Episode #36 Surprising Signs of Perimenopause

Perimenopause can show up in ways many women don’t expect. In this Doctor Dialogue, Winona's Dr. Cat and our guest expert Dr. Hahn discuss some of the lesser-known symptoms that often catch women off guard.

The conversation explores how hormonal shifts can affect the body in surprising ways, from sudden sensitivity to smells, to itchiness in unusual areas, to frustrating brain fog. The doctors also answer real questions from the community about heart palpitations and other symptoms that can begin in your mid-30s.

Tune in twice a month for these important conversations — right from your own home. 🎧

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Transcript

SPEAKER_02 0:00

Welcome to the Menopause Hour, your go-to source for answers to your burning menopause questions, the ones you won't get from your OBGYN. Brought to you by Winona, where menopause care is made easy. Download our free Winona community app where thousands of women connect and access exclusive content, expert-led courses, exciting events, and more. It's time to take the guesswork out of your hormonal journey.

SPEAKER_01 0:25

Hello, hello everyone. Welcome to our March Doctor Dialogue. I'm so excited that you guys are here. I know that we'll have a couple people jumping in as the numbers kind of tick up a little bit. But just wanted to say, so glad that you guys are here and you're making the time to be here tonight. If you want, I always think it's a kind of fun thing. And just in case you haven't been here before, at the bottom of your screen, there's like a little chat button. And so like in the chat, that is going to be your best place to kind of engage tonight. And we really want you to, you know, either listen in, engage wherever you feel like you need to be, that is what we want you to be able to do. But we're so glad you're here. Um, as you can tell, we have some amazing doctors on the call with us tonight. Um, we have Dr. Kat, who may be a familiar face to you, um, but we also have a new face, um, Dr. Han, which is super exciting. Um, and that is one thing I love about these doctor dialogues is that we get to bring, you know, these experts together to really have a conversation and chat about all these kind of topics that might be on top of your on top of mind for you. Um, and tonight we're talking a little bit about surprising signs of perimenopause. We're gonna get into that topic. Um, and then at the end, we'll have some time for Q ⁇ A as well. So I do always say that the questions do often come pretty rapidly, and we try to get to as many as possible. So even though that's gonna be a little bit more in the second half of the call, please start throwing those questions into the chat now, um, and I'll take a look at them and make sure that we can get to as many as possible. Um, but I just want to say again, thanks for being here. We hope that this is a helpful call. Um, and I will pass it off to our doctors to introduce themselves and get into the topic. Um, maybe Dr. Kat will start with you and then Dr. Han, or yeah, I'll look to go to you.

SPEAKER_03 2:20

Because a lot of the women, if they've been in around a Winona, they've seen my face. So they've known me before. Um, but I'm Dr. Kat Brown, I'm the medical director at Winona, and I've been one of the prescribing physicians since December of 2021. Um, I'm a board-certified OBGYN, nationally menopause certified as well. Um, grew up in the Philadelphia area, and now I'm back to this area after working in the Army for 12 years and moving around the country a little bit. Um, also a mom of three, and I have several hobbies that I like to do, and it's uh finally starting to warm up here, and I'm hoping to get out in the garden soon because that's one of the things I love to do. I'm just waiting for the rest of our snow to thaw. There's still some like dirty piles of snow in the corners of everything. Um I'm waiting for all that to go away. But anyway, um, happy to be here. Love doing education for patients, and we're so happy to have Dr. Hahn. I actually had the benefit of meeting Dr. Han a few months ago. We had a Winona women's event. Um, and so happy to have her here. So I wanted her to introduce herself because she's our special guest tonight that you don't often get to see on our doctor dialogue. So, Dr. Han, take it away.

SPEAKER_05 3:26

Thank you so much. Um, yeah, so I'm Taylor Hahn. I'm uh a dual board certified OBGYN and an obesity medicine, um, and also a um certified menopause practitioner. So I do kind of the full scope of um women's health win um outside of pregnancy is kind of how I like to frame it. So um I uh am out of India based out of Indiana and I do own my own private practice as well, um, where I am able to practice all of those things and it's in a direct care model. Um, so out of network of insurance, which is the nice thing because I can actually really spend time with my patients and get to know them. Um, but I love also being involved with some of the digital platforms because I just think that I I can only take care of my small little region of the world or even of the the United States and the this um little state that I'm in. So um, so I love the reach that um digital platforms can um that have the capability to to move forward. So um so happy to be here. Uh I we are also getting warmer weather here, and um I can't wait because I'm very much like a runner and like person to get outside and and move outside with my kids. So yeah.

SPEAKER_03 4:47

Yeah, we we can't wait for the warm weather. Like we've had a tough winter this year for sure. Yes, yes. But um we'll jump right into the topic of tonight, which was surprising signs of perimenopause. And I think that this is a great topic to go into because I think a lot of times when women start doing the deep dive and starting to research and trying to figure out what's going on, many of us have kind of heard that our periods start to get a little out of whack. And we know that like periods can get irregular, but there are so many other symptoms that can really creep in that can be kind of like sneaky and indolent that we don't really know that that's related to her hormones. So, what's the strangest thing that you've heard from patients recently, Dr. Han, that a symptom that is, you know, kind of unusual and surprising to the patient that they didn't realize it was perimetopause?

SPEAKER_05 5:33

Yeah, um, a lot of, you know, I've actually seen it, I think mentioned a couple of times on social media as well, um, which is so nice to be able to also sort of validate for my own patients, like, no, there there are other people experiencing the same. Um, but not just the itchy ears, um, but like itchy sort of just in places where you wouldn't anticipate would be itchy, right? So like um I've had patients who have talked about like like their eyeballs itching and um and like nostrils, and I I think it kind of all speaks to um, or not maybe not all, but some of that portion speaks to the the hormonal changes and hormonal fluctuations and um what we know about um where hormones um uh attach to in the body. Yeah, absolutely.

