Anxiety and Menopause w/Helen Bennett (Episode 44)

SPEAKER_05 0:02

I've had anxiety on and off since a young adult. I've had periods of years where I function normally and times when I haven't. In the past, I've found that continual exposure has helped my world to become gradually bigger and got me back to normal times. However, I'm now in perimenopause, hormones all over the place, and anxious as hell. However, some days I go out and do things, others, like now, I'm shaking thinking about walking around the block. How do I deal with exposure in this situation? As I'm so up and down, that it's not working like it did in the past. A podcast with the peri expert would maybe help a lot of women going through this. It's been four years so far, and I'm worn out. Well, and there's other emails we've had too. Can you talk a bit about perimenopause and anxiety management? I'm so disappointed to learn that my entire gender has been overlooked in healthcare. I'm wondering if and when you'll be airing the episode on menopause and anxiety. Can you please do an episode on anxiety and the menopause? Uh, we have listened, and today is that day. My name is Joshua Fletcher, also known as Anxiety Josh, and I'm a psychotherapist who specializes in anxiety disorders and previous sufferer based in Manchester in the UK.

SPEAKER_04 1:30

And I am Drew Linsolata coming to you from New York in the US of A. I am a therapist in training, also specializing in anxiety and anxiety disorders. I'm an author and a podcaster on this topic, and also had a good time with anxiety disorders and depression in my own life for 20 plus years. Good times. Since we have been asked to do an episode on this topic, and we have searched high and low, mostly high, for a guest to help us and an expert in this. We have someone today. We have Helen Bennett, otherwise known as the menopause therapist, with us. Helen, say hello to the crowd, our studio audience, especially.

SPEAKER_01 2:06

Thank you, Gary. Um, I am the menopause therapist. I have a private practice as a counsellor specializing in menopause and fertility. I have lived experience of uh menopause, early menopause in fact, um, specifically POI, which is premature ovarian insufficiency when there's a cessation of ovarian function before 40. Um, and that my experiences led me to realise that there were a lot of there was a real lack in understanding about menopause in therapy. And my therapists uh didn't cope particularly well with me bringing it up, and so I decided to set my private practice with those areas as the focus. It's lovely to be here.

SPEAKER_05 2:45

Wow, your therapist didn't cope well with you bringing it up. Why, why? It's so it's such a common thing. I mean, uh, like I it baffles me. And I'm glad that by the way, Drew and I are doing an episode on this because more guys need to talk about it too as well. It needs to be spoken about more.

SPEAKER_01 3:01

Absolutely. I mean, my experience was whenever I brought it up in therapy, it sort of got shut down and the topic moved on or it wasn't picked up on. And I very much sense that it wasn't something that my therapists, and I brought it up in a few different therapeutic environments, didn't seem comfortable talking to somebody, perhaps because I was in my 30s, perhaps it's because they hadn't explored their own feelings of menopause. This was well before the Davina McCall documentary brought menopause and talking about menopause into the mainstream. That's amazing. I suspect that was shame.

SPEAKER_04 3:33

Yeah, and that's that's actually is a shame. So I'm guessing that you struggled for longer than you probably had to because you were dismissed.

SPEAKER_01 3:41

Absolutely. I think the well, I mean, I I think that's the experience of a lot of people with menopause is that it's only once you realize that it's perimenopause that you can look back and notice when your symptoms started. For me, certainly, my symptoms started in my 20s, but I thought it was anxiety, funnily enough. I thought it was um uh you know, a plethora of different suggestions and treatments from GPs that didn't work um for all the different symptoms. And it was only once my period stopped and I really crashed, my emotions and mental health really crashed, that I was diagnosed.

SPEAKER_05 4:17

Yeah, thank you for for joining us um today. Um, I think a good place to start as well, particularly because you know, there'll be people listening who are very familiar with the experience. Maybe they're going through the menopause or the perimenopause, um, or people who who know about it, and people who know absolutely nothing about it, particularly if you know if if they're a guy or someone who doesn't go through that. Uh let's just start from the very beginning uh in terms of kind of what what are the menopause or the perimenopause uh and what's what's happening there.

