Hi, I'm Louise Aria, and welcome to season six of our New Zealand here on podcasts The Little Things.
And I'm Francesca Rudkin. Good to have you with us. You might have noticed that we're releasing podcasts every two weeks this year. They're available at the same time on Saturday mornings throughout the year.
And you will probably know by now. In this podcast, we talk to experts and we find out all the little things you need to know to improve different areas of your life. We can't throw all the confusion and the overload of information out there just to bring news to simplify your life.
So good to have you with us now. In season four, we spoke to Ultra Troial marathon runner and trainer Kathy Duffy about not letting middle age stop us from setting goals. And Luise, you took that episode to heart. You decided to enter a trail marathon. Would you have just completed? Congratulations?
Wow, he's completed is the right word for it. I don't blow anyone away. I did it. I did finish it. You know that was interesting.
Was it what you thought it would be like?
Yes, yes, it actually was. It was pretty much exactly as I thought it would be. Look, it was so much fun and I at the time I was saying never again, and but a few days later it's like, I want another crack at that. So yeah, like you and I we did the two we are in twenty fifteen, so that's even gosh, well, it's not was the end of twenty fifteen, wasn't it. And we've done plenty of other challenges, either together or a part in the interim. But I could not I guess that was the fundamental thing.
I couldn't believe how much more the training took out of me as a decade later, and how much slower I am, and you would think less precious. Maybe the kids are older, I'm not running around as much.
I don't know.
It was the whole exercise of preparing and executing was was just harder. And maybe also because I was doing alone, not with your Francisca.
Ah. I don't know if that would have made a difference, but it is. You do get a little bit of a fright. I noticed that suddenly I wasn't running as fast as I had been, or couldn't get to the top of a mountain or a hill as fast as I could a couple of years ago, and I was a bit taken back by that, and I just thought, oh, I'm just not as fit as I used to be, but you trained pretty hard.
Yeah.
I think there are differentely things. Having done this this time, almost like a newbie, there are things I would do differently, like really protecting myself in my space and my energy, not trying to just do to roll on in normal life and do that. I don't know how I would achieve that, but I'm sure there's something I found that I could either do strength work or speed work or endurance work.
I just could not.
Put the three, Oh that's interesting together in a week without feeling completely wiped out.
Yeah.
Yeah, So, I mean, you know, we're probably going to talk about that a little bit today as well. And one of the other things I noticed is that is that there weren't a lot of people who look like me in this event. I mean, I know it is one of those, you know, sort of elite events in Australia, but there were a lot of young athletes, but there
just weren't a lot of women my age. And then when I so I did being researcher, I did a little bit of a look on the stats, and I saw that there were like eighty forty to forty nine year old orready four women who were forty to forty nine and only thirty nine who were fifty to fifty nine. Now that's half. You know, like we all know, there are hundreds of reasons you might not continue to do this stuff. But this is exactly what we were talking
to Cathy about. Well, wasn't it. Why do we drop off in middle age?
So on knees pack up?
Well, there are a niece definitely came to mind.
Well, I'm very proud of you because I can remember when you had completed your cancer treatment. You said to me your breast cancer treatment. You said, I don't ever think I'm going to be out in the bush running long distances ever again. And it's just a little reminder, never say never, no no.
Siftly been in a different kind of summer. I was out in the Bosha Uni esterday, not running, just hanging out with my family and said, you know, I've been in this bush all summer. You've never even been to the beach. So yeah, that's the other thing. Maybe I do an event like in November and training through the winter and have my whole summer off. Anyway, live and learn, Francis Scarez, you know I need to learn from my
own lived experience. Well, congratulations, thanks and thank you for all your support as well.
That's all right. It's very easy to support from the sidelines, isn't it. Today on the podcast, we're delighted to have friend of the podcast speaker, author and menopause expert Nicki Beizant back with us. Nikki is the author of two books, This Changes Everything and The Everything Guide, both must have books for those heading into or in their midlife years. Nikki is also dedicated to helping women and workplaces navigate to the menopause journey and healthy aging.
She Nicki really is an ally to the midlife woman, and she's just co authored the non medical section of the International Menopause Society's New Guidelines in Women's Midlife Health and Menopause Report, which is incredible, and she's here with us now to cover off some of the highlights and the key updates from the report. We're so lucky, Hei, Niki.
Hi, thank you for coming in. I very much appreciate it.
It's great to be here with you guys. Again.
Firstly, can you just tell us a little bit about the International Menopause Society and the aim of this review that they've done.
