How to Navigate Peri/Menopause

Summary

Podcast Summary: Mind If We Talk?

Episode: How to Navigate Peri/Menopause
Host: Sreela Roy-Greene (C)
Guests: Dr. Amy Shah (A), Rekha Shah (D), Dr. Natalie Crawford (B)
Date: July 2, 2026

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Episode Overview

This episode explores the emotional and physical realities of perimenopause and menopause, highlighting the often-overlooked mental health impacts. Therapist and host Sreela Roy-Greene moderates a moving, multi-generational conversation between Dr. Amy Shah—a physician experiencing perimenopause—and her mother, Rekha, who reflects on her unrecognized struggles during menopause decades earlier. The episode ends with in-depth expert advice from Dr. Natalie Crawford, a reproductive endocrinologist, on understanding, preparing for, and advocating during this life transition. The tone is empathetic, honest, and empowering.

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Key Discussion Points & Insights

1. The Hidden Toll of Menopause on Mental Health

• [00:00-01:02] Amy introduces the theme: lack of knowledge about menopause and perimenopause leaves women feeling isolated, stressed, and misunderstood.
  • “Not having knowledge about menopause and perimenopause and just women's bodies in general is a huge toll on women's mental health and physical health…we have so much stress and, you know, trying to do it all and then on top of that they're really feeling the mental toll of their bodies changing.” – Dr. Amy Shah [00:00]

2. Personal Stories: Intergenerational Impact

Rekha’s Menopause Journey

• [03:03-04:30] Rekha describes overwhelming anxiety and insomnia during menopause, not recognizing these as hormonal symptoms.

  • “I just thought it is me and my willpower. I did not know that that was menopause.” – Rekha [03:12]
  • Felt judged by family, described as “going crazy” [03:59, 10:33]

• [08:15-10:28] Rekha recounts physical symptoms—hot flashes, night sweats, palpitations—and seeking medical help without answers. Only later did she connect these dots to menopause, with Amy’s eventual guidance.

  • “Nobody had any clue that this is a menopause. And I had no clue until I talked to Ami. And Ami also at that time, I don't think she had any idea.” – Rekha [09:23]

The Physician’s Perspective

• [05:25-07:46] Amy, as a doctor entering perimenopause, highlights the generational shift in awareness but also the confusion from conflicting information—even in the medical field.
  • “We never really learned about a transition that happened 30s and 40s. Like, we thought of something that's happening in your 50s as something menopause.” – Amy [05:35]
  • “Not even doctors know this. We didn’t learn this in medical school.” – Amy [05:55]
  • Stresses that symptoms often dismissed or misattributed to other causes (work stress, mood, etc.).

3. Cultural Silence and Consequences

• [12:23-13:40] Rekha shares that menopause was never discussed in her Indian community. Stigma and ignorance led to severe misunderstandings, even family crises.
  • “When I got the menopause, I have never heard of menopause.” – Rekha [12:23]
  • She tells a story of a relative nearly running away due to untreated menopausal anxiety, misunderstood by her family.

4. Progress, Support, and Shifting Narratives

• [14:34-16:24] Amy discusses how contemporary access to information, improved communication, and dialogue (as opposed to secrecy) change how women experience this transition.

  • “Society used to think of menopause and perimenopause as a decline of life…But it’s not necessarily a decline, it’s a reshifting of the body and brain.” – Amy [15:42]

• Hormone Replacement Therapy (HRT) is now more openly considered, whereas in Rekha’s time it was taboo and largely unavailable [16:24-18:02].

• [23:36-24:12] On breaking taboos:

  • “I’m talking about it very naturally…It should be a conversation that’s not like a taboo or weird.” – Amy [23:36]
  • Rekha encourages women not to feel shy and to proactively share knowledge [24:12]

5. The Power of Community & Family

• Rekha now leads family health discussions and supports over 100 relatives via WhatsApp, act as the mentor she never had [19:01-19:35].
• Both reflect on newfound respect and empathy this journey has brought to their relationship [25:42-26:04].

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Notable Quotes & Moments

• On Medical Gaslighting and Its Effects:
  • “Women are always dismissed about their symptoms, like they're never really told what's happening to them.” – Amy [07:23]
• On Dismissal in Society:
  • “She doesn't have willpower…she can’t do anything. Everybody thinks I’m going crazy.” – Rekha [10:33]
• Changing Intergenerational Conversations:
  • “My son jokes…‘I'm the 18 year old boy that knows the most about perimenopause and menopause’…we laugh, but it’s true.” – Amy [23:36]
• On Grieving:
  • “Is it normal to grieve who I used to be?” – Listener question [49:27].
    “Grief is a normal part of evolution and life being dynamic…leverage that grief into gratitude…and actively work to become that next version of ourself.” – Dr. Crawford [49:49]

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Expert Segment: Dr. Natalie Crawford (Reproductive Endocrinologist)

Understanding Perimenopause vs. Menopause

• [28:27-31:43] Dr. Crawford offers a simple, visual explanation of ovarian aging and the transition to menopause.
  • “Inside your ovary is a vault where all your eggs are kept…every month, you have a group of eggs that is sent out of the vault…over time, we run out.” [28:27]
• The first symptom: shortening cycles, not irregularity (a misunderstood sign even among providers).
  • “…one of the first signs is that your cycle is actually going to shorten…now they’re 24, 25 days…that’s not curious at all…she’s starting to enter into…the perimenopausal transition.” [28:50]

Why the Research Gap?

• [31:57-33:13] Historical exclusion of women from clinical research; slow progress due to long-term nature of outcomes like brain health [31:57].

Impact on Mental Health & Why Suffering Isn't "Normal"

• [33:13-36:02]
  • “Estrogen receptors exist throughout your entire body, but especially in the brain…When estrogen leaves the system, you notice it…your mood will be low, your energy will be low, brain fog…” – Dr. Crawford [33:53]
  • Emphasizes the legitimacy of psychological symptoms, and the life-changing potential of appropriate hormone therapy.

