In this episode, you'll hear from pelvic health physiotherapist, Helen Edwards, accredited practising dietitian, Jacqui Cotugno, and leading endocrinologist, Dr Christina Jang, as they take a deeper dive into perimenopause and explore how diet and lifestyle changes can help relieve symptoms. They'll also explore how hormonal changes can affect mental health and wellbeing, and how to get support.
Our guest Alice also shares her personal experience with perimenopause and its impact on her mental wellbeing.
Does exercise help perimenopause symptoms? Do I need to change my diet? How does perimenopause affect my mental health? Listen to find out!
Make sure you listen to our next episode, where we explore the transition from perimenopause to menopause and what that looks like.
Feel free to leave us a review too — we'd love to hear your thoughts.
Featured in this episode:
Katie May
Our host, Katie is a single mum in her late 30s. She is a communications expert with 17 years' experience and is passionate about health and wellbeing. She is currently studying Italian just for fun and absolutely adores her pet greyhound, Piper.
Helen Edwards
Helen is a pelvic health physiotherapist working as clinical lead in the Gynaecology Physiotherapy Screening Clinic at Caboolture Hospital. She has a passion for women’s health, lifestyle medicine and the connection between mind and body. Helen has been supporting women with bladder, bowel and sexual dysfunction for over 25 years.
She's currently involved in research and is undertaking a PhD at the University of the Sunshine Coast, exploring the impacts of menopause in the workplace at Caboolture, Kilcoy and Woodford Health Directorate. In her spare time she enjoys running, spending time outside with her horses or relaxing at home with the family.
Jacqui Cotugno
Jacqui is an accredited practising dietitian and a credentialed diabetes educator at Metro South Hospital and Health Service. She is also a clinical prevention manager at Health and Wellbeing Queensland.
Dr Christina Jang
Dr Jang is a Brisbane-based endocrinologist treating all endocrine conditions, with a special interest in female reproductive endocrinology, including menopause. She is a staff specialist in endocrinology at the Royal Brisbane and Women's Hospital (RBWH). She is a senior lecturer at the University of Queensland and president-elect of the Australasian Menopause Society (AMS).
For her, endocrinology is an area of medicine which presents opportunities to deliver far-reaching benefits to her patients.
Alice
Alice is an active healthy and very health-aware 78-year-old concerned about the lack of information for women and their doctors about the stages of the menopause process.
She now has an excellent female GP and is on a low dose of Menopausal Hormone Therapy (MHT).
She continues to work part time as a speech pathologist and dance movement therapist and enjoys dancing, singing, song writing, writing, improvisation, travel and being a grandmother.
Episode Resources
Health and Wellbeing Queensland
Health and Wellbeing Queensland is an independent health promotion agency working to drive generational change across physical activity, nutrition & wellbeing.
Australasian Menopause Society (AMS)
The AMS is a not-for-profit member-based society aiming to improve the quality of life for women during and after the menopause. The AMS helps women and their health professionals better understand the transition through this stage of life by providing accurate, evidence-based information about premature menopause, perimenopause, menopausal hormone therapy (MHT) and alternatives, osteoporosis and how to locate a doctor interested in women's health. Visit the AMS website for more information.
Jean Hailes for Women's Health
Jean Hailes for Women's Health is a national not-for-profit organisation dedicated to improving women's health across Australia through every life stage. They work in public health, research, clinical services and policy. Their website has practical and easy-to-understand information for women and for health professionals. Visit the Jean Hailes website for more information.
Lifeline
Lifeline provides free, 24-hour telephone crisis support service in Australia. Counsellors are available to provide mental health support and emotional assistance, not only via telephone but face-to-face and online. Visit the Lifeline website for more information, or call them on 13 11 14.
Beyond Blue
Beyond Blue is an Australian mental health and wellbeing support organisation. They offer free, qualified mental health support via chat or phone. For more information visit the Beyond Blue website or call them on 1300 22 4636.
Transcript
Vox pop:
I think the worst thing was the rage because I felt like I was completely bonkers. And I think the fact I was dancing about 23 hours a week was what saved my sanity at the time.
Katie:
Welcome to It Can't Hurt to Ask, the podcast answering all your health and wellbeing questions.
My name is Katie and in this second season we're focusing on the stages of menopause.
You just heard from Alice, and everyday Queenslander who shared her experience with perimenopause and mental wellbeing, and we’ll hear more from her later.
In today’s episode we're talking about perimenopause and it's a meaty one. We're covering diet, lifestyle and mental health.
