Perimenopause, Decoded: Breaking Down The Perimenopause Survival Guide || Episode 25

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Thanks for joining me on menopause unscripted.
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Remember, the change is just another beginning.
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Welcome back to another week of Menopause Unscripted.
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I am back with one of my favorites, Dr.
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Tara Noakdar.
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She is a DO and she is one of my favorite people to work with when I'm dealing with patients who need HRT.
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And I'm not a prescriber, so when I have a patient come in who needs or could potentially benefit from hormone replacement, she is one of my favorite people to work with.
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Well, thank you for coming back with me.
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Thank you for having me.
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I'm so excited to be here.
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Um obviously, I think so highly of you and your practice and what you do, and I think it's so amazing that you decided to go ahead and get menopause certified because you can recognize when and how hormones or or the discussion of hormones or the discussion of menopause and perimenopause will be beneficial to your patients and you know who to refer to, and I think that's super important.
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That having people that I can work with in a team environment just it's so helpful for a patient, especially, yeah, because we can have trusted providers, patients can understand more about this, and they can understand the physicality from me, and then they can understand a lot of the other implications from you.
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Yeah.
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So thank you.
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It's a great combo.
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Yes, definitely.
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It definitely like this is not something that you can do in like an isolated environment or siloed for women's health.
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Yeah, like nothing in perimenopause and menopause exists in a vacuum, like everything uh has another layer.
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So it's important to have a team.
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And that is a perfect segue into our book from today because this explains so many of the layers.
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So we are book clubbing the Perimenopause Survival Guide, written by Dr.
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Heather Hirsch.
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And we are both menopause society certified and went through a lot of Heather's education.
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Could you tell us a little bit more?
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Because you are definitely deeper into it than I am.
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Yeah, so um I think I touched on this last time I um podcasted with you, but when I started to realize that like I didn't know enough about perimenopause and menopause to treat it, I was kind of like reaching through all of the material on my own and figuring it out on my own, which was fine for a little while.
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Um, and then eventually I thought to myself, okay, there are these resources out there like Heather Hirsch's um courses or Rachel Rubin's courses, and so I decided to take the plunge and just do her course.
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Um I specifically did the um the hormone, like getting comfortable with hormones for practitioners.
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Um I don't think that's what it's called, but it's something like that.
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Close enough.
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Close enough.
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Yeah.
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Um, so I decided to do that one, and it was a great um like line by line, she really delves into the stuff that we're always questioning, you know, the things that patients are questioning, that patients are worried about, and she has a way with words, I'm not gonna lie.
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Like she just knows how to explain things really well so that we can explain it to patients.
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Um, so I I think that aspect of that course was really helpful for me.
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And just getting more and more comfortable with talking about it and talking about hormones and hormone replacement or non-hormonal medications.
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I mean, the the course is like very um involved.
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It's not just like these are hormones, this is how you use them.
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Bye.
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Yeah, it's pretty involved.
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And there's a lot of the things, like you already said, that are the non-hormonal options as well.
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I'm currently enrolled in the botanical medicine.
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Oh, you're you're doing that one.
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Yeah, I Dr.
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Suzanne, I love her, and I really wanted to like learn from her more and definitely like hear more about the botanical side of things.
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But I also love that she has a lay people course and is writing these books and other resources for people who are patient side versus a practitioner side.
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And this is a very complex book, but I feel like it lays things out really well.
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Yeah, the it organizes things so easily and just relatable, you know.
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It's like people see themselves in these words, and I think that's super important.
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Oh, I definitely, I definitely did.
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Yeah.
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Well, so we kind of talked about a way to break this down for an audience because there is a lot of information here.
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And one of the things that we kind of both agreed on is that her four pillars of health that she explains are a kind of a good starting point because then she breaks everything into uh symptom, what does she call it?
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Symptom sets.
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Symptom sets, symptom blocks, but they all tie back into these four pillars of health.
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And the four pillars I've opened to this page sleep, diet, exercise, and mental health.
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So it's really like the base of where you need to be before considering anything else, especially hormone replacement or other things, these are not in order, and you don't have like your house cleaned up in this area.
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It's really hard to know like, do you need anything else?
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Yeah.
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Do you talk to your patients about kind of these similar things in your clinical practice?
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Always.
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And I think um almost to the point of being annoying about it.
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I think I think if any of my patients are listening, I'm sorry.
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Right.
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Same.
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I I mean people come in all the time, and I'm like, you you gotta clean house before anything else, and everyone wants a magic cure, they want a magic pixel.
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Yeah, but in reality, none of these things even work if these are not in order.
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Yeah, and I mean, sure, if you take estrogen and you're that's all you're doing, things are gonna improve, right?
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Your hot flashes are gonna improve, your night sweats are probably gonna improve, but if you're not doing the work to make sure you're maintaining your muscle mass and like strengthening your bones, and um, you know, eating a good diet that keeps you satiated and healthy and gets all of your micro and macronutrients, then at the end of the day, you're there's so much missing and you're not gonna optimize.
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Like, I like to talk about optimizing everything because nothing's ever perfect, nothing is gonna do everything, not one thing is gonna do everything for you.
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So hitting each thing independently, each topic independently is gonna really make you whole in the future, right?
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Like, where I always like to talk about the future with my patients because like right now, yeah, hot flashes are really hard.
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So it's a really hard we're gonna work on that and that's gonna get better.
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But if we don't hit all the other things, we're not going to be independent and healthy and strong in 20 years.
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And stay out of nursing home, stay out of nursing home, stay in your house, not having falls, osteoporosis.
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Yeah, and that's a lot of things I talk about people with people too is they come in and they are deconditioned, they are in pain, they are falling, we have a big falls risk issue, right?
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Or we're dealing with a fracture we already had, and that's like with my you know population of women that are mostly postmenopausal.
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But but then I have like the women who are not even in perimenopausal, they're normally menstruating, and people who are perimenopausal, it's like, how can we get ahead of this?
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So then that way you are setting yourself for success later in life and not having these issues, you can maintain a healthy active lifestyle and age well.
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Yeah, and she definitely touches on that.
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She's like really Heather Hurst, she she I think she's really passionate about getting ahead of it, right?
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I think it's so important to think about your future in terms of how can I improve my future now?
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How can I get myself to a point where I won't be worried about falling and breaking my hip or you know, having spine fractures, or um, you know, working on your balance, working on your flexibility, working on your strength, but eating really healthy and and you know, I I I'm also pretty passionate about it.
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My patients are so over me.
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And everyone is so sick of hearing like protein, fiber, lift weights, drink more water, sleep.
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Everyone hates the word sleep hygiene.
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No, but it's true.
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I mean, these are accurate things we need to work on.
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Yeah, it's important.
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And I think especially, I think the part of all of this stuff that I think is the most difficult is like developing habits.
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And I was doing a little um Googling to see like how long does it really take to develop a habit?
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And the average is 66 days.
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Yeah, it takes 66 days of doing something regularly to make it something that becomes second nature, which is a really long time.
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It is, and it's frustrating, especially when you're symptomatic and you want it to be fixed yesterday.
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Yeah, and this is something we talk about here a lot is that a standard physical therapy order says come into PT for two to three times a week for four to six weeks.
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And everyone's like, Why is that the standard order?
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And the standard order of that is because it takes that long to create the habits.
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Yeah.
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And I'm not generally seeing patients longer than that.
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Some I do, but it's because we're trying to form these new neuromuscular pathways where people can then actually carry on on their own.
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I tell people, after six weeks, you aren't done.
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Hopefully, we've created new habits so you can carry on on your own.
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Yeah, exactly.
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So let's talk about these things that are annoying habits.
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And let's start with sleep since that's the top of the list, and then we can talk about our own things.
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So I'd love to hear about your own sleep hygiene and what you do for sleeping.
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Okay, so I never watch TV before I sleep.
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So my routine starts by I put my pajamas on, I brush my teeth, uh, well, I floss my teeth, I brush my teeth, I wash my face, um, and then I get into bed and I read.
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I'm not gonna lie.
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Kindle.
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Okay.
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But I put it on dark mode and it's like the least bright ever.
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It's a paper white, I think.
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But um, but sometimes I feel like my eyes are getting old and I need it to be a little bit brighter.
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I'm getting there, it's okay.
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Um, but I refuse to have the so we have a TV in our bedroom, and that was not my doing.
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I don't like a TV in a bedroom because I don't want that to be a part of like our bedroom is meant to just be for very specific things, right?
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We're sleeping in there, sex, and like reading, relaxing, but it's not for TV.
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TV is excitement, entertainment, and that's for the living room.
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Yeah.
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We have a TV in our bedroom too, but the reason we put it in was for sick days.
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Okay.
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You know, so it's never on.
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We're not watching TV in the bedroom, but if you have a sick day, it's a sick day TV.
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It's really the only thing.
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It's like it's there, it's a pretty crappy old TV, it's fine, but it's literally there for the sick day.
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Yeah, I'm sick that often.
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No, but every once in a while you have that sick day and you're home with your partner and you want to just like lay in bed, because we only we have a pretty small apartment.
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It's like that's that's the TV purpose in there.
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Definitely not watching TV before bed, but it does live there too.
