Understanding your Menopause with Dr. Mandy Leonhardt

Dr Mandy is a dedicated General Practitioner in Hampshire, passionate about women's health, nutrition, and lifestyle medicine. Specializing in premenstrual disorders like PMS/PMDD and menopause.

To learn more about Dr Mandy click HERE

Dr Mandy is a Co-author of The Complete Guide to POI and Early Menopause 

www.hormoneequilibrium.co.uk

Transcript -Automatically Generated

Welcome to this week's episode of Menopause Uprising with me, your host, Catherine O'Keeffe. So you definitely want to get the pens and the paper ready for this one. I'm talking to my lovely friend, Dr. Mandy Leonhardt from the UK, who is the co author of The Complete Guide to POI and Early Menopause. We cover so much.

Oh my Lord. We talk about practical tips in relation to supporting menopause. We talk a lot about lifestyle, about food, and we take a deep dive into phytoestrogens and also into omega 3. I hope you enjoy the session and do check out the show notes for all contact details for Mandy as well. Thank you. So Mandy, we got to know each other through our shared passion and I guess our advocacy work around POI, premature ovarian insufficiency, and you know, just building on awareness and support for, for our young teenagers, our young women who are going through this journey.

How, how are things in the UK in relation to early menopause at the moment? Well, um, things haven't really moved a lot. Um, in the last few years, I would say, I mean, they have been moving into the right directions with, general awareness and slowly and surely the awareness around early menopause and POI also is catching on.

So it's obviously, um, with the general awareness increasing about menopause in the workplace and, uh, HRT accessibility and access to good menopause care, this has a beneficial effect for younger women. Um, but it's slowly trickling through. And I think, unfortunately, uh, the specialist care that, um, women with early menopause need, the provisions for that are still not sufficient.

Um, so we don't have enough specialist clinics in the NHS. We don't have enough doctors who can diagnose this, who have not diagnosed it, have expertise in managing it, uh, and the complexities of it. So women still wait an awful long time for a specialist appointment. And then often they're disappointed because the person they may see may not even have any expertise in early menopausal POIs.

So no, it is not good. There's loads and loads of room for improvement. Yeah, I think we can, we can probably echo that story over here in terms of we have got a lot to do around menopause in general. But particularly when it comes to POI, I was just saying to you earlier in relation to the financial burden that comes particularly with POI, but also if you're on medical management in relation to menopause.

You know, I know. Some of the women I know, they can be going anywhere from 17 euros a month to 55, 60 euros a month for their HRT regime. And unfortunately, we're, we're not where you guys are at in the UK in relation to, you know, having that subsidised. We're nowhere near that actually, you know, so that's, that's another aspect for us that needs a lot of work.

Yes, I completely agree with you, Catherine. And the thing is, um, if you have POI, which is a condition that affects around 1 to 3%, we don't really know the exact numbers, but 1 to 3 percent of women under 40. So this is a lifelong condition that can start at age 12 from puberty onwards, or the beginning, the early years of puberty.

And it goes on for many, many years. It is a huge financial burden. It is a serious medical condition and it's not their fault. No, it's no woman's, no, no one's fault. Um, but they should be supported. It should be recognized as a serious medical condition and, um, the need for ongoing medication and a specialist care should be recognized and it should be made easy and accessible and financially.

not become a burden. You should never think or have to decide between, can I afford my HRT, which prevents your bones from, from becoming brittle and maybe eating a good quality meal, you know, serving good food to your family. This should never be like that. It should be free, accessible, affordable, and, and, It's also the idea that women have to go every single month to go and get their prescription.

You know, once they're stable, I think, I personally think they could get a prescription for a six month supply. And then have reviews once a year, but they shouldn't be made to queue at the pharmacy or back for it. And, um, it is really, uh, the discrepancies. It's really unfair. I know a lot of other medications are affected by shortages at the moment.

I do understand that, but, but this is an essential life saving medicine. This is not a luxury addition or a supplement or an optional. medication that they can choose not to take. It is, um, it is life saving, you know, and it prevents future conditions. It is like not having a thyroid gland and you are running or diabetes and you, you, you're not getting enough thyroid medication.

Um, and I don't want to make that comparison with natural menopause, just to be clear, this is not necessarily a deficiency in my view, but in younger women under 40 or under 45, it is a medical, serious medical condition and we should be teaching all doctors to take it seriously. Yeah, and I think for us, uh, one of the big things here, so we have a medical card scheme where, you know, you get free medication on a monthly basis and I think at a minimum, at a minimum, POI needs to come under that so that automatically the young girl is diagnosed at 11 or 12 or whatever age that automatically should come under that category of illnesses.

That you're there from there on, your, um, your medicines are, are covered because nobody chooses DOI. You know, there's so much to it in terms of, you know, the physical, the psychological, the fertility, and you know, it's such a complex area. Mandy, you just mentioned something there that I was kind of like, Oh, let's touch on this one.

And that was menopause is not a deficiency disease, right? And I know very, very much. Yeah, sorry, at the natural, natural spontaneous menopause. Yeah. Can you just give some insights into this? Because I find there's a huge amount of misinformation and, and, you know, differing views in relation to social media and so forth.

And anyone who, who knows, uh, knows me and the work that I do, I'm very passionate about the fact that natural spontaneous menopause is a natural inevitable stage in a woman's life. And it is not, in my view, it is not a hormone deficiency stage. Yeah. Yes, I agree with you. So we have to just get the definitions right.

Um, in, in here, in the, in u in the uk we have this, uh, we have this, the guidance that says if your periods stop over the age of 45, um, naturally stop. Um, you, um, you experience, uh, menopause as a natural age. So the average age is 51. I do think if you're 45 and your period stopped, you're still quite young.

So you may really notice that you no longer have oestrogen, um, but the average age when periods normally stop in the UK is 51. So this is meant to happen. This is not a deficiency in a sense that you become deficient in something. It is a natural progression because ovaries do age faster and they do, are meant to stop producing oestrogen.

