What is Normal? The Hormone Rollercoaster with Dr. Sonia Davison Part 1

From the first hormonal shifts of puberty to the complex transitions of menopause, hormones shape every stage of a woman’s life — but how much do we really understand them?

In this episode, we’re joined by leading endocrinologist Dr Sonia Davison for a refreshing, no-nonsense conversation about all things hormones. We unpack what’s happening beneath the surface during puberty, reproductive years, perimenopause and menopause. Dr Davison breaks down the science in a way that actually makes sense, while tackling common myths, the real impact hormones can have on mood, energy and overall wellbeing.

This is the kind of conversation every woman deserves to hear — whether you’re navigating your first cycle or your final one.

Jean Hailes for Women's Health https://www.jeanhailes.org.au/

Australasian Menopause Society https://www.menopause.org.au/

Transcript

SPEAKER_00 0:07

Welcome to Healthy Banter, the podcast where women's health gets real relatable and just a little bit cheeky. We'd like to begin this podcast by acknowledging the traditional owners on the land on which we meet today. We would also like to pay respects for elders past and present. Hello, Meg. I'm really well, Jules. How are you?

SPEAKER_01 0:27

Really excited again about today's guest.

SPEAKER_00 0:30

But another good one. Yeah, an amazing one. Dr. Sonia Davison joined us on Healthy Banta to talk All Things Hormones.

SPEAKER_01 0:39

And she's pro. Like we're talking all things hormones. We're talking about what they do to your body. We're talking about how that affects our body and mostly about what's normal. Yes. What should we expect?

SPEAKER_00 0:52

Yeah. And how to feel normal.

SPEAKER_01 0:54

Yeah.

SPEAKER_00 0:54

Yeah. She was wonderful. I'm going to read a quick bio for her just so that our listeners know her background, but she was incredible. So here is Dr. Sonia Davison's bio. Dr. Sonia Davison is an endocrinologist with a special interest in women's health and has worked in this field for over 20 years. She is a clinical fellow at Jean Hales for Women's Health and has worked at the Women's Health Research Program, Monash University, Victoria, Australia. Sonia is in private practice at the Melbourne Endocrine Clinic, Melbourne, and at Jean Hales for Women's Health. Her PhD and postdoctoral research examined hormones in women, including measurement of androgens and their relationships with age, mood, sexual function and cognition. Sonia is a past president of the Australasian Menopause Society and former editor of its newsletter, Changes. She is a current board member of the Asia-Pacific Menopause Federation. Sonia has published widely in the field of women's health and has presented at women's health conferences, scientific meetings, podcasts, webinars, and community seminars. She has frequently been invited to appear in the media, including the TV show The Truth About Menopause, featuring Myth Warhurst. What a guest. Let's get into it. Sonia, thank you so much for joining us today on Healthy Banta. We we're really thrilled to have you here and chat, hopefully, all things hormones.

SPEAKER_02 2:20

It's my absolute pleasure. I'm I hope everyone's raring to go and listening because we're going to have some great information on women's health for them.

SPEAKER_01 2:30

I agree. Thanks so much, Sonia. It's so lovely to have you here today. Wouldn't you like to start maybe with a little bit of an introduction about yourself and your work as an endocrinologist?

SPEAKER_02 2:42

Absolutely. I work in Women's Health. I work at Jean Hales for Women's Health, which is a national not-for-profit women's health organisation, which has a great focus on education for women's health throughout the ages. I did my endocrinology training, which is hormone specialist training. I did a PhD looking at hormones in women from 18 to 75 in Australia, over 1,400 women. We had some amazing findings that we told the world about, and I've continued to work in women's health. I did some research. I've been the past president of the Australasian Menopause Society, and I just love uh talking about women's health and making women healthy, hopefully, by my words.

SPEAKER_01 3:23

Oh, we're very lucky to have you with us today. So excited.

SPEAKER_00 3:26

Such a great background and very much aligned with all the education we're trying to get out to women. So this is perfect for us. Sonia, can we then go into hormones generally? And would you be able to name, I guess, name the hormones for us and let us know about their function throughout the life stages with women, so sort of from puberty through to menopause?

