Headaches, volatile moods, irregular periods? These are just a few of the symptoms of perimenopause, which can start as early as 35. But it’s not all bad! Host Amelia Phillips and Endocrinologist Dr Rosie Worsley discuss the signs to look out for, how easy it is to manage them, and why so many women just don’t want to talk about it!
Below is an unedited transcript of the podcast episode:
For the last few months, like clockwork, I’ve been having these regular, horrible headaches. Plus I’ve been waking up in night sweats for just a couple of days each month. Now, at first I thought maybe it was my hot bedroom. Then I was thinking it’s my PJs or my sheets. Finally, after months of this, I went to see my gp who suggested it might be Perry Menopause.
What? I’m 42. There’s no way What? What is this? Perry Menopause . Then I learned that it can actually start from around the age of 35. I just wish I’d been more educated on the topic and I knew those symptoms to look out for.
This is healthy her with Amelia Phillips. If menopause is a topic you like me, are putting off until closer to age, say 51, which is the average age of menopause for Aussie women. And I assure you today we are not talking about menopause. We are talking about per menopause, which begins anywhere from age 35 to 45.
I think it’s really important for us moms to be educated on these early signs of perimenopause and feel reassured that nothing is wrong with us and that there are lots of options to help us manage any of the symptoms. Joining me to discuss this is Dr. Rosie Warley. An endocrinologist who specializes in women’s hormone health.
Dr. Rosie holds a PhD and her research on women’s hormone health has achieved multiple awards. She presents at seminars and is in clinic every week working with women and moms like us on their hormone health. Thank you for joining me today, Dr. Rosie. Ah, thanks so much for having me. Amelia. I think it’s so important to bring attention to these sort of aspects of women’s health cuz they really don’t get talked about enough and what you are describing.
Really common for women in their late thirties and early forties. We know that actually about one in five women in their early forties will get night sweats and hot flushes, which is something that women are really shocked about when they start experiencing themselves because it’s not really something.
We talk about it all. So if we talk about what is perimenopause itself, perimenopause is really a description for the years leading up to menopause. With menopause, meaning the last period you ever have your final menstrual period. And the average age of onset of perimenopause is about 47. And what really signifies the start of it is when your periods are starting to become irregular.
But it can occur much, much earlier, and it’s a prolonged process. It can go on for many years. But what I see a lot of women with is even before Perry Menopause, in the years leading up to it, when they’re still getting regular cycles already, they’re starting to get things like night sweats and hot flushes.
So they might be getting really bad PMs. They might start getting menstrual migraines. So this is technically called the late reproductive phase, but I like to call it the pre perimenopause. Because it’s exactly what it’s describing. Uh, Dr. Rosie, I need to talk to you researchers for a moment and say, Can we stop giving these such horrible names?
you mean Carrie Menopause? It’s like what researcher or scientists out there decided, Oh, we’ll just make it sound a bit better and put the word Perry in front of it. Can we think of some better names? Like, I don’t know. Wild Women on Top Common’s gone wild. I, all these names are just putting the fear of God in US Moms
I know it’s so, it’s really overly technical as well, and it’s something that happens to everyone and we should really have better language so that we can just sort of talk about it in a straightforward way. Uh, I know, and look, you spoke about the symptoms and I wanna kind of rattle those off. Sec. But before we jump into those symptoms, what is actually happening during that perimenopause stage or the, what was it, the final reproductive, What was that other name you said?
The late, The late reproductive stage. So that’s when you’re still having regular cycles, so you’re still ovulating every month, but there’s hormonal instability going on. Probably not getting as much hormone level as you normally would be, or as you would have when you were a bit younger when you’re in perimenopause.
You actually will have really irregular, um, ovulation. So it can be really erratic. Some months you won’t ovulate. Some months you will, some months you might double ovulate. Some months the ovulation will have been really early. Sometimes it’ll be late. It’s really, really unpredictable, which is why the symptoms can become really unpredictable as well.
