765
took it off the market, and nobody wanted to prescribe it anymore.
312
00:19:14.825 --> 00:19:18.665
Right. And, actually, we had a a generation of physicians, a
313
00:19:18.665 --> 00:19:22.440
gap in the training during this time. Okay. But what
314
00:19:22.440 --> 00:19:25.880
what they found is that women were continuing to have these symptoms and they were
315
00:19:25.880 --> 00:19:29.399
not being treated, and nobody was listening. Yeah. So they said,
316
00:19:29.399 --> 00:19:33.159
well, you know, as as more women entered the workforce as well and we
317
00:19:33.159 --> 00:19:36.934
wanted better care for ourselves, then we looked and they said, let's look
318
00:19:36.934 --> 00:19:40.775
at this study. What was about that study that caused this abnormality that
319
00:19:40.775 --> 00:19:44.375
we did not predict? Right. Well, what they found is that the average woman
320
00:19:44.375 --> 00:19:48.140
entering that study was age 65. Oh, Oh, they didn't even bother
321
00:19:48.140 --> 00:19:51.020
with the thirties and the forties and the fifties. So what they found is that
322
00:19:51.020 --> 00:19:54.539
we know that once you reach a certain age, age alone will make your
323
00:19:54.539 --> 00:19:58.140
vessels rigid and if you have, risk for cardiovascular disease and you're
324
00:19:58.140 --> 00:20:01.945
forming plaques, adding estrogen to that Yeah. Is going to make those
325
00:20:01.945 --> 00:20:05.565
unstable and increase the stroke. But when they looked at younger women,
326
00:20:05.705 --> 00:20:09.325
women in their fifties, like within the 1st 10 years of reaching menopause,
327
00:20:09.785 --> 00:20:12.845
they actually found lower mortality
328
00:20:13.385 --> 00:20:16.090
rates for all across the board.
329
00:20:17.030 --> 00:20:20.790
So then more studies came along to actually look at,
330
00:20:21.030 --> 00:20:24.630
the benefits of hormone replacement therapy. So the more we
331
00:20:24.630 --> 00:20:28.470
learn about it, the more we are willing to prescribe it and educate the newer
332
00:20:28.470 --> 00:20:32.184
generation of physicians. That is what's so frustrating about the medical industry is the
333
00:20:32.184 --> 00:20:35.565
fact that these studies, they depend so much on the design.
334
00:20:36.025 --> 00:20:39.784
And we, as laypeople Mhmm. Can't really dig into that. And we don't know. And
335
00:20:39.784 --> 00:20:42.845
so we're at the mercy of everyone doing their homework. Absolutely.
336
00:20:44.810 --> 00:20:48.190
Are there any so, well, let me go back to treatments before I move on.
337
00:20:48.410 --> 00:20:51.950
So talk briefly on the types of treatments and hormone
338
00:20:52.010 --> 00:20:55.770
therapy. Like, what do these look like? Yeah. The hormone replacement therapy is
339
00:20:55.770 --> 00:20:59.525
very beneficial. And again, as I mentioned that the estrogen and progesterone
340
00:20:59.665 --> 00:21:03.184
effects not only biologically as the symptoms, but also
341
00:21:03.184 --> 00:21:06.885
psychologically. So for women that are having issues like
342
00:21:07.184 --> 00:21:09.684
increased anxiety, premature dysphoric syndrome,
343
00:21:10.750 --> 00:21:14.590
ADHD, they can actually benefit from being
344
00:21:14.590 --> 00:21:17.809
on hormone replacement therapy. Right. That may be another
345
00:21:18.270 --> 00:21:21.870
adjunct to whatever is their treatment currently, and that may be
346
00:21:21.870 --> 00:21:24.850
beneficial for them as they're going through these transition years.
347
00:21:25.544 --> 00:21:29.384
There are multiple combination of hormone replacement therapy, but when I
348
00:21:29.384 --> 00:21:33.225
explain it to my patient, I said there's systemic hormone replacement therapy, and
349
00:21:33.225 --> 00:21:36.904
then there's a local, hormone therapy. The
350
00:21:36.904 --> 00:21:40.000
systemic therapy is your whole body sees it. So it's like a pill or something?
