DANIEL : [00:00:00] What if I told you there was a medical diagnosis that impacted more than half the population that impacted muscle strength, brain functioning, mental health, sleep, sex drive, heart health, body composition, blood sugar, balance, and more. This diagnosis is rarely discussed in public.

There's a lack of awareness generally, and there's not as much support as people need. Wouldn't you be curious to know more and how to understand what's going on and how to support those in need even if it's not yourself?

So today we're going to talk about the midlife menopause reset. We're going to talk about perimenopause and menopause which directly affects 50. 3 percent of the population and indirectly affects all of us.

This isn't only a women's health issue. We all have women in our lives who are navigating this challenging season in midlife.

In this episode with women's health expert Dr. Amy Edler, we're going to understand more about what's happening and how to make space to understand the midlife menopause reset.

Hi, this is [00:01:00] Daniel from the Spacemakers podcast, a podcast to help you make space to think deeply and rest fully and live an intentional life. Okay. And why are we here talking with a women's health expert on the Spacemakers about perimenopause and menopause? Well, last season we ran a series on making space for life's inevitable resets.

DANIEL: Which was the idea that the habits that set us up for success in our 20s and 30s need to be reimagined and rethought as we hit our midlife squeeze. And, Matt and I talked about a number of topics, but we knew that we had not covered one of the most important topics related to, um, the midlife transition.

Particularly for half the population, which is about menopause and the impact of menopause on the brain and the body and social relationships and a whole lot of other things. And so we're so excited to be able to have my friend and women's health expert, Dr. Amy Edler on the show with us. She is a beloved GP.

Uh, she's been in this field for a long, long time [00:02:00] and is really on the coalface listening to real life experiences of women in particular who are struggling and wrestling with what it looks like to experience the transition changes related to a low estrogen level of perimenopause. Uh, and so we're going to talk about a lot of different things and also hear her personal story.

Before I introduce Dr. Amy, it's important to mention that while we're talking about medical things in this podcast, this information is for educational purposes only, and it's not intended to be a substitute for professional medical advice. So always seek the advice of a GP or another qualified health provider with any questions you might have about an actual medical condition.

But I am delighted to welcome Dr Amy Edler. Welcome to the show.

AMY: Oh, thank you for having me. I'm really happy to be here.

DANIEL: Now I'm going to call you Amy because we've known each other for a while.

Matt and I wrestled for a while about, you know, do we get, I don't know, an endocrinologist expert or a cutting edge researcher [00:03:00] in perimenopause to kind of dazzle us with, you know, deep knowledge, a bit Hooverman style.

But we really thought that actually, you know, it's the lived experience and the stories and being on the coal face that really matter. And, you know, then we thought of you and we're like, oh, you'd be perfect because you've got so many years of experience just being with people and talking. And so I'm so grateful that you could say yes to be on the show.

AMY: I'm delighted to actually. And the way I remember it is several months ago, you and I had that conversation and I almost volunteered myself because I do feel very comfortable talking about these sort of issues. And I think, with all respect to endocrinology colleagues. I think that there's a Holistic nature that a GP can bring.

Yeah, which is fantastic. That's actually really meaningful.

DANIEL: Yeah, and I'd love people to walk away so, you know, for women obviously to walk away with some really helpful encouraging, you know tips and advice about what's going on but also for, you know, men listening to this podcast so that they have an understanding of what's [00:04:00] happening in the loved ones that that they spend time with and to be able to actually have empathy and support because they have an understanding of what it looks like to go through this midlife transition.

AMY: It's wonderful, Daniel. I really, really affirm that. I think it's really healthy.

DANIEL : So we've known each other for a while, haven't we?

AMY: We have. We have. You were mentioning how many years. Yeah.

DANIEL: 19 years next month. Wow. Okay. So we have known each other basically since I came to Hobart.

AMY: Absolutely. Yeah.

DANIEL: That's great. And you've been a doctor for that long. But obviously you've specialised in women's health. That's what, what gets you excited or why did you move into that?

AMY: Why did I move into that? Why? I was never out of that field, to be honest. I grew up in a family of girls and no, no brothers. And I can remember, um, very early on, I wasn't playing with Barbies.