SPEAKER_03 6:23

Another one that I keep getting over and over again, which actually was one of the things that started affecting me personally too in my early 40s was joint pain. Um but I've had an enormous amount of women lately that are experiencing frozen shoulder, you know, which is something really kind of an unusual sign that a lot of women don't think about because often we're thinking like women's health, you know, our ovaries, our uterus, and and you know, we think automatically hot flashes and night sweats, but a lot of women don't realize how much estrogen affects the joint spaces and the tissues. And so like our ligaments and our tendons, our muscle, um, even like the synovial fluid in our joints and and how the joints glide and how they move, like gets affected negatively when we start to have a loss of estrogen.

SPEAKER_05 7:09

So that frozen And but that's what I was gonna say is just just that lubrication part of the joints, um, and um and a level of stiffness that you never experienced before. Yes.

SPEAKER_03 7:22

It's like you wake up and suddenly it's like overnight you feel like you've aged tremendously. Like all of a sudden you feel like God, like I feel like I'm in my 70s all of a sudden. Yeah, making like all kinds of rice crispy crackling noises when you move and everything ship and tight. Yeah.

SPEAKER_05 7:38

Yeah. And also I think that speaks a lot to um recovery. So I I talk to my own patients a lot about um, you know, I don't need your your movement, I don't need it to be like an hour-long hit workout where you are killing yourself, right? Because a lot of it goes into how well are you going to recover after that. Um, and so I talk to patients about that a lot because, you know, we think sometimes that we're in the same shape that we are that we were 10 years ago. And so we try to do the same things, but it speaks so much to how we're recovering, especially in perimenopause, um, that it it's a big difference.

SPEAKER_03 8:18

Yeah, absolutely. And I noticed like if you ever do anything that's really out of your normal routine, like you feel it the next day. Yeah, that recovery is definitely harder as we get older for sure.

SPEAKER_05 8:32

Um I uh I I picked up tennis again for uh last year for the first time in a while, like probably uh a decade or so since I've like really actually like played or tried to be competitive in any way. Um and I thought I was like, I thought I was having like spastic like spasms or sp like some kind of spastic disease process because like because my feet and my calves and everything, like just all of my muscles, like the the things that you don't really think about whenever um you're sort of you get into your day-to-day routine, um, you know, that I see my kids do like every day, and you think, oh, I could totally do that. Then you're like, I definitely can't do that, and I'm never gonna do that again. So um yeah, so it definitely is a it's a you have to you have to rethink your approach to movement and just exercise and being safe.

SPEAKER_03 9:31

So yeah, no, absolutely, and that's important too. Like if you're not someone who's normally doing certain activities, like it's important to kind of listen to your body and and not jump into something that's a total different change for you because you can hurt yourself for sure. Absolutely.

SPEAKER_05 9:47

Yeah. Um, another one that I have seen quite a bit, um, and it's maybe not strange, but I think it creeps up on a lot of um women in perimenopause because they're sort of expecting the opposite, um, is the more frequent periods and the really irregular, weird bleeding. Um I I think sometimes we chalk it up to stress and um and maybe stressful events or life events. Um, but I think most people, when they think of menopause, they think about your periods spacing or skipping. Um and for so many of my patients, it's the complete opposite. I mean, they are experiencing periods like even a week or more early than what they have been like on a schedule for um for you know the as long as they've had periods.

SPEAKER_03 10:38

Right. Yeah, like someone who's been regular.

SPEAKER_00 10:45

Oops, oh cat may have dropped for a second. We'll see if we get her back. We'll come back.

SPEAKER_01 10:54

But Dr. Halley, kind of like while we're waiting, I actually had a question that oh wait, Dr. Kat, you're back?

SPEAKER_03 11:01

Oh, I just did a little thing saying my internet connection was unstable. Sorry about that. No, no, you just you probably freeze him, but the first answer is I get was I making a really crazy face in the freeze. No, no, actually you weren't. You look crazy. That's always my nightmare when you freeze and you're like exactly.

SPEAKER_05 11:25

Yes. No, so we are yes, it's just like they, you know, I think that we tend to sort of write it off a little bit. Um, but whenever I really sit down with patients and um and even have them go through like a an actual like chronological diary of their their periods or or just their bleeding pattern, um, the the light bulb goes off and they're like, oh my gosh, you're so right. I'm having my now where my periods were 27 to 28 days apart, now they're 23 days apart. Like what is happening? And the flow has changed and the way that the the the way that the blood looks is changed, you know, like it's it's very sometimes subtle, um, and maybe not the strangest part of perimenopause, but I think it's interesting how many more patients I see who actually have more frequent bleeding than um than skipping periods or or losing them.

SPEAKER_03 12:21

So that's very common. You know, another thing that affected me, and I've noticed with a lot of my patients recently, and even some of the nurses I work with at the hospital were talking about it just last night on my shift, is the change in tolerance of smells and the change in your sense of smell. Like, I don't know if you remember, like when I was pregnant with my kids, it's all of a sudden I became like a hound dog, and I could smell the citrus smell from like miles away, it seemed like. And I was just very sensitive to smells, and it feels like in perimenopause that comes back. It's like all this there's could be something, and I'm just like, I cannot be in here, I need to move away. Like the smells just are so offensive sometimes. Like people are like, I don't know what you're talking about, I don't even smell it.

SPEAKER_05 13:04

Um, I I have uh quite literally had that experience where you're like, Am I am I having a stroke? I'm not having a stroke, right?

SPEAKER_03 13:14

You know, where you like think that, and as you know, especially as medical professionals, we're oh yeah, we know too much, and so it's so rabbit hole of wondering what's wrong with you when you start to have a system. Yeah, for sure.