SPEAKER_01 4:48

So obviously, with a female or side female at birth menstrual cycle, there are several hormones that are interacting and that are um are creating the right conditions in the body for a fertility cycle or menstrual cycle. In menopause, what starts happening is that is those hormones start dropping, or in perimenopause, they start dropping. But they don't start dropping in a straight line. There's fluctuations, there's highs and lows, which can make female hormones quite difficult to uh assess and and test. So with menopause and perimenopause, the follicle stimulating hormone increases, and that is trying to grow those follicles, trying to create the opportunity for the ovary to release an egg. But meanwhile, the estrogen typically is dropping, progesterone is dropping too, testosterone is dropping, and these can lead to a whole range of different symptoms. Um, and they don't necessarily drop, but at the same time, and the same rate with every single person who's experiencing it. As those hormones drop, that interacts with um other hormones that we have in our body. So hormones like serotonin and dopamine, they are uh lowered, they're not they're not kind of uh they're not having estrogen and progesterone there impacts the levels of serotonin and dopamine, they tend to drop. And those hormones that are associated with stress and anxiety, like cortisol and adrenaline, they don't get balanced out by the role of estrogen and progesterone, which is normally happening in a pre-menopause state. And so as those estrogen and testosterone and progesterone are dropping, the uh experience of cortisol and adrenaline is going higher and higher. So the impact on the body and the body, the impact on mental health is huge because there's no balancing. But it fluctuates as well because it fluctuates in a typical menstrual cycle. In perimenopause, it's fluctuating even more.

SPEAKER_05 6:42

Yeah. Explain so much. I can't, but since I became a therapist, um, I cannot begin to tell you the amount of times of people who've hit the menopause, hit the perimenopause, and their anxiety and even anxiety disorder has started because it makes so much sense that this excess adrenaline and cortisol that is not being balanced out usually by the other hormones like progesterone, and suddenly, you know, they always explain it's like it's like it just hit me from nowhere. Nothing particularly was happening other than this part of my life. Uh, I'd wake up feeling anxious, I'd like I'd go to bed feeling anxious, I'd wake up in the night with with sweats and and things like that. Um, and so for me it makes sense hearing that that at a particular time of your life you are more susceptible, particularly to going inwards and fearing those symptoms if it hits you. Um, yeah, that thanks for explaining. That makes so much sense.

SPEAKER_04 7:44

Yeah, I it almost sounds too like in a typical monthly cycle, pre-menopause, pre-perimenopause, that same thing is happening, I'm guessing. Those balances are changed. Absolutely. That's why so many women will think. Yeah, yeah. Like, you know, all I get it, I get what you guys are saying. We hear it all the time. Like, listen to the podcast, I get it, I understand the principles, but when it's that time of the month, it all goes out the window for me. I hear that every day, every day.

SPEAKER_01 8:07

Yeah, so in the second half of your menstrual cycle, your luteal phase, your estrogen drops. And so that can give all of those feelings of stress and irritability, of mood changes, um, all of you know the typical experience of premenstrual tension or premenstrual stress, um, PMT or PMS, depending where you are. Uh, and also the um when that's in the extreme, there's a diagnosis called PMDD, premenstrual dysmorphic disorder, which is uh really difficult and challenging uh condition to have, which is where those mood swings are so low that it's difficult to function.

SPEAKER_05 8:44

Yeah. We actually had a question sent in as an audio question about that. So I'm glad you mentioned that um as well about you know how can I deal with anxiety around PMDD? And step one that Drew and I always say with any anxiety-related question is learn about what's happening in your body and what's happening. And um, it's it's always really, really good to equip yourself so you know, so it takes away the mystery. Yeah, um I was gonna ask what are some of the main symptoms of um menopause, permenopause, and actually after it might be worth even looking at just seeing how it lines up with the menstrual cycle as well.

SPEAKER_01 9:25

Absolutely. So uh the symptoms officially there's 34 according to many sources in my twin.

SPEAKER_04 9:34

34 of the lovely flavors of menopause.

unknown 9:37

Exactly.

SPEAKER_01 9:38

Like anxiety, there are more and more symptoms the more you dig into it, and the more you you realize that um what happens in what's happening individually to your body. I think certainly a lot of my clients and in my own experience as well, there is a realization if you do start HRT, which is hormone replacement therapy, which is replacing those um those hormones, estrogen, progesterone, and testosterone sometimes, not on uh the NHS in the UK, but that's a separate uh separate topic. Um, so often people only realise when they take HRT that oh my goodness, my sore knee has has eased, and I'm not getting the back pain that I used to be getting, and I used to be have to use eye drops every day, and actually I don't need to use eye drops anymore. So you start to realise how uh your body has has responded to the lack of estrogen. We have oestrogen receptors all over our body, all over, everywhere. So the in your body as an individual will uh kind of lose estrogen. Some receptors will carry on taking what's left and others will be losing out. So that partly explains why everyone's symptoms are different. So some people might experience joint pain, others don't experience that at all. Some people experience hot flushes or hot flashes, as they're called in the states, uh, and others don't. Some people have what they feel is a really quite easy menopause transition, yet perhaps they are dealing with itchy skin and genitor urinary syndrome of menopause, which is otherwise known as vaginal atrophy, or other things that they might put down as just aging rather than necessarily aging specifically related to low oestrogen. So, yes, I don't think I answered your question. Sorry.

SPEAKER_05 11:15

No, listing through the symptoms.

