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 Eora 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. Today's episode of On the Moons is a little bit different. Recently, I had the privilege of speaking at an event for women from a women's shelter. It was one of those perfect Australian days. The sun was shining, the temperature was just right, and the ocean looked absolutely spectacular. We were gathered in this beautiful space overlooking the beach. We could see the sand and the surf stretching out in front of us, sparkling in the sunlight. But what made the day truly special wasn't the setting. It was the women. Of course, it was the women. Many who had joined us had experienced significant trauma. For some of them, even leaving the shelter and coming to an event like this was a really big step. And so the whole day felt like holding something very precious. There was a sense in the room of women showing up for themselves, supporting each other, and being open to learning more about their own bodies and their own health. Before we began the talks, the morning started with a short mindfulness and breathing session. I thought it might be nice to begin today's episode in a similar way. So wherever you are listening from, maybe you're driving, maybe you're walking, maybe you're just sitting quietly for a moment. I invite you to take a few minutes with me. As I record this, I'm sitting at the beach. You can hear the ocean in the background, waves rolling in and out, that steady rhythm of the water. There are people chatting nearby, a few seabirds calling overhead, and the occasional burst of laughter drifting across the sand as people splash in the water. The sun is warm, the air smells like beach, and the whole place has that calm, open feeling that only the ocean seems to create. So for the next few minutes, wherever in the world you are, imagine yourself here by the water with me. If it feels comfortable, allow your body to settle. You might like to sit with your feet on the ground. Or if you're walking, just allow your pace to soften slightly. Let your shoulders drop. Unclench your jaw. And begin by simply noticing your breath. You don't have to make any changes, just notice it. The gentle rise of your chest as you breathe in. And the soft fall as you breathe out. Now take a slightly deeper breath in through your nose. And gently breathe out through your mouth. Again. Slow breath in through your nose. And a slower, relaxed breath out. There is nothing you need to achieve here. Nothing you need to fix. Just breathing. Allow your breathing to become slow and steady. In through your nose. Out through your mouth. And if your mind wanders, which it naturally will, just bring your attention back to your breath. You might feel the air moving past your nose as you breathe in. And the feeling of breath leaving your body as you breathe out. You might even notice a small pause between breaths. Breathing in. And breathing out. Now as you breathe, imagine the body softening slightly with each exhale. Shoulders are relaxed. Let the muscles in your face soften. And allow the body to release any tension it may be holding. Breathing in. And breathing out. If you can hear sounds around you, perhaps traffic or voices, or even the ocean, allow those sounds simply to be part of the moment. There is nothing you need to resist. Just breathing. Slow inhale. And a slower exhale. And perhaps noticing that for these few moments you've given yourself permission to pause, to step out of the busyness of the day, and simply be here. Breathing in and breathing out. And when you feel ready, allow your breathing to return to its natural rhythm. Maybe roll your shoulders slightly. Bring your awareness back to wherever you are. And we'll begin today's conversation. Hi everyone, my name is Kate. I'm a pharmacist by trade, but recently I started my own dive into the menopause space. I am 48, and as I said, I've been working as a pharmacist for 25 years, but I was surprised by my lack of knowledge in this area, and as I started speaking with my girlfriends who are all similar age, I was surprised by how little they really understood. So I started to really educate myself, and yeah, I'm just happy to be here to share it with you beautiful ladies today. I've made a few notes, so I'll just be just glancing down to make sure I don't forget anything. I guess what I noticed it within myself, but also amongst my friends was that we it was a slow decline in how we were perceiving ourselves. So I would be a pretty resilient person, I thought, and then occasionally just feel overwhelmed with anxiety for no reason, no good reason, nothing had changed, or perhaps I was more teary than I used to be, or just cognitively I wasn't as well put together I felt, and it made a big difference in how I perceived myself. So I always liked to perceive myself as you know, pretty capable, pretty pretty well put together, pretty sharp, and then started having these moments of doubt. And as