SPEAKER_05 13:26

Exactly, exactly. So, but no, I totally agree with you on that one. Um, the one of the other ones that I see pretty frequently, um, and again, it's never to say like, oh, this is all chalked up to perimenopause um and and have fluctuation, um new onset, maybe worsening, but new onset anxiety panic attacks, especially. Um, like for for some of my patients who have never experienced any really any kind of anxiety, I know that sounds weird. Like, you know, you have like some of the small pieces of anxiety or episodes of that. Um, but I mean like full-blown out-of-the-blue panic attacks um that we have to then navigate because you know, obviously we want to rule out a a really serious component um to the mental health piece as well. Um, but once we've sort of gone down that road and and they're able to kind of parse out everything, a lot of times it is we we do make that decision that yes, it this is related to perimenopause. Like, um, and it can be really um really debilitating for some people for some people.

SPEAKER_03 14:36

Yes, absolutely. I think it it definitely can be. The other thing too that I think that you know is not talked about enough, but I think more and more women um in, you know, are having the conversation is that you know, your sexual desire, your sense of self, self-confidence, you know, all of that. Like you just you feel kind of an out of body, out of sorts. And so for a lot of women that can equate to a change in sexual interest and libido, um, but also your body may not respond the way that it used to prior to. And that's a that can be sometimes really challenging for relationships in particular. Um, and I know that you know, looking at statistics, I think the divorce rate goes up for women in midlife for sure, because not only are we getting increased anxiety, maybe our tolerance is a little bit low. Um I just remember like at one point just feeling like a monster because I was barking at my kids so frequently, and I was like, this is not me. Like, I don't want to be this mom. But so many different dynamics are changing, and it really leaves women feeling like suddenly they're not in control of their own body and they're not in control of their own life. And that can be really, really tough because most of us, by the time we hit our mid-40s, like we're usually doing well in our careers, you know, we've got our life figured out for the most part, and all of a sudden this hits us like this curveball, and suddenly you're having to juggle and try to figure everything out again, and it can be really, really disheartening and really challenging.

SPEAKER_05 16:05

And I think it also speaks to just the timing-wise, like it couldn't, in some ways, it just like couldn't be the worst timing because because it's you're um a lot of times approaching an age like if you do have children or and have a partner, you're approaching a time where your children become a little bit more independent, and then maybe they're like going off to school or moving out of the house, and that is like so great, but then a lot of people come on as um caregivers for a family member, um, like a parent. Um, and so it's it's sort of like you're trading one caregiving for another. And I it's not necessarily a symptom, right, of perimenopause, but I think it's a a pretty common occurrence that unfortunately we don't talk about enough because people just kind of think, oh, this is my own, this is my own stuff to deal with. Like I don't want to, you know, talk about it and and bring anybody down, but um, that's a huge undertaking for for anyone to do when you are anticipating the end of your periods and uh you know and and kind of moving on in a different phase of life, but then you end up kind of go going back into the caretaking um range.

SPEAKER_03 17:20

Absolutely. Yeah, and it's it's hard to stay afloat with all that when you're also dealing with like insomnia and you're dealing with trying to get through the workday amidst top flashes and trying to deal with the unpredictable nature of your period. I mean, there's nothing worse than being, you know, at work and I don't know about you, but like if I was at work and you know, in the middle of a surgery or doing something and suddenly your period out of the blue when you weren't expecting it for two more weeks, like you know, that just has an effect on your entire day, you know, absolutely like suddenly feel back like you're back in puberty and like not knowing how to navigate periods again.

SPEAKER_05 17:58

Yes, truly, truly. And then um, you know, talking about something that I think probably happens really frequently, even even starting before perimenopause, but that we don't really talk about a whole lot. Um, but um, but could be a little surprising to some is the development of um incontinence, urinary incontinence, leaking. Um I, you know, I have a lot of patients who have sort of sort of normalized that in their lives. And um, and so a lot of times they don't bring it up unless I ask because they think it's so normal. Um, but I always kind of talk to patients about like this could get worse. Um, you know, when you lose that um hormonal component to the vulva and vagina, um, that tissue is really thin, um, it can even further worsen um leaking. And so just kind of talking to patients about what to expect and and that that could be something that comes up, I think is really important.

SPEAKER_03 18:56

Yeah, I think it's really important. And it's so true that unless we ask or unless we have it on a questionnaire, like patients aren't gonna volunteer. And and there's a lot of that because like there's shame associated with it too. Like no one wants to talk about peeing their pants or having leakage. Like, who would want to bring that up in a conversation, you know? Yes, and then that can also affect sex life and intimacy as well. Because, you know, if you're dealing with incontinence and you're dealing with urinary leakage, you know, you're probably worried and and afraid that like if you're gonna be intimate with your partner, what's gonna happen? Are you gonna leak? What's gonna happen? Are they gonna be turned off? Or and that can then have this negative feedback to the libido too.

SPEAKER_05 19:39

Um love that you brought that up because that is like such an elephant in the room that um that when we've I feel like when patients f when I finally get patients to start talking about it, it's just like this air that just goes like, okay, finally I can like I feel comfortable talking about it, I feel comfortable talking about solutions or or ways that um ways that I can adjust, you know, my movement and my core strength and and things like that to to really not to like get big and buff, but to just like keep myself from peeding whenever whenever I don't want it to. So um, but and especially during intimacy, it's just it that's a huge, um, huge taboo topic.

SPEAKER_03 20:26

Yeah, absolutely. Yeah, so hopefully, I mean, some of the women listening, uh, I I don't know if we're getting some questions in, Maddie. Has anybody typed anything in yet or are we gonna keep keep chatting?

SPEAKER_01 20:36

Well, I think we we've got some listeners tonight, or we may, we do have one question as well. And I actually also have a couple questions that I think could be helpful for our community to know as well if we want to jump into those for sure. Um well, our first one's from Val. Um, Val says, Can you talk about heart palpitations? Because I noticed it more. I would like to know, yeah, if it's correlated to perimenopause.

