58: The neuroscience of menopause with Dr Sarah McKay

[00:01] Sonya: Welcome to the Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. I'm Sonya Lovell, personal trainer and passionate advocate for equal and improved health care for women. Today you'll hear from Dr. Sarah Mackay and we will be talking about the neurological transition that happens during menopause. You can expect to hear us talk about hot flushes, changes in sleep, mood, and memory. Enjoy today's episode.

[00:31] Sonya: Sarah, thank you so much for joining us on Dear Menopause today. Welcome. It's nice to catch up for this began. Oh, you gave away my secrets. We literally just spent the first 15 minutes chatting and catching up. So Sarah and I are friends. We have been friends for, gosh, actually a really long time now when I think of back on it. And if anybody on here is also following me on my Instagram account, my At Stellar Women by Sonya Instagram account, you'll notice once a year I post a photo and it's a very special photo to me. And, oh my God, I might even get teary because it's actually this week that we're recording it. That's the anniversary. So the day before I received my cancer diagnosis, sarah and I went on an ocean swim together. It was the first time I'd done that particular ocean swim. And there is this photo that I think you might have taken. It's a bit of a selfie kind of photo. And it's Sarah. And I beautiful. You know what? It's meaningful. I love this photo so, so much because we both just look filled with joy. Like our faces are literally just beaming. Beaming sunbeams out.

[01:43] Sarah: It had been a goal of mine that I fulfilled because of you. Because you said you were organizing a group of friends to do swimming lessons.

[01:52] Sonya: Yeah, we went and had swimming lessons so that we could do the ocean swim. And you have taken ocean swimming to way beyond what I ever did. But that was partly because I got this **** diagnosis literally the next day. So once a year, I shared this beautiful photo of the two of us. So if anybody has come across that photo, this is Sarah. This is my photo buddy.

[02:15] Sarah: Yeah, that was a special day.

[02:17] Sonya: It was a special day. But more importantly, you are here because you are Dr. Sarah McKay, the author of The Woman's Brain book and a distinguished neuroscientist.

[02:32] Sarah: Oh, I'm not sure about that, but I wrote the book. I'm a neuroscientist. I'm not sure about the word distinguished, but I'll take it. I'll own it.

[02:39] Sonya: You take it and own it. That's what we do here on this podcast as women. So, Sarah, we are going to be talking about neuroscience, the impacts of menopause on cognitive function, the brain and why that happens, what we can do about it, and what to look up for. I guess if you are experiencing some cognitive dysfunction at this period, in time. So why don't you give yourself a little intro that you're a little bit more comfortable with than my distinguished neuroscientist intro?

[03:11] Sarah: I've been a neuroscientist probably since the earliest time I could label my career as that. I grew up in Canterbury, in Christchurch, New Zealand, and did my first year of university at Canterbury University, but then switched to Otago University the next year because they had a brand new degree discipline that they had just kind of pulled together. So this is the early 90s. They'd pulled together the brain neuroparts of all of these different departments to create this new discipline of neuroscience. And I was captivated from day one. It had me at hello, as they say, which sounds really cheesy, but I was just like, so fascinated by, I suppose, the neurobiology of human behavior. It was almost the biology of psychology. I was just interesting science question thing to think about that I'd ever really come across. And so I started that degree in 1993, and it's now 2023, and I still think it's the coolest thing ever. I'm still as captivated and interested and intrigued by what neuroscience and neuroscience research and the scientists themselves can tell us about the brain. So I've had a reasonably varied career in terms of a typical academic. I did my PhD studies at Oxford, which was a really amazing time, which is where I met my Irish husband. We now live in Sydney, stop the road from Sonya, did a couple of postdoc positions here in Sydney, which is the sort of first neuroscience job you get or the first research job you get after your PhD training. And I was working in spinal cord injury research, but during that time kind of started to miss being an undergraduate, in that you have to focus your narrow down and focus so much doing academic research that you become an expert in almost nothing. And I was becoming an expert in the things that I was interested in. But I felt like I had FOMO I was missing out and everything else.

[05:15] Sonya: Yeah.

