Ep 20: When Hormones Change, Relationships Change with Neha Kumar, LMFT

When relationships collide with perimenopause, even the strongest partnerships can face unexpected challenges. Hormonal shifts don't just affect the woman experiencing them—they ripple through her closest relationships, often creating confusion, conflict, and emotional distance that neither partner fully understands. 

What makes this transition especially difficult is the silence surrounding it, many women don't recognize what's happening until they're already questioning their relationships and feeling disconnected, while partners struggle to recognize the person they've built a life with.

In this episode, I'm joined by my sister Neha Kumar, a licensed marriage and family therapist with years of experience helping couples through major life transitions. Neha explains how perimenopause affects emotional well-being, communication patterns, and intimate relationships. She also shares how partners can support each other through emotional shifts, when to seek professional help, and why education and preparation might be the relationship-saving tools you never knew you needed.

References

The School of Essential Ingredients by Erica Bauermeister

Connect with Neha Kumar:

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Connect with me:

TikTok

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Eastside Menopause & Metabolism

Audio Stamps

01:00 - Dr. Patil-Sisodia is joined by sister Neha Kumar, LMFT, who shares her journey to becoming a licensed marriage and family therapist helping women through hormonal transitions.

03:10 - Neha reveals many of her relationship therapy patients struggle with perimenopause, often shortly after postpartum recovery.

05:14 - How hormonal changes during perimenopause and menopause affect a woman's emotional well-being and identity.

08:43 - Neha explains the common emotional and psychological challenges women face during constant hormonal transitions from childhood through menopause.

16:04 - Practical strategies for maintaining intimacy and managing emotional changes in relationships during menopause.

22:58 - Neha shares the biggest sources of conflict in marriages or partnerships she sees which are related to menopause.

26:27 -  How partners can better support each other through this transition even when they're not really fully aware of what's happening, and when to seek professional help.

33:55 - Neha offers her top piece of advice for couples navigating this life transition.

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:01

Welcome to the Reset Recharge podcast with your host, Dr. Komal Batia, a board certified endocrinologist, internist, and obesity medicine specialist. This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health. And recharge the conversations you are having with your healthcare providers. While I am a physician, this podcast is purely for educational purposes. No individualized medical advice is being given on this podcast. If you do find information that is helpful, please discuss it with your healthcare provider at your next visit. Hi everyone. Welcome back to Reset Recharge. Today we have a very special guest with us. I'm happy to introduce my sister, Neha Kumar, who is a licensed marriage and family therapist. I've known her her whole life and I'm just excited to be doing this episode with her. Welcome, Neha. Thank you. As we get started, can you talk a little bit about yourself and your background and how you got into marriage, family therapy? I'd love for our listeners to hear that.

Neha Kumar, LMFT 1:07

Yeah, absolutely. I have been a licensed marriage and family therapist since 2018. However, training starts a couple years before that when you're still doing your masters, and so I have had years of experience working with a variety of people, white demographic and initially fun fact, I thought I would get into. Movies, movie marketing, specifically the business of film. And then I spent a summer in India that was life changing where I spent half the summer interning in the film industry in Bollywood there, and then the second half of the summer volunteering in the slums. And that was really eyeopening. And I came away from that summer, still in love with movies and all things film related. However, I, there was a shift in me and I really wanted to start helping people and I. Ultimately went down that path a couple years after graduation, I was in advertising and then I decided to get my master's in clinical psychology and I've never looked back. Yeah.

Dr. Komal Patil-Sisodia 2:02

This is a second career for you. Yes. And I will say for all of our listeners, my sister is probably one of the most talented people I know. When I say triple threat, I mean it, not just in terms of what she can do on. Stage or in a production that is, film or television, just in terms of writing, acting, singing, dancing, actually quadruple threat. But then also just to be such an intelligent, well-read and, educated person in the space of marriage and family therapy. You really can do it all. I know you're my baby sister, but I've always just held a deep admiration for everything that you've accomplished so far.

Neha Kumar, LMFT 2:37

Well, thank you. Right back at you. You have been, my role model in addition to our middle sister since day one, but you were definitely, with the six year age difference, I saw a lot more of sort of what you did academically and watched you go off to college and then medical school and all those things. So you have been a, an inspiration for me my whole life. So

Dr. Komal Patil-Sisodia 2:56

well, thank

Neha Kumar, LMFT 2:56

you. Thank you.

Dr. Komal Patil-Sisodia 2:56

I love doing stuff with my sisters, so I know that's the best. And just as a teaser, I will have an episode with our middle sister coming out around TMJ and how that changes during menopause. But let's dig into relationships, which is why we're here today. And you

3:10

absolutely.

