B (3:50)

Right.

A (3:50)

The cows left the barn. You were fully menopausal. We got. I can do that in two seconds with a blood test. But perimenopause is a lot harder. You have to really listen to the patient, help tease out what's going on. And we guess, and then we start treatment and we see what gets better. It's that simple.

B (4:07)

So I'm glad you mentioned blood tests, because I know so many women who say, I'm not in perimenopause because my doctor did a blood test and said my hormone levels are fine. Can you address that?

A (4:18)

Well, God bless them. Or they're estrogen dominant, which is also perimenopause. Right. Or polycystic ovarian syndrome. So, you know, we. The blood tests are not definitive. I wish, I wish. I think we might be able to use AMH or this ldl, the small, dense LDL C. There's a certain cholesterol molecule that actually goes up only with menopause and not with aging. So we're getting there, but we don't have it yet. So really it takes a doctor who listens to you, believes you, like, runs the gauntlet with you and like, just we start making interventions and we see what works. You know, it is a zone of chaos. And even with our best treatment, we can't stop the process. Right. All we can do is kind of smooth out the edges until she transitions fully. And then after menopause, it's a lot easier because you flatline your hormones and I just give them back, you know? But treatment and perimenopause is literally pinning the tail on a moving donkey, but simply validating her, telling her, yep, this is what's happening. Yep. It's understandable. Yes. Your stress, your anxiety, your sleep disruption, your weight gain, your whatever is a biological consequence of what is happening with your hormones? That in and of itself is such a relief to the patients that. I mean, that's why I wrote the book. No woman should traverse this without education and without understanding.

B (5:42)

First, I want to talk about symptoms, because I will tell you. When I was in my early 40s, I got frozen shoulder and nothing. No other. First of all, I did not know about perimenopause then at that point, nobody associated that in my life with perimenopause.

A (6:07)

It's been five years, the first time I heard of it. And I was, like, on the cutting edge of menopause, you know, like.

C (6:12)

Right, right.

B (6:14)

So. And then I got it again on the other side right around when I.

A (6:23)

Actually.

B (6:23)

When I met you and when I started hearing about perimenopause in the first place, and I was like. So I. But. But I had no other noticeable symptoms. I'm wondering, in addition to frozen shoulder, which I'm. I would be thrilled for you to describe because I thought I had, like, a torn rotator cuff and was very confused because I do not do the kinds of things that would tear a rotator cuff.

C (6:48)

But.

B (6:49)

So it was a real. It was strange. But what are the symptoms that. That might not be so obvious.

A (6:56)

So perimenopause symptoms typically start in the brain. So ovulation is driven by signals coming from the hypothalamus and pituitary. So in our brain, we have glands. Right. So the hypothalamus is kind of a master regulator of your thyroid, of your sex hormones, of lots of things. Okay. And it's constantly sensing for thyroid hormone, for one. Okay. It's also constantly sensing for estradiol. And when those estradiol levels dip in a normal, healthy cycle. Right. We peak at ovulation, and then the estradiol levels kind of taper back down. The brain is like, wait, wait, wait. We really liked that estrogen level, like. Like, we need it back. We want her back again. So it sends this GnRH down to the pituitary, which then produces LH and FSH. So lute, lizing hormone and follicular stimulating hormone. Those hormones go from the brain down to the ovaries. So the ovaries actually don't act on their own unless there's a tumor. Okay. They just wait for instructions from brain. Then those LH and FSH start binding to the follicular cell. So around our eggs, we have these follicles, and then those cells will start producing estradiol. And then after ovulation, progesterone okay. And about half of our body's testosterone, and testosterone is actually fairly steady state. We get a little bit of tenu fluctuation, but not nothing like estrogen and progesterone. So in perimenopause, we. So women, Women are born with all of their eggs. Females, Right. If you're born with ovaries, you have a set egg supply. And there's a lot we can do to, like, tip them off, right? We can smoke, we can have surgery, hysterectomies, inflammatory, inflammatory bowel process, trauma. Like, there are sympathetic nerves going right to the ovary that just start knocking the eggs out. So it's really crazy that we can actually speed up the amount of eggs that we lose. So when you reach a critical egg threshold, level six, somewhere in your late 30s to 40s. Okay. And it's different for every woman. The signals coming from the brain, the ovaries become resistant. There's not enough eggs to give you the same response that you used to get, like an EKG month after month after month. Right. And so the brain's like, huh, where's the estrogen? It's day 22, you know, it's day four. We should be building now. And the ovaries are like, I did what I could. So the brain gets mad and starts sending higher and higher levels of those stimulating hormones. So then you get these massive sur of ovulation, sometimes double, sometimes loop ovulations, two in one month. And so we get much higher levels of estradiol than we ever had outside of a potential pregnancy. And then we have these crashes.

