Perimenopause! Are you kidding me with these symptoms?

0:00 Hey, guys. Welcome to Sarah has questions. Today, we're talking about perimenopause. If you're in it, you know it. It has every symptom under the sun, and yet there's not really a diagnosis for it. Why is that? What's the deal? Let's talk about perimenopause. I have a ton of questions. Let's get into it. I'm Sarah King, and I have a lot of questions. What exactly happens when you orgasm physically? Will popping a knuckle or a joint give us arthritis? What can we learn from our poop? The size of your body doesn't necessarily indicate your measure of health. Yes. And what are your thoughts on that? Cleansing. Do we need to do anything special to our nether regions? In this show, I get to ask all these questions to WakeMed doctors who happen to know everything about everything. Sarah has questions is a production of Capital Broadcasting Company and Mix 101.5.

0:53 It's presented by WakeMed. Today, I'm so excited for this episode, because we're talking perimenopause. And as a 47 year old woman, I know a lot about perimenopause. Today's doctor is Amantia Kennedy. You are a OBGYN for WakeMed. Thank you so much for coming in today. Thank you for having me. And you came in before and talked menopause. I sure did. And so now we're gonna talk about perimenopause. And the thing about perimenopause that gets me is you feel like you're making it up. Mhmm. You know? Like, there and we'll get into the details of this a bit later, but there are so many symptoms. Mhmm. And there are days where you wake up and I'm like, oh, did I just not get enough sleep or is my my brain deceiving me and making me a forgetful person? Mhmm. You know, am I not sleeping because I drank too much coffee?

1:41 Like, you don't know. And then you go to your doctor and they're just like, oh, it's you get dismissed. Mhmm. So let's just start from the very beginning. Yes. What the hell is perimenopause? Perimenopause is the menopausal transition. It's the years leading up to menopause and it's defined by low ovarian functions. So during this time, there's a lot of fluctuations in the hormones that happen. Okay. So that's why we're gonna talk about how these hormones affect us. How does perimenopause differ from menopause? The perimenopause is the years leading to menopause. Okay. It's not it and it's it ends after 12 months of no periods and then you reach the menopause. So the until the final menstrual period. Okay. That's when it ends. So what would be a typical age to start perimenopause?

2:28 So again, I want to emphasize that perimenopause is not menopause. It's the the years leading up to menopause. Right. And it ends with the final menstrual period. So women can enter this transition phase as early as thirties. Yeah. And but majority of them will enter it in their forties. Okay. The median age for a woman entering this stage is 47 in the United States. Okay. And how do you know that you're entering in? Like, what what are the signs of I'm now in the perimenopausal state? So because there's fluctuations in the sex hormones, estrogen and progesterone, particularly, which are the hormones released by the sex hormones, estrogen and progesterone particularly, which are the hormones released by the ovary, women will experience abnormalities in their menstrual cycle.

3:13 And, we actually have two phases of this menopausal transition or perimenopause, the early stage and then the late stage. The early stage during this time, women will start to experience some irregularities with their periods. Sometimes in the very early stages, they may have more frequent cycles. Mhmm. And then they're followed by more sparse, spaced out cycles by more than 7 days, in length apart. And then that is followed by maybe you can skip a month or so. And then the and they enter the late stage when they're starting to skip more than 60 days. Okay. So 2 months. Once you skip 2 months, you're you're getting closer to actually getting to the land of promise, the Yes. No period land, which sounds awesome. And we do we can predict that when women enter this late stage of the perimenopause, they will achieve their final menstrual period within 2 to 3 years. Oh, interesting. Okay. Alright. Well and so let me ask you this.

