Hi, I'm Louise Ari and I'm Francesca Brudkin, and this is season five of our New Zealand Hell podcast, The Little Things. It's good to have you with us.
In this podcast, we talk to experts and we find out all the little things you need to know to improve all the years of your life and cut through the confusion and the overload of information out there.
We've got such good topic today, have looyd Owiz. We're going to talk about midlife rage, midlife emotions. And I think at this point my family would quite like to take over and have their two cents we've maybe contribute to this conversation. I'll keep them a million miles away from this. As a child, I was quite explosive, not all the time, but I could. I was quite unpredictable and I could definitely let loosen and rage a little bit.
And as an adult, and you've known me as an adult, Louise, I've worked really really hard to I suppose, calm things down and challenging moments and you know, I've you know, as immature, you learn lots of ways of dealing with things. If you know that your responsive, you know, i'd maybe just say to people. That's great, I'll have a think about it and come back to talk about things like.
I just learned all these little ways of remaining calm, and actually to the point that when I got really angry, I got quite quiet, and then i'd slow down my talking to a patronizing kind of spit on the ski fields and I'd talk very slowly like this, And when that happens, my kids got, oh shit, she's really angry. Like like, I learned that. That was when I was
really really angry. But then I hit my forties, probably my mid forties, and this explosiveness just came back, all this complete lack of patience for what was going on around me, and you'd never know what would set me off.
I mean, still not the big stuff. I can still when all the big stuff happens, I'm still very calm and but but there'd be just little things that would happen and I finally could no longer cope, and I would just verbalize everything going through my head while at the same time going, you should really just be saying this in your head. You should not be letting this out. But I couldn't. I couldn't stop it. I'd be like
I just been like, who is this person? Then discovered hit and thankfully we've kind of got a middle ground now. But I'm still I'm still slightly I'm actually slightly embarrassed about that behavior, and I'm also still slightly shocked at how it kind of crept up on me over again.
I think you should not be too hard on yourself because because certainly not alone for starters. I mean, I'm impressed that you worked on your explosiveness throughout your life, and I do think as I got to know you more, I did put into practice some of your measured sort of responses to things. Not all the time, but sometimes I don't think I did it nearly so much, and I think I could be.
I was quite a ragy mum.
I think the kids would say, I mean, there's some stories, but I mean I even hurt them, But there were some same we're just thrown into baths. I guess they don't need them. I believe they got flashed out of the toilet. But but look, weirdly, my health, Cristi has changed. I feel deduced with the kids in the mouth of the time, and you were through the sandwichesn't meet them.
Yes see, I would have stopped and going, I'm just going to clean that up. That'd be really annoying.
Oh, I said they had to eat them, but they didn't obviously eat them. They got out of the fun the.
Toilet and dully they ate them. So there you go. So that was that was I.
Feel like my kids have missed out. Maybe maybe I shouldn't let loose a little bit more.
It's probably the worst one, to be fair, And I mean we do laugh about it now anyway, but my health christis changed that that ragey little bit, because I mean, I don't know, maybe it was the universe talking to me, but I felt less irritated by every little thing because something big had happened. But they said, I can get set off. And and I want to know. I guess if it's whether you know that thing about getting to
a certain age and not giving two shits anymore? Is it that or is it realizing life is too short? Or is it hormonal or is it a big old mixture of all of them.
If you didn't give two shits anymore, or if you're realizing life's too short, then you probably wouldn't react at all, would you.
Hmm? Good point.
I mean, you'd probably go, why am I going to antagonize you one? Why am I going to put this out there? If you just roll your eyes and move on.
Well, that's why I can't the keep all worry stuff gets to me because I can't understand why if you're that full of vitriol and hate.
Yeah, yeah, what's up?
Judgment and opinion and yeah all the rest of it, keep it to yourself. Well maybe it's good we let it out somewhere, but somehow more something more productive.
Healthy, that's our healthy way. But maybe they're just all struggling with midlife rage.
Who knows? They can't just think No.
I think there's a lot of rage about everything, and you know, isn't there at the moment in the world. But look, we hear about women struggle with their mood and women dealing with mental health issues such as anxiety and depression, sometimes for the first time in their life as perimenopause sets, and if they even know about peri mortive menopause, it can be so destabilizing for your relationships, your marriage, your job. Does menopause make pre existing anxiety
and depression relapse or intensify? And what can we do to help ourselves. Joining us today is doctor Caroline Gervich. Caroline is a clinical neuropsychologist. She is the Deputy director of her Center Australia, head of the Cognition and Hormones Group, and an associate professor at Monash University. She has a research interest in the neuropsychology of women's health and the role hormones play on cognition. Welcome Caroline, thanks so much for being with us.
Hi Francesca, thank you for inviting me to talk to you today.
Should we start, maybe at the beginning and talk about what hormones are the ones that are impacting our mood and our mental health.
Yes, So during these life phases where our hormones change, like menopause, the key hormones we're talking about are estrogen and progesterone.
