Zoë Foster Blake - Perimenopause, ADHD & Everything That Helped with Dr Fatima Khan

This is not your mother’s perimenopause. 💌 To join our journaling club, subscribe to my imperfect email - https://www.theimperfects.com.au/sign-up-to-our-newsletter/ Joined by guest host Zoë Foster Blake, and Dr Fatima Khan, we’re diving head first into perimenopause: the what, the why, and the how-the-f**k to deal with it. Typically beginning in your late 30’s, and in your brain of all places, perimenopause symptoms include heightened anxiety, irritability, sleep disturbances, brain fog … all things that make you feel further and further away from your best self. Beginning 5 -7 years BEFORE your last menstrual period, perimenopause can coincide with postpartum, the most important presentation of your career to date, and the uncovering of neurodivergence, which may have been painstakingly masked until this shift in hormones. With the expertise of Dr Fatima, and the lived experience of Zoë, we hope this episode makes you feel seen, less alone, and ready to have THAT conversation with your GP. Chapters 00:00:00 The Truth of Perimenopause [TRAILER] 00:01:09 The Meet Cute of Zoe Foster Blake and Dr Fatima Khan 00:06:55 Is this Perimenopause? Early Signs + Symptoms 00:07:41 Zoe’s Perimenopause Journey: No Sleep, Anxiety, Rage, Repeat. 00:09:56 Volcanic Rage, Explained 00:14:59 What Doctor’s Miss: Misdiagnosis + Antidepressants 00:15:57 Why Your Husband Is Breathing Too Loud 00:20:18 Perimenopause Mental Health Screening 00:21:25 Debunking the “You’re Too Young” Myth 00:23:43 Is it Anxiety? Depression? Perimenopause? 00:25:26 The Pill, The Mirena + The Modern Woman in Peri 00:30:44 Loosing Yourself in Peri: Brain Fog + Dementia Fears 00:32:10 The Importance of Testosterone 00:36:00 HRT Myths: Re-educating a generation 00:39:04 A Script for a Script: What to say to your GP 00:41:12 Perimenopause Is a Multi-Organ Syndrome 00:46:09 High Achieving Women + Peri = Shame 00:46:47 When Perimenopause Unmasks Your ADHD 00:54:26 Trauma Reactivation in Perimenopause 00:57:17 Pills + Skills: Why HRT Alone Isn’t Enough 00:58:41 The Longevity of It All 01:00:30 Nutrition 📚Things to read Group Chat, by Zoë Foster Blake - https://bit.ly/4efqR70 Hormone Health is Mental Health, by Dr Fatima Khan - https://bit.ly/4j6G2Ts 💻Things to check out Australasian Menopause Society - menopause.org.au Meno-D questionnaire - https://bit.ly/3Toj3sN Zela Wellbeing - https://bit.ly/4ARGFXu 🎧Imperfects episodes for MORE on hormones Zoë Foster Blake - Zero Lucks Given - https://bit.ly/4y8xwHx Dr Louise Newson - Maybe it’s Menopause - https://bit.ly/4i7xM3F Dr Louise Newson - It’s Hormones. Period. - https://bit.ly/47ya9w2 🩷To host your own Vulnerabilitea House, purchase here - theimperfects.com.au/shop 🩵To purchase our journal (or your novel) My Imperfect Life, click here - theimperfects.com.au/shop 🩵To join our subscriber community, A Little More Imperfects, follow this link - patreon.com/theimperfects 🩷 AND you can subscribe to A Little More Imperfects through Apple Podcasts http://apple.co/theimperfects The Imperfects is not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment. The advice given in this episode is general in nature, but if you’re struggling, please see a healthcare professional, or call lifeline on 13 11 14.

• 0:00Speaker 00

  Zoe Foster Blake.

• 0:02Speaker 01

  That's a woman in perimenopause without ADHD writing a book.

• 0:06Speaker 00

  Dr. Fatima Khan.

• 0:08Speaker 02

  I think most men don't know what perimenopause is, but they were after this podcast.

• 0:12Speaker 00

  Wow.

• 0:13Speaker 03

  Oh my gosh.

• 0:14Speaker 01

  I think we're scaring the boys now. I don't care.

• 0:17Speaker 00

  Two incredible women here to talk all about perimenopause.

• 0:21Speaker 02

  Perimenopause is not menopause because it typically starts five to seven years before your last menstrual period and it starts in the brain, typically late 30s to early 40s.

• 0:33Speaker 01

  Anxiety ramped up to an 11.

• 0:35Speaker 02

  Feeling overwhelmed.

• 0:36Speaker 01

  Sleep was terrible.

• 0:38Speaker 02

  Brain fog.

• 0:38Speaker 01

  Irritable fury, rage over things that shouldn't have been inciting that level of rage.

• 0:43Speaker 00

  It's a real fucker. And no Imperfects episode is complete without some helpful advice.

• 0:50Speaker 02

  We need to move to good sleep and that's a problem because everyone scrolls till midnight.

• 0:55Speaker 00

  I scroll till 11:30.

• 0:58Speaker 02

  But it's fine because you're not going to go through perimenopause, you're fine.

• 1:02Speaker 00

  Probably not the time to be bragging.

• 1:09Speaker 00

  Well, this is a very, very, it's a different episode structurally because no Josh today. Josh has been replaced for one episode only, for very good reason, and not because he doesn't believe in perimenopause, because we wanted to bring in, he does believe in it, by the way, we wanted to bring in a very special guest host for today, Hugh.

• 1:35Speaker 03

  Yeah, no, it's Zoe. Yeah, it's not me.

• 1:40Speaker 03

  Zoe Foster Blake, welcome and thank you for agreeing to co-host the Imperfects podcast.

• 1:45Speaker 01

  It is my absolute pleasure to be here with you as one of the bosses, on the hosting chair.

• 1:50Speaker 00

  You are co-boss.

• 1:51Speaker 01

  Thank you.

• 1:52Speaker 03

  And we are joined by Dr. Fatima Khan, which is such a great privilege for us. I'm going to, I'm going to aim to be succinct here because I feel like probably the less you and I talk, Ryan, on this episode, the better it'll probably be.

• 2:03Speaker 00

  Well, I've got some thoughts.

• 2:05Speaker 03

  So just by way of introductions to both of them. So Zoe was a beauty director at Cosmopolitan and Harper's Bazaar for over a decade, where she amassed an incredible knowledge about skincare products. Zoe founded Go To Skincare in 2014, as well as Go To in 2019, and Bro To in 2020. Zoe's published 21 books with the latest.

• 2:25Speaker 00

  Wow.

• 2:27Speaker 03

  Yeah, apparently.

• 2:27Speaker 01

  I was like 19.

• 2:29Speaker 00

  21's a.

• 2:29Speaker 01

  But some of those little kids' books slip in there, you know?

• 2:32Speaker 03

  Well, you say little, but my gosh, they're popular. They don't take as long to read.

• 2:36Speaker 01

  All right.

• 2:37Speaker 03

  Very popular in our house, that's for sure. With the latest edition being Group Chat, which is released in September, can we, can we quickly talk about Group Chat?

• 2:47Speaker 01

  I'd love to, as long as you like.

• 2:49Speaker 03

  I've said to you before, like, I'm going to read it because I know I'm probably not the target audience, but I feel like it's a really good thing for me to understand because for me, from what I understand, it's a lot about identity and kind of who you, who you planned to be or who you've spent your whole life trying to be. And then when you feel like you've arrived at that place, there's a lot of questions. Is this actually who I want to be?

• 3:11Speaker 00

  Let's mix it up a little bit and let Zoe talk about her book.

• 3:15Speaker 01

  I like that though. That is a good, that's kind of one of the, I like that. He's just gone straight in there. But that is one of the philosophical underpinnings of this book, which is, you know, women's fiction. It's lighthearted. It's intended to be funny and fun. It's about five women, sort of like a perimenopausal bridesmaids. They're all very different, but they've been friends for, you know, 25 years. And one of them is going, her husband's had an affair. So they rally together and they end up in Mykonos for a week. And that sort of puts a spotlight on them as to what you were saying, where they are in life. They're in their mid 40s. They're feeling the stress and the pull of young children and their hormones are going crazy and their partners. And some of them

• 3:57Speaker 01

  are divorced and quite happy. Some of them are not. And the main protagonist is sort of what you were talking about, Stella. She is, she's at that point where a lot of us are in our 40s. We were like, is that where I thought I would be? Is there more than this? Should I have done things differently? Is there still time? And that leads to a sort of a wider existential moment about, am I with the right person? Do I even live in the right house? Is my career all wrong? And so we see her tussle with that. But ultimately, it's a love letter to female friendship.

• 4:31Speaker 00

  I love that.

• 4:32Speaker 03

  Beautiful.

• 4:32Speaker 01

  Yeah.

• 4:33Speaker 03

  Okay. So I think the next thing to do is to ask, so how did you guys meet?

• 4:39Speaker 01

  Fatima and I were on a panel together earlier this year. I was talking about sleep and skin because of Go To and Fatima was obviously talking about perimenopause and the huge amount of impact it's got on your skin and your sleep as well. And then we got to chatting afterwards and then Fatima asked if I would read her book to endorse it. And I loved it. And I tell everyone to read it and.

• 5:03Speaker 00

  Well, when you put, you put a video on Instagram about it and, and when I saw that, because I knew that you guys were coming on together and I was like, oh my God, this is like, what a perfect little preview into how much it meant to you, that book.

• 5:15Speaker 01

  It did. And I, I wanted to talk about perimenopause for a long time, just because I do like to talk to women about, you know, what's going on in our lives and I don't often do it. And I also felt a bit scared to do it because it's very personal and also leave it to the experts. But once I had Fatima's book, I felt like I had a resolution. So I wasn't just talking about my own experience, but I could actually say, and this, I wish this existed because if I'd read that in my late 30s, oh, could have been a very different journey. So it's, it's a really important book. Can't skip this one.

• 5:47Speaker 03

  Yeah. We are so lucky to have you here. Dr. Fatima Khan is a perimenopause and menopause specialist. Wait till you hear the things that she has studied and the degree.

• 5:58Speaker 00

  I can't wait.

• 5:59Speaker 03

  Okay. Well, I'll, I'll do it now. Bachelor of Science in pharmacology and therapeutics with publications of research at Imperial College London. Bachelor of Medicine and Bachelor of Surgery, Imperial College London. Diploma of the Royal College of Obstetricians and Gynaecologists. Membership of the Royal College of General Practitioners. She was a Clinical Fellow at King's College London in Reproductive Gynaecology and Endocrinology, Menopause and Gyna Endocrine Clinic. She has trained in psychiatry, has advanced menopause certification accredited by the British Menopause Society and the Faculty of Sexual and Reproductive Healthcare. Most recently, Dr. Fatima has released Hormone Health is Mental Health, A Life-Changing Guide to Perimenopause and Why Understanding Hormones is Crucial for

• 6:42Speaker 03

  Women's Mental Health, Especially During Midlife. Dr. Fatima, welcome. I feel like the first question I want to ask is, is probably the most predictable one, but what is perimenopause?

• 6:55Speaker 02

  Okay. Well, perimenopause is not menopause. I think everyone knows what menopause is, which is the cessation of your periods, 12 months of no periods, you get your classic hot flushes, night sweats. Anyone can diagnose that. I think no one even heard of the word perimenopause until probably two years ago, because it typically starts five to seven years before your last menstrual period and it starts in the brain, typically late 30s to early 40s. And it doesn't present with hot flushes, night sweats. And so typically it will present with anxiety, feeling overwhelmed, sleep disturbance and brain fog. And it happens

• 7:36Speaker 02

  at the exact time when women are at the peak of their career. It doesn't happen in a vacuum.

