You're listening to On the Moans, where we have conversations about hormones, midlife, and the moments that make us wonder Is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaragle people of the Iora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal Land. Hello, lovely friends. Welcome to episode six of On the Moans, the podcast where we talk hormones, midlife, and the moment when you hear someone chewing and want to silence them with a fork to the throat. Today we're talking about periods gone rogue. Heavy, frequent, unpredictable. The kind of bleeding that makes you plan your life around bathrooms and black pants and wonder why you have to deal with this shit at this age. We'll talk about the biology, why this happens, and then the pharmacology, what actually helps. And I've got a cracker of a woo of the week for you. But first, can I tell you something that I've been thinking about a lot lately? There's something that I've been remembering fondly since it happened a few weeks ago now. It was a small interaction, nothing dramatic, nothing that would ever make the news, nothing that you'd tell someone and expect them to gasp. Just a nice work story. Did you have a nice day at work today? Well yes I did. In fact, I have this one nice thing happened. Oh, that's a nice story. Nice. But it has stayed with me, and I don't think it would have stayed with me twenty-five years ago. The twenty year old version of me would have thought, oh, that was a cute interaction, and then immediately moved on to whatever came next. And knowing twenty year old me was probably playing a computer game or something equally as pointless. But at forty-eight, it lodged. It settled, and it has softened something in me. I would never have described myself as emotional. I'm not a crier and I'm proud of it. It's a badge of honour for me. You know that joke, how do you know if someone is a vegan and the punchline is because they will tell you? Well, that's similar for me. Hi, I'm Kate, and I'm not a crier. My husband is much more emotional than I am, and we have a running joke with a dear dear friend of ours. The joke is that if the two of them had been married, they would still be in the hospital after the birth of their firstborn, still taking photos of the now 20-year-old child because they were both so wrapped up in the emotion and the beauty and the gloriousness of the whole event that they couldn't drag themselves away. But lately I find myself more emotional. We travelled home from Europe to Sydney a while ago, and that flight is long. And the end of your trip, you're tired and you're a bit sad that it's over, but you're also impatient to be home again. Anyway, everyone else was sleeping, but I couldn't for whatever reason. I'm guessing it was because we were in economy, and really who can sleep in economy? So I was watching a dog's life. Dark cabin. Everyone subdued, everyone quiet. You can picture it, right? Now I don't know if you've seen a dog's life, but if you have, then you'll know. I was sobbing like proper hiccupping, gulping, tears streaming down my face, snot running out of my nose, crying. And my son woke and he looked at me and said, Oh my god, mum, are you alright? What's happened? And remember, I'm not a crier, so he hasn't seen this from me in all of his years on the earth. So he's a bit anxious and a bit worried that something serious has happened. And I say to him through gulps and sniffs, this Alright, physical challenge. You go and watch a dog's life and not cry. Go on, I dare you, I double dare you. Anyway, I've been wondering whether part of getting older isn't just feeling more, but feeling more deeply, more slowly, more reverently, sitting with that emotion instead of trying to get through that emotion. Because when you're younger, everything is loud. Your ambitions, your anxieties, your urgency, your impatience. But as you get older, the volume comes down and suddenly you can hear the subtler things. Like this interaction I had whilst working in the community pharmacy one evening. It's Friday evening around 6 p.m. and I'm doing my regular shift at my local community pharmacy. It's a true community pharmacy, independently owned, not part of a big chain, not in a huge shopping mall or on the high street. The owner and regular staff know everyone by sight, they know their names, they know their dogs' names, their kids' names, their medication history, and what they need before they know it themselves. Everyone is a regular, everyone knows everyone. Old fashioned community pharmacy service. In my suburb we have the IGA, the hairdresser, the fish and chip shop, the GP, the pharmacy, and most importantly the bottle shop. What else could a suburb possibly need? So a man comes into the