Episode 2 : Menopause 101

Dr. Sophia:
Welcome to the Dr. Sophia Podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we will talk openly and with heart about all things affecting women from pregnancy, menopause, periods, sexual health, and so much more. Welcome to episode number two. Since we are in the month of October 2023, among other things, October is menopause awareness month. So today we will talk all about menopause.

Touseef Mirza:
Hi, this is Touseef. So there's so much to talk about when we talk about menopause, so we won't be able to go through everything. So I think this is going to be a series eventually.

Dr. Sophia:
Definitely the menopause series. But we will give you the highlights.

Touseef Mirza:
Yes. But we are gonna start digging into it. But we know if you're just like, oh my god, I have so many other questions, please know that we are gonna be looking at so many other of your questions. So I'm excited to talk about this because I know it's a hot topic. And I also find that it's only since the past few years that it's kind of become mainstream. Where before nobody was talking about the M word.

Dr. Sophia:
Listen to me, nobody was talking about it until Gwyneth Paltrow decided to talk about it.

Touseef Mirza:
Oh, is that it?

Dr. Sophia:
I swear that's how it feels anyway. Granted, as a menopause provider or someone who has been caring for women going through the change, quote unquote call menopause for several years and really embracing it, honestly. Really enjoying going through this with women. Helping them understand that going through this change, though it may feel like an out-of-body experience. can be done in a way that's with grace, that you don't have to suffer through menopause as many women have in the past and many women still continue to do. So I'm super excited that we get a chance to talk about menopause because oftentimes we don't even know what the symptoms really are. Women don't even realize that they're entering menopause or in the, the phase that's quote unquote before menopause called perimenopause, it might as well be menopause.

Touseef Mirza:
I'm 51 and I honestly didn't even understand the magnitude of perimenopause until just recently. I just thought it was just-

Dr. Sophia:
Your period stops?

Touseef Mirza:
No, but not just that, but that it was just the symptoms that I was feeling in the past, like five to 10 years was just an aggravation of PMS, but not necessarily understanding that it was a whole other event that was happening in your body. In my body and my hormonal levels.
Dr. Sophia:
This is exactly why we're here, because you are the classic patient. You are the person who comes in and says, I don't know Dr. Lubin, I feel like my brain is not working. I don't know, I just feel hot all the time. What is going on? And she's 44. And I have to then help her through the concept of, well, let's start with perimenopause. And what is the difference? Perimenopause versus menopause? So menopause is when you have gone through a full 12 months without your period. At that point we say you have now transitioned into menopause. The thing is the three to five to 10 years before you go through those 12 months of no period, that perimenopause, you are experiencing a lot of the same symptoms of menopause. And those include hot flashes, night sweats, insomnia, emotional lability, memory problems, joint pain, irregular periods, infertility, vaginal dryness, decreased libido, fatigue, like where did your energy go. Weight gain, depression, anxiety. And the list goes on. And so while you're going through it, especially when you're in the perimenopause phase, oftentimes you may go see your doctor and say, I feel like I'm having some memory issues, this mental fog, or I am having some joint pain. And you may actually see three or four doctors before you actually get to the diagnosis of perimenopause. You may be started on some antidepressants, you may have seen a rheumatologist, you may have seen a neurologist. It all culminates at saying, hey, is it possible that I could be in perimenopause? And once we get to the point of understanding that perimenopause and menopause share so many of the same symptoms is when we can start to think about, well, how can I help myself through these changes that are happening in my body?

Touseef Mirza:
So would you say then, then what one way to approach this? Cause I remember I didn't have a lot of hot flashes in the past 10 years, but I remember that I had some, and I didn't really think they were critical because they were so far and few between. But for women that are going through this, or like you said, joint pain or anything else, do you think it's a good idea, therefore to proactively talk about this with their physician and say, I'm having these symptoms. Could it be perimenopause related?

Dr. Sophia:
Absolutely. The, reason why we are here today is so that you can then kind of string along all the symptoms and realize that you can advocate for yourself, so that you're not just going to like two or three different physicians for something that honestly can be explained by what's happening inside of your body in terms of your hormones. And ultimately going through this transition is a transition and a change and a fluctuation that's happening in your hormones. And those changes are, we are so sensitive, our bodies are very sensitive to these changes. So imagine when we were little kids and we went through puberty, we are going through an exaggerated puberty when we're going through perimenopause and menopause.

Touseef Mirza:
One more time.

Dr. Sophia:
Exaggerated puberty.

Touseef Mirza:
And we thought puberty was pretty bad. Like, we thought it was like insane. I remember I didn't know what was happening with my body and it was so confusing. So it's even worse.

Dr. Sophia:
It can be for a lot. It can be.

