The Perimenopause Symptoms No One Warns You About (And When to Ask for Help)

The full transcript of this episode is below. Lightly edited for readability.

Kelly:

Hi Kelly, thank you so much for joining us on Wellness Simplified. I think this is gonna be a great episode. I know this whole transition period is incredibly confusing for women, and so I’m really looking forward to giving some clarity through this interview.

Dr Kelly Teagle:

Thanks for inviting me. I love to talk about this stuff.

Kelly:

Yay. I really like to start off just by getting a kind of insight into the people, the person that I’m talking to. So could you give me a sense of like what’s your morning routine? How do you start your days?

Dr Kelly Teagle:

Hmm. Yeah, so I’ve actually just in the last kind of 1218 months started to be more intentional around my exercise program. You know, I used to like a lot of people make the excuse about exercising. And then I thought, no, I’ve to start practicing what I preach. So I’m trying to start the day every day now with some kind of movement. So we’re usually going to the gym at least twice a week to do weight training. And then in between, depending on how sore I am or something, it’ll either be a walk, or a little bit of a jog or just sometimes if we’re over at the coast we’ll go for a little walk up the beach to the coffee shop. So yeah, just some kind of movement is what I’m trying to do.

Kelly:

Nice. No, that’s s I love starting the day with movement. Definitely. I feel like it gives you more energy for the entire day.

Dr Kelly Teagle:

and Yeah, and you know, I think particularly with the exercise, I often get too tired at the end of the day and make excuses. So I feel good for the rest of the day. I feel virtuous if I’ve already done it.

Kelly:

Mm, me too. Yeah. Yeah, I’m with you totally. and did you is there any recent habit that you’ve taken on that you’ve been like really positively surprised by how beneficial it’s been?

Dr Kelly Teagle:

Yeah. Well, around that whole movement thing. So I came back from an overseas trip with my partner and where we went skiing and we absolutely loved it. And I just thought, you know, I’ve got to make sure that as I age that I can continue to do this. And I’m just going to have to really double down because, you know, one little injury at our age is so much harder to recover from. And I’m losing lots of muscle mass because I’m now post-menopausal. So I’ve got to really work hard to keep it. So I thought, you know, I’m going to go and see.

Kelly:

Mm.

Dr Kelly Teagle:

somebody who really knows what they’re doing. And I went and found a personal trainer who, who specializes in midlife women, particularly. And she was brilliant because here I’d been going to the gym, you know, most of my adult life, and you know, doing loads and loads of reps on the machines and thinking I was doing such a great job, but not getting any stronger and not really being effective. And it was really just wonderful to get that

Kelly:

Yeah, yeah. Mm.

Dr Kelly Teagle:

input from somebody who really knew what they were doing to teach me no, no, you need to be doing these kinds of exercises and pushing yourself to do heavier and heavier if you want to get stronger. Yeah, so was it was really good. It was an eye opener for me. And I’ve taken that into my encounters with my patients as well.

Kelly:

Nice. I think there’s it’s it’s really empowering for a woman when you get that, you know, of lifting heavy ’cause to start with it can be quite intimidating. I know it was for me, but when you actually start I love it, like I’m totally addicted to liv lifting heady heavy weights now, but for the longest time I wasn’t.

Dr Kelly Teagle:

Thanks. Mm. Yeah, absolutely. It’s, there’s something about, you know, just kind of, I’ve started wearing tank tops because I was always a bit embarrassed about my arms and everything. And so I’m started wearing tank tops because I’m proud of, know, like how my muscles look when they move. And, I’m really proud of like making new PBs, new personal best on my weights and, yeah, so it’s great. It’s good fun.

Kelly:

Nice. Yeah, awesome. and let’s go back to when like Welfame the kind of origin how it all started for you and it started from your own personal experience with c kind of early onset perimenopause menopause. Could you tell me a bit about that journey?

Dr Kelly Teagle:

Yeah, absolutely. So like a lot of women, I was on the pill for a really long time, like probably 25, 30 years, I think. And ironically, I actually suffered from infertility as well, which I didn’t discover until I came off the pill. But you know, what that does being on hormonal contraception for so long, it masks what was going on in the background, which was that I was headed into early perimenopause and menopause. So if I hadn’t have been on the pill, I might have seen the clues of irregularity or my periods stopping, those kinds of things. But in fact, I’ve been on the pill for years and then I swapped over to a marina and marina stopped my periods altogether. So I didn’t have the visual clues about being in perimenopause. And I went through a very tumultuous kind of year or two there in my early 40s separating from my husband. I had two kids under the age of four at the time and I was working very hard as a GP and doing surgical assisting. And as you would expect under those circumstances, I was feeling stressed. was, you know, not sleeping well. I was very snappy, you know, I just did not enjoy my children. I was thinking what the heck is wrong with me?

Kelly:

Yeah.

Dr Kelly Teagle:

You know, I felt really, and I felt guilty and bad that I wasn’t enjoying my children and engaging with them as well. but you know what? It wasn’t until I started to get hot flushes that the penny dropped finally that actually maybe this is not just maybe being a cranky bitch is maybe actually more to do with hormonal changes. and that was a real, real eye opener because then, you know, beyond that, when I did get my marina out, it was pretty clear what had happened.

Kelly:

Mm.

Dr Kelly Teagle:

So I was very lucky because we’re talking quite a long time ago now, goodness, 16-ish years ago. I was 42 when I actually hit menopause and so my son was only one year old. this was like one year after I’d given birth. Yeah, very, very early. And if I hadn’t have had that medical knowledge from being a women’s health doctor, I may not have even picked it up at all, but I was really shocked at the fact that I, you know, I didn’t even think of it as what could have been going on with me. And perimenopause wasn’t actually a thing, nobody was really talking about it. There wasn’t really a word for it. was just, you know, nobody really knew much about the hormonal changes. So I’d have gone to another doctor and said, could this be related to menopause? I might have gotten the standard line, which is, no, you’re still having periods, it can’t be anything to do with that.

Kelly:

Hm.

Dr Kelly Teagle:

But, know, because I actually had colleagues who worked in that space and I was working as women’s health doctor, I was able to access good support and good information and good treatment and it was just transformative. And that, you know, that led to me realizing how much of a need there was and how much of a difference that that can make to people’s lives. And then, you know, fast forward. a little bit after that. you know, maybe another in the next five years, I was doing a lot of menopause work because of my experience, and noticing that women were traveling quite a long way to see me. And that really, if they were well looked after by GP in their own area, I didn’t really even need to touch them, you know, like they’ve had their blood pressure done, someone’s regularly checking on their heart and their weight and this and that. So I didn’t need to do that much other than just talk to them, explore their symptoms, add that layer of expert advice over the top of what their GP could. And that was what sparked the idea of, I could have done this over the phone. I could have done this by telehealth, which was a very new thing back then. You were talking sort of 2016, 2015. There were a few places doing it, but not very many places doing it. So yeah, it was…

Kelly:

Hm.