As usual we’ll be joined by Brisbane-based endocrinologist Christina, who's going to guide us through this conversation, and we’ll also hear from two guest clinicians in today’s episode.
A quick note on terminology. Throughout this podcast, we'll be using the terms women and girls. We use these terms inclusively to mean all people who identify as a woman or girl and recognise that people who do not identify as a woman or girl may still be affected by women's health issues.
Before we get started, we'd like to acknowledge the Traditional Custodians of the land on which we record this podcast. For us, it's Meanjin, the land of the Yuggera and Turrbal peoples.
When you hear the term managing symptoms of menopause, the first thing that might pop into your mind could be menopausal hormone therapy, also known as MHT or HRT.
This is an effective treatment for managing menopausal symptoms. While it's not suitable for everyone, we will be covering that in depth in an upcoming episode.
For today, we're going to focus on lifestyle changes, which is something anyone can do to help manage the physical and emotional symptoms at all stages of menopause.
To explore this further, we'll hear from Helen, a pelvic health physiotherapist with a special interest in menopause.
Helen:
So, there's many things that we can do to improve menopause-related symptoms, but it's also a perfect opportunity to actually make changes which is going to improve our long-term health outcomes.
If we consider, the average age of menopause is about 51 - 52 years, and our life expectancy is increasing. And we're expecting that in about 2030, over 50% of women are going to break that 90-year-old age barrier.
So, we could be living over half our life after menopause, which is really important that we try and grab every opportunity to keep as healthy as we can for the rest of our life after menopause.
One of the important things that we can do is actually education and preparation for this life phase. And if we think that perimenopause starts about four to eight years before we experience menopause transition or the final menstrual period. And so we need to be thinking about these changes in our 30s and 40s, and not waiting till we get into our 50s to make some changes.
One of the key lifestyle changes that we can make is exercise. And this is going to be good for our bone health, for our brain health, for our mood, for our hot flushes as well as for our cardiovascular health. So it has many benefits.
There's many types of exercise that we can do. That can be, we can look at walking, we can look at yoga, we can look at resistance exercise. I think it's important to, whatever you choose, you need to choose something that you enjoy doing so that we can actually make sure that people will participate and continue with it.
It's important to start small and gradually build up. And if you do have any health concerns, obviously talk to your GP or usual health provider in case there's any specific concerns that you need to be aware of for you before starting exercise.
For some women though, pelvic health concerns such as urinary incontinence or prolapse actually stops them from exercising and they will avoid or reduce their exercise because of these symptoms.
So, if you're getting any symptoms like that and you're finding that you don't want to participate in exercise, then it's really important to find a pelvic health physiotherapist who can help guide you and support you to get you back to exercising again for your long-term health, not just your menopause-related symptoms.
Then thinking particularly about pelvic health and the genitourinary syndrome of menopause, non-hormonal treatment options that we can look at are vaginal moisturisers can be useful, particularly the hyaluronic acid-based moisturisers.
We can look at vitamin D – it’s also something that's been shown that may benefit some of the genitourinary syndrome of menopause, as well as it may have an effect on bone health and mental health. So again, talk to your healthcare provider, get your vitamin D levels checked in case that's something that's simple that you could change.
Pelvic floor rehabilitation is also important, so seeing a pelvic floor physiotherapist if that's something that you have access to.
So, chronic stress can also impact our menopause symptoms. And the way that stress impacts is the body relies on the same molecule, pregnenolone, to create cortisol. And it also uses that molecule to create your sex hormones, so your estrogen. And if we're under chronic stress, the body is going to prioritise making cortisol rather than your sex hormones.
So, looking at strategies that can reduce stress has a significant benefit on your menopause-related symptoms. So that may be things like getting outside in nature, looking at mindfulness, meditation, could be yoga, can be general exercises, lots of things that we can do. Breathing exercises - that can be really powerful as well for helping reduce chronic stress, or managing stress-related symptoms.
So, menopause can also impact on sleep, and there are lots of things that we can do to try and improve how you sleep. Getting a good night's sleep actually starts with how you start your day. And if you start your day by actually getting outside in sunlight, that can actually help at nighttime to actually get a decent night's sleep.
Other things that you can do at night is like setting up a bedtime routine that's conducive to sleep, so reducing the lights in the last couple of hours before bed, getting off electronic devices and keeping the bedroom cool can also help.
