Perimenopause - ALL THE THINGS

We're going to discuss what is perimenopause. 

We're going to discuss, what are perimenopausal symptoms, could I potentially be in perimenopause? 

And then I've got a bit of sexy research for you at the end. I know that you think research can't be sexy, but wait, I'm gonna prove you wrong. 

The information shared in this podcast does not substitute working with your primary health care provider; it is general in nature and not considered personalised advice.

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thehollandclinic.com

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Transcript

Dr Kirstey Holland: 0:00

I'm so delighted to have you here to discuss all things, Peri. We're going to discuss what is perimenopause. We're going to discuss, what are perimenopausal symptoms, could I potentially be in perimenopause? And then I've got a bit of sexy research for you at the end. And I know that you think research can't be sexy, but wait, I'm gonna prove you wrong. My name's Dr. Kirsty Holland. I'm the founder and principal practitioner of the Holland Clinic in Melbourne, Australia, and I'm absolutely delighted to be helping woman over the age of 35 rescue themselves from this crazy rollercoaster of peri menopause. Let's get started. Little bit of a medical disclaimer. Of course, I'm not your medical doctor. This relationship really needs to be one-on-one. It's really important for you to find a practitioner that you trust and adore and you need to know that your praccy knows what you're talking about. You need to be seen, you need to be heard. And and of course you want them to have some credentials. I think it's imperative for you to have a really good relationship with people that are taking care of things that mean most to you. I mean, people's health impacts every single aspect of their lives. The women in my clinic tell me so much about the fact that you know, their health impacts, their parenting. Their relationships and of course their professional lives too. So it's so important to have that intact, and particularly in perimenopause, you know, that mum agro really impacts our kids from time to time. And I know a lot of the women in my clinic come in talking to me about the relationship agro, I dunno about you, but many of the women share those stories about you know, I asked you to take out the bin, damnit, you know? And yeah, we, we wanna enjoy our children and we want our children to enjoy us. We certainly don't want to be frazzled and exhausted and feel like we've got nothing left in the tank when it gets to the end of the day around them. So, topics for today, frequently asked questions. Just the very, very basics, you know, what is perimenopause? What happens in perimenopause? What are perimenopausal symptom? You know, I know I see so many women in my clinic who are blatantly perimenopausal and, you know, we're still confused. And it's so interesting, like I was discussing with a a perimenopausal journalist who has been a journalist for 25 years, and she was shocked by the fact that she was in perimenopause when it finally came home to roost for her. And believe it or not, I've been treating perimenopausal women. For 23 years in my clinic in Melbourne, Australia. And when I started to experience exacerbated anxiety, at one point I thought it was all of the stresses in my life. But when I looked at, when I looked around you know, life has been pretty tricky and and pretty stressful. Being a, a single mum for the last 13 years, and my stressors hadn't necessarily changed, but I started to experience this real physical. So sometimes it's really nuanced, you know, these, these menopausal symptoms. And I was like, oh, hang on. This is the progesterone deficiency anxiety. This isn't just the, you know there are lots of different kinds of anxiety. Let me not downplay this. Ellen Vora, who wrote the book, the the Physiology of Anxiety. I think that's what it's called. Don't quote me. Absolutely brilliant book. She'll really talk about all the kinds of anxiety, but I know for a fact that one of my first perimenopausal symptoms was this true progesterone deficiency kind of physical anxiety. So what are perimenopausal symptoms? And then not so frequently asked questions, lemon balm and its impact on libido. Okay, what is perimenopause? Perimenopause is the transitional phase leading up to menopause. So menopause is the point when a woman's menstrual period stops permanently and she's no longer able to become pregnant naturally. So menopause is actually only one day you reach menopause when you have not had a bleed or a cycle for a full 12 months and one. So you have had no period, no spotting, no staining. For 12 months. You have then reached menopause, and then after that one day you are post-menopausal, believe it or not. So that happens quickly during perimenopause. A woman's hormone levels start to drop and fluctuate causing changes in her menstrual cycle. Progesterone is the hormone that tends to decrease. Progesterone is this