SPEAKER_01 0:14

So imagine you're 49. You haven't had a period in about five years because you've got a Mirena coil, but suddenly you're waking up at three in the morning, you're exhausted, your moods are all over the place, and you're wondering what the heck is going on? Is it peramenopause? Have you already reached menopause or is it something else? You Google it and discover that menopause is confirmed after 12 months without a period. Well, that's helpful, right? Because you haven't had one for five years. So what if your periods are still regular, but you've got symptoms that sound suspiciously menopausal? Welcome back to Empower Your Menopause, the podcast all about health, happiness, and hormones for women 40 and beyond. I'm Julie Medacy.

SPEAKER_00 0:58

And I'm James Ellis.

SPEAKER_01 1:01

So today we're going to clear up a little bit of the confusion around paramenopause and the menopause transition. Talk about why it's not always easy to know exactly where you are in that stage of life and why getting the right support might be more important than getting that label right. We like labels, don't we? So, James, why is this something that sounds so straightforward but is actually really confusing for women?

SPEAKER_00 1:28

Well, I think first of all, Julie, the problem or one of the challenges is that people's definition of menopause tends to have varied somewhat outside of you know what we recognise as the clinical definition just then, which is what you mentioned is 12 months without a natural period, providing you're having periods, as you rightly said. Now, previously, people talked about the menopause, or in my mum's day, it was called the change of life, um as as like a multi-year, multifaceted period of a woman's life. And the truth is that that is what today we'd probably call the menopause transition. So, right, so from when a woman first starts noticing some symptoms that could be perceived to be menopausal, or some of those things that we talked about, you know, we had a podcast two, three weeks ago, I can't remember when it was, that was all about some of the different symptoms that people see and feel. But you know, things like hot flushes, things like that, they tend to start, and then obviously at some point woman stops having periods, and those symptoms tend to fade away, and then people think that that whole period there, which can be 10-15 years, is the menopause. Well, effectively, the menopause is that one day, is that 12 months after a woman's last natural period? Of course, the period before that would be considered perimenopause, effectively it means premenopause, and the period after that would be called postmenopause. Now, postmenopause is a period that lasts to the end of your life, right? So you're never kind of getting over it. You might not have the symptoms anymore, but some of the results of what happens to a woman physiologically due to the fall in estrogen, estrogen has a protective um effect over many, many different bodily functions, you know, uh brain health, bone health, uh, fat distribution, uh muscle atrophy. You know, estrogen protects against all those kind of things. So once uh oestrogen falls and declines and hits sort of like really low levels, there are some real pot uh uh potential challenges or increased risk factors to women's health. So you're always postmenopausal after that that day, even if the symptoms have gone. Perimenopause is something that has become somewhat the zeitgeist, I'd say, over the last maybe eight or ten years. It's really not only seeped into popular culture, see it all over the place, internet, you know, uh social media, etc. Whereby previously people didn't really call it that, but now it's kind of become like a more of an accepted term or a more widely used term. So people are talking about it all the time. I suppose to give people kind of a definition of what's going on there is you know, as a woman gets older, Mother Nature doesn't really want you to continue to procreate or have the ability to procreate later into life, yeah, like everything else, a human being has a life has a life cycle, right? And part of that life cycle is giving birth to new human beings, and part of that life cycle is then a steady decline until eventually, you know, like all life, we we pass away. And so the period leading up to that day where a woman can technically no longer procreate because she stopped having having periods, well that is where the challenges start, I guess the differences start. And really, what's happening there is your hormone levels are fluctuating massively. That doesn't necessarily mean that you can see that physically. So you like as you rightly said, you might still be having a period at this time, but you might be having what you'd consider to be an inverted commas menopausal symptoms, and therefore that can last for many many years, right up to the day of menopause and post-menopause, and most of those symptoms are powered by either that fluctuating estrogen and progesterone in the days or the years before the menopause transition, and then afterwards when when it bottoms out and it drops off, and that is why HRT is such a useful tool for women who choose choose to use it because it's putting some estrogen back into their body and therefore helping with some of those hormonal fluctuations. So, once again, menopause is final natural menstrual period, 12 months without one. There you are. Postmenopause is a stage following that. It's worthwhile saying that the average age of natural menopause in the UK, excuse me, and in most western countries, is about 51. So considerable variation in that, but that if you took an absolute average, but you really want to be looking at a range, it's somewhere between most women somewhere between 48, 55 around there, and uh those fluctuations in estrogen that are the things that cause many of the challenges, they can take place up to 10 years before the menopause transition. So that's a long time for a woman to be having symptoms, right? And then if you figure that those symptoms can continue after the day of menopause as well, you might be looking at like a 10, 12, 15 year period of a woman having the symptoms of menopause. And of course, the bigger challenge with this is that no one's individual, as we keep trying to say to people, and so every single woman in the world experiences it differently. Now, yes, you may have an obscure doppelganger who happens to map your symptoms who lives over in Timbook 2 often, but generally, women is very, very different how each woman experiences it. Some women will have no symptoms at all, some women will have a really high symptom load, and so I guess that is what leads to a lot of the confusion, it's terminology, it's people not knowing quite when it starts, when it ends, and the the fact that that that the menopause itself is actually the one day, and that's the sort of like central point around which everything else uh takes place.