Hormones at some point now Saying that though Obviously 80 of women will experience some form of symptoms as a result of this And they do need support. They need to be listened to they shouldn't be dismissed if they um wish to decide to take hrt, they should be offered hrt if there is no contraindication, but at the end of the day It is a balance between the symptoms they experience how well or how well they're not functioning the symptoms they experience their own choice and potentially also maybe looking at, um, Long term health.

So if a woman has been on a lot of medication that would affect her bone mineral density And she has a high risk of osteoporosis. She may wish to take HRT for other reasons health related reasons Even though it's natural so it is a very complex Situation, but we cannot categorically define every single woman over 51 is deficient Yes, hormones levels do go, go down, but it doesn't mean that every single woman wishes or needs to take HRT to have a very healthy life.

Um, um, but I do believe that every single woman who has symptoms or even any other reasons, uh, what that make, makes her want to have a try HRT, she should have access to it in an affordable, accessible way. So, um, but you know, that all women. I find nowadays who have not got many symptoms, they are quite well and they feel, um, like they've graduated to menopause and, um, they're quite happy not having periods and they speak to their friends.

And what happens is sometimes whereas in the past, a lot of men were judged for being on HRT. What I'm hearing now is that a lot of women now, when they speak to their friends are judged. about not taking it, you know, almost as if, oh, why aren't you on it? You know, we all take it. And isn't that a bit silly that you're not taking it?

Well, actually it is her decision, her individual decision. If she's informed herself, um, well, and if she feels well, and she just wants to do this in her own way, um, She should have that choice. It is a choice. It's similar to having that choice or giving women the choice to oral contraception Hormonal contraception.

This is a choice and it is perfect for some women. It is the perfect solution, but not for all There are some women who have other solutions that they want work better for them. And I do believe we need to give women access, but it isn't a compulsory. There should be no societal pressure. This idea of being forever young and beautiful and keeping, you know, everything lubricated is all very well, but we have to, I think, um, not judge women for whatever decision they think is right for them.

I, I think that's so important and I would see that here on a daily basis, the importance of respect when it comes to a person's journey because, you know, I always talk about the individual experience of menopause and I think because it's so individual, Mandy, That means that your management options, how you look after yourself, is going to be very individual to you.

And like, you know, you and I are both going to have a different experience of menopause. You know, so your sisters, your mother, your best friends, et cetera. So I think it is really important that while it's great now with so much awareness, but I think what we have to make sure that comes in tandem with that is that we have the respect for each other as we go through it, you know?

Yeah. And when you, when you look at, um, uh, you know, the management options in relation to, to, uh, to menopause. And I know you're a huge supporter of the lifestyle aspects. Can you just talk us through a little bit in terms of what you feel are those key aspects of lifestyle that we should be looking at?

Because I think one thing, Mandy, that I see sometimes, sometimes some people might think HRT is a get out of jail card and they don't have to, you know, do the exercise or etc. And I think it's important that kind of, to me, you know, the lifestyle is the foundation and everything else comes on top of that.

Yes, I've always, um, like to talk, um, in, in a sense of, um, having a toolbox. So we all have a toolbox and when we open the box, there are loads of different tools in it. Um, so HRT is a standalone treatment, rarely sorts all problems in a woman's life. However, it can potentially enable her to do, to have more energy, to sleep better, to go on and make positive lifestyle changes.

Many women also can look initially at what, what lifestyle changes can, they can, they can improve on. And there are four pillars I find that are quite important, and that is sleep, Diet, movement, and relaxation, or stress management. Those are the four that are individually very important, that you need to look at individually.

So, it's no good if you do a lot of exercise, and you push yourself, and you run, and you lift, and at the same time you eat a very bad diet. Everything comes together. So, and also, exercise can be a form of stress, so it's all very well if you, think you must, you must, you must move all very well, but actually if you exercise late in the evening and that is causing you stress and you can't switch off and you can't sleep, then that's not a good idea.

So we have to look at What are my needs? How can I balance this really well? Um, how do I, what do I do to relax and manage my stress? Is there something I can do? Setting boundaries, um, managing work stress, if it's possible, of course, it's difficult, um, surrounding myself. with positive people who lift me up and give me good energy.

That's one thing, relaxation. Second, sleep. So anything I can do to help sleep, maybe have a better sleep life, um, routine, go to bed at the same time, wake up the same time, avoid alcohol, take some magnesium, um, relax a bit, meditate a bit before sleep, have a hot bath. All of these simple things are often don't cost anything.

Actually, you can save money by not drinking alcohol, but just drops your sleep. And so that's relaxation, sleep, and then diet. Do you eat enough protein? I believe you should eat a portion of protein with each meal. So, we, we argue that if, depending on how active you are, but women need about 1. 5 to 1. 6 gram per kilogram body weight, and it amounts to about 80 to 90 gram of protein, and it's very difficult to get this in one meal.

So, I, I, tell women, you know, look at your breakfast, how you start off your day. There's lots of evidence. If you have a good breakfast with that is rich in protein, you know, you can have protein with yogurt, you can have eggs, you can have a plant based source of protein for your breakfast chia pudding, pudding, for example.

Um, so. Start your day with a protein rich breakfast that regulates your appetite later in the day. Make sure you have some protein at lunchtime and also a nice, a good nutritious dinner. So fiber is important, vegetables and so on. We all know what to eat. Um, and I believe that women don't need to look at what should I restrict?

What should I not eat? Uh, or what should I eat less of? We should be looking at what should I eat more of? So, you know, when you eat plenty of fruit and veg in the day, that biscuit in the afternoon is not con, is not gonna harm you, right? If you have a cup of tea with a biscuit. But if you just have biscuits with cups of tea in the day, that's not a healthy diet.

So it's all about that balance. So that's relaxation, sleep, diet, and then movement. Movement is absolutely essential. But I do understand there are time restrictions when you work full day all day. But then even then you can do small movements. Get up in between, uh, sitting at your desk, ask your employer to give you a standing desk, get up during breaks, leave the building if you can.

