Perimenopause, Plainly Explained with Dr. Michael Lavie

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Welcome to Bodyholic Dr.
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Michael LeVee.
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How are you?
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Thank you.
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I'm great.
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I'm great.
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I'm so excited to have you here.
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You know, I think very highly of uh the way you handle yourself, the way you express your opinions, and in general, the way you bring information to the public.
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So it was crucial for me to get you onto Body Holic.
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And so I'm so grateful.
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Thank you so much.
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We are going to stick to the theme of season four of Body Holic, where I celebrated my 40th by getting on to uh season four, by opening season four.
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And so I've been obsessing over perimenopause, menopause, and such.
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But also the truth of the matter is I do get a lot of inquiries and questions regarding this and working out uh during perimenopause and menopause, et cetera, et cetera.
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So from a medical perspective, what are the earliest biological changes of perimenopause before cycle changes even appear?
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And what are they?
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And why do so many women, and this is the thing that really uh shows up in the questions uh towards me, is why do so many women feel off?
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That's what they describe.
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They describe feeling off in the years before doctors actually officially label it menopause.
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Welcome to Bodyholic with D.
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We don't do fads here.
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We give you the facts that move your body and health forward.
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Wait up, hold up, I'm not a doctor.
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The information in this podcast is for informational purposes only and not medical advice.
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So kick back and enjoy the show.
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So that's a great question because this is really what happens.
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Um the thing is that when we when we want to uh diagnose menopause, it's quite easy.
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It's when uh uh a woman stops getting her periods.
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And this was the uh always the the definition for for many years.
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And the thing and the most intriguing thing about perimenopause is that we see uh sometimes normal menstrual periods and normal hormones, but then still that's the time frame that the several years of mood changes and hormonal changes that do uh proceed.
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And that that's the most um confusing, both for women and both for doctors, and the most confusing period of time, um, because we don't know really how what it what to treat and what to ask.
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And the woman comes, whether whether it's to the obstetrician or endocologist or the endocrinologist or just a family doctor and doesn't really know what to ask.
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Um, but during the the last few years, a few years we know of more and more research about perimenopause.
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And we know that the first thing that changes is that there's a uh disturbance in the hormones.
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Now, the brain, a lot of the times interprets uh the problems and in the fluctuations as a problem.
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The brain knows how to handle low hormones, it knows how to handle uh high hormones.
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It doesn't really know how to handle the fluctuations, it changes.
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And those changes um come with anxiety, with problems of sleeping, with tiredness, fatigue, and all those things that come years before the menstrual period itself changes.
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So these are all symptoms of the fluctuations.
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Yes.
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So um I have to say that really what I'm seeing um, you know, now that I'm in my 40s and I'm uh I'm surrounded by women who are over 40, the what I'm getting really is is this wave of women now in at this point in my life, of women who are really describing deep frustration, almost desperation regarding their day-to-day life.
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And so I'm asking you on a really practical level, is there something that you can actually say that you almost prescribe, uh maybe lifestyle-wise, that you know this works and this will benefit the women and maybe move them away from their very frustrated period of time?
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Or is this the kind of situation where you're like, you know what, it's a matter of time, so just wait it out.
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So uh that's a complex question.
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And I always start uh by the the first thing uh we need to do is diagnose it and put a label on it.
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And um the those the the years of 40, we talked about it slightly before we started, are also the years of of having small kids and uh the stressful jobs and the stressful career, and sometimes even right now in Israel with all that's happening, and it's always hard to pinpoint what's the problem, why am I tired?
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Why am I anxious?
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Why is it because of work?
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Is it because of perimenopause?
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Is it because of so one of the things is to try and pinpoint the problem.
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If you don't get a lot of sleep, uh, if you eat uh improperly, uh if you have a very stressful job, that could be one of the things to change.
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But if everything is ha is perfect and you sleep well and everything's well and you're not stressed at work, then maybe that's perimenopause.
