Episode #43: Hormonal Mood Swings & Brain Fog Explained

 In this episode of The Menopause Hour with Winona, Dr. Cat sits down with Dr. Moon to talk about two of perimenopause's most misunderstood symptoms: mood swings and brain fog, diving into why these symptoms often get mistaken for stress, ADHD, or depression. They also offer another perspective on what's really happening with your hormones and cortisol during this stage of life and share how sleep and nutrition play a key role in managing these symptoms.

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Transcript

SPEAKER_00 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_04 0:25

Hello, hello everyone, and welcome to another one of our doctor dialogues. We're so glad you're here today. I see a bunch of people jumping in. Super exciting that you have taken the time out of your night to be here. Um, that says so much about you just taking taking the reins on your journey wherever you kind of are in that stage, that process. We're so excited that you're here. Um, if you haven't met me before, I'm Maddie. I'm the community manager here at Winona. I've probably seen either your face or your profile, especially if you're in the community. I'm in here a lot. Um, so I'm really excited to see some new faces. I see some familiar faces. Um, really glad that you all are here tonight. Um, but tonight we are going to be talking a little bit about hormonal mood swings and brain fog. Um, and then just as a note, this is a doctor dialogue. So we have a lot of similarities between our typical live QAs, and you'll have a chance to ask questions as well. We also have the amazing uh both Dr. Kat and Dr. Moon who are here with us tonight. So we're gonna hear some really, really great insights from them on kind of what hormonal moon swings and brain fog look like. Um, and then we're gonna get into your questions. If this is one of your first times at one of our events like this, I want to point out a few things that you might want to know. At the bottom of your screen, there's going to be a chat button. Um, that is the best place to go ahead and throw all your questions in there. Um, really anything and everything. We do have a focus on hormonal mood swings and brain fog tonight. So we'd love questions on that, but that is no, by no means the only questions you can ask. We this is still, feel free to ask any question you might have on your mind. We have two amazing doctors here tonight to answer those questions, so we want to hear them. Um I always say it sometimes gets a little bit crazy in there. So I would always throw in your question early. If you have one on the top of your mind right now, go ahead and throw it in. If one comes up during the conversation, you can throw it in. If you're we're in the middle of the questions and you have one, pretty much. If you have a question, throw it in there whenever we whenever you come up and we will kind of work down the list and get to you. Um, so so excited that you all are here. Um, but I want to kind of also jump into introductions for our amazing doctors. Um, so maybe Dr. Kat will start with you, and then Dr. Moon, I'd love you to give a little introduction as well, and then we'll get into the conversation.

SPEAKER_01 3:04

Yeah, so welcome, ladies. You may know me and you may know my face because I'm all over Winona ads right now. But if you've been to one of our live Q ⁇ A's, you've seen Maddie and I before. Um, but I am our medical director at Winona and I'm one of the board-certified OBGYNs that prescribes for patients as well. Um, women's health has been my life. And, you know, I think that um like many other female OBGYNs out there, we've kind of dedicated our lives to helping others and helping women in this space. Um, but menopause and perimenopause is near and dear to my heart because I'm also not only just a doctor, but I'm also a patient as well. I mean, I'm in the thick of it with you and also going through the same journey. And I think that each of us, every woman has their own path. Not every woman's experience is going to be identical. And that's why, you know, getting your questions answered, coming and learning more about, you know, what can be happening, what's going on, and learning as much as you can about your body is so empowering and so powerful to help, you know, for you to help yourself as well. Um, I live in the Philadelphia area. Um, I was in the Army for 12 years, so I moved around the country a little bit. And I had the pleasure of meeting Dr. Moon just a few months back. Um, we actually did a live Winona event um in Indianapolis, Indiana. And she's fabulous. And so I want her to tell you more about herself as well because these doctor dialogues are great. We get to bring on a guest physician to you know have these talks to talk about these specific topics, but it's so nice to get a different perspective because I don't want you to just hear from me all the time. It's nice to get somebody else. So so welcome, Dr. Moon. Thank you so much for taking the time out of your night to join us on this call, too.

SPEAKER_05 4:44

Well, thank you so much for having me. Um, I live in Carmel, Indiana, that is just north of Indianapolis, and I've been practicing here since I finished my residency at IU since 2001, so almost 25 years now. And I've transitioned my practice over to gynecology only. I'm not doing the obstetrics component anymore, with also a focus on the minimally invasive GYN surgery aspect of it, which is a really fun part of my practice too. Um, I became menopause certified because I wanted to make sure I had the extra training and education and support that we need to take care of all of the women that we serve. And I agree with you, this journey is our journey as well. Um, and so, you know, experiencing it in your own way does create a lot more empathy for our patients, uh, even though they may look at it from a different lens. And so I'm just excited to have the conversations tonight and talk about the things that you and I see every day.

SPEAKER_01 5:43

Absolutely. Yeah. And I think, you know, tonight we wanted to focus most on like mood swings and brain fog. And I think those are some of the really challenging symptoms that, you know, some women don't really recognize right away as being indicators of perimenopause, especially early on. You know, I think many of us, if we start to have mood swings or our tolerance is starting to decrease, we can blame it on so many other things, right? I mean, we could blame it on stress, work, you know, so many different things. But these are fundamental things that happen and in response to hormonal fluctuations. Um, and so I think that, you know, that's something important to talk about. But um, how often do you see patients coming into the office with mood swings like as their primary symptom and concern?

