The Menstruality Podcast - 135: How to Feel Better in Perimenopause - REPLAY (Dr Lara Briden)

Episode Date: February 29, 2024

Today we’re actually replaying Dr Lara Briden's first episode with us, How to Feel Better in Perimenopause, because it’s the most popular episode we’ve ever shared, listened over 3500 times, and shared widely, and because we receive more questions about perimenopause than anything else. In the conversation Lara demystifies this major transition that happens in our bodies in the years that lead up to menopause, when many people are left wondering if they’re going crazy, experience symptoms which can seem to come out of nowhere; including anxiety, depression, irregular cycles, insomnia, night sweats, hot flushes, migraines and more.Lara is a naturopathic doctor and the author of The Hormone Repair Manual, Every Woman's Guide to Healthy Hormones After 40, a practical guide to navigating the change of perimenopause and relieve symptoms with natural treatments such as diet, nutritional supplements, and bioidentical hormone therapy.We explore:The four phases of perimenopause and how to navigate them, including the ‘waiting room’ where your periods are very irregular, but you haven’t yet reached the 12 month pint which defines the beginning of menopause. The science behind this life transition and the hormonal events that can drive symptoms like irregular / heavier cycles, sleep disturbance and hot flushes. Lara's rescue prescription for peri-menopause and how it can help you to look after your whole being, and especially your brain and nervous system - Lara assures us that there is always a way to feel better. ---The Menstruality Podcast is hosted by Red School. We love hearing from you. To contact us, email [e-mail]---Social media:Red School: @red.school (https://www.instagram.com/red.school)Lara Briden: @larabriden (https://www.instagram.com/larabriden)

Welcome to the Menstruality Podcast, where we share inspiring conversations about the power of menstrual cycle awareness and conscious menopause. This podcast is brought to you by Red School, where we're training the menstruality leaders of the future. I'm your host, Sophie Jane Hardy, and I'll be joined often by Red School's founders, Alexandra and Sharni, as well as an inspiring group of pioneers, activists, changemakers and creatives to explore how you can unashamedly claim the power of the menstrual cycle to activate your unique form of leadership for yourself, your community and the world. Hey, welcome back to the Menstruality Podcast. Thank you for tuning in today. It's a special episode. If you listened last week, you'll have heard Dr. Lara Bryden,

who's often referred to as the period revolutionary and who we absolutely love at Red School, advising on all kinds of menstrual health challenges from PMS to missing periods to menstrual pain relief. And today we're actually replaying Lara's first ever episode with us, How to Feel Better in Perimenopause. Because it's the most popular episode we've ever shared, listened to over 3,500 times and shared widely across the globe. And because we receive more questions about perimenopause than anything else at Red School. In the conversation, Lara demystifies this major transition that happens in our bodies in the years that lead up to menopause, when many people are left wondering if they're going crazy, experiencing symptoms which can seem to come out of nowhere including anxiety, depression, irregular cycles, insomnia, night sweats,

hot flushes, migraines and more. Lara is a naturopathic doctor, the author of the Hormone Repair Manual, Every Woman's Guide to Healthy Hormones After 40 and this conversation includes the four phases of perimenopause and how to navigate them, the science behind this life transition and the hormonal events that can drive symptoms and Lara's rescue prescription for perimenopause and how it can help you to look after your brain and your nervous system. Lara Bryden, welcome to the Menstruality Podcast. We are so, so grateful to have you here educating and guiding around perimenopause. Thank you so much for being here with us. Thanks for having me, Sophie. I'm looking forward to this. We will dive in the way we

always do with this podcast which is with a cycle check-in and I was listening to your interview with Nicole Jardim on the period party and you were talking about how at that point which I think was in it was earlier this year you were still in the waiting room as you call it yeah get into later the different phases of perimenopause so I am wondering where you're at with your your cycle and how you're doing today yes I'm still in the waiting room but I'm about to graduate to menopause I believe in that my last period which was a which was very scanty little bleed I had in January last year so as you know menopause officially begins when you're 12 months past that final period so I'm getting there yeah about to achieve menopause or graduate to menopause. I love that term graduate to menopause

and how you know are you experiencing your cyclicity are you connecting to the moon like how how is that for you in this phase of your life i would say i'm i'm appreciating the more steady state of you know of the post menstrual years um we do as you probably know i mean estrogen does go up and down even you know after periods stop so it's certainly common that women notice some cyclicity cyclicity and as you say some women choose to create that by tracking the moon i'm not doing that. I'm just enjoying my diurnal rhythms and yeah, just being quite stable. I think there is this kind of cheeky freedom that comes once you get into these post-reproductive years, which of course we can talk about today. Yes, the cheeky freedom. I feel like there is a general rewriting going on around the whole story of menopause, which can't come soon enough and is excellent.