SPEAKER_01 7:38

Yeah, and I I think a lot of women uh misunderstand as well because a lot of the women that we talk to personally um we talk about being uh menopause coaching specialists, and they say, Oh, I'm already through I'm already done with that, as if it just goes away. And uh I I think it's really important that women do understand that this is now you are in post-menopause until you know for the very rest of your life, and it's important to know that so that you can take care of your health appropriately. Yeah, yeah.

SPEAKER_00 8:09

It's interesting, isn't it? That so so because there has been so much, sorry, because there has been so much attention over the last yeah, when we first started co coaching women at this time of life, which is probably eight, nine years ago, we were probably the only people actually doing this kind of stuff. Now, you know, you yeah, you know, you can't throw a stone somewhere without hitting a menopause coach, right? Because there's there's so many people actually out there offering support, which are obviously a good thing because we want people to have as much choice as they as they can when it when it comes to this. Yeah, but I think that you're right, that that period, the post-menopause period, I think people tend to think that okay, you know, there you go. I'm five years, ten years past my last period, I'm five years past my last last hot flush. That is the end of things, and that might be the end of the if you like troublesome part of it, or the immediately apparent troublesome part of it, because naturally, you've got a woman walks into a room, she hot flushes, there's all kinds of things that come with that, you know, everything from embarrassment to confusion to to to panic to whatever it may be. That goes away and it feels like like that is a massive improvement. And of course it is an improvement because if if once it starts to once the symptoms start to wear off, it's a huge improvement on your quality of life from from previously. But I think the the important thing to recognize is that that post-menopausal period is probably never a time where you have needed to look after your body than you're during that time.

SPEAKER_01 9:42

Yeah, absolutely. And I can attest to that, that experience, the relief. But yeah, and that's when when other things really need to get your attention. But back to you know, talking about paramenopause. I mean, how do you know, like, say I'm somebody who hasn't had a period in in quite a few years because I'm using the Moraina coil or some other form of contraception? How am I supposed to know when I'm there, like when I've reached that point in my life?

SPEAKER_00 10:11

Well, I suppose nobody actually can pinpoint that exact answer for you, but what if and obviously we aren't doctors, right? But the the uh a doctor will look at a woman's symptom load to decide whether she is menopausal or not. And when I say menopausal, I mean within that whole menopause transition, at which point, if they feel it's necessary, they will offer usually hormone replacement therapy for them. But yeah, yeah, if you're on any kind of contraception, particularly the morenocoil, it's really, really almost impossible to notice, right? You know, the morena reduces or almost totally stops menstrual bleeding for some women, but that doesn't stop the menopause transition and other hormonal contraceptives, they also amass the change in menstrual patterns. So having no periods doesn't necessarily mean menopause has occurred, doesn't mean that it's not occurred. You've got to take into account all the factors that are going on, which is why a clinician will look at symptoms, age, medical history to provide the clues. And once again, you know, no doctor prescribes HRT based purely on the absence of periods, you know, it HRT will be based on what a symptom load or HRT prescription will be based on the symptom load that a woman is going through. So that's probably not terribly helpful, but but it does bring us on to the next section, which is yeah, does is there a test that you can do?