Um, and why it can be really hard to sort of work out what’s going on because you might have say hot flashes every day for a couple of weeks and then nothing. For a few months. So then people start thinking, Oh, am I going mad? You know, what’s going on here? But it’s a really a sort of erratic function in the ovaries.
And basically what this whole process is, it’s the, the ovaries basically gradually coning out, so your eggs are running out and as you get less and less eggs, you get less and less hormones. And, um, by the time you reach your final, your last period, there’s basically no eggs left. And you are talking about progesterone, estrogen imbalances predominantly that are triggering these symptoms.
Yeah, you’re really talking about a lack of hormones overall. So after you’ve had menopause, you won’t have any progesterone essentially. You have a tiny bit of estrogen, but not much. But the problem. But one of the reasons why you get so many symptoms is because it’s not just a gradual decline in hormone levels.
The hormones sort of go a bit crazy. They go up, they go down, they go sideways. And it’s kind of like putting, I think of it like putting a person’s brain in a washing machine of hormones and it just sort of swishes them all around and it can really, um, you know, make people feel quite shocking. So it’s this sort of unpredictability in hormone levels that can make things very difficult.
Does having children affect it? If you’ve got two women, one’s never had children and one has, will they experience different symptoms or different onset of these? It’s actually not that well studied. Women who have children seem to have menopause a bit later, although that might just reflect the fact.
That women who haven’t had children haven’t been able to have children, and so perhaps their ovaries weren’t functioning as well. Right. I think that’s what, what is different these days is that often women are having menopausal symptoms when they’re still looking after young children or you know, fairly young children who are still at school.
You know, they’re not the classic empty nesters that people used to talk about in the past. So, Things, symptoms like irritability and things like that suddenly become really quite difficult to manage if you, you’re feeling really irritable and you’re also trying to manage like small children and that sort of thing.
So I, I think it’s more the context that women are in at the moment that can impact those symptoms. Oh, I’m hearing you a hundred percent. And if you listen to a lot of my o other episodes, there’s a common thread of this kind of mummy rage that I talk about in a few different episodes. And it’s amazing cuz I’ve spoken to so many guests and come at it from so many different angles, whether it be psychology or kinesiology or whatever, but.
I wanna talk about the mental health impacts of perimenopause because it was really reassuring for me to understand that these feelings I’m getting and it, and it just, I kept saying to Tim, my husband, I’m, This is just not me. Like, why am I raging at my beautiful children? So talk to me a little bit about the mental health.
Impact and some of those symptoms. And then we’ll get onto some of the other more physiological symptoms as well. And that’s exactly what women describe. They say, Look, something that used to not bother me, now I find intensely irritating, or I can’t let go of it. And irritability is one of the more classic symptoms, particularly early on it’ll happen.
Before the period, but as people go through, it might happen more regularly or at sort of erratic random times per menopause is also a time where women are at high risk of anxiety and depression as well. So there’s at least a two and a half times increase in the risk of depression. So it’s a real sort of full gamut of, um, potential mental health effects.
Obviously doesn’t affect everyone like that, but I think things. Irritability can become really difficult to manage, and often while people will end up seeing me or seeking help because the, the mum guilt basically kicks in and they, you know, they try to get treatment so they’re not sort of screaming at everyone all the time and they find it.
It is a really difficult symptom to manage and it’s really very biological and I think when you combine sort of this hormonal storm and then you also combine it with what’s a stressful situation anyway, so it’s pretty difficult to remain calm quite often with small children anyway, particularly if they’re going off and if you are having to manage sort of hormonal symptoms as well, that can be really quite difficult.
But as you say, it’s really, um, helpful to know, okay, each hormones, it’ll pass, you know. Yeah, and it’s unfortunate that it seems to happen at a stage in a mom’s life when she has got just the pressure cooker situation of the young children. Probably rapidly aging parents, probably career challenges, and let’s face this, if you’re still with your partner, you’re probably got their seven year.
Sure you’ve been there for a long time as well. So like you say, it is that kind of washing machine. So let’s talk about some of the other symptoms that if a mum’s listening to this today going, Oh, maybe I am in per menopause right now. You mentioned a regular cycles, whether they’re shorter or longer.