I know again, not everyone has, can do this, but move. as much as you can sit as little as you need. Um, and when you do have the opportunity, focus on potentially some strength training, you know, weight bearing exercise, a bit of jumping, a bit of, uh, some squats, some planking to keep your strength up. So we do see, unfortunately, as a result of menopause, muscle wasting, which is in the worst case called sarcopenia.

And to make muscle, it isn't. Very, very difficult process for the body. You need protein, you need movement. You need to get outside your comfort zone to make muscle. It isn't impossible, but it becomes harder as we get older. So you need to, I think it is important that women get outside the comfort zone when it comes to exercise and try new things.

If you're stuck in a rut and if you're just doing the same old yoga, which is lovely to help you relax, do the yoga, but maybe also look at maybe 10 minutes hits. Couple of times a week, you know, get a skipping rope or do some simple exercises and, and then you can build this up. Um, so I believe in habit stacking, stacking, where you start with one good habit, habit.

For example, you do the plank, you know, five minutes a day. Uh, I don't, I'm sure everyone knows what the plank is on the floor or do some squats, you know, 12 repetitions of squats, three times in a row. Good. And that's your first habit. And you make that a habit that you cannot live without. And it's a really positive change.

And then you created another habit. So that habit might be focusing on your protein intake, you know, and then you established a really good diet. It may not have to be complicated. That's the second habit. And as you stack those little habits that are quite easy to achieve, you actually build up to a really bigger picture, which then doesn't.

feel like you've made, had to make a, make a huge effort to get there. Whereas if I told you to change all these four things at the same time, to relax, to exercise, to sleep, and the same time change your diet, it's overwhelming. It's really overwhelming. So I've, I believe, look at where are you not doing very well at the moment and just make changes in this area.

And then. Create this habit towards better health and then look at another area and so it becomes this habit stacking toolbox that you can utilize and come back to and it makes you more resilient, you know. Um, yeah. I, I love, I love that Mandy and one of the things like when you mentioned about the movement and kind of adding the variety, cognitively, isn't it?

Because that little bit of change, doing something new, the brain loves. Us to bring in, uh, to bring in something new and, you know, I think that's the whole concept of habit stacking. We know it works. And, uh, one thing that, you know, I think is a, is a, comes with menopause for many women is the overwhelm. So, you know, that's, you know, doing things piecemeal, I think, makes it much more, uh, achievable.

Just when you were talking about diet and you mentioned one of my favourite, all time favourite, uh, seeds and desserts, and not dessert, but it, uh, can be dessert, but breakfast is, uh, chia seeds. And, um, for me, I just, I, I, I still look at them and I think you're so small, but you're freaking amazing. But, um, like when we look at that, what about Omega 3?

Um, I kind of, I know a lot of people, you know, I know a lot of people just struggle to eat fish. They just don't like fish. Um, you know, and I know nuts and seeds can be a great alternative, but any insights or thoughts that you have on Omega 3, I would love to hear from you. Yes, so omega 3 is, is very healthy, um, to have incorporate this in your diet.

Um, I do think if you can get this through diet, so two to three gram of omega 3 daily on average, great. There are plant based sources like chia seeds. Now, by the way, I've read something that if you have, if you want the omega 3 from the chia, then you need to use ground up chia. So, they are quite a solid seeds and, um, they are quite difficult for the gut to digest.

They're really good in terms of the source of fiber, but to enhance the absorption, the omega 3 that they contain, I personally like milt chia seeds. So they are not the whole ones that the milt ones are the powder. And you can add them to your porridge to enhance texture. Um, and they are easier to digest.

So that's a good thing. Walnuts are really rich in omega 3. I'm also a big fan of sardines. Um, I know it's not for everyone who doesn't like this. Sardines are superfood and they're cheap, they're longevity, they have a long shelf life, they have little bones, eat the bones because the bones are rich in calcium, they contain phosphatidylcholine, which is good for the brain, they are lower in the, in the food chain in terms of heavy metal contamination, which is a problem with fish now.

Sardines are, they're very universal, you can use them. sardines in many ways. Um, you can take omega 3 supplements. In my view, though, if you choose to go for one supplement, spend a little bit more money on a good quality omega 3. Um, one of my pet tastes is like the bottle. The extra cod liver oil, because that's often rancid, it oxidizes, so it's a very unstable oil.

So when you smell that fishy smell, it's gone off and you shouldn't actually take it anymore because it's oxidized and actually they're no longer beneficial. So omega 3 is very unstable. That's why natural sources are often better because it keeps everything stable, like the mackerel or the fish. So you want to eat the skin with the fish when you eat fish.

Um, that's really important. You don't throw the skin away. The skin is where the omega 3 comes from as well, just under the skin. Um, yes. So when omega 3s are packages, particularly supplements, then I believe they ought to come in a, in a glass jar, not in plastic because the plastic is fat soluble, so then you can have plastic seeping into the omega 3.

So I believe it should be packaged in a dark glass jar so that no light can get through. It's like, it goes. Udo's choice, I think that's a dark glass bottle isn't it? I have heard that, but I would say though, do, uh, and also look at, are they doing testing for having metals? Is it filtered? Is it, because we do unfortunately now have, um, high grades having metal contamination in fish.

There is also, um, a vegan, uh, Omega 3 that is made from algae. So that's that you've got vegan options or vegetarian options now as well. Um, I think omega 3 has many benefits for muscles, for, um, for brain function, even weight loss or weight management. People with higher levels of omega 3 find it easier to lose weight by musculoskeletal function, cardiovascular health.

Um, but it has to be a good quality product. So I do not buy the cotton liver oil that comes in the bottle that you take by the book that if it smells rancid or fishy, it's not good. It's not, it's not. Run, run a line. Yeah, so. And, and Mandy, you, Mandy, sorry, you just mentioned dairy, omega 3 in wheat management.

Can you tell me a little bit more about that? Yeah, so when I did my nutritional course as a nutritionist, um, omega 3, there were studies that we went through that have shown that people who have higher omega 3 intake, who would like to lose weight. So people who, uh, would like to manage their weight because with that I mean they want to lose a bit of weight.