How to Prepare and Protect Your Health

• [37:30-44:45] Dr. Crawford’s “Five Non-negotiables”:
  1. Sleep: “Sleep is when your body has its internal cleanup system.”
  2. Manage Stress: Chronic stress raises inflammation.
  3. Exercise: Build muscle to lower insulin resistance and inflammation.
  4. Diet: Prioritize whole, unprocessed food.
  5. Toxins: Reduce plastic, chemical, and behavioral exposures (alcohol, nicotine, cannabis).
• “It doesn’t have to be perfect to be impactful…” – Dr. Crawford [43:51]

Advocating for Yourself with Health Care Providers

• [45:33-48:08]
  • Schedule a “problem-focused” visit, not just an annual.
  • Prepare your story and voice your questions.
  • “You deserve to know what happens next…If you do not feel like your doctor's listening to you…please go find somebody else.” – Dr. Crawford [47:36]

Listener Questions

• On Losing Your Spark: “It does come back. And hopefully it can be sparklier than ever. But it also might look different, and that's okay too.” – Dr. Crawford [48:30]
• On Grieving: Grief is normal; use it as a tool to define what brings fulfillment now [49:49].

The Importance of Community & Support

• [51:08-51:42]
  • “Have a therapist you love, prioritize community and your friend group, which gets harder as we start to feel more isolated…”

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Timestamps for Important Segments

• [00:00] Amy on lack of menopause education, generational toll
• [03:03] Rekha describes first menopause symptoms and anxiety
• [05:25] Amy as physician, realizing medicine’s knowledge gap
• [13:20] Cultural silence, family impact of untreated menopause
• [16:24] Comparing generational experiences; HRT taboos
• [19:01] Rekha’s role supporting extended family
• [23:36] Open dialogue with children/grandchildren
• [28:27] Dr. Crawford explains perimenopause basics
• [33:13] How hormone changes affect mental health
• [37:30] Preventative habits for better menopause outcomes
• [45:33] How to advocate with doctors
• [48:30] "Will my spark come back?" and grief in transitions
• [51:08] Building a support team beyond just medical care

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Conclusion & Takeaways

• Menopause and perimenopause deeply impact mental and physical health, yet are often dismissed or misunderstood.
• Open, honest conversations—across generations and communities—are key to breaking stigma and supporting women.
• Early awareness, self-education, and lifestyle choices can greatly improve one’s transition.
• Advocacy, both in healthcare settings and within families/friend groups, is essential.
• Grieving changes is normal; support, therapy, and self-compassion help forge a new, empowered sense of self.

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Memorable closing message:

“Grief is a normal part of evolution and life being dynamic…leverage that grief into gratitude…and actively work to become that next version of ourself…” – Dr. Natalie Crawford [49:49]

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If you’re navigating this journey, you’re not alone—and you deserve knowledge, respect, and support every step of the way.

Transcript

[A]

Not having knowledge about menopause and perimenopause and just women's bodies in general is a huge toll on women's mental health and physical health. We have so much stress and, you know, trying to do it all and then on top of that they're really feeling the mental toll of their bodies changing. And so I think to understand and educate yourself on this is something that women unfortunately were never given and still continue to struggle with. Feels unfair really.

[B]

Hey, can I talk to you about something?

[C]

I wish you knew. I wish you knew how lonely menopause felt. I wish you knew why it's so hard for men to share their feelings.

[A]

I wish you knew what it was

[C]

like growing up in a low income family. I wish you knew how hard it

[B]

was not having a college degree.

[A]

I wish you knew what it's like to be me.

[C]

Welcome back to Mind if We Talk, where you get to be a fly on the wall for many therapy sessions and learn some mental health tips in the process. I'm your host, Srila Roy Green, a licensed mental health counselor with over 19 years of experience. In today's episode, I sit down with Dr. Amy Shah and her mother Rekha, who are on opposite sides of the menopause vents. Dr. Amy Shah is a double board certified physician, nutritionist and bestselling author who is entering perimenopause. In our conversation, Dr. Shah's mother, Rekha explains the confusion and suffering she experienced while going through menopause. Her anxiety felt out of control. She was overwhelmed and didn't know that her hormones were to blame. It wasn't until years later that Dr. Shah noticed the massive hormonal shifts that come with menopause. She also came to realize how little of her medical training had focused on this crucial time period in women's life. Dr. Shah and her mother have since learned how to communicate better about menopause and even help other family members prepare for this life phase. Later in our episode, I'm joined by an extra special guest expert, Dr. Natalie Crawford. Dr. Crawford is a reproductive endocrinologist and one of the leading voices in women's hormonal health. She shares her vast knowledge and helps unpack the massive hormonal shifts that come with menopause and ultimately impact women's mental health. We'll also discuss how to optimize your health before perimenopause begins and how to advocate for yourself when you're not getting the support you need. I'm so excited for this one, so let's jump right in. I just Wanted to say thank you so much for being here and for taking the time to really talk about a topic that I think needs to be talked about way more than it already is. For decades there's been a limited understanding of menopause and you know, it's talked about almost like it's just some phase. And the reality is, is that it can be incredibly transformative and life changing for us and again, very subjective to the individual and what they're going through. When you're looking back, you know, what do you feel your body was trying to tell you?

[D]

I started getting more anxious about everything but more about sleep. So, you know, I said, is there something wrong with me why I can't sleep and why I'm getting so much anxious? You know, I did not realize that there is something physically also going on that was causing this trouble. And I, I just thought it is me and my willpower. I did not know that that was menopause. That was the first sign that something is going on. And I couldn't, I couldn't recognize that what is wrong with me.

[C]

Right. And that must have been so scary, right? To not know and feel like you're not in control.

[D]

Yeah, it was very, very, very, very scary. Yes.

[A]

I mean, I think you were saying that you felt like, almost like you were going crazy.

