Episode Transcript
[00:00:01] Speaker A: Welcome to the Alcohol Tipping Point podcast. I'm your host, Deb Maisner. I'm a registered nurse, health coach, and alcohol free badass. I have found that there's more than one way to address drinking. If you've ever asked yourself if drinking is taking more than it's giving, or if you found that you're drinking more than usual, you may have reached your own alcohol tipping point. The alcohol tipping point is a podcast for you. Find tips, tools, and thoughts to change your drinking. Whether you're ready to quit forever or a week, this is the place for you. You are not stuck, and you can change. Let's get started.
Welcome to the podcast. Today I have on the show Jane Hutchins. This is a podcast I've been wanting to do for a long time. This is, I guess we'll call the Menopause podcast, and I think it's going to be really helpful, definitely for women, but men, of course, have women in their lives, and so it's important to just be educated about these kind of issues that impact us all. And so I had reached out and asked, like, who should I have on the show? And someone recommended Jane Hutchins, and she couldn't have come better qualified. Jane has experience in gynecology as an RN and educator. She's worked as a clinical nurse specialist in sexual and reproductive health. She's been an educator and a manager in family planning. She has her masters of science in medicine in reproductive health, and she has a phd in public health. Just to name a few of your qualifications, Jane. And she is coming to us all the way from Australia. So welcome to the show, Jane.
[00:01:55] Speaker B: Thank you very much for having me here. I'm pretty excited about being on. There's lots to.
[00:02:02] Speaker A: Know. I'm like, wow, where do we get to dig into it? I was sharing before we started recording. I do have a lot of women in my groups, like the people who do sign up to do my program. And it's open to men, too, of course. But I have a lot of women, and I've noticed a lot of women who are in their above. So from, especially this age where we start talking about perimenopause and menopause. And I, even as an RN, was sharing. Like, we didn't really talk about it in nursing school, and I worked at a family planning clinic as well, and we didn't really talk about it honestly. That is an area of education that I just haven't addressed. And I don't know if it's. I'm in denial. I'm 46, so it's going to start happening. My mom is constantly sending me, my sister, articles about perimenopause, any little symptom. We tell her, she's like, oh, it's probably perimenopause. And we're both kind of pissed off about that.
[00:03:20] Speaker B: Anyway, she's looking out for you, it's okay, right?
[00:03:23] Speaker A: Because I think for her she's like, I wish someone had talked to this. I wish someone had told me, I wish we had more education. And so we're going to take the time just to talk about what is happening to our bodies as we get older.
[00:03:39] Speaker B: And as we were saying before, in my education, menopause wasn't a big theme either. And we now know, when we look at it, gps. So family physicians, like your family doctor here in Australia, we call them general practitioners, as well as obstetricians and gynecologists, don't actually get taught much about menopause. It's not in their curriculum. And when you think about OBGYN, they really focus on those reproductive years. So once we're no longer reproductive, we're not that interesting.
So it kind of makes sense that it may not be their area of focus, but it needs to be someone's.
So in Australia, some of the people who are picking up the lead with that education, endocrinologists, because it's an endocrine thing, and there are some cardiologists who write into it because it has a really significant impact there, too. If women feel like they don't know anything and haven't heard anything, that's because no one's been talking about it. And it's not because they're necessarily in denial, but they might be.
It's because their GP, their doctor, their obstetrician, all of those people probably haven't spoken about it. And if they have, they may not actually have current information and knowledge.
[00:05:00] Speaker A: Yeah, risk. We're going to get into that because we are a podcast about alcohol. We'll get into the role of alcohol and its impact on menopause. But can we just start kind of with some basic overview of what perimenopause and menopause is?
[00:05:21] Speaker B: Menopause is the day of your last period, so strictly it's a day, and after that you're in post menopause, but we consider you to be through menopause twelve months after your last period. So you have your last period.
Lots of women get to nine or ten months and have another one and have to start that clock again, which is really disappointing. If you have your last period and then twelve months later if you've had none, you're considered to be in menopause or post menopause. So perimenopause is that time leading up to that. And on average it takes about five to seven years. But women can take ten years of perimenopause or as little as two years. So if the average age in North America and Australia is around 51 to have your last period and go into menopause, that means you're getting symptoms, most likely from your early forty s.
And those symptoms relate to reproductive stuff, so not as fertile.
It relates to your periods, how regular they are. They usually get a bit shorter, but more intense and come more frequently. So you may transition from a 28 day cycle to a 26 day cycle. That's nothing. You think, oh my goodness, I have to go to my doctor. You just think they're coming more frequently. You might miss a period here and there.
And closer you get to menopause, the more likely it is that your periods will become more erratic. But it affects other body parts as well because oestrogen receptors and progesterone are everywhere in your blood vessels. They're in your heart, they're in your muscles, your bone, your brain, your thyroid, like they're all over the place.
So when you have changes in those hormones, it's going to affect all those other body parts.
So some of the other key perimenopausal symptoms are mood changes.
Anxiety is a big one, probably more so than depression, but both are there. Aching. It's like you wake up and you think, oh, God, I went to bed at 45 and I've woken up at 85. You can't move, you're stiff, you're sore, you don't have the same recovery from exercise. You're putting on weight without changing anything.
You're having some brain fog, so things are taking you longer to do. You might forget simple things. You find some of that kind of complex thinking a bit trickier. And for me, I was just really slow, like, I could still do stuff, but it took me forever. And I also did forget things. So your skin might change. You might have a feeling like you're going to have a urine infection, but you don't. But you just feel not quite right. You have a bit of discomfort there.
I could go on.
Depending on who you read, between 40 and about 85 symptoms of perimenopause.
Wow. Yeah.
So when people do say when you're in your could be perimenopause, it could be because it covers such a broad range of things.
Yeah.
[00:08:35] Speaker A: Right. So it sounds like perimenopause is that time period leading up to menopause. Menopause is when you're done with your periods and then you're considered post menopause.