SPEAKER_03 21:01

Yes. So I mean, here's the hard thing. Heart palpitations and other heart symptoms can also be a sign of something more serious. So you don't want to ignore it. But it is absolutely part of the spectrum of symptoms, and so many women experience them, myself included. I had a million-dollar workup from my heart too. Um yeah, I I had a um a situation even before I really even knew I was in perimetopause. Well, I started feeling like intermittent chest pains and started having palpitations. And of course, I went right in to get checked out because I was like, oh gosh, something bad is happening. Um like you were saying earlier, am I having a stroke? Um so you end up going in, getting evaluated because it's important to do that because more women die of heart disease every year than die of breast cancer. And I think that's like so many patients are afraid of hormone therapy and afraid of seeking treatment for perimenopause and menopause because they're worried about the risk of. Treatment. But actually, if you ignore the heart symptoms, you could be ignoring something much more serious. So it's still important to get that checked out. But it is related to estrogen's effect on the heart and our internal pacemakers in our heart and that electrical activity of the heart that we can get skipped beats or you can get like um, you know, just a little bit of a palpitations, like where you all of a sudden are aware of your heartbeat and then you're not. Because we shouldn't really be walking around aware of our heart and feeling our heart fluctuate. You know, it should be something that's kind of happened in the background, unless you're feeling your own pulse. Like you really shouldn't be feeling it. Um, but yeah, I think that several women will experience this, you know, when they're going through this change. But it's important not to ignore it. Like if you get pain associated with it, if you get sweaty or what we call diabetic, or you start to feel short of breath while you're having palpitations, or you're having chest pain, typically, you know, under the sternum, under your breastbone, um, that can be a warning sign. So you definitely don't want to ignore that and you don't want to chalk it up to perimenopause and not get it checked out. Um but yeah, palpitations are so very common. You said you had some too.

SPEAKER_05 23:09

Oh, absolutely. And just like random times where um it almost more like flutters, but just like feeling like it's racing. Um and maybe not even skipping a beat, but you're just like, I'm I'm doing nothing different. What's happening?

SPEAKER_03 23:25

So yeah, fluttering. I definitely have experienced that. And it's almost like a the way I can describe it is kind of feels like all of a sudden my heartbeat is almost in my throat for a minute. And then it kind of goes back down. Um, kind of very strange, but but very, very common.

SPEAKER_05 23:41

Yeah. Um, I would also mention just kind of associated with that or related to that, um, just changes that can happen um with hormone fluctuation, um, just to like your cholesterol numbers and um and insulin resistance type of things. Like um, I think we don't talk about that piece as much as more of like the symptoms because that's what we're wanting patients to pay attention to. Um but I constantly see this like slow creep up of um of cholesterol, of um hemoglobin A1C for diabetes and things like that. Like it's sort of the small things that you wouldn't necessarily think of. Um, but I see that all the time when I'm running labs on patients just to kind of do like an overall panel, and I'm like, hey, have you had cholesterol issues before? And they're like, no, I've I've never had an issue with that. So um, so I see that quite a bit um as patients start to get into perimenopause. So yeah, absolutely.

SPEAKER_01 24:43

Yeah, definitely. Well, and I think we do have a few more people typing, so I'll give them a minute to kind of get their questions in. But I I did want to mention one thing that I think is really interesting that you both were talking about kind of in the beginning of the surprising signs to perimenopause. And, you know, because I'm in the communities a lot, I see like a lot of the conversations that are really happening between a lot of our community members. And I think that one I see come up all the time is, I mean, just things about like strange itchiness, like whether that's, you know, lots of different places. I think that there's like lots of different ways that that manifests for people, kind of in that way. And I do see that people are always wondering a little bit about where does that itchiness come from? Like even if it is like a sign of perimenopausic, why does it happen? And is there a way to kind of fix that as well?

SPEAKER_03 25:38

Yeah, I mean, it's really the effect of our fluctuating estrogen levels on the skin itself. You know, our skin is our largest organ in our body. Um, but as we lose estrogen, the the tissues themselves like lose elasticity, lose their ability to hold on to moisture, and actually in itself actually loses some of its thickness of its layers as well. And so um what happens with that is that you know we start to notice changes, especially in the skin of our face, like we start to see signs of aging more, um, start to set in, but also the dryness, like we're not able to retain the moisture that we once were. You know, thinking back to when we were teenagers, like we could wash our face, do whatever kind of acne medication, and the next day, like our skin would be totally fine. In fact, probably be oily again, you know, after using all these very harsh ingredients. Well, come your 40s and your mid-40s, God forbid you use any of those harsh ingredients, the next day you're gonna feel like a lizard because you're gonna be so dry. And I never ever thought in a million years that I would ever have to apply as much moisturizer as I have to apply right now to kind of get through today.

SPEAKER_05 26:45

Three layers of moisturizer, but you literally described like my exact I used to cut, I used to carry those um oil absorbing sheets in every bag that I had. And I remember distinctly um it was like post my second pregnancy, and I was like, oh, my skin feels dry. This is really weird. I haven't had to use those sheets or whatever. And like exactly what you just said, the um I used a product that I was like, oh, this is gonna be amazing. Um, got some nice perioral dermatitis from it, like, because it was just, it was so drying, and um, and I think that's one of the major conversations that I have with patients um um who maybe are thinking about doing even like aesthetic treatments or chemical peels and things like that. I'm like, listen, you you don't even have the basics, like the fundamentals down. Like we need like a good gentle um cleanser for you. We need like good layer of moisturizer that's not gonna be clog pouring for you first before before we ever trek down like the the you know expensive peels and and treatments and stuff. So um, so it's like it it really affects um not just the skin too. I was gonna mention um hair follicles. Yeah. So it might not be like losing hair, although lots of women in perimenopause uh notice a significant amount more of hair loss. Um, but it's honestly just um sort of like the the lack of growth. Um, whereas like it used to be you could, you know, like get your hair cut and you know, four weeks later you'd need to get it cut again because it grow grew so fast. And now you're like, I'm lucky if I can get like anything to grow anywhere. Um but but I see that a lot. I I see the same thing or similar thing in um in postpartum patients as well, because you think about the the hormones sort of dropping and declining drastically. Um, you know, when we get that huge um hair loss um postpartum, and then um it takes so much more time to grow it back. Like I'm talking like eyebrows, eyelashes, like things that you don't really think about. Um, but I've had lots of patients who have had those issues.