• 7:41Speaker 03

  Zoe, does that sort of resonate with you, that like just hearing that?

• 7:44Speaker 01

  Yes, I a hundred percent felt that. And I, I think it was after the fact. So I didn't realise I was in perimenopause until later on. And, and well-meaning friend sort of brought it to my attention. But I think it definitely kicked off in my very late 30s, when I started to feel a hundred percent the mental side of it, before the physical side of it.

• 8:05Speaker 03

  So like anxiety and overwhelm.

• 8:07Speaker 01

  Oh my gosh, yeah. Totally. So anxiety ramped up to an 11 and sleep was terrible, waking up all through the night and never feeling rested. Irritable fury, rage over very things that shouldn't have been inciting that level of rage.

• 8:22Speaker 00

  What's an example? Like what was something that you remember?

• 8:26Speaker 01

  Like, you know, when you're like, your cardigan catches on a.

• 8:29Speaker 00

  Oh, yeah.

• 8:29Speaker 01

  I don't know.

• 8:29Speaker 03

  That does.

• 8:30Speaker 00

  Hell, yeah.

• 8:31Speaker 01

  Hell, yeah. But overstimulation usually. So if like the oven fan was on, my kids were asking for me and there was music playing and then my phone would ring, I would just crack. And so for years, I would say I felt off kilter. And there were, I just explained it as like having a cloud at the top of my head that felt like I wasn't myself. Like I constantly felt premenstrual, like a real bitch. And as I'm sure Fatima will attest, we women are very good at gaslighting ourselves and saying, oh, it's just because I'm stressed, my children are young, business is intense at the moment. Things will calm down soon. Um, and it's not really gonna, uh, unless you get prevention and treatment and all of

• 9:12Speaker 01

  the education and awareness to understand what's going on. And it's normal, but treatable.

• 9:18Speaker 03

  When your husband tells you about his golf, does that help?

• 9:21Speaker 01

  Yeah, that's very helpful. It really calms me down. Yeah. I mean, they're, they're really in the crossfires, the partners during all of this. And they can be completely lovely people who aren't doing anything wrong, but the fact that they exist.

• 9:36Speaker 03

  Hmm.

• 9:36Speaker 01

  And make chewing noises.

• 9:38Speaker 03

  Hmm.

• 9:38Speaker 01

  No good.

• 9:39Speaker 03

  Pigs.

• 9:39Speaker 01

  Will not allow it.

• 9:40Speaker 03

  Absolute trash, man.

• 9:41Speaker 01

  Yeah. Well, you do, you just start to like, sort of hate everybody.

• 9:44Speaker 03

  Yeah.

• 9:44Speaker 01

  It's not a nice feeling.

• 9:45Speaker 03

  Yeah.

• 9:46Speaker 01

  Yeah.

• 9:46Speaker 03

  Especially when it's not who you are.

• 9:48Speaker 01

  Yeah.

• 9:48Speaker 03

  It's so not who you are.

• 9:49Speaker 01

  Yeah, yeah, yeah. Totally, right?

• 9:51Speaker 03

  So, so what's happening then from a more, I guess, physically, what's happening to lead to that?

• 9:56Speaker 02

  So I think if you look at macroscopically in a woman's reproductive lifespan, they're born with a fixed amount of number of eggs and that puberty, they have their menstrual cycle, their first period, when they start releasing an egg. And so menopause is the other end, is the end of their reproductive lifespan. There's no more eggs, therefore no more periods. And it's a retrospective diagnosis, meaning you've got to wait 12 months, no periods. And women are kind of struggling with symptoms. We say, no, no, no, wait 12 months before you have any help. And then we'd say you're in menopause.

• 10:26Speaker 03

  Hmm.

• 10:27Speaker 02

  And so the issue is, we don't just go from monthly 28 day cycles to suddenly nothing. So the peri is the transition leading up to it. And so we know that around 37 till 42, the egg quality and quantity starts to decline. So you have your monthly bleed, but essentially mid-cycle is when you ovulate. And the point of ovulation is to produce an egg, and the egg is they're trying to look for that sperm to create the embryo to implant. And we produce a lot of progesterone at mid-cycle. And that's what helps prepare the lining for pregnancy, but also progesterone is one of the first hormones that declines in perimenopause, because we know the egg quality and quantity is going down, women

• 11:11Speaker 02

  know their fertility is going down. But when you lose progesterone, three things happen. Number one, you start getting heavy bleeding. And with that heavy bleeding, you start losing a lot of iron. And iron deficiency is now linked with independent symptoms such as brain fog, fatigue, restlessness. And it's commonly ignored. And women are just told just to take iron tablets. And a lot of women don't seek help because we've kind of just used to suffering in silence and not seeking help. But one of the kind of under-recognized benefits of progesterone is that progesterone is your body's endogenous tranquilizer. So it stimulates your GABA receptors in the brain. These are the same receptors that are stimulated

• 11:55Speaker 02

  by benzodiazepine, so your valium, diazepam. And so suddenly we're losing the very hormone that helps us with sleep and anxiety. If you try and connect the dot, it makes sense that if you're losing that progesterone, you're not gonna have good sleep. So women present with poor sleep, they present with feeling overwhelmed, anxious and fatigued. And that's what we see.

• 12:19Speaker 03

  Hmm.

• 12:19Speaker 02

  Women are having kids later. And I think it's important to talk about the kind of the social, cultural evolution of why women are finding themselves struggling more than women before is that more and more women have kids later. So a lot of them may be having I V F or conceiving naturally, but they're going postpartum, straight into perimenopause. Most women will still find them in the sandwich generation of working full-time, looking after the elderly parents, household and kids. But then you don't have your calming hormone, you don't have that progesterone. And in the background, estrogen is spiking. So our menstrual cycles are always fluctuating. You have your follicular phase at the beginning, mid-cycle you ovulate, and then you have luteal phase. So you get the estrogen rising,

• 13:03Speaker 02

  then dropping slowly and progesterone going up and dropping down slowly. But what we see in peri is because we're not producing this progesterone mid-cycle, the brain goes slightly manic and it starts over-producing estrogen. It's stimulating the ovaries to produce this egg to come out and ovulate. So we, instead of getting a slow rise in estrogen, we see this kind of massive spike and then crashes, spike and crashes. And we know that disrupts the neurochemistry in the brain. So you get this volcanic rage, because it can stimulate your nervous system and you've lost the buffering from the progesterone. And that's where you feel this kind of anxiety, sleep disturbance, overwhelmed, volcanic rage. And the next

• 13:47Speaker 02

  minute, you're fine. And it doesn't classify as a mental illness, because for major depressive disorders and anxiety disorders, you need to have symptoms for six weeks or more. This is someone who's functioning completely normal. And then suddenly they get complete loss of their emotional regulation and not knowing who they are. And so there's this identity reckoning. And so they'll go to the doctors, they'll do a blood test, everything comes back normal.

• 14:13Speaker 03

  Hmm.

• 14:14Speaker 02

  And they're told that they need to stress less. And well, telling a woman to stress less is actually an insult, because the problem is, the woman who's coming to you at 40, she's built a career for 20 years, performing really well. She's managed to have two, three kids, run a household, maintain a relationship. Nothing has changed for her. So telling her to stop stressing doesn't work, because she's like, well, I don't know what to do. What do you mean by that? Then she goes in second time, and then she's told her, you're not coping, bloods are normal, we're gonna give you an anti-anxiety and antidepressant. I have nothing against anti-anxiety depressant, they're life-saving. But you're not treating the root cause of the problem. And they think they're broken, they're failing, and they lose that confidence.

• 14:59Speaker 03

  Because that medication doesn't fix the problem.

• 15:03Speaker 02

  Well, the medication will alleviate some of the symptoms, um, but will still continue to have all the other symptoms. Because it doesn't fix the brain fog.

• 15:11Speaker 03

  Yeah.

• 15:12Speaker 02

  It doesn't fix the sleep disturbance. It doesn't fix the ultimate ongoing physical symptoms that we'll see, such as palpitations.

• 15:19Speaker 03

  There's also a dangerous message in there that, well, and like a really unkind message that, oh yeah, this is like probably depression or anxiety that, which is so far from what it is. Or if it is that, it's there for a reason.

• 15:31Speaker 02

  I think, I think it's important to understand that women between the ages of 40 to 45 or going through perimenopause is a window of vulnerability in a woman's mental health. We know women are two to four times more likely to develop first onset of anxiety and depression without previous history. This is someone who's got no previous psychological history.

• 15:51Speaker 03

  Wow. That must, that would be so confusing, particularly if there's been no event in your life to trigger it.

• 15:57Speaker 02

  Exactly. So when we are diagnosing psychiatric illness, we always have what we call the biopsychosocial model. So is there a biological cause? We do, you know, blood tests, make sure there's no hypothyroidism, there's nothing else going on. And then we look at what is happening in your life. Is there a psychological vulnerability? Have you had, you know, a divorce that you've gone through, loss of a parent, grieving that? But these women have nothing. Nothing has changed, except their husbands chewing loudly. But also, it's, it's interesting, on the flip side, I get a lot of men bringing or booking appointments for their partners, because perimenopause starts with just worsening PMS. So that's, I always say, the easiest way to track is you're just, it starts with

• 16:39Speaker 02

  seven days before, where you're just feeling really hyper aroused, very irritable, ragey, uncontrolled, kind of reactive responses. And then your menstruation arrives or your period arrives, and suddenly it's like this release of tension, and you're happy. And a lot of women describe themselves as becoming a monster. And then there's shame and guilt, because now you've yelled at your kids and your partner that you've loved for 20 years, and they don't know who they are. And they're like, oh yeah, you must be before your period. And that's fine, if it's seven days, but it eventually expands out to two weeks. And it's happening on a monthly basis for years. And we know women in Australia divorce between 40 and 45, men 45 and 50. Now, that's not saying perimenopause is risen woman divorce.

• 17:24Speaker 02

  We also know it's a time where women are completely squeezed with all the caring responsibilities and that mental load. And then the hormones that would have compensated and buffer the stress system in the brain, we've, we're losing that. We're losing that calming effect. We're losing the estrogen softening of the mood and the spikes, and then in the environment of, um, psychological stresses from life. And there's a concept called allostatic load in medicine, which I was never taught, but there's actually literature on this. And it's just wear and tear on your nervous system that is measurable. So it's understanding, it's not just the estrogen progesterone, it's your nervous system has a capacity. And

• 18:08Speaker 02

  the issue is, a lot of women are conditioned to keep saying yes, overcommitting, people pleasing.

• 18:13Speaker 03

  Hmm.

• 18:14Speaker 02

  But there's a flip switch at 40, late 30s, where your resilience isn't there because of this wear and tear, but also you're losing the buffering. But I think spiritually, it's also a bit of an awakening, where it's like, is this really what I want to do? Like, I'm conditioned to be, you know, the best daughter, the best sister, best colleague, then your wife or partner, then you're the mother, you're head of the school committee, you're, you're always someone for someone else, caring. And then you realise, okay, what about me? Is this really what I really want to be doing? And I think because women don't know what's happening, it's, it's just easy to blame things around us. And the partners unfortunately get the blame. And you can cut this out completely, but this is very controversial. But I always

• 18:59Speaker 02

  say this, even from my personal experience, the kids are the same, the work is the same, and you have the same partner or the same man in your life. It's you who's going through something very transformative in your brain.

• 19:13Speaker 03

  Why is that controversial?

• 19:15Speaker 02

  I don't think people, I don't think, because you don't want to flip across and saying it's your fault.

• 19:19Speaker 03

  Your fault as in?

• 19:20Speaker 02

  Like.