So, genes can also have an impact on our health and the way we behave and our environment can influence how our genes are expressed. And epigenetics is a study of that gene expression. And so with diet and exercise, we can actually influence how our genes are turned on and turned off, which can then influence our long-term health outcomes.
So the good news is the way that we eat, the way we live, the way we think, the way we move, can all impact on our menopause-related symptoms. So we have lots of opportunities to make change.
Katie:
So, when you think about it, depending on when you enter menopause, you might live half your life potentially with menopause, so learning how to live with it and manage the symptoms becomes so integral.
Now we know the importance of exercise and lifestyle when it comes to managing symptoms, but let's look at our diet. What role does that have to play? We'll now cut to accredited practicing dietitian and principal project officer with Health and Wellbeing Queensland, Jacqui.
Jacqui:
When thinking about that perimenopausal time, there are lots of changes happening in your body. So, people will often experience hot flushes, which may contribute to making them feel a little bit irritable across the day. A lot of people have sleep disturbances, they have lower energy.
And so those sorts of factors can then influence the food choices that we make. If we're feeling tired and feeling a little bit down, we're more likely to go towards those. comfort foods or high sugary, high fat foods, because they give us a quick pick me up.
So, I think it's being mindful of those, and if that's occurring, doing whatever you can to set up and establish good sleep hygiene, but at the end of the day, a well-balanced diet is the most important thing.
When we're talking about a well-balanced diet, first and foremost, including foods from each of the core food groups. So plenty of vegetables, or at least five serves of vegetables a day, choosing different colours, at least two serves of fruit across the day, dairy or dairy alternatives.
Our requirements for calcium do increase following that menopausal period because of those estrogen changes and it's really important to ensure that we are getting enough calcium to preserve our bone health.
Maintaining good sources of lean proteins and that can be from lean meats as well as meat alternatives as well. So beans and legumes, soy based products are a great source of those as well.
And finally, our breads and cereal. So really choosing those whole grain options. They're a wonderful source of fibre. Once again, they help with your gut health and they help to keep you fuller for longer and they'll give you that longer lasting energy across the day to avoid some of those peaks and troughs in energy levels because the hormonal changes in the fluctuations in estrogen across the time will already be giving you peaks and troughs in energy levels. So we want to try to balance that out from our food as much as we can.
There is often during menopausal time a lot of attention placed on soy-based products. They naturally contain isoflavones which are a type of phytoestrogen. There's really conflicting evidence about the value of that in relieving menopausal symptoms. What we do know is that they are an important part of a healthy, well-balanced diet. So including things like tofu is a really great protein alternative to include within a healthy, balanced diet, in terms of reaching out and having mass supplements of soya-based proteins and the evidence suggests that doesn't value add. But once again, including soy as part of a healthy, well-balanced diet, is a really great option.
Often people during this time of life, they might be sort of empty nesters, have a little bit more time on their hands. That's what I'm hoping happens! Often during that time of life, they do have more time on their hands and often they are more social. And so... with that, that can come sort of coffee dates or increased alcohol.
The challenge with those substances is that they are stimulants. So that can then contribute to that disrupted sleep patterns that are already occurring because of the hormonal changes. So it can become a vicious cycle then.
Also, we know that alcohol does easily contribute to weight gain. So when we've got those other hormonal changes, predisposing people to weight gain, it's just another layer on top of that. So best to limit consumption where possible.
It's no coffee, I would never say that. But really just being mindful that they are stimulants and they might contribute to those restless nights or may also contribute to some of those gut symptoms that you might be experiencing as well.
Katie:
It's so handy to know that our diet can help us manage the peaks and troughs in energy associated with perimenopause and menopause. But what about the risk of chronic disease? Let's hear some more from Jacqui.
Jacqui:
In terms of those body changes that do occur during that perimenopausal and menopausal phase, we spoke about how there is that real shift in where we store our fat. So earlier in our days, often it's stored more around our thighs and sort of lower part of our body. That starts to shift. So people would start to experience that they're noticing more fat accumulation around their central area.
The problem with storing more fat around our central area is that's where our vital organs are. And so that can put us at greater risk of things like heart disease, type 2 diabetes, and other chronic diseases as well. So that fat can accumulate around those really important organs in that area and can impact on how well they function.
So that's why it's really important to make the most of your GP and having a health check. So they do recommend between 45 to 50 years to undergo a routine health check. It's a good chance to screen all of your bloods, check your blood cholesterol levels, check your blood pressure, check your blood sugar levels and the like, because there can be inherent changes that happen during that time. And that's where people are more likely to develop some of those chronic diseases as well.
