You're listening to On the Moons, 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 friends, welcome to my holiday edition of On the Moans. I want to pause for a moment and acknowledge something that genuinely blows my mind. This week On the Moans was listened to in Australia, America, New Zealand, Canada and the UK, obviously, but also in Slovenia, Ethiopia, Kenya, Turkey, Norway, the Faroe Islands, Chile, the United Arab Emirates, Indonesia, Bermuda, Nigeria, Tanzania, the Isle of Man, Italy, India, and Egypt. Different hemispheres, different accents, different healthcare systems, but the same weird midlife biology, the same questions, the same quiet is it just me moments. And we're going to follow those moments from beaches and bodies and generational mirrors through the pharmacology of Clonidine and straight into the swampier corners of wellness woo. Wherever you are, thank you for being here with me. Let's get on the moons. The four of us are in Hawaii celebrating our daughter's graduation from high school. That's four adults away together in close proximity for 15 days. And Hawaii, or I suspect any holiday really, is very good at exposing things you didn't know you were carrying. I had the privilege of observing my adult children together over these two weeks, and I have some thoughts. Let me set the scene. We're standing on Makapu Beach, Oahu, watching the surf. I'm telling you, they must do something to the water overnight, dye it blue or something, because the colour is unbelievable. We came to Hawaii all puffed up and ready to be snobby about the beaches. I mean we're East Coast Australian. We have beaches, we know beaches, we have the best beaches. But it turns out, as my grandmother used to say, there is enough love for everyone. These Hawaiian beaches are something else, beauty on another level. Anyway, we're standing at the beach and it's a big swell. Proper waves, the kind that demand a pause and a reassessment. But my son is already in the water, not hesitating, not hovering, not negotiating with the ocean, just in. He comes out later all salt encrusted and sun bleached and absolutely glowing and announces, as he always does, that that was the best surf ever. And he means it every time. I've stood on the edge of the water watching him frolic in the waves his whole life. Frolic is the only word for it, throwing himself around with joyful abandon, no regard for anything other than the fun of that exact moment. Like a puppy discovering a roll of toilet paper, fully committed, wildly enthusiastic, and blissfully unconcerned with the mess. I'd stand like this for hours and hours. If anybody asked me where in the waves he was, I'd reply, just look for the person having the most fun. That's him. Today is no exception. He's straight back out behind the breakers, and then he's body surfing in and lets himself get washed all the way up to us so that he gently bumps into our ankles. Quick shake of the head, I don't know how guys do this, get out of the water and shake their heads like that. And he's back in. I'm watching him and I'm thinking, he's so confident in his body. Not reckless, not stupid, confident. He trusts what his body can do. And I'm still standing on the edge, partly because I'm enjoying his enjoyment, and partly because I realise something uncomfortable. I have a very capable body, I've run very long distances, I've endured very long things, I've done some very hard physical stuff. And yet I'm not as confident in my body as my son is in his, which is fine now because he's twenty and I'm forty eight. But I don't think I was ever so confident. So I start interrogating that thought. Is it age? Surely it's a bit to do with that now. I mean no one, no one wants to have to deal with me injured. Just ask my best friend who is a physio. Is it the knowledge that recovery now has terms and conditions? My poor husband has sustained a pastor injury to his left rotator cuff, and it is a miserable and long recovery. No thanks. And here's the next thing. My daughter, who used to rate herself physically, who used to back herself in anything, is standing at the edge of the water being cautious, watching, reading the waves, weighing it up, chance of fun versus chance of getting dumped. This is the same girl who at age two, I remember it distinctly because it was her second birthday, announced to the world at large that she was no longer wearing nappies day or night, or floaties, thank you please. And she is, was, is, such a stubborn personality that when I tried to keep her floatiless head above the water in the pool that afternoon, she tried to bite me. So my mum, her grandma, and I were left to watch her worm her way along the bottom of the pool, push herself up to the top, get half a nostril above the water, take a breath, then sink back down to worming along the bottom of the pool again. And we were thinking she'll get tired of this any time now and we'll be able to reinstall the floaties onto the arms. But no, hours later, and I was bribing her to get out of the pool by offering cake and screen time. So she and I and my husband are standing ankle deep at the edge of the waves. And she's not wrong to be cautious, it is big, and it's crashing into the sandbar which is just there, and everyone before and after the sandbar looked to be having a great time, but those on the sandbar seem to be narrowly avoiding a spinal injury. And I notice this