beautiful immune modulating mind, modulating cool, calm, collected hormone. So when she starts to drop first, estrogen starts flailing. So estrogen is uncontrollable when progesterone is not controlling her. Let's just say that. So this phase typically occurs in women between their late thirties and early fifties, and may last for several years before menopause begin. Now I'm here to tell you that unfortunately for some, and I certainly am one of those women that started to experience perimenopausal symptoms pretty young, and maybe that's why I'm so passionate about having a more graceful experience. For some of us, it can really, be in our lives for at least 15 years, and I'm here to tell you that even at that point when you are menopausal, unfortunately the research shows that those crazy unwanted symptom can actually last for an additional six years post that day when you do reach menopause, which is usually around 50 or 51 years of age in Australia. This phase typically occurs in women between their late thirties and early fifties, and may last for several years before menopause begins. On average perimenopause lasts four to six years, but it can be as short as one year for some lucky ones, or as long to as long as 10 to 15 unfortunately I'm more in the 10 to 15 category. And like I said, perhaps that's probably why I'm so passionate about trying to make this more of a graceful experience. To date, I've probably experienced most of the symptom. Woman can continue to experience unwanted symptoms for six years after they reach menopause, as I mentioned before. I just want you to know that everything that I'm saying is backed in evidence-based science. I absolutely love the research. I am not gonna bore you with it. I won't read through the research articles, but I've got them on hand. You're welcome to my slides, so please let me know if you'd like a copy. DM me book a clarity call if you wanna talk through the research. I am such a research tech nerd. I would absolutely love to and I would love to share these with you. Let me know if you want them. Okay. What happens in perimenopause? So perimenopause is the transitional phase leading up to. During which a woman's body undergoes various hormonal and physiological changes. Here are some of the key events that occur during perimenopause. Hormonal fluctuations, estrogen, progesterone levels begin to fluctuate during perimenopause. Progesterone generally starts to decrease first, and then because progesterone is decreasing and she usually has this beautiful modulating effect on estrogen, estrogen does start to flail. These hormone fluctuations contribute to the various symptoms experienced during this time, changes in the menstrual cycle. Women often notice that their menstrual cycles are either shorter or longer or more painful. Sometimes there's more clotting in the menstrual cycle. As the hormone levels change, a woman's menstrual cycle may become irregular. So many perimenopausal women coming to my clinic going, God, I thought I was pregnant. You know, my 28 day cycle was, out at 37 days and I was experiencing all these crazy signs and symptoms. My breasts hurt. I had a headache. It was kind of like a migraine. God, that's all I needed. At the tender age of 47 to be pregnant and be mindful that during premenopause you absolutely can fall pregnant. So please be careful. It's not over yet Periods may become heavier or lighter, and the duration between periods may, may become shorter or longer. Going from a 28 day cycle, you might now have a 24 day cycle, which shows that there's this deficiency in progesterone creating a shorter luteal phase. Or suddenly you can start to have this 37 day cycle. So we have anovulatory cycles in perimenopause, so sometimes we don't ovulate and sometimes, believe it or not, we can match it magically, ovulate twice in one month. That's why we quite often have identical twins in women in their forties. Ask lots of gynecologist women in their forties can quite often fall pregnant twice in the same month. Yeah, I mean, it doesn't happen all the time, but it happens. It's a thing. Alright, so some women may also experience skip periods ovulation changes, as I mentioned before, ovulation may become irregular, even cease altogether during peri. This leads to decreased fertility, although it's still possible for women to become pregnant until she reaches menopause, as I was talking about before. And then the physical symptoms or these brain symptoms. Many women experience physical symptoms during perimenopause, including hot flashes, night sweats, vaginal dryness, and changes in sexual function. These symptoms can vary in intensity and frequency. Boy, do I have something for you if you've lost that little bit of sexy. Emotional symptoms too. How about how about the mum rage? You know, how about the, just losing it at the kids and going, oh my God, I don't even know who I am anymore. My kids don't like me. My husband's worried. I'm worried. You know, it's really important for us to enjoy ourselves