"My Doctor Handed Me Antidepressants". The Truth About Perimenopause Medicine Can’t Explain My Doctor Handed Me Antidepressants"—The Truth About Perimenopause in Ayurveda.

If I had a penny for every lovely woman who reaches out to me saying, my doctor wants me to go on an antidepressant. Today I wanna start with a story of a lovely soul. Let's call her Devi. She isn't one person. She's almost every message I've gotten that starts the same way. Devi is about 40-ish. For 2 years, she's been waking up at 3 in the morning, heart racing, sheets damp, unable to fall back asleep. So she went to her doctor 3 times. On the first visit, she was told it was stress. Try to sleep more. Take a sleeping aid like melatonin. It's harmless. Now, on the second visit, she was handed a prescription for an antidepressant. Somewhere, the physician called her highly functional and said that it's all just mood symptoms. The third visit, almost a year in, a different doctor saw her. Sub filling in for the day, he glanced at her chart. And asked a question almost offhandedly. Have you thought about hormone therapy? Hey there, sisters. Welcome to Actionable Ayurveda. I am your host, Salila, an Ayurveda lineage keeper living between Kerala and California. And I'm not here to give you another wellness hack. I am here to activate your Ayurvedic intelligence, your inbuilt AI, so you can come home to yourself, swastha established in unshakable, unbreakable, unfakeable health. Needless to say, poor Devi sat in her car crying and texted me from there, not because the doctor has said something dramatic, because In that entire year, over 3 visits, nobody had said a word about perimenopause. And for the first time, Devi stood facing the mirror, the fear of aging hanging on her like a dead weight. Her life, her vitality, her health, all expected to fall apart and so easily shrugged off. By even women doctors as just a natural part of aging. So we need today to see if we can shift our perspective a little bit from my matriarchal lineage to yours. This episode is about that gap, that gap of information and why it exists and what we women can do to invoke the power within us to create a new path for ourselves. This episode is not about whether HRT is good or bad. I leave that decision to you and to your physician. What we are going to address today is develop understanding around this from the Ayurvedic point of view, so that when we go to a physician or we go to a practitioner, we are asking for everything that is going to make this transition more successful for you. And we are gonna look at why we don't talk about it anymore. Unless a woman stumbles into it by accident, right? One hears about it from a friend or finds it in a morning on a forum, furiously typing your symptoms into ChatGPT like it's a confessional. Personally, I was told about it by a dear friend who later on got diagnosed with breast cancer. No causation there. She had a history. It happened just like what had happened to her mother at the exact same age. So I did not do anything about it. It spooked me too. Then I mentioned my dry skin to my esthetician, and I have the worst dry skin episodes when I come back to America. When I'm in India, my skin is beautiful. I don't need anything on my body. Except my coconut oil Abhyangams. I don't use a night cream. I don't use a day cream. My skin completely disappears, as in I have no trouble with it except the mosquito bites. So I come back to SFO. As I land in SFO, my skin starts acting up and it's the worst over several weeks that I had noticed in the last 2, 2 to 3 years. When I mentioned this to my aesthetician, she told me how she and her sister are both on HRT and that it was a lifesaver. So asking why are we having these symptoms is only half of what we do on the show. I want to take you somewhere where Ayurveda goes that conventional medicine almost never does. A single simple question, the one that changes The whole trajectory of how we think about this stage in our life. But first, let's deal with the numbers. I don't want this to sound like I'm just telling you an anecdote and asking you to trust me because I'm saying it. The UK government did a survey and looked at nearly 100,000 women. Over 90% did not feel they had been given enough information about menopause. Not some information, enough information. More than a third were not even comfortable raising the subject with their own doctor. Sit with that for a second. Over a third of women. Almost every girl has an initiation, sort of, when we go through puberty. We get a wellness check. Doctors prepare us, mothers prepare us. Yet the end of puberty is left to anybody's guess. And written off as natural part of aging. To feel that the person whose job is to treat our body is not a safe place to bring up one of the most universal transitions a woman's