SPEAKER_03 28:57

Yeah, yeah. And I think the other part too, like with the itching that women experience, sometimes the scalp can be very itchy as well. It's really related to those hair follicles changing and their like cellular turnover, like they just don't respond the way they used to. Yes. But um, for many women that notice like their skin is more dry, they're itching on their arms and legs more often, you know, especially in this winter time too, like sometimes it means like you can no longer take your long, luxurious hot showers anymore because the hotter the water is when we bathe, the more it denudes our skin of its natural protective oils. And so then that can catch up to more dryness. So um you have to think about like dialing the temperature back, you know, and maybe do more things that for ambient temperature control in your bathroom, like either getting a heated floor or having a space heater in your bathroom. Or one of the most luxurious things that I like is getting one of those towel warmers, you know, being able to grab your towel, like you know, some nights hotels always have those. And it's like, oh, these little life luxuries make a big difference. But um, but yeah, this skin itchiness is something that's so pervasive. So many women experience that. Yeah. We probably keep the moisturizer in your industry in business, you know, like in midlife. Really, truly. Yeah, absolutely.

SPEAKER_01 30:16

Awesome. Well, it looks like we have some more questions. Um, our next question is from Elena. Um, and Lena is wondering, she says, Can you talk about how we might separate perimenopause symptoms from symptoms of changing PMS? She says, as a 35-year-old woman, I find myself experiencing more noticeable PMS symptoms than I've um not previously had to deal with. And I wonder if perimenopause is a potential explanation for that, uh, for that. And then she says, and from there, I would wonder about difference in treatment approach. For example, would HRT support be explored first over birth control pills? And then she says, thank you in all caps as well.

SPEAKER_05 30:55

What a good question. And so good. I love this. I love this topic too.

SPEAKER_03 31:02

Want to start answering that for her?

SPEAKER_05 31:04

I was just gonna start with, and I won't go into like like a whole monologue about like birth control pills and like how synthetic hormones oftentimes work very differently in the body and even bioidentical hormones that we use for menopause hormone therapy, right? So um I think there's been a general consensus in, you know, for us um cat as as OBGYNs that um in perimenopause, it's totally reasonable and you should get complete symptom relief from a birth control pill. And that might be a better option than um menopause hormone therapy because it gives you a little bit more of the cycle control, right? I think now we're understanding a lot more that um that some patients don't get all of their symptoms treated with a birth control pill. And um, and sometimes though those types of hormones work very differently for one patient compared to the next patient. Um, and so I think needing to take a little bit more personalized approach um uh for especially for my patients in their 30s, it's like the forgotten patient population, because um, which I I really try to hone in on that because um they're they're the ones that I want to educate and want to be prepared for everything that's gonna be happening to them so that they can't, so that they do know the questions to ask. Um, I really liked that um you asked about um Elena the difference in treatment approach because I think the biggest question really usually is um do you need birth control? Do you need contraception? Um and if that's not the case, um there's there really are not a lot of reasons why you couldn't potentially try um bioidentical hormone therapy because we know that it's really gonna be it's treating a different treating in a different way, right? Um you're not gonna have as much of the cycle control necessarily with that. So I always kind of remind my patients like, hey, this could make bleeding a little more regular or um you know, or different from what you're really wanting. Um, but I think it's a really reasonable approach. What do you think, Kat?

SPEAKER_03 33:22

Yeah, no, I think it is. And and really that's important. I think that I have a lot of patients that start menopausal hormone therapy, and then when their periods are like totally out of whack, they want to tweak their hormone therapy to try to control the periods. And I'm constantly having to educate about how the biogenical hormones are really helping to kind of supplement your body with the hormones it's not making anymore on its own, but it doesn't do as good at suppressing those cycles. So if they really if the periods are really a big issue, then it's not the best treatment option to try to regulate the bleeding. I also think, too, like as women are getting into perimenopause, you know, she mentioned more about like PMS too. I noticed a lot of my patients complain that, you know, the PMS symptoms they had in their 20s or 30s get much worse in perimenopause. And, you know, for women that aren't real familiar with what's happening in your body during the menstrual cycle, when we are going through our OBGYN residencies and we're learning, we study this chart of these hormones, and it looks like a roller coaster. It's up and down and up and down. And really, what happens in PMS is that right before a period comes on, it's this huge fluctuation time in all these different hormones in our body. And the symptoms you're getting, the breast tenderness, the bitchiness, like all these other things, the hormone changes. And so as your body is starting to change all those hormone levels and perimenopause, that can totally get exacerbated and PMS can get worse. I mean, stories about like everyone in the family just staying away from mom, you know, like that time. Um, it can certainly happen. So I have had women that you know start menopausal hormone therapy around that time. And when their PMS is coming on, if their PMS is worse, like for those that are using like a topical compounded estrogen progesterone cream, using an extra pump, like increasing their dose just for that week before. And that can sometimes help symptoms. Um, and I never encourage women to do that without talking to their doctor. Obviously, like let us know and we'll give you advice on what to do and how to tweak things. But I definitely noticed PMS gets worse for a lot of patients when they're in this transition before they actually hit menopause.

SPEAKER_05 35:28

Agreed. Yes. And um, and I think that some people become really, really sensitive, not just to, you know, that second half of the cycle after ovulation where um you're bloated, you're fatigued, you're just um you like just don't feel good, you don't feel like hanging out with anybody, anything. But I think that people become even more sensitive to the the the full drop-off. Um, and that's because they sometimes maybe even starting a little bit lower, and then you're just like totally tanking after. So absolutely.

SPEAKER_03 36:02

Yeah, so many things we have to deal with. So many things. It's so great.