351
00:21:40.080 --> 00:21:43.840
A pill. It's a patch. It's gels. And if you
352
00:21:43.840 --> 00:21:47.200
have a uterus, you need progesterone for, to help
353
00:21:47.200 --> 00:21:50.900
with maintaining the lining of the uterus to decrease the risk for
354
00:21:50.960 --> 00:21:54.575
endometrial cancer. Oh, yeah. But if for women that do not have a uterus,
355
00:21:54.795 --> 00:21:58.395
then you can just use estrogen alone. Got it. There are some women that have
356
00:21:58.395 --> 00:22:02.235
contraindications, and they should discuss with their providers whether they're
357
00:22:02.235 --> 00:22:06.075
candidates for that. With the local therapy, it can help with,
358
00:22:06.075 --> 00:22:09.670
like, those genital urinary symptoms. Yeah. And that's local
359
00:22:09.670 --> 00:22:13.050
estrogen. It can be given effectively without progesterone
360
00:22:13.510 --> 00:22:17.270
because it's not systemically absorbed. I see. There are other hormone
361
00:22:17.270 --> 00:22:21.110
therapy in the market that are local, like DHEA is one of
362
00:22:21.110 --> 00:22:24.625
them that, is a steroid that converts into estrogen and
363
00:22:24.625 --> 00:22:28.465
testosterone locally in the vaginal tissue. Okay. So are you putting this in like
364
00:22:28.465 --> 00:22:32.145
a gel inside your vagina? It's like a little bullet. Yeah. It's like a little
365
00:22:32.304 --> 00:22:35.745
Like a suppository. Yeah. It's suppository. Yes. And then there's a
366
00:22:35.745 --> 00:22:39.490
ring. There's gels. There's different combinations. Okay. But
367
00:22:39.490 --> 00:22:43.010
talking about non hormonal therapy because there's other women that
368
00:22:43.010 --> 00:22:46.630
cannot have hormones or do not want to have hormones,
369
00:22:47.090 --> 00:22:50.929
and there's other options as well. There's non hormonal options to manage
370
00:22:50.929 --> 00:22:54.605
depending on what their symptoms are. Yeah. There is a newer
371
00:22:54.605 --> 00:22:57.664
medication that helps with hot flashes and is non hormonal,
372
00:22:58.365 --> 00:23:01.885
specifically targets the part of the brain that is responsible for
373
00:23:01.885 --> 00:23:04.784
thermoregulation. Yeah. And there is other
374
00:23:05.530 --> 00:23:08.750
non hormonal medications like antiepileptic medications.
375
00:23:09.690 --> 00:23:13.130
There are the medication in the the SSRI or SNRI, the
376
00:23:13.130 --> 00:23:16.809
antidepressant medication group. Okay. So you have a lot of choices. We have choices,
377
00:23:16.809 --> 00:23:20.410
and it tailors to what the most bothersome symptoms are to
378
00:23:20.410 --> 00:23:23.237
you. And our grandmothers would love to hear this. They would love to be have
379
00:23:23.237 --> 00:23:24.677
been a part of it today. Today. Yes. Just like we're gonna wanna be a
380
00:23:24.677 --> 00:23:28.265
part of our our daughter's future. I wanna talk about diet. Mhmm. Is,
381
00:23:29.285 --> 00:23:31.545
is there any diet recommendations you can make for
382
00:23:34.820 --> 00:23:38.580
someone going through perimenopause? Yes. What is proven scientifically to
383
00:23:38.580 --> 00:23:42.340
be most beneficial is Mediterranean diet and diet that
384
00:23:42.340 --> 00:23:45.860
focuses on lean and plant based proteins. Okay. Okay.
385
00:23:45.860 --> 00:23:49.575
Great. This is probably my last question. When it comes to determining whether or
386
00:23:49.575 --> 00:23:53.355
not you are in perimenopause, is there a blood test
387
00:23:53.495 --> 00:23:56.875
that you can use? That's a good question. So we typically
388
00:23:57.015 --> 00:24:00.475
clinically diagnose somebody based on age and their menstrual
389
00:24:00.615 --> 00:24:04.060
history. However, there is a group of women that,
390
00:24:04.380 --> 00:24:08.220
either have a hysterectomy or they have an endometrial ablation or they have an
391
00:24:08.220 --> 00:24:11.820
IUD and they've not had a period. Mhmm. There are a couple of hormones that
392
00:24:11.820 --> 00:24:15.420
we can check, the antimalirian hormone, which is the hormone that, is
393
00:24:15.420 --> 00:24:18.934
released by the early growth of the follicles. Mhmm.
394
00:24:19.315 --> 00:24:23.075
And when it reaches undetectable levels, we know that a woman is
395
00:24:23.075 --> 00:24:26.915
in menopause Okay. Or the follicle stimulating hormone. But again, those are
396
00:24:26.915 --> 00:24:30.355
more helpful in women that are 48 years old or
397
00:24:30.355 --> 00:24:33.940
older. Right. But you're saying that you can detect menopause. Can you detect
398
00:24:33.940 --> 00:24:37.320
perimenopause? Not accurately.
399
00:24:39.059 --> 00:24:42.660
Great. There's not a particular test that says But it's all it's
400
00:24:42.660 --> 00:24:46.495
mostly you have to sit with your doctor and to go through your symptoms. Mhmm.