Dr Kelly Teagle:

probably over the next few years, sort of chewed on that a little bit. then I finally, by 2018, I thought, yeah, no, this is something that’s worth exploring. And so I started seeing telehealth patients from my home office in my bedroom, actually, cobbling together all of these disparate computer and software systems that weren’t really designed for that. And it was slow going. The first three years, probably I was working by myself.

Kelly:

Ha ha.

Dr Kelly Teagle:

But of course, what changed everything for telehealth was COVID, wasn’t it? Because people got used to medical type business, valid medical type business by internet. And up until that point, I’m pretty sure all my patients thought, am I a real doctor or not? yeah, real doctors don’t do this.

Kelly:

Just a lady in her bed. Yeah, yeah.

Dr Kelly Teagle:

And there was no Medicare rebates or any kind of support. So it was very expensive, you know, to deliver an hour’s worth of care to somebody with no Medicare rebate to be able to continue to do it. You have to charge, you know, quite a reasonable amount of money. So yeah, it was a bit of a struggle. But, know, after COVID, I was able to, you know, find other doctors like myself who felt passionate about midlife women’s care. And we banded together and now we’ve got know, 17 of us, I think it is and growing all the time. We’ve seen, we’ve seen 12 and a half thousand patients in the last seven years. Yep.

Kelly:

Amazing. And I Wow, wow. Huge demand. I I think like the story that you just described must be so common and you must now hear that so often of about women feeling really, really confused in that period and not knowing, you know, I as you mentioned, it’s only recently that there’s been this whole conversation about perimenopause, or at least that it’s gained, like it’s gaining in at least in where I live, quite a lot of traction.

Dr Kelly Teagle:

Hmm. Mm.

Kelly:

But yeah, I think that period is i incredibly confusing. And you talked about, you know, feeling guilty, and I it brings up anxiety, so many emotions. Like do I do you see that a lot of the same sort of things in your patients?

Dr Kelly Teagle:

Absolutely. You know, the, the commonest kind of comments that we hear of women coming in at this stage of life is, think I’m going mad. I don’t know what’s wrong with me. I just want to feel like myself again.

Kelly:

Oof, I felt that when you said that, ’cause yeah, I I understand that. I felt that myself. I’ve heard friends say it, like, yeah, that’s it, right? Exactly. I’ve lost myself. Yes, totally. Yeah.

Dr Kelly Teagle:

They just feel like they’ve lost themselves.

Kelly:

And that’s so hard. Like these are amazing women who then like and it doesn’t feel and I like you said, it’s when you don’t understand why. Once you understand why you’re empowered, but it’s that period when you don’t really understand why that’s, yeah, scary and

Dr Kelly Teagle:

Yeah, yeah. Yeah, and look, you know, unfortunately, classic GP training has not included good information about menopause. GPs are, you know, pressured for time and women when they come in, they’ll have one or two priority symptoms that may not actually be connected to menopause or the menopausal transition by their doctor. So it gets, it gets ignored, the conversation doesn’t come up and the patient even if they do bring up the fact that you know, they suspect it’s hormone related. Oftentimes they feel invalidated or gaslit or you know, not well supported because the doctor hasn’t got the time or knowledge or confidence to enter that conversation with them. So you’re really what we provide at Wellfemme. I mean, you know, we’ve got some amazing doctors, don’t get me wrong, who have fantastic medical knowledge. But I think what makes the difference is that we’ve just created this space where we can do long format consultations, take the time, build that connection with the patient. And believe me, even through telehealth, you can actually really make a good connection with a person. It really helps that if you can see them and you know, gauge their their expressions and things like that. But just them feeling connected, you know, with somebody else understood seen and heard. validated and somebody who will with the information provided engage them in shared decision making. That’s just so empowering when you feel like you’ve been out of control of your body and your life for a while.

Kelly:

Yeah, definitely. And I’m interested you run like a survey, a symptom tracker, which has a lot of symptoms on it. Can you talk to me a bit about kind of the range of symptoms? ‘Cause I think people just typically think hot flushes or weight gain and they don’t really realise how many things can actually be symptoms.

Dr Kelly Teagle:

Hmm. Yeah. you Yeah, absolutely. Look, the classic type of rating scale that’s used in menopause doctor space is called the modified green scale. And there’s 20 questions on there 20 symptoms, which you write from zero to mild, moderate, severe, and we sort of get a number. And it’s look, it’s just a ballpark indicator. But unfortunately, it’s a bit of a blunt instrument in that it doesn’t really include a lot of the perimenopausal type symptoms. which tend to be brain fog and memory loss or irritability, things like that, things that related to cognition, particularly, are not really well covered by that. So we do use it because it’s so widely used in menopause medicine that we kind of need to use it so that when we’re talking to other menopause doctors, everyone’s on the same page. But having said that, I think it’s really useful for patients to work out themselves what are their priority symptoms and track those. So just to put it all in context, when you talk about the menopausal transition, I like to call it the menopausal transition, rather than splitting it up into stages because it’s such a continuum and there’s so much crossover with the symptoms at each stage. So think about it like this, so even while you are still having a regular reproductive cycle if you’re lucky enough to have ever had one because some people don’t. But even while you’re still having periods, you can start to get subtle shifts in the reproductive hormones that really start to impact on symptoms. So this is where the problem has been in the past is because women are still actually having a cycle, having periods in some shape or form, that doctors have said to them, well, this can’t be related to menopause because you haven’t stopped ovulating yet. The reality is that as you come into early perimenopause, your ovaries, even though they might be still ovulating regularly, they’re becoming less efficient at producing progesterone. And so you start to get this shift in the balance between the amount of estrogen and progesterone. And we do find the more common symptoms in perimenopause, particularly as you progress along towards menopause, is that people start to notice worsening premenstrual mood. issues or migraine, for example, even if they’ve had migraines in the past that were hormonal, they might get worse over time. Their periods might get heavier and heavier, which is indicating that there’s a bit of a, you know, there’s more estrogen really than there is progesterone to help kind of manage it. So those sort of things are more common. Definitely the mood issues are way more common in perimenopause than at any other stage and what we find is that women who have had a history of mood disorders will find that they come back with a vengeance and maybe worse than ever. And women that have even never had mood disorders, never really suffered from anxiety or depression or PMS might start to experience them for the very first time. So that’s very characteristic of perimenopause. And then as you progress through perimenopause and you’re getting closer to actual menopause, which is when you run out of eggs and you stop ovulating, you’ll find that the further on you go, the more likely it is that you’re going to start to see changes in your cycle. So the cycle could get shorter or longer. You might start to skip periods because you’ve skipped ovulation. So it can become quite erratic. And when you do have periods, they can be floodingly heavy. And then the next ones may be hardly there at all. Lots of variability in menses. if you actually have them because a lot of women have had some kind of surgical procedure or had a marina or are on hormonal contraception which kind of masks it like it did with me. So you may not get those visual clues from your cycle. So then you hit menopause and menopause is really diagnosed looking back after 12 months of not having any ovulations or periods.

