You'll get through it: Understanding menopause Part 1

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Welcome to we Can Solve this, a podcast where we demystify research concepts and share evidence-based best practices, innovations and solutions.
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We hope that the ideas shared here help to build thriving communities, wherever you are.
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Today, we have a fantastic guest with us.
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She is Dr Astrid Batchelor.
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She's an obstetrician, gynecologist and a member of the Menopause Society, and she has declared that she is passionate about women's health.
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I'm definitely going to enjoy this conversation.
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Welcome, Dr Astrid.
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How are you doing?
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Thank you for having me on this podcast.
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Natasha, I am well.
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I am well and giving thanks.
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Awesome, awesome, awesome.
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So, before we jump into the meat of the matter, I would love if you could tell us a little bit more about yourself.
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Sure.
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All right, first things first.
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I'm a proud, immaculate Conception High School girl.
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I'm an alum of that school.
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I also attended the Atlantic College in Wales, united Kingdom.
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I did undergrad in the United States, then went to University of the West Indies and did my medical degree and I also did a residency in obstetrics and gynecology there, did a residency in obstetrics and gynecology there.
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I'm also a recent alum of the Harvard TH Chan School of Public Health, where I did a master's degree in public health management public health, healthcare management.
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Wow.
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So you're very well qualified for the topic that we're going to be talking about today, right?
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I surely hope so.
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So we're going to be talking about menopause, and I would love if we could really demystify this thing called menopause, right?
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So I would love if you could start off by telling us what exactly?
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What is this thing?
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What is menopause?
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Sure, I love that you chose this topic, and a lot of persons think of menopause as this continuum and they don't, so we're not actually using the right language sometimes when we speak about the menopause.
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Ok, so the menopause is an actual singular event.
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It is the last menstrual period, so this is a period of 12.
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This follows a period of 12 months, 12 consecutive months, of no menses.
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So you have not achieved the menopause until you have not seen your period for 12 consecutive months.
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Got you?
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That is the menopause.
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So it's one day, it's one event, it's one event.
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It's one event, it's one event, and this also is going to be accompanied by an increase in particular hormones, one called FSH, follicle stimulating hormone and a decrease in estrogen levels.
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And the reason why I had to say that is associated with those two things is because women can have other conditions, other hormonal conditions that they don't see their periods as well, I love how you've distinguished that.
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All right.
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So menopause is an event where for 12 consecutive months, you've had no menstrual period.
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No menstrual period Great.
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So if that is what menopause is, what exactly is perimenopause?
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Correct.
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So the perimenopausal transition is a period or time leading up to that final event.
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So in most women the perimenopausal transition on average will start about five to seven years before that actual last period, or 12 months of no period, occurs.
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So women will start having symptoms, they may start having missed periods during this perimenopausal transition, and this is usually that bothersome time that women talk about a few years before the menopause occurs, and then even some persons have post the menopause.
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They continue to have some of these symptoms too.
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So then, perimenopause is that timeline surrounding this event occurring.
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So then, perimenopause is that timeline surrounding this event occurring.
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So before I get into the symptoms, so all women go through menopause.
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Every woman.
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If they live long enough, natasha will go through the menopause.
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So the menopause is not a disease, it's not a disorder.
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It is.
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I know you don't like to use the term, but it is a natural event as natural as a young girl going through puberty.
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Right Women will go through the menopause if they live.
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Hopefully that's what our plan is to live long and healthy lives, if they live long enough to enter that period of their life.
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So it really is something that, when you speak about women's health, it's something that women should be aware of, then it definitely is so.
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In all of our lives we go through these transitions.
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We have infancy, we have childhood, we have puberty into adolescence and then we have, of course, our adult years and then we go into our menopausal years or postmenopausal or geriatric years.
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So we're on a continuum timeline of all these changes that we go through in life, and menopause is on that timeline.
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Got you, got you.
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Okay.
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So you started to talk about symptoms, so I think my first question is we've said that you know, all things being equal, like all women will go through this, All women will go through this.
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When is there a particular age that women are going to start experiencing perimenopause leading into menopause.
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So, on average, what we know is that 75% of women will fall into the timeline of somewhere between age 45 and age 55 for this to happen.
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This is perimenopause.
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Well, that is menopause.
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And then the perimenopause now can happen, on average, anywhere between five and seven years.
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So, for instance, if you go into menopause at 45, you may have started experiencing symptoms as early as age 40 going into the menopause.
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Wow, I know, when people turn 40, the last thing that they're thinking about is, you know, is menopause in and of itself.
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But you're saying that, based on the numbers that you're seeing, women as early as 40 could start to see some symptoms of perimenopause, definitely.
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So what are those symptoms?
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What are we supposed to be looking for?
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So the first thing is everybody's afraid of these symptoms and one thing to know is not every woman will experience it.
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Actually, only about 70 to 75% of women actually say that they remember having a change in symptoms in this timeline.