I started speaking with my girlfriends, it's interesting how the conversation, it was like a little whispered conversation, and then if you had the guts to go there, if you could just open up that space, then people are saying, Well, my girlfriends are saying to me, I thought it was just me, which is crazy because really, biologically, there's there's no difference between you and me. There's there's no difference. So why would I think it was only happening to me? I think as women, we see it as a as a failure. So I used to be one way, I am now no longer that way, therefore I am failing at that. And I guess the the message that I'm constantly practicing for myself, and the message that I would like to share with you is that it's actually just biology. It's nothing more than that. And for some reason, we are we're really supportive and we're really understanding of teenagers who go through a huge hormonal shift, aren't we? When when our teenagers are going through puberty, we're we're super supportive. So why are we not as supportive of ourselves and of each other when similarly in midlife a similar thing is happening? So just to speak broadly, menopause is actually just one day in your life. So menopause is defined as a day, 12 months after your last period. But the period before that, which can be up to 10 years, we call perimenopause, which just means around that age, like around that time. The average age of menopause in Australia is 50. So that means perimenopause can be anything up to early, early 40s for some women, even in their late 30s. And it's a it's a real, it's not a nice gentle, slow change. You know, it's a chaotic fluctuation of hormones, which is just like a roller coaster. So the way I've been explaining it, um, the way I like to think about it is it's like our hormones, our sex hormones, acknowledging that um we've got lots of hormones of insulin, melatonin, thyroxin, cortisol, or all hormone hormones. But for the purpose of our chat today, when I say hormones, I just mean our three sexy hormones. And I like to think of them like a girl band. They're like a girl super band. And we've got oestrogen, and oestrogen is Beyoncé. So she's the headline act. She's gorgeous, she's well put together, she's got the big songs, she's doing brain, she's doing mood, she's doing skin, she's doing bones, she's doing tissue, so she's doing vaginal tissue, she's doing our bladder, she's doing memory. Estrogen, Beyoncé, she's not just doing fertility, and we've got estrogen receptors all throughout our body, and so when estrogen starts to fluctuate, you can feel it all throughout your body. It's not just hot flushes, it's changes in sleep, it's changes in mood, bone mineral density. And when Beyoncé is singing well, everything is great. We're sharp, we're energetic, and we're resilient. And then we've got progesterone. So I like to think of progesterone as Adele, so she's got the big, yeah, she's got the big soft melodies, she's the calming voice in the band, she's the perfect juxtaposition to Beyoncé. She's not just about the uterus, she's to do with sleep and calming and making us feel grounded. And that's why some women, even if they don't have a uterus, can still be prescribed progesterone because, again, we've got progesterone receptors all throughout our body. And they actually act on, they're called the GABA receptors, and they're the same receptors that sleeping tablets might work on. So that's how women find progesterone to be calming. And the third member of the band is, of course, testosterone. Testosterone would have to be pink. She's swinging from the ceiling, she's deadlifting anything, she's giving you motivation and confidence and physical strength and drive and that feeling of just getting shit done. And we often think of testosterone as just a male hormone, but women have and need testosterone. And we've got testosterone receptors all throughout our body as well. And testosterone starts to decline from about our mid-20s. When we're younger, everyone in the band is singing beautifully, and the concert is going really, really well. But during perimenopause, Beyoncé maybe not show up one night, Adele forgets the lyrics, Pink has stormed off the stage. So the concert used to be amazing, it's now just a little bit chaotic, and that's what you're feeling in your bodies. And it's worth remembering that even if you're having regular periods, that doesn't mean you're not in perimenopause and can experience perimenopausal symptoms. Even if you're having regular periods, you might not still be ovulating regularly, which means you're not producing a regular amount of progesterone. So that is also something to bear in mind if you're having trouble sleeping or you're feeling more anxious, or you're just feeling that wired feeling. And then estrogen becomes unpredictable. Sometimes it's up, sometimes it's down, and that's where we get the symptoms of hot flushes and night sweats and brain fog and mood changes. So again, estrogen is acting