I was making my sisters have pillows in their jumpers and I was delivering, you know, it always excited me, the women's health field. And, um, even before I chose medicine, I was still very passionate about. Um, well women, I think. Um, [00:05:00] so, yeah, I suppose that's the difference for me. I'm passionate about well women, not just about, um, being in the field where women are unwell.

If you know what I mean. Yeah, that makes sense. There's a slight difference. Yeah, absolutely. A little bit more of a positive spin.

DANIEL : Yeah, no, I love that. And, like, I know how much you have a positive outlook in terms of how you can encourage and inspire women in different areas of life.

DANIEL: So Amy, I want to hear your story as well, but before we do that, why don't we, you know, start with the basics. I mean. Yes. Okay. I've read a book on menopause because I didn't even know what questions to ask, but a lot of people like me, they don't even know the difference between what perimenopause and menopause is.

So can you give us the basics and a bit of an understanding?

AMY: Absolutely. Really happy to do that. Um, I actually think before I do, I actually think that um, where you started before you read that book is a really powerful platform that you are sharing with most of our listeners and that actually bringing just those starting steps.

I can, I can debunk those things. So perimenopause, menopause, [00:06:00] what's the difference? So the average age that an Australian woman or someone with a uterus who doesn't identify as woman will go through menopause is 51 years of age. Okay. And menopause is actually a retrospective diagnosis. It's when you stand in a moment of time, look back, and there's 12 months without a menstrual period.

So that's sort of the sim, you know, simplistic.

DANIEL : We call that in productivity terms, we call that a lag measure, where you measure it once it's happened, but it doesn't have any lead indicators.

AMY: That's right. And so it's almost like a status, you’re pre or you’re post in terms of that. If we put that aside, Perimenopause is, uh, a term that we give to the fluctuation of oestrogen, so not low oestrogen yet, but the chaotic fluctuations that lead to the end of our fertility years.

So our perimenopause, we tend to sort of call the space [00:07:00] before menopause our perimenopause. However, our fertility lasts between one to two years after our menopause. Okay. Interesting. So peri is a little bit fluid and it's sort of mostly before, but a little bit after.

DANIEL : Yeah, so it's a grey space and it can last a long time and there's a lot of it really can. What are the age ranges that we're looking at?

AMY: Yeah, it's a great question. So if I say that menopause is 51, the physical symptoms of perimenopause can start four to seven years prior to that. Okay. And the mental health cognitive symptoms can start five years before the physical.

DANIEL: Okay.

AMY: Therefore, if I'm seeing a new patient in my clinic, anywhere from 35,

DANIEL: Wow.

AMY: before I see them and call them into my room, perimenopause is on my mind. And I think that's a real misnomer in, certainly in our culture, probably of Australia. We think of menopause as in the 50s.

DANIEL : Yeah. Yeah. Yeah.

AMY: But actually it isn't.

DANIEL : Yeah, and, and this is the big kind of [00:08:00] realisation I've had because I'm 47 obviously my wife is similar age to me Most of our friends are a similar age to me and I'm, and everyone around me, you know the women in my life are actually significantly experiencing challenges, symptoms, wrestling with the chaos of the estrogen changes that happen. It's a wonderful word for it.

Yeah. And it's a, it's a huge thing. I just didn't realise what a massive impact it has on people's lives. And, and I, this is why I think it's really important to talk about it, particularly because as you mentioned, um, women will see a GP even or a medical kind of specialist, and they won't necessarily be thinking these symptoms could be linked to the changes in estrogen at 35.

AMY: It's just not on the radar.

DANIEL : And it's really important we can have this conversation.

AMY: That's right. And I certainly, I've been looking back to my medical career, really racking my brains, my memory, um, which is patchy anyway, but I cannot recall doing a really big educational chunk on this [00:09:00] time of life, which is really interesting because it affects, look, it affects people in different ways, but I would say most people with a uterus are affected.

DANIEL : It's astounding, isn't it? Ok, so there's 50. 3 percent of the Australian population are women. So the book I read was by Mary Haver, The New Menopause, and one of her big take home ideas is, I mean she's an American, uh, doctor, but essentially her take home idea is that actually a lot of women are going to GPs and medical specialists.