So these are sex hormones and they're the hormones.
That regulate our reproductive function, and that's often what we think about when we talk about estrogen and progesterone, but they actually do a whole lot more than just regulating our reproductive functions. So they can cross over our blood brain barrier and enter our brains and have quite potent effects on different brain areas and particularly brain areas that
regulate our mood and regulate our thinking skills. So that's why these times of life where our hormones change, we can also experience changes in mood and thinking skills.
As well, because we often think of them as the six hormones, but there's so much more to them than that.
Yes, yes, so much more so. That's right.
They are the sex hormones and as I said, regulate reproductive function. But these hormones, so we know probably a bit more about estrogen and how that works in the brain, and we've learned a lot about how estrogen works in the brain from animal research, and these studies show that these hormones actually are quite potent sex steroids in the brain, so that means that they have an impact.
They actually change the thickness or density of.
Our connections between our different neurons and the way different parts of our brains communicate.
They also have an influence on neurotransmitter systems.
So these are chemicals in the brain, and you will have probably heard of things like dopamine and serotonin, So these are chemicals in the brain or neurotransmitter systems in the brain that are really important for regulating our mood and regulating our thinking skills. So at times when our hormones either fluctuate or gradually decline, our brains react to this. And some people are sensitive to these hormone changes in terms of their mood and thinking skills, and.
Some people aren't.
So it's not a uniform conclusion that we draw that when your hormones change, your mood will change, because that's absolutely not the case. But for some people, they're just sensitive to hormone changes. But all this animal work that's been done has really laid that scientific basis for us to have a really good guess at why some people might be more sensitive to times of hormonal change.
So throughout our reproductive lives, we go from puberty through pregnancy up to perimenopause. Is that the impact we're seeing is it? Are some of us more sensitive all the way through or can it vary?
Yes, it's such a good question. I think there's both scenarios. So there's certainly some people who are sensitive to hormones always.
So there's some people who during.
Their reproductive years when they're experiencing a menstrual cycle for women, or people assigned female at birth, when they're experiencing a
menstrual cycle. Each menstrual cycle has little fluctuations in estrogen and progesterone, and the time of the menstrual cycle that most people who are sensitive to hormone changes experience mood symptoms is in that pre menstrual so in the few days before someone gets their period, and at that time, in terms of our hormones, our progesterone levels are increasing and our estrogen levels are a bit lower than our
progesterone levels at that point. So the thought is that it's the progesterone that is some people are sensitive to, and not even the progesterone itself, but the progesterone has metabolites, which is kind of when it breaks down and flow on effects from the progesterone, and so one of them is called alopregnant alone. But that is what the theory is, that some people are sensitive to an increase in this alopregnant alone, and when that increases, some people experience these
mood symptoms. So some people experience that. Then there's some people who experience quite significant mood changes in the postnatal period, and there's lots of significant hormone changes that happen both
during pregnancy and in the post natal period. I should also say that having a baby is a huge life change as well, so we can't just say, well, it's all hormones, because there's lots that happens when someone has a baby, but there's also quite significant hormone changes, and so it's thought that some people again are sensitive to those hormone changes.
And then the next life.
Phase for females that a lot of people are sensitive again to hormone changes is in that perimenopause, so the menopause transitioneers and early postmenopause. So sometimes we see someone in perimenopause and it's the same person who's been sensitive at different life phases to hormone changes.
But then sometimes someone's had none of that. They've not had any kind.
Of pre menstrual mood symptoms, they haven't had any postnatal depression or post natal anxiety, but during menopause they experience for the very first time a big change in their mood.
So I think there's both types of people. Some people are just.
Sensitive to hormone changes, and some people experience mood changes for the first time during menopause, and whether that's a hormone sensitivity or a number of other factors contributing to it. We're still kind of learning and understanding why those mood changes come about, but it seems to be related for a lot of people the hormone changes.
And have we been able to work out why someone might be sensitive.
No, that's a really good question. So there's probably a number of factors. So there's probably some genetic factors our genetic makeup. Some people might carry certain combination of genes that makes them a bit more sensitive to changes in hormones. There's also a theory that some people who have experienced trauma throughout their lives and have got a sensitive or a more sensitive endocrine access that governs our stress response, that person might also be more sensitive to changes.
In our reproductive hormones.
So there's a bit of a crossover between these different endocrine axes that govern different That are hormones that govern different responses, so stress response, reproductive hormones, or sex hormones. So there's also a theory that those who have experienced trauma of some sort, and trauma can be lots of
different things. It's a really personal I mean, somethings are obviously trauma, and some things are not necessarily considered trauma, but for an individual that you know, poor attachment when they were younger, or peer bullying or things like that can constitute trauma for an individual. And so all sorts
of things might make someone more sensitive to hormones. And then sometimes we're I mean, it could be a combination of genetics of trauma for some people, or yeah, I guess we just don't really know exactly why some people are more sensitive.
