# Zoë Foster Blake - Perimenopause, ADHD & Everything That Helped with Dr Fatima Khan

An episode of [The Imperfects](https://invisiblenetwork.ai/podcast/1476501557), 11 Oct 2026, 1 h 30 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/01M4A92KCFDN5V6X4Q0MJ9VTBD.mp3

This is not your mother’s perimenopause. 💌 To join our journaling club, subscribe to my imperfect email - https://www.theimperfects.com.au/sign-up-to-our-newsletter/ Joined by guest host Zoë Foster Blake, and Dr Fatima Khan, we’re diving head first into perimenopause: the what, the why, and the how-the-f**k to deal with it. Typically beginning in your late 30’s, and in your brain of all places, perimenopause symptoms include heightened anxiety, irritability, sleep disturbances, brain fog … all things that make you feel further and further away from your best self. Beginning 5 -7 years BEFORE your last menstrual period, perimenopause can coincide with postpartum, the most important presentation of your career to date, and the uncovering of neurodivergence, which may have been painstakingly masked until this shift in hormones. With the expertise of Dr Fatima, and the lived experience of Zoë, we hope this episode makes you feel seen, less alone, and ready to have THAT conversation with your GP. Chapters • 00:00:00 The Truth of Perimenopause \[TRAILER\] • 00:01:09 The Meet Cute of Zoe Foster Blake and Dr Fatima Khan • 00:06:55 Is this Perimenopause? Early Signs + Symptoms • 00:07:41 Zoe’s Perimenopause Journey: No Sleep, Anxiety, Rage, Repeat. • 00:09:56 Volcanic Rage, Explained • 00:14:59 What Doctor’s Miss: Misdiagnosis + Antidepressants • 00:15:57 Why Your Husband Is Breathing Too Loud • 00:20:18 Perimenopause Mental Health Screening • 00:21:25 Debunking the “You’re Too Young” Myth • 00:23:43 Is it Anxiety? Depression? Perimenopause? • 00:25:26 The Pill, The Mirena + The Modern Woman in Peri • 00:30:44 Loosing Yourself in Peri: Brain Fog + Dementia Fears • 00:32:10 The Importance of Testosterone • 00:36:00 HRT Myths: Re-educating a generation • 00:39:04 A Script for a Script: What to say to your GP • 00:41:12 Perimenopause Is a Multi-Organ Syndrome • 00:46:09 High Achieving Women + Peri = Shame • 00:46:47 When Perimenopause Unmasks Your ADHD • 00:54:26 Trauma Reactivation in Perimenopause • 00:57:17 Pills + Skills: Why HRT Alone Isn’t Enough • 00:58:41 The Longevity of It All • 01:00:30 Nutrition 📚Things to read • Group Chat, by Zoë Foster Blake - https://bit.ly/4efqR70 • Hormone Health is Mental Health, by Dr Fatima Khan - https://bit.ly/4j6G2Ts 💻Things to check out • Australasian Menopause Society - menopause.org.au • Meno-D questionnaire - https://bit.ly/3Toj3sN • Zela Wellbeing - https://bit.ly/4ARGFXu 🎧Imperfects episodes for MORE on hormones • Zoë Foster Blake - Zero Lucks Given - https://bit.ly/4y8xwHx • Dr Louise Newson - Maybe it’s Menopause - https://bit.ly/4i7xM3F • Dr Louise Newson - It’s Hormones. Period. - https://bit.ly/47ya9w2 🩷To host your own Vulnerabilitea House, purchase here - theimperfects.com.au/shop 🩵To purchase our journal (or your novel) My Imperfect Life, click here - theimperfects.com.au/shop 🩵To join our subscriber community, A Little More Imperfects, follow this link - patreon.com/theimperfects 🩷 AND you can subscribe to A Little More Imperfects through Apple Podcasts http://apple.co/theimperfects The Imperfects is not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment. The advice given in this episode is general in nature, but if you’re struggling, please see a healthcare professional, or call lifeline on 13 11 14.

## Transcript

[0:00] Zoe Foster Blake.
[0:02] That's a woman in perimenopause with ADHD writing a book.
[0:07] Dr. Fata McCann.
[0:08] I think most men don't know what perimenopause is, but they will after this podcast.
[0:12] Wow.
[0:13] Oh, my gosh.
[0:14] I think we're scaring the boys now.
[0:15] I don't care.
[0:17] Two incredible women here to talk all about perimenopause.
[0:21] Perimenopause is not menopause because it typically starts five to seven years before your last menstrual period and it starts in the brain, typically late 30s to early 40s.
[0:33] Anxiety ramped up to an 11.
[0:35] Feeling overwhelmed.
[0:36] Sleep was terrible.
[0:38] Brain fog.
[0:38] Irritable.
[0:39] Fury.
[0:40] Rage over things that shouldn't have been inciting that level of rage.
[0:43] It's a real fucker.
[0:46] And no Imperfects episode is complete without some helpful advice.
[0:50] We need to move to good sleep, and that's a problem because everyone scrolls till midnight.
[0:54] I scroll till 11.30.
[0:58] But it's fine because you're not going to go through Perry, so you're fine.
[1:02] Probably not the time to be bragging.
[1:09] Well, this is a very, very – it's a different episode structurally because no Josh today.
[1:18] Josh has been replaced for one episode only for very good reason and not because he doesn't believe in perimenopause because we wanted to bring in – he does believe in it, by the way.
[1:31] We wanted to bring in a very special guest host for today, Hugh.
[1:34] Yeah.
[1:36] No, it's Zoe.
[1:36] Yeah.
[1:37] Yeah.
[1:38] It's not me.
[1:38] Why is it right?
[1:41] Zoe Foster-Blake, welcome.
[1:42] And thank you for agreeing to co-host the Imperfects podcast.
[1:45] It is my absolute pleasure to be here with you as one of the bosses on the hosting chair.
[1:50] You are co-boss.
[1:51] Thank you.
[1:52] And we're joined by Dr. Fatima Khan, which is such a great privilege for us.
[1:56] I'm going to aim to be succinct here because I feel like probably the less you and I talk, Ryan, on this episode, the better it will probably be.
[2:03] Well, I've got some thoughts.
[2:05] So just by way of introduction to both of them.
[2:07] So Zoe was a beauty director at Cosmopolitan and Harper's Bazaar for over a decade, where she amassed an incredible knowledge about skincare products.
[2:15] Zoe founded GoTo Skincare in 2014, as well as GoTo in 2019 and BroTo in 2020.
[2:21] Zoe's published 21 books with the latest.
[2:25] What?
[2:25] Yeah.
[2:26] Wow.
[2:27] Yeah, apparently.
[2:27] I thought it was like 19.
[2:28] 21's amazing.
[2:29] But some of those little kids books slip in there, you know.
[2:32] Well, you say little, but my gosh, they're popular.
[2:34] They don't take as long to read.
[2:36] All right.
[2:37] Very popular in our house, that's for sure.
[2:39] With the latest edition being Group Chat, which is released in September.
[2:45] Can we quickly talk about Group Chat?
[2:47] I'd love to, as long as you like.
[2:49] Because I've said to you before, like, I'm going to read it because I know I'm probably not the target audience, but I feel like it's a really good thing for me to understand.
[2:56] Because for me, from what I understand, it's a lot about identity and kind of who you are
[3:02] who you planned to be or who you've spent your whole life trying to be.
[3:05] And then when you feel like you've arrived at that place, there's a lot of questions.
[3:09] Is this actually who I want to be?
[3:11] Let's mix it up a little bit and let Zoe talk about her book.
[3:15] I like that, though.
[3:16] That is a good, that's kind of one of the, I like that he's just gone straight in there.
[3:20] But that is one of the philosophical underpinnings of this book, which is, you know, women's fiction.
[3:25] It's lighthearted.
[3:26] It's intended to be funny and fun.
[3:28] It's about five women, sort of like a perimenopausal bridesmaids.
[3:32] They're all very different, but they've been friends for, you know, 25 years.
[3:36] And one of them is going, her husband's had an affair, so they rally together and they end up in Mykonos for a week.
[3:42] And that sort of puts a spotlight on them as to what you were saying, where they are in life.
[3:47] They're in their mid-40s.
[3:49] They're feeling the stress and the pull of young children and their hormones are going crazy and their partners and...
[3:56] Some of them are divorced and quite happy.
[3:58] Some of them are not.
[4:01] And the main protagonist is sort of what you were talking about, Stella.
[4:05] She is at that point where a lot of us are in our 40s.
[4:08] We were like, is that where I thought I would be?
[4:11] Is there more than this?
[4:13] Should I have done things differently?
[4:15] Is there still time?
[4:16] And that leads to sort of a wider existential moment about am I with the right?
[4:21] person?
[4:21] Do I even live in the right house?
[4:23] Is my career all wrong?
[4:25] And so we see her tussle with that.
[4:26] But ultimately, it's a love letter to female friendship.
[4:31] I love that.
[4:32] Beautiful.
[4:32] Yeah.
[4:33] Okay.
[4:34] So I think the next thing to do is to ask, so how did you guys meet?
[4:37] Yeah.
[4:39] Uh, Fatima and I were on a panel together earlier this year.
[4:42] I was talking about sleep and skin because of GoTo and Fatima was obviously talking about perimenopause and the huge amount of impact it's got on your skin and your sleep as well.
[4:53] And then we got to chatting afterwards and then Fatima asked if I would read her book to endorse it.
[5:00] I loved it.
[5:01] And I tell everyone to read it.
[5:03] Well, you put a video on Instagram about it.
[5:06] And when I saw that, because I knew that you guys were coming on together, and I was like, oh my God, this is like, what a perfect little preview into how much it meant to you, that book.
[5:15] It did, and I wanted to talk about perimenopause for a long time just because I do like to talk to women about, you know, what's going on in our lives, and I don't often do it.
[5:25] And I also felt a bit scared to do it because it's very personal and also leave it to the experts.
[5:30] But once I had Fadiman's book, I felt like I had a resolution.
[5:33] So I wasn't just talking about my own experience, but I could actually say, and this, I wish this existed, because if I'd read that in my late 30s, oh, could have been a very different journey.
[5:44] So it's a really important book.
[5:46] Can't skip this one.
[5:48] We are so lucky to have you here.
[5:51] Dr. Fatima Khan is a perimenopause and menopause specialist.
[5:55] Wait till you hear the things that she has studied.
[5:58] I can't wait.
[5:59] Okay, well, I'll do it now.
[6:01] Bachelor of Science in Pharmacology and Therapeutics with Publications of Research at Imperial College London.
[6:07] Bachelor of Medicine and Bachelor of Surgery, Imperial College London.
[6:11] Diploma of the Royal College of Obstetricians and Gynaecologists.
[6:14] Membership of the Royal College of General Practitioners.
[6:17] She was a Clinical Fellow at King's College London in Reproductive Gynaecology and Endocrinology, Menopause and Gyna Endocrine Clinic.
[6:26] She has trained in psychiatry, has advanced menopause certification accredited by the British Menopause Society and the Faculty of Sexual and Reproductive Healthcare.
[6:35] Most recently, Dr. Fatima has released Hormone Health is Mental Health, a life-changing guide to perimenopause and why understanding hormones is crucial for women's mental health, especially during midlife.
[6:46] Dr. Fatima, welcome.
[6:47] I feel like the first question I want to ask is probably the most predictable one, but what is perimenopause?
[6:55] Okay, well, perimenopause is not menopause.
[6:59] I think everyone knows what menopause is, which is the cessation of your periods, 12 months of no periods.
[7:05] You get your classic hot flushes, night sweats.
[7:07] Anyone can diagnose that.
[7:09] I think no one even heard of the word perimenopause until probably two years ago because it typically starts five to seven years before your last menstrual period and it's not a good time.
[7:19] And it starts in the brain, typically late 30s to early 40s.
[7:24] And it doesn't present with hot flushes, night sweats.
[7:27] And so typically it will present with anxiety, feeling overwhelmed, sleep disturbance and brain fog.
[7:35] And it happens at the exact time when women are at the peak of their career.
[7:39] It doesn't happen in a vacuum.
[7:41] Zoe, does that sort of resonate with you, that like just hearing that?
[7:44] Yes, I 100% felt that.
[7:48] And I think it was after the fact.