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If you feel crazy, even though life is pretty good, that's maybe perimenopause.
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And yes, there are things to do.
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One of the things is, and we know it's a healthy diet, um strict, uh, strict um uh body body work and um and physical exercise, whether it's it's uh anaerobic or aerobic exercise, we can talk about it later, but doing physical exercise helps.
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And also if we target that that phase of perimenopause, hormonal treatment can really help.
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Um, I see it a lot.
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I mean, um people uh women who work out with me and uh feel very tired, and um, and we talk about it and we say, okay, maybe perhaps it's the paramenopause, and they I put them on hormone or hormonal treatment, then eventually they say, Oh my god, I mean, my workouts are completely different now.
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I feel more energized, I feel better, um, my sex life is better.
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So um, so if it's not the other related things, it could be, uh, I would definitely think about perimenopause and ask my my doctor about it.
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Could it be uh perimenopause?
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Is there something to do?
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And the question and the answer is yes, there is.
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So the um, so first we just look at the lifestyle and what's objectively going on in life.
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And then when you're seeing that, okay, life is just, you know, continuing as it's continuing.
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Maybe even we took actions to reduce the stress, but still there's that um fatigue and anxiety uh symptom.
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That's where we step in and say, you know, hormonal treatments might actually work.
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Yeah.
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I mean, one of the things, one of the things to check is also the thyroid and and the prediabetes or diabetes that happens.
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But yes, once we've uh deleted those things and we've seen that they're fine, then yes, paramenopause could be one of the things.
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Okay.
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So what happens when we take the blood test and check the thyroid, et cetera?
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Can you walk me through that?
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So um let's let's go to the end point.
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In perimenopause, the the most frustrating thing is everything is fine.
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The labs could be great because, first of all, the labs look at just the the uh the point of of taking.
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I mean, if you take it Monday morning, so they tell you that the hormones are fine at the point that you took them.
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We're not checking the hormones during the day and during the changes.
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And and we've talked about it that the the fluctuations aren't things that that make you go crazy.
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So and and since we can't check for fluctuations unless we do it in a research uh facility, like taking blood tests every hour and so, uh, we we won't know.
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And the majority of of women with the weak that we see in perimenopause have perfect lab results.
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Um so so that's one thing to bear in mind.
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Even for doctors, I mean, that's one of the things we've talked about it for the last few years.
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Up until a few years, we said, okay, your labs look perfect, you're not in menopause, it's not that, don't take hormones.
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Now we know that sometimes, even though um labs are perfect, hormones could uh benefit.
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Super interesting.
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What what age um would you say?
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Because I from just you know, from my layman's point of view, it seems like uh 45 is the perimenopause age.
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But all of a sudden, I'm you know, when I'm really paying attention closely, I'm hearing, I'm hearing it from different spectrums of the 40s.
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But can you can you maybe shed a little bit of light on that?
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So so usually in Israel we say that the the age for menopause itself is 51, and but the but the age goes from 45 to 55.
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So perimenopause is taking five years earlier.
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I mean, so it's 40 to 50, I would say.
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Um, so definitely women of 40, 41, just after finishing childbirth, maybe, um, start feeling that those symptoms.
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And and and sometimes again, it's it's really hard because you just gave birth two years priorly, and now you feel tired.
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So am I tired because I have a small baby?
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Am I tired because of lactating?
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Or is it something else?
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Right, right, right.
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Absolutely.
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Um so by the way, there are signs on ultracell that we could know of lutile insufficiency, what we call that's the the medical term.
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Um, because the ovaries, um uh we'll talk about like um the the job of the ovaries, the their uh and one of the things is to make the follicles, one is to make the eggs, and one is to make the hormones.
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And most of the time when you're young, it works fine, but then the eggs uh deplete, and also and at the later stage, when you're going into menopause, also the hormones deplete.
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But that that phase of where the of the eggs deplete when you still are hormonal uh sufficient, that's the phase of perimenopause.