body goes through, that points to a problem in society. Researchers sat down and interviewed women about their clinical visits, and this story came up again and again and again. Symptoms were dismissed outright. Anxiety or low mood is called stress. SSRIs, selective serotonin reuptake inhibitors, are prescribed with no real discussion of whether it might actually be hormonal. Some women printed out national clinical guidelines and brought them into their appointments themselves. They took their own health in their hands. They did the homework for the doctor, and only then were they taken. Seriously. SSRIs, if you have gone to an American doctor, then you're probably very familiar with this term, are prescription medicines used mainly to treat depression, anxiety, and other mental health conditions. Why the name reuptake inhibitor? Serotonin is one of the many chemical messengers in the brain, and they're called neurotransmitters. Last time, We spoke about GABA, which is another neurotransmitter. So the brain has lots and lots of neurotransmitters. Scientists keep finding new ones. If I remember correctly, we have about 52 identified neurotransmitters. They carry signals between our nerve cells in the brain called neurons. If you look at the architecture of a nerve cell, it has a head that looks like a starburst. That's called an axon. And from the axon, there are these branches or roots that come out and that connect to other nerve cells. This is how the nerve cells conduct and talk to each other. They transmit electrical impulses and they receive electrical impulses. That's how they carry the signal between brain cells. Serotonin usually is taken back, absorbed back into the cells once it has done its job. That process is called as a reuptake. But SSRIs, selective serotonin reuptake inhibitors, block this process. Blocking reuptake means more circulating serotonin available to help pass messages between brain cells. SSRIs are called selective because they mainly affect serotonin. Selective because it particularly selects serotonin out of the cocktail of neurotransmitters that are circulating in our brain. Some of them are familiar to us— dopamine, glutamate, GABA, norepinephrine, acetylcholine. These are all the different neurotransmitters. Like I said, there's many, many neurotransmitters. Science is always finding new ones. So why are physicians not upfront about talking about perimenopause, menopause, or why is a fairly common, well-studied hormone treatment sitting behind this wall of hesitation? Here's where it gets historically interesting. We go back to the early 2000s. There is a study called the Women's Health Initiative, and it's the reason a whole generation of doctors got spooked. It linked hormone therapy to increased cancer risk. The reaction was almost instant. Women stopped taking HRT in huge numbers. Doctors largely stopped recommending it. And here's what tends to get left out of that story. A lot of the women in that original research were more than a decade past menopause already. That's a very different biological window than the women we are usually talking about on this show. Women in their perimenopausal or early menopausal years. We now understand HRT behaves differently depending on how soon after menopause it starts. The risk changes too. That correction has been sitting in the research literature for years. And it has not, by and large, made it into the 15-minute appointments we have. That is the honest, unglamorous answer to why did my doctor never mention this? It's not usually because your case wasn't worth mentioning. It's because an entire cohort of clinicians trained in the shadow of a scare, a scare a lot of researchers now consider more nuanced than the headlines led on. The caution stuck around a lot longer than the caveat did. I want to be really clear about something here. It would be easy for an episode like this to tip into Western bad, natural medicine is good. That's not what we are talking. For a great many women, HRT is a legitimate, well-evidenced, even life-changing option, not just for hot flashes, but also for things people don't always connect it to— bone density, cardiovascular issues. And if that conversation hasn't happened for you yet, I want you to have it. I want you to at least try, not instead of anything I'm about to tell you, but alongside with it as complementary care. And now here's the part where I want to slow down and be careful about what I say, because this is the actual heart of the episode. Notice something about the way Devi's story went? Sleeplessness, trying to manage stress, low mood, take this pill, hot flash, here's a patch, here's a fan for your desk. Every response aims at the symptoms sitting right in front of the doctor. And not one of those 3 visits until the very last one did the doctor ask a more