Zoë Foster Blake - Perimenopause, ADHD & Everything That Helped with Dr Fatima Khan

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Zoe Foster Blake.
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That's a woman in perimenopause with ADHD writing a book.
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Dr. Fata McCann.
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I think most men don't know what perimenopause is, but they will after this podcast.
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Wow.
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Oh, my gosh.
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I think we're scaring the boys now.
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I don't care.
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Two incredible women here to talk all about perimenopause.
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Perimenopause is not menopause because it typically starts five to seven years before your last menstrual period and it starts in the brain, typically late 30s to early 40s.
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Anxiety ramped up to an 11.
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Feeling overwhelmed.
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Sleep was terrible.
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Brain fog.
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Irritable.
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Fury.
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Rage over things that shouldn't have been inciting that level of rage.
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It's a real fucker.
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And no Imperfects episode is complete without some helpful advice.
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We need to move to good sleep, and that's a problem because everyone scrolls till midnight.
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I scroll till 11.30.
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But it's fine because you're not going to go through Perry, so you're fine.
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Probably not the time to be bragging.
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Well, this is a very, very – it's a different episode structurally because no Josh today.
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Josh has been replaced for one episode only for very good reason and not because he doesn't believe in perimenopause because we wanted to bring in – he does believe in it, by the way.
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We wanted to bring in a very special guest host for today, Hugh.
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Yeah.
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No, it's Zoe.
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Yeah.
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Yeah.
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It's not me.
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Why is it right?
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Zoe Foster-Blake, welcome.
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And thank you for agreeing to co-host the Imperfects podcast.
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It is my absolute pleasure to be here with you as one of the bosses on the hosting chair.
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You are co-boss.
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Thank you.
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And we're joined by Dr. Fatima Khan, which is such a great privilege for us.
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I'm going to aim to be succinct here because I feel like probably the less you and I talk, Ryan, on this episode, the better it will probably be.
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Well, I've got some thoughts.
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So just by way of introduction to both of them.
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So Zoe was a beauty director at Cosmopolitan and Harper's Bazaar for over a decade, where she amassed an incredible knowledge about skincare products.
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Zoe founded GoTo Skincare in 2014, as well as GoTo in 2019 and BroTo in 2020.
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Zoe's published 21 books with the latest.
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What?
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Yeah.
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Wow.
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Yeah, apparently.
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I thought it was like 19.
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21's amazing.
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But some of those little kids books slip in there, you know.
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Well, you say little, but my gosh, they're popular.
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They don't take as long to read.
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All right.
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Very popular in our house, that's for sure.
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With the latest edition being Group Chat, which is released in September.
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Can we quickly talk about Group Chat?
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I'd love to, as long as you like.
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Because I've said to you before, like, I'm going to read it because I know I'm probably not the target audience, but I feel like it's a really good thing for me to understand.
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Because for me, from what I understand, it's a lot about identity and kind of who you are
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who you planned to be or who you've spent your whole life trying to be.
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And then when you feel like you've arrived at that place, there's a lot of questions.
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Is this actually who I want to be?
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Let's mix it up a little bit and let Zoe talk about her book.
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I like that, though.
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That is a good, that's kind of one of the, I like that he's just gone straight in there.
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But that is one of the philosophical underpinnings of this book, which is, you know, women's fiction.
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It's lighthearted.
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It's intended to be funny and fun.
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It's about five women, sort of like a perimenopausal bridesmaids.
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They're all very different, but they've been friends for, you know, 25 years.
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And one of them is going, her husband's had an affair, so they rally together and they end up in Mykonos for a week.
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And that sort of puts a spotlight on them as to what you were saying, where they are in life.
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They're in their mid-40s.
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They're feeling the stress and the pull of young children and their hormones are going crazy and their partners and...
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Some of them are divorced and quite happy.
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Some of them are not.
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And the main protagonist is sort of what you were talking about, Stella.
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She is at that point where a lot of us are in our 40s.
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We were like, is that where I thought I would be?
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Is there more than this?
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Should I have done things differently?
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Is there still time?
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And that leads to sort of a wider existential moment about am I with the right?
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person?
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Do I even live in the right house?
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Is my career all wrong?
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And so we see her tussle with that.
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But ultimately, it's a love letter to female friendship.
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I love that.
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Beautiful.
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Yeah.
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Okay.
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So I think the next thing to do is to ask, so how did you guys meet?
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Yeah.
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Uh, Fatima and I were on a panel together earlier this year.
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I was talking about sleep and skin because of GoTo and Fatima was obviously talking about perimenopause and the huge amount of impact it's got on your skin and your sleep as well.
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And then we got to chatting afterwards and then Fatima asked if I would read her book to endorse it.
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I loved it.
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And I tell everyone to read it.
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Well, you put a video on Instagram about it.
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And when I saw that, because I knew that you guys were coming on together, and I was like, oh my God, this is like, what a perfect little preview into how much it meant to you, that book.
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It did, and I wanted to talk about perimenopause for a long time just because I do like to talk to women about, you know, what's going on in our lives, and I don't often do it.
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And I also felt a bit scared to do it because it's very personal and also leave it to the experts.
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But once I had Fadiman's book, I felt like I had a resolution.
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So I wasn't just talking about my own experience, but I could actually say, and this, I wish this existed, because if I'd read that in my late 30s, oh, could have been a very different journey.
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So it's a really important book.
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Can't skip this one.
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We are so lucky to have you here.
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Dr. Fatima Khan is a perimenopause and menopause specialist.
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Wait till you hear the things that she has studied.
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I can't wait.
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Okay, well, I'll do it now.
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Bachelor of Science in Pharmacology and Therapeutics with Publications of Research at Imperial College London.
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Bachelor of Medicine and Bachelor of Surgery, Imperial College London.
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Diploma of the Royal College of Obstetricians and Gynaecologists.
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Membership of the Royal College of General Practitioners.
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She was a Clinical Fellow at King's College London in Reproductive Gynaecology and Endocrinology, Menopause and Gyna Endocrine Clinic.
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She has trained in psychiatry, has advanced menopause certification accredited by the British Menopause Society and the Faculty of Sexual and Reproductive Healthcare.
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Most recently, Dr. Fatima has released Hormone Health is Mental Health, a life-changing guide to perimenopause and why understanding hormones is crucial for women's mental health, especially during midlife.
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Dr. Fatima, welcome.
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I feel like the first question I want to ask is probably the most predictable one, but what is perimenopause?
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Okay, well, perimenopause is not menopause.
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I think everyone knows what menopause is, which is the cessation of your periods, 12 months of no periods.
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You get your classic hot flushes, night sweats.
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Anyone can diagnose that.
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I think no one even heard of the word perimenopause until probably two years ago because it typically starts five to seven years before your last menstrual period and it's not a good time.
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And it starts in the brain, typically late 30s to early 40s.
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And it doesn't present with hot flushes, night sweats.
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And so typically it will present with anxiety, feeling overwhelmed, sleep disturbance and brain fog.
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And it happens at the exact time when women are at the peak of their career.
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It doesn't happen in a vacuum.
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Zoe, does that sort of resonate with you, that like just hearing that?
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Yes, I 100% felt that.
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And I think it was after the fact.
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So I didn't realise I was in perimenopause until later on.
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And well-meaning friend sort of brought it to my attention.
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But I think it definitely kicked off in my very late 30s when I started to feel 100% the mental side of it before the physical side of it.
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So anxiety and overwhelm.
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Oh my gosh, yeah.
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Totally.
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So anxiety ramped up to an 11 and sleep was terrible, waking up all through the night and never feeling rested.
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Irritable fury, rage over very things that shouldn't have been inciting that level of rage.
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What's an example?
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What was something that you remember?
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Like, you know, when your cardigan catches on a door?
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Oh, yeah.
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That does make sense.
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Hell, yeah.
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But overstimulation usually.
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So if like the oven fan was on, my kids were asking for me and there was music playing and then my phone would ring, I would just crack.
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And so for years I would say I felt off kilter.
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And I just explained it as like having a cloud at the top of my head that felt like I wasn't myself.
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Like I constantly felt premenstrual, like a real bitch.
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And as I'm sure Fadim will attest, we women are very good at gaslighting ourselves and saying, oh,
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it's just because I'm stressed, my children are young, business is intense at the moment, things will calm down soon.
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And it's not really Anna unless you get prevention and treatment and all of the education and awareness to understand what's going on and it's normal but treatable.
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When your husband tells you about his golf, does that help?
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Yeah, that's very helpful.
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It really calms me down.
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Yeah.
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I mean, they're really in the crossfires, the partners, during all of this.
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And they can be completely lovely people who aren't doing anything wrong, but the fact that they exist and make chewing noises...
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No good Pigs We'll not allow it Absolute trash man Yeah Oh you do You just start to like Sort of hate everybody It's not a nice feeling Yeah Especially when it's not who you are Yeah It's so not who you are Yeah yeah yeah Totally right So what's happening then From a more I guess physically What's happening to lead to that
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So I think if you look at macroscopically in a woman's reproductive lifespan, they're born with a fixed amount of number of eggs.
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And at puberty, they have their menstrual cycle, their first period, when they start releasing an egg.
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And so menopause is the other end.
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It's the end of their reproductive lifespan.
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There's no more eggs, therefore no more periods.
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And it's a retrospective diagnosis, meaning you've got to wait 12 months, no periods, and women are kind of struggling with symptoms.
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We say, no, no, no, wait 12 months before you have any help.
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And then we'd say you're in menopause.
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And so the issue is we don't just go from monthly 28-day cycles to suddenly nothing.
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So the peri is the transition leading up to it.
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And so we know that around 37 to 42, the egg quality and quantity starts to decline.
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So you have your monthly bleed, but essentially mid-cycle is when you ovulate.
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And the point of ovulation is to produce an egg, and the egg is there trying to look for that sperm to create the embryo to implant.
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And we produce a lot of progesterone at mid-cycle.
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And that's what helps prepare the lining for pregnancy.
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But also progesterone is one of the first hormones that declines in perimenopause because we know the egg quality and quantity is going down.
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Women know the fertility is going down.
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But when you lose progesterone, three things happen.
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One.
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Number one, you start getting heavy bleeding.
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And with that heavy bleeding, you start losing a lot of iron.
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And iron deficiency is now linked with independent symptoms such as brain fog, fatigue, restlessness.
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And it's commonly ignored.
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And women are just told just to take iron tablets.
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And a lot of women don't seek help because we're kind of just used to suffering in silence and not seeking help.
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But one of the kind of under-recognized benefits of progesterone is that progesterone is your body's endogenous tranquilizer.
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So it stimulates your GABA receptors in the brain.
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These are the same receptors that are stimulated by benzodiazepine, so your valium, diazepine, diazepam.
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And so suddenly we're losing the very hormone that helps us with sleep and anxiety.
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if you try and connect the dots, it makes sense that if you're losing that progesterone, you're not going to have good sleep.
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So women present with poor sleep.
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They present with feeling overwhelmed, anxious, and fatigued.
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And that's what we see.
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Women are having kids later.
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And I think it's important to talk about the kind of the social cultural evolution of why women are finding themselves struggling more than women before is that more and more women have kids later.
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So a lot of them may be having IVF or conceiving naturally, but they're going postpartum straight into perimenopause.
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Most women will still find them in the sandwich generation of working full time, looking after the elderly parents, household and kids.
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But then you don't have your calming hormone.
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You don't have that progesterone.
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In the background, estrogen is spiking.
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So our menstrual cycles are always fluctuating.
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You have your follicular phase at the beginning, mid-cycle you ovulate, and then you have luteal phase.
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So you get the oestrogen rising, then dropping slowly and progesterone going up and dropping down slowly.
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But what we see in PERI is because we're not producing this progesterone mid-cycle, the brain goes slightly lower.
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manic and it starts overproducing estrogen.
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It's stimulating the ovaries to produce this egg to come out and ovulate.
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So we, instead of getting a slow rise in estrogen, we see a kind of massive spike and then crashes, spike and crashes.
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And we know that disrupts the neurochemistry in the brain.
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So you get this volcanic rage.
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because it can stimulate your nervous system and you've lost the buffering from the progesterone.
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And that's where you feel this kind of anxiety, sleep disturbance, overwhelm, volcanic rage.
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And the next minute you're fine.
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And it doesn't classify as a mental illness because for major depressive disorders and anxiety disorders, you need to have symptoms for six weeks or more.
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This is someone who's functioning completely normal and then suddenly they get...
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complete loss of their emotional regulation and not knowing who they are.
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And so there's this identity reckoning.
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And so they'll go to the doctors, they'll do a blood test, everything comes back normal.
222
00:14:14.032 --> 00:14:16.633
And they're told that they need to stress less.
223
00:14:17.414 --> 00:14:26.918
And telling a woman to stress less is actually an insult because the problem is the woman who's coming to you at 40, she's built a career for 20 years.
224
00:14:27.618 --> 00:14:28.839
performing really well.
225
00:14:29.380 --> 00:14:33.804
She's managed to have two, three kids, run a household, maintain a relationship.
226
00:14:33.984 --> 00:14:35.325
Nothing has changed for her.
227
00:14:36.726 --> 00:14:40.770
So telling her to stop stressing doesn't work because she's like, well, I don't know what to do.
228
00:14:40.810 --> 00:14:41.631
What do you mean by that?
229
00:14:42.011 --> 00:14:45.494
Then she goes in second time and then she's told, okay, you're not coping.
230
00:14:46.215 --> 00:14:46.956
Bloods are normal.
231
00:14:47.076 --> 00:14:49.258
We're going to give you an anti-anxiety and antidepressant.
232
00:14:50.250 --> 00:14:52.013
I have nothing against anti-ncider depressant.
233
00:14:52.033 --> 00:14:52.814
They're life-saving.
234
00:14:53.215 --> 00:14:55.158
But you're not treating the root cause of the problem.
235
00:14:55.178 --> 00:14:56.500
And they think they're broken.
236
00:14:56.940 --> 00:15:00.085
They're failing and they lose that confidence and self-esteem.
237
00:15:00.105 --> 00:15:02.249
Because that medication doesn't fix the problem.
238
00:15:03.167 --> 00:15:11.649
Well, the medication will alleviate some of the symptoms, but we'll still continue to have all the other symptoms because it doesn't fix the brain fog.
239
00:15:11.989 --> 00:15:13.669
It doesn't fix the sleep disturbance.
240
00:15:13.949 --> 00:15:19.090
It doesn't fix the ultimate ongoing physical symptoms that we'll see, such as palpitations.
241
00:15:19.110 --> 00:15:28.852
There's also a dangerous message in there that, well, like a really unkind message that, oh, yeah, this is like probably depression or anxiety, which is so far from what it is.
242
00:15:28.912 --> 00:15:30.312
Or if it is that, it's there for a reason.
243
00:15:31.166 --> 00:15:39.351
I think it's important to understand that women between the ages of 40 to 45 or going through perimenopause is a window of vulnerability in a woman's mental health.
244
00:15:39.591 --> 00:15:47.515
We know women are two to four times more likely to develop first onset of anxiety and depression without previous history.
245
00:15:47.916 --> 00:15:51.838
This is someone who's got no previous psychological history.
246
00:15:51.898 --> 00:15:57.001
That would be so confusing, particularly if there's been no event in your life to trigger it.
247
00:15:57.447 --> 00:15:57.827
Exactly.
248
00:15:57.888 --> 00:16:02.652
So when we are diagnosing psychiatric illness, we always have what we call the biopsychosocial model.
249
00:16:03.153 --> 00:16:04.614
So is there a biological cause?
250
00:16:04.954 --> 00:16:08.978
We do, you know, blood tests, make sure there's no hypothyroidism, there's nothing else going on.
251
00:16:09.839 --> 00:16:11.881
And then we look at what is happening in your life.
252
00:16:12.242 --> 00:16:14.023
Is there psychological vulnerability?
253
00:16:14.083 --> 00:16:18.928
Have you had, you know, a divorce that you've gone through, loss of a parent, grieving that?
254
00:16:19.529 --> 00:16:20.390
But these women have nothing.
255
00:16:20.410 --> 00:16:20.790
Yeah.
256
00:16:21.030 --> 00:16:23.734
Nothing has changed except the husband's chewing loudly.
257
00:16:24.375 --> 00:16:27.340
But also it's interesting on the flip side.
258
00:16:28.537 --> 00:16:35.903
I get a lot of men bringing or booking appointments for their partners because perimenopause starts with just worsening PMS.
259
00:16:35.943 --> 00:16:48.252
So that's, I always say, the easiest way to track is you're just, it starts with seven days before where you're just feeling really hyper aroused, very irritable, ragey, uncontrolled kind of reactive responses.
260
00:16:48.332 --> 00:16:51.575
And then your menstruation arrives or your period arrives.
261
00:16:51.615 --> 00:16:54.136
And suddenly it's like this release of tension.
262
00:16:54.156 --> 00:16:54.257
Yeah.
263
00:16:54.957 --> 00:16:55.518
And you're happy.
264
00:16:55.678 --> 00:16:58.340
And a lot of women describe themselves as becoming a monster.