everywhere, it's acting in our brain, it's acting on serotonin pathways, dopamine pathways, and GABA pathways. So they're all to do with mood, motivation, and calmness. So that's where we're getting the anxiety and the sleeplessness and the lack of concentration. And that's why women often saying, just don't feel like myself. So it's not failure, it's just neurobiology. So we're getting jointa and itchy ears and urine retract infections or phantom urine retract infections. This is all just not your body failing you, it's just a hormonal environment is changing. Interestingly, so with hot flushes, estrogen is working in that part of the brain that is in the hypothalamus, and that is the part of your brain that tells you when you're hot. And it's basically that part of your brain going, ah, we we must be hot quick. Let's dilate those blood vessels, let's put on a big sweat because we need to cool you down, and that's what we experience as a hot flush. Um, so the good news is that there are some foundational health things that we can do that make a really big difference. It's really boring, but the first one's sleep. You just need good sleep. It's how your body and your brain resets itself, but because of the perimetopausal symptoms, sleep is often, often the first thing that gets disrupted. How can you get better sleep? Simple things. Morning, morning sunlight is really critical in setting that circadian rhythm, keeping a fairly regular bedtime, and also reducing alcohol in the evening. Um, small improvements make a really, really big difference. The second thing is muscle strength and exercise. Again, you all know this, but muscle strength and exercise supports your bones, it supports your metabolism, it helps your insulin sensitivity and it supports your mood. So strength training in menopause doesn't necessarily mean lifting really heavy weights, although heavy weights does put extra stress on your spine and your muscles, which makes them stronger. Um, I did read a study where they had, they divided, I think it was 75 people into groups of three, they were all over 65. One group lifted really heavy weights three times a week, one lift one group lifted medium to light weights three times a week, one group did nothing. And then they looked at these little markers in the brain to look at um brain aging, and the group that lifted the heavy weights had a much lower brain age. So that just means I guess that building muscle and doing exercise is more than just your strength, it's also helping your brain. Nutrition, now I'm gonna say most, if not all, women are not even eating enough protein, meat, eggs, Greek yogurt, although I hear that there's a there's a shortage of Greek yogurt and people are panic buying Greek yogurt. I know in my house we go through a lot of Greek yogurt, but it's so true. It's um you go to Kohl's and there's you're like, where's all the Greek yogurt? Luckily I'm not into cottage cheese, so yeah. That's right. No, I remember in the like in the 80s, your mum having avocado and cottage cheese on toast and thinking, God, that looks bland.
SPEAKER_01Anyway, um I am that mum. So I'm up. So I'm up. Let's go.
SPEAKER_00Yeah, that's right. Um, so again, we're not after perfection, we're just after you know, tiny, tiny little improvements. Movement, um you can't underestimate, uh, you can't overestimate, sorry, just going for a walk. It's so accessible, even a short walk gets you out, you're in a different environment, you're moving your heart a little bit faster, which is pumping blood around your body. It's amazing for sleep, for mental health. I mean, you you know this. Stress, so when we experience stress, obviously it affects how our body reacts to our hormones. That's why deep breathing is so important. Mindfulness, social connection is so important. As humans, we deal with stress a lot better as a group than we do individually. So communities are so so important. Mindfulness practices. I personally need to do a lot better at mindfulness practices, but everything's a journey, right? And it's just a little bit, a little bit each day, a little bit better each day. I know that alcohol at the time feels like it's stress-relieving, but it actually plays havoc with your sleep routine, and you know, so it's it's just best avoided. And then I get a lot of questions about supplements, and there's a lot of I would say noise in the wellness space. So supplements that have really good evidence, vitamin D, calcium iron if you're deficient, uh, fiber if you're not getting enough from your diet. Uh, one thing I would say, um, supplements, more is not more. So, especially with calcium, if you have more than what you need, you risk it calcifying in your arteries and and causing other problems. So, supplements really need to be a conversation that you have with your prescriber. Um, iron, the same. It's best driven by an actual blood test to determine to determine need and fibre. I mean, fibre's a great supplement if you're not getting enough, and