[00:08:49] Speaker B: Yeah. And we have to remember that we spend a very long time in post menopause. Hopefully, if you go through menopause at 50, average age of an australian woman is 84, 85. So you've got 35 years in this state in healthcare. Sometimes it's almost like once you get to menopause and it's like, okay, well, we're done looking after you. You're not having babies, you don't need contraception, so we'll ignore you. But it's a big part of our life, and we need to not be ignored. And in the perimenopause transition, I should say, is what happens is that you have a reduced number of follicles or eggs, and you're struggling to ovulate as much. So in that process, a couple of things happen. You have more hormones from your brain that are saying, come on, come on, come on, ovulate. Just like your brain is pumping out more and more follicle stimulating hormone to try to get you to ovulate, because it's just trying to wring out as much as it can. And then what you end up with is, for a while, you have higher levels of oestrogen. About half of women will have higher oestrogen going into menopause. So they go from where they were, then they peak, and then they drop. So obviously they've got further to drop if they've gone up first, and then the other half of women just go up a little bit or don't go up at all. They just kind of gradually drop, but it's not a straight line. So you go up and then you go down, and then you go up, and then you go down. It's this wild roller coaster, which is so exciting. And so you have symptoms that you think, two months. Oh, I'm okay. Because those two months were okay, maybe you ovulated, and then you might have two months where it's just out of control. So it's that variability that messes with you and messes with how you think you're controlling your body and your life and how you can manage and worsens anxiety. And progesterone is released when you ovulate.
So we always talk about oestrogen, but progesterone is lovely, and we need it as well, so when we, in our hormone cycle from our ovaries, they're the two main hormones we produce, and we make oestrogen regardless, but we make the vast majority of our progesterone when we ovulate, and if we're not ovulating, we don't make it. The progesterone works with Gaba in the brain and some other areas to make you feel more calm and chill.
So you don't have that in perimenopause. You also don't have it in postmenopause, but in perimenopause you really want it and you really need it. So we lose our progesterone first, and while that's happening, oestrogen is just going bouncing off the walls, like doing whatever it wants. And so some of the symptoms are related to estrogen and some, and progesterone and some, who knows?
Or both.
[00:11:55] Speaker A: That's good to know, because it does seem like when we talk about menopause, the main hormone we're talking about is estrogen.
[00:12:03] Speaker B: Yeah.
[00:12:05] Speaker A: Is that because that's what we end up taking.
Can you just talk about estrogen and menopause and why people are taking supplements or not? And what is going on with the estrogen?
[00:12:22] Speaker B: So I think it was just the first one that was researched most early on. So we learnt more about oestrogen receptors early on and the fact that we have them all over the place and that there are different types. When I say early on, I mean pretty early in the 20th century, and we know low oestrogen is associated with increased cardiovascular risk and bone density. So loss of bone density, skin you don't have as fabulous, taut, plump skin, that sort of thing. And then there was a real drive on this doctor. His name escapes me and I think I always forget his name kind of, and subconsciously on purpose. But his book was feminine forever and it was funded by, I think, wyeth, so a pharmaceutical company. It was a big drive in the early introduction, or big introduction of HRT in the was framed as. It was awful. It was just so incredibly profoundly misogynistic. If you don't have oestrogen, you'll be shriveled up. And this is the language he used.
You'll have hostile vaginas.
It's just a vagina, dude. It's not hostile or otherwise.
You're desiccated and decrepit. Yeah. So they're literal words that he used. So it just really swung this thing as, oh my God, I really want some estrogen, I want a lot. I don't want to be that person. He talked about driving divorces and made men kill each other. He's got this fabulous anecdote that he had to give a mobster's wife oestrogen because the mobster said he was going to shoot her if she didn't get an act together. Seriously, this guy was a doctor anyway, so that was kind of overcome. But we did realize through that stage that oestrogen is really important for cardiovascular health, which is why some of the large studies started. And some of them started just with oestrogen and some started with oestrogen and progesterone because we thought, well, that's what happens naturally, let's do that. And it's still predominantly oestrogen. And I think it's because the evidence for oestrogen for those hard risk factors for cardiovascular disease is strongest.
[00:14:46] Speaker A: Oh, interesting. And still there's not a lot of research about menopause in general.
[00:14:53] Speaker B: No, when you look at the research, it's largely around hormone therapy, which is not an inappropriate thing to research. I think it's good, but we'd need more on a whole range of other factors. Like you have oestrogen receptors in your gut, and as they reduce in menopause, it changes your gut microbiome, which changes your gut symptoms.
So you may be bloating because you've added a bit of body fat, or you may be bloated because all your bugs in your gut have changed and you're just kind of adjusting and working out what the heck's happening here. So we need to look at the mental health impacts instead of just saying, oh, yeah, women get more depressed and anxious at menopause, and maybe oestrogen will help, or progesterone. We need to look at that in more detail.
But what is happening there, and that is around hormones in the brain. We know that with PMS and PMDD and perinatal anxiety and depression, we know something's happening, but we don't know enough of that because without knowing the kind of pathways, then we're limited in how we respond to that. It's kind of like, well, let's throw this at it and see if it helps.
[00:16:13] Speaker A: Yeah, definitely something that's needed.
[00:16:16] Speaker B: Yeah.
[00:16:16] Speaker A: Well, let's talk about how alcohol, I'd maybe first talk about how alcohol affects estrogen.
[00:16:26] Speaker B: Sure. So there's a couple of things before we even get to oestrogen. Estrogen, the women metabolize alcoholiday differently to men. So we have less alcohol dehydrogenase in our gut. So we absorb. So we have about 50% less of that enzyme, which means that we end up with blood alcohol levels of about seven to 8% higher than men, even if we're having the same thing. And if you even out for body size and stuff, our livers seem to be more sensitive to alcohol, even at the same level. So we're more likely to get liver damage than a man with the same kind of alcohol effect. Women tend to be smaller and tend to have lower body water content. And all of those influence kind of alcohol saturation, if you like. So then what? Oestrogen and alcohol, their relationship is one of the big things is that they both affect your brain and areas of your brain and your neurotransmitters independently. And when you put it together, it just makes a mess.