265
00:16:58.700 --> 00:17:05.406
And then there's shame and guilt because now you've yelled at your kids and your partner that you've loved for 20 years.
266
00:17:06.166 --> 00:17:07.487
And they don't know who they are.
267
00:17:07.768 --> 00:17:09.929
And they're like, oh, yeah, you must be before your period.
268
00:17:09.949 --> 00:17:11.671
And that's fine if it's seven days.
269
00:17:11.691 --> 00:17:13.913
But it eventually expands out to two weeks.
270
00:17:14.073 --> 00:17:14.293
Yeah.
271
00:17:14.413 --> 00:17:16.695
And it's happening on a monthly basis for years.
272
00:17:17.135 --> 00:17:21.458
And we know women in Australia divorce between 40 and 45, men 45 and 50.
273
00:17:21.778 --> 00:17:24.300
Now, that's not saying perimenopause-arisen woman divorce.
274
00:17:24.560 --> 00:17:31.526
We also know it's a time where women are completely squeezed with all the caring responsibilities and that mental load.
275
00:17:32.166 --> 00:17:39.247
And then the hormones that would have compensated and buffered the stress system in the brain, we're losing that.
276
00:17:39.267 --> 00:17:40.767
We're losing that calming effect.
277
00:17:41.288 --> 00:17:48.749
We're losing the estrogen softening of the mood and the spikes and then in the environment of psychological stresses from life.
278
00:17:49.689 --> 00:17:56.410
And there's a concept called allostatic load in medicine, which I was never taught, but there's actually literature on this.
279
00:17:57.370 --> 00:18:01.051
And it's just wear and tear on your nervous system that is measurable.
280
00:18:02.133 --> 00:18:06.995
So it's understanding it's not just the estrogen, progesterone, it's your nervous system has a capacity.
281
00:18:07.956 --> 00:18:13.998
And the issue is a lot of women are conditioned to keep saying yes, over committing, people pleasing.
282
00:18:14.518 --> 00:18:22.922
But there's a flip switch at 40, late 30s, where your resilience isn't there because of this wear and tear, but also you're losing the buffering.
283
00:18:23.622 --> 00:18:27.184
But I think spiritually it's also a bit of an awakening where it's like,
284
00:18:27.944 --> 00:18:29.165
is this really what I want to do?
285
00:18:29.265 --> 00:18:41.532
Like I'm conditioned to be, you know, the best daughter, the best sister, best colleague, then you're a wife or partner, then you're the mother, you're the head of the school committee, you're always someone for someone else caring.
286
00:18:42.452 --> 00:18:44.734
And then you realise, okay, what about me?
287
00:18:45.034 --> 00:18:46.635
Is this really what I really want to be doing?
288
00:18:47.575 --> 00:18:53.037
And I think because women don't know what's happening, it's just easier to blame things around us.
289
00:18:53.317 --> 00:18:55.097
And the partners, unfortunately, get the blame.
290
00:18:55.117 --> 00:18:58.678
And you can cut this out completely, but this is very controversial.
291
00:18:59.158 --> 00:19:07.741
But I always say this, even from my personal experience, the kids are the same, the work is the same, and you have the same partner or the same man in your life.
292
00:19:08.281 --> 00:19:13.443
It's you who's going through something very transformative in your brain.
293
00:19:13.663 --> 00:19:14.783
Why is that controversial?
294
00:19:15.317 --> 00:19:19.479
I don't think people, I don't think, because you don't want to flip it across and say it's your fault.
295
00:19:19.659 --> 00:19:20.939
Your fault as in?
296
00:19:21.139 --> 00:19:21.720
The woman's fault.
297
00:19:21.860 --> 00:19:22.560
The woman's fault.
298
00:19:22.580 --> 00:19:23.060
Yes, okay.
299
00:19:23.100 --> 00:19:23.620
I didn't say that.
300
00:19:24.761 --> 00:19:25.101
Yeah.
301
00:19:25.901 --> 00:19:27.722
I certainly didn't say that.
302
00:19:28.665 --> 00:19:35.008
Hi, it's Ryan from The Imperfects, and I'm reaching out to you now because we need your help, gosh darn it.
303
00:19:35.468 --> 00:19:36.588
Hang on, why do we need...
304
00:19:36.968 --> 00:19:46.452
Sorry, no, I'm just making a plea to the listeners and viewers to ask them to subscribe to the show in whichever way they see fit because it really helps.
305
00:19:46.592 --> 00:19:48.913
The more subscribers, the better we can make this show, am I right?
306
00:19:49.627 --> 00:19:50.647
Yeah, but I don't think we need to...
307
00:19:51.048 --> 00:19:52.868
I think we could just ask them politely.
308
00:19:52.948 --> 00:19:54.969
Yeah, but if I use the emotional music...
309
00:19:55.029 --> 00:19:56.069
I think the music's a bit much.
310
00:19:56.189 --> 00:19:56.429
Is it?
311
00:19:56.589 --> 00:19:57.390
Who's playing that music?
312
00:19:57.750 --> 00:19:58.830
Doesn't matter who's playing the music.
313
00:19:58.950 --> 00:20:03.952
The important thing is we're pulling at the heartstrings and asking them to do us a solid.
314
00:20:03.992 --> 00:20:06.393
Could we not just ask them straight?
315
00:20:06.873 --> 00:20:11.895
It'd really help us if you guys subscribed because we'd be able to make more of the show and make the show better.
316
00:20:12.475 --> 00:20:14.316
Oh, and not use emotional manipulation.
317
00:20:14.516 --> 00:20:14.716
Yeah.
318
00:20:14.956 --> 00:20:15.616
Yeah, I reckon.
319
00:20:15.976 --> 00:20:17.577
We can give it a go, but I doubt it'll work.
320
00:20:18.294 --> 00:20:32.424
The problem is, so there was a position statement from the Royal College of Psychiatrists in March 2026 this year, identifying that this window of vulnerability in mental health does not always respond to anti-anxiety and depressants.
321
00:20:32.864 --> 00:20:39.970
And we need to have a hormonal lens because despite medicating women, they're still not feeling optimal and still finding all the symptoms are there.
322
00:20:40.810 --> 00:20:55.051
And the problem is we need to use more validated questionnaires like Menody, which is a specific questionnaire for screening for mental health in women transitioning to perimenopause and menopause, developed from a Monash group here in Melbourne.
323
00:20:55.732 --> 00:21:02.714
And it specifically asks questions about irritability, rage, suspiciousness, paranoia.
324
00:21:03.354 --> 00:21:10.036
It talks about isolation, loss of self-esteem, all the things that standard depression scores don't capture.
325
00:21:10.856 --> 00:21:17.938
And so when we're going through that, what's happening is our perception is changing of who we are and the people around us.
326
00:21:19.077 --> 00:21:24.901
And that is then reflected in how we see our partners and how we see our children and how we see people around us.
327
00:21:25.261 --> 00:21:27.582
So just how long were you in this state of confusion for?
328
00:21:27.602 --> 00:21:29.203
Like not knowing what was going on.
329
00:21:29.824 --> 00:21:31.464
I think we need Hamish on this podcast.
330
00:21:31.505 --> 00:21:32.605
That's all we need.
331
00:21:32.985 --> 00:21:33.546
Um...
332
00:21:34.947 --> 00:21:36.268
And, oh, gosh, you know what?
333
00:21:36.288 --> 00:21:39.111
And it coincided with lockdown as well, which was pretty intense.
334
00:21:39.432 --> 00:21:39.652
Yeah.
335
00:21:39.952 --> 00:21:41.314
And I had a young baby.
336
00:21:41.394 --> 00:21:53.887
So I think what you're saying, Fatima, to that point is we just can't catch a break because if we do have our kids in our 30s, we've got toddlers, and then we finally feel like we're back to ourselves for maybe 30 seconds and then this starts happening.
337
00:21:54.727 --> 00:21:59.650
And so you kind of go, well, I'm not really sleeping well because I've still got a two-year-old or three-year-old in the house.
338
00:22:00.490 --> 00:22:07.194
But then your menstrual cycle went bananas and, you know, I was sweating through my T-shirts and all of these things.
339
00:22:07.214 --> 00:22:10.135
It was all ramping up, but I didn't still know what it was.
340
00:22:10.395 --> 00:22:11.276
I really didn't know what it was.
341
00:22:11.316 --> 00:22:12.296
And it's crazy to me now.
342
00:22:12.317 --> 00:22:12.597
And it was...
343
00:22:13.417 --> 00:22:25.048
Reading Fatima's book, it was like I was crying because I'm like, my story and so many women's stories who just don't get seen, heard, validated or understand what's going on.
344
00:22:25.088 --> 00:22:31.554
So it's so important because I don't like the idea of so many women out there and their partners feeling...
345
00:22:32.675 --> 00:22:38.059
Awful, just not themselves, like a mean, mean bitch who just cannot get a break.
346
00:22:38.139 --> 00:22:41.282
And as you say, nothing is maybe externally changed.
347
00:22:41.842 --> 00:22:42.603
It's all in here.
348
00:22:43.463 --> 00:22:50.589
It's literally all in your head, but it's not in your head, if that makes sense, because you can't tell yourself that it's not really happening.
349
00:22:50.912 --> 00:22:53.894
So is that how you first got onto perimenopause?
350
00:22:53.914 --> 00:22:55.396
Was it through Fatima's book?
351
00:22:55.556 --> 00:22:55.896
No.
352
00:22:56.637 --> 00:23:05.183
No, my sister, who's a few years older than me, and a friend who was sort of hearing me talk about this stuff, but I thought I was too young.
353
00:23:05.904 --> 00:23:12.249
And so I went to my GP at 43, which is not too young, and was told I was too young.
354
00:23:12.509 --> 00:23:13.290
And this happens a lot.
355
00:23:14.211 --> 00:23:22.116
And I'm sure you can talk to that in a minute, Fatima, about this, the situation where we come in with a list of symptoms and bloods and all of this to go, I think this is happening.
356
00:23:22.597 --> 00:23:33.325
Anecdotally, I feel very confident in this and are told all kinds of things that are not true and outdated and harmful, I would say, and have been for a lot of years.
357
00:23:33.865 --> 00:23:42.932
So I then saw a specialist, a reproductive endocrinologist who put me on the right path and I went on HRT and am better.
358
00:23:43.492 --> 00:24:04.438
So because it's like, I imagine, and Fatima, you kind of mentioned this, I guess, a little bit, which is that if you're someone, if you're a woman who has dealt with anxiety, depression, and had like really fluctuating up and down moods your whole life, and then you get to an age where it's...
359
00:24:05.998 --> 00:24:13.509
it's happening maybe more or in a different way, I can imagine how you might go like, well, it's probably the depression.
360
00:24:13.549 --> 00:24:14.811
It's probably the anxiety.
361
00:24:16.233 --> 00:24:22.202
So how do you know, how can you differentiate or how do you know it's not that and it's perimenopause?
362
00:24:23.947 --> 00:24:26.188
So there's two presentations, right?
363
00:24:26.208 --> 00:24:28.510
So you have new onset anxiety and symptoms.
364
00:24:28.670 --> 00:24:32.332
So that's easy because they'll be like, I've gone through worse things in my life.
365
00:24:32.392 --> 00:24:33.393
I've done stressful things.
366
00:24:33.433 --> 00:24:34.553
I don't know why I'm feeling overwhelmed.
367
00:24:34.593 --> 00:24:39.596
I've gone to this board meeting 100 times and now I'm finding I'm standing there feeling really overwhelmed.
368
00:24:40.237 --> 00:24:43.178
And then and so that's someone who's obviously new.
369
00:24:43.218 --> 00:24:43.959
Nothing's changed.
370
00:24:44.099 --> 00:24:46.020
And then you think, OK, what is it that's causing it?
371
00:24:46.040 --> 00:24:49.082
Because if it's not a psychological trigger, it's not.
372
00:24:49.411 --> 00:24:54.493
then we know perimenopause presents with that anxiety, as I described the mechanism earlier.
373
00:24:55.213 --> 00:25:01.715
So again, you have hormone depressive disorders, so mood disorders related to hormonal transitions.
374
00:25:01.815 --> 00:25:09.418
And we recognize puberty is a window of vulnerability for mental health symptoms and also postpartum as well in pregnancy.
375
00:25:10.278 --> 00:25:14.881
So anytime there's a hormonal transition, there is a window of vulnerability in mental health.
376
00:25:15.422 --> 00:25:18.004
But there is no education on perimenopause.
377
00:25:18.244 --> 00:25:24.909
And typically perimenopause was defined as a change in your menstrual cycle, more than seven days plus or minus.
378
00:25:25.009 --> 00:25:26.410
That's all it was described as.
379
00:25:26.590 --> 00:25:31.192
described under the straw criteria, which is described with irregularity on your menstrual cycle.
380
00:25:31.732 --> 00:25:44.358
Now that doesn't serve the modern women because the modern women, a lot of them don't have that history because they would be on the Marina IUD, which is a very commonly used interuterine device for contraception and bleeding control.
381
00:25:44.378 --> 00:25:49.040
So typically women are put on that in their mid thirties or late thirties.
382
00:25:49.500 --> 00:25:52.622
And so you've lost that signal of the erratic period.
383
00:25:52.702 --> 00:25:55.523
And so you might be getting all the symptoms and not knowing what's happening.
384
00:25:56.003 --> 00:26:10.153
But also we've always associated hot flushes, night sweats and menopause with kind of this cessation of periods in older women and, you know, kind of negative connotation of this old woman with white hair, grey hair.
385
00:26:10.233 --> 00:26:13.475
And that's not the modern peri woman.
386
00:26:13.615 --> 00:26:15.776
That's not the modern menopausal woman in her 50s.
387
00:26:15.796 --> 00:26:20.380
But peri biologically, we know the egg quality and quantity is declining.
388
00:26:20.400 --> 00:26:21.020
Yeah.
389
00:26:21.540 --> 00:26:22.601
37 to 42.
390
00:26:23.081 --> 00:26:25.803
So biologically, you are losing that progesterone.
391
00:26:25.843 --> 00:26:30.185
I go on and on about it in the book because no one's connecting the dots.
392
00:26:30.205 --> 00:26:36.188
This is why they're coming in with the same thing of sleep disturbance, anxiety, overwhelm, reduced resilience, distress.
393
00:26:36.929 --> 00:26:44.413
And then we start seeing a lot of women finding they're drinking more and more alcohol because that's the only thing that takes the nerves off.
394
00:26:44.893 --> 00:26:49.076
But the problem with that is that it actually causes a further disruption in sleep.
395
00:26:49.929 --> 00:26:51.951
And we know that it disturbs your deep REM sleep.
396
00:26:51.971 --> 00:26:53.492
So you're not getting deep restful sleep.
397
00:26:53.532 --> 00:26:55.694
And the next day, your cognition is not sharp.
398
00:26:56.074 --> 00:26:57.055
You're feeling more foggy.
399
00:26:57.095 --> 00:26:59.437
Your executive function is not working well.
400
00:26:59.457 --> 00:27:01.018
So it's this kind of vicious cycle.
401
00:27:01.719 --> 00:27:02.840
They're on the antidepressants.
402
00:27:02.860 --> 00:27:04.101
Then they're on the sleeping pill.
403
00:27:04.141 --> 00:27:05.162
Then they're on Xanax.
404
00:27:05.202 --> 00:27:10.566
And they come in with this cocktail of medication, you know, like, okay, come on, we need to weenie off of this.
405
00:27:10.766 --> 00:27:12.508
And then we restore the biology.
406
00:27:13.577 --> 00:27:14.518
Everything goes away.
407
00:27:15.098 --> 00:27:24.384
And I think what we need to do, if anyone's going to take anything, is we've always focused on estrogen, progesterone, and testosterone to an extent on reproduction.
408
00:27:25.085 --> 00:27:30.928
And women's health research has always been around trying to get you pregnant, keep you pregnant, and deliver the baby safely.
409
00:27:31.349 --> 00:27:35.211
And the reason no one knows about perimenopause is because it's not studied that well.
410
00:27:35.772 --> 00:27:39.594
And when there is research, there's no kind of education at medical school.
411
00:27:40.114 --> 00:27:42.176
I wasn't told about perimenopause.
412
00:27:42.656 --> 00:27:44.338
in my six years of medical training.
413
00:27:45.338 --> 00:27:48.161
And then even after that, I did six years of hospital training.
414
00:27:48.181 --> 00:27:49.482
So 12 years of training.
415
00:27:50.182 --> 00:27:51.303
I had to go study it.
416
00:27:52.164 --> 00:27:53.846
And that's when I was told about it, right?
417
00:27:54.266 --> 00:27:57.289
So I've got that privilege of having this knowledge.
418
00:27:57.309 --> 00:27:58.209
But, I mean, it shouldn't be.
419
00:27:58.229 --> 00:28:04.375
It should be standard curriculum for every single doctor because every single woman will experience this transition.
420
00:28:04.395 --> 00:28:04.915
Right.
