What if the anxiety, brain fog, & sleepless nights are actually SIGNS of PERIMENOPAUSE starting in your late 30s?

and they feel like not themselves anymore. They feel like— I mean, I'm a 48-year-old female in perimenopause, and there are definitely days I'm like, whose body is this?

Like, so who am I? How am I— was it possible that I'm changing?

So perimenopause starts out with having declining progesterone. So we have 3 main hormones that, that we talk about: estrogen, progesterone, testosterone. Women don't make progesterone if they're not ovulating. And so when you start noticing you have less and less progesterone, often women will start having symptoms of perimenopause. And those symptoms when you have lower progesterone can be difficulty getting to sleep, staying asleep, feeling anxious, irritable, annoyed, edgy, sometimes apathy where you're kind of like, I just, I don't know, I don't care anymore. I just don't have the motivation I have. Heart palpitations, joint pain, those can be very sort of progesterone-type symptoms.

The best medicine is Hello, hello, hello, hello, Top 5% Method crew! I'm super duper excited to have Dr. Jennifer Rowlands in our pod. Welcome, Dr. Rowlands.

Thank you, nice to be here.

I want to talk about something. First, I want to introduce yourself. I don't want to be rude. Can you tell me what you do and who you are?

Yeah, I'm Dr. Jennifer Rollins. I am a board-certified OB-GYN, and I'm also boarded in integrative or holistic medicine. And I see patients every day who want to kind of dive a little deeper into their health and figure out a plan to feel good now and in the future.

That's amazing. I think we all want to be healthier and figuring out the ways to be able to, to have— live a healthier life. And something that came up is that October 18th is Menopause Awareness Month. Is that right?

Yeah. World Menopause Day is October 18th, and October in general is Breast Cancer Awareness and Menopause Awareness Month.

Oh my goodness. So, so many topics.

It's a female, it's a female month. We got this covered.

Yeah. No, I think it's so important to celebrate, but also to become more aware. And that's exactly the topic I wanted to talk about today with you. Because growing up I heard about menopause. I knew that it was going to come someday, but then something new came up in my sphere. Perimenopause. Can you tell me more and tell our audience what is perimenopause like? What is it? And then we can talk a bit more about menopause after.

Yeah, perimenopause is— so this is really a transition, right? Perimenopause is the 3 to 10 years leading up to menopause, and menopause is defined by one year without your period. So it's this transition that happens as your ovaries are not making as much hormones as they used to. You kind of have all these symptoms that start to develop because of the lack of hormones. And so it's this transition phase. I kind of— I feel like it's just one continuum of the same thing, right? So it's not like— I think when I was younger and starting medical school, I sort of— they described menopause like, like women just like went through this door, right? Like they just like, oh, and gumdrops and rainbows and like, you have arrived in menopause. And it's like, that's not really what happens. It's this transition that happens over years. And most— we're starting to finally understand and to not understand, but really talk about perimenopause and the fact that women can have just hormonal havoc during this time. And they feel like not themselves anymore. They feel like— I mean, I'm a 48-year-old female in perimenopause, and there are definitely days I'm like, whose body is this? Like, What?

So who am I? How am I— was it possible that I'm changing so much? So can you like— first, my understanding from menopause is that, okay, this is the start when you don't have your periods anymore, and a couple of things are going to be happening. And I want to talk about those things that are going to be happening because I want to keep it simple for everyone. And then perimenopause, I mean, 3 to 10 years is kind of a big deal. Uh, I'm happy that— I don't know who started popularizing this, but I'm happy that somebody did. So what do you— what are the changes that happen in those 3 to 10 years to a woman when she's in perimenopause?