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Yeah, yeah.
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What's on your nightstand?
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Oh god.
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Um I'm gonna take a picture and send it to you.
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Okay, it's a shit show.
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Am I allowed to say that?
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It's a nightmare.
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You can say anything you want.
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Um, I have about like seven menopause books that they look really pretty, and I'm just gonna leave them there.
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And I've read maybe a couple of them.
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Okay.
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Is this the pre-bedtime reading?
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Or no, no.
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I so like my menopause books are not bedtime books.
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Yeah.
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My bedtime books are like fun, exciting, entertaining, or like romanticies, or dragons, you know, Sarah J.
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Mass and Do you see she has two new books coming out?
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No, I've been not paying attention to any of them.
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Just was announced she's got two more books coming out, like one in the fall and one in the early winter.
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Like part of her previous series?
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Oh my god.
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Oh, that's so exciting.
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I know.
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There's like, you know, I will take like small wins in this very scary uncertain world.
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We need it.
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That was a definitely a win this week.
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I was like, something to look forward to.
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Yay, that's really fun, actually.
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Now I'm like gonna go home and find out what there's not a lot yet.
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There's not a lot of info, just announced that they're coming.
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Okay, that's really fun.
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We could speculate, but okay, great.
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Well, that's gonna be on my nightstand also.
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Yes.
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Or in my Kindle.
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Um, and then I have my like random like random things that I sometimes need.
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My nail file.
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Yep.
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Super weird.
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Um, my I have this like foot balm, this prequel foot balm that I put on sometimes before bed.
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Sure.
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Sometimes.
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Um, nail clipper?
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I don't know why.
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Clipping your nails in bed.
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It's always like I think when my if one of my nails like snags on my foot or something, I'm like, oh, I need to immediately address this.
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So and without getting out of bed because I don't want to get out of bed.
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No, you're you're there, you're in it.
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What else?
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I have a flashlight just in case.
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That's smart.
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Yeah.
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Especially like last night with the wind.
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Never know.
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Yeah.
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I think that's it.
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A l a a light thingy.
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Oh, my lip gloss.
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Um, and my water bottle that is right there.
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But that just lives next to me at all times.
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So you said mentioned pajamas.
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Okay.
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So going into some of the things in the book here, do you or underwear to bed?
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Um, only when I'm on my period.
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Okay.
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Because one of the things in here that they're talking about and I talk about a lot in clinic, is letting your undercarriage, your vagina, your vulgar tissues, having room to breathe.
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Yeah.
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And she mentioned several times sleeping in a long nightgown, and I immediately pictured my grandma and I was like, Do people even make nightgowns anywhere?
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They do.
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I have several.
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I was like, do they?
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But I was just thinking, because I like really like loose, flowy pants, and like I I get really hot at night, but I also like to be cozy and I like that like feeling.
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So I turn on my chili pad and like get it make it really cold, and the room is cold, so then I can like wear pajamas.
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But one of the things my patients is, and I am guilty of this too, is like they're wearing like leggings all day that are tight, and then they go to bed and they're wearing tight underwear, and then we see things like bacterial vaginosis, increased yeast infections.
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We see a lot more like vulvo vaginal issues, especially when our hormones start changing.
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Yeah, and you're becoming more sensitive, your pH is changing, and it's like all out of whack.
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And yeah, I I I don't like underwear to bed.
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Do you tell patients that often?
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Okay.
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You need a little healthy breeze.
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Yeah, just like let it air out.
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I mean, not air out.
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I hate to say it like that, but like as if it needs to like I don't know, like that.
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I feel like air out has a negative connotation.
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I don't want to put a negative connotation on it, but it just needs to not be enclosed.
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Yeah, maybe more oxygen, not have that like dark, like anaerobic state down there, right?
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So just get some air down there so it can actually the pH and bacteria and stuff can kind of normalize.
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Yeah, especially when you're wearing yoga pants all day long.
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Yeah, you don't really get that.
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So other sleep tips, like are there other things that you tell your patients to work on for their sleep hygiene, uh, for like just being more comfortable and avoiding some of these symptoms at nighttime?
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Like, what what do you also see in the sleep pillar?
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Yeah, I think making sure the temperature in your room is low ish, like 65.
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I think she mentioned 65 is ideal.
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Yeah, I think she says either 65 or 68, but something like that.
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In the 60s.
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Yeah.
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Um, which for me in the winter, like even in the winter, I hate having hot air blasting at night.
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So I just get more cozy, like you said, rather than have the heat on.
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Um so keeping the room cool, um, not drinking a lot of water immediately before bed.
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I feel like people like chug a glass of water before they go to bed and they're like, I'm up peeing all night.
00:16:38.559 --> 00:16:39.759
Yeah, get that nocturne.
00:16:40.159 --> 00:16:40.480
Yeah.
00:16:41.039 --> 00:16:41.919
I would be too.
00:16:42.159 --> 00:16:42.720
For sure.
00:16:42.879 --> 00:16:44.080
I'm a little guilty of that.
00:16:44.159 --> 00:16:49.039
Like, I will sometimes right before bed just chug and because it's like I'm just thirsty at night.
00:16:49.279 --> 00:16:52.879
Sometimes patients have the same thing, and they try to cut it off like two hours beforehand.
00:16:52.960 --> 00:17:02.000
And I just had a conversation about this on Wednesday about all the different things you can do to have less disrupted sleep just because of you know, the urination in the middle of the night.
00:17:02.240 --> 00:17:07.920
And as my patient gets older, that's one of the times I see falls too, is that they're getting up in the middle of the night.
00:17:08.000 --> 00:17:12.799
Maybe they sit up, they get a little dizzy, and they try to rush the bathroom because they have that feeling of urgency.
00:17:13.039 --> 00:17:13.200
Yeah.
00:17:13.519 --> 00:17:15.599
Or they're tripping over things on the way there.
00:17:15.759 --> 00:17:16.000
Yeah.
00:17:16.160 --> 00:17:16.720
It's dark.
00:17:17.039 --> 00:17:17.279
I know.
00:17:17.440 --> 00:17:18.880
I try to keep my pathway clear.
00:17:19.119 --> 00:17:19.440
Me too.
00:17:20.079 --> 00:17:20.799
Best I can.
00:17:22.000 --> 00:17:26.720
And like with the sleep, I mean, this kind of falls into the hot flashes and night sweats and other things.
00:17:26.880 --> 00:17:33.440
If we can keep it cold, we can have it our sleep hygiene, so we're more relaxed and our nervous systems are a little bit more downregulated.
00:17:33.599 --> 00:17:33.839
Yeah.
00:17:34.000 --> 00:17:35.680
You know, avoiding some things at night.
00:17:35.839 --> 00:17:41.279
Like everyone hates when I'm like the red wine, trying to get rid of it at night.
00:17:41.359 --> 00:17:42.079
I'm so sorry.
00:17:42.240 --> 00:17:47.920
I know you want it, but the alcohol and especially things that are creating that vasodilation that you kind of ramp us up.
00:17:48.160 --> 00:17:56.640
Yeah, and it, I mean, like, it is palpable how different I sleep if I have a glass of wine or a drink and if I don't.
00:17:56.880 --> 00:18:10.400
I mean, it is, it's almost gotten to the point where I'm like, oh, it's the weekend, I might have a drink, but then I'm like, I maybe would rather not have a drink because then I'm gonna sleep badly.
00:18:10.640 --> 00:18:18.960
And this is I always think about like the weekend as my time to catch up on sleep because during the week I'm like so in my head about everything ruminating, yeah.
00:18:19.119 --> 00:18:28.880
It's harder to like sleep well, so I'm you know more relaxed on the weekends, but then drinking alcohol really just like gets in the way of that too.
00:18:29.119 --> 00:18:32.160
So I think avoiding is a really, really good tip.
00:18:32.400 --> 00:18:33.599
Yeah, and everyone hates it.
00:18:33.680 --> 00:18:42.240
And I love coffee, I love my caffeine, and my biggest guilty thing because I had to stop drinking several years ago because of my health issues, but I'm guilty of the like 3 p.m.
00:18:42.480 --> 00:19:10.960
caffeine blast, and or you know, you go to dinner and I'm like, oh, like I'll have an espresso shot as my like dessert, and then you know, my sleep is so disrupted that night because the half-life of caffeine is so long, and then it's you know, waking me up in the middle of the night because yeah, of course, and I um I mean as a rule, I will not drink coffee or anything caffeinated after like noon because I'm very sensitive to it.
00:19:11.680 --> 00:19:12.400
Forgot that stuff.
00:19:12.640 --> 00:19:13.759
Do you touch the fuzzy bunny?
00:19:14.480 --> 00:19:14.720
Sure.
00:19:15.519 --> 00:19:22.079
Um, but like I'm really sensitive to caffeine, like even just having a couple sips of that, like I feel it.
00:19:22.160 --> 00:19:25.359
Yeah, which is kind of crazy, but I'm just sensitive to it.
00:19:25.440 --> 00:19:29.279
So I know if I have caffeine after 12 o'clock, I'm screwed.
00:19:29.359 --> 00:19:30.240
I can't sleep.
