Perimenopause: WTF is happening to our bodies
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I'd be woken up, you know, five, ten times during a night and you'd have to throw everything off, try to cool yourself down. I think one of the most confusing things about perimenopause and I guess figuring out that you're in it...

is that it really hits during that calamity sweet spot of life. One minute a woman's got sore breasts, bloating, bleeding, and then a few days later she's got hot flushes, night sweats, irritability, anxiety. It's like 45. My body's just decided it wants to be a circle. Ah, yeah, it's not what I was expecting. I just wish that you knew what was coming up. MUSIC

I'm gonna get a hot flash, sore boobs Gonna wipe the sweat off my face and my moustache I'm gonna bleed through my undies in That's the feeling of my vagina drying up Vagina drying up It's perimenopause Oh hi there, welcome! I've been working on this song for a while now What do you think? Do you like it? It's for a new band I'm starting called Ovarian Retirement

Now I wanted to rock out because if you're a person with ovaries, at some point if you live long enough, you will go through perimenopause. The period when your ovaries start to run out of eggs and your hormone levels bounce all over the shop.

For some women, this means a suite of symptoms from irritability and night sweats to brain fog and heavy bleeding. And look, that's just the obvious stuff. It's a huge transition that the body goes through. But for a long time, we didn't talk about the chain.

and women suffered in silence. We made an episode on perimenopause and mental health last season. Go back in the feed and have a listen if you haven't already. But we had a huge response to that episode and it made us realise that there is a huge appetite for information that is straight up and evidence-based. We are not trying to sell you stuff or maybe tickets to our show and some band T-shirts.

There's no celebrities, no supplements, there's absolutely no woo-woo. So here it is, the Perimenopause World Tour! Yeah! We're going to be playing four shows to figure out what the hell is going on when it comes to our sex lives, our changing brains, and what it's like to be a young woman in her prime going through perimenopause. Perimenopause.

But first, for opening night, what in God's name is going on with our bodies during this transition? Haywire periods, sheets covered in sweat, aching joints, trouble sleeping, sore boobs. Ugh! And what can we try to do to feel like ourselves again? I'm Yumi Steins and, ladies, we need to talk out and rock out about our bodies in perimenopause. MUSIC

It really feels like a journey into the unknown world of perimenopause. My mum never talked about this. As mentioned, our band is Ovarian Retirement. What's up, Australia? Let me introduce you to Siobhan on lead guitar. She's now 45 and started noticing changes to her body in her early 40s. There was a cocktail of things going on that plucked the strings of Siobhan's perimenopause Stratocaster.

weight gain and like weight gain that just won't budge all around dryness. Like my hair is now this wiry witchy texture. My skin is drier and the all time at menopause or cliche hot flushes. It was hot flushes and just overall being so freaking hot at nighttime that kind of made me join the dots that I'm on my way to menopause, man.

Hot flushes and night sweats are songs played on high rotation when people tune in to perimenopause radio. They're like the Hotel California of ageing. But when we asked you to share your peri stories with us, so many of you mentioned raging changes to your body temperature because guess what? They are the most reported symptoms. For Siobhan, her night sweats would fluctuate, keeping her guessing.

One minute you're hot as hell wishing your bed was in an igloo, then they dissipate and you wake up reaching for the covers again only to wake up later all sweaty. It's such a vicious cycle of hell. My poor husband would wake up freezing and I'd be like, don't even think about turning off the aircon.

Siobhan's just starting to figure out what's going on with her perimenopause and how to manage her symptoms. She's going to update us on her progress throughout the series. We'll come back to her in a little while, but I want you to meet the next member of the band on percussion. Please welcome Jo. Jo wrote in to Ladies We Need To Talk with an email that had a lot of exclamation marks, and rightly so.

Jo's 57 and she's had obnoxiously heavy periods for the last decade. You can be waking up to a crime scene some mornings or, you know, scrubbing your undies, scrubbing your clothes, wearing liners to make sure I don't have the accidents in between if I don't get to things in time. Along with the full-on flow, Jo also has sizeable blood clots.