and enjoy our homes. You know, this beautiful human. This is where you live. You want it to be a really gorgeous experience. So we don't wanna have all of these crazy symptoms, you know, the mood swings, the irritability, the anxiety, the depression, their common emotional symptoms during fair menopause. These may be due to hormonal changes as well as the physical symptoms and life stresses associated with the stage of life. Don't we know it, man? Oh man. We've, we've generally got aging parents. You know, lots of us have, have teenage children. We have established or new relationships. Careers, dogs, you name it, we've got the responsibility going on. We're in the prime of our lives. We certainly don't need premenopausal signs and symptoms to get in our way. And that's kind of my why. Women are so important. They're the nucleus. And you know, of course men are important too, but you know, a lot of the time the women are the caregivers in the householders and, and the mothers, you know, the mother that earth energy. It's so important. Sleep disturbance. So we're meant to do all of this on like zero. Difficulty falling asleep, which is usually a circadian rhythm disruption, which quite often comes along with you know, high levels of cortisol and and a decreased initiation of melatonin. Insomnia and sleep disturbances common during perimenopause, often due to hot flashes. So the hot flashes can wake us at night. As well as that that cortisol being too high as well as emotional symptoms like anxiety. One of my patients describes. When she gets into bed at night and lies next to her husband, she has this real sense of panic and anxiety and has no real reason to be experiencing anxiety or panic. So really does identify it as that progesterone deficiency anxiety. Glad to report that she's actually doing, you know, really well at the moment. Bone loss. The decrease in estrogen levels during perimenopause can lead to a loss of bone density, increasing the risk of o, increasing the risk of osteoporosis. So this is not something that we wanna be doing. We certainly wanna be keeping an eye on our trace mineral levels. We wanna be making sure that we've taking vitamin D in K2 to get that calcium into the bone so that the calcium doesn't deposit anywhere else. Creating oxalate deposits either in the kidney or in the lung or in the vagina no, no thank you. no oxalate deposits in the eyes of the vagina. Changes in cardiovascular health. Estrogen helps protect the. So estrogen helps to protect against heart disease. So the decrease in the estrogen levels during perimenopause may increase the risk of cardiovascular issues. Yeah, so many people go, oh, you know, I've got hot flushes they're really annoying. But unfortunately that vaso symptom is actually, it's a cardiovascular disease risk. So it's really important for us to do what we can to get that under control and also make sure that we're doing heart protective things. So it's important to note that every woman's experience of perimenopause is really unique and the symptoms and their intensity can vary significantly. If you're concerned about your symptoms or need advice on managing them, consult your healthcare provider. Really important. Supporting research again because I'm a tech research data nerd. Here are all the studies. Like I said, please DM me book a clarity call. We'd love to chat to you about the research too, and happy to share these slides. I am here just creating awareness. The research also shows that there's a huge capacity in society to allow for women to. So to generally suffer during our menstrual years as well. Quite often when, when young women are talking about the fact that they need to take time off work because they have, you know, significant pain and debilitating periods, endometriosis or polycystic ovarian syndrome, society sort of, you know, nods, nods along. So we have this capacity to allow women to suffer and we certainly don't need to. It doesn't need to be this way, and we certainly don't need to suffer in premenopause either. Bone loss, cardiovascular. Now, what are the official perimenopausal symptoms? There are like a trillion of them. Professor Pryor talks about a much shorter list. I think she's got about nine sy symptoms on her list, but that, that's technically you know, extremely clinically trial based. And she talks about if you have any three of those who are most likely in perimenopause. Because remember, this is not a disease state. This is just a transitional. And it should be treated as such. Perimenopause is certainly not a disease but the symptoms can be extremely varied. So perimenopausal symptoms vary from woman to woman as well. But here is a comprehensive list of common symptoms experienced during this transitional phase. So irregular periods, as we mentioned before, changes in the menstrual cycle including heavier or lighter bleeding, shorter or longer cycles or missed periods, entirely hot flushes, sudden feelings of. It kind of feels like you have this internal heater and somebody