421
00:28:04.935 --> 00:28:14.084
And the problem is because it's experienced at this late 30s, early 40s, the education we've had is menopause on average occurs at the age of 51, cessation of your periods.
422
00:28:14.464 --> 00:28:17.327
And you might start noticing a few hot flushes and sleep disturbance.
423
00:28:17.347 --> 00:28:17.688
That's it.
424
00:28:17.708 --> 00:28:18.308
That's all you know.
425
00:28:18.789 --> 00:28:20.070
And it's a natural transition.
426
00:28:20.210 --> 00:28:21.632
Everyone's done it for centuries.
427
00:28:21.652 --> 00:28:22.793
Just put up with it, you know.
428
00:28:24.305 --> 00:28:30.490
But we're getting more and more research to do with Gen Z and millennials who are obviously a very different demographic.
429
00:28:30.670 --> 00:28:31.791
They're working.
430
00:28:31.951 --> 00:28:33.132
They've got young kids.
431
00:28:33.152 --> 00:28:34.213
They're not slowing down.
432
00:28:34.954 --> 00:28:44.101
I think it's important to recognize the women that we have sitting in front of us, like Zoe and myself, are very different to like our grandmothers and mothers.
433
00:28:44.121 --> 00:28:48.265
So 25 years ago, which is a quarter of a century ago when I went to medical school, I was...
434
00:28:48.525 --> 00:28:54.550
we would see women and we would keep them on the contraceptive pill for 20, like for basically until they were 50.
435
00:28:55.210 --> 00:29:00.694
And the good thing about the contraceptive pill, although it's synthetic, it will give you some form of masking.
436
00:29:00.774 --> 00:29:04.637
So it will, those fluctuations that we see in peri will mask it.
437
00:29:04.937 --> 00:29:07.499
So you didn't necessarily see this volatility in mood.
438
00:29:08.060 --> 00:29:12.663
And then they would hit 52, we stopped the pill, and we would give them HRT for two, three years.
439
00:29:13.323 --> 00:29:14.725
But also the same women...
440
00:29:15.783 --> 00:29:17.045
were having kids much earlier.
441
00:29:17.225 --> 00:29:18.947
By 30, they would have completed their family.
442
00:29:18.967 --> 00:29:22.591
So by the time they hit 40, 45, they had no children at home.
443
00:29:22.852 --> 00:29:25.455
And by the time I were getting them HRT, they were like semi-retired.
444
00:29:25.955 --> 00:29:28.038
Majority of them weren't in full-time employment.
445
00:29:28.599 --> 00:29:30.741
And then the ones who were working were working casual.
446
00:29:31.322 --> 00:29:50.016
Compared to the person that I'm seeing now at 45, has got probably three kids under 10, working full-time career that she's invested 20 years in, and also is not using the contraceptive pill because we now use since 2011, we've got the marine IUD, which is what we call a long-acting reversible contraceptive.
447
00:29:50.136 --> 00:29:53.518
And the good thing is it's there for five years, you don't need to take a daily pill.
448
00:29:54.019 --> 00:29:57.141
And also in Australia, there's a high uptake of vasectomies.
449
00:29:57.581 --> 00:29:58.022
So a lot of the
450
00:30:01.584 --> 00:30:07.226
And it still is in parts of Europe, especially somewhere like UK, where it's free for the entire reproductive life.
451
00:30:07.646 --> 00:30:11.867
So from the age of 15, if you want to be on the pill till 50, you can have it for free of cost from the government.
452
00:30:12.288 --> 00:30:14.808
So there's no incentive to be doing anything else.
453
00:30:14.848 --> 00:30:17.029
But in Australia, a lot of it is private.
454
00:30:17.189 --> 00:30:20.250
So a lot of men will go and have vasectomies or women will do marinas.
455
00:30:20.710 --> 00:30:23.371
And so then marina is just sitting in the uterus.
456
00:30:23.391 --> 00:30:25.252
You still have the volatility from the ovary.
457
00:30:26.067 --> 00:30:31.008
And these ovarian hormones, oestrogen, progesterone, are not just working on the uterus.
458
00:30:31.048 --> 00:30:39.411
They're working in your brain directly on your dopamine, oestrogen, receptors, which govern mood and executive function and cognition.
459
00:30:39.491 --> 00:30:44.352
And that will probably lead us to ADHD because we're seeing a lot of this unmasking at this age.
460
00:30:44.612 --> 00:30:46.072
And the brain fog is real too.
461
00:30:46.112 --> 00:30:55.415
And I think that's a lot of us get quite scared when we forget very obvious, easy things like a name of a song or the name of the fridge or something and we
462
00:30:55.655 --> 00:30:57.317
snap at our kids because we can't think of the word.
463
00:30:58.578 --> 00:31:05.824
And I was worried about, you know, early onset because my grandmother had dementia and that's how bad it gets for us.
464
00:31:05.884 --> 00:31:09.027
So we really do worry there are very bad things happening to us.
465
00:31:09.127 --> 00:31:13.591
But, yeah, the hormones are kind of in control of all of that.
466
00:31:13.651 --> 00:31:14.432
Certainly the brain fog.
467
00:31:14.572 --> 00:31:17.553
And you're like, Zoe, I don't know many busier people.
468
00:31:17.833 --> 00:31:28.036
And so when you're like running this huge business, writing a book, parenting, all these things, it's quite, is it scary that you're like, what if I can't run the business?
469
00:31:28.156 --> 00:31:29.016
Yes, it's not a good time.
470
00:31:29.136 --> 00:31:30.176
And I was talking to a friend of mine.
471
00:31:30.196 --> 00:31:32.717
She's like, I now take beta blockers before I present.
472
00:31:33.897 --> 00:31:42.101
Even to my staff because I can't, I'm so worried about forgetting my words and looking stupid when I'm meant to be a professional and training them.
473
00:31:42.701 --> 00:31:47.243
So I know lots of women doing lots of things to try and band-aid it.
474
00:31:47.363 --> 00:31:47.783
Yeah.
475
00:31:48.163 --> 00:31:55.927
You know, I think the last time I was in here, I spoke about, because I didn't have my diet, like I didn't have my HRT at that point and I wasn't sleeping and I was anxious and all those things.
476
00:31:55.947 --> 00:32:03.290
And I was using medicinal THC to sleep and melatonin and anything I can get my hands on to try and fix the situation.
477
00:32:03.870 --> 00:32:06.173
But surprise, surprise, it was hormonal.
478
00:32:07.254 --> 00:32:10.037
So it needed attention in a really specific way.
479
00:32:10.678 --> 00:32:16.084
I can completely understand how you're just trying anything you can to try and treat what's going on.
480
00:32:17.485 --> 00:32:19.467
Fatima, what about the role of testosterone?
481
00:32:19.487 --> 00:32:20.709
Does that decrease as well?
482
00:32:21.222 --> 00:32:33.028
I think in terms of when we're talking about the hierarchy of decline in this transition, we know that testosterone levels drop to half at between 35 to 40 is what you had at the age of 20.
483
00:32:33.828 --> 00:32:41.432
And then we see progesterone declining because we're not having the same amount of ovulatory cycles and then estrogen is the last one to decline.
484
00:32:42.052 --> 00:32:52.602
Now, testosterone is important because obviously we know testosterone is linked in men with muscle and kind of having high libido, but it has a really important role in women's libido too.
485
00:32:53.203 --> 00:32:56.626
And in Australia, we have a female licensed testosterone for women.
486
00:32:57.307 --> 00:33:03.613
And it's given for a condition called hyperactive sexual desire disorder, which is a fancy name for low libido.
487
00:33:04.074 --> 00:33:04.875
The moment.
488
00:33:04.895 --> 00:33:05.876
It's a very fancy name.
489
00:33:05.996 --> 00:33:07.397
Very, very.
490
00:33:07.918 --> 00:33:11.742
So the fascinating part is it's only licensed.
491
00:33:11.982 --> 00:33:18.668
So you'll only get it dispensed if your libido is distressingly low and impacting your relationship after menopause.
492
00:33:19.607 --> 00:33:25.009
But biologically, we know that testosterone is already kind of in your tanks, late 30s to early 40s.
493
00:33:25.749 --> 00:33:34.172
And so we have a very interesting study being done called the Sibyl Study at Monash, looking at the role of testosterone for low libido in these younger women.
494
00:33:34.532 --> 00:33:41.134
Because commonly, they will come in with the usual symptoms we've gone through of the mental health changes, but also low libido.
495
00:33:41.174 --> 00:33:43.175
And I think that's very important to know.
496
00:33:43.235 --> 00:33:45.217
when it comes to relationships and intimacy.
497
00:33:45.818 --> 00:33:49.642
And so testosterone is something worth exploring with your doctor.
498
00:33:49.887 --> 00:33:50.828
Yeah, absolutely.
499
00:33:51.948 --> 00:33:59.912
Zoe, I'm really interested to know what happens to your self-esteem when you're going through this, but you don't totally understand what's going on.
500
00:34:00.433 --> 00:34:01.033
Oh my God.
501
00:34:01.533 --> 00:34:03.354
Well, yeah, you feel stupid.
502
00:34:03.394 --> 00:34:04.275
You feel a lot of shame.
503
00:34:04.295 --> 00:34:05.755
You feel guilty for snapping.
504
00:34:06.176 --> 00:34:15.841
And one of the main reasons that I finally advocated for myself was because I was going to lose my relationships with my kids because I was just a tired, cranky mummy all the time.
505
00:34:16.481 --> 00:34:18.002
And I was on a trigger point.
506
00:34:18.082 --> 00:34:21.024
So I did it to salvage relationships, honestly.
507
00:34:21.044 --> 00:34:23.385
I was then putting myself second.
508
00:34:23.405 --> 00:34:28.408
I see, even as I say that, it wasn't about my own mental health, but how I was impacting others.
509
00:34:28.468 --> 00:34:29.009
Relationships.
510
00:34:29.069 --> 00:34:30.550
Such a classic woman thing to say.
511
00:34:30.610 --> 00:34:30.790
Yeah.
512
00:34:31.310 --> 00:34:33.511
But of course, it helped everything.
513
00:34:34.432 --> 00:34:38.554
Sleep is obviously so paramount for mood and anxiety and all those things.
514
00:34:38.594 --> 00:34:41.076
And once that was under control, everything sort of flowed.
515
00:34:41.636 --> 00:34:44.418
But yeah, you don't really like yourself for a while there.
516
00:34:44.569 --> 00:34:51.922
Did you notice, like with the relationships in your life with like kids or home or friends or whatever, once you started taking HRT, did you...
517
00:34:52.192 --> 00:34:52.512
Yes.
518
00:34:52.812 --> 00:34:54.353
I felt like I was looking at my family.
519
00:34:54.373 --> 00:34:55.934
I was like, why can't I have fun?
520
00:34:56.455 --> 00:35:01.438
I married the world's funnest man and he loves having fun with the children.
521
00:35:01.478 --> 00:35:04.720
And I felt like I was just outside of it looking and going, fuck.
522
00:35:04.820 --> 00:35:09.303
And all I do is come in and go, guys, come on, it's dinner time, like fun warden, let's do this.
523
00:35:09.363 --> 00:35:11.244
And I wasn't enjoying anything.
524
00:35:11.624 --> 00:35:13.986
I was just the cranky one all the time.
525
00:35:14.046 --> 00:35:14.246
Yeah.
526
00:35:14.286 --> 00:35:17.768
To not be able to get into the fun would be really hard.
527
00:35:18.048 --> 00:35:23.973
And I did enjoy putting this through group chat because I think, you know, we have a very good nonfiction version of perimenopause.
528
00:35:23.993 --> 00:35:35.704
But in a way, group chat was exactly what the protagonist is going through is just this underlying feeling of not being herself and the restlessness and the sleeplessness and the anxiety and the not liking her husband.
529
00:35:35.804 --> 00:35:38.887
And I think a lot of women will relate to that because it's...
530
00:35:39.427 --> 00:35:40.048
Really common.
531
00:35:41.469 --> 00:35:42.830
Among my friends, at least.
532
00:35:42.910 --> 00:35:44.852
And your friends.
533
00:35:44.972 --> 00:35:47.714
So in writing the book, did you talk to your friends about their experiences?
534
00:35:47.734 --> 00:35:48.995
That's all we talk about ever, always.
535
00:35:49.095 --> 00:35:49.495
Really?
536
00:35:49.575 --> 00:35:50.336
Oh, yeah, yeah, yeah.
537
00:35:51.217 --> 00:35:55.120
Anytime someone does my makeup or I'm like, women my age, it's all we talk about.
538
00:35:55.380 --> 00:35:55.820
Really?
539
00:35:55.860 --> 00:35:56.120
Yeah.
540
00:35:56.941 --> 00:35:57.381
Wow.
541
00:35:57.441 --> 00:35:58.161
You want it?
542
00:35:58.221 --> 00:35:59.001
Who's your guy?
543
00:35:59.041 --> 00:36:00.422
No.
544
00:36:00.482 --> 00:36:02.262
Just trying to figure out when and how.
545
00:36:02.282 --> 00:36:12.866
And I think there's a lot of misnomers about it, you know, and that's why I love Fatima's book as well because there's so much myth and there's, you know, the breast cancer risk is really talked about a lot.
546
00:36:13.006 --> 00:36:17.727
And I had a discussion with a family member the other day who was like, you're on HRT, but that causes cancer.
547
00:36:17.808 --> 00:36:18.548
You should get off that.
548
00:36:18.668 --> 00:36:18.888
Mm-hmm.
549
00:36:19.410 --> 00:36:26.356
And so I feel like we're now, our generation is like having to re-educate our older generation who were told, no, HRT is bad.
550
00:36:26.877 --> 00:36:40.168
So we have talked about HRT before on the podcast, and we'll put a link to that episode in the show notes, but I think it might be really helpful to sort of just talk about, well, what is HRT as a refresher and why is it so safe and so effective?
551
00:36:41.149 --> 00:36:43.071
I think it's important to realise that
552
00:36:44.928 --> 00:36:48.811
To treat anything, you need to, number one, recognize what you're treating.
553
00:36:49.371 --> 00:36:52.414
And most people don't know that you can give HRT in perimenopause.
554
00:36:53.314 --> 00:36:54.535
So that's the first thing.
555
00:36:54.775 --> 00:36:55.556
Sorry, can you say that again?
556
00:36:55.596 --> 00:36:57.958
Most people don't know that you can use HRT on perimenopause.
557
00:36:57.978 --> 00:36:59.239
Yeah, they think you have to wait.
558
00:36:59.259 --> 00:37:06.124
The amount of women who come to me and say, oh, my GP said when you stop your periods for 12 months, that's when we're going to give you HRT.
559
00:37:06.164 --> 00:37:06.464
Gotcha.
560
00:37:06.484 --> 00:37:09.445
So it's more a thing for menopause, not for perimenopause.
561
00:37:09.465 --> 00:37:10.345
That's what they thought.
562
00:37:10.565 --> 00:37:16.808
Yes, because conventionally HRT has been studied for women when they've stopped their period in postmenopausal era.
563
00:37:16.828 --> 00:37:18.148
So that's important to know.
564
00:37:18.588 --> 00:37:21.969
So when your GP is saying that, he's right, because that's what we've all been taught.
565
00:37:22.870 --> 00:37:26.111
And to start in perimenopause, number one, you need to recognize then perimenopause.
566
00:37:26.131 --> 00:37:28.291
At the moment, everyone's being misdiagnosed.
567
00:37:28.312 --> 00:37:29.092
That's something else.
568
00:37:30.352 --> 00:37:36.414
And when you are starting it, the starting protocols are slightly different because you still have your endogenous hormones in there.
569
00:37:36.434 --> 00:37:37.674
So you start much lower.
570
00:37:37.694 --> 00:37:38.715
There are different regimes.
571
00:37:39.195 --> 00:37:45.057
So you need to make sure you're going to a menopause-informed doctor because it is slightly more nuanced when you're managing that.
572
00:37:45.317 --> 00:37:48.098
How do you know if they're a menopause-informed doctor?
573
00:37:49.346 --> 00:37:58.128
So you can go to the Australasian Menopause Society, which is Australia's main regulating body and teaches all doctors and GPs and professionals.
574
00:37:58.468 --> 00:38:05.110
And you put your postcode in there and it will give you all the doctors who are in your area, five kilometre, 10 kilometre.
575
00:38:05.210 --> 00:38:07.850
However, that does not mean they're menopause in form.
576
00:38:07.870 --> 00:38:15.292
It just means they're a member of this community and there's no formal certification in Australia at the moment.
577
00:38:15.872 --> 00:38:17.873
So you've got to just...
578
00:38:18.773 --> 00:38:19.393
Try your luck.
579
00:38:19.714 --> 00:38:20.354
Yeah.
580
00:38:20.554 --> 00:38:21.595
Or speak to someone.
581
00:38:21.935 --> 00:38:22.395
You do.
582
00:38:22.475 --> 00:38:22.875
It's crazy.
583
00:38:22.895 --> 00:38:24.756
The only reason I'm saying that, I recommend that.
584
00:38:24.776 --> 00:38:25.977
So my list is closed.