[7:49] So I didn't realise I was in perimenopause until later on.
[7:53] And well-meaning friend sort of brought it to my attention.
[7:56] But I think it definitely kicked off in my very late 30s when I started to feel 100% the mental side of it before the physical side of it.
[8:05] So anxiety and overwhelm.
[8:06] Oh my gosh, yeah.
[8:08] Totally.
[8:08] So anxiety ramped up to an 11 and sleep was terrible, waking up all through the night and never feeling rested.
[8:16] Irritable fury, rage over very things that shouldn't have been inciting that level of rage.
[8:22] What's an example?
[8:23] What was something that you remember?
[8:26] Like, you know, when your cardigan catches on a door?
[8:29] Oh, yeah.
[8:29] That does make sense.
[8:30] Hell, yeah.
[8:33] But overstimulation usually.
[8:35] So if like the oven fan was on, my kids were asking for me and there was music playing and then my phone would ring, I would just crack.
[8:41] And so for years I would say I felt off kilter.
[8:45] And I just explained it as like having a cloud at the top of my head that felt like I wasn't myself.
[8:50] Like I constantly felt premenstrual, like a real bitch.
[8:54] And as I'm sure Fadim will attest, we women are very good at gaslighting ourselves and saying, oh,
[8:59] it's just because I'm stressed, my children are young, business is intense at the moment, things will calm down soon.
[9:07] And it's not really Anna unless you get prevention and treatment and all of the education and awareness to understand what's going on and it's normal but treatable.
[9:18] When your husband tells you about his golf, does that help?
[9:21] Yeah, that's very helpful.
[9:23] It really calms me down.
[9:25] Yeah.
[9:26] I mean, they're really in the crossfires, the partners, during all of this.
[9:30] And they can be completely lovely people who aren't doing anything wrong, but the fact that they exist and make chewing noises...
[9:38] No good Pigs We'll not allow it Absolute trash man Yeah Oh you do You just start to like Sort of hate everybody It's not a nice feeling Yeah Especially when it's not who you are Yeah It's so not who you are Yeah yeah yeah Totally right So what's happening then From a more I guess physically What's happening to lead to that
[9:56] So I think if you look at macroscopically in a woman's reproductive lifespan, they're born with a fixed amount of number of eggs.
[10:03] And at puberty, they have their menstrual cycle, their first period, when they start releasing an egg.
[10:08] And so menopause is the other end.
[10:10] It's the end of their reproductive lifespan.
[10:12] There's no more eggs, therefore no more periods.
[10:14] And it's a retrospective diagnosis, meaning you've got to wait 12 months, no periods, and women are kind of struggling with symptoms.
[10:21] We say, no, no, no, wait 12 months before you have any help.
[10:24] And then we'd say you're in menopause.
[10:27] And so the issue is we don't just go from monthly 28-day cycles to suddenly nothing.
[10:32] So the peri is the transition leading up to it.
[10:36] And so we know that around 37 to 42, the egg quality and quantity starts to decline.
[10:43] So you have your monthly bleed, but essentially mid-cycle is when you ovulate.
[10:48] And the point of ovulation is to produce an egg, and the egg is there trying to look for that sperm to create the embryo to implant.
[10:56] And we produce a lot of progesterone at mid-cycle.
[11:00] And that's what helps prepare the lining for pregnancy.
[11:03] But also progesterone is one of the first hormones that declines in perimenopause because we know the egg quality and quantity is going down.
[11:11] Women know the fertility is going down.
[11:13] But when you lose progesterone, three things happen.
[11:16] One.
[11:17] Number one, you start getting heavy bleeding.
[11:20] And with that heavy bleeding, you start losing a lot of iron.
[11:24] And iron deficiency is now linked with independent symptoms such as brain fog, fatigue, restlessness.
[11:31] And it's commonly ignored.
[11:32] And women are just told just to take iron tablets.
[11:35] And a lot of women don't seek help because we're kind of just used to suffering in silence and not seeking help.
[11:41] But one of the kind of under-recognized benefits of progesterone is that progesterone is your body's endogenous tranquilizer.
[11:50] So it stimulates your GABA receptors in the brain.
[11:53] These are the same receptors that are stimulated by benzodiazepine, so your valium, diazepine, diazepam.
[12:00] And so suddenly we're losing the very hormone that helps us with sleep and anxiety.
[12:06] if you try and connect the dots, it makes sense that if you're losing that progesterone, you're not going to have good sleep.
[12:13] So women present with poor sleep.
[12:15] They present with feeling overwhelmed, anxious, and fatigued.
[12:18] And that's what we see.
[12:20] Women are having kids later.
[12:21] And I think it's important to talk about the kind of the social cultural evolution of why women are finding themselves struggling more than women before is that more and more women have kids later.
[12:32] So a lot of them may be having IVF or conceiving naturally, but they're going postpartum straight into perimenopause.
[12:39] Most women will still find them in the sandwich generation of working full time, looking after the elderly parents, household and kids.
[12:47] But then you don't have your calming hormone.
[12:49] You don't have that progesterone.
[12:50] In the background, estrogen is spiking.
[12:53] So our menstrual cycles are always fluctuating.
[12:56] You have your follicular phase at the beginning, mid-cycle you ovulate, and then you have luteal phase.
[13:00] So you get the oestrogen rising, then dropping slowly and progesterone going up and dropping down slowly.
[13:07] But what we see in PERI is because we're not producing this progesterone mid-cycle, the brain goes slightly lower.
[13:16] manic and it starts overproducing estrogen.
[13:19] It's stimulating the ovaries to produce this egg to come out and ovulate.
[13:23] So we, instead of getting a slow rise in estrogen, we see a kind of massive spike and then crashes, spike and crashes.
[13:30] And we know that disrupts the neurochemistry in the brain.
[13:34] So you get this volcanic rage.
[13:37] because it can stimulate your nervous system and you've lost the buffering from the progesterone.
[13:41] And that's where you feel this kind of anxiety, sleep disturbance, overwhelm, volcanic rage.
[13:46] And the next minute you're fine.
[13:48] And it doesn't classify as a mental illness because for major depressive disorders and anxiety disorders, you need to have symptoms for six weeks or more.
[13:57] This is someone who's functioning completely normal and then suddenly they get...
[14:01] complete loss of their emotional regulation and not knowing who they are.
[14:06] And so there's this identity reckoning.
[14:09] And so they'll go to the doctors, they'll do a blood test, everything comes back normal.
[14:14] And they're told that they need to stress less.
[14:17] And telling a woman to stress less is actually an insult because the problem is the woman who's coming to you at 40, she's built a career for 20 years.
[14:27] performing really well.
[14:29] She's managed to have two, three kids, run a household, maintain a relationship.
[14:33] Nothing has changed for her.
[14:36] So telling her to stop stressing doesn't work because she's like, well, I don't know what to do.
[14:40] What do you mean by that?
[14:42] Then she goes in second time and then she's told, okay, you're not coping.
[14:46] Bloods are normal.
[14:47] We're going to give you an anti-anxiety and antidepressant.
[14:50] I have nothing against anti-ncider depressant.
[14:52] They're life-saving.
[14:53] But you're not treating the root cause of the problem.
[14:55] And they think they're broken.
[14:56] They're failing and they lose that confidence and self-esteem.
[15:00] Because that medication doesn't fix the problem.
[15:03] Well, the medication will alleviate some of the symptoms, but we'll still continue to have all the other symptoms because it doesn't fix the brain fog.
[15:11] It doesn't fix the sleep disturbance.
[15:13] It doesn't fix the ultimate ongoing physical symptoms that we'll see, such as palpitations.
[15:19] There's also a dangerous message in there that, well, like a really unkind message that, oh, yeah, this is like probably depression or anxiety, which is so far from what it is.
[15:28] Or if it is that, it's there for a reason.
[15:31] I think it's important to understand that women between the ages of 40 to 45 or going through perimenopause is a window of vulnerability in a woman's mental health.
[15:39] We know women are two to four times more likely to develop first onset of anxiety and depression without previous history.
[15:47] This is someone who's got no previous psychological history.
[15:51] That would be so confusing, particularly if there's been no event in your life to trigger it.
[15:57] Exactly.
[15:57] So when we are diagnosing psychiatric illness, we always have what we call the biopsychosocial model.
[16:03] So is there a biological cause?
[16:04] We do, you know, blood tests, make sure there's no hypothyroidism, there's nothing else going on.
[16:09] And then we look at what is happening in your life.
[16:12] Is there psychological vulnerability?
[16:14] Have you had, you know, a divorce that you've gone through, loss of a parent, grieving that?
[16:19] But these women have nothing.
[16:20] Yeah.
[16:21] Nothing has changed except the husband's chewing loudly.
[16:24] But also it's interesting on the flip side.
[16:28] I get a lot of men bringing or booking appointments for their partners because perimenopause starts with just worsening PMS.
[16:35] So that's, I always say, the easiest way to track is you're just, it starts with seven days before where you're just feeling really hyper aroused, very irritable, ragey, uncontrolled kind of reactive responses.
[16:48] And then your menstruation arrives or your period arrives.
[16:51] And suddenly it's like this release of tension.
[16:54] Yeah.
[16:54] And you're happy.
[16:55] And a lot of women describe themselves as becoming a monster.
[16:58] And then there's shame and guilt because now you've yelled at your kids and your partner that you've loved for 20 years.
[17:06] And they don't know who they are.
[17:07] And they're like, oh, yeah, you must be before your period.
[17:09] And that's fine if it's seven days.
[17:11] But it eventually expands out to two weeks.
[17:14] Yeah.
[17:14] And it's happening on a monthly basis for years.
[17:17] And we know women in Australia divorce between 40 and 45, men 45 and 50.
[17:21] Now, that's not saying perimenopause-arisen woman divorce.
[17:24] We also know it's a time where women are completely squeezed with all the caring responsibilities and that mental load.
[17:32] And then the hormones that would have compensated and buffered the stress system in the brain, we're losing that.
[17:39] We're losing that calming effect.
[17:41] We're losing the estrogen softening of the mood and the spikes and then in the environment of psychological stresses from life.
[17:49] And there's a concept called allostatic load in medicine, which I was never taught, but there's actually literature on this.
[17:57] And it's just wear and tear on your nervous system that is measurable.
[18:02] So it's understanding it's not just the estrogen, progesterone, it's your nervous system has a capacity.
[18:07] And the issue is a lot of women are conditioned to keep saying yes, over committing, people pleasing.
[18:14] But there's a flip switch at 40, late 30s, where your resilience isn't there because of this wear and tear, but also you're losing the buffering.
[18:23] But I think spiritually it's also a bit of an awakening where it's like,
[18:27] is this really what I want to do?
[18:29] Like I'm conditioned to be, you know, the best daughter, the best sister, best colleague, then you're a wife or partner, then you're the mother, you're the head of the school committee, you're always someone for someone else caring.
[18:42] And then you realise, okay, what about me?
[18:45] Is this really what I really want to be doing?
[18:47] And I think because women don't know what's happening, it's just easier to blame things around us.
[18:53] And the partners, unfortunately, get the blame.
[18:55] And you can cut this out completely, but this is very controversial.
[18:59] But I always say this, even from my personal experience, the kids are the same, the work is the same, and you have the same partner or the same man in your life.
[19:08] It's you who's going through something very transformative in your brain.
[19:13] Why is that controversial?
[19:15] I don't think people, I don't think, because you don't want to flip it across and say it's your fault.
[19:19] Your fault as in?
[19:21] The woman's fault.
[19:21] The woman's fault.
[19:22] Yes, okay.
[19:23] I didn't say that.
[19:24] Yeah.
[19:25] I certainly didn't say that.
[19:28] Hi, it's Ryan from The Imperfects, and I'm reaching out to you now because we need your help, gosh darn it.
[19:35] Hang on, why do we need...
[19:36] Sorry, no, I'm just making a plea to the listeners and viewers to ask them to subscribe to the show in whichever way they see fit because it really helps.
[19:46] The more subscribers, the better we can make this show, am I right?
[19:49] Yeah, but I don't think we need to...
[19:51] I think we could just ask them politely.
[19:52] Yeah, but if I use the emotional music...
[19:55] I think the music's a bit much.
[19:56] Is it?