00:19:30.480 --> 00:19:33.839
Um, and the same thing with drinking water before bed.
00:19:34.000 --> 00:19:36.720
I stopped drinking by 8 p.m.
00:19:37.279 --> 00:19:39.359
What time is your usually by your usual bedtime?
00:19:39.599 --> 00:19:42.160
I like to think that I'm gonna get into bed by 10.
00:19:42.720 --> 00:19:44.000
You've been smelling a kind of two hours.
00:19:44.480 --> 00:19:50.960
Yeah, it's usually like more like 10:30 or 11, but yeah, I try to I try to start to wind down at 10.
00:19:51.119 --> 00:19:51.599
Yeah.
00:19:51.920 --> 00:19:56.960
The next pillar that we're gonna talk about is nutrition or diet, right?
00:19:57.119 --> 00:20:18.720
And I think this one is so important and it's something that I harp on my patients about aggressively because if you're eating foods that aren't serving you the nutrients that you need, and not only that, but they're kind of doing the opposite, then you're doing it wrong, right?
00:20:19.279 --> 00:20:29.200
I I've most recently myself have really started to try and pay more attention to what I'm eating.
00:20:29.440 --> 00:20:47.759
Not that I ever ate super unhealthy or I don't know, I I generally have a decent diet, but in the last couple of years I've just been trying to make sure that what I'm eating is giving me some kind of nutrition or or nutrients, right?
00:20:48.160 --> 00:20:48.799
Serving you impossible.
00:20:48.960 --> 00:20:52.799
Positively and making me feel good, I think, more than anything.
00:20:52.960 --> 00:21:21.119
Um not to say that I don't have the occasional ice cream or Taco Bell because that's my weakness, but um there's also one really close to me when I'm working, so it's like a little dangerous, but um, but I can also make decent decisions at Taco Bell, or I can also decide that my dessert is gonna be one mochi ice cream, not like a bowl of ice cream, not a pint of Ben and Jerry's.
00:21:22.079 --> 00:21:27.759
So um what she talks about, what Heather talks about in I'm gonna call her Dr.
00:21:27.839 --> 00:21:33.519
Hirsch, I feel is Heather feeling a little too like it feels like um we're besties.
00:21:36.079 --> 00:21:37.119
I I do, I do.
00:21:37.200 --> 00:21:42.640
Um, I mean we did meet and she's just the sweetest woman and she's so smart and kind.
00:21:42.960 --> 00:21:44.720
Um but Dr.
00:21:44.960 --> 00:21:56.400
Hirsch um talks a lot about uh plant based diet, which I basically mostly am also trying to do.
00:21:56.640 --> 00:22:01.680
And my for me it's more because like I don't really like touching meat.
00:22:01.920 --> 00:22:03.200
It's icky.
00:22:04.000 --> 00:22:09.920
And so I, when I cook at home, I'm mostly cooking with vegetables.
00:22:10.000 --> 00:22:10.319
Okay.
00:22:10.559 --> 00:22:25.599
And um, you know, finding protein sources in vegetables is not difficult, especially because vegetable-based proteins are often also high in fiber, which is amazing.
00:22:26.000 --> 00:22:26.640
Double dipping.
00:22:26.799 --> 00:22:27.920
Yeah, double dipping.
00:22:28.079 --> 00:22:39.039
And so um, you know, when you're trying to hit all your nutrients via um vegetables, it be it can get a little bit complicated, right?
00:22:39.200 --> 00:22:44.319
Because a lot of vegetarians or vegans are um deficient in B vitamins.
00:22:44.480 --> 00:22:47.519
Um but there are ways around that, right?
00:22:47.599 --> 00:22:51.599
I think like nutritional yeast has B B vitamins, and she mentions that in the book.
00:22:52.079 --> 00:22:53.680
Um, there are ways around it.
00:22:53.839 --> 00:23:02.480
There are ways to get everything you need in a reasonable way, and it's also like more cost-effective, right?
00:23:03.440 --> 00:23:04.240
Supplements are expensive.
00:23:04.480 --> 00:23:07.440
Supplements are expensive, and meat is expensive.
00:23:07.680 --> 00:23:10.160
Um, tofu's pretty cheap.
00:23:10.960 --> 00:23:11.920
And beans.
00:23:12.000 --> 00:23:12.640
Yeah.
00:23:13.359 --> 00:23:22.319
And for me, like I guess I can't do soy or legumes, so it's really, really hard for me to do a plant-based diet and really get in protein.
00:23:22.480 --> 00:23:30.880
So I do eat more meat, but then I have to be really careful that I'm getting enough fiber as well, not just kind of falling into all only protein.
00:23:30.960 --> 00:23:31.279
Yeah.
00:23:31.519 --> 00:23:39.200
And so I I'm a big griller, like I have a barbecue outside, and I meal prep generally on Sundays.
00:23:39.279 --> 00:23:43.200
And so when I'm grilling my proteins, I'm gonna mix into other things for the week.
00:23:43.279 --> 00:23:48.079
I might also like grill a bunch of like vegetables as well to make sure I've kind of got both sides.
00:23:48.400 --> 00:23:51.920
But the legumes and soy unfortunately really upset my system.
00:23:52.079 --> 00:23:56.559
So I've really and I can't do gluten at all, so that kind of cuts out that and vegetable protein.
00:23:56.880 --> 00:23:58.480
Man, you just can't eat anything.
00:23:58.799 --> 00:24:06.559
I can eat I can eat animal stuff, any animals I'm fine with, which I hate saying that, but like any animals I'm fine with.
00:24:06.799 --> 00:24:07.440
Not you, Doc.
00:24:07.680 --> 00:24:10.559
No, Docie, you're you're not on that, you're not on my menu, baby.
00:24:10.960 --> 00:24:13.200
He also benefits from the grilling.
00:24:13.599 --> 00:24:16.000
I have a little sous chef over there for sure.
00:24:16.319 --> 00:24:26.480
But also, like, it's uh you know, it's one of those things I have to be really mindful about what I'm consuming, yeah, and making sure that I'm getting enough fiber and getting enough vegetables.
00:24:26.640 --> 00:24:31.519
And I don't think that that's hard for me, but I do have to be very, very mindful what I eat.
00:24:31.680 --> 00:24:33.119
I also love Taco Bell.
00:24:34.079 --> 00:24:40.559
But I love Chipotle, Chipotle is like my sick food, it's like a burrito bowl, it's my my comfort go-to.
00:24:40.960 --> 00:24:42.319
It's hard.
00:24:42.480 --> 00:24:45.599
It's just I have to make sure I'm not eating too much of it because it's really good.
00:24:45.839 --> 00:24:51.680
And they keep like spamming me with coupons for like a free guac doesn't help because I'm like, oh, I have a free guac by Sunday.
00:24:51.759 --> 00:24:53.279
I guess I'm fibering guac.
00:24:53.680 --> 00:24:53.839
What?
00:24:54.079 --> 00:24:54.480
Fiber.
00:24:54.799 --> 00:24:56.880
It's not you know, avocados are great for you.
00:24:56.960 --> 00:25:01.759
Like good fat, so you know the chips are the part that you know maybe not as good.
00:25:02.079 --> 00:25:02.720
Okay, fine.
00:25:02.960 --> 00:25:04.720
But but I digress.
00:25:05.039 --> 00:25:08.880
The but it it is something, and I harp on my patients about this all the time.
00:25:09.039 --> 00:25:34.720
And I think people are so sick of hearing about you have to have so much protein, you have to have so much fiber, but they're forgetting that like we used to eat a lot more whole foods, and like that just isn't happening as much anymore, or we're being marketed with so many commodity foods and things that are really hitting that this like bliss point of like just that perfect sweet, salty fat where it becomes almost an addict an addiction.
00:25:34.960 --> 00:25:35.599
Absolutely.
00:25:35.839 --> 00:25:41.359
I sent you an article, I don't know if you've read it yet, but it is an old article, and I will link it in the show notes.
00:25:41.440 --> 00:26:03.680
But it is this New York Times article from like 2013, but it literally talks about the addictive science of junk food, and even though it's old, it's one that I tell I re give that resource to patients all the time so they really understand why they're craving these things that really aren't very good for us because it was designed that way.
00:26:04.000 --> 00:26:09.519
Yeah, it was by design, it was on purpose to make us want it more and more and again and again.
00:26:10.640 --> 00:26:15.039
And you can eat an entire bag of Cheetos and they don't make you full because they dissolve.
00:26:15.200 --> 00:26:29.680
And this article talks about how they are like the most perfectly engineered junk food because they're cravable and you can eat in a whole bag and not be full, which just it just hurts my heart knowing that this was done to us.
00:26:29.920 --> 00:26:30.240
Yeah.
00:26:30.400 --> 00:26:32.640
So it is kind of sad and disappointing.
00:26:32.880 --> 00:26:33.519
It is.
00:26:34.319 --> 00:26:49.759
Um, I wanted to pull in the symptom sets on this nutrition part because I think there are so many of the symptom sets that are involved with nutrition or that nutrition is involved with, right?
00:26:49.839 --> 00:26:51.920
So which ones did you really hone in on?
00:26:52.160 --> 00:26:53.920
So I think sleep and anxiety.