I love that addition to it. Cheeky freedom. Yeah. So I think it was earlier this year in February that you published the Hormone Repair Manual. Yeah. Yes. a practical guide to feeling better in your 40s and your 50s and beyond exploring how to navigate the change of perimenopause and to relieve the symptoms with natural treatments. I'd love to hear what inspired you to write the hormone repair manual. What was it that called you to bring this to the world? Yeah, that's a good question. Well, as you know, it's my second book. So my first book,

Period of Perimanual, was a deep dive into menstruation. And that book contained a chapter on perimenopause. But as I just worked with my patients and interacted with my readers around the world, I realized there was this gap about knowledge in our 40s, like more precisely, there seemed to be this misunderstanding, and not just amongst women, but doctors as well, that menopause is something that happens in our 50s, that it's sort of way off in the future for some women, when in reality, as we'll talk about, perimenopause, which is anywhere between two to 12 years leading up to the final period is for most women, the time of symptoms, if they're going to be symptoms. So not all women experience symptoms,

but I would say what the research shows is if they're going to be symptoms and often they're neurological, they are more likely to occur in this lead up to menopause. And because most many women don't understand that or there hasn't been a discussion of perimenopause, they're left wondering what the heck is wrong with them. And just, you know, going down all other sorts of rabbit holes looking for the solution. And yet there's this, I would say, quite major transition happening that I wanted to shine a light on. So that was the origin of Hormone Repair Manual. It's for women in their 40s. And I do use the word perimenopause somewhere on the cover, but it's not in the title of the book, mainly because I just wanted women to know that this is for them. If you're 35 plus, this book is for you. Alexandra and Sharni refer to the time running up to menopause as the quickening.

They've sort of found a different phrase. I think, again, to include more and to invite more people in because people see the word menopause and they go oh no not for me yeah not not until I'm in my 50s yeah yeah when we have people writing to us all the time at red school saying you know I'm experiencing hot flushes migraines sleep challenges anxiety and depression you've you also speak about the breast pain and the how cycles can get heavier or irregular heart palpitations like there's so much going on in this second puberty I think is another term I've heard you use yes perimenopause could could you help us to understand that the core sort of physiological changes that are going on that create so much of these symptoms yeah well in the earliest phases of a normal perimenopause which

in some women can start as or as early as our late 30s the first hormonal event to happen is the quiet exiting of progesterone. Not entirely. It does vary, but we do, we start to have shorter luteal phases, which I think your listeners will know what that means. We start to have some more cycles when we don't ovulate. So that means that wonderful, calming, period-lightening, migraine-preventing hormone, progesterone, is quietly dropping away. And we can do things to try to improve our progesterone through the years, but it is to a large degree, an inevitable part of this process. It's, it's, it's the follicles becoming less active, less vital as we move towards the natural transition of menopause. So this, the fact that losing progesterone is such a big part, especially in the early phases of perimenopause has also been potentially a missed part of the conversation.

Like we hear a lot about estrogen and estrogen is doing things too through these years, but the losing progesterone is a, is a big part of it. So that's, I do talk about in that book and I'll talk about it in my book. And of course, as you say, the book is a lot about natural treatments I also do talk about the value of different kinds of hormone therapy particularly for some women the value of supplementing progesterone real progesterone not progestins not the pill but real progesterone in cases where the symptoms are strong. Yeah, that was new to me when I started researching you that it's actually a huge cause of these changes is the losing progesterone. Yeah, I think there's a lot of misinformation out there or just misunderstanding about what's actually going on in our bodies at this phase. Yes. So Professor Gerilyn Pryor, who I think you've asked, you know, I talk about her in my book. She's a close colleague of mine. She's a reproductive endocrinologist. She has a scientist. She runs something called the Center for Menstruation and Ovulation Research. And she's published multiple papers on progesterone. She has been a cheerleader for progesterone for decades. And so a lot of what I talk about in the book,

including some of the protocols are from her. And I just think her work has been so valuable for women. And I'd like, I'd always want to see her work better known. So I always try to find an opportunity to mention it, but that's, that's where a lot of the, my discussion of progesterone comes from. And I might just say something about just to reiterate the difference between progesterone and progestins, the contraceptive drugs, progestins, and that has been a big part of the confusion over the past several decades is that the word progesterone has been used interchangeably to also describe progestins and that is not accurate scientifically you know progesterone is distinct from those drugs and progesterone itself the progesterone we make or the progesterone we can in some cases take has benefits particularly for mood and sleep and migraine prevention that progestins don't have in fact the progestins are often the opposite and

can contribute to anxiety so I'm saying all of this just to shine a light on, you know, a potential treatment that women might not have been aware of that can be a lifesaver. Thank you. I'm excited to look at the ways we can what we can do to feel better later in the conversation. I'm really excited about that. Before we do, I think it would be great if we could walk through the way you've described the four phases of perimenopause. There's a couple of fantastic Instagram posts on your feed that I'll link to in the show notes that map out these four phases. And it starts with the very early perimenopause, I think, which is around two to five years. Yes. So, and again, some of this is coming from Professor Gerilyn Pryor. So the phases of the menopause transition, and we'll talk them through, have been in existence, have been talked about for a while, but Professor Pryor is who added the very early perimenopause. And again, she calls it the very

early perimenopause, but that's of a normal perimenopause. There is also, of course, a situation of early menopause, which is a different topic, which we won't, I think, cover today. But we're talking about women who are undergoing a normal transition. Very early perimenopause is when symptoms begin, but cycles are still regular. The bleeds are regular, but for anyone tracking their cycles with cervical fluid or temperatures, what you'll see is what I mentioned earlier is the shortening luteal phases, the less robust luteal phase, sometimes an ovulatory cycles and symptoms are beginning so the symptoms we've alluded to would be mostly neurological so increased risk of anxiety depression potentially

