Episode 27: Perimenopause/Menopause: How they affect anxiety and periods

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn 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 talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Please note today's episode covers sensitive content on serious mental health issues, including depression and suicide. Viewer discretion is advised. Hello everyone

Welcome to the Dr. Sophia ObGyn podcast. I am so happy to be in 2025. We are excited for just everything new that's happening, but moreover, we are always excited to talk to you about menopause.

Touseef Mirza:
Yes, yes. Again, menopause.

Dr. Sophia:
Again, menopause. And it's interesting because it seems like it's almost like it's never ending, and the reality is it's not.

Touseef Mirza:
The floodgates have officially opened.

Dr. Sophia:
They have totally opened. So it's good for us to continue the conversation because it just affects so many people and so many women have questions about what's going on in their bodies. And in this particular episode, I'd like for us to really touch on two aspects. One is just menstrual irregularities, and the second is the mood changes and mental health issues that can come up during the menopause season, perimenopause transition. But without further ado, I have with me as always, my dear friend and co-host Touseef Mirza.

Touseef Mirza:
Hello everybody. And yes, happy 2025. So we've had a few episodes on menopause and it's almost like the gift that keeps on giving. The more we talk about it, there's more questions, there are more specific questions, different ways of looking at it, and also examples. So we thought, let's continue this journey. I think that's gonna be a topic that's gonna be coming up a lot this year.

Dr. Sophia:
I think for me, the reason why it just keeps coming up is because I have patients who, you know, really peak my thought process around this issue all the time. And I had a couple of recent patients that kind of made me come back to, okay, we still need to talk about it. We still need to bring it back to the conversation because women are still very lost. You know, women are still very lost as to what could be happening, what is happening, and how they're feeling when it comes to being perhaps in your, I don't know, somewhere between your mid to late forties and early fifties when you're experiencing some of these changes.

Touseef Mirza:
So before we start to dig into the nitty gritty we always like to start with just setting the playing field in terms of the basics. So, what is perimenopause and menopause?

Dr. Sophia:
Okay, so perimenopause, perimenopause is the transition that a woman goes through before she actually reaches full menopause. Perimenopause can last anywhere from 10 up to 15 years before a woman actually experiences her last period, menopause being going through 12 full months without a period that is considered when you're in menopause. So everything else before that, whether you're getting a period, it's starting to skip months, it's coming more frequently, it's more heavy, it's more painful, it's not coming, it's lighter, you just don't know what's gonna happen with it. All of that is heavy menopause.

Touseef Mirza:
So what is the average age of women who are in menopause?

Dr. Sophia:
The average age of women in menopause is around 51 in this country.

Touseef Mirza:
So that means if you said that it's up to 10 to 15 years before, then it can go almost all the way back to like 35, 36?

Dr. Sophia:
In your late mid to late thirties. That's correct. Because you can actually go through menopause and be completely normal if you go through menopause at, let's say 45. So, meaning that at 45 you stop getting a period.

Touseef Mirza:
So there is a percentage of the women's population that would be in menopause at 45?

Dr. Sophia:
Even earlier.

Touseef Mirza:
Even earlier.

Dr. Sophia:
We consider, we consider if a woman goes through menopause, even at the age of 40. To still be considered normal. Now, is she on the very early end, absolutely. But it wouldn't be a cause for concern to say, oh my gosh, something's really wrong. It's wow, you've really gone through menopause on the earlier side as opposed to a woman who stops getting her period, let's say at 32, a woman who stops getting her period at the age of 32, we would consider as being very premature in terms of having menopause. And that would prompt a whole series of other tests for us to try to understand why she went through menopause so early, and likely would lead to some type of what we call ovarian insufficiency, meaning a problem with the ovaries and why the ovaries stopped creating those sex hormones.

Touseef Mirza:
So it means that a woman that's between 40-45 can still be considered quote unquote normal, normal for being menopausal. There's not an issue there.