00:26:54.079 --> 00:26:56.480
Um, when I eat better, I sleep better.
00:26:56.640 --> 00:27:01.039
When I eat better, I feel better, and my anxiety level is definitely improved.
00:27:01.119 --> 00:27:03.279
And I think also because I'm sleeping better, right?
00:27:03.599 --> 00:27:03.920
Absolutely.
00:27:04.000 --> 00:27:06.240
Those things tie dramatically mental health and sleep.
00:27:06.480 --> 00:27:06.960
Yeah, yeah.
00:27:07.119 --> 00:27:14.240
And when I'm eating better, I'm more regular, I'm not constipated, I'm less gassy.
00:27:14.319 --> 00:27:18.640
And so, like, that also contributes to like feeling better when I'm sleeping.
00:27:18.799 --> 00:27:29.359
And I like again, sleep hygiene and like getting good sleep is so important to the rest of our bodily functions and the rest of our mental health, also.
00:27:29.680 --> 00:27:32.000
And so that is a big one for me.
00:27:32.240 --> 00:27:37.839
Um and then obviously the the weight gain part, right?
00:27:38.000 --> 00:27:54.960
So when and and I I don't sometimes I think that like am I so concerned with having a nutrient-dense diet that it's like kind of becoming a problem?
00:27:55.359 --> 00:27:59.519
Like, do I have yeah, or or is it like disordered eating, right?
00:27:59.920 --> 00:28:09.359
I don't think so because I think I'm too lazy for disordered eating, to be honest, but um, but I do think that there is like a slippery slope.
00:28:09.599 --> 00:28:10.000
Definitely.
00:28:10.640 --> 00:28:16.079
But when you're eating well, it makes it easier to maintain a normal weight.
00:28:16.160 --> 00:28:23.279
And that includes like not drinking a lot of alcohol and like setting um what's the word I'm looking for?
00:28:23.519 --> 00:28:25.359
Boundaries, boundaries, yeah, right?
00:28:25.519 --> 00:28:26.960
Boundaries and limits for yourself.
00:28:27.039 --> 00:28:29.200
So like during the week I don't drink alcohol.
00:28:29.599 --> 00:28:31.359
Friday doesn't count as a weekday.
00:28:31.599 --> 00:28:34.400
So like I did have a drink last night, right?
00:28:34.640 --> 00:28:36.319
And it doesn't have to be so restricted, yeah.
00:28:36.640 --> 00:28:37.279
Yeah, yeah.
00:28:37.440 --> 00:29:01.279
And like I do it that way because I sleep better that way, and so I'm trying to avoid waking up super groggy the next day, so back on sleep, but then nutrient-wise or nutrition-wise, I like trying really hard to meal prep on Sundays so that my week isn't all thinking about what do I eat tomorrow, what do I eat for lunch, what do I eat for dinner, because I have it all planned out, right?
00:29:01.440 --> 00:29:10.559
And that allows me to not have not have to have the brain space for all these annoying things that I would otherwise have to think about.
00:29:11.039 --> 00:29:14.079
Um I think that's a really big deal too, right?
00:29:14.160 --> 00:29:19.200
So that ties into weight, but also the um mood changes and that kind of thing.
00:29:19.440 --> 00:29:28.480
I don't know, I think everything is so tied together, and she does such a good job of breaking it up into um like approachable sets, right?
00:29:28.720 --> 00:29:30.880
But they're all tied in to each other.
00:29:31.200 --> 00:29:42.640
And you know, with like the stress level, you know, it's like if you I you know, it's for like this last week, I didn't get a chance to meal prep on Sunday, and I've ended up door dashing so many meals this week.
00:29:42.720 --> 00:29:56.880
And looking at my food budget this week, it was like literally stressing me out and creating more stress because I was like holy crying, I'm paying like$35 to have a salad door dashed when I could make that thing at home for seven dollars.
00:29:57.039 --> 00:30:07.599
Yeah, and that was creating anxiety and stress for me this week because I was literally door dashing so many meals and looking at how that was like affecting my food budget for the week.
00:30:07.680 --> 00:30:12.000
Yeah, and that was a really big stressor for me this week of like it was 11, you know, 11 a.m.
00:30:12.319 --> 00:30:14.079
What am I gonna have for lunch at noon?
00:30:14.160 --> 00:30:28.079
And having to make that decision and decide which thing I was gonna buy because like what's gonna be satisfying me the afternoon, I'll get have to get through an afternoon of clinic, but also what is like wallet-friendly, and that was a very big stressor in this last week.
00:30:28.240 --> 00:30:50.160
And I Dora Dash occasionally, like is like a treat sometimes, or like I just didn't get a chance to like have that food, but every day this week felt incredibly excessive, yeah, you know, and it's prepared food, which is not necessarily as clean, or it's probably gonna be like having a lot more, you know, unhealthy fats and stuff in it, which I'm recognizing, but also that was this week, yeah.
00:30:50.480 --> 00:31:01.039
But the disordered eating I think is really important because people, especially when we're kind of getting to perimenopause and menopause, we might be having a more difficult time managing our weight all of a sudden.
00:31:01.279 --> 00:31:03.839
And some people get so neurotic.
00:31:04.000 --> 00:31:23.519
And I have patients who are literally weighing themselves a couple of times a day, and they're so stressed about that that I think that it can become neurotic, and trying to educate people, you know, about eating, but then also like the next pillar of exercise, I think is really important.
00:31:23.759 --> 00:31:43.279
So people I'm seeing in here that this is an issue, most of them have some sort of orthopedic pain, and their weight management, healthy weight management definitely has part to do with that, but then also my patients who are maybe incontinent in realizing that that extra weight is like pushing down on their pelvic floor, yeah, and that this can be part of their continence issue.
00:31:43.519 --> 00:31:55.440
And over the last year, I experienced some of that myself where I was a little heavier like last winter after the fire and we stressed and everything, and my incontinence actually got uh markedly worse.
00:31:55.519 --> 00:32:16.720
I was having some overactive bladder things, I was definitely having some urge incontinence, and after losing just a few pounds, it actually improved dramatically, which I honestly didn't think that like that little bit of weight that I had to lose would make it so different, but it it did, and it was really a thing that I noticed and have talked to patients about too.
00:32:17.039 --> 00:32:26.240
Yeah, and I think that's a hard one to talk to patients about, especially when they're already feeling like self-conscious about their weight and what's um changing.
00:32:26.400 --> 00:32:28.319
Um, but it is a good point, right?
00:32:28.480 --> 00:32:43.119
So if you're having these new onset urinary symptoms, it may be because of the weight that you've put on, but it's not the only thing, and I hate, I really hate just focusing in on weight as the problem.
00:32:43.599 --> 00:33:04.160
Um, I like talking more about like feeling good in your skin and feeling more comfortable rather than like losing weight because I think especially for me, I um I don't know, over the last like six years have gained a lot of weight.
00:33:04.400 --> 00:33:11.680
Um and I used to be like 132 pounds soaking wet, right?
00:33:12.000 --> 00:33:16.799
And now I'm like 139, 140, 142.
00:33:17.039 --> 00:33:26.400
But I've also in the last two years have been working really hard to put muscle on, and um, so now I feel more like stable.
00:33:26.480 --> 00:33:37.279
I'm like probably 138, 136, um, but I'm more muscle than I used to be, which I feel like helps me feel good about myself.
00:33:37.359 --> 00:33:52.079
And like my clothes from whenever ago aren't fitting, um, and so I'm like getting rid of them slowly, but I don't feel like I don't look at myself and think like, oh well, my clothes don't fit, or this is too tight, and like I'm fat.
00:33:52.480 --> 00:34:06.400
It's more like that's just not who I am anymore, and I've put on a lot of muscle and I'm very strong, and I'm stronger than I was before, and I'm trying to think about it that way, and I'm trying to express to my patients that like maybe that's the goal.
00:34:06.480 --> 00:34:21.440
Maybe we're trying to be stronger and more more physically fit but physically balanced and flexible, and you know, our bones are healthier, and I don't I don't like to harp on weight.
00:34:21.679 --> 00:34:22.559
No, and same.
00:34:22.639 --> 00:34:24.559
Like, I don't recommend people get a scale.
00:34:25.280 --> 00:34:27.840
And I'm like the scale number doesn't matter.
00:34:27.920 --> 00:34:34.079
It's like more the body composition that matters, and having more lean muscle mass is gonna help your metabolism, which is only gonna help everything.
00:34:34.639 --> 00:34:41.760
Having more muscle, and that's gonna be and doing exercises that are loading your body are gonna help with that bone health over time.
00:34:42.000 --> 00:34:56.320
Avoid sarcopenia as you get older, which is like that muscle wasting, which the minute I hit menopause, it was like I that sarcopenia happened to me really fast, where all of a sudden I was like, I swear to god, I don't have triceps anymore, and my quads felt like they're gone.
00:34:56.480 --> 00:35:10.079
Yeah, just like those two areas in specific for me, I had to work really hard and I I continually have to work really hard at making sure that the diet stuff I'm working on, like my nutrition, is then doing something for me with exercise.
00:35:10.320 --> 00:35:10.719
Exactly.