Yeah. So perimenopause starts out with having declining progesterone. So we have 3 main hormones that, that we talk about: estrogen, progesterone, testosterone. And I use the word estrogen. There are actually 3 estrogens in our body, but I use the word estrogen as like in general, kind of as those hormones that we're doing. So when we go through— when we're born, we're born with a set amount of eggs. And so as we start to get in our 40s, then our body recognizes like, hey, we don't have as many of those guys around anymore. We're just not going to ovulate this month and lose an egg, right? Like we, we don't want to be using it this month. So women don't make progesterone if they're not ovulating. And so when you start noticing you have less and less progesterone, often women will start having symptoms of perimenopause. And those symptoms when you have lower progesterone can be difficulty getting to sleep. Staying asleep, feeling anxious, irritable, annoyed, edgy, sometimes apathy where you're kind of like, I just, I don't know, I don't care anymore. I just don't have the motivation I have. Heart palpitations, joint pain. Those can be very sort of progesterone type symptoms. And as we go further and further along in our 40s, then we start actually not recruiting those follicles anymore to then ovulate. So the first half where it says we should recruit some follicles, we should get one to be kicked out. Known as ovulation, that sort of spurs this estrogen to make estrogen to make estrogen. Well, if you're not really doing that, you're also not making estrogen either because we have a finite amount of eggs that we ultimately are going to— we're going to run out, right? We're going to be done. Yeah.

So we have a storage of eggs. I did IVF, so my doctor was like, you have a storage of eggs and now you don't have any more. When you're born, you have eggs.

Yeah.

Is there anything I could do to get more eggs? Like, no.

Yeah, yeah, yeah. It's not a reset button. There's no, like, no add to the, like, video games. Like, I won 10 coins. I get some more eggs. It doesn't work.

You can improve the quality. Can you improve the quality of your eggs? I don't remember.

You can improve egg quality. Actually, there's a lot of people take a supplement called inositol, which has been known to improve egg quality. Egg quality is also determined by, again, like environment too. Like, are you eating healthy? Are you taking care of yourself?

Are you avoiding—

are you exposed to toxins? Like, that determines the quality of your eggs. When you had IVF, they took those eggs out and they said not just how many, how many are there, but what's the quality. They gave a rating like A eggs, B eggs, C eggs. Like, they gave you a rating because you wanted to know that you're going to put in the higher quality ones first and then, you know, kind of go from there. So when you go through perimenopause and you start having declining estrogen, then women notice hot flashes, mood swings, memory recall— why did I go in this room? What's my neighbor's name? What's that kid I went to high school with? Vaginal stuff.

Where did I put my keys? Where's my makeup? Yeah.

Shoot, I forgot the kid at pickup, school pickup. You know, like those are all related because the brain loves estrogen and people have anything vaginal and bladder is all estrogen. So urgency, UTIs, bacterial vaginosis, all those things are related to low estrogen. Skin changes, you start noticing like, what's up with these wrinkles? Like, what's up with the skin? Not quite as good as it used to be. Why is my skin so dry? You know, those are all sort of estrogen-related symptoms. And then testosterone is very much libido. Muscle mass, focus. We call this vitality hormone for a reason, you know. We know that testosterone also is very good for our heart and our bones and our muscles. So those are— so you start sort of experiencing these symptoms that start to happen because of the declining hormones. And then ultimately all those hormones are low enough, you don't cycle anymore, and then you're in menopause.

Oh wow, it's like— it feels like a downfall. It's just— no, it's not a downfall. It's just a different word. Transitioning. So I want to make it—

I like to call it a midlife upgrade because I feel like there are things that you do, you realize, like, yeah, I mean, there are things that I gotta change, but there are also some good things too. Like, oftentimes the BS meter gets up there and you go, you know, I don't need to do that school field trip anymore because I ain't doing it.

You become your authentic self. Yes, menopause.

Yes, there are people who realize, like, you know, I can say no, or This relationship's toxic, and maybe I need to have a different person in my life. I need to focus on me. I've been focusing on raising children and spending my whole life with— for everybody else. Maybe I need to, like, think about myself. I often have women come in in their late 40s who are like, I gotta start prioritizing me. Like, I gotta start working on my health because I'm seeing all these symptoms develop, and I'm realizing I've spent the last, you know, 15 years raising children and I haven't really paid attention to my own health.