Dr. Sophia:
That is correct. So a 44-year-old woman walks in the door and says, I haven't had my period for a year and a half, but you know, I didn't notice 'cause this actually has happened. This is the true story of having a patient who was, you know, very high-powered in her job and just, and also at the time was having some family challenges, had lost a parent and didn't realize that she actually had not had her period for over a year. So when she had the moment to kind of take a step back and come into the doctor, and, you know, of course I'm prompting, oh, okay, well, when was your last period? And when she had to go back and try to figure that out, she was like, wow, it's been over a year. And I said, oh, okay, well, are you experiencing any menopause symptoms? And she says, why are you asking me that?

Touseef Mirza:
And how old was she?

Dr. Sophia:
44. She says, well, why are you asking me that? And I said, because it sounds like you're in menopause. And she says, what? And it was like the first that she'd even thought about it as a real possibility and having to go through that conversation with her. Well, you no longer have a natural opportunity to go through, like, let's say for fertility reasons, right? If she wanted to have children or was still considering children. Well, that became something that was completely off the table.

And when I asked her, I said, did you notice that you weren't getting a period? She says, well, you know, I was under a lot of stress and I just thought that that's what it was, but now things are better. And so, you know, I, yeah, I kind of, I really wasn't sleeping that well. I was feeling a little tired, but I just thought that that was all related to stress. I didn't realize that I was going through menopause.

Touseef Mirza:
That woman brings a very good point because usually that didn't happen to me, but you would think, oh, it's probably because I'm stressed. And so you just put it on the back of your mind and you just keep, keep going, keep going, keep keep going, pushing through, you know, try to do a little bit more meditation, you know, like, you know, but you're not really fully understanding what's really happening going on, or the potential of what is really going on.

Dr. Sophia:
That is correct. And don't get me wrong, I'm not saying that stress cannot impact your menstrual cycle because it does in a very tremendous way. And to her point, it may very well be that stress is what pushed her over the edge into menopause early. Or on the earlier side, you know. But the reality is, she is in fact, menopausal. And we proved it by going through the exercise of actually checking her hormones and seeing where she was, because she was surprised. And I kind of felt a little bad having to break that news to her because it was obvious that once I told her that it made her feel like she'd really lost something. In terms of her womanhood, so to speak. You know? I had to kind of reassure her, okay, it's okay that you've gone through this, this process, this very natural process. Let's move on and start talking about, well, what are some of the symptoms you're experiencing right now?

Touseef Mirza:
You bring up a very good point: for the longest time, well, number one, menopause was never talked about. Number two, if menopause was talked about is there's, there was this stigma around that associated with maybe, like, like you're saying, the womanhood, the vitality of a woman, you know, and that, so therefore, it's almost not a dirty word, but you know, you don't wanna be associated with that.

Dr. Sophia:
Who wants to be associated with menopause? When you thought about menopause as a younger person, you're like, that's my grandmother.

Touseef Mirza:
Exactly.

Dr. Sophia:
You know, it just made more sense to think of it as being someone who was very old.

Touseef Mirza:
It's such a shame, you know, I think, thank God we're here now, and I know we still have a lot of work to do, but it's, it's really a shame that women in the past had to go through it this way.

Dr. Sophia:
Well, I think women in the past went through it by not going through it, right? In the sense that they didn't go through the conversation. They went through it and it was completely silent. So it's like no one knows what's really happening.

Touseef Mirza:
So let's talk about that. So when a woman is in perimenopause or menopause, we talk a little bit about hormones, which hormones are we talking about? And what's happening to the hormones?

Dr. Sophia:
I just like to remind everyone one more time, estrogen. Estrogen is a hormone that helps us have a lot of vitality. And estrogen does so many things in the body. As a matter of fact, it has over 400 functions in the body, and a majority of those functions are happening in our brain. And so when it comes to some of the mood changes that are associated with perimenopause and menopause, we can even take that a step back. We can look at it in terms of young people or younger women when we're going through, let's say, PMS, let's say, you know, puberty.

And we can go as far back as that because that's when our brain is really exposed to estrogen and the changes and fluctuations that happen in our bodies in terms of estrogen and how we respond. And so I feel like sometimes perimenopause and menopause, it's like we were talking about this PMS on steroids, you know what I'm saying? It's like PMS, but on 10 in terms of how a woman can be feeling in her mind emotionally

Touseef Mirza:
Without realizing that it's the hormones. And it's not you. Like, that's what PMS feels like. Yes. It's like all of a sudden you are in a funk and you have no idea why, and you think your whole world is upside down, everything's-

Dr. Sophia:
Crashing down.

