Peri-Menopause Anxiety

mood swings, depression. You know, it's a lot. Our hormones are changing during this very long phase of our life. And there is so much more to menopause than what you may think, you know, which is just one day you stop getting your period and that stuff. It's a sometimes seven to any your process of hormones changing before that inevitable stop in menstruating happens. And this has not

talked about in society unfortunately. What you're going to learn from my guest today, Dr Stephanie Fabian, is that medical doctors are getting less training now in recognizing symptoms of perimenopause and menopause. You have to be your own advocate, and so I highly recommend starting to learn about this, and I'm hoping I'm doing a service for any people out there that might be wondering what's going on in their forties as they suddenly maybe feel like a teenager again,

not in the best of ways. And how in our ages society where unfortunately, not only do we sort of abandon our elders, right, people in their forties and fifties now are seen as older in the workplace at least, and it can be pretty difficult to want to talk about this hormonal change that affects our moods, our anxiety, our physical cell that goes on intermittently for seven to ten years. And you know, you spend forty weeks in

your life of your life. That would be great if you only had to work forty weeks in your life, forty forty hours a week at a job most weeks of the year. Well, you're going to run into having your perimenopausal symptoms at work and you need special kinds of relief. Usually these things might involve time or change of environment within the workplace, and it can be pretty scary to talk about because we don't want to be seen as not being assets to the workplace at our age,

because obviously we are. So there's that kind of anxiety. I mean, even if you don't physically start getting panic attacks when you're in perimenopause, there is a lot that affects your brain and emotional health when you're going through such a big physical change. And serotonin is mildly connected to estrogen as well, so when that starts to change, it does affect our serotonin, not as much as I thought it did actually in Ductor Bobby and will take

us through that. But yeah, So this is the second talk that that people have h a need for in their life. The first one is you know about getting your period, and then the second one is about the years and years it takes for your body to go through what it needs to go through for your period

to stop. And it's not simple and it's not quick, And it might be a great episode for you to listen to, even if this isn't something you're going to be going through, but it might help you understand the struggle that maybe people you work with, howe, or people in your family or friends of yours, or anyone you

know in this age range. So there is hope of course, But I think what I took most from my talk with Dr Stephanie is we really have to be our own advocate, and we cannot think that we are crazy and that this is in our head. We have to learn as much as we can about what happens during paramount of pause, both physically and emotionally and mentally into our brain. And we can't let doctors tell us that, oh, it can't possibly be happening because they're not trained in this.

So get yourself. Um, I don't know I was gonna say. I don't know what I was going to say. To be honest, get yourself what get yourself this episode so that you can start to learn something about everything that you might be going through or will go through someday if you're lucky enough to hit that age. So again, my guest today is Dr Stephanie Fabian. She is a clinician who has practiced in the Women's Health clinic at Mayo Clinic for over ten years and has evaluated and

treated women with menopausal, hormonal and other health concerns. Relating to that, she has a broad interest in women's health and she is the direct dirt for the North American Menopause Society. Again, the link to that will be in

the show notes. And as the Penny and Bill George director for the Mayo Clinics Center for Women's Health, today we're talking about some of the things in her book called The Menopause Solution, which came out in she said there is a new version that should be coming out this year, and you know, will I will say there

is hope. But again, like with any anxiety solution, it seems as though it's the answers you've heard before, you know, taking care of your health by making sure you're putting healthy food into your body, cutting down on alcohol, if not eliminating it, exercise, meditation, medication as needed, therapy, mindfulness, sleep. But there are a lot of different stressors that can affect someone in perimenopause, and an attitude shift is kind of needed as well, which is that this isn't really

something to dread happening. It's just something to be prepared for. And unfortunately, it seems like there aren't a lot of people out there that are helping us prepare. So I'm hoping I can be a helpful voice in that lack of voices, and hopefully this episode will give you enough bread crumbs to find your way to how you want to handle your paramount of pause. And again, you know, all of the solutions to this are simple, they're not

necessarily easy. Right, when we take care of our brain health or mental health or emotional health, whatever you want to call it, we know what to do, and sometimes we just don't want to do it. Whether it's our depression that's making us lack of the motivation, or a self esteem issue that says, you know, when we're really not worth taking the time to take care of ourselves, or the a d h D which affects our executive

brain function. There are so many reasons why people don't get started on taking care of their brain, emotional, mental health, and I think there's a lot of times I can get tricked by is to thinking, Okay, I hope this episode gives like the definitive number one answer for people, and it's like, there isn't one, right. It's a combination of finding out what works best for you, but we're probably always going to be picking from the same bag of tricks. And it's not because you know, no one

knows what the solution is. These are the solutions, but Again, they're simple, but not easy. That's what makes them so difficult to implement sometimes because again, the mental health that we're trying to take care of can sometimes get in our own way from even starting. So again, I hope you enjoy our conversation about perrymnopause, and I'll see it on the flip side. We're going to talk about perrymnopause,

