28: Navigating Perimenopause and Menopause ft. Dr. Mary Pines

So what is perimenopause?

Perimenopause is the 6 to 10 year sort of transition period, like an off ramp for your hormones before menopause.

And it's been likened to puberty in reverse.

Welcome to the so Fricking Healthy podcast.

My name is Dr.

Mary Pines.

I am a Cambridge trained biomedical scientist and longevity expert with a combined 23 years of research experience, education, and consulting.

All right, so we are back with Dr.

Mary Pines and we're still very excited to have you because our last episode, I feel like we could have talked for two hours just on that, but we're trying to break this up so it's a little bit more digestible because the topics that we're talking about have a lot of turning parts and a lot of things.

And so we're really trying to make sure that these episodes can be actionable and bite size, but also give you a little bit of momentum to maybe think about something that you haven't thought about yet and maybe dig a little deeper on your own.

Let's hop into our next episode with Dr.

Mary Pines where we're going to talk about perimenopause and menopause.

Hey.

My favorite subject.

Me too.

Welcome.

Welcome back.

Thank you.

Delighted.

Delighted to be here.

So let's dive right into it and we're going to start with some basics.

What is perimenopause and what is menopause?

And how do those two things work together and how are they different?

Great question.

Menopause gets all depressed and it seems like we have a vague idea of what it is with.

Perimenopause has really not been out there in the narrative at all until very recently.

There's kind of a sea change happening right now, and I'm.

It makes me delighted.

So let's start with perimenopause because it's probably the most misunderstood and poorly discussed element of the journey of women's health, I think.

So what is perimenopause?

Perimenopause is the 6 to 10 year sort of transition period, like an off ramp for your hormones before menopause.

And it's been likened to puberty in reverse.

So much like with puberty, our hormones will fluctuate pretty wildly in this six to ten year period.

And it, it can.

It can be a little tough, can be a little janky.

It doesn't have to be, and that's why we're here discussing it today.

But it typically starts in the late 30s and it's into the early 40s and then you'll get this six to 10 year transition period before you hit menopause, which is actually defined as a moment in time.

It's the day a woman has had no period for 12 months at an appropriate age.

So the average age for menopause in North America and the UK is 51.

In Switzerland it's 52, right around that mark.

So you might, might.

Every woman's different.

You might have menopause at, at 45, some women as early as their early 30s for various health reasons and some women as late as their early 60s.

So I personally can't wait.

I think it's going to be great not to go through this thing every single month.

And certainly I have to say people fear menopause.

They think it's going to be really hard.

But the empowering thing is that it.

Doesn'T actually has to be.

And for many women, if it's managed well, it's not that hard.

And it can be a real relief for people, the mood shifting and swings and dealing with all that stuff goes away to look a little steadier.

Smooth sailing.

So that's kind of nice.

So from that, from the day of menopause, for the rest of her life she's technically in what's called post me menopause.

Okay, that's good.

So if you're a female with a mensis around that time and you don't have a regular menstrual cycle, it can be difficult because if you're going two or three months without a menses, you might think you've started that 12 month cycle and then you have a men and then.

So I can see that that can also be a little bit frustrating if you're not, if you don't have a regular cycle to go go by.

Absolutely, yeah, totally.

I, I get clients who are like, oh my God, I was 10 months deep and I, I met, I got my period and I was like, no.

And I said, be patient, it's coming, it's coming.

Every woman's different.

Yeah.

I've mentioned it before on another episode that I've had a hysterectomy and not having a period has been awesome.

That I can definitely say is one of those things that like.

No, one of the things they asked me was like, you want like psychological support when you go through a hysterectomy because some women, if they don't have their menses, the theory is that you will feel less like a woman.

And I was just like, nope, I'm good.

I don't need any psychological support.

I'm very happy not to be bleeding once a month, thank you very much.

This is my psychological support.

Right.

I have all the other womanly aspects, so I'm good without that one.

So wait till you guys get there.

It'll be very nice.

She doesn't have kids and she doesn't have her period.

I don't know why I like her.

I don't even know what I do with my time.

I mean, what do I do with all this extra time that I don't have to be changing my tampon and looking after children?