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So we see that on ultrasound.
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One of the things we can see is that hormones looks fine, but you don't really have any eggs or any follicles on your ultrasound.
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So that's one of the triggering signs.
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Okay, maybe that's perimenopause.
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Maybe that's the phase that we don't see the production of eggs, and she could be going through perimenopause.
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Super interesting.
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All right, I've got to pause this for a moment and just say, and now we've got to get into some personal questions because I have to tell you something crazy.
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And I feel like I'm gonna tell you that it's crazy.
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I'm gonna feel like it's crazy, and you're gonna be like, oh yeah, that's that's like what happens.
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Okay, ready?
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I finished, I stopped breastfeeding after almost two years just a few weeks ago, which is amazing, amazing, amazing.
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And um, you know, I never I never really had a normal period at any point in my life.
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There may have been a little point after I finished breastfeeding my uh oldest.
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And then, you know, I started working on my next pregnancy.
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And I I don't know, you know, I can't, I can't understand anything from that period of time really, because there was hormonal treatments.
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But now I finished breastfeeding.
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And again, I'm just uh reminding everybody I'm 40.
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Okay, I finished breastfeeding.
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And for the first time in my entire life, first of all, I the fact that I even got my period after breastfeeding, I just I had to like text my mom.
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I was like, oh my God, I got my period because that's how rare it is for me.
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And then um 40 days later, I got my period again, which was mind-blowing because normally I would be like, I'll have my period again next year.
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And then and then 29 days later, I got my period again, which was as you can see, I I'm speechless.
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So for me, that that is unbelievable.
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Now you're talking, we're talking about the opposite situation, right?
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We get into the 40s and you can see in the ultrasound how you know things are really changing in the ovaries, and then there's me, right?
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Where it's almost like I just hit puberty.
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Yeah.
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So can we talk about that?
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For can we just open up the cards there?
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I mean, first of all, it of course it's it changes from one to to another.
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And one of the things to ask is maybe ask your mom when did she stop uh getting her periods?
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And and if her menopause is at 55, um and you in in your family women uh get menopause later in life, then yes, you probably could could get menopause later, and it means which means that your perimenopause goes is later.
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Maybe you'll be in perimenopause only at 47 or 46.
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That's one of the things.
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The other things we know is that um during pregnancy and and uh in lactation, uh, we breastfeed for almost two years, then the whole hormonal uh axis shuts down.
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Um we know that breastfeeding is is at least a good contraceptive for the the few uh few months and it happens because uh prolactin, which is the hormone of of of uh breastfeeding, shuts down the whole hormonal axis.
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Now, probably what you did is kind of restarted your whole uh hormonal axis.
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And with the changes in lifestyle that you've been doing, probably that's another thing that that makes the system healthy again.
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So uh as we talked about nutrition and we talked about uh physical exercise.
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So perhaps now you're in a better condition that you've been prior to the pregnancies, and maybe you've you've won yourself a few more years until parametopause or until you get that feeling.
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I um was diagnosed in my early 30s as having um uh a polycystic ovary structure.
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I think that's and and would that have anything to do with my periods uh only uh becoming regular later in life?
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So yes, I mean we know uh when we talk about polycystic ovary syndrome, that's a a metabol a metabolic and uh fertility syndrome, um, one of the features is looking the the uh looking at the ultrasound, looking at the appearance of polycystic appearance.
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Now, the polycystic appearance by itself does not mean that you have polycystic ovary syndrome, um, but it is one of the signs.
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And um we know that since it's a metabolic system, uh metabolic uh syndrome, um we see uh problems in in insulin, in insulin resistance in over in women who are overweight and gain weight because of that syndrome.
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Uh, we see high testosterone levels.
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So and we see that sometimes the way we do um when we sh uh change the nutrition and we do uh more physical exercise, we can change that paradigm uh and get that that syndrome to be more regular.
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Um so yes, you could change the look of your ovaries by changing your lifestyle, and you could change the function of your ovaries by changing your lifestyle.
