Menopause, Unscripted.

The Midlife Mind Shift: Anxiety, Mood & Menopause || Episode 30

• Heidi Gastler X Stray Kat Studio • Season 1 • Episode 30

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Menopause Unscripted is a women’s health podcast hosted by Dr. Heidi, the creator of Hey Dr. Heidi. Each episode delivers expert insights, real-life stories, and evidence-based information to help women navigate perimenopause, menopause, and post-menopause with confidence.
This podcast covers topics such as menopause symptoms, hormone replacement therapy, pelvic health, sleep changes, intimacy and relationships, osteoporosis prevention, brain fog, mood shifts, and healthy aging. With a focus on science-backed advice and approachable conversation, Menopause Unscripted offers clarity, support, and practical tips for every stage of midlife.

Whether you are experiencing early menopause symptoms or seeking resources for post-menopausal health, Menopause Unscripted is your trusted source for reliable information and open conversation.

Want to be on the show?
Think you’d be a great guest or know someone with an important story to share? Email us at connect@heydrheidi.com.

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SPEAKER_00

Thanks for joining me on Menopause Unscripted. Remember, the change is just another beginning.

SPEAKER_01

Welcome back to another week of Menopause Unscripted. I'm Dr. Heidi and I'm joined this week by my friend Naomi Zellen.

SPEAKER_00

She is a therapist and she deals a lot with midlife women's uh mental health, which is what we're here to discuss today. Thank you so much for joining me. You're so welcome. I'm so happy to be here. Can you tell us a little bit about your background, who you typically treat, all the things? Absolutely. So I think my my desire to work with women started a really long time ago. I was on some of the pioneering research back in the early aughts with um animal studies. And so I did a lot of the newest animal studies at the time, back in like 2008, um, researching female rats. Okay. Um and that kind of midlife health and female rats. Yeah. So I started fe uh researching endochronology of the female brain. Okay. And specifically looking at kind of the HP axis of stress, anxiety, and depression. And so that's where all of my like excitement for women's health really started. Um female rats, um, which was great at the time, right? Because that was so new, and now we're just talking about it, and it's like incredible that back then it was absolutely not happening. Um, and so since then I've really been interested in you know brain health, women's health in particular, because female brains are different than male brains, and most of the medical research we've done in the past has always been on male brains. Um now we're kind of here at the point of talking about menopause and perimenopause and midlife and how that impacts female brains, so much like significantly different than men, right? Um I have a background in uh clinical mental health. I'm a somatic experiencing practitioner, I am a sex therapist, um, and I work with men, women, and all other genders. Um, and I got to the point of thinking about this period of time because I think we're just so people don't think about women. No, and like you said, the research really did not include us for a long time.

SPEAKER_01

It didn't differentiate between genders. So for a long time we had to extrapolate male data to female brains, which we now know doesn't really translate very well.

SPEAKER_00

It does not translate, yeah. Yeah. Um, and especially because we know that women experience anxiety and depression like at almost like uh double the rate that men do. And so when we get to this state of time in life when women's kind of brain chemistry is really being impacted by the uh decreasing estrogen and progesterone, there are a lot of kind of behavioral and cognitive implications of that. Can we just talk about that for a minute? Like what estrogen does to the brain versus what progesterone does in your mental state? Yeah, I think estrogen is the one that I'm like most focused on because I think it is really important for two things that I that I'm like fascinated by. One, estrogen supports the um kind of the creation of dopamine. And in particular, when we talk about folks or women who are neurodivergent, they're already lacking dopamine, and that makes things like focusing hard, memory hard, initiating tasks hard. Yeah. And so when estrogen starts to drop, or when it's even like kind of going up and down like this, um, it makes everyday challenges sometimes more hard. And women often feel like I just don't feel like myself. And clinical sign of menopause or parametapa. Yes, a hundred percent. Um, and so why that is so important is when estrogen falls and dopamine falls, women just get into this like I'm depressed, I can't do anything, I have brain fog, I just don't feel like myself.

SPEAKER_01

Oh, that is the thing you hear over and over and over in clinic, is like they don't people won't really think that I'm in perimenopause and I'm in this zone of hormonal chaos, but they just don't feel like themselves. And I don't know about you, but I find that a lot of women in here almost are in like menopause brain, right there. Um, they're basically in denial that they're in perimenopause. I think they think maybe I'm not old enough for this. I just had a child, I can't be there, I just had a baby. Yeah, yeah. It's just denial, and I've seen them for oftentimes orthopedic symptoms of this, but we have this conversation about perhaps we should start talking about these things, and women just don't want to go there.

