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The other P word revisited

[00:00:00] Hi everybody. It's Monday and I am back in the office for two weeks. So I decided we were heavy on the OB B last week. So you know we're gonna talk about gyn. I have my coffee here. There's a reason that I want this as an illustration. We're gonna talk about perimenopause and menopause. This is like multiple parts we need to discuss. 

So today will be a small part of it. So this is more, um, definitions cuz I find that there's a lot of confusion about perimenopause menopause. Menopause is defined as one year with no period, one year with no period. Let me qualify in a woman who, um, It makes sense that she would be in menopause, meaning you could have one year with no period. 

When you're 18, you are very unlikely in menopause. There are multiple other reasons that could be causing it. So we are talking about women in the age range during which menopause would be more common. Most women will go through menopause at 51, meaning 51 1 year with no period. Perimenopause is that [00:01:00] annoying period of time that precedes. 

They talk about it as the time that surrounds menopause, meaning preceding menopause, and it can last up to 10 years. So in a previous post, I called it the other P word, because you all ladies seem to be so pissed off whenever I mentioned the P word. Everyone's like, does that mean I'm getting old? The answer is, you're getting whatever you're getting. 

I don't know. But you are not getting old just cuz you're in perimenopause. Because perimenopause can start at 40 or 41 or even earlier, meaning 10 years before you go through menopause. Let's say you were destined to go through menopause at 49, which is still within the norm, 39. You might start having perimenopausal symptoms. 

What would those be? They could be as mild as, gosh, I'm really moody right before my period, or, Ugh, my boobs really hurt. Or, God, I'm having really strange bleeding. And strange bleeding could. Heavy bleeding, light bleeding, longer bleeding, shorter bleeding, missing a period, getting a period every two weeks. 

So I say to patients, anything could happen when it comes to perimenopause with regard to bleeding. Literally anything [00:02:00] heavier, longer light or shorter, anything could happen. So if a woman comes to me and she's. 38, 39, 42, 44 in that range and says, Ugh, my period's kind of strange and again, my boobs hurt. 

I'm wanna kill my family. Right before my period, I'm getting a little bit more acne. I'm feeling my ovulation a little bit more, or I'm having a twingy pain on either side a like two weeks before my period. Any of those symptoms coupled with things like God, I feel like I can't gain lose weight. I feel like I'm getting a little bit more weight around my. 

I will say to her, you know what it sounds like, and she'll often say to. , you're not gonna say perimenopause, are you? You know what I'm gonna say back? Yeah. I'm gonna say perimenopause, not because I'm trying to define this as some period of time where we're all getting older, but because I find that, first of all, knowing what the likeliest situation is, is comforting. 

But also I find that when we can say, listen, all of us are kind of going through the same thing. And if you have a complaint to a doctor and a doctor can pretty quickly be like, oh, I [00:03:00] think this is what it. . That to me is always so much more calming than, oh, I don't know what that is. That sounds weird, right? 

So we don't wanna hear that. Now when I say, oh, it's likely perimenopause. It's never likely perimenopause done. It is, Hey, it's likely perimenopause. I cannot prove perimenopause. I can only disprove the other things that it could be, for example, thyroid dysfunction can present with. Weird period, mis period, heavy period, light period, all those things it can present with mood changes and weight gain, right? 

So I have to rule out thyroid issues. Often you'll have just seen your internist a couple of months beforehand, so they will have done your thyroid, but if they haven't, we can easily send you for your thyroid. Second is if you're bleeding is anything more, then we need to prove there's nothing else. So what I say to patients, in perimenopause. 

Anything less, meaning lighter bleeding. Shorter bleeding, less frequent bleeding. Great. That's not dangerous. Make sure it's not your thyroid, but then you're [00:04:00] fine. But anything more meaning heavier, longer, bleeding in between periods, still likely nothing. Still likely perimenopause, but has to be ruled out. 

How by having a pelvic ultrasound that looks at the lining of the uterus to make sure that there isn't anything in there that shouldn't be in there. And that's my kind of, um, gracious vernacular for shouldn't be tumor in the lining of your uterus. Let's assume the lining of the uterus is thicker than it should be then. 

It doesn't mean there's something bad. It means that your gyne. Might have to do other tests, a fancier ultrasound to see if there's a polyp, an endometrial biopsy to prove there's nothing in there. If you hear the word biopsy, do not run for the hills and freak out because in this setting, it is really of the variety of, gosh, I'm pretty sure there's nothing in there, but your lining looks thin. 

