You're listening to a mother Mere podcast.

Hi there, I'm Claire Murphy, Australian Women.

Welcome to your full body health check.

As I have established if you've been listening over the last few weeks, I am deep in Perry menopause territory and I would like to say I think I'm finally getting a handle on it.

It's taken me a bit, but I feel like I'm there, which is good.

I love it.

And I'm doctor Mariam, I'm an Australian GP.

It's time our training reflected reality.

Females deserve better because a lot more women deserve more than silence when it comes to this transition in their life.

Coming up today, Mariam, the science of Perry, menopause and menopause.

What do you recall from your training about menopause Little to nothing.

Well, if it's any consolation, I've been chatting to a band student to try and find out how much they're getting now and he did say to me, yes, they have had a full year in obstetrics and part of that has been a focus on menopause and like endometriosis and things that are impacting women quite significantly, and they are getting more training now, so host generation I hope.

So.

I mean, I've also got a friend whose doctor is GENZT, like the eldest of the gen zs are now old enough to be your doctor, which makes me feel ridiculously old.

There's so much happening around the discussion and menopause.

There's a lot happening online right now.

You might have seen if you are in the same threads as me, weighted vests, vaginal estrogen disappearing, labia, more protein, more fiber.

So we're going to unpack a lot of those things today, and you've probably been told a lot of these things in your social media feed.

We're going to find out what is actually beneficial and what is actually useful when it comes to menopause.

We'll also pop in a time for a quick consult for Adek today.

Now she's had her uterus out.

She's quite happy about that, to be honest, but she's not sure if she still needs to keep up certain health checks now that it's gone.

We're also going to head to med school too, because Mariam, you know me.

You know I'm a history nerd and I've been delving back into a little bit of medical history.

I love this stuff this week.

Tell me do I have a story for you.

I Am going to tell you how a pig car straighter helped change how we give birth.

That's happening school next, Welcome to med school.

Okay, we have established I'm a history nerd.

Anything that delves back into the past I'm writing into and from researching this show, I've been able to really tap into medical history stuff, which is it's a wild place to be when we figured out how to do stuff to humans, Like the way we did that not acceptable in today's terms, but like back then, we just did what we had to do, right.

So I was literally today years old when I found out the origin of the first ever reportedly allegedly because we don't know fo one hundred percent sure successful caesarean section okay on a human being yep, Because this was happening on animals before it was happening on humans.

It was not done by a doctor.

It was done by a Swiss pig guilder.

Oh okay, what is a pig guilder?

We will get to that.

It's the year fifteen hundred.

Elizabeth is pregnant, She is about to have a child.

She is a wife of a man named Jacob Nufa.

Now, she was struggling to give birth.

As you know, we know, the ability for women to survive childbirth back then was nowhere near what we have today.

She'd been in labor for days and despite the best efforts of all the midwives who were around her, none of them could deliver that baby.

Now, Jacob, you might remember, as I mentioned, is a pig guilder.

It essentially means he dissecxes pigs, so he lobs the nuts off the boys.

He whips out the uteruses of the girls unless they are the breeding kind.

So he was also though, used to helping those pigs give birth, and in some of those instances they had to remove the piglets surgically.

He's feeling pretty desperate by this point, right, He's looking at his beautiful wife Elizabeth and seeing her struggle, and he wants to save both the life of his wife and his unborn child.

He decides to step in and save her himself.

Now, he had done similar surgeries like this, as I mentioned, but not just on pigs.

He'd done it on cows, He'd done it on horses.

So he kind of had a little bit of an idea what to do.

Back then, pig carstraders would sometimes do sea sections if they thought the mother might die, just to save the babies, and midwives were aware of the method, but in the early fifteen hundred, sea sections were only allowed if the mother had died, so it wasn't to save her life, it was to save the baby's life.

Jacob had to get special permission from authorities to perform this surgery because Elizabeth was still very much alive, so he got the permission.

He called in a bunch of midwives to help him out, thirteen in fact, but only two of them would agree to do this because it was so much against regulations.

Using a razor blade, he cut open Elizabeth, removed their stuck baby, sewed her back up, and she survived.

The baby also survived.

And not only did Elizabeth survive this surgery, she went on to have five more children, including a set of twins, which means he did a decent enough job that her uterus was still fully functional after all of that.

God, I'm eagle parts horrified and impressed, right Like, no sterile gloves, no anobetic no antibiotics, oh my god, no antibiotics.

And he just had a razor blade.

