THREE THINGS EVERY WOMAN SHOULD KNOW ABOUT MENOPAUSE
One of Australia's Most Popular Podcasts with Hundreds of 5 Star Reviews
Grab your FREE Ebook copy now!
Have you struggled to lose weight and keep it off?
Start your journey to boost metabolism and transform your body into a fat-burning powerhouse.
Episode 227:
Show Notes
Episode 227:
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 (00:58) Hello, lovely friends. Dr Lucy here today, and I am a bit lonely. I'm without any friends. No, Dr Mary. No special guest, just me, but I thought it was important to record this podcast as we end October, which is Menopause Awareness Month and I have just come back from the World Congress of Menopause run by the International Menopause Society, and luckily for me, it was in my hometown of Melbourne. So I've just had five glorious days connecting with some of our incredible guests who you've already heard and just soaking in all the expertise. And I wanted to share a couple of really important takeaways with you.
Dr Lucy Burns (01:45) So the first thing that I wanted to share, and it is a mantra that you've heard us say a variation of, which is that the management of menopause and perimenopause, and they are two distinct things. I will go through them. There is no one-size-fits-all all. There is no one thing that works for every woman and there is something for everyone. So what I thought I'd talk about quickly just to remind you. So perimenopause is the time leading up to menopause and it can start, you know, as early as your late thirties. It's unusual, but it can start that early, more likely to start mid-forties and it can go for, you know, anywhere up to 10 years, but it's more likely to maybe be three or four years. And it is a time of hormonal upheaval. So hormones go up and down. And this is because our ovaries are coming to the end of their life, as in the eggs that women produce that are there from when they were a fetus, they're running out. And as they run out, then we get different levels of hormones and those hormones can fluctuate day to day, hour to hour, and hormones, as we all know, have a profound effect on our body. And so women can experience incredible symptoms that vary from day to day, so they're not consistent and I think that is the thing that causes the most distress. Sometimes, if you know what's coming, you can manage it. But when things change from day to day, it can feel like you're running blind. So we need to help women through this phase and up until recently hormone replacement therapy was really, really on the outer and considered harmful. And most women were told they couldn't use it. On top of that, many of the symptoms that women experienced and still experience were dismissed and, you know, trivialised. And this has come out actually since our last week's recording, which we did on what menopause in the workplace, where we've had hundreds of emails from women saying that, yes, this was me. And I didn't know, I thought I was just losing my mind. I thought I was becoming incompetent. I'd lost my confidence. So a lot of these symptoms that are really debilitating can, two things for you to know. One, they can be treated and two, they're not permanent. So you're not losing your mind. You're not going crazy. There is light at the end of the tunnel.
Dr Lucy Burns (04:41) So that's the kind of perimenopause upheaval period. And as you've heard over the past few months from our guests, you know, symptoms range from, you know, obvious hot flushes and sleep disturbance and night sweats. They're the standard, what we call vasomotor symptoms. But then there are the cognitive symptoms, which are things that are in our brains, so brain fog, word-finding difficulties, and memory loss. And again, they're often not permanent. So you would have heard from, we had Anne Augustine in and she's a memory expert and she said that, yes, that often improves. So huzzah for that. And then we've got musculoskeletal symptoms of joint pains, muscle aches, all the artises, so the capsulitis, adhesive capsulitis of shoulders, all of those things come in that perimenopause period and they're often improved with a combination of things. So again, it's never just one thing a combination of things like lifestyle options. So again, just focusing on nutrition, you know, it's very hard to get good sleep if you don't actually go to bed. So making sure that you go to bed on time, then we look at things that are, you know, beyond that. And for many women is using MHT or as it was called HRT and you know, to emphasise again, there are lots of different regimes, lots of different doses, and it's about finding the right regime for you and sometimes giving it a go.
Dr Lucy Burns (06:24) That's the perimenopause bit. Moving into the menopause bit. So menopause is when the periods are finished. That's the end of it. There's no more upheaval, so to speak, but many women still experience symptoms. So it's not like they necessarily stop. For some women they do but for many, they don't. Many women still have hot flushes well after their periods have stopped and it's important that as medical practitioners, we recognise that. And we don't say to somebody, Oh my God, it's too long. And you're too old to be still having those or conversely, you're too young to be experiencing those symptoms. We need to listen to and believe our patients. And so the thing that we know though, is that after the menopause period, there is multiple things that happen to women's bodies and the three things that I want to remind us to talk about are bone health. So we lose bone mass and develop osteoporosis postmenopause. That's one. The second one is our metabolic health. You know, my love, Dr Mary's love. We love to help women with their metabolic health. And for many women, their metabolic health was fine until they transitioned through menopause. For some women, their metabolic health is not so flash to begin with, and then they go through menopause and it becomes a whole lot worse. And I'm coming back to that.