[19:56] Who's playing that music?
[19:57] Doesn't matter who's playing the music.
[19:58] The important thing is we're pulling at the heartstrings and asking them to do us a solid.
[20:03] Could we not just ask them straight?
[20:06] It'd really help us if you guys subscribed because we'd be able to make more of the show and make the show better.
[20:12] Oh, and not use emotional manipulation.
[20:14] Yeah.
[20:14] Yeah, I reckon.
[20:15] We can give it a go, but I doubt it'll work.
[20:18] The problem is, so there was a position statement from the Royal College of Psychiatrists in March 2026 this year, identifying that this window of vulnerability in mental health does not always respond to anti-anxiety and depressants.
[20:32] And we need to have a hormonal lens because despite medicating women, they're still not feeling optimal and still finding all the symptoms are there.
[20:40] And the problem is we need to use more validated questionnaires like Menody, which is a specific questionnaire for screening for mental health in women transitioning to perimenopause and menopause, developed from a Monash group here in Melbourne.
[20:55] And it specifically asks questions about irritability, rage, suspiciousness, paranoia.
[21:03] It talks about isolation, loss of self-esteem, all the things that standard depression scores don't capture.
[21:10] And so when we're going through that, what's happening is our perception is changing of who we are and the people around us.
[21:19] And that is then reflected in how we see our partners and how we see our children and how we see people around us.
[21:25] So just how long were you in this state of confusion for?
[21:27] Like not knowing what was going on.
[21:29] I think we need Hamish on this podcast.
[21:31] That's all we need.
[21:32] Um...
[21:34] And, oh, gosh, you know what?
[21:36] And it coincided with lockdown as well, which was pretty intense.
[21:39] Yeah.
[21:39] And I had a young baby.
[21:41] So I think what you're saying, Fatima, to that point is we just can't catch a break because if we do have our kids in our 30s, we've got toddlers, and then we finally feel like we're back to ourselves for maybe 30 seconds and then this starts happening.
[21:54] And so you kind of go, well, I'm not really sleeping well because I've still got a two-year-old or three-year-old in the house.
[22:00] But then your menstrual cycle went bananas and, you know, I was sweating through my T-shirts and all of these things.
[22:07] It was all ramping up, but I didn't still know what it was.
[22:10] I really didn't know what it was.
[22:11] And it's crazy to me now.
[22:12] And it was...
[22:13] Reading Fatima's book, it was like I was crying because I'm like, my story and so many women's stories who just don't get seen, heard, validated or understand what's going on.
[22:25] So it's so important because I don't like the idea of so many women out there and their partners feeling...
[22:32] Awful, just not themselves, like a mean, mean bitch who just cannot get a break.
[22:38] And as you say, nothing is maybe externally changed.
[22:41] It's all in here.
[22:43] It's literally all in your head, but it's not in your head, if that makes sense, because you can't tell yourself that it's not really happening.
[22:50] So is that how you first got onto perimenopause?
[22:53] Was it through Fatima's book?
[22:55] No.
[22:56] No, my sister, who's a few years older than me, and a friend who was sort of hearing me talk about this stuff, but I thought I was too young.
[23:05] And so I went to my GP at 43, which is not too young, and was told I was too young.
[23:12] And this happens a lot.
[23:14] And I'm sure you can talk to that in a minute, Fatima, about this, the situation where we come in with a list of symptoms and bloods and all of this to go, I think this is happening.
[23:22] Anecdotally, I feel very confident in this and are told all kinds of things that are not true and outdated and harmful, I would say, and have been for a lot of years.
[23:33] So I then saw a specialist, a reproductive endocrinologist who put me on the right path and I went on HRT and am better.
[23:43] So because it's like, I imagine, and Fatima, you kind of mentioned this, I guess, a little bit, which is that if you're someone, if you're a woman who has dealt with anxiety, depression, and had like really fluctuating up and down moods your whole life, and then you get to an age where it's...
[24:05] it's happening maybe more or in a different way, I can imagine how you might go like, well, it's probably the depression.
[24:13] It's probably the anxiety.
[24:16] So how do you know, how can you differentiate or how do you know it's not that and it's perimenopause?
[24:23] So there's two presentations, right?
[24:26] So you have new onset anxiety and symptoms.
[24:28] So that's easy because they'll be like, I've gone through worse things in my life.
[24:32] I've done stressful things.
[24:33] I don't know why I'm feeling overwhelmed.
[24:34] I've gone to this board meeting 100 times and now I'm finding I'm standing there feeling really overwhelmed.
[24:40] And then and so that's someone who's obviously new.
[24:43] Nothing's changed.
[24:44] And then you think, OK, what is it that's causing it?
[24:46] Because if it's not a psychological trigger, it's not.
[24:49] then we know perimenopause presents with that anxiety, as I described the mechanism earlier.
[24:55] So again, you have hormone depressive disorders, so mood disorders related to hormonal transitions.
[25:01] And we recognize puberty is a window of vulnerability for mental health symptoms and also postpartum as well in pregnancy.
[25:10] So anytime there's a hormonal transition, there is a window of vulnerability in mental health.
[25:15] But there is no education on perimenopause.
[25:18] And typically perimenopause was defined as a change in your menstrual cycle, more than seven days plus or minus.
[25:25] That's all it was described as.
[25:26] described under the straw criteria, which is described with irregularity on your menstrual cycle.
[25:31] Now that doesn't serve the modern women because the modern women, a lot of them don't have that history because they would be on the Marina IUD, which is a very commonly used interuterine device for contraception and bleeding control.
[25:44] So typically women are put on that in their mid thirties or late thirties.
[25:49] And so you've lost that signal of the erratic period.
[25:52] And so you might be getting all the symptoms and not knowing what's happening.
[25:56] But also we've always associated hot flushes, night sweats and menopause with kind of this cessation of periods in older women and, you know, kind of negative connotation of this old woman with white hair, grey hair.
[26:10] And that's not the modern peri woman.
[26:13] That's not the modern menopausal woman in her 50s.
[26:15] But peri biologically, we know the egg quality and quantity is declining.
[26:20] Yeah.
[26:21] 37 to 42.
[26:23] So biologically, you are losing that progesterone.
[26:25] I go on and on about it in the book because no one's connecting the dots.
[26:30] This is why they're coming in with the same thing of sleep disturbance, anxiety, overwhelm, reduced resilience, distress.
[26:36] And then we start seeing a lot of women finding they're drinking more and more alcohol because that's the only thing that takes the nerves off.
[26:44] But the problem with that is that it actually causes a further disruption in sleep.
[26:49] And we know that it disturbs your deep REM sleep.
[26:51] So you're not getting deep restful sleep.
[26:53] And the next day, your cognition is not sharp.
[26:56] You're feeling more foggy.
[26:57] Your executive function is not working well.
[26:59] So it's this kind of vicious cycle.
[27:01] They're on the antidepressants.
[27:02] Then they're on the sleeping pill.
[27:04] Then they're on Xanax.
[27:05] And they come in with this cocktail of medication, you know, like, okay, come on, we need to weenie off of this.
[27:10] And then we restore the biology.
[27:13] Everything goes away.
[27:15] And I think what we need to do, if anyone's going to take anything, is we've always focused on estrogen, progesterone, and testosterone to an extent on reproduction.
[27:25] And women's health research has always been around trying to get you pregnant, keep you pregnant, and deliver the baby safely.
[27:31] And the reason no one knows about perimenopause is because it's not studied that well.
[27:35] And when there is research, there's no kind of education at medical school.
[27:40] I wasn't told about perimenopause.
[27:42] in my six years of medical training.
[27:45] And then even after that, I did six years of hospital training.
[27:48] So 12 years of training.
[27:50] I had to go study it.
[27:52] And that's when I was told about it, right?
[27:54] So I've got that privilege of having this knowledge.
[27:57] But, I mean, it shouldn't be.
[27:58] It should be standard curriculum for every single doctor because every single woman will experience this transition.
[28:04] Right.
[28:04] And the problem is because it's experienced at this late 30s, early 40s, the education we've had is menopause on average occurs at the age of 51, cessation of your periods.
[28:14] And you might start noticing a few hot flushes and sleep disturbance.
[28:17] That's it.
[28:17] That's all you know.
[28:18] And it's a natural transition.
[28:20] Everyone's done it for centuries.
[28:21] Just put up with it, you know.
[28:24] But we're getting more and more research to do with Gen Z and millennials who are obviously a very different demographic.
[28:30] They're working.
[28:31] They've got young kids.
[28:33] They're not slowing down.
[28:34] I think it's important to recognize the women that we have sitting in front of us, like Zoe and myself, are very different to like our grandmothers and mothers.
[28:44] So 25 years ago, which is a quarter of a century ago when I went to medical school, I was...
[28:48] we would see women and we would keep them on the contraceptive pill for 20, like for basically until they were 50.
[28:55] And the good thing about the contraceptive pill, although it's synthetic, it will give you some form of masking.
[29:00] So it will, those fluctuations that we see in peri will mask it.
[29:04] So you didn't necessarily see this volatility in mood.
[29:08] And then they would hit 52, we stopped the pill, and we would give them HRT for two, three years.
[29:13] But also the same women...
[29:15] were having kids much earlier.
[29:17] By 30, they would have completed their family.
[29:18] So by the time they hit 40, 45, they had no children at home.
[29:22] And by the time I were getting them HRT, they were like semi-retired.
[29:25] Majority of them weren't in full-time employment.
[29:28] And then the ones who were working were working casual.
[29:31] Compared to the person that I'm seeing now at 45, has got probably three kids under 10, working full-time career that she's invested 20 years in, and also is not using the contraceptive pill because we now use since 2011, we've got the marine IUD, which is what we call a long-acting reversible contraceptive.
[29:50] And the good thing is it's there for five years, you don't need to take a daily pill.
[29:54] And also in Australia, there's a high uptake of vasectomies.
[29:57] So a lot of the
[30:01] And it still is in parts of Europe, especially somewhere like UK, where it's free for the entire reproductive life.
[30:07] So from the age of 15, if you want to be on the pill till 50, you can have it for free of cost from the government.
[30:12] So there's no incentive to be doing anything else.
[30:14] But in Australia, a lot of it is private.
[30:17] So a lot of men will go and have vasectomies or women will do marinas.
[30:20] And so then marina is just sitting in the uterus.
[30:23] You still have the volatility from the ovary.
[30:26] And these ovarian hormones, oestrogen, progesterone, are not just working on the uterus.
[30:31] They're working in your brain directly on your dopamine, oestrogen, receptors, which govern mood and executive function and cognition.
[30:39] And that will probably lead us to ADHD because we're seeing a lot of this unmasking at this age.
[30:44] And the brain fog is real too.
[30:46] And I think that's a lot of us get quite scared when we forget very obvious, easy things like a name of a song or the name of the fridge or something and we
[30:55] snap at our kids because we can't think of the word.
[30:58] And I was worried about, you know, early onset because my grandmother had dementia and that's how bad it gets for us.
[31:05] So we really do worry there are very bad things happening to us.
[31:09] But, yeah, the hormones are kind of in control of all of that.
[31:13] Certainly the brain fog.
[31:14] And you're like, Zoe, I don't know many busier people.
[31:17] And so when you're like running this huge business, writing a book, parenting, all these things, it's quite, is it scary that you're like, what if I can't run the business?
[31:28] Yes, it's not a good time.
[31:29] And I was talking to a friend of mine.
[31:30] She's like, I now take beta blockers before I present.
[31:33] Even to my staff because I can't, I'm so worried about forgetting my words and looking stupid when I'm meant to be a professional and training them.
[31:42] So I know lots of women doing lots of things to try and band-aid it.
[31:47] Yeah.
[31:48] You know, I think the last time I was in here, I spoke about, because I didn't have my diet, like I didn't have my HRT at that point and I wasn't sleeping and I was anxious and all those things.
[31:55] And I was using medicinal THC to sleep and melatonin and anything I can get my hands on to try and fix the situation.
[32:03] But surprise, surprise, it was hormonal.
[32:07] So it needed attention in a really specific way.
[32:10] I can completely understand how you're just trying anything you can to try and treat what's going on.
[32:17] Fatima, what about the role of testosterone?
[32:19] Does that decrease as well?