Mm-hmm. , uh, we’ve spoken about those. Irritability we’re spoken about hot flushes or night sweats that are occurring kind of in almost Yeah. Certain times of the month. Yeah. Or it can be erratic. What are some other symptoms that could be a sign of premenopause? Say one of the classic ones is vaginal dryness.
Oh, lovely. Okay. And so that Yeah, exactly. Dried up and we, Sorry ladies. So, and it can be something that’s there all the time. It might be something that, you know, you’re just finding you need a bit more loop than usual. Um, to that, that can really be quite wide ranging as well. Some women find that their libia overall is not what it was.
Mm-hmm. . There can be cognitive issues. So people starting to find, they’re finding it really difficult to remember things or they’re finding it harder to multitask, or they’re having to write a lot more lists than usual. Mm-hmm. , which again, is hard because as you say, women are often facing these things when they’ve got, they’re sort of that peak busyness in their whole life.
I think they’re trying to manage so many different things at the same time, and it puts a lot of pressure on them sort of physically and mentally. So then all these symptoms really. Come out. Sleep disturbance is a huge one as well. So it can be insomnia or some women get this sort of funny symptom where they, there’ll be a certain time in the morning, like 3:00 AM where every morning they wake up and they go, Oh, I’m awake now.
Yes. But they try to go back to sleep and they just can, Or you go back to sleep five minutes before the alarm goes off. That’s right. And they’re not necessarily worried or anything. They’re just awake. Hello? It’s very annoying. Yes, I get that too. Gosh, I’m ticking a lot of boxes here. Not the vaginal dryness, thank goodness.
But that’s a lot of the other boxes I have to, Oh look, there’s more. There’s more. Um, but there’s, Okay, keep going. Joint and muscle pain, it’s pretty common. Oh yeah. And the other one that I see all the time, menstrual migraine. So this can be women that have either never had migraine before, or they’ve had migraine in the past, but it’s sort of been fairly irregular.
They haven’t had it very often. Uh, whereas often in menopause you get this big flare up of migraine. Often it occurs just before your period, but sometimes it’s just over overall, you know, it’s, it’s a very common thing. So migraine and headaches are, are really common around this time as well. Is there any lifestyle factors that.
Bring on perimenopause sooner or anything we can kind of control that could influence it? Or is it really just look at your mum and that’s pretty much a sign of, you know, whenever she went through menopause, work backwards from there. Yeah, it’s mainly, look at your mum. There’s a couple of things. So smoking, you know, is bad for all tissues, including ovaries.
So if you smoke, that tends to bring it on earlier. We also know smokers are more likely to have severe hot flashes, and that’s because. Smoking the nicotine can affect the way that estrogen is metabolized in the liver. So they do effectively have less estrogen. So that’s a big one. Really ill health of any kind can affect it as well.
So if you are drinking very heavily, that’s not gonna be too helpful either. And then there’s been. Concerns around, you know, weight. So people who are very, very overweight might have worse symptoms, but we don’t know that it necessarily affects the timing of onset. Okay. And for the mums listening who are ticking a few boxes, like me and you went to see a gp, what are some of the more conventional treatments that a GP might offer or a specialist and endocrinologist such as yourself?
So there’s a few different things. For some people just knowing about it is enough because they know what to. They know that they’re okay, that they’ll get through it, that it’ll pass and that it’s not that they’ve got some terrible tumor or something like that. Yeah. Um, so sometimes reassurance is what people need, and then it really depends on what their specific symptom is.
So one of the really common treatments is actually the pill. Because the peel contains estrogen and progesterone, so it even out your hormone levels, and it also provides contraception because that’s one of the big traps around perimenopause is even though your period might not be regular, you can still get pregnant and we don’t reliably consider you to be not able to get pregnant.
