00:02
Dr. Ade
Welcome to the Modern Midlife Collective podcast. The place where we get unapologetically real about thriving in midlife health, hormones, and everything in between.
00:12
Dr. Jillian
I'm Dr. Jillian.
00:13
Dr. Ade
And I'm Dr. Aday.
00:14
Dr. Jillian
Together we're your guides to navigating this powerful season with confidence, strength, and the wisdom you deserve. Welcome back to the Modern midlife collective. I'm Dr. Jillian Woodruff. I'm a board certified gynecologist, a surgeon, sexual medicine expert, and a nationally certified menopause provider.
00:36
Dr. Ade
And I'm Dr. Adeya Kendipe, Dr. Of nursing practice, certified family nurse practitioner, functional medicine, and hormone expert. And in medical weight loss.
00:46
Dr. Jillian
Today, we're adding our voices to an incredibly important conversation regarding menopause. People are finally starting to talk about this, but even with more awareness, there are still so many women who feel confused, overwhelmed, even ashamed that are being bogged down in misinformation.
01:05
Dr. Ade
Exactly. And this isn't about breaking the silence. It's about joining the chorus of women and providers pushing back against outdated beliefs and misinformation. So the more voices we add, the louder the truth becomes.
01:20
Dr. Jillian
That's right. So let's start with the basics. Dr. Aday. Menopause is a single point in time. It's defined as 12 months of having no period. So it is something that you diagnose looking back. So from the time of your last period, if 12 months have passed and you haven't had a period, you are now in menopause. And everything after that is called post menopause. The average age of this occurs is around 51 years old. But some people will go through menopause much earlier and others much later. But what most people experience. So the symptoms surrounding this time, they really occur during the transitional period leading up to menopause. And that is what we call perimenopause. In the perimenopausal years, as you know, maybe tell us a little more about that and how long that can last.
02:12
Dr. Ade
Yeah, Perimenopause really can start as early as your 30s or 40s and can last about four to 10 years. So it's when your hormones start to fluctuate. So your sex hormones, like your estrogen and progesterone start to kind of go up and down depending on what's happening. And that's when women really start to notice those symptoms. Like irregular cycles, maybe heavier bleeding, sleep issues, brain fog, weight changes, anxiety and hot flashes.
02:41
Dr. Jillian
Absolutely. That's what I'm seeing in my clinical practice, is that women start to have many symptoms and then they may not even attribute those symptoms to perimenopause or to menopause because they aren't the traditional hot flashes and night sweats. Even if you don't have hot flashes or night sweats, you could still be having symptoms that are attributed to these fluctuations of hormones. And I always think that this time of perimenopause before someone is menopausal are the most difficult periods to treat because the hormones fluctuate so wildly. So even symptoms that people had, maybe during their reproductive years, let's say, they suffered from premenstrual syndrome or pms, those become much more exacerbated during this time. So I'm always telling them, like, we're running after this roller coaster. Whereas in menopause, you're kind of like down in the valley, and nothing really changes significantly.
03:40
Dr. Jillian
So it's easier to make people feel, wow, like, feel much better.
03:44
Dr. Ade
Yeah. And because of the wide range of the timing where it can happen, one of the things we hear is, you know, patients will say, well, I didn't know it was perimenopause. Maybe they've gone to a provider and they've had some concerns. Some women are more in tune with what's going. Going on with their bodies are, and some are not. But they'll say, I went with these symptoms, and I was just told, maybe it was depression, maybe you're just having anxiety. And some people just feel like, you know, they're losing control of their body and maybe even their minds. So what reality is, it's hormonal changes. Knowing that we have receptors all over our bodies that can really exhibit different symptoms. So it can vary from woman to woman, right? Dr. Jill?
04:21
Dr. Jillian
Exactly. And, you know, I think what's really disheartening is feeling of just not feeling yourself and the feeling that you may be going crazy. And especially it's hurtful when you're told, oh, this is normal, or this is what's supposed to happen. This is aging. This does not have to be aging. And just because something is typical does not make it normal. And this period, I see that people really start to have severe symptoms that affect their work. And, you know, usually at this time, when you're in perimenopausal years, you really ascending to the top of your career, which takes a lot of focus and attention. You often have a very busy family life, which takes a lot of focus and attention. And these changes start to affect your work, your relationships at home, your work performance, your mental health, your quality of life.