SPEAKER_05 6:31

Very frequently.

SPEAKER_01 6:33

Yeah.

SPEAKER_05 6:33

And and they do attribute it to a wide variety of other things. And so uh if women want to say, well, I think I'm feeling this way because my dog died, or maybe they've had you know a work event change or their kids are stressing them out. And then they ask me, How do I know if it's these life stressors or perimenopause? And I like to collaborate with them that it's probably both. Like we all have life stressors, and those are gonna contribute, but when your hormones begin to change, it makes it harder to adapt to that and it makes it harder for you to get through those times because our life is a journey of stressors, they're always gonna be coming at us, but it really I feel like it takes away your ability to compensate, like you used to be able to.

SPEAKER_01 7:21

Absolutely. Like you just can't roll with the punches and that your resilience goes down a little bit too, right?

SPEAKER_05 7:27

Tremendously.

SPEAKER_01 7:28

Yeah, yeah, absolutely. I I would say too that for us at Winona, the percentage of patients that come to us seeking treatment that have been dealing with mood swings for a long time, um, and and maybe they've gone to see their primary care doctor and they've been given like an antidepressant first, you know, that's so, so common. And it can help to a certain degree, right? It can help with a little bit of it. But when this the root causes hormonal fluctuations, in addition to all those other life stressors, the antidepressant can only do so much, right? You know, it might help keep your moods a little bit more even keeled and maybe help you to not get as angry or, you know, but it may not get to the root cause of the issue and it may not really help totally. Um, and that's why women end up seeking, you know, additional treatment options.

SPEAKER_05 8:15

And if their primary care provider is um promoting some of those different medications, particularly the SSRI family, I notice that women get a much higher chance of weight gain and a much higher chance of low libido, which just makes the perimenopause worse.

SPEAKER_01 8:34

So much worse, right? Yeah. Because I mean, God knows that, you know, during perimenopause itself, the weight issue, the menobelly, that's the infamous menobelly that women are fighting against, you know, what we used to do in our 20s and 30s to try to help keep fit and you know keep our weight down may no longer work, you know, when our hormones are in such flux. And our stress hormones are so high, should just anything you're doing to try to lose weight, sometimes it's a losing battle until you get things balanced again.

SPEAKER_05 9:03

So I agree. They the understanding of where hormones can be instrumental here is not a big enough message to all physicians. And that's our challenge to continue to promote that to them.

SPEAKER_01 9:19

Absolutely. Absolutely. Yeah. And then brain fog, I mean, that's the other thing we wanted to kind of focus on too. And and this, you know, brain fog can be a different constellation of symptoms for different patients. But most women come in just saying, I just don't feel like myself. Or, you know, they have a difficulty like maintaining focus. Um, you know, the classic thing is like leaving the room to go in another room to fetch something to finish one task, and then you get distracted when you get to the other room and you don't even remember why you went in the room in the first place. Um, and some of us, you know, I used to really revel in the fact that I was great at multitasking. And now if I don't make a list of things to do, and if I don't really focus on getting a task done, it can be very difficult to stay on task and get things done and not get distracted for sure.

SPEAKER_05 10:09

I'm really um saddened to see how it affects people's work performances because a lot of women at this stage in their careers are in their prime and they've worked their way up their corporate ladders or they're owning their own businesses, you know, whatever it is. And now suddenly they can't perform at their job at the same level they were doing before, and they feel uh so inadequate in their professional arenas.

SPEAKER_01 10:38

Right. And that's so challenging too, because as you know, for women, we're already kind of fighting that battle of not making as much of as our male counterparts. You know, there are by far not nearly as many female CEOs and managers and companies that there are as men. So to throw this like health struggle in that in that equation makes life even harder. When we're already fighting for workplace equality and equal pay, you know, that's been a long fight that we've been fighting for a long time. And we're still not there. You know, it's like women all over are still trying to break that glass ceiling and trying to break through it. Um, but we still have a long way to go before you know women and men are really considered equivalent in the workplace, no matter what the industry, whether it be medicine or whether it be corporate America or wherever else. And so throwing this curveball of brain fog and perimenopause and menopause, what a challenge that women are going through. It's it's insane, really.

SPEAKER_05 11:38

It is, and I see it every day in terms of how it impacts even like at like we're talking about primary care and how they can be misdiagnosed. And I have so many women coming in who have been told that they suddenly have ADHD and now they're being put on stimulants to help promote their brain activity when we know that's not the real cause of this sudden change in focus.

SPEAKER_01 12:04

Yes, I see that a lot too.

SPEAKER_05 12:07

A ton.

SPEAKER_01 12:07

And then the problem is if you have a family history of like hypertension and other medical problems, those stimulants that are then given to you know help ADHD symptoms can make hypertension rear its ugly face and like their blood pressure can go through the roof and other medical problems can happen as a result. But but also it comes back to you know, antidepressants don't always help with the mood swings. Going on an ADHD medication to help treat the brain frog when it is really, you know, hormonally related can only do so much. Like, so it's not going to get them back to themselves and back to what they consider to be their their normal.

SPEAKER_05 12:44

I think that the stimulants also exacerbate their anxiety and the sleep disturbance. And I think it also exacerbates like the heart palpitations that we see women get so frequently during this time. So then they end up at the cardiology office getting whole monitors, million-dollar workups.