[05:16] Sarah: Eventually, after a whole lot of soul searching and a long story I won't get into, switched from academic research into science communications as a career. And that coincided, as often life does, with falling pregnant with my oldest son, who's now 15, had my second boy 18 months later, and since then have really built a business up broadly in science communication. So talking and writing, educating within neuroscience, because that's still my jam. And I suppose my most recent feather in my cap is that I've just published my second book. So the first one was looking at the woman's brain, a womb to tomb, kind of journey through the lifespan, looking at sort of women's health through the lens of neurobiology. And the second book is really zooming in on one of the chapters of that first book at the neurobiology of pregnancy and motherhood. But we're here to talk about menopause.

[06:15] Sonya: We are.

[06:16] Sarah: It's all related. All these these ideas around neuroscience and women's health and the kind of mash up of the two of them is a really, really hot field in neuroscience right now. For so long, women's health has been neglected in health and medicine more broadly. Specifically, it was neglected within neuroscience. Not explicitly ignored, just kind of not considered. It was almost considered biological sex as anything relevant. And I say there's more studies on brain imaging looking at left handedness and right handedness than there is looking at, say, reproductive history or menopause or the menstrual cycle. We're more interested someone's left handed than anything else.

[07:05] Sonya: Yeah, it says a lot, doesn't it?

[07:07] Sarah: That's kind of where that's the kind of the world I'm playing in at the moment.

[07:11] Sonya: And before we move off this topic into what we're really here to talk about today, I do want to touch on, because I know there's a lot of listeners to dear menopause who are either coaches or their personal trainers, others that are in supportive roles for women. And I wanted to touch on your incredible course that you run as well.

[07:31] Sarah: Yeah. Oh, thank you for giving me the chance to do a bit of promo. Well, I've got a suite of online professional development courses, so they ask for people in the helping profession. So, as you said, coaches, therapists, psychologists, teachers, personal trainers. I've got a couple of courses on applied neuroscience and brain health. We kind of take you through an introduction to neuroscience, an introduction to brain health, and we look at what we can take from the science and apply to everyday life in really pragmatic, practical ways. Being really thoughtful about that. I have another course looking specifically at women's brain health, nature, nurture, and neuroplasticity based on my first book. But I'm continually updating the evidences that comes through in that, and that's very conversation based. It's all women. There's a lot of sharing. It's a really cool course, a lot of juicy conversations. And then a third program, which is really sort of the part two of the basic neuroscience training, which is specifically for coaches, because I was finding about 70% of people that did my other courses for coaches. That's neuroscience coaching network. And again, very much trying to have a mashup of neuroscience and coaching, but without me as the centerpiece because I took a bit tired of myself. I partnered up with a coaching psychologist in Dublin, Ireland, who actually happens to be my sister in law. And we built on a coaching curriculum, but was taking a look at how we can integrate aspects of neuroscience into that with people into geographical trades. They work on projects. We have a speaker's series. So I get all these amazing neuroscientists that I know to come in and speak.

[09:08] Sonya: Wow, that sounds amazing.

[09:10] Sarah: That's a really cool course that runs only one time every year because it's quite chunky that's just coming to a conclusion. So that's the neuroscience coaching network. So there's sort of three types of programs.

[09:21] Sonya: Cool. And I'll link through in the show notes to all of those, so that anyone that is listening that would be interested to learn how they could perhaps learn from Sarah can jump onto those. All right, let's move into the brain during menopause.

[09:35] Sarah: We haven't known a lot for a very, very long time. As I said, women are not a niche, but science and neuroscience has kind of approached women as a bit of a neat but irrelevant, but mumsy. And I say that in a joking way, but just to really put in perspective how little we do know. But also there are people that are working in this space. And I guess it's probably worth pointing out that the first study that will become a classic of its time, looking at the menopause transition, how do women's brains change across the menopause? It was only published and get this, 2021.

[10:18] Sonya: Oh, my gosh, two years ago.

[10:21] Sarah: The first study that was sort of designed in a similar way, looking at what happens to women's brains across the first pregnancy, was published in late 2016, early 2017. So this sort of area of women's health and neuroscience is pretty new. There are other aspects of menopause in particular that we've understood for a reasonable amount of time, but this kind of let's kind of put a neurobiological lens on this point in time, point in the lifespan, is pretty new. But what we now are starting to understand is that adolescence, which happens to biological males and females, pregnancy and menopause, are all very significant neurological transitions in women's lives. So it's really interesting to kind of take a look at what's happening in the brain, although, as I said, it's pretty new. But I think the work that is being done is pretty pragmatic and improving reasonably useful.