basic question about perimenopause and what is actually happening in her body and what is the reason for producing all these symptoms all at once. We are handling a situation where physicians, first of all, do not educate us. About what is going on. They talk to us about stress, sleeplessness as isolated issues. I went to my general practitioner at PAMF three years ago, was not told this was perimenopause. At least the conversation did not go around. Hey, this is what you need to do to learn more about this. It was not about you have two symptoms right now. But you may develop these cohort of other symptoms with time. None of that was mentioned. And when I went and specifically asked for HRT to another doctor, I was prescribed HRT only because I was asking for it. There were lots of things discussed that kind of told me that it was a good idea, it was a bad idea, and maybe it won't work for you at all. I was told that it might even take several months before you even see any relief. So at that point I was like, if the doctor isn't telling me to do something with all their confidence that this is going to help me, then why should I buy a chemical and then put it in my body? And I just decided to go with yoga and Ayurveda like I always do. Contrast this with a situation like, let's say whooping cough, which I got when my little one was a toddler. She gave it to everybody. So I go into the doctor's office, they diagnose me that swooping cough, they laugh about it. They tell me all the symptoms that are gonna come up. They give me the medication. They tell me what, what to take when. I leave from that visit with the information I need, where to look up for more information, the medication I need to get better, what to expect. I feel like I am prepared for this, but when it comes to Perimenopause, menopause, there seems to be almost, it feels to me like this is like a death knell the doctor is handing you. And it feels like, oh, I'm so sorry that you're gonna go through this and your utility for society is over as a woman. So then everybody is like tying themselves in knots, trying to pretend this is not what's really happening. Like it's gonna hurt our feelings if somebody told us, you are going through perimenopause. This is what you need to know. Here are the options for feeling better. This is how you can make your quality of life better. Wouldn't it be amazing if our physician visits gave us a playbook on how to do your next 50 years in a way that you can transition into becoming a matriarch for your community, for your lineage, for your family, for your town? That would be incredible, but that doesn't happen. This is what is different about matriarchal Ayurveda, about the Ayurveda of women, that this is not pathology. This is not a disease. This is actually the second spring coming in your life. We are being prepared for longevity, for another 50 years on this planet, serving, helping, healing. That's what we are being prepared for. How you can handle your daily job, your family, and the pressures in a much better manner. Let's be precise about what we are dealing with here. The enemy is not modern medicine. The enemy certainly isn't hormone replacement therapy. HRT can be a valuable tool for many women. The real enemy is symptom suppression medicine, a healthcare model built on efficiency and not Cellular regeneration and restoration like Ayurveda, a system that is designed to treat your body like a broken machine with isolated parts, and not as an interconnected ecosystem that takes guidance from the cosmos and has a little microcosm within which responds to that. Let's ask a different question, not the one that the clinic asked Devi, not how do we manage this symptom, but what actually is happening in your body underneath all of it. In classical Ayurveda, before a practitioner reaches for a single herb, or a diagnosis, or a supplement, they ask a deceptively simple question, and that is, where is the dhātukshaya? What has been worn away? What has depleted? What has been used up that needs restoration? Because here's the thing about perimenopause that almost nobody tells you. It is not pathology. It's not your body malfunctioning. It's a transition, just like puberty, just like lactation, just like post-pregnancy, just like your periods. And what's driving it is something called as Dhatukshaya. The symptoms, the host of symptoms that you experience Which feels so terrible to us modern women. It is because of the dhatukshaya, the slow, steady depletion of your body's deepest tissues. It does not happen overnight. Happened over decades of adult life. All that pushing through exhaustion, the late-night projects you worked up for, the skipping meals, the ordering takeout at 2 in the morning because you were working on a proposal, running on 4 hours of sleep. Sleep and calling it a