SPEAKER_01 13:04

Yes. And and the stress that that brings on too, right? So then when you're having all those other symptoms, which could be side effects of a treatment option that you're given, like the anxiety and the stress that women go through wondering, is something wrong? Like, am I really going to be okay? You know, it's it's scary. So scary.

SPEAKER_05 13:23

It is. Once again, getting the word out, right? To our fellow physicians. Absolutely. Understand the so many things that women experience during this time.

SPEAKER_01 13:33

Yeah. Well, the good news is, I don't know if you saw in the news that um was it the Melinda Gates Foundation just gave a huge sum of money to the menopause society solely, you know, to use for educating physicians and educating providers on menopause education. So, and hopefully that will be you put to good use. Um, you know, but I think the more and more that people in the media are talking about this, and you know, the more that patients are demanding better, I think that that is also going to change practice too, you know, and and getting the black box warning off of estrogen was a huge step, I think.

SPEAKER_05 14:10

It was amazing.

unknown 14:11

Yes.

SPEAKER_01 14:12

Yeah. Are you seeing a big difference, you know, now with some of your referring um doctors in the community that would send patients to you?

SPEAKER_05 14:20

I am seeing a really big difference within the community. And I'm fortunate enough that uh some of the physicians are also my patients, and they're also hoping to be like similarly aged to me. And so then we can have it even in that doctor-patient relationship where we're having the conversation about um you're in menopause now and you're having these symptoms, and these are the things I can do to help you. And I've had physician colleagues comment to me, I feel so badly now that I didn't know this before, because I think of all the patients that I could have helped by understanding this now, and I said, Well, you can still help them going forward. Like you're not done with this journey yet. And so as we learn these new things and we become educated, now you have that opportunity to turn around and also further this message to your patients.

SPEAKER_01 15:08

Right, right. And you know, we take that oath at first, do no harm. And the thing is, if you don't have the education, you don't have the knowledge about it, it's not malintent, right? You know, it's we can only do the best that we can with the information that we have at the time. We can't go back and change the past, but we can do everything we can to make things better for the future, for sure.

SPEAKER_05 15:28

I think there's a lot of hope for the future and a lot of excitement around the potential of things that we can continue to support our patients in, and uh more research will be phenomenal as well. I think right now the biggest area of research we need to continue to work on is how testosterone affects mood during perimenopause, because so much push right now is only on libido and postmenopause. But I'm sure you experience, like I experience, women having mood improvement with testosterone therapy and perimenopause.

SPEAKER_01 16:06

Yes, yes. And and we really need like some standardized guidelines on testosterone use in women so that we're not taking products that are, you know, meant for men and trying to scale them and trying to gerry-rig things to try to treat women with it for sure. Yeah.

SPEAKER_05 16:23

I'm encouraged that some of our other countries around the globe have approved some of those therapies. Um, and hopefully we can take that information and utilize it. But I'm excited that other countries have the testosterone patches for women and some of the other therapies. And I hope that we can access that at some point here as well.

SPEAKER_01 16:44

Absolutely. I think that would be great. That would be great. Are we getting some questions starting to pile up, Maddie? Are we are we starting to see some things come in?

SPEAKER_03 16:52

Yeah, we got one. Or we got a few going. Oh, excuse me, we've got a few going in here.

SPEAKER_04 16:59

Yeah, we can start with one of Carol's. Um, looks like it's right on track with talking about brain fog as well. Um, but Carol is wondering, she says, what can I do to help with my brain fog? She says when I first started taking estriol, um, she was taking the patch at uh 0.025 milligrams. She says it improved. But after a few months, she's back to having poor memory, and she's now taking the 0.05 milligrams.

SPEAKER_01 17:32

So, I mean, it could be that you need to tweak your dose for sure. But the other thing too that I think that it's also a big elephant in the room that we need to talk about, which um is sleep hygiene, too. I think that that's so, so very important. As someone who has desperately abused my own body in sleep, being an Obi-Joanne on call and being on in the hospital overnight, um, really, I think that we don't put enough emphasis on how restorative our sleep can be toward our brain function and our optimal, you know, attention and everything else the next day. So, you know, hormones are one piece of the puzzle. We also have to do the self-care and the behavioral changes to optimize our wellness in every part of our life, right? So our nutrition is important too, right? So you are what you eat. So the quality of the food that you're putting in your body can really help, you know, optimize your function and how well your your brain performs, but also your sleep too. Like getting, making sure you get that good quality sleep and that you're getting enough sleep that you're not needing to push caffeine the next day to kind of get through the day. Um, you know, that's so important. I don't know what would you add to that, Dr. Moon?

SPEAKER_05 18:42

Well, I think it's important that we're screening for other metabolic issues as well and that we're being thorough. So certainly thyroid checks, vitamin D, B12, ferritin, because we don't think as clearly if we don't have that nutritional support. And so many women need supplements that are gonna be on top of their like healthy diets because we just don't get sunshine and we don't we we can't achieve those levels through healthy food alone. And so you need to be looking at the big total picture when you're taking care of these women and looking at those other metabolic components that can be helpful too.

SPEAKER_02 19:19

Yeah, absolutely. For sure.

SPEAKER_04 19:23

And we have a question next from Nicole. Um, it's a little bit of an open-ended question. Uh, but she says that Nicole says, Libido is my struggle right now. But she says, but the DHEA doesn't really agree with me. What I think she's wondering what can be done here. Is there any suggestions? Um, yeah, I would love to hear from both of you, Dr. Moon and Dr. Kat.