00:35:10.880 --> 00:35:14.719
And also, like a couple weeks ago, I was in Florida or shelling.
00:35:14.800 --> 00:35:25.199
I'm that total nerd who like shells like crazy, and I was telling myself while I was shelling with like the mobility stuff, if I can't get my ass to the ground to pick up a shell, like I don't deserve to do this.
00:35:25.440 --> 00:35:34.960
And I know that some people like they can't bend down, they can't do it, and that's like something that is with that person, but my mobility is really important to me.
00:35:35.039 --> 00:35:40.320
So even just working on the strength, my ability to squat down, get up and down from the ground.
00:35:40.400 --> 00:35:44.000
And I see this a lot with patients where they no longer can get to the ground and back up.
00:35:44.159 --> 00:35:48.639
Yeah, and so something we work on because it can be part of their balance, their mobility, their strength.
00:35:48.719 --> 00:35:52.159
And I'm like, if you fall and you can't get up, we got a problem.
00:35:52.480 --> 00:35:54.800
And I don't want you having to get the button, yeah, right.
00:35:54.880 --> 00:35:57.280
I want you to be able to get yourself off the floor.
00:35:57.840 --> 00:36:02.480
So I think the mobility part's a big part of the you know, the exercise and that as well.
00:36:02.559 --> 00:36:05.280
And that's we kind of morphed into that topic, right?
00:36:05.519 --> 00:36:08.880
We didn't even talk about like the fact that this is another pillar, but it is really like the next one.
00:36:08.960 --> 00:36:17.679
It is so I think it's a super important one, and I was just thinking as you were talking about the shelling, which that's a new is that a verb?
00:36:17.920 --> 00:36:18.639
Yeah, shelling.
00:36:19.039 --> 00:36:20.800
They literally have shelling tours.
00:36:20.960 --> 00:36:21.519
Oh my god.
00:36:21.760 --> 00:36:26.960
And it's like a I have this dream of a retirement job of like being a part-time like shelling guide.
00:36:27.199 --> 00:36:30.400
I know this is so nerdy, but I have always been like a rock collector.
00:36:30.480 --> 00:36:33.280
I'm that person who hiking, I'm like picking up rocks and like.
00:36:33.760 --> 00:36:35.039
I think I want to go shelling with you.
00:36:35.360 --> 00:36:35.599
Do it.
00:36:36.159 --> 00:36:37.679
There's shelling tours.
00:36:37.920 --> 00:36:39.360
Yay! Wouldn't it be so fun?
00:36:39.519 --> 00:36:42.719
Honestly, it sounds kind of um whimsical.
00:36:42.960 --> 00:36:45.519
Yeah, it's really whimsical, it's very relaxing.
00:36:45.760 --> 00:36:55.519
And I never really understood the like endorphins people get from social media, but shelling, if I find something cool, the endorphins kick in and I am just a maniac.
00:36:56.079 --> 00:36:56.800
Just a maniac.
00:36:56.960 --> 00:37:02.480
It's my my girlfriends know I like when the ones I'm doing this with, like, I it's like once I stop, it's like can't stop, won't stop.
00:37:02.719 --> 00:37:05.599
Just you have to like physically remove me from the beach.
00:37:05.920 --> 00:37:06.480
From the shells.
00:37:06.639 --> 00:37:10.800
I you do, and like it's hard like because I'm constantly like looking back, being like, but there's more.
00:37:13.199 --> 00:37:19.199
Um what I was thinking was when you were saying you're bending down to get the shells, my mom.
00:37:20.079 --> 00:37:24.639
Um, she's she had me when she was 37.
00:37:24.880 --> 00:37:28.079
So she's a and I'm 41 now, so do the math.
00:37:28.320 --> 00:37:30.079
Um, don't tell her, I told you.
00:37:30.400 --> 00:37:39.360
Um she I was starting to notice a few years ago that when she would get up, she would throw her weight forward to get up off of a chair.
00:37:39.440 --> 00:37:42.559
And I was like, that that needs to change.
00:37:42.719 --> 00:37:42.880
Right.
00:37:43.039 --> 00:37:44.239
Like, why are you throwing yourself?
00:37:44.559 --> 00:37:46.400
First of all, that's a slippery slope.
00:37:46.480 --> 00:37:49.679
You're gonna end up face first in your coffee table if you keep doing that.
00:37:49.920 --> 00:37:54.159
But also, like, try to use your muscles to get yourself up.
00:37:54.320 --> 00:38:04.480
Don't use your momentum because if you keep doing that, eventually you're not gonna be able to, because eventually you're gonna be frail and you won't be able to throw yourself forward like that.
00:38:04.880 --> 00:38:09.519
That's actually a rule in here that you're not using momentum to get people up and you're not plopping when you go down.
00:38:09.679 --> 00:38:09.840
Yeah.
00:38:10.159 --> 00:38:12.800
And again, things people get so sick of hearing me do you.
00:38:12.880 --> 00:38:16.159
I'm like, no, no, we're gonna use our muscles to get out of the chair.
00:38:16.239 --> 00:38:17.519
And I see people doing that.
00:38:17.599 --> 00:38:26.239
Like, I will physically modify their seating surface to make it so that they can train that before they're sitting out something lower and softer because it's harder.
00:38:26.400 --> 00:38:26.559
Yeah.
00:38:26.800 --> 00:38:35.039
But like getting off the toilet, you know, getting off a low couch, you go to your daughter's house or her couch is squishy, yeah, you know, whatever it is, like that is really a good thing.
00:38:35.199 --> 00:38:36.159
It's super important.
00:38:36.480 --> 00:38:53.199
And then um also being able to do my trainer actually um really, really, I mean, I hate it when she makes me do this, but she makes me do like sit down and stand up on one leg until I can't do it anymore.
00:38:53.519 --> 00:38:57.360
And she started with like it was like a you know, the box thingy.
00:38:57.440 --> 00:38:57.760
Yep.
00:38:58.239 --> 00:39:13.039
At the highest one, we started there, and then slowly she was taking it to the lower one, and I was like, I hate this, but I know it's gonna be good for my future, and I'm gonna have the balance and the flexibility, and I'm gonna be, I'm not gonna be the one who can't get up.
00:39:13.199 --> 00:39:14.000
Absolutely, right?
00:39:14.239 --> 00:39:14.880
It's so important.
00:39:15.039 --> 00:39:29.599
It is, especially like when you have sustained injuries, which I know you have, you start really appreciating the fact of like I've had this disability and I had to work past it, yeah, and we're younger, but what if I had that disability as an older person?
00:39:29.760 --> 00:39:31.679
Yeah, I don't I don't want to have that either.
00:39:32.000 --> 00:39:42.559
Honestly, and it's it's um especially so I what she's referring to is that I broke both of my elbows last almost exactly a year ago.
00:39:42.800 --> 00:39:58.800
Um, and so for about I would say for six weeks, I basically couldn't do a lot of things that I was so used to doing because I couldn't flex all the way and I couldn't extend all the way, which now look at me.
00:39:59.039 --> 00:40:00.800
I know that's great progress.
00:40:01.119 --> 00:40:01.360
Like that.
00:40:02.239 --> 00:40:27.599
Um it took a long time, but um, but I couldn't do all the things I was used to doing, but I was still going to the trainer, and she, um, my trainer Krista, she was like, It's okay, we're just gonna pretend your arms don't exist right now because I was doing physical therapy at home, but we really were focusing on my lower body at that time and my core because I really needed them when I couldn't use my arms.
00:40:28.320 --> 00:40:44.880
And it was um a really challenging time, I'm not gonna lie, but um both mentally and physically, but like the fact that I had been exercising very regularly made it less of an issue for me, right?
00:40:44.960 --> 00:40:56.000
Like I first of all had a decent amount of muscle there already, and so building it back up once I was allowed to start using weights again.
00:40:56.159 --> 00:41:06.639
I mean, I started back at one pound and um I built up really quickly, and I'm I'm back at like 15-pound um bicep curls now.
00:41:06.800 --> 00:41:08.880
I honestly think there might be more than I can do.
00:41:09.119 --> 00:41:09.360
Right?
00:41:09.440 --> 00:41:32.559
I mean, it's not easy, and I can only do like my I get to exhaustion pretty quick, but um but yeah, I mean it took a really long time to get there, but I think because I had that stable background of I've been exercising at least twice, three times a week, very regularly for the last year and a half or so, I was able to recover so much quicker.
00:41:32.800 --> 00:41:34.320
So, I mean that's so important.
00:41:34.480 --> 00:41:37.199
And like one thing she one thing Dr.
00:41:37.280 --> 00:41:41.599
Hirsch talks about in this book is like prepare yourself, right?
00:41:42.079 --> 00:41:45.280
Get your body where you want it to be now.
00:41:45.599 --> 00:41:50.159
Don't wait until you're unable to function.
00:41:50.400 --> 00:41:50.559
Right.
00:41:50.719 --> 00:41:51.840
You can't go back very easily.
00:41:52.239 --> 00:42:01.519
It's so hard, it's so hard to fix what's not working rather than prevent that from being broken.
00:42:01.840 --> 00:42:02.480
Absolutely.