401
00:24:46.495 --> 00:24:50.014
And how can you get, like, how do you get your doctor to talk about
402
00:24:50.014 --> 00:24:53.215
these things? Because I know when I went to my doctor the last time, she
403
00:24:53.615 --> 00:24:56.815
first time ever, do you still get your period? And that was all that was
404
00:24:56.815 --> 00:25:00.150
mentioned. It was the nurse. They never gave me any real, like, do you wanna
405
00:25:00.150 --> 00:25:03.510
talk about what's going on? Have you noticed any of these types of things? Like,
406
00:25:03.510 --> 00:25:07.270
is there any kind of work going towards doctors just to be better
407
00:25:07.270 --> 00:25:10.950
doctors when it comes to women in perimenopause? There is
408
00:25:10.950 --> 00:25:14.435
more awareness amongst us and a lot of us are trying to reeducate
409
00:25:14.495 --> 00:25:17.955
ourselves about all of this, new research that's ongoing.
410
00:25:18.175 --> 00:25:21.555
But another thing that I do want to mention to patients,
411
00:25:21.935 --> 00:25:25.375
and and women in general is that, you know, empower
412
00:25:25.375 --> 00:25:29.130
yourself. If you have symptoms, don't just mention
413
00:25:29.130 --> 00:25:32.970
them at the end of the visit. That's very important because
414
00:25:32.970 --> 00:25:36.750
a lot of times women are too shy or I don't know why they don't,
415
00:25:37.370 --> 00:25:41.210
you know, talk about their symptoms and some of them might feel like it's
416
00:25:41.210 --> 00:25:44.245
in their head or they're made to feel like it's in their head. Well, the
417
00:25:44.245 --> 00:25:48.005
doctor comes in and is typically, like, getting to business. You know, you
418
00:25:48.005 --> 00:25:51.445
come in, and it's pretty quick. And so you feel like they gotta get their
419
00:25:51.445 --> 00:25:55.049
job done first before they get you can get to your questions. You're saying when
420
00:25:55.049 --> 00:25:58.409
you get when the doctor walks in and say, let's talk before anything starts. Yeah.
421
00:25:58.409 --> 00:26:01.769
Absolutely. Allowed to tell them what to do. You're paying them. You are allowed to.
422
00:26:01.769 --> 00:26:05.529
You're that's why you're there. They're there to educate you. But, also, do
423
00:26:05.529 --> 00:26:09.225
not have other problems and then all of a sudden at the end of
424
00:26:09.225 --> 00:26:12.505
the visit, you mention, oh, but I have this and this and this. You don't
425
00:26:12.505 --> 00:26:16.265
make it an a point to actually discuss your symptoms,
426
00:26:16.265 --> 00:26:19.945
only your symptoms. Like, just go for it. Oh, just go make an appointment just
427
00:26:19.945 --> 00:26:23.179
to talk about that. Right. I have a lot of patients. Now that there's more
428
00:26:23.179 --> 00:26:26.779
awareness, a lot of my patients come in for menopausal symptoms or
429
00:26:26.779 --> 00:26:30.460
perimenopausal symptoms. Lots of that. Yeah. Just about that. And I think that's
430
00:26:30.460 --> 00:26:33.899
what it needs to be. There needs to be advertising for that. I'm sorry.
431
00:26:33.899 --> 00:26:37.065
Marketing needs to go into the fact that you know, you can just go to
432
00:26:37.065 --> 00:26:40.525
your doctor and you can just talk to them and ask them questions. Absolutely.
433
00:26:40.985 --> 00:26:44.825
And and your gynecologist will pick up on based on,
434
00:26:44.825 --> 00:26:48.640
as I mentioned clinically, part of the vital signs for
435
00:26:48.640 --> 00:26:52.080
a woman in a gynecologist's office is your menstrual
436
00:26:52.080 --> 00:26:55.760
cycle. Okay. And that will tell us quite a bit Okay. Of where you are
437
00:26:55.760 --> 00:26:58.880
in that space. Your calendar, and don't forget, like I do every time, when was
438
00:26:58.880 --> 00:27:01.765
your last period? Darn it. I knew I was supposed to look that up. Thank
439
00:27:01.765 --> 00:27:05.044
you so much. This has been you. Last time you came with menopause, I learned
440
00:27:05.044 --> 00:27:08.245
a ton. Didn't think I could learn anymore. And what was I thinking? Of course,
441
00:27:08.245 --> 00:27:12.085
I could. Thank you so much. Thank you for having me. Isn't
442
00:27:12.085 --> 00:27:15.470
doctor Kennedy just the best? She was also our guest on the
443
00:27:15.470 --> 00:27:19.149
menopause episode at the end of season 1. Check it out. It's
444
00:27:19.149 --> 00:27:22.450
an awesome episode. You can find out about her and WakeMed
445
00:27:22.510 --> 00:27:26.190
Women's at wakemed.org. Please share this episode with
446
00:27:26.190 --> 00:27:29.565
someone who needs to hear it. If you or your friends are in the
447
00:27:29.565 --> 00:27:33.405
perimenopause zone with me, you're probably already talking
448
00:27:33.405 --> 00:27:37.245
about it. Hit the share button on your podcast player and pass it on.
449
00:27:37.245 --> 00:27:38.305
See you next time.