SPEAKER_00 36:06

It's so great.

SPEAKER_03 36:09

Yeah.

SPEAKER_01 36:10

And Elena, just on the end of that, she just says, Oh, she says, Thank you guys. I feel so seen. It's so hard to find info on PMS versus perimenopause. She says, currently already on the implant, and my gynecologist has recommended a birth control pill on top of that. And I've been curious about other treatment options. She says, Love you, ladies. Thanks a lot. Um yeah, absolutely. But we do have another question from Dawn as well. Um, and Dawn is wondering, she says, I joined to learn where I may be on the menopause curve. She says, I'm 54, I had my uterus removed at 48, along with adding a bladder sling. Um, she says, for several years I've dealt with difficulty finding words, hot flashes at night, um, although she says seems less during the day for the past year, um, itchy above my ears and very dry skin. She says, What treatments should I maybe at my age consider for these symptoms I'm having?

SPEAKER_03 37:06

Well, at 54, even though you had your uterus removed before the age of 50, I mean, you're probably already post-menopause. I mean, you're probably already menopausal. The average age is 52. So if you still retained your ovaries, they were probably making a little bit, you know, of their own hormones and might even still be in small amounts. But I think it's a great time for you to consider starting HRT at this point. And you're in that magic window that we know it's safest. And that's the really important thing to do too. Because if you have a hysterectomy and you have your ovaries removed, you know, really ideally you want to start hormone therapy right away if your ovaries are removed. But then when you're going through menopause naturally, like if we allow your ovaries to kind of go through the normal aging process, we have this window of time where it's safest to start hormone therapy, which was in 10 within 10 years of menopause, um, or before age 60. We just know that the risks are lower profile, you know, lower risk for women than they start within that time frame. And so this is the perfect time to do it. And all the symptoms she mentioned are things that we see so, so often, you know, again we talked about, you know, the brain fog, um, you know, and and also the find the difficulty finding words, you know, that that goes along with that brain fog and having like the short-term memory issues and forgetfulness and having issues multitasking, so many different things. But the hot flashes that will most definitely get better when you start estrogen therapy. And the beautiful thing is we know that taking estrogen therapy alone is really safe. Um breast cancer than taking combination. And because you don't have your uterus, you don't need the progesterone component of the hormone therapy, which is nice. So you have so many options. I mean, there's topical estrogen, patch estrogen pills. We know topical versions do better, um, and a lot of women tolerate those better, but we can use lower doses, so there's a lower side effect profile too. Um, so so many options for that for Dawn. You know, this is perfect time for her to explore.

SPEAKER_05 39:02

Yeah. Absolutely, Dawn. I was also just gonna mention that um where I think we're finding more data coming out too, that, you know, whereas probably when you and I trained, um, Kat, it was it was more, oh, you had your uterus taken out, but you still have your ovaries, they're totally gonna function the exact same way whenever you have your uterus out. Um, and that's sort of how that's the party line that we followed and that I even followed talking to my patients. I think now we're finding actually more studies and more data coming out that show that um oftentimes that ovarian function is compromised whenever you're taking a large amount of that blood supply that it's that it would be getting right from that connection to the uterus. So um, so I think it's interesting to see that um, and and what will come like even in the next decade, um, but I think we're finding that women are starting to experience symptoms earlier as well, just by simply having their uterus taken out.

SPEAKER_03 40:01

Absolutely. And also because we take the tubes out now, you know, prophylax, that's a good thing too. So, you know, years ago we would just do the removal of the uterus. Um, and you know, if you didn't have a history of having, you know, some issues with your ovaries, like we left the ovaries in, we left the tubes in, but now we know that the tubes are the source of cancers. And so now when women are getting or requesting tubal ligation surgeries, or if they're having hysterectomy, we also take the tubes, which is called a salvagectomy. And the tubes, you know, are like I kind of think of like one of those fancy robes, you know. They do look like that. Yes. So like if your body is the uterus, your arms with the little fingers on the end, which are your fimbry of your tubes, are are the arms of the robe, then we have this long, flat part of the curtain, you know, the tissue kind of hanging down, which is our mesosalpinx, or just is basically connective tissue. The ovaries are right around there too. And when we're going to dissect these fallopian tubes to remove them, you know, despite using energy that we think goes in one arm of the tool laparoscopically and back to the device, there has to be some lateral spread of that energy. And some of the tissue of the ovary gets a little damaged when we're doing those, like not to the naked eye, but I definitely think that that's part of the equation that you know, sometimes we're getting that lateral thermal spread to the ovaries or they're getting damaged, and so they're declining their function as a result of us being operating right next door to them on the tubes. Yes, yeah.

SPEAKER_05 41:35

So I think Don said I thought it was coincidental they sent in sort of short. I I have like I actually prepare my patients now, like when I'm doing pre-op for them. I we have that conversation, like, hey, you are probably going to start having symptoms earlier. Um, and that this is a good, you know, your post-op time period is a good time to start having that conversation. Um, and not to ignore them until and just say, oh, well, your post-op from surgery, let's give it six months um uh before we do anything about it, because a lot of patients really do feel the effects of that really early. Absolutely.

SPEAKER_03 42:15

Yeah, and I don't think it's I don't think it's recognized as much, like you said. No, yeah, yeah. Yeah.

SPEAKER_01 42:25

Well, we may have one more question or so on the way. I think there's a few being typed, but I guess like, is there anything that either of you feel is like, especially when we're dealing with, you know, signs of perimenopause that tend to be on the more surprising side that women should be on the lookout for or should kind of just, you know, have the knowledge of like how to, you know, address those if they come up. Because, you know, I think we can talk about the surprising signs, but sometimes, you know, there's things that we can do to either like prepare ourselves for that or what that could look like. I don't know if you have any thoughts on that end.