Until you haven’t had a period for about 12 months. So, uh, that’s why the, the pill is often used for people who are, say, closer to 50 or over. You might be looking at something like an I T I T is essentially the pill, but in a lower dose, if people have really heavy bleeding, then you’d probably be looking at something like a marina i u d and that would treat the bleeding and provide contraception.
And then you could have something like an estrogen patch to help with hot flashes and symptoms like that. So, They’re sort of some of the really common treatments that you can have, particularly for people with really bad symptoms. Sometimes there are more specific treatments you need as well. So for things like menstrual migraine, hormone therapy can be helpful, but often really you need actual migraine treatments.
So medications that specifically treat migraine, they, they probably be a. Most common things.
Course. I know there’s been a bit of a bad stigma around HRT and it has been linked with some cancers in the past. Where are we at now with research? Is it okay to be using now? Have they advanced the technology in HRT therapy? Yeah, look, I think the HRT we use today is. Better than it was. So the old studies that showed a link with breast cancer, so that showed that if you’re on HRT for five years, you increase your breast cancer risk by say 30%.
So as an example, if your breast cancer risk is 6%, it’ll increase it up to 8%. So, um, it certainly does have that effect. The HRT that we have these days, we, we can use actual progesterone as opposed to the synthetic progesterones and the estrogen we use. Basically the same as your own estrogen. So we think that that’s likely to be much safer than the older versions, but we do still have to consider that they probably do increase the risk somewhat of things like breast cancer, there are positives as well, so you will get a reduction in the rate of osteoporosis and fractures.
There’s a reduction in endometrial cancer and a reduction in colon lung cancer. At the end of the day, it really depends on the individual person and what their risk factors are, and it’s really safe for some people and for other people. They really can’t take it at all. Right. And I mean, you were talking about over a five year period it might be something that mums might go on for a short period of time.
Yeah. Um, which reduces any risks quite significantly. Mm. The average duration is one to two years, and we know now that one year of HRT really doesn’t affect breast cancer risk at all. Which is really reassuring. I think the other thing to think about is that it’s essentially the same as the pill, but in a lower dose.
You know, people are on the pill for many years and you are not seeing the same change in breast cancer risk with the pill because you’re comparing to women who are having active menstrual cycles. So it’s really about who you’re comparing to as well. So a lot of it depends on your age and your overall risk factors in terms of what the risk for you personally will be.
And I think it’s important to. Recognize that HRT really does work as far as symptoms. Do you see it in the clinic? Ah, yeah. How a mom feels after going from zero to hrt. Her symptoms are alleviated. It’s incredible. I mean, it’s, it’s like a miracle sometimes really, because people can be really extremely debilitated.
They go on i t and they feel like a new woman, so, It doesn’t work that way for everyone, but when it works, you know, it works so well. On average, it reduces the hot flashes by about 80%. But I think where it really works as well is that it seems to really pick up people’s overall wellbeing. It can really help with that irritability and the mood type issues as well.
So I think you have to look at HRT in context and look at it. Person because often, you know, when you look just at breast cancer risk, you kind of, you know, forgetting the rest of the person. And I’ve certainly met women who’ve had to, you know, give up working because they’ve had what are essentially really bad menopausal symptoms and you put them on HRT and they’re able to function again.
So, you know, it’s very much about the individual and is it a right treatment for. Okay. And then for the moms like myself, who I don’t feel my symptoms are severe enough to go on rt, are there some lifestyle changes I could make or some traditional or complimentary medicine approaches I could take, such as neuropathy, eating estrogens.
Yeah, I think that some of the most important things really are about what? What’s going on overall in your life. So are there things you can delegate? You know, all those sort of simple things. Are there ways that you can get a bit more sleep? Because often, you know, these symptoms, they’re a bit like the straw that breaks the camels back sometimes, you know, you’re adding them on top of an already incredibly stressful life.
So if you’re able to address any of those things, I think it’s really. Full if there are jobs that perhaps you don’t need to be doing that someone else in the household could be doing, I think that’s really helpful as well. The other thing that’s really, um, sometimes comes into play is alcohol. So often women are starting to feel more anxious and they’re very stressed and they’re, you know, the alcohol they’re having in the evening tends to be creeping up.