You think it's going to be enough to feed the cat? Oh, Jo! I know, grotesque, I know. But it's one of those things where you go, oh, dear God, how is this happening still? But, yeah, I'm hoping it's going to ease off. How big is that? Is that like a walnut or bigger? They have been walnut-sized. They have been smaller. They've been slightly larger, I hate to say, but usually smaller. Right, okay. Okay, so more like a blood plum. Yeah.

Literally a blood plump. Quite literally. Jo's issues didn't end with fruit salad. At around the same time as her periods got heavier, surprise, surprise, like Siobhan, Jo also started having night sweats. It started with just, oh gosh, I'm hot and I stick my feet out of the covers. That's how it started. And I had no idea that night sweats were actually a symptom or a sign of perimenopause.

For someone who hasn't experienced it, Jo, what does it feel like to have night sweats? You know, you would have sweat over your face, sweat under your armpits, sweat on, you know, in all the crevices and cracks. And just wait until that whole feeling of being so overheated would wind down. Now, that can take five, ten minutes for that to happen. And then, of course, by that stage, you're wide awake and it's getting yourself back to sleep again. So you repeat that.

time and time again during the night and then do that week after week, day after day, month after month, year after year, it is quite debilitating. Jo also suffered from aching joints and brain fog. I was just not feeling myself and that's what a lot of women say, they just don't feel like themselves anymore. In that period we call the perimenopause, the ovaries basically stutter. They stop start and so the hormone levels are jumping around all over the place.

Ladies, no rock band is complete without a manager. A kick-ass one, preferably. When it comes to perimenopause, Professor Sue Davis knows what's going on. Sue is an endocrinologist and head of the Women's Health Research Program at Monash University. She understands what's going on with our hormones better than just about anyone. Now, you might think that perimenopause is all about low or declining hormones, but that's just not right.

What's happening in the perimenopause? One minute, a woman's got sore breasts, bloating, bleeding. These are all symptoms of a lot of hormones. And then a few days later, she's got hot flushes, night sweats, irritability, anxiety, and they're all symptoms of low estrogen. So if we were to draw blood and measure hormone levels in the perimenopausal women...

One minute, they could look like a premenopausal woman. The next minute, they could look like a postmenopausal woman. And in between, they can look like anything. So it's just hormonal chaos. Chaos. Is there any way to test whether someone is in perimenopause? So the easiest situation is when a woman's been having regular menstrual cycles for

And then they start to vary in duration by a week or more. So they get closer together or further apart. That's classic of perimenopause with or without symptoms of hot flushes, sweats, etc.,

The problem comes if a woman is not regularly menstruating when she enters perimenopause. So if a woman's had a hysterectomy, has a hormonal IUD, or for some reason enters perimenopause already having irregular cycles, then the diagnosis is much more difficult. Okay, quick band huddle. Perimenopause is a bit of a bitch. She'll keep you guessing. She's hot and cold. But there are some signs that she's hanging around.

Yay.

And if you're wondering why we haven't talked about vaginal dryness and issues around sex, yes, this will hit a lot of us. And we'll have a lot more about how perimenopause affects sex in an upcoming episode. Yes, I'm teasing forward. I asked Dr. Su how many of us go through this natural, feminine, divine hellscape of perimenopausal symptoms.

So our Australian data, so we looked at over 2,000 women and we found that 78% of women will experience some symptoms, but about 30% of women experience moderate to severe symptoms. 30%? Around one in three women. Yeah.

One in three. So if that's not you, it's plenty of people you know. I wanted to understand what's going on with Jo's blood plums. So I asked Dr. Sue, what's happening for women with heavy periods during this phase? When the ovaries are not working so well as you enter perimenopause,

then the brain produces more and more of this hormone called FSH. And you can get overstimulation of the ovaries where the ovaries briefly produce masses of estrogen. The lining of the uterus thickens up, but ovulation doesn't occur. And then you get the massive bleeding from a thickened lining of the uterus. Let's talk about those night sweats.

It's such a stereotype, you know, the sweating menopausal woman. Can you please explain what is happening physiologically? So there's, in the central part of the brain, the hypothalamus, there's a group of neurons. We call them kindy neurons. I think of kindergarten. And these kindy neurons are important for switching on puberty, but they're also important in

in terms of the reproductive cycle once puberty is switched on. And when estrogen levels drop, these kindy neurons start to effectively misbehave and they discharge chemicals onto the center of the brain that controls our thermostat. And they start misfiring and triggering inappropriate sweating or flushing.

even when it's not actually hot in the room. Right, so that's why people in Perry can get so sweaty. Their thermostat's cooked. These raging night sweats are also why a lot of women, like Jo and Siobhan, wake up in the middle of the night and then find it hard to get back to sleep. The chemical surge in the brain that leads to a hot flush also gives out an adrenaline rush, putting the body on high alert.

Speaking of Siobhan, after a few years of struggling with symptoms and not knowing really what was going on, she started to think,

maybe I'm in perimenopause and booked an appointment with her GP to chat about options. I explained all my symptoms and said I'd been doing a bit of research and I'd like to start HRT. And he looked so shocked. Like I just asked him to give me a shot of cyanide or something. Like he literally ignored a majority of my symptoms and

and just lent into the mentioning of anxiety and not feeling myself and suggested I try antidepressants instead. And I just couldn't believe it. It is worth mentioning that my doctor is a man in his late 50s. No judgment. Yeah, a bit of judgment.

Siobhan pushed back against her GP and insisted that she wanted to try hormone therapy. He wanted me to go and have a round of bloods done and another mammogram before even discussing it further. Siobhan went away and did the tests her doctor ordered. I've jumped through all his hoops. I've done all his requests. And in just over an hour is my follow-up appointment. So...

Hopefully, I'm going to get a prescription for HRT to start today. So wish me luck. Just quickly, what Siobhan calls HRT is these days now called menopausal hormone therapy or MHT. We'll check back in with her soon and see where she's at.

Siobhan's experience with her GP is not unique. So many of you have told us about going to your doctor to talk about peri-symptoms and being brushed off or worse, ignored. So MHT or HRT as it used to be known, suffered some reputational damage after a study was published linking the treatment to high rates of breast cancer.

That link has since been debunked. But there is still some lingering resistance by some doctors to prescribe MHT to their patients. Professor Davis says as well as the hangover from this study, there's also a lack of knowledge about perimenopause.

A lot of doctors still feel unprepared and underskilled in prescribing hormone therapy and even uncertain sometimes at making a diagnosis and uncertain who to prescribe for.

Psst, did you know that there's a guide that you can download and bring to your GP? It was developed by experts, including Professor Davis that we're talking to in this episode, at Monash University to help doctors know how to help women in this stage of life. It's called the Practitioner Toolkit for Managing Menopause. Print it out, put it in a binder, stick it to your wall. Do what you've got to do to get your doctor to listen to you.

Despite the issues around getting an MHT prescription, it is the gold standard in care for a lot of perimenopausal women. So the best treatment is indeed hormone replacement therapy and the primary effect is from the estrogen therapy. Anyone who still has a uterus has to take a progesterone

to protect the lining of the uterus from thickening up with estrogen by itself. And then if it thickens up, it causes irregular bleeding and after many years can cause changes that can be precancerous. So estrogen is the most effective therapy taken with a progesterone if a woman has her uterus. Dr. Su, what about other treatments outside of MHT?

There is a new completely non-hormonal medication, Fesalintant, that specifically targets the chemicals that are being released onto the thermostat centre of our body. It doesn't help mood, it doesn't help anything else. It doesn't protect your bones, it doesn't protect your heart, but it does stop the flushes and sweats. Perimenopause is a time when the body is going through a lot of changes. Some are noticeable and some are hidden.

Every single woman should have a health check because in addition to the symptoms, women get changes in their blood cholesterol, they get changes in their bone health, and they might even, a subset of women even find that their blood pressure increases as they go through menopause. So every woman should have a health check to make sure

look at the whole health profile of the woman to make sure that these changes don't persist into the second half of their life. What do you make of the argument that menopause has been over-medicalised? I think we've got an unusual situation now. We do have women who have no symptoms who are being prescribed hormone therapy with the belief that it's going to protect them against a whole range of different diseases and conditions.

which have not been substantiated. And I think that's over-medicalization. On the flip side, we have a whole lot of women with horrible symptoms who should be getting hormone therapy and their treatment has been under-medicalized. So I think we're seeing both situations. That's not a single thing of over or under-medicalization. We're just seeing a mishmash of care right now and getting some consistency in care is really important.

Back to ovarian retirement bandmate Siobhan. So she went through the tests her doctor wanted to do before starting MHT and she got the all clear. Well, I've just got back from the chemist and I've got my first course of estrogel and progesterone tablets in my hot little hand. So I guess my journey starts now, which is very exciting.

Siobhan had high hopes for what MHT could do for her peri-symptoms. Okay, so day three. I don't think I was expecting a miracle recovery, but the only effects I've felt so far, I think being really tired. Like I feel a little bit more fatigued more than anything. And my youngest told me last night that I was cranky mummy. So that's always nice to hear. Yeah.

Day seven, I'm actually sleeping a lot better, but also I'm feeling like really groggy in the morning and tired. Apparently it takes a few weeks to settle in. So anyway, holding hope. Another big change that Siobhan noticed over the past year was weight gain. It's like...

45, my body's just decided it wants to be a circle. I can almost hear you out there nodding in furious agreement. Like where the heck did this midlife bod come from? And I haven't changed anything, like anything to my diet or exercise regime. My thighs are definitely like a lot bigger and my stomach, like just around my waist and just that, I guess that

pudgy bit below your belly button is just, yeah, I don't know if I'm hoping that HRT is going to get rid of that. No, I am hoping that HRT is going to get rid of that.

This sounds like something for band manager Sue to answer. So I asked her what the deal is with perimenopause and weight gain. Of the studies where women have been assessed every single year over several years as they've gone through the menopause, what these studies have shown that the overall creep of increase in weight, which is about half a kilo a year in the population, is

around midlife is not due to menopause. So the absolute weight gain is not due to menopause. But the kicker is, forget the weight gain about getting on the scales. When estrogen levels drop...

our bodies move fat from our bums and our hips into our tummies. So even if a woman's weight does not change, you see between 20 to 40% increase in intra-abdominal fat, that's the fat inside the abdomen, and also total body fat increases. So our body composition changes so that we start to replace some muscle with body fat.

This redistribution of fat means that for some women, their midsection gets more round. But the story doesn't end there. As we get older, our bodies start to replace some muscle with fat. That's because of the drop in estrogen. Estrogen is incredibly important for fat metabolism and muscle function and the way we handle sugar.

So when estrogen drops, we gain central abdominal fat. And that's a real physiological change that, you know, you can't do anything about unless you take estrogen. Ladies, I hate to break it to you, but there is no secret code to crack here. While estrogen is involved in preventing muscle loss, if you're taking MHT thinking it's going to lead to weight loss, cool your jets because uh-uh.

But there are other things that you can do to manage your weight during this phase and beyond. It's boring, but exercise and diet are key.

So women do need to look at that and not blame everything on the menopause. Have I just slackened off a bit in what I tend to eat? Am I having two lattes instead of a coffee with a bit of milk added or cups of tea? Because if you just change a small amount in your diet, but you do it over months, you will gain weight. Yeah, it's true. And you know, back to that half a kilo per year that we all put on, what's the mitigation for that?

Oh, it's food intake and exercise. I mean, as one of my medical colleagues said years ago, it's calories in and calories out. Our bodies are really good accountants. Ugh, bloody accountants. Look, if you've been near the internet or a Pilates studio recently, you'll know that resistance training is all the rage for women of a certain age.

But when it comes to protecting your bones, Dr. Su says we need to think differently. The biggest impact on bone health is not through resistance training, it's through impact. So when women go through menopause, even if they do not have symptoms, the average woman will lose 6% to 8% of their bone, which starts about two years before the last menstrual period and continues to accelerate menopause.

into the first two years post-menopause, and then the loss sort of slows up. Loss of bone density can lead to osteoporosis, but there are things you can do to reduce bone loss. The best way to protect it is with impact exercise. So hopping, skipping, jumping, anything that causes some degree of impact. Just walking around holding a latte is not going to work. Damn it!