insomnia that kind of waking in the night with heart pounding potentially night sweats especially premenstrually increased frequency of migraines a risk for fibromyalgia you know sort of put that in there a lot of that fibromyalgia risk may come from sleep disturbance and then of course for some women heavier periods as a direct result of the lower progesterone increased period pain breast pain and there can be some degree of weight gain even at that early stage. So a big part of what's going on in the early phase is the dropping away of progesterone, but also this is also when we start to see something very interesting happening to estrogen, which is that it's going up and down as it always does through menstrual cycles, but it's the amplitude has increased. So you can have spikes

of up to three times more estrogen than earlier in one's menstruation life. So estrogen is always on a roller coaster. That's its normal pattern. But now we start to get these very steep ups and downs and as you can imagine that does not feel great for some women I mean um estrogen going up in some women spiking high can well it can is directly quite stimulating for mood um but it also in some women can um interact with the immune system in a way that it stimulates mast cells and histamine and that can create a whole set of symptoms perimenopausal allergies hives migraines just nasal congestion and just general and sort of an agitated mood. Histamine is a, both an immune communicator and also a neurotransmitter.

So histamine is quite stimulating to the brain and doesn't feel good when it's in excess, which is why, and I'll just, I know we're getting to treatment later, but I'll just point out that antihistamines can actually be quite helpful for the parent, this, or especially these high estrogen phases of perimenopause, both for sleep and potentially for some of the mood symptoms. And then when estrogen is going down the rollercoaster, that estrogen withdrawal, because estrogen is addictive, even on a sort of month to month basis, we go through a little withdrawal that can trigger migraines that can

trigger more sort of dark moods as estrogen plummets down. And also, that's where the night sweats come in. So and again, I know we're going to get to treatment, but I'll just say one of the strategies is to try to, to reduce the amplitude of those ups and downs, just to try to stabilize it closer to what we were used to. And then, yeah, so that's okay. So that's the, we were on the phases. So phase one is the very early phase. this is when yes for two three years when cycles at least the bleeds are still regular but we're getting this combination of low progesterone and high fluctuating estrogen potentially coupled with a histamine or mast cell or sort of inflammatory reaction to that and then and i just before before

we go on to the next phase can i ask because a lot of people write to us and say am I in perimenopause or am I you know xyz am I am I depressed am I you know do I have a migraine problem or is this actually perimenopause and I guess that's quite a foggy question without necessarily a clear answer is it yeah an assessment is by context and symptoms. So listeners are not going to be happy to hear that there's no definitive blood test for perimenopause, it would be so great if there was, but there's no way. In fact, if you do blood tests, especially for ovarian hormones, or the doctor will say everything's normal. So, I mean, of course, if, if symptoms have, if there are symptoms, it's important to rule out other causes. So the doctor should look at obviously thyroid would be a underactive thyroid

or any kind of thyroid disease would be a, something that could also account for these symptoms that should be looked at. But then once some of the, and maybe vitamin B12 deficiency, some of the things I talk about in the book, but then once those things have been ruled out and you're left with a mid cycle or sorry, a midlife woman with symptoms arising and potentially evidence of that reduced luteal phase perimenopause picture, then the diagnosis

of exclusion is this is perimenopause. And that's one of the reasons I think that this is so often missed is there's just not a nice tidy way to diagnose that. And you're right about the mood symptoms. So it's quite a big deal of overlap. So if there's always going to be some background, potentially stressors in a woman's life, or maybe, you know, background vulnerability to mood problems, but it all just gets dialed up with perimenopause. So I've talked about how the high fluctuating estrogen is quite bad for mood, partly because of the histamine response followed by the estrogen withdrawal.

Losing progesterone is quite bad for mood because progesterone normally has a beneficial stabilizing effect on the stress response system or the, what we call the adrenal HPA axis. So losing that can be quite destabilizing. And so I guess what I'm saying is yet if the diagnosis has been anxiety or insomnia or depression, these changes of perimenopause can be contributing to that. And the same time a way to improve those symptoms without having to take antidepressants for example makes me sad when my patients come to me and they've been having these symptoms in their 40s and they've been given antidepressants when in not that antidepressant medication is bad but in through my lens more targeted treatment for perimenopause would have been is more effective and often is more effective they can make that change onto perimenopause treatment brilliant I think

there's also a section in your book which is how to speak to your doctor I think which must be so helpful because I know so many women and people with periods go to the doctor and they don't quite have the language for what they're experiencing and they don't quite have the language for what they're experiencing and they bring you know whatever they can you know I'm feeling this I'm experiencing that and then the doctor can take them in any manner of directions that might not be exactly what they need so that section in the book feels vital in terms of getting the diagnoses and the treatments and the access to resources that we need. Yeah, they're very popular sections. So there's multiple ones throughout the book, for each, depending on the symptom picture. And a lot of it's about

speaking the language of the doctor and trying to stay on the same page. I just find that's obviously so important because the doctor wants to help you and you want to be helped and you just, you need to have a common language. And so for example, like in some of the, those sections, I use more precise language like an ambulatory cycles, or, you know, is this perimenopause or should my thyroid be ruled out and avoid if possible phrases like, for example, estrogen dominance, which I, some of your listeners may be familiar with that term. It's accurate, but it is sometimes not as precise as some of the other ways of talking about it, if that makes sense.