Touseef Mirza:
And then four days later you get your period and you go, oh, that's why I was so messed up. And then, and then everything makes sense again.

Dr. Sophia:
You're right. And then the world is right again.

Touseef Mirza:
The world is right.

Dr. Sophia:
Again, the world is right again. But in perimenopause and in menopause, you can be in that loop for days and days and days and months on end because the period never comes because that signal to your brain doesn't happen. That everything is gonna be okay because our estrogen levels are back in balance. Or, you know, your brain is not like craving this estrogen for balance.

Touseef Mirza:
So is it that your estrogen and perimenopause and menopause are much lower than when you, before perimenopause when you have periods.

Dr. Sophia:
So it's an interesting question, especially if we're talking about the perimenopause transition, because your estrogen levels are kind of all over the place, and estrogen levels that are too high, what we consider as estrogen dominance can lead to same symptoms, interestingly enough, can still lead to mood swings, irritability in the same fashion as the depletion of estrogen.

Touseef Mirza:
So if your estrogen is too high or too low.

Dr. Sophia:
That is correct.

Touseef Mirza:
Great. Okay. I thought at least like one side we're okay, but no.

Dr. Sophia:
No. All right. No, it doesn't mean that. Oh yeah. If we just keep giving you more just go, go, go, go, go, go, go. Right. That it's gonna get better. Not necessarily. That's, that's actually what the funky part of it all is. And in perimenopause, you're both high and low at any given point. You know, you can be super high and you can be super low. And, then experiencing all the other symptoms that come with low estrogen, including things like hot flashes, including things like sleep disturbances and joint pain, memory issues, mental fog, and not being able to stay focused. Oh, my favorite because it affects me is ADHD on 10.

So it's like the reality of the situation is that estrogen has a big impact on our mood and our mental health. And it doesn't take anything away from someone who may be experiencing, let's say, anxiety and depression. But those things tend to be kind of kicked up a notch during this time. Especially if you were someone who had already previously suffered with either of those things, for example. And it can also be a completely new onset for someone who says, I was fine. I've never experienced depression, and I've never experienced anxiety. And slowly as they're entering their perimenopause and menopause, they start experiencing levels of anxiety, levels of sadness, or just constant feelings of being unfocused and distracted, or just fatigue and depression. In a way that they've, they've never felt before.

Touseef Mirza:
So I think also, I can only speak for myself if I don't feel that I've had that much impact from a mood perspective. It has, but it's been very sporadic. So it's not something that has been constant. And I think that it's important to say that people going through perimenopause and menopause have very different experiences, that it's not like everybody's gonna be going through mood changes or everybody's gonna have joint pain, and so forth.

Dr. Sophia:
I think, like to tell people, perimenopause and menopause is like a mixed bag of 150 different symptoms, and everybody gets their own little handful. So not everybody gets joint pain. Not everybody gets hot flashes. Not everybody gets vaginal dryness. Not everybody gets mood changes. But for those of us who do, you are not alone. Number one.

Number two, it's not your fault. Number three, acknowledge the fact that you may have a hormonal cause for what's happening with you. Number four, still seek medical advice and attention from your psychologist, your psychiatrist, your therapist, your tribe, your social group in terms of support. Because yes, of course you may be having a hormonal issue, but it doesn't change the fact that if you're someone who has suffered from depression in the past, that you may not be having a true major depressive episode that requires psychiatric evaluation and help. It's just being able to understand perhaps what the initiating thing could have been, whether it's a stressor, a life stressor, or the trigger of being in perimenopause.

Touseef Mirza:
I think that requires a lot of self-awareness, because if you are in a certain lifestyle that has a lot of stress, then you might just think, oh, that's just my life. Versus actually saying, well, you know, is this, is this, could this be caused by hormones? You know, to even ask, I've never asked that question. Well, number one, I didn't even, I didn't even know that perimenopause affected me. I was like, I just knew there was menopause, but I had no idea that there were symptoms. And I'm like, oh, yeah, it's true. I did have night sweats, and I was just like, maybe I was hot. You know, I just never-

Dr. Sophia:
Connected it.