Dr Lucy Burns (08:00) And the third little thing that I just want to talk about is something called the genitourinary syndrome of menopause. And that is really around women's pelvic organs, which are all highly oestrogen dependent. And I'm going to come back to that. Thinking about bones, we did do an episode on bones, and I'm just going to summarise your options for bone management. Again, if you don't have osteoporosis, then you can maintain your bone mass with regular weight-bearing exercise. So that's not just walking, but often a little bit of jumping, or for some people, it might be walking with a weighted vest. It's a tiny bit of stomping if you like. So weight-bearing exercise, along with muscle strengthening, because the muscle and the bone, they're really, you know, they're united. They're not separate entities so to speak. If you have osteoporosis or osteopenia, then really, The gold standard is still looking now at MHT as your management and working again, obviously, all of these need to be done in consultation with your doctor because there are still some women that can't take or don't want to take hormone replacement therapy and that's their prerogative. What we want to do is give women all the options. Everything's on the table and they need to then choose based on what suits them, their lifestyle, and their beliefs, but they need to be well-informed with accurate information. And unfortunately, that hasn't been happening for a long time. So that's the bones bit metabolic health, my love, as you know.
Dr Lucy Burns (09:54) So we know that oestrogen, oestrogen is highly protective of women's metabolism and their heart and brain health. So oestrogen keeps our insulin sensitive. So it makes and keeps our bodies insulin sensitive or at least improves it. So for many women, where they were what we call metabolically flexible, i.e. they had normal levels of insulin, they were able to metabolise, you know, get their energy using both glucose and their fat stores that transition through menopause. They become more insulin resistant and suddenly can't access their fat stores because as you all know, you've heard us say this before, insulin high circulating levels of insulin in our blood turn off our fat burning. We cannot access our fat stores and so we can't use that for fuel. And so we're left then just with using glucose and we don't have big stores of that. So we become tired and hungry. Women put weight on around their middle related to insulin resistance. And then we get into this little vortex that once you develop visceral fat in your, so fat in your organs in your liver, in your pancreas, that then perpetuates the insulin resistance. So it's a little bit of chicken and egg. High circulating insulin causes fat to be stored around our organs. Fat stored around our organs in particular in our liver causes insulin resistance. So that's unhelpful, unhelpful and high levels of insulin, not only do they stop us from accessing our fat store. So we start, you know, developing central obesity or central adiposity, but it also affects the way our cells work. So right down at that very. Basic mitochondrial level. So your mitochondria, if you remember, we've gone quite a few paths on this. The mitochondria are tiny, they're in your cells, in every single cell, tiny, tiny. I like to think of them as tiny, tiny furnaces. They're like your energy, your batteries for your body. And when insulin resistance comes along, they don't function as well either. So again, you're tired, your body, it's just not, it's like it's an eight-cylinder car running on four cylinders. It's just putting along. So we really, really want to be able to improve that. And I'll talk to you a little bit about that in a minute.
Dr Lucy Burns (12:46) And then the third thing that I just want to talk briefly about is something called GSM, Genitourinary Syndrome of Menopause. And what this is, is that as I was saying to you, all of our pelvic organs, all of our sexual reproductive organs have buckets, buckets and buckets of oestrogen receptors, and they're all that we call oestrogen dependent. So this includes the vagina, the labia, the vulva, all of the areas around there are all oestrogen dependent. And what that does is it keeps the tissues plump. And when we have plump tissues around there, then the skin has strong integrity. The vagina actually has its own microbiome. So you've heard us talk about the gut microbiome. In fact, we have a great, brilliant podcast coming up next week about the gut microbiome again, but the vagina has its own microbiome. And we know when it's not in balance, that's when women get things like thrush, which is a candida infection, or something called BV, which is bacterial vaginosis, which is just overgrowth of certain bacteria in there. It's really, really important. The whole area down there, oestrogen dependent, and the thing about it. Is that when the tissues are not robust, like they used to be, well, that's when women get things like prolapses. So yes, you can get a prolapse post-childbirth, but you can also find that you suddenly develop a prolapse post-menopause and that's unpleasant. Women also develop things like urge and stress incontinence, which again gets worse after menopause. It's not sounding great, is it? But there's one amazing thing that just about every woman can benefit from, and that is what we call vaginal oestrogen. So topical vaginal oestrogen. Now, interestingly, one of the things that I learned, and this is just a little pearl, like an example of the nuance that's going on here, is that urgency. So, you know, some women have urgency, and some women progress on to have urge incontinence. And it's the thing of like, suddenly you're just walking along all of a sudden you're busting. The commonest one is, you know, the latch key. So you're coming along, walking to your front door and all of a sudden, as soon as you put your key in, you're busting. This can happen to women. all over the place and their brains will develop little triggers. And it's really hard to hold on. It can be really debilitating and holding on in itself. It's not socially kind of easy to suddenly be crossing your legs and you know, you might be giving them a lecture or something. So what we do know is that topical vaginal oestrogen improves that.