It's so helpful. It really does. It's so helpful. So the phases, should we take? Yes, let's get going. Yeah. Let's get to this, essentially four phases and then menopause. So phase one we've

been talking about is mainly based on symptoms and then phase two is when you do start to see some variation in the cycle length and and that's counting from day one of the bleed to day one of the bleed it can start to wobble by more than seven days, variation cycle to cycle. So you might have, in general, sorry, just to interrupt myself with perimenopause is often a shortening of the cycle. That's the normal trend. So you might go from used to, you might be used to having a 30 day cycle and now you're down to a 26 day cycle, maybe in that early phase of perimenopause. That's just really to do with the higher levels of a pituitary hormone called FSH, which is shortening the follicular phase. And then into this phase two of perimenopause,

then you might start varying between, you know, a 24 day cycle and then a 35 day cycle, and then you're sort of bouncing around and that you might stay there for a few years and also the same pattern of shorter luteal phases maybe no luteal phases so that's phase two and estrogen is still quite high and fluctuating at that time and then phase three is when the variation is blows out to way more, like you might go have a 60 day cycle or more, you know, not have not have a period for a few months and then get another one. And phase three is associated with more extended times of lower estrogen, although estrogen

still does spike up quite high around the time of a cycle or an ovulation if you manage to ovulate at that time and so the symptom picture is a little different there might be more you might start to see more symptoms more pronounced for example night sweats or hot flushes from the estrogen withdrawal and that's when when estrogen is lower for more extended periods of time that's when we do start to see more weight gain. This is where with, with the drop in estrogen, we do get a shift to what's called insulin resistance or prediabetes estrogen through our reproductive years protects us to some extent from insulin resistance or prediabetes or that apple shaped weight gain or weight gain around the middle. And then with lower estrogen and at the same time, sort of a shining through of more testosterone,

all of that contributes to weight gain around the middle. And women notice that, of course, we do get this thickening of the waist, which is, I would say, unavoidable to some extent. You know, I really don't, I don't myself, I'm not fighting it. You know, obviously I'm trying to stay healthy and maintain muscle mass. We could talk about that in terms of treatment section. But like I say in the book, like it's, I've got better things to do than, you know, fight to maintain the hourglass figure of my 20s. Like, you know, that's just not, I guess I'm just putting that out there,

that a thickening around the waist is to some extent a normal part of this process and then so that's phase three we're still having the occasional period and then phase four as we said right at the beginning which is where I'm at in and probably at the end of that is the waiting room so this is where you think you've had what might be your final period, and you're waiting, waiting, seeing if you achieve the 12 months, and then you get another period. And so then the waiting has to start all over again at that point. So phase four usually, although phase four, in theory, is actually only 12 months, in practice, lengthens out to two or three years as well. And then once you pass that 12

months with no period, then you, as I said, you graduate to menopause, then you're in what Professor Pryor calls the life phase that begins 12 months after your final period. And that life phase, you know, fingers crossed is going to be 20 or 30 or maybe if we're very lucky 40 years that's you know it's a big chunk of our life so we're entering yeah an important time in our life I'm going to pause our conversation with Lara for a couple of minutes to share an invitation with you. If you'd like to explore how the wisdom within the different phases of your menstrual cycle can support you through all of life's transitions, including perimenopause or the quickening as Red School's founders Alexandra and Sharni call it, we invite you to visit menstrualityleadership.com where you can find out more about our annual

leadership training grounded in the wisdom of the menstrual cycle it's a three-month immersive apprenticeship guided by alexandra and sharni to embody your full authority and leadership through the power of menstruality the doors for this year are open for two more weeks until March the 14th. And you can find out all about it, the curriculum, you can hear lots of stories from our graduates. All the details that you need are at menstrualityleadership.com. And just before we get back to Lara, we're going to hear from one of our graduates, Lizola, about her experience of the menstruality leadership program. Every time I am challenged, I always go back to

the MLP course. There are so many things in each module that help and support me even today so one of the things is the confidence to step in to me you know I come from a you know African background living in South Africa, we have our own ways of doing things, traditions and all this. And so coming into a space that has the kind of intimate information that Alexander and Shani so generously share and, you know, where they share from, both of them, from their warmth to the heart, to the throat and to us and you can feel it and so being you know in my course immediately that insecurity of there's a difference or like I'm having to catch up you know in my in my first, I think the first week,