And talking about symptoms like brain fog and frozen shoulders and changes in kind of body composition and a whole lot of other things, mental health. And they're not getting the support they need because it's not being linked with the changes of menopause. And so it, what you're saying seems to back what she's saying as well.

AMY: Yes, that's definitely my experience too. Yeah.

DANIEL : So it's really important really important.

AMY: Yeah. And I, I suppose whose responsibility is it in a woman's life? Is it the doctor? Yeah. Is it the woman? Is it her girlfriends? You know, is it her male partner?

DANIEL : And [00:10:00] maybe, you know, partly it's a societal response.

That's right. This is why we're talking. That's right. That actually, the broader we understand what's happening.

That's right. The more we can all be there to have the right conversations.

AMY: Yeah, so, um, I certainly think five, maybe ten years ago, Menopause or peri, it just wasn't talked about. I think now if you asked a small cohort, five to 10, um, of the people that you know, women in their forties, it's everywhere on social media.

And that does, that that comes with some negatives, but I think it's also a really great groundswell of change in the conversation as a society.

DANIEL : That sounds good. So, look, why don't we get into some of the biology and then I'd like to hear your story. Yeah. Because my understanding, again, I'm, it's limited, but, uh, the fluctuation or changes in estrogen is really the main kind of kickstart.

There are sex hormone changes, but particularly estrogen is the change that happens in perimenopause and that estrogen, it has a protective effect on the body and therefore the loss [00:11:00] or changes of estrogen has a massive impact on multiple systems. Is that right?

AMY: That is absolutely true. There are estrogen receptors in every part of the body.

So I think traditionally, maybe if you have a sense of what the symptoms are, you might think hot flushes, night sweats, general temperature being high, actually it affects everything top to toe. Um, yeah, frozen shoulder, um, skin, brain, everything like that. Perhaps if I, um, speak to my personal experience, um, now, I don't know if that's a helpful thing.

Yeah, that sounds great. Yeah, I think, um, I think when you finally realise that perimenopause is happening to you, you don't realise it at the time, you look back and you see it. So actually for me, my primary symptom was a frozen shoulder. Just out of the blue, no injury, bam, two years ago.

DANIEL : I mean that is an awful, I've been a physio for a long time. It's a huge disability. It's an awful condition, it's so painful and so debilitating.

AMY: Correct, but did it link in my mind, to be perimenopausal? Of course not.

DANIEL : And you're a women's [00:12:00] health expert. I mean, this is the thing, right?

AMY: Isn't it amazing? It's the ultimate irony. Yeah. Um, but then from there, it was like a really insidious mental health journey for me and, and cognitive word finding. I've known you for so long, I don't know your name.

DANIEL : You keep calling me Tom, you know that right? Yeah,

AMY: Yeah. Do I? I can't even remember.

DANIEL : Alright, dad joke, sorry, keep going.

AMY: I really notice it in my home space, in that I'm going, you know, that thing, that thing, and my two children and my partner, like, they're like, what, uh, uh, uh, you know, what is it that you're trying to, and, and they notice that word finding thing, or brain fog, I just cannot work, you know, work out what I'm thinking or what I need to do.

It's really debilitating.

DANIEL : And you've noticed a change, obviously.

AMY: A huge change. I feel like it hit me like a ton of bricks. It wasn't a gradual onset. But again, the benefit of hindsight, I can see and draw all of those symptoms together.

DANIEL : So, you know, Amy, how has that, like, how has this affected you personally?

AMY: I really [00:13:00] appreciate that question, actually, because it's certainly not something you speak openly about.

Yeah, if you're comfortable, of course. I'm a hundred percent. So, personally, I think, um, I think it's really helpful for me that I'm in the field because I feel really validated. And I feel really educated and empowered in my symptoms, which are head to toe, you know, I've got a lot of symptoms and they have been really disabling at times.

So I feel really blessed and I think there's heaps of women and their partners out there who are not in the field. So they feel like they're going crazy.