00:42:03.360 --> 00:42:03.840
Does that make sense?
00:42:04.079 --> 00:42:04.320
100%.
00:42:04.639 --> 00:42:11.280
And like this is something I talk to people about a lot is that you know, I could not have prevented myself from getting cancer.
00:42:11.360 --> 00:42:29.519
There's no way, but I got through it with more grace and ease than I think a lot of counterparts because I was so healthy and fit that when I started losing that, I started from here, so I had a like a lot more that I didn't get so far down, yeah.
00:42:29.679 --> 00:42:58.880
And again, having that stable base and like having that higher baseline, I didn't get as low, and also it just allowed me to have that mentality of like I can get this back, and I've been still working on getting it back at this point, but one of the you know, other things that was in the symptom sets was really talking about depression, anxiety, mental health, and I think exercise and this go really well together because for me, my exercise is part of my mental health management and stress and anxiety.
00:42:58.960 --> 00:43:11.199
I go and exercise in whatever form that is, and my current forms are powerlifting and hiking, and also daily walking of doc because that is a mental health walk for me as much as for him.
00:43:11.280 --> 00:43:26.639
Yeah, but you know, when we're having more of these potential, like you know, increased anxiety with hormone changes, and we're maybe having like some pre-existing things that maybe are feeling a little worse, you know, then I think it's really important to have tools.
00:43:26.800 --> 00:43:28.800
And for me, exercise is one of those tools.
00:43:28.960 --> 00:43:43.360
Yeah, I think you're totally right, and um that ties in as well, like if you're if you have an injury and your you know, mental health is definitely gonna suffer.
00:43:43.840 --> 00:43:51.280
Um you know, when I couldn't use my arms, I wasn't working for like three months, I I was sitting at home in excruciating pain.
00:43:51.360 --> 00:43:56.800
I was sleeping like 14 hours a day because I was in too much I mean, I my body was recovering, right?
00:43:57.119 --> 00:44:06.960
Um if I'd I didn't have my like twice a week workouts planned with my trainer, Krista.
00:44:07.679 --> 00:44:14.559
I I think I would have, I mean, I already was like probably situational depression, right?
00:44:14.880 --> 00:44:20.480
I wasn't in a full-blown depression because I had things to look forward to and I had that physical activity.
00:44:20.559 --> 00:44:21.840
I was walking a lot more.
00:44:22.079 --> 00:44:29.199
Once I was, once I got over the fear of like, what if I trip over something and fall in a can't catch myself because I have broken arms?
00:44:30.320 --> 00:44:43.599
Um, I started walking more, and so I was walking more, I was outside more, I was exercising regularly, and it I think it really prevented me from falling into like a I can't do anything depression.
00:44:44.079 --> 00:44:47.440
So it's more fan to our like the last of the pillars here.
00:44:47.679 --> 00:45:02.480
Okay, so the last pillar is the mental health pillar, which ties into every single symptom set and every single like person who is experiencing perimenopause and menopause.
00:45:02.639 --> 00:45:06.079
Because um, like let's go through the sets, right?
00:45:06.239 --> 00:45:21.360
Bleeding, uh, not being able to predict when your period's coming, being worried about you know, if you're prepared, it showing up out of the blue, unsuspecting, and then you have to worry about oh my gosh, am I bleeding through my pants at work?
00:45:21.599 --> 00:45:26.960
Um bleeding heavier than usual, not bleeding at all.
00:45:27.119 --> 00:45:30.480
Like this is all, I mean, all of that is so anxiety-inducing.
00:45:30.639 --> 00:45:31.119
Absolutely.
00:45:31.360 --> 00:45:31.679
Right?
00:45:31.920 --> 00:45:35.440
And and um, so that's the first symptom set, right?
00:45:35.679 --> 00:45:38.400
Sleep changes and anxiety, obviously, right?
00:45:38.559 --> 00:45:40.400
You're head to head.
00:45:40.559 --> 00:45:40.800
Yeah.
00:45:41.039 --> 00:45:50.719
If you're not sleeping well, um, you're not recovering well, your anxiety is increased, your depression is increased, your mood changes increase, um, right?
00:45:50.880 --> 00:45:53.840
And so that that almost seems like duh.
00:45:54.000 --> 00:45:54.639
Yeah, duh.
00:45:54.719 --> 00:46:01.440
But then a lot of people are then struggling with like low libido or like not having interest in sex, and like you're tired, right?
00:46:01.599 --> 00:46:02.800
And so that ties in.
00:46:02.960 --> 00:46:12.880
And then if you're having low libido, then you have more anxiety, more mental health issues because I might have a disappointed my partner, you know, there's the relationship ties, and that's anxiety-producing for a lot of people.
00:46:13.119 --> 00:46:14.000
And what's wrong with me?
00:46:14.079 --> 00:46:15.760
Why don't I feel the way I used to?
00:46:15.920 --> 00:46:18.239
What's you know, like that's a big deal.
00:46:18.480 --> 00:46:23.440
Um, and then it the next symptom set, fatigue energy, right?
00:46:23.599 --> 00:46:34.880
If you're fatigued all the time, if you're like just the this idea that you're not feeling like yourself, that is so anxiety-inducing, and that makes you some people spiral, right?
00:46:35.280 --> 00:46:37.679
Hello, yeah, for sure.
00:46:37.840 --> 00:46:44.079
And then on top of that, obviously the mood changes and brain fog, mood changes, mental health, right?
00:46:44.239 --> 00:46:49.039
If you're blowing up at your partner every time they like, I don't know, wash the dishes wrong.
00:46:49.199 --> 00:46:50.480
I'm guilty of that.
00:46:50.719 --> 00:46:51.760
Um, wrong.
00:46:51.920 --> 00:46:53.760
Like, what why why do I care?
00:46:53.920 --> 00:46:58.719
Just they're clean, but you did it weird, yeah, and I absolutely lose my mind.
00:47:00.159 --> 00:47:00.639
Right?
00:47:00.880 --> 00:47:03.519
You I feel like I have to apologize to my partner all the time for being a problem.
00:47:03.840 --> 00:47:04.480
All the time.
00:47:04.880 --> 00:47:05.519
All the time.
00:47:05.760 --> 00:47:08.320
I'm like, like mid-argument.
00:47:08.400 --> 00:47:16.400
I'm like, I realize this is unreasonable, and I'm probably just hormonal right now, but it feels really urgent to me.
00:47:16.480 --> 00:47:16.880
Yeah.
00:47:17.119 --> 00:47:19.920
A couple weeks ago, he's like, So is this what we're gonna be anxious about today?
00:47:20.000 --> 00:47:24.159
And I was like, Yes, it is, and like I probably sounded just like a gremlin.
00:47:24.239 --> 00:47:26.559
It's like, it is, this is the anxiety.
00:47:28.480 --> 00:47:50.239
Yeah, I mean, like, we're all guilty of it, but it's you know, it's part of these hormonal changes, and unfortunately, you know, it's a given, but luckily we both have partners that understand and are helpful, right, and not and then don't react.
00:47:50.320 --> 00:47:55.440
I think that's a big deal because if they were reacting, it would just spiral.
00:47:55.679 --> 00:47:55.840
Yeah.
00:47:56.079 --> 00:48:13.920
Well, and the perimenopause, like, I mean, uh, we were talking about earlier about how you can have these like loop events where you're essentially ovulating twice in a month and the bleeding that can come with it, and the PMS that can come with it, and like all of the like rage feelings and this mental health stuff that can happen, and people don't understand like why is this happening to me?
00:48:14.000 --> 00:48:16.159
Like, why am I essentially having PMS twice in a month?
00:48:16.239 --> 00:48:20.480
Yeah, you know, versus like I used to have it once, or like kind of the PMDD stuff as well.
00:48:21.039 --> 00:48:24.239
But and a lot of this is because that unpredictability of the estrogen.
00:48:24.400 --> 00:48:24.639
Yeah.
00:48:24.880 --> 00:48:33.039
Oh, and with that, you know, if someone goes on estrogen, does it help to like level them out from your perspective as a provider who is prescribing?
00:48:33.280 --> 00:48:42.000
So, yeah, so I think the benefit of going on estradiol is that you're not crashing as much as you were before.
00:48:42.079 --> 00:48:54.400
Your baseline is slightly higher, so you have this baseline that's kind of keeping you even keeled, so that when you do have those big drops, you're not dropping all the way to zero, right?
00:48:54.639 --> 00:48:58.480
So that's why it helps with hot flashes and night sweats, etc.
00:48:58.800 --> 00:49:06.159
Um, but also why it helps with anxiety because you're not having those, those, you're not bottoming out, yeah, right?
00:49:06.480 --> 00:49:19.440
Um, so yeah, it helps a lot with I mean, for my patients at least, um, a lot of their anxiety issues and even depression um and just overall mood.
00:49:19.519 --> 00:49:43.280
I mean, one of my patients actually I'm I just um remembered, I she came to me, she is a menopause provider, okay, and she came to me saying, like, I just noticed that I've been so much moodier and I've just been really down, and she's this bubbly, positive, happy, like everything is great woman all the time.
00:49:43.440 --> 00:49:46.480
So it was really strange to like see this change in her.