SPEAKER_02 3:55

Sure. Hormones are chemical messengers. Uh, they're secreted in one part of the body and they move either a tiny distance or all the way around the body, um, and they make an action occur. And we have over 50 different hormones, they're responsible for temperature, fluid, regulation, energy, etc., but of course, reproduction as well. Um, so our secondary sexual characteristic development, such as breasts, uterus, all of those things, development of hair under the arms, they're all regulated by mostly estrogen androgens, which the main one is testosterone and also progesterone. So children until about eight or ten really have very low levels of those hormones. And then our hypothalamus and pituitary in the brain, tiny, tiny master glands, start pulsing little tiny amounts of hormones such that as they sleep, they develop other hormones which then start to message to the reproductive organs and start everything kick-starting. So puberty is associated with just gentle, gentle, gentle messages happening, and then you can see what happens at puberty rate in hormones. Um, both men and women, even if they're children, have pretty stable hormones, but men's don't uh cycle, and women have cycling levels of estrogen and progesterone produced from the ovaries, with really with a focus on producing an egg every month, and we'll have roughly about 400 cycles from average age 13 to mid to late 40s to about 50. Uh, and that's when perimenopause can happen mostly in the mid-40s when we're starting to run out of eggs. I know we're going to talk about that more. And menopause is the sad lack of last egg and the last period, which average age for Australian women is 51 to 52. And we run out of estrogen and progesterone as women. Men do not, they they just have a slight decline in hormones as they age. And we also um our testosterone is very fascinating. A lot of people are interested in testosterone, but that um decreases with age, not really with menopause.

SPEAKER_01 6:06

Okay, and is that true for both men and women that testosterone decreases with age or just women?

SPEAKER_02 6:13

Well, men want to claim manopause, which is andropause, but um it they haven't got one. 1% of testosterone over their life, where our estrogen, so when we're reproductive from 13 to 4550 or so, depending on that person, that woman, um, our average estrogen will be 400. We don't need to measure it, but after menopause, that level will flatline at 20. So it's a 20th of the level that we've been used to having from 13 to 4550 or so, but our peak levels are 1500 to 2000, so it's a 70th of that level. So that's why women are because people sort of say, why do you medicalize perimenopause and menopause? Why do you fuss on about it? Because that big change in hormone means that 20% of women will have severe symptoms, 20% will have no symptoms and just sail through it, but every other woman will have a moderate to mild uh degree of some symptoms that can uh bother her. And really it's a big change. Uh women go through life, get to 45 or 40 to sort of 50 or uh even 60 for some, and just think, oh, what's happened to me? I I knew what I was doing, and now I don't know if I'm Arthur or Martha because their estrogen and progesterone are just fluctuating so crazily when they get to perimenopause.

SPEAKER_01 7:42

And that peak estrogen, is that during pregnancy? Is that when we're at our highest estrogen?

SPEAKER_02 7:49

Um, well, we do have high levels of hormones when we're pregnant, and that's why some women, and they it it is a very different stage through the first trimester, second and third. So some women can feel just amazing, have luxuriant hair, just feel joy and happy because their hormones are at a good level and steady, especially in the middle trimester. But some women, uh, as you've seen, will have nausea, vomiting as those hormones start to increase in the first trimester. Uh, so and and some women will just feel terrible throughout pregnancy. So I think the main message here is that when it comes to women and hormones, the experience is extremely variable from puberty, reproductive life, perimenopause and menopause and beyond, where it's not one size fits all, although the the good messages that we can talk about really do apply to women, but there's no menopause. Men, menopause take-home message.

SPEAKER_00 8:48

Sonia, with with all of that, before we get to the perimenopause part, is there anything in our 20s and 30s or before then that we can do to help better prepare ourselves for perimenopause and menopause?