[11:22] Sonya: Let's talk about Oestrogen, the impact that that roller coaster of Oestrogen specifically has on cognitive function for women. And some of the symptoms that we often talk about, particularly in the perimenopausal years, which are the brain fog. Why does that happen? What role does Oestrogen play in all of that?

[11:39] Sarah: I think that we give our hormones a really hard time and typically blame them for when things go wrong. Many of us I wasn't I somehow managed to sidestep many of us have been given that message since we kind of entered puberty, that hormones are the cause of emotional instability. And all your hormonal cognitive inability, all the failings of women. And I think it's an unwise way to think about that because it's pretty clear from the science, from animal studies, and from humans that Oestrogen in particular, which we know most about, is what we could call a cognitive enhancer. It promotes health, it promotes resilience, it promotes all things. I don't want to use the word useful, but it keeps us young. What we start to see when we enter perimenopause is Oestrogen is produced by the Ovaries. Puberty at the other kind of end at the beginning is initiated in the brain. So it's various kind of biological clocks and genetic clocks in the brain kind of turning the brain on to signal to the Ovaries menopause at the other end. The message kind of starts down in the ovaries and they sort of just the eggs just sort of start dying out, drying up for want of better language. And so we start to see Oestrogen not necessarily dribble off but kind of go up and down and up and down. It really starts going through a roller coaster and that is because the regulation of the amount of Oestrogen we produce is kind of regulated in kind of a conversation between your Ovaries and your brain. And when there's not enough Oestrogen kind of being released by your Ovaries one month then your brain kind of shouts down to your ovaries to release more and so there might be a lot the next month. And so instead of it being very regulated and cyclical it becomes very dysregulated and roller coastery. And that is perhaps one of the main causes for a lot of symptoms women have. And particularly I don't really know so much about it. I'm more kind of focused on the brain. But things like heavy bleeding women often find that their menstrual cycle changes completely in length, regularity and heaviness of bleeding, et cetera. So we start to see a whole lot of things start to go haywire during this time when you kind of get out the other side. Like you're kind of post menopausal, you've had your year without a period and then you're kind of tracking along after that things kind of tram line out and then it's almost as if your body then starts to learn to function without Oestrogen. But that's not always necessarily functioning as well as it did before. But the perimenopause, those years leading up when your oestrogen is going up and down, up and down is when we see a lot of the issues form, when we think about symptoms and the brain and oestrogen by far. And away. The most well understood of that kind of mechanism is hot flashes or hot flushes, depending on getting all the daytime experience of that surge of heat. I've never had them during the day but I was a couple of years ago starting to and I'm not sure whether it was perimenopausal get night sweats at night, symptoms were such but I still got very regular periods so I just went back on the pill.

[15:03] Sonya: Yeah, I remember us having that conversation actually.

[15:06] Sarah: And that is actually I've been on it since and so now I just don't notice anything. But I'd always had very positive experiences of the pills so I had no qualms. People have got different issues, different risk factors, different kind of vibes around the oral contraceptive pill. I was kind of happy to go back on it, and it sorted everything out. But in terms of that mechanism, what we understand is within the brain, if you kind of zoom on into the brain, you go deep inside the brain. There's a part of the brain called the hypothalamus, and it sort of sits at the center of the brain, and it regulates a whole lot of very basic physiological functions. So body temperature, it helps regulate hormone release of ovarian or gonadal hormones, but all different kinds of hormones in your body. It does things like gets in readings of PH levels in your blood, of gut motility, how much food is being digested and where breathing rate. It kind of gets in all of these sort of data feeds of what's happening biologically in your body and then sort of collates that information and then sends messages back out to your nervous system and to your hormone system to kind of help keep everything working. Hydrothalamus is in charge of body temperature. So it's almost like there's a thermostat in your brain. So I always imagine a thermostat as having kind of an upper setting and a lower setting for kind of physiological homeostasis is the word level where your body can't function because it's too hot or your body temperature drops. It can't function when it's too cold. And if your body temperature rises, say, above that, then your hypothalamus will trigger two kinds of behaviors to help cool you down. One will be you'll start stripping your clothes off, so you'll actually start behaving in a way to cool down. You might have aircon on, open a window or take your clothes off or get a glass of water. So you'll physically behave in a way. And then your body will do things to help cool you down as well. So you'll sweat, your blood vessels will dilate, and then that will help release body heat. So there's those two types of responses. And we know that that temperature setting is regulated by oestrogen because when women start going through perimenopause, the thermostat becomes dysregulated. And what we see in some women, not all women, this happens, but in some women especially, the top level goes down.

