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Maggie McKay (Host): It certainly isn't glamorous or something talked about in everyday conversation, but like it or not, for women, menopause and perimenopause are facts of life, and you rarely hear women say positive things about either if it's discussed at all, But wouldn't it be great to at least find out the facts and learn what to expect before it all happens?

Today we have an expert to do just that and lessen some of the mystery and anxiety over the journey of menopause. Julie Kean is a certified nurse midwife at Tenant Health Central Coast Primary and Specialty Care, women's health, who will share her knowledge with us. This is Healthy Conversations, the podcast from Tenant Health Central Coast. My name is Maggie McKay. Julie, it's a pleasure to have you here today. Thank you so much for making the time.

Julie Kean: Thanks for having me. It's a pleasure to be.

Maggie McKay (Host): So to begin, can you set the stage and tell us what it means to be a midwife? What does that involve? ?

Julie Kean: Midwives covers a lot of areas. most people know midwives as, practitioners that deliver babies and have prenatal care, but in fact, midwives see women from the time of menarchy, which means your first period, until, the later years, even in the eighties and nineties, depending on what practice the midwife works with. So there's a wide range of things that midwives do and that they specialize in. And it's very similar to a women's health nurse practitioner with that added specialty of delivering babies in the hospital.

Maggie McKay (Host): When we're talking about perimenopause and menopause, what are some of the signs and symptoms to be aware of and around what age should women expect to experience these?

Julie Kean: Well, that's a good question because it's different for everyone certainly, but there are some similarities and of course there is an average age of menopause. Which is 51. But it is common for women to start experiencing symptoms called perimenopause, in the late thirties even, but usually the early forties, through the fifties and even into your sixties.

Maggie McKay (Host): That's a long journey.

Julie Kean: It is, but it's not the same for everyone. If you start menopausal symptoms in your forties, you could be done in five years. So it, doesn't necessarily mean that you'll be in perimenopause the whole time. and certainly it's different from person to person. Some women experience it for a year, some, it's a long time for 10 years, and we don't know exactly why that is. And some women have almost no symptoms.

Maggie McKay (Host): Wow. Aren't they lucky?

Julie Kean: Yeah, they are lucky. It goes back to what menopause is and what menopause isn't, and that's, kind of a key to what symptoms do you experience and what is it like for you. Menopause, clinically speaking is defined as one year without a period. So once a woman goes one year without having menstrual bleeding from her last period, that's considered the moment of menopause. That's clinically. After that it's postmenopause. And before that, when, our periods start to get really irregular, for some people, for some people not. that's the perimenopause time. And again, that can be any time kind of in our late thirties to even early sixties.

Maggie McKay (Host): And what are some of the signs?

Julie Kean: It's different for every woman, but common symptoms, I'd say the number one symptom is hot flashes, and I'm sure most people have heard of hot flashes. It's just an internal feeling of heat that often starts in the chest and into the face and can be through the whole body. And they, it usually lasts from one to four minutes. So that's the most common sign or symptom. Other symptoms can be sleep disturbances, mood swings. That's probably the second most common report of a menopausal symptom or perimenopausal symptom is mood changes and it's from fluctuations of hormones. In fact, all menopausal symptoms are most likely from the fluctuation of hormones that happen during this transition time. Another common, experience of menopause are.

Maggie McKay (Host): Night sweats?

Julie Kean: Well, yeah, night sweats that would be in the same category as hot flashes, but different. Some women view those as different things for a good reason because hot flashes disturb sleep and happen at night, whereas hot flashes during the day are out in the open for everyone to see. So both are equally disturbing for different reasons.

Maggie McKay (Host): Right , what about hair loss and weight gain? Are those common?

Julie Kean: Those are common symptoms around the time of menopause and those are commonly caused by, not necessarily from hormones themselves, but are a secondary to the symptoms of menopause, and I'm speaking particularly to weight gain. That's probably another one of the most common. Reports of a symptom during perimenopause, I just can't lose weight or I've slowly been gaining weight and that's really a function of getting older.

Our bodies do that. Our metabolisms flow, our muscle mass decreases, which decreases our need for calories, and because we don't necessarily have a decrease in appetite that goes along with that, we end up gaining some weight, especially over time. And then weight gets harder to lose because we have to eat less and be more active. And with perimenopausal symptoms, we might not have the energy for that. Because again, if you're having hot flashes, you're uncomfortable, maybe you're having disturbances in sleep, you're not gonna feel energetic the next day. So it's really a secondary effect of menopause would be weight gain and really a common part of aging, unfortunately.