SPEAKER_02 9:03

Sure. Um, but but you've got to remember it's phases of life. So up to 18, we're you know, we've had the pubertal spurts and uh whatever, and it takes a while for the hypothalamus and the pituitary to talk to the ovaries and get into a rhythm. It takes some years, about five years. So up to 20, we're studying, and then from 20 to 24 or 25, we're also studying. Again, we might be finding life partners. 30s, we're typically having children, working, trying to get established in our careers. 40s and 50s, we might be at the peak of our careers, but then caring for dependents and caring for elderly people. So we we sort of get lost on the journey, and we don't really need to know too much about what's ahead. But it is good to be alert but not alarmed. But you've also got to remember 20s, 30s, and 40s, women will have these very drastic, normal fluctuations in hormones. So things like PMS, um, psychical symptoms that might be related to heavy bleeding and all those sort of things, endometriosis, polycystic ovary syndrome, they're the things that women are uh you know suffering from in their 20s, 30s, 40s. Again, it is very variable, not everyone suffers, but PMS some people don't even think uh is an entity. But other studies say that PMS, which is really physical and emotional symptoms before and around the period, can uh affect 70% of women just because of those normal hormone situations.

SPEAKER_01 10:37

And that's that's purely just uh an individual thing, is it? Like there's like what makes somebody more susceptible to those type of symptoms, or you know, even as you're talking about earlier, that early stage of pregnancy, some poor women just have so much morning sickness. What what predisposes somebody to be more sensitive to hormones?

SPEAKER_02 10:59

Genetics is probably um like I don't know twins will do what the other twin is doing, so that's where twin studies are very valuable. Family history, but also stress. So if you're working three jobs, if you've got a terrible relationship, if there's domestic violence, if you've got a child with increased needs, if you've got elderly parents who need care or you're caring for someone else, uh, if you've had other health concerns throughout life, they are going to predispose you to having things like PMS and possibly a trickier perimenopause or menopause, just because you've sort of used to struggling, uh, I suppose. Okay.

SPEAKER_01 11:36

And um back to estrogen for a little moment, because obviously it has a very important um role in our reproductive system as women. But estrogen, is that correct? It also plays a role in other areas of our life, potentially like um maybe like inflammation or immunity. Is there much research around that sort of protective mechanism of estrogen?

SPEAKER_02 12:01

When we look, so my PhD was measuring um estrogen and androgens, which are testosterone and other hormones in women. Um and what we have found, not my research, but others, have found that there are estrogen receptors from anywhere from bone, fat, liver, the gut, the brain, they are riddled throughout the body, and we just haven't really worked out exactly what estrogen, progesterone, and testosterone do at various parts in the body. But we do know, for example, after midlife, uh, so after menopause, typical age 51 to 52, but can be 45 to 50, um, we do start to get more arthritis, we tend to get lowered bone density, and we do tend to get other musculoskeletal issues, and there that's a very emerging area, and they have linked uh that with the lowering of estrogen. So, of course, at midlife, if we could intervene and help us in older life with those things that can be debilitating, especially bone density loss, osteoporosis and fracture, um, that would be a really wonderful aim to try and do it at midlife. So a lot of the research has been focusing on brain, particularly mood as well, bones, heart, big, big relationship with vessels and estrogen, believe it or not. Um, so it's it's a really fascinating science. Women are fascinating entities.

SPEAKER_01 13:27

Yeah. I know it it in clinical practice, you just, you know, majority, I think, of my patients are perimenopausal or menopausal women who are just having so many issues with muscle, and then you hear all the all of a sudden there's gut issues, and it's just it's just almost like a ripple effect once that estrogen starts to um reduce in numbers, I guess, in their body. But you know, maybe until this discussion I wasn't blaming the estrogen as much as I should have been, but but maybe now I'm going to be exploring that avenue a little bit more.

SPEAKER_02 14:01

20% of women can have this disabling almost arthritis. They just feel sore, their muscles feel sore, their joints uh are aching, and and that's you know, you can think, oh, it's some sort of lupus or some really wacky arthritis, or but it's actually just perimenopause or menopause, and they can uh benefit from hormone therapy if appropriate for them.