[D]

Yeah, like, you know, my husband probably thought that I'm going crazy because all of a sudden, you know, how can you have a low, low willpower and you know, why you are worried about sleep and why, you know what, maybe you are taking too much stress for nothing and things like that.

[C]

You know, when you, you were describing what you were experiencing, how did that show up in your behavior or did you notice how it showed up in your behavior?

[D]

Yeah, so in my behavior it was happening like, you know, I was working as a HR person and I had a payroll going on on Monday, Sunday, 4 o', clock, I will start thinking about Monday payroll. And I would be like freaking out. And then when I go to the payroll and every little small mistake is like my heart was pumping. I don't think I can handle this and those kind of thing. At the end it was getting so much that I have to leave my job because I couldn't handle the pressure anymore because it was giving me too much anxiety.

[C]

That sounds like just again such an overwhelming and scary time and to not know what was causing it. Amy, how about for you? What were your experiences like or the early clues?

[A]

I think I'm coming from it from a different angle because I'M a physician. And I started to realize that everyone in my friend circle that was like, in their. Even their late 30s and early 40s was noticing, like, changes in our hormones, like sleep, energy, mood, weight, all these things were happening. And my colleagues, even myself, we never really learned about a transition that happened 30s and 40s. Like, we thought of something that's happening in your 50s as something menopause felt like, something that was like hot flashes and night sweats. I think for me, what was surprising was that when I started to learn that perimenopause starts in your late 30s and early 40s, I thought to myself, wow, nobody knows this. Not even doctors know this. We didn't learn this in medical school. And all these people are walking around thinking that they're, you know, not exercising enough. They're not, you know, doing enough. There probably something's wrong with how they manage stress or how their jobs are. They don't realize that there's something else at play. Play at here. And so as I was starting to notice that myself and hearing what other people were saying, my patients and my friends, I started to start to educate women around it. Because to me, it felt like something that we should all know about so that we can kind of just. I didn't want it to be like my mom, where you kind of just chalk it up to something else, or you think you're going crazy, or you think you're depressed, or you think you're anxious without knowing that there's also this other thing that's happening on the other end.

[C]

I think you highlight a really important point, which is that lack of awareness, that lack of education and wanting to be proactive and how important it is to have that 100%.

[A]

And I also feel like women are always dismissed about their symptoms, like they're never really told what's happening to them. And so I thought that the more we can talk about it, the more people can start to tune in. Because before, you don't. If you don't know what could be changing, you almost can't recognize it early.

[C]

And I think you just brought up a really important point too, that it's not always overt or obvious. It can sometimes creep up on a person if they're not paying attention. But I wanted to go back to Rakuff, to your experience a little bit more that, you know, you shared that, you know, for nearly 10 years, you didn't fully understand what was going on. Were there other sensations or body experiences that you had that, you know, you look back on and realize, oh, that's what that was.

[D]

So, you know, it was giving me like a hot flashes. And in the night I will be like freezing and then I'll be, at one moment I'll be sweating and all those things were happening. And I said, oh my God, I don't know what is wrong with me, you know, so first I thought maybe, maybe my heart is wrong and you know, I'm having an attack or some kind of mild attack or something. So I went to cardiologist and you know, we got everything got done, stress test and all that thing. And everybody, they came out all okay, you know, there was nothing wrong with my heart. So then I said, I don't know, you know, what is going on with me. You know, in our group where we are in Indian group, so many women were like wondering, something is wrong. I can't sleep right? And somebody say, you know, I feel hot and I feel cold and nothing is going right. I don't know what is happening. So nobody had any clue that this is a menopause. And I had no clue until I talked to Ami. And Ami also at that time, I don't think she had any idea. But she was telling me that, mom, Prabhu, probably you are stressing out too much. So maybe you should take some mild medicine to calm down your anxiety, you know, Then I started doing the exercise and when I was walking one hour every day, I'm taking anxiety pills every day. And I think I was trying to make myself more happier being with the kids. I'm, you know, doing all the things that makes me happy, you know. So at that time it was somewhat manageable. So I thought, you know, maybe it's working. But I did not know that what is the main medicine for that and how to calm it all down. You know, I was still in the air because I didn't know anything.

[C]

Did you ever feel misunderstood by friends and family when you were going through that?

[D]

Yeah, yeah, yeah. People, people were thinking it that, you know, she, she doesn't have a willpower, she can't do anything. They were thinking that, you know, something is wrong with me, you know, yeah, yeah, yeah.

[C]

No. And it can also feel very lonely.

[D]

I had no help.

[C]

You both mentioned in your pre interview that you both realized together that the difficulty that you were going through, Rekha, was, you know, menopause. Ultimately that was the answer. How did that moment feel for the two of you?

[A]

I think for me, when I started to learn all the symptoms, it just brought me back to my mom. During our Wedding time, which was when she was going through all of this, like the year, the year before the wedding, she was like going through the throes of menopause and I recognize all of the symptoms. And I was like, oh, that. So I told her, I'm like, that's what was happening to you at that time. So she was like, oh, yeah, I had all of those. I had anxiety, I had the sleep issues, I had the mood issues, I had weight gain, you know, like, yeah, weight gain, yeah, like all of those things. All the classic hot flashes, night switch, Everything that she thought was all separate. Like your carpal tunnel you thought was separate, your palpitations you thought were separate. All of those things could have all been from the same thing.

[C]

Yeah, People don't realize how interconnected each piece is. Right. And I think oftentimes people again, are very dismissive, even to themselves. You know, Amy, you, you mentioned about, you know, essentially like medical gaslighting to some degree a little bit earlier, how, how easy it is, especially for women to have their concerns dismissed.

[D]

In our family when we were growing up, I have never heard of menopause. When I got the menopause, I have never heard of menopause.