I hope it wasn't one that he had used for pigs.

Hopefully he washed his hands beforehand.

And that's all she survived and went on to have five more, like I can barely survive daycare drop off.

I know, Elizabeth, like what an absolute champion acobjeez look at.

Some historians do debate whether the pregnancy was actually in uterine, so there is some debate about that.

But this wasn't actually discovered until eighty years after it happened, when someone translated a French physician's diary and they discovered what had happened.

But I can tell you now that baby lived until they were seventy seven years old.

But fun fact, the origin of the word cesarian obviously comes from the old Roman days.

And I mean this is also debated too.

This was part of this whole idea that you could only cut the baby out if the mother was pretty much dying or dead.

And it was something that Julius Caesar put out there and said, like that's the way that you're allowed to cut out a baby.

So it was called a Caesar Ah.

The section part came a little bit later, very.

Un brand for the Romans to make it dramatic, but there you go.

History lesson for today.

Thank you Jacob Nufa and pig car Strator and Caesarean section do it is?

This is so cool?

All right, let's get into the reason we are here today, the science of peri menopause.

There's a lot happening in discussions around the world about it right now.

We are about to bust some myths for you.

Let's do it.

It's time for the checkup.

Mariam, what did the wise old women in your life tell you about menopause?

Honestly nothing, yep, not much at all.

It was like whispered slide comments like she's moody, she's sweat and buckets, but no one said the word menopause.

I was referenced to it as the change, the.

Change, No big chat, no guidance, just silence and suffering with the side of peppermint tea.

Yeah yeah, so I feel like the female's mom and grandma was strong, but they were also left in the dark.

But now we have the science, we've got the language, we've got the platforms, so we should happily say the words perimenopause and menopause out loud.

Yeah.

One hundred percent.

I was the same.

I heard nothing, And I think my understanding of menopause was probably similar to many other peoples in that you suffered some hot flashes and then your period stopped, and that was the definition of menopause for a long time.

And it would happened over a really short period of time.

Yeah, it was just you know, a little.

Like you hear your Randy fifties or something.

Maybe some yeah, and then it's all over.

And it was only when and I've mentioned this Mum and MEA held the very peary summit, that I understood that it was a whole bunch more than that, and that all the symptoms that go with it, and then it can be something you suffer through for ten years or more for some people if you go through menopause really early, so it can be a bit of a wild ride.

Is the Australian medical industry well versed enough you think about this stage of women's lives?

Short answer, not yet.

Okay, the Australian medical system is getting better.

We're definitely going in the right direction, but I think we've still got a bit of cat shop when it comes to perimenopause and menopause.

Most GPS want to help, absolutely, but the reality is women's midlife health hasn't been prioritized in our medical training.

It's great that your friend mentioned that it is something that's starting to change and something that they're learning, but many doctors simply weren't taught how to recognize or treat it appropriately.

And then there's a lot of outdated fears and lots of fear for prescribing, as we've mentioned that the World Health WHI study back in two thousand and two, and then you've got a lot of women told to just write it out.

Or you know, just write it out.

Try.

I cannot imagine if someone teld.

Me to ride this out, like goodness, Yeah, it's really tough.

But now we've got brilliant resources.

The Australasian Menopausal Society has got some amazing information for doctors and patients and a growing number of us are upskilling, which is so nice to see because a lot more women deserve more than silence when it comes to this transition in their life.

So, no, we're not there yet, but the conversation is finally happening loudly and that is a good start.

Amazing.

We do have a lot to get through today, let's do it.

Professor Susan Davis is going to help us unravel and unpack perimenopause and menopause science claims, So stick around.

She's going to join us next scrolling menopause reels, or pery talk as it's referred to Marvat.

There are millions of different things that we're being told are beneficial about this phase of your life, which look to be honest, is better than deadly silence.

We want it to be out there, but as we know, and as we've discussed with lots of different women's health issues, it can be misleading and you've got to read between the lines that sometimes you're being sold something rather than something that might actually be beneficial.

And this was described to me a little while ago that women who are now of perimenopausal or menopausal age are potentially the last cohort of women who were really marketed weight loss stuff, and now that they're no longer really in that period.

And also with the introduction of weight loss medications, as we've discussed in the past two the focus has shifted to start marketing menopause related items to us.

So we need to really tread carefully and figure out what is actually true and what is fact and fiction in this So with all of that information and potential misinformation, maybe we're not sure what to make of it all.