SPEAKER_01 19:48

Yeah, I mean, I think the important thing for us to realize as women is that our libido and our sex drive are not totally hormone derived. And, you know, the hormones themselves are not responsible for everything, right? I'd like to tell patients that our biggest sex organ is actually our brain, right? Um, there's so many good resources out there. And one of the ones that I like to recommend to patients, there's a book by Emily Nagoski called Come As You Are. Um, and it really talks about um our sex drive, you know, what puts the brakes on, what really helps. And and our brains as women really have to be in an optimal space. Our relationship has to be in a good place, right? We we have to feel supported, we have to feel um that we're well cared for, but we also have to be well-rested. Like there's so many different things that can put the brakes on our libido and affect our sexual function and our sexual desire. Um, and I think that not enough people recognize that. Um, and I think that too, like depending on where you are in your relationship, sometimes you have to kind of take it back to the bare basics and going back to like when you first met your partner and when you were like dating and courting, because often we get comfortable and we get in routines and we stop taking those little efforts to kind of put romance in and making an effort to get to know our partners and um you know, and do that. So I think that there's so many other things to take into account besides just the hormone piece of it alone. Now, DHEA is something that we use at Winona to help boost testosterone levels naturally, just because being an asynchronous telemedicine platform, we can't prescribe testosterone on our platform. And every state has different telemedicine restrictions. So there's some states that you could get testosterone through telemedicine, but because we want all of our patients to have the same experience and opportunity, right now we don't offer testosterone on our platform. But for some patients, I do think that going on a dose of testosterone could help significantly. When they also put the work in to the other pieces of that too, to improve their desire and interest in sex and other ways. Um, but yeah, I think that that's something that you might want to consider as well. But yeah, if you Haven't read that book, I highly recommend it. There's also a really good website called OMG Yes.

SPEAKER_05 22:05

Um I was just gonna mention that, one of my go-to's, of course.

SPEAKER_01 22:09

Oh, it's one of my go-to's too.

SPEAKER_05 22:11

And I used to love it the Rosie app too, which was um well, unfortunately, that just went by the wayside, but Rosie was good.

SPEAKER_01 22:18

Rosie was good, but OMG Yes is a website that is purely dedicated toward female sexual wellness. Um, and it has so many resources and so many things that patients can explore with their partner or alone to help optimize, you know, their sexual experience. And I think that for far too long, there's this been this like double standard where, you know, women's sexuality is kind of in hush hush and not important. And, you know, like men are patted on the back for being studs and women have to be, you know, chaste and pure. And but no, sex is important to us too, and it's important to your health, it's important to your relationship. Um, and OMGS has such great resources for exploring that and improving your sex life too. So highly recommend that. What else would you add, Dr. Moon?

SPEAKER_05 23:07

Well, I find a lot of women are really struggling with painful intercourse during this time and really addressing like the vaginal atrophy, the clitoral response, but just you know, like, do they have uh vulvadinia, vaginismus, endometriosis? And so, you know, I tell them, you know, I ask them if they're having painful intercourse, and they say yes. And I'm like, well, nobody wants to do something that hurts. So we have to really make sure we're addressing pain in these patients. Um, I think that's like a huge component to low libido, but I also think there's some other natural things that women can do to go booster libido outside of even our other resources. And it's just like reading a steamy novel, watching a steamy movie. And I like to call it the 50 Shades of Gray effect. How many women got pregnant that year because just even that particular book or movie re-stimulated their desire to be sexual? So that's not to be understated, understanding what kind of like creates that mood for you individually.

SPEAKER_01 24:09

Absolutely. That's so true, yeah. And they do have resources like that on that website on OMGS too, but there's so many other places that you can, you know, get that as well. Yeah. But yeah, that's so true. And I think that um many women I think don't really realize that like the just adding a simple addition of like a lubricant can sometimes make all the world of difference and making sex less painful. But it's it's kind of a self-fulfilling prophecy that when you you have desire for sex and then sex is painful, or you're you're not you're dry and it's really hard to get comfortable, then your desire for sex the next time is affected, right? It's that negative feedback loop in that you don't want to keep putting yourself through that if it's uncomfortable.

SPEAKER_04 24:54

So absolutely, yeah. And our next question is from Val. Um, and this is a little bit of a two-parter question. Um, she says, Belly fat and brain fog are my biggest concerns. She says, I need to be able to remember important things. Um, I have good long-term memory, but not short-term memory, which is interesting. So I think she's wondering a little bit about what she can do about belly fat. And then also with her memory, with the brain fog, is it normal to have long-term but not short-term memory?