Wednesday. That adds up somewhere. By the time a woman hits her 40s, 2 layers in particular have quietly been drained. First is her rasadhatu. Think of it as your body's fluid matrix— your plasma, your lymph, the moisture in your every cell. When rasa runs low, you feel it. You have dry skin, you have brittle hair, you have brain fog. Your skin is Constantly itchy, that specific kind of tired where you're also wired and sleep is not adequate and you just cannot switch off your brain. The second is depletion in your majja dhatu, your nervous tissue, your bone marrow, the insulation around your nerves. When it's depleted, your nervous system loses its cushion, its ability to conduct the nerves beautifully. It's like mayonnaise coating our nerves. And when we go from stressed to hyperactive, quick to panic, uncontrolled rumination, we are not able to drop into real deep sleep. Now hold that picture and watch what happens when estrogen and progesterone starts to drop, making the situation worse than before. Estrogen is made in the ovaries, for anyone who is catching up on these terms. It's also produced in a small quantity in the adrenal glands and the fat tissues of the woman's body. During perimenopause, the ovaries slow down the production of estrogen and progesterone. This leaves the extra work to be done by the adrenal glands to take over that secondary hormone production. You probably have heard people use a phrase like, my adrenals are shot, meaning if you are chronically stressed and overworked, Then the adrenals would just be firing on empty because they struggle to produce these backup hormones, worsening fatigue, sleep loss, and mood swings. And if the body turns to storing a bit of an extra fat layer to get a steady supply of estrogen, can you really fault your body? The extra storage is your body saying, I am not receiving the support I needed to receive. Therefore, I am increasing production of estrogen by holding on to a few extra layers. Starvation and working out at 5:00 AM and throwing in another supplement stack is not going to help at this point. In Ayurvedic terms, estrogen is a metabolic hormone. It's your body's source of transformation from one cell to another. Progesterone, on the other hand, provides Cooling moisture, the kapha quality, structural density, and emotional steadiness. Estrogen, like a pitta hormone, transforms tissues from one to another. Ayurveda has 7 layers of tissue. From food, the body extracts rasa, makes blood, rakta, converts it into muscles, mamsa, Then to fat tissue, which is called Medha. Fat tissue becomes Majja, which is the nervous tissue, the bone marrow. Then to Asthi, the scaffolding of the body. And then finally to Shukra, fertility tissues. And whatever is left over of the Rasa then converts into Ojas, that quality of keeping us Juicy and glowy in the body. And when ovaries start pulling back, your body's supposed to lean onto its deeper reserves, your ojas, through the fat tissue, through the adrenals, to soften that fall. But if the adrenals are weakened and rasa is not transforming adequately into the remaining 7 layers, there's no cushion to lean on. That drop is not a gentle slope over decades anymore. It's a sudden overnight cliff. This is why 2 women can walk into the same clinic with the exact same estrogen reading numbers on their diagnostics and have completely different experiences. One may breeze through with the occasional warming flush, and the other is simply flattened by insomnia, Joint pain, mood swings that scare her. Standard medicine looks at their charts, sees the same hormone levels, and hands them the same patch. Ayurveda looks past the hormone level entirely and asks, whose body tissues can actually receive this signal, and whose body tissue is blocked by ama? Because that's really what a hormone is for Ayurveda. A messenger. And a messenger is only as useful as the road it's traveling on. If the receiver's house is closed shut, then the messenger returns without delivering its message. So you can raise estrogen all day long with a patch, but if the tissue underneath is dry, depleted, inflamed with AMA toxins, with शोधा इन्फ्लेमेशन, विद हाई अमाउंट्स ऑफ़ वाटा, देन इट्स लाइक टर्निंग अप अ रेडियो विद ब्लोन स्पीकर्स। The voice, the sound, the volume does not get clearer. It just gets more distorted. That's why so many women on HRT end up chasing up the right dosage for years, switching patches, adjusting again, still not feeling like themselves because the messengers were sent out. But the house was locked shut. So whether you take HRT or not, your tissue foundation has to be rebuilt. HRT can deliver the signal. It cannot rebuild the house. That's not a criticism of the therapy. It's just not the job it was designed to do. That's where Ayurveda comes in, not as a replacement, but as something that completes the picture. 