4:11 If, when you say skip a period, does that mean no blood at all or just a very little amount of blood? Skip a period means no blood. At all. Mhmm. Okay. We'll be right back because you know I have more questions. I wanna go through the symptoms or maybe and you can tell me this is the part that blows my mind. So maybe you can shed some light on why this is happening. Okay? Yeah. So, and and please add your own because there's just so many, and I don't understand why there are so many. But we'll start with number the first one, which is brain fog. Why is brain fog associated with it? And, honestly, how can you tell the difference between brain fog and not enough sleep? Like, it's just so ambiguous. Mhmm. Yeah. Absolutely. Brain fog is actually a very common symptoms of, perimenopause and up to 40 to 60% of women will experience this. And it's a collection of cognitive symptoms like forgetfulness, difficulty focusing or concentrating, losing objects, difficulty recalling names or verbs, or I can't think of the the the word. The worst. Yes. So it happens because, the fluctuations of the hormones, estrogen and progesterone, we know FX has receptors in the brain Okay. And there's part of the brains that get affected by this, including neurotransmitters, and we're gonna talk about that a little bit later.

5:37 Okay. But, women have this think of it as a computer getting a reboot and they they're just not processing the information as quickly as they used to. Okay. When they when they were when women were tested with actual formal tests, they did score a little bit lower on, attentiveness, concentration, and, verbal recalling Mhmm. But they did not have a decrease in higher cognitive functions like strategic thinking. So you don't lose intelligence? You do not lose intelligence. Gotcha. Well, that's good to know. Yes. And does it ever come back? Does the brain fog ever, like, go out to sea, basically? Good news. It does. It reverses. Good. That's awesome. Once we reach menopause, it does reverse for most women.

6:19 So we really are kinda getting a reboot. We are. Think of it as a reboot reboot. And our brains are plastic. They go through different changes based on our experiences, and they're always changing. Weight gain is another symptom. Gaining in and of itself is one symptom, but why is it always in the belly? Yes. That's called adipose, fat tissue and that is, because as we transition into this phase and we're having these fluctuations in the hormones, let's not forget we're also aging. Mhmm. And that in itself can cause decrease in, muscle mass. And as I've mentioned before, muscle is the largest organ of energy expenditure. And so when you have when we're inactive, like, we don't diet or exercise, or even when we do diet and exercise because a lot of times women will say, I am doing everything I did before and I cannot lose weight. I'm actually gaining weight. Oh, girl. That's me. During this transition phase, though, because of the lack of estrogen, and estrogen does have receptors in the muscle Mhmm. We have an acceleration of, this energy net deficit that we are or actually net gain. So we are gaining more weight than we're losing the weight because of the muscle mass is is we're rapidly, decreasing that.

7:33 It stabilizes in the menopausal years, but especially during this transition phase when we're having this hormone, decline Mhmm. It's a little bit more rapid. So we're starting to get, more more weight. And so it's super important to keep the muscle then. Yes? Yes. And that's when we highly recommend strength training exercises. Okay. Which is not only beneficial for your cardiovascular function, it's beneficial for maintaining the muscle mass. Yeah. Because remember, even Arnold Schwarzenegger, he's going to lose some muscle mass as he ages. But he had a lot to start with. He had a lot to start with for sure. Which is what you're saying. You know? The more you have and the more you then you can lose and it won't be as detrimental. And the goal for, strength training exercises is to maintain the muscle mass so you don't lose it as rapidly during this phase.

8:20 I see. Okay. Next up, we have sore joints. Yes. So it's real. It is real. I I well, I find as I'm going through this perimenopausal state that it's only certain weeks Right. Which is really interesting. Why is that? It's again, we talk about fluctuations of the hormones. Each cycle will be different. It's a it's a time of a chaos in our body. So some months, you may have more estrogen than other months. And when you have less estrogen in your body and estrogen has receptors all over our body, including our joints. Yeah. It it does affect, our joints. So am I feeling inflammation there or am I feeling lack of fluid? No. It's inflammation.