It makes me very grateful I suppose that we're in a slightly more enlightened age where we're talking about these
things before they happen. Because freendiscin I both confessed to not really having any clue about perimidopause for a long time, and it has sort of come into the social consciousness a little bit more, particularly for women obviously, and I just sometimes think about, you know, the jokes around what's the one before you get your period, premist tension, Yeah, yeah, foggy brain and in middle life rage and all of that sort of thing, and you know, we do, we
do laugh things off because we don't understand them.
M m.
Yes, And sometimes that's fine, Like for some people the mood changes the brain fog.
It's kind of mild and you can laugh it off.
It's a coping mechanism, and it's absolutely fine to do that, and it can be.
Pretty subtle and it's not a big deal.
But then there are other people where it's it's not so subtle and it is more of a big deal and it's a bit more.
They can't just laugh it off, you know, they're really struggling.
So I think there's a whole spectrum of experiences that people have, and yeah, the different sort of coping mechanisms or help that people need can also be really varied.
So, Caroline, during perimenopause, in menopause, how are our hormones impacting our brains and our mental health?
So as we transition from our reproductive years into menopause, there's this timeframe, this transition timeframe called perimenopause, and that can span four to eight ten years for different people.
And during that transition time, we move from having the reproductive regular menstrual cycle for people who aren't taking any kind of hormone or contraceptive, and then our sex hormones estrogen progesterone, instead of fluctuating in a regular cyclical pattern start to be a bit more erratic, and they can fluctuate quite rapidly, and at the same time, the estrogen and progesterone are also gradually declining, So that happens, as
I said, over four to ten years. The things that we can notice during that time in terms of our menstrual cycle, that can become irregular, and that's often what the basis of diagnosis of perimenopause is that your mental cycle can be come irregular.
But often just before that happens, people can start to notice changes to their mood and their thinking skills. So that's the brain fog of menopause or perimenopause that people talk about. And the mood changes, the rage, the irritability, paranoid thinking, anxiety, depression, a whole spectrum of different symptoms that fall under that umbrella of kind of a perimenopausal depression that can happen early on in that perimenopausal transition.
They can be some of the first signs that happen, and it might be that our brains start to become a bit sensitive to the fluctuations in our estrogen levels and that gradual decline and progesterone. But if it's happening early in the perimenopause.
It's probably our bodies and brains reacting to the fluctuations in estrogen and progesterone levels that happen during the early stages of that perimenopause and that transition phase.
That's fascinating.
Gosh, that's really making me think back to my late that is an early forties, to be honest, And so would you call it a common phenomenon for women and perimenopause.
So in terms of the mood symptoms, it really varied depending what literature you look at. It's probably about a third of women will experience some depression and about two thirds of women will experience some degree of brain fog.
But I think there can be kind of secondary depression secondary brain fog.
So if people start to experience things like poor sleep, like anyone knows that if you're not sleeping well, it can impact your mood, it can impact.
Your ability to think clearly, So that can happen as well.
But people can also experience just the mood changes or just the brain fog on its own. And there's also a link potentially between the vasomotor symptoms of the hot flushes there's a theory that if you're experiencing hot flashes during the night, then that disrupts your sleep, then you have poor sleep.
Then you have a flow and effect mood changes and to brain fog.
But also, as I said, there's the people who don't experience any of that but just have the mood changes. It might be more directly related to the hormone changes in the brain.
Can I just ask you a quick question.
You're talking about contraception, and this is a thing that's been on my mind, but I haven't known who to ask and you may not be able to answer. So does contraception have any impact on perimenopausal symptoms?
Yeah, so it can, absolutely so, because it flattens out the natural fluctuations in our hormones across menstrual cycles, but then adds in synthetic hormones that kind of replicate that. But if you don't take the sugar pills, so if you're just taking the active hormonal contraception, then it's kind of flattened out, and so you lose some of the effects of a menstrual cycle and you have less fluctuals.
So I think the Australian menopause or Australasian Menopause Society, which extends to New Zealand, suggests that you can keep taking hormonal contraceptives in consultation with your doctor until about the age of fifty And yeah, so that can have a beneficial impact on mood for some people, but some people might also need to consider and talk to their healthcare professional about different options if it's if it's not enough.
Yeah, and there are there are different options. But I found it really helpful just for when those when the metal cycle became really erratic and have to started having a little bit an impact on life. You know, it was one way to be able to It was just another tool to use to try and kind of stabilize things control. Yea, So how many women who have never you know, we talked about the sensitivity and things towards
hormone fluctuations and things. I'm sure it must be quite a surprise for a lot of women to get to sort of middle age and all of a sudden be dealing maybe for the first time with anxiety or a panic attack or this irritability in things.
Oh.
Absolutely, And I think you say middle aged, but I think for some women it's sort of forty, like it's quite early that some women experience some of the mood changes because they can be some of.
The earliest changes.