So Monash University's professor Susan Davis is going to help us unravel that peri fact from menofiction today.

She is one of the five founders of Gene House for Women, is a past president of the Australasian Menopause Society, which you've mentioned a few times, Mariam, and also the International Menopause Society.

And we started off by asking Susan about the claim that having endometriosis increases your chance of going into menopause early.

I'm not aware of any day that that supports endometriosis as a condition causing an earlier menopause, but a lot of women who've had endometriosis have lots of surgeries, and we do know if you have a lot of abdominal surgeries related to the uterusy overs, you can impair the blood supply and that can potentially trigger a slightly slightly earlier menopause.

And the hysterectomy, for example, is the sociated with a very slightly earlier menopause.

Is it true that the earlier you get your period, the earlier you're likely are to hit menopause.

That's not necessarily the case.

In fact, the biggest predictor of when you're going to go through menopause is when your mother or your older sister went through menopause.

The other factors that are associated with an earlier menopause, as I said, hysterectomy and smoking, but those factors only pushed menopause earlier by maybe twelve months, not many, many years.

I guess we have to get our moms to actually start talking about when they got into menopause.

It wasn't a conversation they had a lot.

I was also reading that menopause might exacerbate other issues.

So when you do hit that period, when your hormones start to go a little bit wild, can it start to interact with other conditions, say dyslexia and ADHD and things like that.

One of the most common symptoms of menopause is sleep deprivation, so erratic sleep, waking up not feeling refreshed.

So if your sleep is impaired, any other health condition will be exacerbated, whether it be your ostereoarthritis, your mental health issues, your rheumatological issues, any other condition you've got will be exacerbated by sleep deprivation.

So it's not really an interaction between hormones and a particular condition necessarily, but rather all these other changes in your body are suddenly happening and that will influence any other health condition.

Can we talk about vaginal estrogen.

We've done a whole topic of MHT, so we've got a good understanding of taking it orally and viraygel are a patch.

But there's a lot of conversation around vaginal estrogen and a lot of us are under the impression that you only really used that for vaginal dryness, but the conversation now is around it potentially protecting you from UTIs.

Do we understand that to be the case?

Okay, So vaginal dryness and vaginal symptoms tend to e merge in late perimenopause early menopause.

It's not one of the first symptoms, and the symptoms of that go along with vaginal dryness.

Urinary frequency like getting up multiple times in the night to pee, a sense that you've just got to rush to the toilet, you're in the urgency, and vaginal estrogen can alleviate those symptoms.

But one of the best studies was done in the nineteen seventies that showed that even a symptomatic women who used vaginal estrogen had less urinary tract infections.

So even a sixty year old or a seventy year old woman who has no other menopausal symptoms probably should still be using vaginal estrogen twice a week to protect her bladder and her vaginal tissues.

There is a lot of research going on right now, but I think the one that really stood out for me when it comes to menopause is a lot of people are looking into various ways of delaying the onset of menopause, Like, for example, there's one that is looking at engineering young ovarian support cells and developing drugs that's lower vary in depletion, and then if it is successful, for example, it raises the question of whether women need to go through menopause at all.

How far along do you think we are in the science of menopausal delay.

Okay, so there's a philosophical issue about the concept of menopausal delay.

If you've got a thirty five year old woman who's about to have major surgery and radiation for a condition that's going to affect her ovaries, Removing those ovaries, freezing them, and putting them back in when she's leisure recovered makes a huge amount of sense to me, and that is being done now successfully.

However, what we do no categorically is that the laser you go through menopause see Grady or breast cancer risk is so, if you've got a fifty five year old woman who's gone through menopause versus a fifty five year old woman who hasn't, the one who's gone through menopause will have a lower risk of breast cancer.

Now she goes on estrogen, we are not going to give her as much estrogen as she would be getting as if she was still menstruating and ovulating.

So the hormone replacement therapy gives back estrogen, but not to the level that you had when you were young and your ovaries were working.

If we delay menopause and women in their sixties and even seventies are still ovulating, the danger is that we are going to increase risks of other conditions.

Our bodies are not designed to go through menopause in our sixties and seventies, and there will be other risks and there's no controlling it, whereas we can control the hormone levels.

Do you want to be having PMS when you're sixty five.

Or even just a period when your seventy sounds awful?

Yes?

So if we delay menopause and keep functioning over is, we're going to have all those issues going on to women in their sixties, all the things that women are relieved to get away from by going through menopause.

So it's a different game to hormone replacement therapy.

