The other P word


[00:00:00] Tuesday, October 15th, we are gonna talk about menopause. Okay? So again, all you young gals who are still menstruating, you don't think you need to listen to this, but you do because once you get into your late thirties, early forties, you might start with menopause slash perimenopause or what I call the other p. 

Okay, so by the way, I'm start trying to artfully camouflage that pimple. It's amazing how certain angles it's there. Um, anyway, so here's what we're gonna talk about. Menopause. I'm gonna start with simple definitions as if you know nothing. I don't mean to be insulting, but I found that even the most educated of women, patients, friends of mine don't really know the vernacular. 

And it's not your fault. It's never been taught, and it's a little. menopause is one year with no period. By the way, can you hear my dog eating? In the background, this two dogs are chomping away. [00:01:00] Um, menopause is one full year with no period. I should, um, qualify. With that being said, it should be in a patient where it makes sense to have one full year with no period. 

In other words, if it's a 30 year old with no period, then there's times where it could be other reasons like, Her thyroid or something called polycystic ovary syndrome or a prolactin, um, secreting mass, which is benign. Um, that's a hormone that can suppress your period as well. So again, one year with no period typically in someone who's over age 45 ish would be considered menopause. 

There are a lot of newer gradations with regards to what we consider premature ovarian failure or early menopause. So anyone younger than age 40 is considered really too early to have gone through. There's a gray area between 40 and 45 where someone will go through it. It's not too premature, but it's still a little bit early. 

So again, typical menopause is one year with no period. Most women will go through menopause at age 51. There's this [00:02:00] nebulous term called peri-menopause. Peri-menopause is the time that leads to menopause, and that can be up to 10 years. So imagine if most of us are 51 when we go through menopause, then we could start having perimenopause, P e r i, Perry, in laden. 

It means time surround. Um, it could mean up to 10 years before, so around age 40, 41 or maybe even 38, 39 if you happen to be going through menopause at 48, 49. Now, there's also another term called premenopause, and that really doesn't tell us a lot, meaning it just means any woman like my daughter who's nine, is premenopausal, my best friend. 

38 is premenopausal. So again, premenopause just means before menopause. And it's best used in our world to define, for example, those women who had breast cancer. And we wanna differentiate were they after menopause before, because that implies different risk strata. Okay. Now, other than par premenopause, which we're not gonna discuss, cuz [00:03:00] again it's just a nebulous term that describes everyone. 

We're gonna talk about menopause and peri. Perimenopause that potential decade preceding the year without the period, which is menopause can suck. So if a patient comes to me, and this happens every day, every week in my office and says things like, God, you know what? I'm a little bit Sweatier more than I used to be. 

I'm a little bit hotter at night. I'm not sleeping as well. My boobs hurt more than they used to. I think I can feel like pressure during ovulation. Is that. Three days before my period. I want to kill people when they do this. Like how I used to feel like I wanna kill someone. It usually was like directed at my children. 

Um, that those are all signs, whether or not you know, it of perimenopause. Now they also happen to be signs of PMs, but when it's PMs type symptoms, mood changes, bloating, breast tenderness, ovulation. Mood issues. Um, [00:04:00] again, preceding your period in particular, hot, sweaty, flashy, those are all PMs signs. But when they occur in a woman who's in her late thirties, early forties, by definition, she's in that 10 year stretch before menopause. 

That's probably peri-menopause. Now, patients will say this, I will describe it to them and say, let me guess. Are you feeling X, Y, Z? Oh my God, do you think I'm in menopause? They say, and I say, no, I don't think you're in menopause. You're only 42, 43, 41, 47. I think you are in peri-menopause. And I like to sprinkle that word around liberally and frequent. 

To dissuade the anxiety that ensues because it doesn't mean anything abnormal. It's a normal process that will happen to all of us. For different women, they may or may not experience all of those symptoms. They may have one or two, they may have none. They may be very lucky. Have zero symptoms, normal, period, everything, and all of a sudden at age. 

50 51, they wake up and go, God, I've had a year with no period. I'm done. That's amazing. [00:05:00] For many of us, we have variations of that. Again, maybe hot, maybe sweaty, maybe mood changes. Before I had my hysterectomy at 46. I definitely had the things I mentioned. I was hotter at night. I was so pissed off and angry and moody for three days before my period. 

Um, and ironically I felt like I could keep it together in my office, but when I was home, if it was my day off or a weekend, it would make me really, um, agitated and lacking any patience with my children, even though I have patience with my. Funny, weird. Um, my boobs would hurt. I would feel intense pressure on one side or the other. 

It would last about two or three days. It would go away and two weeks later I'd get my period. Hence, ovulation pain. There's a term for it called mito schmertz, which means middle of the month pain. So again, Somewhere in the early forties, many of us will have these changes. It can also come along with abnormal period and bleeding changes, meaning heavier or lighter, longer or shorter, bleeding in between periods, bleeding [00:06:00] for 20 days straight. 