So, the International Menopause Society is one of the global bodies that is all about women's midlife health and minipause and about getting together experts in the field and medical practitioners and everyone involved in menopause care to study and help each other with all things menopause. I guess you could say it's one of the global bodies that makes recommendations about menopause care.
So they're looking at all the latest research, they're looking at, you know, the experiences that you're having in different countries and things like that, and then they're putting together guidelines for your healthcare provider to be able to go off and say, look, this is the sort of the greatest information that we have.
Yeah, it's aimed mainly at your healthcare provider. You so, and that's anyone who's providing menipause care. But actually these guidelines are available for anyone to read if we want to really dig into all of the info, which I have done.
Very much appreciated the summary.
It's a very large document, which you would expect for recommendations across the board on menopause because menipause is complicated. So yeah, it was one hundred and eighty page document called the Recommendations and Key Messages on Women's Midlife Health and Menopause.
And I think so we're going to try and summarize the summary more an expect today so that maybe you know it obviously offers the resources to go and access this stuff too, because there may be some questions that you do want to bring to your provider. I guess something that comes to mind though, is how do we know our providers are accessing this information?
Yeah, I mean you can't guarantee that, and it would be I would say that your average GP, for example, is not going to go and read this. It's a big commitment to sit down and read this, but they will be able to perhaps deep dive into specific areas if they come up. I think that's quite useful and for us as well. And there is a summary as you pointed out that it can be kind of useful
with bullet points and stuff. But you would expect this kind of this kind of document to filter down into best practice recommendations through different countries because this is across the whole world. The IMS is the one minipause society that is really global. There's individual societies in different countries.
It's one in the UK, there's one in America. You know, there's the Australasian Minopause Society, which is for our part of the world, and there's you know, every country just about has got its own, but this one is what The good thing that they do is that they take into consideration, you know, really global concerns.
So if we can start with the one that sort of took me a little bit by surprise, I guess and made me think because I've been doing a little bit more exercise than usual lately. But can we start with the new section on cycopenia. Cycopenia if I'm saying that right, which is muscle loss in perian menopause. A.
Yeah, this is.
Really good that they've included this because we know that cycopenia, which is muscle loss, happens to all humans. It happens to us with aging, but there's a particular it is particularly common in women postmenopause or women because estrogen has a role in muscle and keeping on keeping hold of muscle and muscle building, So it's really good that they
included this. And sycopenia is connected with osteopenia and ostroporosis, like bone loss and muscle loss are connected, so I think, and we need to all be across this because it gets worse as we age, So it was really good that they included this section. The interesting thing here is that there's really nothing that we can take to alleviate it. We have to do things. We have to our bodies.
We have to exercise, and that is a combination of aerobic exercise they recommend, and strength training or strength exercise. So those two things together are going to be really really important for us to hang on to our muscle and that's going to have impacts for our for not only our you know, our metabolic health, but our bone health as well.
We've been talking about that a lot, that whole idea of the white resistance as we age in things. Does it matter if you're already in your middle aged years and you don't do any does starting now still make a difference.
Well it doesn't say this in this document, but I say editorializing absolutely, yes, you're never too old to start. And actually I just had a conversation with my mother at the weekend, and she's saying, you know what, I'm doing these these get ups. Now I'm practicing getting up off the floor and getting up doing she's getting doing sit to stand. You know, my mother's in her late seventies, you'll be eighty this year. She's doing sit to stand, which is just sitting standing up off a chair, and
she's getting it. She's practicing getting up off the floor. And this is strengthening. This is strengthening exercises. So it actually doesn't matter what age we are. We can start doing things that will help with our musclim bone health, and I think that's super, super important. They recommend a few things in this document, including protein and tail, so that's an important one, which you guys are all across,
I know. And then there are a couple of supplements creating, which again is coming into the consciousness now we're all learning about creating, and another one which was new to me, which is al citraline, which has got some quite interesting evidence around it for promoting muscle growth. But none of these things you can't just take those things and expect your muscles to grow. You'velementary to do the work, work those muscles. You can't just eat protein and expect, you know,
to hang onto your muscle. You've got to eat the protein, maybe take the creatine, and also you've really got to work those muscles, challenge them.
I mean, I know the creatine is a really well researched product, and I know that even people who will say don't need to take any something into the world, but creatine is a good is a good place to start. I certainly it certainly helped me over the years, and then then then I get a bit slack and I stop taking it. So it's about consistency too, isn't it. And we're not going to get away from the protein conversation, are we. No.
I mean, I don't think you need to go crazy on the protein.
I mean I'm not. I'm certainly I have pulled back from it a little bit myself. I'm not I'm not into a protein shake every day anymore. But I think it's pretty useful to just keep an eye on it and make sure that you're including it in every meal and that you're you're getting more than you perhaps would have in the past, and ideally from food I think is always going to be better.