[A]

Like, none your cousins, none of my

[D]

cousin, none of my aunts or, you know, any, any of my relative or my friends, no one talk about menopause. No one. They just say, oh, okay, you getting older, you getting fat, you cannot sleep more. One of my sister in laws was going so crazy because of the monopoly that she ran away from her house because she was getting so anxious and sensitive about it. And she thought that in my house nobody is giving me any importance, nobody talks to me, everybody thinks I'm going crazy. And so no, no one is giving me importance. Why should I live in this house? She left the house. Nobody realized that that was because of the menopause and at that time because of ami, I knew and I told them, I think maybe it's a menopause. And they thought, thought I'm crazy because they didn't know any, any symptoms or anything about the menopause. Her life was totally changed.

[A]

It's so interesting because for their generation, it seems like there's a lot of mental health issues that happened during that, that time that were all kind of, one, it's taboo. Two, it's really looked down upon. And then three, like, nobody really wants to uncover like the roots of it. And for in this situation, she recognized, I recognized it and because after a year or two then she was back

[D]

and she Was, she's, now she's okay and she's living with the family and everything is okay now.

[C]

I think you, you touched on so many really important points is, you know, oftentimes the life change that menopause can bring on. Right. Can often uncover unspoken underlying pre existing issues. Right?

[A]

Yes.

[C]

Question for you, Amy, is, you know, now that you're at that stage, you're entering perimenopause, you know, you have a very different set of tools. Right. Than your mother did. Right. You've got, obviously you've got the medical training behind you, so you've got that little edge. But then you've got the research, you've got societal changes, the narratives change. It has changed quite a bit with all that knowledge. What still surprises you about this specific topic and phase of life?

[A]

I think unfortunately, and fortunately we have now so much information and sometimes it's competing information. So a lot of what I'm dealing with for myself and for my patients is like, what's actually the right way to go? What are the right treatments? What are the right tools? And so I still think there's a lot of confusion. We don't have all the answers, we don't have all the research.

[C]

But you know, I, I, I can't help but think that maybe it's good that we are coming at it from a place of curiosity rather than trying to suppress.

[A]

Yes. I think society used to think of menopause and perimenopause as a decline of life, you know, when women just weren't as important anymore. And now it's like, But I think now what I'm understanding is that it's not necessarily a decline, it's just like a reshifting of the body and brain. And so you have to kind of adjust to it.

[C]

I think taking away that stigma that menopause means the end, but instead looking at it more as a, this is an opportunity to reinvent. You know, Rika, you had your journey, Amy, you've had your journey. How have they differed? How have they been similar? What did you notice?

[A]

Yeah, so I think I'm still not in the, in the stage where she was, but I think it's very different. One, because I am catching it earlier, so I'm watching myself. Secondly, because I think that knowing what she went through, I know, you know, the things to watch for. And then I think also we're very different people knowing that for her, like her big, very big piece of her journey was this anxiety piece and it was something that she's always struggled with and it just was like exaggerated in so many ways. So I think for me, I understand that that's like a little bit different than my journey. But definitely, you know, I'm looking at the sleep issues. I definitely see what people are saying about energy, mood. There's lots of different things that I'm watching for. But I think I'm still pre and peri menopause, whereas I think she felt her most of her symptoms at the very end, which is typical for women. And also she really, I think we didn't talk about it yet, but she didn't have access to or even a discussion about hormone replacement therapy as a treatment option that most women today do. And at the time it was kind of a taboo subject and nobody really prescribed it with the. Because of the feared risks of cancer.

[D]

Yes.

[A]

And so that wasn't even an option for her when she was going through. She would have been a perfect candidate for it.

[C]

Curious to hear from you a little bit more. Rika is about knowing what you know now. What are some ways that you would like to support Amy when she gets to that point or is, you know, starting to get into that point? You know, what would be some of the ways that you would want to show up for her?

[D]

I, I will do anything and everything for her. Whatever support she needs it, you know, I know the medicine wise she will take care of the whole, you know, what, whatever hormone therapy or whatever she can do. But as a mentor, you know, whatever she needs help, I will, you know, I will be ready for her.

[A]

And I was saying on the pre interview that she has like a group of a family group of like how many? Like hundreds, 100, 100 people or more.

[D]

Right.

[A]

And she gives advice there all the time about health and life. And so she's not just supporting me and my brother and my kids and her husband, but she's supporting an entire extended family who really takes her advice.

[D]

Yeah, you know, they, they talk to me about anything and everything. And I said, I'm not a doctor, you know, I don't know everything, but I try to give my experience and whatever I know. And yeah, we have a group and we do talk to each other and I try to, you know, we try to help each other.

[C]

I love how you're showing up in the way for these hundred plus people in your life in the way that you wish somebody had shown up for you.

[A]

Do you. You probably wished you had that when you were going through this because you got the support of your family.

[D]

Yeah. But at that time, you know, the phone was not that much available and social media was not there that much. Now we have like, a WhatsApp group, so we can talk to each other more. At that time, there was nothing.

[C]

Now that you've both had this opportunity to get some clarity, when you look at your mother, Amy, like, do you feel like you see her through a different lens now based off of what you know about what she was going through then, what she's been going through, who she is today? Has that changed your lens?

[A]

It's definitely changed my lens because I think at the time, even I didn't really know about menopause. I just was, like, giving her advice about how to manage her stress and anxiety and sleep issues and weight gain as, like, separate issues. And then when I really understood what was happening to her, it just. Nor, like, it made me realize, like, oh, wow, she was just going through a life phase. That's normal. We kind of were like, even as a family, kind of like, trying to help her figure out, like, what she needed to do. It was like she. My dad said, okay, well, quit your job, because clearly that's what's happening. You know, that's what's making you stress.

[D]

And then it.

[A]

But, like, had he known now what we know, we would have said, oh, it's not necessarily like, the job. It's what's happening to you in this situation. So definitely would have been different had we known. And looking back at it, I'm like, oh, okay, that makes sense.