Katie:
Thank you to Jacqui and Helen for those valuable insights on how diet and exercise can have such a broad impact, not just to how we feel day to day, but also for our long-term health.
Now, to help us dive deeper into the hormonal side of things we have joining us in the studio Brisbane-based endocrinologist Christina, welcome back.
Christina:
Thanks Katie, it’s nice to be here.
Katie:
Now we know our hormones change during perimenopause, which therefore can impact our mental health. Christina, as an endocrinologist, what else can some of us expect to experience as our hormones shift during this stage?
Christina:
Some women are really well and they have very few symptoms at all and it's really important to acknowledge that. For others though, the mental health symptoms can be really quite debilitating.
Some women may experience some sadness or depression or anxiety and some women can also get this phenomenon that they refer to as brain fog, which is what they're describing is some forgetfulness or difficulty with concentration.
Katie:
And so what can people do when they're experiencing some of these symptoms? Like what are some of the support systems or services out there that they should think about?
Christina:
I think the first thing to do is to touch base with their general practitioner. Just confirm that it is related to the menopause and that they're getting the right treatment.
Hormone therapy could be something that might be helpful for them. Maybe there could be a role for a psychologist or counsellor. Therapy can provide coping strategies for managing mood changes and stress. And cognitive behavioural therapy or CBT can also be very effective for treating anxiety and depression.
Katie:
And so what about support groups and things like that can be helpful too, right?
Christina:
Sure, I mean, connecting with others experiencing perimenopause can provide emotional support and reducing feelings of isolation. Most women going through this will have friends, work colleagues who will also be at a similar age and experiencing similar symptoms. And oftentimes women who are able to talk to others in a similar situation, find that very helpful.
Katie:
Yeah, I can imagine that, all of the gang stick together and then support each other through things. This is just another phase of life that we can share and go through together.
What about things like mindfulness and other ways to reduce that stress?
Christina:
Yeah, and similarly that's the same. Practices like mindfulness and meditation can help manage stress and improve mental health.
Alice:
I was getting these attacks of absolute rage and it's a tribute to my family that they survived. And when I say rage, I mean like, you know, really completely unreasonable, ‘wicked witch of the west’ stuff.
But at least I knew what was happening. So I was able to say to them, look, just, you know, stay away from me, you know, don't push me because I'm close to the edge.
And then there was the energy drain, obviously, and the brain fog. So it was a full suite of horror.
Katie:
So we just heard from Alice then, who shared her experience with some of the mental health symptoms she experienced during perimenopause and menopause. And I must say, I really empathise with her in the sense that when I have anxiety or panic attacks, that's a real internal horror, and that's something that I'm experiencing personally, but the people like Alice where what's going on with their body is actually being funnelled externally to those around them. It must be so scary to feel kind of out of control in that sense. I really feel for Alice and thank you to Alice for sharing her story.
Do you have any advice in those situations where the feelings are kind of being projected out onto those around them? How can loved ones be supportive at that time?
Christina:
Yeah, it can be a really difficult time. And I think Alice already alluded to it, she identified what was happening, she had sought some help in terms of how to deal with it herself and then she told her family that this was what she was experiencing and in that sense, she was educating them about what was happening.
Sometimes if Alice was going to her GP for example, it might be helpful if she took her family along and the family were able to speak to the GP or even the psychologist if that was the case, if Alice was seeing a psychologist.
Katie:
Yeah, it's about that open communication, isn't it? And everyone understanding sort of what's at play here and what's happening.
Christina:
Absolutely.
Katie:
Well that brings us to the end of this episode. If you'd like to learn more about managing perimenopause or your mental health, be sure to check out the show notes where we've listed some handy resources and links to information.
Christina, before we head off, what's one key takeaway you'd like our listeners to remember today?
Christina:
Well, like always, education is the key. Be aware that your symptoms can be due to the hormones, menopause or perimenopause, and talk to someone, whether that's a friend, a partner or a GP about how you're feeling.
Katie:
Yep, absolutely. Always good to speak up when you need help.
In our next episode, we'll be diving deep into the menopause itself. How does it feel to transition from perimenopause and what symptoms we might experience with this particular phase of life.
So hit that subscribe button and don't forget to leave a review if you've enjoyed today's conversation.
Thank you so much to Christina for joining us today and to the team at Queensland Health for making this podcast possible. We'll see you next time on It Can't Hurt to Ask.