Can we blame menopause for midlife body changes because it is I think it's become quite convenient to do so.
Yeah, I know, and we all can kind of relate to that, right, because I've had so many conversations with women over the years where they've gone, well, you know, I haven't changed anything, and look, I've just packed on the weight all of a sudden, all of a sudden. Is this constant refrain, I think? And this is it's a hard one. But the evidence, and this is what this recommendation also says, we can't blame menopause for weight gain as we age. There's just as an evidence tying
those two things together. We can blame blame menopause for a redistribution of weight, so that is related to the loss of estrogen. We get that redistribution of weight through the middle of our bodies, and that happens even if you are a normal quote unquote normal weight or a smaller and a smaller body. And I've noticed that myself.
I've always been in a relatively small, smaller body, and I have still seen that that bit of distribution where there's just a bit more weight going on around the middle, and that is that is estrogen related. But the body change, the weight gain is really more around aging, around getting older and the things that come along with that, which are lowered activity, lowered energy expenditure, and perhaps a little bit more energy intake, so eating a bit more.
And you might think to yourself, Oh, I still do my daily walk or I still do this that, but maybe you're not walking as fast as you're used to or as far as you used to, or like I think, if we actually stopped and we're really honest about it, I mean, I know where my weight gain came from. It came from I've got no cartridge left of my knees. And my knees were so painful it's taking me a year to eighteen months really to rehab them. And I'm
back on track now. Yeah, and now the weight is slowly coming off because I'm able to be consistent with my exercise again, which is great. But yeah, No, there was a little moment there where I was like, oh, this is so convenient just to blame this on but very metaphors and go, oh, well that's what it is. I actually, no, Francisco, if you stop and you're honest about yourself about what you eat, what you've been drinking, and how you've been exercising. It's kind of there on the paper.
Eight to ten kilograms even on it. If you started from a smaller frame, then that just creates that lethargy, doesn't it. It just feels that much harder, particularly for some of those weight bearing exercises, like oh my god, I mean I think it's the one. What's the one where you get on the floor and then you jump up per burpie burpie. That's when you're like, whoa, everything's everything smooth?
Sa same. I've been doing a lot of running, and you know, every couple of k's I lost made it just a little bit easier.
Yeah.
And I mean also if you think about menopause symptoms, so a lot of the things that happen in perimenopause and menopause hot flushes, sleep, you sleep, disturbance, you know, mental health issues. All of these things actually make us less likely to move.
Super heavy periods. They would also make you.
Get more tired, you get more, you get more you know, lethargic. You are exhausted, and you've got life or the life things that happen. You know, you can't get away from so all of those things can make us less inclined to move our bodies and make it more difficult, and so that then can lead to muscle loss. Muscle loss is related to weight gain because if our muscle is metabolically active, and that makes us if we have less muscle,
we're more inclined to gain body fat. And so all of these things together, you know, can impact on weight. So and also you know, we can expect to gain a little bit of weight with age, which is not an unhealthy thing either.
I thought it was a bit of a protective factors at some point.
Well, your fat cells make estrogen their little estrogen factories, so we kind of need a little bit of body fat as we get older to help us with that. So all of these things together are impacting our body shape and size, and we probably need to have a it's not just one thing obviously, to solve those problems. We need to kind of look at everything.
What I quite like is I do like a guideline, and so you know, if this does give us some guidelines about one hundred and fifty minutes of moderate intensity exercise per week with a couple of sessions in resistance exercise, which I'm sure for inchisc and I've probably talked people's ears off this list many episodes of The Little Things. But again, even us knowing all of that information, we've you know, we fall off the wagon too, and I
quite like to just going back to basics. One hundred and fifty minutes that's what, Yeah, five thirty minute.
Walks or yeah.
And what's interesting about it one hundred and fifty minutes is that we know from the local research that fewer than half of women are actually doing that one hundred and fifty minutes, right, interesting, like forty forty six percent or something, less than half of us. So it is just as basic as that really is, getting up and moving whatever you can do is going to be useful. Yeah.
And I also noticed that, you know, diet has spoken sort of throughout the document quite a bit, and the Mediterranean diet still seems to be the recommendation.
Yeah, which is, if you think about it, a very sensible pattern of eating thing crazy whole foods, you know, healthy fats, lots of plants. You know, it's not rocket science, it is real basic stuff. But we do tend to latch onto the latest shiny thing that comes along or that we see on the socials that's got the promise of you know, blasting your minno belly fat, which is really not a thing.
