MANAGING STRESS DURING MENOPAUSE
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Episode 211:
Show Notes
In this third episode of our Menopause Series, Dr Lucy Burns and special guest Dr Ivana Matic-Stancin, a seasoned Melbourne-based GP with over 25 years of experience, explore a holistic approach to managing menopause symptoms and enhancing the quality of life. Beyond hormonal changes, they discuss practical tips, lifestyle adjustments, and medical perspectives aimed at empowering women to navigate this transformative phase with confidence and vitality.
Defining Menopause Phases: Dr Ivana defines the three phases of menopause: perimenopause, menopause, and post-menopause. Perimenopause is characterised by irregular menstrual cycles and hormonal fluctuations, leading up to menopause, which is marked by the cessation of periods. Post-menopause refers to life after menopause when hormonal levels stabilise.
Comparison with Puberty: Drawing parallels with puberty, Dr Ivana explains how menopause is a natural life stage akin to adolescence. Both involve hormonal changes, emotional shifts, and physical adjustments. She highlights the need for societal understanding and support for menopausal women, similar to the support given to adolescents.
Challenges of Perimenopause: They discuss the challenges faced by women during perimenopause, including symptoms such as hot flushes, night sweats, mood swings, and sleep disturbances. Dr Ivana emphasises that these symptoms can significantly impact daily life and emotional well-being.
Japanese Windflower Analogy: Dr Lucy introduces the analogy of the Japanese windflower to illustrate the phases of menopause. Women don't have to feel powerless, like flowers swayed by the wind; instead, they can find stability and resilience despite the challenges of menopause. Dr Ivana elaborates on how women can embrace their inner resilience and beauty during this transformative phase of life, finding strength in their unique journey.
Overview of Dr Ivana's Menopause Clinic: Dr Ivana provides an overview of her specialised menopause clinic, where she conducts hour-long consultations. These consultations are comprehensive, addressing not only physical symptoms but also the emotional and psychological aspects of menopause. She emphasises the importance of understanding each patient's unique circumstances and health risks to tailor treatment plans effectively.
Lifestyle Adjustments and Emotional Well-being: Dr Ivana and Dr Lucy discuss the importance of lifestyle adjustments during menopause, such as maintaining a healthy diet, regular exercise, and adequate sleep. They also emphasise the role of emotional awareness and stress management techniques in improving overall well-being.
Commercialisation and Evidence-Based Approaches: Dr Lucy raises concerns about the commercialisation of menopause treatments and emphasises the importance of evidence-based approaches. She commends CBT as a scientifically validated method that empowers women by teaching them practical skills and promoting emotional intelligence.
Empowerment and Long-term Benefits: They conclude by discussing the broader benefits of CBT beyond managing menopausal symptoms. CBT fosters emotional intelligence and mindfulness, skills that are valuable throughout life. It empowers women to navigate menopause with confidence and resilience, promoting overall mental and emotional well-being.
Cognitive Behavioral Therapy (CBT) Program: They delve into Dr Ivana's six-week CBT program designed specifically for women experiencing perimenopause. CBT helps women understand the interconnections between their thoughts, emotions, and physical sensations. It equips them with practical skills to manage symptoms and enhance emotional resilience during this transitional phase of life. Contact Maxwell Medical Group for information and the waiting list. You can find Dr Ivana on www.doctorivana.com.au.
Link to Menopause checklist: www.rlmedicine.com/checklist
Episode 211:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson 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 Lucy Burns (0:23) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (0:58) Good morning, gorgeous listeners. How are you this morning? It is a beautiful day in Melbourne and I hope it's lovely, wherever you are in the world, whether it's beautiful sunshine or maybe some snow if you're a ski bunny, who knows? But this morning, I am joined as part of our Menopause series by one of our guest experts. Her name is Dr Ivana and like me, she's a lifestyle medicine physician, passionate about lifestyle options for women and just giving, I guess women all the options, all cards are on the table. She has a special interest in psychological medicine. So we're going to be talking about that today. Welcome to the podcast, Ivana.