difference in her. She used to launch herself headlong, so confident that whatever she encountered she could deal with, no, not deal with, smash into the ground and dominate. Now she assesses, and suddenly I'm watching four iterations of bodies on the same beach. My son, instinctive confidence, twenty-year-old man boy, all shoulders and back muscles and floppy wet hair. My daughter, emerging caution, relatively new to her woman's body and all that that entails. Me, capability wrapped in vigilance and perimenopause. And my husband, who is a very fit ultramarathon runner, who tried to do the right thing and pick up some weights, and has ended up with a sore shoulder and is unable to raise his left arm. And I wonder, is this what happens when awareness creeps in? When you learn that bodies can be hurt, that recovery isn't guaranteed, and that confidence has consequences. And then, because Hawaii is generous like this, with its bluer than blue water and whale song and too many fish and turtles to count, the observation widens. By now, my daughter has grabbed a boogie board and headed out, so my husband and I are taking the opportunity to have a quiet chat in the comforting familiar stance of watching our feet disappear into the sand with each wave whilst our children play in the waves, a place we have stood for many, many hours together. I observed to him that being with our children when they're together like this is like being with best friends who have been best friends their whole lives. No, it's not like being with best friends, it is being with best friends. It's lovely, it's funny, it's also slightly excluding. They have inside jokes, a shared language, a shorthand I don't know, and they'll throw me a bone occasionally, let me in on it, slowly and with deliberate language explain it to me. And for a moment I think, I'm in, I'm part of the cool group, they want to include me. But the next moment I'm on the outer rim again. I don't know the Instagram reels they refer to. I can't speak the language, although I did try it once after a pina collada. Wow, this sunset is bus, which got a cringe and comments like, never ever do that again. Okay, fair cool. It didn't sound good coming from me. You're right. And I wonder, is this how my mum feels when my sister and I are together? My sister and I don't live together, obviously, she has her family and I have mine, but we are still very close. And, like my children do, we have our parents in common, which is bonding. I make a mental note to be more aware of this when my mum and sister and I are together again, although likely I'll forget to be so thoughtful and just enjoy being on the inside. As I'm having a quiet reflection later in the afternoon sitting by the infinity pool watching the Hawaiian sun sit over the Pacific, a sight we never see on the east coast of Australia, my daughter accuses me of having a superiority complex, which I would like to say, for the record, I believe is unfair. I'll let you be the judge. Apparently my superiority complex is about two things. One, having an abnormally small head, which I do, objectively. I can choose from the kids' range of helmets and glasses and hats. The lady who was taking my photo when I was getting my license renewed asked me to move the chair closer to the camera. Good license photo though. I could go straight to the casting room to be bunkmates with vinegar tits. If you know, you know. And my second superiority complex is about being fast in the bathroom, which I also am. Who wouldn't be? What is there to do in there? It's not just about the bathroom though, I am generally a fast moving person. Unless I'm running, in which case the pace is very pedestrian. She reminds me of the time we were boarding a plane, Row six, and I have congratulated my husband on securing row six because we are usually at the back, and I cannot stand slow people, so filing off a plane is torture for me. She says, Bushy isn't the word. I think impatient. She's enjoying this now, got a real roll on, and she reminds me of the Molokini dive the day before. I was the first one in the water and waited loudly as everyone else in my family was getting in. I'm mildly offended by her remarks, but my frontal lobe kicks in and I manage to laugh them off and then make sure to splash it when we get in the pool. Although I'm still thinking about it later in the evening, and I bring it up with my husband when we get into bed that night. He is a truly wonderful person, plus he has had some experience managing the mother-daughter dynamic in our household. He says, She's not really saying you think you're better than us because of your skull circumference and bladder efficiency. She's saying something closer to you move through the world at a pace and with a confidence that makes the rest of us feel slow, in the way, and mildly judged. You are fast moving, decisive, comfortable being first, unbothered by mild social friction, highly tolerant of action, and low tolerance of inertia. We are slower to transition, more socially attuned to flow and politeness, less bothered by waiting, and possibly more avoidant of being seen as pushy. Thanks. I think. What makes this a pot kettle black situation is that as a child, she had to be first at everything. First to be served dinner, first to arrive, first to win, even if she didn't. She's deeply intolerant of people who can't. Case in point, she was furious at