Dr. Komal Patil-Sisodia 3:11

You are the expert in that arena in my life. And I know I talk to a lot of, I talk to you about a lot of patients who are struggling with this. So in your practice, how often are you seeing couples struggling with relationship issues, especially when the woman is coming into perimenopause and menopause? How frequent is that?

Neha Kumar, LMFT 3:28

In my clinical practice, I have seen, I would say a good amount of. Patients who come in that are dealing with menopause, the bulk of my experience has been in primary mental health.

3:39

In

Neha Kumar, LMFT 3:40

the recovery field. So most people think recovery. They think substance abuse. Yeah. However, there is a movement that's been happening and it's just getting bigger and bigger for primary mental health issues. Severe depression, severe anxiety, PTSD, maybe substance abuse is secondary and co-occurring. But a lot of the women that I've seen who come in with severe anxiety and depression are dealing with perimenopause or menopause. And even. You know before that there's a lot of postpartum stuff and then that sort of feeds into some of the feelings that they experienced during perimenopause and menopause.

Dr. Komal Patil-Sisodia 4:15

Yeah. And with women having kids later nowadays Oh yeah. Perimenopause comes hot on the heels of postpartum. So I'm sure the, you're seeing the gap become shorter and shorter there.

Neha Kumar, LMFT 4:25

Yes, and it's a lot, it's a lot for women to have to navigate. I think at a baseline, being a woman comes with a lot of different obstacles and things that we have to overcome. And so working with clients who are coming and maybe have had postpartum or are experiencing it currently and don't really know how to deal with it, it has been very interesting. And then on top of that, maybe they've had postpartum. Just 10 years ago and now they're dealing with the perimenopause.'cause like you said, people are having Yeah. Children later and so they feel like they really can't catch a break.

4:58

Yeah. Things

Neha Kumar, LMFT 4:59

just, by the time their kids are old enough to sort of sit back and be like, okay, they're self-sufficient. Then they start experiencing a lot of the stuff that comes with the perimenopause. So it's a lot.

Dr. Komal Patil-Sisodia 5:07

Yeah, it is. And it can be so overwhelming, I think. Absolutely. So Neha, from a psychological standpoint, how do hormonal changes during perimenopause and menopause affect a woman's emotional wellbeing and identity?

Neha Kumar, LMFT 5:21

That is a great question. So as far as emotional wellbeing goes, I think when people, women start to experience perimenopause, they're thrown for a loop. First of all, a lot of people don't know what that is. I think that's fair. That's fair.

Dr. Komal Patil-Sisodia 5:35

Why we're doing

Neha Kumar, LMFT 5:35

this

Dr. Komal Patil-Sisodia 5:35

whole

Neha Kumar, LMFT 5:35

thing, right? Yeah, exactly. And I think this is actually a much larger issue because when it comes to any sort of female reproductive stage, whether that's puberty or prenatal stuff, a pregnancy postpartum. All of that stuff. Women, I feel like we don't really talk about it. I think in this country maybe it's a little bit more than some other cultures around the world, but in general, either it's not talked about or it is glamorized.

6:01

Yes. And

Neha Kumar, LMFT 6:02

so people have this. Either they don't know anything about it or they have this perception that, okay, it's gonna be great perimenopause. If you weren't my sister and I wasn't a therapist, I would not have been exposed to that word by now. Yeah. And that's really unfortunate because most women think, okay, I have, I'm gonna have my period, and then it's just gonna stop one day. Boom. And that's it. And that's not true. And perimenopause is the beginning of the end. It's. Like that transitional phase before it does stop. And that comes, as you know, with a lot of hormonal fluctuations, which unfortunately can lead to a lot of lack of emotional regulation or emotional dysregulation. And that's something that I think people need to be a little bit more sensitive and understanding of because it's not something that. A person can necessarily control. And I think there's a huge misconception around that. Whether it's your period or perimenopause or menopause. Just get it together, you know, this is gonna happen. This is a natural thing, so control your emotions. And that is, it's not, it's very difficult.

6:59

Yeah.

Neha Kumar, LMFT 7:00

And then, as far as identity is concerned, you go your whole life for the most part of it, most. People start their period around 12. It's getting younger and younger nowadays, that's a whole other episode because of environmental and whatever considerations there to all of a sudden have that sort of stop. It's a double edged sword because a lot of women are praying for the day that their period ends because it's not fun to have your period. And then on the other hand, it really. Is a part of our biological identity, whether or not you choose to have kids or whether or not you can have kids, whatever, what you choose to do with that reproductive stuff is obviously your own choice, however it is ingrained in you. And so when that stops, it's. Scary. It's saddening, it's disheartening. And so there's a lot that goes on. There's the emotional dysregulation and then there's the fears around losing identity. That's so well put.