pharmacy, shuffles on his four wheel walker more accurately. He's ninety. He hands me his prescriptions, and then he says, with a bit of a twinkle in his eye, I'm not gonna lie, I've left my wallet in the car. Now I could have sent him back to the car, couldn't I? That's okay, you shuffle on back to the car with your cankles and your walker and get your wallet whilst I put these through for you. But actually what I do is I joke, because that's how I operate, and I say, Okay then, what are you going to barter with to pay for your scripts? And without missing a beat, he says, Well, I could leave you my watch. So I say, Nah, I've already got a watch, what else have you got? And he pauses for half a second, and then he says, What about a verse of poetry? And I say, That would be wonderful. So he goes and sits down on one of the chairs out the front and I head back into the dispensary to fill his prescriptions. And while I'm doing that a woman comes in and stands near him. So it's me in the dispensary, the old guy sitting in the chair, and now this younger lady, say she's in her seventies, and they're chatting, and I think, Oh that must be his daughter, because they're laughing, they're engaged, they look completely at ease. I finish dispensing, I walk out the front stand in front of him, next to her, and say, Alright, here are your prescriptions, now where's my poetry? And he just launches, no warning, no hesitation. He starts reciting Chaucer in the original old English, and the woman and I just freeze. We are completely transfixed as this ninety year old man performs this verse beautifully, confidently, like he's opening a door he's opened many times before. When he finishes he says very calmly, I learnt that in 1952. We give him a round of applause because of course we do, and the woman turns to me and says, I'll pay for his prescriptions. And I think, that's nice, she's his daughter. He gets to his feet though, and he turns to her and says, Thank you so much. And a penny drops for me, and I say, Oh do you know each other? And she says, No no, I've just met him, I'm happy to pay though. And I say, No no, you don't have to do that. He's a regular, this is a local community pharmacy. We know him. If I say to him that's fine, come back when you're ready, I know he will. But still, how beautiful. Every part of it. I had chosen to engage, to be a bit cheeky, to connect, he'd picked it up and run with it. He sat down and thought about what he could offer. I continued the joke. He delivered magnificently, and then a complete stranger steps in with generosity simply because she'd been part of something lovely. And that moment has stayed with me, not because it was extraordinary, but because it was quietly, profoundly human. And I don't think I would have held on to that moment when I was younger. I don't think I would have let it land. Because when you're younger, you're busy proving things, proving you're capable, proving you're interesting, proving you're enough. But somewhere along the way in midlife when you have enough behind you, something shifts. You stop collecting moments like trophies and start holding them like gifts. I see this shift most clearly in my kids. My son, who is nearly 21, and yes, he is gorgeous, and no, I am not at all biased. Recently bought himself a pair of red linen pants. Loose fit, relaxed. He looks effortless. He looks like a god, to be honest with you. Well I think so anyway. Now let me be clear, these are not pants my husband would ever have picked up off the rack for himself. Ever. So my son holds them up and says, Hey Dad, give these a go. My husband tries them on under absolute sufferance. And damn, they look fantastic, and he ends up wearing them out to dinner that night. All because our son gave him the confidence to try something. Not by forcing, not by convincing, just by offering belief. Similar thing happened with my daughter. She got her nose pierced. And I remember thinking, that looks amazing, and she is so beautiful, again, not biased, and on her absolutely fabulous face. It is the right mix of cute and sassy, but I am too old for that. And I verbalized this to her and she sends it right back at me. Why? Who decided that? So I did it. And afterwards my husband and I were talking about how lucky we are. How lucky we are to have children who don't just grow forward, but reach back and say, Come with us, you're allowed to evolve too. And then because now I'm in the mood for reflection and gratitude, I realized it's not just our kids, it's our friends too. Starting this podcast, I would never have done it without them. Not because I didn't have the idea, but because without their encouragement I wouldn't have believed the idea deserved air. I wouldn't have thought I had