SPEAKER_01 25:30

I think every woman's experience with memory and brain fog is is different, but it's not uncommon for me to hear that from patients that the short-term memory is more affected. Um, because your long-term memory has been well established. And a lot of the things that are in your long-term memory you've you've been aware of and dealing with for a long time. Um, now the belly fat issue is such a struggle. Um, our metabolism changes. One of the things I find in my patient population is that a lot of patients are not getting enough protein or fiber in their diet. Um, so the days of us going low calorie and the calorie in, calorie out, um, and trying to do aerobic and cardio workouts to try to lose weight, you got to throw all of that out the window. It's what we really need to do is we need to focus on strength training and weight training, resistance training, you know, really helping maintain our muscle mass because that's what really drives our metabolism is having a good core muscle mass. Um, and most women are not getting enough protein in their diet. And if you're not, your body is really not going to lose weight. Your body's going to try to hold on to those extra pounds because it thinks you're kind of in starvation mode, no matter how much you try, you're trying to lose weight. Um, and then also going back to making sure you're drinking enough water, making sure you're getting good sleep, because it doesn't matter how good you eat and how good your diet is and how well you're exercising, if you're not getting restorative sleep for your body to heal itself, you're you're still going to hold on to weight too. And I think that's a struggle too, especially if you're dealing with night sweats and insomnia related to your symptoms of perimenopause or menopause. So, you know, it's really like going back to basics and really taking care of your body. But I encourage women to kind of track their macros. Um, don't worry about calories so much. I want people to eat whole foods that go bad, you know, sticking to the periphery of a grocery store, staying away from highly processed packaged foods, eating all the colors of the rainbow they can, but getting enough protein in their diet too. Um, and it's hard sometimes getting enough protein. So adding in like protein bars or protein shakes, what you can to try to help supplement that, I think is really helpful too.

SPEAKER_05 27:40

Um, in terms of the short-term versus the long term, I like to think about it how our brain chemicals affect our hippocampus. And we certainly know that the hippocampus is kind of that store of short-term memory, and it seems to be more impacted by estrogen changes than some of our other areas of our brain, like the prefrontal cortex, you know, like reading about that. Like I was a biochemistry major in college, so I love to read about all that and think about all that. But I think that's why short-term memory is more affected. Um, I agree with everything you just said about menobelly, of course. Um, we know that's quite the struggle, but I I have found that if you can, the sodium intake through the processed foods is a huge contributor to that menobelly. And also, we talk about how our insulin and glucose changes metabolically with the estrogen falling. So I like to remind people that even if you're not diabetic and your blood sugar is normal, your body's probably producing more insulin now than it used to in order to maintain that. And insulin's our fat-storing hormone, and we're gonna store that fat in our visceral organs, like our liver and our abdomen. So that's the huge contributor to the belly fat as well as the sugar storage, which is why that macro of more protein, more fiber, less carbs is so helpful.

SPEAKER_02 29:02

Yeah, absolutely.

SPEAKER_04 29:06

And it looks like our next question tonight is from Jennifer. Um, and Jennifer says, in regard to the mood swings, um, this is maybe a little bit as she's looking for some concrete uh suggestions here, but she says, How do you check yourself before you actually do something or say something you will regret?

SPEAKER_01 29:26

How do you check yourself before you wrap yourself? Exactly. Exactly. Yeah. I mean, I always I don't know. I guess the best way for me to describe this would be to be give the guidance I give to my children. Um before you say anything, is it kind? Is it helpful? And does it have a purpose? Um because yes, we can respond kind of reflexively, and we could, you know, say something we're gonna regret. And then if you're like me, I will then perseverate about the thing I said that was wrong for a long time because I regret saying it. Um, so yeah, slow yourself down, take a step back. Um, often too, I encourage people to journal and to write things down that maybe, you know, seeing it written down sometimes can be helpful before you're gonna say something out loud. But in real life, like we don't always have the time to like pull out a journal or you know, we all have our phones. You could actually type it into your phone on a note and kind of like dwell on it, look at it, and decide whether or not you want to use that. Um, but there's so many different um tools out there, like symptom logs and things like that, that you could kind of chart and see, you know, kind of gauge where you're at from day to day, you know, charting your mood to see if it's something that you need to do something about. Um, but yeah, every every person, every individual is going to struggle with that, I think. And some of us are much better at it than others. You know, I've met some people that, you know, when you're around them, they have such like a peaceful presence or vibe or aura or whatever you want to call it. And you just feel good being around them. And they never almost never say anything that seems offensive or or off the wall or anything like that. And I always strive to be more like those people.

SPEAKER_05 31:17

I think learning to take big deep breaths, you know, and like really like breathe in and out a couple times. And even if I feel like I need to respond something in the moment, I can decide if this is something I can respond to later. And I might even say, let's say my children did something that was very bothersome and I felt like they needed a punishment or something or consequence, and I realize that I'm not feeling rational. I might even say to them, I'm not happy with your doing right now. And I would like to discuss this with you later, but I'm going to need a moment and we will talk about that tomorrow. Because I realize that I don't feel rational right now. And my response will probably be like to ground them for the rest of their life when that is, and then I don't want to have to like change that later. So I would rather let them know that I'm not happy, communicate that, and then say, I want to talk to the student later. I have to have time to think about it. And my response is getting so much better the next day.

SPEAKER_01 32:09

Oh, yeah. Once you've had time to like sleep on it and think about it.

SPEAKER_05 32:13

Or even talk to someone about it, you know, to you know, talk to your husband, talk to your best friend, talk to your mom, talk to somebody and be like, I know I'm overreacting, but geez, OP, you know, and so that helps me process it by talking to someone else first.

SPEAKER_01 32:27

Yeah, absolutely. But if you do have an outburst or you do do something that you regret, the people that you're closest to, you know, there is value in doing repair afterward too. And I think that that's important to recognize, like, and especially for our children, to let them see that we are vulnerable human beings. And there's certainly been times where I've been post-call and I've been sleep deprived and I've barked at them. And then the next day I'm like, oh guys, we need to talk. I'm very sorry. That was not how mommy wanted to show up, you know, last night. Um, and and I think there's value in that, knowing that yes, like the people that we're closest to sometimes see our worst sides of ourselves. And it's okay to do that repair work afterward with them.