So if a woman comes to me and says, oh my God, I'm having really irregular bleeding of any variety, and she's in her late thirties, early. Many of you are probably nodding your heads going, yep, we heard you say this. I will say to them, I'm not worried. It's likely perimenopause, and that doesn't mean you're going through menopause early. 

This could last a decade, but we have to do a couple things to rule things out. For example, let's check your thyroid if it hasn't been checked in the last three to six months because your thyroid can mimic these changes. Let's do a pelvic ultrasound if your bleeding is heavy or persistent or irregular. 

My version of irregular that does not worry me is lighter, shorter periods, then you don't need an ultrasound. But anything of the more variety, longer, heavier, lasting, more frequent days, ma lasting in between your periods where you're bleeding and spotting, then that warrants an ultrasound again, to make sure that there's nothing in the lining of the uterus that is causing the irregular bleeding that we are just kind of ascribing to [00:07:00] perimenopause. 

So what I say to patient, I cannot prove perimenopause, but I can systematically disprove the things that might mimic it, like your thyroid, like an abnormal pap smear. If you haven't had a pap smear in a while, like you, like vaginal discharge that might be causing spotting and like a pelvic ultrasound that will rule out anything abnormal in the lining of the uterus. 

So again, you go to your doctor, you have some irregular bleeding or changes. They should do these things to make sure you're okay and it doesn't have to be done immediately. I mean, some patients say, can I write it out a month or two? The answer is yes if you want to. You certainly. I never like to do that, but I offer that to patients if they want. 

Um, so again, let's determine that everything else was normal. Now, can you do my hormones to tell me if I'm in perimenopause? And the answer is no. Western doctors like me. Um, and I say that in contrast to naturopaths, who I very much respect, but they, they practice differently. We believe that your hormones are gonna fluctuate every day, every week, and every. 

So if I check today's hormones, that's just a [00:08:00] snapshot in time, and that is not actually helping me tell you, oh, look, you're in perimenopause. Because during perimenopause, the hallmark is menstrual and hormonal irregularities, right? So even if you're not having really irregular periods, but you're having all those other signs and symptoms, if I check your F S H hormone, follicle stimulating hormone, and your estrodiol, which is your estrogen, Those two numbers, which in menopause will be high fsh, low estrogen, and perimenopause. 

They can actually look normal because the range is so broad and because remember I said it changes every day, so I would really need to check you every single day for month to be able to say, oh look, they're fluctuating peri. But why would I do that? There's no value in it because I can already tell you by definition of your age and your symptoms and the other things we've rolled out. 

You're in perimenopause. Now, there are certain practitioners, and I, I'm not saying it's right or wrong, they, but they practice differently where they will do blood and [00:09:00] salivary tests to check for these hormones, and patients will come to me and say, look, they told me that my hormones were irregular and the. 

I believe that because I knew your homeowners are irregular. If patients want or need something proven, I'm fine with it, but it can cost money and it's, um, arduous because you're supposed to check every day for a month to see what your saliva and sometimes correlating it with blood are doing. And again, to me it doesn't change what I'm going to tell you, which is you are in perimenopause, we've ruled everything else. 

How do you feel are these symptoms that you want me to help you fix? Because if so, I can help you fix them through various means. Just like we talked about with hot flashes last night, there are very traditional Western things. Believe it or not, healthy women who are not smoking, who are over 35 can start the birth control pill to control these symptoms. 

It will control the bleeding. Often the mood, often the breast tenderness, it certainly will stop ovulation pain because the pill stops ovulation. So the most Western medical is start the birth control pill. If it's only bleeding that you're having, that bothers [00:10:00] you. You could put in the I U D that has progesterone hormone in it. 

That will really help your bleeding and it either eliminate it or make it lighter. If it's just the mood, again, you could start low doses of SSRIs. You could be good about taking your magnesium and your vitamin D exercise, nutrition. So like I keep saying even. My last week was not fabulous, but I'm back on track today and I'm starting my intermittent fasting and I'm really determined to give up the carbs. 

So if you catch me like at a drive-through, flag me down , um, because that stuff is definitely makes mood worse and probably subtle hormonal fluctuations that we can't measure. Um, and then there's still again other things. Acupuncture. So there is very traditional Western. There is very traditional Eastern. 

There's kind of in the middle. Um, do you have to treat perimenopause? No. It is a natural occurrence that if you are happy enough knowing it's there, it's okay. And it's, I'm dealing with these symptoms, you don't need to treat it. Now, as a [00:11:00] Western doctor who likes integrative medicine, I'm happy enough to say, listen, it's natural. 

Don't worry about it. But I'm also happy enough to say, listen, it's natural. But I'm willing to fight nature when nature doesn't serve me and I'm not doing something that is harmful to me. Um, so again, menopause a year with no period. Perimenopause is that time that precedes menopause and can last a decade. 

The other P word I call it because people get so freaked out when in reality it's just a natural, normal thing. It does not mean you're old. Um, pre-menopause simply means any time before menopause. So it's really nebulous and doesn't really help us. Um, and I think that's it. If there's anything I didn't touch upon, let me know.