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Some persons are quite lucky and they have gotten away with the menopause, the transition, without any real disruption to their lives, with the menopause, the transition, without any real disruption to their lives.
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But for that 70 to 75% of women, most persons, are going to complain of either what we call vasomotor symptoms, which is going to be like your hot flashes.
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Some women may feel particularly very hot at nighttime.
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They say they wake up in the middle of the night sweating.
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Some persons may have issues falling asleep, staying asleep.
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Moodiness that's one thing.
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Anxiety, feelings of agitation.
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Some persons may have a little bit of depression along with it.
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Some persons may notice they have a little brain fog that's a common one where they say I'm not really remembering things, I don't feel as sharp as I used to be.
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Those are what we call vasomotor symptoms.
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Other women are going to experience, which is quite common, the genital urinary symptoms of menopause, which is going to be the changes to the genital area.
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So they might experience vaginal dryness.
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That's a very common symptom, and along with vaginal dryness, they actually will say that the area looks different too.
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So the vulva area does not look as plump as it used to be.
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Some persons may complain of pain with sex or pain after sexual intercourse.
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Some women may notice changes in their urine.
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They might feel like they leak a little bit, or they're just not able to hold their urine as well as they used to.
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So those are the genitourinary symptoms.
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Oh, and I forgot burning.
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Some women will complain of this random burning.
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They end up in their gynecologist's office over and over, and it's not a discharge, but they have this funny feeling down below.
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That's one of the genitourinary symptoms of menopause.
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But the truth is, menopause is happening in every single cell of our body, every single cell, every cell of our body.
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But I thought it was just related to your period, no.
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So we are sexed human beings.
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Your cells know that you are female.
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Estrogen is flooding through your body right now.
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It's in your blood vessels, it's in your cells.
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So everything from your hair is affected by estrogen, which is why, as we age as women, some women will complain of thinning hair or the hair is falling out.
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Our skin estrogen plays a major role in skin.
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So keeping your skin nice and glowing which is why they always say pregnant women look like they're glowing and the hair is nice and thick it's because all of that estrogen is at play.
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In that time, our memory.
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There are certain parts of our brains that estrogen is affecting the function.
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So that's where the brain fog comes from.
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That's where that hot flash comes from, because estrogen is affecting the thermoregulation in the brain.
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We get wrinkles as we get older because the skin changes.
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We even get effects on our bones.
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That's a very common one with menopause.
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Persons don't tend to talk about it enough the possibility of osteopenia or osteoporosis, which is basically a weakening in the density of our bones.
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Very important to know because as we get older, women are going to be at risk of getting fractures.
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People may say you shrink or you're beginning to look like you've hunched over.
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That's because bone density isn't as great as it was when you were young.
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Estrogen has a part in that too.
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Estrogen has a part in your breasts, which is why, as you get older, breasts may go south in some women, or you've lost the density in your breasts and even our blood vessels.
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Cardiac health is very important in the menopause region, so estrogen also has an effect on your heart and your blood vessels.
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Can you believe that?
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No, I didn't realize that.
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Yes, so women are actually at increased risk of cardiac or heart events after the menopause as well.
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So it's not just that hot flashes, you know people always think about it's hot flashes, hot flashes, hot flashes and loss of periods.
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It's so much more than that.
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So it's just as significant a change as moving from being a little girl to getting breasts and you know, growing up and getting tall and all the estrogenized changes and you look beautiful and like a woman.
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Now All of these things are also changing when you're in menopause but you really have put a different spin on things, because I I know, if I look back at the information that's been out there, I'm not necessarily seeing, or I would not have seen, a lot of information about menopause, and menopause would have just been presented as oh it's.
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When you stop seeing your period, what I'm hearing you say is that there's like a fundamental hormonal shift that's happening in your body.
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It's our entire ecosystem, changing Entire ecosystem, so not just the ovaries and not just Not just the ovaries, because estrogen is running and flooding through our bodies.
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The ovaries are making the estrogen, but remember this estrogen is going everywhere in our bodies, so there is a change on all the functions that estrogen used to affect or help or do in our bodies.
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Is it just estrogen?
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Are there other hormones that are at play as well?
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There are other hormones at play.
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So we have progesterone at play and we have testosterone at play, but the major game changer is going to be the estrogen.
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Going to be the estrogen.
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So what are some of the misconceptions that you have come across in your practice that other women, or even just people in general, have about perimenopause and menopause?
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So the first thing is that a lot of persons don't talk about it, and when we don't talk about something or we don't have information, we make it up.
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So hence that's where myths come from.
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So one thing that they talk about is you know, everybody thinks that it's the standard age is in your 50s.
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So there is truth to that.
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The average woman somewhere between age 45 and age 55.
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Studies tell us that age 51 is the average age.
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So because of that, they don't know about the perimenopause.
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So all these other things happening to them they think it can't be, you know, related to this problem.
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But it is actually related to this problem.