SPEAKER_01 11:19

I mean, I could be here a long time listing them, but the physical symptoms, the ones that people always talk about are hot flushes and insomnia. They're they are the ones that most people think of when they come to menopause. And um, I think that's something that personally I found really difficult when I was experiencing it, was it was kind of felt like that was all that people cared about. That's all that the GPs cared about. It's what it felt like at certain times. Um whereas for me, I experienced almost all the items, the you know, the symptoms on the list. I was gonna say items on the list because it feels a bit like that sometimes. So it can be joint pain, muscle aches, um, as we mentioned before, insomnia, which is related to uh the way that your body thermoregulates the kind of level of thermoregulation. Um you uh the your body is not actually getting hotter than it would normally, but your level of coping with it changes. So that's different over um when when estrogen is low. Um so insomnia can be related to just not being able to get to sleep and having lots of thoughts, and we'll talk a bit more about kind of racing thoughts and intrusive thoughts, which also often increases in in menopause. Um body shape changes, you tend to put on fat, your body chooses to put on fat around the middle because that's fat cells are a way of increasing estrogen in the body, so it's the natural bodily response to low estrogen as to lay on fat cells.

SPEAKER_04 12:34

Oh, goodness is amazing. I know I'm learning so much.

SPEAKER_01 12:38

Um thinning hair, brittle nails, um, I mean, like, yeah, osteoporosis, so bone bone density changes, which is one of the more serious um implications of menopause. Um, I mentioned genital urinary syndrome menopause before, otherwise known as GSM. Um used to be known as vaginal atrophy, but it's been changed because it actually affects a lot more of the genital area than just the vaginal area. And that's the thinning and and um drying out of the skin that's all around the bladder, urethra, vul area, um, and that can lead to initially infernal itching, horrific itching.

SPEAKER_05 13:16

Outside and inside, yeah.

SPEAKER_01 13:18

Outside and inside, and around bladder and urethra. So it also leads to incontinence, urinary urgency, um fissures, uh, painful sex, uh the vagina shortens, the cervix drops, it all becomes much more difficult, uh less lubrication. Um, and a lot of the time that's misdiagnosed as thrush. So people might be taking thrush creams, but it doesn't help. Uh and then so that's something that often is untreated because of shame. So that you know, and when we're thinking about menopause and anxiety as well, if you are incontinent because of your menopause or because you feel like it's something that's happened to you because of child worth or because of aging or because perhaps you have a prolapse, which is another risk of the thinning of the skin, um, then that might impact your feelings about going out, feelings about socializing, feelings about laughing even when you're with friends, uh, because it can result in an accident. Yeah. Consequences, something that people don't talk about enough. So I'm glad I've managed to squeeze it into this podcast because I do it.

SPEAKER_04 14:29

You know, if we talk about the intersection between these physiological issues and an anxiety state or an anxiety disorder, for somebody who is more vulnerable to develop an anxiety disorder because they have a you know high degree of anxiety sensitivity or they score high on neuroticism, they're internally focused, they're really sensitive to what's going on with them. Yeah, it sounds like holy crap, the wheels are falling off for me, and now I'm freaking out because of how I feel.

SPEAKER_01 15:01

Like that makes perfect sense.

SPEAKER_04 15:02

How would it not trigger?

SPEAKER_01 15:08

Just don't work anymore. Not even close to adequate, right? Yeah, yeah, and it it impacts um tired, you know, you feel much more tired. Fatigue is a is a huge symptom of menopause. Um it's you can become allergic to certain things, some sensitivities increase. So people find that they're allergic to nickel or they're allergic to they get hay fever and they've never had hay fever before. And it's all linked to to low hormones. Uh tinnitus is another thing that I know is associated with anxiety, also. So a lot of people experience tinnitus, they might experience uh, as I said earlier, skin changes, itchy skin, dryness, in growing hairs, even is part of that that people might not have experienced before. Um pins and needles in the extremities, that often happens, particularly at night. Uh, burning mouth, metallic taste. In fact, quite a lot of the symptoms of um people experiencing COVID are quite similar to symptoms in in menopause or perimenopause as well. Um, so that metallic taste people talked about with COVID is um is quite common in menopause as well. Nausea, breast pain, um, changes in body odor. You stink. I stunk. I suddenly sunk, and it stunk differently. It wasn't my body odor, it was a different body odor, and it's really destabilizing when you smell, you don't smell like yourself. Um, so that's that was a real shock to me.

SPEAKER_04 16:29

I mean, destabilizing is such a good word.

SPEAKER_01 16:32

Yeah, I mean, this whole thing often makes um woman or assigned female at birth, people who are uh just they doubt themselves, they don't know who they are anymore. It doesn't feel like them, and there's that fear that this is it, this is what it's going to be like.