Maggie McKay (Host): Unfortunately is right. It's such a dismal picture, menopause, isn't it?

Julie Kean: It is, but it doesn't have to be, part of. Menopause and part of how we view menopause has a lot to do with our culture and, our psychological view on what's happening to our body. And I love to talk about what pause is, but sometimes we forget to emphasize what menopause isn't. And it isn't a disease. it isn't wrong. And it certainly isn't a failure. And in our culture, we view aging in general as this bad thing, as a failure. We're very scared of it. And don't even talk about death. that's the ultimate, most scary thing we can talk about. And, when we think of, Okay, my body's changing and getting older, that's a scary thing.

And that can exacerbate a lot of these symptoms. Instead of looking at it as, oh, hey, you know, My metabolism is flowing. Gee, I'm changing. Not that, that has to be a really fun thing to think about, but we can also have a different perspective. Whereas we change our, gaining weight into being curvy or not measuring our weight necessarily, but maybe measuring our fitness. Like, Okay, I'm gonna lift weights and just maybe see a little bit more muscle. And that's maybe a better way to approach our changes at this time.

Maggie McKay (Host): I kind of liken it too. It reminds me of when we were younger and there were always some people who were very dramatic about having their period and other girls who were like, I don't know, I don't really have cramps. It's not a big deal, whatever. Then you go fast forward. Maybe 40 years. And the same ladies who were complaining and dramatic about the period, same about menopause. It took over their lives. And the other ones, I have friends like this, two groups and the other ones were like, Yeah, I have night sweats now and again, or, but it is what it is. And I thought that's the way to go.

Julie Kean: That's the way to go. I a hundred percent agree with you that it's not all in our head because these symptoms are real a hundred percent. But how we deal with them and how we approach our attitudes toward that makes a huge difference. And so I'm really glad you bring that up because we can be sad and, dramatic, like you said about it. And maybe that's comforting to some people. Maybe that's just how they like to approach change, but it's certainly we have the ability to be mindful of what's happening and, enjoy every moment of life, even at this time of change, Menopause.

Maggie McKay (Host): Also, we touched on it a little bit, but real quick, what about nutrition and lifestyle? How do they factor in when it comes to menopause ?

Julie Kean: They factor in greatly. Our experience with menopause has a great deal to do with our lifestyle, and so there are a lot of things that affect how we will go through menopause. One being genetics. and what we just talked about, culture and just how we are as a person. There's our body type. health conditions, certainly like if we have diabetes or have had surgery, things like that. But number one is really lifestyle. So our diet, what we eat does affect hot flashes, does affect our sleep and our energy and, how much we drink. Alcohol has a huge effect on hot flashes as well.

And things like risk for cancer, go up with alcohol, exercise another great way to control or maybe reduce some of the unwanted symptoms of perimenopause. And so those are all in our control for the most part. Now, again, you go back to some of those symptoms that you're feeling really don't make you want to eat well and exercise, and I can see you might wanna drink But, if we keep in mind that, hey, I do have control over this and if this is really disturbing, it's just great to have that feeling of I can do something about this even without my doctor, without hormones, without all these things. Just by changing a few things in our diet.

Maggie McKay (Host): How does a woman choose a treatment option? Because I remember decades ago it seemed like hormones were the only choice. Then those kind of got a bad rap, or you just had to suffer through it. But fast forward to now, what does treatment look like?

Julie Kean: Yes, there was a time back in the eighties where everyone got hormone therapy because they thought it would prevent cardiovascular disease. Well then in 1991, they started the Women's Health Initiative in the United States. It was the biggest, study for women's health that had happened, and it's ongoing. And what they found was that hormones don't actually prevent heart disease in a lot of ways. And it's not recommended to take hormones for that. But what they did find eventually about hormones is it's not that bad. And what they thought for a while, Gee, it's gonna raise your risk of breast cancer.

But they've noticed new things about the study now looking back that it's not necessarily the hormones themselves, it was the type of hormone and so they were giving a synthetic type of progesterone. And now they think there's new kind of more hopeful studies that using the natural micronized progesterone, just called micronize progesterone or prometrium, does not raise your risk significantly for breast cancer, especially in the first five years. And so there are a lot of options to treat the symptoms of perimenopause and menopause. And actually, they're not just hormonal.