SPEAKER_03 43:01

I think the biggest thing, some of these things kind of creep in one by one, little by little. And as human beings, we kind of start to assimilate little small changes into our normal and every day, and we don't notice in them until they make a bigger impact on us. So I think that women need to be really good about being observers of their own body. And I think it's really important to start kind of like jotting things down, thinking about doing a symptom diary, because that's really the best way that doctors like Dr. Han and I can really help you is when you come with that like information. And you know, if somebody comes to me with like a symptom log and they said, you know, I'm having this happen every single day, or I'm having these symptoms, and I can look at what's written down as like a constellation of symptoms. It's so much easier for me to know how to treat them and what to do and kind of what dosage to start them on than if I don't really have that information. And I think that that also helps women to recognize patterns. That's really important too, because some of these things are so subtle and they kind of creep in. But I think that you know until you kind of look at the big picture and you see the forest through the trees and start to notice it. But actually all these things have started around the same time and and they're just starting to get gradually worse. I think that that's important to kind of keep a keep a log of to help yourself to know when to seek care.

SPEAKER_05 44:19

Absolutely. And then I was going to say too just really remend remembering that you can be just to be an advocate for yourself. Because I think especially since we're talking specifically about perimenopause, I think a lot of patients go in with um with kind of an an open heart and an open mind to it and want to ask questions but sometimes might get shot down by their clinician and they say, oh you're too young. You're too young for perimenopause. But that's why I love having these conversations with um with patients who might even be be earlier than what I personally think would that they're likely to be in perimenopause or not. But I'm I'm constantly surprised when patients describe all of their symptoms, I'm like I actually think you are I think you are in perimenopause. So um you know and just remembering that blood tests are not um end all the end all be all um they can be a really helpful adjunct um to to your health information um but so much about perimenopause is just um the symptom tracking like what you were talking about.

SPEAKER_03 45:30

Yeah it's really helpful.

SPEAKER_01 45:33

Yeah we have a question next we had a couple more thrown in here we have a question from Marie and Marie's wondering says how can we protect our iron levels when periods are closer together?

SPEAKER_03 45:47

Yeah so if you're someone who has struggled with anemia in the past and you've dealt with like low iron levels after heavy periods or even during pregnancy if you start noticing in perimenopause that your periods are getting closer together it's important to kind of get a baseline CBC I think you know which is a blood count after this cycle to see how low are you actually dropping because you might benefit from iron supplementation. And then along with iron supplementation that the unfortunate friend that comes with that is some constipation as well because almost always when we take oral iron we don't metabolize all of it and it can cause some constipation as a side effect. So you don't want to take iron unnecessarily so I wouldn't just go out and buy iron. So you know if you haven't had screening blood work like with your primary care provider to kind of see where your blood count is and you know check your you know liver and kidney function and your cholesterol and all that I think it would be important to get that blood count especially after you've had periods back to back to see like are you actually losing enough blood volume that it is affecting your iron levels because sometimes what we see qualitatively on a pad or in a tampon might not actually equate to a change in your blood work. And that's the only reason I would really recommend iron supplementation is if your iron levels are low and your hemoglobin drops significantly.

SPEAKER_05 47:04

Yeah, I completely agree. I do have some patients who um who like you mentioned don't tolerate the oral iron supplementation as well and so there are definitely other alternatives that you can talk to um your own clinician about um too if that's if that's a concern for you. But I'm always surprised at how much the the female body um just compensates. And um it's really just it once again it it doesn't surprise me because women's bodies are amazing but um but it's always surprising when I think like oh my gosh you're going through like three super plus tampons in an hour and like your iron is still beautiful your ferritin your stored iron is awesome like your your body was like made to survive for sure.

SPEAKER_01 47:53

Yeah and it looks like we have another question from Victoria um and Victoria's wondering so she says I started taking um the cream and DHEA last year um she says at first it regulated me but now I'm seeing massive muscle loss water retention in my legs and I'm starting to notice my sleep is being broken up again.

SPEAKER_03 48:18

She says my question is um what do I regularly check to help keep symptoms down but not at the sake of others coming on well I think the important thing in that question Maddie is that she mentioned starting the meds a year ago depending on how old you are and where you are in this journey as you continue to age you know you might be on a certain dose of hormone therapy but then as your ovaries are continuing their own aging process and they're kind of downregulating how much hormone they're making, your symptoms may start to resurge. And it's not that the medicines aren't working anymore. It's just that you started a medication based on what your hormone levels were and now if your own internal hormone levels are lower you might need a dose adjustment to keep your symptoms under good control. So you know I would reach out to the doctor who's prescribing to you and let them know that you're seeing those changes and maybe some adjustments need to be made in your dose to keep you feeling your best. So I think that's yeah.

SPEAKER_05 49:16

Yeah I totally agree.

SPEAKER_01 49:19

She did want to add that she's 51 and she says she's still getting regular periods I don't know if that uh changed anything but I thought I'd throw that in there.

unknown 49:26

Okay.

SPEAKER_03 49:27

Yeah I think you know as you get further into your 50s that see that kind of goes along with the probably needing an increase in your dose as well Victoria Well that looks like that was all of our questions for tonight that I'm seeing in the chat right now.

SPEAKER_01 49:44

But just as like kind of an ending note since we've been talking so much about perimenopause, the signs of it kind of like all that goes into that is there anything that you feel is important to kind of leave the women here tonight or later on that are watching this back um just of something that they should know kind of just about perimenopause about the signs or um just anything you feel like might be good knowledge I guess to impart?