[C]

Yeah, yeah. And it's easy to go into, like, problem solving mode. Right. And I think sometimes that's what I often hear is, you know, when we don't stop to listen to validate the experience and understand the why, that's often where things get mixed up. And then it contributes to even more misunderstanding, especially around something like this. But I think it's important, especially for our audience to hear, how do you both feel that, you know, the dismissal or ignoring of menopause, how do you think that it's collectively influenced women's mental health as a whole?

[A]

I think that not having knowledge about menopause and perimenopause and just women's bodies in general has. Is a huge toll on women's mental health and physical health both. But really mental health, because we have so many pull. We have so much stress and pull on our lives already as women. You know, most. Many women are dealing with their children, their jobs, their maybe like, aging parents or relationships and, you know, trying to do it all.

[B]

But.

[A]

And then on top of that they're really feeling the mental toll of their bodies changing. And so I think in my mind to understand and educate yourself on this is something that women unfortunately were never given and still continue to struggle with and feels unfair really.

[C]

Yeah, yeah, I agree. Rika, what do you think?

[D]

My generation. Yeah. Like some of the people say, oh, she's crazy, you know, she doesn't want to.

[A]

It's an immense toll. Yeah.

[C]

You know, now that you both have all this knowledge, all this experience, how are you changing the narrative or changing the dialogue for, you know, the grandkids slash kids, you know, in this generation?

[A]

I think for me, I'm talking about it very naturally. Like my son jokes like he's, he's like, I'm the 18 year old boy that knows the most about perimenopause and menopause and I, and we laugh, but it's true. Like it should be a conversation that's not like a taboo or weird. It's not just for girls, it's not just for, you know, for older people. It's for everybody to understand. It's part of life. It's like pregnancy. Everybody knows that women get pregnant. Like so that's how it's changed for me. And the way I talk about it, I talk about it freely and not with any taboo.

[D]

You should openly share what you have knowledge for the menopause and people should not be ashamed of asking, you know, what's going on because of the menopause. If you can help someone, that will be very, very nice because some of the people don't know. But you should not feel shy about talking about menopause because that's very, very regularly people feel go through.

[C]

And my last kind of softer question, you know, how has going through this journey, has it brought you both closer together?

[A]

Honestly, knowing what she went through and looking at it from the frame of this was like a normal part of her life. It makes me understand her so much more. Like she really thought that she was having some kind of mental and physical breakdown. And I think this really makes me realize that she was, it was just part of her journey and what a difficult part of that journey it was because she didn't really have a lot of support from doctors, from her family, from her friends.

[C]

Yeah, yeah. A lot of respect for getting through

[A]

all of that understanding and, and, and empathy.

[C]

Yeah, yeah.

[A]

For that.

[C]

Yeah. Rika, do you feel like it's brought you closer to Amy?

[D]

You know, we are getting more closer or because of the, all this conversation on menopause and she tells me this is what, what you were going through and that it feels so much better and you feel so much better. And I feel so much closer to Ami when we have that conversation.

[C]

I love hearing that. And what a lovely note to officially end on.

[D]

Thank you.

[B]

Thank you.

[C]

As we heard, Amy and Rika are now creating a support system for other female family members so they don't have to suffer alone and in confusion the way Rika did. But there is still so much misinformation, lack of research, and even gaslighting in the medical field that can make these conversations tricky to navigate. So I sat down with Dr. Natalie Crawford, a reproductive endocrinologist, to better understand the mental and psychological changes that take place during menopause and how women can best prepare and best advocate for themselves. Dr. Natalie Crawford is a leading voice in fertility and women's hormonal health. She just published her first book, the Fertility Optimize youe Lifestyle, Hormones and Reproductive Health, and has an incredible podcast of her own that's called As a Fertility, hormones and health. Dr. Crawford has a wealth of knowledge to share and we were honored to have her weigh in on this conversation. I am really excited to have this conversation specifically about this topic. What inspired you or ignited your passion when it comes to menopause perimenopause in women?

[B]

Thank you for having me. And I'm a reproductive endocrinologist. What has inspired me and always kept me trying to educate women and create content is the number of times I've sat across from a really smart, educated woman who said, I wish I'd known this information sooner. Just this basic fact that we are not taught about our bodies, as simple as how our menstrual cycle really works, what we need to do even to optimize or understand our fertility. And that just becomes even more apparent as we progress through the later reproductive years and into perimenopause and beyond. And we know that when we go through such a huge hormonal transition, it impacts not only how we feel right now, but also our long term health as well. So I always say ovarian health and function. The ovary is my favorite organ. That is really what I'm so passionate about helping, you know, women really understand so that they can be making the decisions that are right for them and making them from a place of knowledge and data for our listeners.

[C]

Could you educate us a little bit on what the differences are between perimenopause and menopause?

[B]