menopause and the anxiety, grief moods that accompany it. But you know, before we get into that, i'd love to chat with you just what the basics are. What what is perrymnopause? What is menopause? Yeah, I mean, that's such a great question. And I've said many times that we get the talk when we're about to start our periods, but nobody gives you the talk when you're about to

stop your periods. And there are a number of reasons for that, UM, including that the timing is variable for for many women, and so we there's no set time like your thirty five years of age. You need to get the talk now. So and UM providers aren't really comfortable UM giving the talk, which is another major issue we can talk about. But let's talk about definitions here. So first of all, starting with the easy one, relatively easy anyway, menopause is defined as no period for a year,

and that's with it without any manipulation. So you have a uterus and you would have been menstruating otherwise, and you haven't had an endometrial ablation, and you don't have an I U D that would make you stop bleeding, and you're not on a birth control bill that would make you stop bleeding. So without all those caveats aside

nature taking its course, it's no period for a year. UM. The mean age in the United States is around the age of fifty two UM, but anything after the age of forty five is considered normal, and about us are done by the age of fifty five. So when you back it up, what are the stages they get you to menopause? And we call that the menopause transition and

the time leading up to the last menstrual period. And you don't actually know it's the last menstrual period until it's been a whole year, right, so you're actually we sort of call it perimenopause until you've been a year with no period, when in fact you were menopausal when you had that last period. Right. So that's why this definition gets a little gray and fuzzy in there. Now

that time leading up to menopause. Perimenopause can last for several years, and it can be when your periods start to get a little bit of regular um, And it can be really subtle at first. It may be you know it's off by three or four days, or your periods are getting shorter or longer, or they're getting closer together for their part, So the variation can be pretty

much anyway. Um. And then you can occasionally miss a period and you feel like you might be in menopause then because you could have hot flashes and nights west and sleep disturbance in your mood is crazy. And then it all just kicks back in again for a while. And I had a male colleague once described this time frame as like a boat motor sputtering, and I went, oh, dear God, that is like such a classic male description for a female reproductive stage. And I was going, darn it.

He's kind of right, you know. So people have described it as kind of like a um, a candle flickering or fluttering, and I usually just say, look, it's not like a light switch. You don't just flip it off

in your and your over stopped working one day. They really do kind of come in and go out for a little a little bit of time, and you might blame it on one thing or another, like I got sick and you know that I didn't have a period for a couple of months, which can happen um or you get particularly stressed and you're not sleeping in your period stopped for a couple of months, and then they

kick back in. So it's a very rocky time frame for a lot of women because it's so unpredictable in what your hormones are doing, and until things sort of settle out post menopause, it can be pretty disruptive. And so when someone has gone one year without menstruating and so now they I guess it would say in menopause, But I guess we don't say in menopause after that year, right, do we say post menopausele or something or that's a

great question. So some people just say you're in menopause um or you are post menopausal for the rest of your life. So so I think either could be accurate. You are you're technically in menopause or post menopausele either is fine, and for me, I'm in I'm calling what I'm in perimenopause, but I am having hot flashes, the mood swings. If they're not perimenopause, then I, you know, maybe they should just lock me up and throw away the key because I've gone insane. But like it has

to be. But I also have a d h D and I also have depressions, So but I know those two um bedfellows. This feels different because it's so intermittent, and it's there's a lot mixed in with it. And so do I sound like I'm in perimenopause or am I? Am I experiencing something else? You very likely are in perimenopause, just from your age alone and your description of your symptoms. So it just seems like estrogen is a I don't know how to put it, a beast in terms of

there's too much, there's too little it. How are we having the same symptoms with different levels of am I making sense? Like sometimes we have too much, sometimes we have too little. Why do they produce a similar symptoms? I think it's the the changes in estrogen levels that

cause the biggest issues. Um, So what happens in perimenopause is your brain is trying to tell your ovaries, hey, not here, and from your ovaries, where are you, and they put out these brain chemicals that stimulate the ovaries a lot to say, you know, come on, let's hear

from you. And then the ovaries overshoot sometimes and so you can actually get higher estrogen levels than you've ever had in the rest of your reproductive lifespan because your brain is over stimulating your ovaries to get them to work, and eventually they don't respond, which is why you know, it kind of dies out eventually. But so so you're right, you can have these highly variable estrogen levels and and you know, sometimes when your estrogen levels or high, you

might feel great. Other women might feel breast pain, um when they're super high. But when they start to fall is you know, if you're going from super high back to zero, that's a big shift. And and so that's a night sweat, hot flash, irritability, can't sleep, you know, the whole thing. Um when that when that shift is occurring. So it's more the variability. Although high levels and low levels can cause symptoms, it's more the variability and the

changing that is so disruptive to women. And is there a tie in I've I thought, I read this that serotonin is affected by estrogen, and so in that sense, if the estrogen is being erratic, so goes our serotonin levels. Well, yeah, it's not that simplistic. So the neurotransmitters are definitely connected, and and serotonin can be impacted during all of this.