DANIEL : Yeah, I can imagine. So on the one hand, you know, let's say, and I'm picking some of the common symptoms. You're starting to sweat at night. You're experiencing these hot flashes.

You're losing words. You're feeling like your, your cognitive, you know, decline is occurring, uh, and maybe you have some painful condition like a frozen shoulder.

AMY: And you've suddenly got a donut around your belly. Exactly. Your body's changed massively.

DANIEL : And what [00:14:00] you used to do isn't working. Correct. And, and, and yet what I'm hearing is if you don't know that that's perimenopause and you don't have any support, well that's far harder than having the awareness and realising that this is actually what happens.

I agree. And it's actually normal. It doesn't necessarily mean it's not painful, it's not painful, but it is, or that you can't do something about it to some extent, but, but to normalise it and to share it. Correct. Sounds like it's actually been helpful for you. And that's what people need.

AMY: That is absolutely what they need.

So that's, yeah, that's my first point of two in that, um, even to the male listeners today, just have it on your radar. This is a huge, this is like a period in that. It's something that's absolutely part of our normal, um, developmental change. The second thing I'd like to say is that, um, I think the, the way that it's really affected me, is that it's made me realise that I'm ageing.

[00:15:00] And I think that, um, is a huge part of perimenopause for a woman is that you suddenly realise you're going to get old and that there's an ageist, we're ageist as a, as a population quite possibly. I mean, I, I say that as an opinion.

DANIEL : No, no, I agree with you from what I've seen as well. I mean, again, we've talked a lot about this in the last season, the idea that actually the midlife transition uh, comes with this idea that we start to confront our finality and the fact that we're getting older or people around us are passing away or that we're suddenly seeing those changes.

But what you're saying is it's even more pronounced for women or at least it's faster and more rapid and the society and distressing. The other thing is our listeners have written to us a lot and it's the women listeners who have actually said to us, actually, one of the words you haven't used yet is invisible.

And you know, there's an invisibility that happens with women as they age in our society. There is an ageism. That is different than for the average man. So I agree with you and from what I've heard as well, and from what I'm seeing in the society around us. And that's [00:16:00] all really tough.

AMY: I agree. And some of the ways that we've tried to not be invisible leading to that time, you know, our brain, our looks, our weight, things like that, all of a sudden, are lost to us, are out of our control, and are doing crazy things in moments, like in a work meeting, where you need to perform, you suddenly can't perform.

It's the height of gaslighting, I think, if I may respectfully use that term, because all of a sudden a woman doesn't perform. Um, isn't able to do what she wants to do to be visible and to be, to have significance.

DANIEL : And look, I'm, I'm guessing here's the first time I've thought of this, but, uh, you know, I know that women in their like late twenties now and early thirties, you know, they have a massive career disadvantage because of having kids most of the time.

So then you hit, you know, your mid forties and you're thinking, well, now's my time and what you're saying is actually I'm also struggling because I'm actually having the chaos of hormonal changes that are impacting my performance and [00:17:00] sleep, and sleep.

AMY: Oh, don't even. That's a huge area of distress for so many women.

That's right. And I think it's a really important thing to mention as well in the Australian context that women leave the workforce in droves because of their perimenopause or menopausal symptoms, okay? Yeah, it's a real fiscal problem so anything  that we can do to increase awareness to get people, even the government thinking about how can we support women through this time?

Yeah, we're going to be working longer and more empowered. Huge, isn't it? It's huge.

DANIEL : So look, maybe it would be helpful to get in some details about the types of symptoms that are most common. Do you mind if I read some stats that I read? So I read a poll of 22, 000 women in midlife, uh, and the top five symptoms of menopause, or perimenopause I assume, are weight gain, so body composition change.

The second one was brain fog and memory issues, which you've talked about, which is huge. Uh, third one was anxiety and depression. Third, uh, the fourth one was sleep disruption. And the [00:18:00] fifth was hot flashes, or hot flushes, depending on which word you choose to use.

AMY: Hot, just hot. It's just hot, yeah.

DANIEL : So, um, we can't talk about all of them, but I suppose from your experience talking with, you know, I assume thousands of women, uh, what are the symptoms that, you know, maybe average women find the most confronting or distressing that you'd like to encourage them with?