SPEAKER_01 11:57

Yeah, yeah, yeah. I mean, we we'd like to think that, wouldn't we?

SPEAKER_00 12:02

Well, everybody would, yeah. And yeah, there was a uh we did an episode a couple of weeks ago which has got a deep dive into testing around the menopause transition. And the truth is, is that unless you are experiencing symptoms super super early, so 45 and below, a doctor is unlikely to offer you any kind of blood test to confirm whether you're menopausal or not. Because without wanting to be too blunt about it, doctors see that as a waste of money. Because when your hormones can change from day to day, from week to week, from month to month, what your readings today might be when it comes to your hormone levels, they won't be the same in a week's time or two weeks' time or a day's time. So, you know, it it doesn't really offer a full clinical picture to people. So you know, uh it just it just doesn't give them a clear enough thing. And so the thing that they tend to test is coming something called follicle stimulating hormone. Follicle stimulating hormone is the hormone that is released that tells the womb to get ready to potentially accept fertilised egg, estrogen kicks up, and uh what follicle stimulating what happens with follicle stimulating hormone and why it could it can be used as a test for some women is that when it notices the there's a feedback loop, when it notices there's not enough estrogen being produced, it actually increases the the amount of follicle stimulating hormone. So it's the easiest hormone for people to test, but they they just won't use it routinely unless you're under 45 because it's not really giving them a useful clinical picture. And once you get past the actual day of menopause, providing you can tell when it is if you're having natural periods and you're not on contraception, there's no point in testing for it when you're 12 months past your last period because what's the point? Then we know that you've hit a clinical definition, right? So it's a doctor will always rely on clinical assessment and symptoms more often than single hormone results. So if you want to go into more detail on that, head back. It's actually five weeks. I've just looked at our show notes. Episode 98 Can You Test for Menopause? We've got a deep dive on that one. But I suppose the other thing that we should ask, and I'm gonna throw this one back to you, Julie, because I feel as I'm talking far too much today as a man and female perspective, is does it really matter if a woman can establish precisely when menopause occurred or not?

SPEAKER_01 14:46

Um, yeah, and I don't I don't really think I don't really think it matters as much as what's going on with our body, what's going on with our health, and what can we do about it? Because the ultimately the answers are pretty much the same thing, right? And one of the things that I think we we find is that after 40, we just blame everything on hormones. Yeah, right? My lids are all over the place, must be my hormones. I'm really fatigued, must be my hormones. I can't think straight or stay focused, must be my hormones.

SPEAKER_00 15:20

Yeah, and Devon's home weight, it must be my hormones as well.

SPEAKER_01 15:24

Oh yeah, yeah. Yeah, I've wanted to use that one more than once in my life. Um, you know, and and I appreciate that we're finally talking about menopause more openly, and even in the workplace now, which is really crucial. Um, but you know, we can't, we can't, it's like, you know, when when you have a hammer, all you see is a nail, right? We we need to take a step back and remember that there are a lot of other things that can be going on with our bodies, especially at this phase of life. We're very busy, we're working long hours, we've got families to take care of, we've got a lot of stress, we're constantly running and and we are behaving differently, our society is faster paced than it used to be a couple generations ago. So we might be experiencing things like fatigue or anxiety or changes to our sleep or not sleeping, um, weight changes, all of those things. And it's true that menopause can be part of the picture, it can be a big part of the picture, but it isn't necessarily the whole picture. So there could be other causes going on here. You know, we we could have, you know, there are a lot of women being diagnosed later in life with ADD or ADHD. There are a lot of women who are finally getting diagnosed with thyroid issues. Um, you know, there are so many different things that can be going on. Now, generally speaking, again, if you're reasonably healthy and you've got some of these symptoms, the answer is going to be more or less the same thing. It's going to be about lifestyle and managing uh your health based on whatever it is that you're experiencing. And as James said before, these symptoms are all different for different women. So we have to look at the whole picture because you're a whole person with a whole life, and it isn't just going on a diet, it isn't just um adding an exercise, it isn't just, you know, if you're overwhelmingly fatigued and not sleeping well, sticking in a heavy workout is not going to be a good thing, generally speaking, for your body. We have to look at what else is going on and what might be contributing. So we can't assume that absolutely everything is menopause, but we do also have to acknowledge that there are hormonal changes. And no, that doesn't mean your body is suddenly falling apart, right? This whole, this whole phase of life is a normal biological transition. We talk all the time with kids about puberty. We talk about women going into pregnancy and and childbearing and child rearing and child development. I mean, we focus so much on all these other stages of life, but menopause kind of gets, you know, set aside, even though we're talking about it more. There's a lot we still don't know. So, not wanting to be all gloom and doom, of course, we'd like to talk about what we can actually do about these things, because you know, you need you need to know that there's a light at the end of the tunnel, right?