05:16
Dr. Jillian
And that's why? Understanding what's happening in your body and what's changing is just as important as understanding menopause.
05:24
Dr. Ade
Absolutely. And we want to normalize having this conversation among women. You know, it's not something that only happens when you are older, like in your 60s. And it doesn't have to be just hot flashes and night sweats. You know, I remember that there is this viral. I'm not sure if it's that Dr. Jill, an African American woman who was sitting in the stadium and her head was smoky and she was having a hot flash on full display, and it was caught on camera and it went viral. So when we're taught that, you know, when you're having these hormonal shifts, that's what you experience, and it's not necessarily just that. Right. It can look different for everyone.
06:03
Dr. Ade
Some women will have no symptoms, and some women will have minor symptoms, while others struggle for years, you know, and unfortunately are not getting the help that they receive. So there is no one size fits all for, you know, that transition into hormonal journey.
06:18
Dr. Jillian
Such a normal process, you know, having these normal. I hate the word. Right, I just said it. But a typical symptom is the hot flashes. But can you imagine how that woman would have felt so embarrassed by something that is typical? And also, it's probably something that she may not have known that she could have done something about or that could have been prevented. And she probably was told that this is just what happens. It's a normal fact. Many people think that, you know, they may have hot flashes that go away after a year. And sadly, we know that for many people, this is not true. So this is why education matters. This is why we're doing this podcast. Informed Women make empowered decisions.
07:03
Dr. Ade
Absolutely. And even though it's a natural process. Process, Right. If it's leading to, like he said, if it's impacting your work and your life and your sexual life, your social life, definitely something needs to be done about it. You don't have to live it. Just because it's a natural process doesn't mean you have to live miserably either. So here are some key things every woman should know. Perimenopause can start earlier than you think. Symptoms are real and valid. You deserve to be heard. You have options. Lifestyle changes, hormone therapy, supplements, and much more to help you get through this journey.
07:41
Dr. Jillian
So let's explain what's really happening with our hormones during this time. I think that's really important to share. During perimenopause, your estrogen and progesterone levels fluctuate unpredictably. Estrogen and progesterone are produced by your ovaries. And so these levels are sometimes quite high and sometimes quite low. And I would say mostly it's the estrogen that's fluctuating, unpredictably high and low. But progesterone tends to just decline first. And this is the hormone that helps you regulate your cycles and also supports restful sleep. So as it lowers people during perimenopause, that time period leading up to menopause, they may experience unpredictable, irregular cycles. Sometimes it could be quite heavy because that progesterone level is decreasing.
08:34
Dr. Jillian
They come irregularly and then people may have symptoms that come from having heavy or prolonged periods, like low iron levels and anemia and low thyroid levels, also because it's affecting their sleep. When their progesterone levels are so low, they will have insomnia. And then if you don't sleep, I bet you're probably pretty irritable. And that certainly is going to affect your focus and concentration the next day. And the estrogen going up and down erratically contributes to hot flashes. So when those levels are low, you'll have hot flashes. You may have night sweats and you may not have those things. You may have the mood swings that come, the irritability that happens. The breast tenderness, that's something that I notice a lot at midlife in women who didn't have breast tenderness, maybe during their regular menstrual cycles.
09:29
Dr. Jillian
But now, all of a sudden, it's difficult even to shower because their breasts are so sensitive.
09:34
Dr. Ade
Oh, just listening to all of these things. Think about years of how women could experience these symptoms until they finally reach menopause. What we've talked about is that 12 period, 12 month period where you have periods, right? And once you reach menopause, your hormone levels, particularly your estrogen and your progesterone settle at much lower levels. Then you have no fluctuations at all, but that consistent deficiency, right? No estrogen, it leads to, like, vaginal dryness and bone loss, which is a significant thing for women as you get older. The changes in the skin, the vaginal dryness, the dry skin, the hair thinning and metabolism, which is one of the biggest complaints that I see in my practice.
10:18
Dr. Ade
It's like I'm trying everything I can, but I just can't seem to lose this weight, especially my midsection, where we start to accumulate extra visceral fat, which starts to lead to problems down the line with our control of blood sugar and Blood pressure and more.