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But then, but then there's there's me.
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And this is really interesting because I didn't change anything in I want to say I I can honestly tell you that I didn't change anything in 10 years.
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Okay, maybe maybe in the last 20 years, probably in my 20s, I had a whole lot of ups and downs, but actually overall I'm uh people think I'm extreme.
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I think that's ridiculous.
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I'm just very healthy.
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So in in my choices.
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So um that then then I wonder, like, because I don't I don't have any of the other signs of the poly um.
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Yeah.
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So so it's interesting to me.
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Like, how does this make sense?
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Or am I am I super on uh am I in the outlier, or is this something that actually is more common?
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No, one of the things is that um the minority of polysistic ovary syndrome is what we call lean PCOS, meaning women who are fit and who are lean uh and still have that metabolic problem.
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Um so one of the things to diagnose is taking the blood tests and looking at metabolic uh indices like uh testosterone and estrogen and um insulin resistance, and sometimes even fit and lean women have problems with those hormones.
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Now, um my guess is that you're one of them, uh, and and also and and by changing your lifestyle is not something that changes the that uh the syndrome.
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And maybe just getting older and uh breastfeeding and uh and with the pregnancies that changed something in your hormones that now is kind of changing the regulation of the hormones and and gives you more regular periods than than before.
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Super interesting.
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Would it have anything to do also?
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And maybe this is completely me making it up, um, with the amount of follicles that I used to see in the ultrasounds because uh when you know I had I had fertility treatments, especially on the second pregnancy, it was a really uh long process.
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So I would regularly see a lot of follicles.
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It really, and it was exceptional.
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And every time I would actually go through uh harvesting the eggs, they harvested so many.
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So does that also have to do with it, like maybe literally making more room, or am I making it?
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So the interesting thing about bolsistic ovary syndrome is that it's not a deficiency in eggs, sometimes opposite.
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You have a lot of follicles, and the thing is that the regulation is disrupted.
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Um at a normal period, what happens is that you see you see begin your your uh your menstrual period with a lot of uh follicles with a lot of eggs, normal women, and then um there's uh a regulation that just gives out one that ovulates.
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Um there's one uh specific follicle that's the chosen one, and then at the Disrupts the others from growing, and then that follicle ovulates.
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Now, something in that regulation goes away or is disrupted in the pulsistic ovary syndrome.
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And uh so there's a lot of psych FOMOs, having a lot of choices that you don't know what to choose from.
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Um so you have a lot of follicles and nothing gets chosen.
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Um maybe now that you have less follicles because of the age, it's easier, kind of easier to choose from.
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It's easier to get the one follicle.
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Wow.
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Okay.
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Really, really interesting.
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Um I'm there's also something that on a professional level I'm noticing that I want to bring up that a lot of really strong, really active women in their 40s uh also describe um that their body just stops responding to uh training, to nutrition, uh, also to sleep.
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Sleep is, you know, a really big deal.
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Once you hit 40, there's a whole uh down uh regulation or or actually melatonin just isn't produced as much.
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Um what could these women do to actually help themselves if it's not hormonal uh therapy just yet?
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Um, and they're doing everything they're supposed to do.
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They are, you know, top-notch with taking care of themselves.
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So again, I mean, one of the things that goes uh that happens with perimenopause is the sleep disturbance.
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And that sleep disturbance uh affects your training.
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When we know that's one of the most important things for recovery and for uh strength building and is getting good sleep.
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And we're not sleeping as as good as you should, even though you're going for that eight hours.
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But if you keep waking up during those eight hours, then that's not proper sleep.
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Um, so one of the things to do is maybe um take melatonin or take sleeping pills and get you know the good periods of sleep.
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And one of the things to to think about is is again, if it's perimenopause, um, is taking just another uh is taking a home roller treatment that could potentially help you help you sleep better and then help you recover better.
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Um, one of the things we see is that the domes, uh the muscle fatigue are longer.