Thanks. Um. To achieve a healthy weight, um, people who have a higher omega 3 content in their diet found it easier to lose weight with 2 3 gram of omega 3 daily intake in their diet. And that can come from supplement or from food. So there's good evidence that omega 3, it is not, just to be clear, not a weight loss, uh, magic pill.

All I can say is that if your diet is rich in omega 3, you may find weight management, either keeping your weight or achieving your weight loss goal, you might find this easier. And I guess that's why the Mediterranean diet, that's very high in Omega 3. Correct. So again, That's why it's kind of the one we all Yeah, but again, this comes back to this toolbox.

Just taking Omega 3 and then eating pizza and burgers all day, it's not going to make you lose weight. It is the combination of higher Omega 3 intake. with, uh, with lots of fiber and vegetable, vegetables, um, green leaf things, nuts and seeds and whole grains. That combination will be more likely to not only help you achieve your, your healthy weight, but it will also set you up for a healthier, healthier life.

Um, future in terms of cardiovascular health and bone health and getting all your nutrients from your diet. Um, which is obviously very important as we get older to really focus on that. Um, but just to be clear, we eat around 700 or 800 meals a year. If you just have a couple of meals that aren't perfect, the world's not going to come to an end.

It's your average intake is of what you do as a matter of habit. And that's when I think this. It is important that you develop good habits, you know, that you don't eat five days a week, just having a horrible sandwich from the corner shop. Not that sandwiches are bad from corner shops, but that you just eat ready made things with low nutritional value.

But maybe make your own sandwich before you go to work. And think about what you could put on that would enhance the nutritional value of that sandwich, you know, put a bit of kimchi on it. Um, you know, egg, egg, you know, put boil an egg and slice it and put it on with a bit of salad, uh, to enhance protein content on their little things that don't have to be expensive.

You can do in also going back to your chia pudding. That's something that travels well, if you put it in a little pot. Um, so, um, there are lots of simple things everyone can do. And the tea pudding is a great one for travel. I find, you know, if I have a day where I'm on site somewhere and I've got a few hours to travel, I'll always do tea pudding because I'll eat it at some stage of the day.

And as you said, it travels. And it's so handy having it made the night before too. Yeah, exactly. And just, um, um, before we move on to one of your other pillars, um, fight a wee stringent. And I know, um, I, in your, in your book, which we'll talk about in a few minutes, um, The Complete Guide to POI, um, I think you, you talk about phytoestrogens, um, in your book.

Can you just, cause that's another area that there can be a bit of confusion, um, about in terms of how they work and how they can benefit. Yes. So, phytoestrogens are, uh, compounds that occur in plants. that interact with our estrogen receptors. So, hormones are little messenger molecules that go around our bloodstream and they go to the target organ where they interact with specific receptors.

And we have got estrogen, testosterone, progesterone receptors. Now, phytoestrogens are plant derived molecules that are not chemically exactly like our own hormones, but they are a little bit similar. So they can go to estrogen receptors and can interact with them. They can activate them. They don't quite have the same effect as our own hormones, like our estrogens, you know, estradiol, for example, would have, but they interact.

And so foods rich in phytoestrogen are, for example, soy. Um, the tofu, um, anything soy derived, um, and that gets, if you, um, if you ingest or if you eat a soy based product, soy milk or, um, tofu or edamame beans, then if you have the right sort of gut bacteria, you might be lucky enough to break down the soy into an, a phytoextrin that's called Equol.

Now not everyone is that lucky. able to do this. This depends very much on the bacteria that are living in our gut, the microbiome, and some people are lucky they can produce this phytoestrogen in their own gut, which then is really helpful for potentially managing certain menopause symptoms, while other people are not.

But on the whole, it is established that, um, phytoestrogens or a diet rich in phytoestrogens, so the soy base or the marmite and beans or even just sage tea. Um, they can be really helpful in managing mild symptoms, so not in the form of a supplement, but they do also come in the form of supplements, and the most famous are, uh, sage, so concentrated sage extract, isoflavones that come from red clover, or soy based supplements.

Now, supplements are much more concentrated. They will be more likely to have a positive effect. If you want to have a nutrition, uh, an effect from just nutritional intake or fight regions, you would have to take a, take in or eat a good portion three times a day of soy based products, you know, soy milk, tofu or, or not to, or something else.

And not everyone can do this. And in some people it has many benefits, visual effects and other people doesn't do much and it depends on what your diet is anyway from the start. Certainly what is very reassuring is that in women with breast cancer, if they cannot take either phytoestrogen supplements or HRT, they can certainly eat a good amount of phytoestrogens in their diet that is not shown to be harmful.

It can actually prevent potentially recurrence of breast cancer because they are not. We, we, we know that they're actually a diet high in phytoestrogens have, um, those women have a lower risk of breast cancer in general. So they have many health benefits, the diet resources. Now with the supplements, it is a bit tricky because a lot of them have not been scientifically tested.

And a lot of them only have very short clinical trials. So we don't know what would happen if you took an isoflavonoid or if you took, um, um, A soy based supplement that is very highly concentrated for several years. We just don't know, um, whether they're safe or not. Um, but in the short term, for example, sage, sage extract has been known to help with hot flushes and night sweats.

Um, but certainly nutritional hydration are perfectly safe for most of us. And we should actually incorporate them in our diet, um, as a matter of routine if we can. Um, you know, uh, if you'd like the taste. Um, where supplements are slightly different. And just when you mentioned there, one of the big ones is the soy milk.

Because I find not all soy milks are made the same. Um, I don't know if you've experienced that. But in terms of, you know, that's another aspect to be mindful of, isn't it? You know, the quality. of, um, you know, of any of these, you know, food sources that you're buying, you're buying, but I know the one that jumps out at me often is the soy milk.

Yeah. Unfortunately, um, a lot, so obviously soy milk does not come as a natural product. It has to be processed from the soybean. It is an ultra processed product. And I personally don't have soy milk. I'm, I get an allergy. It's called oral allergy syndrome. So I can't, when I eat, uh, the soy based sugar or milk, my mouth swells up.