[17:39] Sonya: The bottom level also goes up a.

[17:40] Sarah: Bit, so it gets a whole lot narrower. So you've got your body temperature kind of cycling along, and when it goes above the top level, which is lowered down because of lack of, your body suddenly goes, oh, my God, it's really hot in here. We've got to do something quickly to cool down. Ten years ago, or if you were a male of the same age, your body temperature could have risen to that level and your hypothalamus wouldn't have panicked.

[18:08] Sonya: Yeah, got it.

[18:09] Sarah: It would have been within the normal bounds.

[18:11] Sonya: But now that normal, normal seas become.

[18:14] Sarah: Narrower, panic stations, we've got to cool down. We've got to cool down. And so what happens, you have this massive physiological response because your body's really trying to cool down really quickly. You get this hot flash. And if it's at nighttime, this is why women wake up kind of in this, like, panic with this big sort of surge of adrenaline is your body is trying to wake you up so you can behave in a way to cool down as well.

[18:43] Sonya: That's interesting. So that's triggering that response to get a glass of water, turn on, kick.

[18:48] Sarah: The doon on the way, but hosh, it's panic stations. Panic stations. And because you're asleep, your body has to you have to wake up. And so the surge of adrenaline wakes you up. And that's what you feel. You literally feel this kind of adrenaline. It's almost like you wake up in a panic as you're having the hot flash. And I was speaking to someone else way while ago who used to work in a sleep clinic, and she said, same thing happens with sleep apnea when someone when the kind of everything sort of closes down.

[19:21] Sonya: So they can't breathe, and there's no not enough oxygen coming in. The brain panic, and there's a big.

[19:27] Sarah: Surge of adrenaline, which wakes the person up enough, open up their airways enough to be able to breathe. And what happens that could happen, if that happened once, you'd probably be all right. But if that's happening a few times a night and then a few nights a week and then a few weeks a month, you're getting these surges of adrenaline that are waking you up. The sleep is becoming very disrupted, and it is very, very easy in the middle of the night to kind of almost it's hard to be rational and cool, calm and collected emotionally about that's happening to you. So we've got the hot flashes during the day that may be, depending on how you're approaching it, manageable or not, but the sleep disturbances at night do have quite a lot of knock on effects. Now, we know that Oestrogen is part of this regulatory process because if you put Oestrogen back in with menopause hormone therapy around this time, pretty much in most people resolves the issue. And we understand the underlying neurobiology behind the Oestrogen kind of moving the thermostat back to its levels. Again, what's also interesting is sort of night sweats and waking up in a panic aside, even if that's not happening to you, we know that there is a very tight relationship between thermoregulation and sleep and sleep architecture. So if you remember your kind of high school textbook or you've ever looked at sort of what happens through the stages of sleep at night, you know, you go at the beginning of the night down into deep sleep, and then you kind of come back up again. And then you might go through dreaming sleep or REM sleep. We call this sleep architecture. There's this pretty predictable and very healthy pattern of sleep that we can measure through the course of the night. And that's actually quite tied up with thermoregulation so in women, even, who are not being woken at night by their hypothalamus going panic stations. Panic stations. Even if there's a slight dysregulation in body temperature, we see disruption to no sleep architecture. And that may not even be something you're conscious of because often you'll wake up at night and you'll go back to sleep, and you won't even know that you did or remember your partner went to the bathroom and you're like.

[21:54] Sonya: No, I see it all the time. So I wear an aura ring, which everybody that's listening is probably pretty well aware of by now. And one of the reasons that I wear that is I pay quite a bit of attention to my sleep patterns. And it amazes me how often I see on the data where it tells me I've been awake during the night and I have no recollection of being awake at all. So I guess it's not a fully conscious awake. It's a little bit more of a subconscious awake.