Let's think about what's actually happening from an ovarian level. And then what happens to our symptomology and what we can look out for? I want everybody to imagine that inside your ovary is a vault where all your eggs are kept. Women are born with all the eggs they're ever going to have, and we run out of them over time. Every month, you have a group of eggs that is sent out of the vault. Each egg grows inside a follicle, and during our ovulatory years, one of these eggs will grow to maturity and ovulate, and the rest of them will die. And then the next month, you'll have another group. So we are constantly losing many eggs every single month. Over time, though, we run out of eggs and the vault gets emptier, and the brain and ovary are perfectly coordinated, but they can't actually see what's happening. So what starts to happen is as the vault gets emptier, fewer eggs come out every month. This is the ovaries protective mechanism to not run out as fast. Fewer eggs come out, but the brain doesn't know this and starts by sending out its normal signal. This is when we start to see some of the signs of perimenopause. From a symptomology standpoint, one of the first signs is that your cycle is actually going to shorten. So classically, a woman will sit across from me and say, my periods used to be 28, 29 days, and now they're 24, 25. Isn't that curious? And I'll say, oh, that's not curious at all. In my brain, I'm immediately thinking, her egg count is lowering. She's starting to enter into what we consider the perimenopausal transition. So we start to see that the brain and ovaries are still communicating at first, but the response is changing. So we're growing an egg faster, we're ovulating sooner. We're actually having less days of that unopposed estrogen. Because the follicular phase of the first half of the cycle is when your body's getting that high estrogen time, you're feeling your best, you're feeding your blood vessels, your bones, you have your peak libido. You actually get fewer days of that when you start ovulating sooner. So women start to have the number one symptoms of I don't feel like myself. They start to feel a little bit off. And it's because their overall estrogen is lower. And if they're tracking their cycles, they might notice they're having a shortening of their cycle, but their Cycles are still regular. So one of the problems is many providers as well will think that perimenopause is when you start to have irregular cycles. And so a woman will say, well, but my cycles are regular. And then they'll get dismissed sitting at a doctor's office saying, oh, well, it can't be this. So it's really important to say, well, what's happening physiologically and how is that presenting? Because that estrogen's so crucial. And when you start to have just less total days of estrogen in the month, you will start to feel it mentally, mood, energy, and that is that driving factor. From there, if we think about perimenopause in stages, I always say perimenopause equals what we call in the fertility space, diminished ovarian reserve dor, because if you have a lower egg count, you are starting to go through some of the hormonal changes of perimenopause. Meaning for most women, they will have these hormonal changes in the five to seven years before they go through menopause. And the average age of menopause is 51 to 52.

[C]

I loved that, the way you explained that, because it's, it's very palatable. So I really appreciated that. How did you come to realize the lack of research and awareness around women's health, especially in this arena?

[B]

I mean, as an OB GYN and an rei, I've done research in women's health. And so back in fellowship, we have to do a thesis project extensively research it. I got a master's in clinical research. And it became really obvious that across the span, there is a paucity of research when it comes to women's health, especially hormonal issues or even natural fertility, things that don't require medical intervention. Women have been obviously were excluded from certain trials for a really long time period. And it has been viewed historically as a less quote, important topic. The other thing, though, that's difficult, these outcomes take a really long time to study. So if we're trying to look at something like brain health after menopause and what you should be doing in perimenopause to have improved brain cognition and decrease your rate of Alzheimer's disease, we're talking about decades of research that we'll have to undergo before we get that answer. And we always have to weigh risk, benefit for the individual woman who's sitting across from us. And that leverages itself into the hormone space as well. When we have less research, that doesn't mean something's not important. It just means we have to evaluate what the potential risks and benefits are for the person sitting in front of us.

[C]

Right. It's so unique to that individual. Which actually helps me segue into my conversation with Dr. Shah and her mother. Amy's mother, Rika, described her experience with menopause as being really difficult. And one of the things that, you know, she touched on is that common misconception of, you know, that it's just a physical experience. Came to find out obviously, that that's not the case. So I would love to hear from you as an expert. Here is how those hormone changes, how those fluctuations impact our psychological and emotional health as women.

[B]

I think what you touched on that's so important is that things can be natural or normal, and it doesn't mean that suffering should be normalized. Let's be real scientific about it. Estrogen receptors exist throughout your entire body, but especially, especially in the brain. We know that women, if we look at our regular menstrual cycle as a good baseline, at times of your higher estrogen, you have improved cognition, your mental health is improved, and at times where you have your lowest estrogen levels, you have more depressive episodes, more swings in your mood, higher anxiety levels, in addition to feeling more off and less stable, less happy and having more brain fog. So estrogen is a really important hormone for the female brain. To act like we should just transition through. Having it be gone and be a perfectly normal, same version of ourself as we were when we had these high estrogen levels is really such a ridiculous claim. At the end of the day, every woman should make the decision on if hormone replacement is for her or not. And we should have choices and we should be able to leverage all the tools in front of us. When estrogen leaves the system, you notice it, you don't feel like yourself, your mood will be low, your energy will be low, brain fog, difficulty concentrating, anhedonia, lack of joy, and things that previously brought you joy, those are really shared experiences from a low estrogen state. And I always tell patients this is going to change your life. Something as simple as starting very low dose estrogen will titrate it and get it to the right level. You're going to feel like a different person. And women come back crying, saying that they really just thought this was something they'd have to suffer with forever. It's a tough place right now. And I have to acknowledge that one of the most important things is if you are considering hormone replacement therapy, that you have a doctor, a provider, a clinic that you trust, who will listen to you if you feel dismissed or gaslit. We're past that. Please go seek somebody else.

[C]

I'm so glad you touched on gaslighting. This is something I find myself often saying in my sessions to my female clients who are going through any medical issue, to be frank, but especially when it comes to hormonal changes, life changes that are, again, perfectly normal, but dismissed because you deserve to be heard and you certainly don't deserve to be gaslit.

[B]

Well, it is really important because sometimes we just assume this is the experience everybody else is having. We don't know what a good empathetic practitioner can look like if all we've experienced is the other version. But we'll just double down and say, your health is so crucial to your well being, to your entire lived experience, and it is worth fighting for and advocating for. And the way I like to think about it is let's put it in three buckets. You have to learn what's normal. We've got to raise your fund of knowledge so that we can understand what's going on. Two, we have to be empowered to advocate for our own health. This means finding the right doctor, knowing the questions to ask. And three, we want to take control and optimize the things in our world that can influence what we are experiencing. And those are really the three buckets that women should focus on when it comes to thinking about our hormone health. As we go through these transitions, are

[C]

there ways that come to mind where women can protect themselves or prepare to some degree for these very, again, normal life changes?