Touseef Mirza:
It not necessarily, but it can, it
Dr. Sophia:
It can be for a lot of women. And when I say an exaggerated puberty, or at least let's think about it maybe from PMS, for example. You know, it's like PMS on steroids. You know, let's say that the emotional lability that's happening within you or what feels basically like an out of body experience.

Touseef Mirza:
Is it because it's, it's more the emotional or the stress and the anxiety is amplified? Or is it because we have it for so long? Well, is it the length or the intensity of it?

Dr. Sophia:
I think it's both. It's the fact that you can be in this stage of your life for the next five to 10 years. I think it's the fact that it can be daily.. At least when we're going through PMS, we can say that it's some type of cyclical change. Meaning that, you know, every 28 days you're, you may experience some PMS symptoms. But here with perimenopause and menopause, those are symptoms you can be experiencing daily. Those hot flashes are not necessarily going away because it's been three weeks. No. They can progressively become more significant as you approach full menopause. That's number one. And number two, they can continue for up to 10 years after you've gone through a full menopause.

Touseef Mirza:
So what does full menopause mean?

Dr. Sophia:
Full menopause means you've gone to 12 months, period free. No period. So full menopause, I mean 12 consecutive months of no period.

Touseef Mirza:
So once you hit that, then you're in menopause.

Dr. Sophia:
That's correct.

Touseef Mirza:
And then are you considered to be menopause until the rest of your life? Or is there another phase?

Dr. Sophia:
It's menopause until the rest of your life.

Touseef Mirza:
Okay. But does that mean that if, I don't know the first year after menopause, I still have a few symptoms of, of hot flashes or my joints hurt or something like that, that could be there for the rest of my life or that may not be the case, it just depends?

Dr. Sophia:
So when I say you're menopausal for the rest of your life, once you hit menopause, it means menopause simply says a cessation of your period. That's it.

Touseef Mirza:
Because I’ve heard of the term post-menopause.

Dr. Sophia:
Exactly.

Touseef Mirza:
What is that?

Dr. Sophia:
So post menopause or post-menopausal is exactly as it says. You've gone through menopause, you've gone through the period of cessation or stopping having a period. Now the symptoms associated with menopause, like we've just talked about, I listed just a few, those can persist. You start to have them before you fully go through the change of no periods for 12 months and they can get worse after you've gone through those full 12 months of no period.

Touseef Mirza:
Can they get better also?

Dr. Sophia:
They eventually do.

Touseef Mirza:
No, but can somebody have worse symptoms in perimenopause and in menopause that it's less like can there be all different ways of-

Dr. Sophia:
The variety of symptoms, variety of menopause and the variety of symptoms is so great. No two women go through menopause the same way. No two women go through menopause the same way. No two women go through menopause the same amount of time and all women should have grace with themselves when they're going through it.

Touseef Mirza:
Because it can be very confusing because some of these different symptoms can be due to so many other things. So you're, you're thinking, well is it menopause? Is it perimenopause? Is it really because I'm not eating well? Is it, am I anxious because of something in my personal life? Or is it because I'm not sleeping enough? Like there's so much, so many different factors that can actually affect to get these symptoms.

Dr. Sophia:
Yes, but let's talk about it. Let's get into a little bit of the nitty gritty. So for example, imagine a woman who is not sleeping well. Right? Imagine how that over time you've gone now 3, 4, 5 days in the week where you've literally only had three hours of sleep. Why? Because you have difficulty perhaps falling asleep. So at 9, 10, 11 o'clock at night you try to fall asleep. You finally fall asleep, let's say at like one in the morning. And then you get up at four in the morning because you're feeling hot, you're feeling sweaty, and you wake up at four in the morning and then it's like impossible for you to fall back to sleep until 6:00 AM and you have to be up at seven. So now let's talk about it. You've really only had four, maybe if you're lucky, a total of five hours, but that's a total of five hours of interrupted sleep.

Dr. Sophia:
So now you wake up, it's seven o'clock, you're doing your routine, getting ready for work, but you're tired. And so we now have started that cycle. We didn't get enough sleep, we go to work, we're tired. Now add to that, the fact that you're feeling like you just don't feel as sharp as you usually would. You feel like you're at a loss for words. You're talking to someone and you're like, uh, uh, uh, or you are like, that word is at the tip of my tongue. And you don't realize that that may be related to the fact that you didn't sleep well. Or is it just related to the fact that you're having all of these symptoms due to the fluctuations in your hormones that's happening in your body. And they may be a continuum. That one doesn't happen necessarily without the other, or they could be completely independent. But the bottom line is understanding that they may be associated. And so when you are going through the perimenopause, menopause changes, it's being able to recognize that, hey, I'm experiencing some joint pain. Is it because of the change in my estrogen levels that I may be experiencing this joint pain? Or am I just having arthritis?