AMY: I agree with that list, actually. It's not the heat stuff that will bring a woman to me, generally, to my clinic. It'll be rage. Okay. And irritability. And I'm shouting at my partner and my children and I cannot control myself. And I feel like I'm going mad. I hear that all the time.

DANIEL: Okay. Wow.

AMY: Right? And then I bring out the list from the Australasian Menopause Society, which is a not exhaustive list of symptoms, but it shows a whole heap of things that women have never thought of. Oh, my skin is so dry. I'm like a desert dragon. You know, I cannot moisturise enough, but they're not going to come in to me [00:19:00] because of that.

But then suddenly I'm putting the pieces of the puzzle together and we see like, so often it's the dawning of a realisation. Oh my goodness. Yes. Yes, that, yes, it's like a switch has been, um, turned off in my libido. I hear that a lot and it's distressing. And partners, you know, we're trying to navigate the patient, my patient or client and their partners are trying to navigate.

It's a really, really hard thing and it is literally hormonal.

DANIEL : So it sounds like, I mean, it's a bit like a, I'm thinking of a Agatha Christie's mystery movie where you have all these different parts of the mystery and then suddenly you look at whodunit, right? And in this situation, well, it's the changes in sex hormones that link all the different pieces together.

Oh, I had a frozen shoulder and now I'm irritable and my skin's dry and I've lost my sex drive.

AMY: And I can't lose the weight.

DANIEL : I ache in every part of my body. I can't sleep. And I like it. But can you imagine going to a medical professional and actually for them just saying, you know, oh, it's just old age.

Get [00:20:00] used to it. You know what I mean? So, so it's so important that people can make those links and then get the help they need.

AMY: I absolutely agree with that. Yeah.

DANIEL : Is there anything else you'd say before we get into maybe hormone replacement therapy and other ideas? Yes. Is there anything you'd suggest from a encouragement or support perspective?

AMY: Absolutely. I've got something that, um, is really a big part of what I bring when I am practicing is that, uh, in traditional Chinese medicine, um, actually this time of our lives as women is called the second spring. Isn't that beautiful? And actually what it refers to that from when as a woman or someone with a uterus, when you get your period, that is your first spring.

The time of fertility, but the gift of this time of our life is that it's the second spring, fertility is gone, it's not something we need to burden with responsibility anymore, it's the time of self nourishment. And I feel like that's a really, um, important hope point. I really like to plant seeds of hope into this time.

The other thing is [00:21:00] too that um, many women say, I'm not the person my husband married, and I say, I know, isn't that good? Because who'd go back? Because who would, who would lose the wisdom or the maturity or the, the experiences that we've had in our life? We wouldn't, the treasures. And actually growing old together is not like Romeo and Juliet

It's actually the grandparents who aged together is the ultimate love because growing old together takes so much patience with yourself and your partner and your body. So much of a journey of acceptance, And embracing the gift that age can be, which I feel is quite countercultural, to think of age as a gift and I certainly feel I'm not quite there yet in terms of accepting that for my body, but it is a gift and thinking of it like that doesn't take away the distress of the symptoms, cognitive and physical, but it does change the way that we manage those symptoms and it changes our [00:22:00] trajectory in terms of how we live and what we believe about age.

DANIEL : Yeah, it's beautiful. I love it. It connects very much at a broader level with a lot of the things we've been talking about with the second mountain and the idea that the second half of life is, uh, it's something to actually celebrate because the pain and the struggle actually propels you into a different way of being.

AMY: That's right.

DANIEL : That maybe instead of that kind of image of, you know, the young lovers who are gazing at each other and I don't know, you know, hearts throbbing, maybe it's an image of two people on the deck of, you know, Veranda looking outward on a rocking chair together. That's right. And having spent 40, 50 years together holding hands, it's a different expression of life.

But it's actually equally beautiful and it's just different. It is, isn't it? We need to change how we see the world and ourselves as we move through that.

AMY: Absolutely. You know that song, Leor, 20 years ago, Let's Grow Old Together? I sing that to myself.

DANIEL : It's nice.