585
00:38:25.997 --> 00:38:28.458
So please, you know, this is not a podcast to get more patients.
586
00:38:28.478 --> 00:38:29.759
My list has been closed for a long time.
587
00:38:30.359 --> 00:38:33.121
And I tell everyone, we have an email saying, go to the AMS.
588
00:38:33.141 --> 00:38:35.883
And then we get people emailing back saying, I went on that.
589
00:38:35.983 --> 00:38:36.643
I saw someone.
590
00:38:36.823 --> 00:38:38.024
They didn't know what they were doing.
591
00:38:38.644 --> 00:38:40.245
And so I think we should put a disclaimer in here.
592
00:38:40.486 --> 00:38:42.307
That's just a directory of clinicians.
593
00:38:42.447 --> 00:38:44.169
It doesn't mean they're menopause-informed.
594
00:38:44.669 --> 00:38:48.372
But if you go to their website, they'll have things that they'll say they're menopause-informed.
595
00:38:48.933 --> 00:38:57.200
But moving back to HRT, because when you go in at 43, you're not going to get HRT is the point I'm trying to make.
596
00:38:57.360 --> 00:39:01.944
So you've got to understand that if you say, oh, I've got perimenopause, can I have HRT?
597
00:39:01.984 --> 00:39:04.286
That's when the back of the book, I've got scripts.
598
00:39:04.526 --> 00:39:05.467
Yes, it's so good.
599
00:39:05.487 --> 00:39:09.468
And when you say scripts, you don't mean prescriptions, you mean actual dialogue scripts.
600
00:39:09.488 --> 00:39:11.049
You can tear them out.
601
00:39:11.129 --> 00:39:13.049
Yeah, a bit of Xanax and things.
602
00:39:13.669 --> 00:39:14.810
I don't know what I call them in the book.
603
00:39:14.850 --> 00:39:17.850
I call them conversation scripts.
604
00:39:17.870 --> 00:39:19.831
This is literally what to say to the GP.
605
00:39:19.851 --> 00:39:20.811
This is so good.
606
00:39:20.831 --> 00:39:21.732
What a great idea.
607
00:39:21.752 --> 00:39:22.772
Can we roleplay it?
608
00:39:23.512 --> 00:39:24.353
Yeah, yeah, yeah, do it.
609
00:39:24.533 --> 00:39:28.495
It says here, I've been tracking my symptoms over the last three months.
610
00:39:28.535 --> 00:39:28.975
Here we go.
611
00:39:28.995 --> 00:39:30.596
Okay, so you're the doctor.
612
00:39:30.636 --> 00:39:31.437
I'll be the doctor.
613
00:39:31.477 --> 00:39:32.738
My mood's all over the place.
614
00:39:32.798 --> 00:39:34.239
I'm yelling at my partner.
615
00:39:34.319 --> 00:39:35.520
My kids are intolerable.
616
00:39:35.580 --> 00:39:37.261
Well, I assume something's happened in your life then.
617
00:39:37.281 --> 00:39:38.661
You must be, have you lost your job?
618
00:39:39.442 --> 00:39:40.503
No, it's the same job.
619
00:39:40.923 --> 00:39:42.004
I'm almost getting promoted.
620
00:39:42.024 --> 00:39:42.144
Okay.
621
00:39:42.484 --> 00:39:43.585
And the kids are the same age.
622
00:39:43.625 --> 00:39:45.266
Any experience of anxiety or depression?
623
00:39:45.886 --> 00:39:48.608
Well, I'm feeling really, really anxious and feeling really overwhelmed.
624
00:39:48.648 --> 00:39:51.830
Yeah, well, we can prescribe you some anti-anxiety pills for sure.
625
00:39:51.850 --> 00:39:52.230
No probes.
626
00:39:52.690 --> 00:39:53.650
But I'm not anxious.
627
00:39:55.150 --> 00:39:57.991
Honey, let me tell you something.
628
00:39:59.271 --> 00:40:00.252
Oh, no.
629
00:40:00.292 --> 00:40:14.854
So I guess on a serious note to really for women to leave with this conversation a bit more informed, there is a questionnaire with psychological, physical and sexual symptom history.
630
00:40:14.914 --> 00:40:16.235
There are about 30 points on there.
631
00:40:16.555 --> 00:40:17.375
You're meant to fill that in.
632
00:40:18.343 --> 00:40:21.364
Because no one can ignore a list, right?
633
00:40:22.105 --> 00:40:26.207
And then there are scripts literally saying, I have tracked my symptoms.
634
00:40:26.447 --> 00:40:27.507
These are my symptoms.
635
00:40:28.288 --> 00:40:30.689
Do you think I could be in perimenopause?
636
00:40:31.009 --> 00:40:35.551
Do you think I can do a trial of estrogen through the skin as a patch or a gel?
637
00:40:35.671 --> 00:40:36.712
And can I take some...
638
00:40:37.052 --> 00:40:38.273
micronized progesterone.
639
00:40:38.753 --> 00:40:41.816
I have read this, this, this, and then, so it's all in that.
640
00:40:42.356 --> 00:40:44.998
So you're going with all the work done.
641
00:40:45.498 --> 00:40:47.020
The GP will do some blood tests.
642
00:40:47.040 --> 00:40:50.982
I think it's important to exclude any other pathology because women do present with other things.
643
00:40:51.343 --> 00:40:53.784
They might want to do a pelvic ultrasound scan if you've got bleeding.
644
00:40:54.225 --> 00:41:00.369
But we've made the book really handy because when I do, when patients come to see me, I have a questionnaire of 30,
645
00:41:01.911 --> 00:41:02.671
symptoms on there.
646
00:41:03.292 --> 00:41:07.735
And every time women say, I didn't even know half of these were part of perimenopause.
647
00:41:08.316 --> 00:41:10.378
So they're blaming other things, as you said.
648
00:41:10.398 --> 00:41:11.038
Like joint pain.
649
00:41:11.338 --> 00:41:11.599
Yeah.
650
00:41:12.159 --> 00:41:12.820
No one knows that.
651
00:41:12.980 --> 00:41:14.621
The joint pain is one of the first things.
652
00:41:14.661 --> 00:41:19.505
So my hip and pelvis basically shat itself a couple of years ago when this was all happening as well.
653
00:41:20.226 --> 00:41:22.928
And that's one of the first indicators is joint pain.
654
00:41:23.448 --> 00:41:24.169
Interesting.
655
00:41:24.409 --> 00:41:25.270
Sounds so fun.
656
00:41:25.290 --> 00:41:25.390
Yeah.
657
00:41:25.674 --> 00:41:27.156
Because you should be very jealous.
658
00:41:27.176 --> 00:41:28.257
I think we're scaring the boys now.
659
00:41:28.698 --> 00:41:29.399
I don't care.
660
00:41:31.461 --> 00:41:32.643
Scare them more.
661
00:41:33.024 --> 00:41:37.309
I think we need to change the nomenclature, which is how we phrase it, because menopause doesn't serve anything.
662
00:41:37.349 --> 00:41:38.571
Meno just means menses.
663
00:41:38.951 --> 00:41:40.333
Paws means cessation, right?
664
00:41:41.034 --> 00:41:43.938
We need to call it the multi-organ syndrome of menopause.
665
00:41:44.398 --> 00:41:46.398
which is it is a multi-organ syndrome.
666
00:41:46.438 --> 00:41:54.380
You name each organ in the body, starting with the brain, and then we can go down and I can list you at least three symptoms per organ.
667
00:41:54.880 --> 00:41:57.021
And this is why they're so vague.
668
00:41:57.541 --> 00:42:10.364
And when you go in, GPs are overwhelmed, and we used to call it like this heart-sinking patients walking through, the busy woman, and we used to call it TAT, which is an acronym for TIDE all the time, because we don't know.
669
00:42:10.384 --> 00:42:12.485
You do the bloods and they're coming in and they're just, you know,
670
00:42:15.365 --> 00:42:18.227
And you just tell them to just relax and stop doing so much.
671
00:42:18.267 --> 00:42:22.529
And I think now we've advanced a lot, especially the brain research in the last few years.
672
00:42:23.169 --> 00:42:27.451
But if you look at the brain, we know 60% of women will complain of cognitive symptoms.
673
00:42:27.551 --> 00:42:29.092
This is data out of Monarch, 60%.
674
00:42:29.272 --> 00:42:33.614
So that's brain fog, concentration, attention, word recall.
675
00:42:35.155 --> 00:42:39.297
executive functioning and then you've got the mental health which is anxiety overwhelm.
676
00:42:39.737 --> 00:42:48.802
Then you move we see other things such as vestibular symptoms so feeling dizzy, vestibular migraines, you get burning mouth syndrome so the ear, nose, throat is infected.
677
00:42:49.163 --> 00:42:51.424
You go to the heart we see cholesterol go up.
678
00:42:51.864 --> 00:42:53.086
We see blood pressure go up.
679
00:42:53.126 --> 00:42:54.327
We see palpitations.
680
00:42:54.768 --> 00:42:57.771
And the commonest symptom globally is joint pain.
681
00:42:58.072 --> 00:43:05.681
So a woman will suddenly have frozen shoulders, bursitis in the hips, runners for 20 years getting at least tendon ruptures.
682
00:43:05.921 --> 00:43:07.443
So how long would that joint pain have?
683
00:43:07.463 --> 00:43:08.104
Tendon ruptures?
684
00:43:08.504 --> 00:43:08.724
Yeah.
685
00:43:09.085 --> 00:43:09.606
Oh, my gosh.
686
00:43:09.666 --> 00:43:09.766
Yeah.
687
00:43:10.569 --> 00:43:11.769
That got him.
688
00:43:12.509 --> 00:43:12.990
So triggered.
689
00:43:13.030 --> 00:43:13.630
He can't tell you.
690
00:43:13.730 --> 00:43:14.430
I won't be able to run.
691
00:43:15.270 --> 00:43:15.810
It's not you.
692
00:43:15.830 --> 00:43:17.090
They'll just be running.
693
00:43:17.110 --> 00:43:18.651
They haven't changed anything and they're running.
694
00:43:18.911 --> 00:43:20.211
Remember, women have changed nothing.
695
00:43:20.231 --> 00:43:22.091
That's an extremely traumatic injury.
696
00:43:22.111 --> 00:43:22.692
That's surgery.
697
00:43:22.712 --> 00:43:24.272
That's like, that's awful.
698
00:43:24.292 --> 00:43:25.392
Now he gets it.
699
00:43:25.512 --> 00:43:26.752
We get labral tears.
700
00:43:26.932 --> 00:43:29.193
They're just doing Pilates class and they've got a tear in their hip.
701
00:43:29.213 --> 00:43:31.653
And like all these weird and wonderful things.
702
00:43:31.753 --> 00:43:32.654
And last year.
703
00:43:32.714 --> 00:43:34.054
That's very wonderful, but yeah.
704
00:43:34.874 --> 00:43:42.220
Last year, for the first time, they published a paper which kind of establishes these cohort of symptoms as the musculoskeletal syndrome of menopause.
705
00:43:42.680 --> 00:43:49.645
We have something called the genital urinary syndrome of menopause, which is bladder symptoms, painful sexual intercourse and vaginal dryness.
706
00:43:49.925 --> 00:43:58.432
But we're now finding all these things, the metabolic syndrome of menopause, where you get prediabetes, you get weight around the midline and you haven't changed anything you're eating.
707
00:43:58.452 --> 00:44:00.954
You haven't changed your exercise and you're putting on weight.
708
00:44:01.094 --> 00:44:02.875
This is what all the women are talking about.
709
00:44:03.075 --> 00:44:03.956
I eat the same.
710
00:44:04.016 --> 00:44:05.556
I train harder than ever.
711
00:44:05.576 --> 00:44:09.538
I have bloody protein coming out of my ears, like creatine.
712
00:44:09.558 --> 00:44:12.360
We're doing all the right things and our bodies are changing.
713
00:44:13.480 --> 00:44:15.361
There is so much to this.
714
00:44:15.962 --> 00:44:21.384
So Fatima, you mentioned women coming out of pregnancy, giving birth and going straight into perimenopause.
715
00:44:21.464 --> 00:44:22.625
Can you explain more about that?
716
00:44:23.280 --> 00:44:34.468
I think one of the questions is that women don't know whether they've, when are they experiencing perimenopause in between pregnancies, especially if you're having your baby's late 30s, early 40s.
717
00:44:34.749 --> 00:44:38.571
When does postpartum changes go straight into perimenopause?
718
00:44:38.591 --> 00:44:43.035
And I think it's just being aware that when you're pregnant, you have very high levels of hormones.
719
00:44:43.075 --> 00:44:45.497
You don't experience symptoms of perimenopause and menopause.
720
00:44:46.057 --> 00:44:49.518
but it's post-delivery, postpartum, the hormones decline.
721
00:44:49.898 --> 00:45:01.262
And so you can obviously experience postnatal blues, or we call them the baby blues or depression, but also it's not uncommon to go straight into perimenopause because we know that equality in quantity is going down.
722
00:45:01.302 --> 00:45:11.306
So I think a lot of women will find that they might experience changes in their mental health after the third or fourth baby in their 40s that they may have not experienced with their first and second baby.
723
00:45:11.346 --> 00:45:13.847
And does that get confused with postnatal depression?
724
00:45:14.107 --> 00:45:14.507
It does.
725
00:45:15.088 --> 00:45:27.036
So we normally say if you're in your 40s and having babies later, you need to be mindful that there is this kind of convergence of postnatal depression turning into perimenopause.
726
00:45:27.916 --> 00:45:35.722
And it's very confusing because when you're breastfeeding, you have high levels of prolactin, which suppresses your ovulation, means no ovulation.
727
00:45:36.322 --> 00:45:38.604
You don't get the same amount of estrogen and progesterone.
728
00:45:38.964 --> 00:45:45.388
So we know when you're breastfeeding, you have this kind of mild chemical menopause where you do get some night sweats and sleep disturbance.
729
00:45:45.468 --> 00:45:49.050
And so postnatal is really a hormone depression if you are experiencing that.
730
00:45:49.470 --> 00:45:56.034
But then where do you know whether it's the breastfeeding, it's the postpartum, or is it the perimenopause?
731
00:45:56.374 --> 00:46:01.478
And we also see, I mean, you may not need to add this, I see a lot of women have their third, fourth baby and then suddenly,
732
00:46:02.238 --> 00:46:07.499
they're going through marital conflict in a divorce and it's actually perimenopause and not postnatal depression.
733
00:46:08.439 --> 00:46:08.979
It's rough.
734
00:46:09.499 --> 00:46:31.504
Is there an element of like, especially if you're like, if you sort of identify as sort of like a striving person, like an ambitious person, is there an element of like embarrassment that you don't want to admit out loud that you're struggling with these sorts of things, like you don't want to come across as like you can't handle the workload or if you've always been able to handle it?
735
00:46:31.644 --> 00:46:32.424
Does that come in totally?
736
00:46:32.464 --> 00:46:33.325
Totally, yeah.
737
00:46:33.505 --> 00:46:36.726
That's the shame spiral of going, I used to be so competent.
738
00:46:37.167 --> 00:46:44.690
And now, as you say, nothing else has changed, but I'm not able to handle really minor things that wouldn't set me off previously.
739
00:46:44.710 --> 00:46:45.791
Yeah.
740
00:46:46.031 --> 00:46:47.592
Yes, so the shame is real.
741
00:46:48.152 --> 00:47:00.518
But I also think part of that we commonly see in high-functioning women and they start to feel, they use the word, I feel really stupid, is we're seeing this unmasking of ADHD in women in their 40s.
742
00:47:01.238 --> 00:47:07.160
A lot of the things I was thinking, there's also elements of ADHD in there as well, which could be, that must be so confusing.
743
00:47:07.580 --> 00:47:11.482
So what I see is, okay, you've got peri-symptoms, let's give you some HRT.
744
00:47:12.842 --> 00:47:15.043
And they still have ongoing symptoms.
745
00:47:15.463 --> 00:47:20.585
And it's because they're seeing this unmasking of ADHD, because despite giving them oestrogen,
746
00:47:21.642 --> 00:47:28.445
which regulates dopamine, the main neurotransmitter in ADHD, they still continue to have issues with executive functioning.
747
00:47:28.466 --> 00:47:36.470
So that's word recall, verbal memory, and trying to kind of orientate tasks, initiate tasks.
748
00:47:36.530 --> 00:47:39.371
And there's a whole ADHD score, which I'm not going to go through now.
749
00:47:40.011 --> 00:47:44.654
And so those are the women that need to go to a psychiatrist who's got a hormonal lens.
750
00:47:44.674 --> 00:47:46.235
So we work multidisciplinary.
751
00:47:46.255 --> 00:47:47.055
So they might find
752
00:47:47.475 --> 00:47:53.998
The ADHD medicine eventually helped with those anxiety and executive functioning and vice versa.
753
00:47:54.358 --> 00:48:01.120
So we see women who've got, are on stimulant medication from a young age because they were diagnosed with ADHD.