Dr. Sophia:
But at least if we're thinking about it , then we can bring that kind of question up to our doctors.

Touseef Mirza:
So basically any of those symptoms we can say, you know, is this, could this be related to me being perimenopausal or being in menopause?

Dr. Sophia:
That is correct.
Touseef Mirza:
Because if we don't bring it up, then it might be just considered symptomatic to another-

Dr. Sophia:
Some other thing, other disease. And then when we think about it as being some other disease, then we are never really addressing the true problem-

Touseef Mirza:
Or it takes a long time to get there.

Dr. Sophia:
Or it takes a long time to get there, right?

Touseef Mirza:
Right. Okay. So we barely talked about hormones and estrogen. I know that this is a really big subject in of itself. So we'll definitely do another podcast on that. When we talk about perimenopause and menopause, we usually say the hormones. Estrogen seems to be the predominant one that we talk about. Is that really the guilty culprit? But there are also other hormones because we always say it in plural. So what are the other hormones and is estrogen the guilty culprit?

Dr. Sophia:
So estrogen definitely not the guilty culprit. There are several different hormones that are changing at the same time during this time. But estrogen is definitely the predominant one. Because estrogen is, we need estrogen for so many functions in our bodies.

Touseef Mirza:
We as in women, or women and men?

Dr. Sophia:
We as in women and we as in men.Because estrogen is actually very protective. It's protective for our bones, it's protective for our hearts, it's protected for our brains, it's protective for our skin. So we in general mean both men and women. However, as a predominant hormone for women, when estrogen levels are low, it is affecting us in all these places, including bone, breast, heart, skin, vagina. It affects the skin or the tissue, the mucosa, the inner lining of our vagina.

Touseef Mirza:
And would you say the moment that we are starting in menopause, the estrogen hormone is decreased? Is that an indicator?

Dr. Sophia:
That is exactly what's happening. So in perimenopause there are a lot of fluctuations that are happening. Sometimes it's high, sometimes it's low, and it's those changes, those constant fluctuations in the hormones that can lead to things like the hot flashes, for example, that women very much experience. But it also can lead to things of like vaginal dryness, changes in our skin, the skin feeling also very dry. It can also lead to some of the memory loss or the memory issues that we feel. Some of the mental fog that we feel, all of those things can be related to menopause and specifically to estrogen. But estrogen is not the only one. We're also thinking about thyroid hormone. We're also thinking about progesterone. We're also thinking about testosterone and all of these cases.
Touseef Mirza:
Can you say those three slowly again?

Dr. Sophia:
I sure can. So estrogen women as women, we have estrogen as our predominant hormone. Yes. But we are also concerned with thyroid hormone. We're also concerned with progesterone. We're also concerned with testosterone. And the reason why is because when these hormones work in concert and they're working well, this is when we feel our most vibrant cells. This is when we're talking about, hey, I wanna feel like I'm 25 again. And we don't necessarily have to want to feel 25 again-

Touseef Mirza:
I don't feel like we're 25 again <laugh>

Dr. Sophia:
But the concept of having vitality in the second half of our lives is important. And it's okay. We should want to feel that way, because the second half of our lives we're in more control. This is actually the time when women tend to feel the most confidence. When some of us go through menopause, it's so debilitating. It takes away so much of our vitality that it limits us in the sense of what we're capable of and can take away from some of the confidence that we can feel at that ripe age. And so that's why I feel like it's so important for us to really understand menopause. Truly de-stigmatize menopause. Let's talk about that.

Touseef Mirza:
I mean, honestly, it almost feels like menopause is so mysterious that it can't be actualized almost. You know? Like I think that's, that's what's been in the ether since I've been around anyways, you know? Menopause is such a mystery, but it's not. It's just that people don't talk about it openly.

Dr. Sophia:
It's, it's that people don't talk about it openly and honestly, when we think about menopause, we see, all we think about is a woman who's fanning herself perhaps, and or at the butt of someone's jokes. Right. We think about like, in movies, we just see a woman who's like having hot flashes and people laughing or, or that kind of thing, as opposed to really understanding, having some compassion, having some empathy around a change that's happening in a woman's life. That can really affect how she feels. And not just on the inside, but certainly on the outside.

Touseef Mirza:
So as I'm listening to you, it just feels like there's just so much stuff. You know, there's not just one hormone, there's many hormones, there's many symptoms. It continues for the rest of your life. And even if there's certain things in terms of stats you see, but you might feel different. It kind of almost feels insurmountable. You know, it feels like, oh, okay, so am I doomed to the moment I hit perimenopause, menopause? You know, because it just feels so heavy. So how do we deal with this with a little bit more levity?