9:02 Okay. So would an anti inflammatory diet help with this? Absolutely. Okay. Alright. Itchy skin. Some women complain of itchy skin. Does that I mean, is this something that is real or are they making it up? They just need some lotion. No. It's real because as we do age, our skin, gets thinner. Mhmm. And actually, we do have estrogen receptors on our skin as well. Estrogen's everywhere. Everywhere. And so women will have drier skin and thinner skin. So it can some women can have a little bit more exacerbation, of the symptoms than others. Mhmm. And everybody's different. Not everybody's gonna have all the symptoms at once, but dry skin is one of the Okay.

9:46 Complaints. Yeah. For sure. And there's also I'm reading our my producer put this list together and I'm reading through this and here's one. Bugs crawling on you. Some people get the sensation of bug is that have you heard of that before? I have heard of it before and some women have a like, it's not as common. Yeah. I'll say that. But it goes with the dry skin. I would think it's got something to do with your nerves as well because it you know, the the ends. Well, it has to do with, like, you know, with hot flashes, which is a very common symptom Yes. Has to do with vasodilation Okay. Of the blood, like, the little capillaries. So that could be part of of it as well. Feels that way. Mhmm. Okay. This is one I have, phantom smells. I'll smell stuff and no one else will smell it, and this has all started in the past 5 years. Yeah. Have you ever heard of that? I have heard of that.

10:35 And, you know, actually, I heard one woman saying that she heard she smelled like there was smoke in her house and then she would go to her children's room and her adolescent, like, did you smoke? And they're like, no. We didn't. We are not smokers. But, but it it is. Do we understand it all? We don't. We have so much ongoing research as we speak Oh, I bet. Regarding, a lot of the symptoms because, you know, as women, we we do demand more research and we do demand some answers to to better, help our lives for sure. I have just recently heard that even in rat studies, they didn't study female rats. Can you what? You know, it was in 1987 that FDA required researchers to actually study drugs in women Yikes. Only. Everything was based on male studies as well. Chihuahua. So and it that was we were alive, both of us. Yes. So yeah. I was in elementary school that I it makes my blood boil. If I mean, were they curious? Were we that confusing to them that they thought they just couldn't figure it out? Like, that says a lot. Well, either confusing or not important. I don't know. Or they they do those things. I don't know. Does it make your blood boil? It does a little bit. Oh, it makes mine really. I mean No. It does a lot. Okay.

11:51 Thank you. Let's be real. You're mad. We're all mad. Oh, yeah. But but the good news is that there's so much ongoing research. More is coming. That's what makes me excited for our daughters. Yes. Because when they enter into menopause, it's going to be a different world. Because by that time, we'll have another decade or so. I well, actually, numerous decades of research, and they'll be the beneficiaries of it. And then that's exciting. And I think what our generation's big thing is is we need to just bring awareness to them that they don't let yourself be dismissed. Absolutely. That's so important. That's an important message. And we were talking about this next symptom. We I've got 2 more, that you've mentioned that you have issues with. I don't because I would do a morning show at 4 AM every day. So it's sleeping issues. I never have a problem falling asleep, but I know a lot of women experience, insomnia.

12:44 Absolute. This is actually when they studied the 4 most common symptoms of the menopausal transitions. Yeah. Half flashes, night sweats, difficulty sleeping Uh-huh. Which include insomnia Uh-huh. Genital urinary symptoms. Oh, like a leaking. Not only leaking, but, vaginal itching, dryness, painful sex, etcetera. Okay. Urinary tract infections, etcetera, but also mood changes, irritability, anxiety, depression. So those were the 4 most common symptoms. So let's talk about insomnia. Yeah. It's a very common complaint and actually can be quite, distressing for a lot of women because lack of sleep can cause, irritability the next day, can cause decreased focusing and concentration, so your your coping mechanisms are diminished as well. But, we know that estrogen has, receptors in the brain. We know that it it affects parts of the brain that control, some of these circadian rhythms. Okay. So a lot of times, women will suffer from insomnia.