But serotonin levels can be impacted by a lot of things, including what's going on in your life, you know, and whether you're getting enough sleep and exercise and everything else. So so so many things impact those those neurotransmitters, estrogen being just the one. Anxiety bites will be right back after a quick little message from one of our sponsors. What I thought was so interesting, And I'll get to this chapter in a second chapter five Moods and you.

But there was a mention of grief, and you mentioned grief in the part of your book where you talk about maybe going through a premature amount of pause. But I feel like, even at the right time men of pause, there must be grief. I never really thought about that because I don't want to have children, and so I'm not conflicted about not being able to reproduce anymore. And but of course people who didn't have children, there may be some grief and then even grief about getting older.

I mean, it's it's very strange. I mean, I feel young, I look young, and my body is doing something that I saw episodes of The Golden Girls about when I was a kid, you know, so it seems it feels. Um, I'm not in the part yet where it feels liberating. I'm I'm in the part where I don't want this to change. I don't mind getting a period every month. I don't mind feeling the way I felt since I was thirteen, you know, I I'm in grief. I think, yeah,

I think that's an interesting concept. And and in talking with women, it's not a universal experience in my in my experience, it's it's something that some women have have to go through, and some women are really just yeah, let it be gone. I'm really happy to move on. But I think I think you're right. I think there is something about leaving that reproductive phase, if you will, Um,

it's somehow sad. You know, you're saying goodbye to something, even if you don't really care and don't want to have a baby, right um, but you're you're leaving it behind. And I think it also is associated with agism too. You're entering a time where you can't anymore. And I think more and more women really don't want to be defined by their reproductive status, like I can or can't have a baby. I mean, but that still is somehow a gateway that we all passed through. That that I

think a lot of women struggle with. You know, am I am I somehow not worth anything to society anymore because I don't have eggs being produced, you know, and released every month. And you know, so many people know so little about menopause that honestly they have no I mean, I know people that I didn't want to vote for Hillary Clinton because they were worried what she would be like on her period. I mean, I'm really just trying

to be funny here, but it is funny. I'm half serious that we worry about that because most people don't even know, you know, what it means that nobody would ever know I'm past my child bearing years if they wanted to be ages um, because they would they have

no idea what age that is, you know, right? I know I just read something that I think in Sweden women are going to have time off for menstrual situations and they specifically in the article we're talking about period pain and I'm thinking, God that you know the seven to nine to ten years of perimenopause through menopause were

these symptoms come in. To be in a workplace is really hard, and I think that leads to a lot of anxiety to like you have to hide this thing you're going through, which actually can show up on your face when you're sweating. Yeah, that's exactly right. And it's interesting you bring this up because this conversation about menopause in the workplace is really taking off, and I think that's a good thing. Europe's a little bit ahead of us there and that um they're really pushing workplace policies

for menopause. And I think we are now where we were with pregnancy and lactation about thirty years ago. We're starting to say, hey, we should have these conversations about what this means for women in the workplace. And where I work at Mayo Clinic, we're in the process of developing a work place policy um around menopause, because you're right, it is it can be disruptive. It can go on for a long time. It can be anything from I'm in the middle of a business meeting and I break

out in a sweat. I start to have, you know, pit stains, and people are wondering what's wrong with me? And I'm having trouble word finding. And some of the women that I that I see are like, I can't have this happen. You know, I'm an executive, I'm the CEO, and and they're like, I can't have this happen. You have to make this stop, or I'm not sleeping. And I had one woman that literally said she sweated out

her mattress to the point where it molded. Oh my god, I'm like, wow, okay, all right, So those are some serious nights. What's going on? Right? And and she had to have her husband come pick her up at work at the end of the day because she couldn't drive

home without falling asleep. So so some of these symptoms are incredibly disruptive, and it's hard to function during the day when you're not sleep being at night, or when you're so irritable you want to rip your spouse's eyes out um or you know, there's there's there's a lot going on, UM, and I think we need to have conversations about one, educating people about what this time is, and we should be able to talk about it. And it shouldn't be an age is discussion, right, it should

be UM, a normal conversation. This is a normal phase of life. This is not a disease. A hundred percent of women are going to pass through the stage if they're lucky enough to get that far right, So we need to be able to have the conversations and and not have it turn into, UM, a reason for discrimination, which that's definitely afraid of me too. And I'm getting anxiety as you're saying it because I'm like, well, you know what, never mind, No, let's not have the conversation.

