WHAT IS THE DIFFERENCE BETWEEN MENOPAUSE AND PERIMENOPAUSE?
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Episode 206:
Show Notes
In this week’s episode, Dr Mary Barson and Dr Lucy Burns delve into the crucial topic of menopause and perimenopause, providing valuable insights and practical advice.
Menopause: Menopause is one day marking 12 months after the last period. Post-menopause begins the next day.
Perimenopause: This is the transition period leading up to menopause, lasting 3-10 years, with hormonal fluctuations.
Prevalence and Impact:
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20% of women experience no symptoms.
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Most women have mild to moderate symptoms.
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20% suffer severe symptoms impacting quality of life.
Common Symptoms and Concerns:
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Hot flashes and night sweats.
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Sleep disturbances.
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Weight gain, especially around the middle.
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Fatigue and brain fog.
Metabolic Triad of Menopause:
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Decrease in estrogen.
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Increase in insulin levels.
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Increase in cortisol levels.
Managing Symptoms:
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Sustenance: Adopting a whole food, low carbohydrate diet to reduce insulin levels.
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Sleep: Prioritising adequate and consistent sleep.
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Strength: Engaging in resistance training to build muscle and lower insulin.
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Stress Management: Developing skills to handle stress, focusing on internal responses rather than eliminating external stressors.
Menopause Hormone Therapy (MHT):
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MHT can be used as an adjunct to lifestyle changes, especially for managing severe symptoms like night sweats and sleep disturbances.
Overall Advice:
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A combination of lifestyle changes and, if necessary, MHT can significantly improve the quality of life during perimenopause and menopause.
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Continuous learning and adaptation of these strategies are essential for managing symptoms effectively.
Closing Note:
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Future episodes will continue to explore menopause and perimenopause with various expert guests.
For more information about Real Life Medicine and our programs and special offers: www.rlmedicine.com
Episode 206:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Mary Barson (0:23) Hello lovely friend, Dr Mary here and welcome to this fabulous episode where I am joined by my wonderful colleague, Dr Lucy Burns. We have a fabulous topic lined up for today. We're talking all things menopause and perimenopause. Very relevant to everyone, actually the entire human race. This is a relevant topic. How are you today, lovely Lucy?
Dr Lucy Burns (0:44) I am fabulous, thanks gorgeous Mary. Really, really well. I have just been nailing my sleep of late which is always helpful and it just sets me up for the day. So yeah, feel great, great. Excellent.
Dr Mary Barson (0:58) You have given several fabulous talks on menopause and perimenopause, you've travelled around Australia giving talks on menopause and perimenopause which is something that you know very, very well about helping women be healthy, stay healthy, get healthy, reclaim health, during this period of their lives. So, first of all, could you just let us know what is the difference between menopause and perimenopause? Let's start there. What do we mean by these strange confusing terms?
Dr Lucy Burns (1:31) Yeah,absolutely. So menopause, menopause is actually just one day of your life. It's a bit like your birth date. It's one day and it is a retrospective date, in some ways, because it is the day that is 12 months after your last period. So even if your periods have become irregular, and you're having them every sort of six months, that is that's not menopause, yet. It's so it's a one day, 12 months after your very last period. So and then once you have that one day, you go then the next day, you're into post-menopause, so you've had your one day Then you become post-menopausal.
Dr Mary Barson (2:19) I feel like there should be some sort of celebration a menopause party I don't know That's just me, yes.
Dr Lucy Burns (2:27) No, and why not? You have a birthday party. So we should yeah, menopause day. And again, it can be a bit trickier for women who don't have periods and those women are people who have either had a hysterectomy or an endometrial ablation or they're using some contraceptive like Marina, which doesn't mean you don't have periods. So for some women, they may not know the exact date. But I mean, it's just a nebulous term really, it was just pulled out plucked out of the day because there's nothing magical that happens before the 12 months versus the day after the 12 months. Unlike being born, which is actually an event. So before that day of the one day of your life where you suddenly go, I've reached menopause and then the next day you become postmenopausal. Before that day, there's this transition period called Perimenopause and perimenopause is when things start to change. And that period can go from any time three to four years is the average. But it can be 10 years. So you can have 10 years of hormonal fluctuation leading up to the one day of your life. Yeah, I know. I know. It's a very, and again, again, we just need to put it into perspective. So 20% of women will have no symptoms around menopause or perimenopause at all. So if you're one of those women has after you you are in a you're in a minority, you're pretty blessed. And it's, I think, pretty much luck of the draw, although there are some lifestyle factors that can improve the chances of you being in that 20%. We then have, you know, a significant number of women who have some symptoms that are annoying, but transient, they sort of mosey their way through and it's not that disruptive. So like everything in medicine, there are always little chunks, and then we have probably 20% of people for whom the the changes are severe, like they have severe consequences of these hormonal fluctuations, which can really impair their life like the quality of their life. So I thought today we'd go through a few of these and explain I guess one of the things that we get asked the most, we asked three things. Why am I so tired? Why am I gaining weight? Why can't I think properly? They would be the three, which is why I do a webinar on that because those are the three most common topics and it's why our webinars, we do lots of webinars, lots of masterclasses, but these ones, we get maybe five times the amount of people attending these as everything else. So it's clearly a topic that is important to women and affects women.