[22:17] Sarah: And it's probably absolutely and we just don't have any memory of it, or we didn't come into conscious awareness enough to register it. But the ring is obviously registering it, or sometimes, because it's on your hand, you might have moved your hand, but you might be asleep or something.

[22:36] Sonya: Like my husband, who was snoring beside me. Yeah, okay.

[22:42] Sarah: And this is a bit of a long winded way to say that even if you're not having hot flashes and night sweats, perimenopause can disrupt sleep via this mechanism. And sleep is really the foundation of almost everything else when it comes to brain health and well being. When it comes to what you were talking about with cognition, brain fog, hormones play a little part in that. We could talk about that. Emotional regulation, anxiety, depression, hormones can play a role in that. But sleep is still foundational. And we all know what it's like if you miss one night's sleep. But if you miss multiple night's sleep and you've got consistently disrupted sleep, it is very, very hard for everything else to then healthily follow along. It's almost inevitable, in a way, that women start to suffer various other health and well being symptoms, even if they're.

[23:42] Sonya: Not noticing that they're displaying obvious perimenopause. Yeah, interesting. So moving then onto the brain fog and you mentioned that we talk about the brain fog and some of the cognitive impacts. Talk us through that a little bit. Yeah.

[24:01] Sarah: So that's really a colloquial word. It's a little bit like baby brain I just wrote a whole book on which is really a word that we are almost using to describe an inability to function in the way we kind of feel like we should, or we used to. And it's interesting because sometimes we see this during pregnancy as well as during perimenopause. Women may say, oh, I've got brain fog. And we'll bring them into the research lab, and they're cool, calm, and collected, sitting there in a nice room with no distractions, perhaps a nice cup of tea. And they do their cognitive tests, and we're not picking anything up. Cognitive decline, we're not picking up drops in scores of memory. Everything's functioning fine. That's not always the case with everyone, but often we're not picking anything up during pregnancy. Motherhood we're not picking up cognitive decline. Menopause, sometimes we do, but often we don't. It's almost more of a shorthand phrase or a way that women use to describe overwhelm. There's just a lot going on. I don't feel myself, I'm not experiencing well being and what's happening at this point in life. It's not just your hormones changing.

[25:16] Sonya: Oh, no, there's a lot going on.

[25:17] Sarah: Yes, I'm a classic example. Careers tracking what along really well. I've got teenage sons. One's going to start HSC soon. Thankfully, the great teenagers aren't causing me any issues at this stage. Touchwood. But aging parents in three different countries in the world that me and my husband are now trying to go and visit and arguing to drag teenage sons along. And it's just like there's a lot going on.

[25:49] Sonya: It's a lot.

[25:49] Sarah: And I don't even have a very busy life because I work for myself, so I'm very careful with my time and I'm very fortunate. So it's almost sometimes when we're saying brain fog, brain fog, what we're saying is, I can't cope. I can't cope. But we've been fed a pretty strong cultural message our entire reproductive lives. That when we feel that we can't cope, it must be something neurological. It's clearly my baby brain or my brain fog. That's one part of it. However, we also know that oestrogen is neuroprotective. It helps build resilience. It keeps your brain younger. It kind of keeps everything functioning. And when we sort of start to see these levels go up and down, there is a case to be made that perhaps it could be responsible for this kind of fuzzy cognitive feeling. But it's very, very hard to tease out from issues around sleep and issues around mental health, anxiety, depression, mood disorders, which can be a consequence of the poor sleep as well, because what we have found is when we give women menopause hormone therapies, and that's the best test, is it the lack of oestrogen. Put it back. And we're not really we don't always necessarily see the significant cognitive improvement. Some of the only times we see it, but not in all women, in all studies, is perhaps women have had to have their ovaries removed. Perhaps they've got a burial cancer, and they plunge straight into sudden menopause. They haven't had the five years of going up and down to get used to it, to wean their body on and off sometimes. In that instance, putting oestrogen back in helps, but we're just sort of starting to unpack. Why menopause hormone therapy works some ways in some woman and other ways in others, another woman. What we can do about that. But I think by and large the story is oestrogen is a cognitive enhancer and as soon as you start removing it, we may start to see decline. But the decline is not significant enough that it could be only due to the lack of oestrogen there's often going on.