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Another myth is that people think you can't get pregnant in this perimenopausal timeline.
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So many women coming into the office at 40 and they want to come off the contraception because they think they can't.
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So there is something called perimenopausal pregnancy.
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You will be shocked to know.
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So, yes, you need to still stay on your contraceptive method because the risk is decreased, but you very much can still get pregnant.
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Right, and we do see that in persons.
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A lot of people don't understand the changes in the period.
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Some persons think that it's just gonna stop and go away.
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It doesn't ever really happen like that.
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So unfortunately there is this up and down situation where people tend to have missed periods.
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So it's on this month off next month, month gone for three months, gone for six months.
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Unfortunately, I had a patient who went for 11 whole months.
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She thought this was it?
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She almost got there, almost got there, and then the period came back.
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That's why it's so important to count that.
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It's those 12 months of no period.
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So that's one of the things.
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So it's not going to be just it's gone and it's gone forever.
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It's going to come, go, come go, and some persons even have change in patterns where they'll have these heavy bleeds or these long, prolonged bleeds as well, because the estrogen levels are, you know, our body works by positive feedback.
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So they drop this month and your body tries to bring it back up and then so you get this long period the next time and it keeps doing this.
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I tell people it's like a little stock market graph right, zigzag, up and down, until finally you kind of plateau.
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Another thing persons think it's going to be a negative part of their life.
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That's a big misconception about the menopause.
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Now, let's be clear we're living longer.
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You know, back in the 1800s a lot of women weren't making it to menopause, which is why we didn't know a lot about it.
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But now we are, you know, getting to the point of 80 years old and older, and so more women are going to menopause and we're living longer timelines in menopause.
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So right now, the average woman is going to be expected to spend a third of her life in menopause.
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If we make it to 100, which I hope we do one day, when, on average people are making it to 100, we'll be spending a half of our lives in menopause.
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Really and truly, the reproductive years will be a smaller part of our lives.
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So women need to have a positive outlook that life goes on and you can have a wonderful, enjoying, interesting life in menopause.
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So we need to change our mindset.
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You know they think, oh, it's if we're just going to age and everything goes downhill.
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That's not true.
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A lot of persons are thriving in their menopause period.
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So I use the word period there, as in timeline period, as in the.
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So one of the questions that I would love to get some feedback on is how do I go about knowing that I'm in perimenopause, because or maybe it's a loaded question Is there a lot of information out there?
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I mean so that a woman could recognize what's been your experience?
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Are they thinking that these hot flashes is because of this is what's been your experience, you know.
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Are they thinking that these hot flashes is because of this is what's happening?
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Are they thinking that the dryness that I'm experiencing, are they aware that there's this period in their life called perimenopause and they quite possibly could be in it?
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What's been your experience?
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Well, I love that the conversation has increased around menopause, so you do have a lot more women with some knowledge about it and that they're aware that something is happening or something is supposed to be happening and so this might be it, and they may present to the doctor's office or start reading, looking for information, asking friends.
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So I think, because of that uptick in the information, more women are now seeking out assistance to find out if this is what is happening.
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Now.
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The catch with menopause is that it's also happening at around the timeline that we are aging, in our 50s, where things begin to change anyway, are having some symptoms and we need to find out are these symptoms because of the menopause or the menopausal transition versus?
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Are the side effects of other illnesses that are lurking or brewing, or are the side effects of aging?
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So you know, persons may come in with the thinning here and it's falling out and okay.
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Is this menopause or is there a family history of hair loss?
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You know at this age a family pattern of hair loss as well?
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Some persons may come in with the hot flashes and the night sweats.
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Unfortunately, there are other conditions that cause hot flashes and night sweats, so we may have to investigate to make sure that this is what is actually happening.
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So there are some you know constitution of symptoms that we will ask patients, things that tend to go together is this happening?
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Is that happening?
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Are you experiencing this?
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And we can also do some tests to find out too I was going to ask you about that.
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So you know is do you, do you test for menopause or do you just go?
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Well, you know how.
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What?
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When was?
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What's the date of your last period?
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so we usually speak about the periods of to see what the pattern is with the periods, but there is a test that we can do.
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So the hallmark test of the menopause is the follicular stimulating hormone.
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So any value.
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Well, for me, getting academic over 25 is going to be symbolic of the menopause is upon us at this point in time, and of course we look at decreasing estrogen levels too.
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Now, in the perimenopause, though, it can be tricky, Because remember I spoke about that little up and down zigzag line.
00:18:45.202 --> 00:18:54.828
So, depending if we get tested on a day where we're up, then it may come back as a totally normal FSH, totally normal estrogen level.
00:18:54.828 --> 00:19:00.055
So it's not really so predictive or diagnostic in the perimenopausal period.
00:19:00.055 --> 00:19:08.887
We mostly look at the symptoms at that point in time, but when we have the actual menopause occurring it's usually diagnostic in that time.