I don't want anyone to know because they're going to think I can't do my job as well. And but it's true, how do we you know? In one way, it's nice to talk to other people who get it and say I really can't find my words right now. You're having, you know, jokingly, people will say things like that, I'm having a senior moment where you're trying to say can you get me that? Oh, go, what's that thing we write on it, it's um, you know, um paper paper,

give me the you know, we have those moments. But why wouldn't I mean, I have to be totally honest. Why wouldn't would discriminate? You know. So I'm very anxious for us to have this conversation because how is it not going to backfire? What do we do? I'm very anxious too, and I have to. I think we have to be very clear about what we're asking for in

the workplace. And I actually, you know, as as Uh, a medical director of the North American Menopause Society, we had this conversation at our last national meeting, and I'm like, what is it we are asking for? Is it a cold room at work? So it's amazing. I mean, you know, Frazer, you have a lactation room, you have a cold room. I mean, what is it? What is it that we're asking for? Because I think when you start talking about

workplace accommodation, that gets very sticky. And so you know, if it's being able to take your jacket off in a corporate environment for the five minutes when you're having

a hot flash, I get it. But I also think we need to flip this conversation and look at what's happened with menopause management in the last twenty years, and that is, we used to have about us women using hormone therapy to treat menopause symptoms before two thou two when the Women's Health Initiative study came out, and since then, hormone therapy US rates have dropped to orders of magnitude like four to six percent now, and so we have a lot of undertreated women out there. And so my

thought is we need to educate women. We need to educate their healthcare providers. There are treatment options out there that are available that are safe and effective that we're not using. And so is it so much that we need to accommodate someone at work, Yes, maybe, but we need to offer effective therapy for these symptoms so that women can keep doing their job and get the promotion and take the next job if they so choose to do.

Because think about the lost human capital for women not being fully at their peak form during this time of their life where they are at their peak form. Right. Well, well, that's what I wanted to bring up, is that I honestly would rather have me now in the workforce and me at and you know, I'm smarter, I'm more capable, I'm whatever. I'm just much energy. But you know, yeah, there are moments where I may forget a word and I may be physically uncomfortable, but it really doesn't affect

my performance. I am not actually experiencing a moment where my intelligence levels are dropping. And I feel like being able to watch someone maybe forget a word sometimes or be a little spacey um, be a little physically uncomfortable is not indicative of their job performance. You know. I think a lot of companies started doing this, and then I think the pandemic disrupted a lot of that um

extra stuff that we bring into the office. Right, maybe there's a yoga room, a meditation room, you know, for everybody of all genders and walks of life. Maybe there are these sort of mental health break rooms things like that. And you know, this notion of let's make work as comfortable as home, and then the pandemic hits. I think it disrupts it and people are like, oh, I'm just

gonna work from home. Right, I think you're right. I think COVID may have helped us out in many ways because it's accelerated, um, having us think outside the box in terms of what work looks like and where work is and how we're getting it done. And maybe, um, it's much more flexible now and it can be on people's own time. So I think we may have moved ourselves in a positive way just because of the COVID pandemic.

And you know, now we have more access to virtual care than we ever have before, which is making it possible for a lot of women to get menopause consultations virtually with experts that they might not have had access to before. So I think even for the care aspect, it's made things a lot easier to Oh, that's great, Right, you could talk to someone outside of your state. That's right. But you know, it would be nice if you could just without being questioned, you know, like a privacy thing.

Just work from home when you feel you need to. I think that helps a lot too, so you can

sweat and privacy and when you're not needed, take a nap. Um. But again, every time I say this, I get this cringe and twinge of anxiety of just like, oh god, it seems like we're so it seems like we're too much, you know, but I do think this kind of care could benefit men as well or people that don't go through menopause, you know, absolutely, And some women may not have that option if they're you know, factory workers for example, you can't opt to work from home, right, So I

think we need to think about different work environments too. And even those of us who are you know, seeing patients. Think of the nurses in the emergency room, they don't have the option to say, Hey, I think I'm gonna work from home today. So uh so, I think some jobs are are more amenable to that kind of flexibility,

others are not, and we have to figure out how to. Again, I think a lot of this is education and a lot of it is not making it a joke, Like why is menopause always the joke at the water cooler um where you get it conjures images of angry, red, sweaty women, right um. So, so I think we need to sort of break past that um to where you know, when women are bringing it up, it's not it's not automatically going to be a it's a joke. We'll be

right back. You mentioned in your book, uh your chapter called moods, and you I mean it's so overwhelming to me to look at all of the things that happened during menopause. You know, you talk about depression. You know, someone might be going through depression for the first time. And again it's not like somebody died and they might have a year of grief, but this again could be

seven years, ten years. And so we're you know, talking about people could take antidepressants, cognitive behavior therapy, managing your stress, and it's like there's so much you can do, which is great, but it also seems like a lifestyle change, like how you've got to add in time in your data, meditate every day and stretch. And that, you know, is what do you recommend for people that think they're starting in on perimenopause. Well, I think you bring up a

really good point. One. Let's just back up and get a bigger picture here, because I think so many women in this life phase are taking care of everybody else except for themselves, right, So so many people are you know, whether it's kids or aging parents, or your next dooring neighbor, or your dog or your partner. I mean often you are the last person on the list. And so part of this I think is, hey, thanks change in perimenopause, and as you go through the menopause transition, your own

health risk may change. That's a time when whereas women, our cardiovascular risk goes up as we go through the menopause transition. And so it's like we should like take stock of where are we Are we taking care of ourselves? Are we exercising like we should? Are we sleeping like we should? Are we managing stress like we should? And so I think rather than just looking at it is oh no, all these bad things are going to happen to me, I think it's take stock and am I