Dr Lucy Burns (15:59) And interestingly, and again, this is a little nuance, systemic oestrogen. So whether you take that through a patch or a gel or even a tablet, that will make urgent continence worse, which doesn't quite make sense, but that's what the research is showing. So little nuances like that was a little pearl of wisdom that I took away from that. So if you have urgency and you're on oral or topical oestrogen, and you're not using a tonal oestrogen. Then it might be worth a chat with your doctor. So the thing about all of this is that things are still coming out in the research and what's happening is that symptoms that were previously dismissed as being nothing much and now being, you know, women are being heard. Women are being listened to. Things like brain fog, it's not that you're stupid. It's not that you've got no intelligence. It's just that, again, a combination of oestrogen, which is their brain receptors, but also insulin. Again, insulin resistance. We know that in people who have insulin resistance, their cognition is not as sharp as it used to be. There's stuff we can do. That's the whole point. It's not that you can just go, Oh, well, God, you're just, you know, dithering old woman. You're not. There's stuff we can do. And this is, of course, the thing that Dr Mary and I love, love showing people, love teaching people. We are absolutely passionate about improving insulin resistance.
Dr Lucy Burns (17:44) Now, I mean, we say this a lot. We really do but here are lifestyle measures that you can take. And I guess the thing that I was heartened by at this symposium, at this conference, was that almost every speaker said, that you need to do lifestyle, you need to look at lifestyle factors, we need to look at things that women are doing, you know, things that we can change. And we need to look at do they need hormones or do they need other things other than hormones. And again, there's a whole heap of medications that are outside the scope of this potty to talk about. But there is, there's lots and lots that we can do to improve the situation. And I know that there are people out there who think that, well, it's natural and we just need to go through it. But childbirth is natural. And two things happen. Women often need help in childbirth. Because for some women, without medical intervention, they would die, and that's unhelpful for everybody. But also, women have medication and pain relief in childbirth. Not everybody, but some women do. And there's no shame in that. Pregnancy, there are some women who breeze through pregnancy. And there are other women who are hospitalised with morning sickness or hyperemesis gravidarum. Everybody is different. And just because one woman breezes through menopause or perimenopause doesn't mean that that is the standard that every other woman should be held to. What we want to do though is give women choice. We, at Real Life Medicine, are pro-choice. There is no one-size-fits-all all. There is something that will work for everybody and nothing that will work for everybody if that makes sense.
Dr Lucy Burns (19:51) So as part of that, this is why we are passionate about lifestyle medicine, and I've talked about the four S's. I've recently added two more. I will remind you of the four S's. So the 4S is sustenance, which is really nutrition. And as you know, we do low-carb nutrition and we do that because low-carb is a powerful lever to improve insulin resistance. It gives your pancreas a rest. We prioritise protein because most women undereat protein. And we need protein for just about every cell in our body. So obviously muscle, but proteins also form the basis of all our enzymes, our hormones, all of our skin, joints, bones, they're all proteins. So we definitely need protein. So sustenance, we know stress management is important, and I'll tell you what, I was so excited to see a slide that talked about the effect of cortisol on weight management. We've talked about it a lot, but it is always good to have it validated at an international conference. So there is absolutely no doubt. that excessive stress increases, well, it increases insulin resistance. It increases a central, okay, central weight gain. And remember that the way that we need to learn to manage stress. It's not the absence of stressors that makes stress, that is stress management. It is a skill set. We teach it all the time. We talk a lot about hypnosis, meditation, and tapping. Journaling, breathing, counselling, CBT, something called cognitive behavioural therapy, and DBT. All of these are stress management techniques. We talk about obviously strength training. Okay, and the reason for that is that muscle is your metabolic organ. The more muscle you have. The more sensitive your body is to insulin, so the less insulin-resistant you are. We talk about sleep. Again, sleep is your superpower and I understand in the perimenopause period it can be hard. There are lots of times in our life when sleep is tricky. Raising young children, sleep is tricky. When we're stressed, sleep is tricky. I get that, but there is also a large proportion of us that just don't go to bed. We sit up all night watching Netflix. We scroll on our phones. We drag ourselves into bed at midnight and then get up at six o'clock and wonder why we feel exhausted all the time. So the first step is to go to bed, to go to bed a bit earlier and to really prioritise and value your sleep. There are interventions obviously for