I'm.

I'm.

I jest.

I jest.

Anyway, so, okay, first of all, I had no idea perimenopause was like six to 10 years.

I thought it was like two to three years before.

So now let's talk about then, what the symptoms are and what actually changes in a woman during this perimenopause time.

You said there was some hormonal shifts.

So what's leaving?

What's coming?

I mean, I've got definitely more hairs on my chin than I did before.

Is that a symptom of perimenopause?

Because I'm hoping it is.

Otherwise I'm turning into a man.

Yes, I know.

It's so interesting.

The research, until very recently has been so lacking and that.

That's why we're all relatively in the dark still.

But there's been some really amazing studies lately.

There's some incredible resources you can follow on, on socials around where the research is going, and the latest can provide those for you for the show notes.

But really, there's over a hundred symptoms of perimenopause, which is totally insane.

Right?

Hair growth in weird places is one of them.

But backing it up.

Just a second.

What is going on here?

Why?

Let's start with why.

And like a moment on the hormones, and then I'll start.

I'll talk about symptoms, because that's really so important.

And most women are in the dark, rightfully so.

Doctors are, too.

Insanity.

So, as women, we're all born with a supply of eggs, which we release monthly during the ovulatory phase of our cycle until we begin to run low.

So after each egg is released, we get a surge of progesterone, the second half of our cycle, which is a really important hormone that helps us sleep.

It's important for brain function.

It's very calming to the brain, among a ton of other important things.

So once we get older and our eggs start running low in supply, we are Entering perimenopause, the corresponding surges of progesterone also start to dwindle.

So how do you know you're in perimenopause is when you start to get these progesterone related symptoms.

And this is again one of the least discussed aspects of the female hormonal journey.

So I'll go into it a little bit.

Every woman is a little bit different in how her hormones behave.

But generally the very first signs of perimenopause manifest because of progesterone decline, which leads to things like poor sleep, fatigue, brain fog, anxiety, forgetfulness, lack of concentration.

Those are some of the top signs.

And along with that, her cycle will also become a little shorter in general.

So from 20 to about 25 or 26 days.

And her flow will often be much lighter, but not always.

And it will be generally a shorter cycle.

It might go down to three or four, five days.

Those are the first signs.

And as we get deeper into perimenopause, other symptoms commonly arise as well.

And as I said, there's over a hundred of them.

It's wild.

So some are super unusual.

And some of them are, well, I'll, I'll name a few and we'll go from there.

So some of the weird ones, and you can see the full list from a group called Morphis out of the US which is run by two wonderful women who are perimenopause and menopause advocates.

We did a survey of over 3,000 women and just published the results last year.

So some of the weird ones are like itchy ears, tinnitus, inflammation, vertigo, digestive problems, body shape changes, social anxiety, a hard bloated stomach, brittle nails, all kinds of things.

So there's a lot of things going on in the body.

And everybody responds quite differently to this changing hormonal landscape.

And you know what's interesting is that about half of the top 10 symptoms are psychological.

So looking at the top 10, like fatigue, brain fog and sleep issues, memory loss and forgetfulness, anxiety, joint pain, lack of concentration or focus, hot flashes and sex drive, in that order.

And so given that half of those are psychological, it would be easy to misdiagnose yourself or as a doctor.

So because many of them are related to other common health problems like thyroid issues or depression, maybe signs of chronic stress rather than signs of hormonal changes.

So especially when you look at what women are doing in their 40s, like super busy with career, or if you have children, or maybe caring for aging parents, a myriad of very real demands so it's easy to think as a woman we're losing our minds, but.

And it can be really scary.

But a lot of these symptoms could just be related to your hormones and a natural part of aging.

So that's during menopause.

So that at the end of that six to ten year window, once the egg supply runs out and we stop menstruating, progesterone has been up and down and up and down all over the place, like a roller coaster for that, for that six to ten year period.

And now it's sort of low, it's, it's pretty much at its lowest.

It will be like prepubescent and then estrogen will start to go wonky and wild and all over the place.

And this is why some women will get symptoms of menopause and that tends to be the more classic ones that hear about like the hot flashes at night or dryness, dry vagina osteoporosis, some.