[32:21] I think in terms of when we're talking about the hierarchy of decline in this transition, we know that testosterone levels drop to half at between 35 to 40 is what you had at the age of 20.
[32:33] And then we see progesterone declining because we're not having the same amount of ovulatory cycles and then estrogen is the last one to decline.
[32:42] Now, testosterone is important because obviously we know testosterone is linked in men with muscle and kind of having high libido, but it has a really important role in women's libido too.
[32:53] And in Australia, we have a female licensed testosterone for women.
[32:57] And it's given for a condition called hyperactive sexual desire disorder, which is a fancy name for low libido.
[33:04] The moment.
[33:04] It's a very fancy name.
[33:05] Very, very.
[33:07] So the fascinating part is it's only licensed.
[33:11] So you'll only get it dispensed if your libido is distressingly low and impacting your relationship after menopause.
[33:19] But biologically, we know that testosterone is already kind of in your tanks, late 30s to early 40s.
[33:25] And so we have a very interesting study being done called the Sibyl Study at Monash, looking at the role of testosterone for low libido in these younger women.
[33:34] Because commonly, they will come in with the usual symptoms we've gone through of the mental health changes, but also low libido.
[33:41] And I think that's very important to know.
[33:43] when it comes to relationships and intimacy.
[33:45] And so testosterone is something worth exploring with your doctor.
[33:49] Yeah, absolutely.
[33:51] Zoe, I'm really interested to know what happens to your self-esteem when you're going through this, but you don't totally understand what's going on.
[34:00] Oh my God.
[34:01] Well, yeah, you feel stupid.
[34:03] You feel a lot of shame.
[34:04] You feel guilty for snapping.
[34:06] And one of the main reasons that I finally advocated for myself was because I was going to lose my relationships with my kids because I was just a tired, cranky mummy all the time.
[34:16] And I was on a trigger point.
[34:18] So I did it to salvage relationships, honestly.
[34:21] I was then putting myself second.
[34:23] I see, even as I say that, it wasn't about my own mental health, but how I was impacting others.
[34:28] Relationships.
[34:29] Such a classic woman thing to say.
[34:30] Yeah.
[34:31] But of course, it helped everything.
[34:34] Sleep is obviously so paramount for mood and anxiety and all those things.
[34:38] And once that was under control, everything sort of flowed.
[34:41] But yeah, you don't really like yourself for a while there.
[34:44] Did you notice, like with the relationships in your life with like kids or home or friends or whatever, once you started taking HRT, did you...
[34:52] Yes.
[34:52] I felt like I was looking at my family.
[34:54] I was like, why can't I have fun?
[34:56] I married the world's funnest man and he loves having fun with the children.
[35:01] And I felt like I was just outside of it looking and going, fuck.
[35:04] And all I do is come in and go, guys, come on, it's dinner time, like fun warden, let's do this.
[35:09] And I wasn't enjoying anything.
[35:11] I was just the cranky one all the time.
[35:14] Yeah.
[35:14] To not be able to get into the fun would be really hard.
[35:18] And I did enjoy putting this through group chat because I think, you know, we have a very good nonfiction version of perimenopause.
[35:23] But in a way, group chat was exactly what the protagonist is going through is just this underlying feeling of not being herself and the restlessness and the sleeplessness and the anxiety and the not liking her husband.
[35:35] And I think a lot of women will relate to that because it's...
[35:39] Really common.
[35:41] Among my friends, at least.
[35:42] And your friends.
[35:44] So in writing the book, did you talk to your friends about their experiences?
[35:47] That's all we talk about ever, always.
[35:49] Really?
[35:49] Oh, yeah, yeah, yeah.
[35:51] Anytime someone does my makeup or I'm like, women my age, it's all we talk about.
[35:55] Really?
[35:55] Yeah.
[35:56] Wow.
[35:57] You want it?
[35:58] Who's your guy?
[35:59] No.
[36:00] Just trying to figure out when and how.
[36:02] And I think there's a lot of misnomers about it, you know, and that's why I love Fatima's book as well because there's so much myth and there's, you know, the breast cancer risk is really talked about a lot.
[36:13] And I had a discussion with a family member the other day who was like, you're on HRT, but that causes cancer.
[36:17] You should get off that.
[36:18] Mm-hmm.
[36:19] And so I feel like we're now, our generation is like having to re-educate our older generation who were told, no, HRT is bad.
[36:26] So we have talked about HRT before on the podcast, and we'll put a link to that episode in the show notes, but I think it might be really helpful to sort of just talk about, well, what is HRT as a refresher and why is it so safe and so effective?
[36:41] I think it's important to realise that
[36:44] To treat anything, you need to, number one, recognize what you're treating.
[36:49] And most people don't know that you can give HRT in perimenopause.
[36:53] So that's the first thing.
[36:54] Sorry, can you say that again?
[36:55] Most people don't know that you can use HRT on perimenopause.
[36:57] Yeah, they think you have to wait.
[36:59] The amount of women who come to me and say, oh, my GP said when you stop your periods for 12 months, that's when we're going to give you HRT.
[37:06] Gotcha.
[37:06] So it's more a thing for menopause, not for perimenopause.
[37:09] That's what they thought.
[37:10] Yes, because conventionally HRT has been studied for women when they've stopped their period in postmenopausal era.
[37:16] So that's important to know.
[37:18] So when your GP is saying that, he's right, because that's what we've all been taught.
[37:22] And to start in perimenopause, number one, you need to recognize then perimenopause.
[37:26] At the moment, everyone's being misdiagnosed.
[37:28] That's something else.
[37:30] And when you are starting it, the starting protocols are slightly different because you still have your endogenous hormones in there.
[37:36] So you start much lower.
[37:37] There are different regimes.
[37:39] So you need to make sure you're going to a menopause-informed doctor because it is slightly more nuanced when you're managing that.
[37:45] How do you know if they're a menopause-informed doctor?
[37:49] So you can go to the Australasian Menopause Society, which is Australia's main regulating body and teaches all doctors and GPs and professionals.
[37:58] And you put your postcode in there and it will give you all the doctors who are in your area, five kilometre, 10 kilometre.
[38:05] However, that does not mean they're menopause in form.
[38:07] It just means they're a member of this community and there's no formal certification in Australia at the moment.
[38:15] So you've got to just...
[38:18] Try your luck.
[38:19] Yeah.
[38:20] Or speak to someone.
[38:21] You do.
[38:22] It's crazy.
[38:22] The only reason I'm saying that, I recommend that.
[38:24] So my list is closed.
[38:25] So please, you know, this is not a podcast to get more patients.
[38:28] My list has been closed for a long time.
[38:30] And I tell everyone, we have an email saying, go to the AMS.
[38:33] And then we get people emailing back saying, I went on that.
[38:35] I saw someone.
[38:36] They didn't know what they were doing.
[38:38] And so I think we should put a disclaimer in here.
[38:40] That's just a directory of clinicians.
[38:42] It doesn't mean they're menopause-informed.
[38:44] But if you go to their website, they'll have things that they'll say they're menopause-informed.
[38:48] But moving back to HRT, because when you go in at 43, you're not going to get HRT is the point I'm trying to make.
[38:57] So you've got to understand that if you say, oh, I've got perimenopause, can I have HRT?
[39:01] That's when the back of the book, I've got scripts.
[39:04] Yes, it's so good.
[39:05] And when you say scripts, you don't mean prescriptions, you mean actual dialogue scripts.
[39:09] You can tear them out.
[39:11] Yeah, a bit of Xanax and things.
[39:13] I don't know what I call them in the book.
[39:14] I call them conversation scripts.
[39:17] This is literally what to say to the GP.
[39:19] This is so good.
[39:20] What a great idea.
[39:21] Can we roleplay it?
[39:23] Yeah, yeah, yeah, do it.
[39:24] It says here, I've been tracking my symptoms over the last three months.
[39:28] Here we go.
[39:28] Okay, so you're the doctor.
[39:30] I'll be the doctor.
[39:31] My mood's all over the place.
[39:32] I'm yelling at my partner.
[39:34] My kids are intolerable.
[39:35] Well, I assume something's happened in your life then.
[39:37] You must be, have you lost your job?
[39:39] No, it's the same job.
[39:40] I'm almost getting promoted.
[39:42] Okay.
[39:42] And the kids are the same age.
[39:43] Any experience of anxiety or depression?
[39:45] Well, I'm feeling really, really anxious and feeling really overwhelmed.
[39:48] Yeah, well, we can prescribe you some anti-anxiety pills for sure.
[39:51] No probes.
[39:52] But I'm not anxious.
[39:55] Honey, let me tell you something.
[39:59] Oh, no.
[40:00] So I guess on a serious note to really for women to leave with this conversation a bit more informed, there is a questionnaire with psychological, physical and sexual symptom history.
[40:14] There are about 30 points on there.
[40:16] You're meant to fill that in.
[40:18] Because no one can ignore a list, right?
[40:22] And then there are scripts literally saying, I have tracked my symptoms.
[40:26] These are my symptoms.
[40:28] Do you think I could be in perimenopause?
[40:31] Do you think I can do a trial of estrogen through the skin as a patch or a gel?
[40:35] And can I take some...
[40:37] micronized progesterone.
[40:38] I have read this, this, this, and then, so it's all in that.
[40:42] So you're going with all the work done.
[40:45] The GP will do some blood tests.
[40:47] I think it's important to exclude any other pathology because women do present with other things.
[40:51] They might want to do a pelvic ultrasound scan if you've got bleeding.
[40:54] But we've made the book really handy because when I do, when patients come to see me, I have a questionnaire of 30,
[41:01] symptoms on there.
[41:03] And every time women say, I didn't even know half of these were part of perimenopause.
[41:08] So they're blaming other things, as you said.
[41:10] Like joint pain.
[41:11] Yeah.
[41:12] No one knows that.
[41:12] The joint pain is one of the first things.
[41:14] So my hip and pelvis basically shat itself a couple of years ago when this was all happening as well.
[41:20] And that's one of the first indicators is joint pain.
[41:23] Interesting.
[41:24] Sounds so fun.
[41:25] Yeah.
[41:25] Because you should be very jealous.
[41:27] I think we're scaring the boys now.
[41:28] I don't care.
[41:31] Scare them more.
[41:33] I think we need to change the nomenclature, which is how we phrase it, because menopause doesn't serve anything.
[41:37] Meno just means menses.
[41:38] Paws means cessation, right?
[41:41] We need to call it the multi-organ syndrome of menopause.
[41:44] which is it is a multi-organ syndrome.
[41:46] You name each organ in the body, starting with the brain, and then we can go down and I can list you at least three symptoms per organ.
[41:54] And this is why they're so vague.
[41:57] And when you go in, GPs are overwhelmed, and we used to call it like this heart-sinking patients walking through, the busy woman, and we used to call it TAT, which is an acronym for TIDE all the time, because we don't know.
[42:10] You do the bloods and they're coming in and they're just, you know,
[42:15] And you just tell them to just relax and stop doing so much.
[42:18] And I think now we've advanced a lot, especially the brain research in the last few years.
[42:23] But if you look at the brain, we know 60% of women will complain of cognitive symptoms.
[42:27] This is data out of Monarch, 60%.
[42:29] So that's brain fog, concentration, attention, word recall.
[42:35] executive functioning and then you've got the mental health which is anxiety overwhelm.
[42:39] Then you move we see other things such as vestibular symptoms so feeling dizzy, vestibular migraines, you get burning mouth syndrome so the ear, nose, throat is infected.
[42:49] You go to the heart we see cholesterol go up.
[42:51] We see blood pressure go up.
[42:53] We see palpitations.
[42:54] And the commonest symptom globally is joint pain.
[42:58] So a woman will suddenly have frozen shoulders, bursitis in the hips, runners for 20 years getting at least tendon ruptures.
[43:05] So how long would that joint pain have?
[43:07] Tendon ruptures?
[43:08] Yeah.
[43:09] Oh, my gosh.
[43:09] Yeah.
[43:10] That got him.
[43:12] So triggered.
[43:13] He can't tell you.
[43:13] I won't be able to run.
[43:15] It's not you.
[43:15] They'll just be running.
[43:17] They haven't changed anything and they're running.
[43:18] Remember, women have changed nothing.
[43:20] That's an extremely traumatic injury.
[43:22] That's surgery.