754
00:48:01.501 --> 00:48:07.323
Those medications aren't working anymore, especially in that luteal phase before their menstrual cycle.
755
00:48:07.683 --> 00:48:11.745
Suddenly they're just finding they can't find the words, they're losing train of thought.
756
00:48:12.505 --> 00:48:14.966
And so now they're having to double...
757
00:48:15.366 --> 00:48:18.210
their stimulant medication just before their menstrual cycle.
758
00:48:18.851 --> 00:48:21.214
And even when they're doing this yo-yo, it doesn't work.
759
00:48:21.274 --> 00:48:27.382
And so we add in a little bit of estrogen to stabilize it, and it works beautifully because you're getting this estrogen fluctuation.
760
00:48:27.863 --> 00:48:30.206
So it's kind of this beautiful intersection of...
761
00:48:30.987 --> 00:48:37.310
There's perimenopause, the hormonal buffering system changing, and we see ADHD and also neurodivergence.
762
00:48:37.350 --> 00:48:41.193
And so it's important to have a curious mind.
763
00:48:41.893 --> 00:48:52.699
And because everyone, I always say ADHD and perimenopause, they have overlapping symptoms and you don't know which is starting when and which is ending when.
764
00:48:53.339 --> 00:49:03.768
And it's about, again, listening to the women and trying to go to experienced people and titrating both of them because they converge at this stage to make it even easier for our brains.
765
00:49:04.488 --> 00:49:10.273
Well, Zoe, one of the things that we enjoy discussing is our good friend ADHD.
766
00:49:10.293 --> 00:49:10.533
Yeah, yeah.
767
00:49:10.553 --> 00:49:12.595
And so I'm new to the club and...
768
00:49:16.538 --> 00:49:17.900
I didn't know I had ADHD.
769
00:49:18.000 --> 00:49:18.580
There were hints.
770
00:49:18.701 --> 00:49:19.321
There were signs.
771
00:49:19.441 --> 00:49:22.905
But it really came out pretty hard.
772
00:49:23.686 --> 00:49:38.542
And feeling so scattered with the brain fog, with so many pressures on me, whether that's the school WhatsApp or the amount of things that I had to keep in my memory, the mental load every day, plus work, plus everything else.
773
00:49:38.762 --> 00:49:47.726
But also like in the last like, I don't want to say like five, six years, go to has been like, there's been like huge, like huge changes.
774
00:49:47.806 --> 00:49:51.488
And like, I know you've gone through like really stressful periods.
775
00:49:51.648 --> 00:49:53.669
And extremely mentally taxing.
776
00:49:54.429 --> 00:50:01.473
And I sort of laugh a little because if you look at things will calm down soon, that's a woman in perimenopause with ADHD writing a book.
777
00:50:03.240 --> 00:50:05.983
Who was undiagnosed and untreated for both.
778
00:50:06.463 --> 00:50:07.785
And it was a stressful book.
779
00:50:07.825 --> 00:50:10.648
It was anxious, inducing, and it was a lot.
780
00:50:10.868 --> 00:50:12.269
And it was a big project as well.
781
00:50:12.690 --> 00:50:21.018
This one, Group Chat, this is a medicated woman who's sleeping, having a great time, wrote a funny book, had the bandwidth and the capacity to have fun again.
782
00:50:21.038 --> 00:50:21.138
Yeah.
783
00:50:21.919 --> 00:50:24.840
And so for me personally, just the black and white of that is insane.
784
00:50:24.880 --> 00:50:30.301
But the ADHD, you know when you get it and you can spot it in everybody else?
785
00:50:30.941 --> 00:50:33.582
It's the same women who I'm spotting have perimenopause.
786
00:50:33.642 --> 00:50:35.842
And that overlap, as you talk about, is quite intense.
787
00:50:35.902 --> 00:50:41.164
But I found, you know, the stimulants are really helping with the pulling focus.
788
00:50:41.704 --> 00:50:49.946
And I was thinking the other day how I sat in a board meeting and I've done them for 14 years and never really paid attention.
789
00:50:51.306 --> 00:50:52.327
I think you sent me that message.
790
00:50:52.387 --> 00:50:53.268
It's been noticed.
791
00:50:54.309 --> 00:50:55.931
But I felt terrible.
792
00:50:55.951 --> 00:51:07.382
I felt this sadness and grief afterwards because I felt so disrespectful to my team for so many years who have been so good at preparing everything and...
793
00:51:08.443 --> 00:51:14.807
And making me so accommodated, honestly, is this like, oh, the founder's here and oh, I don't like numbers.
794
00:51:15.607 --> 00:51:17.268
And I just put it down to I don't like numbers.
795
00:51:17.368 --> 00:51:21.991
But it was disrespectful and I would interrupt and I'd have my phone here and my laptop here and I'd just go, oh, blah, blah, blah.
796
00:51:22.631 --> 00:51:24.712
Oh, what about, hey, we're doing sunscreen next year.
797
00:51:24.732 --> 00:51:25.533
Should we make a hat?
798
00:51:25.553 --> 00:51:26.193
Yeah.
799
00:51:26.493 --> 00:51:27.554
In the middle of the budget.
800
00:51:27.834 --> 00:51:33.097
And so the difference in that for me was quite a remarkable one.
801
00:51:33.297 --> 00:51:34.358
Wow.
802
00:51:34.638 --> 00:51:36.579
So I can testify.
803
00:51:36.839 --> 00:51:46.566
But that's a really interesting point because I think like particularly like with women who are diagnosed with ADHD, often they've got narratives that have lasted since childhood.
804
00:51:46.586 --> 00:51:55.093
And often that's like, you know, they've maybe been, they struggled at school and they were told that they were dumb or slow and that's sort of carried through.
805
00:51:55.313 --> 00:52:00.457
But that must be such a, I can't even imagine that feeling of going like, oh, actually I can do.
806
00:52:00.937 --> 00:52:04.099
now participate in these things that I thought that I couldn't or...
807
00:52:04.559 --> 00:52:06.620
It was a relief, right?
808
00:52:06.780 --> 00:52:11.602
And it was, I wouldn't classify myself as a kid as someone who couldn't really pay attention.
809
00:52:11.682 --> 00:52:13.924
I didn't have maybe the classic tropes of that.
810
00:52:14.664 --> 00:52:21.507
I instead was a super high functioning, overproductive woman who was writing books, running a business, having a family.
811
00:52:21.587 --> 00:52:26.530
And so outwardly, everyone's like, the question I get the most is, how do you do it all?
812
00:52:28.564 --> 00:52:30.846
My brain is going in 40 different directions at once.
813
00:52:31.106 --> 00:52:33.247
And it's not always great.
814
00:52:33.808 --> 00:52:37.130
But it's, you know, it's harnessed and it can be wonderful.
815
00:52:37.530 --> 00:52:42.914
I think that's a really important distinction to make because you were mentioning earlier about you couldn't focus.
816
00:52:43.074 --> 00:52:45.056
Actually, with the girls, it's the other way around.
817
00:52:45.076 --> 00:52:50.479
So the boys are hyperactive and they can't focus and they're told that they're poor students because they can't sit.
818
00:52:50.499 --> 00:52:50.679
Right.
819
00:52:51.520 --> 00:52:54.461
But women don't have a problem with hyperactivity, it's inattention.
820
00:52:54.481 --> 00:52:56.042
So they tend to be the perfectionists.
821
00:52:56.142 --> 00:52:57.523
It's the school captain.
822
00:52:57.603 --> 00:53:06.147
It's the one who is, you know, because they've learned to perform and they work extra hours and extra prepared because they know they compensate.
823
00:53:06.167 --> 00:53:12.730
They've got structures and lists and things in place to make sure that they're able to perform.
824
00:53:12.750 --> 00:53:17.052
So they've been performing until Perry hits and then that buffering goes.
825
00:53:17.072 --> 00:53:19.033
So it's actually the perfectionism process.
826
00:53:19.653 --> 00:53:22.818
is the trait you're looking for in adult ADHD girls.
827
00:53:23.158 --> 00:53:26.283
There'll be traits there in attention that they're trying to compensate.
828
00:53:26.603 --> 00:53:31.911
And that's why it's really important to know that they present differently because we have different hormones and you don't have estrogen and we do.
829
00:53:31.931 --> 00:53:32.231
Mm-hmm.
830
00:53:33.307 --> 00:53:34.307
Couldn't have said it better myself.
831
00:53:34.367 --> 00:53:36.988
Yeah, The Perfectionist, which I sort of wore as a badge of honour.
832
00:53:37.228 --> 00:53:37.568
Yeah.
833
00:53:37.748 --> 00:53:41.049
But it's really just fear.
834
00:53:41.289 --> 00:53:43.749
And so how's that changed now, like the fear?
835
00:53:43.829 --> 00:53:47.410
Oh, look, I'm still pretty new to it.
836
00:53:47.570 --> 00:53:49.031
It's only been this year.
837
00:53:49.311 --> 00:53:52.672
But I feel, yeah, I think the relief is the thing.
838
00:53:52.832 --> 00:53:53.072
Yeah.
839
00:53:53.392 --> 00:54:00.433
Relief and a bit of shame about how I maybe perform and the interrupting and the over-talking and all of those things.
840
00:54:00.473 --> 00:54:00.853
Really?
841
00:54:00.873 --> 00:54:02.994
So you look back and see the performance?
842
00:54:04.235 --> 00:54:19.591
Yeah Wow Yeah, yeah, yeah Oh yeah God Yeah And then you know Throw in a public profile And like The performance becomes Even more elevated Of course Then you have to show up As a certain Zoe Foster Blake Yeah Yeah Yeah
843
00:54:20.628 --> 00:54:21.970
I'm a real mongrel underneath.
844
00:54:22.530 --> 00:54:23.512
You know me in real life.
845
00:54:23.792 --> 00:54:25.274
Not that I'm saying, but I believe you.
846
00:54:27.156 --> 00:54:35.546
And then the third thing is we see a lot of reactivation of previous trauma.
847
00:54:35.566 --> 00:54:35.686
Yeah.
848
00:54:36.787 --> 00:54:46.853
So research has shown that women with previous trauma at any point in their life, they have high levels of PTSD scores and depressive scores.
849
00:54:47.373 --> 00:54:59.460
And so then those are the women who are taking the HRT, taking the stimulant, and they still have the symptoms of trauma, which is kind of hypervigilance, reactivity, feeling on edge, can't relax, feeling tense.
850
00:55:00.240 --> 00:55:15.465
And so then we need to look at trauma-informed care, have things like EMDR for the trauma processing, because what happens is when these hormones fluctuate, especially when you lose that lovely progesterone, the calming effect, brain kind of panics.
851
00:55:15.585 --> 00:55:16.665
It likes predictability.
852
00:55:16.965 --> 00:55:18.486
And now it's lost the calming effect.
853
00:55:18.506 --> 00:55:20.326
So it goes in your amygdala, your fight or flight.
854
00:55:20.887 --> 00:55:24.728
And then it thinks, when was the last time you felt under threat?
855
00:55:25.188 --> 00:55:28.390
And it will go to your previous history of any traumatic experience.
856
00:55:28.430 --> 00:55:30.011
It could be bullying in the playground.
857
00:55:30.632 --> 00:55:32.333
It could be workplace bullying.
858
00:55:32.353 --> 00:55:33.914
It could be domestic violence.
859
00:55:33.954 --> 00:55:37.396
I think trauma, we have a very narrow definition of trauma.
860
00:55:37.816 --> 00:55:42.019
And so even with HRT and stimulant, they don't get better.
861
00:55:42.259 --> 00:55:44.300
And the amount of women who do EMDR, they come to me.
862
00:55:44.320 --> 00:55:46.242
I get third, second opinions all the time.
863
00:55:46.662 --> 00:55:47.222
I'm on HRT.
864
00:55:47.282 --> 00:55:47.723
I'm on this.
865
00:55:47.903 --> 00:55:49.884
And I literally look at them and I say, okay.
866
00:55:50.304 --> 00:55:52.406
Like your bloods are perfectly fine.
867
00:55:52.446 --> 00:55:54.028
You're absorbing estrogen really well.
868
00:55:54.708 --> 00:55:56.890
But there's nothing that I can do for you.
869
00:55:56.910 --> 00:55:58.011
You need to have EMDR.
870
00:55:58.411 --> 00:56:02.475
We get them to see a trauma-informed therapist and they suddenly start sleeping.
871
00:56:03.296 --> 00:56:04.477
They're feeling amazing.
872
00:56:04.497 --> 00:56:05.577
They're feeling calmer.
873
00:56:06.238 --> 00:56:09.421
And I think it's important to have this trauma-informed care as well.
874
00:56:09.521 --> 00:56:12.403
And so this intersection of supporting woman's brain is,
875
00:56:13.344 --> 00:56:14.464
is fascinating.
876
00:56:14.945 --> 00:56:30.409
But I really want to emphasize the trauma activation, because if you are listening to this and you're still feeling that you're feeling anxious, you're not sleeping, you're feeling hypervigilant and irritable and not yourself, then you need to address the third layer.
877
00:56:30.569 --> 00:56:31.990
And a lot of that is this kind of
878
00:56:33.325 --> 00:56:34.326
No one wants to go there.
879
00:56:34.346 --> 00:56:39.432
It's that inner work, which I say the patch won't heal, which is addressing your unhealed wounds.
880
00:56:39.712 --> 00:56:47.020
I mean, dealing with the trauma, that's something that you can't really – I mean, EMDR is maybe the closest thing, but there's no pill for it.
881
00:56:47.060 --> 00:56:52.045
There's no like – you can't erase the memory or the – yeah.
882
00:56:52.345 --> 00:56:54.207
And it feels like such a – well, it is –
883
00:56:55.368 --> 00:57:17.632
um the more you talk about it it requires such a holistic approach like there's so many like it's a real fucker and it feels so overwhelming and i'm not a i'm not a woman but it feels so overwhelming but i like if if so so if when you first heard about all of this were you overwhelmed or was it more like oh it's a relief or is it a combo
884
00:57:18.884 --> 00:57:19.704
Yeah, combo always.
885
00:57:20.525 --> 00:57:27.449
To know that it had a name and it was not just in my head and then to be able to treat it.
886
00:57:28.150 --> 00:57:29.431
But it is pills and skills.
887
00:57:29.471 --> 00:57:31.172
You know, you have to work on your inside stuff.
888
00:57:31.192 --> 00:57:31.652
Pills and skills.
889
00:57:33.613 --> 00:57:39.218
You have to work on your stuff as well because a lot of it does come up at this time as well.
890
00:57:39.358 --> 00:57:44.202
And anything that's been masked at all, it just drops.
891
00:57:44.862 --> 00:57:46.103
It is, isn't it?
892
00:57:46.203 --> 00:57:50.867
That lack of dopamine and estrogen and you're just like, I can't do this anymore.
893
00:57:50.887 --> 00:57:51.807
I need help.
894
00:57:52.488 --> 00:57:57.192
And I think most women probably get to breaking point before they actually seek help.
895
00:57:57.792 --> 00:57:58.513
It just sucks.
896
00:57:58.753 --> 00:57:58.873
Yeah.
897
00:57:59.333 --> 00:58:01.675
Well, because they don't know what's going on, right?
898
00:58:01.916 --> 00:58:03.938
And so they will lose relationships.
899
00:58:03.998 --> 00:58:10.084
We know from superannuation data that women are retiring early.
900
00:58:10.804 --> 00:58:13.607
They're losing $150,000 of earnings a year.
901
00:58:13.627 --> 00:58:15.549
They're leaving with less money.
902
00:58:15.689 --> 00:58:16.971
Economically, we're losing money.
903
00:58:16.991 --> 00:58:17.651
So it's actually...
904
00:58:18.632 --> 00:58:19.653
A bigger problem.
905
00:58:20.294 --> 00:58:20.875
I go back.
906
00:58:21.295 --> 00:58:24.879
We keep talking about menopause and you just think, oh, yes, cessation of periods.
907
00:58:24.939 --> 00:58:25.259
It's not.
908
00:58:25.680 --> 00:58:27.782
It's a whole body transition.
909
00:58:28.303 --> 00:58:29.644
The brain is impacted.
910
00:58:29.684 --> 00:58:31.767
The hot flushes start in the brain.
911
00:58:32.027 --> 00:58:33.428
A thermostat is in the brain.
912
00:58:34.329 --> 00:58:39.291
And then you've got the physical symptoms, which, you know, is skin, heart, gut.
913
00:58:39.331 --> 00:58:41.392
We haven't even gone through it because we don't want to.
914
00:58:41.633 --> 00:58:44.314
And, you know, we lose 30% of collagen.
915
00:58:44.334 --> 00:58:46.035
A lot of women don't think that.
916
00:58:46.195 --> 00:58:48.956
A lot of women don't realize that their joint pain is related to this.
917
00:58:48.976 --> 00:58:51.077
They don't realize their gut symptoms are related to peri.
918
00:58:51.457 --> 00:58:52.898
They don't realize their...
919
00:58:53.618 --> 00:58:57.923
kind of vestibular neuritis and all these other ENT symptoms are related to that.