So I can't have this soy protein. But what I can have is edamame beans. I can eat the whole edamame beans, the frozen ones. I love them. I buy them frozen in the back. They're really cheap. And I add them to rice because they've got extra protein. Um, I like the textures, the edamame beans. as a whole bean are really healthy, but I personally cannot drink soy milk.

I do, however, have, have many patients who have no problems with soy milk. Um, but yes, it is ultra processed and, um, it, there's lots of, um, lots of additives in soy milk. You know, you, you have, and there's also, you know, You have to be mindful. You cannot rely on soy milk for your calcium intake. It is not the same as dairy that has, is rich in calcium.

Soy milk does not have natural calcium. It has to be fortified. So if you are concerned about your bones and you, you wish to have calcium in your diet, do not rely on soy milk. Check if it's got calcium in it, but it would have been added. It's not a natural compound in soy. So yes, you have to do your, your research.

Um, it's not for everyone. Um, um, But I do think, I think the, sorry, the edamame beans are, I mean, like you, I love them, and just, I know Tesco, the freezer section in Tesco, um, nearly always has edamame beans. And as you said, They are inexpensive, so they're a great one to buy a bag or two, throw it into the freezer, and then just add it as a little side portion, um, to your meal.

And that gives you a nice, um, daily edition of Phytoestrogen on top of, um, the other foods Absolutely as well. Yeah. You can also, um, you can also go into the garden or if you know someone who's got a sage, a sage plant in the garden, I mean, in my garden, it, it grows like a wheat. It, it grows really big. You can have it on your windowsill and pluck a few sage leaves.

leaves, rub them together, crunch them up, wash them, put them in a, in a cup of tea, and pour some hot water over it with a bit of honey. Um, that is not a very high, dose of hydration, but it can certainly, it is not harmful to do this. It's really good for the throat. I do like a bit of sage tea sometimes.

Not everyone's cup of tea is a bit bitter, but it's like from a herbalist point of view, a lot of herbalists recommend sage tea, um, just a few leaves, you know, um, so you can try that as well. Yeah, it's all of it, you know, putting it in your toolbox, isn't it? Exactly. Just one area, and I know we've, we've spoken kind of, um, we've spoken about this before, uh, the adrenal glands.

So, I know that, um, I talk a lot about stress and the impact of stress, and obviously some stress is brilliant. We all need, you know, hydrogen portisol, I guess, to do our work every day, but it's just when it's chronically ongoing that, um, it puts pressure on, um, our, our whole body, really. Uh, and I know the adrenal, um, adrenal fatigue is something that, um, you're very interested in.

Can you just maybe give us some insight in relation to, you know, why that force killer you mentioned, that relaxation, why it's so crucial in these years? Yeah, so, So when we look at hormones and the female life cycle, the perimenopause is a particularly vulnerable time when estrogen fluctuates a lot, women don't make progesterone, it impacts on their sleep and their resilience.

And when you then have, so you have, imagine a bucket that you can fill with stress and you can cope with it. You carry this bucket every day that keeps filling up. And there comes a point when the stress is so much, the bucket overflows and you can no longer carry it and manage it. And I think that when stress, so women should be able to deal with a certain degree of stress, but when stress becomes too much and you tip over the edge, then it becomes a magnifying glass to all the symptoms that are already going on during, particularly during the perimenopause.

So let's say you've got a bit of anxiety, but you're just about managing it. And then someone else asks you to do something which you cannot longer manage. So your stress adaptation breaks down, your anxiety will go up. Um, and well, and you, you, you lose your coping skills. Now, this And when we talk about stress, the early stress adaptation comes with an increase in cortisol, which is the fight and flight hormone.

This is normal when we're stressed, when we're in a fight or flight situation, cortisol goes up, but we cannot sustain this. We cannot walk around with high cortisol every day, all day, because it has lots of, it is, it become, become inflammatory as well. It can lead to weight gain, inflammation, disrupted sleep, skin problems, all sorts of issues.

So there comes a point when the drill classes. which make the cortisol say, you know what, we've had enough. We need a break. So that is the second or third stage of adaptation where they actually no longer respond as they should to stress. So you have a stressful situation, but that No longer, you no longer make cortisol now, and you feel just fatigued, wiped out, tired.

Um, or we used to call this in a, like a breakdown, you know, a complete breakdown where you cannot function anymore. And instead of having this wide and tired sensation, you just feel generally tired. You wake up in the morning with no energy and the day goes on. So we should have some energy in the morning when cortisol is high, but we should also relax in the afternoon, following our circadian rhythm.

Cortisol drops in the afternoon, and we shouldn't have, um, immeasurable sources of stress in the afternoon, um, when we actually, our body physiologically should be calm and settling to get ready for sleep. So, these stress adaptations processes are very disrupted in perimenopause because not only do women have the most stress in their life during that time with the burden of often young children.

elderly parents, stressful job, career, and so on. But also that this is one of the most fragile times in a woman's life. And there comes a point when it's tipping over the edge and she may just have a breakdown or burnout. We would call it, we used to call it burnout and she literally cannot function anymore.

And she's just an emotional wreck. She's low depressed and gives up her job and all of what all the consequences we are aware of. So yes, that's why relaxation, we want to not get to that point where we have a breakdown or burnout. We want to recognize that the stress is getting to us. And we can no longer take on more stress.

We need to take steps to reduce this amount of stress. And it is really individual, really difficult, but we have to do this. Otherwise, imagine you're helping everyone all the times and everyone wants something from you. How are you supposed to help them? If you are not feeling well, there comes a point when you break down and then you are incapable of helping anyone.

So when women, or when anyone notices, look, I'm at the brink of not functioning, I'm. Very stressed, very wired and tired. I have the energy in my body is really negative, affects me negatively. I have physical symptoms, mental health symptoms that affect me. The we have to start setting boundaries start saying no Start to have protected relaxation time away from everyone else And that is something that is individual that could mean you go out for a walk in the countryside either by yourself with a dog Or with a good friend that you can share your problems with or you have a bath and lock the door or you um Whatever it is that you that helps you relax But relaxation is when I a lot of women when I ask them this question, what do you do to relax?