I was so nervous starting my course. My husband was nervous. I think my dogs were nervous. My cats, everyone was nervous for me. And after the first call, I cried. I cried because the welcoming that I felt. I had this image in the first meditation that we did of myself standing on a cliff

and my arms are reaching out and I'm about to jump or fly, but I am not scared. In fact, I'm excited that finally, I think I'm going to fly. So it's been really really really powerful for me the self-development in the course was immense you know it was immense I really love the term the waiting room that analogy is really beautiful yeah you know having

having been in the waiting room for a while yourself and obviously having worked with so many women and people with periods who have been in the waiting room it must be a huge stretch psychologically to go from this very regular for those who have regular cycles yeah regular like ebb and flow of the cycle to you know just not knowing if you're going to have a cycle in 30 days 60 days 90 days can you offer some you know some of your own experience or what you share with the people you work with about how to how to cope with the with life in the waiting room. Yeah. Well, like I said, I have personally found it quite stable. No, I mean, in a little bit, we can talk about my sort of this return to girlhood, this sort of emotional aspect of it, which I did not quite expect, but just to answer

your question about the uncertainty of your bleed about, I say about one in three to one in two women have quite heavy periods during perimenopause, especially those final, like the final hurrah of the periods can be flooding sometimes. So there's an added stress if you're waiting for a period, which could be a period where you bleed through your clothes, right? Like like there's definitely I personally did not have that experience because my periods just got lighter and lighter which is another way it can go but I'll just say yeah for women who are nervous about that that's when you start to you know get women sort of needing to you know seek medical intervention to try to avoid these really crazy difficult periods um and it's also just a practical thing of you have to keep period products in your bag at all times

and sort of be alert for when you're going to yeah when your neck's going to bleed um yeah i hope that answers the question in terms of the psych, like the actual sort of emotion. Yeah. There would not be that. There's usually no ovulation at all in these final phases. There's a bleed. There's a, an ovulatory kind of breakthrough bleed coming through once in a while. That's usually what it was, although you might get the occasional ovulation and very often when the ovulation or estrogen, you know, kicks back in and you're moving towards another period, you'll get a quite a dramatic change in symptoms. Like you might go from having night sweats and being sort of insomnia and kind of more depressed to being suddenly, oh, the hot flushes or the night sweats are gone and a bit of euphoria. And then into that, you know, more anxiety

pictures. So this is, I talk about in my book, be alert just know that estrogen is fluctuating between at times very low and spiking back up to high and just understanding that that's what's happening and you know be able to interpret your experience through that lens knowing it's not going to last it's just you know some final instability yeah that is immensely helpful to have the kind of roadmap that you've laid out in this book, to be able to at least understand or to normalize what's happening or validate all the different symptoms that you might be experiencing, although it doesn't make them go away. I think it can take away from that feeling of, am I just going crazy here? Because why are all these things happening to me and no one's talking about this you know so I'm so pleased and so grateful that you're bringing your work through

so that people can feel more validated in this yeah validated and also I would argue most there's always a way to feel better like there's always a way to feel better but what you've just said there am I going crazy it's a common experience of perimenopause unfortunately especially and it's yeah that feeling of am I going crazy is because it seems to come out of nowhere it seems to be unconnected you know these are we will have gone through our life sort of having a sense of what makes us feel a certain way and what we can expect and then suddenly we're just getting symptoms that seem to come out of nowhere and And that's, yeah, I think that's, that's potentially one of the most destabilizing parts of it. So yes. So I hope conversations like this and my book and all

the other books that are out there about perimenopause can help to normalize this and help women not feel like they're going crazy make them real make you realize that you're not alone yes let's and let's also talk about how we can feel better yes exactly no this is we're talking multiple years potentially of challenging symptoms you know how can we how can we manage these health challenges yeah let's go there. What can we do to feel better? Okay, well, let's talk about the neurological symptoms first, I guess, the sleep disturbance, potentially the migraines, the mood. I have what I call the rescue prescription for perimenopause and it's sort of three three tiers of treatment and levels of treatment that are you you know you could basically start with level one

for a few weeks if if that that often doesn't that's often enough for about 50 percent of women and then if not then you can sort of move to level two and that's the way I lay it out. But level one is what I call the basic action plan for brain recalibration. I talk about brain rewiring in this book because this process of losing first progesterone and then this crazy ups and downs of estrogen and then eventually losing estrogen, the brain literally has to rewire itself

and learn to do things differently so you can help it in that process by just looking after your brain and nervous system and so some of that becomes very basic things but I'll start with the no alcohol because I know that's painful to hear but I will just say for what it's worth, I find that is actually often one of the single most important lifestyle changes to begin with, to, to, as a, you know, to start with, I start with usually the no alcohol and a magnesium supplement, those two things, because the magnesium also helps to reduce the craving for alcohol. And I just, I partly mentioned the alcohol because I've seen a lot of social media sort of messaging around using wine to get through perimenopause. And I would say that's not

the way that's exactly what I was thinking I was thinking so many people go well the end of a long day of not only managing all the responsibilities of my life but also all these changes that happening crack open the bottle of wine relief yeah it's not the way I'm sorry to be the bearer of bad news but it's and I've always been, you know, I've always been, I would have a few drinks in a week, you know, you know, even occasionally I still do have a beer here and there, but just for myself through, this is through the, my experience for myself and also for all my patients, it's really consistent. If you can stop alcohol, you will stop waking up in a sweat in the night. And so often when I'm

sitting there, I'm like, this glass of wine looks delicious. And I would love to have this. But then I know I'm going to wake up all sweaty at three in the morning, it's just not worth it. You know, when you start to sleep, he starts to become so precious in these years, you're like, all these things I need to do to sleep, and then I'll feel so much better. So and the other thing to say about alcohol for what it's worth, and I just think this is an important piece of information. Alcohol increases the risk of breast cancer quite substantially. I mean, the risk of breast cancer is always relatively low,

but moderate alcohol intake, even, you know, five to say eight drinks in a week increases the risk of breast cancer more than estrogen therapy does so just to put it in perspective right because a lot we have this and we can talk about estrogen therapy a little bit i mean i'm quite i'm an agnostic, quite neutral. Like estrogen therapy can be quite helpful. So I'm acknowledge all of that. A lot of my patients use it. Not everyone needs it.