Touseef Mirza:
I just never connected it. And I was just like, ah, you know, like, who cares? But now, if I were in my forties with this information, I would be like, oh, this is interesting. You know?

Dr. Sophia:
That's the whole point of why we're continuing to have this conversation. At least if we are talking about it, then it might be a little like, huh, ding, ding, ding, ding, ding. When I do go to the doctor to say, hey, is it possible that why I'm feeling some of the symptoms that I'm feeling? Could it be related? And I think just being able to ask the question, because somewhere you at least got the information that it's a possibility, already puts you light years ahead.

Touseef Mirza:
So let's talk about the real world situation. We've been talking about mood swings and how it can affect women. So can you give us an example of what you've seen?

Dr. Sophia:
So, you know, I don't wanna be all gloom and doom when it comes to menopause or the perimenopause transition per se. However, you know, two of my patients really come to mind, and why? It's because one of them was in perimenopause, and she's a woman who had actually suffered with some anxiety in the past, but was very high functioning, didn't require any medications, and really able to just kind of power through in terms of her life, and felt very happy. And she did suffer a breakup, but certainly one of those people who wouldn't let something like that stop her in her tracks. But in this particular instance, not only had she gone through the breakup, but she came to me and she was like, I just feel like I'm losing my mind. And I say, well, first of all, let's-

Touseef Mirza:
What does that mean? Losing my mind?

Dr. Sophia:
What? Losing my mind? Well, she's like, I saw a psychiatrist a couple of weeks ago, and I got started on Wellbutrin because I've just, my anxiety and my depression seems to be- I, I don't understand, which is

Touseef Mirza:
An antidepressant?

Dr. Sophia:
Which is an antidepressant and anti-anxiety. And it was just like, okay. And in the same vein, she's like, and I don't understand, you know, actually I haven't had my period, and it's almost been like eight or nine months already. And I said, okay. And I said, are you experiencing anything else? Are you having trouble sleeping? She said, yes, I'm definitely not sleeping well. And I said, well, I don't know. I feel like it may be that you're going through some perimenopausal changes, especially knowing that you haven't had your period, and you know, these hormone fluctuations can be affecting your mood. And she says, well, I don't, I really don't know. Could you, you know, check? I said, well, let's start with just checking where you are in terms of your hormones. And lo and behold, yes, it did show us that she did have some lower estrogen.

FSH is one of the things that we checked in terms of hormone panels to see if you're in menopause, and though it may be high, that's suggestive of menopause, it can change when you are perimenopausal, because like I said, your hormones can be up and down at any given point. But being that she had been consistently without her period, I suspected that her lab work would help to kind of identify that. And a few days after I saw her, and we'd done her hormone panel, and she'd already been started on her medication, a few days later, she called me even more panicked. And the conversation was, I'm in a really dark place. I, for the first time in my entire life, feel like I just don't want to be here.

And I said to her, okay, who do you have around you? If this is how you're feeling? Do you feel like you need to go to the hospital? I think, you know. And she said, no, but thank God I do have people who have been checking on me. Like she had a good social network and support. And so and she said, so you were the next person. I felt like if anybody could help me that it would be you. And I said, well, I'm glad that we're talking. And I said, I just, I really feel pretty strongly that now I have your labs to prove it. You're definitely perimenopausal, and I think you need some hormone replacement. And she said, I'm willing to do anything to not feel this way. So I wanna say about 12 days later, she again reached out and said, I can't believe how I feel. I can't believe how much better I feel.

Touseef Mirza:
So she started to take the medication, like right after.

Dr. Sophia:
So we started her on some hormone replacement, and she was just completely in awe of how different she was feeling. And she said, I'm so grateful because I knew that the way that I was feeling wasn't normal. And I knew everybody was like, oh, get over that guy. And I knew that it had nothing to do with him. You know, having been through that recent breakup, she kept putting it in her mind that it must be because of that. Yes, of course. It could have been an inciting factor. Don't get me wrong. I'm not diminishing emotional connections and the emotional liability that happens after you have a betrayal. But it just wasn't her. And she's like, I just feel like I'm back to myself. And I think that was the key.