Dr Ivana Matic-Stancin (00:41) Hi Lucy, thank you for having me.
Dr Lucy Burns (00:43) Ah you are welcome, gorgeous woman. One of the things that I have been so impressed about is, again, your approach to helping women with menopausal symptoms, particularly in the fact that it's offering them a skill set that they may not have had. And that's basically what we're going to be talking about today. One of the things I always like to start with though, and again, I have said this a few times, but I love to repeat it on the podcast because people get confused. Menopause, post-menopause, pre-menopause, perimenopause, what are all the pauses?
Dr Ivana Matic-Stancin (01:22) Big M word, isn't it? Yes, so perimenopause is, I would say, everything that's happening to us when we start transitioning from quite fairly regular menstrual cycling when we start transitioning towards our last menstrual period. So it can be anything from one to 10 years, and it's very individually different for every woman.
Dr Ivana Matic-Stancin (01:51) Menopause is literally your last menstrual period. So that's the day in your life when your last menstrual period and after that you don't menstruate anymore. Which for some women can be tragic, for some women it can be quite a celebratory event. So it's also very different for every single woman and post-menopause is basically everything that's happening after that in life. And for most of us, sorry, it's actually another 30 to 40 years, which is a big chunk of life. So we really want to have a good quality of life. And that's why I'm so really passionate about mental health because I think we all want to live a good life for 30, or 40 years.
Dr Lucy Burns (02:40) Yeah, absolutely. And it's interesting, isn't it? Because when, you know, when we talk about teenagers or kids going through puberty, and we know that that's a very, you know, time of upheaval in their life, and everyone will go, oh puberty, and there's, you know, some kind of gnashing of teeth of the parents as they navigate that life with their children who are, you know, hormonal and all over the place and happy one day and crying the next and all of that's wildly accepted and nobody talks about that as, well, we're starting to, but nobody did talk about that as the same. It's like the same thing in reverse for peri.
Dr Ivana Matic-Stancin (03:21) It's amazing. It's totally amazing. It's a mirror image of puberty, but it's really amazing how nowadays in the last so many generations, we are really holding our teenagers and we are very aware of the fragility of that stage. But no one is really holding peri-menopausal women. They are so dismissed most of the time and they are lost in that process and very often ashamed.
Dr Ivana Matic-Stancin (03:47) So I think it's really great that we are starting these conversations in a public space because that's actually starting creating that safe space for this transition.
Dr Lucy Burns (03:59) Absolutely. And what I'm hoping over time is that the stigma and the way that people weaponise it as in, Oh my God, they're so hormonal. Or when women are told, you're just hormonal. And it's like, well, hang on, just hormonal, like it's nothing. Just hormonal is everything. Just hormonal is actually the reason. Yes, I am just, it's not the just. I am hormonal. I've got hormones that are wildly fluctuating, giving me physiological symptoms that are outside of my control, you know, at its very basic function. And it's weird. It's just weird that it's used to denigrate us.
Dr Ivana Matic-Stancin (04:45) Easily dismissed, I would say yes.
Dr Lucy Burns (04:47) Yeah, absolutely. So, Dr Ivana, you run a menopause clinic in your general practice. Yes, tell us a bit about that.
Dr Ivana Matic-Stancin (04:55) Yes, yes I do. I run a Menopause Clinic, which is not really a standard GP clinic, but it's a menopausal health GP clinic. It's different because it takes one hour. The consultations are one hour long. And I really try to give some space and time to explore together with my patients. Their life journey, their physiology, their psychology, their life circumstances, and then we together make a plan for how we can move forward depending on their symptoms and also depending on their other health conditions and health risks. So that's one mobility that I offer, but recently I started offering something called CBT group. Six weeks course for perimenopausal women, which I really think it's a great space to address this perimenopausal transition even more comprehensively and better because, over the six weeks course, we can actually explore this interconnection between our cognition, our brain, our thinking, our logic, our emotions and our body sensations. And that's what basically CBT is. It's basically a connection between thoughts, body sensations and emotions. Very often we walk through our lives not knowing that there is a big interplay constantly happening in our body between these three modalities of our humanity.
