The Menopausal Journey, Explained with Dr Shauna Watts

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So what is the menopause journey? Well, look, it's definitely very tricky and most people know that they're having a time that's all over the place. Everything feels like it's going haywire or it doesn't. So some women are absolutely sailing through the perimenopause and they're kind of wondering what the fuss is about. But basically, if you think auto, whenever you're born and actually in the womb is when you have the most eggs, by the time you're born, you've already gone from 10 million to 1 to 2 million. And eggs just keep dropping off until the point of. At the age of around 50, you've gone from having 10 million eggs to less than 1,000 eggs. So basically, the ovary has run out of eggs. And menopause occurs whenever you've had no period for 12 months. And. But that's a very tricky diagnosis because what happens if you don't have a uterus because you've had a hysterectomy? Or what happens if you have a Mirena and you don't have periods? Or what happens if you've got polycystic ovaries and you don't have periods? So in medicine, we have definitions. Some of them are really a bit outdated. I do wonder whether something will happen with this. But menopause is one day in your life 12 months after your last period if you have a period, and the rest of the time, well, it's a pretty tricky diagnosis. And perimenopause is a variable period of time up until the menopause, and it can be anything from two to 10 years. And that's why, if you think of the average age in Australia for menopause is 51. So still within the realms of completely normal is a menopause at 45, which therefore means it's completely normal to be perimenopausal from your 35. And so the reality is that this is a conversation that we need to be moving back a couple of decades so that people do not get into their late 40s or 50s and they're completely struggling as to what on earth is going on and why has no one mentioned this. Now, I won't go into this in too much detail, but the reality is there are another significant group of women who either have an early menopause and that's 40 to 45, or premature ovarian insufficiency. And the youngest patient I've seen with that is 19. So never disclude anyone based on age, never Say to someone, oh, well, you wouldn't know about that because you're only 30. Because the reality is you can be actually any age. So whenever we look at what happens. So the pre menopause is basically whenever you're, you know, from your probably 17 or 18, and you have a very regular cycle right up to the perimenopause. And what this diagram is supposed to show is that the perimenopause is a period of hormonal chaos. And lots of women describe it as a roller coaster ride. And sometimes they feel really well, and then other times they actually feel and horrendous. And then they think they're going insane and then their partner wants to strangle them because they're so grumpy. And then they have two weeks of feeling okay again and then their period comes back, but then it goes away and it's absolute chaos. But I felt that that slide didn't really say what was saying, so I changed the slide and that's what I think the perimenopause looks like. And the reality is that. And what we do know is that diagnosing this is really tricky. And the other thing that we know is that for years we've been told that this time of life is just about not having periods anymore. So cheer up. You know, you don't have your period anymore and you can't get pregnant anymore. And so shouldn't you all be quite happy about that? But in actual fact, what we now know is that actually these hormones should never have just been called sex hormones. For years we thought these hormones were about growing hair and growing boobs and if you're a man having a bigger penis and all those things. But actually what we now know is that these hormones are actually potent virtually everywhere in our body. And we have to stop thinking of them as ovarian hormones because actually most of them are made in your brain and they're made in lots of other places as well. And even if they're not made there, they probably have a rule there as well. And I have to say, the vast majority of women who come to see me are probably complaining of brain symptoms. So things like not sleeping, suddenly feeling really, really anxious, not being able to remember their words, losing their train of thought, no longer trusting themselves that they can actually have a conversation with people and not actually look like an idiot at the end of it. I'm putting that out in advance because, you know, I might start to forget what I meant to say. But basically, if we start at the top of our heads and work our way down. I'm not going to go into all of them. It really does depend on what list you look at. It could be 33 symptoms, 44 symptoms, 49 symptoms. Just depends on what list you look at. But basically, from hair thinning on your head to hair growing on your chin and mustache, to vertigo, tinnitus, brain fog. You can have dry eyes, a dry mouth, reflux, bloating, weight gain, unable to sleep, hard palpitations, frozen shoulder, plantar fasciitis, hip pain, and the list goes on. So I'm being really cheerful here. I'm making you all feel really excited about this, aren't I? So, obviously we've touched briefly on Debbie Gaunt's very sad story, but the reality is that it's not unheard of for me to have women. In fact, it's probably virtually every appointment I have. The person cries in the appointment, and they might be crying because they just have so bad fatigue that they can't move and they can't be bothered with anything, or that they're so angry and irritable that they're fighting with everyone and they're worried they're going to ruin all their relationships, or that they're feeling so sad and disconnected that they no longer want to hang out with friends or socialize, and they just don't feel like themselves. I think one of the commonest phrases I get told is, I just don't feel like me anymore. And I think that is a really hard thing for someone who's felt one way their whole life, and they suddenly don't recognize themselves both inside and on the outside. So the overall result is I see a big drop in confidence. And that confidence is in every aspect of life. I see women who no longer have the confidence to drive on the freeway, maybe even if they've lived in Sydney their whole lives, but suddenly they're really scared in the car. I see women who have no confidence that their bladder will last a journey, and therefore they need to go and know where all the toilets are all the time. I see women who feel like they can no longer chair a meeting at work because they are so afraid that they won't remember a word. I've had a CEO of a company tell me that she was trying to tell her staff to get the lunch for the important meeting from the fridge, but she couldn't remember the word fridge, so she had to call it the cold cupboard. And her very young PA was looking at her very puzzled, couldn't quite work out what she meant. And Had a patient the other day told me that she couldn't remember the word toe, so she had to call it a foot finger. So, you know, and I have people coming in actually convinced that they've got a brain tumor or they've got dementia and they're really, really scared. And the problem with the perimenopause is that actually there's no blood test for it either. So again, I find it so frustrating that so many people will go to their doctor and I will put myself back a few years and I probably would have made exactly the same mistake. We would have looked at your blood test and we'd said, oh, well, it can't be the menopause because your hormones are okay. But the reality is there is no blood test for the perimenopause. And if you have someone who's telling you it can't be the perimenopause because your hormones look okay, politely thank them and move on to someone else. Because the reality is you probably know your body better than anyone and if you feel like you're ticking a lot of these boxes is you're probably right. The perimenopause is what's called a clinical diagnosis. It's based on history. And I do a number of questionnaires with my patients and it's very, very clear who's got the perimenopause and who doesn't. So what are the evidence based treatments? I know that hormones have basically had a very, very bad rap and as Taylor Swift would say, they really need to shake it off because actually they have a very, an undeserved bad reputation. And I know that there are a number of women in the room who I have already started on hormones and they can be absolutely life changing for the right person. And it is no coincidence. I've been a doctor for 25 years and there is no doubt in my mind that hormones are the thing that help the most people. Most of the time when I do my four to six week review, it is often like I am seeing a different person. And even if I wanted to make myself feel better and convince myself that the person was better and wanted to pat myself on the back, what I do is I actually redo all their questionnaires and I never give them their original one because I don't want them to please me and try and make it look a bit better. And it is unbelievable when you see the transformation. Now that's not to say that hormones are for everyone, but what I believe is that hormones are a conversation that every single person deserves to have an, an intellectual and smart conversation about with someone who knows what they're talking about. You don't have to take hormones at all, but I think you deserve to have a conversation about why they may be beneficial. So let's talk about estradiol or estrogen. Estradiol is the most potent estrogen in the body and that is the one that we're really using more and more. So the hormones that we used to use years ago and the hormones that had kind of all the bad press are kind of all out now. And what we use are ones that are identical to your own bodies. They actually come from yams, but they're absolutely, absolutely chemically identical. And the safest way to put estrogen into your body is actually through your skin. So we use either patches or a gel in Australia. And to be honest, there is a worldwide shortage of patches at the minute. So that's why I often steer my patients towards a gel because it's actually made in Australia and we know we've got like a five year supply in reserve for all the Australian women who are jumping on board. And estrogen has a lot of impacts, but I don't have time to get into them all. Progesterone, look, it's essential. If you've got a uterus, we have to give you progesterone, and that's because it protects your uterus and the lining from getting too thick. If you get a really, really thick lining of your uterus, you've got an increased risk of endometrial cancer. So that's one of the main reasons we put you on it. However, even sometimes people with a Mirena, who in theory do not need progesterone, we will also give them progesterone because it's a really great way of getting you to sleep. So it definitely has more benefits than we know. Testosterone, again, this has become quite topical at the minute, both in men and women. But what I want to say to you is testosterone is not a male hormone, it's a human hormone. And again, it's had the wrong label for years. And if you are someone who's maybe in your 50s and you've got a partner who's also in their 50s, they have more estrogen than you do. So tell your partner that they've got estrogen, they've got progesterone and you've got testosterone. Testosterone actually begins to decline in women, actually in our 30s, so well before the perimenopause, but then in the perimenopause it really starts to go down more. And the main symptoms that people will complain of are decreased libido, but also other symptoms that seem to be beneficial are things like muscle strength, fatigue and mental clarity. And I had a lady recently who had accidentally been a little bit over enthusiastic with her testosterone. She hadn't grown a beard and she hadn't grown anything else that she shouldn't have grown. But what she did say is, wow, this is amazing. I'm getting everything done. So it's definitely a really interesting one. I know a lot of you follow the Insta famous doctors on social media and they're really jealous of us because in Australia we've got the only form of testosterone in the world and designed specifically for women. And they even put it in a little pink tube just to make sure that you know that it's just for women. But the reality is for us, we're really lucky because in the US and the uk, if they don't privately import androfen, which is our version, they have to try and take a tenth of a sachet. And I don't know if you've ever tried to take a tenth of anything. It's pretty challenging. So obviously there are other evidence based treatments for the perimenopause and postmenopause things like the combined oral contraceptive pills. Sometimes we use that. Cognitive behavioral therapy, meditation and mindfulness, a Mediterranean diet. And there are other new drugs on the market that are beneficial, particularly in patients who are maybe having active treatment for breast cancer, who we probably don't want to give hormones to. There's a few new options up our sleeves.

One thing that I hear repeatedly from all my new patients is that often their past experiences with appointments to address their symptoms of menopause have made them feel rushed, unheard and frustrated. As a doctor of 25 years with first hand experience and understanding the many symptoms that one woman may encounter in her menopause transition, I knew I couldn't do this subject justice in a 15 minute appointment. Which is why I've created the menopause appointments designed to support you on your journey through the perimenopause and post menopause. This 60 minute session gives you and your doctor the ideal amount of time to understand your concerns, needs and desires. It gives us time to do a comprehensive assessment, including a full review of your medical history, assessing your mood, your sleep, weight and libido, and much more. Receive referrals for tests as needed, prescribe suitable medications if required, perform a skin analysis and leave you with a comprehensive, tailored plan unique to you. This is crafted to help smooth your transition through the perimenopause and postmenopause and allow you to thrive, not just survive. If you or someone you know is experiencing perimenopause or continuing to have symptoms in the post menopause, these appointments are for you. You can book an appointment with one of our doctors today. We have clinics located at Forester Speech and Newcastle, and you can book online@ubydoctorsaunawatts.com this podcast and any information, advice, opinions or statements within it do not constitute medical, healthcare, or other professional advice. Information is provided for educational and entertainment purposes only. If you have any health concerns, always consult your doctor.