anything worth saying. And that's a dangerous thought, isn't it? How many people are walking around with voices they've silenced, not because they lack insight or value, but because they lack witnesses. Hype women and men. People who say yes, that matters, yes, you matter, yes, you can do it. There's a long running Harvard study, decades long, that looked at predictors of success and well being. Not income, not education, not class. The strongest predictor, the people you surround yourself with, the quality of your relationships, who encourages you, who reflects you back to yourself, who reminds you in moments of doubt that you can do hard things. Which brings me to Malaysia, november twenty twenty four. An ironbound adventure race, forty eight hours in the remote jungles of Malaysia. A mountain bike, a kayak, a backpack, a compass, and a map. Whatever food and water you can carry, and off you go, see you at the finish line. Oh, and last year remember they had to stop the race for twelve hours because there was a herd of elephant on the track, so you know, also that. It was well outside my capabilities. I am a tentative mountain biker at the best of times, but turned out that was only half my problem because the mountain they sent us up and over was so covered in elephant poop we could hardly ride our bikes anyway, and ended up carrying them for about fifteen hours. I am not exaggerating. Four women on my team, me plus three others, and the other three literally carried me through. And at multiple points during that race my body is saying no. And also I was hanging off the side of a mountain holding onto a rope with nothing but my hands. I'm also thinking, I don't think you're keeping yourself safe. And my mind is saying, you shouldn't be here, you're holding everyone back. You can't do this. And my team kept saying, You can absolutely do this, keep going, we've got you. Together we can finish. They didn't carry me, well actually at one point trying to cross a river, I think they may have actually carried me, but moreover, they held me. They let me belief until mine came back online, and I crossed that finish line, not because I was the strongest, good god, far from it, but because I was surrounded by people who refused to let me quit on myself. And that's the through line, isn't it? From a ninety-year-old man reciting chaucer, to a stranger paying for prescriptions, to children handing confidence back to their parents, to friends saying start the podcast, and teammates saying one more step. We don't feel things more deeply as we get older because we're fragile. We feel them more deeply because we finally understand what matters. Connection, encouragement, belonging. And maybe that's the quiet gift of aging, not the loss of sharpness, but the gaining of meaning, not the fading of ambition, but the widening of courage. And maybe the real measure of a good life isn't what you achieve alone, but how many times you were brave because somebody else believed you could be. Surprise, plot twists, dramatic exits. In perimenopause, hormone levels don't decline smoothly, they fluctuate wildly. Your ovaries may have a few last heroic estrogen surges, and those surges can thicken the uterine lining even more. So, yes, heavier bleeding before menopause isn't uncommon. But that doesn't mean it's harmless and it definitely doesn't mean ignore it. Heavy bleeding can lead to iron deficiency, fatigue, dizziness, hair loss, brain fog, and that bone deep exhaustion where everything feels harder than it should. Next, we need to talk about a phrase the internet loves, estrogen dominance. This term gets thrown around like it's a diagnosis. It isn't. Most of the time, what people are describing isn't sky-high estrogen, it's low progesterone relative to estrogen, especially during anovulatory cycles. This is a ratio problem, not estrogen being a villain. Estrogen isn't evil, it's just the only one left in the office approving endometrial growth because no one told it to stop. And if someone tells you estrogen dominance is caused by toxins and can be cured with a $90 detox tea, they are not your healthcare provider. They are your wallet's natural predator. Sometimes heavy bleeding is not just perimenopause. We need to talk about fibroids, benign muscle tumours that can distort the uterine cavity and increase bleeding. Adenomiosis, where endometrial tissue grows into the uterine muscle, often causing heavy painful periods. Endometrial hyperplasia and cancer risk, which increases with age and unopposed estrogen exposure. I'm not here to scare you, I'm here to recalibrate your alarm system. If bleeding is heavy, persistent, increasingly frequent, happening between periods after sex or causing anemia, that is not waited