[43:22] That's like, that's awful.
[43:24] Now he gets it.
[43:25] We get labral tears.
[43:26] They're just doing Pilates class and they've got a tear in their hip.
[43:29] And like all these weird and wonderful things.
[43:31] And last year.
[43:32] That's very wonderful, but yeah.
[43:34] Last year, for the first time, they published a paper which kind of establishes these cohort of symptoms as the musculoskeletal syndrome of menopause.
[43:42] We have something called the genital urinary syndrome of menopause, which is bladder symptoms, painful sexual intercourse and vaginal dryness.
[43:49] But we're now finding all these things, the metabolic syndrome of menopause, where you get prediabetes, you get weight around the midline and you haven't changed anything you're eating.
[43:58] You haven't changed your exercise and you're putting on weight.
[44:01] This is what all the women are talking about.
[44:03] I eat the same.
[44:04] I train harder than ever.
[44:05] I have bloody protein coming out of my ears, like creatine.
[44:09] We're doing all the right things and our bodies are changing.
[44:13] There is so much to this.
[44:15] So Fatima, you mentioned women coming out of pregnancy, giving birth and going straight into perimenopause.
[44:21] Can you explain more about that?
[44:23] I think one of the questions is that women don't know whether they've, when are they experiencing perimenopause in between pregnancies, especially if you're having your baby's late 30s, early 40s.
[44:34] When does postpartum changes go straight into perimenopause?
[44:38] And I think it's just being aware that when you're pregnant, you have very high levels of hormones.
[44:43] You don't experience symptoms of perimenopause and menopause.
[44:46] but it's post-delivery, postpartum, the hormones decline.
[44:49] And so you can obviously experience postnatal blues, or we call them the baby blues or depression, but also it's not uncommon to go straight into perimenopause because we know that equality in quantity is going down.
[45:01] So I think a lot of women will find that they might experience changes in their mental health after the third or fourth baby in their 40s that they may have not experienced with their first and second baby.
[45:11] And does that get confused with postnatal depression?
[45:14] It does.
[45:15] So we normally say if you're in your 40s and having babies later, you need to be mindful that there is this kind of convergence of postnatal depression turning into perimenopause.
[45:27] And it's very confusing because when you're breastfeeding, you have high levels of prolactin, which suppresses your ovulation, means no ovulation.
[45:36] You don't get the same amount of estrogen and progesterone.
[45:38] So we know when you're breastfeeding, you have this kind of mild chemical menopause where you do get some night sweats and sleep disturbance.
[45:45] And so postnatal is really a hormone depression if you are experiencing that.
[45:49] But then where do you know whether it's the breastfeeding, it's the postpartum, or is it the perimenopause?
[45:56] And we also see, I mean, you may not need to add this, I see a lot of women have their third, fourth baby and then suddenly,
[46:02] they're going through marital conflict in a divorce and it's actually perimenopause and not postnatal depression.
[46:08] It's rough.
[46:09] Is there an element of like, especially if you're like, if you sort of identify as sort of like a striving person, like an ambitious person, is there an element of like embarrassment that you don't want to admit out loud that you're struggling with these sorts of things, like you don't want to come across as like you can't handle the workload or if you've always been able to handle it?
[46:31] Does that come in totally?
[46:32] Totally, yeah.
[46:33] That's the shame spiral of going, I used to be so competent.
[46:37] And now, as you say, nothing else has changed, but I'm not able to handle really minor things that wouldn't set me off previously.
[46:44] Yeah.
[46:46] Yes, so the shame is real.
[46:48] But I also think part of that we commonly see in high-functioning women and they start to feel, they use the word, I feel really stupid, is we're seeing this unmasking of ADHD in women in their 40s.
[47:01] A lot of the things I was thinking, there's also elements of ADHD in there as well, which could be, that must be so confusing.
[47:07] So what I see is, okay, you've got peri-symptoms, let's give you some HRT.
[47:12] And they still have ongoing symptoms.
[47:15] And it's because they're seeing this unmasking of ADHD, because despite giving them oestrogen,
[47:21] which regulates dopamine, the main neurotransmitter in ADHD, they still continue to have issues with executive functioning.
[47:28] So that's word recall, verbal memory, and trying to kind of orientate tasks, initiate tasks.
[47:36] And there's a whole ADHD score, which I'm not going to go through now.
[47:40] And so those are the women that need to go to a psychiatrist who's got a hormonal lens.
[47:44] So we work multidisciplinary.
[47:46] So they might find
[47:47] The ADHD medicine eventually helped with those anxiety and executive functioning and vice versa.
[47:54] So we see women who've got, are on stimulant medication from a young age because they were diagnosed with ADHD.
[48:01] Those medications aren't working anymore, especially in that luteal phase before their menstrual cycle.
[48:07] Suddenly they're just finding they can't find the words, they're losing train of thought.
[48:12] And so now they're having to double...
[48:15] their stimulant medication just before their menstrual cycle.
[48:18] And even when they're doing this yo-yo, it doesn't work.
[48:21] And so we add in a little bit of estrogen to stabilize it, and it works beautifully because you're getting this estrogen fluctuation.
[48:27] So it's kind of this beautiful intersection of...
[48:30] There's perimenopause, the hormonal buffering system changing, and we see ADHD and also neurodivergence.
[48:37] And so it's important to have a curious mind.
[48:41] And because everyone, I always say ADHD and perimenopause, they have overlapping symptoms and you don't know which is starting when and which is ending when.
[48:53] And it's about, again, listening to the women and trying to go to experienced people and titrating both of them because they converge at this stage to make it even easier for our brains.
[49:04] Well, Zoe, one of the things that we enjoy discussing is our good friend ADHD.
[49:10] Yeah, yeah.
[49:10] And so I'm new to the club and...
[49:16] I didn't know I had ADHD.
[49:18] There were hints.
[49:18] There were signs.
[49:19] But it really came out pretty hard.
[49:23] And feeling so scattered with the brain fog, with so many pressures on me, whether that's the school WhatsApp or the amount of things that I had to keep in my memory, the mental load every day, plus work, plus everything else.
[49:38] But also like in the last like, I don't want to say like five, six years, go to has been like, there's been like huge, like huge changes.
[49:47] And like, I know you've gone through like really stressful periods.
[49:51] And extremely mentally taxing.
[49:54] And I sort of laugh a little because if you look at things will calm down soon, that's a woman in perimenopause with ADHD writing a book.
[50:03] Who was undiagnosed and untreated for both.
[50:06] And it was a stressful book.
[50:07] It was anxious, inducing, and it was a lot.
[50:10] And it was a big project as well.
[50:12] This one, Group Chat, this is a medicated woman who's sleeping, having a great time, wrote a funny book, had the bandwidth and the capacity to have fun again.
[50:21] Yeah.
[50:21] And so for me personally, just the black and white of that is insane.
[50:24] But the ADHD, you know when you get it and you can spot it in everybody else?
[50:30] It's the same women who I'm spotting have perimenopause.
[50:33] And that overlap, as you talk about, is quite intense.
[50:35] But I found, you know, the stimulants are really helping with the pulling focus.
[50:41] And I was thinking the other day how I sat in a board meeting and I've done them for 14 years and never really paid attention.
[50:51] I think you sent me that message.
[50:52] It's been noticed.
[50:54] But I felt terrible.
[50:55] I felt this sadness and grief afterwards because I felt so disrespectful to my team for so many years who have been so good at preparing everything and...
[51:08] And making me so accommodated, honestly, is this like, oh, the founder's here and oh, I don't like numbers.
[51:15] And I just put it down to I don't like numbers.
[51:17] But it was disrespectful and I would interrupt and I'd have my phone here and my laptop here and I'd just go, oh, blah, blah, blah.
[51:22] Oh, what about, hey, we're doing sunscreen next year.
[51:24] Should we make a hat?
[51:25] Yeah.
[51:26] In the middle of the budget.
[51:27] And so the difference in that for me was quite a remarkable one.
[51:33] Wow.
[51:34] So I can testify.
[51:36] But that's a really interesting point because I think like particularly like with women who are diagnosed with ADHD, often they've got narratives that have lasted since childhood.
[51:46] And often that's like, you know, they've maybe been, they struggled at school and they were told that they were dumb or slow and that's sort of carried through.
[51:55] But that must be such a, I can't even imagine that feeling of going like, oh, actually I can do.
[52:00] now participate in these things that I thought that I couldn't or...
[52:04] It was a relief, right?
[52:06] And it was, I wouldn't classify myself as a kid as someone who couldn't really pay attention.
[52:11] I didn't have maybe the classic tropes of that.
[52:14] I instead was a super high functioning, overproductive woman who was writing books, running a business, having a family.
[52:21] And so outwardly, everyone's like, the question I get the most is, how do you do it all?
[52:28] My brain is going in 40 different directions at once.
[52:31] And it's not always great.
[52:33] But it's, you know, it's harnessed and it can be wonderful.
[52:37] I think that's a really important distinction to make because you were mentioning earlier about you couldn't focus.
[52:43] Actually, with the girls, it's the other way around.
[52:45] So the boys are hyperactive and they can't focus and they're told that they're poor students because they can't sit.
[52:50] Right.
[52:51] But women don't have a problem with hyperactivity, it's inattention.
[52:54] So they tend to be the perfectionists.
[52:56] It's the school captain.
[52:57] It's the one who is, you know, because they've learned to perform and they work extra hours and extra prepared because they know they compensate.
[53:06] They've got structures and lists and things in place to make sure that they're able to perform.
[53:12] So they've been performing until Perry hits and then that buffering goes.
[53:17] So it's actually the perfectionism process.
[53:19] is the trait you're looking for in adult ADHD girls.
[53:23] There'll be traits there in attention that they're trying to compensate.
[53:26] And that's why it's really important to know that they present differently because we have different hormones and you don't have estrogen and we do.
[53:31] Mm-hmm.
[53:33] Couldn't have said it better myself.
[53:34] Yeah, The Perfectionist, which I sort of wore as a badge of honour.
[53:37] Yeah.
[53:37] But it's really just fear.
[53:41] And so how's that changed now, like the fear?
[53:43] Oh, look, I'm still pretty new to it.
[53:47] It's only been this year.
[53:49] But I feel, yeah, I think the relief is the thing.
[53:52] Yeah.
[53:53] Relief and a bit of shame about how I maybe perform and the interrupting and the over-talking and all of those things.
[54:00] Really?
[54:00] So you look back and see the performance?
[54:04] Yeah Wow Yeah, yeah, yeah Oh yeah God Yeah And then you know Throw in a public profile And like The performance becomes Even more elevated Of course Then you have to show up As a certain Zoe Foster Blake Yeah Yeah Yeah
[54:20] I'm a real mongrel underneath.
[54:22] You know me in real life.
[54:23] Not that I'm saying, but I believe you.
[54:27] And then the third thing is we see a lot of reactivation of previous trauma.
[54:35] Yeah.
[54:36] So research has shown that women with previous trauma at any point in their life, they have high levels of PTSD scores and depressive scores.
[54:47] And so then those are the women who are taking the HRT, taking the stimulant, and they still have the symptoms of trauma, which is kind of hypervigilance, reactivity, feeling on edge, can't relax, feeling tense.
[55:00] And so then we need to look at trauma-informed care, have things like EMDR for the trauma processing, because what happens is when these hormones fluctuate, especially when you lose that lovely progesterone, the calming effect, brain kind of panics.
[55:15] It likes predictability.
[55:16] And now it's lost the calming effect.
[55:18] So it goes in your amygdala, your fight or flight.
[55:20] And then it thinks, when was the last time you felt under threat?
[55:25] And it will go to your previous history of any traumatic experience.
[55:28] It could be bullying in the playground.
[55:30] It could be workplace bullying.
[55:32] It could be domestic violence.
[55:33] I think trauma, we have a very narrow definition of trauma.
[55:37] And so even with HRT and stimulant, they don't get better.
[55:42] And the amount of women who do EMDR, they come to me.
[55:44] I get third, second opinions all the time.
[55:46] I'm on HRT.
[55:47] I'm on this.
[55:47] And I literally look at them and I say, okay.
[55:50] Like your bloods are perfectly fine.
[55:52] You're absorbing estrogen really well.
[55:54] But there's nothing that I can do for you.