Dr. Sophia:
It starts by simply understanding that we are going through a change. And when we understand the kind of change we're going through, we can do better at addressing how to better go through that change. And a couple of things which are simple but may not be that easy, is perhaps dietary changes, lifestyle changes. Understanding that, let's say, for example, some of the emotional symptoms that may be happening at the time that we don't make big important decisions, perhaps without taking into account a self-check-in. How am I feeling today before I go into this meeting and either feel like I'm a mess-

Touseef Mirza:
So self-awareness?

Dr. Sophia:
Having the self-awareness so that way we can help people help us. Help those that are around us be more cognizant about the thing that's happening within us. So it doesn't have to feel so insurmountable, it's just that we have to recognize that it's happening in the first place

Touseef Mirza:
And that it's okay.

Dr. Sophia:
And that it's definitely okay.

Touseef Mirza:
That nothing is wrong with you because that's what's happening. You didn't do-

Dr. Sophia:
Anything wrong. Exactly. You didn't do anything wrong. And moreover, when you're going through something that is natural, it doesn't mean that there shouldn't be some form of therapy or something that helps it along that makes you feel better. I remember going through puberty and having acne, for example. And boy am I happy that there was acne treatment so that I didn't have to suffer with acne. Was it a natural process? Sure. But I certainly didn't wanna suffer through it. And it's the same concept as we go through menopause. Yes. It's a natural process, but having some grace and saying, hey, I don't have to suffer through it. And to figure out what is the best option for you. First starting with accepting that you're going through it, giving yourself some grace, and then figuring out what are the best modalities to help you through it.

Touseef Mirza:
So it's almost, so, if I understand correctly, it's number one, recognizing that it's just natural. That's just what it is. That's just a normal process of what a woman goes through. Number two is to look at maybe that, like the latent things that you can check off, like diet and exercise, being self-aware.

Dr. Sophia:
Absolutely. Absolutely.

Touseef Mirza:
And then third is about-

Dr. Sophia:
Having a conversation with your doctor.

Touseef Mirza:
Right. Self-advocacy. Like really talking about it and not talking about it. Not just talking about the symptoms, but also just saying like, could this be related?

Dr. Sophia:
To perimenopause and menopause?

Touseef Mirza:
Menopause, yes. And forth, having some grace,

Dr. Sophia:
Definitely having some grace with yourself.

Touseef Mirza:
And when we say having some grace, what does that mean?

Dr. Sophia:
Grace means that, because menopause can almost feel like an out-of-body experience. Grace means when you wake up and you're a little bit more cranky, that you say to yourself, you give yourself a countdown of 10 and say, I think I'm having a moment where I am emotional, anxious, having some paranoia, feeling a little depressed. And this may be related to my menopause. Maybe this is a day that I need to talk to a friend. Maybe this is a day that I need to tell my boss I need to come in an hour later while I collect myself. Maybe this is a day that you definitely take a walk, go to the gym, try to do something else that's gonna help release some endorphins. Um, but it's acknowledging when I say have some grace, I say, have some acknowledgment and be okay with the fact that this is the change your body is going through.

Touseef Mirza:
And not beat yourself up.

Dr. Sophia:
Definitely not beat yourself up or just get upset. Don't just get upset. Don't just say, why am I going through this? This sucks. I don't understand. Say, I know I'm going through this, this is what I'm gonna do to help myself.

Touseef Mirza:
Be gentle with yourself.

Dr. Sophia:
Being gentle and helping other people to be gentle with you.

Touseef Mirza:
You know, I think we need to have so much more of these conversations because as women, we're all gonna go through it.

Dr. Sophia:
That’s right.

Touseef Mirza:
There's no way I…

Dr. Sophia:
There’s no escaping.

Touseef Mirza:
We'll all have different degrees and different symptoms, but the change is there. No matter what, like puberty.

Dr. Sophia:
That's right.

Touseef Mirza:
I think for now, I know we could talk so much more in terms of estrogen and the symptoms and what are the different potential ways that we could address perimenopause, menopause. But that will be for next episode.

Dr. Sophia:
Yes. So for all of you who are listening to us today, Our top three takeaways are: menopause is when you've gone through 12 consecutive months without your period. Perimenopause, the time before you go through menopause, and you're experiencing many of the changes, the symptoms of menopause, except perhaps you're still getting your period. And finally, you're not losing your mind. Have some grace with yourself and help others to have grace with you while you're going through this process. Until next time, embrace your body, embrace yourself. This is Dr. Sophia, and I'll see you next time. Disclaimer, this is general medical information. Please refer to your physician for specific medical advice.