really taking care of myself? And the way that's going to set me up to be healthy for the rest of my life is more the way we should be looking at it. And you know, I really have to sit some women down and go, you know how when you're in the airline and they go put the oxygen mask on yourself before you put it on the person next to you when the plane is crashing, Well, that's that's this. I mean, you have got to take care of yourself first, so you can't take care of all

these other people in your life that need you. So so I think that's the first message that it's not selfish to take care of yourself. No, No, it's like life saving and it can make your quality of life so so much better. If you take the time and go exercise like you know you're supposed to but you just don't. You will feel better, you will sleep better, you will have better eating habits. I mean, it's all kind of snowballs in the right direction if you just

start taking care of yourself. So instead of looking at this like, oh, this is going to be terrible, what do I do? And you know, how do I manage it? Uh? The funny thing was when when I wrote that menopause book back in and by the by the way, the second version is about to come out. I'm excited and the Spring of twenty three. But when I was writing that, my mother said, why are you writing a menopause book?

And I was like, uh, I go, well, I never asked you, mom, what was your experience like with menopause? And she said, well, I think I might have had a hot flash once at a cocktail party when I had a glass of wine. And I went, wow, okay, all right, lucky her is she she's she just lying or she just so I'm like, you know, revisionist memory here. I don't know if that was really her experience, but she was like, this is such a non issue. I don't even understand why you're writing a book about it.

So so some women, I mean, I think that's fair to put out there, really stop their periods and that is the end of the story. And they got nothing, I mean, like no issues, and so God bless them. That's not the majority of us, um, and most of us are going to have something. And I think rather than just dreading the whole thing, you may or you may not get some issues as as you go through.

And you were talking specifically about mood. I think for those women that are the ones who need to be just a little aware about what is happening are the

ones that have had mood issues in the past. So if you've had a major depression in the past, or if you've had especially those hormonally related mood issues like PMS symptoms or like postpartum baby blues or a real postpartum depression, those are the women that are going to tend to struggle when their estrogen levels are falling around menopause. Um are those women who had trouble when their estrogen levels fell in the past. So if you've had that happen to you before, just be on the alert that

this could happen again. And so what worked before typically will work again. So if you were on an antidepressant before and it was great and it worked for you, that's where you need to go. Or kindnited behavioral therapy is always a great adjunct to anything, and sometimes it's enough on its own, but sometimes needs to be added to an antidepressant for those women who are also having hot flashes and night sweats that that time right around

on perimenopause. An early post menopause hormone therapy can actually be very good for mood too. If you're much past those first couple of years after menopause, hormones are not going to help you with your mood, so so we need to think about something else after that. But sometimes that combination of hormone therapy for symptoms and an antidepressant

works great too. So so there's a number of things that women can do, but I think being proactive and starting with the healthy lifestyle stuff even before you get there is a great place to start. I think it's so great because you know, I've had anxiety, depression, a d H d H in varying degrees my whole life, and weirdly, it's always been kind of a health conscious person. And so I feel very lucky that I was starting to do all of these things since it was my twenties.

So I have a you know, five to seventies a week, very gentle workout life, you know, bloodies and bloods of walking, and uh, I have a therapist, and I stretch and e well, do yoga and meditate and spiritual life like all the things. And I think what you said just helped calm me. And I did go back and into the presence last year because I was anticipating, you know, maybe something's going on here. It was hard to start going through this during the lockdown because I was like,

it's this lockdown as this periamoyu. But so what you were saying is like, instead of dreading it, because I think that was happening to me, I'm like, I'm already doing all the things, and so there's nothing i can do, you know, And it's like, yeah, no, you're doing all the things that you might have a lesser you might be. In other words, what I'm experiencing now. It doesn't mean that it's going to keep getting worse and worse and

worse and worse. This might be how it is. It might stay here for a few years, but this might be it, which is it's okay, I can I can handle this now. My guess is you this is probably as bad as it's gonna get. Right, let's hope. Um you're already you said doing the things that you know will help and that have helped you in the past.

And so I think that's a key for women is just knowing the tools in your toolbox and making sure you have those available to you, that you can employ them when you need them, right, And so I think not not every woman has a great toolbox, so setting that up in advance is key. Well, one of the tools that I think is being taken on of our toolbox, not that it was ever that helpful anyways, but it is nice to have a glass of wine. And as your mom said, she had one after a glass of

wine at a cocktail party. It's I think for women out there, if your relaxation at night is a glass of wine, you might really want to find something else for now that you can do because it does. Alcohol does affect it. Yeah, you're exactly right. Um. And you know, one little warning is if you're using that glass of wine to relax after a hard days of work, it's probably not a great idea. Men of us are not you. You're used alcohol to relax, which is a warning sign

right there. Um, And and you're right, um. Alcohol can make you flash. So can using a hair dryer. So can drinking a warm beverage. So can eating that. Using a hair dryer and drinking a warm beverage. Oh wow, caffeine can make you flash. And so so there's a number of triggers. And and you know, I have women going, oh my god, you mean I can't have a morning cup of coffee, And I'm like, calm down, you can.

It might you might have a hot flasher too, But it's life, right, I mean, So have your cup of coffee, have a couple of flashes, go dry your hair. You're gonna flash again, you know. I mean, it's all right, it's not the end of the world. And it doesn't mean you can't have a cup of coffee ever, or a glass of wine ever. But the glass of wine can impact your sleep. And let's just talk a little

bit more about that you can impact your sleep. So you think it's great, it's going to put you to sleep, but then it makes you have less effective sleep, less efficient sleep, and so you're not sleeping as well throughout the night. And also alcohol is a depressant, so if you're using it to calm down, but you're already having mood issues too, it's probably not your best bet, right.

UM So I think probably better to go take a walk around the block after you go have dinner and kind of you know, settle yourself and maybe do a little meditative um breathing, etcetera. Is a much better way to go than the glass of wine. We'll continue the interview on the flip side of a quick message from our sponsors. You mentioned in your book too that in addition to sleeping issues, um one of the stress the ways that stress can affect women in very menumus menopauses

control issues. And I just wanted you to speak more and that you may worry that you have no control or feel the need to exert too much control. I feel like that's such a huge thing that I never hear anyone talk about. Well, I think when women feel out of control. They seek to gain more control, right, And so I think a lot of women that I see in my office feel like they can't control or

predict things. Whether it's their mood, whether it's weight gain, which is so incredibly frustrating to people in midlife um or, or whether it's what is going on at work. But they feel a little out of control. And so your first your first reaction is to try to rain everything in too where you have it all under control again. And sometimes you know, I mean that's part of getting older and letting things go a little bit. Yeah, to the dishes have to be all done before you go

to bed. What's going to happen if they're not? You know, what is the worst case scenario of you didn't get the last thing on the list done before you go to bed. Right, So you start realizing that that the world isn't going to fall apart if you don't have

perfect control all the time. And that goes back to one of your solutions is people doing cognitive behavior therapy, you know, just learning to reframe their thinking or develop better mental habits with because I I have that, I have this you know, list making obsession, and and it's like irrational, like if things don't get done before bed, but I know the best thing for me would be to get full eight hours just to go to bed and it'll look at well. I've learned that things look

completely different in the morning. And if it starts looking really black, you know, the night before, I'm like, I think I just need to go to bed and it'll it'll be different in the morning, which is almost always true. So and every time I start looking for more control and it is now like what is going on in your life that you feel like you have to have

more control. So so that's when the anxiety level is higher and you got to pull out the tools in your toolbox to try to get your anxiety level down. You know. One of the best things for giving up control for me was having three daughters. Um, so there you have no control with three daughters and so uh so that was probably one of the best sercises and letting things go um and that has continued throughout their

lives too. If they're now in their early twenties. Well, it's it's like what you're saying is everything I talked about on every episode of this podcast. No matter what the subject is, anxious people want control, and there are things we have control over, but we don't want to do those things because they're not as fun. Yeah yeah, I know I can exercise it and I can sleep, but we want control everythings were never going to have.

And I think if you're like that anyway, probably does get exacerbated during this time, especially because as we talked about at the beginning, it's a little bit like, well, here you are, you know, entering the second phase of your life. And I think you're right, it can be this happy lesson, this gift of a time of really learning how to let go, especially we haven't had the opportunity to really do that before, you know, in any big way. Um is just saying yeah, this is gonna happen.

This is what it looks like. Yep, I am getting older. Hey maybe I'm wrong about how bad it's going to be in terms of post menopause whatever, you know, like this is it's it's like you said earlier, we're lucky to even be here at this at this point. So well, I think it also gives you a time to step back and prioritize what's really important. And I have this conversation with my patients all the time how to say no, so and I've struggled with that myself, but I think

this is part of the control thing too. It's really okay to say no, and it's empowering to say no, like you don't have to do everything you're asked to do or invited to do, or even if it's an honor, should you really do it? And is it in your best interest to do it? And so I think, um, figuring out how to have on your plate what you want on your plate and and get the other stuff off is just so important and liberating. I love that. I love that you brought that up, that that's so

important when we're going through a massive change. But I think it's is so important anyway, especially for people who have anxiety that people don't say no for many reasons. One is like they don't even know they have the option.

I think a lot of people with any kind of self esteem issue just think, who am I did not do this, like you said, especially if it's something that well, this is an honor, I should say yes, I'm being asked to speak at this thing, or you know, um, I don't know anything like yeah, that's when you said that I just felt so relaxed. I can say no to things or say, you know, I'm not gonna do one thing this week, you know, if it's a social

event or something, but I really can't do it. It doesn't I love that that That is a great way to take care of ourselves too. I think for anxiety at least, well and then and then think about it this way you I mean, I used the yes no yes sandwich like yes, that is a really important thing. You bring up our project you're talking about or opportunity. Um no, Unfortunately I can't do it this time, but think of me next time, which is the second yes,

or I have somebody else in mind for you. So it's a good way to actually mentor other people because you can give them opportunities and be the sponsor for somebody else to open a door. So so I think now is that time to embrace what you know. You are in the senior position and you can help other people and you don't have to take it all on yourself. And I still exercising that every day. Well, thank you

for saying yes to me today. I really appreciate you breaking down for us what's really going on inside of our our bodies and how how we can look at this phase of our lives, and and and do you have anything else that I haven't asked you that you'd like to let everybody know. Well, I think one of the important things is that, um, there are things that you can do so so women don't have to suffer through this. And I see this again and again and again.