This is so important because people normally talk about the midlife crisis where overnight they don't recognize themselves. They just have like— they just like emerged. But I like the term midlife upgrade. So when does that— could— when could that happen? So it's like everybody's very different. And for our listeners, I want to make sure that if they're starting to have symptoms of like maybe anxiety or not sleeping well or not staying asleep or other things that are happening that you listed, that they might be in perimenopause? Is there an age time, or what is the timeline?

Well, so if it can be 10 years before menopause, like say your mom went to menopause at 45, it might be that you're experiencing symptoms in your late 30s, right?

Wow. Or it could be 35. It could be at 35, you could be already in perimenopause depending on your biology.

Yeah. And there's also people who are— say your mom went through menopause at 60, right? You're, you're on the other end because an average means there's people above and below you, right? So if you went through— your mom went through menopause at 60, you may not even start having symptoms till you're 52. I had a patient recently who's 58 who just now started having irregular cycles, and that's her thing. So she—

I hope it's me. I hope it's me. I'm flying to Montreal. I'm going to ask my mom.

Yes. That's actually a great thing to do. You should ask your family about menopause because first of all, it breaks the stigma of this, right? I have asked my mother and she was like, No, it wasn't that bad. I'm like, girl, let me just tell you some incidents I remember when I was 22. If you're menopause and I started having some conversations, she was like, oh yeah, yeah, I did have some major like yelling episodes and depression. And, you know, it so breaks the conversation for other women in your family to be okay with talking about it. It also helps educate that you're not alone, right? Because a lot of, a lot of women will say to me, God, I just feel so alone. Like nobody gets it. Nobody gets me. My husband thinks I'm going crazy. My kids think I'm yelling too much. And if you don't talk about it amongst each other, then it feels very isolating. And we— I mean, there was just this released by the Surgeon General saying, like, loneliness— we have an epidemic of loneliness, right?

Oh yeah.

That it's like the same as smoking 10 to 15 cigarettes a day. Like, it's that bad for your health.

It's literally one of the first blog posts I wrote on LinkedIn is the loneliness epidemic. So what— I'm a very actionable person, and that's a very— this is a very top 5 method. Top 5% method is very actionable. What can— I don't want to say that, oh, we don't want to go through the phase, like we don't want— we're not avoidant, we want to go through it. But what are the ways to maybe alleviate the symptoms or help with the insomnia? Or if you have anxiety, or how— what can women do to just like— because you still have to work. You still have bills to pay.

Yeah, I think, you know, I'm a big fan of kind of writing down what are the symptoms that you're going through because you may not recognize them as actually being perimenopause, right? So when women come to me and they have a list of like, does this rash have anything to do with it? Does this itchy ears have anything to it? Like, I love it. Like, let's go through and talk about all the things that are happening to you. So bringing those symptoms, if you still have cycles, making sure you've tracked your cycle so we even know, like, You know, was it last month? Is it 2 months for like, what are— what's going on with your cycle?

Gosh, I got to— I got to track my cycle. But the other thing is like, if you hang out with some girls, like my trainer at some point was a woman, my periods and her periods were synced. How do I know that I'm like potentially getting into perimenopause or if I'm just hanging out with my trainer 4 times a week that are like, we were in sync, literally she started and then I would start a day after.

Yeah, well, if you're having regular periods, you know, you're unlikely to be getting into perimenopause yet, right? If you're having pretty regular periods and some people—

I'm very regular. I clockwork.