Dr Ivana Matic-Stancin (06:45) So during these six weeks course we meet for 90 minutes each Saturday in the clinic and we talk together about this fragile stage of our life, how it's actually, how we can represent, what we can do about that, how we can actually connect, understand these parts of ourselves and how we can do something to change the course of our life for better rather than for worse. So that's the CBT part. I also do online health coaching slash therapy, which is basically one-on-one talking to my patients, about how they can actually change their lifestyle, how they can change the way they live their lives, how they can understand better, again, to live healthier lives after the last menstrual period.
Dr Lucy Burns (07:44) Yeah, absolutely. And it's interesting because we often talk about how there'll be sentinel moments in a woman's life where they sort of take notice of what's going on. And, you know, in particular, I think one of the biggest ones is always pregnancy. You know, women who are planning a pregnancy and then become pregnant spend a lot of time making sure they're looking after themselves. They eat well, they, you know, they do specific pregnancy-related exercises and all of those things that, you know, if they were smoking, they stopped smoking, most women stopped drinking. There's a lot of care that goes into looking after yourself in that, and pregnancy is a transition state as well. And I think that we need to start the conversation around menopause, having the similar level of care and attention that it needs, that this is a significant component, part of your life where they're, you know, yes, like pregnancy, lots of hormones, but that there are lots of things that you can do about it. And you don't need to be, you know, sometimes I think people feel like they're just some, you know, those little daisies, like those thin, what are they called? Japanese, Japanese windflowers, they are, and they're these tall flowers, they're very lovely, but they're at the mercy of the wind, they just have to move whether the wind decides to blow hard or not blow hard that day. They've got no sort of autonomy and we don't have to be like that. Like, yes, menopause can be like the wind and it'll come along and it might blow hard for some women, much harder for other women, but we don't have to just take it.
Dr Ivana Matic-Stancin (09:27) Absolutely. And it's all about being flexible in that approach, understanding what can I change and what I cannot change, so how can I adapt.
Dr Lucy Burns (09:38) Yes, absolutely. Yes, yes. What's what is in my control and outside of my control? I love that. That's great.
Dr Ivana Matic-Stancin (09:45) For example, my physiology, and the time going through this normal natural transition of my life is something that I can't reverse or change. I can't change my genetic makeup, with what genes I'm born in this world. I can't change the upbringing that I had when I was little. But I can understand how that can influence my life now and for the future and what things I can do now in everyday life to actually turn all these things to work for me, not against me.
Dr Lucy Burns (10:19) Indeed, indeed. In fact, we have a little saying and often have to caveat because sometimes people feel a bit triggered by it, but you know, again, this is looking at say metabolic health and weight gain that being overweight is not your fault, but it is your responsibility. And there's lots of reasons and people will go, no, it is my fault because I ate all the food or I ate all the junk or whatever. And I always go, no, we've got to look at why you did that. And that is a combination of so many things of, you know, family circumstances, of modelling, of trauma, of all the things and then genetics. I think the thing that we need to recognise as women is that people have different symptoms. 20 % of women cruise through menopause with no symptoms. Huzzah for them. Yeah, lucky. This means 80 % of women will have some symptoms and for some women, they're extreme.