• 19:21Speaker 03

  The woman's fault.

• 19:21Speaker 02

  The woman's fault.

• 19:22Speaker 03

  Yes, okay. I didn't say that.

• 19:24Speaker 02

  Yeah.

• 19:26Speaker 00

  I certainly didn't say that. Hi, it's Ryan from The Imperfects and I'm reaching out to you now because we need your help, gosh darn it.

• 19:35Speaker 04

  What, why do we need?

• 19:36Speaker 00

  Sorry, no, I'm just making a plea to the listeners and viewers to ask them to subscribe to the show in whichever way they see fit because it really helps, the more subscribers, the better we can make this show, am I right?

• 19:49Speaker 03

  Yeah, but I don't think we need to, I think we could just ask them politely.

• 19:52Speaker 00

  Yeah, but if I use the emotional music.

• 19:55Speaker 04

  I think the music's a bit much.

• 19:56Speaker 00

  Is it?

• 19:56Speaker 03

  Who's playing that music?

• 19:57Speaker 00

  Doesn't matter who's playing the music, the important thing is we're pulling at the heartstrings and asking them to do us a solid.

• 20:03Speaker 04

  Could we not just ask, like, just ask them straight?

• 20:06Speaker 00

  Like, it'd really help us if you guys subscribed because we would be able to make more of the

• 20:10Speaker 04

  show and make the show better.

• 20:12Speaker 00

  Oh, and not use emotional manipulation?

• 20:14Speaker 04

  Yeah.

• 20:14Speaker 03

  Yeah, I reckon.

• 20:15Speaker 00

  Well, we can give it a go, but I doubt it'll work.

• 20:18Speaker 02

  The problem is, so there was a position statement from the Royal College of Psychiatrists in March 2026 this year, identifying that this window of vulnerability in mental health does not always respond to anti-anxiety and depressants, and we need to have a hormonal lens because despite medicating women, they're still not feeling optimal and still finding all the symptoms are there. And the problem is, we need to use more validated questionnaires like MenOD, which is a specific questionnaire for screening for mental health in women transitioning to perimenopause and menopause, developed from a Monash group here in Melbourne. And it specifically asks questions about irritability, rage, suspiciousness, paranoia,

• 21:03Speaker 02

  it talks about isolation, loss of self-esteem, all the things that standard depression scores don't capture. And so when we're going through that, what's happening is our perception is changing of who we are and the people around us. And that is then reflected in how we see our partners and how we see our children and how we see people around us.

• 21:25Speaker 03

  So just, how long were you in this state of confusion for, like, not knowing what was going on?

• 21:29Speaker 02

  I think we need Hamish on this podcast, is what we need.

• 21:32Speaker 01

  Um, uh, oh gosh, you know what, and it coincided with lockdown as well, which was pretty intense.

• 21:39Speaker 03

  Yeah.

• 21:39Speaker 01

  And I had a young baby, so I think what you're saying, Fatima, to that point is, we just can't catch a break because if we do have our kids in our 30s, we've got toddlers, and then we finally feel like we're back to ourselves for maybe 30 seconds and then this starts happening. And so you kind of go, well, I'm not really sleeping well because I've still got a two year old or three year old in the house. But then your menstrual cycle, it went bananas and, you know, sweating through my t-shirts and all of these things, it was all ramping up, but I didn't still know what it was. I really didn't know what it was. And it's crazy to me now and it was reading Fatima's book, it was, like, I was crying because I'm like, this is my story and so many women's stories who just don't get seen,

• 22:22Speaker 01

  heard, validated or understand what's going on. So it's so important because I don't like the idea of so many women out there and their partners feeling awful, just not themselves, like a mean, mean bitch who just cannot get a break. And as you say, nothing is maybe externally changed, it's all in here, it's literally all in your head, but it's not in your head, if that makes sense, because you can't tell yourself that it's not really happening.

• 22:50Speaker 03

  So is that how you first got on to perimenopause? Was it through Fatima's book or?

• 22:55Speaker 01

  No, uh, no, my sister, who's a few years older than me and a friend who was sort of hearing me talk about this stuff, but I thought I was too young. And so I went to my GP at 43, which is not too young, and was told I was too young. And this happens a lot. And I'm sure you can talk to that in a minute, Fatima, about this, the situation where we come in with a list of symptoms and bloods and all of this to go, I think this is happening. Anecdotally, I feel very confident in this and are told all kinds of things that are not true and outdated and harmful, I would say, and have been for a lot of years. So, um, I then saw a specialist, a reproductive endocrinologist, who put me on the right

• 23:39Speaker 01

  path and I went on HRT and am better.

• 23:43Speaker 00

  So, because, because it's like, I imagine, and Fatima, you kind of mentioned this, I guess, a little bit, which is that if you're someone, if you're a woman who has dealt with anxiety, depression and had like really fluctuating up and down moods your whole life, and then you get to an age where it's, it's happening maybe more or in a different way, I can imagine how you might go like, well, I've, it's probably the depression, it's probably the anxiety.

• 24:16Speaker 00

  So how do you know, how can you differentiate or how do you know it's not that and it's perimenopause?

• 24:23Speaker 02

  So there's two presentations, right? So you have new onset anxiety and symptoms, so that's easy because they'll be like, I've gone through worse things in my life, I've done stressful things, I don't know why I'm feeling overwhelmed, I've gone to this board meeting 100 times and now I'm finding, I'm standing there feeling really overwhelmed. And then, and so that's someone who's obviously new, nothing's changed. And then you think, okay, what is it that's causing it? Because if it's not a psychological trigger, then we know perimenopause is, presents with that anxiety, as I described the mechanism of it earlier. So again, you have hormone depressive disorders, so mood disorders related to hormonal transitions. And we recognize puberty is a window of vulnerability for mental health symptoms and

• 25:06Speaker 02

  also postpartum as well in pregnancy. So anytime there's a hormonal transition, there is a window of vulnerability in mental health, but there is no education on perimenopause. And typically, perimenopause was defined as a change in your menstrual cycle, more than seven days plus or minus.

• 25:24Speaker 00

  That's all it was described as?

• 25:26Speaker 02

  Is described under the straw criteria, which is described with irregularity in your menstrual cycle. Now, that doesn't serve the modern women because the modern women, a lot of them don't have that history because they would be on the Marina IUD, which is a very commonly used intrauterine device for contraception and bleeding control. Typically, women are put on that in their mid 30s or late 30s. And so you've lost that signal of the erratic period. And so you might be getting all the symptoms and not knowing what's happening. But also, we've always associated hot flushes, night sweats and menopause with kind of this cessation of periods in older women and, you know, kind of negative connotation of

• 26:05Speaker 02

  this old woman with white hair, grey hair, and that's not the modern peri-woman. That's not the modern menopausal woman in her 50s, but peribiological, we know the egg quality and quantity is declining 37 to 42. So biologically, you are losing that progesterone, I go on and on about it in the book, because no one's connecting the dots. This is why they're coming in with the same thing of sleep disturbance, anxiety, overwhelmed, reduced resilience to stress. And then we start seeing a lot of women finding they're drinking more and more alcohol because that's the only thing that takes the nerves off. But the problem with that is that it actually causes a further disruption in sleep and

• 26:49Speaker 02

  we know that it disturbs your deep REM sleep. So you're not getting deep restful sleep and the next day your cognition's not sharp, you're feeling more foggy, your executive function is not working well. So it's this kind of vicious cycle, they're on the antidepressants, then they're on the sleeping pill, then they're on Xanax and they're coming with this cocktail of medication, you know, like, okay, come on, we need to wean you off of this. And then we restore the biology, everything goes away. And I think what we need to do, if anyone's going to take anything, is we've always focused on estrogen, progesterone and testosterone to an extent on reproduction. And women's health research has always been around trying to get you pregnant, keep you pregnant and deliver the baby safely.

• 27:31Speaker 02

  And the reason no one knows about perimenopause is because it's not studied that well. And when there is research, there's no kind of education at medical school, like, I didn't, I wasn't told about perimenopause in my six years of medical training. And then even after that, I did six years of hospital training, so 12 years of training. I had to go study it and that's when I was told about it, right? So I've got that privilege of having this knowledge, but I mean, it shouldn't be, it should be standard curriculum for every single doctor because every single woman will experience this transition. And the problem is, because it's experienced at this late 30s, early 40s, the education we've had is menopause on average occurs at the age of 51, cessation of your periods,

• 28:14Speaker 02

  and you might start noticing a few hot flushes and sleep disturbance, that's it, that's all you know. And it's a natural transition, everyone's done it for centuries, just put up with it, you know?

• 28:24Speaker 02

  But we're, we're getting more and more researches to, to do with Gen Z and millennials, who are obviously a very different demographic. They're working, they've got young kids, they're not slowing down. I think it's important to recognise the, the women that we have sitting in front of us, like Zoe and myself, are very different to like our grandmothers and mothers. So 25 years ago, which is quarter of a century ago, when I went to medical school, we would see women and we would keep them on the contraceptive pill for 20, like for basically until they were 50. And the good thing about the contraceptive pill, although it's synthetic, it will give you some form of masking. So it will, it, those fluctuations that we see in perio will mask it. So you didn't necessarily see this volatility in

• 29:07Speaker 02

  mood. And then they would hit 52, we stopped the pill and we would give them HRT for two, three years. But also the same women were having kids much earlier. By 30, they would have completed their families. So by the time they hit 40, 45, they had no children at home. And by the time I were giving them HRT, they were like semi-retired, majority of them weren't in full-time employment. And then the ones who were working were working casual. Compared to the person that I'm seeing now, at 45, has got probably three kids under 10, working full-time career that she's invested 20 years in, and also is not using the contraceptive pill because we now use since 2011, we've got the Marina IUD, which is what we call a long-acting reversible contraceptive. And it has, the

• 29:50Speaker 02

  good thing is it's there for five years, you don't need to take a daily pill. And also in Australia, there's a high uptake of vasectomies. So a lot of the reproductive burden conventionally was carried by women. And it still is in parts of Europe, especially somewhere like UK where it's free for the entire reproductive life. So from the age of 15, if you want to be on the pill till 50, you can have it for free of cost from the government. So there's no incentive to be doing anything else. But in Australia, a lot of it is private. So a lot of men will go and have vasectomies or women will do marinas. And so then you, Marina is just sitting in the uterus, she still have the volatility from the ovary. And these ovarian hormones, estrogen, progesterone, are not just working on the uterus, they're working in your brain, directly on your dopamine,

• 30:34Speaker 02

  estrogen receptors, which govern mood and executive function and cognition. And that will probably lead us to ADHD.

• 30:41Speaker 01

  Hmm.

• 30:41Speaker 02

  Because we're seeing a lot of this unmasking at this age.

• 30:44Speaker 00

  Yeah.

• 30:44Speaker 01

  And the brain fog is real too. And I think that's, a lot of us get quite scared when we forget very obvious, easy things, like the name of a song or the name of the fridge or something. And we snap at our kids because we can't think of the word. Um, and I was worried about, you know, early onset, because my grandmother had dementia and um, that's how bad it gets for us. So we, we really do worry there are very bad things happening to us. But um, yeah, the hormones are kind of in control of all of that. Certainly the brain fog.

• 31:14Speaker 00

  And you like, Zoe, I don't know many busier people. And so when you're like running this huge business, writing a book, parenting, all these things, it's quite, is it scary that you're like, what if I can't run the business?

• 31:27Speaker 01

  Yes, it's not a good time. And I was talking to a friend of mine, she's like, I now take beta blockers before I present, uh, even to my staff because I can't, I'm so worried about forgetting my words and looking stupid, um, when I'm meant to be a professional and training them. Uh, so I know lots of women doing lots of things to try and

• 31:46Speaker 00

  A little hack.