B (9:35)

Is that why periods get so heavy?

A (9:37)

Yes.

C (9:38)

Okay.

A (9:38)

So we then have crashes. And progesterone can't keep up to shed the lining. So that. And that starts happening even when you, before your periods become irregular, the brain is working double, triple time to try to force these ovulations. And our neurotransmitters, our glucose uptake, you know, in the brain, our TR are the speed at which we transmit across the neurons. All of this is affected by our sex hormone levels. So it used to be predictable. And ekg, like, now becomes a zone of chaos. Like, I threw spaghetti at the wall as you just run out of eggs. So that 7 to 10 year transition is chaotic. And that is. So sleep disruption, anxiety and depression, and brain fog, typically for most women, are the first symptoms they see. There was a beautiful paper Elisa Dunn last year called I just don't feel like myself. And they quantified it, and she spoke at the menopause Society meeting last year. I'm like obsessed to get her on the podcast. And the first researcher who was like, all these women saying, this can't be wrong. And so they quantified it and they're like, yes, this is the hallmark of perimenopause. I just don't feel like myself and I can't put my finger on it. So pretty crazy.

B (10:52)

And what, because we know mothers in particular will put their health last.

A (10:58)

Yes.

B (10:59)

In the. Especially during this time with, you know, raising young kids or even high school age kids. There's. There's just no time for yourself. Can you sort of speak to the things that we should be doing to take time for ourselves now in perimenopause, I've raised children.

A (11:18)

My kids are 22 and 25. I've been through it. I get it. But what, you know, what I would tell her at 35, what I would tell Mary Claire at 35 is, this is coming. I knew nothing about perimenopause. It was a definition that I had to check on a checklist. It was not anything I treated.

B (11:35)

And you're an obgyn?

A (11:37)

Yes. I didn't treat it. I didn't put it as a diagnosis. I didn't. Nothing. Nothing. Certainly like some of the symptoms we would treat. Oh, she has hot flashes, but she's still having periods. Oh, she's got heavy periods. Never connecting the dots that all of this was due to this. I didn't even know about the zone of chaos till three years ago.

B (11:53)

Wow.

A (11:54)

So, like, mind blowing. So I would tell her, educate yourself. Which is why I wrote the book, like this is coming. And it could infect your body in multiple ways. We have estrogen progesterone receptors throughout our body. You need to be prepared for this so you don't feel crazy. Okay, Number two, prioritize your sleep. Prioritize your stress reduction. Get into therapy now. Don't wait until it's, you know, you're in a crisis. Like, start putting up boundaries, protect, you know, stop saying yes to every single thing. You know, like, this is a storm you're going to weather and it's going to affect multiple, you know, and so you can't be everything to everybody at all times. You must, must, must put your health first. Your kids can make a sandwich. Your kids can get their homework started. Your husband can pick up the slack. So, like me trying to be all the things to all the people at all times, like, I was drowning, drowning. And so I would go back and be so kind to her and Say you must, like, since I've done all those things, like at 57, I am literally living my best life. Like I want all your 30 year olds to be me at 57, like healthy, happy kids, a 30 year relationship that's still going strong, the best sex I've ever had in my life, the best boundaries I've ever put in my life, the best time. I say no all the time, you know, like no, no, no, no, no. And I'm living like my dream job. Like I created this job. I, I, I, you know, just felt so called. I went with my calling, right? And I had beautiful career and I risked it all to do this. And you know, I want that for everyone. And had I not learned how to navigate this and get the toolbox going and maximize my nutrition, my exercise, my stress reduction, my sleep and like really not feel selfish that I could be the best version of myself for everyone else. That's everything.