SPEAKER_05 33:10

Yeah, absolutely. We've all done it. Yes. Absolutely.

SPEAKER_04 33:16

And our next question is from uh Navra. Um, and she is wondering, she says, what antidepression, what antidepression and anxiety prescribed medications can interact in negative ways with the hormonal process.

SPEAKER_01 33:35

Well, this I guess this is a bigger discussion. I mean, we can't really get into like every possible medication that is out there, but you know, there's certainly some medications that could be prescribed that can sometimes negatively interact with your hormone therapy if you do go on treatment. Um, but not so much. Like I think mainly my concern as a prescriber are with some of the more advanced like antipsychotic medications. Um, some of the medications that are used for like bipolar disorder can sometimes interact with um with DHEA or with hormone therapy. But for your standard, like antidepressants and SSRIs, usually they can be used safely together with hormone therapy without much of an issue. So, you know, really for most of the common like antidepressants and any anxiety medications, there really shouldn't be an issue that's like a lot of negative interaction.

SPEAKER_05 34:28

Yeah, I don't think that there's a lot of like direct interaction between those meds and hormones. I think they can work together for the most part for our patients. And we certainly know some of them can enhance our hormone therapy.

SPEAKER_02 34:45

Yes.

SPEAKER_04 34:46

Absolutely. And our next question is from Laura. Um and Laura is wondering, she says, can you talk about the link between brain fog, anxiety, and histamine?

unknown 34:59

Yeah.

SPEAKER_01 35:00

And histamine. I don't know if you want to tackle this one, Dr. Moon.

SPEAKER_05 35:03

Well, there's definitely been a buzz about this online recently where we're seeing a lot of the uh information around PMDD and we're seeing a lot of information around um pepsid and you know the different antihistamines. I think this is a very intriguing area that we're beginning to see a little bit more information around. I haven't seen any robust clinical trials that make me recommend it routinely in my practice. However, if patients are interested in trying an antihistamine, certainly those medications are safe to use. And if that seems to be something that helps manage their mood during that time, then I'm I'm glad for the patient that that is helpful. You know, I think it's just still kind of in those stages that we're learning more about it. It's kind of early and new.

SPEAKER_01 35:51

Yeah. However, anecdotally, I would say like my experience with this specifically has been on labor and delivery. Um, we for a long time used an old school medication called visceral, which is adorax, you know, which is hydroxazine in the same family as Benadryl, um, to help with anxiety, especially because we didn't want to give a lot of the acute anti-anxiety medications to a patient in labor because it could affect the baby. Whereas the antihistamines were safe to give. Um, and would also help them with any itching they got from the rapidural or anything like that, too. So, yeah, so we we definitely have used that throughout the years. Um, and it definitely has helped anxiety a lot, especially in our highly anxious patients in labor. But I never really thought about it toward my perimenopause or menopause patients. Yeah, so that's interesting. Wonder if we'll see more about that.

SPEAKER_05 36:44

I do see many of my uh colleagues in the psychiatric space prescribing the hydroxysine really routinely for panic and anxiety, and it seems to be effective for a lot of patients.

SPEAKER_01 36:58

Yeah, it's certainly a lot safer than the benzodiazepines, too, that can have a lot of potential. Yeah.

SPEAKER_05 37:04

Much safer long term.

SPEAKER_01 37:05

Yeah.

SPEAKER_05 37:06

Absolutely.

SPEAKER_04 37:08

And our next question is from Amanda. Um, and we had two people thumbs this one up. So this is a popular question. Um, she said, How much protein and fiber per day would you recommend?

SPEAKER_01 37:19

Yeah, so I usually recommend protein content based on height. And you can search online, you can put in your BMI or your height, and it'll give you a generalized protein goal. Um, for me specifically, like I'm I'm 5'8, and when I was like calculating how much protein I needed, I thought, well, I was like getting maybe 60 grams, 70 grams, and I thought I was good. But when I looked it up and I actually worked with a nutritionist and like a weight loss coach a few years ago, I realized that for optimal muscle maintenance and weight loss, I really needed to be at 120. So I was getting like half of what I needed as far as protein. Um, and it's insane that I was getting half. No wonder I wasn't feeling good, right? And as far as fiber, I think at least is it 30 grams of fiber?

SPEAKER_05 38:08

30 grams a day that we try to shoot for.

SPEAKER_01 38:11

Um, and you can get so much of that from like whole grains, but also green leafy vegetables, but you know, not being afraid to like add in a fiber supplement. Like they have such great fiber supplements now that can be odorless and tasteless. It's not like our grandmother's like metamusole when they used to drink gritty drinks. I buy these little packets and actually get the on-the-go packets of benefibre that like it's just like a little, it looks like a little drink packet, and you can put it on any food and any beverage, and it adds some fiber to your daily intake, which makes life really, really easy. Um, and I am a connoisseur of protein drinks now, too. I mean, I I get them, I have my kids drinking them too. Um, instead of getting regular chocolate milk, they're getting like protein milk now.

SPEAKER_05 38:57

Yeah, and I and I really like to focus on the plant-based proteins because there's so much longevity data around that right now. You know, those are like big buzzwords. We want to live longer, healthier. And so, you know, what do you study about sanitarians? So there's a lot of that plant-based uh protein. And so I think, you know, not that you have to be a vegetarian or vegan or anything like that, but I think that if you can find those sources through plant-based, that that's probably going to be healthier long term for you as well.