[55:56] You need to have EMDR.
[55:58] We get them to see a trauma-informed therapist and they suddenly start sleeping.
[56:03] They're feeling amazing.
[56:04] They're feeling calmer.
[56:06] And I think it's important to have this trauma-informed care as well.
[56:09] And so this intersection of supporting woman's brain is,
[56:13] is fascinating.
[56:14] But I really want to emphasize the trauma activation, because if you are listening to this and you're still feeling that you're feeling anxious, you're not sleeping, you're feeling hypervigilant and irritable and not yourself, then you need to address the third layer.
[56:30] And a lot of that is this kind of
[56:33] No one wants to go there.
[56:34] It's that inner work, which I say the patch won't heal, which is addressing your unhealed wounds.
[56:39] I mean, dealing with the trauma, that's something that you can't really – I mean, EMDR is maybe the closest thing, but there's no pill for it.
[56:47] There's no like – you can't erase the memory or the – yeah.
[56:52] And it feels like such a – well, it is –
[56:55] um the more you talk about it it requires such a holistic approach like there's so many like it's a real fucker and it feels so overwhelming and i'm not a i'm not a woman but it feels so overwhelming but i like if if so so if when you first heard about all of this were you overwhelmed or was it more like oh it's a relief or is it a combo
[57:18] Yeah, combo always.
[57:20] To know that it had a name and it was not just in my head and then to be able to treat it.
[57:28] But it is pills and skills.
[57:29] You know, you have to work on your inside stuff.
[57:31] Pills and skills.
[57:33] You have to work on your stuff as well because a lot of it does come up at this time as well.
[57:39] And anything that's been masked at all, it just drops.
[57:44] It is, isn't it?
[57:46] That lack of dopamine and estrogen and you're just like, I can't do this anymore.
[57:50] I need help.
[57:52] And I think most women probably get to breaking point before they actually seek help.
[57:57] It just sucks.
[57:58] Yeah.
[57:59] Well, because they don't know what's going on, right?
[58:01] And so they will lose relationships.
[58:03] We know from superannuation data that women are retiring early.
[58:10] They're losing $150,000 of earnings a year.
[58:13] They're leaving with less money.
[58:15] Economically, we're losing money.
[58:16] So it's actually...
[58:18] A bigger problem.
[58:20] I go back.
[58:21] We keep talking about menopause and you just think, oh, yes, cessation of periods.
[58:24] It's not.
[58:25] It's a whole body transition.
[58:28] The brain is impacted.
[58:29] The hot flushes start in the brain.
[58:32] A thermostat is in the brain.
[58:34] And then you've got the physical symptoms, which, you know, is skin, heart, gut.
[58:39] We haven't even gone through it because we don't want to.
[58:41] And, you know, we lose 30% of collagen.
[58:44] A lot of women don't think that.
[58:46] A lot of women don't realize that their joint pain is related to this.
[58:48] They don't realize their gut symptoms are related to peri.
[58:51] They don't realize their...
[58:53] kind of vestibular neuritis and all these other ENT symptoms are related to that.
[58:57] But I think what we need to see is that for women, these hormones throughout their reproductive lifespan have supported every single organ.
[59:07] And we know at menopause when these hormones are declining,
[59:12] We know we are accelerating ageing on a cellular level.
[59:15] So if you're talking about longevity, there's a lot of bro signs in this.
[59:19] But for women, it's very simple.
[59:21] We know women in Australia live on average till 84.5 years of age.
[59:25] The main cause of death is Alzheimer's followed by heart disease.
[59:28] Main cause of disability is a fall and breaking your hip.
[59:31] Yeah.
[59:32] There's no cure or treatment for these.
[59:34] But before menopause, these illnesses do not exist because estrogen is cardioprotective, neuroprotective, protects your bones and every single organ.
[59:44] Within 10 years of menopause, we see accelerated aging on a cellular level and an increase in chronic disease.
[59:53] And we know that because cholesterol goes up, blood pressure goes up.
[59:56] So then you go to a doctor and now you're ending up with a blood pressure tablet, cholesterol tablet, anti-anxiety, sleeping pill, pain thing.
[1:00:03] So it's this polypharmacy thing.
[1:00:06] And we need to go back to the root cause.
[1:00:08] And when you give them the natural hormones back, suddenly all this laundry list of symptoms disappear.
[1:00:16] Of course, there's the other layers that you need to address too.
[1:00:18] The skills.
[1:00:19] The skills and skills.
[1:00:19] The skills and also if there's ADHD addressed that.
[1:00:22] But majority of women will find that when we address just the period, that's already a relief.
[1:00:27] Yeah.
[1:00:28] And we can titrate the anti-anxiety back.
[1:00:30] That's a huge part of it for a lot of women is what you're saying.
[1:00:32] Yeah.
[1:00:32] There's a huge part.
[1:00:34] I always emphasize the foundations, which we haven't really spoken about.
[1:00:37] I think whatever you do with or without HRT, you still need to prioritize whole nutrition because the amount of women who under eat, again, because they're trying to lose weight and they've been told reduce calorie.
[1:00:48] So eat less and exercise more.
[1:00:49] That's what your GP tells you as well, right?
[1:00:51] Oh, you just need to eat less and exercise more.
[1:00:54] And so then they're calorie restrict.
[1:00:56] And so they're...
[1:00:56] have a coffee at breakfast and nothing till lunchtime, then a toast tea.
[1:00:59] And so we know that blood sugar imbalance are very prominent, which causes, again, changes in your energy, cognition, and mood.
[1:01:08] So stabilize the blood sugar with whole food breakfast, a little bit of protein, fiber, and good fats.
[1:01:13] Make sure you're eating your three meals that can be quite small, prioritizing movement, but not doing cardio.
[1:01:19] We want to do more strength training, building muscle because it helps with insulin sensitivity and, again, blood sugar.
[1:01:25] Then we need to move to good sleep.
[1:01:26] And that's a problem because everyone scrolls till midnight because the algorithm is designed to do that.
[1:01:31] I scroll till 11.30.
[1:01:34] But it's fine because you're not going to go through peri, so you're fine.
[1:01:39] Probably not the time to be bragging.
[1:01:40] No.
[1:01:43] But, you know, you have testosterone as your advantage there.
[1:01:46] But there's this 3 a.m. waking, that woman wake up at 3 a.m. and bright awake and they can't switch off.
[1:01:53] And so the problem with the screen is that it will disrupt your blue, the blue light will disrupt your melatonin and raise your cortisol.
[1:02:01] But the other problem with scrolling is it is working on the same pathways of depleting the dopamine that's already depleted for ADHD.
[1:02:08] So you can see we're losing the hormones.
[1:02:10] We're then scrolling, losing that dopamine.
[1:02:12] And so you've got to be very strict, 9 o'clock phones away, no blue light 90 minutes before.
[1:02:16] And then you've got to... 90 minutes.
[1:02:18] 90 minutes before.
[1:02:19] They normally say 90 minutes before.
[1:02:21] Wow.
[1:02:21] I feel like I read something yesterday that said 30 minutes, but 90...
[1:02:24] It's normally 90 minutes.
[1:02:25] 90.
[1:02:26] Wow.
[1:02:27] I mean, just to think about circadian rhythm, evolutionary, we would wake up in the morning with sunrise, naturally, not with a haunting alarm jumping out, which already spikes our cortisol in the mornings.
[1:02:37] We would naturally wake up and then by sunset,
[1:02:42] we would not be doing anything because there was no artificial light.
[1:02:46] There was no light, yeah.
[1:02:47] So evolutionarily, every single organ and cell in our body has its internal body clock, including digestion.
[1:02:54] So if you eat too late, the stomach acid is reduced.
[1:02:58] This is why you get more reflux because we're not designed to eat late meals.
[1:03:02] The stomach hasn't evolved.
[1:03:03] So if you eat a late meal, not only you don't digest it, there's sitting there, stomach acids reduce.
[1:03:08] We need stomach acid to break the food down, to push it down.
[1:03:11] But also we then get a spike in our cortisol because the body's like, why are you eating so late?
[1:03:17] And so then we have blood sugar irregularity.
[1:03:20] So it's understanding that we've got to respect that circadian rhythm and the phones is not great or artificial light.
[1:03:26] Then we talk about stress.
[1:03:29] Now, stress is a perception.
[1:03:31] What stresses Zoe out might not stress me, but no human has ever carried the load of a modern woman.
[1:03:39] We've always lived in communal, tribal...
[1:03:41] It's here for them.
[1:03:42] Yeah, I've seen it.
[1:03:43] We all started that club at the same time.
[1:03:45] Even if men were hunter-gourning women joining them, kids were raised by grandparents, aunts, uncles with other kids in a village.
[1:03:51] Women were bringing food.
[1:03:52] Yeah.
[1:03:53] And now you've got this nuclear family of the pressure is how to expect someone to wake up in the morning, do three lunchboxes, get to work, come back at 6 p.m., prepare dinner, do the laundry, do the ironing and then prepare for the next day, get the book day uniform ready.
[1:04:09] So I talk about this loneliness epidemic that I'm seeing in women because it's.
[1:04:16] They don't even have time for themselves, let alone to even call a friend back because they're all exhausted to even talk to each other.
[1:04:23] And so now they're isolated.
[1:04:24] And the problem is in life, whenever we go through something alone, it becomes a suffering because in our brain we think, oh, my God, this is only happening to us.
[1:04:34] And because we've not had open conversations, because, again, it reflects like, am I the only one going through this?
[1:04:38] Maybe I don't want to talk about this because my friend's not talking about this.
[1:04:42] The problem with that is that then it kind of you continue to suffer a long time before you seek help.
[1:04:49] As far as when you go out and meet your friends and girlfriends and when you start talking about this, then, you know, actually, we're all the same.
[1:04:56] And there's kind of this sense of humor, but also a sense of relief to be like, oh, this is just normal.
[1:05:01] All my friends are experiencing the same mental load.
[1:05:04] And we know from studies, men and women who earn the same amount of money, do the same hours,
[1:05:09] Women will still carry the mental load and the invisible workload.
[1:05:16] And it's not that it's a man's fault.
[1:05:18] Men are wonderful.
[1:05:19] They're trying their best.
[1:05:21] I have to agree.
[1:05:23] I know.
[1:05:23] I'm married to one.
[1:05:24] Bless him.
[1:05:25] I have to remind myself he's trying his best.
[1:05:28] I don't have my village around me.
[1:05:31] But also maybe worth mentioning that some men aren't trying their best as well.
[1:05:35] That would be even harder.
[1:05:37] And so women aren't trying their best.
[1:05:39] I'm generally giving the benefit of the doubt.
[1:05:40] You're supposed to support me here.
[1:05:42] But you're right.
[1:05:43] I mean, men need to step up.
[1:05:44] I'm trying.
[1:05:44] I'm trying.
[1:05:45] I'm trying my best.
[1:05:48] I think the modern man is.
[1:05:50] I mean, my father's generation was like nothing.
[1:05:52] He came home.
[1:05:53] And I think that's where we're just going to go straight into my four layers that I talk in the book, which is whenever we talk about women's health, you need to understand what's happening in their body.
[1:06:03] Then you go out of their ovaries from the uterus to their brain and other organs.
[1:06:07] Then what is their life perspective?
[1:06:09] Who are in their lives?
[1:06:10] What is their workload?
[1:06:11] And then you're going to look at the systems around them.
[1:06:14] And so I talk about feminism, patriarchy, capitalism and consumerism because we're all trapped in this feminism dialogue.
[1:06:24] Feminism is great.
[1:06:25] OK, we're sitting here because feminism gave us the opportunity to have a voice, to vote, to own land, open a bank account, you know, and we're very grateful for that.
[1:06:33] But it also told us that we can do it all at the same time, have the careers, be the mother, be the wife, be the best mum.
[1:06:41] And...
[1:06:42] The problem with that is it didn't create the framework for women to go and thrive.
[1:06:47] And so the framework is a patriarchal framework designed for a man to turn up to work at 8.30, get home at 6, where the woman was looking after cleaning, cooking, cooking.
[1:06:59] taking care of all the invisible load, which I'm not going to list because every woman listening to this knows what it is.
[1:07:05] But what's happened is that now she's doing the same hours, but then she's still carrying the same amount of invisible load and mental load.