Yeah. I mean, the early perimenopause can be still some regularity to it and then it starts to become a little bit off. But the— but, you know, if you're hanging out with your trainer and it's changing, but that's not really a pattern, like, right? What's happened the last 6 months of your cycle? Because in any given time, things can happen quickly, right? Like, so you decide to go on a fad celery diet or whatever, and like your cycle goes away because you're in this like fad diet or whatever, celery juice, because that was just like a recent trendy thing. Like, it's so— it's, it's kind of like things can change. You, you're in the middle of finals week and you stayed up till 2 AM, you drank too much coffee and you didn't work out and you're stressed out, and then you're, you know, your cycle's off. Like, so things can happen here and there, but I'm talking about patterns. Like, yeah, usually people will come in and say, okay, for the last 6 months my periods have been like Sometimes 35, sometimes 42. Sometimes I skip one. Like, they're kind of like showing that. And you can use apps, you can use paper calendars, you can— however you keep track of these things. But, you know, it's, it's hard to go into a doctor and say, I think in July I had— like, it's much easier to have written it down before you go there, or use an app or something, right? Because everybody's human. And so if you kind of go back and like, what happened in July? What happened in February? I don't know.

I use apps when I was, uh, when we were trying to pregnant.

Yeah.

And, and then I stopped. But I think it's good to, to know. I mean, first I'm going to start with the interview of my mom. It's like, Mom, when did you get your menopause?

Yeah, yeah, yeah, yeah. It, it, it— there definitely is links in how your mother went through it and what is the, the age in general with when she, she did go through it. And, and sometimes too, it's, it's another moment for you to connect with your mom too, right? Like, I mean, to connect and to in some ways value your mom because she did do what she did to be your mom and has been through this. And so I think just like when you— I feel like when you have a baby, right, you go to your mommy like, is this pic— this acne on this kid normal? Like, this kid's doing this, is this normal? Like, I feel like we don't do that in menopause and we should. It's like, okay, Mom, like, I want to like burn my house down. Is that okay? Like, did you—

I want to change my whole— I want to change my whole life. And it's like, what? What are we talking about?

Yeah, yeah, yeah. So it's another way to connect with your mom and connect with other women too, which I think is really, really important too.

So what are the preventative measures and screenings that women in their 30s likely, or 40s, should prioritize to ensure that they have a healthy transition into perimenopause and menopause?

Yeah, I think so. Women in their 30s, definitely, because how you— what your health is like in your 30s and 40s determines how you're gonna live in your 50s and 60s, right? It's so determined on the women who kind of have things dialed in in their 30s and 40s do so much better during this transition because it's not a shock, right? If you suddenly have lived your life not very healthy and then you get to 45 and like things start— the rails, the wheels start coming off of the car, it's like, wait, now you me to eat differently and I got to exercise and I got to go to sleep at night and I can't drink alcohol. And like, it just becomes like a lot versus, you know, if you had started in your 30s kind of trying to set this up for yourself, it would have been better for you long term to, to prevent disease as well. We know from the centenarian studies, which are these wonderful studies that are done in certain areas of the world where these people live longer than anywhere else, right?

They live in their 100 areas.

Yeah, 100, 110, 120. These are centenarians. And what we know from those studies is that prevention is so much— you're less likely to have problems if you prevent it to begin with than if you try to reverse it, right? These people, when you look at them, they're in their 80s and 90s and they don't have chronic disease. They end up having it like later, and they have a shorter period of time when they're dealing with chronic disease, as opposed to most Americans who are dealing with one more chronic diseases by age 60. By like 65, they have 2 or 3. You know, it's like we were trying to go back and reverse things. That's much harder and worse for your health than to prevent to begin with.

This is so golden what you've said.

Yeah, it's really important.

What are the prevention measures? You talked about like reducing alcohol, exercising. What else?

Yeah, I mean, you're not gonna prevent menopause. Every woman's gonna go through menopause, but you can certainly make that transition better. So Yeah. So for understanding like a certain way you're eating, right? So if you're somebody who— if you're focusing on anti-inflammatory diet in your 30s and 40s, then those transitions you have to make where you have to add a little protein, add a little fiber, pay a little more attention to a little lower carb, like that's not so much of a hard step compared to just being like someone eating McDonald's in their 20s and then suddenly having to change a whole lot. Yeah, those are things I think from a medicine perspective of prevention, I'm a big fan of having someone test their bones. In medicine, we say don't check your bone health until 65. Why would we wait 25, 20 years after menopause or 15 years after menopause for someone to check their bones? Like, the cat's out of the bag there. Like, we need to be checking people's bones in their 40s and their 50s because nobody wants to end up finding out they have osteoporosis at 65 and they could have done something at 47. Do you know what I mean?