SPEAKER_05 16:46

And if you're already feeling quite dissociated, because again, lots of people who listen to this podcast may or may feel dissociated from their identity, from their bodies. I imagine, you know, when you when this happens, you know, it could be even more frightening or even more kind of but it's the reason why we're doing this podcast. It's like, well, it doesn't you know learn about it, see it, you know, see it coming, or if you're going through it now, it's like okay, you know, actually all this stuff's really common, you know, and here's why it's happening. And you've got this, you're not uh you're not you know fading away into the abyss, you're not doing anything like that. You will get to that place, but sounds like it it can be a very rocky ride for people, yeah.

SPEAKER_01 17:29

Absolutely, and it can last anything from four to twelve years, perimenopause. So it's typically four to seven, but some people it lasts much longer, and people can go on into having hot flashes into their into their eighties and and beyond. Um, and let's talk a bit actually about the average age. So that's something that's important to um to raise. So the average age in the West is is 51, and that's the typical age that people think of. Um, but I've found a lot of people don't even realize that it's that young, they think that menopause happens in your late 50s, and so we have people who believe that they're in early menopause when actually they're really pretty much the average, average age of perimenopause, which is when yours started in 30s. Well, my perimenopause I well, the equivalent of it, the POI equivalent, I suspect started in my twenties. That was when I started getting symptoms. Wow. But at the time I would be in a meeting and I would be sweating and really hot. You know, the the way that people describe, and I certainly felt a hot flush, is it's almost like a sort of vump. Sometimes it's from the face down, sometimes from the chest up, and it's this kind of eruption of heat and sweatiness. And you think everyone can see it, you think everyone can spot you feeling hot, and so often women end up drawing attention to themselves, they're flapping their papers, they're turning their fans on, they're taking all their clothes off. And actually, we've learned that you know, a lot of the time people don't really notice, and that kind of yeah, the the anxiety that can that happens with your hot flush is will extend the the length of time that the hot flush takes.

SPEAKER_05 18:59

And what would you say to people? Sorry, Helen, like so obviously there's a lot of symptoms that overlap with people who have anxiety, anxiety. I'm just I'm aware now of maybe a lot of our listenership going, oh, maybe I've just been going through the menopause really early. Uh and obviously statistically, probably not, you know, some people very early, some some not.

unknown 19:21

Yeah.

SPEAKER_05 19:21

What would you say to people like like what's the process to kind of get that checked and see?

SPEAKER_01 19:26

Find out. Yeah, it's a really good point. So one in a hundred uh women or assigned female at birth have a natural early menopause, and that's the cessation of ovarian function before 40, and that's known as premature ovarian insufficiency or POI. And then there's uh I can't remember the actual stat, but early menopause is the cessation of menopause or ovarian function between 40 and 45. And then after 45, it's seen as normal because that average is 51. But obviously that means that there's outliers, there's people who still have periods into their 60s, and there's um there's this this there's all of the people who also have earlier menopauses due to chemical menopause, which is sometimes used as an option for things for conditions like PMDD or surgical menopause, so hysterectomy, zephorectomies, they can all impact menstrual cycle or stop the menstrual cycle, and so that's another cause of uh or reason for POI. So if you're I always used to think when I was first diagnosed, I would look around the supermarket and think, well, there's more than a hundred women in here. I bet I bet I'm not the only one. And that was I found that oddly comforting actually to think that even though it feels very much, particularly with a POI diagnosis, that you're the only person because people often don't talk about it. Um and yeah, early menopause, a lot of a lot of women extremely shocked when their doctors say that that's what it is, or perhaps when they realize what it is, they think I'm too young. I'm not I'm not old. This is something that I associate with age.

SPEAKER_04 20:52

Yeah.

SPEAKER_01 20:52

And people often they feel like that.

SPEAKER_04 20:54

For people who you know, people who are listening that are thinking, yeah, this might be me. What would you suggest they do? Now, let's let's first address the girl the elephant in the room, because I think we have to. It and it was brought up in one of the emails that was sent in. At least in the US, things like low T were literally marketed into an epidemic because you know, it's guys. So low T, we've got to talk about low T. Whereas so much of the stuff you're saying, it's the first time I've ever heard that. Like, how is that even possible? So if your advice is, you know, yeah, go to your OBGYN, get checked out, check, get your hormones all checked out. We also probably have to acknowledge in that discussion that in many times there might be a no, no, no, no. It's not that. It's not that. You get dismissed. So, what would you suggest somebody do to advocate for themselves and start to get checked out to see if maybe this is what's happening to them?