00:49:46.639 --> 00:49:46.880
Sure.
00:49:47.039 --> 00:49:55.280
Um, and I know her socially, so you know, she expressed to me like, I don't know what this is, but I think I'm perimenopausal.
00:49:55.360 --> 00:49:57.599
Her periods are still the same, they haven't changed yet.
00:49:57.840 --> 00:50:07.760
Not a lot of other things have really changed, but this one thing, um, and at first she thought it was situational, you know, like going through some things with her partner, with her family.
00:50:08.000 --> 00:50:15.840
But we put her on estrogen, and the next time I spoke with her, she was palpably a different person.
00:50:16.079 --> 00:50:18.239
She was like, I feel normal.
00:50:18.320 --> 00:50:20.960
I feel back to who I was six months ago.
00:50:21.199 --> 00:50:26.559
And it was such a relief for her because she was trying to figure out like what's going on.
00:50:26.719 --> 00:50:26.960
Right.
00:50:27.199 --> 00:50:37.679
It's such a scary thing to like suddenly have all these like thoughts and um you know, thought processes going on that you had never really experienced before.
00:50:37.840 --> 00:50:38.960
That's that's a lot.
00:50:39.199 --> 00:50:42.559
It's a lot, and that is really anxiety-producing and feeds into this mental health.
00:50:43.119 --> 00:50:45.760
I'd like to ask you, and I've got a couple questions about this.
00:50:46.000 --> 00:50:52.239
The role of progesterone for people with mental in mental health and also with sleep, what is your general thoughts on that?
00:50:52.559 --> 00:51:02.159
So I think progesterone can be so helpful for the people that tolerate it well for anxiety and sleep.
00:51:02.320 --> 00:51:02.639
Okay.
00:51:02.880 --> 00:51:06.480
So it um increases your GABA, right?
00:51:06.800 --> 00:51:11.920
It basically increases your calming neurotransmitters.
00:51:12.159 --> 00:51:22.400
Um and so taking it at night before bedtime helps kind of like bring you down, get you calm, get you ready to sleep, get you sleep, right?
00:51:22.800 --> 00:51:33.119
But then also overall, it's keeping you calmer, it's keeping your um uh like preventing you from going into these anxiety spirals.
00:51:33.199 --> 00:51:35.280
Um, but some a lot of people don't tolerate it.
00:51:35.440 --> 00:51:43.760
So let's talk about that because I got some questions about lack of tolerance and depression related to poor tolerance to progesterone in the last week.
00:51:43.920 --> 00:51:47.760
So, with those people, is it that they just don't tolerate progesterone?
00:51:47.840 --> 00:51:49.039
Did they need to change the form?
00:51:49.199 --> 00:51:51.440
Did they need to finish change the delivery system?
00:51:51.599 --> 00:51:55.519
Like, what is your recommendation for somebody who isn't tolerating it well?
00:51:55.920 --> 00:52:01.440
So when you're not what I do when someone's not tolerating it orally is I say put it in vaginally.
00:52:01.519 --> 00:52:01.679
Okay.
00:52:01.920 --> 00:52:06.159
Okay, so the same capsule, you just put it right up there.
00:52:06.400 --> 00:52:10.159
Then how does that change it, like in terms of like delivery that might be better?
00:52:11.199 --> 00:52:13.920
Well, it's bypassing the GI tract, right?
00:52:14.079 --> 00:52:22.239
So it's you're hopefully bypassing the nausea and like the upset stomach that a lot of people get, and is why they're not tolerating it.
00:52:22.719 --> 00:52:29.519
But it tends to lose that GABA activity when you're using it vaginally and you're not using it orally.
00:52:29.840 --> 00:52:34.320
So um, for some people, using it vaginally still helps with sleep.
00:52:34.480 --> 00:52:34.639
Okay.
00:52:34.880 --> 00:52:38.480
I have like a couple of patients that it still works fine for.
00:52:38.639 --> 00:52:48.800
Um, I have one patient actually who the capsule itself is really irritating to her, so she like takes it out of the capsule and puts it in.
00:52:49.360 --> 00:52:56.559
Um, and that she actually is sleeping really well, despite, you know, previously not.
00:52:56.880 --> 00:53:10.880
So um I think it's hit or miss, but when you change the formulation or when you change the route, you're technically not supposed to be getting the um the sleep and the anxiety relief that comes with oral mycronized progesterone.
00:53:11.119 --> 00:53:16.480
So, in that context, like what what do you do if you're also not tolerating it vaginally?
00:53:16.559 --> 00:53:22.159
Because some people still don't tolerate it vaginally either, is then you're thinking, okay, we we need to do a formulation change.
00:53:22.239 --> 00:53:34.400
We need to maybe try uh synthetic progesterone, which if the goal is protecting your endometrial lining, which most of the time it is, then fine.
00:53:34.559 --> 00:53:37.360
Like the other progestines do fine.
00:53:37.760 --> 00:53:40.239
And how are those formulated and how are they delivered?
00:53:40.480 --> 00:53:43.519
Okay, so uh there are a few different kinds, right?
00:53:43.599 --> 00:53:47.519
There's my favorite one, which um helps with bleeding also, which is the IUD.
00:53:47.599 --> 00:53:50.400
Okay, the Levonogester IUD somarina.
00:53:50.719 --> 00:53:54.719
Um, you can use it for five years and you don't, it's like a set it and forget it.
00:53:54.800 --> 00:53:55.039
Okay.
00:53:55.199 --> 00:53:56.559
What was that infomercial?
00:53:57.920 --> 00:53:58.880
Ronco Peel.
00:53:59.199 --> 00:54:00.719
It was my verse history chicken.
00:54:00.800 --> 00:54:04.719
I know exactly, I can literally see that commercial when you say that.
00:54:04.960 --> 00:54:06.239
Yep, set it and forget it.
00:54:06.320 --> 00:54:07.760
Um so that's really nice.
00:54:07.840 --> 00:54:14.880
Uh helps with bleeding, you know, helps with cramping if you're having more painful, more heavy periods.
00:54:15.440 --> 00:54:22.000
The other oral synthetics would be things like um uh agestin.
00:54:22.320 --> 00:54:22.639
Okay.
00:54:22.880 --> 00:54:25.920
Uh you could do northendrone acetate.
00:54:26.000 --> 00:54:28.639
Wait, is agestinorndrone acetate?
00:54:29.280 --> 00:54:30.239
I think yes.
00:54:30.559 --> 00:54:35.440
Remember how I told you there were like so many medications on my version of the menopause society test?
00:54:35.519 --> 00:54:35.840
Yeah.
00:54:36.079 --> 00:54:37.119
I I can't remember.
00:54:37.599 --> 00:54:39.679
I'm I'm pretty sure.
00:54:39.920 --> 00:54:41.280
And now I'm doubting myself.
00:54:41.440 --> 00:54:43.280
But there's also vera.
00:54:43.599 --> 00:54:43.760
Yeah.
00:54:43.920 --> 00:54:47.199
There's Provera, which is mandroxy progesterone acetate.
00:54:47.360 --> 00:54:56.719
Um, these also have some side effects, so it just depends on what your side effect profile or what your symptom profile is, too, right?
00:54:56.800 --> 00:55:06.000
So there's also SLIND, which is a Drosperinone oral contraceptive pill, which is helpful if you're also trying not to be pregnant, then you're perimetapausal.
00:55:06.159 --> 00:55:12.400
Um, but it does a really great job of blocking the androgens.
00:55:12.480 --> 00:55:15.440
So if you also have low libido, that might not be my first choice.
00:55:15.760 --> 00:55:18.480
So there's a lot of moving parts in this, right?
00:55:18.559 --> 00:55:28.880
So you have to think about what other symptoms the patient is having, what their goal is, why they need the progestin um in order to decide which one would work best for them.
00:55:29.119 --> 00:55:37.519
So even someone who might be experiencing negative mood changes in related relation to this, they could potentially try different forms and it might give them a better result.
00:55:37.840 --> 00:55:42.719
Yeah, I mean the mood, the mood changes part, I feel like estrogen does a better job with that.
00:55:42.960 --> 00:55:56.800
Um the anxiety often is a progesterone um or like a progesterone uh fact symptom, a low progesterone symptom.
00:55:57.039 --> 00:55:59.840
Um, but can be improved with estrogen.
00:55:59.920 --> 00:56:01.599
Also, it just depends on the person.
00:56:01.920 --> 00:56:07.920
And the the synthetic um progestins are generally not found to be helpful for the anxiety.
00:56:08.159 --> 00:56:08.400
Okay.
00:56:08.800 --> 00:56:13.360
And yeah, because that was the big question for me is like, what if it makes my depression worse?
00:56:13.679 --> 00:56:20.960
And I was like, honestly, I don't have a great I find that it's not super common to make your depression worse.
00:56:21.119 --> 00:56:23.440
And if it does, like, there are so many other options.
00:56:23.840 --> 00:56:32.559
And there's even if you're if the main reason you're on a progesterone or progestin is for your endometrial lining, you could also try duo-ovy, right?
00:56:33.199 --> 00:56:38.719
Dewey is also a really amazing option where you it you don't even need the progestin.