Dr. Komal Patil-Sisodia 7:51

And I think to your point, we don't do a great job of educating women around perimenopause and menopause, but really about any of the hormonal changes that are occurring in their lifetime. I remember going through sex ed when I was a kid, and it was just. So glossed over. And that may be a generational thing because what I've seen my son and his classmates go through is very different. Maybe on the other end of spectrum, like maybe a little, a little much. Yeah. A lot of information that I don't know that they're fully equipped to handle. But I think the one thing that we really don't teach. Girls and young women. And women as they age is how many hormonal changes they will go through in their lifetime and how much that affects their emotional wellbeing and identity. So in your experience, what are some common emotional or psychological challenges that women do face during these transitions? Because. Everything is constantly changing. Really, if we look at it across the lifespan of a woman, to your point, there is, your childhood where things are pretty carefree, puberty, the reproductive years, and decisions around whether or not you want to or can have children.

8:59

Exactly.

Dr. Komal Patil-Sisodia 9:00

And then perimenopause, menopause, and post menopause. And so it's like constant shifts. It's. The only constant that we really have is change as women

Neha Kumar, LMFT 9:09

I know, and yet we live in a society that's so structured and by the book, and it doesn't really matter how you're feeling one day, it's you've gotta get this done and if it doesn't get done, no one else is gonna do it. And so I think it's when you're going through those huge hormonal shifts, sometimes it's just hard to function at a baseline. And then. You have to think about, okay your work outside the home. You work inside the home, your children, whatever it might be. We all have a million different responsibilities. And so from an emotional standpoint, again, that dysregulation comes in. There's just so many stressors. And then the life in general, and then the added anxiety and feelings around my body is changing. My moods are changing. I can't control this. I think. It goes for anybody that if they feel a lack of control around something that is very anxiety inducing. And so what I have seen in my professional practice is women who are going through perimenopause in particular, where the periods are totally irregular and the hormones are all over the place. Becomes sort of a game of, okay, how do I get through each day? Yeah. And I think we tend to have a very macro view of things of okay, if I accomplish this, this, and this each month, then that's great. But with these changes in our cycles as women, we almost have to look at it as a day-to-day thing. And I think when we do that, we set ourselves up for success as opposed to failure. Because if we look at things from a macro lens, it can be very overwhelming. And so emotionally, the anxiety and then it can also cause just depression just due to the hormonal shift psychologically you might start questioning, when you're really highly vulnerable and sensitive. Yeah. Sometimes you question choices you've made or what you're doing now or it's your life's trajectory. And so it can we, I feel like women, we are reborn. Yeah. Yeah. You know, multiple times throughout our lives. Yes. Slightly that

Dr. Komal Patil-Sisodia 10:59

we counted already.

Neha Kumar, LMFT 11:00

Exactly. Exactly. And so with these rebirths comes, obviously the growth, but growth generally doesn't happen. They call it growing pains for a reason. It's not just physical, it's emotional. And so I would say emotionally and psychologically, there's a wide span of things I have. And that's not to say that everybody who goes through perimenopause is going to be anxious, is going to be depressed, is going to be dysregulated. That is not, that is fairly common. However, I've worked with people who like. I didn't have postpartum. I was, I was blissed out after I had a kid, or, yeah. The transition to menopause was whatever. Yeah. You know, it's kind of all over the board.

Dr. Komal Patil-Sisodia 11:35

Yeah. And I think that's what makes it so hard too, right? To find community in these experiences because everybody's experience is so vastly different. Absolutely. From one person to another. One of the things that I see in my practice with other hormonal conditions, I'll use thyroid as an example. It is a well known fact that when your thyroid function is off, if you have underlying anxiety or depression, it can get significantly worse. And that becomes. Part of the workup that we do to check up on those patients. Yeah. I imagine it's much the same with perimenopause and menopause. If there is an existing predisposition to to depression or anxiety, I can imagine that has the potential to get significantly worse. Yeah, and even if. You don't have those diagnoses, the hormonal shifts can cause that Absolute, absolutely. You loved what you were saying about Rebirth. Did I ever give you a copy of that book? The School of Essential Ingredients? Yes. I loved it.

Neha Kumar, LMFT 12:29

It was so good.

Dr. Komal Patil-Sisodia 12:30

It's such a good book. Right? And I think I've talked about this in another podcast episode. But that one passage where the woman talks about her pregnancy and how she feels everything inside of her shifting, but externally, she looks the same to everybody else in her life. Yes. And they expect her to behave the same and act the same and she gives birth and she feels like her former self shatters into a thousand pieces and she has to like quickly put them together'cause she's got this new life to take care of. To me that is just. I have not found a better description of what it means to be a woman, especially through all of these different life stages. So, shout out to Erica Bauermeister. That was a powerful passage. I've talked about it for years now. No, you have,

Neha Kumar, LMFT 13:14

but it helped me. Because you sent that to me when I was going through my postpartum depression with my Leila. Yeah, I remember. And I remember just feeling so hopeless and so, yeah, I mean, hopeless is probably the best word to describe it. I couldn't see the light at the end of the tunnel. And I think when we are talking about all of these rebirths and these hormonal shifts, it can be really hard to feel a sense of comfort if you don't know that there's an end in sight.