I mean thick, so I need to prove there's nothing by doing a quick endometrial biopsy, and it literally looks like a skinny little. That we put up into the lining of the uterus, scrape, scrape shape for 10 seconds, as I [00:05:00] usually say, you'll hate me for those 10 seconds, and then it's done. But again, it's not a biopsy of I think there's something wrong and I need to prove it. 

It is, oh, I'm pretty sure there's nothing wrong, and I just need to support that. Okay, so again, heavy irregular bleeding. Likely still perimenopause, but check out your thyroid and check out your uterine lining. Lighter bleeding, likely peri. No need to do anything other than at least make sure your thyroid's okay. 

So once we've defined, okay, this is all fine, this is perimenopause, then what? Well then we still can't predict when menopause is gonna happen. In other words, menopause can last, can happen. 50 51, like I said, 52, 53, and that perimenopause can precede it by years. So let's say you're 43, you have perimenopausal symptoms. 

The doctor cannot do a blood test to tell you when you're gonna go through menopause because no blood test exists. Many practitioners, typically, not medical doctors, but I would say integrative doctors, naturopath. They're not wrong, but they will often check your hormones [00:06:00] to see what's happening. We practice very differently as medical doctors versus, um, naturopaths in this regard. 

And again, this is not a judgment as to what is right or wrong, it's just the way we were trained. Meaning if I say to you, , I'm gonna disprove the things I don't want to happen, and then I can net out at, okay, you're in perimenopause. Then I might say, do you need me to help you? Meaning if you're having symptoms that bother you, we can try to fix them. 

The difference is that when they check hormones, they will be able to see over the course of several weeks or even a month or two, Where your fluctuations are happening, and they will potentially treat those fluctuations. Again, I'm not saying it's wrong. My view is those fluctuations still fluctuate, meaning this month's fluctuations might not be the same as next month. 

So even if I examined you every day of this month and saw where your hormones were at, they can change every week, every month, every six months, every year. So it's actually not going to really predict or help me. So better I think, is to. , what are your symptoms that are bothering you? Yes, I have figured out [00:07:00] that these are from perimenopause because I have proven that they're not from thyroid or other issues. 

And then let's try to fix them. I'm gonna do a different video about what we can do to fix them, um, because they might range from, again, hot flashes, mood changes, acne, things like that. But this video really is to help you guys understand. , what is perimenopause? Many women will say to me, oh, my mom went through it really early. 

Oh really? How old was she? Oh, well, I mean, she stopped her period at 51, but she started going through it at like 42. That's actually not early because what she was going through was again, what. Perimenopause, which is very common and precedes menopause by up to 10 years. Okay, so that is our definition of perimenopause. 

Menopause will be a year with no period. Why ca? My caveat for this is that there are some women who are on the birth control pill. Or they have the I U D that stops their period and they won't even know when they went through menopause. Is that terrible? No. That's awesome. They might have breezed through [00:08:00] menopause and it might have been completely masked, and that's okay. 

So if you are one of those women who's on the pill, because yes, you can be on the pill. Even at 49, 50, 51, if you're not smoking and don't have other risk factors, you might breeze through menopause and that's okay. And then your doctor will help decide with you when to stop the pill. And I kind of say somewhere between age 50 to 53, 54, we have to empirically decide together. 

should we take you off? Is this a good time to go off? You might say things like, hell no, my kid's starting to go to college this year, or something else is going on. I don't wanna go off this year and find out that I'm Moody's all get out and then have to go back on it. So I kind of give them that cushion and we decide together when to go off. 

And somewhere in that age range we go off. And if we're lucky, Stop your, your pill and you've gone through menopause and you didn't even know it. Sometimes your period has come back because you didn't actually go through menopause. And then we have to play with it a little bit, your mom's history. And if you have older sister's history, that can feed into it, meaning we do tend to follow our mom's histories. 

If a mom went through menopause very early, meaning no period [00:09:00] for at least a year, at age 30, 35, 40, she went through it early. Then you really might go through it as well. Okay. All right. That is it for perimenopause menopause. I know a lot of you wants to talk about being sweaty and schvitz. That's where I brought in my coffee to show you and about the dry vagina. 

I didn't bring anything to show you, but we're gonna talk in the next couple days about what can help hot flashes and how to fix a dry. Okay. Bye.