10:33
Dr. Jillian
You're making this sound so terrible. But yes, hearing every single day, we're hearing this right. I can't lose weight. Women are really struggling. They're not getting answers. Being unable to lose weight or having increased weight around the midsection is quite typical of menopause as you're in perimenopause. So as those estrogen levels go down, you're preferentially storing fat around the midsection. And like you said, the issues with our blood sugar and our insulin sensitivity, we need estrogen, so our cells will be sensitive to insulin. Insulin is needed to carry our glucose into our cells to be used for fuel. And unfortunately, if we have increased or let's say decreased sensitivity to insulin, then the glucose just sits out there in our bloodstream. And I say it causes havoc. It damages our blood vessels and it gets deposited as fat.
11:35
Dr. Jillian
And then we start also having cholesterol issues. The list goes on and on. But there is hope. But one of the reasons this happens where you experience perimenopause and menopause in all parts of your body is because we have hormone receptors all over our body. And I think that's why some people may have symptoms, like we said, that they don't attribute to menopause. There are estrogen receptors in our brain, in our skin, in our blood vessels, in our heart. That's why decreased estrogen and increased hot fluid flashes leads to an increased risk of cardiovascular disease. Estrogen keeps our blood vessels flexible, dilated, so the blood can go through and get to all parts of our body. And when the estrogen goes away, our blood vessels become firm and rigid. And that's not good.
12:29
Dr. Jillian
Especially let's say if we have increased cholesterol and we're forming pox, like obstructions in these firm, rigid blood vessels, that's going to increase our risk of cardiovascular disease. We have estrogen receptors in our eyes. People start to experience dryness right in their eyes during this time. So not just vision changes, there's other changes that come from low estrogen in your eyes, skin. We discussed the vagina. Yes. Oh, urinary symptoms we didn't talk about. Estrogen is needed for our bladder. When we start having lack of estrogen there, you may start having increased frequency of urination. You may have just gone and used the restroom.
13:13
Dr. Jillian
And then a little while later you're going back and you're not having a lot of urine that you've avoided because your bladder is just kind of spasming and making you feel like you have to go to the restroom when you don't. So estrogen soothes the bladder. It's very important there as well. And then you, Dr. Day, do a lot of work in the GI system, and we know the importance of our hormones, our estrogen and our progesterone in our GI system that helps our metabolism of food and the motility of our intestines is super important.
13:52
Dr. Ade
Yeah, exactly. And I think it's one of the most important reasons why this education is so key. Because the hormones are changing. Right. We just talked about how you have receptors all over your body, in your heart, in your gut, in your brain. So there has to be a shift. As we're seeing these shifts happening in our hormones, we have to make sure that we're adjusting. So we'll talk about that more later. But the other important thing, too, is midlife women start to notice things like facial hair, assuming that they have high testosterone. People make assumptions because you have hair growth, but sometimes that's not the case. Right. So what's really happening is that your estrogen is dropping so that it throws things off balance. Think about things being in balance. If you have more of one, it can kind of throw things off.
14:38
Dr. Ade
So you start to see symptoms of high testosterone. So even if your testosterone levels are in a normal range or lower, the lower estrogen makes it more noticeable that you have the testosterone there. So it's about that ratio of necessary levels. And that's why with each patient, it's important that you're going to someone that can really understand what's happening during this stage of life. Lots of things being thrown at you. Again, don't lose help. There is hope. This might seem like there's a lot of things going on, but this is just the process. And it's just really good to be aware of what could happen in your body at each stage.
15:17
Dr. Jillian
You're absolutely right, Dr. Day. And you brought up a very important point about testosterone. And, yes, that's so interesting. I do hear from a lot of women that they must have high levels because they're having hair growth around their. On their face or on their chest, or maybe even they're starting to have acne that they haven't had since puberty. Right. Well, testosterone is a little bit different than estrogen and then progesterone. At this time, your testosterone levels start to decline. You probably mid to late 30s, they just start to go down as slowly. And as your testosterone levels decline, you have changes in mood. Testosterone also has receptors in the brain, and so it's responsible for actually helping us to stay calm. It decreases anxiety, decreases. It also increases libido, our desire for intimacy, even our ability to orgasm. Mental clarity.