13:39

Absolutely,

Neha Kumar, LMFT 13:40

And also because we, like I said, you know, we both agreed, we just, don't talk about these things and it can become this sort of like silent secret that some people know about and some people don't. And then you experience it and then it's just, it can be really difficult. And I'm. I'm also glad that you brought up the testing and how hormonal levels can exacerbate existing depression symptoms. Because a lot of times when I've seen clients who are have TRD, which is treatment resistant depression, there's many different ways to navigate that. Sometimes I've had clients come to me and say, you know, I have tried, eCTI have tried every antidepressant under the sun. I've tried this, I've tried that. I've tried this, I've tried that. One of the things that we do ask them is, medically speaking, have you had, oh, your labs done? Have you checked your hormone levels? Yeah. And sometimes they're like, no. And then they get that taken care of and they're like, oh my God, this was actually like a biological, physiological thing. Sometimes it's not. Sometimes it's a personality disorder, but sometimes it's hormones.

Dr. Komal Patil-Sisodia 14:38

Yeah. It's funny, I actually just had a patient message me this week and a younger person who, maybe late thirties, maybe around your age, that had been on an antidepressants since their, since giving birth to their child because they were having hot. Flashes and anxiety and all of these different symptoms and we talked a bit about perimenopause and the fact that they come from an ethnic group that goes through perimenopause and menopause a little earlier. So we discussed maybe starting a low dose of an estrogen patch because they had an IUD in place and okay, they texted me and said, my gosh, I have not needed. I tapered off my Effexor and I have not needed to restart it since I started on my estradiol patch, which is right. So sometimes that can help. I've had some patients where, they keep escalating the dose of their SSRI, which is a class of depression and anxiety medications. But then they add the hormone replacement therapy and they can actually come down on those doses. Because they find that they don't need quite as much that so they can work in tandem together. Sometimes you can see an improvement where you may not even need some of those meds if there's no underlying history of anxiety or depression already. So to me, that is just mind blowing that I know we can see that much of a difference for people. So going back to our earlier conversation about women just not being educated on. All of these things about themselves and then feeling hopeless, feeling overwhelmed, and not knowing how to navigate it. If we're not getting educated, our partners are not getting educated. I mean, that's the big gap that's there. So how do you see that these changes manifest? In communication patterns, intimacy or conflict resolution between partners. Because if the person who's going through it doesn't know, the assumption is that their partner doesn't know, and I can imagine that just is like grounds for miscommunication all over the place. Yeah.

Neha Kumar, LMFT 16:32

Well, yes, and you're, you hit the nail on the head because what happens with any sort of emotional dysregulation in a relationship is. The other person has to sort of, it kind of balance it out. If you go through periods of, getting along fine, things are great, and then all of a sudden one person becomes sort of volatile or really emotional or really sensitive, the other person is going to. Wonder what happened. The good news is that if you've been with this person for a long time and and you have made it to the stage where you're hitting perimenopause, then chances are you have fairly decent communication. Because that's number one. I would say that is, a huge factor in couples being able to navigate any sort of challenge. But when it comes to perimenopause in particular, there's one person that's going through this intense. Hormonal mood, emotional, psychological shift. The other person needs to be able to step in and be really understanding and be really compassionate and empathetic as opposed to impatient or irritable or, then have a really volatile reaction to their partner's volatility. So I think the biggest thing is communicating, but you're right, if a woman doesn't really know what's going on with her, then her partner's not gonna know. So I would highly recommend that women really start researching. The stages that they're gonna go through. And in addition to that, talking to friends and family, to the extent that they feel comfortable about what their experience has been. Because the more we connect with each other and hear each other's narratives and stories, and this is I'm a huge believer in this, the easier it is. To get through these struggles. One you have a sense of community, you realize you're not alone. Two you learn, you know about, you learn coping skills from other people. And so in doing this research, in connecting with others who have been through this, women can really learn what it's. What that, that stage is going to be like, and they can share that with their partners and say, look, this is coming up. And so if, be prepared, be prepared. You know, preparation is key. And it's so interesting because I was thinking about this. Yeah. And we have like a big recital or a big match or a big anything. Yeah. We know it's coming up and we practice, right? Like we prepare. That's true. Prepare, prepare, prepare. And I think in general when it comes to healthcare, especially in this country, there is, it's a lot of reactionary stuff. Yeah. I think people are really, in the last five, 10 years, people have started getting into the proactive preventative stuff, which I think is wonderful, but we're not quite there yet with women's health.