SPEAKER_01 14:25

In your earlier years, then so say in that bracket, say 18 to late 30s, 40s, I know it's a bit busy in there because we're studying and we're having babies and things. If we were like from a from a preparation point of view, if we exercised more or if we like you know, worked on our bone density, worked on our muscle mass, does that help as we then head towards perimenopause, menopause, or does that sort of make it worse because all of a sudden we can't maintain that function that we have?

SPEAKER_02 14:59

Um the body is a machine. We do need to look after it. And it is tricky when you're a bit younger. You might be dealing with what is life, what's my place in life, but it's all about balance, not being too thin, not being overweight for your height, doing a reasonable amount of weight-bearing exercise, but also not doing too much, avoiding smoking, vaping, alcohol excess. I know some of the younger ones will do binging, but we want them to have less than 10 alcoholic drinks a week if possible. Um, having enough calcium in diet to protect the bones later on, having enough vitamin D, but of course not getting skin damage and which might predispose to cancer. It's all about balance and you just don't want to be at one extreme. And it is really important to uh just be healthy if you can. I know some people don't have that option, but as healthy as you can be for that body as you're at each life stage. Um, so for example, in when you're less than 10 and someone says eat your vegetables, well, it would be a good thing if you ate your vegetables.

SPEAKER_00 16:06

I'll I'll let my kids listen to this tonight.

SPEAKER_02 16:10

There might be some, but even having the milk, so great source of dairy. But if they can't have milk, having yogurt, having cheese, it's all about balance. Uh, and if you do have a difficult uh fussy eater at home, it's finding the ways that you can um get all that stuff into them without having the things you shouldn't be forcing them to have things that they don't want, apart from the green vegetables they should be producing. Thanks, Sonia.

SPEAKER_01 16:40

Sonia says eat your vegetables.

SPEAKER_00 16:42

Yes. Can we move into perimenopause and discuss what that looks like in terms of what starts to happen to the hormones and then what does that look like physically for us, cognitively? Like how does that what are the sim signs, symptoms, or the most common ones generally?

SPEAKER_02 17:01

Um well, perimenopause is when we start to run out of eggs. It's a little sad. The hypothalamus and the pituitary are desperately sending the messages down to the ovaries, but the poor ovaries are giving up. Um they're running out of eggs. It is a normal thing to do. So it's typically in mid to late 40s, maybe about 47 or so, and it usually lasts for about five years, but it can last 11 years, studies have shown. So if you think that you're uh the typical woman at menopause, the last period, the last egg, no more estrogen, is 51 to 52. This can also start happening from 40 and possibly even uh late 30s for some women. Of course, there is premature menopause, which is another thing altogether. About 3% of women have menopause before the age of 40. They are a very special group and need specialist advice because they're robbed of their estrogen at a young age. So we start to get because the pituitary is trying so hard to get the ovaries to make the estrogen, and they're missing a little bit of estrogen because it's a feedback system which goes between the ovaries, the hypothalamus, and the pituitary. So the pituitary will try extra hard and a little egg that was just going to die off anyway, because we're born with hundreds of thousands of eggs when we we are when we're born, but they just die off and they're meant to die off, so that only 400 will develop over our reproductive lifetime typically. So it will get an egg that was about to die off, and it will actually recruit that egg because the messages were so strong, and then you might get a really big surge in hormones, um, and the estrogen and the progesterone in perimenopause will either be normal and the women will just feel like they're normal cells, or they'll start to feel menopausal, or they'll start to get symptoms of estrogen excess, so bloating, breast tenderness, mood disturbance. Um, and again, we start to get menopausal symptoms from perimenopause, flushes, sweats, uh, feeling hot. Generally, when the estrogen falls down before the period, they will start ramping up. PMS might be exacerbated, and that again is usually before the period, can be mid-cycle, can be during the uh cycle. They might start to get migraine, joint aches and pains, sleep disturbance, urinary symptoms, frequency, urgency, leakage of urine, they might start to get some vaginal dryness, their libido might start to lower, and they might get mood disturbance, so crankiness, anxiety, um, and just feeling low mood as well.

SPEAKER_00 19:39

It doesn't sound like how do we stop this?