SPEAKER_03 50:12

I would just say learn as much as you can, read as much as you can talk to your friends, make sure that you're keeping track of what's going on in your own body. You know we we have to be our best advocates for ourselves like you know and I I wish I knew your body as well as you did but as your doctor like we only know what we see when we see you for 20 or 30 minutes and maybe Dr. Han has more time you know if you had that practice model maybe you can spend more time with your patients. But but you as the woman like you are living in your body day in and day out you know what's going on in your body and you are are the best observer of what's going on. And so that's the the big thing I would say is that you know make sure that you're staying on top of like really monitoring yourself, learn as much as you can so that you can be proactive about recognizing um you know and and just educate yourself educate your friends that that's the big thing I would push home at the end of these QA's is that you know this is a great opportunity for you to learn stuff but then take this and roll with it. You know go find reputable sources like we have some great articles in our medical journal page on Winona. You can go to the Metopause Society they have great patient facial facing information as well there's more and more documentaries and stuff that you can watch in the comfort of your own home that you don't have to read on the internet. And actually the one that I filmed last summer is actually going to be starting I think premiering this weekend. Oh awesome that's amazing um if you go to revoke.com which is the the health organization that produced the the menopause um it's perimetopause and menopause documentary series and there was several other OBGYNs that went we went to Costa Rica for a few days um and just and they brought patients and put them all in a house together to talk and with all these experts and it I'm really I'm excited to see it. I hope that like all my segments didn't get cut out too much but I'm sure they didn't it was great because I got a chance to go to Costa Rica. There's another one called Balanced which just came out I've been dying to watch but I haven't bit the bullet to like pay for the access to watch it but that was like that was made by two monks which is actually fascinating. Yeah um there's also the M Factor which was out like last year um there's so much I mean I think that you know right now this is the time like we are women living in the best time right now because there's so much on social media stars are talking about this women are opening up and and we don't no longer have to so like suffer in silence anymore. Menopause is kind of like a buzzworthy thing right now but I'm glad it is because education is getting out there and more women are going to have access to resources. And like with the FDA removing the black box warning on estrogen oh my gosh that's just gonna so many more doctors that weren't even considering adding this into their toolbox or that didn't care before. Now if they want to keep up and they want to keep their patients happy they're gonna have to jump on the train and have to like join us Dr.

SPEAKER_05 53:15

Han yes I think um I think that's a really important thing that patients can um kind of important and but also simple and sometimes might make patients feel a little uncomfortable. But you are more than welcome to ask your clinician if they feel comfortable managing perimenopause and menopause or evaluating it. And we as clinicians should be able to like swallow our pride if we can't and say you know what I don't think I'm the best person to help you but let me get you to the person who can let me get you the help that you can. So I think not taking the um the paternalistic answer that is I know what's best for you you're not in perimenopause you're too young um and taking that and and challenging that and coming back and saying I'm still I I feel a certain way and I know that this is not normal for me. So if you don't feel like you can help me could you point me in the direction of somebody that you feel like could so um I I really think I really wish we would stop practicing medicine like in these big just silos and sort of um saying that's not my that's not what I do or you know like everybody does everyone who takes care of women should know something about women's health and and what we're going through outside of a pregnancy.

SPEAKER_03 54:45

So absolutely yeah and I think yeah don't take no for an answer. I think that's so important.

SPEAKER_01 54:51

Yeah absolutely yeah well I was gonna say thank you so much Dr. Kat and thank you so much Dr. Han for just being here tonight and for being willing to give a little bit of your guys's time I think this was like really I think just a great conversation. I love getting to hear I think just two people that are passionate about what they're what they do and really supporting women I think that's like such a great conversation just to get to listen to and be a part of as well for sure.

SPEAKER_03 55:18

Thank you so much for taking the time to come and join us Dr.

SPEAKER_05 55:21

Han at the screencast I got to I got to pawn the children off on my husband always a good excuse for sure absolutely yeah absolutely thank you so much for having me this is awesome I always love having conversations like this just to because because you learn so much even just from the questions that come up and everything.

SPEAKER_03 55:47

So yeah absolutely the women that couldn't join us tonight will be watching this back on the replay and hopefully you know share it with your friends. So ladies that those of you that attended thank you so much for taking time out of your evening but don't gatekeep this information like share the link to the replay with your girlfriends talk to them and you know at your you know working you know reading groups and things like that you know let them know this information is out there.

SPEAKER_01 56:13

Absolutely completely agree well thank you everyone for being here tonight um and I think Dr. Kat said earlier as well but if you're ever interested in more information um we do have our uh the menopause uh hour podcast um that's a great thing to listen to has tons of information we also have tons of articles on our bywinona.com um which really goes into a lot of detail about all of these topics as well as well as the fact that if you are already a Winona patient or are interested in becoming a Winona patient is that your Winona doctor is available 247 as well in your patient portal um just to chat through kind of just like this and ask questions. So um we always just like to kind of point everyone in the direction of here's some answers, here's where you can find some information. I think that's such an important aspect to kind of touch on as well. But yeah, thank you everyone so much for being here tonight and I hope that everyone has a great um rest of their night afternoon whatever time it is where you're tuning in for sure.

SPEAKER_03 57:17

Yeah and if you're on social media and you want to follow you can follow me on Instagram Dr. Han, do you want to give them information about where to follow you?

SPEAKER_05 57:25

Yeah sure I'm on Instagram Facebook LinkedIn anywhere um but it's uh TaylorHon H A H N dot M D.

SPEAKER_03 57:33

So and then my Instagram is at Dr Kat O B G Y N. So you'll find all kinds of information I think both of us like to share educational stuff for patients. Yeah I mean the more we get more information out there we are helping all women out everywhere you know we're sharing this information.

SPEAKER_01 57:51

So absolutely yeah and then my Instagram is I love it.

SPEAKER_00 57:56

Give it Maddie out there maybe sometime well thank you guys again so much for being here tonight. And uh hopefully we'll get to have you again sometime Dr. Hahn I think that would be great.

SPEAKER_02 58:14

Yeah perfectly have a great evening guys bye all right thanks for spending time with us we hope today's conversation helped you feel more informed more supported and a lot less alone if you're ready to go deeper download the Winona app. It's free it's for you and it's filled with resources, real stories, expert insights and a vibrant space to connect with women navigating the same season. Have questions? Join our next live QA. Until next time, take care of yourself. We'll be here when you're ready for more