18:59

Yeah,

Neha Kumar, LMFT 19:00

and I don't think this is due to lack of interest or laziness. I think that we're so busy, and this is another podcast episode, but in reality it's like times have changed. Yeah. We are expected to manage the home and the kids and work outside of the homes. We're so busy. I would imagine somebody who's like. I don't know. 48. They have three kids. They're driving around to games. They're doing the school drop off. They're going to work, they're making sure they're meeting their corporate deadlines. Oh, what's for dinner? Gotta figure that out. Got a meal prep. You skip your period one month and you start feeling slightly irritable. The last thing on your to-do list is go to your doctor. Yeah. Or even make an appoint. Or it's, it might be like a fleeting second of a consideration, and then that's it because you. Because you're too busy and we do tend to put ourselves last.

Dr. Komal Patil-Sisodia 19:41

Yeah. And there's an access issue in healthcare. Right, exactly. So it's not even like you're gonna get that appointment as quickly as you want it. Absolutely. That is really tough. Let's move on to some other questions that I've had, as women are experiencing changes in libido, physical changes like vaginal dryness or pain with intercourse. During menopause, how can couples navigate this while still maintaining a fulfilling, intimate relationship? Yeah, because they're already having difficulty communicating on this other front and so that the advice of preparation is great. This is a whole other ball of wax, I think it is.

Neha Kumar, LMFT 20:15

Yeah. Absolutely. And that's a really good question. I think a lot of it is reframing,

20:21

mm-hmm.

Neha Kumar, LMFT 20:21

Intimacy. And I'm not saying that you need to just not have sex and be okay with it, I think, but you have to be okay with there being a period of time while you're figuring things out. There's vaginal dryness and then there's like emotional dryness, right? Like some women might not just be psychologically or emotionally wanna get down. Yeah. You know, it's like, I don't feel well. I feel like I wanna rip your head off and you're. Trying to be, sexually intimate. There's the physiological, like, I literally can't do this. My body is not primed. And yeah, ready for you. But then there's also the emotional side of it. So I think whether it's one of those or both of those, the communication is key in. Spouses talking to each other and saying, look, this is, excuse the pun, a little bit of a dry spell, and we need to figure that out. It doesn't mean that it's going to last forever, but when you are in a healthy relationship, that shouldn't be a make or break. But if it's something that's very important to each of you, then to be able to go to a doctor and support each other in that. I think is key for a husband to say, why don't we go see, you can see a sex therapist, you can see a doctor such as yourself if you're trying to get medication to help with your sex life for your, physiological issues. But I think reframing intimacy and finding other ways to be intimate until you guys can figure out how you can get back to what your sexual baseline was.

Dr. Komal Patil-Sisodia 21:42

That's great. You did talk about the misconceptions a little bit, right? The misconceptions around sex has to happen x number of times a week or Yeah. Whatever, in order for it to be fulfilling. Yeah. I love the concept that that baseline is different for everyone. Totally. I. How do you encourage people to talk to their partners about that?

Neha Kumar, LMFT 22:01

I think just very openly and honestly, and setting aside time for it, no partner wants to feel like, okay, after a full day of work and dinner and bedtime and all of the things that they're, being bombarded with this, but say, Hey, this is something that's going on. I would really love to be able to talk about it openly, maybe after the kids go to bed and sit down and just be very honest and even a lot of times I've found that mentioning the elephant in the room at the beginning of the conversation in terms of. What the issue is or how they might react. Like, I don't know if you're gonna get upset or if you're gonna get defensive or whatever it might be, but actually that lowers their chances of getting upset and defensive if you just sort of call out. That's try to

22:38

do.

Neha Kumar, LMFT 22:39

Yeah. If you just say, it would be nice if we could have this conversation, without, too many emotions, so setting aside time, setting a framework for the conversation in terms of what it's about and being able to communicate effectively is really huge.

Dr. Komal Patil-Sisodia 22:51

That's really great. So in your experience, what are some of the biggest sources of conflict in marriages or partnerships that you see related to menopause? I

Neha Kumar, LMFT 23:00

would say first and foremost it's the emotional dysregulation. All marriages go through dry spells when it comes to sex, and so it's, I've, I have never met a couple that's just got married at 25 and they've just been going at it ever since. Irrespective of kids or whatever, I don't think that exists. That's like a unicorn that, that, you know, just, it's not real. That's like the romance book relationships, right. Yeah, exactly. Right, exactly. Especially the Regency romance, you know? Bridgeton. Yeah. But, I think, most couples that have reached that point in their marriage can get through a sexual dry spell. I think it's the emotional side. Most, most, like I said, since most couples have already experienced that, they tend to lean on their partner emotionally more so, and like for the companionship and the emotional intimacy. And the friendship and the laughter. And then when one partner is all of a sudden really emotional or sensitive or sad or angry or whatever it might be, it can be really hard for the other partner to, okay. It's like, well, this is what our anchor was, right? Yeah. And then that anchor is gone and they just feel like they're drifting off and drifting apart. And so that is probably one of the biggest challenges.