00:19:09.515 --> 00:19:12.243
So I have, I guess, a trick question to ask you.
00:19:12.243 --> 00:19:17.207
You speak so eloquently about perimenopause and menopause.
00:19:17.207 --> 00:19:25.028
How much coverage does this topic get in medical school when you're getting your degree?
00:19:25.028 --> 00:19:29.689
Or is it because you've gone away and done specialized training in this era?
00:19:30.732 --> 00:19:31.494
So that's a good question.
00:19:31.494 --> 00:19:38.788
When I was in medical school, I mean, we did speak about the menopause, but we didn't speak about it in as much knowledge as we have now.
00:19:38.788 --> 00:19:42.425
Definitely, when I did residency training, there was a lot more training on the menopause.
00:19:42.425 --> 00:19:50.288
But you know, there is actually something that happened why the menopause came off the agenda of a lot of doctors.
00:19:50.288 --> 00:19:52.840
So menopause was something they used to treat.
00:19:52.840 --> 00:19:58.182
You know, back in the 60s, 70s, 80s, quite a bit, women were on hormonal replacement therapy.
00:19:58.182 --> 00:20:03.303
There was a huge study that came out, the WHI the WHI study, correct.
00:20:03.303 --> 00:20:12.749
There was a huge study that came out and basically the study made us think that we were crazy for putting women on hormonal replacement therapy.
00:20:12.749 --> 00:20:24.501
So they came out and said it was causing cancers, causing heart attacks, causing all sorts of problems, and a lot of doctors after that refrained from treating the menopause.
00:20:24.501 --> 00:20:28.335
They didn't want to be liable for problems with their patients.
00:20:28.335 --> 00:20:31.403
Of course we can see how that can change the way you practice.
00:20:31.403 --> 00:20:38.661
And then we have to go back and think well, you know, this can't be true because so many women were on it before and they were benefiting from it.
00:20:38.755 --> 00:20:43.584
Let us re-look at this study so years ago now, back in the 2000s.
00:20:43.584 --> 00:20:55.263
They've gone back many years of research and backtracking and they have taken a second and third and fourth look at this study and they came back with some new guidelines.
00:20:55.263 --> 00:20:56.406
What are the new guidelines?
00:20:56.406 --> 00:20:59.720
So HRTs are not the enemy.
00:20:59.720 --> 00:21:03.307
And what is HRT Hormonal Replacement Therapy?
00:21:03.307 --> 00:21:09.483
Okay, they're not the enemy, but they should be used under certain guidelines and criteria.
00:21:09.483 --> 00:21:18.648
So what they were doing was every woman was getting hormonal replacement therapy and we know now that that shouldn't be the practice or protocol.
00:21:19.454 --> 00:21:41.307
So there are conditions that will, unfortunately, will not going to give hormonal replacement therapy chronic illnesses like uncontrolled diabetes, uncontrolled hypertension, history of a stroke, history of blood clotting disorders, history of breast cancer or breast cancer in their families.
00:21:41.307 --> 00:21:43.057
You are not an ideal candidate.
00:21:43.057 --> 00:21:51.683
Also, we found that it worked best in women who were having that category of symptoms called the vasomotor symptoms.
00:21:51.683 --> 00:21:57.336
So those women actually had the best benefit out of hormonal replacement therapy.
00:21:57.336 --> 00:22:02.637
In medicine we always try to say do no harm, so don't create problems where there were no problems.
00:22:02.637 --> 00:22:11.736
So if you are going through menopause without any problems, no disruptions to your lifestyle, then really and truly probably don't need hormonal replacement therapy.
00:22:11.736 --> 00:22:21.718
But for the persons who are having extremely bothersome disruptive symptoms, these vasomotor symptoms, and they don't have these contraindicating conditions.
00:22:21.718 --> 00:22:26.310
As I mentioned before, they would be good candidates for hormonal replacement therapy.
00:22:26.310 --> 00:22:43.835
So we found that these women with the umbrella symptoms of what we call vasomotor symptoms, which is the hot flashes, the night sweats, the mood disturbances, brain fog, those symptoms they benefited most from hormonal replacement therapy.
00:22:44.415 --> 00:22:46.660
So let's take it back just one step.
00:22:46.660 --> 00:22:50.346
What is hormone replacement therapy?
00:22:50.346 --> 00:23:05.425
I know a few moments ago you spoke about estrogen and progesterone and testosterone and you made the solid case that by the time you get to the event of menopause, those hormone levels have decreased or declined.
00:23:05.425 --> 00:23:09.124
So what exactly is hormone replacement therapy?
00:23:09.905 --> 00:23:10.287
Perfect.
00:23:10.287 --> 00:23:17.265
So the estrogen, the progesterone, the testosterone levels begin to fall when we go through the menopause.