13:48 You were saying that, off off air, you were saying that that the they're trying to pull estrogen from places. What were you saying with that? So what what our brain does when we're kinda going into this decline of ovarian function, because that's what perimenopause is, our brain, in order to compensate for it, starts to express some more receptors for estrogen so that it tries to catch as much as it can. So it creates more receptors. It creates more receptors. Oh, it's kinda like an alcoholic. Whenever they have too much alcohol, they they create more receptors. And then when they don't get it, they get crazy. Right. So they do. They it is trying. Our brain is trying to compensate for it, but there is always decline, decline, decline. Right. So a lot of times, women will suffer from insomnia, and it's a very common distressing symptom. Yeah. It's miserable. I mean, not being able to sleep has to be miserable.

14:32 Yes. So would So would is the same thing at play here when it comes to mood and the mood swings? Absolutely. We, know that estrogen also affects the neurotransmitters like serotonin and dopamine. Mhmm. And when you have less serotonin production in our symptoms I mean, in our system Mhmm. Then we feel more depressed. We're in more depressed mood. Oh, that honestly, like, I I'm reading through this and it seems like a long list, but I have a lot of these. A lot of women have them. Yeah. Yeah. And it's not, like, every day. Mhmm. And that's what makes it so frustrating. It's like it's some days you feel normal, and then some days you don't. And you're like, where is this coming from? Right. And a lot of women feel alone in this.

15:16 Like, is it is it me? Am I going through What's going on? Exactly. Exactly. Last symptom is decreased libido. Yes. Remember, estrogen and progesterone are sex hormones. So naturally, when we have a decline in our sex hormones, we also have a decline in our libido. But, as we talk to women, libido is very complex for us women. It's not just physical, it's also psychological. So it's important to address how they're feeling, how they're doing. What we know now is that, you know, as women, we take on our lives as adults and we compensate and kinda suppress some of of the things that are a nuisance to us. But as we're going through this transition and we're having this depletion of our sex hormones, we don't have those coping mechanisms that we used to and all of a sudden, we can't we we don't feel like taking on any more emotional, burden for us and we don't feel like taking on the slack, of our partners, for instance. Oh, yeah. Picking up socks. So exactly. Things that didn't bother us before. Yeah. But all of a sudden, it puts you in a rage state. It does. And and the thing is it can be very confusing for the partner as well because, you know, they also feel rejected or they feel that they I don't know this person anymore. Like, who are you? Right. But I think that during this time, it's very important to have an open communication with your partner so that you can have the support.

16:45 Also, with the low libido, and as I mentioned before, during this transition times, we also have genitourinary symptoms, and that includes vaginal itching, vaginal dryness. And sometimes sex feels like a sandpaper. A lot of times, women will describe it as. And so when you're not when you're not feeling good and then physically you're also not feeling good, then you're not feeling like you need to be an intimate. Yeah. But what I do want to encourage women that are listening right now is that there is help. You know? Being miserable is optional at this point. There are many options that treat the symptoms. And also, there's not just one medication can help at all. It can be a multi, system treatment. It may involve more than just one physician. Okay. I've this you made me think of 2 further questions. 1, your partner, yes. Mhmm. You know, talk to your partner and let them know where you are and all those things. What about colleagues at work? Like, this is gonna affect your work. And that's the for me, that's that's the hard part because you're like, I don't know why I can't remember anything today. You know? So do you have any suggestions for those moments? Well, I think that the more we talk about this and the more awareness there is, I think the more grace it will be in the work place as well. And I think that the more women talk about it, you know, I I bet you if you talk to one of your colleagues that is the same age as you are, they will completely understand. My female colleagues get it. Female colleagues will get it.