So, You know, without meaning to, you’re having huge volumes of it and that that doesn’t help either. So cutting back on things like that, cutting back on smoking, all the usual kind of things. Eating well where you can. And there certainly are some herbs that do help as well. So things like black cohosh, red clover, they do have some benefit.
For some people. They tend to work, we think for about three or four months at a time, and then sometimes they’ll wear off, But you might only need. Relief for for a short while and then you can go off it and go on it again. So they’re probably the main things. What about evening primrose oil as an option?
It’s really good for breast tenderness, which is another common symptom, but it doesn’t seem to do much for other symptoms. Okay. And then including phytoestrogens in your diet and phytoestrogens being estrogens that occur in some. Such as soy products, they’re like SOS tofu, soy milk. You know, there’s foods like flax seeds, oats, barley.
Even. I think apples and carrots contain a little bit. Mm. When we eat these phytoestrogens, our bodies may respond as if our own estrogens were present. What are your thoughts on these as a method to reduce some of the severity of our symptoms? Well, look, there was. Sort of a lot of interest in this about, oh, 10, 15 years ago.
And I think unfortunately it hasn’t really panned out. Um, it doesn’t seem to have been as helpful as what we thought it might be, so I, I don’t tend to sort of promote that, cuz I think it’s a lot of effort compared to what benefit you might get from it. But I don’t think there’s any harm if, if people wanna.
Yeah, I was doing it just a second half of my month of my cycle, so from about day 15 onwards, just switching out, having soy milk in my teas and study of one, but it did help alleviate the sweats a little bit. Oh, that’s great. Yeah, and it wasn’t that, Much of a, a challenge for me to do. I think that people should go with something like that, which is, you know, it’s safe and it’s sensible and easy to do.
There’s no harm doing it, and it’s not like there’s going to be well designed, randomized, controlled trials that are gonna give you an answer to that anyway. No, of course. It’s all observational. Exactly. I think if you’ve got simple things that work for you, I certainly think that’s a good. Okay, so finally, for the moms listening, can you share any reassuring words that could help us reframe our attitude towards perimenopause and menopause to one, to more of admiration for the female body and for the life that it gives us.
Look, I personally, I’m quite looking forward to the other side of it. I think that women who are, women who are postmenopausal overall are actually much happier than premenopausal women and, but as women get older, they do tend to get wiser and happier and less anxious. So I think there’s. Quite a good lighter at the end of the tunnel and certainly not having periods and things would be very convenient.
Some people do have quite a rocky experience on the way to that other side, but there are treatments there if you need it to help you get through. But for most women, it’s not that bad. For most women, their symptoms are pretty manageable with things that they’re able to do themselves or things they can do at home.
So I think overall it’s a positive thing and I think it’s, We don’t really know why we, we have menopause. There’s not many animals that do, and it’s probably because I don’t wanna be 85 with a newborn. Thank you very much. That’s a very good reason. . Well, well, exactly. I think so, and it’s because of, I think, the vital role of grandmothers in our society.
And I think evolutionarily, grandmothers are really important. And I think when you have children and you, you know, if you’re lucky enough to have a good mother yourself, you know, you see how important the grandmothers are and you think, well, yeah, there’s probably a reason why, why evolutionarily, we have grandmothers and menopause is part of that.
So I. It’s a positive in that way, but yeah, that’s right. Nobody wants to have any more babies. Tuck that old, do . Well, moms just recognize the symptoms and know that you’re not going loopy. It’s just your hormones. Know that there are so many treatments out there, uh, lots of less scary options than jumping straight into hrt.
That may help. And I love, as you say, Dr. Rosie, it’s a phase that we go through and when we come out the other side, hallelujah. No more contraception. And yes, let’s face it, we don’t give a shit anymore and we can just own it. Own the matriarch that we become. So bring that on. Exactly. Yeah. . Dr. Rosie, thank you so much.
Thanks so much for having me. That was great.
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