other sleep disturbances and we do know that people need things like. CPAP machines if they have sleep apnea. Again, night sweats can be improved with hormone replacement therapy. There are all sorts of things that we can do to improve the situation, but step one, go to bed. And then I'm just going to add in a bit of sunshine. And again, having just come back from a glorious holiday in the sun, I can tell you sunshine is helpful. We are circadian beings. We have circadian rhythms. We all know that we are as humans supposed to be awake in the day and be asleep at night. Unfortunately, some of us have to work night shift and that's just the way our society is set up. If you're working health in hospitality and police, or fire brigade, there's many, many jobs that require humans to be awake at night. And I'm going to tell you, we know. But that does have health effects. We know that people, night shift workers, have increased rates of cancer. We know that night shift workers have increased rates of obesity, of stress. There's a million things. So if you are lucky enough to not have to work at night, then please get up early, and go outside. Even if it's just for 10 minutes, as soon as you can and get some morning sunlight, it is very, very good for you. Vitamin D is super good for you. And then social connection. And again, I've just come back from a glorious holiday with two other couples. So there were six of us and gosh, we had fun. We laughed, we read books, we played cards like it was just. Wonderful. So deep, meaningful connections. You don't need hundreds of friends, but everybody does need a couple of good friends.
Dr Lucy Burns (24:55) So lovelies, they're the 6S’s. 6S’s for success. We have spoken about those before. So as you know, at Real Life Medicine, we are in the business of looking after women. We do see men, of course, as well. So I know we spend a lot of time talking about women and of course, this menopause series relates largely to women's health, which is indeed a men's issue as well. Okay, women look after their men folk and men folk need to look after their women folk. It is a societal thing that we should know about a couple of little offerings from us. If you are going through perimenopause and you have hot flushes in particular, and you have something that has been coined meno rage, so you're irritable, okay, you find yourself snapping and getting cranky or that the rage can just come upon you feeling like a volcano and you're having trouble with your sleep, well then we have created a little hypnosis bundle specifically for those three issues. Sleep, hot flushes, Irritability slash meno rage, and you can check those out on our website at rlmedicine. com/feel-better and that link to that of course in the show notes. What I want to finish with lovelies is just a little thing to think about. If you're pre-menopausal or perimenopausal, it is time to get your metabolic health in order now. It is time to kind of approach menopause almost, you know, match fit if you like because it will get worse. It honestly will and that's just a fact of life. There's nothing we can do about that per se. If you are post-menopausal, and I know that a lot of you who listen to us are, I know we have lots of women who listen to us in their 50s, 60s, 70s, and beyond. And for that, we are extremely grateful. And I think that for many women, particularly 60s, 70s, and 80s, you are underserved. Nobody is looking after you. So my lovelies, really, it's not too late. To improve your quality of life with really specific and actionable lifestyle factors. Okay, again, thinking about your food thinking about your strength. Okay. The thing that we know is that as we get older, people experience, you know, they fall, they have a fall, a fall, a fall is not a problem in a young person because their bones are strong. A fall when you get older is a big problem and people break their hips. And so what we want to do is really think about that.
It's we want to live what we want to do. We want to live long but healthy lives because a long life without your health is not much of a life at all. And I guess that's what I want to finish with my loves. So again, you know where to find us. If you want to have a look at any of our programs, if you want to connect with us, you know where we live, rlmedicine.com. You can have a look at all of the things that we do. We have got Momentum, our membership, which is currently open. The next round of the 12 Week Mind Body Rebalance isn't until February. And again, you're welcome to join the wait list for that if you want to, but if you want to get cracking now, then come and see us at Momentum. It's great. We've got so many wonderful things that we do, including. Next month's offering, which is we're really looking at strength, strength and mobility along, of course, with a whole bunch of friends and fun.
Dr Lucy Burns (28:50) All right, gorgeous ones. Well, I thought I was just going to come on and chat for 20 minutes. And here I am nearly half an hour. Have the most spectacular of weeks. Next week, we have a slightly famous guest. If any of you have ever read Wheat Belly - William Davis is up with us next week, and I can't wait to share our interview with you. With God, I've got my tongue-tied. I can't wait to share my interview with him, with you. Have a beautiful week, lovelies. I'll talk to you soon. Bye now.
Dr Lucy Burns (29:26) 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.