AMY: Accept it, you know, or go on that journey. I'm not there [00:23:00] yet, like I said.

DANIEL : Yeah, but the acceptance and the letting go of what has been is what brings you into that second spring. It does. And that's been the message for both men and women, actually, that we've shared in the podcast. But there's a, there's a kind of almost a violent transition for women by the sound of it. Correct. Whereas for men, they're often forced to enter that space for different reasons.

AMY: That's right. Yeah.

DANIEL : So let's flip a gear a little bit and let's talk about hormone replacement therapy. So HRT or, you know, I think MRT in the states, or MHT, I'm sorry, in the states. But essentially the ability to, to have some type of estrogen or progesterone hormone replacement therapy to counteract, like you said, the fluctuations.

Now, uh, I'm, this is an interesting one for me. Now, I'm a guy. Obviously, I'm coming from a guy's perspective. But when my wife first talked to me about, you know, hormone replacement therapy for herself, uh, my immediate thought was, oh, that doesn't feel natural. And, um, and look, her, her comments were really great and she educated me, which was super helpful because [00:24:00] she'd been educated by a women's health expert.

But um, when I read this book by Dr. Mary Haver, this quote stood out and probably summarises the flipping mindset that I had, which is many will argue that menopause is a natural process and we should just let it take its course and allow our bodies to do what they're supposed to do. My response is that yes, the process is natural, but that doesn't mean that it's not harmful.

Hmm. And I just realised that actually, a loss of estrogen is harmful to a woman's body particularly, and it has chaotic effects on really important body systems, like the heart, the bone system, like diabetes, Alzheimer's. Like, it's, it's, and just because it's natural doesn't mean we shouldn't, we should accept it necessarily.

And that was a real flip for me. Not that I really need the flip, but it helped me understand what my wife was going through and her decision making. But um, I'm wondering if you could speak to HRT and some of the thoughts that you would give generally, of [00:25:00] course, to, um, to women knowing that it's obviously complex based on the age and the stage, et cetera.

AMY: Absolutely. Absolutely. Absolutely. So yeah, there's. Yeah. At least 20 things I'd like to say, but I'll try and, um, I'll try and give an analogy. It's a little bit like a dinner table. And when we hit this stage of life, in the same way that it's affecting lots of body systems, there's a lot of different meals or options to, um, meet those symptoms, depending on, um, you know, what is going on.

And also what, what is important to the woman and also can they afford HRT because unfortunately it's still, the cost is still a little preclusive for a lot of our women. But that aside HRT we now call it MHT. Okay, but same, same. Replacing the estrogen is a huge tool in our arsenal. It's not the only tool that's sort of the bare bones of it.

It's a [00:26:00] huge tool, but it's not safe for everybody. Um, it's hard to remember the date, but I think about 2001, a big study called the Women's Health Initiative came out and it affected negatively many, many medical professionals. I think in Australia to not want to prescribe HRT because of concerns about stroke, heart attack risk, and breast cancer risk.

That data has been, um, more uh, look really um, separated and, and the errors of that study have been seen now. I think that you're absolutely right in that quote in that not having something if you need it is actually, can be really harmful.

DANIEL : Yeah and that study in the end it probably led to a significant negative backlash. I really agree. Without the evidence actually behind it. I really agree. Because it was over exaggerated.

AMY: Um, so if a patient came to me and they had these symptoms, it would definitely be a conversation.

It's not something I'm ever going to force on a woman. Um, but the really good news is that there's, um, different ways to have a serum [00:27:00] replacement. So not, uh, oral is not the primary, um, step that I take. Transdermal, which is jargon essentially for through the skin. So gel or a patch. the way that that gets into our body, it bypasses the gut, so it actually can affect brain and cognitive symptoms much better than a neural form.

DANIEL : So we take, if we take the how out of essentially hormone replacement therapy, I mean, if we, what's the, what's the purpose? What's the, what are the potential benefits?

Let's say you have a woman in perimenopause rather than who is, you know, at the end of menopause. Yes. And they're talking about HRT or, sorry, hormone replacement therapy, and you are suggesting this might be an option. Yes. Why? Like, why would you replace the estrogen?