Touseef Mirza:
So I think it, and, and you're talking a little bit about it, and I think it's important to point out that going through a breakup or going through a loss or going through something that's really close to you, obviously has some emotional impact. So we're not saying that everything is, you know, caused by hormones. So we are human beings, and therefore we feel things. And sometimes absolutely. We're down and sometimes we're up. And that's just part of the human experience. But it's to either realize the intensity or the-

Dr. Sophia:
The extremes.

Touseef Mirza:
The weight, perhaps the weight of it. The weight of it.

Dr. Sophia:
And like I said, many women will not experience their perimenopause transition this way. Certainly not to that extent, but it can happen. It's the reason I think it's, it's no, it's, I should say it should be no surprise that the highest number of women who have committed suicide are in that age range of 44 to 65.

Touseef Mirza:
It's just so crazy.

Dr. Sophia:
Which is so wild.

Touseef Mirza:
Yeah. You would think that at that age we're, I guess more-

Dr. Sophia:
We got it together.

Touseef Mirza:
We got it. You know, we know ourselves, we're a little bit more grounded. But if you have lost touch with yourself, yeah. Like that woman, yes. Then you're just like, well, what, what's going on? So the awareness of this is so important too.

Dr. Sophia:
Well, that's the reason why I say we can still have this menopause conversation like 10 more times. Yeah. And it's just because it's literally being aware. The more you think about it and say, oh, could this be what's happening? I know I heard someone talking about, Hey, I'm 43 and for whatever reason, I'm not able to handle my kids coming and yelling and screaming and whatever that they're doing. When I get home, I'm not able to handle my boss asking me to do four more things.

I'm not able to add anything else to my usual plate. Could I be potentially experiencing hormonal changes? I feel so fatigued all the time. Could I be experiencing hormonal changes? And I think it's just even acknowledging that it's a possibility.

Dr. Sophia:
Helps women to think about other ways that they could be kind of helping themselves. And I'm not saying the answer is hormones. It doesn't mean that when you're going through this, the first step is going to be hormone replacement. Absolutely not. It usually is just dietary changes and changes in sleep and changes in exercise that can actually mitigate a lot of these things.

But it's the thought, it's being able to go back and say, wow, this could be what's going on. And so let me look at this through another lens. So that's one lady that I had, I had another lady who was in full blown menopause, full blown, and had been on antidepressants for some time, and she said, you're my last resort. And I said, last resort. And I was just really like, wow.

Why? And she said, you know, this, these medications are not helping me anymore, and I was gonna jump off a bridge. And she was like, not figuratively. She said, really? Wow. And I was just like, wow. Yeah, exactly. She was 54 at the time. We did our blood panel, we did everything. And we started on hormones. And I wanna say a month later we saw her again, because we usually would do a check-in a month later. And she said, you've changed my life. I don't even think I need this antidepressant anymore. And it's to the point where now where I believe about a year and a half in, she's completely stopped all of her antidepressants and she's only on hormone replacement.

Touseef Mirza:
So this sound, I mean, that's amazing. And it, it, if you hear that for the first time with these two stories, it almost feels like it's the magic pill. Right? So what is actually happening that is reestablishing, I guess, a balance of the hormones, but what's actually happening?

Dr. Sophia:
So again, like I've said, estrogen really does have so many functions in the brain. And for one of those women, the one who was actually completely menopausal, not only was she treated with estrogen, but she was actually also treated with testosterone. Again, another hormone that we don't typically think about in terms of for women, any woman who is receiving hormone replacement with testosterone must be because they have low libido or some type of sexual dysfunction that is treatable. Some what we consider as an FDA approved cause or reason to treat a woman with testosterone. But in fact, testosterone also has so many functions in the brain. And one of those,

Touseef Mirza:
Like naturally, like we were born with it.