18:11 But, you know, as we're bringing our partners during this discussion That's a good point. And educating them as well. That is a good point. Partners, they will be more understanding because they have that at home. Yeah. They it's the old adage, you, educate women, you educate the world. Exactly. Because we educate everybody. Agreed. And then you're saying there's treatments. Hormone replacement therapy got a real bad rap in the nineties. And I know there's politics and all kinds of stuff behind. I think, in fact, PBS is coming out with a special on menopause and the whole hormone replacement therapy. So is it good or bad? So in the nineties, you're right. They did do women's health initiative. They did do a large study where they included a lot of women and they thought if we give them hormone replacement therapy, it will help their cardiovascular function. What they found, and they stopped the study early, is that actually they increased the rates for stroke, so they stopped the studies. So as soon as media got a hold of that, then everybody, took it off the market, and nobody wanted to prescribe it anymore.

19:14 Right. And, actually, we had a a generation of physicians, a gap in the training during this time. Okay. But what what they found is that women were continuing to have these symptoms and they were not being treated, and nobody was listening. Yeah. So they said, well, you know, as as more women entered the workforce as well and we wanted better care for ourselves, then we looked and they said, let's look at this study. What was about that study that caused this abnormality that we did not predict? Right. Well, what they found is that the average woman entering that study was age 65. Oh, Oh, they didn't even bother with the thirties and the forties and the fifties. So what they found is that we know that once you reach a certain age, age alone will make your vessels rigid and if you have, risk for cardiovascular disease and you're forming plaques, adding estrogen to that Yeah. Is going to make those unstable and increase the stroke. But when they looked at younger women, women in their fifties, like within the 1st 10 years of reaching menopause, they actually found lower mortality rates for all across the board.

20:17 So then more studies came along to actually look at, the benefits of hormone replacement therapy. So the more we learn about it, the more we are willing to prescribe it and educate the newer generation of physicians. That is what's so frustrating about the medical industry is the fact that these studies, they depend so much on the design. And we, as laypeople Mhmm. Can't really dig into that. And we don't know. And so we're at the mercy of everyone doing their homework. Absolutely. Are there any so, well, let me go back to treatments before I move on. So talk briefly on the types of treatments and hormone therapy. Like, what do these look like? Yeah. The hormone replacement therapy is very beneficial. And again, as I mentioned that the estrogen and progesterone effects not only biologically as the symptoms, but also psychologically. So for women that are having issues like increased anxiety, premature dysphoric syndrome, ADHD, they can actually benefit from being on hormone replacement therapy. Right. That may be another adjunct to whatever is their treatment currently, and that may be beneficial for them as they're going through these transition years.

21:25 There are multiple combination of hormone replacement therapy, but when I explain it to my patient, I said there's systemic hormone replacement therapy, and then there's a local, hormone therapy. The systemic therapy is your whole body sees it. So it's like a pill or something? A pill. It's a patch. It's gels. And if you have a uterus, you need progesterone for, to help with maintaining the lining of the uterus to decrease the risk for endometrial cancer. Oh, yeah. But if for women that do not have a uterus, then you can just use estrogen alone. Got it. There are some women that have contraindications, and they should discuss with their providers whether they're candidates for that. With the local therapy, it can help with, like, those genital urinary symptoms. Yeah. And that's local estrogen. It can be given effectively without progesterone because it's not systemically absorbed. I see. There are other hormone therapy in the market that are local, like DHEA is one of them that, is a steroid that converts into estrogen and testosterone locally in the vaginal tissue. Okay. So are you putting this in like a gel inside your vagina? It's like a little bullet. Yeah. It's like a little Like a suppository. Yeah. It's suppository. Yes. And then there's a ring. There's gels. There's different combinations. Okay. But talking about non hormonal therapy because there's other women that cannot have hormones or do not want to have hormones, and there's other options as well. There's non hormonal options to manage depending on what their symptoms are. Yeah. There is a newer medication that helps with hot flashes and is non hormonal,

22:58 specifically targets the part of the brain that is responsible for thermoregulation. Yeah. And there is other non hormonal medications like antiepileptic medications. There are the medication in the the SSRI or SNRI, the antidepressant medication group. Okay. So you have a lot of choices. We have choices, and it tailors to what the most bothersome symptoms are to you. And our grandmothers would love to hear this. They would love to be have been a part of it today. Today. Yes. Just like we're gonna wanna be a part of our our daughter's future. I wanna talk about diet. Mhmm. Is, is there any diet recommendations you can make for someone going through perimenopause? Yes. What is proven scientifically to be most beneficial is Mediterranean diet and diet that focuses on lean and plant based proteins. Okay. Okay.