So it increases the risk factors for reduced frontal lobe functioning. And your frontal lobe is kind of behind your thyroid. And it's where you do all your tricky stuff. It's where you work out your tax return. It's where you make those complex decisions. It affects your amygdala, which is where your emotions are. When you have that gut response to something, and you've responded may not have said anything, but you can feel it, and you haven't even worked out why yet.
They both affect your hippocampus, which is where you do your nice long term memory and some short term, but mainly your long term. But the other thing that alcohol does and that I see some women talk about why alcohol is great in perimenopause and postmenopause is it increases the conversion of weak androgen. So weak testosterone, which we store in our fat, it increases the conversion of that to oestrogen. So by having alcohol, you make your own oestrogen from your body fat a bit, which is kind of extraordinary.
But the benefit of having that little bit of extra endogenous oestrogen so you've got from your own body is far outweighed by the risk of the alcohol that you've had to get that little bit of oestrogen. And different women will convert it at different rates. And it's called aromatization.
And you need a bit of body fat to begin with. So if you are very slim or have low body fat percentage, then you can drink all the alcohol you like, and you won't be doing it because you won't have the androgen sitting there. And that is one of the thoughts around. We have hormones stored in our fat as kind of a bit of a protective thing. So we do gain weight through perimenopause. The amount is wildly variable, but some of the idea of that is, well, maybe it's just to kind of give us a buffer. And you probably know that if you're 75 or 85 and you get pneumonia, you want to be doing that with a bit of body fat. Not no body fat. It does give you a buffer when you are unwell as you age.
Yeah. So that's the big thing. Alcohol can increase your endogenous oestrogen.
I'm not suggesting doing, and I strongly suggest not to drink for that reason, because you can't try to therapeutically adjust your hormone levels with anything other than hormones, to be honest, or spyoestrogens.
[00:20:23] Speaker A: Right. And the other thing with alcohol. So it sounds like drinking alcoholiday can increase your estrogen. And so for some women.
Well, I don't even want to go there, but what I was going to say is a lot of women, you were saying with menopause or perimenopause, you're having the mood changes, the anxiety, the fatigue and brain fog, which is also related to drinking too much alcohol. Absolutely.
And so it's all getting confused.
[00:21:01] Speaker B: And the other really important thing to say about that is that research has shown you may have a detectable increase in oestrogen in your blood or in your saliva.
But this is the big thing. It might have some benefit to how you feel, but that's purely. Well, sorry, from my perception, that's a numbing effect. It's not a genuinely therapeutic effect, if that makes sense. Any benefit is just because you've numbed out from what's happening, but what it hasn't shown and doesn't show, and I really strongly believe will never show that increasing your estrogen, that little bit by alcohol, improves any of your other outcomes, because drinking will worsen your cardiovascular health. We know that.
So if you think, oh, I need a little bit more oestrogen, because having none is not great for my cardiovascular health, doing that through drinking actually just makes your cardiovascular health worse.
So it's not a valid intervention to try to moderate your oestrogen levels.
[00:22:16] Speaker A: Well, and then so men, if men are still hanging in here listening to this, and correct me if I'm wrong, maybe you can add to this.
Some men, the more they drink, it's lowering their testosterone and increasing their estrogen. And so some men have even gotten the gynecomastia, which is the boobs, the man boobs, and have had other effects of having higher estrogen and lower testosterone because of the alcohol is that right? Yeah.
[00:22:50] Speaker B: And it's the same process. They're converting some of their androgens, their testosterone, which there are a couple of different types, into estrogens.
Okay. So they're also ramatizing their male hormones into female hormones. So not great. And yet, sexual performance, sexual satisfaction, body composition, lots of changes. And the other thing with alcohol and hormones is women who have low progesterone, either because of it, they may have polycystic ovary syndrome, or they may be on something like the depopavira injection or postmenopausal.
So when they look at women who drink at moderate to high levels, those women have greater cravings than women who are ovulating normally.
So there's something about progesterone affecting our craving and our level of desire and our level of kind of discomfort, if you like. And again, it goes back to that kind of progesterone, chills you out and makes you feel a bit more relaxed. And things are okay in the world.
Yeah. So there's lots of complex interactions, and then you add another one, and I shouldn't do this, but. So estrogen increases dopamine.
We know that first heat of alcohol is dopamine, and then you just crash and burn, and you don't get that after the first kind of 2030 minutes.
But then you throw in things like ADHD and autism spectrum and alterations in those brain chemicals.
They're all kind of amplified at perimenopause as well. So if you are neurodivergent or have ADHD and perimenopausal, that's enough of a clash or a fire brewing there. And if you throw alcohol on top of it, it's just volatile. Like, it really makes it much more difficult to manage your mental health, your cognitive health, and then all of what is happening in perimenopause.
[00:24:59] Speaker A: I was just going to say, like, I'm glad you brought that up, because that was actually something that someone had asked about, that they had feelings or symptoms that are kind of traditionally ADHD symptoms, and they were like, am I feeling ADHD or am I feeling menopause symptoms? Like, they were confused about it. So can you talk more about that?
[00:25:24] Speaker B: Yeah, I think the way to kind of tease through that is to really get into detailed history and see if you can plot those symptoms under either perimenopause or ADHD, but also to recognize that perimenopause may simply reveal ADHD. So you may have been managing fabulously and just kind of built your life around it, and you had systems, and you're organized and you've got checklists or whatever it is that you've done and whatever type of employment you've chosen to kind of suit who you are.