00:23:17.265 --> 00:23:40.015
So we can actually give women hormones to replace these hormones that they're no longer creating naturally and get them back to what we call a physiological level, just like a normal daily level of these hormones in their body, which will allow them to regain those lost functions that they were having.
00:23:40.015 --> 00:23:47.320
So it kind of mellows out those symptoms, those vasomotor symptoms that I explained a while ago, back to their normal levels.
00:23:47.320 --> 00:23:52.034
So these hormones, we're not giving them in large doses.
00:23:52.034 --> 00:23:56.165
They're usually quite small doses that just get us back to our regular daily levels.
00:23:56.674 --> 00:23:59.865
Persons may confuse them with oh, is it like a birth control pill?
00:23:59.865 --> 00:24:03.045
Because birth control pills have estrogen and progesterone.
00:24:03.045 --> 00:24:07.066
So birth control pills do, but those are not physiological levels.
00:24:07.066 --> 00:24:12.346
We give birth control pills at levels that we want to try and manipulate your cycle, I see.
00:24:12.346 --> 00:24:13.208
So that's different.
00:24:13.208 --> 00:24:15.623
These hormones are way lower.
00:24:15.623 --> 00:24:22.041
So you should not be trying to take birth control pills as hormonal replacement therapy.
00:24:22.041 --> 00:24:25.676
The dose would be way too high the different doses.
00:24:26.778 --> 00:24:41.749
So when you talk about hormone replacement therapy, this is because you're trying to regulate or or stabilize or or bring back those hormone hormone levels um after after the event of menopause, correct?
00:24:41.769 --> 00:24:45.465
so to stabilize them back to similar levels where they were before.
00:24:46.147 --> 00:24:57.461
When you talk about menopause on a whole, though, is that the only sort of option that's available to women as they go through this or they enter this next stage of life?
00:24:57.461 --> 00:24:58.423
Definitely not.
00:24:58.463 --> 00:25:00.367
So we have quite a few options.
00:25:00.367 --> 00:25:04.365
So the first thing I was saying is some women will need nothing, absolutely nothing.
00:25:04.365 --> 00:25:09.945
Most women will need absolutely nothing other than reassurance, because education is key.
00:25:09.945 --> 00:25:17.263
So a lot of women, if they actually know what to expect, then a lot of persons will actually say, oh okay, that's what.
00:25:17.263 --> 00:25:25.420
That was All right, I can handle that, because I'm expecting these changes that are happening, because the changes may not be bothersome to their lifestyle.
00:25:25.420 --> 00:25:26.682
It's just something to be aware of.
00:25:27.444 --> 00:25:38.490
Some persons may have issues of the genital urinary symptoms but they don't which are the burning symptoms of vaginal dryness, sometimes painful sex.
00:25:38.490 --> 00:25:44.208
If those are your symptoms, then we can actually give you vaginal remedies.
00:25:44.208 --> 00:25:50.087
We don't have to go into the realm of the full systemic hormonal replacement therapy.
00:25:50.087 --> 00:25:57.079
We can give you vaginal lubricants, vaginal moisturizers that can help you with those symptoms.
00:25:57.079 --> 00:26:11.924
We can even give you extremely low dose estrogen to the vagina, and a lot of persons are afraid of this and I'm telling you now the dose in the vaginal estrogens are so low that they do not affect your systemic estrogen level.
00:26:11.924 --> 00:26:18.132
So you don't have to be afraid that the vaginal estrogen is going to give you cancer and it's going to cause problems.
00:26:18.132 --> 00:26:18.613
It's not.
00:26:18.613 --> 00:26:21.807
It's really just treating those local symptoms that you experience.
00:26:21.807 --> 00:26:27.044
So, persons with just genitourinary symptoms they just get treatment for their genitourinary symptoms.
00:26:27.044 --> 00:26:30.900
They don't need to take the patch or the pill or the other things.
00:26:30.900 --> 00:26:39.002
There are persons that we are able to treat with other things, like SSRIs.
00:26:39.002 --> 00:26:46.099
Ssris the layman's term for them is like antidepressant medications, but we're not using them for depression.
00:26:46.099 --> 00:26:48.525
We're using them for the purpose of.
00:26:48.525 --> 00:26:53.567
They actually do help with some of those vasomotor symptoms like the hot flashes.
00:26:54.496 --> 00:26:56.423
There are some natural remedies as well.
00:26:56.423 --> 00:27:06.376
You know persons will tell you about evening primrose oil and the black cohosh and some other Chinese remedies from the East, and in some women they work.
00:27:06.376 --> 00:27:14.777
Studies have been done on them Tends to usually be inconclusive in terms of some person say yes, some person says not really, we're not so sure.
00:27:14.777 --> 00:27:18.527
But some women take them and say they think that you know they do work.
00:27:18.527 --> 00:27:22.989
There are hormonal replacement therapies from different sources.
00:27:22.989 --> 00:27:28.364
Some come from like yams and soy, because they have natural phytoestrogens in them.