Dr. Sophia:
Yes, we're born with it, women have estrogen and we have testosterone. If anything, we actually have more testosterone, you know, like per capita versus estrogen in our bodies. And so it's interesting that it's not one of the hormones that we really consider in terms of hormone replacement, but in this particular case, for this particular patient, yeah. It made a huge difference.

Touseef Mirza:
So what's actually happening is that the load of estrogen and testosterone was too low for it. That is correct. That inhibited the normal functionality of the brain. By replacing the, those levels of estrogen and testosterone, and, and in that particular woman led her to feeling more-

Touseef Mirza:
Reestablished levels?

Dr. Sophia:
Reestablished a certain balance. Which allowed her to have more mood stabilization.

Touseef Mirza:
So it's a, it's a better state of homeostasis of how we were homeostasis being in balance of how our body is supposed to function.

Dr. Sophia:
How it's supposed to feel, and it optimally functioning. Again, I don't want to make it seem as if everything is, goes back to just, oh, just do throw hormones at it. No, I like to point out that every conversation comes with what's in your diet? How are you eating? Let's make sure that we're taking away any inflammatory foods. Let's make sure that we're adding in lifting and weights in terms of your daily routines for exercise. Also doing, you know, low impact, like just walking. And how that helps to simply add to a sense of peace and balance. But in those two particular cases, yeah. The hormones definitely made a difference.

Touseef Mirza:
And also, you take into account the medical history as well. Yes. Like, like you would do with any other.

Dr. Sophia:
Yeah, absolutely. There's no question. So mood changes can be expected in a lot of women who go through the perimenopause and menopause transition. And I think we need to basically scream it from the mountaintops so that women are aware that it is something that can happen during that time.

Touseef Mirza:
I think the next step is to, in your everyday life, become aware of your being. Sometimes we just don't think about those things. You know, this is all knowledge we have, but we don't put those two things together when it happens because we're just doing life.

Dr. Sophia:
You know, I know the concept of life is just life today. And I get it.

Touseef Mirza:
I'll give you an example. One of the reasons why I journal all the time is that I actually write down how I feel. And that has been my salvation, because that has forced me to recognize every day how I feel. Because, because before that, I'm just like going, and if I feel like, you know, crappy, then I'll just keep crappy. But it's not something that is in front of mind.

Dr. Sophia:
Like, you're not focusing on it. It's, you're not really acknowledging it in a way that allows you to kind of dig in and look in, or even observe.

Touseef Mirza:
And say, oh, this is happening right now. And especially in the, you know, information overload and the noisy world that we live in it's hard. We have all this knowledge, but sometimes it's hard to actually like, bring it together and say, oh, hold up, hold on. If this is what's happening? And I'm at fault too. Don't get me wrong, it's still difficult, but at least I have a little bit more-

Dr. Sophia:
Awareness of it. Like insight, insight, awareness, you know, paying attention. And actually, you bring up another point. I feel like some of the, some of the challenges that we're experiencing in our perimenopause, specifically in this day and age, one of the things that makes it so, I guess in, in the forefront, I know for me, for me in particular, is the advent of social media. Like the access to so many distractions. You know, it's just so abundant from, let's say a woman who was going through this 10 years ago. Just the fact that our phones have become such like little computers in our hands all the time, increasing our access, but also just literally increasing our distraction. And distractibility. And I feel as if that too has had an even greater impact on women as we're going through this kind of distraction, this, this, this transitional period.

Touseef Mirza:
So are you saying that you've seen an increase in women who have more perimenopausal or menopausal symptoms? And that your observation is, could that be linked with the fact that on top of the normal load of perimenopause, menopause, we now have an extra load of the phones that can create more mental noise? That doesn't help.

Dr. Sophia:
I just feel that it's definitely additive. The fact that we have increased in our quote-unquote unquote mental noise from these outside distractors that is at our fingertips at all times.

Touseef Mirza:
So what would you say if women are in their thirties or in their forties or their fifties and they want to talk about it with their physician? Should they just to, to make sure if, if something is, is a little bit off, you know, it could be, like you said, it could be their joints, it could be cognitive, it could be their menstruation, it could be all these things. Who should they start to talk to first? Like can they just go see their primary care physician or should they go more to the obgyn.