But perimenopause, and those changes just kind of takes the COVID off and says, no, we're going to make it really hard. And everything that you're experiencing, we're going to amplify and make more intense. So certainly in Australia, the women are most likely to be diagnosed in perimenopause more than any other age at all, more than a teenager. And it is that kind of revealing effect. And it can be difficult to work out which is which. Or am I just burnt out? Is it neither of those things? You're just burnt out. You've raised your family, you've worked really hard. Maybe you don't have kids, but you worked really hard. You've got other responsibilities. We've had a pandemic.
The world's going to hell in a handbasket, and you've burnt out.
So it can be really difficult to tease some of that out sometimes.
And I would suggest that to really look at the symptoms and see if you can work out what is happening. But also some of the interventions are the same. So one of the things that I realized in my clinical practice that nearly every woman needed, particularly in this kind of, was to just rest.
And I don't mean kind of lie on the couch and watch movies. I mean really good quality rest. So doing some yoga, nidra, that sort of thing. There are a couple of american women who are just spectacular in this space. So Karen Brody, Octavia Raheem is absolutely. They're all really focused on good quality rest. And what happens with that is you calm down. Although that neurological annoyance, and certainly that's what I felt when going through perimenopause. Like, yeah, I had hot flushes and yada yada, but I just felt like my brain was irritated, and I'd never had that sensation before in my life. This is just weird. Like, it wasn't a headache, it was just annoyed. And I don't mean cranky annoyed. I was that, too. But it just felt like my brain was not right and irritated. And reducing oestrogen makes it a bit inflamed. We know that. So again, we've got all these complicating things. If you've got neuroinflammation, that's not great for ADHD, and that may be part of the trigger why oestrogen loss in perimenopause.
Uncovers it. I'm not sure if that answered your question or not.
[00:28:31] Speaker A: Oh, no, that's helpful. And I was just thinking, like, oh, what a storm. A lot of women are in their midlife, and so you have all the stuff that goes along with midlife. Like, you were talking about being a caregiver, your kids are grown, you're at a point in your career, you're like, I don't know if I want to do this.
And then you have these other things that are coming out and being amplified by perimenopause. And then for a lot of the women that I work with, everything is further amplified by alcohol. And so you're saying, like, okay, find ways to soothe your nervous system. Find ways to rest is so important.
That's why I always say, like, okay, remove the alcohol first, because sometimes that will uncover some underlying issues you didn't realize you were covering up with the drinking.
[00:29:31] Speaker B: Absolutely.
Physiologically, alcohol will be making it worse, apart from any kind of behavioral things or how it's affecting how you relate to people and your sense of safety and all of those things. But, yeah, midlife is wild.
It's kind of a test. And the other thing to really stress is that everyone's experience is really different. So for some women, it's really hard.
Again, I've just got australian data, but I think it's probably the same in North America. About 80% of women have a manageable perimenopause. That bit's annoying, or that's hard, or I have to train harder, or I've lost my muscle tone or whatever it is, but they can manage.
Ten to 20% have really nasty time. So that's one of the things to bear in mind, too. When you look through the great big, long list of symptoms and you see the memes and when you see how it's represented in movies, and this is totally out of control. Bitchy woman. It doesn't have to be like that, and it's not like that for most of us.
[00:30:42] Speaker A: Well, what are some ways that we can treat the symptoms?
[00:30:47] Speaker B: Yeah, obviously I'm here, so I think not drinking is a really great first place to start because it will increase all of the things that are already happening, apart from any other risks associated with alcohol. But all of the mental health, the mental health things are the biggest women can manage. Hot flushes, they might hate them, but really, it's a minute here and there during might be ten times a day, but the anxiety is, for some women, it's the first time they've ever experienced anxiety. They'll come into clinic and say, I don't know what's happening. I feel like I'm losing my mind. And I've sat down. I thought, okay, well, let's do some reflection.
No, not worried about anything. Everything's pretty cruisy. But why do I feel panicked? So what you do depends on what your symptom is. Basically, it might be that they're feeling lack of motivation and depressed. They might be feeling exhausted. In my clinical practice, fatigue and the anxiety, brain fog and weight gain or body composition changes are the things that people worry about. The other stuff they feel they can manage. So your symptom control or your symptom intervention needs to match what's happening.
I have found that most women need to start by resting, and not drinking is part of that. For instance, if they have a whole lot of lifestyle factors that can be benefited. So changing the way they eat or when they eat or how they eat or their relationship with food, because perimenopausal women have high levels of disordered eating. And in fact, it gets worse at perimenopause compared to. So we really don't want to just put someone on stupid diet and feed into that disordered eating stuff and poor body image and unhappiness.
But there may be lots of stuff. She may need to make some changes to work or to how the family works and work on boundaries and all of that. But if you're feeling overwhelmed, anxious and exhausted, and you haven't slept for the last ten years, you're not in the headspace and you just don't have the capacity. Like, your brain doesn't work well enough to be able to do all that.
You go to work, you come home, you make dinner, you collapse.
That's why I start with resting first.
So you just have a bit of space in your life and in your brain to think, okay, yeah, I can do this now.
And to not do everything at once. So some women, the main thing I do with them is yoga, nidra. Some women, the main thing I do with them is get them to eat a bit of protein.
Because if you're working with women in their late 40s onwards, in particular, there's still quite a lot of fat phobia as well.
So people are on skim this and skim that and skim that. And it may not be the same thing in the states, I'm not quite sure. And so they're not getting any good fats. And your brain is fat. You need fat. You just need fats. That are healthful and less of the saturated fat from your deep fried foods and your fast food. So I might need to focus on increasing protein in their diet and how they can do that. Might be increasing fiber in their diet and how they can do that if they're having symptoms and they don't want to take any pharmaceutical interventions, any menopause, hormone therapy, things like a good dose of phytoestrogen daily can help with some of the symptoms, like hot flushes and.
[00:34:33] Speaker A: What's the phytoestrogen?
[00:34:35] Speaker B: Yeah, it's a compound in plants that can interact with our estrogen receptors.