So the median age of menopause is fifty one, but if perimenopause, that transition can go up to ten years, it can be sort of forty early forties. So some people don't even have menopause on their radar, so they don't necessarily know why they're starting to feel a bit anxious, a bit paranoid, irritable.
So the connection might not be there.
And it might come a bit out of the blue, and it can be really hard to deal with.
And I think the timing of menopause is now with our lifestyles, is often at a time of life that people are really quite particularly women, are quite stretched and quite busy. So in the middle of your life, you're
often at the prime of your career. You might have teenage children, perhaps elderly parents who might be managing house, the household, like you might be doing a whole lot of things, and so you're just really busy and stretched, and with that often comes stress, and so I think that's a huge factor that sometimes we forget to take into the into consideration. When we think about the impact of these hormonal changes, it can sometimes be like the
tipping point. You can kind of cope and then you get to this point where you just can't cope with all of that pressure and stress anymore.
And so it might be the hormones that are triggering things. But then if we look at the whole story and take a holistic approach, is often a lot going on for that person at the same time.
Well, that's that's right.
So that leads nicely into the you know, that rage and that irritability, that sort of almost breaking point. Then you kind of have little all out and then regroup.
Yes, yes, and I think within that presentation of depression, we've done a bit of work at her Center, which is at Monish University where I work, led by Professor j. Shukulcanni, where we've looked at characterizing that perimenopausal depression, which is a bit different to a clinical depression at other life phases because.
It's a bit more on. It can be for some women quite on off.
So suddenly there's that rage or that paranoid thinking, that irritability kind of out of nowhere, and then you do bring yourself back together and feel like okay, So it's kind of got this on off flavor to it that's a little bit different to that potential, you know, ongoing sadness or helplessness that might be part of a clinical depression at other life phases, if.
I hit an explosive moment at home, Caroline, half the time, I'd just be going off, saying whatever was going through my head, and at the same time I'd actually would have it was like I was looking at myself outside my body, going who are you? What are you doing what? It was really strange that two things could be happening
at once. That I could be putting so much effort into yelling and you know, at my family about something ridiculous like the fact that no one can put dishes in the dishwasher, and at the same time I was sort of going, goodness me, Francesca, what on earth is going on with you? Who are you? You know?
It was bizarre, Yeah, And that's not uncommon.
That's that's a very common description of the feelings and the emotions and how they play out for a lot of people.
And I think it is good to make that distinction that, like you say about the on off and you're not saying this is a rule. You're saying this is in general. But if you are feeling like, gosh, am I clinically I mean, obviously your first portocoll is your health professional, But am I clinically depressed?
Or is can I?
And this is why they often tell you to do a diary, don't they to kind of work out when how often that's happening, what time of the month it's happening, what time of the even the day it's happening.
Yeah, exactly.
And for that reason, we also developed this scale it's called the MENO D that people can access and it provides people are capacity to rate their perimenopausal depression to kind of get an objective score.
To say where am I at? Is this really I need to.
Follow up with a doctor or is this okay? So there's in the MENOD there's cutoff scores. But I think if anyone's concerned, intuitively within yourself, just go and speak. Don't hesitate. Always go and speak to a health care provider. Because there's so many different options out.
There to support people.
People shouldn't just have to bear, you know, put up with it and bear it and get through. I think that that thinking is something that's definitely changed that we now appreciate that it's quite common to experience changes to mood and to experience brain fog. But you shouldn't just have to suffer, because you know, four to ten years is quite a long.
Quite a long time.
Yeah, I've pulled up the questionnaire. It's quite extensive. It's good. It's about four pages, but it's going to cover everything, which is fantastic. Oh, thanks for pointing us in that direction, Caroline, that's awesome. Another thing that's almost the opposite of everything going on in your brain at once and exploding is nothing. Having moments of blankness and struggling to kind of get through the brain fog is something that a lot of people talk about as well.
Yeah, that's something that's I think gained a lot of traction and discussion, particularly in the social media space over the past maybe decade. And it's weird because brain fog isn't a term like depression. It's not a term that has a clinical description. It's not a diagnostic or medical term or psychological term. It's just a term that's emerged from the community to describe their experiences. And we've asked
them in about what it is for them. You know what is brain fog, And people talk about memory lapses, attention lapses, difficulty in making decisions, that word finding difficulty, you know that when you've got a word on the tip of your tongue and you just can't find the right word. So they're the main kind of symptoms that fall under that umbrella of brain fog for women, and our understanding of it is a bit similar to the depression, like we think that some women again when they're sensitive
to the hormone fluctuations. There's estygen receptors in our brain in the front part of our brain, which is really important for our higher order executive functions like organizing our thoughts, as well as in a part of our brain called
the hippocampus, which is really important for our memory. So, again going back to the science, it makes sense that when these hormones are fluctuating and declining and they're in brain areas that are really relevant for our thinking skills, that there might be a flow on impact to our thinking skills. And again there's all the other stuff that can impact life, stress, poor sleep, mood changes, So all
of those things independently can impact your thinking skills. But then the hormones might have a direct impact for some people as well on their brains and on their thinking skills. But one thing I do like to always add is that while women experience this brain fog in daytay life, it's very real.
