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. Jillianne Woodruff. I'm a board certified gynecologist, sexual medicine expert, and nationally certified menopause provider.
00:35
Dr. Ade
And I'm Dr. Aday. I'm a doctor of nursing practice, functional medicine expert, obesity and metabolic health specialist. And we're here to give you science backed strategies and real conversations to empower your midlife health journey. So it's time for a new segment, Midlife Myth to Modern Medicine, where we break down common belief that's floating around and replace it with science backed truth every woman deserves to know. And wow, today's myth is really a good one because it's what so many women out there believe. Even highly educated women, health conscious women.
01:12
Dr.Jillian
That's right. I was actually so shocked by this one. A very well educated, successful female friend of mine, she shared this with me and she thought that this is what happened right before menopause. She said that she had heard from a friend of hers that the year before you go into menopause, you bleed continuously for a full year and then your period stops and bam, you're in menopause.
01:39
Dr. Ade
Wait a minute, a full year of bleeding? Wait, no sex during that time? That sounds miserable and really off base. So what really surprised you was that other women had heard the same thing or.
01:55
Dr.Jillian
Well, I did start to ask around because I was wondering exactly that, like, is this a one off or do other people think this? So I started to ask and people had said, oh yeah, I heard that too. Really, really shocked me is when I asked my younger sister and she said, yes, I absolutely heard that you bleeped for a full year, no sex and. And then there's menopause. But of course she had talked to me, she said, and realized that this was a midlife myth and not in fact, the truth wasn't modern medicine. So we need to clear this up.
02:27
Dr. Ade
Okay, Jill, well, this is the time that we need to shout it from the rooftops and really bust this midlife myth and replace it with some modern medicine. So is there any truth to this idea that someone could bleed for a year straight before menopause? Is this really true?
02:45
Dr.Jillian
So yes and no. What it gets wrong is that you Bleed for a full year, and then that somehow means that you're in menopause. That is absolutely not true. What can happen is that your periods can change during perimenopause. They can become lighter, they can become heavier, they can be shorter, they can be longer. But a period that lasts more than seven days is abnormal and should be evaluated. And I think one thing to keep in mind is just because there may be something that happens to you that is common does not make it normal. And so we do need to make sure that you're getting checked out during this time. This is called if you have bleeding that lasts for more than a typical period. This is dysfunctional uterine bleeding. Dysfunctional. It's right in the title. This has to be evaluated.
03:33
Dr. Ade
Yeah, I bet you see this a lot, Dr. Janelle, in practice. And sometimes I come across this and I tell women, yeah, you're having more bleeding. This could be perimenopause. You know, this is something that might need to be evaluated by your gynecologist. So it's so important to clarify. Just because it's common doesn't mean it's normal. So tell us more about this dysfunctional uterine bleeding. What is it? What causes it?
03:59
Dr.Jillian
What makes this more common during perimenopause is that fluctuation of your estrogen and progesterone hormones. So these hormones really fluctuate wildly during this time. Sometimes they're quite high, sometimes they're quite low. The other thing is that each of your cycles where you normally would have ovulated each month, some cycles you may ovulate, others you may not. And so these cycles become more estrogen dominant. The progesterone is what leads to you shedding that lining of your uterus and having a period. And when the divide between the hormones, hormone levels, so let's say your estrogen goes up really high and your progesterone is more on the decline. And so the estrogen leads to a building of the lining of your uterus, and then when it sheds, there's a lot of bleeding that happens.
04:48
Dr. Ade
Makes so much sense. And as you're heading towards menopause, with all the yoing of the hormones like you just described, it's no wonder that women start to get a lot more bleeding. Especially they have other issues, you know, like fibroids and things like that, which could probably worsen with more estrogen. So. So if someone's bleeding is changing dramatically, they shouldn't just write it off as getting older, right?
05:12
Dr.Jillian
That's right. And what you just mentioned you brought up fibroids. That's an important one. And probably more than 50% of women have fibroids of some size. Some may be very small, may not cause any issue. But one of the things that happens when that estrogen goes higher is that it can lead to fibroids growing larger and then lead to you having bleeding. So, yes, thank you for bringing that up. There's also polyps. Estrogen can make polyps grow, polyps can lead to bleeding. And there's also things that are not so good that cause heavy bleeding and you're more at risk for as you age. So those sorts of things would be atypical cells within the uterus or even a cancer within the uterus.
05:51
Dr. Ade
So.