But I'm pretty resistant to those claims now. But again, still well, since we last spoke to, two of my children have left home, but I've still got one rugby player in the house, so, you know, just trying to balance that with my husband and I both wanting to drop some wait and feel healthier. Still working on getting that balance plus budget and everything else. Like it's all a bit crazy, isn't it. But it's good to know that there are just these simple things we could keep going back to.
Yeah, and the interesting thing also was that they do note that hormone therapy is not really going to do much in terms of that body change. It's not going to melt off fat, and it's not going to really change that redistribution. It is useful for insulin resistance, like it can lower insulin resistance. That's useful, but it's not necessarily going to do anything in terms of our body shape and size.
So don't jump on the ah TOI t not change anything else. And you know, a month later ago, oh you know, oh why aren't I drifting a bit away? Why are not losing a bit away? Yeah, okay, Can you tell us a little bit about primary ovarian insufficiency because there was a lot of that in the report as well, and I'm not usually familiar with what that is and how it compares to early menopause. Is it the same thing, It's sort of related. So it's premature ivarian insufficiency.
So that is it is happening when younger women younger than forty are experiencing menopause. And the reasons are not really that no one, they don't really know why. It's pretty brutal, and it can happen in very young women. And actually I learn something from this, which is that it happens in three point five percent of women, which is quite high large.
It's more than I thought it was.
It is also interesting that if they say in this recommendation that if it's untreated, it leads to lower life expectancy. So it's pretty important that women are diagnosed if they do have this, if it does happen to them, And because because the treatment is actually hormone therapy, very important to have hormone therapy through until the natural age of menopause.
So if you have, if you're going through premature menopause at say thirty five, you kind of need to be on that hormone therapy through until your early fifties at least.
How would you know what would what would be the little red flags?
Well, they've put some diagnostic criteria in this report, which I recommend you know that would be a good thing for your healthcare professional to be across. But there are some there are some key things that they look at. One of them as if sh levels, which is a hormone and disruption to your lucky periods stop basically and
not come back. And so there's all kinds of there's various criteria, but that is something that if you've got disruption to your cycle and you are younger than forty, that's worth really talking to your doctor about.
Well, it's a bit of a worry, isn't it, Because people are waiting a little bit longer to start their families too, So yeah, yeah.
Child rearing or you know, trying to get pregnant. Even so, it's pretty interesting. It's also interesting that in that group of women, in that POI group, there is a real prevention role from hormone therapy from MHT, so can it can really help to prevent heart disease and cognitive decline and osteoporosis, all these things. It's it's really indicated for that which it's not necessarily for the rest of us, but for women with POI, it's really important to have that hormone therapy to sort of.
Protect their health for the future. I'm sure there's a lot of women who is sort of thirty five forty who it's not the first thing that comes to mind if they have some of those symptoms. No, you know, you're not thinking to yourself, and it probably won't be.
But it's really worth understanding and knowing that that's a possibility and getting it checked out because it's it does have some long term risks.
So we we've used HIRT you and MHT, but they're the same thing, right, the same thing.
MHT is just the new term that they prefer to use for hormone therapy. Hormone replacement therapy is not really an accurate acronym. I guess you could say it does not really replacing hormones back to your premenopausal level, So they sort of say menopause or hormone therapy to be a bit more accurate of what it's what it's about. But yeah, I just usually say hormone therapy because.
Well that covers it doesn't it's covering.
Yeah.
So in terms of you know, the information, I thought it was interesting about the information around quality of life, psychosocial, psychological, cognitive health was interesting, particularly the cognitive health. But that's a bit I sometimes find slipping, like grasping for words and remembering things, which is brain fog.
Yeah, all that stuff.
So what do we what do we know about MHT or hormone therapy and cognition now that we've learned.
Yeah, well what we've learned is that we still don't really know if it's going to if it's going to prevent dementia. It seems like no. Well at the moment, the evidence is no for women who go on to hormone therapy at the sort of normal age of menopause. But that again, like I said, with the POI, with
the premature ovarian insufficiency, that is a different thing. There are known benefits of being on hormone therapy for those women because it's so much young, they're losing those that estrogen so much younger, so they can actually it can help them with their risk for alzheimers and dementia, but for most of us probably not. So you'll see people on the socials talking about how it can prevent dementia. That's not proven at this point. It may be in
the future, we just don't know. At the moment, they can't say that. So they can't say, take hormone therapy for the prevention of dementia. They just can't say it.
But in the moment, has it got some benefits for that cognitive function that that brain fog as we were talking about, does it?