It happens in about two thirds of women.
For some people's subtle some people can have quite a big impact. But when we do a neuropsychological assessment, which is when we assess someone's cognitive capacity, their actual ability to reason and to make judgments and to use their attention and their working memory and to learn, it's normally.
In the normal range. So people during.
Menopause, even those women who are experiencing brain fog, their actual core cognitive skills don't change, so they're still able cognitively.
That's a really important It's almost more like imposter syndrome that you've ended up with. You think you can't do it, but you are still functioning well.
Yes, but some people just need some support.
So they might just need a bit more structure or a little bit more you know, time to do things, or a little bit less distraction while they're doing tasks. So it's just the support the scaffolding that people might need so their brains can continue performing at their best.
I know, when I can't reach for a word or a name or so forth, all I really do need is a little bit of understanding and time, not idea when you're trying to record a podcast and it happens, but you know, all I need because I know it's there. And what I would prefer rather than someone maybe finishing my sentence or giving up on it, is just that
time is it. Just give me a minute, it will come to me, you know, because I get more frustrated when I have to leave it and then go oh, and then it'll come to me in the middle of the night when we're awake, because we're awake.
Through yes exactly. And it's not that helpful then. But that's the other thing that is.
I think some people with they get anxious to try and find the right word or to try and think, and I think that anxiety can make the brain fog worse. So I think you said like a bit of time, I think that's like perfect just to try and you know, relax and not stress too much about it and just to back yourself and note like the word is still somewhere in my mind or I am still able to make decisions, but I just need a bit more space in my head to do that.
And that what was thirty seconds? Maybe I don't know.
I'd probably give up myself after about thirty seconds.
I first, yeah, I sort of first mentioned it to my GP, probably before I even knew there was a thing called perimenopause. And she would say, she'd sort of say to me, Okay, tell me what it is that you can't remember. I go, oh, a name, or does it?
Then she goes.
And then I got to one scenario, Caroline, I said to it, I can't I couldn't remember where the mayonnaise was in the super market. And she went on, that's one that we might we might just make a note of. And she said, but it's never happened again. But I think that that was the first thing. The first thing a lot of women probably go to is, oh, my gosh, am I heading towards dementia, have id early on set dementia, And it could be very you know, it's easy to make that assumption.
Oh, absolutely, because if you think about very superficially the kinds of experiences you have, like you know, forgetting where things are, forgetting names, losing your train of thought in a conversation like those things might sound very superficially like the early stages of dementia, but I think it's a few really key differences between menopausal brain fog and dementia are. One is age, So people aren't diagnosed with dementia generally of the Alzheimer's type, at least until the age of
sixty five, and even early on. Said, it's sort of more fifty plus, So just because of someone's age alone, it's very unlikely that people are experiencing the early stages of dementia. And if it is early on set or young ones at dementia, that's quite rare, but it exists. But the presentation then often has more mood symptoms, more behavioral changes. It's not the same as that kind of forgetfulness or not finding the right word or so.
I think they're some of the key differences.
And often also with dementia, it's other people around you who become quite concerned rather than the person the individual themselves.
Whereas in menopause it's very much the individual.
Who's ghost So true.
Yeah, So I think there's a few factors that are quite different, and certainly clinically and neuropsychologically, the presentations are really quite different when you drill down.
So what other issues are you seeing when it comes to cognitive and mental health issues with women?
So the other clinical question I have been receiving a lot in recent years is women who present and they've got these cognitive changes and their menopausal and they're questioning where they've got ADHD.
So this is a new thing that's popped up.
It wasn't a question that came up, I don't know, five years ago or so, but.
It's more and more frequently people are.
Questioning this, and there's sometimes it's because the peri apause.
A woman has children and they've been diagnosed with ADHD, and through taking a children through that journey, they've you know, obviously been made aware of what ADHD is and what the symptoms look like, and they've identified so many of the characteristics in themselves, and then they've felt like they're really experiencing this and they've always been experiencing the symptoms of ADHD or the characteristics of ADHD, but they've kind of managed, but they've got to a point where they
can't manage anymore. So that's often the presentation of people. And in that case, like clinically to tease apart, is this like a new onset of brain fog.
That looks a bit like ADHD?
Or is this a genuine ADHD, like a brain type, a neurodevelopmental condition that someone's always had. We spend a lot of time talking to someone and really understanding their history and understanding what their presentation is. So just for people who are unaware, so ADHD attention deficit high practicivity disorder.
It can present quite commonly for females as just the inattentive component, So that's things like forgetting things, losing things, losing your train of thought, sitting in a conversation and then realizing you've just missed most of the conversation, haven't
been listening. So that's one presentation of ADHD inattentive. The other presentation is that hyperactive impulsive where people feel like they're on the go, they've got a motor inside them, they sort of talk excessively or butt into conversations.