I'm like Taking first notes.

Yeah, bone scan, bone health, very important. Muscle health, very important. Knowing if you have, you know, under— talking to your family about maybe genetic things that you're predisposed to, thyroid, diabetes, whatever it is. And even genetic testing, like the— I think medicine is going to go in the direction that we all know our genetics early on in life and that we know what we're set up up for, right? So if I take a genetic test and I know— well, I have, for example, and I know I'm set up for diabetes, like I have diabetes all over. We're Italian, we love pasta. It doesn't help our genes.

I love pasta too.

Yeah. So I have to be more vigilant to be making sure that I have good blood sugar balance and making sure that I'm taking care of myself from that perspective because I have the genes set up for diabetes, right? If I just kind of waited until I got my yearly one at some point and they said, oh, now you're diabetic, like I've missed the mark. I could have just— I could have done things earlier on to pay attention to that.

That's amazing. This is like the first time I hear about like checking bone health. So just that is a breakthrough for me. And so you talked about like— I took a lot of notes. Chronic diseases. What are the most common chronic diseases that happen in America? I want to start with America because 95% of our audience is in the US. Yeah.

Yeah. So for women, heart disease, right? Heart disease is still on the top of the list. Um, we worry a lot about breast cancer, right? But we, but heart disease is actually, uh, higher up on the list of killing women than breast cancer. And so, you know, obviously chronic diseases we worry about, like diabetes, cancer, you know, there's Peter Attia is a longevity medicine doctor and he talks about the four horsemen, right? Cancer, uh, neurodegenerative diseases like dementia, heart disease, and metabolic diseases like diabetes. So those are kind of what he calls the Four Horsemen, or now we should call it Four Horsewomen, right? Because we're—

Four Horsewomen, yes.

You know, those are the things that you're sort of aiming to not end up with later on, right? So you want to do things that are going to be proactive to not end up having those chronic diseases later on. I will say, out of all— I mean, if you're looking at all four of those, Here I am saying it again, but there's nothing more studied than exercise. Wow. There's nothing more studied. The best medicine is honestly moving your body. And because we were meant to move our body, we were meant to move, right? Like 100 years ago, people were farming all day. Women were taking care of kids and cleaning their house. Like we were moving, moving, moving. And we're now living in such a sedentary lifestyle where we sit on our desk all day and then we go home, drive home, eat our dinner, go sit on the couch. Like we're just not moving. And so Moving is so essential. If you look at all of those blue zones and you read Dan Buettner's book and you look at centenarian studies, they all move their body. They don't all do the same thing. Some of them are farmers, some of them are housekeepers, some of them are— do like martial arts. I mean, like, they have very different cultures, but they all move daily.

So any type of exercise, do you recommend? Like, I like— personally, I like cycling and then lifting heavy. But is there any recommendation in terms of exercises that can help you prevent some of these horsewoman diseases?

Yeah. So, so I think number one, always pick something you're gonna enjoy and you're gonna do.

Okay.

Right. That you're gonna do. Two is you also have to pick something that's going to be what you're capable of doing too, right? Can you, I mean, I could tell you to go, you know, do a HIIT workout, but if you don't even walk, it's probably not gonna be your thing. Like it needs to be What do you enjoy doing that you're going to make sustainable? What can you do? Physical limitations. And then if you look at sort of long-term health, there should be a combination of like cardio plus resistance training, right? We got to put stress and pressure on our muscle and our bones. So it has to have some form of resistance training and cardio. But those things could be very different for different people. Some people do resistance training because they lift weights. Some people do resistance training in the form of like Pilates with a machine. Some people do, you know, like there's different ways you can do it. So it's like, what is the— what brings you joy? Because I think that if it's something that doesn't bring you joy, you're not going to stick with it. So it's got to be something you like. Like, I cannot cycle. Like, good for you, because I am a— I used to run marathons, and I swear to God, you get me on a bike and I'm like, are we there yet? And I look, it's been like 4 minutes, and I'm like, it's 56.