24:08

Yeah. The emotional dry spell and all this is

Neha Kumar, LMFT 24:11

the emotional dry spell of one person feeling like the other one is just flying off the handle and they're being pushed away. Or they're not being pushed away, but they're like, I don't wanna be around you at all. Have you seen that? Everybody loves Raymond episode. It's where deborah's on her period, and Ray just does not know how to handle it. It's so funny. Yeah. That show. That show is a classic. I love that show. Yeah.

Dr. Komal Patil-Sisodia 24:33

But yes, it's very difficult to work through some of that. I was actually reading an interesting stat

24:39

mm-hmm.

Dr. Komal Patil-Sisodia 24:39

When I was putting together one of my prior podcast episodes that I. I think up to 50 to 60% of divorces in the age range past 40 Yeah. Are initiated by women.

Neha Kumar, LMFT 24:52

Isn't that crazy? That's so interesting.

Dr. Komal Patil-Sisodia 24:54

Yeah. And the data was. Basically inferring that this perimenopause, menopause period, because it's causing so much emotional dysregulation and probably leading to, the, both the emotional and sexual dry spells, right? I how many relationships become untenable because people cannot necessarily communicate that and it leads to the dissolution of these marriages or these partnerships. Absolutely. Yeah. It's higher than we think it is.

Neha Kumar, LMFT 25:21

Yeah, I think there's also a. Probably like a more in depth conversation there too, because there's the untenable side of one person becoming emotionally dysregulated. Yeah. But then I think from a biological perspective, if I remember, the first thing I learned in biology is we are here to procreate, right? Yes. And so if a woman is done with that era of her life, she's having all of these emotions, she's probably also having a lot of. Epiphanies. Yeah. I'm not gonna call it a midlife crisis because I, this is part of our cycle. This is part of who we are naturally, and I don't think we're meant to be in crisis, but I think a lot of women probably start questioning choices like, well, I've had my kids, clearly I can no longer have kids. Maybe this marriage has served its purpose. You know, and the reason I'm saying that is'cause I've worked with clients who are like, we had our kids and we get along great, but. We're kind of just friends. He doesn't really do it for me anymore. And the kids are older and so it's a very interesting how those are some of the things that I've seen is like the emotional distance that happens as a result. Yeah. And then whether or not they can work. Them their way back.

Dr. Komal Patil-Sisodia 26:24

Yeah. To

Neha Kumar, LMFT 26:24

Growing together.

Dr. Komal Patil-Sisodia 26:25

Yeah. And so I guess, this leads to the next few questions, which are, how can partners better support each other through this transition? Even when, they're not really fully aware of what's happening. Yeah. And then do you specifically have some strategies for improving communication when these symptoms are rearing their head and people are going through, maybe not midlife crises, but midlife awakenings to what it is they may really want?

Neha Kumar, LMFT 26:49

Yes. It's so interesting. I would say that communication is huge, right? Yeah. And then educating oneself, whether that's through research or talking to people or talking to your medical professionals and letting your partner know this is what's coming up or this is what's happening now. I think the onus lies on both people. I think, there's a reason that when you get married in some traditions you say, for better or for worse, this is one of those situations that's for worse. But that doesn't mean that it needs to necessarily end things, but I think, or pay worse. Spouses and significant others. The onus is on them to really go out of their way, to be more patient, more empathetic, and if it's really affecting them emotionally recognizing, you know what, maybe I need to talk to someone too, and knowing not to personalize it, getting their own help, their own self-care, making sure that that's on track.

27:36

Yeah.

Neha Kumar, LMFT 27:36

And then also educating themself and, being there for their spouse. And I think women, a key part of this is insight, because I think, yes, when you are having huge hormonal shifts that are life changing, making you question your identity, making your emotions go up and down, there's. Yeah, there's a huge aspect of that might be uncontrollable, but when you have insight into the fact that you are going through something that's making you a little bit more all over the place, then yeah, I do think the onus is on you to really take a look at your triggers. Yeah. Really think about, okay, what's ticking me off? What's and resetting and what I mean by resetting. And I think the relationship reset is huge because something I've noticed with couples and also personally is I feel like every six months. Things sort of like shift a little as your kids get older or as maybe your finances change a little bit or just there's always like some weird shift and it's like what comes with that is like you have, you end up having different needs or like different asks of your partner in terms of like, okay, I know this was our routine for the last 6, 8, 10 months or year.

28:35

Yeah.