[1:07:13] And men are still doing the same work.
[1:07:15] They're trying their best to do the other things.
[1:07:17] So it's just working against them.
[1:07:20] So now women are stuck.
[1:07:21] So when I see women who have spent 20 years building their career,
[1:07:25] And they have to be in the office at 8.30 and finish at 6.
[1:07:28] What do they do?
[1:07:29] And capitalism is this system which tells you you're only worth if you're bringing in money.
[1:07:35] You need to be productive to be worth.
[1:07:38] So their self-esteem and their value of who they are is linked with what they're bringing in, how much they're earning.
[1:07:45] And so we've kind of devalued.
[1:07:48] Women choosing to maybe stay at home or doing flexible hours, all of those things, because there's guilt when they go part-time or stay at home.
[1:07:55] And then there's consumerism, which is, you know, particularly targeted at women, which is all around even when they feel like they have enough, there's always something else to buy.
[1:08:04] So then there's this pressure of earning and keeping the money going for obviously financial pressures, but also this constant buying and targeting of you're not good enough, you need another person,
[1:08:15] You know, the latest trendy jacket and the latest kind of hairspray and all those things.
[1:08:20] And I think it's important just to be aware that you could be taking the ADHD medication and taking the HRT and having your EMDR and you're still feeling really trapped because the system is not designed to cater for any human to carry this load.
[1:08:36] Yeah, I mean, I've never thought about it to that extent.
[1:08:40] Like if you're a lawyer, you're an engineer.
[1:08:42] I mean, when I'm seeing these patients, like, well, she's a barrister.
[1:08:44] What am I going to tell her to go part-time?
[1:08:46] She's self-employed.
[1:08:47] And also realise that we know 40% of relationships break down.
[1:08:50] So I see a lot of single women who don't have the opportunity of going part-time.
[1:08:56] So here they are working these five days.
[1:08:58] Then from that money, they're paying for the childcare and the nanny.
[1:09:02] And so these are the structures that we need to question.
[1:09:05] Now, there are lots of places that are flexible.
[1:09:09] But as a larger society, majority of them are not going to have that flexibility.
[1:09:15] Of course, we're going to move that way.
[1:09:16] And I think it's really important to move that way because Australia has a shortage of skilled workers.
[1:09:22] And we need to capitalise on 50% of our demographic who are female.
[1:09:27] But then you need to address these issues, right?
[1:09:30] Offering them flexible working, making sure you have benefits.
[1:09:33] menopause workplace policy and because we want to have workforce retention it's great for the economy and it's great for women you know we know that when women are working they have better self-esteem working for what they want to work it's a different thing for working just to survive I think it's important to know I think work brings women a lot of joy and it's going back to that same thing what is it that you want to do with your life um
[1:09:58] I'm going to stop talking there because I feel like I've rattled a lot of things.
[1:10:01] No, no, no.
[1:10:02] It's been amazing.
[1:10:02] It's changed a lot of people's lives probably.
[1:10:04] Yes.
[1:10:04] It's so incredible.
[1:10:05] But I want to ask about, so I remember when Penny first showed me the pregnancy stick to say that we were having our first child.
[1:10:12] I remember in that moment there was a very obvious physical thing in front of me that like, okay, I really need to look after her here.
[1:10:21] I need to help her through this.
[1:10:22] And I think all men would know that experience when their partner's pregnant, you drop everything and everything's about them.
[1:10:29] and you're protecting them and looking after them, what can I do for you?
[1:10:31] How are you feeling?
[1:10:32] What are you going through right now?
[1:10:34] How can I support you?
[1:10:36] That's an obvious one, but I feel like this is a time where they probably need it more, that kind of attention and support and support
[1:10:46] proactively thinking about how can I make your life better with all you're going through.
[1:10:50] And compassion, just general.
[1:10:52] Compassion.
[1:10:53] And also to go back to the first big hormonal beat, which is tweens and puberty, which I'm heading into soon, and how mindfully...
[1:11:03] certainly I think our generation are parenting that moment and how aware we are of it and how scared to be honest of like what's coming in, how we have to learn how to counter the big emotional moments and everything.
[1:11:15] So I, I totally agree.
[1:11:17] Those other big hormonal moments get so much attention and so much care and compassion.
[1:11:23] And this one is just like,
[1:11:25] Fucking sort it out.
[1:11:26] Yeah.
[1:11:26] And so I just wonder, do you have anecdotally any stories of partners or men who have just done really good things in this?
[1:11:37] Like what should I happen?
[1:11:39] Can I tell you what we all do?
[1:11:40] All the women I know, we send memes to our husbands all the time so that we don't sound insane.
[1:11:45] So we're sending memes about like perimenopausal things that we do in a funny way.
[1:11:50] to go, but for real, this is why I do this.
[1:11:52] Like, you know, the oven fan noise?
[1:11:54] That's why I crack it when that's on.
[1:11:55] Or, you know, various things.
[1:11:57] And so the man sees it and he goes, oh, that's so funny.
[1:11:59] That's so true.
[1:12:00] But then it's probably just like, I can't wait for the next meme.
[1:12:02] But like, what should men be doing anecdotally?
[1:12:07] You've already been saying that that's been a good example of how to just support.
[1:12:12] And then maybe in conjunction with that question,
[1:12:18] So, Zoe, if years ago before you were across perimenopause, if Haim had heard a podcast explaining this and he noticed all the symptoms, if he had approached you and said, hey, Zoe, I think it could be, have you thought about perimenopause?
[1:12:34] How would that land?
[1:12:36] Yeah, it's like when you say, you premenstrual, babe.
[1:12:38] It doesn't go well, does it?
[1:12:40] Don't ever say that.
[1:12:41] Don't ever say calm down either.
[1:12:43] I think it's all about the moment and the tact, right?
[1:12:46] Because if you've got a woman who's crying and is – like I was at points where I was just, you know, texting him in the middle of the night going, I cannot sleep.
[1:12:56] You know, I'm awake.
[1:12:57] I'm so anxious about this, this, this.
[1:12:59] I don't know.
[1:12:59] I just sort of venting.
[1:13:00] And he would just have to be the crumple zone for that.
[1:13:03] Yeah.
[1:13:03] I think if he knew what was going on, it would be super helpful.
[1:13:06] And then there would be those moments of deep vulnerability where a partner could come in and say, honey, just as a well-meaning friend could do and say, don't take this the wrong way, but this could be perimenopause.
[1:13:17] Should we get you an appointment?
[1:13:18] I think that would be well received.
[1:13:20] Yeah.
[1:13:20] Okay.
[1:13:20] Great.
[1:13:21] Because I think that's compassion and care and depending on the woman's state of mind and mood, but I think it's obviously a show of care.
[1:13:29] So we know at puberty, you can have horrible mood swings.
[1:13:33] And even with pregnancy and postpartum, we have the same kind of understanding and compassion, not just for emotional volatility, but also body changes.
[1:13:44] And I typically tell my women in their 40s, I want you to have the same compassion
[1:13:49] as you go through pregnancy.
[1:13:50] In pregnancy, you're getting a belly, you're getting bigger, your moods are changing.
[1:13:55] You're not going around saying, oh, look at this, I have an ugly belly.
[1:13:58] Because you should hear the derogatory things women say to themselves about their body, about the way they look in the mirror, because they don't know what's going on, right?
[1:14:06] So suddenly...
[1:14:08] They're getting sagged skin.
[1:14:09] They're changing their body shape.
[1:14:11] And also I'll say you need to educate that this is the biological transition, have the same understanding and compassion.
[1:14:17] You need to show it to yourself first before someone else can show it.
[1:14:20] But I think going back to Zoe, I think most men don't know what perimenopause is, but they will after this podcast.
[1:14:27] Because I think any man who goes to their partner and says, I think you're in perimenopause, actually will be well-received and quite relieved.
[1:14:36] Yeah.
[1:14:36] And it's not that you're just being moody before your period.
[1:14:39] So if you are going to say something, and I always say perimenopause is just worsening PMS.
[1:14:44] So if you're noticing someone's getting that, because normally as the woman, even with the best self-awareness, they're so busy.
[1:14:52] And as Zoe was mentioning earlier, we're so good at gaslighting ourselves that we will complain about, oh, I haven't eaten today.
[1:14:59] And I think I'm just a bit stressed.
[1:15:00] And I think the kids are annoying me.
[1:15:01] And you're just being annoying.
[1:15:02] And we don't really connect the dots ourselves.
[1:15:05] And sometimes you being as an observer of someone who's been in your life for 5, 10, 20 years is like, I know, Zoe.
[1:15:13] This is not Zoe, you know.
[1:15:14] Mm-hmm.
[1:15:15] Rather than being, so he's being a horrible bitch.
[1:15:17] That didn't go down well when I said that.
[1:15:19] I did not like that.
[1:15:22] And being more inquisitive.
[1:15:24] I get a lot of men, as I said, making an appointment.
[1:15:27] They bring their partners in.
[1:15:29] Or the women will come and say, oh, my husband Googled you and found you and made this appointment.
[1:15:34] And she's like, oh, I've just been feeling all of these things.
[1:15:36] And I went to my GP and the bloods were normal.
[1:15:38] And they showed me the blood test.
[1:15:40] I'm like, yeah, you're in Perry.
[1:15:42] And they start crying.
[1:15:43] They start crying.
[1:15:45] Because for the first time, they feel seen, heard, because they genuinely are crying every day thinking they've got dementia.
[1:15:53] They were high-functioning until that moment.
[1:15:55] They've succeeded and they've gone to a doctor and they said, there's nothing wrong with you, stress less.
[1:16:00] Or they've been told, get an antidepressant.
[1:16:02] They're like, but I'm not depressed.
[1:16:03] Like, I mean, I'm not depressed.
[1:16:06] We have an epidemic of that.
[1:16:07] And the problem with that is we're giving women these medication at the very time when they're already having issues with intimacy and changes in their body shape with weight gain.
[1:16:18] Antidepressants and anti-anxiety medications will cause weight gain.
[1:16:22] they will cause sexual dysfunction.
[1:16:25] They reduce your libido, decrease your arousal, and then they're an independent risk factor for reducing your bone density, which we know women are predisposed to at losing between perimenopause and menopause and increased risk of osteopathic hip fractures.
[1:16:39] And there's lots of psychiatrists who...
[1:16:43] are struggling to get people off because when they're on there, you can't taper off them because the brain neurochemistry is so dependent on them.
[1:16:49] So antidepressants, anti-anxiety, great.
[1:16:53] Treat them for that period.
[1:16:56] But being on them for a decade long, I mean, we're kind of pathologizing life and not giving people and human... Because the other thing it does is numbs you from feeling anything.
[1:17:06] A lot of women say, I want to feel something.
[1:17:08] I want to feel that connection.
[1:17:10] So it takes away the highs and the lows, doesn't it, a little bit?
[1:17:13] Yeah.
[1:17:13] I mean, listen, if you're someone who's, again, got trauma and other things and your volatility is so much, it's a relief.
[1:17:18] You can breathe because you're not feeling everything because you don't want to feel everything.
[1:17:22] Trust me.
[1:17:22] It's exhausting feeling too much.
[1:17:24] And if you've got ADHD and that, that over feeling of everything is too much.
[1:17:28] And I think that's where I talk a lot in the book around nervous system support because we're in this heightened sympathetic nervous system of overdrive where our...
[1:17:38] Parasympathetic, which is our rest or repair, it's a complete imbalance.
[1:17:41] They're out of sync where we can breathe, we can relax, we're feeling calmer.
[1:17:46] We have space to respond rather than react.
[1:17:49] And so we need to be proactive in doing things like breath work.
[1:17:53] It might be sound bath for you.
[1:17:54] It might be doing meditation for you.
[1:17:56] It might be doing journaling for you.
[1:17:58] Maybe sitting 60 minutes without any noise because that's sensory overload.
[1:18:02] Mm-hmm.
[1:18:03] You've now had all the treatments and they're still feeling all the symptoms because they haven't really addressed everything else.
[1:18:10] I mean, going back to evolutionary days or times, we would be spending our time in nature.
[1:18:18] And so you have beautiful sun, air, you've got plants.
[1:18:23] We know when you're on greenery, you reduce your cortisol by 40%.
[1:18:27] And you're not under threat.