So I think it's not a one size fits all, but just to put it in perspective, it's something we have feared for a couple of decades and yet big picture, even moderate wine consumption is more dangerous from a breast cancer perspective so yeah that's motivating yeah it is and it's also just kind of clarifying it's it's not it's not your friend it's really not good for the brain or sleep or anything or hormone balance i mean alcohol not to spend too much time on this, but it alcohol impairs the body's clearance of estrogen. So estrogen is already spiking up to three times normal and alcohol increases that and alcohol causes the histamine and a mast cell response. So it's, it's not friendly to the body. And so, and to the perimenopause body and brain specifically. So

that's number that, so that's part of the brain rewiring basic action plan. The other, I mentioned a magnesium supplement. I usually give magnesium glycinate combined with the amino acid taurine. Those two things are very stabilizing for the nervous system. They both help to support GABA, which is our calming neurotransmitter that the neurotransmitter that progesterone normally supports and as we just said we're losing progesterone so we're losing GABA stimulation in the brain every month so any other way we can improve GABA will help the situation magnesium is

one of the best ways to do that and then the next part of the basic action plan and this is just so obvious but moving the body makes a huge difference especially i would say getting outside moving the body outside getting some of that outdoor light building muscle can help to well feel better um building muscle is good for the brain it's good for you know movement is good for sleep and all of that obviously can help to mitigate the shift to insulin resistance or weight gain around the middle. Do you recommend strength training then Laura? I do working with weights. I mean, the funny thing is full disclosure. Yes, I do. I

recommend it in the book. I think the research around that is super solid. I don't personally do it yet because I enjoy other things. So I always feel like I need to sort of disclose that, but I think it's great. I think what I have done looking at all that research and around weight training is modifying my yoga practice to include more planks and, you know, squats and lunges and just focusing on building muscle using my own body weight. So that's the direction I've gone with it you could do that with Pilates I mean but yes for people who strength training is very good for the brain and very good for metabolism and I would say my patients who do it consistently have fewer

perimenopause symptoms than other patients so yes to that um how how often a week are we talking in terms of you know even just a couple times a week can make a big difference so yeah whatever you have time the great thing about strength training is potentially it's quite efficient i mean you get in there and you you know do some lifts and it's you get a lot a lot done for not that much time so yeah I mean I'm sure there you could probably have guests that know a bit more about strength training than I do given that I don't practice I would feel so sheepish about that but I know I love walking and yoga and I'm just like I need and you are doing it because you're using your own body weight which is absolutely a part of it

I just know for myself personally one of the one of the blessings of infertility because I was trying to conceive for four and a half years one of the blessings was it it made me try everything and in the run-up to my IVF process which was wonderfully successful with my my little one who we heard crying earlier yes I I did I did everything to get as fit as I possibly could and I started doing HIIT workouts with weights and I have never felt better than in those you know in that six months where I was um eating a really like anti-inflammatory diet no alcohol no sugar um doing the the HIIT workout the weight training I felt incredible you know in my, in my mind, in my, in my body. Yeah. So I'm, this is inspiring me this conversation to get back on it. Yeah, absolutely. Yeah. It's,

it's just a win-win. It's very good for the body. Absolutely. Great. So, so the basic action plan so far is we've had the magnesium, the getting outside and the weight and the strength training and taking out alcohol. Yes. And also just scheduling time for rest. So that is sometimes I realize as I'm saying it, that is sometimes easier said than done. I understand that people have busy lives. They often have a lot of responsibilities, especially at this age, because there could be, you know, children and also aging parents and a career and it's a lot and I understand that but I just I guess the argument I try to make in the book is if there was ever a time to slow down it's now because not only will that help symptoms, but also it will help to shepherd or escort or support the brain through this transition time, which will pay dividends in the future in terms of a healthy brain and, you know,

reduce mood symptoms going forward. And also, and I explained this in the book, looking after the brain during the menopause transition will help to reduce the long-term risk of dementia. And that is the research around that is a little frightening, but also empowering because it means we can do something about it. And some of the research suggests that actually some of the, some types of dementia begin with menop, as in, you know, the brain potentially starts going down a bad pathway if it hasn't been given the support that it needs. So there are lots of ways to support the brain. And I dedicate sections in the book to that. But a big part of it is the basic action plan for the brain, as we've been talking about, including scheduling time for rest, which will

help sleep i found interesting yeah i mean one thing about sleep is we always we're so focused on what we can do to sleep but actually a big part of what we can do to sleep for sleep is to reduce calm our nervous system during the day so that it's better prepared for sleep when we get to the night so i that's just i think an important takeaway excellent schedule time for rest one of the things you speak about is how perimenopause can actually be a tipping point for long-term health you know just refer to it with dementia does that happen with other areas of health yeah that'd be cardiovascular health as well I would say that potentially could be inflammatory or immune conditions.