Kelly:

Hm.

Dr Kelly Teagle:

Again, pretty hard to diagnose in some cases if somebody’s not actually having periods and it’s not really very aware of cyclical symptoms or feelings of ovulation. So it’s a little bit rubbery, but to tell you the truth, when it comes to treating symptoms, it often doesn’t really make much difference whether they’re actually officially menopausal or not, know, the approaches are often the same. So, yeah.

Kelly:

Hmm. As you were saying that I was thinking of you know, it’s one thing that we’re seeing an increase in awareness or in women, I feel, but it seems to me as you’re speaking like there needs to be a greater awareness in general, you know, in workplaces for men, you know, like that for example, what you were saying about the hormonal shifts that actually create increased anxiety or increased irritability.

Dr Kelly Teagle:

yes.

Kelly:

or brain fog, like things that impact, like really can seriously impact pe women at work or relationships and so forth. And so that kind of education needs to be broader than it probably is at the moment.

Dr Kelly Teagle:

Mm. Absolutely. And you may be aware that the government has finally launched a public awareness campaign around perimenopause and menopause, which is super important just to get the conversation started and you know, put it out there as a normal life stage that you know, hey, maybe think maybe think about this as one of the things that could be going on. In terms of the mood issues in particular, this is this is probably the thing that causes the most sort of, I guess, hassles and potential trauma for people is the mood issues. You might be aware that the highest rates of completed suicide are in women in the 45 to 55 year old age group, which coincides with perimenopause. Yeah. And we’ve seen a lot of cases of that in the media. There’s a really great

Kelly:

Wow, that’s so sad. Yeah, yeah. Yeah.

Dr Kelly Teagle:

charity foundation called the Debbie Gawnt Foundation run by her husband. Debbie unfortunately took her own life during very, very suddenly and unexpectedly during perimenopause. So there’s a lot of people who are pushing for greater awareness around that. And definitely the public awareness campaign will help. But we’ve just got to keep talking about it. Yeah. And so just to finish off the, you know, about the,

Kelly:

Mm. Yeah, definitely.

Dr Kelly Teagle:

kind of end to end, I suppose, natural history of menopause. After menopause, interestingly, mood symptoms actually mostly seem to level out quite a lot. And I guess it kind of makes sense when you tie the emotional instability of perimenopause with the hormonal instability. You know, it really impacts on the brain and causes all those brain related symptoms. you know, sleep disturbance, flushes, irritability, headaches, all of those kinds of things that we’ve been talking about the mood issues, they’re all originating in the brain. And it’s to do with that chemical imbalance that comes from the hormonal imbalance. So it kind of makes sense when you think about that, that postmenopausal when you’re no longer ovulating, it’s a lot more stable, like the estrogen is low, very low and pervasively low for a long

Kelly:

Hm. Yeah.

Dr Kelly Teagle:

time thereafter, but stable. so women do report that their mood gets much more stable and they are more content postmenopausally. So that’s something to look forward to. Yeah, the thing that we have to be really mindful of though, is that because of that low estrogen that continues on thereafter, that has a lot of physiological effects, consequences, bone loss, rise in heart disease risk and dementia risk.

Kelly:

Something to look forward to.

Dr Kelly Teagle:

And you’ve got to remember that dementia and cardiovascular diseases are the equal highest killers of women in Australia, two thirds each of those things. That everything else is the other one third. And one other thing that I really want you to understand is that the longer you are past menopause with low estrogen, the more likely it is you’re going to have genitourinary symptoms related to low estrogen.

Kelly:

Hmm. Yeah.

Dr Kelly Teagle:

So thinning and drying of the vaginal tissues, which can lead to them being more easily damaged, pain during intercourse, difficulty becoming aroused and lubricating, and urinary issues, which are super, super common. know, two thirds of women in their sort of 50s and 60s are going to be experiencing urinary problems, if not more. And these are often very, very treatable. So it’s really worth knowing that it’s

Kelly:

Mm.

Dr Kelly Teagle:

quite likely that you will experience that if you’re lucky enough to live well beyond menopause and that they’re well treated often with even just with vaginal oestrogens rather than using hormonal treatment.

Kelly:

Okay, well, we do not want any of those, so let’s jump into treatment. But before I do jump into treatment, I’m just curious, just so people can get a sense, like what’s the general like I know it’s different for each woman, but what’s the age range of that transition? and is it impacted, is it purely genetic, or it seems like from what your story, and it makes sense to me that it’s all like what’s the it’s also lifestyle. So what’s the balance between lifestyle and genetics as far as when a woman

Dr Kelly Teagle:

Yeah. Yeah, yeah.

Kelly:

goes through that transition.

Dr Kelly Teagle:

That’s a really excellent question. And do you know, I’m, I don’t think that we are actually fully at the bottom of that. I do think that genetics is probably the lion’s share of it. But there are other what we call idiopathic cases where we’re really not quite sure. And that was the case with me. You know, we’re never really quite sure why some people run out of eggs sooner than others. But, you know, how, how young or old your mother was going through. can be bit of an indicator. The age of your sister, if you’ve got an older sister, is probably a bigger indicator than even than your mother, because your sister is going to be more closely resembling you genetically than your mum. That is if you had the same data, I guess. Yeah, so that’s an important point. The average age of menopause for Australian women is 51. And so what we we find is that the Most women will go through between the ages of 45 and 55, but about 10 % will be either side of that. So they can be younger or older. 1 % will even be less than 40 when they go through it. And that is super important to identify. So for anybody who has experienced this or knows someone who has, if you have a long period of time, other than pregnancy, is, where you are naturally not having periods or you lose your periods, you lose your ovulations, and you are experiencing really, really low levels of estrogen as a result. If this is happening at a really young age, then that means that you could be deprived of estrogen for a decade or more longer than the average woman. Now think about the impact of that when we know that your bone loss accelerates at menopause. Imagine if you’re going through that. in your 30s or even your 20s rather than, you know, in your 50s and what the knock on impact of that is. You’re to have bones like chalk by the time you’re in your 50s and you know, be a sitting duck for heart disease and you know, osteoporotic fractures and all sorts of things. So it’s really important not to sit on that. You know, lot of people go, yeah, I haven’t got any periods, but you know, I don’t know why, but you know, I don’t miss them at all. But

Kelly:

Yeah. Yeah.