It can help. It can help indirectly with that, I think is the answer. So what happens is it helps you to sleep better, It helps you to have fewer hot flushes. Both of those things are going to make you feel more sharp. It can help you just with all of the general menopause symptoms, the moose stuff, the you know, all of the the pain stuff as well. Like you know, there's benefits potentially on joint pain from this, you.
Can think or clearly when you're not soft, of those things help you to help you to be a bit sharper.
And certainly the sleep thing, and that comes through quite strongly in here is that addressing sleep is a really really important part of everything else.
You've got to be careful about anxiety, though, don't you, and not just expecting it to be the answer there. If you've got severe anxiety, then that might need to be addressed in other ways.
They do make a distinction between anxiety and depression. Yeah, and I think the anxiety they've said, no, it's probably not going to help with that, but with some forms of depression it will help. And I think that's certainly the experience of many women as well.
That when I went to see my GP about my mood swings which were turning sort of towards, you know, just being constantly angry at my whole family. You know, she talked to me quite a lot about anxiety and depression and those the mood and where it was because, as she said to me, actually maybe there is something else that we should be looking at, you know. As a result, in the end, she just thought, maybe I
had a good night's sleep, i'd be fine. But it is worth you know, if the doctor does have that conversation, it is worth pursuing it and you know, and making sure you're getting.
The right, Yeah, and it might help you. Combination of therapy is too, like an antidepressant plus some woman therapy that might be like amazing for your moods.
And look, the exercise definitely helps as well.
Exercise how with everything? Yeah, it truly does. It's the one consistent, kind of uncontroversial thing across all.
Of this, and I think that's at any age, honestly, but.
Yeah, yeah it is, and for all humans to be honest.
Yeah, we're supposed to move right.
Yeah, you're listening to the little things. And our guest today is author and menopause expert Nicki bizand covering off all the latest information on perimenopause and menopause. We'll be back after the break. Welcome back, Nicki. Many women don't want to take hormone therapy or hormone replacement therapy, or they can't, so we've got some good news for them. There's some other other options for them, maybe some non hormonal pharmacological therapies with good research backing them.
Yeah. Well, I think the good news across the board here is that if you look at the recommendations throughout this document, there is always more than one thing in those recommendations. Not just take hormone therapy. It's always a whole range of things. And this is something that I've long been saying. It's a jigsaw puzzle and you've got to look at all the different pieces, and hormone therapy is just one piece of the puzzle. It's an important
piece for some women. And then there's always people who just don't want to do that or who feel who can't do it for whatever reason, because there's risks and reasons why you might not be able to take it. So in here we've got an interesting section on complimentary therapies, which is everything non pharmaceutical if you like, including things
like Chinese herble medicine. And I was quite interested to see that they have They have sort of cautiously recommended some of these things that are worth quite worth the try in a scientific way. They're saying, these are worth a try, and one of them is Chinese herble medicine. One of them is black cohosh which is out there. I think the soyosa flav ownes is another thing. These
are all in supplements that you might see. But they also do say that the evidence is very low for a large number of herbs and nutrients that you also may see, So you kind of need to be a bit savvy in terms of just looking at what is promoted and marketed versus what there is evidence behind. But I also thought some of the interesting things that they mention are the kind of mindfulness things. Mindfulness yoga was one thing that they thought that they recommends potentially useful
for some menopause symptoms. Tai Chi another nice. And these are all to me, those are all kind of like stress relieving things, aren't.
There, Mum loves Loves are tai Chi? I've been into it for years. Yeah, yeah, so that's kind of interesting, I thought. And then the other thing in terms of other kinds of pharmaceuticals is that there's some new new things in the pipeline, and one of them is these this new class of drugs which are called neuerkin and three receptor antagonists.
Yeah.
Yeah, I'm glad you said that, because I was. I was trying to bring those up, but I wasn't sure.
So the first one of these is out and it's called Featherlina tent and what it is is a drug which is acting on the temperature sensor and the brain which is the hypothalmus that is helping with hot flushes, and there's some really good trials showing that it really does help with hot flushes, and it's a non hormonal treatment, so it's a really good news woman, for example, who've had breast cancer or who can't take hormones for whatever reason.
It's licensed around different countries around the world. It is not approved here, but it is available here, which is a kind of a tricky distinction. But you can get it through a kind of a backdoor under the Section twenty nine of the Medicines Act, which just means that you can get a prescription for it and you can access it. It's not funded and it's quite expensive, but I expect that that'll be something that's they'll be looking
to get funded for the future. And there's more of these in the pipeline, these kinds.
Of and they've had ICTs and yes, they.