• 31:46Speaker 01

  Band-aid it, yeah. You know, I think the last time I was in here, I spoke about, because I was, didn't have my diet, like I didn't have my HRT at that point and I wasn't sleeping and I was anxious and all those things. And I was using medicinal THC to sleep and melatonin, anything I could get my hands on to try and fix the situation. But surprise, surprise, it was hormonal.

• 32:06Speaker 00

  Yeah.

• 32:07Speaker 01

  So it needed attention in a really specific way.

• 32:10Speaker 03

  I can completely understand how you're just trying to, trying anything you can to try and treat what's going on. Um, Fettam, what about the role of testosterone? Does that decrease as well?

• 32:21Speaker 02

  I think in terms of when we're talking about the hierarchy of decline in this transition, we know that testosterone levels drop to half at between 35 to 40 is what you had at the age of 20. And then we see progesterone declining because we're not having the same amount of ovulatory cycles. And then estrogen is the last one to decline. Now testosterone is important because obviously we know testosterone is linked in men with muscle and kind of having high libido, but it has a really important role in women's libido too. And in Australia, we have a female licensed testosterone for women, and it's given for a condition called hyperactive sexual desire disorder, which is a fancy name for low libido. The moment.

• 33:04Speaker 03

  It's a very fancy name.

• 33:05Speaker 01

  Very, very.

• 33:07Speaker 02

  Um, so it's the, the fascinating part is it's only licensed, so you'll only get it dispensed if your libido is distressingly low and impacting your relationship after menopause. But biologically, we know that testosterone is already kind of in your tanks, late 30s to early 40s. And so we have a very interesting study being done called the SIBL study at Monash, looking at the role of testosterone for low libido in these younger women. Because commonly, they will come in with the usual symptoms we've gone through of the mental health changes, but also low libido. And I think that's very important when it comes to relationships and intimacy. And so testosterone is something worth exploring with your doctor.

• 33:49Speaker 03

  Yeah, absolutely. Zoe, I'm really interested to know what happens to your self-esteem when you're going through, through this, but, but you don't totally understand what's going on?

• 34:00Speaker 01

  Oh my God. Well, yeah, you feel stupid, you feel a lot of shame, you feel guilty for snapping. And one of the main reasons that I finally advocated for myself was because I was gonna lose my relationships with my kids. Cause I was just a tired, cranky mummy all the time. And I was, I was on a trigger point. So I, I did it to salvage relationships, honestly. I was then putting myself second. I see, even as I say that, it wasn't about my own mental health, but how I was impacting others.

• 34:28Speaker 03

  Relationships.

• 34:29Speaker 01

  Such a classic woman thing to say, yeah. But um, of course it helped everything. Sleep is obviously so paramount for mood and anxiety and all those things. And once that was under control, everything sort of flowed. But yeah, you don't really like yourself for a while there.

• 34:44Speaker 00

  Did you, did you notice, like with the relationships in life with like kids or home or friends, whatever, once you started taking HRT, did you?

• 34:52Speaker 01

  Yes. I felt like I was looking at my family. I was like, why can't I have fun? I married the world's funnest man and he, his whole, he loves having fun with the children. And I felt like I was just outside of it, looking and going, fuck, and all I do is come in and go, guys, come on, it's dinner time, like funward and let's do this. And I wasn't enjoying anything. I was just the cranky one all the time.

• 35:13Speaker 00

  So not, yeah, to not be able to get into the fun.

• 35:16Speaker 01

  Yeah.

• 35:16Speaker 00

  Would be really hard.

• 35:17Speaker 01

  And I did enjoy putting this through group chat because I think, you know, we have a very good non-fiction version of perimenopause, but in a way, group chat was exactly what the protagonist is going through is just this underlying feeling of not being herself and the restlessness and the sleeplessness and the anxiety and the not liking her husband. And I think a lot of women will relate to that because it's really common, among my friends at least.

• 35:42Speaker 00

  And, and your friends, have you, so in doing the book, in writing the book, did you talk to your friends about their experiences?

• 35:47Speaker 01

  That's what we talk about ever, always.

• 35:49Speaker 00

  Really?

• 35:49Speaker 01

  Oh, yeah, yeah, yeah. Anytime someone does my makeup or I'm like, women my age, it's all we talk about.

• 35:55Speaker 00

  Really?

• 35:55Speaker 01

  Yeah.

• 35:56Speaker 00

  Wow.

• 35:57Speaker 01

  You want it? Who's your guy? No, like, um, just trying to figure out when and how. And, and I think there's a lot of misnomers about it, you know, and that's so, that's why I love Fettam's book as well, because there was so much, there's so much myth and there's, you know, the breast cancer risk is really talked about a lot. And I had a discussion with a family member the other day who was like, you're on HRT, but that causes cancer. You should get off that.

• 36:18Speaker 00

  Mm-hmm.

• 36:19Speaker 01

  And so I feel like we're now, our generation is like having to re-educate our older generation who were told, no, HRT is bad.

• 36:26Speaker 03

  So we have talked about HRT before on the podcast and we'll put a link to that episode in the show notes. But I think it might be really helpful to sort of just talk about, well, what is HRT as a refresher? And why is it so safe and so effective?

• 36:41Speaker 02

  I think it's important to realise that to treat anything, you need to number one, recognise what you're treating. And most people don't know that you can give HRT in perimenopause. So that's the first thing. Yeah.

• 36:54Speaker 00

  Sorry, can you say that again? Most people don't know that you can use HRT on perimenopause.

• 36:57Speaker 02

  Yeah, they think you have to wait. The amount of women who come to me and say, oh, my GP said when you stop your periods for 12 months, that's when we're going to give you HRT.

• 37:06Speaker 00

  Gotcha. So it's, it's more a thing for menopause, not for perimenopause. That's what they thought. Yeah.

• 37:10Speaker 02

  Yes, because conventionally, HRT has been studied for women when they've stopped their period and post-menopausal era. So that's important to know. So when your GP's saying that, he's right, because that's what we've all been taught. And to start in perimenopause, number one, you need to recognise then perimenopause. At the moment, everyone's being misdiagnosed, that's something else. And when you are starting it, the starting protocols are slightly different because you still have your endogenous hormones in there. So you start much lower, they're different regimes. So you need to make sure you're going to a menopause informed doctor because it is slightly more nuanced when you're managing that.

• 37:45Speaker 00

  How do you know if they're a menopause informed doctor?

• 37:49Speaker 02

  So you can go to the Australasian Menopause Society, which is Australia's main regulating body and teaches all doctors and GPs and professionals. And you put your postcode in there and it will give you all the doctors who are in your area, five kilometre, 10 kilometre. However, that does not mean they're menopause informed. It just means they're a member of this community and there's no formal certification in Australia at the moment. So you've got to just try your luck or speak to someone. The only reason I'm saying that, I recommend that. So my list is closed. So please, you know, this is not a podcast to get more page. My list has been closed for a long time. And I tell everyone, we have an email saying that go to the AMS and then we get people emailing back saying,

• 38:35Speaker 02

  I went on that, I saw someone, they didn't know what they were doing. And so I think we should put a disclaimer in here. That's just a directory of clinicians. It doesn't mean they're menopause informed. But if you go to their website, they'll have things that they'll say they're menopause informed. But moving back to HRT, because when you go in at 43, you're not going to get HRTs, the point I'm trying to make. So you've got to understand that if you say, oh, I've got perimenopause, can I have HRT? That's when the back of the book, I've got scripts.

• 39:04Speaker 01

  Yes, it's so good.

• 39:05Speaker 00

  And when you say scripts, you don't mean prescriptions, you mean actual dialogue scripts?

• 39:09Speaker 01

  You can tear them out.

• 39:10Speaker 02

  Yeah, it was like, yeah, a bit of Xanax and things. I don't know what I call them in the book. I call them, I call them conversation scripts. Yeah.

• 39:17Speaker 00

  This is literally what to say to the GP.

• 39:19Speaker 03

  This is so good. What a great idea.

• 39:21Speaker 00

  Can we role play it?

• 39:23Speaker 02

  Yeah, yeah, yeah, do it. It says here, I've been tracking my symptoms over the last three months.

• 39:28Speaker 00

  Here we go.

• 39:30Speaker 03

  I'll be the doctor.

• 39:31Speaker 02

  My mood's all over the place. I'm yelling at my partner. My kids are intolerable.

• 39:35Speaker 00

  Well, I assume something's happened in your life then. You must be, have you lost your job?

• 39:39Speaker 02

  No, it's the same job. I'm almost getting promoted.

• 39:42Speaker 00

  Okay.

• 39:42Speaker 02

  And the kids are the same age.

• 39:44Speaker 00

  Have you experienced anxiety or depression?

• 39:45Speaker 02

  Well, I'm feeling really, really anxious. I'm feeling really overwhelmed.

• 39:48Speaker 00

  Yeah, well, we can, we can prescribe you some anti-anxiety pills for sure. No problems.

• 39:52Speaker 02

  But I'm not anxious.

• 39:55Speaker 00

  Honey, let me tell you something.

• 39:57Speaker 02

  No. So, so I guess, on a serious note, to really, for women to leave with this conversation a bit more informed, there is a questionnaire with psychological, physical and sexual symptom history. There are about 30 points on there. You're meant to fill that in because no one can ignore a list, right? And then there are scripts literally saying, I have tracked my symptoms. These are my symptoms. Do you think I could be in perimenopause? Do you think I can do a trial of estrogen through the skin as a patch or a gel? And can I take some micronized progesterone? I have read this, this, this,

• 40:40Speaker 02

  and then, so it's all in there. So you're going with, with all the work done. The GP will do some blood tests. I think it's important to exclude any other pathology because women do present with other things. They might want to do a pelvic ultrasound scan if you've got bleeding. But we've made the book really handy because when I do, when patients come to see me, I have a questionnaire of 30 symptoms on there. And every time women say, I didn't even know half of these were part of perimenopause. So they're blaming other things, as you said.

• 41:10Speaker 01

  Like joint pain?

• 41:11Speaker 02

  Yeah.

• 41:11Speaker 01

  No one knows that. The joint pain's one of the first things. So my hip and pelvis basically shattered itself a couple of years ago when this was all happening as well. And that's one of the first indicators is joint pain.

• 41:23Speaker 03

  Interesting. Sounds so fun.

• 41:25Speaker 01

  Because you should be very jealous.

• 41:27Speaker 02

  I think we're scaring the boys now.

• 41:28Speaker 01

  I don't care.

• 41:30Speaker 02

  But.

• 41:31Speaker 01

  Scare them off.

• 41:32Speaker 02

  I think we need to change the nomenclature, which is how we phrase it. Because menopause doesn't serve anything. Meno just means menses, pause means cessation, right? We need to call it the multi-organ syndrome of menopause, which is, it is a multi-organ syndrome. You name each organ in the body, starting with the brain, and then we can go down and I can list to you at least three symptoms per organ. And this is why they're so vague. And when you go in, GPs are overwhelmed. And we used to call it like this heart sinking patients walking through, the busy woman. And we used to call it TAT, which is an acronym for tired all the time. Because we don't know, you do the bloods and they're coming in and they're just, you know, it's this whinging women. And you just tell them to

• 42:16Speaker 02

  just relax and stop doing so much. And I think now we've advanced a lot, especially the brain research in the last few years. But if you look at the brain, we know 60% of women will complain of cognitive symptoms. This is data out of mona, 60%. So that's brain fog, concentration, attention, word recall, executive functioning, and then you've got the mental health, which is anxiety overwhelm. Then you move, we see other things such as vestibular symptoms. So feeling dizzy, vestibular migraines, you get burning mouth syndrome. So the ear, nose, throat is infected. You go to the heart, we see cholesterol go up. We see blood pressure go up. We see palpitations. And the commonest symptom globally is joint

• 42:57Speaker 02

  pain. So women will suddenly have frozen shoulders, bursitis in their hips, runners for 20 years, getting Achilles tendon ruptures.