It can reduce symptoms like hot flushes and has been in some research. It's a little bit mixed, but most researchers show if you have good levels of phytoestrogens from things like soy, for instance, it can improve your cardiovascular risk factors and your brain health, because that's the other thing around this time, and I'm really careful not to say it when someone comes into my clinic and they're in the midst of it, like they're in the middle of the storm, that what you do in perimenopause sets you up for your health thereafter.
So, for instance, your cholesterol will naturally go up a bit in perimenopause, and for most women, it'll just come back down without any major intervention. It's just a phase because everything's kind of a maelstrom or being tossed up in the washing machine, and your blood pressure will go up a bit, and then it usually will come down usually enough.
But if you're drinking a lot or if you're just drinking consistently, even a couple of drinks a day, which is not a lot if you have a really high salt diet, if you don't have any fiber, you never eat vegetables, unless it's a chip, a fry, then those changes that happen at perimenopause stick.
So instead of naturally coming back down, they can either stay where they are or get worse. So it's a really wonderful opportunity, a window. And when you're feeling rubbish, to hear someone say, oh, it's a great opportunity, you just want to punch them. But we have to kind of be mindful of when we say this to people. It isn't a really important opportunity. Maybe that's a better word of kind of setting it say, okay, what I've been doing and how I've been living just isn't cutting it anymore. I feel awful. What do I need to do? And if you can get that right, it can make the rest of your life, so much better in every way. Your mental health, your mood, your quality of life, how much fun you have, your sex life, and all of your health risks, like your mental health, dementia, cardiovascular.
[00:36:52] Speaker A: Yeah, that's so important. And easier said than done. I appreciate.
[00:36:57] Speaker B: Totally.
[00:37:01] Speaker A: Well, when would you take. And where are we with hormone replacement therapy?
[00:37:07] Speaker B: Because.
[00:37:09] Speaker A: It wasn't recommended. Now it's back, and then it's not like, where are we with that?
[00:37:15] Speaker B: So I'm also a naturopath. And so some naturopaths will have very strong anti hormone therapy stance. Some, and particularly in North America, in USA and Canada, some naturopaths can prescribe it, so they tend to be more pro it. I'm pro it. I'm pro anything that makes you feel better. I really don't care what it is. And because I have that orthodox medicine background as well as the nutrition naturopathy, I can kind of pull from wherever I like, which is just a luxury. But if someone feels a lot better on it, why would you not take it is the short version. So then we look at the history of it. There were a couple of really big studies in the most people are familiar with is the women's Health initiative. And the initial report from that came out in 2002. And they stopped that study and they had like 785,000 women in it, or something like that. Over 700,000. It was enormous.
It's very hard to get such a big study just on a drug and as a longitudinal study. So looking at women over a long time, and they stopped it because women had an increased risk of heart attacks and breast cancer. They were the two things.
And there was some very, very poor reporting about it. So they said you had a 26% or 24%, and then it was changed to 26% increased risk of breast cancer, which if you say this medication you're taking 26, you'll throw it out. And women did literally throw it out. And if you look at any of the graphs about hormone therapy use, you can see it just climbing, climbing, climbing, and then just going off a cliff when this news came out in 2002.
So it didn't increase your risk by that.
Your actual risk went up by less than 2%. So it's just how some of it was reported.
So it was around actual risk versus community risk and a whole range of relative risk and all of those things. So that was the big reason why everyone stopped it. But there were some really important things about the research, and lots of people bag it big time, but fantastic information came out of that study and there were just a couple of glitches. So the first glitch was they enrolled women, I think from about the mid forty s to the mid seventy s and then put them on hormone therapy.
Yeah.
[00:39:54] Speaker A: Just to clarify, when you say you're on hormone therapy, is it estrogen?
[00:40:00] Speaker B: Yes. So in their study, they did estrogen only and then they did estrogen and progesterone. So they had two groups. Yeah. And the type of progesterogen was really important. The first thing they did was get women in this huge age span and put them on hormones. Some women were freshly menopausal and some women had been in menopause for 2025 years.
And then they didn't separate out the findings based on women's age.
So they said, just gave you one answer for everything.
And it's like, well, when they did separate it out, they found that young women who started hormone therapy had reduced risk of cardiovascular disease and breast cancer. But if you put a woman on hormone therapy ten or more years after menopause, it increased her risk.
So we didn't get that kind of nuance in 2002. We just said, oh no, it's going to kill you, stop.
And that was just totally not right information. So they went back 17 years later and worked out that if you're on the hormone therapy, you had less heart disease, breast cancer risk and so forth, if you had it within ten years. And the idea of that is if you start a drug when you're 75, you've already got cardiovascular disease because you're 75. And that's really different to being 50. And so oestrogen seems to protect you from developing, say, atherosclerosis, which is a key driver of heart attacks. But it may not help if you've already got it. It won't stop it from breaking off and giving you a heart attack or stroke. So that was the big thing that they did. They didn't divide women by age and they put everyone on the same kind of doses and it didn't matter how long it had been since menopause. So if you take it during perimenopause or start, I should say, in perimenopause or in the first five to ten years, risks are fine. So the second thing is they used higher doses than we use now.
They used higher doses of oestrogen and progesterone, and the type of hormone they used is different. So oestrogens are kind of body identical. They like our hormones anyway. And that wasn't the issue because they found a difference in between the women who just took oestrogen and the ones who took progesterone as well. So the ones who took oestrogen and progesterone had a slightly increased chance of breast cancer. The women who just took oestrogen didn't.
So it's kind of teasing it out like, you can't just take one sentence to describe it all. So what we know now is that the progesterogens that they used and is still in some hormone therapy and some contraception are synthetic progesterones and they act differently.
The reason they are included in hormone therapy is to stop you from getting cancer of the uterus, because if you take oestrogen after menopause, it will start building up the lining of your uterus like you're going to have a period. And if you do that and do that and do that and do that, then it increases your chance of endometrial cancer or uterus cancer. If you use a progesterone or progesterogen, either that stops that.
It makes sense to do.
But what we now know, sorry, this is the short version. What we now know is that we can take a micronized progesterone. So it's a body identical progesterone. It works like our progesterone works, but has more than that effect on the uterus. So it still protects us from endometrial cancer or uterine cancer, but it doesn't increase our risk of breast cancer. And you get some of the other nice benefits of natural progesterone so that you might have better quality sleep. You are more chilled out. People love this form of progesterone, but about 10% of women hate it and don't do well on progesterone at all, at any time in their life.
And that's unfair.
So there's an increasing move to hormone therapy now that is using this type of progesterone, because you have lower risk factors, less likely to get any of that breast cancer, like less likely than if you didn't take it. So it's safe.
Some of the issues around hormone therapy and why I'm saying hormone therapy and not hormone replacement therapy comes to kind of dosing considerations.
And it's a philosophical thing. People will also call it menopause hormone therapy, or MHT. The idea of that is that we're giving just enough to reduce any long term consequences of no hormones or very low hormones. You still have some, even if you don't take drugs, but reduce your risk, hopefully, of some of those longer term symptoms. What we're not doing is replacing your hormones. We're not giving you nearly anywhere near the amount of hormones you have when you're 30 and certainly like a drop in the ocean compared to your hormone levels when you're pregnant. And so we think about it, oh, my goodness. But you're taking hormones, that's got to be an issue. But you look at the hormone levels in pregnancy and that doesn't cause breast cancer.
I think sometimes we just have to kind of do a bit of a practical reality check and ask some really basic questions.
So there's something in there that just, oh, yeah, estrogen doesn't cause breast cancer also, by the way, but it can promote it if it's already there.
You'll find some practitioners will ask a woman to go and have a mammogram before they commence hormone therapy to make sure that's not already there.
And that's just practical, sensible intervention. And it does explain why breast cancer does sometimes show up in pregnancy, because they've got lots more oestrogen. So if it was sitting there, it can promote it.
In North America and Australia, we have a pretty similar approach to menopause hormone therapy. Australia refers to the North American Menopause Society for our guidelines as well. And in those guidelines, the only two absolute 100% we know this is going to do. The thing we're going to say it's going to do.
Indications for using hormone therapy is vasomotor symptoms, or hot flushes and night sweats, because if you can't sleep, nothing works. And the other one is urogenital. We used to call it vaginal atrophy, but that's just very depressing language. So, vaginal dryness, irritation and an increased risk of urine infection. It is low. Vaginal oestrogen is the biggest cause of urinary tract infection in women 50 years and older.
And topical oestrogen works a treat and is 100% safe, even if you've had breast cancer, and really great for all of that. So there are a few practices, maybe a couple in Australia, but certainly, for whatever reason, and I don't know why, it seems to be Britain based, that go high dose, they go outside the recommended doses, outside the doses recommended by the British Menopause Society and the International Menopause Society and names and so forth, and there's no indication for that and there's risk factors for it. As I said, the only two documented case reasons are the vasomotor, the hot flushes, night sweats and vagina and urinary bladdery kind of symptoms.
But that's not to say that it won't be found in the future, that taking low doses are effective for cardiovascular prevention. And there's some indication that it may help with dementia and there's some indication it may make it worse. But we're leaning towards might be better for dementia to take some low level. And that could be that you're having 150 grams of tofu or soy milk a day, or it could be that you're taking a pharmaceutical. And the other thing with the pharmaceutical is that there's a move towards topical oestrogen and you have fewer side effects and risk factors with that because you bypass liver, whereas if you take a tablet, you'll have different risk factors. So it's pretty messy. But the short version is it's safe. If you want to try it, try it. If you don't have the right result or the one that you were hoping for, or if you get side effects. This goes for absolutely anything you take, by the way. Then it might be the dose, you might need less, you might need more. Or it could be the form. So it does come in different forms. So you might be better with that type of progesterone, you might be better with the progesterogen and that sort of thing. So with anything, as I say, it might be your migraine intervention or whatever it is, don't try one thing and give up. Unfortunately, sometimes we need to play around with it.
[00:49:31] Speaker A: Well, thank you. Yeah, I appreciate getting the education about that because it's been confusing. Kind of like eggs.
Eggs, egg cholesterol, are they bad?
It's one of those things in science that changes. And I think people need to realize.
[00:49:52] Speaker B: That is that there's so much emotion in about. This is kind of just a sciency thing. We need to look at the data and just be sensible. But there's a lot of emotion about it. And if you look in Facebook groups and interviews and focus groups and that sort of thing, people get really cranky and really sometimes not very reflective in how they were speaking and acting on social media.
[00:50:22] Speaker A: You're kidding.
[00:50:25] Speaker B: Everyone has to take it. And if you don't give me that therapy, you're the worst person in the world. I'm going to report you to the medical board versus no one should ever take it. Hormone therapy is the worst thing in the world. And it's just like, just relax. We're all different people. We all need different approaches. Let's just have a cup of tea and let's have a talk about it.
The really important thing I also want to say is even if you do end up taking hormone therapy, all of those other lifestyle interventions are still really important.
So you still need to have a good quality diet. I would still recommend looking at your relationship with alcohol and all of the complexities around that about what's prompting you to drink and what it triggers and what's underneath and all of that stuff moving.
With the reduction of oestrogen, we lose muscle mass, which then sets off things like insulin and resistance and greater frailty. So you're more likely to fall, so you're more likely to break your hip. It's a whole sequale. So you need to do some resistance training or doing some hard yak. So that's a very australian expression. So some really hard grunt work in the garden, not just going for a walk.
I love pilates, but you need more than that and you need to develop. My belief is that you need to develop a really good quality rest practice and some mindfulness meditation, some yoga, ninja, whatever it is, some breathing exercises. 1 minute breathing exercise can bring down your cortisol and do ridiculously good things for your nervous system for a 1 minute investment of time. So you still need to do that regardless of whether you're taking a herbal supplement, a nutritional supplement or a pharmaceutical that's your foundation. The other stuff is kind of cherry on top.