I didn't know there was anything I could do. You know, whether it's the hot flushes and the nights wests, or the horrible moods stuff, or not sleeping, well we're vaginal dryness or pain with sex, whatever it is, they're suffering and they don't really know that there are options out there. And so I think the important thing to note is there are a lot of options out there, and whether you do or don't want to use hormone therapy or

any other treatment, we've got lots of options. And so, you know, just putting in a plug for the North American Menopause Society, it's menopause dot org. But there's a located provider tab there, so you can actually put in your zip code and find somebody who's certified and menopause it's in your area. So I think if you're not getting answers from your from your local healthcare provider. A

lot of providers aren't even educated menopause anymore. And we actually did a study on this in where we surveyed graduating residents across the country from A B G y N Family medicine and intral medicine, and none of them are receiving more than an hour or so of education about menopause during their training programs now and so we have a whole bunch of uneducated providers UM with regard

to menopause management. So I think it's important to when you're asking those questions, I understand if you have the provider who knows something about it, or if they don't feel comfortable with it or don't have that skill set, then there are other resources available. That's brilliant. And I will tell you I just thought of this. I was having, uh, about a year and a half ago, heart palpitations, and I know myself very well, and I thought, I think this is anxiety. I think this is related to UM,

you know, having been so isolated during the lockdown. But you know, let me just get it checked out, because it was it was happening a lot and I went to a cardiologist and they were incredible and they really found nothing wrong. And once I found nothing wrong, they sort of went away. And I thought it might be a symptom of paramenopause. I had heard that could be and so when I was in the office, I said to the cardiologist was a young man. I said, I'm

really not worried about this. Is want to let you know I have a feeling this is paramenopause. And he goes, oh yeah, because I said I I'm in parma. Oh no you're not, as though I had said I'm a big, ugly monster, and he was like cheering me up. And I was like, oh no, no no, no, it's not a like it's I am like, it's you know, and it's okay, yeah, and it's okay. I'm not calling myself old, and it was I I changed doctors after that because I was just appalled, you know, and yeah, I don't even want

to say I know. He meant, well, it's it, there's no no, he just sends exploding. He thought he thought it was a a derogatory statement, right, Yeah, so interesting. One more quick point on a study that was recently published that I think is so important that I think the implications are important. A study that came out in menopause last year, and it showed that women even before they start to have significant cycle length and regularity, so

their periods really haven't changed. They have the same symptoms as women who are in menopause to the same degree and with the same degree of bother and and out of the you know, it was like fifty different symptoms. Only hot flashes were a little bit less. Everything else was about the same. So the sleep disturbance, the mood disturbance, the all of the other symptoms of menopause, we're pretty much as bothersome before any changes in menstrual cycle length

occurred as they were in menopuzzle women. And that to me was just a big aha moment that that is like for all those women that come into their doctor's offices and are still having periods and they're saying, I have all these symptoms that are going well, you couldn't

because you still have periods, so you're not there. Um, it's so validating to all those women who are reporting having these symptoms when they're forty five or forty six or forty seven years of age and still having regular periods. So I think that just speaks to yes, it's for real. Yes, you are experiencing it, You're not making it up, You're not crazy. Um. Are there things that we can do about it? Absolutely? And you need to you need to

see somebody if they bother something after you. Hi. I hope you enjoyed learning all about what happens to our emotional and mood health during Perry menopause. Hopefully you're a little better educated and not too scared about when it's going to happen to you. But let's look at some of the takeaways. So, first of all, just starting relatively easy. Menopause is defined as no period for one year, and that's without any manipulation such as an I U D

or a birth control pill. The mean age in the United States for hitting menopause is around fifty two, but anything after the age of forty five is considered normal. The stages that get us to menopause is called Perry menopause, and it can last for several years, from seven to ten years. Some of the symptoms of Perry men pause are hot flashes, night sweats, sleep disturbance, and a crazy mood.

After you have stopped menstruating for one year and you're able to say that you went through menopause, you are now considered post menopausal. It is changes in our estrogen levels that cause the biggest issues in perimenopause. So sometimes our levels can spike, which is because our brain is desperately contacting our ovaries and saying where are you, and the brain chemicals can over stimulate the ovaries, and that leads to higher estrogen levels than you've ever had in

the rest of your reproductive lifespan. And then eventually, when the ovaries don't respond, the brain stops pushing them to respond, and the estrogen just kind of dies out. Eventually. What causes breast pain or trouble sleeping or mood changes is not just because the estrogen is too high or too low, but it is the swings of it going super high and then back to zero. That's when you get your nights. What's hot flash, irritability, can't sleep, it's the very ability.

