Welcome to the Brilliant Fertility Podcast. I'm your host, Dr. Katie Rose, and this podcast exists to help illuminate the path ahead of you. With expert interviews, clinical pearls, and real client success stories, my intention is to bring you hope for when possible on this journey and to give you tools and resources to navigate the ups and downs on the road before you. If you find this podcast helpful, don't forget to subscribe on your favorite listening platform. And I have a big request. If you have a minute, can you leave us a five-star review? And let us know what did you learn, what did you come away with? Did you leave with that spark of hope? This helps more people like you find the podcast. My mission is to support as many humans as possible on their path to become parents. And by you sharing and subscribing, you're part of that mission too. And I'm so grateful for you for being here. And welcome you to the conversations, the questions around fertility. Um, our goal with this podcast is not just to get accurate information out there, but to be a part of creating community, creating a better world, being part of the village, and um giving you that hope for what's to come. And today we're talking about perimenopause, which can feel like a very hopeless place to be if you are also trying to conceive. And there are a lot of misconceptions out there about perimenopause. It's so interesting because I've brought it up a few times on social media, and I have some followers who are beyond menopause who have written into me and been like, 40 years old is way too early for someone to be going through perimenopause. Like, what are you talking about? And I was just like, oh, this is interesting. So I think we need to have a talk about this. Um, first of all, I just want to put out there, because I know this age question is one of the factors that makes people feel really pressured, really stressed out. And hearing the word perimenopause can just add fuel to that fire. So, like, let's just pause for a second, take a breath. Perimenopause does not have to equal panic when it comes to fertility. It it's this term that really just means the time around menopause, the time before menopause. I hate that it even has the word menopause in it because I feel like like that word is, you know, the real cutoff point for fertility. Perimenopause is not. You can get pregnant, someone can get pregnant in perimenopause. My attorney would want me to tell you at this point that this is not medical advice to please talk to your providers about your fertility plan. But I do want to talk about my experience with perimenopause in practice and how I've supported my patients through their fertility journey while they've technically been in perimenopause. Um, I'll share a bit about my own fun perimenopausal symptoms that are emerging that, again, family members have told me, like, oh, you're too young to be in perimenopause. And you know, with all the love, because I know sometimes they listen, uh, this is my specialty. Like, I have literally spent the last 13 years in medical practice around women's health, hormone replacement therapy, fertility. I probably get more inquiries, interestingly, about perimenopause than I do about fertility. I don't know what the universe is trying to tell me there right now. But it can be a really challenging time and it can make you feel absolutely insane to be having these hormonal changes going on, especially when other people are like, you're too young for that. It's like, well, let's talk about it. So, by definition, perimenopause defines about the eight to 10 years before menopause. And it can be signaled by subtle changes. Some people, it's their period changing by a day or two, right? Their period might have been heavier before and it's lighter now. It might have been lighter before and it's heavier now. For others, it's a change in their cycle length. So if someone typically had a 28-day cycle, now it's 26 days, 25 days, or could be longer. It could be they were a 28-day cycle and now it's 30 to 32 days. There is not one single change that we are looking at to tell someone that they are in perimenopause. Rather, it's kind of a cluster of things that are often present. And it can range in severity. Again, it can be very subtle changes in a menstrual cycle to heart palpitations and insomnia and mood swings and irritability and like this just absolute intolerance for things that used to feel just fine in life. And first off, if you are in that category of people who are feeling like they just can't handle anything, like their whole body is betraying them and their symptoms are feeling really out of control. I want you to know that you're not alone. And I say that because some of the women that I'm working with in my practice are feeling like they are the only person in the world going through this, that they don't believe any of their friends are experiencing this same type of situation right now. And maybe that's true if you have a friend group of 10 women who range in age and they're not all at that same point yet, because this can hit, you know, anytime between 35 to 45. And I mean the perimenopausal symptoms, not menopause itself. The average age of menopause is about 52, but they're outliers. And I've had patients go through menopause as early as 42 in my practice. Anything below 40 is considered premature menopause. And I've had patients who are 56 and still having a pretty normal menstrual cycle. So there is quite a wide range there. And the best predictor that we have of the age that someone will go through menopause is when their mother went through menopause. This is not a hard and fast rule by any means, because there's a lot of other environmental factors, stress factors that may play a role. Um, I do want to bust some myths of that I've heard patients talk about with going through menopause at a certain age, like did IVF put me into an early menopause? Did being on birth control for 15 years put me into an early menopause? No, we don't have evidence for that. So, you know, some of the stuff that I'm seeing from influencers online who are discouraging people from going through IVF because it will put them through an early menopause is absolute bull crap. We don't have that evidence. What