Wouldn't be able to license it in the States, for example, it's got FDA approval. It's approved in the States, yeah, and in the UK, I think too.
And there's a whole lot of other.
Kind of new new things coming down the line. There's another type of estrogen called estheterol, which is being and it's in development A slightly safer they say form of estrogen therapy we especially for breast tissue, has let less impact on breast tissue. So there's all these kinds of things. There's research going on, and there's more research going on into androgens, into testosterone and stuff as well, which is kind of interesting. I think.
I was curious about how New Zealand is keeping up when it comes to accessing whether it's the drugs, and I think I was away with a group of ossies recently and we were discussing our various different hi t and what was available for them and their options. It seemed a lot more varied than what I can access if I want to go on hormone therapy in New Zealand.
I think we doing okay here. I mean, we do have more options for estrogen then we had a few years ago. You know, we've got estrin gel now available and funded, which is a good thing. We've got different you know, we've got several brands of patches, which is also good that that's some of that is thanks to some pressure put on by women who were a bit
angry about their options being taken away. One thing that's happened recently which is slightly disappointing, is that testosterone for women, that the one form of testosterone for women that is made for women, andropheme it's called that has not been approved by FIMAC for funding or it's been given low
priority I should say, for funding. So that means that we're still having to pay quite a lot of money for that if we want that form of that form of testosterone, which is inequity, I think because men have got access to four or five different kinds of funded good point.
Yeah, So did they have to give a rationale when they no?
Right, as long as I know they don't have a ration now, the rationale would be that they're just trying to balance all the different kinds of things that they've got a fund. But this one, Yeah, is disappointing. And I think we can potentially make a bit of noise about this because it's not acceptable.
Really well, it's a health issue. It's not a just a I want to feel better.
Issue, and you know, just as specifically for sexual health is important and women's sexual health should not be less important than men's. I think I think we can all.
Agree with that absolutely. Yeah, Sure, can we just talk a little bit about you know, we've debunked the myth over the years about hormone therapy when it comes to breast cancer in particular. Is there anything new there, Nikki?
There is a good section in these recommendations on breast cancer, and I think there are a couple of things that stood out for me there. One. I mean, they do reiterate that the risk of breast cancer from hormone therapy is low, which we knew and has been gradually gaining traction.
But we do know that the risk is low, and it's akin to the risk that we have of breast cancer from lifestyle things, so from inactivity that's a big risk factor for breast cancer, and alcohol is as well, so it's about the same as that the risk from breast cancer. And if we're going on to hormones at the time of menopause or just before, the risk is low. The risk increases slightly with duration of treatment, but it
goes away once you stop treatment. A thing that I was interested to see and hear, and something I've only become aware of in the last year or two is this issue of breast density.
Feel very much.
Said yeah, because my boob's got denser, and I, you know, a mamogram wouldn't do the trick in the end, I was having to have ultras and things.
So breast density increases can increase with hormone therapy, but also having dense breasts actually increase is your risk of breast cancer as well. So those things you're not necessarily you're not necessarily gonna know if you've got dense breasts from your regular mamogram because they don't tell you. And the recommendation in here is that is that if you're on hormone therapy, that you should have more monitoring of
your breast tissue. So that is something that I think we need to just be really aware of.
I don't know if my breast well, they'll tell you that ye if you ask right, no, no, if you've had breast cancer. So we didn't see it because you have such That was you know, that was why their argument that they didn't pick mine up and the previous mamogram was that my breast tissue was dense. And I was like, well, if my breast tissue tissue was dense, should we have had a different should we be looking for different diagnostics? Sort of you know, so screen.
Or they get you back. So I had a couple of sists and they couldn't see them properly, and they just said to me, look, your breath, your breast is quite dense, so we need to get you back to
just to have another lock. I actually misheard the woman, and I didn't think I thought it was purely that I didn't catch that they'd court NEThing is he going, and they're all so lovely and they're so nice to you when they go through the whole process, and then someone sits you down and says just you know, it's all kind of like, yeah, I thought it was all okay. I had no idea you weren't worried. Oh, I hadn't really thought. I didn't think I had the information to
be worried yet. So that was quite bundy.
But it's super important because it also was a funding issue. You know, if we are going to need more callbacks or people are making judgment.
Of course, it's substantially more investigation was being doance right.
Yeah, yeah, but it's something that I mean, there are there is some potential here for AI to help us with this one, because it should just be an easy thing to say to you when you've had your mamogram, Oh, your your brist tissue is dense. Just we need to just be aware of that. It's not uncommon. It's something like forty percent of women have got some level of density in their breast. So it's pretty pretty interesting that
that's something that's been noted here. I kind of want to go and get another mamogram now and China.