And people can also have a combined presentation, but the.
Undiagnosed woman is often the one who has that inattentive ADHD, and I think a lot of people look at inattentive ADAH and it's very easy to tick those bloxes. Like we all forget things from time to time. We all sit in a conversation and our brains drift off and we're not present and we miss things. So a lot
of the characteristics of inattentive ADHD are really common. Sometimes it means that they can be missed, but I think in terms of a clinical diagnosis, it has to be that they're kind of pervasive and that they really are present in more than one setting, and that they impair functioning. So it's really separating out, you know, what is normal degrees of inattention that we all experience from time to time from something that is someone's neurodevelopmental brain conditional brain
type where it's really causes challenges. And often people have a history where they've managed or they've been misdiagnosed with depression and anxiety and all sorts of things, and then they get to this point and it's quite clear that they've always had this, but it just hasn't been diagnosed, and so sometimes that's quite a big journey for people to go on to get a late diagnosis and to you know, all the what ifs iphony are known and so yeah, it can be quite confronting for people, but
also there can be an element of relief for some people as well when they do have a diagnosis later in life and a new understanding, a new lens to understand their world.
That's a lifetime of what in our family we call the aha moments. My daughter was diagnosed at thirteen and we spent a year going oh ah, you know, like because everything kind of fell into place and things like that, so that came back. Imagine how that's overwhelming. If that's a lifetime of those. Yeah, absolutely, yes, I think it's
probably like everything, Caroline. When we have a symptom, it's really important to, you know, make sure you're talking thoroughly to your gp about it and not presuming it's just one thing or the other. It's like, there's such a massive list, isn't there of menopausal symptoms, And yes, a lot of the time they do. That's what they are.
It is to do with the hormones. But you've always got to make sure that you're just double checking that there's not something else at play and something else going on.
Yeah, absolutely, yes, definitely always worth having if you're concerned and it's you know, occupying your mind and in thinking about it, always worth having a chat to your healthcare provider.
You're listening to the little things and our guest on the podcast today is clinical neuropsychologist doctor Caroline Gerbert, talking about how our hormones impact our brains and our mental health. Will be back shortly after the break. Welcome back, Carolin. Maybe we could talk about some tips to help us through all this, how we can manage it If our mental health is suffering, is medication the best option? Or can lifestyle and dietary changes and things help?
So I think a combination of everything can be most helpful.
So I think you can always start with kind of behavior change lifestyle change, but if that's not helping, I think it's definitely recommended that people go and have a chat to your GP and make sure you've got a GP who has a really good understanding of menopause because it's not everyone's area of specialty, and so if someone's experiencing sort of a new onset depression around menopause, they might want to be speaking to their GP about different
types of hormone therapies or antidepressants if hormone therapies aren't appropriate for them, and for the sort of brain foggy cognitive symptoms as well. Might want to be thinking about really practical things that people can do just to support their cognitive health during the menopause transition.
So that's things like, you know, using.
Your diary, like feeling comfortable to put everything in your diary so you don't have to hold it in your head, and using lists to remember what to do, kind of doing the brain dumps to get all those thoughts that are floating around in your head onto a piece of paper to clear some space so you.
Can think clearly.
And you know, in workplaces, making sure people put things in an email so they don't shout them out in the corridor. And then you're trying to hold more bits of information in your head, so put the onus on other people to structure things for you and email them through and help with prioritization if need be. So I think there's kind of practical things. There's medication options, but I also think midlife and menopause is a really good
opportunity to sit back and reflect on your lifestyle. And think about healthy lifestyle and what's good for our kind of brain health. So it's the same things that we say for heart health, it's exactly the same for brain health. So it's things like exercise is super important, and exercise on its own can also help mood. So making sure
people exercise and get moving is very important. Making sure as much as possible that you get good sleep, and there's help out there if you're not sleeping well, again, speak to your doctor about it. It's really sleep is crucial, you know, Making sure do you have time out so you're not on the go all the time, making.
Sure your brain is stimulated, making sure you've got a good balanced diet like Mediterranean diet, and making sure you're not using alcohol as a coping strategy because that's not going to help your brain that I think, you know, some people kind of turn to alcohol as as a quick fists and makes them feel better temporarily, but.
It's not going to help in the long run.
So there's lots of kind of healthy lifestyle things that people can do. And I think you know, midlife is a great time to reflect on your own lifestyle.
Yes, and we've covered a lot of those points it was one of the reasons for doing this in the first place, was how how to help ourselves and sit I know, for me, exercises a big one and I really know when I can't the impact it has on me. Yes, with same with diet and getting that time out can sometimes be one of the hardest parts.
Absolutely, but it might not even be.