23:45 Great. This is probably my last question. When it comes to determining whether or not you are in perimenopause, is there a blood test that you can use? That's a good question. So we typically clinically diagnose somebody based on age and their menstrual history. However, there is a group of women that, either have a hysterectomy or they have an endometrial ablation or they have an IUD and they've not had a period. Mhmm. There are a couple of hormones that we can check, the antimalirian hormone, which is the hormone that, is released by the early growth of the follicles. Mhmm. And when it reaches undetectable levels, we know that a woman is in menopause Okay. Or the follicle stimulating hormone. But again, those are more helpful in women that are 48 years old or older. Right. But you're saying that you can detect menopause. Can you detect perimenopause? Not accurately.

24:39 Great. There's not a particular test that says But it's all it's mostly you have to sit with your doctor and to go through your symptoms. Mhmm. And how can you get, like, how do you get your doctor to talk about these things? Because I know when I went to my doctor the last time, she first time ever, do you still get your period? And that was all that was mentioned. It was the nurse. They never gave me any real, like, do you wanna talk about what's going on? Have you noticed any of these types of things? Like, is there any kind of work going towards doctors just to be better doctors when it comes to women in perimenopause? There is more awareness amongst us and a lot of us are trying to reeducate ourselves about all of this, new research that's ongoing. But another thing that I do want to mention to patients, and and women in general is that, you know, empower yourself. If you have symptoms, don't just mention them at the end of the visit. That's very important because a lot of times women are too shy or I don't know why they don't, you know, talk about their symptoms and some of them might feel like it's in their head or they're made to feel like it's in their head. Well, the doctor comes in and is typically, like, getting to business. You know, you come in, and it's pretty quick. And so you feel like they gotta get their job done first before they get you can get to your questions. You're saying when you get when the doctor walks in and say, let's talk before anything starts. Yeah.

25:58 Absolutely. Allowed to tell them what to do. You're paying them. You are allowed to. You're that's why you're there. They're there to educate you. But, also, do not have other problems and then all of a sudden at the end of the visit, you mention, oh, but I have this and this and this. You don't make it an a point to actually discuss your symptoms, only your symptoms. Like, just go for it. Oh, just go make an appointment just to talk about that. Right. I have a lot of patients. Now that there's more awareness, a lot of my patients come in for menopausal symptoms or perimenopausal symptoms. Lots of that. Yeah. Just about that. And I think that's what it needs to be. There needs to be advertising for that. I'm sorry. Marketing needs to go into the fact that you know, you can just go to your doctor and you can just talk to them and ask them questions. Absolutely.

26:40 And and your gynecologist will pick up on based on, as I mentioned clinically, part of the vital signs for a woman in a gynecologist's office is your menstrual cycle. Okay. And that will tell us quite a bit Okay. Of where you are in that space. Your calendar, and don't forget, like I do every time, when was your last period? Darn it. I knew I was supposed to look that up. Thank you so much. This has been you. Last time you came with menopause, I learned a ton. Didn't think I could learn anymore. And what was I thinking? Of course, I could. Thank you so much. Thank you for having me. Isn't doctor Kennedy just the best? She was also our guest on the menopause episode at the end of season 1. Check it out. It's an awesome episode. You can find out about her and WakeMed Women's at wakemed.org. Please share this episode with someone who needs to hear it. If you or your friends are in the perimenopause zone with me, you're probably already talking about it. Hit the share button on your podcast player and pass it on.

27:37 See you next time.