SPEAKER_00

Right, yeah. I think historically the conversation around perimenopause or menopause is like, oh, that's women in you know their 50s. Right. That's that's not me. I can't that can't possibly be me. But what we know is that perimenopause starts as early as 35, and for women who are neurodivergent, that actually some of the newer research is coming out that they might experience it even sooner. Why is that? Um, I think it's just the way that their brains are. I think there isn't enough research to give a like a specific, like this is the thing that's pointing to it. But if I were to take an educated guess, I think because women's brains who are neurodivergent because of the already lower dopamine, when it even starts to creep down just a whisper, it just is going to start the cascade of all of the things that impact their health, right? And I think what you mentioned is so important, is that right, it's not just mental health that's impacted. There's bone health, there's pelvic floor health, there's cardiovascular health, and all of these things are impacted. And it's kind of that slow burn, which is why I think sometimes it's hard to even notice because it happens so discreetly, and then it's like bam. And so I think that's why so many women are like, no, it can't be that, and it's like, yeah, it is. But really, that's what we've got going on.

SPEAKER_01

Exactly. So for just a moment, can we talk about what neurodivergency entails versus neurotypical? Because for someone who isn't a therapist, yeah, we hear these terms, right? Yeah, great question. We don't necessarily know what these things mean, and is that me? Because I think everyone wants to be neurotypical, right? Because they think that is normal. Yeah.

SPEAKER_00

Can you just kind of tell us a little bit about the liberally? So, folks who are neurodivergent, they mostly experience, not always, there are obviously an array of symptoms, but folks who experience neurodivergence, they have um parts of their brain, mostly in the forebrain, um, with uh executive functioning. Um, and that's really the main thing that impacts a lot of neurodivergence. And executive functioning is a part of your brain that helps you again with task completion, with following through with tasks, um, with being able to um just initiate and get motivated. And uh sometimes, you know, in young kids, I'm thinking right now just women, but in young kids we see that in a lot of hyperactivity, right? There's a hyperactivity piece to it because we can't regulate ourselves. Um, and then sometimes there's the inattentive piece where we can't focus enough. Um, and all of those kind of converge in the front of your brain. And what we know about folks who are neurodivergent too is that their brains and their executive functioning skills actually grow and develop at a much slower pace than neurotypicals. So, neurotypicals, if you see in the classroom the kids can sit down, you know, they pay attention. Um kids who often struggle with the neurodivergence can't meet that same expectation because their brains just don't have the chemicals inside to help them sit still. And they sound like ADHD. It's like what you described. Yes, yes, yeah. And you hear this a lot with women in midlife that like their ADHD feels worse or we're not able to focus or brain fog or exactly those things. Yeah, which is why, going back to what we were just talking about, right? If you already have less dopamine in your brain to be able to do tasks, and then all of a sudden the chemical that helps make dopamine estrogen starts to fall, you are not making as much dopamine as you ever were before. So, women in particular with ADHD or neurodivergence who experience and go through perimenopause and menopause are kind of getting a twofold in that experience because of that. So, great, great insight.

SPEAKER_01

So, you're talking about dopamine estrogen reduction, and this is making me think it's a little bit of a swing of topic, but of the drug addict, which I'm on, yeah, and how that helps with having more dopamine in the brain, which has to do with like the sexual functioning and call.

SPEAKER_00

Can we just go and swing there for a minute? Totally. So, what happens when you are taking a drug? And I will say, like right now, I'm a therapist, so you know, I'm not a doctor, so what I know of this is that when you take a certain drug that helps with functioning of dopamine, is that it often our brains work, or these little connections are called neurotransmitters. And in the center, in those middle of the neurotransmitters, is kind of this communication center where they're all talking to each other. Um, and what happens when you don't have enough dopamine is that there isn't enough dopamine to talk to each cell. And so, what those drugs are doing is actually allowing the dopamine to hang out in that center and talk for a little bit longer rather than getting sucked up. And so it allows your brain to actually experience dopamine inside of your head for a lot longer, and that's part of what's happening in that drug.

SPEAKER_01

And how does dopamine affect our sexual functioning versus our attention?