SPEAKER_02 39:26

Yeah, absolutely.

SPEAKER_04 39:30

And our next question is from Kathy. Um, and Kathy is wondering, she says, how often should we check our B12 levels?

SPEAKER_01 39:39

I think for the average person, when you get your yearly wellness labs, like your blood count, your thyroid evaluation, will be a good time to check, you know, for anemia labs if you are anemic. So if you've had any kind of um change in your GI tract, sorry, my dog's walking in the background. Um, he came in and he's like, oh no, I'm not getting attention in here. Um if you've had like a gastric bypass or a gastric sleeve or any kind of like GI surgery where you've had a significant um component of your bowel removed or anything like that, then that could be a little different. Like you might struggle with B12 levels a little bit more and you might have to have them checked more frequently. Um, but yeah, I think getting a check at a baseline, you know, with yearly labs is fine. And then if they're normal, you might not even need to check them continually. Most patients that you know are not struggling with anemia or not struggling with levels, um, don't all of a sudden develop a B12 deficiency. Um, but it's certainly something to get checked if you are not feeling great and you haven't had it checked recently. You can certainly request that, you know, from your primary care doctor.

SPEAKER_05 40:48

I think the other thing to remember with B12 is I see a lot of people coming in um low normal, and I still think it's optimal to be at that higher end. So, you know, whatever your lab cutoff is, if you're just like barely over that threshold because it's a water-soluble B vitamin and it's not really dangerous to get some extra. If I see women at that lower end, I'm still going to encourage them to maybe add their B complex to kind of get that a little bit more maximized for them because it might make a little bit of a difference in how they feel.

SPEAKER_02 41:19

Yeah. That's a good point, too.

SPEAKER_04 41:23

And we have a question next from Carol. Um and Carol is wondering, she says, Do you think GLP1s are good or bad when you are on H uh HRT?

SPEAKER_01 41:34

This is a great question. And actually, we're learning more and more about this all the time. But the studies coming out are actually showing us that women that are on both are actually having better weight loss results than women on GLP1s alone. You know, they they work kind of synergistically. And so women in this time frame in this space that are also taking hormone therapy, when they add a GLP1, they tend to be more successful being on both. Um, and and women end up doing better with their weight loss being on both. So, you know, I think if a woman is struggling with weight loss and struggling with metabolism and hormone therapy might help to balance things a little bit and get them back on track, but they're still struggling with weight. Adding a GLP1 is a great addition to help you get to that optimal weight goal. Um, and I I see a lot of patients doing that and doing very well with it.

SPEAKER_05 42:26

I'm really fortunate in my private practice that I happen to have a board-certified obesity medicine weight loss nurse practitioner that works with me. And we end up seeing pretty much, we both end up seeing pretty much all of our perimenopause and menopausal patients, and her and I work together to optimize this in our patients. And so large percentages in my practice are on both, and it does very much accelerate and promote that rapid, healthy, because we talked about that, like kind of weight losses. And so the GLP ones also, interestingly enough, I've found really treat the hot flashes in the night sweats, which is great. Um, the manobelly. And so, you know, how many of the perimetopausal symptoms will start checking their, you know, off the line. And then I have to uh remind patients that if you come off your GLP, you might start getting hot flashes. So it's just like it's so interesting how all these things are interacting, and we're just learning so much in real time as we're prescribing it to more patients.

SPEAKER_01 43:26

Yeah, absolutely. Learning more and more about these every day, you know.

SPEAKER_04 43:32

Absolutely. And our next question is from Val. Um, and Val is wondering, she says, how does cortisol levels play a role in perimenopause?

SPEAKER_01 43:43

Yeah, so for those that don't know, cortisol is your stress hormone, basically. And it's your, you know, the levels are higher when we think about like fight or flight and high sympathetic tone. Um, but when your cortisol levels are high, your body's in a high stress state. And so What does our body do when we're in a high stress state? Cut out all optimal extra functions, right? So, like things like weight loss, um, you know, sleep optimization, our our mood and our resilience can go down if we're in a high stress state, too. Um, and so what happens is when you're dealing with insomnia, you're dealing with so many symptoms of perimenopause, you're dealing with the stress, the mood swings, you're then dealing with, you know, hot flashes and night sweats, and you're not sleeping well, um your cortisol levels are gonna rise, and then you're gonna be struggling to try to get back into balance. Um, and so sometimes optimizing your hormones with treatment like hormone therapy can help those cortisol levels to finally start coming down so that you can get, you know, better results as far as taking your treatments and things like that. But um I think that's a struggle that so many women and the cortisol levels I think are really highly responsible for the meadow belly development too. You know, that storage of that kind of spare tire in the middle as well. Um, and so really it's really important to try to decrease stress levels as much as possible. Um, and it's hard to do, especially when you're you're the mom or you're the woman in the family who's, you know, managing everything, plus your balancing career, and then you're dealing with all these health issues coming in and perimenopause. It's a real struggle to try to do that naturally. So sometimes we need the help of medication to kind of help us get those levels down.

SPEAKER_05 45:26

I agree. I think the sleep disturbance from your hormone changes happens first, which really results in a huge cortisol spike. And that causes all the weight gain. So if we can get their hormones optimized for good sleep cycle, we can recorrect all of that.

SPEAKER_02 45:45

Absolutely.