Dr Mary Barson (5:34) I'd like you to know that it's important to everyone, as I mentioned before, this is a human-wide issue that everybody needs to be aware of.
Dr Lucy Burns (5:42) Yes, you are right, you are right. And men, men do not have the same hormonal upheaval that women do. They do get hormonal changes as they age. So men are immune to changes in that and when I'm talking about hormones, here, we're talking sex hormones, so estrogen, progesterone, testosterone, men do get changes in their testosterone levels as they get older, they definitely do. But it is not the same roller coaster upheaval, a dramatic switches that happen. And I think it's really important to tell people that these are not, these are just bodily functions. Nobody can control this. This is not women being dramatic. It's not women being hysterical. It's not women being, you know, tedious, or flaky or fragile, or any of those. This is physiology.
Dr Mary Barson (6:41) Given that this is physiology, there is still a lot that women can do, and that women need to know, to help them navigate this path and even broader, I'd say that society needs to know that workplaces need to know that we all need to understand. So to help, you know, 50% of our beautiful population navigate this glorious time of life. What would you want to say to these beautiful women, to everybody who wants to help support women go through this time?
Dr Lucy Burns (7:20) Yeah, absolutely. Great question and I think, again, if we look at things like where how far along we've come, with, for example, things like pregnancy and maternity leave. So as an example, many women when they're pregnant, develop nausea that can be mild, moderate, or severe. Nobody, you know, if a woman is pregnant, she's vomiting a head off. Nobody will say to her, I just toughen up, will you? Like it's a physiology, and we now accept it, and we now recognise it and there are, you know, legislation in place, there's leave, there's maternity leave, there's all sorts of leave around that because it's physiology. So it's exactly the same with menopause. It's just hormonal changes, again, that nausea is brought about by hormonal changes, as are other symptoms of menopause or perimenopause again, remembering menopause is just one day so leading up to it, we basically women get big shifts, big shifts in estrogen and progesterone. Every month, women have a shift in estrogen and progesterone when they're ovulating. So anybody who is just, you know, a standard woman who's ovulating, who's not taking the oral contraceptive pill, has no has chips, which is why you know, and again, we recognise this we know, we know there are mood changes before your period. We know you're hungry before your period, all of those things. But when we have this perimenopause period, it's like those shifts are just amplified. So women can go from having blood levels of estrogen that are high, and what will be considered normal, normal, and then they can plummet. And that can happen within a day, which is part of the reason why blood tests around perimenopause are not very helpful. And in fact, most people most doctors would suggest, don't do them because they don't actually tell you anything. They might be normal. And people are then told oh, it's not menopause because your bloods are normal. They might be low and people go– oh my god, you know, you've got terrible menopause, but then the next day, they're high. So it's really symptoms that we need to go on. So the commonest symptoms that we know so everybody, I'm assuming people know about flushes and hot flashes, what we call vasomotor symptoms. So they're hot flashes or if you're Northern American, hot flashes, flashes, flushes and the same thing can be you can get sweat with at night sweats. You can get just sleep and sleep disturbance would be a really, really big one which I, myself experienced, I had no idea I was such a great sleeper such a great sleeper, and all of a sudden I wasn't. And I thought I thought initially it was just that I was a bit stressed and then I realised, no, it's actually a menopause symptom. So when you've got those coming in, along with potentially irregular cycling, not necessarily though, again, you can still have regular cycles and some of these menopause symptoms. But part of the thing we need to be really mindful of is that not every symptom is menopause or perimenopause. So for example, I just mentioned night sweats. We need to make sure that those night sweats, they are very common in menopause. They're also common in some other medical conditions at lymphomas, cancer, so sorts of things, thyroid conditions, they're common causes of night sweats. So it's always there for looking at the whole picture, a constellation. We do this a lot in all medical conditions, we can't take one little snippet of information and make a diagnosis.
Dr Mary Barson (11:12) You need to look at the whole person in front of you.