It's not like you have to go and spend a day a week in a spa, although that might be nice, but it might just but you know, having making sure that you have, you know, five minutes just to go for a walk by yourself with no phones, no stimulation, just some actual switch off or just a breather in the middle of the day, have a cup of tea or whatever it is.
But just little bits of switch off where you're not your brain isn't bombarded with stimulation.
Any breaks.
I like that, Yeah, many breaks, Everything's many these days, Caroline. Conversation ahead with women quite often when they have symptoms to do with their mood, maybe low mood and things like that, maybe they're not sleeping as well on things. Often we're all having the same conversation with our GPS. Do we need HI or do we need any depressants. How do we make that decision.
It's such a good question and we actually don't know the answer. So we're trying to run a clinical trial at the moment where we're trying to do this head on head comparison and antidepressants and hormone therapy because that hasn't been done, so we don't know that answer at
the moment. Our clinical guidelines say to go with the antidepressants because they've got a stronger evidence base, but there just hasn't been as much research with hormone therapy for mood so I think that's why there's not as much evidence there. Although the guidelines do say that you can try hormone therapy for moods as well, it's just not
the first line treatment that's recommended. So I just think it's really important to go and have a really good discussion with your GP, and you can look at the Australasian Menopause Society is a really good place to read up and they've got literature for anyone who wants to have a look at what the recommendations are for that to go to your GP with that see a.
Bit more equipped to have the conversations.
And be honest about it. I think if you've never really suffered from mental health, then it's quite hard to go in and have that conversation and sort of put it on the tables. But it's important that we do how far along is that research. Can we just rush that along a bit love to.
Russia.
We're working through as quick as we can, and.
How slow research can be.
It can be really slow. Funding can be really hard for every research as well.
So we're doing the best that we can to try and learn more and get those answers.
But I think also you know, if you're not.
Someone who's experienced depression in your life and your hormones change and your experienced depression for the first time, maybe trying to replenish those hormones might be a good place to start. But have that conversation with your GP.
And I think the good news there is that there are resources like the Australian Minipause or society. There are more resources with even in space research that we do have that women can themselves with or do that research before they go to see someone. And if you don't get the answers that you think you need, or if you feel like you're getting brea off, try try again with somebody else prehaps.
Yes, exactly, And I think that's hard, Like often when you're feeling vulnerable and you build up the courage to go and speak to a GP. If you do get dismissed, which can sometimes happen if it's not someone's area of specialty, it can be hard to try again. But I think you know, always try and find that new self to keep trying until you get to a point where you feel better.
You mentioned before, you know, will we hit this sort of period of our lives, it is a good time to sort of have a little bit of a reset and think about our cognitive health. But should we always be looking after it like shou should we be saying to it? Should we be sort of more aware of out even our older teenagers and things like that near cognitive health and putting in good practices.
Now Absolutely, I think all through our lives we should do what we can to do the best for ourselves to optimize our brains and our physical health always, but I think people probably have other priorities, as you know, teenagers, and so I think midlife is a great time if you haven't already implemented some of those things like you know, a regular exercise routine and a healthy diet. It's not too late to start to still, you know, there are things that these they modify our risk of later life
dementia and things like that. We do have some degree of control and we can try and do our best to have some of those healthy lifestyle approaches and they have short term benefits and longer term benefits as well.
I'm going to ask a really dumb question, and I'm blaming it on minopause. Okay, our brain is a muscle, right, our.
Brain, It adapts.
So our brain they often use the words of being, you know, plastic, it's malleable.
So it keeps changing always.
And so you know, the more we do good things for our brain, our brain will respond and will adapt. And that's why people recommend things like you know, learning a new skill or taking up new hobby or you know, challenging yourself because that builds new connections in the brain and strengths and connections in the brain. So, yes, our brain keeps changing as we as we grow.
That's what's so cool about it. As we can improve it, it can grow and get better. That's what's so neat about it.
Yeah, yes, yes, always, yes, you know.
It's interesting. I was gonna ask you, you know, we really need to support each other a lot more going through this period of time and how we can do that. But I wonder whether the best thing that we could do is get our partners to listen to this podcast. Yeah, because I think most women, we were all we are quite understanding of what other women are going through. Yes, and as Lu said before, we're having a lot more
conversations about it. But I think probably where we struggles and other environments, like in the workplace.
Yes, yes, exactly, and I think some workplaces are more progressive and there's more conversations about menopause and menopause in the workplace and supporting women through menopause and yeah, but I think the more conversations that happen, it just becomes, you know, part of our dialogue and it's not such a big deal and it's not so taboo and there's
less stigma if there's more conversations. And I think, you know, at the heart of it, in terms of the workplace, we want to be able to keep women and all their talents and that diversity in the workplace, and there's Sadly, far too many women who get to a point and for whatever reason, whatever's going on for them, they leave work during those menopause transition years, and you know that's terrible, rather than seeking the right supports and then being able
to do their best to thrive during this time. So I think it's really important that there's support coming from all different places so everyone can be at their best.