B (13:50)

What I want to tell you is the, the things that you talk about in terms of nutrition and physical health and bone density that again, just don't occur to someone in their 30s and 40s, what really matters, because I now care about bone density and it's a little late.

A (14:12)

So gosh, we've reached our maximum like natural bone density. Not that we can't affect it, but like your maximum bone strength and muscle abilities are somewhere in our 20s to 30s, you know, and that was the time when I was not getting enough sleep, running around the hospital trying to raise a toddler in medical school, you know, like, like God only knows what I decimated in order to, you know, meet my goals for education. But then as I've taken care of my grandmother and my mother, you know, and watching how my aunts, who most of my aunts had cancer and died before the frailty and before the dementia. But if they run the cancer gauntlet, right, this is on both sides of my family. My mother and my grandmother didn't get cancer, but, and they don't have heart disease. They didn't have heart disease. They had horrible frailty, like loss of independence, requiring long term care because they could not take care of themselves. This was not what they wanted. They did not want to go down this way. And my grandmother and my mother, my mother right now is in a memory care unit, completely frail, has fractured multiple bones and lives in constant pain and can't remember my children's names. And so when I think about that and how I do not want that and I don't want to scare your younger listeners but, like, they're probably going through some of this with their grandparents or whatever. I'm like, this doesn't have to be your biological reality. And so what works? What do we know works? Muscle is everything. I never understood this. Muscle controls your blood glucose. Muscle is what protects you against aging. You know, muscle, muscle, muscle. And muscle weighs a lot. So all those years I spent chasing the scale, chasing, being thin, and I had thin privilege, and I would, I would feel this joy when I got on the scale and I was down two pounds and my scrubs were loose. And, you know, and I'm like, you're an idiot. Like, like that was not helping you. Like, what, what really matters? And so something kind of magical happened across the menopause transition where I stopped caring about being thin and realizing that being strong was absolutely what I had to focus on in order to avoid the, the fate that my mother and my grandmother went through.

B (16:31)

And so we can. When. When we are thinking about taking time for yourself. It's one of the most crucial protective factors is caring about bone, like bone

A (16:44)

and muscle, because they go together. The butt musculoskelet works together. So strong muscles mean strong bones. When you pull on that tendon at the end of the bone, you are stimulating the bone to get stronger. So in a nutshell, that's how it works. Also vibration and jumping, and there's, there's fluid inside of the osteocytes that when you shake them up, they'll. That'll stimulate it too. So you'll see vibratory plates. I'm like, I'd rather you jump if you can. If you can't jump, a vibration plate is probably your next best thing. So, you know, lots of what we do. Adequate protein, adequate vitamin D. I mean, it's very, very basic, you know, but not focusing so much on cardio. Cardio is important, and I love Pilates for many things, but it is probably not your best bet. Like, if you want to be the most of efficient at protecting your bone and muscle strength, you are going to need to lift heavy weights. My children have told me I am an almond. I was an almond mom for most of their lives. Like, I would, like, put the noodles on the side for the spaghetti and, like, eat the sauce, you know, oh, my God. I did all the things to try to stay thin. It worked. But I was really probably sacrificing. Now I've, I've, I've. My bone density has improved. I'm not on medication for that. I am on hormone therapy, which is FDA approved for the prevention of osteoporosis. So, like, I'm doing all the things to try to avoid frailty and avoid dementia.

C (18:07)

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B (20:05)

Merit beauty dot com. Okay, so I want to spend a little bit of time on hormone replacement therapy and the specific hormones, because I think there's just still misinformation out there. Okay, so when we're talking about bone density and, you know, prevention of Alzheimer's and all of the symptoms that start to creep up. When does hormone replacement therapy even become a conversation?

A (20:34)

Sure.

B (20:35)

When is it helpful? When is it overkill?

A (20:38)

Go the ma. So bone density, specifically, I have better evidence for bone density. Than for dementia. So let me be clear.

B (20:45)

Right.