I know, like, when you come to LA, I'll try to invite you to a class. Not that I want to change you, but I used to hate cycling. Hated it. I didn't understand. My butt hurt and anything. And then I went to a studio with me. It was like a club. And I used to club when I was like young in Montreal and stuff, club a lot. Why did I like clubbing? Because of the music. So music and I ran my half marathon of Vancouver. Based on music. So music is my fuel. So I fell in love with cycling because it was kind of like I'm hitting the club, but it's 6:30 AM with my healthy and sexy friends. So that's what changed. And also the half marathon was all based on music. So I agree with your principle of doing what you enjoy and how critical it is.

Yeah, you got to have something you enjoy. And, you know, it does help to mix things up because your body, again, just like any athlete will tell you that there are NFL players who do ballet, right? Like, they have— they have no way.

No way.

Yes. And, and yeah, because you have to mix up those muscle groups, right? You have to try this different strength training. Like, when I used to run, I used to do things with rowers back in college because totally different muscle groups, right? Totally different type of exercise. So it's important that those different types of muscle fibers are being used too. But yeah, you, you want to make sure that you're sort of And I also think making it part of your lifestyle is important. So I lift weight, I do yoga, hot yoga, which I did today. And I do have hot yoga. I know, I hated it. My first couple times I did it, I'm like, this is a disaster, like these people are trying to kill me. But 8 years later, I'm like obsessed with it too, like your cycling thing. But when I— when— and I lift weights, but I also like make my daughter, who's 14, my accountability partner. So like Thursday we lift and she is bossy. She's like, you said, you, you know what I mean? And the hand comes up and the finger, and I'm like, okay, yeah. So I make her in charge of it because she will make me go, right? Because she's bossy.

So you look, you look like you're very fit, um, and I saw you in person, you were very fit too. So I think it's working, and it's inspiring.

Brooklyn, because it's due to her making me go.

This is a message from me, Katheline Jean-Pierre, to you. Thank you for taking care of your mom. So, advertisement closed. Another topic I want to talk about before going back to this topic of menopause and perimenopause is dementia. Can you first prevent it? And then if you think you have it, or what are the signs of dementia?

So there's a fantastic book called The Menopause Brain by Lisa Monscany. And what is brilliant about this woman is she's a neuroscientist, but she's the very first female, or very first scientist, to show estrogen literally in a brain scan going through the brain of a female. It's like we're marker— it's a marker we can see of like the effects of estrogen on the brain. And her book is so critical because we know there's 2 to 3 times the risk of women getting Alzheimer's than men.

Mm.

So why, right? Why would— why is that the case? That doesn't— is it because we live longer? That's true. We do on average live about 4 years longer than men. But it's not the age thing because, to be honest, we spend more years in disability than men because we go through menopause. So we go through this transition where this wonderful hormone called estrogen is neuroprotective. It protects your brain against inflammation. Then suddenly it's turned off, right? There's no more estrogen. So the brain is dealing with chronic inflammation, toxin exposure, things that are being exposed to. It doesn't have its like protective effects. And you think about a 45-year-old person who then does this for 20 years, right? And they develop dementia in their 60s and 70s because they've had chronic inflammation without this protective hormone called estrogen. And so basically, this is her book, is is a landmark publication about how this is really what's happening is these women are kind of getting like set up. And then for some women, that 20 years of chronic inflammation to the brain ultimately leads them to dementia. Now, there are many, many causes of dementia. Alzheimer's is just one of them, right? There's vascular dementia. There's a lot of different types of dementia. But the idea is like this sort of like hit to the brain for 20 years in a female is much different than a male who's just over time, their lifetime is lowering their hormones. They don't go through this like you know, menopause, right? It's not like they suddenly, like, their testes don't make testosterone anymore. It's not— that's not what happens. It gradually happens over their lifetime. So the idea is that, you know, and then you, you add other things for inflammation. So someone has blood sugar problems, then they have diabetes. So that's another hit to the brain for inflammation. They have maybe lupus or some sort of chronic condition that may cause inflammation in general. And then now they have another hit to their brain. Like, it's like, it's like all these things accumulate, if that makes sense. And so the idea of the research that's done for women is, is we're now starting to understand the power of putting someone on HRT for, you know, brain health, right?