[28:01] Sonya: And one of the other areas that I know that can play an impact on concentration and I guess a little bit of being able to play that. Mental gymnastics is if a woman is iron deficient and that can be something that becomes common during perimenopause. If you're experiencing that heavy period, heavy bleeding as a result of your oestrogen and progesterone kind of dancing away together in the background. Yeah. And that is often where women really are encouraged to go and see their GP and have some testing done. Not hormone testing, because if you're only in perimenopause, hormone testing is not going to give you an accurate picture of what's going on. But testing things like your iron and your B Twelve and there's a whole host of other biometric markers that can be tested, but they can also play into what we're talking about here, which is that general overwhelm feeling of something's not right.

[28:56] Sarah: Something's not right. And I think it's just a time in life when you've got to put your big girl pants on and if you haven't got a good relationship with a health professional that you trust, who you can talk through all of this stuff with and approach the issue from different angles. Look at well being and whole health well being. Assess it yourself, but talk it through with someone who knows what they're talking about, too. It's really the kind of time in life when you've got this opportunity in front of you to sort of assess what's going on, what's going well. You sort of start need to up leveling a bit with your nutrition and with your exercise, with absolutely training all of these issues.

[29:44] Sonya: And it's also a time where we have this, I believe this prime opportunity to up level all those things that you've just discussed, all the lifestyle aspects stress management, sleep, exercise, nutrition, but not just using a short sighted approach of, well, this is going to help me through perimenopause, but actually really taking it into that extra level of this can increase my health span, which means I'm going to be healthier for longer, as long as I live. And I think that that's an approach we really need to start talking about with women more.

[30:20] Sarah: Yeah, absolutely. I suppose it's different for me because I have been an information gatherer and consumer of science and health and medical information most of my career. How many women kind of I don't think they let their daughters, if they had daughters. Go through puberty so ill informed.

[30:44] Sonya: No, exactly. As if, well, school didn't tell me.

[30:47] Sarah: This is going to happen. It's almost as if they've kind of lost a little bit of agency in terms of their own health and well being. They've been giving it away to everyone else all of these years and it's such a good time. There's no coincidence. This is the midlife is when women start getting all the names in the world, like Karen's and AGS. There's various other more offensive terms I won't use that get thrown around about women in midlife. When women finally start going actually, you know, it's a come up, start focusing in on me, but there's still women out there I think you kind of want to shake and go you've just got to sort of start looking after yourself. If you're not going to do it now by the time you're in your late forty s, early fifty s, when you're going to do it. And I don't believe that those same women would let their family members approach a phase of life so important.

[31:49] Sonya: That's such a good point.

[31:50] Sarah: But then that's me. And I'm not saying that's me almost kind of blaming women, but I think self involved.

[32:02] Sonya: Yeah, but I don't even necessarily think that it's blaming women. I think we're blaming society and culture. Why bother? Because society doesn't place any value on me anyway once I pass to this age.

[32:14] Sarah: Yeah, I guess it's just transition time and I suppose it's always a chance to reflect and you know, where your first half of your life, it's gotten under your skin, how is it shaped and sculpted you up into this point and kind of how are you going to live the second half of your life? Hopefully you'll get another whole second half, another 50 we should do.

[32:38] Sonya: Yeah, that's my plan.

[32:40] Sarah: Yeah, it's mine as well. So my genes probably aren't written that well, unfortunately, but I'll do my best with the other 70% of stuff that I can do. It's a bit of a 70 30 equation, but I mean, I guess what I'm saying is there's a ton of information out there for women going through menopause.

[33:00] Sonya: There is now.

[33:02] Sarah: Yeah, there is. This is so much and the research is kind of coming through to allay especially within that kind of segment of decisions around if you're going to start taking hormones. There was just so much confusion and misinformation and fear around that as an option. And I think I certainly see women my age. It was almost like that kind of bypassed us or we were too busy not clubbing the turn of the century when all that information came out about hormone therapy.

[33:37] Sonya: That was yeah, the Women's Health Initiative.

[33:39] Sarah: And yeah, listen to Fat Boy Slim. The women freak out about that, which is really good. So if you haven't had issues with cancer like yourself, you haven't got risk factors. The information is there now for us to sort of start making really smart, wise decisions and having that as an option. It was off the table ten years ago.

[34:02] Sonya: Yeah, it was.