[B]

I think understanding that there's a lot we don't know here, but there is some information we can take from the fertility data and then apply it to the midlife time period. And that's how I like to frame this. So let's start by saying we'll go through the buckets and we'll go backwards. Let's start saying optimize. Can we modify our ovarian health? But by saying the longer I can live a healthier life and decrease inflammation, I have the potential, it appears, to influence how many eggs are in the vault and coming out and how long I might be able to extend my ovarian lifespan. Now, we're not talking about going through menopause in your 60s or something much longer, but knowing the fact that even going through menopause one year later substantially improves your health outcomes later decreases your risk of heart attack, cardiovascular disease, metabolic syndrome, stroke, even cancer, means that we should pay attention to ovarian health before we're in the midlife stage. Something I'm really passionate about thinking about these reproductive years, or specifically those prime years as I like to say, like you're done with your family, but perimenopause still feels like it's a way off. This is probably one of the greatest opportunities for intervention we have. So I put these into my five non negotiables that every woman should think about and make active decisions on. One is going to be getting enough sleep. Okay. Sleep is when your body has its internal cleanup system. So if we're cutting our sleep window short, not only are we increasing our foundational inflammation that we're waking up and starting the day with, we're also impairing how our brain can send out signals to our ovary. So getting enough sleep and good quality sleep is number one. Number two is going to be chronic stress. And we'll say number three is gonna be exercise and I'm gonna loop em together. And number four is food and five is toxins. We really have to understand the word insulin resistance, which becomes a big player in midlife and beyond, but it's actually a huge factor to your ovarian health function and your egg count. So insulin is hugely problematic when it's at these high levels. Okay, well how does that go into stress and exercise? Exercise is one key one. And one thing that women should start doing much earlier is building skeletal muscle when you lift weights. So if I have more skeletal muscle, I have more ability to use glucose without needing insulin, lowering my glucose levels, lowering my insulin levels, making my cells more insulin sensitive or able to respond at a lower level. But if we can build that muscle base beforehand, we're going to be in even a better position. But then three is going to be in those high stress moments when you get out of that bad meeting or you have the bad news, or you are scrolling on your phone, you saw something really triggering. Try to activate that skeletal muscle, go for a 5 minute walk, do 10 squats, understand your body so saying, oh, more glucose is released. I now need to go utilize that, use it up so I can quote run from the bear and get back to baseline. And the earlier we learn to do these things and we make this a part of our day to day life. I call these the foundations of your day. Sleep, stress and exercise. We can start to lower our inflammation levels earlier. And the other two categories worth mentioning here, the prevention state is gonna be diet and toxins. So diet, what we see is that ultra processed foods and artificial and added sugars are highly inflammatory. With no nutritional benefit. But if we are lowering our daily exposures, if most our diet is fruits, vegetables, fiber, whole foods, healthy fats, then when it comes to wanting cake on your birthday, that's no big deal because your total inflammatory burden is lower and you're able to tolerate some of these shifts. So we want to make those day to day choices from a place that will decrease inflammation and improve our gut microbiome. And then number five is environmental toxins. So paying attention to getting rid of plastics, limiting avoidance to toxins, I often hear somebody say, well, I can't control every toxin out there, so I'm going to control none of them.

[C]

Sure.

[B]

Instead let's just control what's in your home, let's control where you spend most of your time and make this as low toxin of environment as we can so that when we are in a podcast studio, in a hotel, at a restaurant, we know our body has the reserves to tolerate that inflammatory rise. Because your body has an immune system that can take care of inflammation. And then the other is the behavioral toxins that we have normalized in society. Cannabis, nicotine, alcohol, they don't provide any health benefit and they do increase inflammation in addition to damaging the number of eggs you have and how they function. So it's crucially important that these are not constant exposures for us. And looking at decreasing inflammation sooner is actually going to improve as you go through these transitions in midlife. Because estrogen is an anti inflammatory hormone. What women start experiencing outside of the not feeling like myself start to be these high inflammation symptoms. Fatigue, gaining weight, the bloating, all of this is because estrogen's low and inflammation starts to raise. So instead of waiting till you have a problem to start trying to figure this out and having to fail first or be miserable, I really want women to start looking at this earlier so, so we can say I've already cultivated this life.

[C]

So, so helpful and so informational. One thing that I find, at least in my practice is when I'm talking to my clients, especially those who are mothers, working mothers, is that there is such a neglect associated with. I put myself on the back burner because I have to prioritize my family saying I don't have time, especially as women, mothers, all of that. It's that idea of we have to hold it together, we have to keep it together, but we need to, to also get the sleep, check our diet, check our toxins, make sure we're getting our exercise, make sure we're doing A, B and C to make sure that we are okay before it adds up to your point, and then our systems get overwhelmed.

[B]

Oh, absolutely. And I always like to think it doesn't have to be perfect to be impactful.

[C]

Right.

[B]

I always like to say, let's imagine we have a scale and it's your inflammatory burden. Every little choice is ticking up how much inflammation you're exposed to. So, yeah, the perfect world would be to have a zero, but that's not realistic. So if it is a day and you didn't get as much sleep, it is now more important that in this day we try to eat those healthier whole foods that are lower in inflammation, that we don't drink alcohol that night, that we do use our skeletal muscles. So giving ourselves the freedom and the flexibility to understand how our body's working every day doesn't have to be perfect. Perfect, and we get a new fresh start with the next day. But similarly to what you said is that women do put their health on the back burner. They take care of everybody else but themselves. And that will work until it doesn't. And you will get so sick, you will feel so bad that then you can't take care of anybody, including yourself.

[C]

Exactly.

[B]

And we really have to switch that martyr narrative, instead saying proactively, if I can do these things now, I will show up as a better version of me. And really structuring our day around our health first and foremost, because when you lose it, it is so hard to get it back.

[C]

They say health is wealth. Right. I do want to touch on this because I think one of the barriers that I know, I see also as a therapist is having those difficult conversations. I'm sure that our listeners that are tuning in are thinking, you know, how do I even begin to have this conversation with my doctor? What are some like maybe openers or suggestions that you have for our folks here that can help them?