Neha Kumar, LMFT 28:35

But now that this has changed, can you maybe step in and do this and I can do that, or can you lift this load a little bit? Like whatever it might be. And so. In this case, I think you have to have that reset as well and sit down with your partner and say, this is how. Things are shifting for me. So how can we navigate this where we both feel like it's fair for both of us in terms of whether that's like communication or responsibilities in the house or with the children or whatever it might be. So knowing what your triggers are, and then also being very communicative and having that reset and sitting down and saying, okay, now that this is another phase, this is another season of our relationship, how are we gonna navigate it? And then coming up with some sort of plan. So I would say that that's my biggest. Communication suggestion is not just saying. Honey, I might be really mean the next couple months or the next 10 months. I would be horrible for the next week. Yeah. I would be horrible to you. Just

Dr. Komal Patil-Sisodia 29:27

beware.

Neha Kumar, LMFT 29:28

Yeah, exactly. So maybe we come home, it goes Yeah, I know, right? But it goes a lot deeper than that. So I think being able to sit down and say, okay, what are our goals? What do we still need to, what are we still responsible for? If I am not wanting to have sex, if I am irritable. What do you like? What do you need? What do you need? Do you want more? Do you want a night out with your guy friends? Do you want like us to at least watch a movie together and cuddle like once? Like what do we both need? Do I need space? Like you have to be able to advocate for your needs, but then also really listen to your partner's needs and come to sort of. A happy medium so that you don't end up just fighting all the time.

Dr. Komal Patil-Sisodia 30:02

Yeah. So at what point do you recommend, because we focused a lot on self-care and understanding what you need for yourself in order to be successful in this. When do you recommend that couples actually go seek professional help? Like, couples therapy, marriage counseling, seeing a sex therapist, you can see a therapist individually, right? Yeah. But at what point do you know to pull the trigger to go to couples therapy? What does that look like?

Neha Kumar, LMFT 30:24

That's, yeah, that's a question I think with therapy and with couples therapy, with any sort of therapy or psychological mental health help. We always say, just like with substance abuse, there's like a survey that people take to basically figure out whether they have an alcohol problem or they have a substance problem. And so ultimately you have an issue with substances if it is getting in the way of your ability to. Function and thrive.

30:49

Okay.

Neha Kumar, LMFT 30:49

And it's affecting, and there's other, obviously other criteria, DSM five, whatever but if it's, there's something in your life that's a problem to the extent that you can't function either personally Yeah. Socially, professionally, emotionally, whatever it might be, then that, that's when you need to get help. So if I have a client who's ha going through perimenopause or if I have a male client whose wife is going through perimenopause and they're saying, our marriage is really shifting, and I give suggestions to that individual and they come back and they're like, it's still bad. Or It's getting worse, it's getting worse. If it, if you, if there's a constant pattern of a breakdown of the marriage or a lack of marriage functioning, I'm gonna say you guys should see somebody jointly.

31:27

Yeah.

Neha Kumar, LMFT 31:28

And then that, I would say that the couple's therapist would probably be the one to suggest the sex therapy if I was seeing the couple and I felt like they just weren't getting on the same page. Yeah. Or they weren't hearing each other. I think I would really try to build insight.

Dr. Komal Patil-Sisodia 31:41

So I have a question. You talked about a scale that you can use to measure whether you're having a substance issue. Affect your ability to thrive. Is there something like that that people can take for themselves when it comes to a relationship, or are you just trying to look for the signs? That's

Neha Kumar, LMFT 31:59

a great question. I. There has been nothing that I have seen used in my clinical practice. Okay. Or even in my training.

32:06

Yeah.

Neha Kumar, LMFT 32:06

And maybe that's something that I'm sure there, that they exist, but there's no standard of standards. Yeah. There's no, yeah, exactly. So there's no standard survey there. Generally people you should create it. Nay. Yeah, I know right. To you. I would take it. I

Dr. Komal Patil-Sisodia 32:18

mean, I'm kind of curious from, yeah. A therapist or mental health professional's perspective, like what are the key points that, because I can, yeah, I can figure it out based on hormone levels or symptoms that people are telling me. It would be interesting to see it from that perspective.

Neha Kumar, LMFT 32:32

Yeah, absolutely.

Dr. Komal Patil-Sisodia 32:33

Have you ever seen cases where menopause actually strengthens relationships?

Neha Kumar, LMFT 32:37

That's a really good question. You know, a lot of times, most of the people that come to me are dealing with some sort of like major stressor. Yeah. Yeah. But sometimes some of those stressors are not their marriage or they're not their relationship. Yeah. I'm thinking of one case. I haven't seen that a lot to answer your question, but I have seen Yeah. Which is fair. Where I think what happened was she was more sexual. And the husband was less so. Yeah, I think he had some ED issues and yeah, so it was an issue for them'cause she wanted it more initially and then he just didn't over the years and he was very comfortable with just cuddling and he loved her. There was no emotional Lack, there. But then I think once she started menopause, she, her libido went down and he was like, this is great. Yeah, this is wonderful because okay, so so they matched. They matched basically. Yeah, they matched and yeah and that's another thing, right? Because I think oftentimes we think, oh, you know, in any marriage the man wants it and the woman doesn't. And that's not necessarily the case. No, it's not. And there's a huge spectrum of everything in between, not just there's some people that. Would like to, be intimate occasionally or all the time, or not at all, or, and so that's just something in general that I think most couples navigate. Yeah. Whether or not perimenopause or menopause is at play.