school about dawdlers on the stairs. There was one girl with a wheelie bag, everyone else had backpacks, and this bag apparently represented the moral collapse of school society. So her teasing me now feels cynical. Is this a superiority complex? No, but can it feel like one to the people around me? I am very comfortable being competent in public. I trust my body, trust my timing, trust my judgment, and don't need a consensus to act. That reads as confidence to some and it reads as arrogance to others, and maybe it reads as threatening to teenagers who are still calibrating their own competence. Especially daughters. It seems teenage daughters must find flaws in their mothers, reframe mum's strengths as annoying traits, and knock confidence down a peg or two to make room for their own. If I were tentative and anxious, she'd likely accuse me of being weak or soft. I can't win this round. Luckily winning isn't the goal. More crucially though, am I doing the same thing with my mother? Am I noticing her intolerances, her rigidity, her impatience more and more, and feeling just a little bit smug that I think I manage mine better? Until Hawaii gently taps me on the shoulder and says, You're not above this love, you're not all that, you're just in a different chapter. The uncomfortable truth is that sometimes the things we judge most harshly are the things we are rehearsing. But also, if my biggest sins are a small skull, an efficient bladder, intolerance of dithering, and early water entry, I think I'm doing okay. Clonidine is one of those drugs that when I say the name, people respond with, oh, isn't that for blood pressure? Or isn't that for kids with ADHD? Or my aunt took that for hot flushes, or they gave me that in hospital when I was withdrawing from something. And the answer is yes, all of the above. But it is one of the most pharmacologically elegant drugs we have because what it really does is turn down the body's stress amplifier. Let's talk about what it is, how it works, and why it pops up in so many different clinical settings and why it can be both incredibly useful and occasionally a bit spicy. Clonidine is an alpha-2 adrenergic agonist. That sentence alone probably caused half of you to mentally check out. So let me translate. Clondidine works on the sympathetic nervous system. That's the fight, flight, or freeze system. Specifically, it acts centrally, that means in the brain, to reduce the release of noradrenaline. And noradrenaline is the chemical that says heart, beat faster, blood vessels, constrict, brain, stay hyper alert, body, stay tense. Sleep, lol. No. How does clonidine actually work? Alpha 2 receptors are presynaptic receptors. Think of them as the nervous system's breaks. When clonidine stimulates these receptors, noradrenaline release decreases, sympathetic outflow from the brain decreases, peripheral stress signals quieten. So heart rate comes down, blood pressure comes down, sweating reduces, hypervigilance softens, the body stops acting like it's permanently late for an exam. That single mechanism explains why clonidine has so many different uses. Let's go through them because this is where clonidine starts to look like a Swiss army knife. Hypertension. Blood pressure. This is its original indication. By reducing sympathetic tone, clonidine lowers blood pressure, both systolic and diastolic. It's not first line anymore because it can have rebound hypertension if stopped abruptly, and we have gentler long-term options. But it still gets used, especially in resistant hypertension, short-term blood pressure control, and hospital settings. Menopause hot flushes and night sweats. This is where clonidine sneaks into the on the moons territory. Hot flushes are not just about estrogen, they're about thermoregulatory instability in the hypothalamus, driven partly by noradrenaline. Clonidine narrows the thermoneutral zone, reduces vasodilation, calms the sympathetic spikes that trigger flushing. Is it as effective as estrogen? No. Is it useful when estrogen isn't an option or as an adult? Absolutely. Especially for women who describe adrenaline surges or sudden sweats or palpitations without anxiety. ADHD, especially in children, but also in adults, clonidine doesn't stimulate focus like dexamphetamine. Instead, it reduces impulsivity, calms hyper-arousal, and helps with emotional regulation. It's particularly helpful when ADHD comes with sleep issues, aggression or irritability, and ticks. And in adults, especially midlife women, it sometimes helps when ADHD symptoms are amplified by hormonal chaos. Anxiety and panic, off-label. Clonidine doesn't treat thought-based anxiety, but it is very good at treating body anxiety. The kind that feels like heart racing, chest tightening, internal buzzing, something bad is about to happen. It works by calming the physical stress response, which can then stop the brain from catastrophizing what the body is doing. Sleep, especially hyper-arousal insomnia. Clonidine doesn't knock you out. Instead, it reduces nighttime sympathetic tone, helps the brain disengage, can be especially useful for early morning awakening. It's often used when sleep problems are driven by PTSD, ADHD, menopause, or withdrawal states. And withdrawal syndromes. Clonidine is a workhorse here. It's used in withdrawal from opiates, alcohol, benzodiazepines, nicotine, not because it replaces the drug, but because it reduces