A (20:45)

And brain fog is very different than dementia. Right. And we'll talk about the difference.

B (20:49)

Yes.

A (20:50)

So for bone density, the most rapid rate of bone loss is in perimenopause. Okay. We don't have, no one studied perimenopause yet, by the way. We don't have a large scale study on the treatment of perimenopause in the history of the world. And so that's crazy. Yeah. So a lot of it is anecdotal. The menopausy docs getting together. What does the menopause society say? And we know that in perimenopause, we know for mental health, hormone therapy is more effective than SSRIs for a new diagnosis of anxiety or depression. And you're perimenopausal, you should try hormone therapy first. Not to say you won't need an ssri. There's no reason to get off your SSRI if you're on it and you're doing well. I'm not saying that, but, you know, we are starting those patients on menopause hormone therapy, not birth control pills. Very, very different. If you need contraception, if you are having heavy bleeding that is disrupting your life, birth control pills can be really helpful short term for that type of thing. But if, if, you know, your husband had a vasectomy, your cycles are still, you know, not bothering you, you know, and you're having sleep disruption, you're having hot flashes, you're having mental health changes. We're starting, we're doing menopause hormone therapy, which is estrogen plus or minus progestogen. Progesterone turns out, is great for sleep. So for bone health, we know for a postmenopausal woman, it's prot. Your bones for as long as you take it. Forever. Okay, forever. And the earlier you start, the better. We don't have a study saying, okay, if you start in perimenopause, but it makes sense. So I just tell patients like, most likely we're protecting your bones. And I'm encouraging patients to get a bone density. As soon as you realize you're perimenopausal, you need to know what your baseline is. Insurance probably won't cover it. That young, out of pocket. Most places you can get it for around a hundred dollars. And I feel like it's worth the investment so that, you know, I've never seen a woman more motivated when she sees if she's got osteopenia or osteoporos. All of a sudden her habits kick in. Like, she's like, holy shit. You know, like, I didn't see this coming.

B (22:47)

And you can still get out of osteopenia, but not osteoporosis.

A (22:52)

Oh, yeah, I, we, oh, I get patients out all the time or improve their bone density. I mean, they, when you lock and load and do the habits, I mean, the studies are clear. The lift more trial looked at osteopenia osteoperson these women in their 60s and 70s and they did weight training, you know, squats. They like would jump up to a pull up and let go and bounce. You know, they had a very specific set of exercises and within seven months they'd improved, you know, percentage points on their bone density, which is huge. We know for osteoporosis it's protective. They have less fractures, they have less, you know, and so also balance training is important. So I love Pilates and yoga for that because if you don't fall, you tend to not break as much, you know, and so, you know, everything works together. For brain fog, you know, anecdotally, we know hormone therapy can be very, very, very effective when you take some of the chaos out of perimenopause. By stabilizing with hormone therapy, brain fog will get better. Brain fog is I don't know where I put my keys, right?

B (23:52)

Yeah, yeah.

A (23:53)

Dementia is I don't know what my keys are for. Big difference. Okay. Brain fog gets better in postmenopause. Once those hormones stabilize, brain fog tends to clear up. Okay. Unless you're on the path to dementia. Dementia is a disease with symptoms in old age that starts in midlife. The plaques start really getting laid down in midlife. You know, what do we know are the most. What can you do to intervene hormone therapy if you're high risk, if you have the, if you have the gene, which only 2 or 3% of us have. So the APOE 3 or 4 gene, menopause hormone therapy in those patients seems to be protective. However, we don't see it across a general population. Okay. It's kind of a net neutral, so I'm not going to use it to prevent dementia. However, the things that prevent dementia, also prevent heart disease, also prevent obesity, also prevent bone density changes, you know, regular exercise, both cardio and, but specifically for dementia, hearing loss. So. And here's, here's the cat. I just read the study and it went viral when I did a thing on TikTok, a study just got came out last week looking at estrogen receptors across all the auditory so from the cochlea all the way to the auditory processing center in the brain, estrogen receptors are everywhere. And so. And women are having acceleration of what they were calling age related hearing loss, but it was ramping up across the menopause transition. And hearing loss is one of the biggest risk factors for dementia. And so, yeah, and so we're like, wow, you know, it's related maybe to the hearing loss. It just, it's so fascinating when you think of it.