00:56:38.800 --> 00:56:41.039
Yeah, it just gives you a different option altogether.
00:56:41.599 --> 00:56:43.840
Oh, so back to like the symptoms.
00:56:43.920 --> 00:56:48.559
I'm sorry we did digress, but I wanted to kind of touch on that because that was a big question that was this last week.
00:56:48.800 --> 00:56:49.119
Of course.
00:56:49.360 --> 00:56:52.159
Let's go back to the other symptom sets where this is really impossible.
00:56:52.639 --> 00:56:53.360
That's what we were doing.
00:56:53.519 --> 00:56:56.000
That's what we were doing is how I die we made you digress.
00:56:56.239 --> 00:56:59.440
Well, I think the only one that's left is the weight gain, right?
00:56:59.679 --> 00:57:00.079
Yeah.
00:57:00.480 --> 00:57:05.360
And obviously, if you're struggling with body composition or body image, it's gonna affect your mental health.
00:57:05.440 --> 00:57:05.679
Yeah.
00:57:05.920 --> 00:57:12.159
Or if you're starting to get super neurotic, they keep, you know, and having neuroses about it, definitely gonna increase some anxiety and mental health.
00:57:12.480 --> 00:57:12.800
Yeah.
00:57:13.119 --> 00:57:21.679
So, you know, our mental health is related to every single thing that we do all day long.
00:57:22.639 --> 00:57:27.119
Or alternatively, everything that we do affects our mental health.
00:57:28.079 --> 00:57:31.280
Um, and one thing that I actually love that Dr.
00:57:31.360 --> 00:57:34.559
Hirsch talks about a lot in this book is CBT.
00:57:34.719 --> 00:57:36.400
Yeah, she talks about CBT a lot.
00:57:36.800 --> 00:57:37.360
She really does.
00:57:37.519 --> 00:57:42.239
And I have a lot of patients who have benefited a lot from CBTI and CBT A.
00:57:42.480 --> 00:58:01.599
So CBTI is for insomnia, okay, and CBT A is for anxiety, and um it it's really, really amazing how helpful CBT can be for patients who their primary issue is their mental block.
00:58:01.760 --> 00:58:02.159
Sure.
00:58:02.480 --> 00:58:03.039
Right?
00:58:03.280 --> 00:58:07.679
Um, and that's something that they had never experienced before, right?
00:58:07.760 --> 00:58:27.280
And it's like very tied into their perimenopausal mood changes and hormone changes, and so it's like a new experience, they don't know what to do, but CBT really helps you pinpoint what is putting that block in place and helps you find out how to get past it, and that's I think really interesting, and I love that she talks about it so much.
00:58:27.519 --> 00:58:27.920
Definitely.
00:58:28.159 --> 00:58:30.079
Can I ask, what do you do for your own mental health?
00:58:30.159 --> 00:58:34.639
Like, what are your mental health kind of activities?
00:58:34.800 --> 00:58:37.519
I mean, what are your things that you do to improve your own mental health?
00:58:37.760 --> 00:58:41.119
Um, I exercise is a big one for me.
00:58:41.199 --> 00:58:49.920
Um, and I and I joke with my trainer about this, but like I see her twice a week, which means I see her more often than I see most people.
00:58:50.480 --> 00:59:09.199
Um, and she is one of my favorite people, and we've developed this really fun relationship where we just have a great time and we just tell stories and make each other laugh, and so that's like a really uplifting, fun, you know, two hours of my week.
00:59:09.920 --> 00:59:11.760
How hard is it to do core work when you're laughing?
00:59:12.400 --> 00:59:12.800
Really hard.
00:59:12.960 --> 00:59:16.079
I swear my trainer makes me laugh in order to make my core work harder.
00:59:16.320 --> 00:59:20.239
I've like many a time fallen off the big ball.
00:59:20.960 --> 00:59:23.039
Yesterday was like crazy.
00:59:23.280 --> 00:59:26.239
Um, but so that's one big thing that I do.
00:59:26.480 --> 00:59:44.960
I also try to make sure that I eat well, and because when I'm eating well, I like feel so much better about myself, about my body image, about my um uh like overall, you know, well-being, but also um it just feels good, right?
00:59:45.039 --> 00:59:47.920
Like if I'm digesting well, I'm feeling better.
00:59:48.159 --> 00:59:58.960
So the third thing that you mentioned that you like to do for your mental health is so the third thing that I do for my mental health is I like to try to keep a gratitude journal, and actually this it's it's in here.
00:59:59.199 --> 01:00:01.360
I had just started this one fresh.
01:00:01.599 --> 01:00:04.880
Um and then it turned into, yeah, my friend got it for me.
01:00:05.039 --> 01:00:11.760
And it turned into like also um things for work, but it's hard not to do that.
01:00:12.000 --> 01:00:24.480
Yeah, and I try to uh like one page is labeled the my biggest take takeaways from this week, or my biggest takeaways from yesterday, or my biggest takeaways from uh, I don't know, things that stand out to me.
01:00:24.559 --> 01:00:38.800
So I like to do that at the end of the day, and it does a good job of wrapping up my um day, make it make it easier to um just put things away so I'm not just reeling, and then it's easier to fall asleep.
01:00:38.960 --> 01:00:39.440
I love that.
01:00:39.760 --> 01:00:50.239
One of the things I really liked in the book was her suggestion to do an audio gratitude journal so you could go back and listen to it, and I really might adopt that because she was saying you kind of like listen to yourself talk.
01:00:50.400 --> 01:00:53.519
It's almost like a little self-self-hypnosis, self-meditation.
01:00:53.679 --> 01:00:55.440
I thought that was really like a lovely idea.
01:00:55.599 --> 01:00:58.880
Yeah, and to hear yourself talk about your high points.
01:00:59.360 --> 01:01:03.119
So I feel like this is a really great place to wrap up this conversation.
01:01:03.440 --> 01:01:08.400
So before we close out for the day, could you just tell us where everyone can find you in your practice?
01:01:09.119 --> 01:01:09.840
Absolutely.
01:01:10.000 --> 01:01:16.320
Um, you can find me at my website, www.drtara now.com.
01:01:17.199 --> 01:01:26.960
Um and you know, there you can like read a little bit about me, you can click on the FAQs, and you can click to book an appointment if that's what you want to do.
01:01:27.119 --> 01:01:31.199
There's also my phone number and everything is on the website if you want to reach out to me.
01:01:31.440 --> 01:01:33.920
Um, I do discovery calls also.
01:01:34.079 --> 01:01:46.239
So, you know, if you're not sure if I'm the right fit for you, or if you just have some basic questions and you kind of want to get an idea of what I'm like as a clinician, um, that's an easy way to do it too.
01:01:47.280 --> 01:01:50.239
So, well, thank you for telling us everywhere we can find you.
01:01:50.400 --> 01:01:53.360
I think it's wonderful that you do those discovery calls too.
01:01:53.679 --> 01:01:58.480
And for everyone who's watching, I'd like to thank you for being here for another week of menopause inscripted.
01:01:58.800 --> 01:02:01.440
If you like this conversation between myself and Dr.
01:02:01.599 --> 01:02:03.760
Tara this week, please come back next week.
01:02:04.079 --> 01:02:06.400
You can follow us everywhere you find your podcasts.
01:02:06.719 --> 01:02:08.800
We really encourage you to like, follow, and subscribe.
01:02:08.880 --> 01:02:13.119
It really helps us to continue to bring this free educational content for you.
01:02:14.000 --> 01:02:15.519
After I said all of that, uh Dr.
01:02:15.679 --> 01:02:18.400
Tara, can you answer one final question for me?
01:02:19.039 --> 01:02:19.599
Absolutely.
01:02:20.800 --> 01:02:26.719
I just would like to know what is your daily health non-negotiable okay.
01:02:27.039 --> 01:02:33.519
So that one, I mean, I feel like I have a few of them, but let's just go with um movement.
01:02:33.679 --> 01:02:47.679
I try to at least do some form of movement every day, whether it's like an evening walk after dinner, or um, if I didn't get in a workout that day, which most days I don't, but I probably do about three times a week.
01:02:47.920 --> 01:02:58.800
But if I don't, I'll do like a set of push-ups or something like that just to make sure I'm doing something, some form of movement to to you know keep me on the move.
01:02:59.360 --> 01:02:59.920
I love that.
01:03:00.159 --> 01:03:03.039
Thank you so much, and thank you for being here another week.
01:03:03.360 --> 01:03:03.840
Thank you.
01:03:03.920 --> 01:03:05.519
I can't wait to come back.
01:03:06.400 --> 01:03:08.400
Now I have to end with the boring stuff.
01:03:08.559 --> 01:03:11.679
While I am a doctor, I am not your doctor.
01:03:12.320 --> 01:03:16.880
This podcast is for entertainment and educational purposes only.
01:03:17.280 --> 01:03:24.880
If something in today's episode resonated with you, please bring this to your own healthcare team and self-advocate.
01:03:25.039 --> 01:03:26.800
We always are promoting that.
01:03:27.039 --> 01:03:35.039
I cannot wait for you to join me on next week's episode of MetaPause Unscripted for another hot topic.