[B]

I love this question because often the medical system is not very patient centric, but we don't know how to play our own role in that system. Three things to touch on. The first is schedule the right type of appointment. 90% of the time, somebody a friend of mine will say, oh yeah, I have a doctor's appointment next week for my annual. I'll just bring it up then. So if you are feeling fatigue, hormone change, irregular cycles, painful periods, pain with intercourse, dry vagina, gaining weight, schedule a problem specific visit. You can call in and say, I have irregular periods or I have fatigue and you can now have 20 minutes just to talk about this problem. So schedule a Problem focused visit. Because then your doctor will walk in and the first question they will say is, what's bringing you in? Or, oh, your periods are irregular. Let's talk about it. So that's gonna already make it easier. You have the opening question. Second is going to be, think about your story. Your medical history is providing so many clues to what is actually going on. But the number of times that I will sit across from a patient and they have a really hard time verbalizing what they've been experiencing, what's been happening. I get it. They're nervous, they've waited for the appointment. It's overwhelming. It's not your language. Medical speed can be really confusing. So take the time to think through what is bothering you. So going in with that story, like, okay, my doctor's gonna ask what brings you in today? Prepare your answer. Know what brought you in. Be able to provide that baseline story, because every question they ask will depend on that. And so it's important for you to have thought through some of these things. But if your doctor's giving you pushback, try to get to the bottom of why or give them this kind of global. These tests I'd really love to have, because xyz, I understand they may not get covered.

[D]

So.

[B]

So they may not be trying to be mean or prohibitive. It might just be them thinking, oh, you don't wanna pay out of pocket for this.

[C]

Right.

[B]

The last two really important. You deserve to know what happens next. And I always tell my patients the end of my visits, I say, okay, your next steps. So if your doctor doesn't round all of that out and you're sitting across from them, you can end that way and say, wait, I just wanna clarify the next step. Steps always clarify the what next? If you do not feel like your doctor's listening to you or you don't understand them or they're not holding space for your questions, please go find somebody else.

[C]

I often say to my clients, like, you are your best advocate.

[B]

Yes.

[C]

And to ask for that extra touch or to ask for your, you know, I think not shrinking ourselves.

[B]

Yes.

[C]

Right. We do have one listener question that I would love for us to end on. One listener wrote in to ask, I feel like I lost my spark. Does it come back?

[B]

It does come back. And hopefully it can be sparklier than ever. But it also might look different, and that's okay too. Just like any life transition, you're going to come out of it as a new version of yourself. Our goal is to help you come out of it as A better version of yourself and not to be just left in the darkness. I encourage you to really seek care, the doctor you trust, really learn about your body and then control those other factors. The unknown for women specifically is the scariest thing I find. When we don't know what's happening to our body and we don't know what we should do and we don't know where we should go, we feel more lost and our spark is more dull than ever. So starting on this journey of exploration because as you said, your health is worth prioritizing, health is wealthy. Start to learn your body, advocate for your own health, controlling what you can, and I bet you'll come to the other side feeling better than ever.

[C]

I do want to touch on this other question because it touched me when I read this. Is it normal to grieve who I used to be? And it ties into the question that we just answered here too. And you know, I'll speak to this initially as absolutely it is normal to grieve the person you used to be. Curious to know your response to that as well.

[B]

Oh, absolutely. Grief is a normal part of evolution and life being dynamic. And I always say, if we can leverage that grief into gratitude for who we were and use that to seek who do we want to be or what do we want to be on the other side, Right. When patients complain about this to me, I always say, well, what is it we grieve the most? What part of that and how do we seek to find something like that or that same feeling or happiness or interest or joy? How do we prioritize that so that we can feel the best? And I'll add to this, there's been so much fear in women's health, especially in midlife. You shouldn't have to navigate this transition alone. So think about your care team being multi Persona, but you should have somebody who is as enthusiastic of you feeling your best, having a therapist you love, prioritizing community and your friend group, which gets harder as we start to feel more isolated or depressed or less like ourselves and really taking the time to have this team which isn't just a doctor, but it's many different players that are helping us be that more sparkly version of ourself. And we can grieve who we were. We should actively work to become that next version of ourself that makes us no longer grieve the past because we're excited to be where we are.

[C]

And you touched on something really important that I want to highlight especially is that it is so important to have that social network community as well as not just your, your medical experts. And you know, obviously of course I'm going to say have a therapist you trust because you know absolutely 100%. But the other piece too is, is that expand to the people and, and lean on the people that you know are going to support you. It's easy to isolate and sometimes feel like you're an island unto yourself, but it is all the more important to make sure you, you're getting those touches in with the people that you feel like you can trust.

[B]

100%.

[C]

You know, we can't isolate and nowadays it's so easy to just kind of be like, oh, I'm just going to be a shut in. Not to say there's anything wrong with that. But if you are especially going through a difficult time, it is so important to lean on your social supports, family, the people who you know you can kind of go to and have those conversations with, in addition to all of the other resources that you've already touched on. Thank you again for being here with us.

[B]

Thank you for having me. It's been wonderful.

[C]

Thank you. This is an ad by BetterHelp. In this episode we're discussing how menopause and hormonal changes can have a significant impact on women's mental health. Representation in women's health care is essential both for physical and mental health, because taking care of our minds, not simply our bodies, is another pillar of health to consider during menopause. And learning how to process and express what you're feeling or even identify it in the first place, takes practice and therapy can help create a space to do that without judgment. BetterHelp makes it easy to get the support you deserve. Visit betterhelp.com mindifwetalk for 10% off your first month. That's better. H E L p.com mind if we Talk? I want to give a big thank you to BetterHelp for their passion for this project and for giving us a platform to to champion the well being in all of us. Mind if We Talk is produced by Acast Creative Studios in collaboration with Better Help and hosted by me, Sri La Green. If you like what you just heard, drop us a review in Spotify or Apple Podcasts and share the episode with your friends. Maybe one of our topics will help someone in your life and remember your happiness matters. Mind if We Talk is intended for entertainment and education, not for mental health diagnosis or medical advice.