• 43:05Speaker 00

  So how, so how long would that joint pain?

• 43:07Speaker 03

  Tendon ruptures?

• 43:08Speaker 02

  Yeah.

• 43:08Speaker 03

  Oh, my gosh.

• 43:10Speaker 00

  That got him.

• 43:12Speaker 01

  So triggered, you can't.

• 43:13Speaker 00

  Hang on, I won't be able to run.

• 43:15Speaker 01

  It's not you.

• 43:16Speaker 02

  They'll just be running. They haven't changed anything in their running. Remember, women have changed nothing.

• 43:20Speaker 03

  That's an extremely traumatic injury. That's surgery. That's like, that's awful.

• 43:24Speaker 01

  Things are bad.

• 43:24Speaker 00

  Now he gets it.

• 43:25Speaker 02

  We get labral tears. They're just doing Pilates class and they've got a tear in their hip. And like, all these weird and wonderful thing. And last year.

• 43:32Speaker 03

  That's very wonderful, but yeah.

• 43:34Speaker 02

  Last year, for the first time, they published a paper which kind of establishes these cohort of symptoms as the musculoskeletal syndrome of menopause. We have something called the genital urinary syndrome of menopause, which is bladder symptoms, painful sexual intercourse and vaginal dryness. But we're now finding all these symptoms, the metabolic syndrome of menopause, where you get prediabetes, you get weight around the midline, and you haven't changed anything you're eating, you haven't changed your exercise, and you're putting on weight.

• 44:01Speaker 01

  This is what all the women are talking about. I eat the same, I train harder than ever, I bloody protein coming out of my ears, like creatine, we're doing all the right things and our bodies are changing.

• 44:13Speaker 03

  There is so much to this. So Fatima, you mentioned women coming out of pregnancy, giving birth and going straight into perimenopause. Can you explain more about that?

• 44:23Speaker 02

  I think one of the questions is that women don't know whether they've, when are they experiencing perimenopause in between pregnancies, especially if you're having your babies late 30s, early 40s? When does postpartum changes go straight into perimenopause? And I think it's just being aware that when you're pregnant, you have very high levels of hormones. You don't experience symptoms of perimenopause and menopause. But it's post-delivery, postpartum, the hormones decline. And so you can obviously experience postnatal blues, or we call them the baby blues, or depression. But also, it's not uncommon to go straight into perimenopause, because we know that equality and quantity is going down. So I think a lot of women will find that they might experience changes in their mental

• 45:05Speaker 02

  health after the third or fourth baby in their 40s that they may have not experienced with their first and second baby.

• 45:11Speaker 00

  And does that get confused with like postnatal depression?

• 45:13Speaker 02

  It does. So we normally say if you're in your 40s and having babies later, you need to be mindful that there is this kind of convergence of postnatal depression turning into perimenopause. And it's very confusing because when you're breastfeeding, you have high levels of prolactin, which suppresses your ovulation, means no, you don't get the same amount of estrogen and progesterone. So we know when you're breastfeeding, you have this kind of mild chemical menopause, where you do get some night sweats and sleep disturbance. And so postnatal is really a hormone depression if you are experiencing that. But then where do you know whether it's the breastfeeding, it's the postpartum,

• 45:53Speaker 02

  or is it the perimenopause? And we also see, I mean, you may not need to add this, I see a lot of women have their third, fourth baby, and then suddenly they're going through marital conflict and a divorce. And it's actually perimenopause and not postnatal depression. It's rough.

• 46:09Speaker 00

  Is there an element of, of like, especially if you're, like, if you sort of identify as sort of like a striving person, like an ambitious person, is there an element of like embarrassment that you don't want to admit out loud that you're struggling with these sorts of things? Like you don't want to come across as like you can't handle the workload? Or if you've always. Been able to handle it. Does that come into it?

• 46:32Speaker 01

  Totally. Yeah. That's, that's the shame spiral of going, I used to be so competent. And now, as you say, nothing else has changed, but I'm not able to handle really minor things that wouldn't set me off previously.

• 46:44Speaker 00

  Yeah.

• 46:45Speaker 01

  Um, yes. So the shame is, is real.

• 46:48Speaker 02

  But I also think part of that we commonly see in high functioning women and they start to feel, they use the word, I feel really stupid, is we're seeing this unmasking of ADHD in women in their forties.

• 47:01Speaker 03

  A lot of the things I was thinking, there's also elements of ADHD in there as well, which can be, that must be so confusing.

• 47:07Speaker 02

  So what I see is, okay, you've got perry symptoms, let's give you some HRT. And they still have ongoing symptoms. And it's because they're seeing this unmasking of ADHD. Because despite giving them estrogen, which regulates dopamine, the main neurotransmitter in ADHD, they still continue to have issues with executive functioning. So that's word recall, uh, verbal memory and trying to kind of orientate task, initiate task. And there's a whole ADHD score, which I'm not going to go through now. And so those are the women then need to go to a psychiatrist who's got a hormonal lens. So we work multidisciplinary. So they might find the ADHD medicine eventually help with those anxiety

• 47:50Speaker 02

  and executive functioning and vice versa. So we see women who've got, um, are on stimulant medication from a young age because they were diagnosed with ADHD, those medications aren't working anymore. Especially in that luteal phase before their menstrual cycle. Suddenly they're just finding they can't find the words, they're losing train of thought. And so now they're having to double their stimulant medication just before their menstrual cycle. And even when they're doing this, yo, it doesn't work. And so we add in a little bit of estrogen to stabilize it. And it works beautifully because you're getting this estrogen fluctuation. So it's kind of this beautiful intersection of this perimenopause,

• 48:32Speaker 02

  the hormonal buffering system changing, and we see ADHD and also neurodivergence. And so it's important to have, um, a curious mind. And, um, because everyone, I always say ADHD and, um, perimenopause, they have overlapping symptoms and you don't know where, which is starting when and which is ending when. And it's about, again, listening to the woman and trying to go to experienced people and titrating both of them because they're converge at this stage to make it even easier for our brains.

• 49:04Speaker 03

  Well, Zoe, uh, one of the things that we enjoy discussing is our good friend ADHD.

• 49:10Speaker 01

  Yeah, yeah. And so I'm new to the club and I didn't know I had ADHD. There were hints, there were signs, but, um, it really came out pretty hard. And feeling so scattered with the brain fog, with the so many pressures on me, whether that's the school WhatsApp or the amount of things that I had to keep in my memory, the mental load every day, plus work, plus everything else.

• 49:38Speaker 00

  But also like in the last, like, I don't know, I want to say like five, six years, go to has been like, there's been like huge, maybe even longer, like huge changes. And like, I know you've gone through like really stressful periods. Yeah.

• 49:51Speaker 01

  And extremely mentally taxing. And I sort of laugh a little because if you look at things will calm down soon. That's a woman in perimenopause with ADHD writing a book,

• 50:03Speaker 01

  who was undiagnosed and untreated for both. And it was a stressful book. It was anxious inducing and it was a lot. And it was a big project as well. This one group chat, this is a medicated woman who's sleeping, having a great time, wrote a funny book, had the bandwidth and the capacity to have fun again.

• 50:21Speaker 00

  Yeah.

• 50:21Speaker 01

  And so for me personally, just the black and white of that is insane. But the, the ADHD, I, I, you know, when you get it and you can spot it in everybody else. It's the same women who I'm spotting have perimenopause and that overlap, as you talk about, is quite intense. But I found, you know, the stimulants are really helping with the pulling focus. And I, I was thinking the other day how I sat in a board meeting and I've done them for 14 years and never really paid attention.

• 50:51Speaker 03

  I think you sent me that message.

• 50:52Speaker 01

  It's been noticed, but I, I, I felt terrible. I felt this, this sadness and grief afterwards because I felt so disrespectful to my team for so many years who have been so good at preparing everything and, and, and making me so accommodated, honestly, is this, oh, the founders here and, um, oh, I don't like numbers. And I just put it down to, I don't like numbers, but it was disrespectful. And I would interrupt and I'd have my phone here and my laptop here and I'd just go, oh, blah, blah, blah. Oh, what about, hey, we're doing sunscreen next year. Should we make a hat?

• 51:25Speaker 00

  Yeah.

• 51:26Speaker 01

  In the middle of the budget. And so the difference in that for me was quite a remarkable one.

• 51:33Speaker 00

  Wow.

• 51:33Speaker 01

  Um, so I can testify.

• 51:36Speaker 00

  But that, that's a really interesting point because I think like, uh, particularly like with women who are diagnosed with ADHD, often they've got narratives that have lasted since childhood. And often that's like, you know, they've maybe been, they struggled at school and they were told that they were dumb or slow and that's sort of carried through. But that must be such a, what an, I can't even imagine that feeling of going like, oh, actually I can now participate in these things that I thought that I couldn't or.

• 52:04Speaker 01

  It was a relief, right? And, and it was, I, I, I wouldn't classify myself as a kid as someone who couldn't really pay attention or I didn't have maybe the classic tropes of that. I instead was a super high functioning, overproductive woman who was writing books, running a business, having a family. And so outwardly, everyone's like, the question I get the most is, how do you do it all? And now we know, my brain is going in 40 different directions at once. And it's not always great, but it's, you know, it's harnessed and it's, it can be wonderful, but.

• 52:37Speaker 02

  I think that's really important distinction to me because you were mentioning earlier about you couldn't focus. Actually with the girls, it's the other way around. So the boys are hyperactive and they can't focus and they're told that they're poor students because they can't sit. But women don't have a problem with hyperactivity in attention. So they tend to be the perfectionist. It's the school captain. It's the one who is, you know, because they've, they've learned to perform and they work extra hours and extra prepared because they know they're compensated. They've got structures and lists and things in place to make sure that they're able to perform. So they've been performing until Perry hits and then that buffering goes. So actually the perfectionism is the trait you're looking for in adult ADHD girls.

• 53:23Speaker 02

  There'll be traits there of inattention that they're trying to compensate. And that's why it's really important to know that they present differently because we have different hormones and you don't have estrogen and we do.

• 53:32Speaker 00

  Hmm.

• 53:33Speaker 01

  Couldn't have said it better myself. Yeah. The perfectionist, which I sort of wore as a badge of honor.

• 53:37Speaker 00

  Yeah.

• 53:37Speaker 01

  But it's really just fear.

• 53:39Speaker 00

  Hmm. And, and so how's that changed now? Like the, the fear?

• 53:44Speaker 01

  Um, oh, look, I'm still pretty new to it. It's only been this year, but I feel, yeah, I think the relief is the thing.

• 53:52Speaker 00

  Yeah.

• 53:53Speaker 01

  Relief and a bit of shame about how I maybe perform. And the interrupting and the over talking and all of those things.

• 54:00Speaker 00

  Really? So you look back and see the performance?

• 54:04Speaker 01

  Yeah. Yeah, yeah, yeah. Oh, yeah. God. Yeah.

• 54:08Speaker 00

  Hmm.

• 54:09Speaker 01

  Hmm. And then, you know, throw in a public profile and like the, the performance becomes even more elevated.

• 54:14Speaker 00

  Of course. Then you have to show up as a certain Zoe Foster Blake.

• 54:18Speaker 01

  Yeah.

• 54:18Speaker 00

  Yeah. Hmm.

• 54:20Speaker 01

  I'm a real mongrel underneath. You know me in real life.