B (25:36)

It's so fascinating because it just all comes down to, well, this is all feeling very women related when estrogen's involved. So it feels like, I mean, thank goodness now studies are being done. But what if people still have this fear of they hear estrogen and they think cancer?

A (25:56)

They shouldn't. They absolutely should not. Okay, that was a genie got let out of a bottle with, you know, I don't want to demonize a study. You know, you're a scientist. It's like we have tons of data that came out of that study. Data I use every day, all the osteoporosis data, the heart disease data. It's just a data set. The way that it was interpreted and introduced in an almost viral fashion before the Internet really, really, really skewed, myself included. I was scared of giving hormone therapy was the last choice, you know, because I was worried I would hurt her. But now we know that that data doesn't hold up. That for the vast majority of patients, the, you know, overwhelming majority of patients, hormone therapy, the benefits will far outweigh the risks for most women.

B (26:41)

Okay. I just needed that to be said because that, that still comes up a lot for people. And I think a lot of my friends have said they've talked to their doctor and their doctor's like, it's, it's not. That's like a last resort. And I'm like, what?

A (26:58)

So if your doctor is not certified by the menopause society, remember, we're not teaching our residents right now anything clinically relevant about menopause. Okay? There's, there, there's pushes. Different states are trying to mandate menopause education and ACOG is fighting back and saying no. American College of OB gyn. Who? The abac. American Board of OB gyn. So like, they are fighting this. Listen, they have a lot to do. Gynecology is hard, okay? Like, of course we got a lot to do. Taking over all of women's health. We need a separate specialty just for the health of women outside of the breast and uterus. You know, like, I have an A. And all this, but no one taught me about this or this or, you know, and like, I can't deliver babies and do surgery and take care of her bones and her brain and her heart and everything else. So anyway, there's a problem. So if you're wonderful OB GYN or internist or whoever, if they haven't sought out training and education outside of, like, what was offered to them by the traditional Western training programs, they're not going to be that helpful.

B (27:58)

Okay, now I want to talk about sex. Because what I hear over and over is, and. And I think after learning a little bit more, a lot of the things that women interpret as busy, tired, momming, family life, kind of tired of their partner, you know, like, not tired of them, but just like, been there, done that, maybe is related to changes that are going on inside their body.

C (28:33)

It could be that are impacting.

B (28:35)

What do you hear?

A (28:36)

So when we talk about. And there's great books written on this, you know, come as you are, she comes first. You are not broken. Kelly Casperson. Like, the work done by the female urologist is incredible because they were treating men and women and realizing there is a huge discrepancy here. Like, we got 37 products for men's sexual dysfunction, and we got two for women, and no one knows about them. And so when we look at a female, you know, patient comes into me and says, I'm struggling with sex. I'm like, okay, there's five buckets. And they can overlap as to why. So we have relationship disorders, right? Like, do you feel connected? Do you. Do you feel supported? Is this, you know? Yeah, I. No. No medication is going to fix that, right? So, like, is this a person you would want to have sex with if something else was different, you know? Okay. No, I hate him. I mean, I'm like, well, then I'm like, okay, you don't need a prescription for me. So then we have arousal disorder. So that is lack of blood flow. So, like, when we think about, you know, it's much easier to explain in a man, but, like, the clitoris is the exact analogous to the head of the penis. So are you getting enough blood flow to the area for us? We need mucus, right, for lubrication. So enough blood flow to make enough mucus production, like, come across. Is the clitoris becoming engorged so that it can be stimulated. Like, all these things have to happen in the pelvis, right? So arousal is the physiologic response to a stimulus, right? And so then we have pain. So if it hurts. Your brain doesn't want to do it in general, right. You know, if it's uncomfortable, this is supposed to be fun and pleasurable and, you know, something you want to do. And if you're having pain from the process, and for menopause or low estrogen states like postpartum, like hypothalamic suppression and even long term birth control pills, we will lose architecture in the area, like the thickness, the elasticity, the mucus production all declines and it becomes this red, raw, rough area that, that is not incapable of giving you pleasure. And so you don't want to be touched. Right. And so that we have to fix the pain. So if she's having pain, that is number one. We must get this worked up and figure out is this gsm, general urine syndrome of menopause or low estrogen? Is this vulvodynia? Is this something else? You know, has this been going on your whole life? Has it ever been pleasurable? Did you ever, you know, and then we have desire. So desire is what happens in the brain. And so that is all of the neurons and synapses and hormones saying, this is a good idea. I want to do this. Okay? And so there's spontaneous desire, which is you wake up and you want sex. Okay. You don't need a stimulus. You're just like, yes, this seems. Yes. You know, you don't need a partner. You know, you can masturbate or figure out your own situation or whatever. But like, yes, this is good. And then, and then there's reactive desire where you, you receive a stimulus. It could be doing the dishes. It could be, you know, whatever. You watch, you watch heated rivalry.