Of those types of things.

I have a question because we are all women who have lived in the western world and I have heard rumors that women living in the eastern countries, specifically Japan and some of the other Asian countries where their diets are different, don't actually experience these symptoms.

And I believe also when I was taking the hormone health course at iin, the Institute for Integrative Nutrition, they'd also had said that it is not necessarily, quote, normal now.

It's normal because we've had maybe a hundred years of this, but it's not necessarily a normal thing for, for our bodies to be producing these symptoms, but that our lifestyle and the way that we've lived now is exacerbating that.

What are, what's your take on that?

Is that a true analysis?

Is there something that we could be doing differently to help minimize those symptoms?

Or is that kind of just.

Yeah, not, not as true as I hope it should be?

Yes, absolutely.

That's a great, that's a great point and a great question.

So I think the same thing can be said for cycling women around PMS and the perimenopause menopause transition.

It tends to be worse.

Yeah.

For I'm not so sure about different parts of Europe, but definitely some parts and worse in North America based on our lifestyle factors.

And that's kind of tragic because we have normalized that PMS and menopause are really hard and yeah, they are because we're doing all these things that don't really jive with having healthy hormones and supporting our monthly cycles cycle syncing.

If you Will if you're a cycling woman, then later in life the, the perimenopause transition.

And there's all sorts of things.

But for example, in Japan, women don't tend to experience difficult menopause partly because habits they tend to walk more, they eat a ton of fiber and omega 3 rich foods, minerals from, you know, fish and seafood and that.

And their diet's really different.

And they're also, their orientation to aging is totally different.

And this is huge.

There was actually a massive study done not that long ago, a few of them around aging and mindset.

And it's so true that we see over and over that when people expect to suffer, they'll suffer more regardless.

There's a really excellent researcher named Ellen Langer, believe it's Langer who studies the body mind connection and she's been doing it for 45 years or something like this.

And she has definitive data that say when we expect the worst, we get the worst.

And definitely in the studies around perimenopause and the and menopause, in cultures where there is that expectation, it's much harder for women.

And that's one of the key factors.

So going into it with a mindset like, okay, I got this, we're gonna be fine, is one of the best tactics.

Yeah, the mind is so powerful.

I mean, I think there's been, I hope there's been some studies about mindset and cancer treatments.

Like if a person believes the cancer treatment is going to work, it's more likely that it will work.

Obviously everybody is a patient of one data point.

You can't repeat the experiment with someone who's got a negative mindset, obviously.

But there was an interesting story.

I think it was a podcast, at least an episode maybe on this American Life.

It was a Japanese family whose grandmother had been diagnosed with cancer and they decided not to tell her and because mentally it's too much.

And then there was a lot of ethical debates about not telling someone and letting them live a very nice end of their life versus telling someone and letting them decide about things.

And it turned out that even though this woman had only a very short period of time, six months to a year to live based on this cancer, she didn't know it and she ended up living for like another 10 years.

It's like one of these miracle stories.

But you're thinking, is it really a miracle story or is it like you said, when you get cancer, you expect to have these things happen to you and then therefore it happens because, you know, a self fulfilling prophecy And I think you're right.

I've never been too much into affirmations because I'm generally a very positive person.

But I.

I'm.

I'm getting the sense, like, I just got this little brainchild of, like, my daily affirmation needs to be.

I'm young, my body functions well.

I'm young, my body is awesome.

You know what I mean?

Like, instead of, like, oh, I hit 45, you know?

Exactly.

It's so written into our culture, and it's in insidious little ways that we don't even notice.

It's wild.

Yeah.

And just having that youth, youthful mindset of I can.

Because my belief is.

And there's other longevity experts who agree with me, aging in the way that we see aging is really.

It's such crap.

Aging should not come with pain or fatigue or the things that we suffer with.

Lack of motivation.

That kind of stuff that's often related to mindset.

And it's also related to caring for your body.

We don't see people aging like that in countries like Japan and in other places in the world.

Yeah.

It's wild.

Yeah.

What are your.