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We see less recovery.
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Uh you're doing the workout, and and and usually you could feel that you could exercise the next day, and now you feel that you can't.
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Um that's one of the most interesting and and the common symptoms of perennials.
00:22:45.359 --> 00:22:45.680
Okay.
00:22:46.480 --> 00:22:51.359
So um when I just want to pull out something you just said.
00:22:51.680 --> 00:22:54.480
You mentioned sleeping pills.
00:22:55.359 --> 00:22:55.920
Yeah.
00:22:56.240 --> 00:22:58.799
As opposed to so there would be melatonin, right?
00:22:59.039 --> 00:23:00.400
That's what everybody talks about.
00:23:00.559 --> 00:23:04.400
And then there's um the hormonal treatment that can actually help.
00:23:04.559 --> 00:23:07.839
But then when you say sleeping pills, what are we talking about?
00:23:08.240 --> 00:23:27.920
I I that's like the the last resort, but if everything else fails and you need proper sleep, then yes, uh uh there are um chemical agents uh like uh the bin and and stuff like that that can help you trigger your sleep um during a specific period of time.
00:23:28.160 --> 00:23:32.960
It's not something I would uh register for two in two years straight.
00:23:33.200 --> 00:23:33.599
Mm-hmm.
00:23:33.759 --> 00:23:34.160
Mm-hmm.
00:23:34.319 --> 00:23:34.720
Mm-hmm.
00:23:35.359 --> 00:23:42.799
Um now there's there's also the woman who I might fall into this category at times.
00:23:43.039 --> 00:23:59.920
I think um I try to really listen to uh my body regularly, but I do see uh a lot of women who train with me um kind of ignore all these, they they'll tell me all kinds of things that are going on, but then they'll just override it.
00:24:00.240 --> 00:24:03.119
Would you say this is a risk factor?
00:24:03.519 --> 00:24:12.160
Um, or not only that, they'll override it and and work through whatever it is that they're describing, maybe that fog, that fatigue.
00:24:12.319 --> 00:24:26.000
Um, what if they medicalize it and also just kind of keep treating it with, I don't know, something for ADHD, something for ADD, like, you know, that kind of um uh medicalization.
00:24:26.559 --> 00:24:28.880
What is that even a risk?
00:24:29.039 --> 00:24:31.119
Is that a problem to override it?
00:24:31.279 --> 00:24:32.640
Can you get into that a little?
00:24:33.039 --> 00:24:38.400
I'm not sure that it's a risk, but it does affect your lifestyle and and the quality of life.
00:24:38.559 --> 00:24:49.119
Um, I think that eventually uh the the women you talk about are very uh know their bodies and um and it's always important to listen.
00:24:49.279 --> 00:24:52.240
Uh listen to the signs, even the small signs.
00:24:52.400 --> 00:24:56.079
If you feel that something is wrong, um you're probably right.
00:24:56.240 --> 00:25:00.000
I mean, uh at least for a uh a specific period of time.
00:25:00.160 --> 00:25:02.559
If it's a a week or two, okay, you can override it.
00:25:02.640 --> 00:25:10.400
But if it goes on for a few months and so, uh, and you know your body and you feel something is wrong, then again, you're probably right.
00:25:10.640 --> 00:25:20.160
That would be uh the first time I would go to see a physician, um, whether it's a family doctor or an obstetrician or an endocriminologist.
00:25:20.319 --> 00:25:39.519
Now the thing is that again, since we go like to the regular doctor and you have like 10 minutes per patient, and you see a normal, uh normal, a normal patient with normal lab tests, then the easiest thing is saying, okay, you're just hormonal, uh, go home, or you're you're perfectly fine.
00:25:39.599 --> 00:25:52.319
Uh, but when you take the time to listen that something is wrong, then then then yes, then we can sometimes see what's wrong, whether it's the sleep, whether it's nutrition, whether it's physical exercise, and whether it's hormonal instability.