Dr Ivana Matic-Stancin (11:47) You know what Lucy, I've heard that statistics many times and it made me wonder, you know, when the statistic was made because what I think is happening, if we just move from that data to something else that actually in the Western world, more women are actually suffering from perimenopausal transition than in some other parts of the world like Asia. So then I'm thinking these statistics about 20% of women not having any symptoms, cruising through perimenopause. When was the statistic made? Because the world is changing, the world is faster, there is more stress, there is less community support, there are more issues happening and more burden on a woman as a carrier of the family life. So I think if we start doing this statistical research now, I'm just betting that the numbers would go from 20% cruising down to maybe 5% cruising.
Dr Lucy Burns (12:51) Indeed they could well be, you may well be right. It's interesting, isn't it?
Dr Ivana Matic-Stancin (12:53) It's my theory. It's nothing proven, but it's totally just the way of thinking, you know.
Dr Lucy Burns (12:59) Well, I guess if we, you know, we often talk about a concept called the metabolic triad, which is insulin, cortisol and estrogen. So we know that those three hormones are intrinsically linked. So we know in menopause, estrogen will go down, which means insulin will rise and potentially cortisol will rise. But it's sort of a side issue here that we know that again, I don't have any studies to quote on this, but women's role in 2024 is vastly different to women's roles in the 1950s, for example. And yes, women did work at home, but, and again, it's easy to reflect and kind of makeup stories, but my thoughts are that their attention wasn't quite as divided as it is now. Now you've got women who seem to be responsible, obviously for children and if they have children, raising children, they're teenagers by the time the woman is going through menopause because we're often having our kids later compared to the 50s where people are their kids in the 20s. Their parents are now older, so they've got aging parents to care for as well. And on top of that, they're back in the workforce. And for some women, they're just hitting their strides in their career, finally having had a big break from kids and all of that sort of stuff. So they've got all of that. Plus, they've still got mouthwash a lot, the pet poo, the shopping, the bills, all of those sort of just mundane tasks that never seem to stop. So I think that there's a lot going on then that will elevate a person's cortisol levels.
Dr Ivana Matic-Stancin (14:44) Absolutely, I'm burning to add to that list that you just started, you know, the aging parents, the financial uncertainty, the increasing fear about the future of the world and the planet, the increasing workload and work demands. Did they say aging parents? I don't know, did they mention that? Yes. The increasing influence of social media could be great but also can put lots of pressure on us to compare and strive to be better, to be younger, and to look better. So the list is endless. That's actually burdening nowadays, women in their 40s and 50s.
Dr Lucy Burns (15:26) Yeah, absolutely. Yeah. And so you're right. And so then when we have that increased cortisol, again, all the triad, it increases insulin, further decreases estrogen. So this interplay between those three hormones means that the good news in some ways is that we can look at, well, what can we do with each one? So how can we naturally just improve our cortisol levels so that we're not constantly on high alert? And I guess this is where you come in, Ivana with your wonderful work.
Dr Ivana Matic-Stancin (16:05) I think you do the same Lucy with your wonderful work. We are all trying to actually help women understand what's going on and that's not their fault as you said sometimes they start feeling, am I going crazy or am I going through menopause? What we can do is really review our lifestyle. I think the first thing we need to understand as a woman in our 40s and 50s is that we need to pause. We first need to pause and review and then reflect and regroup. So I have like a little three-step process in my mind when I'm talking to my patients. It's pose, review, regroup.
Dr Lucy Burns (17:01) I love that pause, review, regroup. Yes.
Dr Ivana Matic-Stancin (17:04) Because very often we are actually hit by this physiological hormonal transition when we are at the peak of our finishing running rates when we are in full speed when we are doing everything and we can do everything and we actually feel quite sufficient and capable of doing everything. But then this hormonal surge just slumps us and we start having all sorts of different symptoms, body aches, insomnia, anxiety, pains. Hot flushes are a very, very small part of the whole story. And lots of women don't have hot flushes. Not every woman has hot flushes. But other body symptoms, gut changes, constipation, diarrhoea, and intolerances to certain foods.