What is HRT?

Hormone replacement therapy.

Okay, how does it work? What is it?

So you're basically replacing the hormones that are gone, right? So when you lose estrogen, progesterone, testosterone, then you give patients back estrogen, progesterone, and testosterone. And so it's not like they're going through this moment where they're never going to have estrogen for the next 40 years of their life. They actually will get back in the form of HRT. Because we on average live about 81 years of our life, so we're spending 30 years in menopause, a third of our lifetime without these valuable hormones. So the idea is giving someone back those hormones so that they're not loo— they're not having this cascade of problems that are happening related to their lack of hormones.

And how does it work, hormonal? Like, it sounds like this big thing. I don't know, to me it sounds like chemo. But it's not.

Uh, no, I mean, it's so like you take oral progesterone at night and you give— take an estrogen patch. Like, it's just like any other medication, right?

It's patch. Okay.

Yeah, there are a lot of— well, there are a lot of different forms of hormone replacement therapy. Obviously you have to talk to your doctor about what's the right form for you, but it's not a, uh, I mean, it's not a complicated thing in that it, it's restoring what you're missing. So I mean, I have— I have a patch sitting right here. Like, here's an estrogen patch. That someone might put on because this is their estrogen instead of their ovaries because their ovaries aren't making it anymore.

So basically, like, does someone take it if they're in perimenopause or menopause? When is it prescribed?

Either one. So if you're in perimenopause and your cycles are 3 to 4 months apart and you're not sleeping and you're edgy, irritable, hot flashing, having bone problems, yeah, you can take HRT. It's not specifically just for menopause, even though we call it hormone replacement therapy or menopause hormone therapy. It can be given in perimenopause.

Interesting. No, I think it's super interesting. And then the biggest signal is if you start having irregular periods. Yeah, there's— if you have your periods, you're not in peri— you're likely not in perimenopause.

You're likely not in perimenopause. Yeah, because again, you're consistent. Now, does it happen? For sure. There are I've had 49-year-old women who are like, yeah, I have a pretty regular period, but I'm having all the symptoms. And so they're still having a period. So, but, but like, they're pretty close, right? If I would have waited like 2 or 3 months, I bet it would start going off. You know, the periods would change. So by definition, if we're making like a clinical diagnosis, yes, you want to have a change in someone's cycle that's sort of indicating perimenopause combined with symptoms.

When we think about menopause and perimenopause, So how do you manage weight gain during that period of time? Because it's an important period of time and some people gain a lot of weight and they can't control it.

Yeah. So the lack of estrogen causes insulin resistance and insulin resistance and elevated cortisol are the two big drivers for perimenopause weight gain. So people typically— women typically get it in their midsection. So you have to address both hormones. You have to sort of figure out, can you do something from a lowering insulin standpoint or a cortisol standpoint, or do they ultimately end up on hormone replacement therapy because the problem is low estrogen? So then do you give them back estrogen to then fix that? So it's a very— it's not a very simple, easy answer. A lot of patients, I'll talk to them about these are the things likely causing the weight gain. Which makes sense for your moral compass to go down? Does it make sense for us to talk about nutrition and lifestyle? Does it make sense to talk about supplements? Does it make sense to talk about hormones, because you need time. You need to time with your patient to talk about these things. I can't— so many examples I could give you where someone came in and they're like gaining weight, and then it's as simple, sometimes as simple as like, well, they're going to bed at 2 AM and getting up at 6. Like, we gotta get— you need to sleep, you know? Like, so it's not a simple answer to say every woman should do this, because there are different pieces of the puzzle that someone may or may not be doing. So we have to identify what are the things that we can do for them, you know?