• 54:23Speaker 03

  Not that I've seen, but I believe you.

• 54:27Speaker 02

  And then the third thing is we see, um, a lot of reactivation of previous trauma. So research has shown that women with previous trauma at any point in their life, they have high levels of PTSD scores and depressive scores. And so then those are the women who are taking the HRT, taking the stimulant, and they still have the symptoms of trauma. So which is kind of hypervigilance, reactivity, feeling on edge, can't, you know, relax, feeling tense. And so then we need to look at trauma informed care, have things like EMDR for the trauma processing. Because what's happens is. When these hormones fluctuate, especially when you lose that lovely progesterone,

• 55:12Speaker 02

  the calming effect, brain kind of panics, it likes predictability. And now it's lost the calming effect. So it goes in your amygdala, you fire to flight. And then it thinks, when was the last time you felt under threat? And it will go to your previous history of any traumatic experience. It could be bullying in the playground, it could be workplace bullying, it could be domestic violence. I think trauma, we have a very narrow definition of trauma. And so even with HRT and stimulant, they don't get better. And the amount of women who do EMDR, they come to me, I get third, second opinions all the time. I'm on HRT, I'm on this, and I literally look at them and I say, like, your bloods are perfectly fine, you're absorbing estrogen really well.

• 55:54Speaker 02

  But there's nothing that I can do for you, you need to have EMDR. We get them to see a trauma-informed therapist and they suddenly start sleeping.

• 56:02Speaker 00

  Hmm.

• 56:03Speaker 02

  They're feeling amazing, they're feeling calmer. And I think it's important to have this trauma-informed care as well. And so this intersection of supporting women's brain is fascinating. But I really wanna emphasize the trauma activation. Because if you're listening to this and you're still feeling that you're feeling anxious, you're not sleeping, you're feeling hypervigilant and irritable and not yourself, then you need to address the third layer. And a lot of that is this kind of, no one wants to go there. It's that inner work, which I say the patch won't heal, which is addressing your unhealed wounds.

• 56:39Speaker 00

  That, I mean, the, dealing with the trauma, that it's, that's something that you can't really, I mean, EMDR is maybe the closest thing, but there's no pill for it. There's no like, you can't erase the, the memory or the, yeah, that. And it feels like such a, well, it is, um, the more you talk about it, it requires such a holistic approach. Like, there's so many, like, it's a real fucker. And it feels so overwhelming, and I'm not a, I'm not a woman, but it feels so overwhelming. But I, like, if, if, so Zoe, if, when you first heard about all of this, were you overwhelmed or was it more like, oh, it's a relief? Or was it a combo?

• 57:17Speaker 01

  Uh, yeah, combo, always. Uh, to, to know that it had a name and it was not just in my head. Um, and then to be able to treat it. But it is pills and skills, you know, you have to work on your inside stuff. Trademark. Um, you have to work on you.

• 57:34Speaker 00

  That's good.

• 57:35Speaker 01

  You have to work on your stuff as well, because a lot of it does come up at this time as well. And, um, anything that's been masked at all, it just drops. It, it, it is, isn't it, that, that lack of, of dopamine and estrogen, and you're just like, I can't do this anymore, I need help. And it, it, and, and I think most women probably get to breaking point before they actually seek help. It just sucks.

• 57:58Speaker 00

  Hmm.

• 57:59Speaker 02

  Well, they, because they don't know what's going on, right? And so they will lose relationships. We know from, um, superannuation, um, data that women are retiring early. They're losing hundred and fifty thousand dollars of earnings a year. They're leaving with less money, economically we're losing money. So it's actually a bigger problem.

• 58:19Speaker 00

  Hmm.

• 58:20Speaker 02

  I go back, we keep talking about menopause and you just think, oh yeah, cessation of periods. It's not, it's a whole body transition. The brain is impacted, the hot flushes start in the brain, a thermostat is in the brain. And then you've got the physical symptoms, which, you know, is skin, heart, gut. We haven't even gone through it because we don't wanna, and you know, we lose thirty percent of collagen. A lot of women don't think that, a lot of women don't realize that their joint pain is related to this. They don't realize their gut symptoms are related to peri. They don't realize their kind of vestibular neuritis and all these other ENT symptoms are related to that. But I think what we need to see is that for women,

• 59:01Speaker 02

  these hormones throughout their reproductive lifespan have supported every single organ. And we know at menopause, when these hormones are declining, we know we are accelerating aging on a cellular level. So, and if we're talking about longevity, and there's a lot of bro science in this. But for women, it's very simple. We know women in Australia live on average till eighty four point five years of age. The main cause of death is Alzheimer's followed by heart disease. Main cause of disability is a fall and breaking your hip. There's no cure or treatment for these. But they're, before menopause, these illnesses do not exist because estrogen is cardio-protective, neuro-protective, protects your bones and every single organ.

• 59:44Speaker 02

  Within ten years of menopause, we see accelerated aging on a cellular level and an increase in chronic disease. And we know that because cholesterol goes up, blood pressure goes up. So you, then you go to a doctor and now you're ending up with a blood pressure tablet, cholesterol tablet, anti-anxiety, sleeping pill, uh, pain thing. So it's this polypharmacy. And we need to go back to the root cause. And when you give them their natural hormones back, suddenly, all this long realistic symptoms disappear. Of course, there's the other layers that you need to address too.

• 1:00:18Speaker 00

  The skills.

• 1:00:19Speaker 01

  Pills and skills.

• 1:00:19Speaker 02

  The skills, and also if there's ADHD, address that. But majority of women will find that when we address just the peri, that's already a relief. And we can titrate the anti-anxiety back.

• 1:00:30Speaker 00

  That's a huge part of it for a lot of women, is what you're saying.

• 1:00:32Speaker 02

  It's a huge part. I always emphasize the foundations, which we haven't really spoken about. I think whatever you do, with or without HRT, you still need to prioritize whole nutrition. Cause the amount of women who undereat, again, because they're trying to lose weight and they've been told reduce calorie, so eat less and exercise more. That's what your GP tells you as well, right? Oh, you just need to eat less and exercise more. And so then they're calorie restrict. And so they have a coffee at breakfast and nothing till lunchtime, then a toastie. And so we know that blood sugar imbalance are very prominent, which causes, again, changes in your energy, cognition and mood. So stabilize the blood sugar with whole food breakfast, a little bit of protein, fibre, and good fats, make sure you're eating your three meals, that can be quite small.

• 1:01:16Speaker 02

  Prioritizing movement, but not doing cardio. We wanna do more strength training, building muscle, because it helps with insulin sensitivity. And again, blood sugar, then we need to move to good sleep. And that's a problem because everyone scrolls till midnight, because the algorithm is designed to do that.

• 1:01:31Speaker 00

  I scroll till eleven thirty.

• 1:01:33Speaker 02

  Yeah. Um, but it's fine, because you're not gonna go through peri, so you're fine, but.

• 1:01:38Speaker 00

  Probably not the time to be bragging.

• 1:01:43Speaker 02

  But, you know, you have testosterone as your advantage there. But there's this three AM awakening, that women wake up at three AM and bright awake and they can't switch off. And so the problem with the screen is that it will destruct your blue, the blue light would destruct your melatonin and raise your cortisol. But the other problem with scrolling is it is working on the same pathways of depleting the dopamine that's already depleted for ADHD, right? So you can see we're losing the hormones, we're then scrolling, losing that dopamine. And so you've got to be very strict, nine o'clock phones away, no blue light, ninety minutes before, and then you've gotta.

• 1:02:17Speaker 00

  Ninety minutes, ninety minutes.

• 1:02:19Speaker 02

  They normally say ninety minutes before.

• 1:02:21Speaker 00

  Wow. I, I feel like I read something yesterday that said thirty minutes, but ninety.

• 1:02:24Speaker 02

  It's normally ninety minutes.

• 1:02:25Speaker 00

  Ninety, wow.

• 1:02:27Speaker 02

  I mean, just the thing about circadian rhythm, evolutionary, we would wake up in the morning with sunrise naturally, not with a haunting alarm jumping out, which already spikes our cortisol in the mornings. We would naturally wake up and then by sunset, we would not be doing anything because there was no artificial light.

• 1:02:46Speaker 00

  There was no light, yeah.

• 1:02:47Speaker 02

  So evolutionary, every single organ and cell in our body has its internal body clock, including digestion. So if you eat too late, the stomach acid is reduced, this is why you get more reflux, because we're not designed to eat late meals, the stomach hasn't evolved. So if you eat a late meal, not only you don't digest it, this is sitting there, stomach acid's reduced. We need stomach acid to break the food down, to push it down. But also we then get a spike in our cortisol, because the body's like, why are you eating so late? And so then we have blood sugar irregularity. So it's understanding that we've gotta respect that circadian rhythm. Uh, and the phones is not great, artificial lights. Then we talk about stress.

• 1:03:29Speaker 02

  Now, stress is a perception, what stresses Zoe out might not stress me. But no human has ever carried the load of a modern woman. We've always lived in communal tribal.

• 1:03:41Speaker 01

  It's here for them.

• 1:03:41Speaker 00

  Yeah.

• 1:03:42Speaker 01

  Yeah, thanks.

• 1:03:43Speaker 00

  We all started that club at the same time.

• 1:03:45Speaker 02

  Even if men were hunter-gathering women, joining them, kids were raised by grandparents, aunt, uncles with other kids in a village, women were bringing food. And now you've got this nuclear family of, the pressure is, how do you expect someone to wake up in the morning, do three lunchboxes, get to work, come back at six PM, prepare dinner, do the laundry, do the ironing, and then prepare for the next day, get the book day uniform ready. So I talk about this loneliness epidemic that I'm seeing in women. Because, forget, they don't even have time for themselves, let alone to even call a friend back, because they're all exhausted to even talk to each other. And so now they're isolated. And the problem is in life, whenever we go through something alone,

• 1:04:29Speaker 02

  it becomes a suffering, because in our brain, we think, oh my God, this is only happening to us. And because we've not had open conversations, because again, it reflects, like, am I the only one going through this? Maybe I don't wanna talk about this because my friend's not talking about this. The problem with that is that then it kind of, you continue to suffer a long time before you seek help. As far as when you go out and meet your friends and girlfriends, and when you start talking about this, then you know, actually, we're all the same. And there's kind of this sense of humor, but also a sense of relief to be like, oh, this is just normal, all my friends are experiencing the same mental load. And we know from studies, men and women who earn the same amount of money, do the same hours,

• 1:05:09Speaker 02

  women will still carry the mental load and the invisible workload. Um, and it's not that it's a man's fault. Men are wonderful, they're trying their best.

• 1:05:21Speaker 00

  I have to agree.

• 1:05:22Speaker 02

  Yeah, that, I know, I'm married to one, bless him, you know? Um, I have to remind myself, he's trying his best, it's, I don't have my village around me.

• 1:05:30Speaker 00

  Hmm.

• 1:05:30Speaker 02

  And.

• 1:05:31Speaker 00

  But also maybe worth mentioning that, like, some men aren't trying their best as well. Like, that, that, that would be even harder.

• 1:05:37Speaker 02

  And, and so women aren't trying their best. I'm genuinely giving the benefit of the doubt, you're supposed to support me here. Um, but you're right, I mean, men need to step up.

• 1:05:44Speaker 00

  I'm trying, I'm trying, I'm trying my best. Try my best.