00:27:28.364 --> 00:27:32.442
There are some that are going to come from like the urine of a horse.
00:27:32.442 --> 00:27:33.715
That's where they make them from.
00:27:33.715 --> 00:27:38.895
They take the estrogen from there and you get the conjugated estrogens and then they take them.
00:27:38.895 --> 00:27:45.449
They can come in different administrations, so oral tablets or the patch.
00:27:45.449 --> 00:27:52.587
Some people take them as gels, sprays, even vaginal rings that you insert for months at a time.
00:27:52.587 --> 00:27:56.779
Sprays even vaginal rings that you insert for months at a time.
00:27:56.840 --> 00:28:16.155
So there are many different preparations of these varying treatments of hormonal therapies and there are lots of non-hormonal therapies as well on the market so, really, as a woman steps into this next phase, it isn't that she just there are options that she can include in her toolkit for how she's going to be living her life after this event, surely.
00:28:17.096 --> 00:28:34.509
I think the biggest option in your toolkit actually is to have a gynecologist that is willing to help you navigate this journey, to educate you about the journey, so you know what there is to expect to know when there are red flags that something is not normal or something that we can optimize a little bit better.
00:28:34.509 --> 00:28:40.627
Another thing about it is that we're always talking about the symptoms, the hot flashes.
00:28:40.627 --> 00:28:43.944
The other things that we need to talk about are the bones.
00:28:44.795 --> 00:28:56.737
Yes, you mentioned that estrogen plays a role in bone strength as well, very much so as well, very much so.
00:28:56.757 --> 00:29:02.659
So, women, as we get older, the vitamin D and the calcium that make our bones nice and dense and strong begin to decrease, because estrogen had a part in the role of production of these things.
00:29:02.659 --> 00:29:20.422
So, as we get older, if we didn't have that great diet growing up where we were loading up the calcium stores and loading up the vitamin D stores and we weren't, you know, doing weight bearing exercises all along, that also helped to contribute to the porosity of our bones, we can actually lose bone density.
00:29:20.422 --> 00:29:28.042
So one thing going in your toolkit going into the perimenopause and menopause is also remember calcium replacement.
00:29:28.042 --> 00:29:36.607
Got you Calcium replacement, vitamin D replacement, and exercise with weight-bearing exercises, weight-bearing exercises.
00:29:37.035 --> 00:29:47.126
So weight-bearing exercise does not necessarily mean weight lifting it's in the umbrella, but it's exercises that you're actually loading your actual body weight on the bones.
00:29:47.126 --> 00:29:49.414
So walking is weight-bearing exercise.
00:29:49.414 --> 00:29:51.063
It's doing things like squats, functional movements of things that you typically do.
00:29:51.063 --> 00:29:52.007
Those are what we call weight-bearing exercises.
00:29:52.007 --> 00:29:56.484
Doing things like squats, functional movements of things that you typically do those are what we call weight-bearing exercises.
00:29:56.484 --> 00:30:09.423
If you're in your 30s, I would very much encourage you, though, to actually do some weightlifting, because weightlifting is also good for the bones, but also good for muscle mass, which we tend to lose as we get older as well.
00:30:10.035 --> 00:30:32.548
So what I'm hearing is that there is a holistic approach that we should be looking at as women, so it's not just considering whether or not hormone replacement therapy is for us, but we should also be looking at diet and exercise and making sure we're getting the right calcium and vitamin D, and just being informed about the changes happening in our body.
00:30:32.548 --> 00:30:33.150
For sure.
00:30:38.555 --> 00:30:43.292
So the most important thing about life and you know, is just remain healthy throughout the whole thing which is going to come from, you know, proper food intake.
00:30:43.292 --> 00:30:49.256
Make sure that we're eating food that is properly nourishing our bodies, that can help us through any phase of our lives.
00:30:49.256 --> 00:31:00.023
Making sure that we're moving our bodies in an intentional way, which is going to be like your exercise, your weight-bearing exercises, and this can change, the look of this can change as we go through life.
00:31:00.023 --> 00:31:02.721
As I was saying, when you're younger, make sure you're trying to do those weightlifting.
00:31:02.721 --> 00:31:05.604
When you're older, you may change to, okay, more weight-bearing.
00:31:05.604 --> 00:31:18.509
So, walking, doing some squats, doing some intentional movements, functional movements.
00:31:18.509 --> 00:31:28.323
Making sure that we are not smoking that's a big one we're drinking alcohol in moderation or as little amount as possible, and that we are just generally treating our body good and our minds well too.
00:31:28.343 --> 00:31:41.929
So we do find that women who have some you know those vasomotor symptoms you know more of the hot flashes or the headache related to the menopause are sensitive to these symptoms.
00:31:41.929 --> 00:31:54.741
Also are persons who may have experienced sensitivities during their menstrual years, like persons who had premenstrual syndrome, where they used to get a lot of the changes going up to their menses, because those are all hormonal changes.