we do know is that the reasons that people may need to go through IVF at a certain point could also be linked to going through an earlier menopause. Someone being on birth control for 15 years may have been masking underlying symptoms that would have pointed us towards a certain type of hormonal imbalance or situation like PCOS, endometriosis that could inform how they experienced those hormonal changes. So you're not alone, whether you've gone through IVF or you've been on birth control in the past, those aren't contributing to your experience of perimenopause, but they may have been masking something that was going on that was never properly addressed in the first place. But what's also important to acknowledge here is that we just have an overall lack of funding and research in women's health issues. Women weren't included in studies until the mid to late 90s because we were considered to be too complicated. And if that makes you feel enraged, it should. And your rage is valid. And we've got some episodes about emotional processing that it might be good to listen to, uh, do some EFT tapping around because we can't spend all of our time in that place today. Where I really wanted to spend some time is just reassuring you that perimenopause is not a death sentence for fertility. And we need to get really serious about your lifestyle, your boundaries, your vision for what you want the next 10 years of your life to look like. And I think if there's one common factor that I would bring to the table here in terms of getting the best result in perimenopause is actually learning how to slow down and listen to your body. I don't have concrete evidence in terms of like a research study, a double-blind placebo-controlled study. But my experience working with women who are having a more intense perimenopausal experience is that there is very likely some trauma that has not been processed. They have very likely been tolerating situations that have now become intolerable, whether that's a relationship dynamic, a dynamic in the workplace, that because they had a lot of fun estrogen in their body and they were like, oh, whatever, I'll just brush it off. Like I feel okay, even though like that kind of sucks. Like things become intolerable. And women are made to blame, like, oh, you're hysterical, basier hormones. Like, get a grip, you need to figure yourself out. When really we have just been put in impossible positions for so much of our lives. And when we reach that point where symptoms are really heightened, we have to find those practices to slow down and we have to learn to trust ourselves enough to make some changes. Some of the patients I've had who have the most profound change in what perimenopause started as with insomnia and irritability and weight gain, who two years later are actually feeling like the best version of themselves, even though they're technically still in the thick of it, have made the most profound changes in their work-life balance, in their processing of emotions, in setting their boundaries. And we didn't really do a whole lot physically. I know it would be so great to have someone just say, here is your magic pill. And there are some things that actually do make the symptoms more tolerable. But I want to be clear like we cannot stop a moving train. Like if someone is headed towards menopause, we can't just say, Oh, here we're gonna give you this, and it will pause it indefinitely. It's more of like just creating an environment where we can smooth out those tracks to allow things to happen more easefully and to give someone the best chances of conception if that is still their goal during that time frame. So, really, from the ages of, I would say about 38 to 45 is when we have to tighten up on the lifestyle. And maybe tighten up is that it's not the best term to use. So I'll correct myself on that because we want to get really clear on what our body needs for nourishment. We want to get really devoted to honoring our body's wisdom and using practices that allow it to function at its highest level. So that means getting eight hours of sleep or creating the environment to get eight hours of sleep. We can't always control what happens, but we can start to create the environment for that to happen. So we set a timer that tells us to start getting ready for bed at a certain time. We are in bed at the same time every night, like that becomes non-negotiable. If you want my full 10-step to optimizing your circadian rhythm and sleep, I will add that link in the show notes today because there are many factors that can contribute to getting a good night's sleep. And it can become a real vicious cycle in perimenopause, where if you're not getting enough sleep and then you're feeling that like exhausted but totally wired phenomena, it then becomes harder to get to sleep and get a good night's sleep because you're basically running on adrenaline. And it can take a little time to get back in that happy place of sleep. So, in that handout, I do go through, you know, what supplements that I might use and under what situations and always talk to your provider about any supplement changes. But I do love a magnesium. I do use melatonin, especially in my patients who are trying to conceive, because that is an antioxidant, but it is also a hormone. So we want to use it safely, we want to use it in a proper way, and we want to use a form of it that can be well utilized, both in terms of getting to sleep easily and also supporting the uh that antioxidant effect on the ovaries. The other fact that we have to look at is nutrition. So again, we talked about protein in the last episode. And I would say for people who are going through perimenopause, protein is so important. If you're someone who's just gotten away with running on fumes and not getting enough calories, not getting enough protein your entire life, you are likely gonna have a harder experience as you reach perimenopause and your body is like, nope, that doesn't fly anymore. We don't have the tolerance for that. And it might feel like you have to baby yourself a little bit. Like, you're telling me I gotta have, I gotta like put myself down by 9 p.m. and serve myself three meals per day. And I have to sit down and chew my food and be present during those