Serotonin levels can be impacted by a lot of things, including what's going on in your life and whether you're getting enough sleep and exercise. So many things impact neurotransmitters in your brain that develop serotonin estrogen is just one of them. Let it be note that perimenopause and menopause is a normal phase of life. This is not a disease. We need to have conversations about perimenopause and how to care for people going through it in the workplace without

it meaning to discrimination. One positive is that after the pandemic, we now have more access to virtual care than we ever did before, which is making it possible for a lot of women to get menopause consultations virtually with experts that they may not have had access to before due to their locations. When we are thinking about going through these changes in our life, there are other health risks involved. During the menopause transition. A woman's cardiovascular risk goes up

as well. So in taking stock of where you are, are you taking care of yourselves? Are you exercising like you should? Are you sleeping like you should? Are you managing stress like you should? Looking at a menopause transition is oh my god, all these bad things are going to happen to me. Maybe think about it as taking stock and really looking at it is are you taking care of yourself in the way that's going to set you up to be healthy for the rest of your life.

You have to take care of yourself first or you cannot take care of all the other people in life that you need to. If you've had major depression in the past, or anxiety, or any kind of hormonially related mood issues like PMS symptoms or postpartum depression, these are the people that will tend to struggle when their estrogen levels are falling around menopause, and so it's important to

take care of your mental and emotional health. If you were on antidepressant before and it was great and it worked for you, consider staying on it during perimenopause because it can help with hot flashes. Cognitive behavioral therapy is always great to add in with that as well. Some women who are having hot flashes and night sweats, hormone therapy can actually be very good for mood as well.

If you are much past the first couple of years after menopause and you are no longer getting a period, hormones may not help you with your mood, so you may think of something else for that, like an antidepressant or more lifestyle changes. A lot of things can cause hot flashes, like having some alcohol to relax so alcohol can stimulate a hot flash. A hair dryer con stimulate a hot flash. Drinking a warm beverage, eating salsa caffeine can make you hot flash. There are a number of triggers,

but again, pick your poison. If you need your coffee, just know that you might have a hot flash. But in terms of wine and alcohol, it can impact your sleep. So you might think alcohol is helping to put you to sleep, but it makes your sleep less effective and less efficient, so you're actually not sleeping as well throughout the night. Many women going through paramount of pause feel out of control and they want to seek to gain

more control. They feel like they can't predict things, whether it's their mood or their weight gain, which is incredibly frustrating. But it's important to look at how we handle feeling out of control. Our first reaction is to try to rain everything in and have control over it, but we might want to look to what we know works for anxiety, which is acceptance. What is the worst case scenario if you didn't get the last thing on your to do list done before you go to bed? I am I'm

bad with that one. Don't ask me to give up my to do list. One way to take care of yourself that we may not think of is it's okay to say no, and it's almost empowering to say no. You don't have to do everything you're being asked or invited to do, even if it's an honor or even if you think you really should do it. One way to practice saying no is to use a yes sandwich, such as, wow, I thank you so much for the opportunity.

Unfortunately I can't do it, but think of me next time, or I have somebody else in mind for you, which would be a good way for you to mentor the person who you are passing this opportunity onto. If you need any help with anything. If you want to find out anything more about menopause or perimenopause, going to the North American Menopause Society website. It's menopause dot org. Again, the link will be in the show notes. There's a located provider tab you can put in your zip code

and find somebody who is certified in menopause in your area. Unfortunately, due to a study that was done at the Mayo Clinic in they surveyed graduating residents from across the country from O B. G y N to family medicine, internal medicine. None of them are receiving more than one hour of education about menopause during their training programs right now. So we have a whole bunch of uneducated providers headed out

into the world with regard to menopause management. So it's important to understand if you have a provider who knows something about it or who doesn't, and if they don't feel comfortable or have that skill set, you need to know that they're our other resources available, and of course you need to be your own best advocate. Again, if you want to read any of these takeaways, you can go to my website Jen Kirkman dot com click on anxiety Bites. That link is also in the show notes.

As we are winding down here and almost in our last ten or so episodes of the season one, which ends in August, I would beg you, I'm now begging if you could leave a five star review on Spotify or Apple Podcast. Those are the two places that have podcast reviews and just say you love the show. Whatever you want to say about those five star reviews do help keep it climbing in the algorithm. I actually saw a huge jump in the charts um last week when a bunch of you did heed my call to write

some reviews. So it really helps. And I want to keep being able to help people with anxiety. And the more people that find out about this podcast, the more people will be getting help with their anxiety. And you know, doesn't that make a better or society less people out there annoying you with their anxiety while you're trying to live with yours. Okay, and just remember anxiety bites, but

you're in control. For more podcasts for my heart Radio, visit the I Heart Radio app, Apple podcast, or wherever you listen to your favorite shows.