[00:52:28] Speaker A: Yeah, very good. Well, I do have a couple of questions about supplements that came.
[00:52:34] Speaker B: Yeah, sure.
[00:52:35] Speaker A: One was, well, first of all, supplements, are they truly necessary in menopause?
[00:52:43] Speaker B: Yeah, I guess it depends what supplement you're talking about.
So a lot of women are iron deficient.
They are from the minute they have their first period until a year or two post menopause.
If you're going to supplement with iron, it may be absolutely necessary, but get your levels tested. There was a study in America released last year, I think that showed something like 41% of women in reproductive years are anemic. That's just absurd. And if you're feeling tired and you can't think properly and you can't remember anything, you might just be anemic, may not be perimenopause, it may not be ADHD.
So if you have low levels of vitamin D, you need to supplement. If you have low levels of vitamin B, twelve, you need to supplement. So it's because that will affect your brain health long term and your ability to make red blood cells. I would say at the really core level, check the level of whatever it is that you're thinking about taking and seeing if you need to supplement. There's a whole bunch of nutrients and truths, and not necessarily vitamins and minerals, but other things like, say, coenzyme Q ten that we know are critical, but we don't have good tests for. While I say test, we can't for a whole bunch of stuff, you base it on your symptoms. I think a lot of people don't have adequate omega three fatty acids in their diet, and they haven't ever. And that may be one that would be beneficial to supplement with. You can test for it, but you may just know that you've never eaten any fish in your life or you don't eat nuts, and so you can say you're going to be low, you don't have to pay for the test, and so that can be beneficial.
Some people, if they're very stressed, might find just a general b complex to be helpful. There's a really surprising study, I think it was in Singapore that came out maybe last year, and they used what I would call a pretty low level multivitamin and multivitamin and mineral supplement. So, like, it had a little bit of everything and not a lot of anything, and it wasn't even. Yeah, everything was sub therapeutic. The doses were so low and it found really good outcomes on people who are in their mind blowingly good. Better cognition, better strength. It's just surprising. So again, eat it first, and then if you need to supplement on top of that, if you can get it from your diet, that will always be better, because every nutrient needs other nutrients to hang out with and work.
The B vitamin group, like, we know it's B group vitamins, because they hang out together, they're a gang, they don't work in isolation, and that applies to every other nutrient. And B group vitamins also need magnesium at times and that sort of thing. If you can get it from food, we know you have more diversity of nutrients in the food. They're going to work in ways that we just don't know about yet. Plus, it's food and that's what you want to be eating. And you get more joy from food, hopefully. So if you eat a nice, healthful plant, rich with lots of protein and some good fats, that's a solid foundation, and then supplement to kind of top it up if you need.
As we age, our absorption of some nutrients will decline, so that can maybe increase our need for supplementation. But I don't recommend everyone just go out and get ten of everything, because it's not sustainable, it's expensive, it's boring. You do it for a while and two weeks later you stop.
It might be more effective for you to just eat breakfast if you've never done it before.
That one thing might be the most effective thing you can possibly do for your health.
[00:56:59] Speaker A: Well, that's really helpful. Thank you. And then they also asked about magnesium specifically. They said, it's kind of been a buzzword, so can you speak to magnesium supplements?
[00:57:13] Speaker B: I will declare my bias. I love magnesium. Magnesium, just divine. So it comes in multiple different forms, and it's a mineral, it's reasonably easy to absorb and use in your body. We know that it is needed for at least 300 different enzyme reactions in the body. It does a lot. We know we need it to make GABA, which is our main chilling out neurotransmitter. We need it, I kind of think, ironically, we need it to calm our nervous system, and we need it to make energy in our mitochondria, in our cells. It does both. It's magic. Magnesium comes in different forms. There is some research that suggests magnesium three in eight is more for brain cognitive benefits and is more likely to cross the blood brain barrier. But other research show that other magnesiums do the same. There's definitely research that shows magnesium oritate seems to be more specific for cardiovascular benefits.
There's been some studies about giving people a magnesium oritate supplement in a hospital, for instance, after having a heart attack or a bypass.
But the one I love is magnesium glycinate. And the two barrel names is kind of the form that the magnesium is in what it's bound with.
And so magnesium glycinate is bound with glycine. And glycine also helps make taurine and gaba and chills you out, and it helps your quality of your sleep. So you can take glycine as a standalone supplement, just straight glycine, and it can improve the quality of your sleep.
Taking magnesium glycinate, you kind of get more bang for your buck. You're getting all of it.
[00:59:05] Speaker A: Well, it sounds like it's earned its buzz.
[00:59:07] Speaker B: Yes.
[00:59:09] Speaker A: Okay.
[00:59:11] Speaker B: Again, it's one of those things. We know low magnesium is associated with high blood pressure and cardiovascular disease.
[00:59:17] Speaker A: Well, how about this one is after years of alcohol use, is there a specific supplement we should consider for peri or menopause help?
[00:59:28] Speaker B: That's interesting.
So I guess it's timing.
One of the things that one of the nutrients that alcohol particularly depletes is vitamin B one or thiamine. Thiamine. Thiamine. So if you're reducing alcohol or drinking any alcohol at the moment or recently stopped alcohol. It may be beneficial to take some b one for a period of time, and the dosing regime will vary depending on how much alcoholiday, how long, and other stuff. But that is something that you might take, say, a b complex and then just a separate vitamin B one. And for whatever reason, it's usually 100 milligram tablets. So that's a really specific one, because by depleting vitamin b one, it affects me, who stumbles on my word, then a specific part of your brain about speech, and you can end up with a condition called Wernicky Korsakov syndrome. So you have speech and movement issues, and that's about vitamin B one, but that's not that common. That's the extreme example, if you like.
I think overall, B vitamins would be a useful thing. That doesn't mean you need to take it long term.