• 1:05:48Speaker 02

  I think the modern man is. I mean, my father's generation was like nothing. He came home and and I think that's where we're just gonna go straight into my four layers that I talk into book, which is whenever we talk about women's health, you need to understand what's happening in their body. Then you go out of their ovaries from the uterus to their brain and other organs. Then what is their life perspective? Who are in their lives? What is their workload? And then you've got to look at the systems around them. And so I talk about feminism, patriarchy, capitalism and consumerism because we're all trapped in this feminism dialogue. Feminism is great. Okay. We're sitting here because feminism gave us the opportunity to have a voice, to vote, to own land, open a bank account, you know, and we're very grateful for

• 1:06:32Speaker 02

  that. But it also told us that we can do it all at the same time. Have the careers, be the mother, be the wife, be the best mum. And the problem with that is it didn't create the framework for women to go and thrive. And so the framework was, is a patriarchal framework designed for a man to turn up to work at eight thirty, get home at six, where, where the woman was looking after cleaning, cooking, taking care of all the invisible load, which I'm not gonna list because every woman listening to this knows what it is. But what's happened is that now she's doing the same hours, but then she's still carrying the same amount of invisible load and mental load. And men are still doing the same work. They're trying their best to do

• 1:07:16Speaker 02

  the other things. So it's just, it's just working against them. So now women are stuck. So when I see women who have spent twenty years building their career and they have to be in the office at eight thirty and finish at six, what do they do? And capitalism is this system which tells you, you're only worth if you're bringing in money. You're, you need to be productive to be worth. So their self-esteem and their value of who they are is linked with what they're bringing in, how much they're earning. And so we've kind of devalued women choosing to maybe stay at home or doing flexible hours, all of those things, because there's guilt when they go part-time or stay at home. And then there's consumerism, which is, you know, particularly

• 1:07:58Speaker 02

  targeted at women, which is all around, even when they feel like they have enough, there's always something else to buy. So then there's this pressure of earning and keeping the money going for obviously financial pressures, but also this constant buying and targeting of, you're not good enough. You need another, you know, the latest trendy jacket and the latest kind of hairspray and all those things. And I think it's important just to be aware that you could be taking the ADHD medication and taking the HRT and having your EMDR and you're still feeling really trapped because the system is not designed to cater for any human to carry this load.

• 1:08:36Speaker 00

  Yeah, I mean, I've ne- I've never thought about it in those, i- i- to that extent.

• 1:08:40Speaker 02

  Like if you're a lawyer, you're an engineer. I mean, when I'm seeing these patients, like, what, she's a barrister. What am I gonna tell her, go part-time? She's self-employed and also realised that we know forty percent of relationships break down. So I see a lot of single women who don't have the opportunity of going part-time. So here they are, working these five days, then from that money, they're paying for the childcare and the nanny and it. And so these are the structures that we need to question. Now, there are lots of places that are flexible, but as a larger society, majority of them are not going to have that flexibility. That, of course, we're gonna move that way. And I think it's really important to move that way because Australia has a shortage of skilled workers and we need to capitalise on fifty percent

• 1:09:25Speaker 02

  of our demographic who are female. But then you need to address these issues, right? Offering them flexible working, making sure you have menopause workplace policy and because we wanna have workforce retention. It's great for the economy and it's great for women. You know, we know that when women are working, they have better self-esteem. Working for what they wanna work, it's a different thing for working just to survive. I think it's important to know. I think work brings women a lot of joy and it's going back to that same thing. What is it that you wanna do with your life? Um, I'm gonna stop talking there because I feel like I rattled a lot of things.

• 1:10:01Speaker 00

  It's changed a lot of people's lives.

• 1:10:04Speaker 02

  Yes.

• 1:10:04Speaker 03

  It's so incredible. But I, I wanna ask about, um, so I remember when, when Penny first showed me the pregnancy stick to say that we were having our first child. I remember in that moment, there was a very obvious physical thing in front of me that like, okay, I really need to look after her here. I need to get help her through this. And I think all men would know that experience when their partner's pregnant, you drop everything and everything's about them and, and you're protecting them, looking after them. What can I do for you? How are you feeling? Um, what are you going through right now? How can I support you? That's an obvious one, but I, I, I feel like this is a time where they probably need it more, that kind of attention and support and, um, practically thinking about how can I make your life better with all that's go- or,

• 1:10:49Speaker 03

  or you're going through.

• 1:10:50Speaker 00

  And compassion, just.

• 1:10:51Speaker 01

  Compassion. And also to go back to the first big hormonal beat, which is tweens and puberty, which I'm heading into soon, and how mindfully, certainly, I think our generation are parenting that moment and how aware we are of it and how scared, to be honest, of like what's coming and how we have to learn how to counter the big emotional moments and everything. So I, I totally agree. Those other big hormonal moments get so much attention and so much care and compassion. And this one is just like, fucking sort it out.

• 1:11:26Speaker 03

  Yeah. And so I just wonder, do you have anecdotally any stories or, or of, of partners or men who have just done really good things in this, like, like what should?

• 1:11:38Speaker 01

  He's hoping. Can I tell you what we all do? All the women I know, we send memes to our husbands all the time so that we don't sound insane. So we're sending memes about like perimenopausal things that we do in a funny way to go, but for real, this is why I do this. Like, you know, the oven fan noise? That's why I crack it when that's on or.

• 1:11:56Speaker 03

  Yeah. And so, and so the man sees it and he goes, oh, that's so funny. That's so true. But then it's probably just like, I can't wait for the next meme. But like, what, but, but what, what should men be doing anecdotally? What have you seen that's been a good example of how to just support?

• 1:12:11Speaker 00

  And, and then maybe in, in conjunction with that question, if, uh, so Zoe, if years ago, before you were across perimenopause, if Haim had have heard a podcast explaining this and he noticed all the symptoms, if he had have approached you and said, hey Zoe, I think it could be, have you thought about perimenopause? How would, how would that land?

• 1:12:36Speaker 01

  You on, yeah, it's like when you say, you're premenstrual babe. It doesn't go well, does it?

• 1:12:39Speaker 03

  Don't, don't ever say.

• 1:12:40Speaker 01

  Don't ever say that. Don't ever say calm down either. I think it's all about the moment and the tact, right? Because if you've got a woman who's crying and is, like I've, I was at points where I was just, you know, texting him in the middle of the night going, I cannot sleep, you know, I'm awake, I'm so anxious about this, this, this. I don't know, I just sort of venting. And he would just have to be the crumple zone for that. I think if he knew what was going on, it would be super helpful. And then there would be those moments of deep vulnerability where a partner could come in and say, honey, just as a well-meaning friend could do and say, don't take this the wrong way, but this could be perimenopause. Shall we get you an appointment? I think that would be well received.

• 1:13:20Speaker 00

  Yeah, okay, great.

• 1:13:21Speaker 01

  Because I think that's compassion and care and depending on the woman's state of mind and mood, but I think it's, it's obviously a show of care.

• 1:13:29Speaker 02

  So we know at puberty, you can have horrible mood swings. And even with pregnancy and postpartum, we have the same kind of understanding and compassion, not just for emotional, um, volatility, but also body changes. And I typically tell my women in their forties, I want you to have the same compassion as you go through pregnancy. In pregnancy, you're getting a belly, you're getting bigger, your moods are changing. You're not going around saying, oh, look at this, I have an ugly belly. Because you should hear the derogatory things women say to themselves about their body, about the way they look in the mirror, because they don't know what's going on, right? Suddenly, they're getting saggy skin, they're changing their body shape.

• 1:14:11Speaker 02

  And also, I'll say, you need to educate that this is the biological transition, have the same understanding and compassion. You need to show it to yourself first before someone else can show it. But I think going back to Zoe, I think most men don't know what perimenopause is, but they will after this podcast. Um, because I think any man who goes to their partner and says, I think you're in perimenopause, is actually will be well received and quite relieved. And it's not that you're just being moody before your period. So if you are gonna say something, and I always say perimenopause is just worsening PMS. So if you're noticing someone's getting that, because normally as the woman, even with the best self-awareness, they're so busy. And as Zoe was mentioning earlier, we're so good at gaslighting ourselves

• 1:14:56Speaker 02

  that we will complain about, oh, I'm just, I haven't eaten today. And I think I'm just a bit stressed and I think the kids are annoying me and you're just being annoying. And we don't really connect the dots ourself. And sometimes you being as an observer of someone who's been in your life for five, 10, 20 years is like, I know Zoe, this is not Zoe, you know? Rather than being, Zoe's being a horrible bitch.

• 1:15:18Speaker 03

  That didn't go down my one, I said that.

• 1:15:19Speaker 01

  I did not like that.

• 1:15:22Speaker 02

  And being, being more inquisitive. I get a lot of men, as I said, making an appointment. They bring the, the partners in and all the women will come and say, oh, my husband Googled you and found you and made this appointment. And she's like, oh, I've just been feeling all of these things. And I went to my GP and the bloods were normal and they showed me the blood test. I'm like, yeah, you're in peri. And they start crying. They start crying because for the first time, they feel seen, heard and they're, because they genuinely are crying every day, thinking they've got dementia. They were high functioning until that moment. They've succeeded and they've gone to a doctor and they said, there's nothing wrong with you stressless. Or they've been told, get an antidepressant. They're like, but I'm not depressed. Like, I mean, I'm not depressed.

• 1:16:05Speaker 01

  Hmm.

• 1:16:06Speaker 02

  We have an epidemic of that. And the problem with that is we're giving women these medication at the very time when they're already having issues with intimacy and changes in their body shape with weight gain. Antidepressants and anti-anxiety medications will cause weight gain. They will cause sexual dysfunction. They reduce your libido, decrease your arousal. And then they're an independent risk factor for reducing your bone density, which we know women are predisposed to losing between perimenopause and menopause and increased risk of osteopathic head fractures. And there's lots of psychiatrists who are struggling to get people off because when they're on there, you can't taper off them

• 1:16:47Speaker 02

  because the brain neurochemistry is so dependent on them. So antidepressants, anti-anxiety, great. Treat them for that period, but being on them for a decade long, I mean, we're kind of pathologizing life and not giving people and human. Because the other thing it does is numbs you from feeling anything. A lot of women say, I, I wanna feel something. I wanna feel that connection.

• 1:17:10Speaker 00

  So it takes away the highs and the lows, doesn't it, a little bit?

• 1:17:13Speaker 02

  Yeah, I mean, listen, if you're someone who's again got trauma and other things and your volatility is so much, it's a relief. You can breathe because you're not feeling everything, because you don't wanna feel everything. Trust me, it's exhausting feeling too much. And if you've got ADHD and that, that over feeling of everything's too much. And I think that's where we, I talk a lot in the book around nervous system support. Because we're in this heightened sympathetic nervous system of overdrive where our parasympathetic, which is our rest of repair, it's a complete imbalance, they're out of sync. Where we can breathe, we can relax, we're feeling calmer, we have space to respond rather than react. And so we need to be proactive in doing things like breath work. It might be sound bath for you. It might be doing meditation for you.

• 1:17:56Speaker 02

  It might be doing journaling for you, maybe sitting sixty minutes without any noise because that's sensory overload.

• 1:18:02Speaker 00

  Hmm.

• 1:18:03Speaker 02

  You've now had all the treatments and they're still feeling all the symptoms because they haven't really addressed everything else. I mean, going back to evolutionary days or times, we would be spending our time in nature.

• 1:18:18Speaker 02

  And so you have beautiful sun, air, you've got plants. We know when you're on greenery, you reduce your cortisol by forty percent. And you're not under threat. You're in rest and repair, which is really important to reduce our heart rate, our blood pressure. We kind of open our bowels more frequently and we're more responsive to love and attention and connection. And, you know, maybe there's a tiger coming along and you'll go into your fight or flight, which is your kind of survival instinct. But the problem now is our nervous system is overstimulated because we wake up in the morning with this kind of loud alarm, we jump out. And then we're going to then grab our phone, then we're gonna scroll.