out. That's investigate. Treatments. First up, marina, the intrauterine device people either adore or despise. Merina releases levonogesterol, a progestogen, directly into the uterus. It thins the endometrial lining and often dramatically reduces bleeding. For heavy menstrual bleeding, it can be an absolute hero. It's one of the most effective treatments we have. It can help adenomiosis, it provides contraception, and in some women it can act as the progestogen compound of menopause hormone therapy. So why the mixed reviews? Because bodies are not identical machines. Insertion can be painful, some people experience prolonged spotting, some notice mood changes or acne, some love it and forget they even have a uterus. Merina is a tool, a very good one, but it's not compulsory. If it doesn't suit you, that's not failure, that's just your biology. Next, tranexamic acid. This medication reduces bleeding by helping blood clot more effectively in the uterine lining. It's taken only during heavy bleeding days, not continuously, and it can significantly reduce blood loss. It doesn't fix the underlying cause, but symptom control matters. Non-steroidal anti-inflammatory drugs like ibuprofen or neproxin can also reduce bleeding and pain by lowering prostaglandins. The chemical messengers involved in inflammation and uterine contractions. They're not suitable for everyone, but when used appropriately, they are legitimate medical tools. Then there's the oral contraceptive pill, which some women use in perimenopause to regulate bleeding and suppress hormonal chaos. It can be helpful, but age, blood pressure, migraine history, smoking status and clot risk all matter. This is not a one size fits all decision. There are also progestogen only options and cyclic progesterone strategies that can stabilize the endometrium in certain situations. My point is this, there are options. Bleeding chaos is not your destiny. And there are times when medication is supportive, but investigation is also non-negotiable. Midlife bleeding changes may require blood tests, iron studies, pelvic ultrasound, cervical screening review, and sometimes endometrial sampling. If you're being told it's just perimenopause without anyone asking how heavy, how often, how long, or whether you're anemic, that's not reassurance, that's dismissal. You are allowed to escalate politely. You are allowed to ask questions, you are allowed to say, This is affecting my life, and you are allowed to keep doing this until you get a resolution that works for you. Friends, you know I curate each episode of On the Moans the way one might curate a cathedral, stone by stone, arched with evidence, supported by peer review, and designed to withstand the centuries. But at the end, when the incense clears and the choir's all gone home, I like to wander out the back, kick over a few misunderstood factoids, drag them into the alley behind the wellness centre, and set them alight to create my dumpster bin fire segment, Woo of the Week, where we lovingly take a very ordinary thing and gently escort it back down off the wellness pulpit it absolutely does not deserve to be preaching from. This week's woo is a simple mineral that somehow developed delusions of grandeur. Magnesium. The supplement has been marketed as the solution to anxiety, insomnia, migraines, constipation, ADHD, perimenopause, burnout, and the general emotional exhaustion of being a woman with a calendar. Apparently, if you're tired, bleeding heavily, can't sleep, can't think, can't cope, and feel vaguely haunted, you don't need systemic change or hormone support. You just need magnesium. Shall we unpack it? What magnesium actually is and what it absolutely isn't. Magnesium is an essential mineral. It's important. It's necessary. It is also not a neurotransmitter, not a nervous system reset, not a trauma intervention, not hormone therapy. Magnesium's role is quietly important and deeply unsexy. It works as a cofactor in hundreds of enzyme reactions. Energy production, muscle contraction, nerve conduction, heart rhythm, bone health. Magnesium does not do things per se, it helps other things work. And that's it, that's the whole job description. If magnesium fixed anxiety, insomnia, and perimenopause, psychiatry would be a bulk by aisle. Why is magnesium so wildly oversold? Magnesium is the perfect wellness supplement. It's real, it's generally safe, it's deficiency adjacent, and most people don't understand dose, delivery or physiology. So low magnesium becomes the explanation for everything modern life breaks. Tired? Magnesium. Stressed? Magnesium. Bleeding like a crime scene? Magnesium. Crying in the car? Magnesium. Can whoever does magnesium's branding please give me a call? True magnesium deficiency is uncommon