00:31:54.741 --> 00:32:04.307
So we do find, too, that women who had that in their reproductive ages may also be more sensitive to these symptoms in the perimenopausal period too.
00:32:04.307 --> 00:32:07.026
So that's something that you can as a conversation.
00:32:07.026 --> 00:32:11.480
You can start with your doctor even earlier to say well, you know, I had P.
00:32:11.480 --> 00:32:18.067
How can I optimize myself now for the perimenopause and the menopause, because I may be susceptible to having some of these symptoms?
00:32:18.067 --> 00:32:21.826
So it's also doing self-awareness and knowing what is happening.
00:32:23.134 --> 00:32:23.215
So.
00:32:23.215 --> 00:32:25.240
So, doc, I'm going to ask you a tongue in cheek question.
00:32:25.240 --> 00:32:29.901
This is not just in my head, this is I'm not imagining all of these symptoms.
00:32:29.901 --> 00:32:33.288
This is like something actually is happening to my body.
00:32:33.535 --> 00:32:35.162
Something actually is happening to your body.
00:32:35.162 --> 00:32:41.661
There are changes that are occurring in your body, yes, and in your mind, and in your mind as well, and in your mind.
00:32:41.661 --> 00:32:43.981
So persons say, oh, you know, I can't remember anything.
00:32:43.981 --> 00:32:44.944
You know it's old age.
00:32:44.944 --> 00:32:50.625
Well, you know, it can happen in the perimenopausal transition, these cognitive changes.
00:32:50.625 --> 00:32:59.395
But of course, like anything, as I said, the problem is that this transition is also happening in a timeline where we are also changing because we're aging.
00:32:59.395 --> 00:33:12.398
So if you find that you're having some particular symptoms, get them checked out as well to make sure that there isn't another actual brain related issue or something that would affect your memory occurring at the same timeline.
00:33:12.519 --> 00:33:17.488
And you're saying all things being equal, this event is going to happen to all women?
00:33:17.488 --> 00:33:18.430
I would hope so.
00:33:18.430 --> 00:33:23.106
So this is a conversation that we should be having with our daughters as well.
00:33:23.394 --> 00:33:36.053
It is, and I actually implore persons to tell their daughters because that's what has happened we had a generation of persons who were not passing down this information to their daughters that this thing is going to happen to you, and, of course, culturally as well.
00:33:36.053 --> 00:33:44.820
Some people don't tend to talk about certain things culturally, and so you have people who are out here, lost, not sure what exactly is happening to them.
00:33:44.820 --> 00:34:00.141
So the same interest I tell people that we take in our daughters when they're going through menopause, they are going through puberty, or when your daughter is pregnant, you should actually also arm her with information about what happens and can happen in the menopause too.
00:34:00.762 --> 00:34:02.970
So what I'm hearing is education is key.
00:34:02.970 --> 00:34:09.567
So just learning about what's what's going to happen to your body and just being aware of of the changes.
00:34:09.567 --> 00:34:14.016
And, as you mentioned, it's not the end of the world One, it's not in your head.
00:34:14.518 --> 00:34:20.860
It's not in your head and it's definitely not the end of the world, and there are things that can help you there's a toolkit.
00:34:20.880 --> 00:34:23.224
There's an approach that you can take For sure.
00:34:23.224 --> 00:34:31.038
So, as women out there, where would you recommend that we go to get more information about perimenopause and about menopause?
00:34:31.438 --> 00:34:32.119
All right, so perfect.
00:34:32.119 --> 00:34:36.244
So what I would want is that you have the correct information, correct information, right.
00:34:36.244 --> 00:34:38.454
No more myths out there.
00:34:38.454 --> 00:34:40.204
So correct information.
00:34:40.204 --> 00:34:42.132
So, the first place, your doctor.
00:34:42.132 --> 00:34:46.248
Speak with your doctor about the symptoms that you are having, the symptoms that you are having.
00:34:46.248 --> 00:34:57.320
Make sure you choose a doctor that is easy to speak to about these symptoms, a doctor herself or himself that have educated themselves on the newest guidelines about menopause.
00:35:01.125 --> 00:35:03.295
In addition to that, there are also websites.
00:35:03.295 --> 00:35:05.063
My number one go-to website is menopauseorg.
00:35:05.063 --> 00:35:08.972
That is a menopausal society for which I am a member of.
00:35:08.972 --> 00:35:22.342
You can also find who are the menopausal providers in your area from that website, but they also have a lot of patient-facing information too Frequently asked questions, notes on menopause.
00:35:22.342 --> 00:35:23.867
That's a perfect place to go.
00:35:23.867 --> 00:35:28.101
They even have an Instagram, so you can go to their Instagram Also.
00:35:28.101 --> 00:35:39.175
See if you can find persons on Instagram who are menopausal providers, because they often, like this, do podcasts or do Instagram lives or have information on their site about menopause.