Dr Ivana Matic-Stancin (18:00) And then lots of women get lost in that whole jungle of new symptoms and they're in full speed. And then they start searching. Of course, we all search on Google. We jump on the computer and search for what's going on. And then we can find lots of information and some of the information is really even more misleading and confusing, which contributes to that sensation of disorientation that lots of my patients actually feel when I see them and meet them for the first time in a clinic.
Dr Lucy Burns (18:30) Yeah, absolutely. And I think you're right. I mean, there's this industry being formed around menopause now. And commercial entities see a market that they can exploit. And so there's powders and potions popping up everywhere with menopause slapped on them and suddenly they can charge three times the amount and make claims that this will help your menopause. And look, just some things, some women will lay claim to something. And again, I'm all for that. If whatever you're doing makes you feel better, then all power to you. What I dislike is when companies though, lay claim to evidence that doesn't exist. And so what I love about your CBT is that it is evidence-based. There are things that women can do outside of MHT or HRT again. You know, for those of you who've listened, you know that I'm agnostic when it comes to MHT. If it works for you, wonderful. I'm all for it. If you can't take it because you've had estrogen receptor-positive breast cancer, or you don't want to take it, or it didn't agree with you, then fine. We will work around it. It's kind of like with or without, we can make a difference. So I love that the CBT work that you're doing is evidence-based and has been shown, proven within clinical trials to help rather than just be some new age fan dangle thing.
Dr Ivana Matic-Stancin (20:07) Exactly, exactly. It does help and what's the beauty of that is that it actually empowers the person because you are learning certain skills that you can use to help you live a better life, to harness not only these perimenopausal symptoms but it's actually increasing your emotional awareness, your emotional granularity, your emotional language. You are actually growing as a person so you can take these skills for the rest of your life, for everything in your life, for all other difficult emotions that you might have as a human being living on the planet Earth and handle them better. Because no one taught us, when our generation and the younger generation, women in their 40s and 50s, no one taught us in primary school or secondary school about emotional intelligence and mindfulness and the importance of understanding our internal world, our psychology, our physiology, not physiology, psychology. So these old skills are packed in a small course that can actually give you these tools that then you can develop further and do a lot with them to live a better life.
Dr Lucy Burns (21:19) Yes, I totally love that. And you're absolutely right. I mean, these days, again, kids have so much, you know, when we grew up, it was children should be seen and not heard. So you weren't allowed to express yourself. You were, if you did, you were being naughty.
Dr Ivana Matic-Stancin (21:34) Especially female kids. Sorry. Girls are nice. Girls are supposed to be nice and quiet and to please and help other people. And boys will be boys.
Dr Lucy Burns (21:47) Although no, no, no, absolutely true. But I would also argue though that boys were taught to repress their emotions because big boys don't cry. So they were told don't show vulnerability, just, you know, stiff upper lip, be strong, stop being weak. So they've got that narrative running through their mind and we've got the, be a good girl, be quiet, don't be difficult. you know, just go with the flow, all of that we've got the people pleasing. They've got emotional repression where people please as well. What a great combo.
Dr Ivana Matic-Stancin (22:23) That's why the world is in the state that it's now, I guess.
Dr Lucy Burns (22:28) Yeah, absolutely. So I think it's great to know though that there are skills that women can learn. And this is, I think, one of the big things around stress management is that it's a skill, it's just a skill shortage if people think that stress management means the absence of external stressors. And I will have people who go to me, but Lucy, you know, what can I do? I can't get rid of my kids. I've got old parents, I can't get rid of them. I have to work, we need the money. You know, there's nothing I can do. And it's like, you know, you're being the Japanese windflower here. There's lots that you can do.
Dr Ivana Matic-Stancin (23:07) Absolutely. Absolutely. And it takes time. It's not something you can do in 15 minutes consultation. It's not something that you can do even in one-hour consultation. It takes time.