I tend to take what are called activated B vitamins. So it just means that they're in a form that it's easier for your body to use so you can absorb them more readily, and then your body doesn't have to convert them through as many steps before it's ready to be used by the cell.
The other thing is to think about what were you eating and what supplements did you take for the 1020 years of drinking? So are you really low in omega three fatty acids because it's never been part of your life, or it might be while you were drinking, you are really cognizant of the fact that you needed to kind of boost up stuff. So I'm sorry, but there's no one hard and fast answer. You may need some nice liver support, but you could also just get that through drinking dandelion coffee, something gentle. You don't want to do anything really savage. You don't want to do any high dose of anything, really. I think having alcoholiday for a long time has been a stress on your body, and you want to be gentle with it. You want to kind of nurture it back to thriving. So making sure you've got those nutrients for your brain and for your mitochondria. So magnesium and omega three fatty acids, they're the kind of starting point for most people.
I don't have a set. Oh, so you drink. This is what you need to take? Kind of protocol, but, yeah, I think it's a reasonable question. And again, alcohol will reduce, reducing memory, reduce your nutrient absorption. So think about, what's my gut like?
Has that been messed about? A bit. So maybe your approach is doing stuff to make sure that your gut's healthy. So having lots of plant food, having foods, that fibers that support your gut microbiome, that's more important than taking a probiotic.
Perfect.
[01:02:51] Speaker A: Okay, one last question before we let you go. If we did one thing to help ourselves after becoming alcohol free and impairimenopause or menopause, what would that be?
[01:03:04] Speaker B: To be kind to yourself.
[01:03:09] Speaker A: Oh, I just put my hand on my heart. Wow.
[01:03:12] Speaker B: So to not be angry with yourself for drinking and to have some compassion, and then that being in that head space and that heart space will make any other intervention easier. And I think one of the reasons it's hard to rest is because sometimes when you rest and all of that noise and distraction is taken away, that's when your voice comes in and your self criticism and that sort of stuff. So when I say rest, I say almost flippantly, but it's not easy necessarily. So, yeah, I think the most important thing is to have some self compassion. Listen to Kristen Neff and about self compassion, she's got lots of free stuff that you can listen to and listen to yourself.
It might be that what you really feel that you need to do more than anything is get into the ocean.
It might be that you want to eat plants, you really need to eat some veg. Or it might be that, you know that you haven't done any real exercise since you're at school, whatever it is. But to not go into that in a punishing way.
So now I've got to do this to make up for all those years that have been bad. It's like, you weren't bad. You just did a thing that society told you to do, and you did what you did to get through and to manage. And now that you know that, it's not helping, or not helping anymore, or not helping how you like? Cool. Let's just change track. Let's do something different.
[01:04:54] Speaker A: Well, I appreciate that so much. I'm so glad I asked that.
[01:04:59] Speaker B: And I appreciate one last thing to say. One of the things that we know in Australia, and I don't know if it's the same there, but middle aged women are the key growth market for alcohol. In fact, women in general. So the mummy with their sippy cups of wine, mummy dates drinking is a really nasty advertising, but perimenopausal women are the other ones. So groups of women getting together to bitch about their husbands and their job in their hot flushes and drinking wine, but they're also the group of people who are stopping drinking, whether they've had one drink twice a week or a bottle of wine a night, wherever they are on that spectrum, we know that women in perimenopause are stopping drinking, and I think that's because they go, yeah, this is not working.
And because there are people like you who now offer an alternative to a model of alcohol cessation that wasn't working for women.
So that's a really good thing.
Yeah.
[01:06:04] Speaker A: I mean, we're sounding the alarm, right?
[01:06:07] Speaker B: Totally. And not just saying, oh, my God, this is really bad, but saying, and this is what we can do to support you.
Wow. Because we can do without the fear guilt stuff.
Right.
[01:06:21] Speaker A: We do that enough to ourselves.
[01:06:23] Speaker B: Totally. Yeah.
[01:06:25] Speaker A: Just going back to that self kindness and self compassion. That's so wonderful.
[01:06:30] Speaker B: Yeah. We always should start there.
[01:06:33] Speaker A: Yeah. Well, thank you so much. I appreciate you coming on the show and sharing your knowledge with us. How can someone find.
[01:06:42] Speaker B: Ah. So probably the best place is my Instagram. I'm there more than Facebook. And, yeah, I'll have a new website.
I have a couple resources coming up that people might be interested in. And I just have some downloads that are free, like basic perimenopause nutrition, that sort of thing. So you can always get.
[01:07:02] Speaker A: That's wonderful. And it's online, so you can help people all over the world.
[01:07:06] Speaker B: Yeah, I don't have any physical presence anymore.
That sounds weird.
Yeah, it doesn't. It's like I'm a ghost. Yeah, I don't have a physical clinic, so I do everything online now, which is awesome.
[01:07:21] Speaker A: Yeah, I think it's needed.
[01:07:23] Speaker B: It definitely needed.
[01:07:25] Speaker A: I think that's wonderful. So I'll link to your instagram, and then once you're up and running with your new website, people can find you there. Thank you so much, Jane. I appreciate you for having me.
[01:07:37] Speaker B: It's been really great. And, yeah, obviously, I can talk about this at length. I hope I didn't overwhelm people with stuff.
[01:07:44] Speaker A: I think it's going to be really helpful.
[01:07:46] Speaker B: Cool. Great. That's the goal.
[01:07:50] Speaker A: Thank you so much for listening to this episode of the Alcohol Tipping Point podcast. Please share and review the show so you can help other people, too. I want you to know I'm always here for you. So please reach out and talk to me on Instagram at alcoholiday tipping point. And check out my website, alcoholtippingpoint.com, for free resources and help. No matter where you are on your drinking journey, I want to encourage you to just keep practicing, keep going I promise. You are not alone and you are worth that. Every day you practice not drinking is a day you can learn from. I hope you can use these tips we talked about for the rest of your week. And until then, talk to you next time.