SPEAKER_01 21:44

Absolutely. I think raising the conversation with your GP or your your doctor is the first port of call. Um, yes, you may be turned away and you may need to to to get a second opinion elsewhere. In the UK, it's improved a lot because doctors Are finally being trained in menopause. For many GPs, menopause didn't even form part of their initial training, or at best, they had a half a day of menopause training, despite the fact it was going to affect half of their patients. So now that is changing, thankfully. There is a lot more focus on it. Nice guidelines state that if you are under 45, you should have a blood test. So in the UK, that would be a FSH follicle stimulating hormone test between six weeks apart. So that's to make sure that within hopefully a range of an average mantic menstrual cycle, it's testing whether that follicle stimulating hormone is higher than it would normally be. And that's a good indication of early menopause. If you're 45 or over, they tend to go on symptoms. So if you go to your GP or your doctor and you say, I'm having these, this list of menopause symptoms, they may discuss options with you and discuss whether it's appropriate for you to try HRT or whether you can try SSRIs, they can be suitable for people who don't have uh don't have aren't don't wish to take HRT or aren't able to take HRT because of medical reasons.

SPEAKER_05 23:07

It's also really and thank you for that, Helen, as well, but it's also really important to realise that this can work the opposite way too. So I've worked with people with an anxiety disorder who've been kind of misdiagnosed as going through the menopause because the symptoms go both ways. So it's really interesting. So if you're thinking, well, I I I'm listening going, yeah, I went to the my doctors and I and I had that, and they told me it was the menopause and this and that, and I've tried HRT and it's not really helping. Yeah, you're not forgotten either. This is why it's really important, and it's I imagine it's just really tricky as well because they overlap so much. You know, I I'm having uh heart palpitations in the night, panic attacks and hot flushes, and I can't sleep. That ticks both boxes, you know. Uh, you know, for because when you're in the midst of an anxiety disorder, your hormones are all over the place, too. Not the same, because it's just reacting to your interpretation of a fear response. But when you're in a place like Drew was saying before, like actually, I'm I'm already susceptible to these things, and then I felt like I was making progress, and now I've hit this certain age and I've noticed these certain feelings. It's really important to distinguish what it is going there. So, yeah, chatting to your doctor, chatting to your GP, getting the tests done to see, you know, what is part of this anxiety disorder cycle, what could potentially be uh perimenopausal, menopausal. Um, and kind of it's one of the trickiest questions that I hear. Like, how do I know? I'm how do I know if my symptom is this or anxiety? I'm like, well, you don't sometimes, right?

SPEAKER_01 24:47

And you might never as well. Absolutely.

SPEAKER_04 24:50

Yeah, I'm so appreciative that you just said that you might never, because I was gonna say we have to acknowledge that like more than one thing can be true at a time. You could be having anxiety issues and be experiencing the effects of hormonal changes in your body, even if you're not in perimenopause or menopause, your hormone levels are gonna change, and you might never actually know exactly. Well, this symptom is hormones, and this symptom is we just don't know.

SPEAKER_05 25:14

Crowding is flash.

SPEAKER_04 25:15

Yeah, is it that's exactly right. It's both you know, PMDD and not until you look at it. But I I think it it leads us to the whole like the idea then, and a lot of people in our community will say, okay, cool, what what Helen is saying is great, and now I'm gonna get tested because if I get tested and the lab results say this, then I do this and it's fixed. Is it?

SPEAKER_01 25:36

I mean, this is one of the difficulties is that just like any other medication, HRT it's often reported, at least more recently, as though it's almost it's like a silver bullet. It's it's gonna sort things out immediately. And actually the HRT journey is is often a challenging one. Sometimes people people do feel better straight away, but then their skin reacts to however they're um they're you know, perhaps they're taking patches, their skin doesn't like the patches, perhaps their hormone levels aren't right. It can be an ongoing um my mum hated it.

SPEAKER_05 26:08

She would not want to be saying that. She hated it. She was like, she had to come off it. She was like, that's yeah.

SPEAKER_01 26:14

Some people find migraines increase. There's a lot of there's there's risks with any medication, of course. And I'm not a doctor, you know. I can talk a bit about it, but uh I would certainly recommend that all of the listeners go and speak to their GP to talk about what might be suitable. But there's many different preparations, there's many ways of taking it. There's patches, there's pills, there's there's topical um estrogen, testosterone, there's there's gels, there's sprays, and it might it's worth considering the fact that you might need to chop and change to find the thing that works for you.

SPEAKER_05 26:41

Finding what else what works for you. Uh it's it's remarkable that we're just having this conversation about what should be a very normal topic. Right. Uh and and I just wanted to kind of touch on the subject of like I mean, it is for me. Yeah, yeah, it's it just feels like it should, you know, but obviously it's not, and and not not many people do talk about it. Uh, I you know, particularly and I I just think addressing the shame thing, why would it be shameful? And obviously, you look through things through a through through history, through a I do anyway, with an a feminist lens on and can see why. But in general, I it baffles me now that there's still that old stigma there. Um why is that so? Is is it passed down through generations and when people had it difficult? What what what what do you think about that? Because I think it that needs to stop, doesn't it?