SPEAKER_00 18:29

Yeah.

SPEAKER_01 18:29

Yeah, yeah. And that's not how we roll anyway, right?

SPEAKER_00 18:33

Yeah. So yeah, so let's talk about that then, right? So, you know, a woman is knows that she's somewhere in the menopause transition, she's not sleeping well, she's exhausted, she's starting to feel unlike herself. What is the starting point? What do you do about it first?

SPEAKER_01 18:50

Yeah, well, I I think the first thing is to get appropriate medical support, right? We want to make sure that if you're having uh severe, especially if you're having severe symptoms, but if there's something going on that's disrupting your life, your quality of life, your ability to function at work and day to day, you don't need to wait to confirm menopause or something else before you talk about your symptoms with your doctor. That's that's really important. Um there are plenty of options for you, like HRT, if that's appropriate, um, that may help you. Um, but but those those symptoms really do deserve some attention some attention. Um, especially if you're having these things before you turn 45, because those are that's not considered usual in the course of things. But we also need to look at the bigger picture, right? Because, like we said, these aren't glamorous or sexy things to think about, but improving our sleep, getting enough restful sleep, finding ways to do that, making sure we're getting the right nutrition. Um, you know, we we don't eat nutrients, right? We eat food. But what foods are you eating? What are you doing to support your physical body and your and your brain health? Getting enough physical activity, because with that dip in estrogen, if this is related to menopause and that menopause transition, that dip in estrogen is going to affect your bone mineral density and your muscle mass over the course of time. And that's our longevity. I don't want to say prescription, but that's our longevity formula, our independence formula is keeping up our strength and keeping our bone health good. Um, and you know, stress, of course, we always say it's the number one enemy of women in this phase of life. I mean, it's really the number one enemy for everybody, but we we need to learn how to manage those things. And yes, hormone changes can affect these things, but most of the time, as I said before, you're a whole person with a whole life. Not none of this stuff happens in isolation. So we need to look at the the bigger picture. Like I said, especially with strength training and that. And the other thing is, you know, what works for one person might not work for another. And just because something worked great for your sister, your girlfriend, or you know, some somebody you know through work doesn't necessarily mean that's the right thing for you specifically. So it's important to look at your individual, your individual help.