920
00:58:57.963 --> 00:59:06.895
But I think what we need to see is that for women, these hormones throughout their reproductive lifespan have supported every single organ.
921
00:59:07.716 --> 00:59:10.960
And we know at menopause when these hormones are declining,
922
00:59:12.120 --> 00:59:15.423
We know we are accelerating ageing on a cellular level.
923
00:59:15.523 --> 00:59:19.146
So if you're talking about longevity, there's a lot of bro signs in this.
924
00:59:19.427 --> 00:59:20.808
But for women, it's very simple.
925
00:59:21.268 --> 00:59:25.392
We know women in Australia live on average till 84.5 years of age.
926
00:59:25.792 --> 00:59:28.395
The main cause of death is Alzheimer's followed by heart disease.
927
00:59:28.595 --> 00:59:31.317
Main cause of disability is a fall and breaking your hip.
928
00:59:31.337 --> 00:59:31.477
Yeah.
929
00:59:32.318 --> 00:59:34.020
There's no cure or treatment for these.
930
00:59:34.520 --> 00:59:44.249
But before menopause, these illnesses do not exist because estrogen is cardioprotective, neuroprotective, protects your bones and every single organ.
931
00:59:44.650 --> 00:59:52.637
Within 10 years of menopause, we see accelerated aging on a cellular level and an increase in chronic disease.
932
00:59:53.398 --> 00:59:56.282
And we know that because cholesterol goes up, blood pressure goes up.
933
00:59:56.302 --> 01:00:03.792
So then you go to a doctor and now you're ending up with a blood pressure tablet, cholesterol tablet, anti-anxiety, sleeping pill, pain thing.
934
01:00:03.812 --> 01:00:05.355
So it's this polypharmacy thing.
935
01:00:06.492 --> 01:00:08.553
And we need to go back to the root cause.
936
01:00:08.734 --> 01:00:15.678
And when you give them the natural hormones back, suddenly all this laundry list of symptoms disappear.
937
01:00:16.119 --> 01:00:18.480
Of course, there's the other layers that you need to address too.
938
01:00:18.660 --> 01:00:19.081
The skills.
939
01:00:19.101 --> 01:00:19.801
The skills and skills.
940
01:00:19.921 --> 01:00:22.743
The skills and also if there's ADHD addressed that.
941
01:00:22.763 --> 01:00:27.847
But majority of women will find that when we address just the period, that's already a relief.
942
01:00:27.927 --> 01:00:28.067
Yeah.
943
01:00:28.087 --> 01:00:30.068
And we can titrate the anti-anxiety back.
944
01:00:30.388 --> 01:00:32.550
That's a huge part of it for a lot of women is what you're saying.
945
01:00:32.590 --> 01:00:32.730
Yeah.
946
01:00:32.918 --> 01:00:33.978
There's a huge part.
947
01:00:34.139 --> 01:00:37.260
I always emphasize the foundations, which we haven't really spoken about.
948
01:00:37.280 --> 01:00:48.364
I think whatever you do with or without HRT, you still need to prioritize whole nutrition because the amount of women who under eat, again, because they're trying to lose weight and they've been told reduce calorie.
949
01:00:48.485 --> 01:00:49.825
So eat less and exercise more.
950
01:00:49.845 --> 01:00:51.486
That's what your GP tells you as well, right?
951
01:00:51.886 --> 01:00:53.967
Oh, you just need to eat less and exercise more.
952
01:00:54.427 --> 01:00:56.108
And so then they're calorie restrict.
953
01:00:56.148 --> 01:00:56.668
And so they're...
954
01:00:56.948 --> 01:00:59.789
have a coffee at breakfast and nothing till lunchtime, then a toast tea.
955
01:00:59.809 --> 01:01:07.550
And so we know that blood sugar imbalance are very prominent, which causes, again, changes in your energy, cognition, and mood.
956
01:01:08.031 --> 01:01:13.772
So stabilize the blood sugar with whole food breakfast, a little bit of protein, fiber, and good fats.
957
01:01:13.912 --> 01:01:18.953
Make sure you're eating your three meals that can be quite small, prioritizing movement, but not doing cardio.
958
01:01:19.393 --> 01:01:25.038
We want to do more strength training, building muscle because it helps with insulin sensitivity and, again, blood sugar.
959
01:01:25.418 --> 01:01:26.819
Then we need to move to good sleep.
960
01:01:26.919 --> 01:01:31.603
And that's a problem because everyone scrolls till midnight because the algorithm is designed to do that.
961
01:01:31.983 --> 01:01:33.104
I scroll till 11.30.
962
01:01:34.945 --> 01:01:38.488
But it's fine because you're not going to go through peri, so you're fine.
963
01:01:39.008 --> 01:01:40.510
Probably not the time to be bragging.
964
01:01:40.530 --> 01:01:41.090
No.
965
01:01:43.289 --> 01:01:46.310
But, you know, you have testosterone as your advantage there.
966
01:01:46.650 --> 01:01:52.952
But there's this 3 a.m. waking, that woman wake up at 3 a.m. and bright awake and they can't switch off.
967
01:01:53.572 --> 01:02:00.495
And so the problem with the screen is that it will disrupt your blue, the blue light will disrupt your melatonin and raise your cortisol.
968
01:02:01.315 --> 01:02:08.076
But the other problem with scrolling is it is working on the same pathways of depleting the dopamine that's already depleted for ADHD.
969
01:02:08.376 --> 01:02:10.057
So you can see we're losing the hormones.
970
01:02:10.297 --> 01:02:12.177
We're then scrolling, losing that dopamine.
971
01:02:12.657 --> 01:02:16.758
And so you've got to be very strict, 9 o'clock phones away, no blue light 90 minutes before.
972
01:02:16.818 --> 01:02:18.318
And then you've got to... 90 minutes.
973
01:02:18.358 --> 01:02:19.118
90 minutes before.
974
01:02:19.158 --> 01:02:20.859
They normally say 90 minutes before.
975
01:02:21.179 --> 01:02:21.619
Wow.
976
01:02:21.859 --> 01:02:24.600
I feel like I read something yesterday that said 30 minutes, but 90...
977
01:02:24.920 --> 01:02:25.680
It's normally 90 minutes.
978
01:02:25.760 --> 01:02:26.260
90.
979
01:02:26.440 --> 01:02:26.840
Wow.
980
01:02:27.100 --> 01:02:37.536
I mean, just to think about circadian rhythm, evolutionary, we would wake up in the morning with sunrise, naturally, not with a haunting alarm jumping out, which already spikes our cortisol in the mornings.
981
01:02:37.576 --> 01:02:41.302
We would naturally wake up and then by sunset,
982
01:02:42.392 --> 01:02:46.414
we would not be doing anything because there was no artificial light.
983
01:02:46.454 --> 01:02:47.254
There was no light, yeah.
984
01:02:47.274 --> 01:02:54.538
So evolutionarily, every single organ and cell in our body has its internal body clock, including digestion.
985
01:02:54.938 --> 01:02:58.299
So if you eat too late, the stomach acid is reduced.
986
01:02:58.320 --> 01:03:02.161
This is why you get more reflux because we're not designed to eat late meals.
987
01:03:02.321 --> 01:03:03.462
The stomach hasn't evolved.
988
01:03:03.842 --> 01:03:08.365
So if you eat a late meal, not only you don't digest it, there's sitting there, stomach acids reduce.
989
01:03:08.665 --> 01:03:11.087
We need stomach acid to break the food down, to push it down.
990
01:03:11.607 --> 01:03:17.331
But also we then get a spike in our cortisol because the body's like, why are you eating so late?
991
01:03:17.351 --> 01:03:19.752
And so then we have blood sugar irregularity.
992
01:03:20.213 --> 01:03:26.096
So it's understanding that we've got to respect that circadian rhythm and the phones is not great or artificial light.
993
01:03:26.617 --> 01:03:28.218
Then we talk about stress.
994
01:03:29.302 --> 01:03:31.022
Now, stress is a perception.
995
01:03:31.062 --> 01:03:38.264
What stresses Zoe out might not stress me, but no human has ever carried the load of a modern woman.
996
01:03:39.044 --> 01:03:41.485
We've always lived in communal, tribal...
997
01:03:41.525 --> 01:03:42.525
It's here for them.
998
01:03:42.565 --> 01:03:43.786
Yeah, I've seen it.
999
01:03:43.806 --> 01:03:45.546
We all started that club at the same time.
1000
01:03:45.566 --> 01:03:51.788
Even if men were hunter-gourning women joining them, kids were raised by grandparents, aunts, uncles with other kids in a village.
1001
01:03:51.808 --> 01:03:52.868
Women were bringing food.
1002
01:03:52.888 --> 01:03:53.508
Yeah.
1003
01:03:53.628 --> 01:04:08.880
And now you've got this nuclear family of the pressure is how to expect someone to wake up in the morning, do three lunchboxes, get to work, come back at 6 p.m., prepare dinner, do the laundry, do the ironing and then prepare for the next day, get the book day uniform ready.
1004
01:04:09.560 --> 01:04:16.185
So I talk about this loneliness epidemic that I'm seeing in women because it's.
1005
01:04:16.565 --> 01:04:22.849
They don't even have time for themselves, let alone to even call a friend back because they're all exhausted to even talk to each other.
1006
01:04:23.269 --> 01:04:24.629
And so now they're isolated.
1007
01:04:24.810 --> 01:04:33.274
And the problem is in life, whenever we go through something alone, it becomes a suffering because in our brain we think, oh, my God, this is only happening to us.
1008
01:04:34.255 --> 01:04:38.737
And because we've not had open conversations, because, again, it reflects like, am I the only one going through this?
1009
01:04:38.757 --> 01:04:41.538
Maybe I don't want to talk about this because my friend's not talking about this.
1010
01:04:42.599 --> 01:04:49.061
The problem with that is that then it kind of you continue to suffer a long time before you seek help.
1011
01:04:49.161 --> 01:04:55.962
As far as when you go out and meet your friends and girlfriends and when you start talking about this, then, you know, actually, we're all the same.
1012
01:04:56.223 --> 01:05:01.384
And there's kind of this sense of humor, but also a sense of relief to be like, oh, this is just normal.
1013
01:05:01.504 --> 01:05:03.484
All my friends are experiencing the same mental load.
1014
01:05:04.065 --> 01:05:08.986
And we know from studies, men and women who earn the same amount of money, do the same hours,
1015
01:05:09.906 --> 01:05:15.829
Women will still carry the mental load and the invisible workload.
1016
01:05:16.329 --> 01:05:18.050
And it's not that it's a man's fault.
1017
01:05:18.470 --> 01:05:19.690
Men are wonderful.
1018
01:05:19.790 --> 01:05:21.031
They're trying their best.
1019
01:05:21.371 --> 01:05:22.211
I have to agree.
1020
01:05:23.232 --> 01:05:23.492
I know.
1021
01:05:23.652 --> 01:05:24.412
I'm married to one.
1022
01:05:24.472 --> 01:05:25.233
Bless him.
1023
01:05:25.253 --> 01:05:28.734
I have to remind myself he's trying his best.
1024
01:05:28.954 --> 01:05:30.175
I don't have my village around me.
1025
01:05:31.356 --> 01:05:34.917
But also maybe worth mentioning that some men aren't trying their best as well.
1026
01:05:35.898 --> 01:05:37.599
That would be even harder.
1027
01:05:37.739 --> 01:05:39.100
And so women aren't trying their best.
1028
01:05:39.120 --> 01:05:40.501
I'm generally giving the benefit of the doubt.
1029
01:05:40.521 --> 01:05:41.921
You're supposed to support me here.
1030
01:05:42.762 --> 01:05:43.622
But you're right.
1031
01:05:43.662 --> 01:05:44.563
I mean, men need to step up.
1032
01:05:44.583 --> 01:05:44.803
I'm trying.
1033
01:05:44.823 --> 01:05:45.443
I'm trying.
1034
01:05:45.483 --> 01:05:46.184
I'm trying my best.
1035
01:05:48.931 --> 01:05:50.352
I think the modern man is.
1036
01:05:50.372 --> 01:05:52.253
I mean, my father's generation was like nothing.
1037
01:05:52.293 --> 01:05:53.073
He came home.
1038
01:05:53.853 --> 01:06:02.558
And I think that's where we're just going to go straight into my four layers that I talk in the book, which is whenever we talk about women's health, you need to understand what's happening in their body.
1039
01:06:03.039 --> 01:06:07.201
Then you go out of their ovaries from the uterus to their brain and other organs.
1040
01:06:07.541 --> 01:06:09.262
Then what is their life perspective?
1041
01:06:09.302 --> 01:06:10.383
Who are in their lives?
1042
01:06:10.403 --> 01:06:11.183
What is their workload?
1043
01:06:11.583 --> 01:06:13.625
And then you're going to look at the systems around them.
1044
01:06:14.385 --> 01:06:24.052
And so I talk about feminism, patriarchy, capitalism and consumerism because we're all trapped in this feminism dialogue.
1045
01:06:24.092 --> 01:06:25.032
Feminism is great.
1046
01:06:25.132 --> 01:06:33.098
OK, we're sitting here because feminism gave us the opportunity to have a voice, to vote, to own land, open a bank account, you know, and we're very grateful for that.
1047
01:06:33.798 --> 01:06:40.223
But it also told us that we can do it all at the same time, have the careers, be the mother, be the wife, be the best mum.
1048
01:06:41.504 --> 01:06:41.704
And...
1049
01:06:42.737 --> 01:06:47.100
The problem with that is it didn't create the framework for women to go and thrive.
1050
01:06:47.680 --> 01:06:58.787
And so the framework is a patriarchal framework designed for a man to turn up to work at 8.30, get home at 6, where the woman was looking after cleaning, cooking, cooking.
1051
01:06:59.828 --> 01:07:04.771
taking care of all the invisible load, which I'm not going to list because every woman listening to this knows what it is.
1052
01:07:05.431 --> 01:07:12.696
But what's happened is that now she's doing the same hours, but then she's still carrying the same amount of invisible load and mental load.
1053
01:07:13.396 --> 01:07:15.537
And men are still doing the same work.
1054
01:07:15.577 --> 01:07:17.218
They're trying their best to do the other things.
1055
01:07:17.699 --> 01:07:20.000
So it's just working against them.
1056
01:07:20.500 --> 01:07:21.481
So now women are stuck.
1057
01:07:21.621 --> 01:07:24.703
So when I see women who have spent 20 years building their career,
1058
01:07:25.383 --> 01:07:27.986
And they have to be in the office at 8.30 and finish at 6.
1059
01:07:28.186 --> 01:07:28.867
What do they do?
1060
01:07:29.427 --> 01:07:35.354
And capitalism is this system which tells you you're only worth if you're bringing in money.
1061
01:07:35.854 --> 01:07:38.177
You need to be productive to be worth.
1062
01:07:38.697 --> 01:07:45.424
So their self-esteem and their value of who they are is linked with what they're bringing in, how much they're earning.
1063
01:07:45.865 --> 01:07:47.366
And so we've kind of devalued.
1064
01:07:48.247 --> 01:07:55.310
Women choosing to maybe stay at home or doing flexible hours, all of those things, because there's guilt when they go part-time or stay at home.
1065
01:07:55.770 --> 01:08:04.934
And then there's consumerism, which is, you know, particularly targeted at women, which is all around even when they feel like they have enough, there's always something else to buy.
1066
01:08:04.994 --> 01:08:15.679
So then there's this pressure of earning and keeping the money going for obviously financial pressures, but also this constant buying and targeting of you're not good enough, you need another person,
1067
01:08:15.999 --> 01:08:20.323
You know, the latest trendy jacket and the latest kind of hairspray and all those things.
1068
01:08:20.983 --> 01:08:36.036
And I think it's important just to be aware that you could be taking the ADHD medication and taking the HRT and having your EMDR and you're still feeling really trapped because the system is not designed to cater for any human to carry this load.
1069
01:08:36.136 --> 01:08:40.260
Yeah, I mean, I've never thought about it to that extent.
1070
01:08:40.518 --> 01:08:42.059
Like if you're a lawyer, you're an engineer.
1071
01:08:42.079 --> 01:08:44.401
I mean, when I'm seeing these patients, like, well, she's a barrister.
1072
01:08:44.421 --> 01:08:45.922
What am I going to tell her to go part-time?
1073
01:08:46.303 --> 01:08:47.263
She's self-employed.
1074
01:08:47.504 --> 01:08:50.706
And also realise that we know 40% of relationships break down.
1075
01:08:50.726 --> 01:08:56.211
So I see a lot of single women who don't have the opportunity of going part-time.
1076
01:08:56.251 --> 01:08:58.352
So here they are working these five days.
1077
01:08:58.412 --> 01:09:01.755
Then from that money, they're paying for the childcare and the nanny.
1078
01:09:02.376 --> 01:09:05.358
And so these are the structures that we need to question.
1079
01:09:05.518 --> 01:09:08.621
Now, there are lots of places that are flexible.