• 1:18:59Speaker 02

  It's overstimulation. The nervous system was never designed to be constantly scanning for threat. And then you get in the car, then there's that stress driving down Punch Road, getting the school, kids to school. Then you get to your work at nine. And they know that from studies, women have made about twelve plus decisions. They've got decision fatigue by nine o'clock. And a man has only made one decision, right? So I think the, the mental load is part of why the nervous system is being overstimulated, but our environment is then ping, ping, ping, we're overconnected.

• 1:19:31Speaker 00

  Yeah.

• 1:19:31Speaker 02

  The nervous system is not designed for this, checking emails every five minutes, checking the news. And guess what? The news is all about clickbait. So it's all about fear mongering. So this poor sympathetic nervous system, the amygdala, is exhausted from constantly scanning. And it's supposed to recalibrate back to your parasympathetic nervous system. So you're kind of just like, yeah, I'm calm, I'm safe. But when you're overstimulating it from your environment, it stays in that amygdala because it deems that you're unsafe now. So it's constantly scanning. And so that irritability, agitation, and it's not a normal rage. I call it a volcanic rage because rage is just being angry. Volcanic rage is this eruption, uncontrolled rage where you're, you're like yelling.

• 1:20:14Speaker 02

  And you can hear yourself yelling, but you wanna stop, but you can't stop.

• 1:20:18Speaker 01

  Mm hmm.

• 1:20:18Speaker 02

  And you know you're being unreasonable and you know you're being horrible and mean and you love this person. So there's this internal turmoil of trying to stop, but it's a volcanic eruption and you can't stop. That's a very vulnerable, frustrating place to be. And women will basically experience, you know, intrusive thoughts on, I don't think I wanna live anymore. I don't, if this is how I'm gonna live life, it's not worth living. And obviously some women go all the way through to having more intrusive thoughts. And if you're listening to this, it's important because we know that women between this demographic and perimenopause and even going up to menopause do experience higher rates of suicide. And the amount of women, and I document this, they literally will say, oh, I just don't think it's worth living anymore.

• 1:21:03Speaker 02

  Or they'll be crossing over the West Gate Bridge and saying, I thought of driving my car off.

• 1:21:08Speaker 00

  Hmm.

• 1:21:09Speaker 02

  And I have to just make sure that that was no intention. It was just a thought and it kind of went away. And that's, and they, and they, and they, these things are happening, but they're scared to share it because they don't wanna be sectioned. And they don't want their kids taken away. They don't want their husband thinking something's wrong. And of course, those are the conditions where you do want something like a, you need a formal mental health psychiatric assessment. And I think if you're listening to this as a partner and you're seeing these changes, rather than thinking she's going mad and I don't wanna be with her anymore. It's just knowing any woman between thirty seven and forty three onwards can experience perimenopause which starts in the brain. It's literally as simple as that.

• 1:21:49Speaker 02

  It's a biological transition where you're losing the hormones with fluctuating estrogen, which buffer your thoughts and your cognition. And when you're in that state of hypervigilance, we, we can't feel anything. You kind of numb out. So you can't feel love. You, you don't wanna be touched. It's like, you know, it's like you're agitated and you're irritable. And so the partner's trying to hug you and, and support you. And then we're pushing them away. You know, we push the loved ones and when they mean to put that. So it's a, it's a very confusing time.

• 1:22:21Speaker 00

  I imagine, um, from the partner's point of view, if it's a, like if it's a man, you know, like traditionally, um, you know, as we all know, like men like an answer to things, like we, you know, we immediately wanna fix things. And I suspect like that that would be quite a, a, not necessarily a relief, but it's almost like, yeah, that's kind of in some ways, good news for the man that it's like, oh, okay, this is, this is something in the same way that it might be good news for a woman to hear that about themselves. That it's like, this is a thing that all women go through in one way or another. And so for the man to be like, okay, good, we, we.

• 1:23:00Speaker 01

  It's treatable. We can, yeah, we can make steps to help you.

• 1:23:03Speaker 00

  Yeah.

• 1:23:04Speaker 02

  I think the issue is, um, there's still a stigma around it because if someone's going to PBT, we accept that, there's compassion. They go through pregnancy and postpartum. We've got frameworks, multidisciplinary frameworks by governments to support women.

• 1:23:19Speaker 00

  Mm hmm.

• 1:23:20Speaker 02

  The problem with Perry is that there is no support. So it's a very fragmented care. So women are now having to Google, find their own people, go to group chat and find from their friends who they go. And then I've got this fragmented care of seeing a psychiatrist, seeing a psychologist. And so I think we need to have more robust frameworks and guidelines and then have government funded hubs because not everyone can access private care. This is expensive.

• 1:23:49Speaker 01

  So expensive, yeah.

• 1:23:50Speaker 02

  And part of the Australian Senate Inquiry in twenty twenty four had recommendation for Medicare subsidized menopause hubs. And so we know that, um, the New South Wales, uh, government has been given forty million dollars to have four menopause hubs set up. And it's multidisciplinary. So you've got endocrinologists, cardiologists and gynecologists. And also as part of this recommendation, now we have PBS subsidized HRT.

• 1:24:18Speaker 00

  Hmm.

• 1:24:19Speaker 02

  It's important to know that's there, but it's very limited. They have very long waiting times. And no one's got sixty nine months to wait while they have to, you know, show up in life. And so number one, we need guidelines, which are then making sure that every woman is being given the same treatment. And then there's no kind of inequity of healthcare uh, distribution because just because you live in a certain postcode or have money.

• 1:24:45Speaker 00

  Hmm.

• 1:24:45Speaker 02

  Uh, that's not how we want our healthcare system to be represented, right? So menopause is a universal experience. And I think as a government, we are doing better. We've done some great things since the Senate inquiries, but there's lots of room that, uh, we need to, or room for improvement.

• 1:25:02Speaker 00

  Hmm, for sure.

• 1:25:03Speaker 03

  So I just, I can't help but does, the first thing I'm thinking when you say that is that, so last week I, I had a quite a nasty case of the sniffles.

• 1:25:12Speaker 00

  You're right.

• 1:25:12Speaker 03

  Yeah, and I went down pretty bad. And I really, I really struggled for a bit.

• 1:25:16Speaker 00

  We should do an episode on the sniffles.

• 1:25:19Speaker 03

  But it just makes me think, can you imagine if menopause and perimenopause happened to men?

• 1:25:24Speaker 00

  Oh.

• 1:25:24Speaker 03

  Society would, it just would stop.

• 1:25:26Speaker 00

  Oh, Jam and I were talking this other day. It's like if men experience, we would be, we would be taking ourselves to emergency every month.

• 1:25:33Speaker 01

  I'm bleeding again.

• 1:25:34Speaker 00

  Yeah, I'd be like, this is horrific.

• 1:25:36Speaker 02

  Well, you wouldn't take yourself to emergency because, because there would be frameworks and guidelines on it, like there are for heart disease. And I think, and I think it's fair to say, important to say, someone who's listening to this, I don't want them feeling angry at the system around them. But to be fair, most guidelines are based on a middle aged white man.

• 1:26:02Speaker 00

  Hmm.

• 1:26:03Speaker 02

  Um, in the US, things like heart disease, lung disease, diabetes management. And we just basically apply them onto women.

• 1:26:13Speaker 00

  Hmm.

• 1:26:13Speaker 03

  Yeah.

• 1:26:14Speaker 02

  That's, they're not studied in women. So even the bigger diseases, forget women's health. The bigger diseases, we know that when we give beta blockers for heart disease prevention. To men, it prevents further cardiac events. And when we give it to women, it has worse outcomes. So we've got to start looking at women as not just small men, but also they have their own unique biology. But I think going back to you would never go to emergency because there would be, you would never suffer. Because we would have researched it. There would be a guideline.

• 1:26:48Speaker 04

  Yep.

• 1:26:48Speaker 02

  And, you know, and so the issue is the reason why they're suffering because it's not studied and.

• 1:26:54Speaker 05

  Hmm. We have to find the information ourselves and then advocate for ourselves. It's more work.

• 1:26:58Speaker 02

  It's exhausting.

• 1:26:59Speaker 05

  Medical admin, it's expensive. Yeah.

• 1:27:01Speaker 02

  It's time consuming. So yes, so we won't go into a bit more of the.

• 1:27:06Speaker 03

  Well, I had plenty of support for my sniffles, so I was.

• 1:27:08Speaker 05

  Thank God.

• 1:27:09Speaker 03

  Um, thank you so much. This has been an incredibly important, um, oh, sorry, did you?

• 1:27:15Speaker 02

  No, I was like, I'm just gonna finish talking now because I think we talked about everything.

• 1:27:19Speaker 05

  No, you've done an amazing job.

• 1:27:20Speaker 03

  Incredible. You really have done an amazing job today because I just feel like for, I think for two things, for women to feel less alone in this and to have a better understanding of what's happening for those who don't know yet. For those who are going through it right now, for those who have been through it to hear this. But I also think also for men to have a greater understanding of what's happening to the women that they love in their life. I, I think this is so incredibly important. And I feel so lucky to have been sitting here with both of you today. Thank you, Zoe, as well for sharing your, your experience of it.

• 1:27:52Speaker 05

  Just to the men, don't take it personally would be my advice.

• 1:27:55Speaker 03

  Hmm.

• 1:27:56Speaker 05

  It's not about you.

• 1:27:56Speaker 04

  Yeah, for once.

• 1:27:59Speaker 05

  For once.

• 1:28:01Speaker 03

  Uh, but yeah, it's been wonderful to share this time with both of you. So thank you so much.

• 1:28:05Speaker 05

  Pleasure. Thanks for having us.

• 1:28:06Speaker 02

  Yeah.

• 1:28:07Speaker 04

  Thanks, guys. Wow.

• 1:28:11Speaker 04

  Stick around after this to hear a little more. All right, well, we've got Bella here again. And Bella, you're gonna talk to us about what, uh, question we have in our journaling club this week. But actually, what is the journaling club? I don't think we've really ever talked about a lot of that before.

• 1:28:25Speaker 05

  Yes, so our journaling club is for everyone who has signed up to my imperfect email, the newsletter. And you can do that either via the website or via a link in the show notes of this episode.

• 1:28:36Speaker 04

  Awesome.

• 1:28:36Speaker 05

  And every week we send out a reflective question based on this week's episode.

• 1:28:41Speaker 04

  And what's that question? What have we got for the week?

• 1:28:43Speaker 05

  This week it is, how has your relationship changed with your body?

• 1:28:47Speaker 04

  Oh, that's good. I mean, I, I feel tempted to go dark because there's many things I don't like about my body. But, um, I also think as I get older, I'm starting to appreciate things and trying to have a better relationship. So I reckon it's a good challenge to try and, if you can, answer that question positively.

• 1:29:03Speaker 05

  And if you'd like to submit your reflections, we would love to read them.

• 1:29:06Speaker 04

  It's a great newsletter just to, because I don't want Bella feels weird plugging our own newsletter. But, uh, it's got, it's not just a journaling club. There's also, uh, helpful tips from the episode, which will be amazing, given how helpful this episode we just had on was. Uh, and if you, um, join the email, maybe you could join some of the people that you, like you were telling me before, that there are people who have journaled every single week and have submitted their entries every week. So it's a pretty exciting space to be.

• 1:29:30Speaker 05

  Yeah. If you're listening to this on the Monday that the episode comes out and you'd like this question in your inbox tomorrow, sign up by the website or the link in the show notes.

• 1:29:44Speaker 04

  This show was made in the lands of the Wurundjeri Wurundjeri people and we pay our respects to elders past and present. The Imperfects is not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment. The advice given in this episode is general in nature. But if you're struggling, please see a healthcare professional or call Lifeline on 131114.