Dr. Sophia:
Oftentimes, women first go to their primary. Okay. And that's just because again, when they start experiencing certain symptoms such as perhaps night sweats, insomnia, joint pain, the first thought is not necessarily to go to an obgyn, but to go to their PCP or their primary care and say, Hey, I'm feeling some of these symptoms, you know, can you help me? Is there someone else I need to see? Because primaries oftentimes are also the ones who kind of coordinate care as well. And so I'm not surprised that that's typically the first place that people go.

Touseef Mirza:
But it's okay to go since now we are more, we are more knowledgeable and we know that some of these things are actually associated with hormones. Could I also go see my obgyn?

Dr. Sophia:
The answer to that is absolutely to bring up some of those concerns, those symptoms you may be experiencing to your obgyn, and to kind of go through it to see what else may be related. Because I think that's the other thing. We can kind of stay focused on one symptom without realizing that we are experiencing a couple of others that can kind of bring the picture together. And so I think that that's where perhaps seeing an obgyn makes it a little bit better in that, because we can ask certain questions, certainly what's happening with your period, when was the last one? And so many times when they're like, yeah, I'm getting it every month. And I'm like, okay, well did you, when was the last time? And then when we start to calculate when you're getting your period, we notice then that there are changes happening because it used to come in the beginning of the month, now it's coming in the middle and then it comes again at the end of the month.

Dr. Sophia:
Yes. Okay. You got your period, but you kind of got it twice in the month. But certainly not in a normal type of way. Or maybe you got your period at the beginning of September and the next one wasn't until October 27th. Okay. Yes. Did you get your period every month? Yeah, 'cause you got it in September, you got it in October, but there were six weeks in between, you know? And that is considered abnormal. So if we're having the conversation, sometimes when you go to maybe your primary and you say, yeah, I get my period every month, they're not necessarily digging deeper.

Touseef Mirza:
Because if I would've learned all the disinformation in my early forties, if something would be wrong, now what I would go say is that, you know, this is what's happening. And then I would say, could it be related to hormonal changes, which I have never said in my life. You know what I mean? Yes. Like that would always be my question. Now that I have this knowledge. Yes. Because that was never presented to me at any point. And so I think that we need to become more proactive and become self-advocates.

Dr. Sophia:
You're 100% correct for your own health and health. You know what, it's more than just estrogen, progesterone, and testosterone. When we say hormones, there are other things we're talking about also, we're also talking about your thyroid, for example. And so fluctuations and changes in your thyroid hormone can also lead to changes, menstrual irregularities, mood changes, fatigue, cold intolerance, all kinds of things. So it's not just one size fits all. However, I think it's good to feel empowered to be able to ask more questions.

And I don't think you're wrong to say, Hmm, well, I know I'm having these symptoms. Is there any chance that they could be hormonal? Could there be another influence here? Is there something else I could be doing? And at the end of it, the answer still could be yes or no. And the treatment could still be hormones, or no hormones. The treatment could still be; maybe you just need a vitamin D supplement. Maybe you need, you know, to be eating differently. Adding more vegetables to your diet, adding more water to your diet, and getting more sleep. So there is no one answer, one size fits all. I just want everybody to be aware that these things exist, that they are possible, that there are possibilities.

The other place that I wanted to just mention in terms of perimenopause is the concept of menstrual irregularities. How many times do I get a woman who comes into the office, she's 47, and says she's missed her period, maybe for two months. She knows she's not pregnant. And so she's like, what's going on? Something's really wrong with me. And I have to say, it doesn't quite seem like something's really wrong. Did you realize that there's a possibility you could be in perimenopause? And she says, well, I'm only 47. And I said, I know you're only 47, but yes, you can still be experiencing perimenopause. The first thing that has to happen, any woman in their forties who has any changes with their period, is definitely a pregnancy test. Because I have two women in my practice right now. One who is 47, and the other one who will be 48 when she delivers.

Who had spontaneous pregnancies, meaning they did not go through any kind of IVF or anything. And they certainly were not planning it. Big surprises. And so yes, whenever you have a change in your menstrual cycle, first thing check a pregnancy test. But moreover, it's the understanding of all the different changes that can happen with your period when you're in this transition. It can skip months, which is very classic because you're having what we call an ovulatory cycle, meaning you're not really ovulating every month. And that's part of the reason why you're not getting the period.