SPEAKER_01 27:33

Yeah, absolutely. The amount of people who've said to me that they've spoken to their to their friends who are all in their 50s and they're the only one who's having menopause symptoms, and I just don't believe it. And I think it's because people don't want to admit to some of these things, they do feel shame about it, they do feel like they um, you know, they might be finding other ways to try and preserve their youth, and admitting to to menopause can be quite difficult for a lot of people because there's so much societal stigma around aging as a woman.

SPEAKER_04 28:03

Yeah, I was wondering about that, the ageism thing. Because if you're a woman and now you're going through this this natural part of life that all women go through, you're less useful, you're less desirable, you're less what, you know, that's that probably contributes. Yeah.

SPEAKER_01 28:17

It's it's a loss, it's a loss of fertility, it's a loss of youth. And it and for a lot of people, me included, that's a really difficult transition to feel like you're you're not fertile anymore, you're not able to have children. And traditionally, you know, generations ago, that would mean that you had a certain role. But in modern days, uh the the age, even at the average age of menopause at 51, women are often working in stressful jobs. They are they might have young children, teenage children at home, they might have aging parents, they've got a lot of different things going on for them than somebody, say my grandmother's generation, would have experienced when they were going through menopause.

SPEAKER_05 29:00

It's a very old school mindset, isn't it? Uh to quote one of my good friends, um, she's gone through the menopause now, decided not to have children. And it was a bit Paulie going through it. And she said to me one day, I was like, Are you all right? She goes, No, I am no longer a vessel, I am merely flesh now, I am nothing. And uh just a nod to the fact that actually the old taboo of you know, your purpose is like, come on, man, what are we living in 70 the plantagenet era? Well, come on, but you know what it's ridiculous.

SPEAKER_01 29:32

I think I think these feelings persist. Sorry, sorry, Joe.

SPEAKER_04 29:34

No, no, you're no, I want to hear what you have to say, but I think uh interestingly, and I you guys could, I mean, clearly both therapists, I'm being trained, you know, and hammered away with like, well, therapy through the lifespan, the lifespan, the lifespan. You would think that this part of a female lifespan would be more than like three paragraphs of the textbook and one statement by a person. Oh, yeah, and also there's like, you know, hormonal changes and that sort of stuff. Think about that. But like, well, yeah, but okay, can we go back and talk a little bit more about that? Because it would seem like an enormous change in a female life.

SPEAKER_05 30:05

Well, what about anxiety and pregnancy, though?

SPEAKER_04 30:07

You could fill an entire library with that. That's exactly right. But I will admit in my training, and I think probably with the best of intentions, I'm not picking on anybody, but it's in there, but barely glossed over. Like, hey, think about maybe a woman is dealing with menopausal issues. Next, now we're into the next topic.

SPEAKER_01 30:33

And also, it's not just your female clients, it's all of your clients, mothers, grandmothers, sisters who are who are dealing with menopause symptoms that are really challenging. A lot of we haven't really talked about rage and irritability, but we might hear we might have a teenage client and be thinking, my god, your mum's a monster. Failing to understand that actually the mother is really struggling with with the menopausal rage, which is like nothing I or many of the people I've spoken to about it has ever come across. It's it's hot, it's fast, it's it's almost uncontrollable. And and that, and it's different from any anger you ever felt before. And perhaps that's what's going on when our when our male clients in their 50s is talking about their female partner and their female partner's irrationality. And perhaps, you know, as therapists, we might be thinking, oh, that sounds a bit BPD or that sounds a bit something. But perhaps actually they're going through menopause. And I think it's really important for all therapists to be aware of of menopause because whoever they're dealing with might be bringing menopause into the even if they're not aware of it.

SPEAKER_04 31:37

This is so good. I'm gonna listen to this episode again. I I appreciate that, yeah, yeah in a big way.

SPEAKER_05 31:44

Also, is the is the message though in in general if you're going through the menopause, um are you okay? It's a natural thing. I know it's horrible and uncomfortable, but I'm what I'm hearing is that you're okay. You know, you're gonna ride a horrible ro hot rocky road, but you're alright. It does happen, you know. You shouldn't hide it behind uh on abide by some taboo, you know. You're allowed to tell people. We certainly would welcome some uh menopausal did it anyways. Well, they'll get read out. Uh uh, and just know that and just be aware of it. You know, we always love banging the knowledge of his power drum, it's because it takes away that mystery and cuts out a million what ifs in your head. If I actually probably focus where my worries here now, but yeah, and um no thank you for for addressing um and and giving us like an introduction to it, really, because that's where I want to want to start. I've already learned so much already.

SPEAKER_01 32:43

I think something that's really important to say though is that not everyone experiences a difficult menopause transition. Because when you hear us talking like this, you might think, oh my god, it's just horrific. How are these people walking around?

SPEAKER_04 32:54

Yeah, half our audience right now is freaking out, like, oh no, they're just waiting for me.