SPEAKER_04 45:47

And we have another question from Nara, and she is wondering, she says, Do you have any special recommendations in addition to nutrition for anemic patients?

SPEAKER_01 46:00

Well, I guess is in addition to diet and like supplementing with any nutrients that you're deficient in if you're anemic. I think the other important thing too is that especially in perimenopause, if you're still having menstrual cycles, your period can get very erratic when you're going through the perimenopause transition. Like some women will start to have more than one period a month, or they might skip a month, or their flow may change. And there are treatments that are out there that are great for managing and reducing the amount of your menstrual flow because for some women, that can be the source of their anemia. It's just simply losing too much blood during their periods. Um, and there can be other reasons. I mean, there's some genetic factors and reasons why some patients are more prone to anemia than others, but most often it's nutritional deficiency or it's from excess blood loss. Um, and so it's it's really important to get the source and the diagnosis of why you're anemic so that we can figure out how to treat you best. And so that's important. You know, you don't want to just randomly start treating yourself with things if you don't really know why you're anemic. Um, so whoever's running your labs, if it's your primary care doctor or if it's your OBGYN, like when they run labs to check your blood count and to see what your hemoglobin and hematocrit level are, and you're checking your ferritin and your iron levels and B12 and folate. Um, if any of those are off, I mean, it's really about trying to figure out why. You know, why are these doing that? So, how can we correct that?

SPEAKER_05 47:24

Also, I think there's an underutilization of iron infusion. Um, I feel like there's a big push for just over-the-counter iron supplements. And we certainly know prescription ones can be more effective paired with vitamin C, and then not be afraid of using the infusions if that's if you're truly an iron-deficient anemia. I have just had such good luck with getting the iron fusions, getting people feeling better faster.

SPEAKER_01 47:50

Oh, yeah, yeah, absolutely. Especially, I mean, we use it for our pregnant patients all the time because for people that are struggling with constipation, then they take oral iron and they get more constipated. And then, you know, we really just don't absorb iron as well orally, especially if it's not, you know, given with a vitamin C. Um, and so yeah, the iron infusions can help really, really well.

SPEAKER_04 48:14

Absolutely. And that looks like that might be all the questions we have tonight. But I would love to hear maybe Dr. Kat and then also Dr. Moon, kind of as we're wrapping up, is there like one piece of advice you would give for, or maybe two pieces each, I don't know, about dealing with hormonal mood swings and brain fog?

SPEAKER_01 48:36

Well, I think trying to give yourself a routine and a pattern and a lifestyle that you can deal with and you can live with regularly. Like trying to design your life to optimize your wellness can help with mood swings, I think. And, you know, I think it's just it's hard, it's a struggle, but I think that that's important to do too. I mean, I think rather than looking at perimenopause and menopause as this horrible thing that's happening to you, let it be a reminder to bring yourself back to self-care and give yourself permission to take care of yourself again. Like design your life the best it can be that serves you best. Um, and I think that that will go a long way into improving how you feel and improving the mood swings and brain fog too.

SPEAKER_05 49:28

I mean, I just like I like to acknowledge to women, these these things are real, they are common, they are understandable. And if you can think a little bit more about like, um, don't ask what is wrong with my body, but ask like what is my body trying to tell me? Like just frame it in a different way. And I think it's gonna, it's gonna make you handle it so much better when when you think of it through a different lens.

SPEAKER_01 49:53

Right, right.

SPEAKER_04 49:55

Absolutely. Well, thank you so much, Dr. Kat and Dr. Moon, for being here tonight. I think this was a really interesting conversation. It was great to hear you both kind of like work with each, like feed off each other. I think that was like such a great conversation. And thank you also, everyone who um has come out tonight to listen, to ask your questions. Um, really, this is why we do these events is for you all. So I'm so glad that you all were able were able to have some of your questions answered. There were some really great ones tonight, I feel like that we were able to really get in on as well. Um, and then just also want to give a few reminders that if you are a Winona patient already, um, you can always reach out to your Winona doctor in your patient portal. Um, they would love to answer questions for you there. Um, that's a great place. There's also a lot of amazing other resources through Winona, such as we have the Metopause Hour podcast, which I love. It's great to either put on when you're, you know, you can be in the car, when you're at the gym, at work, um, lots of different great places to listen to that. And then we also have a number of articles in our medical journal, um, which is a really great thing to check out as well. So there's tons of resources that Winona has, um, including we have more doctor dialogues like this, we have live Q ⁇ A's, um, and I would love to see some more of you all here as well, um, to either see you all again um or feel free to bring a friend. These are completely free events. So we would love to have you all join us again. Um, but thank you, Dr. Kat. Thank you, Dr. Moon, again so much for being here. It was really, really such a great conversation tonight.

SPEAKER_01 51:36

It was. We had some great questions tonight. Did wonderful. Yeah.

SPEAKER_03 51:42

Absolutely.

SPEAKER_04 51:43

Well, I hope that everyone has a wonderful night wherever you find yourself tonight. Um, and hopefully we'll see you at one of our next events as well.

SPEAKER_01 51:53

Yeah, thanks so much for coming on, Dr. Moon. It was really great to have you.

SPEAKER_05 51:57

Had a great time. Thank you.

SPEAKER_01 51:58

My dog has come in through his pets now. So if you see my art, that's why.

SPEAKER_05 52:03

He wants to love. Yes. Absolutely. Awesome.

SPEAKER_00 52:08

Have a good night, everyone. Have a great night, all. 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.