SPEAKER_00 21:21

A couple of points that I just want to add that you know, if you're looking the the medical support thing, which is which is really, really important to get appropriate medical support from a professional, one of the things that I noticed quite a bit is that when symptoms or potential symptoms start, or a woman is unsure about them, some women tend to have a reluctance to want to go and discuss that with their doctor because they see it as confirmation of them aging. And so that can be that can be a challenge from a mental point of view. You know, none of us want to think that we're getting old. To have something that could potentially be a marker that says you're getting old can be a tough thing to do. So that is quite a challenging thought process for some women, not all women, obviously, to go through. The other thing is if you feel as though something might be going on, so now talking to the listeners who might be in perimenopause, I would note down as much stuff as you can to take in to see your GP or your doctor. Because the more information they have, the better a clinical picture they can give to you. So, you know, there's loads of apps and things out there now. You want to do it old school, get a notebook, track things like symptoms, track things like how you're feeling, track things like your mood, you know, go in there fully informed and go in there with a view to what it is that you would like before you go in. So you can be really, really clear with your GP about what it is that you're looking for. Are you looking for confirmation? Are you looking for support? Are you looking for HRT? Are you anti-HRT and just want to go through a through a natural way? You know, when you go in to have that conversation with your GP, make sure that you've got an idea of what it is that you want from it, yeah, and go in with as much information as you want. So I think that's really, really important. And then, yeah, the bigger picture stuff, the problem is that most people find that all those things that you talked about, you know, sleep, nutrition, physical activity, and stress, A, quite boring, and B, quite a lot to take on all at the same time. Now, the boring stuff, I kind of get it, you know. I've lost count of the amount of women who say to me privately, can I have a bit of menopause advice? And I say, sure, you know, let's start off, you know, tell me about your life. Oh, so how stressed are you? And they almost glaze over because how stressed are you is not a com a question that they associate with being in the menopause transition. So yeah, I think we need to get past this idea of everything requires a quick fix that somebody can just give me a supplement or a nutritional pill or a diet stuff because it doesn't. Now, there's my second point on that would be yes, trying to look at sleep, nutrition, physical activity, stress, mindset, all those things ends up sounding like a full-time freaking job. Right? And that puts a lot of people off actually seeking advice. The key thing to think about or I would advise you to think about is you don't have to do all those things at once, right? Pick one yourself or speak to people who who can help you see the the uh trees from the woods about what might be A the thing that is bothering you the most and B the thing that is going to give you the biggest bang for your book. So if you are exhausted, we can help look for what the reasons behind that might be and maybe help you see patterns that you don't see see yourself. Of course, if you love doing the investigation and write mind maps and things like that and working it out, by all means you can do this kind of stuff yourself, but it is an area where where menopause coaches can come in, right? So we aren't saying here's another lengthy list of checklists, you know, improve your protein, eat three meals a day, slow down with your eating, make sure you've got good fats on your diet, make sure you've got APC and X mineral supplements, and you've got you know a teaspoon of magnesium every every day. It's too much. So you've got to think, try and work out what's what, rather than trying to change everything at once. And that is that is that tends to be what people find, you know, the boring stuff, and it's not exciting, but it's the stuff that actually works, which is why that's that's how we look at things, not a full checklist of things you might be doing, but looking at the one or two really meaningful priorities because that will make any change you want to make much more manageable. So, yeah, Julie, if a woman is overwhelmed by conflicting advice, where would you help her identify where to start?

SPEAKER_01 26:18

Well, I'd first of all, and you know, I would I would highly recommend talking to somebody like James or me or another coach or or somebody who understands this stuff, because sometimes it's hard to see what's actually going on until someone who's got a more objective view can can hear it all and put it into some kind of order. But but as you said, um just making an improvement in one area, just one area. And one of the things I love about this is that no, it's not sexy, no, it's not immediate, but it's it's it has a snowball effect. And when you can do something, I say, okay, I really need to work on my sleep. So that might be setting up a better sleep environment, you know, making sure the temperature's good, the you've got some blackout curtains, that you've got the right kind of covers. Maybe if you're having hot flushes and night sweats, you've got a change of pajamas easily accessible. Anything like that, you may find very well that just improving your sleep improves your moods, it improves your brain fog, it implowers your cravings, it helps you with your weight, it makes working out easier, your energies better. I mean, these things tend to flow across all of the different areas of your life. So don't think that by focusing on just one thing, you're only going to be touching on that one thing, right?

SPEAKER_00 27:45

And the other thing as well is that the effect of a change that you don't that you make, that you don't expect it to have that the wide, it can have wider ranging consequences than just that change. And it and it can be in a way that you don't even see at first. So a really typical one would be you know, a woman is not sleeping great, she has put on some weight, she's concerned about that weight gain. You know, something as simple as making sure you've got protein at every single meal can really help with that because it will help stabilize your blood sugar, then you're not snacking as much, then you can manage your appetite a little bit better because you're managing your appetite a little bit better, your um your weight is dropping because your blood sugar is more balanced, you're less prone to stress, you're probably better equipped for having a better night's sleep, so your sleep's gonna improve as well. So, something that starts off as a really basic nutritional intervention, which is just eat some bloody protein at every single meal, can have a really wide-ranging knock-off knock-on effect in other areas just beyond nutrition, precisely because all the bodily systems are so intertwined in the way that they work with each other.