2 things in particular do most of that rebuilding cellular regeneration work. The first is rehydrating rasa. The single herb that Ayurveda reaches for here, generation after generation, is Shatavari. If you've spent any time in this Ayurveda world, you've probably heard the name. It's considered the premier go-to herb for a woman's reproductive and hormonal system. There's a reason it stood the test of centuries. Kshatavari is heavy, unctuous, and deeply cooling. It goes straight into nourishing that rasa fluid layer we just talked about. Modern research actually backs this up. Kshatavari carries natural plant compounds that gently interact with estrogen receptors, not overriding your body's own production. It softens the Spikes in estrogen, the crashes that show up as hot flashes and mood swings. Think of it less like a hormone, more like a buffer. Now, how you would actually use it is half a teaspoon of Shatavari root powder stirred in a cup of milk with a cup of water, cooked till it reduces back to 1 cup of milk. You add a pinch of nutmeg as you take it off the stove. Stir in a little ghee and have it every evening as a simple bedtime ritual. This is literally an internal moisturizer. The reason we simmer it till it's reduced back to one cup is so that the milk is a more effective yoga vahi carrier of the good properties. The shatavari itself becomes more digestible. By cooking, because remember, shatavari is harder to digest. It's highly kapha. It is unctuous, and it is cooling. Therefore, if your digestive strength is affected by your perimenopausal symptoms, then any herb you take must be processed in a way that your body can handle it. So popping shatavari pills will give you a very different result. From cooking it down as a kshirapaka, a decoction with milk, a medicine that is extracted in milk. The second is to re-insulate the majjadhātu, which has worn out its outer layer of that delicious, unctuous, mayonnaise-like fat. For this, we have to use an external therapy. We talk about this external therapy a lot in this Podcast, and that is Abhyanga. Warm Dhana Vantaram oil massaged into the skin every morning before you shower. Here's what makes this more than just a nice self-care ritual: your skin is not just a barrier; it is twak. It is your largest hormonal organ. Twak or twacha means that which needs to. be touched so that it can remain healthy. Our skin is wired directly into our nervous system. When warm Dhana Vantaram oil moves into the skin, carrying with it all the herbs that it's holding in its essence, it doesn't just sit there. It reaches those receptors that send a signal straight to the brain. Turn down the cortisol, switch on your parasympathetic system. The rest and digest state. It's replacing physically some of the insulation that estrogen used to provide. Next time you walk into a doctor's office, I want you to step in as an informed, active advocate for your own self. If you decide to take HRT, take it with full awareness. Use the Ayurvedic prasayanas to build a healthy tissue foundation that will allow for those hormones to then work safely in it. Effectively, and if you decide to forego HRT, don't suffer through your symptoms. Use this Ayurvedic tissue building protocol to nourish your rasa, lubricate your majja, protect your nervous system. Do not accept a healthcare conversation that starts and ends with just symptom suppression. That is not the way to go through perimenopause, menopause. If you're looking at the next 50 years of your life and thinking about legacy. and longevity. Stop asking, how do I turn off this symptom? And start asking, what has my body given away over the last decade? And what do I need to reverse that damage? If you're curious about what happened to me, well, I never went for HRT. Based on my matriarchal wisdom, this is the coming of the second spring in a woman's life. This time of transition is for You to purely exist for your own joy, like the 8-year-old you were, chasing butterflies, rescuing kittens, and watching the rain turn into pearls on the flowers in your garden. This is the time for chasing your dreams, dancing with your purpose, and meditate on what and who brings you deep, restorative peace. If this message rang true for you today, take a moment to screenshot this episode, Text it to 3 girlfriends in your life who deserve to know the full story about their bodies. Subscribe to Actionable Ayurveda on Apple Podcasts or Spotify. And you send me such lovely messages, such glowing things you have to say about this podcast. Leave a review for us on this platform so that more women like you can find it and can benefit from these protocols. Let's keep challenging the narrative around women's health together. Until next time, honor your tissues, build your resilience, and take back control of your vitality.