No, I think it's important. And I want to close off on this important topic for other women and their partners. Because if you're listening and you're a man, you're going to be partnering. And if you're heterosexual, you might be partnering with a woman as a partner. And you might want to be able to support her. But also, even if you're not heterosexual, and you have girlfriends, yeah, you want to be aware of what's happening with them as well. So October is a special month, and I want to make sure that you give us some parting advice to celebrate this very special month for women.

Yeah, I think, you know, as far as partners, I, I love when partners come to visits with their partner, like when the husbands come or the wives or whoever is your partner or just your supporting friend, right? Because it's hard for someone to— I mean, I have a husband too, and I've definitely been like, this is what I'm going through, but he doesn't really understand hand as much as if he heard it from a provider that's like, yeah, a lot of women are going through this. Like, this is actually normal. Your wife's not trying to make your life hard. She's having these emotions, you know. So I think it's sometimes very validating for that person to know that their partner's in the room and that that partner is then aware, like, oh yes, this is what's happening, you know, like, this is what's happening to her. And also opening the communication because sometimes things like someone's libido goes down and there's a conflict of like what's normal for sex when you're in perimenopause and menopause and how often and how should this go. And so sometimes couples can't always have these conversations because they're not sure to where to even start. So sometimes I can help in those avenues to break open that conversation to say, yeah, let's— okay, what's— what do you feel is normal? What do you feel is normal? And let's kind of open up that conversation. So there's there's some things that I can sometimes bridge for patients. And so it's nice when they bring their partner with them. I think also, you know, the books, I mean, reading the book about perimenopause with your partner is helpful too, right? Like, look, 100 women said this.

What is the book about perimenopause? Because you named a couple of books. I don't know. Oh, there's a bunch of books. Menopause Brain?

There's Menopause Brain. There's, so one of the better books is The New Menopause. And then her, so The New Menopause is written by Dr. Mary Claire Haver. It's a really good book about, what to expect, right? What's happening to you? This is what you're going to go through. So I love that book and I often reference it for patients to start reading just so they have an idea as like what's happening. So I think those are, those are ways that partners can be supportive. I think the most important part about this month is like, you're not alone. There are other women that are feeling the way that you're feeling. You need a good community and you need to find a right provider that's going to be kind of in sync with your goals.

That's amazing. Well, thank you so much, Dr. Jan. I feel like I've learned so much, and I hope the audience has learned as well. I think for me, a big takeaway is really like looking at the human, myself, holistically and prevention. And listen, I used to spend an hour and a half at the gym. I'm gonna get back to that. And my vitamin D, I wanna— I like to do my little walk. Outside for vitamin D. And so those practices and really identifying also what helps me gain balance as eventually I'll be in perimenopause and menopause. Thank you so much. Where can we follow you? I mean, I follow you on YouTube, but what are all the different places people can follow to learn?

Yeah, I'm on Instagram, so @drjen.md. I am on YouTube with my name, Dr. Jennifer Rollins. Obviously my website, I have a website that has my name, drjenniferrollins.com. So that's where I have resources of— I'm actually building a midlife academy, which is like like different lessons with workshops that women can take that are specific for their individual needs. And then I have a quiz called, Are You in Perimenopause? That's on my website and also off of YouTube. So a lot of patients will take that, or clients will take that and try to figure out like, okay, what do I do now? What's my next step?

I love it. And when is the Midlife Academy launching?

October.

Oh, wow. In the menopause month.

Yep. Yep. I have two workshops. One is HRT and Perimenopause, and one is Better Sex.

In my life. We like that too. Well, thank you so much. This was Dr. Jennifer Rowlands. Follow her everywhere— YouTube, on her website, on IG— and then go take the quiz, go figure yourself out.