What is that? What is it that you do? They break into tears. They're like, well, no, I don't relax. I haven't, I don't know what it is. I can't think of what it means to relax because I'm never relaxed. I go to bed. Then my husband wants sex. It's another thing I don't want anymore. Then I feel guilty. Then he goes to the second spare room.

Then my teenage daughter comes in because she's looking for something. Then, you know, they can never truly relax. And. This is so, so essential because we, chronic ongoing stress is one of the most harmful things for our health. And, um, we need to recognize it and nip it in the bud and not allow it to go on.

But this is something we, every person has to, Individually recognized no one can do this for you and just taking the step to say no I am gonna go and you're gonna be okay for an hour while I am going to my yoga class Or you're gonna Be perfectly fine heating up that meal in the microwave while I'm in the bath and I will not be disturbed come come what may So just making these rules, you know, you're an adult you can make these rules you can reduce this But it is not easy.

I acknowledge it isn't easy and just to be clear Exercise can be a form of stress. So when you do exercise a lot and you feel you don't recover any more properly, you feel very achy and you, um, it takes you a long time to recover. Maybe switched around a little bit, maybe do some yoga instead of strength training, do something, you know, really consciously to relax those muscles as well.

I like magnesium in the bath, for example, as a muscle relaxant. Um, but it is a, is a process, and unfortunately, many women and people in general need to reach that breaking point when they no longer function before they do something about it. But we should not be allowing that. We should step in before it happens, right?

And I think, Mandy, that's so powerful, what you're saying, because I think it's like we can't pour from an empty cup. And I think so many women are putting everything before themselves and it takes, like you just had it there, you were so firm. No, and it's, it's establishing those boundaries. I mean, I found myself personally, Boundaries have been a huge part of my own personal growth as I've gone through perimenopause.

And I found in certain aspects of my life, I definitely didn't have boundaries. Or I didn't have the boundaries that I needed to have. And I, for me, I, I really feel that that's been one of the great learnings, the great opportunities that I've had in perimenopause. Because it's made me kind of realize, hang on, listen, I need, I need downtime here.

I need that kind of time. Protected relaxation, you know, I, in order for me to be a good partner, a good mom, etc. I need that downtime. And I think as women, we're not very good at giving that to ourselves. Yeah, I agree. I think a lot of women got into this habit to micromanage everything and to sort everything out themselves and to, um, Yes, to be and also remember if you are 25 and you've got certain jobs to do you are in a completely Physiologically in a completely different place.

So we cannot compare 25 year old woman That does a full time full time job with a 45 year old woman hormonally speaking, right? So women often tell me look My stress isn't different from 10 years ago. Why can I no longer manage with the same stress level? I cannot really complain about my stress. It's not much different.

My job's the same. My home situation's the same. Nothing really has changed. But I cannot cope with the smallest demands on me anymore. It's because you're hormonally unhealthy. different. Your estrogen fluctuates and the brain is the organ that is the most affected by these fluctuations and your adrenal glands are trying to pick up the pieces by increasing cortisol.

They recognize, oh my god, she's stressed. She can barely cope. She's got no energy. Okay, let's make some cortisol and hope it's over soon. But let's just help her out. But this is not a long term strategy to just thrive on stress hormones like adrenaline, cortisol. A lot of women get palpitations, they get, um, they get mood problems, they get anxiety, and a lot of anxiety is driven by cortisol because it makes you feel on edge and that feeling of panic, uh, or lack of decision making.

The brain is the organ we need to look after the most. It is the organ that suffers the most during that time. Transition from. having lovely steady hormone levels that we can rely on to being menopausal and things calm down again. So menopause is great for many women. It's often the paramenopause that's the problem, but menopause can be a time of, of, um, stability and relief for many women.

I'm not saying that they don't have other symptoms happening then, but in terms of, you know, brain function and fluctuations. Often the perimenopause is the most difficult uh, to treat and we have to be kind to our brain. We have to recognize it's our brain that is doing the, all the work here is trying.

It doesn't know if it's coming or going because the ovaries are no longer listening. The adrenal glands are doing their own thing. We are stressed and the brain can't switch off and we need to allow that brain to rest. Now, sleep is the next thing that's important because that's the time when the brain rests.

And if we don't rest, if we don't allow that brain to recover and do its housekeeping at night, we cannot function in the day, aka brain fog, memory issues, word finding. Loads and loads of women experience that. Hmm. I I think, yeah. Sleep is, I, sleep is, look, sleep is the one, you know, we'll all talk about till the cows come home.

Yeah. And certainly I think for me that's. That's one I'm playing around a lot with at the moment, just to try and get things, figure out exactly what gives me a rightful, uh, a good sleep. But yeah, I won't get, I won't get into that now. Um, and Mandy, just your first book, and we can ask the second in a minute, but your first book, um, by far has to be, globally, the best resource, um, I've seen in relation to, um, POI, early menopause, uh, that you co, you co wrote with, uh, Hanna, it's a fantastic resource and I put the, I put the link to it in the show notes, um, I, I know it gets, uh, it's a bestseller and it's doing fantastic, which is great.

But tell us a little bit about your next project, which is coming, I think, in June. Yes, so it will be called What Every Woman Needs to Know About Her Skin and Hair. And the subtitle is, um, how hormones on the inside affect you on the outside. Um, because I do hear from a lot of women that not only do we have to battle with the, um, mental health and the physical symptoms of the menopausal transition.

Um, but it's also, they have questions, for example, why do I start growing whiskers in the perimenopause? Why do I have air growth? Why, why do I get at a certain age when I thought, you know, I'm no longer teenage. I had that when I was younger, but I really thought I would never have acne again. Why is it happening to me now?

So you know what? It really affects women's confidence. When with all of this, for example, I do have a section on stress in the book and explain what stress does to your skin because We gain a lot of our self confidence from the way we look and just looking at social media. It's just a minefield of advice and perfect photoshopped images of women or what we're meant to look like.