SPEAKER_01 28:56

Yeah, a hundred percent. And I and I think that's one of the one of the really beautiful things about coaching, because things that you would never think of. You know, my hammer and nail, you know, example for most most women come to us, want to lose weight, and they've they're frustrated because they they struggle with it. But when we help them improve their sleep or add protein, something as simple as that that wouldn't necessarily connect logically, all of a sudden, all these different areas are improving, and they think, I never would have thought of that. Well, you know, because that's not what's being pushed at you on social media, and then the other thing is like a ping pong ball or a pinball machine, and you're bouncing back and forth between this advice and that advice. The more important thing here is consistency, and I don't mean consistency for a week. I mean try a two or three weeks or even a month of something and doing that consistently, which isn't perfect, you know, don't shoot for perfect, but maybe 80% of the time, and you're doing at least some of those things. It's a it's a gradual process, but when you get through it, you'll find you might look back and you know, like when you're in a standing in a queue and you think, oh, just I'm waiting forever and ever and ever, I'm never gonna get to the front. And you look behind you, you know, in front of you there are five people, and suddenly behind you there's a hundred people. It's like, oh yeah, I have come a long way, right?

SPEAKER_00 30:24

So let's just start wrapping a couple of things up, then, right? So three things to remember, I suppose, to bring this to a bit of an end. You know, perimenopause, menopause, postmenopause are three different stages of the wider menopause transition. The the boundaries aren't always as obvious as we would like them to be, right? Particularly if contraception is playing a part somewhere in that, or you're on the moreno coil, particularly for and another merenal coil can be used for other challenges as well. Um, you don't need to know exactly where you are to help or to seek help or to address your symptoms, right? You don't need to have gone X months without a period or whatever it is. As soon as you start feeling that something is not quite right, go and seek medical help about it or seek the help of a nutritionist coach, somebody who knows what they're talking about. And then finally, I think you know, I'm seeing an increasing amount of sort of like just generic menopause out-of-the-x plans out there, which you know don't aren't without their merits. Um, and lots of them have many, many merits, but really it's your individual health, your own symptoms and circumstances that matter much more, which is why trying to personalize an experience is much, much better. So, Julie, anything you want to say before we head off?

SPEAKER_01 31:48

Um yeah, I just wherever you are in this whole stage of life, you know, there's not, you don't have to tough it out. You're not gonna win some award for you know reaching a particular finish line or going, you know, going through the motions and and passing some kind of uh non-existent test.

SPEAKER_02 32:09

Yeah.

SPEAKER_01 32:09

Um but whatever it is, just just know that you deserve to feel listened to. And if you're not getting that from your doctor or your coach or your whoever else in your life you might be seeking help from, look, keep looking because you deserve to feel listened to, you deserve to know what your options are, and to get the support that makes sense because your quality of life is important. And this is again, this is lasting, gonna last you through the through the rest of your life, even after those major symptoms subside. So we want you to have the support you need so you have the quality of life you need, so you can live that long, fruitful life and be active and do all of those things that you've been waiting to do, you know, until that that someday.

unknown 32:58

Yeah.

SPEAKER_00 32:59

So we talked about all the different areas that can pan into a health plan for somebody in midlife or who's going through the menopause trap transition. If you're not sure quite where to start when it comes to that wider health picture and which one you might want to focus on first, we offer um something that Julie's put together which we think is quite clever. It's called the Midlife Health Check-in. So it's a quiz style format where you go onto our website, it's absolutely free, you answer some questions, and we will send you a report of where we think you probably need the most support and what might need you to turn your attention to. So you can find that at quiz.fabulousbeyond40.com. Now, if you're interested, I understand, appreciate rather that today's conversation has been a little bit more sort of like chatting through the issues and things. We've also put together a more structured blog um on perimenopause versus menopause. You can find that at fabulousbeyond40.com forward slash blog. We will put both of those links in the um in the show notes below so you can jump on them uh both obviously free. So quiz.fabulousbeyond40.com is one. The other one, fabulousbeyond40.com forward slash blog. So Julie, I think that's it for this week. I'm gonna let you sign off. I've talked enough for today.

SPEAKER_01 34:28

Yeah, um thank you for for sticking with us and thank you for being here. Make sure that you like and subscribe and share so we can get the word out to as many women as possible. And for now, we've been James and Julie from Fabulous Beyond 40, and we're here to remind you to stay strong and stay fabulous, and we'll see you next time.

SPEAKER_00 34:46

See you next time, guys. Cheers.