just kind of turned up the volume. Initially, it's quite a kooky feeling. You sort of think like, oh God, is it me? Or is it just like really hot in here? Oh yeah. The other night I had a really interesting hot flash. I was like, oh, whoa, whoa. And it kind of overtook me. Yeah, it was really, really interest. Sudden feelings and warmth, usually in the face, neck and chest, often accompanied by sweating and redness. I haven't had the sweating and redness yet, but you know, I'm ready for it. I'm ready for it. Night sweats, hot flushes that occur during the sleep, causing excessive sweating and disrupting sleep. Believe it or not, lots of women in our clinic talk about their, hot flushes when they're on the most appropriate individualized precis. Evidence-based safe supplementation that you can really tone down the volume on those, on those night sweats and hot flushes, sleep disturbances, difficulty falling asleep, difficulty staying asleep, or waking up too early. Mood changes the irritability, anxiety, depression may become more common. Vaginal dryness. A decrease in estrogen levels can cause dryness, itching, or discomfort during inter. Lots of per menopausal women suddenly start to experience like a thrush type sensation or start to have a lot of UTIs. The vaginal microbiome is really important. We really need to keep an eye on the vaginal microbiome and make sure that we are doing the right things to ensure that it's as healthy as it possibly can be. We want those mucus membranes to be moisturized from the inside out, and we want those beneficial bacteria to be on our side and not working against. A decreased libido, changes in hormonal levels can lead to reduced interest in sex drive as well as a reduced interest in the householder responsibilities. So, you know, some that we find ourselves going, oh, really can't be bothered cleaning the house really can't be bothered. Vacuuming. I don't necessarily think that these are such a bad idea. I quite like those ones just saying. So the urinary issues increased frequency and urgency or incon. And breast tenderness. Breast may feel sore or tender or more so than usual weight gain. We often see changes in metabolism and hormonal fluctuations, and particularly that weight gain around the middle, you know, just where you zip those genes up, you know Joint and muscle pain very, very common in premenopause frozen shoulder and suddenly a sore hip. And suddenly my knees are doing something really strange, you know, aches and stiffnesses in the joints and the muscles, and. I'm here to tell you that I'm somebody that's had so many accidents in her life, unfortunately. And I wouldn't necessarily say I'm clumsy but you know, car accident at the age of you know, 18 months of age in traction for six months. I dislocated my back and cracked my cocky skiing when I was about 21. I had a knee injury a couple of years ago broke my left arm I have a screw in nine plates, so I'm here to tell you that the joint and muscle pain really resonates with me. With that fluctuating estrogen levels. So particularly when my estrogen is lower in my cycle, it's really important for me to lubricate from the inside out as much as I possibly can. So I take like, you know, lots and lots of proresolving mediators, I take lots of fish oil and I really hammer the magnesium. One of my favorite supplements in the whole world is something called Synergesic it's a really, really, really high dose turmeric with a couple of safe, effective botanical painkillers, absolutely fantastic stuff. Headaches. went through a phase where I had these two, I had these just random headaches and I'm not somebody that has headaches either, so you may have experienced them as well. An increase in that headache or migraine. And quite often we have that you know, wo, women will notice that they'll have that, that migraine or that headache cyclically. So it'll be like, ah, every time just before my period. Or if it's an iron deficiency headache, it's quite often a, a depleted headache after your period. But there are a lot of progesterone deficiency migraines and headaches in my clinic that I see quite regularly. But these are also pretty easy to treat Fatigue, the generalized. There has never been a time in your life where you have been more inflamed with less energy. So yeah, that's per menopause. But there is a way to increase your energy levels and decrease that inflammation. So feeling more tired or lacking that energy. Memory and concentration problems. You know, women talk about brain fog or, you know, walking into the room and going, what am I doing in here? Or Have you ever put your keys in the fridge? And the cocoa pops, you know, in the freezer, it's that kind of thing. Or like, where the hell did I park the car? Oh my God, I've totally forgotten. Like I just cannot remember, or just very confidently interjecting the completely in incorrect word, straight into the sentence, with full confidence, or forgetting the word completely and not being able to access it at all.. So