meals. What the f like I have had patients be really upset about needing to slow down and baby themselves. I've I've had multiple people use that term. And as a master of reframing, I really want to also give the opportunity to look at this as a time of like deep nourishment. There's so much wisdom that comes from having lived to this point in your life. And what would happen if you slowed down and you honored your body's wisdom and you listened to what it was asking for? And I know that there can be an element of fear around that. Like, well, what if I start listening to my body and it tells me something that I don't like? And valid, but does that change what your body would be communicating? Or is it just going to keep dropping hints that get louder and louder until it's basically screaming at you? So just like everyone else who I work with who is struggling to get pregnant, someone in perimenopause is going to get the assignment from me to slow down and listen to their body and nourish their body and become devoted to nurturing and nourishment. And that may look different for every single person. It certainly will, in terms of what our nutritional strategies are, what our supplement strategies are, what points I would be using for acupuncture are going to be so different for someone who has this kind of stereotypical blood deficient, yin-deficient pattern versus someone who has like a really sluggish metabolism, insulin resistant, spleen deficiency, damp phlegm pattern. And I know that was like a lot of words that if you don't have a lot of experience in traditional Chinese medicine, you're like, did you just call someone a damp phlegm pattern? I sure did, because in the traditional Chinese medicine model, and of course I use a lot of acupuncture in my practice. We're not just looking at like, oh, there's this diagnosis of perimenopause, or this person has endometriosis or PCOS or infertility. It's like we are observing the patterns and how those symptoms are presenting for a person. Are they hot? Are they cold? Do they feel weak and tired? Or are they angry and frustrated? Um, there's so much about their digestion and their sleep and how they think and feel and how those symptoms present that would cause us to use a different point protocol and really honor where that person is every time they come in. That's the beauty of using a system of medicine that is so individualized, is it's not even just based on like, oh, well, this is your pattern. So every time we're going to use this point, it's, oh, well, how are you showing up today? What is your body asking for today? And the more we can do that, it doesn't mean you have to get acupuncture as part of this plan, but it is such an effective tool. But it means that you are creating that little space for yourself every single day. And again, coming back to there's one thing that I would tell every person who is struggling with perimenopause, it would be to carve out a few minutes per day and just be fully present to your body, maybe placing a hand over your chest. Taking a few breaths and asking, what does this body need today? And then work with someone who can help you establish rituals, practices, individualized plan to meet you where you are. There are certain scenarios in which I will start to utilize hormone replacement therapy in someone who is trying to conceive and is also experiencing perimenopause symptoms. That is an extremely individualized place that often involves using compounded hormones that can be really customized to what their experience is. I would say it's probably about 10% of the perimenopausal trying to conceive patients that I work with that I will use hormone replacement therapy with. And then the others, once we get really dialed in on nutrition and these self-care practices and sleep and utilizing acupuncture or you know other energetic tools to help balance their nervous system, usually we are seeing improvements within three cycles. And just yesterday, actually, I followed up with one of my patients who, just based on age alone in her early 40s, like we could qualify as being in perimenopause. Um, she is trying for baby number two after also having recurrent miscarriages. And it's like when she's really busy and she's traveling a lot and she's just not really slowing down because she's also she's just a very energetic person. She's always doing the things I think has described herself as like, oh, I don't, I don't really like sit down. So for her, when she is more intentional around those, when she comes in for acupuncture more frequently, her periods are painless and more um as someone who's she's had experiences of like flooding, extremely heavy periods, her periods are more tolerable, like a more moderate flow that is a significant improvement for her. So just know that like these changes can happen and they can maintain for quite a while. Um, and again, we cannot stop the moving train, like every cycling person is going to go through menopause at some point, but we can buy time and we can make it a much easier experience and through that think increase the chances. So if you're if you're really just solely focused on like, oh my God, I'm 40 and I have these changes, and there's so much pressure and there's so much contraction that happens around some of the changes that people make, they'll come in and they'll be like, I don't know what's wrong with me. Like I cut out sugar, I cut out alcohol, I cut out coffee, I'm exercising five days a week, but like I've still gained five pounds and I can't sleep and I'm having heart palpitations, and I just feel like this frazzled shell of myself. Then we have to flip those practices on their head. Maybe that means really slowing down. And instead of doing five days a week of cardio, we're doing three days a week of yoga and five days a week of just like slow, gentle walks. Maybe that means we are adding in like really slow, cooked, nourishing foods, like porridges and stews and soups, things that are really easy to digest. Like we have to meet someone where they are, and then cycle by cycle make the adjustments to where they are feeling more like themselves. And again, sometimes it also means setting some boundaries, making some changes in life to address things that shouldn't be tolerated