It's not as if we're using it as an excuse for any kind of poor behavior or poor work outcomes or anything like that. So it's a knit win, right if it's not, and like you say, just giving us that moment if we need it or I know there's a lot of talk about uniforms, people who work in places where they wear uniforms where they're not practical.
When you have when you have a hot flush.
Yes, exactly, exactly.
Sometimes, Yeah, we're not just talking about the corporate workplace. We're talking about across the board.
Yes, sometimes people need layers so they can adapt to however whatever their body temperature is feeling for them.
I mean, we have arguments all the time about the airct and in our building.
Yes, yes, so golden here, yes, yeah, exactly, Yes, it depends who has the controller.
When it comes to our cognitive health and the other things that we've been talking about. Caroline, I suppose if you do want to reach out and get some help, the first place you go to is your GP.
Yes, definitely always yeah, go and have a chat to your GP.
And also the other place is good websites like the Australasia Menopause Society, where there's good resources, evidence based resources. So I think, you know, looking at those kinds of websites as well as having a chat to your GP.
Doctor Caroline Goovich, thank you so much for talking to us day and normalizing our irritability and our rage and our you know, our low mood and everything else and our brain fog, everything else that comes with that.
We really appreciate it.
Fantastic tips, yeah yeah, and the men O D questionnaire that's going to be that's going to be a brilliant tool for people. So thank you so much.
Thank you, Francisca and Louise, thank you for having me.
How good is doctor Caroline Goovitch. I just love the fact that it's all evidence based, science based. There is a reason that you have this irritability and this rage and that everything that the world is. You know, it seems to be changing around you.
I hang on every word, and I only wish that perhaps I did have more of an understanding of that. I'm not even kidding. In my late thirties and early forties, which is when I would say, I was at my lowest EBB mental health wives and it wasn't related to the birth of a baby or anything else. Like, there's nothing else to put my finger on except for a lot of probably a lot of.
But there was also a lot going on in your life at that point.
Yes, well, as she explained it as often, it offers that horrible kind of convergence of everything of everything.
Yeah, but I think you're right.
I think this one is for the boys too, and actually was just reflecting and maybe for my kids just I'll just take some snippets out and send it to them, because that might.
Just explain those Raigie drives to school. Did you ever have those? You just screamed at the children all the way to school?
No, once I put the horn on. Oh yes, I feel like that was that was I just we were driving through the lights and I were arguing, and I just put the horn on. But we were quite close to school, so of course they were mortified because everyone was staring at us and until when they stopped off the wall. So we had it, had a good day.
There was the mother of five that winteresso and I'm not gonna I got it. And literally I remember walking the kids to school and you're driving past what she got the horn on.
The minivan for? And then she explained it.
Yeah, no, I think I think I got it off her. And I remember using what's going That was actually pretty effective. Hey really quickly though, Caroline mentioned a questionnaire you can do if you're just trying to work out sort of what level your symptoms are at your perimenopausal symptoms. It's called meno dno slash D. If you google that, you'll take you through to the questionnaire and it's from the mon Nash University and it's great for you to maybe
use as a tool. But if you're struggling to maybe you know, explained and listened to by your GP, you could always sort of maybe print out and take it in and go, look, here we go. I've done a bit of a this is where I'm at, this is what we need to do something with, So that could be potentially a really great tool. Just just want to
touch on one other thing. I found that really interesting, the sensitivity and how they've worked out how some people are more sensitive to hormone fluctuations in it, but we can't quite work out why.
Yeah, a little bit probably to do on that. I'm sure they'll get to it.
The Australasian and menopause Al Society is also really good, a really good point of reference for and more information and I'm pretty sure that's their name of their website as well, so and that will keep you up to date with research as well. It's it's a full time, it's a frull time. And I think we've touched on lots of elements of menopause, but not done a specific one about.
This, about that age, mood and the things like that. I think I think we often talk about other things a little bit more than we open up about that hemnopause maybe, or we try and we do. We do try and laugh it off because what else gotta do? Cry and ray and put your horn on and just leave your hand on that horn for as long as
you're lining. Maybe that's my joy of the week, just exprussing yourself, just you know, put your hand on the horn and just let it blair and let everyone look at you and just let it out.
Then just give them the evidence.
Yeah.
Yeah, well that's a good joy.
I like that.
Do you have one.
I'm full of a cold, so I my joy is coming.
I'm feeling very grateful for good health when you have it. So yeah, it's just a cold, but my god, it's really it's kind of doing a number on me.
Well, we know what happens to Louise, which you can't exercise. You know, I get a bit range, you get a bit rangy. There we go. Thanks for joining us on our new zealanderial podcast, Serious Little Things. We hope you share this podcast with the women in your life. We can all live with a little less rage.
You can follow this podcast on iHeartRadio or where ether you get your podcasts, and for more episodes from us on other topics, head to zid Herald dot co dot ZT and we'll catch you next time on the Little Thanks