And actually, um, you know, Hormones play a huge role for hair, skin, and hair, and I have a lot of women, for example, they come and see me and they say, oh, you know, alongside my menopause, sometimes I also feel my hair is really thin, and, you know, I can cope with the hot flushes, but the thought of losing my hair is actually really awful.

And I, And that over time, these questions kept building up and I thought, hold on a minute, this is not just a single woman, these are many women, they want to know why are they having dark patches like melasma, why are they thinning their hair, why are they, um, losing their armpit hair or their pubic hair as they get older, um, which some women do not like, by the way, I know that a lot of women spend a lot of money on removing hair, but other women are quite shocked about certain, you know, physical changes that happen as they get older in terms of their appearance and what happens to our collagen and so I wanted to understand that because Um, it is a really big part of women's confidence And so I haven't got the solution for all of these problems necessarily, but I can give women an understanding of why these things happen, potentially how you can mitigate them and look after yourself and, and find hope, um, and treatment options for your hair thinning or your acne or, you know, uh, look at skin and hair.

Um, and also I tidy up with a lot of myths for some fingernails, biotin supplements that don't work or calcium supplements for fingernails or nails are completely rubbish. So I looked at all the evidence. I looked at, um, What supplement should women spend money on? If any, uh, is there anything they can do from the diet point of view to help with that?

What's the evidence for HRT and skin and hair and so on? Um, so I looked at all of that, but it does kind of cover puberty, pregnancy related skin and hair problems. Every time we go through a hormonal change, it can affect our outside. And often women, that's what women struggle the most. So it's, that's what the book is about.

Long winded answer. Brilliant. So that's it. That's, uh, yeah, no, no, no, that sounds brilliant, because I, you know, everything you're touching on there, I mean, I, I, I hear all of those symptoms, and like you say, um, just this morning, I was talking to a woman who was telling me about how her hair was pinning, and she's very conscious when it comes to photos and things just about her hair, and I totally get that, I mean, I'm, I'm blessed, I know I've got a fine head of hair, Which, you know, uh, definitely in the family, but I, I, I, I could understand if I, you know, it's, that, that does impact, um, in terms of how you feel, your confidence, and so forth.

But one thing that's, uh, cause I know loads of people are interested in this one. So what is it with the whiskers? What, what, what is that about? Yes. So, now first of all it happens loads. It is entirely normal to have a bit more hair growth as we go older. But what I've realized is that as you go through the perimenopause and estrogen fluctuates, the ratio between testosterone and estrogen changes.

Testosterone declines as we get older too, but often, Estrogen drops and then in relation to estrogen again, this is not a deficiency, but in relation to estrogen We have a little more testosterone and then as we get older there's an enzyme called 5 alpha reductase And that turns actually testosterone that we really quite like for libido and energy into dihydrotestosterone and dihydrotestosterone stimulates hair growth and hair follicles.

And then there's another thing. Now you think, Oh, I must rush to the doctor and have my hormone levels checked. No, actually hair follicles make it themselves. They make dihydrotestosterone, DHT, and that leads to hair thinning down the midline. Hair follicles are not always associated with that, but hair growth around the face.

There are certain arteries here as well that supply this particular, so this area around the chin, the lower chin, is very dense with androgen receptors, so I was talking earlier about estrogen receptors, but now it's the testosterone receptors, so they're very dense, and when DHT increases, Um, in relation to each other in the skin, you, it, it stimulates, um, fine hair that we normally don't see to turn, they're called vellum hair, to turn to terminal hair.

So terminal hair is what we've got on our head and we want to keep that, but we don't want visible terminal hair. In a form of a beard, but these hairs, and then you might ask, okay, look, I've just plucked this hair out. You wake up next morning and there's another one. Why can't the same hair be the same?

No, I can categorically say it is not the same hair. We've got thousands of invisible vellum hair in our face. that we can't see. However, you pluck one out and a millimeter next to it. It's the next one. And you've got THD in that area and overnight it grows. It's not the same hair and you can pluck until the cows come home.

You'll never pluck all of them out. They will come back saying that you can There are ways to deal with that. If it's really bad, laser treatment can help. Plucking, just keep plucking them as they come. Um, but there's certain supplements like soul palmetto, uh, can reduce the amount of testosterone there.

So, But it's entirely normal. And to be fair, why shouldn't we just let it grow? It's just society telling us we have to have a smooth, wrinkle free face at all times. I'm not saying you shouldn't pluck them out anymore, but there might come a point when you just say, you know what? I'm happy with the way I look.

But, you know, yes, it is unfortunately in many women inevitable. And most 80 year old women, I would think, have a degree of hair growth on their chin because of that, different balance between the testosterone and the estrogen and just entirely normal. While men lose their hair, women become, but then we also lose our body hair, sadly.

That's simply just not fair. Like that's just not fair, right? No, no, I know. I know what you're saying. Um, but that's, that's so, so interesting. So, um, I can't wait to get, uh, get your book when, when it comes out. Cause yeah, looking skin is a massive, I mean, gosh, we could talk all, we could talk, maybe, maybe we'll talk again.

Before your book comes out and we can talk a little bit more about it. That would be fantastic. And just to be clear, this book is not about, um, skin care in a sense that about beauty enhancing. It's about helping women to understand why things happen and that they've not done anything wrong or that it's not, it's a lot genetic.

But again, alcohol comes in. Alcohol also increases that. So, but again, it's not your fault. Um, so I wanted women to understand why it happens and what they can do about it and not to spend money. huge amounts of money on certain lotions, potions that they've been sold on Instagram, you know, just to give an example to actually look at what is effective.

Yeah. Yeah. I think that's, that's, that's, that's, that's, that's really, that's really important. And, um, just there, you just saw the mention of, um, social media and I, I, I know it's, uh, interesting. It's out there and there's a huge amount of conversation. Any, any, any tips, Mandy, you give to anyone who's trying to navigate information on social media?

Yes, so this is difficult because we do get, um, a lot of information nowadays from social media. Now, if you have particular person that you follow and you quite like what they say, do not take, even if they have a good reputation, don't take everything for, uh, at face value. I find the best people who, uh, are giving medical advice have a qualification.