I don't know if you've worked with this, but maybe what are your thoughts on the benefits and risks of hormone replacement therapy for women?

There's some creams that have, like, topical things, and in general, I guess the idea is to replace some of those hormones that are being naturally phased out.

I mean, it seems like it's kind of a band aid.

I mean, it's something.

Is that something that a woman has to do then forever?

Is that hormone replacement therapy something as, like, a transition?

I don't know much about it, honestly.

Haven't looked it up.

But I'm also curious, like, what's the downside of doing that?

Why is not every woman doing hormone replacement therapy?

Fabulous question.

Oh, wow.

This is a.

This is super important.

And I would say we don't know much about it, and doctors are still warning against it because of some seriously flawed research that came out in 2001, which is just patently wrong, and it made all the media and the headlines.

But before that, doctors were using estrogen very successfully to mitigate symptoms.

But anyway, long story short is the research was all over the place, but we now have such excellent research showing that hormone replacement is very safe and very protective for almost every woman and every expert under the sun in functional medicine.

That I know is like, oh, my God, what a travesty.

We had this so wrong.

And actually, it's interesting, Peter Attia and Adrian Huberman just had a big hoedown about.

This is one of the biggest tragedies in modern medicine was this blanket statement that hormone replacement is not good for women because it has so many proven health benefits when you go bioidentical and that's important.

So the same as the body produces and it actually helps prevent cancer and is a strategy, yeah, strategy to beat cardiovascular disease, osteoporosis, dementia, Alzheimer's.

It's great for diabetes management later in life when the A1C tends to creep and the list goes on and the data show consistently, like in lieu of all those sort of down the road diseases that HRT can improve mood and skin sleep, a sense of vitality, sexual function, overall, basically everything.

Your hormones, as I said in the previous podcast recorder, are really your master regulators.

And in fact the risk of all cause mortality, aka dying of any cause, anything, is reduced by about 30% in women who are on hormone replacement.

Wow.

Yeah.

So there's a ton of benefit.

Wow.

Yeah.

And the data are now starting now showing us very clearly that starting earlier is much more protective and better for longevity.

Because the old idea with HRT and many docs, many standard medicine docs will still say this, that you shouldn't start till you're post menopausal, which is absolutely untrue and the wrong approach if you want to preserve your health and your sanity if you have symptoms.

So it's best to start well before menopause if your hormones are low.

I at 43 just started doing a progesterone low dose pill in the second half of my cycle.

Absolute game changer for my sleep.

Oh my gosh.

And you know, so protective, really important for the gut integrity too.

Low estrogen produces leaky gut oftentimes and just way more sensitivity bone health as well.

So you don't necessarily want to wait until you have symptoms because like anything that's going wrong in the body, by the time you're symptomatic, your body is sending out help signals because damage is being done.

So that's why the testing we talked about in the last episode, starting nice and early, is really good.

So yeah, you mentioned the test and I was thinking about that.

So as a woman age 35 to 40, somewhere in there, like I said, I'm going to get ready, I'm going to my gynecologist.

Should we ask what should we ask for to start that conversation so that they can determine what levels of hormones that you need and if they don't, if they're not receptive, does that mean you should just find another gynecologist?

Like, what's.

Yes, yes, yes.

Move on, run the other direction.

Because they are not current in terms of what to ask for if they're not receptive or they say, oh, you're too young and you're exhibiting symptoms and you've done some blood testing.

Run the other way in terms of what to ask for.

Yeah, just tell them, here's the symptoms you're experiencing.

Let them know you are interested in HRT whether you are or not.

That's a good justification for them to actually measure your hormone levels and they'll do a blood panel.

Or if you want, you can do the more comprehensive test we talked about last time through a functional provider or naturopath, the Dutch test or similar.

We covered a lot of great topics.

Yeah.

So I maybe before we end this episode, if there was like one thing you could tell women about perimenopause and menopause that you haven't mentioned already, like, what would that be?

What would be the gold standard of something?

You're like, please just remember this thing.

I'm going to tell you.

Or maybe you can restate what you already did, but I want to make sure that we have a really good take home message of the.

Wow.

That's a good question.