Dr Kelly Teagle:

under the surface, there’s a lot going on. call this, if it’s under the age of 40, it’s called premature or primary ovarian insufficiency. And it’s a really serious medical issue that needs to be followed up.

Kelly:

Mm-hmm. okay, let’s go into first of all, we talked about all the symptoms, but do you also do blood t blood tests and which ones and w what other kind of diagnostic tools do you recommend or in practice?

Dr Kelly Teagle:

Well, from listening to me talking so far, you’re probably starting to realize how blurry the lines are between the different stages of menopause and how clear cut it really isn’t a lot of the time. And to be honest, bloods can really make that worse. Bloods can be really misleading. So the thing about, I had this graph that I like to put up when I’m doing presentations, and it shows that in the reproductive years, if you’re lucky enough to have a regular cycle, that is,

Kelly:

Right.

Dr Kelly Teagle:

You’ve got this beautiful rhythmic dance of the estrogen and the progesterone going along beautifully cyclically. And then at the other side, you’ve got this flat line like a dead patient or something that’s really low. But in the middle, you’ve got spaghetti. In the middle of the graph, the perimenopausal time, and this is why I say it really impacts on the brain, is that the levels are changing often within…

Kelly:

Yeah.

Dr Kelly Teagle:

day to day, you know, they can be quite different. you know, we don’t know when we do a blood test, have they been stable like that for a while? Are they on their way up? Are they on their way down? You know, you could actually get a snapshot of blood tests that looks really perfectly normal, or you could get one that looks really badly abnormal, like as though you’re well postmenopausal, but you’re actually still having periods. So it can really be misleading. And so I don’t find that really helpful at all. If we are treating, know, or suggesting a treatment, hormonal treatment, it’s based on our clinical experience and observations of pattern recognition. You know, we know roughly from the history, often quite precisely from the history, what stage of the peri-, the menopausal transition the woman is likely to be in. And really it’s the symptoms themselves that are guiding us in what sort of treatment is going to be the most useful, not whether or not she’s actually finished having ovulations. The thing that does make a difference here is whether or not she needs contraception. So, you know, that might be one scenario where we absolutely have to do some blood tests and prove menopause before, taking someone’s marina out and putting them at risk of unwanted pregnancy. So sometimes the blood tests are needed if we are treating someone with testosterone because we have a TGA approved product for women in Australia for a hyposexuality disorder, which is fabulous. We’re one of the few countries in the world to have this. It’s not on the PBS yet, sadly. But anyway, it can be quite effective if women have hyposexuality disorder, but it’s very, very important that we don’t over-treat and put them into the male hormone range because nobody wants irreversible voice deepening, hair loss, growing a beard, acne, weight gain, no one wants that. So in that situation, we will also track with bloods to make sure we’re keeping them in the safe female range. But yeah, there’s very few scenarios where it’s really important.

Kelly:

Right. Yeah.

Dr Kelly Teagle:

for treatment success.

Kelly:

And how does that work? I was gonna go first to natural, but while we’re talking about it, let’s jump straight into bioidentical hormones. And well first of all, maybe you can take a step back and you can just talk to me about how they work, what they are, and I then I have a couple of other questions.

Dr Kelly Teagle:

Yeah. Yeah, sure. So I think there’s a lot of confusing terminology in this space. And a lot of the reasons that women will give for not wanting to seek treatment is because they make this, they have all these assumptions about what hormonal treatment is, what the risks are associated with it. There’s a lot of mythology and misinformation going back to some big studies that were done at the turn of the century. which really put women and doctors off the use of MHT. So doctors became de-skilled in prescribing it. Patients stayed away from it, you and if a doctor tried to prescribe it, they’d go, you you’re trying to kill me, you know, why would you give me that? So there was a lot of bad press around hormonal treatments. And a lot of women think that hormones aren’t natural. You know, I want a natural treatment. So they will… go and use any manner of unproven types, herbs and supplements and things like that. But I mean, nothing’s really more natural than the hormones that your ovaries have been producing for decades when you think about it. And we are lucky enough these days to have what we call body identical hormonal treatment products, which have been really well tested, rigorously well tested, gone through the TGA approval process. And we have a very clearly defined set of tests that have been done on those drugs. we really know how, sorry about that, we know how the side effect profile is likely to go and what the risks are associated with that, because you have to prove all those things to get TGA approval. So we actually have… very natural body identical hormone products, which haven’t really been shown to significantly increase breast cancer risk at all, unlike the mythology. And yeah, it’s quite good to have those now in our arsenal, as opposed to, you back in the 80s, 90s, they were all synthetic products, some of them produced from Maers urine, which women are horrified by. So those were… there were synthetic progestins, which was like a synthetic form of progesterone rather than actual natural progesterone, which we now use. So there’s this difference. then you’ve got, so you’ve got body identical, which is what we prescribe at Wellfim. When it comes to bioidentical, what people are usually referring to is compounding. And that’s a different thing again. So they, I don’t quite understand why people think that compounded hormones are any different than the body identical prescribed ones because they aren’t. But the difference is that with compounded products, there’s very little in the way of certainty around the quality assurance, you know, what the dose is consistently, consistency and testing around the side effects and harms. So the problem is, it’s a bit of an unknown quantity. because nobody’s actually regulating what’s going into those and it’s done very, very differently, perhaps from one compounding pharmacy to the next. So that’s why you’ll often hear in the media about testing being done on products and they find that there was none of the main ingredient actually in there or too much of it. And the risk there is that we know if you don’t get the ratios of estrogen and progesterone correct,

Kelly:

Mm mm.

Dr Kelly Teagle:

you can get over thickening of the lining of the uterus, which can put you at risk of endometrial cancer. So it’s super, super important that you actually get good advice to make sure that you’re getting the right ratios of these things. Anytime anyone tries to give you a cream that you rub on your skin to get progesterone, it doesn’t work. You don’t absorb progesterone through your skin. So again, puts you at risk of endometrial thickening.