Dr. Komal Patil-Sisodia 33:47

Yeah. I think that's fair.

Neha Kumar, LMFT 33:48

I think that's fair.

Dr. Komal Patil-Sisodia 33:49

Yeah. So if you could give one key piece of advice. To couples navigating menopause together, what would it be? Great question. Or a list, right? Like if you have a list of things that you know, to your point, what is your preparation recommendation list?

Neha Kumar, LMFT 34:03

That's a great question. I would say that there are a number of things that you can do to prepare. The first again, is the education piece. Yeah, educate yourselves, ladies, because unfortunately, the way the system is now is nobody's going outta your out of their way to educate you at all. I'm gonna say that again. Nobody is going out of their way to educate you about what will come to pass. Yeah. The way that healthcare works today is that people unfortunately dealing with end up dealing with things and then going to the doctor and then trying to get something for something that has already happened.

34:36

And

Neha Kumar, LMFT 34:37

there's such a shortage in terms of healthcare workers and access to healthcare that the people who are being seen are largely being seen because it's like emergent situations or acute situations. And so if you're just like, I would like to prepare myself for something that'll happen in 10 years, people are gonna be like, go to the library. You know, unfortunately. And I think that there's a shift that needs to happen with that, but till that shift happens. Yeah, educate yourselves. Do some research talk, talk, talk. Share your stories, share your narratives, ask your family.'Cause that can also give you some sort of like. Indication as to what you might be inheriting in terms of certain things, especially if there's like a pattern that exists in your family. So educate yourself in various ways. Educate your partner. I would say this also can affect how you, interact with children, educate your children, and just be prepared in that way. But in addition to that, and in addition to the communication piece of once you have received that education and talking to those. That are closest to you is taking care of yourself first and foremost, we find, and I'm sure medically speaking and behaviorally speaking, in terms of behavioral health, things are always exacerbated. Any sort of condition is exacerbated. If you're not getting good sleep, you're not eating well. If you're not getting moderate exercise, no one's telling you to run a marathon, movement, you know all of those things. Nutrition, exercise, sleep. Self care. I'm a huge proponent of that. Infusing your life with moments of joy. If you aren't doing those things on a fairly regular basis to keep yourself at, a fairly healthy baseline, then when you do have these huge hormonal, transitional phases, yeah, it's going to be that much more difficult because you have, you're not utilizing some of the best. Coping skills available to you, which is just taking care of yourself, in a great way. So there's the education, there's the communication, and then there's really just taking care of yourself. And also acceptance. I think accepting.

Dr. Komal Patil-Sisodia 36:30

That's really hard,

Neha Kumar, LMFT 36:30

isn't

Dr. Komal Patil-Sisodia 36:31

it? Because it's very hard, especially in the society when we're taught that as women, we have to juggle everything perfectly. All the time. Yeah. And that we can't age while we're doing it.

Neha Kumar, LMFT 36:40

Yeah. Oh yeah. We have to look a certain way and be a certain way and present a certain way and speak a certain way. And Lord knows I don't follow that one. So

Dr. Komal Patil-Sisodia 36:49

neither do I.

Neha Kumar, LMFT 36:51

So I think that's part of our charm. Exactly, exactly. But I think acceptance is huge. But acceptance can only come if you educate yourself, if you don't, if you don't know what's to come, then accepting it when it happens is very difficult.

Dr. Komal Patil-Sisodia 37:03

Thank you so much. This has just been such a great conversation about how people can start navigating all of these changes and figuring out a strategy for self-care and building a stronger partnership. Where can listeners find you if they want to learn more about your work?

Neha Kumar, LMFT 37:18

That's a great question. I am currently working actually on my website, but it is pros and psyche.com or prose and underscore psyche. That's my Instagram handle. I'm not super active on it. I'm hoping that will change in the near future, but as a working mom, you get to things when you can. Absolutely. Yeah, absolutely. So give yourself grace. Right? Absolutely. I am. That's closing words. I'm not gonna stress, I'm accepting

Dr. Komal Patil-Sisodia 37:44

my busyness. That is wonderful. Thank you so much. I hope everybody enjoyed this episode. You can find Neha at the website and the social media handle. She said we'll go ahead and link them in the show notes and thank you all for listening.

Neha Kumar, LMFT 37:56

Thank you. Thanks so much for having me.