00:35:39.175 --> 00:35:53.289
And, of course, otherwise you can Google, but make sure you're getting your information from the right source a proper medical website, not blogs where people are giving their own opinions a lot of the time.
00:35:53.289 --> 00:35:56.358
So you can find information from those sources.
00:35:57.246 --> 00:36:00.034
How do I have this conversation with my doctor?
00:36:00.726 --> 00:36:06.670
You know, I tell persons when they're going to see their doctor I'm so afraid what is the right way of bringing it up to my doctor.
00:36:06.690 --> 00:36:07.112
Yes, how do I bring?
00:36:07.152 --> 00:36:07.271
it up.
00:36:07.271 --> 00:36:08.615
Just bring it up to your doctor.
00:36:08.615 --> 00:36:11.373
Doc, I'm having a problem.
00:36:11.373 --> 00:36:16.175
I am experiencing X, y and Z.
00:36:16.175 --> 00:36:18.030
You don't have to wait.
00:36:18.030 --> 00:36:24.217
I mean, excellent bed manner is me being able to get it out of you in a patient that isn't speaking.
00:36:24.217 --> 00:36:27.146
But I love when my patients come in and they go Doc.
00:36:27.146 --> 00:36:31.146
The hot flashes, hot flashes, man and I go okay, so we're there.
00:36:31.146 --> 00:36:32.710
We're at this part of our lives.
00:36:32.710 --> 00:36:34.014
Let's talk about it.
00:36:34.014 --> 00:36:35.838
Be very direct.
00:36:35.838 --> 00:36:39.157
That's the only way you're going to get direct answers and ask your doctor.
00:36:39.157 --> 00:36:41.527
Sometimes I think I may be going through the menopause.
00:36:41.527 --> 00:36:42.833
I have these symptoms.
00:36:42.833 --> 00:36:47.168
Are you comfortable with treating patients going through the menopause?
00:36:47.168 --> 00:36:50.067
And if, if not, could you refer me to somebody who is?
00:36:50.067 --> 00:36:52.012
There's no shame in doing that.
00:36:52.853 --> 00:36:55.347
And that's something that I can do as a patient, of course.
00:36:56.010 --> 00:36:57.576
Do you know any other doctors?
00:36:57.576 --> 00:37:02.695
If you are not comfortable, do you know any other doctors who are very good at treating menopausal patients?
00:37:02.695 --> 00:37:04.943
Can I have?
00:37:05.003 --> 00:37:05.405
a referral.
00:37:05.405 --> 00:37:06.547
Got you, got you.
00:37:06.547 --> 00:37:21.436
So, as we come to the end of today's really very informative session on demystifying menopause, any final advice that you would give to women in general, irrespective of their age?
00:37:21.918 --> 00:37:22.159
Sure.
00:37:22.159 --> 00:37:28.338
So I want to let them know that the menopause is natural.
00:37:28.338 --> 00:37:32.208
If you live long enough, you are going to go through the menopause.
00:37:32.208 --> 00:37:33.170
No reason to fear it.
00:37:33.170 --> 00:37:47.534
Just make yourself educated about the menopause, know what to expect, let your doctor know when you think you have entered this period of your life and also enjoy the transition.
00:37:47.534 --> 00:37:52.190
Sometimes Think about what is on the other side of the menopause too.
00:37:52.190 --> 00:37:54.699
Right, so we all think about.
00:37:54.699 --> 00:38:02.166
You know there were a million books written about puberty and adolescence and we couldn't wait to get through the awkward puberty, the acne, this, that, that.
00:38:02.166 --> 00:38:05.846
But you know when it finishes you're going to be gorgeous and look like a nice young woman.
00:38:05.846 --> 00:38:10.047
Well, think about that as well with menopause, that it is a transition.
00:38:10.047 --> 00:38:12.755
It might be a little awkward, but you will get through it.
00:38:12.755 --> 00:38:20.447
And then the other end of it we have our entire rest of the one third of our lives to live and we want to thrive in that period as well.
00:38:21.329 --> 00:38:26.612
Well, on that final note, I would love to thank you so much, dr Astrid Batchelor.
00:38:26.612 --> 00:38:30.266
You really have demonstrated that you're passionate about women's health.
00:38:30.266 --> 00:38:51.186
It was a really very easy conversation and I think we learned a lot about perimenopause and menopause where to go for information if we want to find out more about it and really understanding that there's a toolkit that we can use, you know, once we hit the menopause, to guide us through to the next stage of our life.
00:38:51.186 --> 00:38:54.855
You know, and hopefully we'll all be living until we're 100.
00:38:54.855 --> 00:38:56.458
That is the aim.
00:38:56.458 --> 00:38:57.427
That is the aim.
00:38:57.427 --> 00:38:59.974
Thank you so much, dr Astrid.
00:38:59.994 --> 00:39:01.905
Batchelor, thank you for having me.
00:39:32.960 --> 00:39:37.503
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