difficulty focusing, remembering or thinking clearly, that can certainly be a sign of perimenopause. Have you noticed the spatial awareness? I know that that's not written on here, but so many women report this like just. Walls are suddenly jumping out at you. You know, like just bumping into walls all over the place or, or finding yourself just bumping into the corner of the table, or just not getting just not just not getting it right. You know, like when you're driving and you have to know where the car begins and ends, you know? Have you sort of lost that sense of where you begin and end and suddenly you're just bumping into everything or dropping things? I remember saying to my partner, I was like, oh, before I get my period, I just like drop things and then I was like, ah, I don't think it's just before I get my period. I think I'm just starting to generally drop things. Changes in skin and hair. So our skin tends to dry out. Sadly, everything is drying out right? So dry eyes, ears, nose, vagina. We need to moisturize everything from the inside out. You can't get enough MCT oil. You can't get enough avocado oil enough olive oil, all the good oils. Butter. Go for it. Acne. Yeah. Suddenly women are coming into my clinic going, oh my God. Like I had acne when I was, you know, prepubescent. What's going on? I feel prepubescent now. Well, actually I'm here to tell you that perimenopause is the second puberty. It's literally, I think it's actually worse. I think perimenopause is worse than puberty. Hair thinning too. But there's a lot you can do about that. You can make sure that you're not detoxifying your androgens or your male hormones down the female pattern boldness pathway. And you can also make sure that your iron's okay, thyroid issues, iron and androgen detoxification, really talk into that hair thinning. Keep in mind that not all women will experience every symptom. Lucky ducks, and the intensity and the duration of symptoms can vary greatly. It's essential to consult a healthcare professional if you're concerned about any premenopausal symptoms you're experiencing. And then I have a little treat for you. This is honestly a godsend. Lemon balm and it is so gentle. I mean, honestly, a beautiful, beautiful herb like lemon balm Lemon balm and libido. Lemon balm is, a little bit sexy. I absolutely love this study. It looked into how Lemon balm, also known as Melissa Officialis L, can help with sexual dysfunction in women. It's pretty awesome. They had 89 women with reduced sexual desire. Either one gram of lemon balm extract or placebo daily. And guess what? The results were super promising. Those who took the lemon balm experienced significant improvements in arousal, lubrication, orgasm and sexual satisfaction and even pain reduction compared to the placebo group. So, you know, often perimenopausal vaginas are drier and the mucosal membrane is thinner, so sex can actually become quite painful. There's so much you can do about that too. But yeah, so this really helped that as well. So, come on. I mean, my goodness, we don't wanna lose the sexy just because we are transitioning and we're in the prime of our lives. The cherry on top, the participants were keen to continue treatment. So generally in a clinical trial, when participants are keen to continue treatment, you know that it's working, cuz why would you be doing it if it wasn't working for you? So if you're a perimenopausal woman looking for a little boost in the bedroom, lemon balm might be worth a try. Just remember, it's always best to chat with your healthcare professional before starting new supplements. And this is just for informational and educational purposes. But please have a look at this research. It's absolutely compelling. My name is Dr. Kirsty Holland. I'm the founder and practitioner of the Holland Clinic in Melbourne, Australia. And it's been my absolute privilege to bring you this informational peri chat Thank you so much, and I'll see you next time. Bring your lover, bring your sister, bring your cat, bring your. I'm trying to raise awareness for perimenopausal women because this is not just in our heads and quite frankly, women are really sick and tired of the head tilt and the you know that's about right for your age love. It doesn't need to be this way. We certainly can thrive and have an incredible experience transitioning from our fertile years into our menopausal. And I'm here for it. I'm here to help you do it. I'm here to teach you how to access alternative fuel sources. I'm here to bring you research. I'm having such a great time talking to so many perimenopausal women worldwide about what they're experiencing and what they need to know. And I'm just so delighted that you took the time out with me tonight. Thank you so much for being here. Absolute pleasure to be in your company. Take it easy and have a gorgeous evening. And let me know what you need to know more of you can find me on Instagram and Facebook and reach out on my Facebook page or my website. Super easy to find. Take it easy.