1080
01:09:09.478 --> 01:09:15.282
But as a larger society, majority of them are not going to have that flexibility.
1081
01:09:15.382 --> 01:09:16.542
Of course, we're going to move that way.
1082
01:09:16.963 --> 01:09:21.846
And I think it's really important to move that way because Australia has a shortage of skilled workers.
1083
01:09:22.726 --> 01:09:27.029
And we need to capitalise on 50% of our demographic who are female.
1084
01:09:27.569 --> 01:09:30.091
But then you need to address these issues, right?
1085
01:09:30.231 --> 01:09:33.333
Offering them flexible working, making sure you have benefits.
1086
01:09:33.433 --> 01:09:57.811
menopause workplace policy and because we want to have workforce retention it's great for the economy and it's great for women you know we know that when women are working they have better self-esteem working for what they want to work it's a different thing for working just to survive I think it's important to know I think work brings women a lot of joy and it's going back to that same thing what is it that you want to do with your life um
1087
01:09:58.732 --> 01:10:01.773
I'm going to stop talking there because I feel like I've rattled a lot of things.
1088
01:10:01.793 --> 01:10:02.013
No, no, no.
1089
01:10:02.033 --> 01:10:02.533
It's been amazing.
1090
01:10:02.573 --> 01:10:04.274
It's changed a lot of people's lives probably.
1091
01:10:04.294 --> 01:10:04.614
Yes.
1092
01:10:04.994 --> 01:10:05.654
It's so incredible.
1093
01:10:05.674 --> 01:10:12.877
But I want to ask about, so I remember when Penny first showed me the pregnancy stick to say that we were having our first child.
1094
01:10:12.917 --> 01:10:21.260
I remember in that moment there was a very obvious physical thing in front of me that like, okay, I really need to look after her here.
1095
01:10:21.300 --> 01:10:22.300
I need to help her through this.
1096
01:10:22.420 --> 01:10:27.962
And I think all men would know that experience when their partner's pregnant, you drop everything and everything's about them.
1097
01:10:29.063 --> 01:10:31.546
and you're protecting them and looking after them, what can I do for you?
1098
01:10:31.566 --> 01:10:32.447
How are you feeling?
1099
01:10:32.467 --> 01:10:34.390
What are you going through right now?
1100
01:10:34.410 --> 01:10:35.311
How can I support you?
1101
01:10:36.052 --> 01:10:45.466
That's an obvious one, but I feel like this is a time where they probably need it more, that kind of attention and support and support
1102
01:10:46.867 --> 01:10:50.812
proactively thinking about how can I make your life better with all you're going through.
1103
01:10:50.952 --> 01:10:52.293
And compassion, just general.
1104
01:10:52.313 --> 01:10:53.214
Compassion.
1105
01:10:53.375 --> 01:11:02.324
And also to go back to the first big hormonal beat, which is tweens and puberty, which I'm heading into soon, and how mindfully...
1106
01:11:03.205 --> 01:11:15.816
certainly I think our generation are parenting that moment and how aware we are of it and how scared to be honest of like what's coming in, how we have to learn how to counter the big emotional moments and everything.
1107
01:11:15.876 --> 01:11:17.817
So I, I totally agree.
1108
01:11:17.837 --> 01:11:23.422
Those other big hormonal moments get so much attention and so much care and compassion.
1109
01:11:23.802 --> 01:11:24.983
And this one is just like,
1110
01:11:25.223 --> 01:11:26.163
Fucking sort it out.
1111
01:11:26.203 --> 01:11:26.424
Yeah.
1112
01:11:26.604 --> 01:11:36.888
And so I just wonder, do you have anecdotally any stories of partners or men who have just done really good things in this?
1113
01:11:37.769 --> 01:11:38.749
Like what should I happen?
1114
01:11:39.809 --> 01:11:40.850
Can I tell you what we all do?
1115
01:11:40.890 --> 01:11:45.312
All the women I know, we send memes to our husbands all the time so that we don't sound insane.
1116
01:11:45.332 --> 01:11:49.554
So we're sending memes about like perimenopausal things that we do in a funny way.
1117
01:11:50.394 --> 01:11:52.576
to go, but for real, this is why I do this.
1118
01:11:52.616 --> 01:11:53.997
Like, you know, the oven fan noise?
1119
01:11:54.197 --> 01:11:55.558
That's why I crack it when that's on.
1120
01:11:55.978 --> 01:11:57.279
Or, you know, various things.
1121
01:11:57.459 --> 01:11:59.441
And so the man sees it and he goes, oh, that's so funny.
1122
01:11:59.461 --> 01:12:00.001
That's so true.
1123
01:12:00.642 --> 01:12:02.743
But then it's probably just like, I can't wait for the next meme.
1124
01:12:02.883 --> 01:12:07.146
But like, what should men be doing anecdotally?
1125
01:12:07.166 --> 01:12:11.530
You've already been saying that that's been a good example of how to just support.
1126
01:12:12.110 --> 01:12:15.272
And then maybe in conjunction with that question,
1127
01:12:18.053 --> 01:12:34.497
So, Zoe, if years ago before you were across perimenopause, if Haim had heard a podcast explaining this and he noticed all the symptoms, if he had approached you and said, hey, Zoe, I think it could be, have you thought about perimenopause?
1128
01:12:34.577 --> 01:12:36.258
How would that land?
1129
01:12:36.278 --> 01:12:38.659
Yeah, it's like when you say, you premenstrual, babe.
1130
01:12:38.679 --> 01:12:40.039
It doesn't go well, does it?
1131
01:12:40.059 --> 01:12:41.579
Don't ever say that.
1132
01:12:41.599 --> 01:12:42.840
Don't ever say calm down either.
1133
01:12:43.831 --> 01:12:46.033
I think it's all about the moment and the tact, right?
1134
01:12:46.053 --> 01:12:56.321
Because if you've got a woman who's crying and is – like I was at points where I was just, you know, texting him in the middle of the night going, I cannot sleep.
1135
01:12:56.521 --> 01:12:57.442
You know, I'm awake.
1136
01:12:57.502 --> 01:12:58.983
I'm so anxious about this, this, this.
1137
01:12:59.003 --> 01:12:59.504
I don't know.
1138
01:12:59.524 --> 01:13:00.404
I just sort of venting.
1139
01:13:00.985 --> 01:13:03.026
And he would just have to be the crumple zone for that.
1140
01:13:03.047 --> 01:13:03.567
Yeah.
1141
01:13:03.767 --> 01:13:06.089
I think if he knew what was going on, it would be super helpful.
1142
01:13:06.109 --> 01:13:17.139
And then there would be those moments of deep vulnerability where a partner could come in and say, honey, just as a well-meaning friend could do and say, don't take this the wrong way, but this could be perimenopause.
1143
01:13:17.159 --> 01:13:18.321
Should we get you an appointment?
1144
01:13:18.821 --> 01:13:20.182
I think that would be well received.
1145
01:13:20.202 --> 01:13:20.422
Yeah.
1146
01:13:20.503 --> 01:13:20.663
Okay.
1147
01:13:20.803 --> 01:13:21.043
Great.
1148
01:13:21.063 --> 01:13:29.291
Because I think that's compassion and care and depending on the woman's state of mind and mood, but I think it's obviously a show of care.
1149
01:13:29.791 --> 01:13:33.275
So we know at puberty, you can have horrible mood swings.
1150
01:13:33.596 --> 01:13:43.668
And even with pregnancy and postpartum, we have the same kind of understanding and compassion, not just for emotional volatility, but also body changes.
1151
01:13:44.048 --> 01:13:48.273
And I typically tell my women in their 40s, I want you to have the same compassion
1152
01:13:49.430 --> 01:13:50.571
as you go through pregnancy.
1153
01:13:50.652 --> 01:13:55.277
In pregnancy, you're getting a belly, you're getting bigger, your moods are changing.
1154
01:13:55.297 --> 01:13:58.260
You're not going around saying, oh, look at this, I have an ugly belly.
1155
01:13:58.280 --> 01:14:06.710
Because you should hear the derogatory things women say to themselves about their body, about the way they look in the mirror, because they don't know what's going on, right?
1156
01:14:06.730 --> 01:14:07.391
So suddenly...
1157
01:14:08.192 --> 01:14:09.653
They're getting sagged skin.
1158
01:14:09.673 --> 01:14:10.854
They're changing their body shape.
1159
01:14:11.254 --> 01:14:16.998
And also I'll say you need to educate that this is the biological transition, have the same understanding and compassion.
1160
01:14:17.138 --> 01:14:19.500
You need to show it to yourself first before someone else can show it.
1161
01:14:20.060 --> 01:14:27.245
But I think going back to Zoe, I think most men don't know what perimenopause is, but they will after this podcast.
1162
01:14:27.446 --> 01:14:36.152
Because I think any man who goes to their partner and says, I think you're in perimenopause, actually will be well-received and quite relieved.
1163
01:14:36.172 --> 01:14:36.272
Yeah.
1164
01:14:36.852 --> 01:14:39.456
And it's not that you're just being moody before your period.
1165
01:14:39.496 --> 01:14:44.103
So if you are going to say something, and I always say perimenopause is just worsening PMS.
1166
01:14:44.424 --> 01:14:51.495
So if you're noticing someone's getting that, because normally as the woman, even with the best self-awareness, they're so busy.
1167
01:14:52.316 --> 01:14:59.163
And as Zoe was mentioning earlier, we're so good at gaslighting ourselves that we will complain about, oh, I haven't eaten today.
1168
01:14:59.183 --> 01:15:00.525
And I think I'm just a bit stressed.
1169
01:15:00.545 --> 01:15:01.666
And I think the kids are annoying me.
1170
01:15:01.706 --> 01:15:02.947
And you're just being annoying.
1171
01:15:02.987 --> 01:15:05.290
And we don't really connect the dots ourselves.
1172
01:15:05.550 --> 01:15:12.617
And sometimes you being as an observer of someone who's been in your life for 5, 10, 20 years is like, I know, Zoe.
1173
01:15:13.178 --> 01:15:14.559
This is not Zoe, you know.
1174
01:15:14.579 --> 01:15:15.460
Mm-hmm.
1175
01:15:15.660 --> 01:15:17.381
Rather than being, so he's being a horrible bitch.
1176
01:15:17.841 --> 01:15:19.883
That didn't go down well when I said that.
1177
01:15:19.903 --> 01:15:21.523
I did not like that.
1178
01:15:22.324 --> 01:15:23.885
And being more inquisitive.
1179
01:15:24.507 --> 01:15:26.808
I get a lot of men, as I said, making an appointment.
1180
01:15:27.248 --> 01:15:28.789
They bring their partners in.
1181
01:15:29.689 --> 01:15:34.011
Or the women will come and say, oh, my husband Googled you and found you and made this appointment.
1182
01:15:34.411 --> 01:15:36.672
And she's like, oh, I've just been feeling all of these things.
1183
01:15:36.932 --> 01:15:38.512
And I went to my GP and the bloods were normal.
1184
01:15:38.532 --> 01:15:39.613
And they showed me the blood test.
1185
01:15:40.153 --> 01:15:41.313
I'm like, yeah, you're in Perry.
1186
01:15:42.174 --> 01:15:43.054
And they start crying.
1187
01:15:43.834 --> 01:15:44.735
They start crying.
1188
01:15:45.615 --> 01:15:53.158
Because for the first time, they feel seen, heard, because they genuinely are crying every day thinking they've got dementia.
1189
01:15:53.658 --> 01:15:55.658
They were high-functioning until that moment.
1190
01:15:55.959 --> 01:15:59.780
They've succeeded and they've gone to a doctor and they said, there's nothing wrong with you, stress less.
1191
01:16:00.805 --> 01:16:02.746
Or they've been told, get an antidepressant.
1192
01:16:02.766 --> 01:16:03.867
They're like, but I'm not depressed.
1193
01:16:03.947 --> 01:16:05.288
Like, I mean, I'm not depressed.
1194
01:16:06.088 --> 01:16:07.309
We have an epidemic of that.
1195
01:16:07.489 --> 01:16:17.494
And the problem with that is we're giving women these medication at the very time when they're already having issues with intimacy and changes in their body shape with weight gain.
1196
01:16:18.034 --> 01:16:22.077
Antidepressants and anti-anxiety medications will cause weight gain.
1197
01:16:22.757 --> 01:16:24.619
they will cause sexual dysfunction.
1198
01:16:25.239 --> 01:16:39.170
They reduce your libido, decrease your arousal, and then they're an independent risk factor for reducing your bone density, which we know women are predisposed to at losing between perimenopause and menopause and increased risk of osteopathic hip fractures.
1199
01:16:39.991 --> 01:16:42.092
And there's lots of psychiatrists who...
1200
01:16:43.073 --> 01:16:49.475
are struggling to get people off because when they're on there, you can't taper off them because the brain neurochemistry is so dependent on them.
1201
01:16:49.935 --> 01:16:53.176
So antidepressants, anti-anxiety, great.
1202
01:16:53.496 --> 01:16:55.777
Treat them for that period.
1203
01:16:56.117 --> 01:17:06.220
But being on them for a decade long, I mean, we're kind of pathologizing life and not giving people and human... Because the other thing it does is numbs you from feeling anything.
1204
01:17:06.280 --> 01:17:08.280
A lot of women say, I want to feel something.
1205
01:17:08.320 --> 01:17:09.721
I want to feel that connection.
1206
01:17:10.392 --> 01:17:12.873
So it takes away the highs and the lows, doesn't it, a little bit?
1207
01:17:13.113 --> 01:17:13.393
Yeah.
1208
01:17:13.473 --> 01:17:18.715
I mean, listen, if you're someone who's, again, got trauma and other things and your volatility is so much, it's a relief.
1209
01:17:18.775 --> 01:17:21.936
You can breathe because you're not feeling everything because you don't want to feel everything.
1210
01:17:22.056 --> 01:17:22.436
Trust me.
1211
01:17:22.476 --> 01:17:23.937
It's exhausting feeling too much.
1212
01:17:24.637 --> 01:17:28.138
And if you've got ADHD and that, that over feeling of everything is too much.
1213
01:17:28.158 --> 01:17:38.002
And I think that's where I talk a lot in the book around nervous system support because we're in this heightened sympathetic nervous system of overdrive where our...
1214
01:17:38.502 --> 01:17:41.485
Parasympathetic, which is our rest or repair, it's a complete imbalance.
1215
01:17:41.505 --> 01:17:45.948
They're out of sync where we can breathe, we can relax, we're feeling calmer.
1216
01:17:46.329 --> 01:17:48.751
We have space to respond rather than react.
1217
01:17:49.451 --> 01:17:53.375
And so we need to be proactive in doing things like breath work.
1218
01:17:53.475 --> 01:17:54.776
It might be sound bath for you.
1219
01:17:54.916 --> 01:17:56.557
It might be doing meditation for you.
1220
01:17:56.898 --> 01:17:58.319
It might be doing journaling for you.
1221
01:17:58.899 --> 01:18:02.782
Maybe sitting 60 minutes without any noise because that's sensory overload.
1222
01:18:02.803 --> 01:18:03.123
Mm-hmm.
1223
01:18:03.463 --> 01:18:09.531
You've now had all the treatments and they're still feeling all the symptoms because they haven't really addressed everything else.
1224
01:18:10.452 --> 01:18:16.880
I mean, going back to evolutionary days or times, we would be spending our time in nature.
1225
01:18:18.452 --> 01:18:23.394
And so you have beautiful sun, air, you've got plants.
1226
01:18:23.454 --> 01:18:26.696
We know when you're on greenery, you reduce your cortisol by 40%.
1227
01:18:27.356 --> 01:18:28.296
And you're not under threat.
1228
01:18:28.496 --> 01:18:33.418
You're in rest and repair, which is really important to reduce our heart rate, our blood pressure.
1229
01:18:33.858 --> 01:18:35.819
We kind of open our bowels more frequently.
1230
01:18:36.239 --> 01:18:39.761
And we're more responsive to love and attention and connection.
1231
01:18:40.561 --> 01:18:46.924
And, you know, maybe there's a tiger coming along and you'll go into your fight or flight, which is your kind of survival instinct.
1232
01:18:47.484 --> 01:18:53.948
But the problem now is our nervous system is overstimulated because we wake up in the morning with this kind of loud alarm.
1233
01:18:54.048 --> 01:18:58.090
We jump out and then we're going to then grab our phone.
1234
01:18:58.651 --> 01:18:59.571
Then we're going to scroll.
1235
01:18:59.591 --> 01:19:01.092
It's overstimulation.
1236
01:19:01.132 --> 01:19:03.854
The nervous system was never designed to be constantly...
1237
01:19:04.634 --> 01:19:05.575
scanning for threat.
1238
01:19:05.656 --> 01:19:11.043
And then you get in the car, then there's that stress driving down Punt Road, getting the kids to school.
1239
01:19:11.203 --> 01:19:12.465
Then you get to your work at nine.
1240
01:19:12.585 --> 01:19:16.229
And they know that from studies, women have made about 12 plus decisions.
1241
01:19:16.290 --> 01:19:20.455
They've got decision fatigue by nine o'clock and a man has only made one decision, right?