SPEAKER_00

Love that, yeah. Same thing. So we have a handful of chemicals in our brain that yes, they do a lot of things. So, one, we're talking about attention, but dopamine also in our sexual functioning is impacted by estrogen. And it's also impacted by oxytocin. So, oxytocin, as we know, is a chemical that makes us want to bond with people, makes us warm fuzzies. Yes, it's the warm fuzzies, it's the like, ooh, look me in the eye, I want to hug ya. And oxytocin is also something that estrogen helps create. And so when estrogen starts to drop, right, our desire, and it's all right, these kind of cascades all are happening at once. So as estrogen starts to drop and oxytocin starts to drop, we actually don't want to feel connected to people. That's kind of when people say, Oh, maybe I'm a little depressed or I'm not feeling like I really want to be around people. That's a part of that component, right? In particular when it comes to relationships, right? If you want to reach out to your partner and one, you're like already kind of moody and feeling not yourself, and your partner's reaching out to you, and the chemical that like tells you, hey, reach out to your partner, is also tanking. Yeah, you're kind of like, ugh, get away from me. They say, Don't touch me. Don't touch me. Yeah. Um, and I think that's really important because we see that in how relationships start to really be impacted in this stage of life.

SPEAKER_01

And it has nothing to do with the relationship itself most of the time. It's just more the fact that there's like these chemical changes and as we kind of know desire and stuff lives in the brain a lot of this. So yes, yeah. Do you see that in like sex therapy that you do in the sex like couples counseling?

SPEAKER_00

Yeah, I'd say, I mean, working with a lot of midlife couples, what we know about is, you know, what the research indicates is there's actually a lot of divorce that happens in that time because I think women are going through so many changes in their body, and I think this is why things like educating ourselves of what's actually happening is gonna be really important because I think often, yes, there are marriages that maybe we wanna end for good reasons, and maybe there are marriages that maybe have ended because women were going through something really challenging and maybe didn't know themselves or their partners didn't know, and they didn't actually have the support they needed to get through this life transition.

SPEAKER_01

That makes so much sense. I am rereading Come As You Are right now. And every like literally every chapter makes me wish that every single person knew these things about their relationships and about themselves, both men knowing it about women and understanding better, right, and women knowing what they're experiencing during this time.

SPEAKER_00

100%. Yeah, and I think if you kind of go with what um I think Emily Nagoski is an incredible sex researcher, um, you know, the biggest thing that came out of that book was the accelerators and the brakes that she talks about, right? What pushes on the gas for desire and what kind of slams on the brakes? And if we kind of bring it all together, right, if you have so many things slamming on your brakes, you're not feeling yourself, you're overwhelmed, your sleep is disrupted because of menopause, right? You're having a hard time connecting with your partner, your kids are driving you crazy, you're struggling at work because your brain feels fuzzy because you haven't been sleeping. And those are things that are constantly putting on the brakes of your desire. And so when people come and see me, kind of trying to figure out, well, wow, I just like don't want to have sex, I'm not connected, I just like feel so distant from them. We feel like roommates, it's like, oh man, you are working from empty. That you will slam down the brake, and there is just nothing hitting that gas pedal. And so we gotta learn what are the things that are putting on those brakes in your relationship, in your body, in your life, right? You have to kind of see it holistically, so that we can bring in more of the space. Be like, okay, what's on that accelerator? What real what's gonna turn you on? What's gonna allow you to be inside of your body? How do you want support to look? It's gonna look different in this time of life than it might have otherwise. It's fun, like your husband doing the dishes starts being real sexy and being a turn on, right? Yeah, cleaning the house, cleaning the dinner house, yes, taking care of the kids, do the thing for me. Like, I don't want to have to do it. Yes. Absolutely. Yes. This was actually the chapter I was just listening to in my drive-in. Oh my god, amazing! Like, I just listened to this about two hours ago. Uh-huh. Uh-huh. Yeah. And I think that's so important. How how support in this time is is just so pivotal. Definitely. Yeah. So let's go back to the brain.

SPEAKER_01

We talked about dopamine and we talked about estrogen. Let's pop over to progesterone and what that does.

SPEAKER_00

Not as I I will be honest, I'm not as familiar with progesterone. No problem. I have taken most of my dive into estrogen and oxytose, and I will say. But we don't know that like when estrogen drops, oftentimes at the same time, the progesterone starts dropping off, also.

SPEAKER_01

Correct. And that can affect our mental health and mood. So, but that's okay. We can kind of skip over that. That's totally fine. So let's go back over to like the ADHD and other mental health disorders that can happen during midlife. And there's kind of this predisposition to if you have this, this kind of can heighten and worsen it. What about other types of mental health problems? Anxiety, depression. I'd asked you earlier about this concept of unmasking. Can we talk about that?