in otherwise healthy people. You're at more risk if you have chronic gut disease, malabsorption, alcohol dependence, long-term diuretics or PPIs, or genuinely poor nutrition. Most women in perimenopause with fatigue, anxiety, heavy bleeding, or brain fog are not magnesium deficient. They are underslept, overstimulated, hormonally unstable, and running a full time life while their ovaries quietly ghost them. Magnesium cannot fix that. Let's be fair to poor old magnesium and take a look at where it does have evidence. Constipation, yes, magnesium, citrate, and oxide pull water into the bowel. They work and they will make you boop, sometimes urgently. Migraines? Modest benefit, some evidence, particularly intravenous magnesium in acute migraine. Oral magnesium may help prevent migraines in some people. Pregnancy leg cramps. Small benefit, low risk, reasonable. True deficiency replacement. Boring? Correct. Useful medicine. Sleep and anxiety, where the claims get slippery. Magnesium may help some people with mild sleep disturbance, muscle tension, occasionally restless legs. But the effects are small and the studies are mixed, and a lot of the benefit comes from taking something at night and slowing the hell down. If magnesium changed your life, one of three things happened. You were actually deficient, it fixed your constipation, or you accidentally started a bedtime routine. Important why magnesium creams, sprays, and patches don't work. This matters. Magnesium is a charged mineral. Your skin's entire job is to keep your insides in and the outsides out. The skin barrier, the stratum corneum, is very, very good at this. Think about it. Out of the thousands and thousands of medications we use, only a handful are available via a patch. And to get transdermal absorption is a feat of pharmaceutical engineering. There is no good evidence that magnesium creams, sprays, oils, or patches raise blood magnesium levels in any meaningful way. That tingling people feel, that's skin irritation, not absorption. If transdermal magnesium worked, hospitals would use it. They don't. We give magnesium orally or intravenously because that's how human physiology works. Different magnesium salts exist citrate and oxide, constipation, cheap, poorly absorbed. Glycinate, fine, gentle on tummies, not magical, but nice. Three and eight. Big brain claims. Weak human data, very expensive. And as discussed, sprays and patches, all marketing. Safety, because it's still a drug, and if it has effects, it can also have side effects. Magnesium can cause diarrhea, electrolyte disturbances, and problems in kidney disease. More is not better, stacking supplements is not harmless. And say it with me, natural does not mean risk free. Prescribe or pass. Magnesium gets a conditional prescribe. Useful for constipation, reasonable for migraines, and appropriate when deficiency exists. Useful for stabilizing a few cell membranes. Not nervous system medicine, not hormotherapy, not absorbed through your skin. And it will not fix a life or a uterus that needs rest, boundaries, investigation, or actual hormonal support. Woo of the week. Done. Lovely friends, this is where I leave you. If your periods have gone rogue, heavy, unpredictable, disruptive, that is not a personality flaw and it is not you being dramatic. And it is not something you need to tolerate quietly because you are at that age. It is biology doing something messy, uneven, and frankly unsupervised, and it deserves investigation support and options. You are allowed to ask how heavy is too heavy. You are allowed to say this is affecting my life. You are allowed to keep pushing for answers that make sense, not platitudes that make you smaller. And maybe alongside all the blood tests and the ultrasounds and the treatment plans, there's also space to notice the other shift that happens in midlife. The one where things land a little deeper, where moments linger, where connection matters more than efficiency. The 90-year-old man and his chaucer, the stranger who stepped in, the children who hand back belief to their parents, the friends who say start the podcast, and the teammates who say we've got you when your own confidence flickers out. We don't get through this stage of life by muscling up and white knuckling it. We get through it together, borrowing belief when we need it, offering it when we can. So if you take nothing else from today, take this. You are allowed to care, you are allowed clarity, and you are allowed to feel deeply, not because you're fragile, but because you finally know what matters. Find me on TikTok and Instagram at prescribe or pass. I'll see you next time. Until then, be kind to your body, sceptical of wellness bin fires, and very, very gentle with yourself.