SPEAKER_02 19:45

I I haven't presented it quickly so that women know this is normal. Yeah. So I think just being armed with that information, my body's undergoing normal changes, things are going to be a bit tricky, they're gonna go up and down, and I will be having symptoms. Mind you, 20% don't. But just I think knowing that that process is happening is a huge relief for some women because they think something's wrong with me, and um I, you know, it's it's me, but it's just actually normal. There's lots of different strategies we can employ, and that one strategy isn't right for all women, uh, to smooth out that ride, knowledge and information, but also being generally healthy, um, listening to your body and trying to work with it.

SPEAKER_01 20:36

And I think for me, knowing that there is no manopause actually really helps part of that process. That process is back it down, because this is mine.

SPEAKER_02 20:47

If men do undergo treatment for prostatic cancer or other cancers, that does hammer their hormones because it you really want their hormones to be very low. Then they undergo their manopause, but that's a very important scenario. Uh the the that's the result of treatment.

SPEAKER_00 21:05

So then is Sonia, is the are the are those signs and symptoms similar for women that go through like that enter perimenopause and menopause naturally versus like the ones you're talking about earlier that go into an early perimenopause versus like um a medically induced one if they have to have ovaries taken out early?

SPEAKER_02 21:28

So medically induced menopause, some women need treatment for cancer, endometriosis, they might have a big ovarian cyst, lots of they might have a nasty virus that knocks out their ovarian function and their ovaries become inactive after that. Radiation can also do that as well, just you know, radiation for cancer treatment usually. So those women do tend to get more severe symptoms, especially, for example, if you went out tomorrow and had both ovaries out, you would really know about it, unless you're very lucky that 20% that don't get symptoms. You'll probably get flushes, sweats, and it will be very, very um rapid and can be severe. The women who have premature menopause, not always. Some of them sneakily escape without having too many symptoms, but periods do stop. They're not making eggs, and we know those women because they're they've lost a certain amount of years of having estrogen cover. Their brain function can diminish, their um bones can diminish, their mood can diminish, and their cardiovascular risk can go up. That's why we generally will try and treat those women with premature menopause with hormone therapy until at least the age of 50, around the age of uh normal menopause.

SPEAKER_00 22:41

Yeah. Well, that concludes part one of Sonia's chat, which was amazing. So fantastic.

SPEAKER_01 22:51

My takeout from today, very excitingly, was that men do not experience a menopause. So no matter what they say, it's rubbish.

SPEAKER_00 23:02

It's all about us, ladies. It is all about us. Um, absolutely. And I think uh my biggest takeout was just that the importance of understanding our hormones uh and what is normal for us.

SPEAKER_01 23:15

Yeah. And I think that's that's just so relevant to to actually get that deep understanding of what hormones are.

SPEAKER_00 23:22

Yeah, absolutely. Yeah, and I think Sonia really broke it down uh in in a way that's really easy to understand because I think it can get so complicated when you're reading about them. So I think just that, you know, they're chemical messengers. Um I really liked how she put that at the beginning of the episode. Yeah, I think that's really great.

SPEAKER_01 23:39

And then on the next episode, we'll do a bit of a recap. We'll look at some tips and um some resources for uh navigating through menopause and look at some management strategies as well.

SPEAKER_00 23:52

Can't wait.

SPEAKER_01 23:52

I can't wait. We'll catch you guys then. Bye. And that's a wrap for today's episode of Healthy Banter. We hope you're leaving with something useful and maybe something worth sharing with a friend because that's what we're all about. Women supporting women, one honest chat at a time. If you loved hanging out with us, make sure to share, follow, or subscribe on Instagram, YouTube, Spotify, or just head to healthybanter.com.au so you never miss an episode. Take the advice that helps, ditch the guilt and keep cheering for yourself. We'll see you next week for more stories, more science, and even more banter. Healthy Banda is hosted, produced and edited by Megan Jules. Our main music theme is composed by Ada Akbal. Healthy Banda is not a licensed health service. It is not a substitute for professional health advice, treatment or assessment. The advice given in this episode is general in nature, but if you are in need of individual advice or consultation, please see a healthcare professional. If you are struggling, call Lifeline on 13314.