It's a good piece of health advice for anybody out there because most of ours, as I would dare say, are having fairly regular mammograms. So maybe if you haven't asked the question, asked the question.
You know, you're always looking for a bit of a conversation starter while your boob has been squashed into a machine.
So so they will.
Tell you if you ask them at the time doing a mamogram. So that's something just to be aware of. And I also just on the breast cancer I thought it was it shocked me, but didn't shock me. But they do note in here that there is a lack of evidence at this stage about hormone therapy for breast cancer survivors, which I think is you know, is not good enough. We need more research across the board actually, but that was the thing that really stood out.
A lot of breast cancer survivors will be on something like to moxaphin anyway for five years post their breast cancer. And I guess it depends at what stage of life you were. But mine was triple negative and I I can't see reason why potentially, you know, that would exclude me from MHT, but I have excluded my self just because don't have the research. Don't have the research.
Yeah, and these are the conversations that are going on all the time, right with breast cancer survivors. You really have to make and make a call yourself on risk versus benefits, That's right, And it's very difficult without that.
But I just pull all the other levers.
Yeah, and which again is you have to be doing anyway we all have to be doing, That's right. Yeah. I think we do put we do tend to put a little bit too much faith and hormone therapy to to all the heavy lifting for us.
No, absolutely, what about other cancers hormone therapy and its relationship to other cancers? Was there anything that sort of stood out for you there? Nikki? It seemed most depending on your health and whatever underlying health issues you may have didn't seem to be any sort of anything startling there.
No, it's pretty like if we're worried about even ovarian cancer, there doesn't seem to be a huge amount of need to worry about that. The main one is really breast cancer, and as I said, again, the risk is low if you have a If you have you know, family history or other risk factors for some of these other cancers like colorectal cancer or lung cancer, those are more worth worrying about than the risk from hormone therapy.
If you have those risk factors, you usually on a fairly good well you'd hope that you're on a fairly good screening plan anyway.
Yeah.
Absolutely, But if you're not, maybe there's something to get And they.
Don't rule out, you know, they don't say you can't be on hormone therapy if you have those either for these cancers. So yeah, that's good news, I think.
So, I mean we're in the space intermittently, you're in the space all the time. You know, what are what are our biggest misconceptions still around around menopause And.
I think we still tend to think that menopause is just about our reproductive function, you know. And actually, as comes through loud and clear in this and across everything that you might see about menopause, it's a systemic change.
It's a systemic transition. So it's our whole body and brain that is changing because of this major hormonal change that we're going through, and so we need to think about the whole body and the whole person, not just you know, the ovarias and the reproductive hormones.
That's interesting you say that, because when I read, to be fair the summary of the report, my overall impression is the importance of our life style choices still plays a really big role in how we're able to manage perimenopause again, because absolutely does.
And thinking beyond menopause toos is it. My big thing now is that actually, menopause is just this one stage
of life and it's not forever. It's a transition that we go through and then beyond that we're going to live, you know, a long time hopefully, and so we need to think about how we want to be for that part of our life, and all of the changes that we make in midlife can really help us to be healthy long term, and that means looking beyond hormones, that is actually looking, as you say, at all all of the things that we can do, all the pieces of the puzzle.
I should probably know the answer to this question by now, but a friend of mine made a comment to me a couple of weeks ago. We had very muggy nights in Auckland and she woke up in some hot sweets and she sort of said, Ah, do you think it was just the weather or do you think I've got a new symptom? And it did make me think. We talk about, you know, how perimenopause can be a ten year kind of journey. Do we kind of stop and start symptoms as we go through.
I think things can change. Things can definitely change across that, across that transition. And I've experienced this myself. You know, things things happen. Things that were happening to me and perimenopause early periament pals aren't happening to me now. I'm kind of post early post menopause now. And your symptoms do change, and you know, it can be that you
need to tweak your treatment as well. You know, if you're having more flushes all of a sudden maybe you need to look at your dose, or maybe it is just hot, like I've had that same but myself.
As I just said, yeah, they were hot nights, they were all.
So it's all the things, and all the things can change. It's a movable feast. It's very very different in individual for everyone. But things do do change and flow, and also other things in your life have an impact. So stress has an impact, sleep has an impact. You know, how much you're moving, how much you're what you're eating. All the things have an impact, and all of those other things can be affecting how we feel.
Yeah, yeah, I would say we've had sort of something happen. It's been a stressful four to five weeks, I guess, and you know, you think you've kind of got on top of things, but then when another event happens, you're like, oh, man, I'm back in the back in the I want to know pain lock or hurt lock or whatever you call it.