1242
01:19:21.076 --> 01:19:21.416
So...
1243
01:19:22.395 --> 01:19:29.998
I think the mental load is part of why the nervous system is being overstimulated, but our environment is then ping, ping, ping.
1244
01:19:30.078 --> 01:19:31.278
We're overconnected.
1245
01:19:31.879 --> 01:19:33.279
The nervous system is not designed for this.
1246
01:19:33.319 --> 01:19:35.780
Checking emails every five minutes, checking the news, and guess what?
1247
01:19:35.800 --> 01:19:37.261
The news is all about clickbaits.
1248
01:19:37.301 --> 01:19:38.681
It's all about fear-mongering.
1249
01:19:39.301 --> 01:19:49.385
So this poor sympathetic nervous system, the amygdala, is exhausted from constantly scanning, and it's supposed to recalibrate back to your parasympathetic nervous system.
1250
01:19:49.405 --> 01:19:51.446
So you're kind of just like, yeah, I'm calm, I'm safe.
1251
01:19:51.466 --> 01:19:51.706
Yeah.
1252
01:19:52.206 --> 01:19:59.391
But when you're overstimulating it from your environment, it stays in the amygdala because it deems that you're unsafe now.
1253
01:19:59.831 --> 01:20:00.911
So it's constantly scanning.
1254
01:20:01.532 --> 01:20:05.094
And so that irritability, agitation, and it's not a normal rage.
1255
01:20:05.154 --> 01:20:07.936
I call it a volcanic rage because rage is just being angry.
1256
01:20:08.356 --> 01:20:12.259
Volcanic rage is this eruption, uncontrolled rage where...
1257
01:20:12.979 --> 01:20:18.282
you're like yelling and you can hear yourself yelling, but you want to stop, but you can't stop.
1258
01:20:18.762 --> 01:20:23.124
And you know you're being unreasonable and you know you're being horrible and mean and you love this person.
1259
01:20:23.505 --> 01:20:28.967
So there's this internal turmoil of trying to stop, but it's a volcanic eruption and you can't stop.
1260
01:20:29.007 --> 01:20:32.429
That's a very vulnerable, frustrating place to be.
1261
01:20:32.489 --> 01:20:38.592
And women will basically experience, you know, intrusive thoughts on, I don't think I want to live anymore.
1262
01:20:38.752 --> 01:20:40.954
I don't, if this is how I'm going to live life,
1263
01:20:41.873 --> 01:20:42.854
It's not worth living.
1264
01:20:43.155 --> 01:20:46.439
And obviously some women go all the way through to having more intrusive thoughts.
1265
01:20:46.980 --> 01:20:57.354
And if you're listening to this, it's important because we know that women between this demographic and perimenopause and even going up to menopause do experience higher rates of suicide.
1266
01:20:57.374 --> 01:20:57.474
Yeah.
1267
01:20:58.415 --> 01:21:03.823
And the amount of women, and I document this, they literally will say, oh, I just don't think it's worth living anymore.
1268
01:21:03.983 --> 01:21:08.409
Or they'll be crossing over the Westgate Bridge and saying, I thought of driving my car off.
1269
01:21:09.210 --> 01:21:12.134
And I have to just make sure that that was no intention.
1270
01:21:12.195 --> 01:21:14.137
It was just a thought and it kind of went away.
1271
01:21:15.512 --> 01:21:24.278
And these things are happening, but they're scared to share it because they don't want to be sectioned and they don't want their kids taken away.
1272
01:21:24.318 --> 01:21:26.299
They don't want their husband thinking something's wrong.
1273
01:21:26.680 --> 01:21:32.724
And of course, those are the conditions where you do want something like you need a formal mental health psychiatric assessment.
1274
01:21:33.324 --> 01:21:48.088
And I think if you're listening to this as a partner and you're seeing these changes, rather than thinking she's going mad and I don't want to be with her anymore, it's just knowing any woman between 37 and 43 onwards can experience perimenopause, which starts in the brain.
1275
01:21:48.108 --> 01:21:49.568
It's literally as simple as that.
1276
01:21:49.668 --> 01:21:58.530
It's a biological transition where you're losing the hormones with fluctuating estrogen, which buffer your thoughts and your cognition.
1277
01:21:59.130 --> 01:22:01.611
And when you're in that state of hypervigilance,
1278
01:22:02.897 --> 01:22:04.939
We can't feel anything.
1279
01:22:05.159 --> 01:22:06.160
You kind of numb out.
1280
01:22:06.220 --> 01:22:07.801
You can't feel love.
1281
01:22:07.921 --> 01:22:09.603
You don't want to be touched.
1282
01:22:09.843 --> 01:22:11.544
It's like you're agitated and you're irritable.
1283
01:22:11.564 --> 01:22:15.167
And so the partner's trying to hug you and support you.
1284
01:22:15.187 --> 01:22:16.629
And then we're pushing them away.
1285
01:22:16.649 --> 01:22:19.571
We push the loved ones and where they mean to put that.
1286
01:22:19.591 --> 01:22:21.553
So it's a very confusing time.
1287
01:22:21.952 --> 01:22:33.381
I imagine from the partner's point of view, if it's a man, traditionally, as we all know, men like an answer to things.
1288
01:22:33.481 --> 01:22:35.243
We immediately want to fix things.
1289
01:22:35.563 --> 01:22:45.351
And I suspect that would be quite a – not necessarily a relief, but it's almost like that's kind of in some ways good news for the man that it's like, oh, okay –
1290
01:22:45.931 --> 01:22:51.553
This is something in the same way that it might be good news for a woman to hear that about themselves.
1291
01:22:51.573 --> 01:22:56.374
That it's like this is a thing that all women go through in one way or another.
1292
01:22:56.634 --> 01:22:59.695
And so for the man to be like, okay, good.
1293
01:22:59.855 --> 01:23:01.155
It's treatable.
1294
01:23:01.495 --> 01:23:03.376
We can make steps to help you.
1295
01:23:03.496 --> 01:23:03.776
Yeah.
1296
01:23:04.756 --> 01:23:11.680
I think the issue is there's still a stigma around it because if someone's going to PBT, we accept that there's compassion.
1297
01:23:11.720 --> 01:23:13.481
They go through pregnancy and postpartum.
1298
01:23:13.501 --> 01:23:19.725
We've got frameworks, multidisciplinary frameworks by governments to support women.
1299
01:23:20.245 --> 01:23:23.146
The problem with PERI is that there is no support.
1300
01:23:23.347 --> 01:23:25.348
So it's a very fragmented care process.
1301
01:23:25.928 --> 01:23:32.571
So women are now having to Google, find their own people, go to group chat and find from their friends who they go.
1302
01:23:32.591 --> 01:23:36.973
And then I've got this fragmented care of seeing a psychiatrist, seeing a psychologist, and so...
1303
01:23:37.970 --> 01:23:48.919
I think we need to have more robust frameworks and guidelines and then have government funded hubs because not everyone can access private care.
1304
01:23:48.959 --> 01:23:49.759
This is expensive.
1305
01:23:49.799 --> 01:23:50.400
So expensive.
1306
01:23:50.440 --> 01:23:50.620
Yeah.
1307
01:23:50.840 --> 01:23:58.887
And part of the Australian Senate inquiry in 2024 had recommendation for Medicare subsidised menopause hubs.
1308
01:23:59.427 --> 01:24:08.415
And so we know that the New South Wales government has been given $40 million to have four menopause hubs set up.
1309
01:24:08.895 --> 01:24:10.236
And it's multidisciplinary.
1310
01:24:10.256 --> 01:24:13.179
So you've got endocrinologists, cardiologists, and gynecologists.
1311
01:24:13.780 --> 01:24:16.562
And also as part of this recommendation, now we have
1312
01:24:16.822 --> 01:24:18.683
PBS subsidised HRT.
1313
01:24:19.183 --> 01:24:29.129
It's important to know that's there, but it's very limited, they have very long waiting times, and no one's got six to nine months to wait while they have to show up in life.
1314
01:24:29.730 --> 01:24:33.252
And so, number one, we need guidelines, which are then...
1315
01:24:34.152 --> 01:24:38.316
making sure that every woman is being given the same treatment.
1316
01:24:38.356 --> 01:24:49.825
And then there's no kind of inequity of healthcare distribution because just because you live in a certain postcode or have money, that's not how we want a healthcare system to be represented, right?
1317
01:24:49.925 --> 01:24:52.067
So menopause is a universal experience.
1318
01:24:52.627 --> 01:24:55.049
And I think as a government, we are doing better.
1319
01:24:55.550 --> 01:25:02.195
We've done some great things since the Senate inquiries, but there's lots of room that we need to, or room for improvement.
1320
01:25:02.814 --> 01:25:03.254
For sure.
1321
01:25:03.735 --> 01:25:11.565
So I just, I can't help but does, the first thing I'm thinking when you say that is that, so last week I had quite a nasty case of the sniffles.
1322
01:25:12.086 --> 01:25:12.907
You all right?
1323
01:25:13.027 --> 01:25:14.209
Yeah, and I went down pretty bad.
1324
01:25:14.429 --> 01:25:16.151
And I really, I really struggle for a bit.
1325
01:25:16.311 --> 01:25:17.713
We should do an episode on the sniffles.
1326
01:25:19.115 --> 01:25:23.816
But it just makes me think, can you imagine if menopause, apparently menopause happened to men?
1327
01:25:24.756 --> 01:25:26.457
Society would just stop.
1328
01:25:26.497 --> 01:25:28.137
Jam and I were talking about this the other day.
1329
01:25:28.157 --> 01:25:32.518
It's like if men experienced, we would be taking ourselves to emergency every month.
1330
01:25:32.598 --> 01:25:35.019
I'm bleeding again.
1331
01:25:35.039 --> 01:25:36.479
Yeah, this is horrific.
1332
01:25:36.499 --> 01:25:43.481
Well, you wouldn't take yourself to emergency because there would be frameworks and guidelines on it.
1333
01:25:43.661 --> 01:25:45.561
Like there are for heart disease.
1334
01:25:45.641 --> 01:25:46.482
And I think...
1335
01:25:48.122 --> 01:25:55.706
I think it's fair to say, important to say someone who's listening to this, I don't want them feeling angry at the system around them.
1336
01:25:55.766 --> 01:26:02.630
But to be fair, most guidelines are based on a middle aged white man.
1337
01:26:04.562 --> 01:26:14.484
in the US, things like heart disease, lung disease, diabetes management, and we just basically apply them onto women.
1338
01:26:14.924 --> 01:26:16.004
They're not studied in women.
1339
01:26:16.384 --> 01:26:30.927
So even the bigger diseases, forget women's health, the bigger diseases, we know that when we give beta blockers for heart disease prevention to men, it prevents further cardiac events, and when we give it to women, it has worse outcomes.
1340
01:26:31.705 --> 01:26:38.787
So we've got to start looking at women as not just small men, but also they have their own unique biology.
1341
01:26:39.187 --> 01:26:46.409
But I think going back to you, you would never go to emergency because you would never suffer because we would have researched it.
1342
01:26:46.929 --> 01:26:48.110
There would be a guideline.
1343
01:26:48.770 --> 01:26:52.951
And so the issue is the reason why they're suffering because it's not studied.
1344
01:26:53.571 --> 01:26:56.372
And we have to find the information ourselves.
1345
01:26:56.632 --> 01:26:57.693
And then advocate for ourselves.
1346
01:26:57.833 --> 01:26:58.474
And it's more work.
1347
01:26:58.534 --> 01:26:59.374
It's exhausting.
1348
01:26:59.434 --> 01:27:00.495
It's expensive.
1349
01:27:00.515 --> 01:27:01.036
It's expensive.
1350
01:27:01.216 --> 01:27:02.056
Yeah, it's time consuming.
1351
01:27:02.517 --> 01:27:03.037
So, yes.
1352
01:27:03.197 --> 01:27:08.281
So we won't go into a bit more of the... Well, I had plenty of support for my sniffles, so I was okay.
1353
01:27:08.301 --> 01:27:08.982
Thank God.
1354
01:27:10.603 --> 01:27:11.204
Thank you so much.
1355
01:27:11.224 --> 01:27:14.987
This has been an incredibly important... Oh, sorry, did you...
1356
01:27:15.367 --> 01:27:15.867
No, no, no.
1357
01:27:15.887 --> 01:27:19.050
She was like, I'm just going to finish talking now because I think you talked about everything.
1358
01:27:19.190 --> 01:27:20.110
No, you've done an amazing job.
1359
01:27:20.171 --> 01:27:21.331
Oh, incredible.
1360
01:27:21.692 --> 01:27:36.842
You really have done an amazing job today because I just feel like for, I think for two things, for women to feel less alone in this and to have a better understanding of what's happening for those who don't know yet, for those who are going through it right now, for those who have been through it, to hear this.
1361
01:27:37.343 --> 01:27:41.946
But I think also for men to have a greater understanding of what's happening to the women that they love in their life.
1362
01:27:42.106 --> 01:27:43.027
I think this is...
1363
01:27:44.027 --> 01:27:48.109
so incredibly important and I feel so lucky to have been sitting here with both of you today.
1364
01:27:48.129 --> 01:27:50.870
Thank you, Zoe, as well, for sharing your experience of it.
1365
01:27:52.331 --> 01:27:54.992
Just to the men, don't take it personally would be my advice.
1366
01:27:56.133 --> 01:27:56.913
It's not about you.
1367
01:27:57.033 --> 01:27:58.414
Yeah, for once.
1368
01:27:59.574 --> 01:28:00.014
For once.
1369
01:28:01.935 --> 01:28:05.217
But, yeah, it's been wonderful to share this time with both of you, so thank you so much.
1370
01:28:05.277 --> 01:28:05.697
Pleasure.
1371
01:28:05.857 --> 01:28:06.577
Thanks for having us.
1372
01:28:06.597 --> 01:28:07.237
Yeah, pleasure.
1373
01:28:07.758 --> 01:28:08.418
Thanks, guys.
1374
01:28:08.778 --> 01:28:09.018
Wow.
1375
01:28:11.419 --> 01:28:13.020
Stick around after this to hear a little more.
1376
01:28:15.010 --> 01:28:15.270
All right.
1377
01:28:15.290 --> 01:28:16.572
Well, we've got Bella here again.
1378
01:28:16.892 --> 01:28:21.396
And Bella, you're going to talk to us about what question we have in our journaling club this week.
1379
01:28:21.496 --> 01:28:23.018
But actually, what is the journaling club?
1380
01:28:23.058 --> 01:28:25.020
I don't think we've really ever talked about it like that before.
1381
01:28:25.301 --> 01:28:25.521
Yes.
1382
01:28:25.621 --> 01:28:36.232
So our journaling club is for everyone who has signed up to Mind Perfect email, the newsletter, and you can do that either via the website or via a link in the show notes of this episode.
1383
01:28:36.672 --> 01:28:36.932
Awesome.
1384
01:28:37.113 --> 01:28:41.517
And every week we send out a reflective question based on this week's episode.
1385
01:28:42.017 --> 01:28:42.778
And what's that question?
1386
01:28:42.798 --> 01:28:43.739
What have we got for the week?
1387
01:28:43.939 --> 01:28:47.483
This week, it is, how has your relationship changed with your body?
1388
01:28:48.088 --> 01:28:48.629
Oh, that's good.
1389
01:28:49.229 --> 01:28:53.273
I mean, I feel tempted to go dark because there's many things I don't like about my body.
1390
01:28:53.673 --> 01:28:58.438
But I also think as I get older, I'm starting to appreciate things and trying to have a better relationship.
1391
01:28:58.458 --> 01:29:02.822
So I reckon it's a good challenge to try and, if you can, answer that question positively.
1392
01:29:03.322 --> 01:29:06.325
And if you'd like to submit your reflections, we would love to read them.
1393
01:29:06.837 --> 01:29:13.219
It's a great newsletter just because I don't want Bella feels weird plugging her own newsletter, but it's not just a journaling club.
1394
01:29:13.239 --> 01:29:18.761
There's also helpful tips from the episode, which will be amazing given how helpful this episode we just had on was.
1395
01:29:19.721 --> 01:29:28.424
And if you join the email, maybe you could join some of the people that you, like you were telling me before that there are people who have journaled every single week and have submitted their entries every week.
1396
01:29:28.484 --> 01:29:30.465
So it's a pretty exciting space to be.
1397
01:29:30.920 --> 01:29:31.140
Yeah.
1398
01:29:31.561 --> 01:29:40.049
If you're listening to this on the Monday that the episode comes out and you'd like this question in your inbox tomorrow, sign up by the website or the link in the show notes.
1399
01:29:44.833 --> 01:29:50.494
This show was made in the lands of the Wurundjeri Wurrung people, and we pay our respects to elders past and present.
1400
01:29:51.134 --> 01:29:58.056
The Imperfects is not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment.
1401
01:29:58.496 --> 01:30:05.038
The advice given in this episode is general in nature, but if you're struggling, please see a healthcare professional or call Lifeline on 13 11 14.