It's a, it's a tipping point. Perimenopause is a tipping point because it's a recalibration of metabolism of the nervous system of the immune system there. It's a known our women's forties is a known risk time for the onset of autoimmune disease or the flaring of autoimmune disease, including autoimmune thyroid. So another just tipping point just is postpartum. So any kind of major hormonal shift change in a person's life can potentially be a danger window for the onset of certain conditions. So that's, yeah. And the research around that is quite strong. So I talk a little bit about that in the book and just talk about it then perimenopause as a window of opportunity for both feeling better and reducing long-term risk of disease. So we've talked about the,

my, what I call the rescue prescription. So this is three levels So we've talked about the, um, my, what I call the rescue prescription. So this is three levels. We've talked about the, you know, the basic action plan, which is what anyone can do. And I'd say is for about at least 50% of women is all they need. And then the next two levels are, um, potentially coming in with herbal medicines and or hormone therapy in some form, either progesterone alone, which I talk about a lot in the book, or progesterone plus estrogen eventually would be kind of the third tier. And the idea is you keep all the basic action plan in place. You don't stop it. Like you don't stop magnesium when you start progesterone. You do both, if that makes sense absolutely so so this is so empowering and i

can't wait a bit to share this with our community because there will be so many people who listen to me and go right there are things that i can do yes because a lot of people i think jump straight to the hormone um treatment because that's what's available and it's really important and really necessary for some people but it's wonderful to know that there are many actions that that can be taken before that and that they work for for up to half the people is really really good news you also speak about the evolutionary advantage of menopause. It came up in your conversation with Nicole Jardim. And I'd love to hear you speak about that.

How do you see that, the evolutionary advantage of menopause? Yes. So this is coming out of the research. And a lot of it, for me, came out of a book that I read that I quote in my own book a couple of times. The book is called The Slow Moon Climbs by Susan Matter. And she's a historian, which the book is a lot about prehistory as well. And she weaves together all these different lines of evidence, including modern day, the very few people in the world who are still hunter-gatherer lifestyle. And their experience, which I'll just say, they experience menopause, of course, you know,

periods stop at around 45, 50, but they don't see it as a bad thing at all. They don't experience symptoms. The fact that we experience symptoms in our modern environment is, I would argue, a classic case of what's called evolutionary mismatch in that our ancient physiology does not fit well with the modern world of environmental toxins and alcohol. And we can circle back to that. But in answer to your question, the evolutionary advantage of menopause is the is the theory that posits that and this is I found this quite profound that a longer human lifespan so a longer lifespan for homo sapiens evolved or was selected for because of positive selection pressure on a post a a female post reproductive phase, like extended phase, a couple of decades,

two to three decades of life continuing past ovarian function. And the way that would work is that, that women in their fifties, sixties, and potentially even beyond are so beneficial to their family group that they're significantly improving the survival of their genes in their descendants, basically. That's called the grandmother hypothesis. But this idea, this way of looking at it, that a longer human lifespan may have evolved because of menopause, because of menopausal women, and that therefore men get to live longer too, because women in their fifties and sixties have been traditionally so beneficial. So it really, to me, cause my background is in evolutionary biology. So I see a lot of things through that lens. And when I read that research, I just felt so different

in myself. It's such a different way of seeing it, knowing that we've evolved to do this, rather than this, my very existence post, you know, in menopause is just an accident of living too long. That is, that is not what the research suggests. Like if we have this, it is true that human lifespan, or sorry, human life expectancy on average used to be shorter. A lot of that was because of childhood mortality and young, you know, early death from all various causes. But what they're also what the research shows now is the human lifespan, biological lifespan has probably not changed in hundreds of thousands of years. So the human frame, like the human body has, has for a long time had the capacity to live to 70 or 80. And so if that's true, and if some of this other evidence is true, then yes, you know, it's very

normal, potentially beneficial thing to have these decades of life after you stop reproducing. And we're one of the only species of mammals who do it actually, which is just also so amazing. It's us, it's orcas, it's pilot whales, and that's about it. Like even our closest relatives, the great apes, keep reproducing close to when their their life ends so it's i think it's fascinating i mean obviously i'm very passionate about this side of things it's it really from almost from a spiritual perspective it really has helped me to think about it this way i love this i love the name for it the grandmother hypothesis yeah it really ties in beautifully with something that alexandra and sharni teach on our menopause courses sorry i'm just having a total brain fog hang on it's i used to have

such a synergistic brain until like a child yeah i was part of breastfeeding yeah yeah you could explain why i'm sure yeah but hang on I'll get there I'll get there on our menopause course yes they teach that the phase of life that women and people who've had periods are entering into and menopause is a phase where our leadership can thrive where we can step into a new kind of authority and be of service in new ways, you know, find our way of being of service and then bring it through, which really, you know, is this an evolutionary thing? Yeah. And it, you know what, it physiologically bubbles up. I have no other way to describe it. Like you do get this, I do get this feeling of, I talk about in the book, kind of being a force for good

and just having things to contribute. And I just want to clarify this grandmother hypothesis, because I've had some feedback from readers who sort of feel excluded if they're not literally grandmothers. They think I'm not a grandmother. I had no biological children, so no prospect of being an actual grandmother, but that't come into it that doesn't matter like it's still we descended from grandmothers and we are still stepping into that role and that can that may or may not involve looking after children I mean that could be involved leadership in the community can just take so many forms and it can even just be you know creativity or just you know spending time in nature or just, you know, there's just so many different ways to embody that energy. often feel invisible because they're actively being excluded from all kinds of areas of life. When what Alexandra Shani is saying, what you're saying, maybe what menopause is saying is we are