[34:03] Sarah: But we've got all of this information and these options now. You just have to kind of, I.

[34:09] Sonya: Suppose, yeah, like you say, put your big bill pads on and go have those conversations. And like we talk about on here all the time, if you do have a GP that you're talking to, that's not helping you in that you do need to start advocating for yourself.

[34:26] Sarah: The women in your neighborhood, asking your mother's groups, asking the I have conversations with mums, high school mums, and one of them was my GP. Won't listen, won't understand. Someone else says, Well, I've got a great GP, so she went off to the new GP. I met a Gynecologist the other day who specializes in midlife women who bleed heavily. And I got her card and I was sending photos of the card to.

[34:53] Sonya: All of my friends.

[34:55] Sarah: We're our own best resource as well.

[34:58] Sonya: And I think for women that aren't lucky enough to live in societies like we are, or in the cities like we are, where we do have all those many options to go to, there are some great online resources that will help you find those support networks as well. If you do happen to be in a more rural and regional area where unfortunately, there is a GP shortage, and if you only have one GP in town, it can be hard to go find another one. Yeah, cool. Awesome. Sarah, thank you so much for your time. I feel like there is all sorts of avenues that we could go down. Congratulations on baby brain.

[35:33] Sarah: No, I'm very proud of it. Not just about pregnancy and motherhood, but I talk about menopause and aging in it as well, because our reproductive histories are an incredibly important part of how we age and how we experience menopause. But I think that this sort of space of women's health and neuroscience is a really exciting one and it's finally starting to kind of show some fruits, the labor of all these neuroscientists out there that have been working on as well. That's such exciting calibri one.

[36:05] Sonya: Yes.

[36:11] Sarah: Hopefully I'll be on a couple of these big podcasts at some point later this year. And good. Get the women's voices heard.

[36:20] Sonya: Yeah, good. A woman's voice, that's a reasoned voice as well is important. So amazing. Sarah, thank you so much for your time. Actually, you know what, I'm going to ask you one question before I go, and I did not prep you for this either, but what are you listening to? Reading or watching right now that is bringing you joy?

[36:38] Sarah: Oh, my God.

[36:39] Sonya: Do you know, I want to know.

[36:40] Sarah: What I just spent the last two days reading. I found a box of old photos and my old school diaries and mementos and things that I thought we lost when our garage flooded in my previous house. But I found them in a box with this old stereo packed in it. So the last couple of days I kept extensive diaries from about age ten until I met my husband and then I had a digital diary after that.

[37:08] Sonya: Wow.

[37:09] Sarah: And I just read my paper diaries, so I felt like I've just relived the first half of my life.

[37:17] Sonya: So cool.

[37:21] Sarah: It's just taken me back, like the photos, reading these detailed accounts of these boys. I was desperate we would hook up and then they'd break my heart and it has just been the most it's really consumed me and moved me and it's a really strange experience to read about your healthy and years at this age. It's been pretty I've been consumed by that.

[37:54] Sonya: I think that is fine. Oh, no, don't embarrass. What a find. But I also look at myself and.

[38:00] Sarah: You just think and then there's a couple of times I read this and say, I hope one day I look back on this and perceive it as a learning experience. But at the moment it's really hard and I'm like going, yeah. Now I'm looking back and it was.

[38:15] Sonya: It'S almost like one of those moments. What would 15 year old Sarah tell 55 year old Sarah? 45 year old Sarah?

[38:22] Sarah: I kind of wouldn't mind going back because there were some pretty there are a lot of really wild parties.

[38:27] Sonya: Life was different back then, wasn't it? Yes.

[38:30] Sarah: Bring me joy and a lot of other emotions I haven't quite got the name for yet. I'll have to get out one of those Brene Brown books and sounds like it find my way through.

[38:40] Sonya: Yeah. Amazing. I love that. Thank you for sharing that with us.

[38:44] Sarah: Awesome.

[38:45] Sonya: Sarah, thank you for your time. It's been a great chat and I look forward to bumping into you at the shops.

[38:50] Sarah: I'll see you there.

[38:55] Sonya: Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of Dear Menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you because you are my biggest driver for doing this work. If this chat went way too fast for you and you want more, head over to Stellarwomen.com Au podcast for the show Notes. And while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.