B (31:50)

You.

A (31:51)

Which seems to have, let me tell you, my patient population. It is a thing.

B (31:56)

Oh, it is a thing. It's huge.

A (31:58)

Like, and I'm all for it. Like, for science, I had to watch it. And I was like, okay, I agree. And you know, reading something spicy, whatever, whatever, you know, and so that is reactive. Like, you got a stimulus and boom, here it was. And so we have different approaches to each of that. So if it's arousal, like your brain is like, yes, I want to do this, but you just can't get the juices flowing in the area. That could be a diabetic problem. That could be a blood, you know, some blood flow. You could have atherosclerosis in the area. Like, we have medication for that. Viagra. Put Viagra in the vagina. It works great. It dilates the blood vessels just like in a man's penis. So you know, Viagra works for that. For desire. Testosterone, like giving you back physiologic levels of testosterone for about half of women can be miraculous and feel really, they'll feel like amazing. And they're having sex dreams again. They're having, you know, spontaneous thoughts. They're initiating sex for the first time in 20 years.

C (32:55)

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B (33:53)

Okay, what supplements are Buyer beware versus

A (33:57)

buyer get it now, Nothing cures menopause. Nothing. No supplement will cure menopause. So by. No, just stop. You know, there's a lot of pink, pink washing, mena washing. So where something, you know, like here's, here's the supplements. I talk to my patients about how much fiber are you getting? We know for your brain, your heart, your gut health, fiber is critical. And most women in the US are getting 10 to 12 grams per day. Now. Now caveat, I sell supplements, so take all this with a grain of salt.

B (34:31)

All right, I take your supplements.

A (34:33)

Thank you. And so our 25 is what we need for gut health, 32 to 35 for women, for cardiovascular health. And so if you want to max out, you need to be hitting 35. And if you're struggling with that, a fiber supplement can help. But the vast majority should come from food. And if you can get it all from food, you don't need a supplement. Okay? We're supplementing a healthy diet here, not taking magical pills to cure an ill. And then you go, then you go through the drive thru. No, it doesn't work like that. Second of all, most of us are deficient and low in vitamin D or deficient. Okay, so Y30 is deficient, like below 30 is deficient, but optimal is 60 to 100 and so quite often, probably 80% of our patients will need to supplement with a vitamin D to get them to the optimal level. So that is something we recommend in our product. We combine it with vitamin K to increase absorption and with, with omega 3 fatty acids because they're super easy to package together and it's a powerful antioxidant, anti inflammatory. I'm really, really impressed by the studies done on menopausal woman Abby Smith Ryan out of North Carolina on creatine, especially those of us who are fighting to hang on to muscle and doing the training. Taking creatine will not make you grow muscles. That's not how it works. But it does seem to be synergistic when you're doing the resistance training for muscle recovery. And there's better studies coming out now on possible brain health as well, cognition and speed. And so we have a product called Mental Multi that I worked on for a year and it's got B vitamins. So many of my patients had elevated homocysteine and they're struggling either MTHFR or something, they've got one of the genes and they're struggling to process folate. And so we put the really high quality B vitamins and folate in there. We added coenzyme Q10 10 for heart health, for the studies done in menopausal women on heart health. And then we added genistein, which is the antioxidant that comes out of soy. So it is, you know, and heavy, you know, soy based diet. And it's been studied in menopausal women for bone health and for hot flashes and stuff. And so, you know, we're super proud of that product, but it's not curing your menopause. We're not going to resuscitate your ovaries with any of this. Like you said, there are things about this phase of our lives where we can shore up up certain areas that are gonna like, hit brain health, hit heart health, hit gut health, you know, and it all works together. And when all that's healthier, everything flourishes, everything does better.