[1:18:28] You're in rest and repair, which is really important to reduce our heart rate, our blood pressure.
[1:18:33] We kind of open our bowels more frequently.
[1:18:36] And we're more responsive to love and attention and connection.
[1:18:40] And, you know, maybe there's a tiger coming along and you'll go into your fight or flight, which is your kind of survival instinct.
[1:18:47] But the problem now is our nervous system is overstimulated because we wake up in the morning with this kind of loud alarm.
[1:18:54] We jump out and then we're going to then grab our phone.
[1:18:58] Then we're going to scroll.
[1:18:59] It's overstimulation.
[1:19:01] The nervous system was never designed to be constantly...
[1:19:04] scanning for threat.
[1:19:05] And then you get in the car, then there's that stress driving down Punt Road, getting the kids to school.
[1:19:11] Then you get to your work at nine.
[1:19:12] And they know that from studies, women have made about 12 plus decisions.
[1:19:16] They've got decision fatigue by nine o'clock and a man has only made one decision, right?
[1:19:21] So...
[1:19:22] I think the mental load is part of why the nervous system is being overstimulated, but our environment is then ping, ping, ping.
[1:19:30] We're overconnected.
[1:19:31] The nervous system is not designed for this.
[1:19:33] Checking emails every five minutes, checking the news, and guess what?
[1:19:35] The news is all about clickbaits.
[1:19:37] It's all about fear-mongering.
[1:19:39] So this poor sympathetic nervous system, the amygdala, is exhausted from constantly scanning, and it's supposed to recalibrate back to your parasympathetic nervous system.
[1:19:49] So you're kind of just like, yeah, I'm calm, I'm safe.
[1:19:51] Yeah.
[1:19:52] But when you're overstimulating it from your environment, it stays in the amygdala because it deems that you're unsafe now.
[1:19:59] So it's constantly scanning.
[1:20:01] And so that irritability, agitation, and it's not a normal rage.
[1:20:05] I call it a volcanic rage because rage is just being angry.
[1:20:08] Volcanic rage is this eruption, uncontrolled rage where...
[1:20:12] you're like yelling and you can hear yourself yelling, but you want to stop, but you can't stop.
[1:20:18] And you know you're being unreasonable and you know you're being horrible and mean and you love this person.
[1:20:23] So there's this internal turmoil of trying to stop, but it's a volcanic eruption and you can't stop.
[1:20:29] That's a very vulnerable, frustrating place to be.
[1:20:32] And women will basically experience, you know, intrusive thoughts on, I don't think I want to live anymore.
[1:20:38] I don't, if this is how I'm going to live life,
[1:20:41] It's not worth living.
[1:20:43] And obviously some women go all the way through to having more intrusive thoughts.
[1:20:46] And if you're listening to this, it's important because we know that women between this demographic and perimenopause and even going up to menopause do experience higher rates of suicide.
[1:20:57] Yeah.
[1:20:58] And the amount of women, and I document this, they literally will say, oh, I just don't think it's worth living anymore.
[1:21:03] Or they'll be crossing over the Westgate Bridge and saying, I thought of driving my car off.
[1:21:09] And I have to just make sure that that was no intention.
[1:21:12] It was just a thought and it kind of went away.
[1:21:15] And these things are happening, but they're scared to share it because they don't want to be sectioned and they don't want their kids taken away.
[1:21:24] They don't want their husband thinking something's wrong.
[1:21:26] And of course, those are the conditions where you do want something like you need a formal mental health psychiatric assessment.
[1:21:33] And I think if you're listening to this as a partner and you're seeing these changes, rather than thinking she's going mad and I don't want to be with her anymore, it's just knowing any woman between 37 and 43 onwards can experience perimenopause, which starts in the brain.
[1:21:48] It's literally as simple as that.
[1:21:49] It's a biological transition where you're losing the hormones with fluctuating estrogen, which buffer your thoughts and your cognition.
[1:21:59] And when you're in that state of hypervigilance,
[1:22:02] We can't feel anything.
[1:22:05] You kind of numb out.
[1:22:06] You can't feel love.
[1:22:07] You don't want to be touched.
[1:22:09] It's like you're agitated and you're irritable.
[1:22:11] And so the partner's trying to hug you and support you.
[1:22:15] And then we're pushing them away.
[1:22:16] We push the loved ones and where they mean to put that.
[1:22:19] So it's a very confusing time.
[1:22:21] I imagine from the partner's point of view, if it's a man, traditionally, as we all know, men like an answer to things.
[1:22:33] We immediately want to fix things.
[1:22:35] And I suspect that would be quite a – not necessarily a relief, but it's almost like that's kind of in some ways good news for the man that it's like, oh, okay –
[1:22:45] This is something in the same way that it might be good news for a woman to hear that about themselves.
[1:22:51] That it's like this is a thing that all women go through in one way or another.
[1:22:56] And so for the man to be like, okay, good.
[1:22:59] It's treatable.
[1:23:01] We can make steps to help you.
[1:23:03] Yeah.
[1:23:04] I think the issue is there's still a stigma around it because if someone's going to PBT, we accept that there's compassion.
[1:23:11] They go through pregnancy and postpartum.
[1:23:13] We've got frameworks, multidisciplinary frameworks by governments to support women.
[1:23:20] The problem with PERI is that there is no support.
[1:23:23] So it's a very fragmented care process.
[1:23:25] So women are now having to Google, find their own people, go to group chat and find from their friends who they go.
[1:23:32] And then I've got this fragmented care of seeing a psychiatrist, seeing a psychologist, and so...
[1:23:37] I think we need to have more robust frameworks and guidelines and then have government funded hubs because not everyone can access private care.
[1:23:48] This is expensive.
[1:23:49] So expensive.
[1:23:50] Yeah.
[1:23:50] And part of the Australian Senate inquiry in 2024 had recommendation for Medicare subsidised menopause hubs.
[1:23:59] And so we know that the New South Wales government has been given $40 million to have four menopause hubs set up.
[1:24:08] And it's multidisciplinary.
[1:24:10] So you've got endocrinologists, cardiologists, and gynecologists.
[1:24:13] And also as part of this recommendation, now we have
[1:24:16] PBS subsidised HRT.
[1:24:19] It's important to know that's there, but it's very limited, they have very long waiting times, and no one's got six to nine months to wait while they have to show up in life.
[1:24:29] And so, number one, we need guidelines, which are then...
[1:24:34] making sure that every woman is being given the same treatment.
[1:24:38] And then there's no kind of inequity of healthcare distribution because just because you live in a certain postcode or have money, that's not how we want a healthcare system to be represented, right?
[1:24:49] So menopause is a universal experience.
[1:24:52] And I think as a government, we are doing better.
[1:24:55] We've done some great things since the Senate inquiries, but there's lots of room that we need to, or room for improvement.
[1:25:02] For sure.
[1:25:03] So I just, I can't help but does, the first thing I'm thinking when you say that is that, so last week I had quite a nasty case of the sniffles.
[1:25:12] You all right?
[1:25:13] Yeah, and I went down pretty bad.
[1:25:14] And I really, I really struggle for a bit.
[1:25:16] We should do an episode on the sniffles.
[1:25:19] But it just makes me think, can you imagine if menopause, apparently menopause happened to men?
[1:25:24] Society would just stop.
[1:25:26] Jam and I were talking about this the other day.
[1:25:28] It's like if men experienced, we would be taking ourselves to emergency every month.
[1:25:32] I'm bleeding again.
[1:25:35] Yeah, this is horrific.
[1:25:36] Well, you wouldn't take yourself to emergency because there would be frameworks and guidelines on it.
[1:25:43] Like there are for heart disease.
[1:25:45] And I think...
[1:25:48] I think it's fair to say, important to say someone who's listening to this, I don't want them feeling angry at the system around them.
[1:25:55] But to be fair, most guidelines are based on a middle aged white man.
[1:26:04] in the US, things like heart disease, lung disease, diabetes management, and we just basically apply them onto women.
[1:26:14] They're not studied in women.
[1:26:16] So even the bigger diseases, forget women's health, the bigger diseases, we know that when we give beta blockers for heart disease prevention to men, it prevents further cardiac events, and when we give it to women, it has worse outcomes.
[1:26:31] So we've got to start looking at women as not just small men, but also they have their own unique biology.
[1:26:39] But I think going back to you, you would never go to emergency because you would never suffer because we would have researched it.
[1:26:46] There would be a guideline.
[1:26:48] And so the issue is the reason why they're suffering because it's not studied.
[1:26:53] And we have to find the information ourselves.
[1:26:56] And then advocate for ourselves.
[1:26:57] And it's more work.
[1:26:58] It's exhausting.
[1:26:59] It's expensive.
[1:27:00] It's expensive.
[1:27:01] Yeah, it's time consuming.
[1:27:02] So, yes.
[1:27:03] So we won't go into a bit more of the... Well, I had plenty of support for my sniffles, so I was okay.
[1:27:08] Thank God.
[1:27:10] Thank you so much.
[1:27:11] This has been an incredibly important... Oh, sorry, did you...
[1:27:15] No, no, no.
[1:27:15] She was like, I'm just going to finish talking now because I think you talked about everything.
[1:27:19] No, you've done an amazing job.
[1:27:20] Oh, incredible.
[1:27:21] You really have done an amazing job today because I just feel like for, I think for two things, for women to feel less alone in this and to have a better understanding of what's happening for those who don't know yet, for those who are going through it right now, for those who have been through it, to hear this.
[1:27:37] But I think also for men to have a greater understanding of what's happening to the women that they love in their life.
[1:27:42] I think this is...
[1:27:44] so incredibly important and I feel so lucky to have been sitting here with both of you today.
[1:27:48] Thank you, Zoe, as well, for sharing your experience of it.
[1:27:52] Just to the men, don't take it personally would be my advice.
[1:27:56] It's not about you.
[1:27:57] Yeah, for once.
[1:27:59] For once.
[1:28:01] But, yeah, it's been wonderful to share this time with both of you, so thank you so much.
[1:28:05] Pleasure.
[1:28:05] Thanks for having us.
[1:28:06] Yeah, pleasure.
[1:28:07] Thanks, guys.
[1:28:08] Wow.
[1:28:11] Stick around after this to hear a little more.
[1:28:15] All right.
[1:28:15] Well, we've got Bella here again.
[1:28:16] And Bella, you're going to talk to us about what question we have in our journaling club this week.
[1:28:21] But actually, what is the journaling club?
[1:28:23] I don't think we've really ever talked about it like that before.
[1:28:25] Yes.
[1:28:25] So our journaling club is for everyone who has signed up to Mind Perfect email, the newsletter, and you can do that either via the website or via a link in the show notes of this episode.
[1:28:36] Awesome.
[1:28:37] And every week we send out a reflective question based on this week's episode.
[1:28:42] And what's that question?
[1:28:42] What have we got for the week?
[1:28:43] This week, it is, how has your relationship changed with your body?
[1:28:48] Oh, that's good.
[1:28:49] I mean, I feel tempted to go dark because there's many things I don't like about my body.
[1:28:53] But I also think as I get older, I'm starting to appreciate things and trying to have a better relationship.
[1:28:58] So I reckon it's a good challenge to try and, if you can, answer that question positively.
[1:29:03] And if you'd like to submit your reflections, we would love to read them.
[1:29:06] It's a great newsletter just because I don't want Bella feels weird plugging her own newsletter, but it's not just a journaling club.
[1:29:13] There's also helpful tips from the episode, which will be amazing given how helpful this episode we just had on was.
[1:29:19] And if you join the email, maybe you could join some of the people that you, like you were telling me before that there are people who have journaled every single week and have submitted their entries every week.
[1:29:28] So it's a pretty exciting space to be.
[1:29:30] Yeah.
[1:29:31] If you're listening to this on the Monday that the episode comes out and you'd like this question in your inbox tomorrow, sign up by the website or the link in the show notes.
[1:29:44] This show was made in the lands of the Wurundjeri Wurrung people, and we pay our respects to elders past and present.
[1:29:51] The Imperfects is not a licensed mental health service and is not a substitute for professional mental health advice, treatment or assessment.
[1:29:58] The advice given in this episode is general in nature, but if you're struggling, please see a healthcare professional or call Lifeline on 13 11 14.

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