as someone who thankfully is self-employed now. Uh, I have absolutely been in work environments where it was very fast-paced, I would say very masculine energies that didn't really honor, respect, and value the wisdom within women's bodies. And so when we can, when we have the opportunities to honor that, we also I tend to see women have an easier experience with that. Um, so I am on the cusp of turning 40. So I'll be turning 40 next month in February. And it's so interesting because even just within the last six months, I've noticed some changes that I would qualify as hormonal changes, possibly perimenopausal changes. And it's been rather wild. And when I can like step outside of my own experience and be the curious observer, I'm like, oh, how interesting. And then of course, there are the days when I'm like, what the actual fuck is this? Like, this is not me at all. I do not enjoy this, I reject this experience. And it's so funny. I and I think we're just we're all gonna be called to experiences that cause us to need to surrender over and over and over again. So I'm doing my best to practice what I preach here and surrender to this experience and reevaluate my own practices. I'm not trying to get pregnant, but if I were, how would I be honoring my body? And I do actually approach my health in that way because when someone does have a really healthy, robust, regular cycle, it's a sign of vitality. And I talked about this in my episode about tracking your cycles and the fertility awareness method with Lisa Hendrickson Jacks. And she talked about perimenopause too, is this time when like you like there is just much less wiggle room for shenanigans. And I'm finding that true of myself. Like I cannot go to bed past 10 p.m. Or my body goes into full FU mode of the heart palpitations and like this buzzing from the inside out feeling that's like super uncomfortable, and it takes a while to like come down from, and then my whole night of sleep is kind of messed up. So it's like I really have to be intentional about that time before bed, and then you know, ideally being in bed by 9, 9:30 and able to fall asleep pretty quickly. Historically, sleep has always been a funky thing for me, and so that's one of the reasons like I have prioritized that so much over the years, but I have to do that even more so now. I have to be even more conscious of getting a high protein breakfast because I've all of a sudden become more prone to headaches. And I don't want to rule out that like for me and for other people, there could be other things going on, right? Like, we don't want to just completely ignore like mold exposure or post-COVID or another type of environmental exposure, like toxic metals. I'm always, you know, keeping tabs on the other things that could be going on. But in general, we have to start with basics and we have to look at, you know, how is someone sleeping? How is someone eating? Are they getting sunlight? And that circadian rhythm truly is so important. And more important, I would say, in perimenopause, like we just our mitochondria, they don't have the wiggle room that they had when we were 25. We can't get away with pulling an all-nighter and then expecting that our hormones are just going to tolerate that. So it's really a time, again, to be devoted to your own well-being, to be devoted to nourishing your body, to slowing down, listening to your body, and figuring out with individualized lab work, not just what's going on with the hormones, because those can actually be super challenging to pin down. They can fluctuate so much more cycle to cycle, but figuring out are there nutrient deficiencies, because that's going to create more havoc now than it did for you 10 years ago. Is there inflammation? Is there blood sugar dysregulation? Is there a mitochondrial dysfunction occurring? Those are going to be more impactful to understand than what that hormone level was on that day of the blood test. I do test hormones because it can be a tool, it can be a baseline for this phase of life, but it's certainly not everything. There's actually a lot more that we have to dig into at that time of life in terms of nutrient deficiencies and inflammation and possibly the buildup of decades of environmental exposures. So when we can look at the whole picture, understand what you as an individual need, we can often give the tools, practices, supplements, recommendations that are really going to make a difference, help you feel better, and optimize the chances of getting pregnant during that time phase time phase. There's um again so much pressure that people feel around age. And at the end of the day, if you're ovulating, there's still a chance of getting pregnant. Every single cycle, there's a chance. We do have to do the right tests. We have to make sure that, you know, physically, anatomically, things are where they're supposed to be, tubes are open, sperm is high quality. Uh gosh, we put so much attention on the women. Let's not ignore the dudes here. Um, but this episode being about perimenopause is is going to be focused on you so that you can actually feel your best while staying open to conception. All right, if you have any follow-up questions about perimenopause, don't hesitate to reach out. You can find me on Instagram at Dr. Katie Rose. And um, if you're in it, if you feel like you are in the midst of this right now, let me know what your experience has been like so far. You're not alone. It does get easier with help, but please don't let symptoms run wild for too long without getting support, because uh without support, it doesn't tend to get easier either. So if you're in the middle of it, I'm sending you so much love. If if you're nowhere near it yet, I don't want you like bracing yourself, like, oh shit, this is gonna be so terrible. Please know that a lot of what you are likely learning here in the podcast now can set you up for an easier experience later, too. All right, you guys, sending you all my love. If you learned something today, if you got something good from this episode, I have a quick request. If you want to hit pause, give us a rating, give us a review on your favorite listening platform that helps this episode get in front of more people and help the world be a better place. Until next time.