Kelly:

So you’ve just told me something which I’m actually taking. We’ve got it live on air. I should come and see you, apparently. I always like to use myself as a guinea pig. Interesting. I’ve never actually heard of this body identical versus I’ve always heard of bio identical. You’re blowing my mind that right now.

Dr Kelly Teagle:

okay, right. I think you should go and get some advice from an evidence-based doctor. Yeah. Yeah, bio identical really just refers to usually it’s because people have gone to integrative practitioners or somebody who prescribes compounded products and they they sell it to you on the basis that they’re individualizing the recipe to you and it might contain estrogen and you know, some form of progesterone from yams or something and some testosterone and they’ll tweak it according to your personal needs. And I’m afraid I’m not very up with salivary tests or any of that kind of stuff. We don’t use those. And they don’t really, they don’t correlate well with serum levels of hormones or treatment success or even reflect people’s level of symptoms. So it’s not really very helpful. But I definitely would recommend to anybody who is currently using compounded products, just have a think about What is it that you’ve been told about those that makes you think that they are better or safer or more natural than the sorts of products that we have now? And I’d suggest maybe go and do a little bit more research or talk to a doctor who’s menopause informed and knows the evidence base for those things.

Kelly:

Hmm, is there any like reports or anything that compare the bio identical or the body identical that we can put in the in the resources? ‘Cause I’m imagining lots of people, myself included, are kinda wanna research some more.

Dr Kelly Teagle:

yeah, well, the problem, the problem with bioidenticals is the fact that they, you know, they’re not, the testing can’t be very consistent, but I’m sure that there are lots of studies and things. I would have to do a bit of perplexity search or something to get the references for you, but I’m sure that there would be something in there.

Kelly:

Yeah yeah, yeah, yeah. I could do Yeah. Hmm. And okay, and another thing that you said that was really interesting was that you said progesterone specifically isn’t absorbed as a cream, but earlier on you mentioned about a vaginal est estrogen cream. So what is so estrogen is absorbed via cream, but progesterone’s not? Like could you talk to me a bit more about the application method?

Dr Kelly Teagle:

Mm-hmm. Yeah. Well, with the caveat that I’m not a biochemist or anything like that, so I only know what I’ve been reading from the testing and things like that. So the reason why micronized progesterone has to be given either orally or vaginally as a little gel capsule is because you can’t get good absorption. It’s not stable in the form of a cream or a tablet.

Kelly:

Sure.

Dr Kelly Teagle:

The synthetic progesterone you can have in a tablet form, but not so much the progesterone. has this like an, in an oily suspension, is in this little gel cap. So we use micronized progesterone in that form. And so if you’ve got somebody who’s got say a patch that’s the same, but I’ve got my estrogen and progesterone in a patch, what they’re actually referring to is that there’s a synthetic version of progesterone called a progestin in that. it’s probably norathisterone. Yeah, so that’s the difference there. Oestrogen is absorbed well through the skin and that’s why we have a lot of transdermal products and we always, wherever possible, will recommend transdermal oestrogen first line for our patients because we know that there’s less risk of unwanted blood clots and strokes when oestrogen is used through the skin as opposed to orally. So if anyone’s out there who’s over the age of 50 on a combined birth control pill still, you need to be getting yourself off that because you have an increased risk and unacceptable risk of unwanted blood clots and strokes if you’re still on those oral oestrogens in the pill over that age. It’s a bit different with hormonal treatments. So if you’re a low risk person, then the types of estrogen that we use in tablets, in the doses that we use are not as high risk as the birth control pills, but still a small risk compared to transdermal. So definitely depending on a person’s medical history, we will definitely be leaning towards one type of treatment or another. But wherever possible, I’m recommending transdermal treatment like patches and gels as a first line. And as I said, you can use vaginal estrogen. directly on the vaginal tissues and genitourinary tissues and it’s very powerful and works very well.

Kelly:

Hm, cool. And I’ve also heard of estrogen and face cream. Like is that just a gimmick or is that a thing?

Dr Kelly Teagle:

We don’t actually have one in Australia. We don’t have any estrogen face creams at all in Australia. And the the estrogen cream products we have haven’t been formulated for the face. If you want to read a little bit more about that, we did do a blog post on Wellfem about, you know, what are the risks of using estrogen on your face. But the problem largely is that we just don’t know what the potential harms are. And and some of the cream preparations that are available, you want to look at whether the co products in there are going to be harmful to the skin and whether the dose that you’re getting is likely to be a problem for the lining of the uterus. There’s many, many unknowns that just haven’t been tested yet.

Kelly:

Yeah. It must be, I imagine, tricky to get the you talked about the importance of getting the dose of the hormones correct. I imagine that that must be particularly hard in that period that perimenopausal period because as you said, like it’s like sp I think you described it as spaghetti, like if you look at the blood test. But but

Dr Kelly Teagle:

Mm-hmm.

Kelly:

If you’re just looking at symptoms, like how do you factor in then all the all the other things that are happening in her life, whether it’s a stressful event or like everything else that correlat that’s happening at the same time? And then also if she’s on some kind of birth control, then you can’t be actually measuring periods as much. Like how do you deal with that to get that really accurate measurement?

Dr Kelly Teagle:

Yeah. Accurate is not necessarily a word I would use in this space. I find working in this space is very much art of medicine territory based on listening to the woman’s story, the pattern recognition in the history, just observation of lots and lots of patients who are going through similar things and offering options to people. So it’s hardly, you know,

Kelly:

Mm-hmm. Interesting.

Dr Kelly Teagle:

precision thing. mean, the guidelines will certainly say if you’re having this much estrogen, you should have this much progesterone to balance it out because that’s what the studies show will give you good endometrial protection. But when it comes to whether or not something’s actually going to help your symptoms, there are just so many variables as you just described. So we don’t know from person to person how one individual person’s body is going to react to a type of hormonal preparation until we actually try it. When I see a woman in perimenopause who has got all this stuff going on, know, lots of irritability and mood, you know, she’s got mood issues and she’s got sleep, broken sleep and all of these kinds of things going on. You know, we’re talking about the entire context, we’re talking about what’s going on in your relationships, what’s going on in your work situation. Do you have concurrent health issues? What medications, drugs, alcohol are you using? All of these things. Because I don’t know, just from looking at somebody and hearing their story, how much of their symptoms are related to the hormonal changes and how much of it’s related to everything else.

Kelly:

Yeah, yeah.

Dr Kelly Teagle:

And it’s impossible to know. So I’m very frank with my patients in saying that I’ll say to them, you know what, I have no idea like how much of your symptomology is related to hormones specifically. And we won’t really know until we try. So here is a range of options that I’ve observed that have worked for people before. These are the pluses and minuses. You know, what are you drawn to if anything, what would you like to try? And It’s really interesting for me as well when they come back to see, you know, what’s what’s helped what hasn’t helped. Sometimes if we’re seeing the beginnings of a good trend, might signify that we need to add more of something. But it’s very, very different from woman to woman. You know, sometimes if the main problem is mood issues in the lead up to to their period, and if they’re some of them are very dreadful, like We know you might’ve heard of premenstrual dysphoric disorder, which is a really, really severe kind of PMS where women can become almost suicidal on a monthly basis. So if women have a really terrible time with premenstrual mood issues, sometimes the best approach is actually to suppress their ovulations altogether. So we’re not putting them into a medical menopause or anything, but it’s kind of like, we use… birth control pills in this space that don’t have oral estrogen in them, because it just means that when they’re not ovulating, they’ve got that background stability in their hormone levels. And then we can kind of sit back for a minute and go, right, what symptoms do you have left? What else is likely to, you know, should we give you a bit of progesterone? Are you getting flushes? Are you getting sort of muscle aches and pains? Like what could we add next here that might help? And of course, overlying all of that is the lifestyle stuff. We’re not jumping for these hormonal treatments as the first line. The initial recommendations are always gonna be around optimizing lifestyle. What are you doing with your sleep routine in the evenings that might be interfering with your ability to get a good night’s sleep? Because there’s no point treating hot flushes if the person’s still gonna be up half the night reading on their…

Kelly:

Totally, totally. Yeah.

Dr Kelly Teagle:

you know, their iPad or something like that and disturbing their sleep or they’re drinking enormous amounts of caffeine before bed.

Kelly:

I think that’s with everything. Like pretty much no, actually, every single interview I’ve done, it just you know, go it really hammers that home. That forget all the fancy stuff. not that I’m saying that body identical hormones are fancy, but forget anything unless you’re really also including the fundamentals, which I’m about to jump onto. But before we do that, just two more questions. One i around this, we talked about how a lot of the risks of body identical hormones have been

Dr Kelly Teagle:

Hmm.

Kelly:

subsequently dismissed. But there are still some risks. Could you talk me through those?

Dr Kelly Teagle:

absolutely. Nothing is ever without risk. And the other tricky thing when you’re on any kind of medication is if you do have some kind of side effect or incident is, was it actually related to the medication or not? Because you can’t be sure. As an example, let’s talk about breast cancer. So The average woman in Australia has a one in seven lifetime risk of developing breast cancer. And that’s regardless of use of any kind of hormonal treatments. So the important thing, which I tell my patients all the time is that I can’t promise you you’re not going to get breast cancer being on this treatment because one in seven of my patients who are being treated by me are going to get breast cancer because one in seven in the community are going to get it. The important thing is that

Kelly:

Yeah.

Dr Kelly Teagle:

when it comes to the risk benefit analysis that we are mitigating as much risk as we absolutely can trying, you know, doing everything we can to prevent and do early detection. Because as I said, the modern body identical products like micronized progesterone haven’t been shown to significantly increase breast cancer risk. But the thing is, if you are the one in seven, and you start to develop a breast cancer, which could have had a lead time 10 or 20 years ago in actually starting to form, we need to detect that breast cancer early at the earliest possible stage, because if it’s hormone dependent, which a lot of them are, and you merrily go on your way, blissfully ignorant, continuing to take your hormones, you could accelerate the process. So it’s not that that treatment caused the cancer, but it’s still a player in the sense that we have to be really rigorous about early detection. And that’s why I’m absolutely militant with my patients about getting them to do their breast screening and preferably monthly breast self examinations on top of that because two years is a really long time between breast screens. And of course, know, getting diagnostic testing done if they need to as well, if they’ve got a lump.

Kelly:

Yeah, definitely. and just one other thing I forgot to ask you in that kind of perimenopause symptoms. what about when estrad estradiol, I think it is, gets really high in that period and the whole issue around detoxification. What’s w how do you treat that?

Dr Kelly Teagle:

Mm-hmm. Yes. Tell me what you mean by detoxification.

Kelly:

So what I’ve read I and also experienced myself in that period of that that initial transition is that estradiol can actually be increased. and like the issue about your body’s ability to detoxify it.

Dr Kelly Teagle:

Mm hmm. Well, I have to say we don’t dabble in in that kind of treatment like the detoxification concept is not something that’s, you know, in conventional medicine at all. I guess what we’re looking at is if the woman has symptoms and signs of having an estrogen, excessive estrogen for whatever reason, maybe it’s breast tenderness, floodingly heavy periods, whatever else is going on. we’re kind of looking at a range of ways of helping to counteract that, I suppose. So if the woman is amenable to having something like a marina or using the ovulation suppression type approach with the pill, you get that much more level type of background levels of estrogen that aren’t kind of going super high and then plummeting down, which is when you tend to get the flushes.

Kelly:

Good job.

Dr Kelly Teagle:

you know, often in those cases in perimenopause, particularly, I will even, you know, do off label type of treatments, like using the progesterone by itself, because estrogen isn’t the problem for that woman. You know, she’s clearly got, signs that she’s got lots of estrogen on board. She’s, she’s, you know, ovulating fairly regularly or having periods. she’s getting floodingly heavy, heavy periods. and so it’s. becomes clear to me from the pattern of symptoms that she’s not low in estrogen and she’s probably not having terrible hot flushes. So oftentimes we will go, okay, well, let’s just see what happens when we give you some progesterone. At very least it might help to help you sleep better and you know, it’s calmative and sedative and it’ll probably help to make your periods a bit lighter. So, you know, it depends on the situation, but no, it’s not, we don’t put them on some kind of estrogen dialysis or anything to get it out of their system.

Kelly:

No, no, I didn’t read that. I haven’t heard of that one. let’s go on to the like the first line as you said, the first line is looking at those kind of fundamentals and you started with sleep. So let’s dive into those natural levers. Sleep and recovery to start with. What do you recommend? Like what is it that you’re recommending to your clients?

Dr Kelly Teagle:

Mm-hmm. Well, so it’s like anything else, you know, we’re doing a very long holistic assessment. And then, you know, my first approach, because even even a 40 minute consult goes by pretty quickly, if you’ve got a lot of issues. So my first approach there is to go, what are your top symptoms? What are your top three things that you would really want to see some improvement in? And then we tend to focus in on those, at least in the first, you know, treatment phase. And so if it’s sleep,

Kelly:

Yeah.

Dr Kelly Teagle:

I’m taking a bit of a sleep history. Have you always been a bad sleeper? Because if you’ve always been a bad sleeper, then that’s the cardinal kind of risk factor for being a bad sleeper in midlife and older age as well, isn’t it? You know, what’s your sleep routine like in the evenings? Are you having trouble going to sleep or you’re having trouble staying asleep? Are you aware of being woken in the night by the need to go to the toilet or because you’re having hot flushes? Or do your hot flushes start when you wake up in the wee small hours and they come on as a result? So it’s getting that really thorough history about, you know, what’s going on. I mean, if they’re super, super stressed, well, you know, kind of that’s always, always a player when it comes to sleep disturbance, if they’re drinking too much alcohol or using drugs. So that stuff is critical. We have to sort that out or there’s no point, you know, even trying any hormonal approaches. Yeah, so I think it’s pretty intuitive, I would say. You know, there are occasions where, well, quite often with midlife women, you would imagine that a lot of them have sleep disorders like sleep apnea or snoring and things like that as well, which have to be actually investigated by their local doctor. or maybe a sleep study, things like that. But there are some screening tests that are readily available, which we actually have in some resources on our Welfare and website.

Kelly:

Hm. And I imagine like dealing with stress is the top one because of the hormonal fluctuations and how they actually like make women more susceptible to that.

Dr Kelly Teagle:

Mm. Yeah, yeah, for sure. It’s, it’s a bit chicken and egg. Often, oftentimes, people come in because they’re exhausted, and they’ve got brain fog, and they’ve got flushes, and they’ve got this and they’ve got that. And, you know, it’s hard to know where that cycle started, but it becomes a downward spiral. You know, the more exhausted that they get, the worse the flushes become, the more sleep disturbed they become, and the worse that more exhausted they become.

Kelly:

Mm, mm.

Dr Kelly Teagle:

And then of course they’re craving carbohydrates because they’re exhausted. their diet starts to go loopy. They might be a prime candidate for insulin resistance and metabolic diseases. So, you know, the important thing is at that critical time around menopause, if you can catch hold of all of that, you’ve got this really critically small window of opportunity to really set some things in place. there and then that will really have a powerful knock-on benefit to prevention of chronic disease, but it’s a narrow window. If you let yourself get too far beyond menopause without dealing with those, then actually all of those processes have kicked in and at some point it even becomes unsafe for you or less safe certainly to start hormonal therapy as a result.

Kelly:

Yeah, yep. and what about other kind of the fundamentals? Are there well you mentioned at the start about for yourself exercise and of course lifting heavy. are there specific other movement or diet recommendations that you give your clients?

Dr Kelly Teagle:

and Yeah, yeah. So once once I’ve seen people a few times, and we’ve kind of got their treatment on track, then I’m starting to zero in on okay, well, we’ve got increased energy levels, you’re sleeping better, you’ve got increased capacity now you’re enthusiastic about, you know, your life again, how can we convert that to action, even small little actions that are going to really yield the biggest results for healthy aging. And I think for post-menopausal women, the really big ones is the cardiovascular disease, the dementia, the bones, we have to stay really focused on that. So my new mantra, which is probably mimicking Mary Claire Haver to an extent is being strong, not skinny. If you’re not, you’ve got to build that muscle around menopause and get those habits to maintain it. Because once you get… into your 70s and beyond, you can’t keep it on your muscle mass just like just falls off you and and bone massed windows really quickly. So we have to shore that up and have the habits in place to maintain it nice and early in that process. So absolutely movement is non negotiable. It has to be in there. It just in terms of prevention of chronic disease, all kinds. It’s really powerful. You know, decent activity levels will

Kelly:

Mm, mm. Yeah.

Dr Kelly Teagle:

reduce your risk of dementia very powerfully as well as bone loss and muscle loss. So the lifting, you know, will really help with your muscles and bones. Pliometric exercises where you’re like jumping up and down a little bit, whether it be skipping or jumping down off a bottom step or a box or whatever you like, those are really powerful at keeping bones strong. Flexibility and balance are often neglected. But you know, when you think about falls risk, which increases your risk of fra- It’s really super important that you’ve got great balance and flexibility really helps with keeping the joints gliding properly to help you prevent from getting arthritis and all of those biomechanical issues later. And of course you need some cardio. You need to get your heart racing a little bit and be breathing hard every single day to help prevent cardiovascular diseases. So there’s those kind of five main key movement types that I would recommend. And protein, in terms of diet, protein is the really big one. And you’ve probably heard this hammered over and over again. But for somebody even just like me, who’s moderately active, I need about, you know, 1.2 to 1.5 grams of protein per kilo per day. So for me, that’s like 19 grams, 90, sorry, grams of protein a day. And that’s really hard to get. That’s like three, 30 grams of protein at every meal. And what’s an egg got in it? Six, eight, something like that. Yeah, so it’s really hard. I have started supplementing with whey protein isolate, just making myself a smoothie every afternoon, just whiz up some plant-based milk with a banana and some whey protein isolate and drink that for afternoon tea, because I just can’t physically get enough protein. I don’t have enough of an appetite to eat enough of it.

Kelly:

Yeah, it’s six. It’s seven, I think, yeah. I do the same. Mm, totally. It’s actually something I think that like for women to at least for a a a brief period of time to track their protein intake, because you’ll probably be surprised by how inadequate it is.

Dr Kelly Teagle:

and Absolutely. So you know, those are just some examples of the things that I like to visit with my patients. Mediterranean diet is absolutely proven to be the best preventer of cardiovascular diseases and dementia in women, hands down. So the principles of that are having plenty of healthy plant, healthy oils like Omega-3s and things in, so we’re talking fish oils, olive oils, avocado oils, nuts, seeds. Very low in red meat, high in fish intake, low processed carbohydrates, but you know, whatever carbs you have should be whole grain, low GI carbohydrates. So yeah, Mediterranean diet definitely, 100%.

Kelly:

Leggings. Yeah. And are there any supplements that you recommend that are actually useful?

Dr Kelly Teagle:

You know, I asked this question of our menopause doctors and I said what supplements do you guys take and pretty much all of them are taking creatine these days? Particularly, yeah, particularly if they’re if they’re lifting They’re taking creatine, but even there’s some evidence for five grams a day for just general health I would caution people to look for a really good good quality pure kind of product and

Kelly:

Yeah, creating is

Dr Kelly Teagle:

to go gently when you first start supplementing, because it can make you really bloaty. Yeah.

Kelly:

Hm, yeah. I had a I did a really interesting interview with Jo Graben. She’s an expert in she does the Bredison Protocol about prevention and treatment of Alzheimer’s and she talked about about creatine for for cognitive health, long term cognitive health, which I wasn’t aware of before then.

Dr Kelly Teagle:

Yeah, absolutely. And I use fish oil as well. Like I supplement with fish oil, again, big part of the Mediterranean diet and I don’t eat enough fish, most people in Australia don’t. But it’s very anti inflammatory, as is estrogen itself, you know, anti inflammatory to help reduce the development of chronic disease, because inflammation is what puts plaques in your arteries in your brain.

Kelly:

Yep, totally. Yeah, I mean I I think that whole inflammation inflammaging saying is so true. If we can keep our inflammation low, it really contributes to longevity. okay, I think that we’ve covered all the basics. Is there anything new as far as treatment support for women in this period that you’re seeing that’s either out or emerging that you’re actually excited about?

Dr Kelly Teagle:

Mm-hmm. Yep. Mm-hmm. Hmm. Well, I can tell you the thing I’m most excited about at the moment, because, know, because we are so, you know, the whole menopause transition thing is so intimately linked with healthy women’s ageing, right? If we can capture that them at that window of opportunity, lead them in the right direction with those types of lifestyle changes that will really make a big difference, then you know, that’s a golden opportunity. But the problem that we’ve had at Wellfemme because we have patients all around the country and our doctors are all around the country is how do we find the best practitioners to help support our women in that journey? And we haven’t really come up with a great solution other than asking each other, do you know someone, do you know someone? But luckily over the last eight years in doing this work, I’ve built up a really great network of health professionals who are really, really great practitioners in the menopause space and just really passionate about. helping midlife women with their healthy aging needs. And I’m talking about pelvic floor physios, I’m talking about exercise physiologists and dieticians and psychologists and personal trainers, health coaches, all of these different kinds of practitioners. And so it’s for a long time, I’ve been thinking, how do we hook them up with the women who need them? How can they find them? So we are about to launch our new directory called MennoConnect.

Kelly:

Awesome.

Dr Kelly Teagle:

And I’m very pleased to say that we’ve managed to bring together a whole bunch of wonderful health practitioners around the country who do local and telehealth type work. And we’re going to be building on that network, you know, more and more and more over time growing it. So I’d really love your listeners to actually have a go at it, sort of see what it looks like. And if they know any fantastic allied health practitioners or doctors who love working with menopausal women,

Kelly:

Mm.

Dr Kelly Teagle:

If they can let us know, then we can invite them to be on the directory as well. And the really big difference with our directory is that we actually have personally vetted these people. We either know them or we’ve checked their credentials, their referees. It’s not just names slapped up on a website.

Kelly:

Yeah, that sounds great. Yeah. That’s super exciting. So I I mean you had told me about this before, but when does it actually launch? Next week. Ooh, awesome.

Dr Kelly Teagle:

Next week, next week. Yes, it’s taken us a long time to get the platform right and to make sure that we’ve got the right people on board. But you know, I think it’s going to be really exciting.

Kelly:

That’s perfect ’cause this will go out next Tuesday, so excellent timing, yay. Well

Dr Kelly Teagle:

Yay! Yay! Yeah, I’ll send you the link so that everyone can have a look at it as well as our Welfare and website with all of our great resources that are on there.

Kelly:

Yeah, definitely. Yeah, awesome. Well, that was my gonna be my very last question. So we’ll go there and then we’ll go to the we’ll swap the the usual way. so yeah, tell us about how we can find you. So website, socials, all of that kind of jazz.

Dr Kelly Teagle:

All of the above. So we have got our website welfm.com.au. Welfm is W-E-L-L-F for Fred, E-M-M-E. And yeah, we’ve got fantastic resources on there. So we’ve got a range of pre-recorded webinars on a huge range of subjects. Some of the more popular ones are things like our one on ADHD and sex topics always get big audiences, I can tell you.

Kelly:

Mm.

Dr Kelly Teagle:

We’ve got a fabulous range of blogs that we’re adding to all the time. We have printable resources. We’ve got our free online menopause assessment tool that you can have it go on and sort of very basic broad brush will tell you the different types of options that might be available for your type of symptoms. So that’s a really good start to go there. And of course you can book appointments with not just menopause doctors, but also menopause nurse or some allied health practitioners through there. So that’s great. We’ve, we are also on socials, of course. So we’ve got a Facebook and an Instagram page. And very excitingly, we have a Facebook online community, our cheer squad, which has got a couple of thousand people in it at the moment. And we, we talk about this kind of stuff all the time, women’s healthy aging, what things are impacting on you. just supporting one another. It’s a very positive space for midlife and menopausal women. Yeah.

Kelly:

So great. Well th and then I always like to end with i s for a woman who’s listening right now, before she gets to see a doctor or any of that, like what’s one thing that she could do to one habit that she could take on from today’s episode?

Dr Kelly Teagle:

Yeah, as we were saying earlier, I think bringing mindfulness to what your specific symptoms are that are really what are your priority symptoms? How are they impacting on you? And this is particularly the case with things like sleep or libido or whatever things that are really multifactorial. if you people are coming along saying I’m exhausted or I’ve got brain fog or my libido is terrible. But you really need to get specific. So bring mindfulness to it, track it. If you’ve got those top three symptoms, maybe even print yourself out a one month calendar and put your red Xs on your days when you’re bleeding or you think you should be, you know, if you don’t actually bleed. And try and track the severity of those symptoms, you know. So if bloating is a big symptom, you might just… give it a score out of 10 on any given day and see if you’re noticing some patterns and whether they seem to be linked to your cycle. So in preparation for a discussion with your GP, I would say get very specific, get very mindful and really have thought through what treatment outcome you would like when you go to see them. Don’t settle, you know, if you’re not getting the answers that sound right to you or you’re not. getting some validation or somebody who’s listening to you and offering you some options, then don’t settle, go and speak to somebody who’s well menopause informed, I would say. We’ve got an article actually, like how to have the menopause chat with your GP. We’ve actually got an article about that on our website as well.

Kelly:

Nice. Yeah. this has been so good. I have like literally been thinking, I have to share this with this person and that person, this person I mean I always share my episodes, but a lot.

Dr Kelly Teagle:

I’m going to, I’m going to have, I’ve scared half the community off their bio identical compound stuff. Yeah.

Kelly:

Yeah. thank you so much for your time. I really, really appreciate it.

Dr Kelly Teagle:

That’s okay, Kelly. Thanks for the invitation.

Kelly:

Yeah. Cheers.