05:52
Dr.Jillian
Absolutely, that has to be checked out. There's other, you know, more impact. Right. With their heavy bleeding that lasts for a very long time. If you're having a lot of blood loss, then it can lead to an iron deficiency anemia. And interestingly, you know, a lot of the symptoms of an iron deficiency are very similar to perimenopausal symptoms. So it really does take an expert to kind of figure out what is causing what, you know, or are they all leading to those same symptoms of fatigue and brain fog or even shortness of breath, walking upstairs where you didn't have before?
06:28
Dr. Ade
Right, Yeah. I mean, so glad you brought that up. But at what point, I mean, now that we've clarified that it's not bleeding excessively for a year that leads to menopause, I mean, what would you say for women that experiencing this but don't necessarily want to take the next step? I know some of the things you could probably do is maybe get a hysterectomy. I mean, how do you mitigate that where there's so much bleeding and it really starts to impact your quality of life?
06:54
Dr.Jillian
Yeah. I think sometimes, actually, people may be afraid that only a hysterectomy will be recommended for them. And so maybe that would prevent them from talking to a medical provider about this because they don't want to be told that, hey, it's a hysterectomy, that's what you need. Right. But you're right, there are so many other treatment options. An evaluation, first and foremost. And the evaluation you should have bleeding, you know, lasting longer than your period. And you'll keep in mind there's always one off. Somebody may have an abnormal cycle one month and be completely fine the next month. Right. So it's not that, oh, I've had one period that Lasts for eight days. I need to run and be checked out? No, not necessarily.
07:35
Dr.Jillian
But if you're having bleeding after sex, if you're having bleeding between periods, or if you're having periods, you know, on more than one occasion that is heavier and lasting longer than usual, then you should be checked out. And treatment options would have to do with what we find in that, you know, evaluation. So if we didn't find anything and there is no precancerous or cancerous cells, then hormonal medications may be the way to go. And that may be just progesterone to match that level of estrogen and keep that stable. Progesterone also thins the lining, which is nice, so you don't shed as much. There's different types of progesterone. It could be birth control pills. This is a place where birth control pills can come in and stabilize the lining, thin the lining, stop your period.
08:25
Dr.Jillian
Aside from that, it would be if you have fibroids or polyps, then there'd be surgical options to remove those or to shrink fibroids. There's other procedures that you could do, some very minimally invasive procedures. And there's also, like I said, if you're approaching menopause, it would be stabilizing with that progesterone. Now, what if we find nothing or the bleeding persists, or you are not a good candidate or can't tolerate or don't want hormones? Then there is a minimally invasive procedure called a uterine ablation. And that ablation is a removing of the lining of the uterus. It's a procedure that typically can be done in your gynecologist's office. And this would significantly decrease or sometimes eliminate your periods without the use of hormones, which is really exciting because some people do not want to additional hormones at this time or at all.
09:24
Dr.Jillian
And so this is a way that you can take care of it. And then there's also, like you mentioned, a hysterectomy, which would be permanent, of course, permanently stop your period. Right. That's the only permanent method for stopping periods.
09:38
Dr. Ade
I think this is powerful. It's so important for women to really be empowered with information, correct information, that it's not okay for you to just bleed endlessly until you get to menopause. But there are different reasons, and I hope that this is really resonating with women out there, that if you do have signs, like what we mentioned, iron deficiency anemia, that could be also a perimenopause symptom, you know, shortness of breath, Dizziness, brain fog, you know, these are signs that maybe the bleeding is the cause. But, you know, if it's not hormones, if it's not that you need a, you know, a surgery like hysterectomy, there are options for you to be able to live and not bleed every single month for weeks and weeks at a time. So that's great that we know what those treatment options are.
10:29
Dr. Ade
So how often do you come across something like this where women wait until things are pretty bad? Is this something that you come across pretty often?
10:39
Dr.Jillian
Yes, I would say, yes. I wish it weren't so. But I would say that usually when people do come and let me actually say, I think some people may realize that they have a problem or something could be a problem, but they may have actually talked to somebody and, you know, been told that this is in their head or they didn't listen to them, you know, and so that's normal. They're told it's in their head. They're told, wait and see. And so I think that's why it's so important to see a hormone specialist. And it's hard to know, like, is this hormones or is this not. But finding somebody, a provider who will listen to you.
11:18
Dr.Jillian
And I know that, you know, the providers I work with that are not hormone specialists, the ones I really respect are those that listen because we don't have all the answers. We have to listen because, you know, the patient usually has all the answers. Right. They just have to put it together. So. So you listen and then you think, okay, how can I help this person? I may not have, you know, the knowledge for this specific situation, but I can find the person that does. And that's what I do. You know, in my office, there's a lot of things that I may come across. I'm like, this is outside of my area of expertise, but I know who I can send you to that can help you with this problem.