00:25:52.400 --> 00:25:55.200
And then we give uh the hormonal treatment.
00:25:55.279 --> 00:25:58.960
I'm not I'm not advocating for hormonal treatment, whatever.
00:25:59.039 --> 00:26:06.160
I mean, that's not the first thing you just give without the proper listening and and kind of uh pinpointing the problem.
00:26:06.640 --> 00:26:07.279
Mm-hmm.
00:26:08.160 --> 00:26:14.880
Um so you just mentioned uh the this is gonna take me to one more question.
00:26:15.359 --> 00:26:20.960
I think that the may the major take-home message is to listen to your to your gut feeling.
00:26:21.200 --> 00:26:25.279
If something feels wrong, then then go search the problem.
00:26:25.359 --> 00:26:33.599
And and but even if you you get uh a message from one doctor that says, oh, it's nothing, you'll be fine, but you won't.
00:26:33.839 --> 00:26:37.599
Just go check and and try another doctor.
00:26:39.440 --> 00:26:41.039
It's like you read my mind.
00:26:41.680 --> 00:26:50.880
That's uh that's actually um I I think that is very important because there really is a lot of information out there.
00:26:51.039 --> 00:27:00.640
Um, and it could be conflicting information and it could just be confusing information that's just not um giving the whole picture.
00:27:00.880 --> 00:27:09.920
Or I I do worry about over-medicalizing and underdiagnosing.
00:27:10.079 --> 00:27:16.960
Like I do worry about the um is is the woman, is she really suffering?
00:27:17.119 --> 00:27:22.720
If she's suffering, can we actually help her really listening to the patient?
00:27:22.880 --> 00:27:31.359
Um, so I do appreciate what you just said because uh getting a second opinion, getting a third opinion is great.
00:27:32.079 --> 00:27:39.759
You know, you don't you never have to listen to the first person who's giving you uh a diagnosis or an under-diagnosis.
00:27:40.160 --> 00:27:49.759
And and regarding um overtreating or so it's it's it's again the the most important thing is not telling the woman you should do one, two, three.
00:27:49.920 --> 00:27:53.920
Um, is giving options, talking about whether it really bothers you.
00:27:54.079 --> 00:28:03.359
I mean, if we say it's pheromenopause and you're fine, I mean you're okay with it, and nothing really bothers you, doesn't really affect your quality of life, then then okay.
00:28:03.440 --> 00:28:05.599
We we we don't need to change anything.
00:28:05.759 --> 00:28:09.279
Um, we don't need to treat something just because it's there.
00:28:09.440 --> 00:28:12.799
Um we need to treat only if it bothers your quality of life.
00:28:12.880 --> 00:28:16.880
But on the other hand, if it bothers you, then yes, there are things to do.
00:28:17.039 --> 00:28:19.359
Um that's another thing to think about.
00:28:19.680 --> 00:28:20.319
Yes.
00:28:20.799 --> 00:28:21.440
Yes.
00:28:22.480 --> 00:28:28.720
Oh, thank you so much for sharing your wisdom and shedding light on this topic.
00:28:29.039 --> 00:28:36.160
And if uh if we're lucky, you'll come back and share light, shed light on other topics as well.
00:28:36.400 --> 00:28:41.279
I always get get these questions in specifically regarding women.
00:28:41.519 --> 00:28:45.759
So um I'm excited to to record with you again.
00:28:46.079 --> 00:28:46.799
Thank you.
00:28:46.960 --> 00:28:48.480
It's an always a pleasure.
00:28:48.799 --> 00:28:50.960
Thank you so, so much, Dr.
00:28:51.119 --> 00:28:52.240
Michael LeVee.
00:28:52.480 --> 00:28:54.880
And we will speak soon.
00:28:55.200 --> 00:28:55.839
Speak soon.
00:28:56.000 --> 00:28:56.960
Bye bye.
00:28:57.359 --> 00:28:58.000
Bye.