You can have period cycles, meaning from the first day of your first period to the next first day of your next period that are a lot shorter. Meaning on average, most women will fall somewhere in between, I don't know, let's say somewhere between 24 and 30 days in terms of when they get their periods. And for the most part, for your own calculations or you know, what you normally go through, it stays around the same days. So if you were someone who's like a 24 to 25 day, you're always about 24 to 25 days. If you're a 28 to 29 day, you're a 28 to 29 day person. Now all of a sudden your periods coming every 18 days can be a sign that you are in perimenopause.

Could it be a sign that something else is going on? Absolutely. Do we still need to investigate it? Absolutely.

To make sure that you don't have something functionally going on with the uterus itself. Absolutely. But that's something that can happen. That your periods start to come shorter and shorter and shorter. The cycle becomes shorter, but it's not necessarily a cause for concern. No. In the sense that it's enough of a concern that you need to come and get it evaluated just in case that it is not perimenopause. That is correct. Okay. But it's the fact that when it is perimenopause, how shocked oftentimes women can be . That some change in their period is happening, and yet they feel like they're still so young, so to speak, which I'm not taking anything away from them being young. I know from myself, I'm still young. Yep. But I still have to go through the facts and, and, and deal with the fact that yes, changes are happening.

Touseef Mirza:
Changes are happening. And then also periods can come anytime.
Dr. Sophia:
They can come, anytime they can last long. I had another woman who came in and said, something's really wrong with me because my period is, I'm on day 18 of my period. Like what's happening again, unfortunately, another possible fluctuation in your cycle that can happen within the perimenopause transition, it could just be anything. It could literally be.

Touseef Mirza:
It could also be just spotty.

Dr. Sophia:
It could be spotty, it could be, it could be almost anything. So I think that's probably what the most frustrating part is. So

Touseef Mirza:
The moral of the story is always have a pad or tampon in your back wherever you go.

Dr. Sophia:
Definitely. Because you never know, because you never know what's gonna happen. Yes. And then number two is to know that it can be like crazy, like totally. It's here. One day it's gone. The next it's heavy, it's light, it doesn't come, then it comes, then it lasts forever, then it goes away, then it's gone for months. And you're like, wow, I'm done. And then it's back. And then we start over.

Touseef Mirza:
When I, the first time, well, the first time a coup two years ago, I was just like, okay, I only need one more month. I didn't have my period for 11 months. And I said, okay, I'm pretty much in menopause. In the 11th month I started a period. I'm like, you gotta be kidding me. We were almost there, we were, I was seeing the finish line and I said, we have to go through this again.

Dr. Sophia:
It's a reset button. And I think that's also another frustrating part because you really do have to go through the full 12 months. Yeah. Before we can consider you in full blown menopause. And you, and it's a reset button every single time you get that period. So it's been six months, no period. Woo hoo. Seventh month, bam, restart again from, from one waiting for another 12 months to go through. Now of course, like I said, change is change, but change always should be evaluated. And so that's why I bring up the point, no matter what the change is, to definitely seek the kind of evaluation and reassurance from your medical provider. Let's be sure of what's happening because there are other reasons and causes for changes in periods. And all of them, no matter what it is, can be addressed.

Touseef Mirza:
We talked a lot about menopause, and we're gonna talk about it again in an upcoming episode where I'm actually gonna be talking, it's in the series of my journey, as in Touseef Mirza going on hormone replacement therapy. So the next installation, we're gonna be talking about what my experience has been. So I hope all of you join us for that.

Dr. Sophia:
We're gonna be here listening to the EFS journey and it's always an adventure with you. So yes. Can't wait to hear about it. We thank you so much for listening to the Dr. Sophia ObGyn podcast. We acknowledge that we did have some sensitive topics In today's conversation, if you are someone who may be suffering with depression anxiety, please, please, please seek medical advice. Until next time, thank you for joining us. Bye bye.

This is General Medical Information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.