Is it really true that you're in a LaBier can disappear when you hit menopause.

No, your labia do not disappear.

Your vaginal tissue can shrink a bit, they don't disappear.

Should menopausal women be weary weighted vests when exercising?

This is the thing that's been marketed at me and quite a few of my friends quite heavily.

Is it beneficial?

We know that weight bearing exercise is beneficial for our bone density, for example, at this stage of life, but is wearing something like a weighted vest going to help exercise?

Is critically important for women of all ages, and whether you wear a weighted vest or not, it's really it's a commercial thing.

I mean, you should do a whole range of different exercises.

You should be doing exercise to keep your heart rate up and benefit your heart.

You should be doing exercise that's impactful for your bones, but you can do that without a weighted vest.

There's a lot of dietary advice as well coming at menopause or women right now, but the overwritching message seems to be that women in this phase of life need more protein and more fiber in their diet.

Would you say yes or no to that?

Women in their entire life need more protein and more fiber.

So don't wait till menopause to start focusing on these things.

Start focusing on that.

But when you're twenty and thirty and forty, so when you get to menopause, it's not even a drama.

Menopause is having his moment in the sun, though, which is really important because it hasn't had its moment, and we have been overlooked as women in the healthcare system in this moment of our lives.

But it's also going to come with a lot of people trying to make money off of us.

So I guess we need to be really wary of claims that aren't medically substantiated.

Where do you suggest women go to be informed about menopause at this time?

I think some of the best websites are the Austulation Menopause Society has great fact sheets, the International Menopause Society has podcasts for the general public and for doctors, and gin House for Women's Health in Australia.

They're all great.

We have great resources in Australia, so people should use them.

I'd love to know from you too, when are Australian women in perimenopause?

Because we're told it's a symptoms based thing, and when the symptoms are bad, like when our periods start to get a little bit out of control, that's when we're officially in perimenopause.

But do we have a definitive way of actually knowing when it's arrived.

So the onset of perimenopause is based on symptoms and what our study published in July showed very clearly that the screaming marker of the perimenopause is new on st hot flushes or night sweats.

So women who even find that their periods have become dramatically heavier or lighter, if they have hot flushes and night sweats, they're probably in perimenopause.

Now those when will go their doctor, and their doctor will say, oh, but your periods are still regular.

Well, we've shown that simply having new on set hot flushes and night sweats in combination with some change in your menstruation is a very solid indicator.

The tricky part is women who have a hormone liud, a hysterectomy, or have had an ended metrial ablation aren't menstruating, so they don't know when their periods are and a change.

And again we would suggest if those women suddenly start getting hot flushes in night sweats, they are entering perry menopause.

That's the greatest market we could find.

So waking up in a puddle of your own sweat on a regular basis, so not just like a ones off, but regularly, that's really the market to say, hey, pery's arrived.

Yes, and every woman experiences differently.

Someone was saying I don't have a hot flush, but then they're throwing the bed covers off or they feel like they're burning inside, but they don't flush.

So it's the language we use, but really loss of heat control is a really major symptom.

Mariam, what do you think about what Professor Davis said about the science of pery and menopause.

There is so much misinformation around.

Prof Davis is a much needed voice of reason.

There's so much noise and misinformation around pery and menopause.

Right now, it's having its moment.

That's amazing, but it'll also becoming a bit of a cash grab.

So everywhere you look, someone's trying to sell a supplement, or a hormone cream or a miracle menopause diet.

But she reminds us that this is a natural life stage, a transition.

It's not a disease.

And while the symptoms can be disruptive, there are evidence based treatments that are hormonal or non hormonal that can work for you.

But we need to be careful.

Just because it's finally getting its time in the sun, it doesn't mean every product being pushed online is legitimate and will work for you.

Being informed is powerful and protects us from being exploited.

I loved her short, sharp and chiny answer.

It's still some of those that's what we need in this day and age.

All right, next, it's time for today's quick consult a Deck's had a procedure, which means she no longer has some of her reproductive organs.

So does that mean she no longer ever has to see a certain doctor ever again?

We'll find out alrighty.

For those of you wondering how you get a question to our good Dr Mariam, who will give you general advice, as we stress, general advice which you can then arm yourself with and take to your own GP.

There is a few ways you can do so shoot us an email well at mammamea dot com dot au.

As you are wildly scrolling through your social media, just holp for a second, especially hopefully if you're looking at Wells social media, send us a DM we will read it.

Or you can be anonymous and pop into the waiting room.