16:18
Dr. Jillian
A big one is motivation. So motivation to exercise, motivation to do something new that is very important and attributed to testosterone. A lot of people think of testosterone as a male hormone, but as we know, testosterone is the hormone we have in the most abundance. We have more testosterone than we have estrogen. And also, testosterone is not just produced in the ovaries. So even after menopause, we should be producing testosterone like in our adrenal glands, that's it. On top of the kidneys and also in our peripheral tissue. But those levels are going down. And as they go down, like you mentioned, that ratio of estrogen to testosterone is not at that perfect level. We went. So it makes it seem like your testosterone level is higher in the bad ways and unfortunately not in the good ways.
17:20
Dr. Jillian
As people start having lower libido during perimenopause, lower desire, more irritability, lack of patience. Those are all very typical symptoms of a decline in testosterone. And this isn't just happening for women. This is also happening for men. They also have a decline in their testosterone levels, which is typical, but they have much higher levels than we have. So we have about 110 of the amount of testosterone that they have. And so their symptoms are going to present in very different ways. So, as you said, it's important to have this discussion with someone who understands hormone balance as a dynamic relationship that's not always just the same. And also just not a numbers game. There's not like a special number that you need to have. Your hormones are really unique to you, and the levels you need are also unique to you.
18:21
Dr. Jillian
So there are some levels who are like, oh, absolutely abnormal. And then there are other things that may be within the normal range, and they call it normal at the lab, but it's just that you're within the average range. But what you need for your optimal health may be different than what your friend needs for their optimal health. And your symptoms may be different. So the way in which we would manage your hormones are really going to depend on what you need to feel your best, what symptoms you are experiencing at this point, particular time in your life. And also the different, you know, medical risk factors that you have are going to be different than somebody else. So how can we optimize your health, decrease risks you have for chronic disease and make you feel your. Help you to feel your best self?
19:14
Dr. Ade
Absolutely. And I think that the first step Right. Is realizing that the change is happening and being, you know, getting the perfect personalized care that you need so that you can feel your best self. And not just feel your best self, but also learning how to live in this new body as you get older with the different changes that are happening. So I think it's really important. I think what you mentioned as well about the testosterone is the confidence that it also gives you because it is something that I noticed when these women come in. It's like you start on the testosterone replacement you and you start to feel better, more confident, more motivation you talked about. So these are things that if you remember when you were younger, you probably had this but didn't realize it.
20:00
Dr. Ade
You start to wonder what's wrong with me? How come I don't have that same drive like I used to getting up in the morning, it's a little bit tougher, you know, or that afternoon fatigue just to keep going for the rest of the day. So these are some things that you can start to think about. Are you experiencing these symptoms? If you are, definitely it's worth going in and seeing someone. And if you're being told that your symptoms are normal and you're feeling like something is off, definitely get somebody to check it out. I think it's worth looking to see if this is something that would benefit you.
20:29
Dr. Jillian
Don't let people tell you that you're too young or just to wait it out. That delay in support can just lead to worsening symptoms and unnecessary suffering. In my opinion, women deserve to understand what's happening in their bodies and deserve to have options for treatment and a timeline for monitoring. If that is the route that you choose, you need to know the options. Hormones may not be right for everyone at all times, but you need to be given the options for what you can do to help you feel your best self. Menopause isn't a quick conflict that you fall off of. It's a transition. It's also a chance to reevaluate your health and your well being. It's a time to prioritize.
21:18
Dr. Ade
Absolutely. So we'll be covering a lot of this in detail throughout this podcast, introducing myths, treatments, and the science behind what actually works.
21:28
Dr. Jillian
We believe that menopause is your most empowered chapter yet.
21:32
Dr. Ade
Thank you so much for listening to the Modern Midlife Collective. If you found this episode helpful, share it with a friend who really needs to hear it.
21:40
Dr. Jillian
Join us next time. Our next episode, we are going to tackle some of the myths associated with menopause and with hormones. And we are going to set the record straight. So thank you for listening and we will see you next time on the Modern Midlife Collective.
21:57
Dr. Ade
Thank you for tuning in to the Modern Midlife Collective podcast. We hope today's episode has inspired you to take bold steps towards thriving in midlife.
22:06
Dr. Jillian
If you loved what you heard, please leave us a review and share this episode with a friend who's ready to step into their power.
22:13
Dr. Ade
We'll be back next week with more insights, strategies and real talk to help you live your best life at any age.
22:20
Dr. Jillian
Until then, remember, thriving at 40 and beyond isn't just possible. It's your birthday, right? We'll see you next time.