And then that just has knock on effects on the sleep, and then that has the knock on effects of what I get up for that run, and then you've really it's the mind of a man aspect is quite huge.
I think oh, absolutely, yeah. And you know, stress is a huge factor in everything. It makes everything worseopause symptom or perimenopause symptom or anything else. It's huge. And so is sleep. So you know the quality and duration of our sleep can really affect everything from our mood to to our pain levels.
I think we owe ourselves a huge amount of self compassion as well.
Absolutely, yeah, we need to be much easier on ourselves. We tend to feel like our bodies are letting us down or we're failing in some way.
That we've got some reason to get on top of this menopause mountain.
Yeah, I do think that because of now there's so much more information out there, right, and the social media. I don't know if you, I mean, I'm immersed in menopause Instagram. I'm just like bombarded with it all the time. But even I can feel like, oh my god, I'm not doing menopause, right, You're not.
Doing It's not like, oh, we've acknowledged perimeniples exists and I have know a bit about it. Tech done. Yeah, it's yeah.
It's I've got to be doing all these things. I've got to be taking this and doing that and moving this way and buying this thing, and you know, doing all the things. And if you're not, you're not you're somehow failing at menopause. I think that that's that's not right either. Everyone's journey is different, and actually it's okay to give yourself a bit of a break. We are getting older, we are getting older as well.
Yeah, yeah, exactly.
I think that's a lovely note to end it on. And if Nikki, there was someone out there who was kind of interested to flick through the to flick through this review or take a look at the summary, where can they find it or do they just pretty much Google? Yeah, you should just be an International Menopause.
Society Society and you and they'll have that. They have the recommendations there on their website.
Look for the guidelines in Women's midlife Health and Minopause.
Yeah, settle in, get a nice botee.
Do what I to, get your heartlighter out, and off you go. Brilliant. Thank you so much, Nikki, really really appreciate you popping in and giving us a bit of an update.
Pleasure.
So lovely to have Nick back in on the podcast. She is just a wealth of information, isn't she when it comes to the perimenopause and the.
Menopause, Yeah, it was. It was an excellent refresher actually, because I think, like I say, I do think that I'm pulling all the levers, and then I talk to someone and go, actually, I'm not sleeping that well, and actually, you know, I could be doing this better, you know, not trying to get an a in menopause, but just for myself.
When she was mentioning yoga, I was thinking of the subscription to some yoga app that I got a year ago used oh sorry, snorting again, And I was like, yeah, do you know what I do use it for? I use their meditation recordings. That's nice, that's but that's like nine minutes of my life or five minutes of my life, you know. And I was thinking the same thing. I'd put things in place, or I'd tried to kind of find a few other sort of complimentary tools to use
to how me through it. But we don't do it. But then, as NICKI was saying, as well, you just have to kind of you can't do it all, and you can't do it, you know, there is no expectation that we do. But I think reading through this report was a real reminder to me that actually, as much as the hormone therapy has helped me a lot, that you don't just go You don't just slap a patch on and think you've ticked all the boxes. There is a lot that we can do. And I still think
of Niki. The main voice I have of Nicki in my head as her telling me that alcohol is not my friend, and you know she's right, so those alcohol free days suddenly become a lot more attractive and important.
I still remember her in the episode the first episode when it was her saying I didn't need to eat as much as my son as I tucked into my pasta.
Oh, you don't need to eat as much as you are right, I.
Don't need it as much as my son, and I had a bowl of kabinara. That's the other thing about doing an event. You can you eat quite a lot while you're try doing all that training, and then you know, I might have to sign up to another event just so I can keep eating in the volumes that I've been eating. She's fantastic and it's a really important thing to keep to off in mind. You do not have to just dig your fingers in and grip on for
dear life through menopause. You don't have to, but you also don't have to take on everything, which we always say. Everything we say, just pick a couple of things that you think. And also she had some really good practical advice about the dense breasts. I didn't know that wasn't in mainstream because that was something discussed with me ten years ago when I went through it. It's really interesting to me that that's only just being kind of commonly talked about in the last couple of years.
Muscle loss and bone density as well, I found really interesting and I think we're going to hear a lot more about that going forward. Nikki has two fantastic books. If you don't already have them, you should pick them up. This Changes Everything and Everything guide both fabulous guides to perimenopause menopause and how to live our best lives? Our best mid lives?
Should we say yeah, anything but met?
Thanks Thanks Low, and thank you for joining us on our new Zealand Herald podcast series, Little Things. We hope you share this podcast with the women in your lives. We're all living our best midlives.
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