My skill. The impact training is the most important. Okay. Why have I not heard about that? I was told to push weights. Weights are good, but for your hip, which is where we worry about too, you need to have a little bit of impact, which is, it doesn't have to be hard, but just gentle hopping, skipping, jumping. Doctor, we're living much longer now. So the post-menopausal period might be more than half our whole lives. And we want to be strong. We want to have sex. We want to be able to lift big, heavy things and not fall over. Yeah.

What is your message to women listening who are worried that this is just a big symbol saying your life from here on is decline? It is continual, nonstop, growing decrepitude. It's absolutely not.

I swim twice a week and I swim with women in their 80s. And they're not unique, but the trick is paying attention to your own health. So women at Midlife are usually self-sacrificing for those around them. They're the givers. They're

They're the linchpin of the family. They're the ones running themselves ragged to look after everybody else. So take some time to look after yourself. So menopause is not the gateway to falling over and being decrepit. It's the gateway to do a reality check and saying, what am I doing to keep myself healthy? Jo, who we met earlier with the sweaty sheets and heavy periods, has started on MHT.

Added to that, she's made some meaningful lifestyle changes.

What has helped me? Number one, looking after my health and my wellness. And number two, the hormone therapy that I'm currently on. It is an absolute godsend because now I'm sleeping really well. I'm feeling great. And I know it's doing so much benefit for me, for my bones, my body. I can sleep during the night without being woken up multiple times. It's huge. The mere fact that I don't have achy joints and sore muscles, that's

that means that I can exercise a heck of a lot more freely now. And just having brain fog, I can have a conversation without forgetting what I was talking about. That's absolute gold. To help with her heavy periods, Jo has started on a drug called Tranexamic and she's still hoping that every period she gets will be her last. There's a few things that Jo wishes she had understood when she was younger.

I wish that I knew what could possibly happen to me. What are some symptoms and signs that you can look out for? And then what can you do to try to minimise those? And what can you do to look after your health? Because really now, whatever we do now is going to have a huge impact on what our future health is going to be like. Our friend Siobhan had high hopes when starting on MHT. After a plodding start, she did notice some changes.

Okay, day 10. I could be reading into this. It could be a bit of the placebo effect, I guess. But I do feel like, well, first of all, I'm definitely sleeping better. I do feel a little bit groggy in the morning still, but I'm definitely sleeping better. One of the biggest shifts that Siobhan has experienced is that her night sweats have leveled out.

I still think I get hotter at night than I ever used to, but it just doesn't come in those crazy instant waves of heat anymore. I'm much more a constant hot mess than one that fluctuates up and down.

Like a butterfly emerging from its chrysalis, by day 16, Siobhan was feeling a sense of transformation. I feel like I've got a spring in my step almost. And I just feel like I haven't had that for a while. So I'm going to say, yeah, it's definitely been a positive. Right now, I'm feeling really happy. Hmm.

Thanks for coming to the show. Yeah, rock and roll. I'm sweaty, but I think it's from the moshing. I feel like we got through some big hits in that set. Like if you have all these physical symptoms and you're thinking, is it, Perry? Could it be? Go see your GP. And if they don't listen or you feel like they're allergic to, you know, women's business, you're going to have to go to the GP.

Send them out the practitioner's toolkit and put it in their hot little doctor hands. Find out what treatments work for your body because no one knows you better than you do. Be kind to that body. Treat it well. But don't expect it to look or behave exactly like it used to because it's changed. It is changing and it will continue to change.

And like Van Halen said, and so did Chris Cross, jump. Get yourself a skipping rope or play basketball or football or dance. And if you know someone who needs to hear this episode, yes, share it with them. Now who's ready for an encore? Who needs to hear our hit song, Blood Plums?

This podcast was produced on the lands of the Gundungurra and Gadigal peoples. Ladies We Need To Talk is mixed by Anne-Marie de Bettencourt. It's produced by Elsa Silberstein. Supervising producer is Tamar Kranzwick and our executive producer is Alex Lollback. This series was created by Claudine Ryan.