sweating, tremor, tachycardia, anxiety, agitation. Again, it calms the nervous system while the body recalibrates. And pain and migraine. Clonidine can enhance analgesia, reduce central sensitization, and be used in some neuropathic pain settings. It's not a primary painkiller, but it helps by reducing the stress amplification of pain. Side effects, because if it has an effect, it can also have a side effect. Common side effects include dry mouth, is very common, drowsiness, dizziness, constipation, and low blood pressure. The big one to respect is rebound hypertension. If clonidine is stopped suddenly, noradrenaline surges, blood pressure can spike, and symptoms can be dramatic. So clonidine should always be tapered, not stopped abruptly. Check out my TikTok and Facebook and Instagram video at Prescribe or Pass on hyperbolic tapering because new guidelines say straight lines are out and hyperbolas are back, baby. Other considerations. Clonidine can worsen depression in some people, can cause fatigue or brain fog at higher doses, and needs caution in people prone to fainting or people with chronically low blood pressure. Clonidine is rarely the drug hero, but it's often best supporting actor that makes everything else work better. It's useful when symptoms are adrenergic rather than purely hormonal. Anxiety is somatic, sleep is wide, tired, estrogen isn't appropriate or sufficient. It doesn't fix everything, but it can turn the volume down enough for people to breathe again. Not every symptom needs to be eliminated, sometimes it just needs to be quietened. And clonidine does that quietly, competently, and without much fuss, which is very on brand for midlife, honestly. Friends, you know I build each episode of On the Moans the way one might prepare for a perfect beach day. The chemical broad spectrum sunscreen applied generously and rubbed in carefully with an ion coverage dose and evidence. The hat, bucket of course, not for fashion, but for protection. Sunglasses, UV rated and non-negotiable. The fake tan because we are nothing if not ironic. And a new bikini chosen optimistically with the understanding that confidence is situational. And then finally I walk across the hot sand towards the white beach and bluer than blue water, believing just for a moment that preparation equals control and that evidence is on my side. But sometimes I don't stand on the white sand and paddle in the clear torquoise water with the turtles. Sometimes I grab a broken rain umbrella, a flannelette shirt from the clothing bin, an old bottle of concealer two shades too dark, squeeze into my speedos circa 1995, and dive headfirst into the swamp creek of wellness that is murky, loud, and full of things that promise protection but mostly just smell like mildew. This is Wellness Woo of the Week, which includes a moment where science shows up with data, mechanisms, and humility, and Woo arrives carrying a vision board and an unearned sense of moral superiority. This week's woo isn't a supplement. It's not a tea or a herb or an essential oil. It doesn't come in a brown glass bottle with a dropper. This week's woo is main character energy. The energy that tells you your calm, your health, your balance are all the results of your choices, good choices, disciplined choices, enlightened choices. It whispers, if other people had just tried harder, they could feel like this too. I was reminded of this on holidays in Hawaii. Sun, salt water, midday naps, and fur obligations. Because when your nervous system is regulated, when you're sleeping, exercising, eating well, feeling resourced and supported, it's dangerously easy to believe that calm is a personality trait. And Wu loves this story. Wu loves people who grow their own organic vegetables, who cook everything from scratch wearing white linen in perfect kitchens, who meditate and journal, exercise daily, have elaborate skincare routines, regular health care, time, space, money, support. Wu presents this as a virtue. But what that ignores is the huge privilege that enables these habits. The privilege of time, money, of flexible work, of reliable safety. The privilege of not existing in survival mode. It turns resources into righteousness, and from there judgment is easy. If you're anxious, you must be doing something wrong. If you're exhausted, you must not be prioritizing yourself. If you're sick, inflamed, burnt out, then maybe you're just not listening to your body hard enough. Stop eating inflammatory foods, exercise more and wind down before a good night's sleep with your red light mask. The most privileged position of all is the ability to say I fixed this naturally. The appeal to nature bias is preaching from a very privileged position in society. Woo wants you to. Believe regulation is a moral achievement. Medicine knows it's a state heavily influenced by biology, environment, and access. So enjoy your calm, enjoy your holidays, enjoy your routines. But don't mistake your circumstances for superiority. I'm speaking mainly to myself now. Friends, that's enough navel gazing from me for one episode. If something in this episode made you feel seen, unsettled, or quietly called out, about your body, about your patience, about the things in other people that irritate you just enough to be instructive, that's usually where the interesting work is. So lean in. Until next time, be kind to your nervous system and generous with your judgments. Bye bye.