I would say that anything is possible for the perimenopause journey in terms of what you may experience and to just be really receptive and be mindful of things that are shifting.

Write them down.

Journal if you have symptoms or things that are changing, that you're like, ooh, what's this?

And just keep tabs on your symptoms, whether they're subtle or not, because they'll start off pretty subtle.

And that's the time that things are changing and you probably just want to start to do some testing.

And if things are uncomfortable, if you're not sleeping well, if you're more anxious, don't let it go on too long because that, you know, damage starts to get, starts to get done in our minds when we're like, oh my God, what's wrong with me?

There's nothing wrong with you.

You're just going through this natural shift.

And like I mentioned, there's over a hundred symptoms.

So, you know, if you wanted to have a look at that list, that group is called morphis.

It might explain to you a little bit better, like why you're feeling what you're feeling.

You're not crazy, you're just going through perimenopause probably.

And then through the journey, it's just more important to support yourself and to reduce your stress.

As we spoke about last time, because we're more sensitive to stress, we're producing less and less hormones, we're not processing them as well.

And so the hormones that we have, we got to be a little more precious about.

So eating well, sleeping well, just taking time to self care.

I think the second biggest action item I would suggest would be to really turn the light on yourself at this point in your life.

The self care piece.

And here I'm not talking about going to the spa and getting your nails done, although you could do that.

I'm talking more about you've probably been super busy with whatever you've been doing for other people, with other people, with your career, your whole life.

But now is the time when you've kind of got to turn the care back to the self and really sort of take that me time.

Make sure you're taking the time to rest more, be gentler, shift into a downshift.

And not to say that you don't have the energy and pizzazz, but just being a bit more mindful about where you spend that energy and making sure that some of that comes back to you.

It's your time and you're worth it.

Like Donna and I always say, it is about knowing yourself better.

It is about paying attention to yourself, listening to your body.

And I think that's exactly what you were saying.

Take the time to just listen to your body.

Take the time to make the notes.

I have a digital journal and so I can have many different journals.

That's a lie because she has 700 journals, electric written.

And as soon as you say, as.

Soon as you said, note it down.

And take note of everything.

I saw Megan have a mini orgasm and I was like, that's another.

Yeah, I journal every morning.

Yeah, I have a medical journal.

So if I get a bump somewhere, I take a picture of it.

Sometimes I get strep throat and I'm like, I'm taking pictures of that bad boy.

I, I take pictures of my toenail fungus.

I take pictures of everything, everything it takes.

I'm like, if I won't remember it like you said, I won't remember that something happened or how long ago it was unless there was like a specific, like, oh, the joy of not having kids.

I love that.

I, I'm a, I'm a journaler.

I'm a journal.

I've been recently going back and reviewing old journals and digitizing stuff.

So just in case my house burns down.

I have it.

Amazing.

And it is just.

Do you see why I love her so much?

But it is definitely.

Yeah.

Okay.

Oh, me too.

Okay, Megan, you're in the favorites category now.

Gosh.

Melting my heart, the two of you.

I made it through the red carpet.

All right.

So that was great.

Thank you so much for bringing us all up to a good baseline.

I feel with.

I learned something with perimenopause and menopause.

I'm actually.

I'm really trying to avoid reading and learning anything about it.

This is the first time where I'm like, I don't want to know.

I don't want to know.

But now I'm like, okay, maybe I should know.

So this is a good first step.

For me to perfect.

Do my affirmations.

Life.

Life will happen.

I should know so I can be prepared.

But thanks.

We.

We have so many other wonderful topics lined up with you.

If you like these episodes with Dr.

Mary, please feel free to check out the link in the show notes and leave a question, because I'm sure you have a question for Dr.

Mary, and we're going to be collecting those questions over the next couple episodes and doing a special Q and A so you can get your voice on air.

Leave your message.

60 seconds.

Only 60 seconds.

So no life stories.

And you'll be hearing her voice.

Yeah.

We will put all that wonderful stuff in the show notes so that you can connect with Dr.

Mary and get in her zone, get all up in.

Her shit, because she's got lots of good stuff.

Lots more for you on this next podcast.

All right, thank you so much, both.

You're amazing.