There is a link to that in our show notes and you can tell us like what topic you want to talk about and what your exact question is it or guide you through it step by step.

The doctor will see you.

Now just through here to consort room one.

Okay, Mariam, it is time.

Thank you for waiting.

How can I help you?

Mariam?

I'm going to take the answer that you give to a day today to some of my friends who have, some very recently, but some quite a time ago, had their uterize uterns uteruses.

However, you say it remove because I feel like this is something that I would want to know the answer to its well.

So a Deck wrote in and she said.

I'm forty nine and I had a hysterectomy twenty two years ago now and I haven't seen a gynecologist since.

Is this something I should still be doing?

Great question.

The impact really depends on the type of hysterectomy you had and whether or not your ovaries were removed during the process.

So a total hysterectomy, which she's mentioned she's had, a full hysterectomy, removes both the uterus and the cervix, while a subtotal hysterectomy removes the uterus but leaves the cervix intact.

Sometimes the ovaries are also removed during the procedure, and that's called a bilateral upheractomy.

And that's when you can get kicked into menopause.

Really, that's right, So why does this matter?

If your ovaries were removed, you'll enter surgical menopause and that can affect your bone and heart health.

Over time, but if your overreas were left, then you'll expec sperience and natural menopause, but without periods, so it can be harder to tell when you're in that perimenopause transition.

That's why knowing the signs of perimenopause and when to see care is important.

So yes, it's a good idea to have, like a midlife health review, even if you feel fine, a GP not necessarily A gynecologist is a good place to start, and they can review your bone and heart health.

Check for any eurogenital symptoms like bladder issues, vaginal changes, or libido changes.

Discuss hormonal therapy or non hormonal therapy if that's something you want to explore, and shure you're up to date with other screenings like your mammograms, your bow cancer screenings, etc.

So what about cervical cancer screening formerly known as perhaps ME.

If your cervix was removed and your cervical screening history was normal prior, then you don't need further cervical cancer screening or PAP tests.

But if you had a subtotal so your cervix is still in sitution, still there, or you had ab normal screenings prior to the surgery.

You should continue regular cervical cancer screening as advised by your doctor or the national program.

If you're not sure what type of hysterectomy you had, your GP or gynecologists can help check your records and go from there.

But yes, the hysterectomy changes how we screen, but it doesn't mean stepping back from your health.

At forty nine, it's a perfect time for a proactive health check, so definitely start by seeing your GP.

So not having a uterust does not remove you no from getting that area checked.

No, he is the short answer for that.

That is such a good question.

I didn't even think about that.

Yeah, in that instance, like you would presume that if you don't have anything there, that's it.

Look at what I get it looked at.

That makes sense.

Thank you for that great question, a deck, and also thank you to people who've been sending us some really great feedback of late, like it's really nice to read what you guys think of the show and what you've been doing with the information that you've been getting from us and taking it to your GPS.

And also, look, I've got a bit of a cheeky ask if you wouldn't mind going and rating and reviewing us.

Oh please do.

In a podcast.

I've been getting great reviews from health professionals as well, which I have been getting some feedback from lots of doctors, so nice.

Yeah, yeah, it's amazing, So thank you so much people who do that.

But if you do rate and review us, it means like we can potentially get into some more people's ears too, So if you would not mind.

Of course, as we do every week, we need to remind you that everything that you have heard here today, all this information is general advice.

It is not specific to you.

Even if you really resonate with it and feel like that is something that you're experiencing, it might be for a different reason.

You might have a different level of it.

You might need different treatments than we've discussed today too, So make sure you take all that information to your own GP and get that specialized advice that is just right for you.

Now, if you have questions about perimenopause, menopause, HRT, slash MHT as we call it, everything in between, get cracking now, because next week we're going to have our Q and A with yourself, Mariam and with some of our experts.

So excited who are going to answer a lot of these questions.

So, as we mentioned before, there's a few ways you can get questions to us.

Emails, DM's waiting room in the show notes.

Get on it, Mariam, thank you again.

We'll see you for your appointment next week.

Bye Bye Well is produced by me Clare Murphy, senior producers Sasha Tanic and Sally Best, with audio production by Scott Stronik, video production by Julian Rosario, and social production by Ellie Moore.

Mama Maya acknowledges the traditional owners of the land.

We have recorded this podcast on the Gatigul people of the Eor nation.

We pay our respects to their elders past and present, and extend that respect to all Aboriginal and Torres Rad Islander cultures.