SPEAKER_00

Yeah. Um so going to, you know, if women are experiencing depression and anxiety in general, right? I think what happens is when we look at a lifespan, if you've come into midlife without any history of anxiety or depression, um, you might experience it for the first time. But I think what you're saying is if I've already experienced anxiety depression, how is that impacted when I get to this point? And when we get to that point, it's really similar to ADHD, right? And neurodivergence in particular is that anxiety levels will often increase because our ability to tolerate stress is at an all-time low. Because we're often not feeling like ourselves. Um, and so anxiety tends to spike because the stresses of life feel even more overwhelming than they did before. Um, our ability, our ability to be resilient in this time of the stage of life for women is has been really disrupted because of all of the hormone changes going on. And so anxiety often increases. And with that, depression can oft also often increase as well. So that can look like um just struggling to get tasks done. And you know, mental health, there's a lot of similar uh symptomology, and so with depression in particular, it can look similar to symptoms of ADHD that women experience, having a hard time struggling, getting things done, having a hard time getting tasks completed. Um, and they do all get uh more uh what's the word I'm looking for? They get um um impacted at the same time.

SPEAKER_01

Yeah. One of the interesting things I see in here is this intersect with mental health and pelvic health and sexual functioning here and also orthopedics. So doing orthopedic PT and doing pelvic chlorine PT are these women who have had reduced resiliency because of reduction hormones. They're getting injured or having injured injuries that were happened previously, kind of seem like they're cropping back up. Then we start trying to do PT. And it's like the ADHD kicks in, which then amplifies anxiety. And oftentimes what I hear is women just beating themselves up. Oh, yeah. Because I'm not doing my PT, I'm embarrassed to come tell you. Yeah they're not making progress because they just can't get on the task. But then we have this like nasty cycle back into the mental health, and so oftentimes I'm trying to co-work somebody with a therapist like yourself at the same time because we have to attack this from both sides, both the physical and the mental, because I am not a mental therapist. So as much as I can try to coach someone through that, that is not my job. Yeah, and this is something that I see on repeat week after week, and it's interesting because I never seen the men doing this. You know, I never seen the men doing this. They just come in and they're like, Yeah, I didn't do my homework, or I did.

SPEAKER_00

But the women, it's like this beating up. And how from a therapeutic aspect can you help somebody with with that and like that feeling of just I mean, these women like just literally, it's like they just are beating themselves up. How can you help with women doing these things? Wow, you're touching on such a bit, there's such a big point, and what women feel every day is the way of the world of needing to be perfect and to do it all and to show up, um, and to you know, the fear of not of not being the person that she knows she can be, right? I think that's what I was before, exactly. And I think that's the hard part. It's like I used to be able to do all of these things, and now I can't, I don't recognize myself. Um, I think to really slow it down and parse out what are the things that are at the root of all of the stress, where is the thing that's causing the biggest um issues, and then really similarly to you know, executive functioning skills are really concrete, so it's really helpful because as overwhelming as the stage can be, if we look at it from an executive functioning um kind of lacking a skill there, that we can do things really quickly. So um getting a really clear timeline, how do we organize our schedules? How do we chunk out certain areas of time? How do we track our energy levels throughout the day, which are impacted by our like cascading hormones throughout the day, right? It's also impacted um by food and diet, which we also know impacts um this time of life. And so being able to track kind of like when am I gonna be the most energetic to do the most difficult tasks? When am I gonna be kind of tired, but I can knock out things that don't take as much mental energy? And being able to track that, and I think where the somatic piece for me comes in is that often people feel something in their body and they feel like they have to go into that feeling. And what I mean by that is, oh, I'm really tired, so I'm gonna continue to be tired until I feel rested enough. When sometimes we don't need to do that, sometimes ourselves out of it's falling into it. Exactly. Cool. Can I give myself five, 20, 15 minutes of rest? And that allows me to know I've rested. Do I feel rested? Maybe not a hundred percent, but maybe just do one or two tasks to see if I can get something done. Oftentimes we can start getting things done once we just do one little thing. But we gotta go for the low-hanging fruit. That's what I always like to tell people. I was like, don't do the hard thing, don't try hard, try easy. It's like just do the one dish or just strip the bed, don't even do the laundry, just get it all done and then just see how you feel, and then kind of take it one step at a time. I think we just often see it too much of a big picture and just little baby steps. Okay, get that energy back up. Exactly. Take up take a rest, it's okay. It's also women, like we can't take rests. That's also given permission, right? I am the worst the absolute worst of it. It's okay.

SPEAKER_01

Yeah, someone telling you that you it's okay. It's okay because we don't do that to ourselves.

SPEAKER_00

Yeah.

SPEAKER_01

But with the somatic therapy, can you tell me the difference a little bit between that and CBT? Because we hear a lot about CBT for women's midlife health. Can we talk a little bit about what somatic therapy can do for us that's a little different?