SPEAKER_01 33:01

Yeah, 25% of people do have a really challenging menopause. 50% of people have symptoms, they recognize it's happening, it's it's you know, it's they they can probably cope. Perhaps they do take HRT, perhaps they don't. They're you know, they are transitioning, but it's okay, transitioning in terms of menopause. And then you get 25% of people who say, Do you know what? I didn't even notice it. My peers just stopped.

SPEAKER_05 33:23

They're the they're the ones we all hate.

SPEAKER_01 33:28

I sometimes wonder whether whether they're the ones who are saying, why is everyone talking about menopause so much? It's fine.

SPEAKER_04 33:34

I went through it. So so should you it was nothing, it wasn't a problem for me, so therefore it's not a problem. That's another whole other topic. But uh we should probably touch quickly, and we can't because we would be here for hours and hours, but at least to touch on it, we can always have you back. But the million dollar question that people are gonna ask you was then what do I do? Because they, you know, they listen to disorder to find the trips, the tips, and the tricks, and how do I how do we get over this? How do I fix this? What do I do? If I'm gripped by this problem that you're describing, or this this experience that I'm that you're describing, what do I do? What am I supposed to do? So how do I fix it?

SPEAKER_01 34:07

I mean, the first and obvious thing is go and speak to a medic, go and speak to your GP, a doctor a doctor, go and tell them about your concerns. Yes, there is the risk that you get turned away, and we hear a lot about women who are turned away and are told no, you're all your blood test is fine and therefore it's it's ignored. But keep a track of symptoms. There's apps available like the Balance app. The Balance website is also an excellent place to find resources and information on menopause. They offer an app where you can track symptoms of menopause, which can really help you when you go and see a GP or a doctor to say, this is what's happening to me and this is what I've noticed. Uh, try and keep an idea about whether some of your mood changes are perhaps linked to your menstrual cycle if you're still having periods. What's happening there? Is it that you're feeling much worse than you used to in that lutual phase, that that second half of your cycle? And then talk to your GP about that because often people find that there are changes in the menstrual cycle, changes in the mood as they're approaching perimenopause or when they're in perimenopause.

SPEAKER_04 35:02

Yeah.

SPEAKER_01 35:02

Or during the menopause transition itself.

SPEAKER_04 35:04

But as a therapist, though, I mean, I think a lot of people in our community would say, Well, cool, now I'm going to go look for the chemical or the medical, and it'll fix it.

SPEAKER_03 35:11

Yeah.

SPEAKER_04 35:12

But some things you mentioned before, it can be a wild ride getting it right, or maybe it doesn't help you at all. Where does the the emotional, mental, cognitive coping skills and tolerance skills start to enter into this?

SPEAKER_01 35:24

Yeah, so there's lots of uh supportive evidence around CBT for menopause. So cognitive behavioral therapy is proven to help uh hot flushes and insomnia. There's a uh course available for therapists to do if they wish to, or nurses and other medical professionals. I think I'm run by the British Menopause Society that specifically uh is manualized like most CBT and uh provides ways of coping with hot flushes and insomnia, which for many people that can be enough. And it's proven to reduce the impact of hot flushes, the the severity of them, and so they become less problematic. So some people are having 30, 50, 60 hot flushes a day, and it can reduce the impact of them.

unknown 36:05

That's a lot.

SPEAKER_05 36:06

So if if you think if you are struggling with it with the symptoms and the menopause and stuff at the moment, might be worth seeing someone who has done that module if you've done C B CBT for CBT for menopause symptoms, absolutely. Yeah, so that's something you could look for if you're looking for a therapist, then you maybe want that on top of it. I think that's a great idea.

SPEAKER_01 36:26

Whether you're a therapist yourself or not. Absolutely. So that's that's specifically for menopause for insomnia and hot flushes.

SPEAKER_02 36:33

Yeah.

SPEAKER_01 36:34

And a lot of it is around psychoeducation, so understanding what's happening in your body, understanding um for insomnia things like sleep hygiene, keeping a track of your symptoms, working out how to how to to assess how you talk talk to yourself about them. Um so that uh that CBT model can can be really effective. And people find that actually once you start thinking about a hot flush and you're thinking this is just a hot flush, it's only going to last 30 seconds, I can cope with this, it's happened before. Those sorts of positive affirmations can really help. So CBT for menopause is great and is recommended by the International Menopause Society and the British Menopause Society, and has recently been included uh in nice guidelines as well, which has caused a little bit of a fuss within people because a lot of people feel that uh GPs are now going to be saying it's all in your head, which obviously it isn't, but um CBT can help and it does have its place, particularly for those people who can't take HRT. There are various topical um solutions, so some people who can't take HRT for medical reasons in terms of systemic HRT, so the HRT that goes through your system, so that's the gels, patches, sprays, pills. If they're not able to take that, perhaps there's breast cancer in their family or they've they've experienced breast cancer themselves, then they may be able to take topical vaginal estrogen if GSM is a problem for them. Uh they might find that there are herb herbal things that can help them by speaking to people who are talking about it. And I would say try and yeah, try and get as much information as you can. There's amazing Facebook groups out there that can help help find information.

SPEAKER_05 38:10

Amazing. Where can people find you, Helen?

SPEAKER_01 38:14

I am at the www.themenopause therapist.com and they can find me there. And also at Counselor Staff Room, which is a community that I co-founded with Zoom.

SPEAKER_05 38:25

I love the Councillor Staff Room. Yeah, yeah. If you're a UK therapist, go on the counselor staff room. Uh you'll often I sometimes comment in there once I've had a whiskey or two and just put something irreverent in there. Like uh, no, it's a really good place. I've done some good training and stuff in there, and um, I've done a few talks for counsellors. I did the first ever talk for counselor staff room.

SPEAKER_01 38:49

You did for the membership organization. Yeah, yeah. Oh, in fact, the Facebook group. So we have a Facebook group and we have a separate off Facebook membership organization as well. Um, so you can find that on the uh counselor staff room on Facebook or counselors-staffroom.co.uk on uh on the internet.

SPEAKER_04 39:06

If you guys go to disorder.fm slash 4444, I will put all of the stuff that Helen's talking about. We'll give you guys all the links.

SPEAKER_02 39:14

Thanks, Drew.

SPEAKER_04 39:15

Yeah, no worries, no worries. Do we want to wrap it up with a didit anyway?

SPEAKER_05 39:19

Yeah, we every episode we all don't forget the community. Um, we're gonna play um did it anyway. Uh this one's an epic one. Um Drew and I liked it uh before we close out. There we go. Let's do it.

SPEAKER_00 39:35

Hey Drew and Josh, this is Tyler, and you can feel free to use my name. I just wanted to share a Did It Anyway from last week. Um I experienced GAD as well as panic disorder, and I took all of those fun sensations to Maui. Uh, the month before I left, I noticed that all my sensations were increasing, and I was really nervous to fly over the ocean. Uh, we were also staying in a really remote part of the island. So when we uh landed, I realized that we had no cell phone reception, which was terrifying, and the airport was a small shack. Um my brain started to spin, and I started to look around and noticed all the beautiful details of the island. The smell of the crisp ocean air blended with plumeria, the waves crashing and birds chirping, the smiling, welcoming people, and all the beautiful flowers. My sensations were with me the whole time, but they got quieter when I completely unplugged from the world and paid attention to the world around me. I woke up early to look at the stars, untainted by city lights. I watched the sun rise and set through waves crashing into black volcanic rock, creating a refreshing salty mist. In the middle of the ocean, I felt the most connected to the earth, myself, and humanity, like it should be, unplugged and connected, echoes from those before us. I felt my nervous system remembering where it came from, and I could finally breathe again. I struggled with sensations while driving, and I even drove the road to HANA. It was the ultimate exposure test of so many twists and turns and one-lane blind turns. It sucks, by the way. Uh, it wasn't comfortable at all, but I did it anyway. I'm so glad I didn't let the sensation scare me out of going. It was so worth it, and I saw so many beautiful things. Maui taught me when we take the time to stop and be with the earth, it has so much to teach us. It helps us to find ourselves, settle our overstimulated nervous systems, smile more, and love the earth and each other more deeply. And all I can say is Mahalo. Thanks, guys.

SPEAKER_04 41:36

Holy cow. That was an amazing did it anyway.

SPEAKER_05 41:41

Yeah, I mean, that beats my first did it anyway, walking into Walmart to get a can of beans. But yeah, I don't know. Go to Hawaii. Uh that that's uh that's brilliant. Well done, Tyler. Uh I noticed the theme tune changed halfway through, Drew.

SPEAKER_04 41:56

Well, well, you know, Hawaii's a lovely place, so we had to increase the ambiance there. And Tyler, we if you're listening, thanks for playing along with us. You know what I love about that? I mean, the language was first per uh soothing and uh inspiring. I love listening to it, but he was paying attention to what was going on around him. Like I my experience is just part of a bigger context where there are waves and plants and people and sun and what else is going on around me. And he connected to those other things instead of making what was happening in his own brain and body the most important thing in the room, even though he wasn't in a room. I love that. Yeah, so good.

SPEAKER_05 42:30

I agree. Thank you so much, Helen, for joining us. Thank you, Tyler, for your did it anyway. Um, if you want to submit your own did it anyway, go to disordered.fm. You know what to do, or you can ask us questions or via via email or audio. And um, yeah, thank you so much, Drew. And we'll catch you again next Friday.

SPEAKER_04 42:49

Yeah, we're out. See you guys later.