AMY: To feel better. To achieve the goals, and every woman's goals are different, to be able to speak in a meeting and not lose my words, to be able to remember the shopping list of two items, to feel better and to be able to function.

So function and quality is really what we're going for, um, more than anything. Because the [00:28:00] woman after, and it does take three to six months, we can see a benefit actually. And the woman, um, may still be symptomatic, but we'll have the tools in her arsenal to be able to cope better.

DANIEL : And it's not just a bandaid because my understanding is that actually if it helps your heart health, if it helps your bone density, if it helps your sarcopenia, your muscle strength, uh, and other areas of life, I mean, it's a protective function for future health.

So it's not just that, actually I'm going to feel better for now, but it will make me worse in the future. Actually, if it's done well, if it's in the right situation. That's right. Hormone replacement therapy can actually give you a longer, healthier life.

AMY: Just like diabetes medicine.

DANIEL : Yeah. Why wouldn't we? That's actually, that's quite a different way of looking at it, isn't it?

AMY: I agree.

DANIEL : It's more like a treatment. Treatment that will provide longer term health benefits rather than something that helps you get over getting older.

AMY: A hundred percent agree. [00:29:00] Slight nuance, but, but really powerful difference, isn't it?

And, and the thing is, I certainly have had people on that medicine into their 80s, but it's the fluctuation of estrogen in the perimenopause that is often causing the symptoms. And so many of my women, not all, but many of my women using the replacement therapy aren't on it forever. You know, it's a five to 10 year rough. That is very rough, you know.

DANIEL : And that makes sense from a medical perspective. We treat the symptoms when we need to, and we have a nuanced approach based on every individual person. So look, just to finish, I mean, are there any, I'd like to ask two more questions. Is there any words of encouragement or practical advice that you would want to finish with to maybe speak to a woman in perimenopause who is experiencing, you know, multiplicity of symptoms, it varies according to each person, but maybe who hasn't yet had the support they need.

AMY: Mm. I think that [00:30:00] it's hard to nail it down, but I would say that um, could you please have it on your radar? And I think it's hard to find a medical professional. There's lots of places in Australia where you couldn't find a medical professional to actually help you in this space, but to know that there are some really helpful resources online to get you started.

And I'll share those with you so we can put them in the podcast notes, because, um, there are a lot of, a lot of resources out there, but not all of them are reputable. So please have it on your radar and please, um, know that, um, not everything's helpful. The other thing I'd probably say, speaking to a partner who's not going through those things, is, could you please have compassion?

Because we don't mean to be ragey. And we don't, we don't have any control over our symptoms. So please could we do this together? Please could we keep the conversation open about my hormonal changes? Because I promise you that it's not forever, and I need you in this space.

DANIEL : That's great. Well, you've [00:31:00] answered my second question about how, what you would speak to in terms of men and partners.

Well, maybe then I'll ask one last, last question. So, you know, I'm, imagine this will be a big imagination, but imagine I'm one of your patients. And I am actually distressed, and it's, I've, I've, I've had a long, hard road and not been understood. Is, what would you say, just to encourage me as we finish?

AMY: Like, in real life?

Yeah. So I'm really sorry, because I think the system's let you down. Welcome to the nest because I've got heaps of ideas for you. Please have hope.

DANIEL : I love it. Dr. Edler, Amy, thank you so much for being on this show. I know that this conversation will be incredibly encouraging for men and women alike who just have not understood the gravity and complexity of what it looks like to get older.

I love your description that, the second part of life is like a second spring, because I think that fits everything I understand of what it looks like to grow older. In fact, [00:32:00] uh, our next season has a hint we're going to talk about what it looks like to have a better second half if you hit half time and you're eating the oranges of half time of life.

And you haven't had a good first half.

AMY: How do you get back out there?

DANIEL : But there's something about the struggle and challenges and complexities that hit us in midlife, whether you're a man or a woman, that actually set us up for a better second half, if we allow it to.

AMY: Yes.

DANIEL : So thank you again for your wisdom. And I'm so grateful you've been on the show.

AMY: Thank you for having me. It's been a pleasure.