Dr Lucy Burns (23:19) Yes, yeah. So what I love then with your six-week program, it's not in six weeks, you know, we can fix you. It's a six-week learning program, like you're learning the skills that you will then take into your life forever.
Dr Ivana Matic-Stancin (23:32) and empowering you to actually go inside and find all these capacities that you always had but forgotten.
Dr Lucy Burns (23:41) Yes. Yeah. Yeah. Yeah. Absolutely. I love that. And I love the empowering word because I know people, again, it's another word that gets bandied about. But the way I like to think about it is that if you're empowered, then you have capacity to make decisions knowing the consequences or the consequences or the actions or the results, whatever word we like to use around those decisions rather than feeling again like you've got no control that you're just that Japanese windflower. You actually can decide that, unlike the Japanese windflower you can do things. I love that. So Ivana, if people wanted to contact you, if they wanted to work with you, how do they find you?
Dr Ivana Matic-Stancin (24:29) They can find me on my website, www.doctorivana.com.au. I offer a free first consultation, which is basically a discovery call. So we can actually have a quick chat so they can see me, they can have a quick chat with me and have some sort of understanding how what I do, how I work. Also, I can have a little bit of understanding and I can give them my opinion. There would be a good place to meet me because I meet people in one clinic, I do this CBT course and I do the online program. If they're interested in the CBT program, they can contact the clinic where I work, which is called Maxwell Medical Group. The clinic is based in Braybrook, which is Western part of Melbourne near Footscray. So they can just ring the clinic, ask about the program and we have a great admin team who will just send them all the information and they can enroll in the program.
Dr Lucy Burns (25:35) Beautiful. We will put all the notes, and all the links in the show notes for this as well. So anybody, who is driving, who can't remember just get when you've stopped driving, you can look in the show notes and they'll all be there, but that sounds amazing. And I think the more options that women have, the more choice, the more freedom, the more autonomy. So I'm, I'm very happy with that. That sounds great. So three things that you would recommend for post-menopausal or sorry, any menopause or women, so whether you're pre-post-peri, any, what, what would you, what do you reckon are your three big game changes?
Dr Ivana Matic-Stancin (26:12)So for all women in their 40s and 50s, avoid the M-word. I think it's very important to remember this pause, review, and regroup. You don't need to suddenly stop your life, but you need to just maybe slow down and review your life and then regroup the way how you live your life. The stress management, the good sleep and the community. The community, the people that we are surrounded with are a very important part of that process of pause, review and regroup. Because if you are totally sleep deprived if you are surrounded by people that are constantly triggering your anxiety, it's very hard to do that.
Dr Lucy Burns (27:12) Indeed, indeed. I love that. Perfect. Good. Well, Ivana, thank you so much for sharing your wisdom with our community. I very much appreciate it. And lovely ladies, if you're out there, know that you don't have to be a Japanese windflower, that you can develop skills, that you can learn empowerment and that you can live your best. And I guess that you can live your best, just live your best life. I know that's a boring old Instagram hashtag, the #bestlife. But that's basically what we're all wanting to do. And the thing is, it doesn't have to be your best life every single day, because we all have bad days. So it's not about every single day having to be perfect, but it's just about having, you know, as good quality days as you can most of the time.
Dr Ivana Matic-Stancin (28:00) Absolutely, and even when you have a bad quality day, just to know how to hold them, how to hold your emotions because you are human, you can't be happy all day.
Dr Lucy Burns (28:08) Indeed. Indeed. Yes, yes, exactly. And dispelling that myth and that we do have bad days and that's normal. That's normal.
Dr Ivana Matic-Stancin (28:14) Thank you Lucy for having me and thank you for all the work that you are working and doing for women in their forties and fifties as well.
Dr Lucy Burns (28:24) you're welcome, Ivana. Thank you. All right, gorgeous people. We will see you next week with another episode of the Real Health and Weight Loss podcast. Take care, peeps. Bye now.
Dr Lucy Burns (28:28) 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.