if you're trying to stuff your body full of protein, as I'm currently trying to do, then eating enough fibre is challenging. So a fibre supplement is, you know, it's it's it's beneficial for your gut health. Um, it's not sexy, but it is important. So, some women, just to move on briefly to the to the hormones, and then I'll hand over. The hormones are, as we've discussed, an option to be uh replaced if that's what you decide you need in consultation with your prescriber. There's different ways that we give um, say, estrogen, for example, so you can take estrogen orally, or transdermal estrogen is uh in a patch or via the gel. Currently we're leaning towards transdermal estrogen, it bypasses the liver, goes straight into your bloodstream, um, it just reduces risk of clotting if if that's something that's important in your particular case. So speak about that with your prescriber. Um, progesterone, if you have a uterus and you're on estrogen, then you will need progesterone. Otherwise, you just build up that lining and build up that lining because estrogen hasn't got anything to tell it not to do that. You can take oral and you can have it as an intrauterine device, and there's also pessary. So there's lots and lots and lots of options that can be tailored to your specific situation. Um, a quick word on testosterone. So, testosterone is not on covered by the PBS. Again, it's um indicated for a very specific reason, and it's best discussed with a prescriber who knows a lot about um menopause and and midlife, but but it's absolutely an option for for some people. Um, and then just a quick word on breast health. So, breast health is now being talked about in terms of so you're not looking for a lung. You're not looking for a cancer. You are just getting to know what is normal for you. So that then I'm the first one who can realise if something isn't right. And we're just talking shape or dimpling or feel, of course, or nipple discharge. Anything like that is a reason to go and speak with your prescriber, and of course, regular mammograms are absolutely important. Thank you. Thank you. I hope you enjoyed that little piece of the talk from the event. I hope you can tell it was a really special day. The setting itself was beautiful. We were sitting in this light filled space overlooking the ocean. The sun was shining, the water was sparkling, and the temperature was absolutely perfect. One of those days where everything feels possible. Starting the morning together with some breathwork and mindfulness, just taking a few minutes to slow down, breathe and arrive in the space, which felt particularly meaningful because the women attending today were from a women's shelter, and for some of them even leaving the shelter and coming to an event takes courage. Something that I take completely for granted for others is a real challenge. These women aren't so different from me. Sometimes it's just circumstance that sends our lives down a very different path. So the atmosphere in the room was incredibly respectful and supportive. And it felt like a real privilege to be invited into that space and to spend time with them talking about hormones, midlife, and understanding what's happening in our bodies. Because many women go through these changes and think something is wrong with them. So many women are dismissed. When really it's biology. And the more we understand about our bodies, the more power we have to make informed decisions about our health. And speaking of hormones, I'll be honest with you. Just before recording this outro, I was scrolling through Instagram, which is always a slightly dangerous activity, and I came across one of those videos where a group of people sit in a room and a whole bunch of rescue dogs are released, and the dogs go around and choose their human. And I'm not kidding, I was sitting there absolutely in floods of tears watching these dogs slowly walk up to someone and decide that was going to be their person. Which is probably a very on-brand emotional moment for someone talking about perimenopause and hormones. Because if there's one thing many women notice in midlife, it's that the emotional dial can get a little turned up. Crying at emails, crying at ads, crying at dogs choosing their humans on Instagram. And while it can feel sometimes a little bit ridiculous, it's also part of the biology of this transition. Hormones influence our brains, our emotions, and the way we experience the world. So if you've found yourself feeling a little more emotional lately, you are definitely not alone. Thank you so much for sharing this experience with me. And if you'd like to learn more about hormones, medication, and women's health, you can find me on TikTok and Instagram and Facebook at Prescribal Pass. LinkedIn, Thomas Dowling Consulting, where I share short educational videos. Until next time, take care of yourselves. Be kind to your bodies and remember, you're not going crazy. Your hormones have just missed a band rehearsal. Bye bye.