11:55
Dr. Ade
Yeah. And it's so important, right? Like starting with a hormone specialist, so important. Someone who can evaluate your symptoms and not just look at just one aspect. I can tell you from practice, women that have been diagnosed with depression because they're just low energy and they don't have the get up and go to go do the things that they want to do. But is it really depression? Is it clinical depression or is there an underlying root cause? So it's important for you to make sure that you are getting evaluated. You're collaborating, like you said, with providers that speak to each other and know when it's okay to say, well, I don't know what's wrong with you, but hey, here are some potential causes, but I will send you to the person that might be able to help you.
12:39
Dr. Ade
You know, it's not great if you are dismissed or told to just wait it out because this is part of getting older. I mean, that thing just really irritates me when I hear it's just part of getting older. Just get out more and exercise more. But it's more than that, right, Dr. Jill?
12:55
Dr.Jillian
Absolutely. And I think I've seen that many times as well where people are get help with their mental health or they're sort of on medications for depression where that wasn't something that they had struggled with before, or even, you know, medications for anxiety where many of these may be symptoms that come from perimenopause or come bring this perimenopausal transition. Gosh, just think about the number of people that we could help if they have the information to advocate for themselves and to say, you know, I think there's something that is happening here that I need help with and not just a kind of a band aid, because of course there are people that truly do have depression and, you know, may need medication as part of their treatment strategy.
13:41
Dr.Jillian
But the real key is also, you know, working with your mental health providers and perhaps even educating them on the hormone aspect and they educate us on the mental health aspect so we can provide this, you know, all encompassing, comprehensive care.
13:56
Dr. Ade
Yes, yes, Very, very important. I absolutely agree. There is definitely a place for medication. But I always tell women, you know, when you feel, when in doubt, you just feel like, you know, this is not the answer. It's okay to get, you know, your questions answered and you should really feel at peace with it. But I really want to ask you, Dr. Jill, what. Why do you think, in your opinion, many women, smart, high achieving women, believe these kinds of midlife myths?
14:26
Dr.Jillian
Oh, simple. We've just never been taught, you know, we've never been taught about this. We haven't really started to talk about this openly. You know, older generations really kept this, you know, puberty periods. All of this was not to be discussed. And this is womanhood. You know, this is something we, you need to discuss with each other. And you know, you and I were walking through this right now and that's why we created this podcast so we could walk through it with a collective, you know, with a group of like minded women. And together we will help to educate on what we know and also get educated on what we don't know so that we could thrive, right?
15:09
Dr. Ade
Absolutely. And I think that we have definitely achieve some milestones generally as educators, as providers. I'm really excited to see stars, you know, like Halle Berry and other people that are starting to talk more about it, Oprah Winfrey. And you know, we've got lots of opportunities, different people using different platforms to talk more about it. So I think the biggest takeaway for us really is we need to keep talking more about it. There needs to be research about what's happening. What does menopause perimenopause look like? There's just not a lot of information out there. But I'm excited for what's on the horizon. It's starting from things like this, like the Modern Midlife Collective and many more people really talking about this. So let's give our listeners some clear takeaways. What should women know about periods and perimenopause?
16:02
Dr.Jillian
The first thing is menopause is defined as lack of periods for 12 months. That's it. So it doesn't matter what happened leading up to that. It's just that I've gone for 12 months without a period. That's menopause. Secondly, bleeding wise, if you are bleeding between periods, you are bleeding after sex. Your bleeding lasts longer than seven days each month. Your bleeding is heavier than what your typical bleed is. These are all things that should be evaluated and how having no sex for a year before menopause. No, that's definitely a midlife myth. That is not true. Dysfunctional bleeding, abnormal bleeding should be evaluated. So I would just advocate for yourself to get the answers that you need, which would include an evaluation to figure out why this abnormal bleeding or dysfunctional bleeding is happening.
16:59
Dr. Ade
Awesome. So basically the takeaway ladies midlife myth, you bleed for a full year and can't have sex before menopause is not true.
17:10
Dr.Jillian
No, it's not.
17:11
Dr. Ade
Awesome. Well, thank you so much. If this episode really helped you rethink what you thought you knew, share it with a friend you never know who needs to hear this right now and would love to hear what other midlife myths you've been told DM us or email us at connectodernmidlifecollective Dot.
17:32
Dr.Jillian
Thanks so much for listening and we'll see you on our next episode.
17:36
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.
17:45
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.
17:52
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.
18:00
Dr.Jillian
Until then, remember, thriving at 40 and beyond isn't just possible. It's your birthright. We'll see you next time.