So they, they have something to back up their claims. So there are doctors or there are nurses or there, they have some kind of face value. But they also back up any facts that they give you with clinical trials. So they, they quote the clinical trials in the, in the post. So if you see, for example, a statement that says HRT prevents dementia, just as a, as a post with no, With no support, no, uh, publication cited, nothing else, then where does it come from?

Where does this person have this information from? Um, because it can scare women who are not in HGT for example. By the way, we are not that clear on what it prevents dementia. We shouldn't be saying that anyway. But, um, so when you see certain statements that sound too good to be true, um, ask the person in the comments, Can you please post some, um, evidence, some clinical trials that back up this statement?

If they cannot come up with anything, then please, going forward, take anything they say with a pinch of salt because it may not be backed up by science. Um, and any good person who posts something that is, um, that is really important, that affects you individually, that resonates with you, and that might even change how you live, what medication you take, what you do about certain things.

Do question where they have that information from. And also, the second thing I would say is, what is the person's agenda? Why do they put that statement out? What does it mean? what they want to create. Do they want to create an emotional response? Do they want to get customers through the door? Do they want to sell a product?

What is their purpose? What do they gain from doing this? There are lots of well meaning people out there. And the other thing, the third thing I would say, if a person was wrong and And you, you counteracted what they said by clinical evidence, by actually coming up with trials that says, look, actually I found this and this, and this is not in keeping with what you were saying.

Then a good person, a good, um, person to follow is someone who is not afraid to say, I was wrong. I stand corrected. And puts that post out and says, look, what I said the other day is not correct. Here's the correction. This is the truth. This is what I found. Or if they just say, I don't know, I rather trust someone who clearly says, I don't know than someone who says, I do know.

And this is the fact. Now, there may be many facts where they do know. But there are lots of unknowns out there and the majority of times I would rather trust someone who says we don't know yet We haven't we cannot say yet, but we are close to maybe there is some indication Those people are much more trustworthy.

I find to follow than those who have the answer for everything and are super confident Confidence is all very well, but it needs to be backed up by science and facts We cannot just trust a person's confidence because they look good or they can talk well. You know, it has to be 100 percent science or not, and if they can't quote the science, don't listen.

Yeah. Yeah. He just reminded me of a saying, Socrates and the philosopher, all I know is that I know nothing. And, you know, I think, you know, I think that is really important in terms of we're all continuously learning. And I think it is very powerful if someone can put their hand up and say, I made a mistake.

I don't, I don't know. So I, but I do think, uh, I do think the more voices that are out there and awareness is amazing, I do think, yes, it's really important that people are mindful, you know, of where they're, where they're getting the information and dissecting that information. I think it's very, very important.

And also what happens if you challenge that person? What happens if you question them? Are they able to have a. Um, a rational discourse with you, uh, without emotion, emotions coming in. Instagram is full of emotions, yeah? So, oh, if you don't do this or that, this will happen. No, it won't. No one knows what happens tomorrow.

None of us knows what happens tomorrow. We cannot, we cannot know. Um, we can predict certain things. We have an idea and we are hoping that certain things will or will not happen. But, um, Um, if you challenge someone and they block you or they become aggressive or they personally start attacking you about who you are or what the way you look or that you're a nobody or whatever.

or they criticize you for any unrelated things, then this is not a way to, to, to, um, go by, you know, to carry out medical discourse. I'm always happy. So I always learn continuously from other people and I look up the evidence. And if, if you said to me, Catherine, you know, Mandy, in your book, you wrote this statement.

I've seen a new study come out that contradicts what you wrote in the book. I would say, Catherine, thank you so much. This is amazing. When the next edition from the book comes out, I will credit you for this. I will correct this and thank you so much. It's really good. I'm always learning. Um, because I can't know everything, you know, um, and things of all things, new things happen.

So just be mindful when you do challenge someone in a polite way, of course, um, how do they cope with criticism? If they can't take criticism in a meaningful way and, um, and have a discourse with you in a civilized way, then what are they, what are they on about? You know, I, um, yeah, yeah, no, I think that's very powerful because at the end of the day, certainly I know from my perspective, it's all about.

I just want to get, um, evidence based clear, clear information out there. Clarity. I like to just think I'm just trying, just my purpose is clarity. And Sam, your book, Hathe, your fabulous book that you wrote, right? It's wonderful and you're doing really well. It's Yeah, no, it's um, it's a bestseller here in Ireland and it's continuously selling out in shops.

So, um, it's great. Yeah. And, and like that, it was very much, it was all based around, um, Just a really practical approach and covering all the management options just just to really help women in terms of okay Look, you don't you don't really I know a lot of women have read it from start to finish But just very much dip in to whatever symptoms is causing you Angst or hassle and then it's look it's use your management options So the thing you're empowered and I just feel Once we're all empowered, then it's a game changer, you know, because then you know, is it your doctor you need to speak to?

What do you need to do? Where, where will you get your score? Absolutely, I can acknowledge it's a very, um, it's a minefield to navigate at the moment because there is contradicting evidence And I think everyone has to find her own every woman Boy, every person has to find their own path, um, and decide what's right or wrong for them and, um, try things out and change things if needed.

And we all get there in the end. Um, and there's always light at the end of the tunnel. And actually, uh, in terms of the, uh, the way women feel and also men, uh, there's good evidence that the happiest people are in their 60s. So happiness levels go up. They go down in our midlife, we all know that. But once they're in our 60s, actually happiness levels increase again and that's good.

So there's, there's light. Yeah, yeah, for sure. And there's the opportunities that come with menopause as well. So, you know, there's, there's the opportunities. Of course! Yes, of course. Mandy, thanks so much. It was brilliant to chat. And I think, look, we definitely, if you're on for it, we definitely, let's talk again in June.

I'd love to talk more about gaming here. I'll send you a copy. Yeah, we'll definitely do. So, thanks a million. Thanks everyone for listening. I'll put all of Manu's details in the show notes and where you can link in and connect with her. And thanks everyone for listening to this episode of Mental Boss Uprising.