SPEAKER_00

Yeah. CBT is great, um, I think in particular with uh depression and anxiety, um, where CBT stands for cognitive behavioral therapy. So what you look at is what are my cognitions, what are things I'm thinking? Um, how does that influence my behavior? Um, and then how you know what is the next step? And so often our the the way they the way cognitive behavioral therapy is kind of taught is that your thoughts influence your behavior. So if you change your thoughts, you can change your behaviors, um, which is great up until a point. Um, because what we also know is that our brains and our bodies aren't disconnected, right? This this also is a part of this. And so somatic therapy actually at the root of it is working with the nervous system, which is uh really working with your five senses. So not just your thoughts, but you're also working with emotions, um, physical sensations, I call that proprioception. So, like, what does it feel like inside? And I'm sure you hear people in your clinic, oh, pain. Okay, pain is a is a kind of a messenger of proprioception. So sometimes we can feel energetics, we can feel things swirly, tingling, almost like when your foot falls asleep, right? There's constant kind of messages inside internally that we want to track. Um, it can be sight, it can be smell, it can be, you know, uh uh vision, something like that. And so somatic therapy takes cognitive behavior behavior behavioral therapy and kind of just expands it, right? We are Expanding, okay. Well, when you think about that thing, what does that feel like in your body? Where do you feel that in your body? Okay, when you feel that in your body, what are the emotions tied to it? So we're really expanding all of that and noticing kind of what the whole body is communicating to us, and then with that awareness, it's the mindfulness piece. What is the next step that we want to do? What is the behavior we want to do? So they're similar in certain ways but different. Um, and they kind of do, you know, stack on top of each other.

SPEAKER_01

So you mentioned pain earlier, which is something I work with people with every day. And one of the things I do here is I try to get people to differentiate between sensations. Is it really pain that you're feeling or is it discomfort? Or is it something else? How do you work with people without from a somatic therapy point of view? Because that's something I deal with all the time, where people are so rooted in that my body hurts. Yeah. I'm like, but does it hurt and when does it hurt? And do I like and working with am I anxious about my condition and does that amplify my pain? Is it really pain? Yes. Is it something else? Because so many times every single thing has become pain by the time they come to see me. And it's not really pain. And so we use a lot of different words like discomfort. Is it therapeutic discomfort? Are you feeling a stretch? Are you feeling the muscle work? Because sometimes just making the muscle work, people think that is pain. Right.

SPEAKER_00

And they can't get that separated. So, how can you work with that on your end? Great question. What we know about chronic pain is that there's often a point of it, and because the way the body works, the our bodies intuitively want to help us. And so when there's pain, we often clamp around the pain to kind of protect it. That's what the body does, which often increases inflammation. And so it's not just that small pain point, it's now the muscles and the tissue around it are clamping down, creating more um inflammation and more pain. And the way I like to work with pain is uh I like to use like a it's uh I use a bullseye model, and so I often like to help people see, okay, if we were to go to the center of where that pain is, how do you notice where there is less pain? And so coming out from the center. Okay. I like this visual. Yeah, yeah, yeah. It's a great visual. People love it. Um, and so what happens is people say, well, the pain is everywhere, it's everywhere, it's everywhere. It's like, and it's generally in a very localized spot. So often I like to have people say, Okay, where is it the most intense? And then can we go out a f a few rings and see, okay, where is it the least painful? Where do you not feel any pain around that center? And can we focus on where there is no pain? And that often allows people to spread their awareness, right? What happens when um when you're working with the nervous system is people kind of get like very tunnel-visioned, and when we kind of focus somewhere outside of that tunnel, we actually expand the nervous system's ability to take in. Oh, what else is happening here? I love that.

SPEAKER_01

And you never heard this, and it's great unless you feel it.

SPEAKER_00

Yeah, please. And that's how you work with it. So, okay, what's the outside? And then okay, can we go in and in? So eventually the person can be in that just one area of pain.

unknown

Interesting.

SPEAKER_00

Yeah, I love this. Yeah. All right, I'm gonna jump topic.

SPEAKER_01

Yeah, there's so many different things I want to talk about. Yeah, so we kind of talked about pain a little bit. Now let's go. I want to go back to the mental health and talk about the concept of unmasking. Yes. So can you tell me what this is? Because I feel like this is me. And I have been telling my boyfriend, I think that all of a sudden I have Tourette's.

unknown

Yeah.

SPEAKER_01

And I don't mean to, but all of a sudden I'm just swearing and dropping F-bombs all the time. Yeah. And he calls me out on it because I don't even know I'm doing it. And I honestly, it's sometimes I think that like my filter has just been taken off. And I try really hard to put it back on, but I feel like I'm then putting back on the mask, like on the damper. Yes. And I feel like lately my damper has just been removed.

SPEAKER_00

And it's hard to put it back on. Can we talk about that? Absolutely, yeah. So another key feature in neurodivergence, and I think what shows up in perimenopause and menopause is impulse control, right? And that's a big thing with masking, is that um when we are masking, we are that we have the ability to kind of have a certain level of impulse control to like keep ourselves in a state of you know what is socially appropriate in different areas. Um, and when our impulse control kind of goes down, we have a lack of uh our filter, if you will, to be able to kind of hold ourselves together in a socially acceptable way, right? And so when people are mad, it takes a and I will say, it is a lot of energy to to kind of keep yourself all rigid and like, okay, I'm gonna just like be a normal human person today. I'm gonna go out in the world and like do my thing. And I think you see this, I think see this with like you know, kids when they come back from school. It's like they, especially if they're neodivergent, they like work so hard to like do the thing at school and then they just like flop. Does this feel like you have to clinic? Because this feels like me. It's like all day at clinics.

SPEAKER_01

I'm like, this is like my clinic persona.

SPEAKER_00

Yes, I have to be the therapist and the healer and I have to keep it together and keep all my emotions inside. Yes, I don't put them onto the patient, right? Exactly. I feel like I lose I leave work and like that just I can't do it. I can't anymore. Yes, yeah. Because of that ability to hold in, and so when we kind of have used up the the the tank of our impulse control or ability to kind of tolerate being in that state, it just kind of goes out the window. And so often we'll hold it in for you know the people outside, but the people that are around us that are closest sometimes are impacted the most out of us not having a filter, and you're like, man, I just like I can't, I just don't want to like deal with you anymore. And I'm really sorry, but yeah, exactly. Like, I'm just gonna be a little bit kooky right now. Yeah, he gets the weirdo side first. Exactly. Yeah, like I just can't, I just can't be, I can't do it. I only have a couple patients I'm willing to see at 6 p.m.

SPEAKER_01

And I think that they get it also.

SPEAKER_00

Yeah, yeah, yeah, yeah.

SPEAKER_01

It's like they have to be able to deal with more of the non-clinic meetings, exactly. So like schedule a youth at this time if like we can be slightly in that gray zone because we can't do it.

SPEAKER_00

Exactly, exactly. Yeah, it takes, you know, because there is so much that energy that it takes to really hold ourselves together. It's exhausting, it's exhausting, yes.

SPEAKER_01

So is this why you hear about like a lot of women just like literally, it's like they just kind of have that like I don't care anymore?

SPEAKER_00

Like, is that kind of why you see this around midlife? Because you know, there's that really popular count that we don't we do not care club, right? And she's so cute, she's at multiple pair of glasses and eye masks and everything, but it's like a thing, right? That we all identify with this at midlife. Is this part of it? Yes, absolutely. I just can't, it's it's holding it all together, and because your resiliency going back to that, and like what you can tolerate is at an all-time low, you have to pick and choose. You get to a choice point of like what are the most important things that like I'm going to focus my time and attention on if I have so little, and if it's gonna be like I just don't care anymore about X, Y, and Z, and I cared about that, it's like okay, that's going out the window because I only have so much and there are so many competing needs, yeah, so much bandwidth and not enough bandwidth.

SPEAKER_01

Exactly. Another mental health thing that I was reading about before you came in is autism, and I don't have a lot of experience with it, but how does this all impact autism? Because I was reading that there's a lot of people who were never diagnosed with autism, and then they get to midlife, and then all of a sudden they come up with this new diagnosis, and it's not new, it's just that they finally were diagnosed in midlife.

SPEAKER_00

How does that tie into all of this as well? Yeah, I think that's such an important call out. I think it's happening more often than not. I think both uh women who are getting diagnosed as autistic later in life and with ADHD or other neurodiversities is that in in childhood, I think I mentioned it a little bit before, ADHD is often associated with like hyperactivity. And so in childhood, boys are often diagnosed more uh more often because of that symptom. It's just like more obvious. Okay. Where women mostly often have the inattentive ADHD or autism where it's like, uh, they can get through and they're not very hyperactive, they can sit down, they can do this thing, and they're often missed because of that. And so they get missed because the symptoms just aren't as loud in childhood. And so they kind of have the ability to get through and get by, but then in midlife, it's like, wait a second, it's just not working. It's just not working because the symptomology just looks so much different in in boys and girls, and then gals get to this phase, and with all the chemical cascading that's happening, and because so much of it uh mirrors executive functioning, which is really what impacts people with uh ADHD and autism, is that it just explodes. It's just like, oh my god, this is so much worse than it ever has been before.

SPEAKER_01

Yeah, and that was exactly what I was reading about was like this explosion. And like that just sounded really intense for people, and yeah.

SPEAKER_00

So yeah, I think it it really impacts, I think you see it the most with women who are in the workplace. Okay. Um, because I think that can be a bit more of it, you can see it in family dynamics, and I think people will come in with it, but I think where it can get particularly uncomfortable because more people write on the outside when we're trying to mask on the outside, but it's not working anymore. And women who are in the workplace are struggling with um relationship dynamics, are struggling to get tasks done, are struggling to um write sleep is impacted, so their memory is impacted, word recall is impacted. And so you really can see it in like work performance, in particular with women with ADHD and autism, because I mean you spend so much time at work, um, especially if you are in an office and sitting down. Um and I think that really is often the trigger for a lot of people to start coming in to get therapy because they see it in the workplace, yeah.

SPEAKER_01

And we hear that all the time like that women just they feel like their work performance is for um is maybe impacted the fact that they are leaving the workforce early or their productivity has gone down. And do you have certain things that you and this it might be really too general, but do you have certain things that you would broadly tell women that these are things that they could be doing to help that in the workplace? Like certain skills or tools, like are there a few that you broadly could say might be good for people to try?

SPEAKER_00

Yeah, I think it's similar, you know, with executive and functioning, I think the biggest thing that I always try to tell my clients is, and I like to talk, I talk in business talk with my clients who are in uh corporate too, where it's like, what are your standard operating procedures? Yeah, right? Like, what are your personal SOPs? You have to have that down. I think it goes back to how do you create a schedule and a way of living that your brain can operate in? And so if you're going into the workplace and you're struggling with meetings at a certain time, you're struggling with emails at a certain time, you're struggling with certain related like coworker dynamics, figuring out when you feel your best self, right? And figuring out what you are going to need to be able to operate in whatever daily schedule you create. So is that working out? Is that that you're gonna need a certain coffee or a drink or uh neurodivergent brains love a stimulant, right? And so, yeah, take a coffee, they're great. Um, so really optimizing like for your brain, because everyone's brain is different, everyone's way of living is going to be different, so you really have to be kind of a little bit of a researcher in your own right and say, okay, well, what is the thing that actually really works for me?

SPEAKER_01

And then implement that. And then implement that when. When.

SPEAKER_00

Yeah, and I always like to say this is another analogy. I love analogies. I'm a therapist. Um, but I tell my clients when they are starting new things or new behaviors, including, you know, creating schedules or tasks, is not to judge the first one. So I always like to say the first pancake is never a good pancake.

SPEAKER_01

Never.

SPEAKER_00

And it's never a good pancake. Sometimes the second one, never a good pancake. So you have to keep trying, right? Don't give up just because the first, second, or third time um didn't work with this new skill or this new thing that you're trying to implement. And so, yeah, that's my favorite thing so many times because that's really it.

SPEAKER_01

And I talk to people all the time about when you can try to do your PT and when you can do your exercise. And for me, I have to have it scheduled in. I'm an appointments girl. If I don't have appointments, I will waste an entire day. Exactly. Absolutely nothing done. Yes. But it's like if I have it scheduled and I make an appointment with myself, then I'll go. That is something everyone struggles with. And it's like I tell them if it doesn't work for you that you did it this time, try a different time. And again, start with a little bit. My favorite motto is something's better than nothing. Because we get so hard on ourselves we have to try to get it all done. Yes. And I try really hard to give people maybe only three or four things. Because my younger self was like, I'm gonna give someone 20 exercises, yes, and no one ever did it because you know this younger person feels like you have to impress the person with how much you know and do all of these things. But no one does it, not right. I can't do it if you throw 20 things at me. It's like three, maybe four tasks. Yeah, do that for a week or two, gain mastery over that level.

SPEAKER_00

Yes, yes. But also, when am I gonna do it? And back to the pelvic floor ladies, a lot of them wait until right before bed.

SPEAKER_01

I'm like, you are too tired then. It's just and they're like, Well, that's when I'm in my bedroom by myself. I'm like, you gotta figure out another time. And I try it's like five minutes three times a week, you know. So I try to keep it really small, and that's something that I find is more helpful. Yeah. But again, like the first time never works, the second time might not work, and so oftentimes people give up before they actually even figure out yes, yep, yep, yep, yeah.

unknown

Interesting.

SPEAKER_00

Yeah, failure tolerance. What failure tolerance, right? We have to learn how to tolerate and be able to be okay with when we don't do it a hundred percent successfully. Think learning how to tolerate the discomfort of not doing it right or well, and going back to what we're talking about, women are just expected to like do everything perfectly and amazing, and then if we don't do it, it's like, oh my god, there's shame and self-doubt that kind of pulls in. And can we tolerate the discomfort of what failure feels like? This is what I love to call say about like just be a kook, like it's okay, it's okay, you can totally be a kooky. It's okay. Like, oh, it's the kookiness, it has a name. Yeah. Failure tolerance. Failure tolerance. Yeah. But we're not taught that. No, we're not. We're not taught taught that we have to do it perfectly right away or we are somehow not worthy. Yes. Yes.

SPEAKER_01

What are some other things, other tips that you give broadly to a lot of your people for this midlife women's health? Like, I feel all of these feels.

SPEAKER_00

Are there other just broad general strokes that you like to give people? Yeah, I think going back to kind of the the um chemicals in our brains, the the things in our brains that are happening are often drawing us away from relationship, right? Away from people. Um, and we are animals at heart, right? We are social creatures, and it's really important for people in general, this is just very broadly speaking, to have great relationships and to have a support system. But I think in particular in this time of life, relationships are so important. They're so vital to our health in so many ways. And I say if there's anything that I would broadly say is creating relationships and leaning on other women who are experiencing this, friends, like siblings, cousins, you know, community, um, spirituality, whatever it is that draws you into a community, I think is one of the best protecting factors. Um, there's a lot of other things. There are medical things we can do, like you can do HRT, you can have really comprehensive multidisciplinary care. But I think for what I like to guide people to is how can you just connect with people? Don't feel alone in this experience. Women that have suffered like kind of alone in this for so long and not anymore. I love that. Friends, friends.

SPEAKER_01

Friendship is so important for midlife women, and oftentimes that's a struggling time because the women or the women, the kids, if you have them, are out the door, you know, you might lose that. Maybe we're leaving work, right? Hopefully, we're finding other ways to be socially connected. Yes.

SPEAKER_00

So yeah, you hear a lot about that, like why friendship in this time is so yes, and some of the hardest times to find. So really making it an effort with that noise, yeah.

SPEAKER_01

You have to do it.

SPEAKER_00

I feel like that is a great place for us to wrap this up.

SPEAKER_01

I hope thank you so much again for being here. And we will put all of the places that people can find you, both um in person and online, in the show notes. Perfect. So thank you again for sharing your wisdom with us.

SPEAKER_02

Wait, you didn't do your health negotiation.

SPEAKER_01

No, I'm not here yet.

SPEAKER_02

Oh.

SPEAKER_00

Well, let's let's start that over. I feel like this is a really great place to wrap this up.

SPEAKER_01

So thank you so much for this conversation of being here today. You're so welcome. We will put everywhere that we can find you, both in person and online, in the show notes. So everyone who wants to learn more about you or maybe work with you, it'll be in there.

unknown

Incredible.

SPEAKER_01

Well, thank you again. And thank you all for being here for another week of menopause unscripted. If you like today's episode with Naomi, please like, follow, and subscribe everywhere you find your favorite podcasts. With that being said, can we just ask one more question? Absolutely. I say we as in like I have only personalities.

SPEAKER_00

Maybe I do.

SPEAKER_01

Yeah.

SPEAKER_00

All your parts are showing up. All your parts want to be like all the weeds. Yes.

SPEAKER_01

Like I try not to we it because I'm like, that's showing.

SPEAKER_00

Yeah. That's too much unmasking my weeds. But can you just tell us what is your one daily health non-negotiable? My one daily health non-negotiable that I actually recently started, I think within the last six months, is my nighttime routine. Ooh, tell us more. I really I never had a nighttime routine. I was really locked in with the morning routine, and now my nighttime routine, I think, is even more important because it sets you up for the next day because sleep is so important. Um I stopped having my phone in my room, so I actually take my phone out of my room at around 7 or 8 p.m. So I'm no longer looking at a screen. Okay. Um I know, it's really hard. It's so crazy. I've bookmarked my days. No screen time at the end of the day or the first hour to 90 minutes. Um I take magnesium, I allow my body to kind of settle and relax, and I read a book. Um, for me, my body had a lot of restless leg syndrome happening. So for me, getting my body slowly integrated and ready into like to slumber um has had a massive impact on my day-to-day. And so that is like a non-negotiable at this point. I love that. Thank you so much for sharing. You're so welcome.

SPEAKER_01

Well, I will see you very soon. Yeah. So we'll be do more conferencing together. Absolutely. Oh, thank you. Now I have to end with the boring stuff. While I am a doctor, I am not your doctor. This podcast is for entertainment and educational purposes only. If something in today's episode resonated with you, please bring this to your own healthcare team and self advocate. You always are promoting that. I cannot wait for you to join me on next week's episode of Metapause Unscripted for another hot topic.