So for those people who cannot take hormones, maybe because they've had a personal risk of breast cancer or they have some other disease process that prevents them from taking the hormones like blood clots. There are other treatments that work really well for hot flashes and sleep disturbances.

Maggie McKay (Host): How can partners help, especially husbands who have no idea what it's like to be a woman, or how can the woman going through it explain it to their partners? Because there can definitely be some tension around people who are going through things like, Sleep deprivation and hot flashes and all of it.

Julie Kean: If I think about it, really open communication about what they're experiencing and the partner number one, should believe the woman, believe his partner, or her partner or whatever, that this is happening and these symptoms are real. They're not all in, the woman's head. Which not too long ago, maybe a hundred years ago, maybe even not that long ago, a menopausal symptoms were thought to be because of a mental disease, because there was something wrong with this woman. And she was being hysterical. and, Silly things like that.

And now we know no way it's a physiological process. It's a natural process, but it causes these symptoms that are really hard to deal with for a lot of women. And so just believing your partner, Oh, you feel that? Okay. Yeah. I believe you. That that sounds awful. Or what can I do to help?

Maggie McKay (Host): What can I do to help you? That's what I always tell my husband. mean goes a long way because at least you know they care. so to wrap it up When you have several of the things, on the list of possible symptoms and signs and consequences of menopause, without losing your mind, what are some tools that you can share with women to use like, I don't know, yoga, meditation?

Julie Kean: Yes, Yes. And yes, those things. I would start with your perspective and keeping in mind that our bodies aren't wrong and that menopause is not a disease. That's number one. Just in that okayness that okay, this is happening. It shouldn't be different. It is happening. And that's okay. the second recommendation. To queue into those lifestyle changes that will really help with the symptoms, potential symptoms of perimenopause. control your weight as much as possible, try to limit alcohol, the current recommendation is one drink per day.

But, studies have actually found that even having more than two drinks a week can very slightly raise your risk for cancer. Not to scare anybody, but it's more clear that, healthy lifestyle is important. Our diets really focusing on fruit and vegetables and getting a variety of nutrients through our food limiting sugar. And I will say a side note on sugar is it can decrease your hot flashes significantly just by cutting out sugar and alcohol. So I guess that's a takeaway is if you're starting to feel like hot flashes are becoming a problem for you. Cutting out sugar if you haven't already is one thing to change.

Maggie McKay (Host): And is there anything else you'd like to share with women listening who are going through it or about to, that we didn't discuss?

Julie Kean: I guess it's that we are all different and we're dynamic beings. We change from the minute we're born to the minute we die, and those changes are all good. And even though they can be painful, if you consider adolescents a very painful time, you consider birth, that's probably was painful, thank goodness we don't remember. But also growing older, it's a grieving process, right? we can grieve how things were because maybe pregnancy was a beautiful time in life and college was a beautiful time in life and now it's different.

Being okay with those changes and saying, Okay, I remember how great life is now, what's in store. And approaching it like that, that things are changing in me and that's normal. And I'm gonna take this moment to feel how I feel, to feel my feelings, to feel what's going on, and maybe embrace it a little bit. And if you can achieve that, you can handle any change in life.

Maggie McKay (Host): I agree. Kind of like mind over matter, even though all the symptoms are a real thing, but still it can help with your attitude or your perspective, like you said earlier.

Julie Kean: It can, and a sense of humor that helps too.

Maggie McKay (Host): That helps with everything. Right? Thank you so much for being here. This has been so helpful and informative, and I'm sure you are going to help a lot of people with this information that you shared.

Julie Kean: Well, thank you so much for having me. I do enjoy this very much and it was a pleasure for me to talk to you.

Maggie McKay (Host): That's Julie Kean, Certified Nurse Midwife at Tenant Health Central Coast Primary and Specialty Care Women's Health. Thanks for checking out this episode of Healthy Conversations. For a referral to a board certified physician, please call the Tenant Health Central Coast Sierra Vista Regional Medical Center and Twin Cities Community Hospital Physician Referral line at 860- 966-3680. And to subscribe to this podcast, visit tenanthealthcentralcoast.com/about/podcasts. If you found this podcast helpful, please shared on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, the podcast from Tenant Health Central Coast. Thanks again for listening and be well .

disclaimer: This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program? Are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital?