Helen Dandurand (Host): Welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host Helen Dandurand. And joining me today is Leanne Bishop, Midwife at Riverside's Women's Health Office, who is here to talk a little bit about menopause. Thanks so much for joining me today.

Leanne Bishop: Yeah, thank you for having me.

Host: Yeah. So, this is your first podcast with us, right? Could you go ahead and get started by telling us a little bit about your background and yourself?

Leanne Bishop: Sure. Yeah. So, my name is Leanne Bishop. I have been in this area since about 2001. First as a labor and delivery nurse for quite a few years and then, around 2012, as a nurse practitioner, nurse midwife. So, I've been in this community for a long time, and I really enjoy the area of women's health and, more recently, specifically in midlife menopause care.

Host: Well, that's great. You have a lot of good experience here to talk about this and a passion for this topic. So, menopause is a term we kind of all know, but it still kind of feels a little mysterious. And could you share a little more about what actually counts as menopause, and also, how that might be different from perimenopause, which I've been hearing a lot lately?

Leanne Bishop: Yes. Thank you for that, because a lot of women are confused about what perimenopause and menopause mean. Menopause has a clear definition, which is when you've gone a whole year without a period, you are in menopause. The average age for that to happen is around 51 or 52, though there is variation when that occurs.

Several years before that time, we would be considered perimenopause, which just means the time around menopause. But often, women are having symptoms four or five, sometimes even six or seven years before they've gone an entire year without a period. There are a couple newer terms that are being used as well now called the menopause transition and people are referring to both the early and late menopause transition. And that all really incorporates perimenopause too.

Host: Yeah. That kind of makes more sense to me in my mind than saying like, "Oh, yep, now that you've been experiencing this for years, for sure this is what's happening." Okay. That makes a lot of sense. So, what are some of those first changes that women notice when they're entering perimenopause and which symptoms make people say, "Okay, something's definitely different here"?

Leanne Bishop: Right. And what's interesting is how individualized that is. So, many women will talk to their friends about these things, of course, or sisters, family members, and kind of compare notes. You know, "I'm experiencing this. Is this what you experienced?" And we see a lot of commonalities, but also some women are very different than their close friends or even their family members.

One common first symptoms is usually your period changing. So often women will report, "I've had very regular predictable periods my entire life. And now, all of a sudden, they're kind of wonky. You know, maybe my period is being late by a week or two, or coming a little bit early." And then, as they are going through their transition even further, they're skipping months at a time. And initially, that kind of scares them. I mean, some of them are taking a pregnancy test, right? Which is still possible in perimenopause. And then, they realize, "No, I'm not pregnant. What's happening with my cycle?" And then, a lot of the other things that you hear about from people you know or, you know, TV and movies where it's hot flashes or night sweats and trouble sleeping. Those are common symptoms. But there are numerous. And it's interesting that some women will not experience any hot flashes, but they have other symptoms that they may not initially realize the reason for those are the hormone changes with, perimenopause.

Host: Yeah. I feel like hot flashes are the hallmark of menopause that you think of. So, what are some of those symptoms that might surprise people that they're like, "Oh, that's what this is"?

Leanne Bishop: Yes, exactly. Sometimes those other symptoms may come after they've had menstrual changes or even before, even while their periods are still monthly, but maybe just a little bit lighter than before. And then, if their periods are still pretty regular, they're often not thinking perimenopause, but they may be experiencing things like joint pain, or trouble sleeping. All of a sudden, they're waking up every day at four in the morning and they don't know why that's happening and they've never had trouble sleeping before. Or weight gain, maybe brain fog. There's different symptoms that they don't realize, "Why is this happening to me?" We often hear women report, "You know what? I just don't feel like myself, but I can't really put my finger on what's changed." And it might be, it's not always, but it may be related to the hormone fluctuations they're experiencing.

Host: Yeah, I was just going to say that, but you kind of hit it right there. Like a lot of people say like, I feel so different. I feel like I'm maybe losing it in this stage of life. And like the hormones are affecting their mood, their sleep, brain fog, all of that. Is there anything else you wanted to touch on around that or...?

Leanne Bishop: I think we could have probably an entire chat about brain fog because it is a common concern actually. All three of those, mood changes, trouble sleeping, brain fog, those are probably in the top five concerns that I hear. And like I said, sometimes they are coming alongside some of those others that we've talked about and sometimes just one in isolation.

But women will often report their mood feels more up and down, you know, where they may be fine for a little while. And then, they have stretches of time that they're very irritable or anxious or depressed, and outside of anything else that's changed in their life. So, they're trying to explain, "I don't feel like anything else has changed or different. I don't understand why I'm feeling this way." Brain fog, a lot of women start to fear that they are developing early dementia. Because they are saying, "Listen, I can't find my words as quickly," or "I walk into a room and I can't remember why I went there. I'm having trouble with word recall. is something really wrong with me here? And again, if they're not . And there is actually a lot of studies being done on decreased productivity at work with menopause symptoms because women will report that, like, I feel like my day is interrupted because of my lack of sleep or how frequently I'm having hot flashes. So, they all can contribute to each other.

And so I think if we can treat often the primary symptom, it often helps the others because if we're sleeping better, for example, our cognitive health is better, right? Our brain is working. If our mood is better, then we're probably going to be feeling better about ourselves and our relationships, and that's going to support a lot of our other wellness characteristics. So, they're all kind of overlapping, but really important to women and need to be addressed.

Host: Yeah. That's great to know. Okay. We're going to take a quick break to talk about primary care at Riverside.

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And we are back here talking about menopause.

Leanne Bishop: Yes. I just wanted to mention a couple of things about what we were just talking about with the brain fog and mood changes. I think something that's important is some women will feel like it's kind of silly to bring up, or they're nervous or embarrassed to talk about it. And also, those symptoms may not be consistent, because during perimenopause we have this hormonal rollercoaster where hormones are going up and down, up and down. In some months, we're still ovulating and having more of a normal cycle and the hormones that we're familiar with. In some months, we aren't.

She's also nervous about talking about it because she doesn't always feel this way. So, women will report, "Hey, you know, for a couple of months, I had all these symptoms. Then, I made the appointment, it got better for a little bit. And then, a few months later, they're happening again." And so, it can be something that's kind of on and off and that's also difficult for her to figure out how significant is it? How serious is it? And should I really bring it up? But we do want her to bring that up and to talk about it.

And I think the reassuring thing we can say about brain fog is that, yes, you're correct. There are studies to validate what you're saying. You are having some changes in cognition, but it is not dementia. And what we have learned is if we treat some of the symptoms of helping you sleep and treating the hot flashes, it doesn't mean that we'll be gone, but it will improve those symptoms because we've seen that in good studies that we know that these changes are real, but they're also treatable.

And then, we are able to give advice too on just some kind of pillars of how to support good brain health and cognitive function in midlife. And so, those discussions can happen, but we won't know that unless, you know, she feels safe to bring it up.

Host: Yeah. And I was going to ask like when should someone stop brushing off symptoms and come talk to a provider? But it kind of sounds like you should always do that, right? Is that kind of what you're getting at?

Leanne Bishop: I think so. I think it's prudent to say, "This is bothering me and I have questions about it. I'm not sure." And even if you don't want prescription treatment, right? And some women will be afraid to talk about it because they will say, "Well, I'm not interested in a prescription for this," whether it's hormone therapy or not hormone therapy. They may say, "But I just still have questions." I think just having that conversation is sometimes adequate and women will then feel okay to say, "If these symptoms get worse, maybe I'll come back and want treatment." But they just want to talk about what's happening with them and their body and to know what is normal and what is not normal, and when should they really be concerned.

Host: Yeah, that makes sense. There's also a lot of mixed messaging out there. What would you say are some of the biggest myths that you hear about menopause, that you're like, "I want to clear this up right now"?

Leanne Bishop: Yeah. I think one myth is Some women have heard, you know, kind of suck it up buttercup. This is just part of aging. This is just part of life. And there's not much you can do about it. So, that is a myth. It is a transition that all women will go through that we will all have hormone changes in perimenopause and menopause. We don't all have the same symptoms. But it's not something we just have to suffer through.

And we don't have to just strive to make it through, but we can still be thriving. We can be happy, we can have a full rich, wonderful life at perimenopause and menopause. It doesn't have to be miserable. So, I think some women think it's just misery is the destiny here and there's nothing that can be done to help them. And I think that's a myth. That is not true.

Host: Yeah. And what options then are available for helping to manage maybe some of those symptoms and how do you help patient's to decide kind of what's right for them?

Leanne Bishop: What's nice is it's not just one-size-fits-all. So, that's nice because all women are different, of course. First, their symptoms are different. Also, their preferences are different and what they're bringing into perimenopause as far as their health status. So, what other health conditions maybe they have that we would have to look at to see if one treatment is right for them versus somebody else.

So, the nice thing is we have a toolbox available to us, some that are prescription, that are hormone-based, what we would traditionally call menopause hormone therapy, and then some are prescription, but non-hormonal. And we have some newer medications on the market in that category, and we have some that have been around for a long time that are also FDA approved for menopause. So, there are a lot of options and other women may choose to use things like cognitive behavioral therapy or some herbal supplements and lifestyle changes and feel like that's adequate for them, that they don't need anything prescription. But it's nice that we have a lot of options.

Host: Definitely. If you could give one piece of reassurance to women listening who might be nervous or overwhelmed about menopause, what would that be?

Leanne Bishop: I think just that it's changing, that the healthcare around midlife and around menopause is changing. So if women have previously been told or heard that we're not listening in the medical community to their concerns and we're not really ready or able to help them, that's not true. And that they should feel confident in seeking care. And I think it's not just you, you know, it is what you have to kind of tell her. Some women think, "Well, maybe it's just me. Other women can do this, and they don't need any help or support through it." It's not a badge of honor necessarily, right, just to suffer through. That what they could do is to feel safe and confident, to seek care and to know that somebody is there to listen and that they're ready to help them through it. And it really is a natural transition, but it's okay to need support through that process.

Host: Definitely. Well, I feel like this has been so great. We've got a lot of good insight in here. And thank you for being here today, Leanne. Is there anything else that you wanted to share or you feel good about this?

Leanne Bishop: Yeah. Thank you for having me. I think we've touched on a lot today and I think we would have an opportunity, certainly to have more conversations in the future. And that I think women will have more questions coming up. And this is just kind of touching on some of the highlights. We could go into a lot more depth on some of these concepts. But really, just to start that conversation I think is important.

Host: Absolutely. Well, thanks again and thank you listeners for tuning into the Well Within Reach podcast. Be sure to like and subscribe to well within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about services at Riverside Healthcare, go to riversidehealthcare.org.