Dr Lucy Burns (11:16) Absolutely the whole person. So we know that there is this thing we like to call the metabolic triad, the marriage metabolic triad of menopause, and perimenopause. So we've just spoken a bit about estrogen, estrogen we know fluctuates and then declines. That's what it does go up, down, up, down, up, down up conquer, you don't get no estrogen, but you get a massive decline. So you go from, you know, say 100% of your estrogen down to about 25 30%. We know that as estrogen declines, we will get an increase in insulin levels. Estrogen is a very good protector against insulin resistance. And we also know that as estrogen declines, we will often get a rise in cortisol and that it's twofold. This rising cortisol one is as estrogen declines, we just do we debt naturally get a rise in cortisol. We also know that women going through menopause are often in the busiest phase of their lives, they've often got, they're juggling work, kids, dogs, parents, bills, all the things, meals, dentists, they're all juggling a lot wearing all the hats, yes. And for though and very little time to themselves, and maybe the time to themselves, they're sitting, you know, watching telly late at night, maybe having a glass of wine to unwind, which is not actually resting, as much as we would love it. So, they then have naturally high cortisol levels. And then we know that the higher your cortisol, the lower your estrogen. And we know that the higher your cortisol, the lower the higher your insulin. And we know that the higher your insulin, the higher your cortisol, and this cycle, this sort of just thing goes on. Which therefore, when we have high circulating insulin, higher insulin than we would like, we know three things happen. One, you will gain weight around your middle, that's what happens to you will feel tired because you don't have access to your fuel store stores. And three, it will increase your brain fog, because insulin resistance can also happen at a brain level, which means your brain just isn't firing as fast as it could. So, therefore, we go right. Next steps, what do I do about this? Thank you very much for all this information. Dr Lucy, Dr Mary, what the hell do I do? Yes. What would you recommend?
Dr Mary Barson (13:47) Yes. So I would recommend starting with something that is, you know, small and doable, looking at what are the small steps that you can take to start improving this metabolic triad. So instead of spiralling downwards, in a vicious cycle of horrible, you can actually start spiralling upwards towards good health, good energy, better mood, and better weight management. And you know, there are there other small doable steps that you can find, and let's see, what would they be?
Dr Lucy Burns (14:21) Yeah, so we have that, you know, the four S's I think, are really important to counter this triad. So the four S's sustenance, which is, I mean, we don't actually usually refer to it as that, but it fits in the S word. So sustenance is your nutrition and for us, of course, the easiest, best, most effective way to lower insulin levels using nutrition is to reduce your sugars and starches. So for us whole food, low carbohydrate. We want to optimise sleep. So again, if you're, going to bed at midnight every night, then probably not ideal. We really want you to be here prioritising going to bed on time. I know it can feel hard and I get it, but you will feel so much better the following days if you've managed to go to bed earlier. Number two, so we've got sustenance, sleep, and strength training, which again, building muscle is so helpful to reducing insulin levels, building muscle, so doing some resistance work also will overall lower your stress levels. So overall improve your cortisol. Building muscle counts as the effect of declining estrogen. And then the fourth s is stress management. And I'm going to add skills there because most people think stress management is the absence of stressors. So you know, manage the external stressors, but it's actually not it's managing the way you respond to stress in your life. And as we said, earlier, or last week, life, life doesn't throw you curveballs life is a curveball, it is always there. Busy, things happen, pop up all the time. So, therefore, four S’s strength. So we've got sustenance, sleep strength, stress. The fifth arm for this and again, if you listen to our podcast from last week, it's not this or that it's not lifestyle or medicine. So the fifth may be MHT for you. So Menopause Hormonal Therapy is an adjunct, it doesn't replace lifestyle, but what it can do is help people implement lifestyle. If you're going to bed at 10 o'clock, but still waking up at 3 am with night sweats and hot and you can't get comfortable and your bones ache, then me telling you to go to bed earlier isn't actually going to be helpful. So you may need MHT as well. Again, for people that are unable to take it for various reasons, breast cancers and whatnot, then this is where you double down on your lifestyle stuff and really make sure you nail it as much as possible. It is not this or that. It is this and that lifestyle, sustenance, strength, sleep, and stress management skills, are super important to improve your symptoms from menopause. And so for you in the now and for you in the future, plus or minus MHT to help you implement those and feel better. So my lovely ones, we are going to be continuing this conversation on menopause and perimenopause. In the future. I have some amazing guests lined up we're going to be talking about it. Not nonstop, but certainly a significant chunk. Because we do know that this is a problem that is pertinent to very very many people or as Dr Mary has said, all people. Indeed. Take care, gorgeous ones bye for now.
Dr Mary Barson (18:09) So yeah.
Dr Lucy Burns (18:13) The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