needed more than ever now in our world. You know, we, our world is turned upside down in so many ways. And perhaps it's exactly the kind of wisdom that can come through a menopausal woman that can help to bring the kind of balance that we need back. Exactly. And in my book, I talk about the invisibility, freedom, two sides of the same coin. So I address that invisibility a little bit. A lot of that's about invisibility to men, which when you actually get here is totally fine. Like it's actually, you know, it's like no one misses that really like you know it's sort of a secret it's a little bit of a I don't know I don't want to overstate it but it is this kind of like secret club kind of feeling like oh actually I dreaded this so much being invisible and now

there's this freedom element to it which um yeah you have to almost live to believe you have to sort of get here to but it also is nice for young women to know that there's something to look forward to i guess i also want to say that but in some ways i remember my menopausal patients kind of talking about some of this and and me not you know 20 years ago when i'm 30 and trying to treat them me not really understanding what they meant to get here but yeah it's um there's a there's a good side to the invisibility too i think and and certainly we're not we're quietly getting a lot of stuff done which yes have done for millennia yeah yes just in closing i'd love to just loop back to something that you

mentioned about this evolutionary mismatch. You know, there's so much going on in our world that our bodies sort of physiologically find hard to work with. How can we manage some of that? I mean, I imagine a lot of the rescue prescription can help. Yeah. So a lot of it, too, is about just realizing it's not your fault. Like, you know, we live. So when I talk, I talk about a modern environment, a modern food environment as well, like the modern, you know, alcohol environment and environmental toxins and we're, we're in this soup of nutrients and lack of nutrients and toxins and that

our ancient physiology never would have had to deal with. So that's, I'm arguing that what's creating a lot of the symptoms. And also it's a different life history too. I think traditionally women would have not potentially gone through the same kind of perimenopause. They would have probably had their final baby at 42 or 43 and then breastfed for a few years and then just quietly slipped into no periods, you know, it would have been a different process. But how do we combat that is with, yes, a lot of the basic action plan, just eating whole foods, getting outside, moving the body, you know, realistically avoiding toxins as much as we can. Some of it is outside of our control. Like one of the examples I give in the book is there's some research to

suggest that what's called a body burden of lead throughout our decades, because, you know, when I was a child, there was leaded petroleum. And so we, you know, we had toxin exposures throughout our life that are potentially affecting us now that we have to just mitigate with, you treatments and feel better but um some of it is within our control so some of it's out of our control and some of it is about yeah just doing the simple things like choosing whole foods and getting outside most of the time i keep coming back to those things but they're very effective yeah and conversations like this are very inspiring in terms of actually prioritizing it

because they're simple and they're effective but often can get put down to the bottom of the to-do list in the busy foray of life so I really appreciate you you know inviting all of us listening to bring them to prioritize ourselves and prioritize that these simple acts of self-care because it sounds like they can be some of the most important things to help to navigate this wild ride that is perimenopause absolutely yeah is there um one thing that you would love to share to people who are listening who are in the middle of some of what we've been talking about yeah is there one sort of golden nugget that you'd like to share in closing yeah it's nice well i'll just say two things i'll just say two things and end with the golden nugget but the next thing i'll just say again is is it it is okay to take hormone therapy if that's going

to make you feel better and that's something you want to do so i just want to remove some of the stigma or shame around that i talk a lot quite a lot about hormone therapy in the book i don't think we from an evolutionary perspective i don't think we need it because I don't think menopause is a state of estrogen deficiency, not, not like that narrative, but at the same time, hormones can help to hormone therapy can help to mitigate some of this evolutionary mismatch that we've been talking about, but the golden nugget is trust your body. Female physiology is not as mysterious or complicated as we've been led to believe.

Your body knows what it's doing. It has a plan. Menopause is normal. We evolved to do it. And also perimenopausal symptoms, if they exist, are almost always temporary. So there is going to be another side. You're going to come out the other side of this.

Thank you, Lara. Thank you so so much thank you for writing this book we're going to link to it in the show notes for everyone that wants to go and find it the hormone repair manual and thank you for demystifying this phase of life for validating for honoring us i deeply appreciate your work and thank you for being with us oh thank you so much for having me Sophie, it was lovely to talk to you. Thank you so much for listening all the way through to the end today. If you loved this episode please subscribe to the podcast and leave us a review, it's the best way you can help this podcast and this work to reach more people and we really appreciate you for it. If you're in perimenopause or the quickening as we call it at Red School and you'd like to channel the wisdom of your menstrual cycle to support you

or if you're in another phase of your cycling years and you want to reclaim the magic of the cycle, we invite you to take your seat for our 2024 Menstruality Leadership Program. The doors are open for just two more weeks until March the 14th. And we would love you to be part of the amazing, wise, cycle passionate circle that's forming. You can find out more about the program and take your seat at menstrualityleadership.com. And that's it for

this week. I hope to be with you again next time. And until then, keep living life according to your own brilliant rhythm.