B (37:05)

Yeah. Okay, so what are the most important points that we haven't touched on when you're cap because you have a captive audience right now of mostly mothers. I'm so grateful for anybody who isn't who's listening as well. But I think for this topic and also this podcast in general, it's a lot of moms listening and who have not necessarily hit this season, but are on route or in the middle of it and don't know it. What would you want them to know other than what we've talked about, of course. And your book is gonna have it

A (37:37)

all this is coming. Don't be scared. You know, there's so many tools out there to help you navigate this. And just trust yourself. If you're like, something's not right, something's not right. I don't know what it is. And not everything is perimenopause, right? Like, you deserve a conversation. You deserve someone to pay attention to you. You deserve to be able to walk into a clinician's office and being taken seriously.

B (38:01)

I mean, I'm gonna end with that. But I will say, even though not everything is perimenopause, I felt like as soon as like sort of this conversation started, my brain went through like the last decade of my life and I'm like, oh, the frozen shoulder. Oh, the overwhelming feeling that I was being heated from the inside, even though there was no sweat. And my brain wasn't like, that's a hot flash. Because at 44, my brain was not thinking there would be a hot flash. Like, that's too young in my mind. But it turns out, you know, and the brain fog and the difficulty going to sleep and all of the things. So I do think, for me, what you have done is a gift of helping us realize we're not going crazy.

A (38:48)

And if that's all I ever do for anyone, my job is done, you know, Like. Like. Cause I felt crazy for so long and I, I deserve so much better than that. And just constantly second guessing myself, always feeling like I had to ask permission for everything. You know, may I do this? Can I have that? Can I change jobs? Can I? Can I? Kinda can. And I'm like, no, you're a big girl and in charge of your own life.

B (39:14)

It's a funny moment when you realize that. And for me, I was like, it wasn't the, you know, being an adult, it wasn't having kids. It was very recent that I was like, oh, wait a second, this is it. This is. It stops here. I get to decide these things because we just aren't sort of programmed that way.

A (39:33)

And you know, for your listeners, I know I'm in a place of privilege. My kids are healthy and you know, they've had the normal, you know, both had adhd. We were able to like, find resources and navigate and they're just thriving as adults. And they're so much fun and they're so beautiful and they're just so happy and, you know, and I Just I hope that for everyone.

B (39:55)

Well, I'm sure they're like gonna be incredibly fluent in this.

A (39:59)

Well, they're very embarrassed. My kids have a joke

B (40:02)

that's funny, but my kids who are younger than yours. But, but. So I have 19, 18, 16 and 15 and they have a joke which is in the. When they see me in a conversation with someone in this. Right. Again in this season with my girlfriends. They're like 5, 4, 3, 2. Menopause. Because they just know it's going to

A (40:26)

come up so funny.

B (40:28)

But they're certainly aware of it. Okay, thank you so much. I'm going to put all of your resources in the show notes. Everybody can follow you on Instagram. They can get your book the new Perimenopause. I am so grateful that you wrote this book. If I had had that book, everything would have been just like the transition would have been smoother. And I'm so grateful that you did this for women. Thank you. Thank you for listening. I hope this was is empowering so that you can take charge of your health and take care of yourself, which is so critical to your children's well being. So I hope that double motivates you. If you enjoy this episode and you want more of this kind of content, let me know. You can always DM me on Instagram @Raising Good Humanspodcast. You can subscribe to my free substack newsletter. Dr. Lisa Pressman, substack. You can do my monthly substack group for 4.99amonth. We just have a very intimate live zoom together once a month. And if you're in the mood and you're really feeling generous, go ahead and give me a five star rating and a little review on Apple Podcasts. Go for it.